Tuesday, January 8, 2013
At least one ligament surgery for RG III
By Dan Graziano
Washington Redskins quarterback Robert Griffin III is having surgery this week to repair the torn lateral collateral ligament (LCL) in his right knee, ESPN's Adam Schefter reported Tuesday evening. During the surgery, Adam reports, Dr. James Andrews will determine what damage, if any, Griffin has done to his anterior cruciate ligament (ACL) and what course of action needs to be taken with regard to that.
On "SportsCenter" on Tuesday evening, Dr. Michael Kaplan speculated that the LCL procedure alone would require a recovery time of four to six months and that the combination of an LCL and ACL reconstruction could keep Griffin out "nine to 12 months, or maybe even longer than that." But no one can say for sure. Andrews is waiting until he gets his arthroscope into Griffin's knee and gets a visual inspection of the inside of the joint before determining his full surgical plan.
But this is not great news. The LCL was sprained Sunday morning and torn by Sunday night, after Griffin reinjured the knee in the first quarter of the loss to Seattle and stayed in the game until it collapsed under him in the fourth. Now he needs to have surgery to repair one of the ligaments in that knee, and they're not ruling out the possibility that they'll also need to repair another. Griffin tore the ACL in that same knee while playing at Baylor in 2009 and had surgery to repair it then, and I spoke Monday night with ESPN.com injury expert Stephania Bell about what that means. This is part of what she told me:
|In 2009, Robert Griffin III tore the ACL in the same knee he injured in Sunday's loss, which complicates what comes next.|
"Anytime you have a second insult to a knee, it's less favorable than the first, and having another procedure is less ideal. I don't know, when he had his original reconstruction, whether they used his patellar tendon [to repair the ACL]. But if they did use it, obviously they can't use it again, so what do they do? Do they use his other patellar tendon? Do they use a hamstring graft? That would have a lot to do with his recovery time. And then there's the issue of whether there's any cartilage damage in the knee as a result of this injury. When you're talking about the life span of his knee, that's going to be one of the big elements -- not just the ligament, but how healthy is the joint itself?"
Stephania followed up this morning to clarify, as some of my readers pointed out, that there's also the option of taking a ligament from a cadaver. But if Griffin has to have a second ACL reconstruction on the same knee, there are several issues at play. I heard today from my friend and reader Tennessee-based orthopedist Chris Sabatino, who offered a little more detail about the problems with operating on the same knee twice:
"Another thing to consider is that with a second reconstruction of the same knee it is sometimes difficult to get exactly the same alignment of the second graft because the placement of the first graft has already caused anatomic changes (i.e., the original hole required to pass the first graft)," Chris wrote. "Even a slight change in that alignment can alter the load sharing between the ligaments in the knee. Think about the knee like a marionette, with each string on the marionette representing one of the ligaments in the knee. If you were to change the position of the string on the handle (malignant) or lengthen the string (laxity in the ligament) you would dramatically change how you could control the marionette."
Which is interesting and suggests that the LCL and ACL issues cannot be viewed as completely separate from each other. But even if you could view them that way, the LCL surgery in and of itself is a significant procedure. This is what Stephania told me about the LCL in particular Monday night:
"With an LCL injury, you worry about that back corner of the knee, what we call the posterolateral corner, which is where the LCL is. When you suffer an injury to anything in that complex, it can threaten the overall stability of the knee. Your biggest concern is: Is that corner intact? Is it stable? Because if it's not, there's more you have to deal with."
The issues here are significant. Even beyond the length of recovery time, there has to be concern about the risk of reinjury and the overall long-term health of the knee for the remainder of Griffin's career and life. He is young and in excellent physical condition, and betting against a full recovery would be a mistake. But from this point forward, he and the Redskins are going to have to be far more careful with this knee than they have been so far, and likely will have to plan around it when drawing up their offense whenever they do get him back.