I am not an expert on the way the human knee is constructed, yet I find myself tasked with writing on that topic as we continue to cover the injury to the right knee of Washington Redskins quarterback Robert Griffin III. So I reached out to ESPN.com injury expert Stephania Bell, and as a result of our conversation Monday night I feel considerably better educated about the way the human knee is constructed and what may lie ahead for Griffin depending on what he finds out when he visits Dr. James Andrews for further testing.
The main point Stephania made during our conversation was that no one will know the extent of Griffin's injury or be able to reasonably forecast a recovery time until such time as a surgeon gets into the knee and identifies how damaged it is. Even if the MRI shows partial tears of the anterior cruciate and the lateral collateral ligaments, as the Washington Post reported Monday, there are attendant issues regarding cartilage and the overall health of the joint that can't be fully determined by MRI results. And while it's not certain that Griffin will have any sort of surgical procedure -- even if it's just an exploratory arthroscopic one, to determine the extent of the injury and establish a proper course of treatment -- it seems safe to assume he will.
To that end, here are some of the issues to watch for with Griffin in the coming days, weeks and months courtesy of Stephania.
Dan Graziano: Does it matter, in terms of recovery time or his post-surgery effectiveness, that this would be the same ACL he tore in college?
Stephania Bell: Possibly. Any time 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?
DG: That's interesting, since the focus in these situations always seems to be on the ligaments themselves.
SB: We've seen guys come back from ACLs more and more. But the cartilage impact may affect things more. In Adrian Peterson's case, they talked about how great the knee looked when they went in -- that there was no damage other than the (ACL and MCL tears). And that had a lot to do with how quickly and how well he recovered. In the case of RG III, he didn't have a completely healthy knee when this injury happened, so does that mean he has a cartilage injury too? We don't know, and that's what makes it hard for us to sit here and say, "Oh, he'll need this long to recover."
DG: Is it possible he has leftover cartilage or other structural damage from the 2009 injury?
SB: It's possible, but he did get drafted. And those guys get examined every which way before the draft. So if there were significant cartilage concerns, I'm sure they would have cropped up during that process, and they didn't. So that and the fact that he's young and amazingly fit and athletic works in his favor.
DG: So assuming they go in and look at the knee, what are they looking for?
SB: The first thing is, what's the extent of the damage inside his knee, and then are there other aspects of the joint or capsule that need to be addressed. 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. RG III being the athlete that he is, that works in his favor. He's young, he's fit, he's highly motivated, and those are all positives. The part we don't know is the anatomy part, which is the part he has no control over.
As I said, I felt like I learned a lot. In particular, I was interested in what she said about the challenge they'd face in repairing his right ACL for a second time, since they wouldn't be able to take a graft from the same patellar tendon they used in 2009 and would therefore either have to operate on the other knee for the purpose of procuring another patellar tendon graft or use a graft from the hamstring instead. Either way, you'd have to think that would lengthen the recovery time, since either you're rehabbing two knees at once or you've done the less reliable repair.
Anyway, much more to come on this, obviously, but hopefully this helped you feel better informed, as it did me.