Merriman weighing tough decision, Taylor gets 'good' news

August, 25, 2008
A trio of defensive superstars find themselves in the injury limelight, so to speak, this week. The knee is the universal culprit joint, with consequences ranging from a minor sprain to a season-ending meniscus injury to a multiple-ligament injury with a yet-to-be-determined fallout. The injuries all share one thing in common: They took a hit on athletes whose presence is critical to the success of their entire defensive unit. Let's take a closer look.

As you read this, San Diego Chargers linebacker Shawne Merriman is evaluating whether he should play, perhaps at the expense of the long-term well-being of his knee, or sit out and protect the longevity of his career and overall health of the knee. Merriman revealed this past weekend that he is dealing with two ligament injuries in his knee: a completely torn posterior cruciate ligament (PCL) and a damaged lateral collateral ligament (LCL). The PCL reportedly has been injured for some time, while the LCL was injured last season when the Chargers played the Tennessee Titans in the playoffs. Merriman also underwent a scope in March to address a torn meniscus but had participated early in training camp and even the Chargers' first preseason game. But by August 9, Merriman was no longer practicing with the team after experiencing increased pain and discomfort with the knee. Persistent pain and instability led Merriman to seek additional evaluation and opinions as to the best course of action, and the answers he is getting are forcing him to make some tough decisions.

Merriman's combination of injuries to his PCL, which helps prevent the shinbone (tibia) from slipping backward on the thighbone (femur), and LCL, which helps prevent the knee from bowing outward, make his situation more challenging. With two of the four main stabilizing ligaments damaged, it is easy to appreciate that the entire joint's stability would be compromised. Given that the knee joint is oddly shaped in that it does not form a tight ball and socket like the hip, or a hinge like the elbow, the ligaments play a much bigger role in minimizing potentially damaging shear forces and controlling overall joint stability. If Merriman continues playing, besides having to deal with the obvious pain and instability that could hamper his performance, he'll also perpetuate further damage to the cartilage in his knee when the tibia and femur bang around as the knee slips. Such cartilage damage could affect the longevity of his career, as well as the overall health of the knee itself.

Some athletes can function well despite a torn or badly damaged PCL, said Dr. Deborah Faryniarz, an orthopedic surgeon at the Arthroscopy and Sports Medicine Clinic in San Jose, Calif. But, she said, when you add collateral ligament damage or a meniscus injury to the picture, "those athletes tend to do poorly with rehabilitation alone. Reconstruction is usually the way to go."

Merriman is clearly tormented by the decision and has said repeatedly that he wants to play, but he must consider the long-term ramifications of doing that. Rehabilitation after PCL reconstruction typically requires approximately nine months. If Merriman were to hold off surgery and somehow survive the season, and the Chargers were to make a playoff run, Merriman could still be rehabilitating into the fall of 2009. So he'd likely be less than 100 percent in 2008, then would miss time in 2009. Plus, if he continues to press on, it'd take additional toll on his knee.

Meanwhile, the news from the Giants regarding two-time Pro Bowler Osi Umenyiora is pretty cut and dried. Umenyiora, the remaining half of the Super Bowl-winning defensive end tandem after Michael Strahan's retirement, was lost for the year Saturday. Umenyiora's injury occurred during the second quarter when it appeared his left foot stuck in the turf while he tried to turn a corner and go around New York Jets left tackle D'Brickashaw Ferguson. The New York Daily News reported that Umenyiora's left knee "locked up," which is a hallmark sign of a torn meniscus. Indeed, the verdict was a torn left lateral meniscus. Coach Tom Coughlin later announced that Umenyiora would undergo season-ending surgery Tuesday and that the recovery period was expected to be approximately four months.

The season-ending prognosis for a meniscus tear might have taken some by surprise because many athletes undergo meniscus surgery and return within four to six weeks. The time frame issued for Umenyiora's recovery implied that Giants team physician Dr. Russell Warren, the orthopedic surgeon who examined him, had opted for some type of meniscal repair as opposed to the more-common partial meniscectomy. The Daily News confirmed a meniscal repair was the decision because, according to Umenyiora's agent, Tony Agnone, "They felt they should save it to help his long-term career situation."

To clarify, a partial meniscectomy is a removal of a piece of meniscus. The meniscus, of which there are two in each knee (medial and lateral), is a fibrocartilage disc that cushions the joint, helps to ensure normal joint mechanics and consequently provides protection for the joint cartilage. It does not have a particularly good blood supply, which means the tissue can't heal on its own. Consequently, after a meniscus tears, the offending flap, which often gets caught in the joint to cause the classic "locking" of the joint, is snipped out. As soon as range of motion and strength return, the athlete can return to the field.

Sometimes, however, the decision is made to repair the meniscus. The aforementioned Faryniarz, who completed a sports medicine fellowship at the Hospital for Special Surgery in New York (where Warren practices medicine), described the rationale. Faryniarz said that patients who undergo a lateral meniscectomy are prone to develop significant arthritis within five years. For that reason, surgeons often choose to repair a meniscus to protect the joint's cartilage.

Faryniarz added that a repair would be even more likely if an athlete had experienced prior injury to that knee. As it turns out, Umenyiora underwent arthroscopic surgery for a similar injury while at Troy University. Because the meniscus does not heal especially well, the knee must be much more protected during rehabilitation after repair. The athlete's activity is much more limited during the early phases of rehab to ensure that the repair holds up, hence the longer recovery period for meniscal repair versus removal. In the long run, the repaired meniscus will add longevity not only to Umenyiora's playing career but also to the overall health of his knee for life.

Finally, some "good" news on the injury front. Newly acquired Redskins defensive end Jason Taylor gave everyone a scare when he was tangled up in a play during the second quarter of Saturday's game against the Panthers. He ended up underneath a pile, and his right leg was bent awkwardly. Taylor, who was clearly in pain both in the immediate aftermath of his injury and while he was examined on the sideline, looked as if he had suffered a serious injury. But the Redskins report that Taylor sustained only a minor knee sprain with no major structural damage. His return is currently projected at 10 to 14 days, barring no setbacks. The Redskins have indicated that they'd be open to Taylor's sitting out Week 1 if that means he'll be healthy and available for the long term.

It seems the season should already be under way, because the injuries certainly are! But we are still a couple of weeks away from the first meaningful contests. There is no doubt that each team is hoping it can get at least its remaining key players to that target date without incident. Don't count on seeing too many of those players taking the field during the preseason finales because teams get conservative as the season draws ever closer. Then the drama really begins.



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