The issue for Kelley Cain, a 6'6 center from Atlanta, is not so much the injury to the knee, but the way her kneecap is formed. She sustained a subluxation of the kneecap in practice in early November after planting to make a move to the basket and inadvertently stepping on the defender's foot. Her kneecap doesn't track correctly, and it has left her vulnerable to injury.
The initial treatments are strengthening and taping techniques to stabilize the kneecap, but Cain did not respond well enough to that approach to make it back to practice. The time needed to recover post-surgery is substantial and means that Cain won't play this year and will take a medical redshirt.
"Eight months, which is why we tried to take all conservative measures first," Moshak said.
The surgery encompasses a layer of steps that include lateral release, medial plication and a technique called Fulkerson osteotomy. Drs. Greg Mathien and Russell Betcher, the team orthopedists, will perform the surgery.
A kneecap that doesn't track correctly in its groove is typically tilted and pulled to the outside of the knee. A person is born with the condition, and it is more prevalent in women.
A lateral release means literally releasing the patella, or kneecap. The fibrous supports on the outer side of the patella are cut so that the kneecap can be placed in a better position.
The plication process is done next and involves the inner side of the kneecap. The inner supports are stitched – actually tucks are made similar to pleats – to tighten them. This will help pull the kneecap into the proper position toward the center of the knee structure and will eliminate the tilt.
The Fulkerson Procedure is the final step in the process. The tibial tubercle (a bony bump just below the kneecap) is cut and moved to improve the extensor mechanism, which is a primary function of the kneecap – to help the knee extend. This procedure alleviates pressure on the kneecap.
"Basically what we're doing here – like I'm going to do it; I'm going to be in there cheering them on – Dr. Mathien and Dr. Betcher are going to change the biomechanics, changing how the kneecap tracks in the groove," Moshak said. "It's not tracking correctly so they're going to move the extensor mechanism over to track the kneecap better."
Rehabilitation is key to recovery because the kneecap must remain mobile, especially with the scarring following the lateral release. That can cause the kneecap to be pulled back to where it previously was on the outer side and defeats the purpose of the surgery.
"Any surgery has its risks," Moshak said. "Playing basketball has its risks. I have no doubt that Kelley is going to return full force. She's a very hard worker. She's very talented. She already knows what to expect. We're already been working on the preliminary strengthening. I have no doubt this one will succeed."
Cain accompanied Moshak to the post-game press conference Sunday evening to announce the decision to undergo surgery. Cain had a procedure done while in high school at St. Pius X and also had a flare-up of the condition over the summer.
"I hurt my knee my sophomore year in high school, and I had to have arthroscopic surgery then," Cain said. "The last time I hurt it was a few months ago. That's why I was rehabbing all through the summer and taking the conservative approach. We were trying to see if I could make it through or not."
"She's a huge loss," Parker said. "Her presence is felt on the bench. She is always up cheering and staying very positive. She hasn't taken any energy from the team. It's tough for a freshman – I know – to deal with an injury like that and to sit out, but she's being very positive about it."
Cain smiled her way through the post-game press conference.
"Everything happens for a reason," Cain said. "I am just going to go in there and rehab as much as I can as well as I can so I can get back as quickly as I can."
Moshak has a track record of getting athletes back to the court after major knee operations. This type of surgery will be the first for a basketball player at Tennessee, but Moshak has handled it with a softball player in the past.
"I'm working with the best," Cain said.
Cain also has emotional support on the sidelines in sophomore Cait McMahan, who had knee surgery last June and is undergoing rehabilitation. The possibility of McMahan returning at midseason has been mentioned, but she remains out of action and is projected to also need a full redshirt year to recover.
"She's telling me what she went through, and it's helping a lot," Cain said. "She said she would be there for me to help me through rehab."
Cain didn't play in any regular season games this fall. She played in the exhibition game against Carson-Newman on Nov. 6 and put up a stat line of 11 points, 12 rebounds, four assists, three steals and two blocks. She suffered the subluxation the next day in practice during offensive drills.
"Obviously, we're really disappointed because Kelley when she came in it was clearly evident to all of us that she could be a difference-maker for us in the post game," Coach Pat Summitt said. "She's got great hands, soft shooting touch, good up and down the floor.
"It's a big loss for us and I don't think anyone knows how big a loss except for the coaches that watched her play so much and seeing her in practice and early in the season. I think we are doing the right thing by making sure that she gets healthy, and she will be 100 percent and good to go. With our medical staff and Jenny, I feel very confident that she'll be ready to return next year."
Cain's debut as a Lady Vol will now be delayed a year and she will join six other newcomers on the court that Tennessee signed from the class of 2008.
"That just means that now we have seven freshmen," Summitt said. "It's going to be interesting."