Kelley Cain to undergo surgery Tuesday

Tennessee center Kelley Cain is scheduled to undergo a two-hour surgery Tuesday afternoon to fix her right kneecap and will be hospitalized for two days. She is the first Lady Vol basketball player to undergo the three-part procedure, but the medical staff – citing Cain's attitude and pre-surgery rehab – is confident she will back on the court next season.

"She's going into this very positively, and she's got a good basis for the exercises immediately after," said Jenny Moshak, the Lady Vols assistant athletics director for sports medicine. "I think Kelley's attitude and work ethic as a whole has gotten her through a lot already of what she has been through, and that should carry over."

Kelley Cain, a 6'6 freshman from Atlanta, is scheduled to undergo surgery at 1:30 p.m. at St. Mary's Medical Center. Moshak said that Cain would remain hospitalized for two days. Exams began last week at Tennessee and continue through Thursday – depending on class schedules with preset exam dates – but Cain has completed her tests so her fall semester is done.

"I think she knows this is something that I have to take care of and then get behind me," Coach Pat Summitt said of Cain's mindset about the surgery. "Obviously having Jenny to work with her and her staff we have ample time to do that. That's exactly what we want to do and have her ready next year."

Cain has a kneecap that does not track correctly because of the biomechanical structure that she was born with, and it is a condition more prevalent in females. She injured the knee – she sustained a subluxation of the kneecap – in practice in early November after planting under the basket and stepping on a defender's foot. The knee did not respond adequately to rest and rehab, and Cain was never able to return to practice.

She has yet to play in an official game – she did play in one exhibition game after missing the first one because of a concussion – so Cain will redshirt this season.

The surgery involves three parts, which will all be done Tuesday: lateral release, medial plication and Fulkerson osteotomy.

Drs. Greg Mathien and Russell Betcher, the university's orthopedic surgeons, will perform the surgery.

The 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.

"They're releasing on the outside and on the inside, all that has been stretched, so we need to tighten it," Moshak said.

The Fulkerson Procedure, named for Dr. John P. Fulkerson, a knee specialist in Hartford, Conn., is the final step in the process. Fulkerson is a Yale-educated surgeon who was the team physician for the New York Giants at one point in his long and esteemed sports medicine career, which began in the 1970s.

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.

That last step in the process involves "moving the insertion of the patellar tendon over so that it tracks the kneecap correctly within the groove," Moshak said.

The bone will be moved and screwed down with two screws, which are "permanent unless they bother her, and she wants to take them out later," Moshak said.

Moshak has rehabbed two kneecap cases in the past with a softball player and basketball manager, and both went well.

Although Cain is charting a new path in terms of kneecap surgery for a Lady Vol basketball player, "I don't think it's new ground in the medical profession," Moshak said. "It may be new ground to Lady Vol basketball right now."

In an interview with knee1.com, a part of the body1.com website, a medical education and marketing company, Fulkerson said, "My main area of interest has been the soft tissue structures around the front of the knee, not just the kneecap and the joint itself. The investing soft tissue around the knee can become painful as a result of overuse. Chronic imbalance of the kneecap can cause stretching and pain in the support structure around the front of the knee. We have studied the use of computerized tomography and tomographic imaging to better delineate the alignment of the kneecap and the proper mechanical function of the kneecap.

"I developed a technique for antero-medial-tibial-tubercle transfer to better realign the kneecap extension mechanism onto healthier cartilage and place the kneecap into a more-normal alignment pattern. This osteotomy achieves both diminished pressure on the kneecap as well as realignment of the knee's extension mechanism."

Essentially, Moshak said, Cain should end up with a kneecap "that won't slide out," as it does now.

Cain won't make the trip to California next week when the Lady Vols play at UCLA and at Stanford and will instead go home to Georgia to recuperate "with some things that I give her, the exercises," Moshak said, "and I'll call and check in on her."

Cain will then report back to Knoxville after Christmas with the rest of the team. She can't stay in Knoxville for rehab while the team is on the road because NCAA rules don't allow Tennessee to pick up the cost of a hotel in town while the team is traveling.

Cain's rehab process will begin immediately.

"The key part of the rehab is quad strengthening," Moshak said. "Quad strengthen first and then get range of motion because the quad helps with range of motion. Eight months total to full back to basketball. It will all be controlled."

Cain has a sideline rehab partner in sophomore Cait McMahan, who had knee surgery last June to repair her femoral condyle. That is considered a 12-month rehab, but McMahan has participated in some limited basketball activities.

"She's doing basketball things at six months, but it's all controlled," said Moshak, referring to the conditions under which McMahan can participate. "So it just depends."

The open-knee procedure is a major surgery – the rehab timetable for Cain is eight months – but the Tennessee medical staff has no reason to believe that Cain will not only benefit, but come back better.

"The bottom line is you get an excellent surgeon, which we have in Dr. Betcher and Dr. Mathien, you get good quality rehab, and you get a work ethic like Kelley has and to me that paints a picture of success," Moshak said.

Cain will be a redshirt freshman in 2008-09 and will join a class of six signees for a freshman class of seven.

"I think it's to her advantage to get this done right now, and that's what I'm thinking about," Summitt said. "I can't worry about six freshmen, seven freshmen. At this point you've got so many, what's one more?"

PRACTICE REPORT: The Lady Vols returned to practice Monday afternoon after the weekend off to study for exams. The two-day layoff didn't dampen their enthusiasm as the session lasted two-and-half hours and was, once again, up-tempo.

"A lot of energy," Pat Summitt said. "I think we're getting better in our sprinting and our transition. Just trying to get a lot of reps in and going those four-minute segments (to simulate game conditions). We may up that to six (Tuesday) and then taper."

The next game is this Thursday against Middle Tennessee at 7 p.m. at Thompson-Boling Arena. Exams end that same day so all of the players will have completed the fall semester.

The team ended practice Monday with a full-court offensive drill and had to score 100 points on both baskets in four minutes with an assortment of three-pointers, mid-range jumpers and layups. This time the nine players hit the mark with time to spare, and Candace Parker punctuated the drill with a slam in the final seconds.

Summitt pronounced herself to be pleased overall with the energy level and the effort.

"This is a team that has to understand how we want to play the game all the time and not by coasting and trying to pace ourselves because that's not going to get it done," Summitt said.


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