Can McGahee do it?

What is the likelihood that Bills first-round draft pick Willis McGahee will come back after tearing three left knee ligaments during the January Fiesta Bowl? Everyone associated with McGahee, including the Bills, is fairly confident of course. Mike Doser turned to Dr. Robert Bronstein M.D., an associate professor of orthopaedics and surgeon at the University of Rochester Medical Center, for an independent assessment.

Mike Doser: Could you explain the seriousness of Willis McGahee's knee injury?
Dr. Bronstein:
Essentially it's a knee dislocation when you have three of the ligaments involved. We always used to say that that kind of injury was going to be career-ending and now we say it's career-threatening. It is not necessarily career-ending, and people can get back from it. Each injury is a little different in terms of the way they tear – an ACL is pretty much an ACL, but when you get three of the four or four of the four (ligaments), some tears also affect the nerve and there are vascular problems, maybe the artery is torn. So they're pretty significant injuries and not everyone is going to come back from one.

Doser: What's the difference between people who can come back from the injury and people who can't?
Dr. Bronstein:
(The difference) is often due to things that we don't even know. You need a good surgery done to start. You need pretty good and aggressive rehabilitation afterward. And a lot of it relies on the individual. When you're dealing with someone like this, you're dealing with an athlete, they're in good shape to start, and they're going to put good effort into it, but even that might not be enough. But you have to be concerned about soft tissue damage that we don't have a measure of.

Doser: Soft tissue is a wild card then?
Dr. Bronstein:
Soft tissue is the wild card. When the bones are sliding past each other that far, they can do damage to the joint surface itself. When you get MRIs of these, you'll see all this bone bruising that occurred. It's just like the bone hit on the other bone. It banged on it and hit. And there's nothing we really do about the bone bruising. We're not going to see it when we look at the surface. You'll see it on an MRI. But that may be a factor as people are trying to come back. And one of the biggest complications after this is what is called arthrofibrosis, or scarring in the joint where you don't get the motion back or you need additional surgeries to get the motion back.

After you fix (the ligaments), an athlete is going to need motion as well as stability. I'm not sure what happened in this particular case, but a lot of times when you have a multiple ligament knee injury, one of the cruciate ligaments, rather than being torn right in the middle, one comes off bone. It's nice when you get that because that one can be repaired rather than what we call "reconstructed," meaning rather than be replaced with another tendon to come through the joint to become a ligament. Like your usual ACL (surgery) is an ACL reconstruction. We put a tendon through. We don't try to stitch back the one that's there. But with multiple ligaments, a lot of times one of the cruciates – either the anterior cruciate or posterior cruciate peels off a bone and can actually be repaired back and the other one usually needs to be reconstructed.

There's a soccer player playing with the Rochester Rhinos A-League club who had a three-ligament, dislocated knee, Lenin Steenkamp. He's still playing. That was several years ago. So he's had two to three successful seasons since then. And is back as a player/coach this year. He's done extremely well.

So it can be done.

Doser: Let me read to you what occurred with McGahee's surgery and you tell me how favorable it would be to heal from it: The surgeon had to reconstruct only the ACL because that tear was near the center of the ligament. The PCL and MCL tears were at the end of the ligaments, so each was sutured back to bone into its normal anatomical position.
Dr. Bronstein:
That sounds favorable. And that's what I said. Usually it's the case that one of the cruciates is off a bone and usually the collateral, in this case the MCL – the medial collateral – is off a bone. But if you have both cruciates torn in the middle … it's more surgery, more chance of scarring in there and it's a tougher rehab.

Doser: How similar was Steenkamp's injury to McGahee's do you think?
Dr. Bronstein:
Lenin Steenkamp's injury sounds exactly like it. Lenin's done pretty well. He's gone without a brace now. He wore a brace his first couple of years and he went without a brace last year and this year. I don't know what his 40 time is, but he's certainly done a good job playing. He's been one of the star players. And he's playing a sport where you're running throughout the entire game. You're planting and twisting on the knee.

Doser: Athletes who suffer this kind of injury say their knee is going to be stronger before. Does it actually heal up stronger?
Dr. Bronstein:
In terms of strength, I think a lot of times when they measure people who are stronger after suffering the injury, it's because they never really put in the effort (to strengthen the area) before. The reconstruction and surgery is not making the knee any stronger. In terms of actual muscle strength, the rehab is making them stronger.

Doser: Can an athlete truly recover from something like this, or does he lose some of his effectiveness?
Dr. Bronstein:
It's certainly not 100 percent that someone can come back from this. Generally, you see someone who tears his ACL and you can tell it's going to take some time, but he'll be back playing.

You just can't say that with this kind of (multiple ligament injury). It's career threatening, that's the term we use, it's not necessarily career ending. But it certainly threatens the career.

Doser: How have medical technology advancements aided in repairing this kind of injury?
Dr. Bronstein:
: The last 10 years, the technological improvement in dealing with these kinds of injuries have been drastic. The surgery itself, with refined techniques, is why a lot of people can get back after these injuries whereas they never used to be able to. You go back a little further, and these were amputations. Certainly the risk of amputation was quite high with a dislocated knee.

There still is an amputation risk if you get the artery and you get the nerve. There's a big function risk. There is a lot of function risk. But you go back 20 years and there were a lot of lost limbs from this.

When you have this the artery going down the back of the knee does not have a lot of play. It's pretty much tethered down. So when you get this much of an injury when the bone displace so much, you pull on that and you can tear (the artery). You can also tear the nerves or injure the nerves where the foot wouldn't work normally. These are pretty big deals.

Doser: Do you think McGahee is capable now of reaching that high level of play the NFL demands?
Dr. Bronstein:
It probably depends on how he has done now. You should be able to get a good indication right now. If he has rehabbed to the point where he has been drafted, he's probably going to be able to do it. If you saw him on the day of his injury, you say, "Geez, this may be it for you. We'll try and hopefully it won't be."

But it sounds like he's got his stability and he's got his function and he's probably done pretty well to even be considered.


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