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Press Release: STATEMENT FROM JAMES R. ANDREWS, M.D., ANDREWS INSTITUTE REGARDING PROCEDURE PERFORMED ON ROBERT GRIFFIN III

TK

By TK
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J-bomb

J-bomb

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So just to get caught up on everything when Dr. Andrews wrote "ACL was a redo" does that mean just a tweak/fix of the old ACL or a complete reconstruction? According to Rich Campbell the re-do means a complete reconstruction (according to his tweeter). Any updates on this or verdicts on what re-do in this case actually means there is a big difference in a tweak/fix vs complete reconstruction with new grafts etc...

Redo of old injury surgery no new grafts...

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Ingtar

Ingtar

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I think they reconstructed both ligaments. That sucks, but there is no one better than the man who performed the surgery. He is literally the best orthopedic surgeon on Earth when it comes to ligament repairs in the knee, shoulder, and elbow.

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Sekhmet187

Sekhmet187

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I think they reconstructed both ligaments. That sucks, but there is no one better than the man who performed the surgery. He is literally the best orthopedic surgeon on Earth when it comes to ligament repairs in the knee, shoulder, and elbow.

He already made a statement that basically pointed out he didn't have to reconstruct the LCL.

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njxbean

njxbean

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http://bramelsecondopinion.com/2013/01/09/whats-ahead-for-robert-griffin-iii/

[/url]

What’s Ahead for Robert Griffin III

Posted by Jene Bramel on January 9, 2013

Robert Griffin III had reconstructive knee surgery this morning to repair his LCL and ACL. The surgery was successful, according to Dr. James Andrews, and involved a “direct repair of his LCL and a re-do of his previous ACL reconstruction.”

Though Dr. Andrews confirmed the details of the injury and surgical procedure in his statement, a number of questions remain.

How did Griffin aggravate his LCL sprain and sustain a catastrophic ACL injury while playing in a protective brace?

This question deserves more attention than it’s getting in the media. Shortly after his injury, the Redskins said they would not allow Griffin to play until his knee was no longer at risk of an aggravation or additional injury. That proved not to be the case, since there would be no reason for Griffin to play in a brace if there were no concerns about the stability of his knee.

Injuries to the knee happen in multiple ways. The LCL is most commonly injured when the knee is stressed from the side. The restrictive, hinged brace that Griffin was wearing is generally very good at stabilizing the knee against another blow to the inside of the knee. The ACL is often injured by a rotational stress, which is very difficult to prevent with a brace, especially the kind of brace Griffin was wearing last weekend.

An orthopedic surgeon I spoke with today told me that it would be unusual for a braced LCL to fail. Further, he felt that Griffin’s final play didn’t have the look of an acute injury. More specifically, he felt that Griffin’s knee buckled in such a way – non-contact but low-velocity – that it was the final manifestation of an already comprised knee joint.

Whether Griffin’s LCL sprain was a higher grade than reported, had already been re-injured, or Griffin’s previously repaired ACL graft was already damaged is impossible to say. But the way in which the knee buckled in a brace that wasn’t meant to protect against the rotational stress against the ACL may help explain why Griffin suffered such a severe injury while braced.

Is Griffin at higher risk of another future ACL injury because the ligament has now been reconstructed twice?

This is a complicated question. Those of you following the story closely have seen the differing opinions on this question (and the discussion on how soon Griffin may be able to return to play).

The short answer is yes, Griffin is at higher risk, but it’s a risk that is difficult to quantify.

I spoke to the same orthopedic surgeon about the challenges of repairing a previously reconstructed ACL graft. When an ACL is reconstructed, tunnels are made into the thigh and shin bone to serve as anchors for the graft that will serve as the new ACL.

Though there are concerns with the graft having less blood supply than a natural ACL, the graft usually anchors well and the bone tunnels fill in without issue after a new reconstruction. With subsequent reconstructions, those tunnels must be larger and a different method of anchoring the graft may often be necessary. Larger tunnels require more bone grafting and a slightly different angle for the graft. Those factors can cause the reconstructed ACL to loosen over time. That, in turn, leads to a higher risk of failure.

The good news is that the risk is not terribly high and is lessened by Griffin’s young age and the rehab protocols available to an elite NFL athlete. Thomas Davis, a linebacker with the Carolina Panthers, is an interesting comparison. Davis suffered a graft failure soon after returning from his first ACL tear but is now playing well after his second reconstruction.

Just how soon could Griffin return to the field? Is 6-8 months a reasonable estimate?

Estimates for Griffin’s return to play ranged from 6-8 months to 8-10 months to 10-14 months this weekend. Dr. Andrews did not give a specific estimate today, saying only that “it’s everyone’s hope and belief that…he will be ready for the 2013 season.”

Andrews’ statement and other sources are implying that Griffin does not have any injuries to the structures to the posterolateral corner (PLC) of his knee (more on PLC injuries in this post on Fred Jackson’s LCL injury) and that his procedure was able to be performed arthroscopically. Unless Griffin has an unexpected setback, he’s very likely to hit the more optimistic side of reported estimates.

Though the dual ACL/LCL injury is worrisome, both grafts should heal at the same rate and can be rehabbed together. With the now common accelerated rehab schedule for reconstructive knee surgery, 8-10 months is a reasonable expectation. I’m not aware of a clear NFL comparison, but the NBA’s Ricky Rubio recently returned to practice about nine months after a dual ACL/LCL reconstruction. Griffin will have different issues to face as a mobile quarterback in a higher contact sport, but the rehab comparison is notable.

Can Griffin return as quickly and effectively as Adrian Peterson did in 2012?

This may be the most common question I’ve seen today. It’s possible that Griffin can match Peterson’s superhuman recovery from his ACL/MCL/meniscus injury. But it’s unlikely.

Peterson’s associated MCL and meniscus injuries were no cakewalk, but there’s still reason to be worried about Griffin’s LCL injury if there are any unreported associated PLC injuries. Also notable is the state of Peterson’s knee prior to his reconstructive surgery. Dr. Andrews termed Peterson’s joint “pristine” – save the ACL, MCL and meniscus tears, of course – and likened it to that of a newborn baby. That is not likely to be the case with Griffin’s knee, which has undergone one ACL reconstruction and the stress of playing on a partially torn LCL for multiple weeks.

Most importantly, don’t mistake Peterson’s dramatic early return for a new norm in ACL recovery. Though it’s true that a total knee reconstruction is no longer a 12-18+ month injury, neither should an athlete be presumed to recover to full pre-injury form in six months.

Griffin has an excellent chance at a full recovery and it’s possible that he’ll be off the PUP list in time for the first week of the 2013 season. But it’s best to temper your expectations for the first month of 2013, even if his recovery and rehabilitation go smoothly.

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Sekhmet187

Sekhmet187

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If Dr. Andrews does not have permission to speak about the procedure it means all these speculations and comments are horsecrap.

He already spoke. Chris Russell is likely referring to him answering questions. He gave an official statement and theres no reason to believe its off.

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Rocky52Mc

Rocky52Mc

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The fact that the ACL got re done dosent sound like good news to me. All we can do is hope that RG3's knee will heal as good as Adrian Peterson's. He proved that with a lot of hard work, the knee could be better than ever. Lets pray this will be the case!!

HTTR

If you want to bring up Peterson, the only comparison is these two players dedication and drive. MANY many MANY players have come back from an ACL or any ligament injury, even a total replacement of the ligaments and have come back in 8 months.

Truth is, Griffin, to be healthy will probably need to miss an amount of training camp, but he should absolutely be ready for week 1. No doubt in my mind at all. I had an LCL, from a worse surgeon, I had setbacks, and I was running and cutting and sprinting within 6 and a half while I rested on my ass for the first 2 months.

Rod Woodson tore his ACL in week 1 and played in the damn Superbowl. He had surgery in September and played in February....

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Bangee7

Bangee7

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Get well Robert, we're all rooting for you.

The news did seem positive today, but it's a little early to be claiming a victory just yet.

I remember the '82 skins used to roll Theismann out a lot. Not just boot legs, but also a rolling pocket on some plays. We may see that come back into play next year to get RG3 into space.

Whatever plays they decide to run, we need better protection on passing plays from our RT next year.

Hail !

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TheGoodBits

TheGoodBits

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"...and a re-do of his previous ACL reconstruction." Is "re-do" a medical term? And I wonder if Dr. Adickes, who did the first ACL, is cringing at that description.

Revision is the medical term, but re-do is actually the accepted laymans version of it in the medical field. Saw that discussed on twitter earlier but can't remember who. Maybe Rich Campbell.

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Skinz4Life12

Skinz4Life12

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"...and a re-do of his previous ACL reconstruction." Is "re-do" a medical term? And I wonder if Dr. Adickes, who did the first ACL, is cringing at that description.

Apparently the first doctor kind of did a "quick fix" type job to have RG3 heal quicker. I'm sure Dr. Andrews did a great job the 2nd time around

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Orrbe

Orrbe

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Good Luck to the Kid, a speedy recovery, with some added help in key areas the sky's the limit starting with his stepping on the field, I have the utmost faith in Dr. Andrews, A.P. was never better, I believe RGIII will show the same type of success... Sometimes a rebuild done right and rehabbed right can actually be stronger than original...God Speed....HTTR!!!

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longball

longball

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Apparently the first doctor kind of did a "quick fix" type job to have RG3 heal quicker. I'm sure Dr. Andrews did a great job the 2nd time around

I think the first doc did a great job. Did you see his explosive speed early season remember it left defenses clueless? Or perhaps his Heisman campaign? Just the nature of the beast really. Maybe a weakened LCL caused it, its all speculation. But he is a high level athlete and will recover. Can't wait to root him on.

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Skinz4Life12

Skinz4Life12

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I think the first doc did a great job. Did you see his explosive speed early season remember it left defenses clueless? Or perhaps his Heisman campaign? Just the nature of the beast really. Maybe a weakened LCL caused it, its all speculation. But he is a high level athlete and will recover. Can't wait to root him on.

i'm not saying he did a bad job, but that's what some reports were saying

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