Marcus Lattimore

I haven’t written much on college injuries during the NFL season, but many of my readers asked me to comment on Marcus Lattimore’s severe knee injury. After lots of media speculation throughout the weekend on the extent of the damage, USC team physician Dr. Jeffrey Guy released a statement detailing Lattimore’s injuries. It doesn’t provide specific information on Lattimore’s diagnosis, but is a good starting point for discussion.

University of South Carolina junior running back Marcus Lattimore suffered a significant impact to the front of his right knee during the Tennessee game on Saturday. The ensuing hyperextension of the knee resulted in injury to several ligaments. There were no fractures or additional injuries, according to team physician Dr. Jeffrey Guy. Lattimore’s surgically repaired left knee was uninjured during the play.

Lattimore is resting comfortably and will continue to be evaluated over the course of the week. Marcus has already begun the process of prehabilitation prior to surgery and to his eventual return to football.

Severe hyperextension injuries are almost always associated with tears of both the ACL and PCL and are very often associated with tears to either the MCL, LCL or both. The statement confirms that Lattimore tore at least three, and possibly all four, major knee ligaments.

There’s more to worry about than the knee ligaments with traumatic knee dislocations, however. Tearing of a major artery at the back of the knee, injury to a major nerve along the outside of the knee, posterolateral corner (PLC) injuries, fractures to the kneecap or top part of the tibia and meniscus injuries are all possible. I think Dr. Guy’s statement implies that Lattimore’s artery was found to be intact and that he doesn’t have a severe bone injury. Hopefully, it’s also suggesting that there’s no damage to the nerve, PLC or meniscus, but I don’t think that’s entirely clear from the statement.

It’s very hard to speculate on what Lattimore is facing without knowing his specific injuries, so I’ll keep the discussion general.

There are two major decisions to be made while the swelling around the athlete’s knee settles. First, the athlete and medical team must decide whether to reconstruct all the ligaments in the same surgery to whether to perform a staged reconstruction. They’ll also have to decide whether to delay surgery for a few days or a few weeks.

Previously, most surgeons preferred a delayed approach. More recently, there are reports that earlier surgery and starting rehabilitation immediately is as effective in preventing long term problems, even for multi-ligament repairs. We’ve seen the dramatic effects of an aggressive early rehabilitation schedule in ligament and tendon injuries, with Adrian Peterson and Terrell Suggs being among the most recent successful examples.

There’s also controversy in the orthopedic community on whether to fix all the ligaments at once or stage the surgeries. Surgeons once preferred to fix the MCL/LCL injuries first, then waited a few weeks before reconstruction of the ACL and PCL tears. Some surgeons now repair all the ligaments in the first surgery. In Lattimore’s case, that decision will be affected by whether or not there are injuries to the PLC structures and peroneal nerve.

What does all this mean for Lattimore?

The best case scenario is that there are tears to his ACL, PCL and MCL only. If he has avoided damage to his LCL, peroneal nerve or other PLC structures, Lattimore is less likely to have long term instability of his knee joint (associated with PLC injuries) or any loss of sensation in his lower leg and foot drop (associated with peroneal nerve injuries). Also, if he’s able to have an early surgery addressing all ligament tears, he will be able to start definitive rehabilitation sooner than later.

Unfortunately, the risk of scar tissue and knee stiffness, arthritis and chronic pain after surgery to repair these injuries is significant. But it’s far too early to call this injury a career-ender. Willis McGahee suffered a similar injury with no damage to his LCL, nerve, PLC structures, etc. and recovered after an extended rehab period. It’s possible that Lattimore could do the same.

I expect we’ll see many more details on Lattimore’s injuries and the timing of his surgeries in the coming weeks. It’s unlikely he’ll get a chance to show he’s returned to form until 2014. Here’s hoping we’ll be talking about him as the latest medical-orthopedic-rehab marvel then.

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