| A recent survey of NFL physicians showed that nearly 100 percent of NFL athletes who tore the primary stabilizing ligament in the knee -- the anterior cruciate ligament -- were able to return to competition after surgery.
That doesn't mean all were as good as they were before their injury. But they came back.
The problem for McGahee is he tore three of the four ligaments that hold the knee in place.
The Bills express confidence McGahee will fully recover. His doctors in Miami rave about his chances. McGahee is undaunted.
|
| "I was told I can make a 100 percent recovery, and that's what I'm planning on doing," McGahee said. "I'm very confident. I think I'll be better than I was before."
Before his injury, McGahee ran the 40-yard dash in 4.28 seconds, which is faster than any player who has spent significant time with the Bills in the last 20 years.
The fact is no one can say for sure if he will be the same player he was.
Ask medical experts if McGahee can come back, and they answer along the lines of, "Yes, but . . . "
|
| "Assuming the surgery was technically correct and the rehab very good, expectations should be favorable," said Dr. Mary Lloyd Ireland, orthopedic consultant for Eastern Kentucky University and a representative of the American Orthopedic Society for Sports Medicine. "But there are people who just don't come back." |
 |
| "If all the stars align correctly, he should turn out to be an effective player," said Dr. Marc Fineberg, chief of sports medicine in the University at Buffalo Department of Orthopedic Surgery, and team physician for UB football and basketball. "But there are a lot of stars to be aligned." |
| Look at the way the lower leg bone, the tibia, swings so smoothly from the femur, the big bone in the thigh. The patella, the bone known as the kneecap, sits neatly in front of the joint.
What looks like a simple hinge is actually a marvelous bit of engineering. |
| Ligaments are tough bands of tissue made up of many individual fibers that help connect the bones and keep them in alignment. Without strong, tight ligaments, the knee joint would be too loose.
The medial collateral (MCL) and lateral collateral ligaments (LCL), located on the sides of the joint, prevent the knee from moving too far in the side-to-side direction. The anterior cruciate (ACL) and the posterior cruciate ligaments (PCL), which cross over within the joint, control the front to back motion of the joint. |
| In the past, doctors attempted to sew the ACL back together in a major operation. Today, surgeons have years of experience with using a slice of the patellar tendon, which connects the lower leg bone to the kneecap and the quadriceps muscle above it, as a replacement for the ACL.
This is what was done to McGahee, whose ACL was torn in the middle.
An ACL reconstruction involves drilling holes in the tibia and femur through which the replacement tissue is threaded and attached to the bone. Instrumentation is better, allowing doctors to anchor the graft tightly in the bone and in the right place so the joint is correctly aligned. Because of stronger fixation devices, doctors can rehabilitate patients more quickly instead of keeping them immobilized for long periods, which causes permanent stiffness.
|
| "The placement of the grafts is critical," Ireland said. "The No. 1 reason for failure is misplacement of the tunnels."
If the knee isn't properly aligned or if the new ligament stretches, patients suffer arthritis.
Doctors usually wait weeks before reconstructing an ACL until good range of motion returns to the knee and the quadriceps muscle is strengthened. This appears to lower the risk of developing excessive scar tissue, a complication that can cause stiffness. |
| But the PCL becomes more difficult to repair if left untreated, which often requires doctors to operate immediately in patients with multiple ligament injuries. This is what happened with McGahee. The injury occurred Jan. 3. Dr. John Uribe, a renowned Miami orthopedist, performed the surgery Jan. 5.
"Your hand is forced," Ireland said. "You have a window of opportunity before the ligament loses integrity." |
| The man who has overseen McGahee's rehabilitation says Uribe got good news when he cut open McGahee's knee.
Ed Garabedian, director of physical therapy at Miami's HealthSouth Doctors Hospital, said McGahee's PCL and MCL tears were at the end of the ligaments, so each was sutured back to the bone into its normal anatomical position. If the middle of the ligaments had suffered full tears, it would have required full reconstruction of those two, as well. Tears in the middle of the ligament tend not to heal as nicely, experts say.
"That's where the big difference was in his favor," Garabedian told the Miami Herald.
McGahee did not injure the left knee's lateral collateral ligament, which he had injured midway through his senior season of high school in 1999. Uribe was the surgeon then, too. |
| McGahee also did not suffer any artery or nerve damage, which is even more debilitating. Miami running back Robert Edwards took three years to come back from a knee injury in which he suffered torn ACL, MCL and PCLs, a partially torn LCL, a severed artery and a stretched nerve. Edwards saw only limited duty last season.
Doctors are far more aggressive in rehabilitation than in the past. McGahee was exercising the knee on Jan. 6, the day after the surgery. Thus began a six-days-a-week workout routine that still continues. McGahee was lifting weights just days later. Just four weeks after surgery, he discarded crutches, two weeks ahead of schedule, according to Uribe. On April 22, he conducted a workout for scouts that included running in a straight line. His daily routine now includes two hours of rehabilitation, including weight lifting, walking, jogging and massage.
Garabedian says McGahee is a marvel as a patient due to his phenomenal conditioning and his determination. |
| "His mental approach to things -- he's so positive," he said. "I don't know what keeps him that way. The guy has never winced, never moaned, and I know he had to be in some sort of pain. . . . Willis heals well -- he has great genetics."
The ACL takes the longest to heal. Doctors say it can take anywhere from 10 to 18 months based on the recovery periods of those who have suffered both ACL and MCL tears.
"You're taking tendon from one part of the body and inserting it in another," Uribe said after the surgery. "That ligament has to develop a blood supply. It has to incorporate itself into the body. And that takes quite a while." |
| Indianapolis running back Edgerrin James took only 10 months to return from an ACL tear suffered in 2001. He was good last season -- gaining 989 yards -- but was not quite back to his old form. Baltimore running back Jamal Lewis missed a little more than a year with his ACL reconstruction. He came back last season and gained 1,327 yards.
Former Washington back Terry Allen is another success story, posting three straight 1,000-yard seasons after an ACL reconstruction in 1994.
Atlanta's Anderson came back from an ACL injury to post a 1,000-yard season in 2000, but then suffered a serious injury in his other knee and has not come back. |
| Players such as Cincinnati's Ki-Jana Carter, Miami's Yatil Green and Denver's Terrell Davis are among those who never were the same after their ACL injuries and endured repeat injuries to the knee. In Davis' case, damage to the shock-absorbing cartilage in the joint hindered his comeback even more than the ACL repair.
Experts say that is a key unanswered question about McGahee, whether microscopic damage to the cartilage took place or develops in the future.
The man who did the surgery is optimistic.
"Anybody watching that game who saw the ferocity of the blow and the deformity of the knee, they will be very surprised," Uribe says. |
|
| taken from a Buffalo News article written by Mark Gaughan and Henry Davis - News Staff Reporters, 5/10/2003 |
