SportsDoc Update: Ankle, Knee 9/1/2013
While the U of U is usually pretty difficult to get the information from about player injuries, using their own Tweets (see Trib blog) and experience in caring for sports injuries for a long time would lead to the following interpretation and possible timelines for return to play. These are totally conjecture in my part and a "best guess" as to what is going on.
Kenneth Scott (Ankle Fracture of fibula/ligament damage) - Scott Tweeted out that he had a fractured fibula and some ligament damage requiring surgery. The fibula is the bone on the outside of the ankle and lower leg. There are certain kinds of fractures of this bone that don't require surgery. Other types of fractures of this bone have some ligament damage associated with them, usually around the ankle, and those usually require some kind of surgery to stabilize the injury. The surgery usually involves placement of a screw or two to hold the bones together while the ligament and bone heals. Healing time is usually about 6 weeks is everything goes well, and then another month or two of rehab. Some of how fast things go have to do with how aggressive the rehab is initiated and how fast the athlete is able to get range of motion and strength back. Some would have the individual in a cast for the first 6 weeks with no movement going on and others may use a boot and start some earlier range of motion at 3-4 weeks depending on how it looks because there are screws in place to hold things together. That is largely up to the treating physician. Best case scenario, with the most rapid rehab, it would be end of the season or a bowl game if playing was a possibility. Whether that happens I'm sure will depend on if a Medical Redshirt is in the picture to enable Scott to have another full season of eligibility or not. It should be the kind of injury that he could come back and be 95-98% on when healed.
Brian Blechen (Knee Tendonitis) - Blechen's case is a little more difficult to interpret what is really going on. Reports are that he simply has had "tendonitis" in his knee and by his Tweet, he has had some kind of surgery this week. There are certainly some perplexing things about this. Tendonitis is an inflammation of a tendon caused by some kind of repetitive stress on that tendon. It can happen anywhere in the body - shoulders,elbows,hips, knees,etc.- where the amount of repetitive stress on the tendon exceeds its capacity to take it and microscopically the fibers break down and tear. This induces an inflammatory response in the body's attempt to heal it and is why it hurts. Sometimes the injury can heal by simply avoiding the activity that overstressed the tendon in the first place, or rest, and other times depending on the severity requires more involved treatment that would include medication and therapy. In the knee in particular, and from my experience, it is the strenuous nature of the off season program with the weights and running for conditioning that can sometimes be the culprit, especially for a football player because during the season the volume of running and lifting involved is more limited and done on grass or turf.
The best guess at what Blechen has is Patellar Tendonitis or Jumper's knee because there are very few tendonitis problems that would even require surgical intervention around the knee, and the requirements of his particular sport, repetitive explosive movements would be more affected and limiting resulting in the need for more aggressive treatment. Most cases of Patellar tendonitis can be resolved by a combination of activity modification, anti-inflammatory medication, and some rehab, along with taping or a simple strap around the knee while playing. The need for some kind of surgical intervention implies the problem has been going on for a while, usually months, and that the pain is now limiting his ability enough that he can't be productive on the field.
There are different options with what may have been done if that was his diagnosis, but one could surmise from the fact that he might come back "in a few weeks" that the most aggressive option, opening the tendon up and removing scar tissue was not done. That is usually a 3 - 6 month heal and the results from that surgery aren't that great. Again, it is only conjecture, but the best guess would be that he had a "PRP" treatment which is concentrated platelets from the blood that can stimulate healing where it isn't happening naturally. "PRP" stands for "platelet rich plasma". Usually a blood sample is taken from the patient, spun down to concentrate the platelets into a clump - a clot basically, and then re-injected into the injured area. This is done with a needle under direction of ultrasound to get it into the right part of the tendon, and is considered a surgical procedure. It can "jump start" the healing process in cases of chronic tendonitis. It doesn't always work, and the use of "PRP" is still controversial because it hasn't proven to be the "panacea" we hoped it would be, but a lot of athletes will have it done to help their injuries in an attempt to get back playing when other things have failed. It is a legal and legitimate procedure. If that was done, it will hopefully help Blechen to get back on the field. and that could happen as soon as 2-3 weeks, if all of the assumptions made are correct. As mentioned above all of this may be totally different if he has a different type of tendonitis as we don't know the specific diagnosis other than by conjecture, but this a best guess scenario.
A couple of questions do come to mind. In general, to require any kind of surgery for a tendonitis or to be a best option, it usually has to have been going on for at least 3 months, and failed lots of other treatment options. One wonders how it is to the point of needing surgery at this particular time, since we ( the public/press) have only known about it for a few weeks. Sometimes it has to do with failure of the athlete to disclose a problem because they want to play The other question is "have all the non-surgical options been exhausted" since any kind of surgery at this point in the season with an important player will take him out for some period of time, and most tendonitis issues can be controlled until a season is over, and then do the surgery. We probably won't get the answers to those questions, but they're out there.
Hopefully this will be informative if nothing else. The SportsDoc is giving only an educated opinion based on what limited information is available and it may be totally off base but is unbiased. There is no insider information involved, only what has been given to the general public.
Russ Toronto, MD
Dr. Russ Toronto has served top athletes in Utah since 1981 through his own private practice and through affiliation with various orthopedic groups. He received his medical degree from the University of Utah in 1979.
With over 25 years of experience treating, coaching and playing along side his patients, Dr. Toronto is uniquely qualified to treat any athlete, any time. As one of the first sports medicine specialists in Utah, his level of expertise can be seen in a distinguished career. He has served as a team physician for University of Utah football, the Triple A baseball team, and at many high schools, helping direct sports medicine for their programs. In 2002, he served as one of the venue physicians for Olympic Snowboarding. He has also served on the Governors Council for Physical Fitness and as a medical advisor for many club sports including gymnastics, running and soccer. Dr. Toronto has provided care for pro athletes, college athletes, high school athletes, and recreational athletes in a wide range of sports. He has been invited to present at over 50 sports medicine conferences, written a newspaper column, and has discussed sports medicine topics in videos and on the radio.
In addition, Dr. Toronto is a former collegiate baseball player, avid backcountry skier, and proud husband and father of five children. His passion is returning athletes to the playing field at whatever level they participate.
Follow Dr. Russ Toronto on Twitter: @DrRussToronto