After Teddy Bridgewater suffered what appears to be a knee dislocation, Dr. David Argo of Beacon Orthopaedics and Sports Medicine appeared on the Ken Broo show on The Big One, 700 WLW FM.
Ken: What was the injury like? How did it happen? A non-contact drill. Let’s bring in an expert on all of that, from Beacon Orthopaedics and Sports Medicine Dr. David Argo. Good morning, thanks for joining us.
Dr. Argo: Good morning, Ken.
Ken: It seems as though there was no artery damage to Teddy Bridgewater, and it seems like the nerve is okay, so it’s not as bad as it could have been, right?
Dr. Argo: Well, when you have a knee dislocation, that’s where the tibia, which is the lower bone in the leg, and the femur, which is the upper bone in the knee, come apart. Basically, the tibia will slide out from under the femur either forward or backward. In order to that it has to tear at least two or sometimes three ligaments in the knee. Just about everyone has heard of the ACL, the anterior cruciate ligament, is in front and dead center of the knee. There is a posterior cruciate ligament, too. They are called “Cruciate” because they cross: cruciate means cross. In order for the tibia to come out from under the femur, it has to tear both of those ligament.
Ken: So you’ve got at least the ACL and the PCL that are probably torn. There are ligaments that stabilize the side of the knee, one is called the MCL, but I don’t know what the other one is. Probably, there is damage there, too, I would think.
Dr. Argo: Absolutely. The lateral collateral ligament, or the LCL, and the medial collateral ligament, or MCL, those are the two on the outside. And “collateral” means “outside,” so they are the outside parts of the knee. So when a dislocation occurs, often times you tear all four of the major ligaments. But the dangerous part is that the major blood vessel that supplies the rest of the leg, it’s about the size of your index finger, that goes down behind the knee. That vessel is there, the artery is there, the nerve is there, and the vein is there, if that comes out and is trapped, you could lose your leg. It is an automatic right now emergency to get that injury seen and to the closest sports medicine clinic. It sounds like they got him to a specialist quickly enough that they saved his leg and the nerve and the artery are okay.
Ken: Alright, so all of that happened. It’s gruesome and it’s dislocated, but what are they doing with Teddy Bridgewater right now? You can’t just go in and fix it when it happens. There has to be a period of time before you can actually go in and surgically repair this, right?
Dr. Argo: Right, they usually wait until he has full range of motion, gets all the swelling out of the knee, and just let the muscles and everything calm down. A lot of times if you rush right in and do it, he can develop hypertrophic scar tissue that limits motion down the road. So if you let everything calm down, let the swelling go down, gentle rehab just to keep his motion, and then go in and do a reconstruction. It’s a major, major reconstruction.
Ken: Now we went through this, well, not quite to this level, but Carson Palmer went through knee surgery and came back within eight or nine months, maybe ten months. He was there for the first preseason game following that injury in January. This seems a little bit more devastating than what Palmer had. Am I right?
Dr. Argo: It is. Palmer had his knee subluxed enough that it didn’t fully dislocate, so some of the major stabilizing ligaments were still intact. I think Carson tore his ACL and his MCL, and his PCL and LCL were okay. But with a total knee dislocation, what they are describing for Teddy Bridgewater, it would be (having not seen his MRI or examined him), but that kind of dislocation, I tell my patients it’s a year before you think about doing anything competitive, and then you start building your strength up. I hate to predict, but I think a year and half before full recovery.
Ken: Right, which is probably why they went out and spent what they had to spend to get Sam Bradford in to quarterback that team. We are talking with Dr. David Argo of Beacon Orthopaedics and Sports Medicine. Okay, so, can you take the ligament that’s been torn and fix it, or do you have to go to a cadaver? Do they harvest something from outside the body to fix this?
Dr. Argo: Well usually when you have a knee dislocation, there are too many ligaments torn to take the patient’s own tendons or ligaments. Because of this, they will usually use a cadaver, and I think that’s what Carson has. That’s the other thing, though, you have to make sure you get the right tissue, the right quality. It’s a major, major reconstruction that’s done. He’s going to have some major rehab ahead of him.
Ken: So let’s say that everything calms down in the next couple or three weeks, let’s say he has the surgery toward the end of September, he has it done then. The rehab on this begins immediately?
Dr. Argo: Oh yes, right away the rehab will start. Mainly with trying to get the muscles to come back. The quadriceps muscles and the hamstrings, because those are the protective muscles of the knee. Those will actually help with the healing process because they will take a load off the way the knee will shift. You want strong quads and strong hamstrings. Again, that’s the advantage for Teddy. He’s, I think, twenty-three years old, he’s build like a truck. He has hamstrings and quads that any lineman would love to have. He’s got a great opportunity to rehab this thing and get back.
Ken: Recovery time of a year and half. Is that for you or me, and someone that plays tennis or plays golf, but not an elite athlete. So there’s that timetable. How did this even happen, it was a non-contact play. It sounds like he was just putting one foot in front of the other. How does an injury like this happen?
Dr. Argo: Well, in orthopaedics, we call this the perfect storm cliche. The body is going one direction, he’s firing those powerful muscles in a different direction, and then it’s being stretched all at the same time. It’s the perfect torque, the perfect force, and the perfect angle all have to be happening in conjunction. Like I said, it’s really the perfect storm. I’ve seen this in soccer players who run down the field with the ball and all of a sudden, they make a little turn and it happens. I’ve treated football players go up for a pass, and they are about to take off to leap up and grab the pass, and it dislocates their knee right there.
Ken: It’s amazing. I’m old enough, you’re old enough to remember that if you had an injury like this twenty five years ago, this guy isn’t playing another down of football. It’s amazing the medical strides that have been made particularly with this kind of injury. With baseball, it’s the elbow reconstruction since 1974-75, but this particular injury, go back to as recently as 1990 and I know we’ve had players that play on two reconstructed knees. We had a kid in this town, nice guy now, Kevin Walker. He played on two reconstructed knees for the Bengals and I know that’s one thing. This, twenty-five years ago, Teddy Bridgewater would have been moving on to whatever else he was going to do in life, right?
Dr. Argo: Twenty five years ago, they probably would have put him in a cast. They would just have stabilized his knee and he would have been that way for four to six weeks, then his knee would be extremely stiff. His football career would be over. I hate to say someone is lucky, but he is fortunate to have this occur at this point when he is young and he is healthy. The science that we have now in orthopedics is amazing. They’ll probably supplement his surgery with either platelets or stem cells. Those are the kind of things we’re doing at Beacon, where we’ll do an ACL reconstruction and, just to be straightforward, we’ll put PRP or platelet rich plasma or even stem cells in to help augment the repair. We’ve seen faster recoveries and less swelling and less pain by doing that. It’s that whole regenerative medicine thing that we at Beacon have really embraced.
Ken: Thank you, Dr. David Argo of Beacon Orthopaedics and Sports Medicine for helping us understand the injury and recovery time ahead of Teddy Bridgewater.
Dr. Argo: Thank you, Ken!