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October 22, 2008

BehindTheMedspeak: Is Tom Brady's knee injury potentially career-ending?'

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I was saddened to learn that the great New England Patriot quarterback had to go back to the OR last Wednesday (October 15) — nine days following surgical repair of his severely damaged left knee — for a second procedure.

Here's this past Monday's (October 20) Associated Press story with the details.

    Brady confirms 2nd knee operation to fix infection

    Injured New England Patriots quarterback Tom Brady confirmed for the first time this weekend that he had not one, but two operations on his injured left knee.

    In a posting dated Saturday [October 18], Brady thanked fans for supporting him "during the challenging times" and confirmed that he had surgery on Oct. 6 and again on Wednesday.

    "The (first) surgery [at the Kerlan-Jobe Orthopaedic Clinic in Los Angeles] went well and my doctor described my knee as 'rock solid,'" Brady wrote on tombrady.com. "Unfortunately, in the week following the surgery, I developed an infection. ... We were proactive with the infection and the doctors went in for a second procedure this past Wednesday to clean and to test the wound. The results of the tests have all been positive and we are very thankful."

    The Patriots, citing team policy, have not commented on the injury that knocked Brady out of the opener against the Kansas City Chiefs and ended his season. Although Brady has been widely reported to have sustained a torn anterior cruciate ligament, he did not give specifics on the injury.

    The reigning NFL MVP said he is excited to begin rehabilitating his knee for the 2009 season and told young fans to be prepared for the unexpected.

.....................

Here is an excerpt from Brady's website: "On October 6, I had surgery to repair my knee from the injury that took place four weeks earlier [September 7] in our season opener. The surgery went well and my doctor [Dr. Neal S. ElAttrache] described my knee as 'rock solid.' Unfortunately, in the week following the surgery, I developed an infection. The infection is very treatable and, through a course of antibiotics, it will be knocked out of my system. We were proactive with the infection and the doctors went in for a second procedure this past Wednesday to clean and to test the wound. The results of the tests have all been positive and we are very thankful."
....................

Brady's injury is believed to be torn anterior cruciate (ACL) and medial collateral (MCL) ligaments, an injury which requires extensive rehabilitation following surgical repair, usually taking a year or more to return to normal functioning — if all goes well.

The surgical repair is most often accomplished using a tendon taken from the patient's own body or cadaveric tissue from a tissue bank.

Post-operative knee infection, while rare, does happen even in the very best of hands, witness Brady's case.

You can bet the choice of surgeon was not made lightly.

Should infection occur, all bets are off.

It could be a one-time occurrence in which, as Brady stated above, surgeons were able to completely clear the joint space — or there may have been subclinical traces left behind which won't surface for a while, but might well go on to take up permanent residence in his knee.

A chronically infected replacement ligament — in effect, a foreign body in the joint space — is a potential career-ender, as infection weakens the surgical repair and surrounding tissues, making re-injury more likely.

I'm keeping my fingers crossed they got it all.

The alternative (see the case of Joe Jurevicius, among others) is frightening.


October 22, 2008 at 10:01 AM | Permalink


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