Football season is starting and already some teams have lost key players to knee injuries. Shawn Merriman was expected to lead the San Diego Chargers defense this season; now his season is in doubt due to injury. Osi Umenyiora, All-Pro defensive end and the best defensive player on the Super Bowl Champion NY Giants, is out for the season with a meniscal tear. Interestingly, these two injuries and their planned treatment highlight some of the subtle issues that professional athletes and their physicians must deal with.
As Umenyiora was trying to turn the corner around the Jets tackle, it looked as if his foot got stuck in the turf. Initial comments made after the game were positive in that there appeared to be no ligamentous damage to his knee. Unfortunately, newspaper reports the next day announced that Osi would be out for the season with a meniscal tear.
The meniscus is a fibrocartilage, wedge-shaped cushion between the two main bones of the leg: the femur (or thigh bone) and the tibia (or shin bone). It helps to stabilize the knee joint and to protect the cartilage of the knee. Athletes often tear their meniscus by twisting the knee, pivoting, or decelerating. Pain and swelling are common symptoms. More worrisome is when the knee locks or gets stuck in a certain position. This is indicative of a meniscal tear that has moved into the joint; it sounds like this is what happened to Umenyiora.
The meniscus itself doesn't have a great blood supply, so it doesn't heal well on its own. When tears occur that don't respond well to conservative management, arthroscopic surgery is performed to cut out the piece of torn meniscus. This is a quick procedure, which gets people back to sports and activities as soon as their motion and strength are normal. So, hundreds of thousands of patients who have undergone this procedure are wondering, why does Osi have to miss the entire season?
This is where the subtleties come into play. There are occasions when the meniscus tears in such a way that it can be sewn back together. Umenyiora had such a tear. This provides a better long-term outcome for patients, as you aren't removing any of their shock absorber: therefore, less chance of arthritis down the road. The downside is that the recovery period is prolonged, as it is imperative to protect the knee during the healing process.
It probably would have been easy for Umenyiora to say, "I don't want to miss this season; cut out the meniscus and I will deal with the long-term effects down the road." It would have been easy... but not smart. Osi is doing the right thing to help his long-term career.
Shawn Merriman has a damaged posterior cruciate ligament (PCL) and lateral collateral ligament (LCL). These are two of the four stabilizing ligaments in the knee. The PCL is injured less frequently than the ACL, and it functions to prevent the tibia from sliding back on the femur. The LCL stabilizes the outer aspect of the knee, and prevents bowing of the leg. Unlike ACL injuries in football players, PCL injuries do not always cause instability and can often be treated nonoperatively. LCL injuries are uncommon and also usually respond well to conservative treatment. The problem for Shawn is that these conservative treatments work well when a given ligament is injured in isolation.
When more than one ligament is injured, there is a much higher risk of instability as well as more serious injury, especially when one is playing professional football. Based on initial reports, it seems as though the doctors Merriman has seen are recommending surgery to reconstruct/repair the ligament damage.
Unlike Osi, Merriman seems to be taking a different approach. He has stated that he will do anything he can to play this season. Is this smart in light of the potential damage he can do to himself by continuing to play? Herein lies the subtlety in caring for high-level professional athletes. Doctors can explain the injury and give their treatment recommendations, but they can't force a player to follow their advice. Only Shawn Merriman and Osi Umenyiora know how important the 2008-09 season is relative to the importance of being able to play for a longer time in the NFL.
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For more information about sports medicine, visit the Joe DiMaggio Sports Medicine Center.
Mission statement: Manhattan's Joe DiMaggio Sports Medicine Center is devoted to rendering the very best non-surgical foot and ankle care, specializing in effective, non-intrusive methods as a primary objective. At the same time, the Center is affiliated with the world renowned Hospital for Special Surgery (HSS), affording traditional surgical and other options. The HSS, located in New York, has been recently rated the Number One hospital in the country for orthopedics by the US News and World Report. The Center also offers the expertise of orthopedic surgical and non-surgical clinicians in all areas of care.
The Center is named after American sports icon Joe DiMaggio, whose heel spur disability remains one of the most well-known sports injuries in history.