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Robert Griffin III's Knee Injury -- And the Prospects for His Comeback

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In case you have been stranded on a remote island far away from any Internet/phone/television connection, all world quarterback and great hope of the Washington Redskins, Robert Griffin III, tore his Anterior Cruciate Ligament (ACL) and Lateral Collateral Ligament (LCL) ligaments in a first round playoff game earlier this month. With the fears of those who watched Robert Griffin III's buckle realized, the Washington Redskins announced that the rookie franchise quarterback would undergo surgery to repair both his LCL and his ACL.

While debate will continue to simmer over who is to blame for the injury, RG III will have a long road to regain the electrifying mobility he showed during his rookie season. While he can use Adrian Peterson's recovery from ACL injury this season as motivation, Griffin's recovery will be complicated by the involvement of his LCL, a secondary stabilizer of the knee. Griffin previously sprained his LCL in a December game against the Ravens and returned to play the last three games of the regular season wearing a bulky knee brace.

In addition to the muscles and tendons around the knee, it is stabilized by four ligaments; the MCL and LCL that stabilize the sides of the knee and the ACL and PCL. If you want to go to the gym and ride the exercise bike you may not rely on the ligaments for stability but for those that need to make sudden changes of direction while being chased by 300 lb. defensive lineman, the ACL is crucial.

Using Adrian Peterson's remarkable comeback as a benchmark isn't as simple as comparing injuries or even surgeries. For Peterson his ACL injury, his first, involved tears to his ACL and MCL. His subsequent procedure involved a reconstruction of his ACL but did not involve any repair or reconstruction of the MCL, as it is less commonly addressed with surgery. After his procedure, his surgeons commented that the rest of his knee seemed to be in excellent condition.

Dr. James Andrews, who has been entrusted with the careers of the best baseball, football and basketball players of the last several generations, performed the surgery on both Adrian Peterson and Robert Griffin III.

Griffin III's surgery differed from Peterson's in that the LCL ligament was directly repaired and the assumption is that it will somewhat modify his recovery and rehabilitation. It is crucial to repair the LCL as leaving it alone may cause future problems with the ACL and rest of the knee. Like the ACL, the LCL will not repair itself and surgery is needed to restore the normal stability of the outside part of the knee.

After the surgery, Dr. Andrews stated that a "direct repair" of the LCL was performed, likely involving repair of the LCL ligament and any other damaged structures on the outside portion of the knee. Much of the concern over RG III's return stems from the importance of this area to the long-term health of the knee.

As surgeons are unable to repair or stitch together the injured ACL when it is partially or completely torn, a reconstructed ligament is fashioned from a piece of tendon from the patient's own body or from a cadaver donor. The donor ACLs, or allografts, while they do offer a quicker and often easier recovery, have recently been suspected of an increased risk of re-tearing. Because of this many surgeons have returned to using replacement ligaments harvested from the patient's own hamstring or patellar (knee) tendons as they offer a greater chance of long-term success. ESPN reported that Dr. Andrews was likely to use part of the patellar tendon from RG III's left knee. Normally the graft would be taken from the patellar tendon of the injured knee, but as that site was used for Griffin's initial ACL surgery at Baylor in 2009, that option was no longer available.

If Dr. Andrews was able to restore the stability of Griffin III's knee, the next nine months will involve the long process of restoring the range of motion, leg strength and function of his right knee. With the fact that this is the second ACL injury and surgery on the same leg combined with the added complication of the LCL repair, the rehabilitation process may initially be more guarded to ensure that both the ACL and LCL are sufficiently strong. Once this initial protective phase is completed, RG III will likely begin a rehab program to regain the strength and mobility needed to protect his knee against further injury.

Griffin will likely be unable to resume straight-line running until at least three to four months after surgery, barring any setbacks. Side to side movement, a greater challenge to the stability of the knee, will begin later in his recovery. Griffin III will progressively add football-type activity until he is ready for a return to full practices and games, a timeframe that Dr. Andrews gives as nine to 10 months.

An important question for the Redskins will be not only will he be ready to play but also will they consider protecting the future of the franchise by limiting his early season reps much in the way the Washington Nationals limited ace pitcher Stephen Strasburg's workload after Tommy John surgery. Given his work ethic and desire to play, it seems likely that RG III will be pushing to return to football at the earliest possible moment -- but should the Redskins let him?

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