Initial Impressions of AO
This is a repost from Cuseregular on Syracusefan.com I don’t think he would mind me putting it here for people to see.
Having been teaching orthopedics and sports injuries for 20 years here’s the initial impression.
First off x-rays are essentially useless in this scenario and none of us should take solace in these initial reports. They wont even pick up the type injury this early that Harangody has. The only potential positive is in reading between the lines as the training staff reporting this as good news to lay people really suggests the inital orthopedic evaluation was a good one without any instabilty aka major ligament ruptures. However, MRI tells all and will find out if there’s any partial tears in the ligaments in the area, the tendons or other soft tissue supporting structures.
Also it distinguishes very well cartilage type injuries such as involving the Harangody type of issue which injures what is known as the hyaline cartilage lining of bones that can get injured with trauma but heals quickly (vs. other ortho injuries). That could be the scenario here if he planted/landed wrong and/or twisted his knee.
The other type of cartilage injury to what is known as fibrocartilage is when you hear referred to as “torn cartilage” relates to meniscus injuries which essentially are the “shock absorber” and cushioning in the knee between the upper leg bone (femur) and the lower leg bone (tibia). Often torn just partially which he could play through albeit with somewhat diminished capacity ala Terrence Roberts from a few years ago. A total tear through is different and he’s done for the year.
Though I didn’t get to analyze and see the replay exactly enough, the initial impression based on the mechanism of injury and how it happened leads to some optomism. From what I could tell he didn’t get hit and rather he twisted it in landing a bit. Most significantly and positively was that I could see the orthopedic eval. on him and everything looked intact when they stressed the ACL and MCL. Again this is what they probably informed the family of in conjunction with the negative x-rays. And again we’ll need to wait to see the MRI to see if there’s any partial tears because the ortho eval. wouldn’t be positive likely in this scenario.
His reaction was appropriate especially coupled with a patient who has a history of knee injuries, hears a “pop” and feels the very real physical pain of what essentially is a twisting of the knee. The prolonged pain and the way he was helped off the court is a cause for concern. That being said the poping in an of itself isn’t a huge deal as every joint including the knee has several ranges of motion associated with it before failure of supporting ligaments. Like with cracking your own knuckles if moved a certain way every joint can pop (or cavitate in technical terms) and this is not suggestive for injury in and of itself.
If accompanied by positive orthopedic findings and later then MRI then of course it is associated with severe injury. But the pop itself isn’t. For example with the ranges of motion aspect of joints extend your middle finger backward until you cant go anymore (that’s the active range of motion), then when it can go no further grab the finger between the thumb of the index finger of the other hand with the index finger near the top and the thumb on the other side at the base and pull back gently and watch it move more (that’s the passive range of motion associated with joints). Then when hitting a barrier gently pull further into what’s called the accessory joint play motion area and you’ll hear a pop. Anyfurther goes beyond the joint limits of anatomic integrity and causes ligament damage.
All joints have this motion associated with it but rarely are extended that far so the fact he heard a pop isn’t worrysome to me, again, especially combined with an negative orthopedic evaluation. And as an aside this is why most teams have some sort of therapist to regain these ranges of motion since it’s not a dramatic leap of logic to suggest this can lead to improved performance on the field/court when having full motions in ones joints.
So long story short based on the way it looked like it happened combined with what we know so far is worst case scenario is he has a Harogody tyype deal, a partial grade 2 tear of ligament(s), a complete tear of the meniscal cartilage, a dislocated patella out of the groove it rides in, or finally a tear of his patella tendon. All of these would keep him out for the remainder of the year.
More likely I think is a sprain of one the ligaments (grade 1) which will show up negative for any tear on the MRI (with maybe only a little associated swelling), a partial tear of the meniscal cartilage, a transitory partial dislocation of the patella (partially in and out quickly), or even just a tweaking of the knee joint hyperextension like without any structural damage at all except for a little short term swelling (essentially less than a grade one sprain); all of which can cause short term significant pain. With any of these he can play albeit probably being a little gun shy at first. So looked at in its totality the mechanism of injury is in his favor along with the fact that the initial ortho eval looked positive. It likely looked more serious than the damage will hopefully turn out to be and I think he’ll be back although somewhat hampered by the nagging nature of it.
