Washington Redskins

Checking in on Robert Griffin III as He Continues to Recover from Knee Surgery

LANDOVER, MD - DECEMBER 09:  Quarterback Robert Griffin III #10 of the Washington Redskins waits to be introduced before the start of the Redskins game against the Baltimore Ravens at FedExField on December 9, 2012 in Landover, Maryland.  (Photo by Rob Carr/Getty Images)
Rob Carr/Getty Images
Dave Siebert, M.D.Featured ColumnistMay 2, 2013

Nearly four months ago, football fans across the country watched in stunned silence as Washington Redskins quarterback Robert Griffin III suffered one of the more heart-wrenching knee injuries in recent memory. On Saturday, however, RG3 had them anything but silent.

According to the Associated Press (via ESPN), RG3 "did a few jumping jacks, jogged in place and bounced up and down on the stage" for cheering fans at a Redskins draft party. In other words, he might very be well on his way to starting Week 1 of the 2013 NFL season.

We should have seen this coming.

Obviously, no one wants to see injuries happen. Yet if anyone was prepared to tackle a round of reconstructive knee surgery and rehab, it was RG3.

After all, this isn't his first time around the block. In 2009, as a member of the Baylor Bears, he tore his right anterior cruciate ligament (ACL) for the first time. He recovered to start the 2010 season.

Will he repeat that feat this year?

Alas, it is still too early to tell. Comparing the two injuries isn't quite like comparing apples to apples, as RG3's 2012 injury included a right lateral collateral ligament (LCL) tear in addition to a rupture of the reconstructed ACL from 2009.

Nevertheless, slowly but surely RG3 is headed in the right direction.

According to a document compiled by acclaimed orthopedic surgeon and sports medicine specialist Dr. Peter Millett of the Steadman Clinic in Vail, Colorado, patients should be introduced to agility drills and light running sometime between post-operative weeks 12 and 20.

Not only is RG3 well beyond that milestone—his jumping jack feat marked week 15, day three—he got there with the added variable of a torn LCL.

Why does that matter? Simply, it complicates both the surgery and recovery.

RG3's physician—renowned orthopedic surgeon Dr. James Andrews—needed to repair both the ACL and LCL. According to the AP (via CBS News), Andrews directly reattached the ends of the torn LCL and used a tendon graft—a piece of muscle tendon taken from elsewhere in RG3's body—to replace the torn ACL.

Dr. Andrews called it a "a re-do of his (2009) ACL reconstruction." In this case, he used part of RG3's left patellar tendon—the part of the knee a doctor hits with a reflex hammer—to serve as a replacement ACL.

In other words, in 2013, RG3 tore the very tendon used to replace the original ACL that tore in 2009.

Fortunately, the human body is prepared for such a scenario.

Over the weeks and months following ACL reconstruction surgery—even a second one—the body cements the tendon graft into place and remodels it into tissue more closely resembling a natural ligament—a phenomenon called "ligamentization."

While his body started the ligamentization process, RG3 started down the lengthy road of rehabilitation.

Early ACL rehab relies heavily on establishing the full range of motion of the knee. In fact, Dr. Millett's rehab protocol states patients should ideally be able to maintain full, passive leg straightening—meaning straightening by a therapist without assistance by the athlete—within the first post-operative week.

However, such exercises place significant stress on a repaired LCL. A brief anatomy lesson explains why.

The LCL connects the outside of the femur to the fibula—or the thigh bone to one of the bones of the lower leg. By doing so, it reaches its maximum length when the knee is fully straightened.

In short, the rehab of one reconstructed ligament depends on the strength of another.

See the problem? Most would.

RG3 didn't.

Just as in 2009, RG3 blazed through the initial stages of his rehab.

By early February—less than one month after his surgery—he could bear enough weight to walk up and accept his Offensive Rookie of the Year award at the NFL Honors ceremony.

On April 7, Mike Shanahan believed RG3 to be on pace to set a recovery record.

Then, on Saturday, RG3 did jumping jacks.

Without reading too much into a simple exercise most people learn in grade school—and one that probably represented more of a PR move than anything else—RG3's recent appearance showed a few things.

First, it confirmed he likely suffered no setbacks during the first few months as he progressed through basic exercises. Second, it re-demonstrated his ability to bear weight. Finally, it proved basic jumping and lateral movements are now within his grasp.

Yet perhaps most importantly, it showed RG3's medical team is comfortable with him making such a public display.

What's next? In all likelihood, RG3 will continue on with another month or two of strength training and agility exercises of steadily increasing intensity. Assuming all goes well, football-specific drills loom on the horizon.

After football-specific drills?

Well, football.

In short, RG3 continues to impress. Yet are his accomplishments surprising? Will Carroll—Bleacher Report's lead writer for Sports Medicine—spoke with Mike Reinold, one of the top physical therapists in the country, about that very question.

"I've worked with enough athletes that anything they do doesn't surprise me any more," Reinold said with a laugh. "The thing that you have to remember is that no two surgeries are alike. A lot comes down to how hard the athlete is willing to work before and after the surgery."

RG3's unbelievable conditioning prior to the injury also plays a huge role.

"The better someone goes in, the better someone comes out," Reinold explained.

Carroll agreed, though he also credited recent progress in the realm of exercise and rehab science.

"Griffin is the latest of the very visible successes we've seen with ACL cases," Carroll said. "None are the same, but we're seeing that advances in surgical technique, rehabilitation and, most importantly, pre-surgical conditioning are leading to shortened return times."

In the end, however, superhuman healing is probably just in RG3's nature.

"Super-conditioned athletes like Griffin and Adrian Peterson have advantages beyond the best doctors and 24/7 care," Carroll added. "They're just freaks, and I mean that in the best possible way."

Make no mistake. RG3 still has a long way to go, and optimism needs to remain just that—optimism. The last stages of rehab tend to be the most difficult and prime for setbacks, as an athlete can very easily push himself too hard once his or her knee feels normal.

To be clear, his knee is still anything but.

In addition, despite recent examples, a six-month recovery from a knee reconstruction remains the exception of all exceptions, not the norm.

This timeline cannot and should not be expected for athletes who suffer similar injuries in the future, and RG3 may very well still miss significant time this season. Rushing back from injury is the worst thing he can do, and therapists are surely advancing him forward only when they are absolutely certain he is ready.

That said, one thing seems certain: So far, so good.

 

Dave Siebert is a medical writer for Bleacher Report who will join the University of Washington as a resident physician in June. Except where otherwise cited, medical information discussed above is based on his own knowledge, and quotes were obtained firsthand unless otherwise noted.

Follow Dave on Twitter for more sports, medicine and sports medicine.

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