NFL Injury Report: Darrelle Revis’ Season Ending Injury

Each week, RulingSports.com will analyze one NFL player’s injury.  Sports Medicine doctor, Dr. Mandy Huggins (Twitter:  @HugginsMD), will provide medical analysis of the injury.  Alicia Jessop will then break down some of the contract ramifications of the injury.

Dr. Mandy Huggins’ Medical Analysis

In Sunday’s week 3 game against Miami, Darrelle Revis, all-pro cornerback for the Jets, injured his left knee. He fell awkwardly then grabbed his knee during a play in the 3rd quarter. Today, an MRI confirmed the injury: he has a torn anterior cruciate ligament, or ACL, in his left knee. Unfortunately, he will be out for the season, as he will reportedly undergo surgical reconstruction followed by a lengthy rehabilitation program.

The ACL plays a critical role in knee stability, and it is the one knee injury of greatest concern in athletes. The ligament’s role is to resist forward movement of the tibia (shin bone) in relation to the femur (thigh bone), as well as to provide rotational control. Many reports note that Revis’s injury was a “non-contact” injury, meaning there was no impact from another player. ACL ruptures have a non-contact mechanism of injury about 70% of the time. They usually occur during deceleration, pivoting, changing direction or landing from a jump. The athlete commonly hears or feels a “pop” in the knee, which is accompanied by pain and swelling.

There is some debate about treatment for an ACL rupture, depending upon age, activity level, type of sport, associated injuries, etc. Some individuals can regain some amount of stability with rehabilitation, and can avoid surgical reconstruction. However, given the nature of professional football, an NFL player should have his ACL reconstructed if he wishes to play again. The type of activity (e.g., pivoting, cutting, changes in speed) required in football is not amenable to non-operative treatment; an ACL-deficient knee would likely have too much instability to endure these activities. That being said, it should be noted that ACL reconstruction is not a guarantee that he will be able to return to sport.

The surgical procedure for an ACL rupture involves forming a new ACL from another tendon graft. It is performed arthroscopically. Which tendon graft to use as the “new” ACL is also a subject of debate in the literature, however, the most commonly used tendons are hamstring, patellar, or allograft (cadaver tissue) tendons. The timing of the surgery after the injury depends on other factors, such as the amount of swelling or the presence of concomitant injuries in the knee, such as a meniscus tear. It is common for an athlete to undergo rehabilitation before the surgery (“prehabilitation”) to address swelling, quad strengthening, and range of motion. Post-operative rehabilitation protocols, including weight-bearing status, depend upon the type of graft used and concomitant injuries.  Goals again include reducing swelling and maximizing range of motion, strength, and balance. Lastly, the athlete needs to demonstrate readiness with functional and sport-specific activities. Progression through rehab should be individualized to each athlete, so timeframe for return to sport is variable. Maturation of the tendon graft alone takes up to 6 months. But barring any complications, Revis should be ready for football again in 6 to 9 months.

Alicia Jessop’s Contract Analysis

The timing and seriousness of Revis’ injury could not have been worse.  This summer, Revis faced a difficult decision as he entered the final year of his contract.  That decision was to attempt to demand a lucrative new contract by holding out, or rather, report on time to training camp and attempt to earn a lucrative new contract by playing.

Arguably, Revis made the more honorable decision by actually upholding the terms of his current contract and reporting on-time for training camp.  Hopefully, that honor will stand out to the Jets and other teams as representative of Revis’ integrity when the star player begins renegotiating his contract.  The obvious issue though, is that because of his season ending injury, Revis will be unable to put up any numbers after Week 3.  Thus, it is likely that Revis will not renegotiate his contract this season, as any leverage he had was stripped of him because of his injury.

Given this, Revis must dedicate himself fully to his rehabilitation and maintain a rigid training program to stay at the top of his game.  If he returns at the level he was at this season in 2013 (the last year of his contract), he may be able to convince the Jets or other teams into paying him the type of salary he was planning on making next season.  Nonetheless, this injury is an incredibly tough break for Revis.

Mandy Huggins, MD is a board certified sports medicine physician. She blogs regularly at http://www.drmandyhuggins.com.

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