Ryan Tannehill’s MRI showed no structural damage, so why would he need season-ending surgery?

When Tannehill was diagnosed with a partial ACL tear (and MCL injury) of his left knee last season,  he had 2 options – surgical ACL reconstruction or immobilization with aggressive rehab. I want to set the record straight because I’m hearing and reading a whole lot of non-medical speculation about what Tannehill, the Dolphins, and the medical team should have done differently in light of his unfortunate re-injury. Ryan Tannehill didn’t “skip” surgery, nobody was trying to take a shortcut, and his decision wasn’t so outside-the-box. I saw a lot of stories from training camp about how the quarterback’s knee looked great and was no cause for concern. In fact, just this morning, I commented that we needed to be cautious because athletes with partial ACL tears often feel great until one awkward step changes everything.

Treatment of a partial ACL tear with a clinically stable knee in a professional athlete involves difficult decision-making. In the case of an ACL tear where the athlete has obvious instability of the knee despite rehab and bracing, the treatment is more clear: surgical reconstruction. But we know that some athletes with partial ACL tears do okay without surgery. The likelihood that a partial ACL tear will do okay without surgery depends on the percentage of fibers torn, stability on exam, the type of athletic demand, and a lot of other factors. Tannehill’s knee was deemed by his surgeon to be clinically stable. He could have chosen to go either way, but he and his team weighed the risks and benefits of surgery and ultimately decided it would be best for him to treat his partial tear non-operatively. This was a reasonable choice. Have you or anyone you know had surgery and suffered complications? Every surgeon will tell you that the worst type of surgery they could do is an unnecessary surgery. In this case, it would have been very unfortunate for the Dolphins’ QB to have surgery if he didn’t need it.

Earlier today, Tannehill’s left knee appeared to buckle as he side-stepped toward the sideline. An MRI reportedly did not show re-injury to the ACL – unfortunately that does NOT mean that he’s in the clear. It is concerning that the quarterback’s knee buckled the way that it did, after months of rehab, in a knee brace, in the absence of contact. The risk of treating a partial ACL tear non-operatively is not just that it could completely tear. The biggest risk is that the knee could continue to buckle and cause other damage in the knee. When the knee gives way due to ACL instability, the bones strike each other and this can lead to significant damage to the articular cartilage and menisci. Articular cartilage injury can be catastrophic to a professional athlete’s career.

Today’s MRI likely showed some clues as to why Tannehill’s knee buckled (characteristic bruising patterns in the bones are often seen).  The quarterback will have a thorough exam, likely by multiple knee surgeons, to determine whether or not his remaining ACL fibers are effectively stabilizing his knee. For now, we wait. Sadly, after today’s buckling event, season-ending surgery is a real possibility.



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