WWE mainstay and megastar John Cena won't be around to deliver his Five Knuckle Shuffle for a while as he recovers from elbow surgery.
Most WWE fans have already heard the news of his injury, but some may not understand what was wrong with him in the first place. The question of when he returns is a significant one, as he is in the midst of a feud with WWE Champion CM Punk.
There has been some debate about how long he will be out of action. WWE.com originally put his recovery time at two to three weeks.
John Cena tweeted otherwise:
I am supposed to lay low for SIX WEEKS. I will send surgery photos and video to @wwe so they can see how bad it really was..— John Cena (@JohnCena) September 19, 2012
With any kind of post-surgery recovery, even the best estimates are still just estimates. Understanding the extent of Cena's injury and the procedure he went through can give us a clearer picture than conjecture.
The grueling nature of pro wrestling catches up with every wrestler in the end. Night after night of getting thrown around the ring took its toll on Cena's elbow.
Fragments of the bone had begun to chip and roam around loose in his arm. This is known as osteochondritis dissecans.
Summitmedicalgroup.com states that osteochondritis dissecans "is a disorder in which fragments of bone or cartilage come loose and float around in the elbow joint."
Physical trauma over time, something that WWE stars endure daily, can cause this type of fragmentation.
Osteochondritis dissecans is often seen in baseball players. The stress of throwing a baseball multiple times can lead to this injury as well.
Major league pitchers Johan Santana and Drew Storen, among others, have had to get bone chips removed from their elbow.
John Cena was wrestling just a day before his surgery. He was in the Night of Champions main event just two nights before the procedure.
News of Cena's injury and surgery came as a surprise because the effects weren't obvious to those watching him perform in the ring.
While a starting pitcher's lowered velocity is obvious to fans, Cena could still do his job, just uncomfortably. The Summit Medical Group website says this type of injury may cause the elbow to swell and "you may not be able to completely straighten your arm."
As tough he is, eventually the injury would have made it too painful for him to perform. Surgery was inevitable.
Dr. James Andrews performed arthroscopic surgery on Cena's elbow on Tuesday, Sept. 18. Dr. Andrews is famous in the sports world for performing major surgeries on players like Drew Brees, Peyton Manning and Michael Jordan.
Cena fans can rest easy knowing that he was in experienced, expert hands.
The goal of surgery in this situation is to remove the damaged structures. A tiny camera is inserted into the injured joint which allows the surgeon to work in the small, cramped area.
Cleaning out the debris is sometimes referred to as "scoping" the elbow. The minimally invasive nature of the procedure is designed to limit scarring and speed up recovery time.
That's good news for the Cenation.
The Los Angeles Times quotes Dr. Andrews as saying, "I performed an arthroscopic procedure on his elbow and took out a bunch of spurs. Everything went really well."
The first step was successful; now comes the hard part for WWE bookers and Cena fans, the waiting.
The question on everyone's mind is "will John Cena be ready to perform at Hell in a Cell on Oct. 28?"
Going by the timetable that Cena tweeted, he won't be ready to go until two days after the pay-per-view.
After Washington Nationals pitcher Drew Storen underwent the same surgery on April 11, he didn't pitch in a simulated game until July 3. That's nearly three months.
Unlike Cena, he was allowed to ease back in.
Baseball is clearly not the same as wrestling, just as Storen's elbow is not Cena's. Still, it's clear that this is a major procedure that requires significant recovery time.
Clevelandclinic.com discusses recovery after arthroscopic elbow surgery:
Recovery varies from one week to several months, depending on the extent of the surgery. Most patients can return to heavy work and sports within three to six weeks of surgery if the procedure is minor. However, three to six months is often required for complete recovery.
There is no way WWE is going to let Cena rest for three to six months.
He is too big of a star and they are too dependent on him to take the patient route. While that may be beneficial for Cena's long-term health, he will likely be in the ring as soon as he is able to lift a man over his shoulders,
Cena is famous for his work ethic in the gym and should recover faster than the average patient. Still, it's unlikely that Cena will be fully healthy by Hell in a Cell.
Dr. Andrews' statement about "a bunch of spurs" leads one to think recovery time will be longer than the minimum.
It's more profitable for WWE to showcase a Cena who is not at full strength than to keep him out of the ring for as long he should be. He is the biggest star in a sport where stars are vital.
Rushing Cena back, however, can worsen the injury and cause long-term damage. Vince McMahon and WWE have a big decision to make.