Wilson Betemit was set to be the Orioles' DH this season, filling in around the infield as needed. It's a valuable role, and one that will be tough to fill in for the Orioles at this late date.
The Orioles lost Betemit last season, which forced them to bring in Manny Machado—a move that helped carry them to the playoffs as Machado established himself as an elite young talent. This one's different and will be the first big challenge for Buck Showalter in 2013.
Images showed that Betemit has a Grade II+ sprain of his PCL. This injury can take as much as 120 days to recover from, as Matt Diaz did in 2008, or as little as 15, such as Darwin Barney last season with a very minor sprain. Surgery would likely cause Betemit to miss the entire season, especially if there's further damage inside the knee.
The current plan is to rehab the knee without surgery, which gives Betemit a chance to return in as little as six to eight weeks. It's a chance, not a certainty, with the possibility very real that the rehab will fail and surgery will be necessary. At that point, he would miss most if not all of the '13 season.
I asked Bleacher Report's David Siebert to break down why this is such a difficult injury to come back from. Here's his report:
The posterior cruciate ligament (PCL) is the most important of the four stabilizing ligaments of the knee. Located in the back of the knee, its primary function is to prevent the lower leg from moving backward in relation to the thigh by connecting the backs of the femur (thigh bone) and tibia (shin bone). By doing so, it helps keep the leg in a straight line and provides support to the knee during everything from walking to sprinting and cutting.
When an outside force overwhelms the PCL's ability to deter backward motion, a sprain results. For instance, the so-called "dashboard" PCL injury occurs when an unrestrained passenger is thrown forward into the dashboard during a car accident.
When the passenger hits the dashboard, the body continues forward, but the dashboard drives the knee back, stretching or tearing the PCL. Knee hyperextension can also cause the injury, as forced over-straightening of the leg forces the top of the lower leg to move backward in relation to the thigh.
In Betemit's case, he appeared to suffer the injury when he planted his right foot in such a way that his right leg was entirely straight at the time his foot impacted the ground. As he was already a few steps into his run at the time, momentum kept his upper body and thigh moving forward. However, his planted right foot could not follow suit. The result? A knee hyperextension and PCL tear.
Treatment for PCL sprains is controversial. Unlike the ACL, the PCL has at least some innate healing ability, and low-grade sprains are usually treated with rest and physical therapy. In fact, some studies even suggest that surgery for high-grade tears is no better than conservative treatment. That said, Betemit's sprain is being called "grade 2 or 3," implying a partial or complete tear, respectively.
As such, he will probably elect to undergo definitive surgical PCL reconstruction using a tendon graft taken from somewhere such as his patellar tendon—the part of the knee a doctor hits with a reflex hammer—to effectively replace the ruptured ligament. The other "associated injuries" mentioned along with Betemit's PCL tear may also make surgery more preferable.
Unfortunately, Betemit is in store for a lengthy recovery regardless of how he and his doctors choose to proceed. Rehabilitation following surgery could require upwards of nine months as he progresses from basic range-of-motion training to strength training and onwards.
The body needs time to cement the tendon graft into place within the knee, and the graft's workload must be increased very, very slowly while that happens. Additionally, quadriceps strengthening will be crucial during Betemit's healing, as strong quads can take stress off either his healing PCL or surgically implanted graft, depending on what he decides.
Thanks, Dave. All in all, it's very bad news for Betemit and the Orioles. The course of treatment and surgery will be determined over the next few days, while Dan Duquette and Buck Showalter work to figure out how to fill in for a versatile player with only one roster slot.