Last year, a flurry of preseason ACL tears sent quite a few players—such as free-agent wide receiver Danario Alexander—to the sidelines for most or all of 2013. The seemingly high number of injuries over a short time period even sparked some debate as to whether or not it was approaching "epidemic" levels—though that is another conversation altogether.
Several months later, the light at the end of the recovery tunnel is probably in sight for many.
Yet not for Alexander.
The young wideout underwent surgery to reconstruct his ligament in August. At the time—assuming an average recovery time of nine to 12 months—a return for the start of the 2014 season remained very possible.
In other words, his rehabilitation all but reset.
A number of different factors play into the need for a revision surgery. Re-injury, poor healing of the graft and persistent knee instability despite the repair are three common scenarios, but regardless of the reasons behind a revision surgery, the procedure essentially constitutes a redo.
For Alexander, it likely seemed like the calendar flipped from January all the way back to August. That said, with persistence and a bit of luck, playing in 2014 was still not entirely out of the question.
Then came the infection.
According to Fox Sports' Alex Marvez, a post-operative infection set in following the second reconstruction, necessitating further surgical intervention as well as intensive antibiotics:
Having undergone his initial ACL surgery last August following a preseason injury, Alexander suffered complications that required him to undergo a second reconstruction. Infection followed that forced Alexander to receive intensive antibiotic treatment as well as the subsequent surgeries, the source said.
Based on the information that is available, the nature of the infection is not entirely clear. As always, precise medical details are not available to the public.
That said, given the need for multiple subsequent surgeries, it seems likely Alexander's infection extended into the knee joint itself—the fluid-filled space between the femur and tibia. To treat such an infection, a surgeon often utilizes further arthroscopic surgery—frequently multiple times—to both quite literally wash out the joint as well as ensure the resolution of the infection.
After all, unless quickly recognized and treated, joint infections can cause serious damage in the short term and, as a result, the potential for severe long-term complications.
Nevertheless, post-operative infections are an unfortunate reality in all surgical fields at all levels—including the NFL. Even with the best surgeons practicing the best medicine and sterile technique—as is surely the case with Alexander—the risk can sometimes approach zero, but never reach it.
For example, in 2008, New England Patriots quarterback Tom Brady also suffered from a similar infection after his own ACL surgery. Elsewhere, last year, Patriots tight end Rob Gronkowski contracted a post-operative infection in his forearm.
With prompt identification and management, surgical infections usually fully resolve—but not always. Furthermore, persistent infection can lead to bone and tissue destruction—up to and including, in the case of an ACL reconstruction, failure of the graft.
For Alexander, a graft failure could mean the need for a third ACL surgery. Fortunately, no news of such a nightmare has yet surfaced, and the chance of it coming to that point probably continues to decrease as time presses on.
Where does that leave the former Charger heading into next season?
At this point, Alexander would be at about the four-month mark of his rehab under the best of circumstances—likely with at least another four or five months to go. The addition of the infection—essentially a recovery pause button—may end up extending his already-lengthy ACL rehab process by several more weeks to a few months.
In short, Alexander stepping foot on an NFL field in 2014 seems all but impossible. Yet if all goes well—nowhere near a given, it seems—2015 is not out of the question.
That said, given his injury history—now approaching double-digit knee procedures in total when taking into account the five prior left knee surgeries Marvez mentions—one can only wonder if a team will be willing to take a chance on anything other than a short-term contract.
Dr. Dave Siebert is a resident physician at the University of Washington who plans to pursue fellowship training in Primary Care (non-operative) Sports Medicine.