After battling a left patellar tendon injury last year, Atlanta Falcons left tackle Sam Baker suffered a right-side tear on Saturday during a preseason game against the Houston Texans. According to NFL.com's Gregg Rosenthal—citing a report by his colleague Ian Rapoport—the lineman will miss the 2014 season as a consequence of the injury.
Rosenthal adds that Baker appeared "emotional as he was helped up to his feet," and the entire NFL community certainly sends him its best wishes.
Later, ESPN's Adam Schefter confirmed that the injury constituted a tendon rupture. A rupture makes effective walking—not to mention playing in the NFL—next to impossible, and surgery will likely follow.
In fact, due to the underlying anatomy, that surgery will probably come fairly soon.
Ordinarily, the quadriceps muscle group—four muscles that form the bulk of the front of the thigh—connects to the patella, or kneecap, via the quadriceps tendon. The patella, which sits within the quadriceps tendon complex, then attaches to the top of the tibia, or shin bone, via the patellar tendon.
Along with the quadriceps tendon, the patellar tendon—technically a ligament, as it connects two bones rather than muscle to bone—transmits the force of the contracting quadriceps muscles to the front of the thigh, thereby straightening the leg.
For an offensive lineman in the NFL, an intact and strong extensor mechanism—the quadriceps muscles and both the quadriceps and patellar tendons—is critical in order to drive forward into the opposing defensive line.
That said, when the patellar tendon completely tears—sometimes a result of, for example, sharply contracting the quadriceps to push off the ground and leap into the air—the quadriceps lose their major connection pathway to the lower leg. As a result, it becomes extremely difficult or impossible to straighten the leg.
A quadriceps tendon rupture can produce similar symptoms.
After rupturing, the patellar tendon may retract downward and away from the patella. If it sits there long enough, it may begin to scar and tighten into a new, shortened position.
That's where early surgery comes in.
By intervening in the operating room before the patellar tendon tightens up, an orthopedic surgeon can help minimize the amount of strength and range of motion an athlete may lose as a result of the rupture. Surgical techniques and approaches vary depending on the precise nature of an injury.
Following surgery, Baker and his physical therapy team will likely start moving the knee early. Studies—such as a 2004 manuscript (subscription required) by Bhargava and colleagues in the scientific journal Injury—suggest post-operative immobilization is not necessary. Early motion also generally leads to better outcomes.
Over the coming weeks and months, the tackle will slowly increase the load he places on his knee, beginning with walking and progressing to more strenuous activities such as strength training. When he regains almost all of his strength—or all of it, if his rehab goes exceptionally well—he will likely receive clearance to return to the field.
Unfortunately, the entire rehab process can require upwards of four to six months. Stressing a healing, repaired tendon too early risks re-injury.
Usually, patellar tendon repairs carry a good prognosis as long as the diagnosis and surgical treatment occur early. That said, a significant reduction in strength and range of motion remains a small possibility even with the best surgeons practicing the best medicine.
Barring such a complication, however, Baker can return to form. After all, this year's injury involves the opposite knee as his 2013 version. Furthermore, he recently completed the necessary rehab, proving his determination and recovery ability.
In other words, the veteran lineman already knows how much he needs to pull out of the tank, and for now, nothing yet suggests he can't do so a second time around.
Dr. Dave Siebert is a second-year resident physician at the University of Washington and a member of the Professional Football Writers of America. He plans to pursue fellowship training in Primary Care (non-operative) Sports Medicine.
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