How Marcus Lattimore Can Return from Injury to Take the NFL by Storm

Dave Siebert, M.D.@DaveMSiebertFeatured ColumnistFebruary 13, 2013

Last October, star University of South Carolina running back Marcus Lattimore went down with one of the worst knee injuries the sports world has ever seen. In the days that followed, it would have been easy to think his career over—another sobering reminder that injuries are a part of football.

Yet this one felt different. The outpouring of support began immediately. After becoming a sure lock for the early rounds of the NFL draft, Lattimore's career was supposed to end years from now following a successful, multiple-year stint in the pros.

Believe it or not, it still can.

At the time, however, it didn't seem fair. A 21 year-old budding superstar is not supposed to suffer one career-threatening knee injury, much less two—Lattimore tore his left ACL in 2011. He also shouldn't have to work through months of grueling rehab once, let alone twice.

Unfortunately, that is where Lattimore stands today, as according to a report by Geoff Hobson of the Cincinnati Bengals' official website, he suffered tears of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL) and lateral collateral ligament (LCL) in his right knee on the play.

The clip of the injury makes it clear why the damage turned out to be so significant. Be advised that the video is quite graphic:

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Slow-motion replay shows a direct blow to Lattimore's right knee, causing it to buckle under the weight of two Tennessee defenders.

The result of the play was a knee dislocation—an injury defined as the complete displacement of the tibia, or shin bone, in relation to the femur, or thigh bone, with simultaneous rupture of at least three of the four main stabilizing ligaments of the knee. Lattimore's medial collateral ligament (MCL) is the only ligament that remained intact.

For a better—but not entirely anatomically correct—mental picture of Lattimore's dislocation, imagine attaching the ends of two rectangular blocks using four pieces of tape—one on each side. Now, cut three of those four pieces. The resulting instability of the blocks is not unlike the state of the leg following a knee dislocation.

To make matters worse, knee dislocations pose a serious threat to the popliteal artery—the primary blood supply for the lower leg. If the knee's normal anatomy is altered drastically enough, the artery can be compressed or torn. Without a functioning popliteal artery, the lower leg can die within several hours unless a vascular surgeon emergently repairs the vessel once the knee is reduced.

Fortunately, popliteal artery damage did not occur in Lattimore's case, and he "only" required the surgical reconstruction of his three torn ligaments. In early November, Drs. Jeffrey Guy, Lyle Cain and James Andrews performed the operation, deemed it a success and discounted the need for any future procedures.

Though exact details are not available, speculation suggests that the surgery likely consisted of using tissue grafts from places such as Lattimore's patellar tendon—the part of the knee a doctor hits with a reflex hammer—to replace the ruptured ligaments.

Now three months out from surgery, Lattimore is well on the road to recovery. Unfortunately, his rehabilitation this time around will be significantly more complicated than what he went through following his 2011 ACL tear. A brief review of the functions of the four main knee ligaments shows why that is:

  • ACL: connects the flat ends of the femur and tibia, preventing the tibia from moving forward or twisting inward in relation to the thigh
  • PCL: connects the flat ends of the femur and tibia, preventing the tibia from moving backward in relation to the thigh
  • LCL: connects the outside of the femur to the fibula—a small bone running alongside the tibia—preventing the knee from buckling outward
  • MCL: connects the inside of the femur to the inside of the tibia, preventing the knee from buckling inward

When all intact, the ACL, PCL, MCL and LCL work in concert to allow for stability and balance while performing complex and dynamic movements such as sprinting, changing directions and cutting.

Following his 2011 injury, Lattimore had other intact ligaments within his knee to support his ACL graft as his body cemented it into place.

This time, he doesn't.

For that reason, Marcus will have to be patient—more so than ever before. The slow, steady progression from range of motion drills to strengthening exercises to full contact practice will likely require upwards of an entire year.

That said, as of Jan. 22, his progress is already staggering.

Andy Staples @Andy_Staples

Marcus Lattimore visited Senior Bowl practice today. Walking without a limp, said he's feeling good.

Andy Staples @Andy_Staples

Lattimore said Dr. Andrews called his progress "nothing short of a miracle."

For several reasons, we shouldn't be surprised. First and foremost, Lattimore's 2012 injury is not to the same knee as his prior ACL tear, an injury from which he returned both quickly and strongly.

Additionally, there is prior precedent of successful return from such an injury. Current Denver Broncos running back Willis McGahee was taken with the 23rd pick of the 2003 NFL Draft after suffering a similar injury—tears of his ACL, PCL and MCL—during the 2002 Fiesta Bowl. After sitting out the entire 2003 NFL season, McGahee became—and remains—a solid starting running back.

Finally, Dr. Andrews' track record speaks for itself. Minnesota Vikings running back Adrian Peterson nearly broke the all-time single-season rushing record a mere 12 months after surgical reconstruction of his left knee, and Washington Redskins quarterback Robert Griffin III may be ready for the 2013 NFL season after tearing the ACL in his right knee for a second time during the 2012 playoffs.

All of that said, one can make the legitimate argument that cases like Peterson and RGIII are outliers rather than the norm and therefore cannot be applied to Lattimore. That very well may be true.

But it might not be, too.

Will Carroll—Bleacher Report's Lead writer for Sports Medicine—addressed that very question:

Lattimore has already proven himself a quick healer once, and I think that, while you'd rather never have these, repeat guys like Lattimore or Griffin are more predictable. They know the process, they've shown they can do the work and they have the heart to work their way back.

That isn't the only advantage Lattimore has over past players who suffered similar injuries. Carroll continued:

The amazing advances we've seen in the rehab process make me think that Lattimore can do things faster than McGahee over a decade ago. Better? That remains to be seen, but there's more than a chance now, which is amazing to anyone who saw that injury happen.

As Lattimore progresses through his rehab, his reconstructed ligaments will become stronger and stronger. In addition to his individual healing ability, how strong his ligaments become relies heavily on the successful completion of his rehab. If all goes well, he could theoretically return to top form, and nothing yet suggests that he is not already on that path.

However, if all does not go well, it will be most evident when Lattimore attempts to cut. If for whatever reason they cannot be fully rehabbed, grafted ligaments may not be able to provide the balance and support needed to quickly change directions.

In addition to these physical obstacles, Lattimore needs to overcome mental barriers, as well. No one can suffer two severe, life-changing knee injuries and not look at the field in a different light from that point forward, and a tentative running back can be just as bad as a slow one.

How do these potential limitations affect Lattimore's draft stock this April? Bleacher Report's NFL Draft Lead Writer Matt Miller weighed in:

I had him in the second round pre-injury, of course pending how well he played this year. He's a unique talent, someone I had above Trent Richardson before his first injury. Had he stayed healthy this year, Round 2 was very likely.

But what about now? After Lattimore officially declared for the NFL draft in December, Miller discussed the running back's value following two dreadful knee injuries in an article focusing on Lattimore's updated draft stock. Like Will Carroll, Miller noted his already-documented ability to heal quickly:

If Lattimore can convince team doctors that he'll be a quick healer—and he was with his first knee injury—then it stands to reason that he could see himself drafted in the second or third round of the 2013 NFL draft by a team with the patience to let him sit out for at least part of the upcoming season.

If a team does take that risk—and if it pays off—they could be in line for quite a player, as Miller also noted in his December article:

He's a big back at 6'0" and nearly 225 pounds, but he also has good change-of-direction skills. The South Carolina offense became more dynamic (during the 2012 season), and head coach Steve Spurrier asked Lattimore . . . to do more than simply run past defenders. Instead, he's now looking for openings and learning to be patient.

Make no mistake about it—Lattimore has a long way to go. Nevertheless, while the change-of-direction skills Miller mentions will take time to return to their previous level, his patience and ability to recognize holes in the defense should bounce back much more quickly once he hits the field.

Given that upside, there is a great chance he will be drafted. And if that happens, the chance that football fans, players and coaches alike will be smiling when his name gets called is even greater.

Dave Siebert is a medical/injury Featured Columnist for Bleacher Report who will graduate from medical school in June. He plans to specialize in both Family Medicine and Primary Care (non-operative) Sports Medicine. Injury and anatomical information discussed above is based on his own knowledge, and all quotes were obtained firsthand unless otherwise specified.

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