Jordan Love’s Knee Injury: An Initial Breakdown:-
At the very end of the Eagles Packers game Jordan Love’s left knee appeared to pop after he took this hit at the very end of the game. let’s take a closer look here at Jordan Love’s knee injury now this is important to think about the knee but also I want to warn you that we could be seeing reports of an ankle injury after the kind of all settles and there’s been some time for things to develop because this mechanism is something that we will commonly see cause both an ankle injury and knee injury but the big thing that everybody is of course.
The Pop and Ligament Concerns:-
Seeing here and I want to focus on in part of this is this pop right because we all see or hear anything that pops on TV we think about things like ACLS we think about ligaments and here you can certainly see something that shifts some sort of Pop right here in this position there to there something pops now whether that’s a ligament Etc we’ll talk through that but I want you to look further down at Love’s ankle because this position of his ankle where the foot is externally rotated as the Philadelphia player is kind of falling and landing on him is also going to cause a potential high ankle injury so here’s the position of concern number .
External Foot Rotation and Potential High Ankle Sprain:-
One if we focus on the position of the foot we’re going to see that Love’s foot is externally rotated so that means that the foot is pointed out this direction relative to the position of his knee and his thigh pointing forward so as we continue to roll this clip forward here what we’ll see is that foot gets trapped the knees forward.
MCL vs ACL: Breaking Down the Injury:-
So the ankle is up and dors of flexion so then as the player falls into him you see that forced external rotation dors of flexion along with that knee pop this position right here is going to stress that high ankle sprain ligament down in the ankle as well as stress some of the ligaments around the knee specifically the MCL but also when we see a shift like this what do we worry about with the ACL .
I will say right off the bat before we get to our anatomy tool the pop that we see the shift that we see does not look like the typical ACL shift that everybody’s concerned of certainly as the player comes in here we do see a bit of a straight knee we see this load come in from the outside in and so that’s going to impart a vus load meaning it’s going to want to push the knee Inward and so this can certainly stress the ACL as well but it doesn’t look like the typical shift pop that we see with an ACL injury and combined with just this extreme angle if we kind of adjust our picture here a little bit that we see down on the foot this is very classic for that MCL high ankle sprain position.
The Anatomy: Ligaments at Risk:-
So now if we look at our biodigital anatomy tool here and we focus on first the knee there’s going to be of course four main ligaments of the knee on the inside we’re going to have the MCL stands for medial on the inside collateral ligament running from north to south stabilizing that joint from those valgus forces so if you think back to the position.
Impact on the MCL Due to the Knee Hit:-
When Love gets his knee hit that Philadelphia player is kind of laning on the outside pushing that knee inward that can certainly put tension on this MCL and cause a tear of that MCL ligament in the front of the knee we have the patellar tendon the patellar tendon connects the patella the kneecap down to the shin higher up above that is going to be the quadriceps tendon on the outside the LCL lateral collateral ligament basically the opposite of the MCL that’s mainly going to get stressed or injured if you have an opposite varis stress say if somebody lands on the inside of the knee and pushes outward but in this case we had a stress coming in potentially stressing putting.
LCL and ACL: Opposite Ligament Stress:-
Some tension on that MCL and causing an MCL injury now the ACL sits deep inside the knee so if we hide all these different structures and Peak down on the inside of the joint that’s where we’re going to see the ACL prevents that tibia from going forward relative to the femur there’s usually some degree of shift and pivot that we see in the ACL tearing where we’ll actually see that tibia shift forward when it’s torn and then pop back abruptly into place so in this position right we’ve got that vus load from the player coming in we also have a player up top pushing him the other way so two forces torquing across that knee and again when the ACL tears we typically see the tibia the shin pop forward and then backwards and so if anything the skin Contours the outlines are going to get narrower and then go out and in this case we actually see it almost looks like everything goes sideways and then comes back rather than front to back it also happens sooner than I would think for the ACL to have shifted if it was the ACL .
Multiple Forces on the Knee:-
I would have expected us to see that shift maybe more down at this time rather than right away higher up and so again the fact that we see everything in that position and then here go outward to me is more suggestive of a shift from something like an MCL as opposed to that dreaded ACL but the fact that we see a shift the fact that we’re seeing a pop implies that there is a moment of instability in the knee that something has likely completely torn even if it’s just the MCL.
I would suspect a complete grade three MCL injury there’s some other ligaments that are smaller that we don’t necessarily talk about as much that stabilize some of that rotation of the knee as well that could be injured but I think of our four major ligaments I would put MCL number one ACL number two not saying the ACL is impossible just saying this looks a little bit more like an MCL position than a true ACL we also don’t see that shift back up necessarily whenever the weight is kind of released off .
So that’s also one thing that makes me less concerned about the ACL compared to the MCL and the other thing I mentioned was a high ankle sprain type of injury so here if we’re looking at that left foot from straight on here’s the tibia that’s the shin the fibulas is the bone on the outside and then the high ankle ligament sits here between the tibia and the fibula when you get into these positions .
High Ankle Sprain Possibility:-
Where the foot is dorsal Flex meaning pulled upwards that locks this tibio tailor joint in place and then when you externally rotate the foot or push it out that has a tendency to want to spread apart the tibia and the fibula which can then stress this aitfl high ankle sprain ligament potentially causing a tear and that’s exactly the position that we see Love’s ankle and foot in that’s going to also stress the deltoid ligament here on the inside and so it’s very common that we can see both a high ankle sprain and an MCL tear ha together because of how that mechanism with the foot being out the knee.
MCL More Likely Than ACL:-
Coming in can affect both of those structures so overall again my suspicion is higher for an MCL tear than an ACL but the fact that we saw that shift we saw it looked like something popped to me suggests that this is a high-grade injury if we’re talking about a complete MCL tear likely doesn’t need a surgery but still can be 4 to8 weeks potentially.
So this could still be a major injury affecting this early part of the season if the dust settles and there’s a lot of ankle pain high ankle sprains if it’s a complete full tear of that ligament could require surgery with something like a tight RPP hopefully though nothing surgical for the ankle .
MRI and Recovery Expectations:-
I don’t think this is like Patell tendon quad tendon rupture because he would not have been able to walk off the field if this was a full rupture of his quad or patella tendon you can walk off the field with an ACL tear or with an MCL tear but you’re not going to walk off the field with the quad a Patell Tenon injury another just thing lower in the differential think about patella dislocation but it didn’t appear to be any sort of reduction of the kneecap on the field so I’d have that lower hopefully we get good news obviously expect an MRI don’t know if that’s going to happen in Brazil or when the team flies back to the States if if it’s an MCL the knee probably won’t swell up that much compared to an ACL the knee is going to be big and swollen within a few hours .