DR. MYERSON:
What I thought I would do is explain the nature of the injury and begin with a slide presentation. I will talk a little about the prognosis and answer questions using some models.
(shows powerpoint slide presentation)
…This is the injury that occurred when the ankle was forced outwards, twisting the ankle, essentially opening up on the inside of the ankle, and this is an example of his ankle where you can see widening on the inside with a tear up the side of the ankle. We call that a torn deltoid ligament on the inside, and this here is called a torn syndesomosis. Higher up on the leg which you cannot see on this picture is a fracture of the fibula so that the force of the injury occurs starting on the inside, exits all the way up through this side called the syndesomosis and then fractures the fibula.
The goal of the treatment is to squeeze the fibula down to the tibia and make sure that everything has healed on the inside.
The surgery that was done was done through two small incisions,
one on the inside of the ankle to remove the deltoid ligament and
lift it out which was blocking the reduction of this bone (points
to model), the talus, to the inner side, the malleolus, and then
apply a plate and screws…Here you can see a model again and this
here is exactly what his ankle looked like at completion of the
surgery…there’s no gap any longer on the inferior aspect of the
ankle and the space now has been shut down. That essentially summarizes
his surgery.
From a technical perspective, the surgery was very successful. I’m very pleased with the course of the surgery. Of course what everybody is going to want to know is, how quickly will he recover? Under normal circumstances this type of injury takes approximately 8-10 weeks to heal the tissues and heal the ligaments sufficiently to return to athletic activity. Now I think there is a reasonable possibility he will return to play in about six or seven weeks; but that is not predictable, and a lot will depend on his recovery and rehabilitation over the next month or two. As I said, however, the surgery, from a technical standpoint, was quite successful. I’ll answer any questions.
Question:
IS THIS INJURY SIMILAR TO ANY YOU HAVE SEEN IN THE PAST OR WAS IT DIFFERENT SOMEHOW?
DR. MYERSON:
This was a similar injury in that the pattern of injury was similar. The force on the ankle was similar. Approximately 10 percent of the time we will need to make an additional incision on the inside of the ankle to flip out the deltoid ligament which is and blocking the reduction of the ankle joint. However, this was identical to those which we’ve treated previously.
Question:
PREVIOUSLY THE INJURY WAS DESCRIBED AS A DELTOID SPRAIN, BUT YOU ARE SAYING THAT TWO LIGAMENTS WERE ACTUALLY TORN, CORRECT?
DR. MYERSON:
Yes, as part of this ligament injury, the inner ligament…I’ll use a model to explain this…if you look at a model, the force of the injury does that…on the inside here where my finger is, is the deltoid ligament and as the injury occurs, this separates, that is called a syndesomosis injury, so indeed there are two ligaments. This ligament, the syndesmosis, is a very large sheet of a ligament which is completely torn, and extends all the way up the side of the leg to the point at which the fracture of the fibula occurs.
Question:
HOW LONG DID THE SURGERY TAKE AND HOW BIG WERE THE SCREWS AND PLATE?
DR. MYERSON:
The surgery took one hour. The size of the plate is about one and a half to two centimeters in length. There were two screws inserted, each 60 millimeters in length.
Question:
WHEN HE DOES COME BACK, WHENEVER THAT IS, WILL HE BE AS GOOD AS NEW, WILL THE RECOVERY BE COMPLETE?
DR. MYERSON:
One hopes that is the case. There is no reason to expect that this will lead to any chronic ankle problems. Once this is stabilized and the ligaments heal, the ankle is functioning on a normal basis.
Question:
HOW MUCH OF A ROLE WILL HIS CONDITIONING PLAY IN HIS RECOVERY TIME?
DR. MYERSON:
It makes a huge difference. He is an extremely well conditioned athlete as you all know and the access to the rehabilitation and health care is a vital role in his recovery process.
Question:
WHAT ADVICE HAVE YOU GIVEN HIM REGARDING HIS RECOVERY, IN TERMS OF TAKE IT EASY, TAKE IT SLOW, DON’T RUSH IT?
DR. MYERSON:
The recovery will be as follows. For the next two weeks he will be using crutches and using a boot for mobilization and mobility. We’ll get him into a swimming pool with a protective vacuum on the leg to allow him to do exercise in a non-weight environment starting soon. Movement of the ankle will begin at approximately two weeks, and by three to four weeks, we’ll get him on a bike and start doing some other lower extremity rehabilitation.
The rest of his muscular skeletal system will be under rehabilitation very promptly. We expect that by four weeks he’ll be at a weight bearing status starting with exercises tolerated depending on his symptoms thereafter.
Question:
HAVE YOU HAD MANY OTHER PATIENTS COME BACK IN SIX OR SEVEN WEEKS?
DR. MYERSON:
Generally not. Generally, it takes 8 to 10 weeks for athletes and non-athletes alike. While it is not unreasonable to hope that he returns to play in six weeks, it is not something we would expect.
Question:
IS THERE A DANGER IF HE COMES BACK IN SIX WEEKS TO INCUR A MORE SERIOUS INJURY IF HE IS NOT COMPLETELY HEALED?
DR. MYERSON:
What happens is, because it takes 8, 10 to 12 weeks for the ligaments to heal normally, if the ankle is not hurting and he is able to commence running and in particular with cutting activities, there is a risk of the screws and plate breaking during that activity. It is something that we acknowledge, that we recognize that ahead of time, but if he is not hurting, we accept that and allow him to proceed with activities and a return to sporting activity.
Question:
TERRELL OWENS OWNS A HYPERBARIC CHAMBER. HOW WILL PURE OXYGEN HELP IN HIS RECOVERY?
DR. MYERSON:
I have no idea.
Question:
WHAT EXPERIENCES HAVE YOUR PATIENTS SHOWN TO BE MAYBE THE MOST DIFFICULT OF REHABILITATIONS WITH AN INJURY SUCH AS THIS?
DR. MYERSON:
Exercising in one a single plane is not a problem. If you imagine an ankle moving in a single plane like that (shows model), there’s not going to be a problem with his ankle, even in the short term. When he returns to athletic activity, any motion which creates a twisting effect…any twisting activity puts a stress on the ligaments and that is what becomes bothersome, and the patient is aware that they cannot return to that cutting motion too soon.
Question:
IF HE IS READY TO PLAY IN THE SUPER BOWL, HOW CLOSE TO FULL SPEED COULD HE POSSIBLY BE?
DR. MYERSON:
It’s too unpredictable, I cannot answer that now. It is a reasonable expectation for him to return to some athletic activity between four and six weeks, but whether or not that that’s going to imply full activities that he needs to be able to do, I do not know.
Question:
AFTER FOUR TO SIX WEEKS, WILL THE SCREWS AND THE PLATE STILL BE IN?
DR. MYERSON:
That is correct. Under normal circumstances, we will leave the screws in place in for about three sometimes four months and then remove them. At that stage, the ligaments have healed sufficiently so that we can remove any of the hardware. If he is going to return to athletic activity prior to that time, we cannot remove the hardware because it provides a supportive role. Under those circumstances, we recognize that the screws are subject to abnormal stress and can fail by virtue of breakage, and if that’s the case, we then simply remove it at a subsequent date.
Question:
HAVE YOU EVER SEEN A PATIENT RETURN IN SIX TO SEVEN WEEKS WITH THIS TYPE OF INJURY AND RETURN TO A HIGH LEVEL OF ATHLETIC PERFORMANCE?
DR. MYERSON:
Yes.
Question:
WILL HE HAVE TO MAKE PERIODIC VISITS TO BALTIMORE FOR REHAB?
DR. MYERSON:
Yes, that is correct. I will see him in approximately two weeks and then regularly after that.
Question:
WERE THERE ANY SURPRISES IN THE SURGERY?
DR. MYERSON:
No, not at all. The surgery was fairly straightforward…it was a smooth operation. The only unexpected event was that I had to make a second incision to remove the blockage of the deltoid ligament that occurs in about 10 percent of these cases anyway, so it was not something that was unanticipated.
Question:
DID HE HAVE ANYTHING TO SAY BEFORE HE UNDERWENT THE SURGERY?
DR. MYERSON:
“Let’s go do it.”
Question:
HOW LONG WILL HE BE HELD OVER HERE FOR OBSERVATION?
DR. MYERSON:
He is already on the way home.
Question:
HOW WERE HIS SPIRITS?
DR. MYERSON:
Excellent, excellent. He has an amazing attitude. He seems to be a very compliant…a compliant individual, and very willing to go through and accepting of the injury. Certainly to me, in our doctor-patient relationship, he came over in a personal way that is very different from his appearance and demeanor on the field.
Question:
WHAT TIME DID THE PROCEDURE START?
DR. MYERSON:
Approximately 9 a.m.
Question:
AND IT LASTED ONE HOUR?
DR. MYERSON:
That is correct.
Question:
WAS HE EVER UNDER ANESTHESIA?
DR. MYERSON:
He was under anesthesia, that is correct.
Question:
DID HE MENTION TO YOU IF HE’D LIKE TO COME BACK FOR THE SUPER BOWL?
DR. MYERSON:
Oh, of course he wants to get back. I think that goes without saying for he, his fans and the whole team.
Question:
CAN YOU TALK ABOUT YOUR MINDSET AS A SURGEON GOING IN AS FAR AS YOUR MOTIVATION TO GET HIM BACK IN TIME FOR THE SUPER BOWL?
DR. MYERSON:
I think that is a very good question. I would like to think that we treat every individual, every patient exactly the same way and indeed, by and large, that is correct. You have to imagine it becomes a little bit difficult under these circumstances where there’s a lot of pressure on the surgeon, and from a technical standpoint, while this is not a very complicated surgery, the goal of the surgery, if we were not in any way compromised by time, the surgery would have been done technically in a very similar way, but given the fact that we were pushed by time in an effort to return him as quickly as possible, that does change to some extent the operative approach to this particular problem so that everything had to be done to gain maximum stability in the ankle in as quick a time as possible.
Question:
HOW WOULD YOU HAVE APPROACHED THIS DIFFERENTLY IF GETTING HIM BACK HOPEFULLY IN TIME FOR A SUPER BOWL APPEARANCE WERE NOT A PRIORITY?
DR. MYERSON:
In some individuals the insertion of one screw alone is sometimes sufficient, instead of using two screws and plate. And that is probably the only major difference that one would approach in an athlete of this nature…to gain more stability to the ankle.
Question:
DOES THE REHAB THEN ALSO CHANGE…IS THE REHAB ALSO ACCELERATED?
DR. MYERSON:
The rehabilitation can be accelerated because of this, yes.
(DR. MYERSON THEN REVIEWED THE POWER POINT SLIDES A SECOND TIME FOR THE MEDIA ON HAND.)
Any further questions?
Question:
DID YOU SAY THE DELTOID LIGAMENT WAS REMOVED?
DR. MYERSON:
No, not removed, the deltoid ligament will heal on its own. The deltoid ligament is a very strong ligament on the inside of the ankle. During the injury, it can pop inside the ankle and if it pops inside it will then block the movement of the bone called the talus…The ligament is not removed, it’s simply flipped out of the way of the ankle joint.
Question:
WAS THIS ONE OF THE MORE SEVERE CASES OF THIS TYPE OF INJURY OR WAS IT MORE CLOSE TO AVERAGE?
DR. MYERSON:
This was a severe injury. I think that in relation to most of these which I’ve treated, it’s what I would have expected.
Question:
IS THE FRACTURE THAT’S HIGHER UP OF ANY CONCERN?
DR. MYERSON:
Absolutely not. That fracture will heal uneventfully without any problems. That fracture has no bearing on the rate of healing whatsoever. In fact we don’t even treat the fracture, we ignore it; that heals; we have to treat it around the fracture and treat the ligaments.
Question:
IS THERE ANY CONCERN ABOUT ANKLE ARTHRITIS IF HE COMES BACK TOO QUICKLY?
DR. MYERSON:
No. He won’t come back unless we think that there’s been sufficient healing. Ankle arthritis can occur in the event of further instability in the syndesomosis and recurrent chronic instability, and that can occur, but it’s not expected here at all.
Question:
IS THE SAME RECOVERY RATE EXPECTED FOR THE FRACTURE?
DR. MYERSON:
The fracture actually does not impact in anyway on his recovery process...If that’s all he had was a direct blow to the side of the fibula and a fracture and he would be able to play on that in four weeks without a problem. It’s the ligament injury that takes far longer to heal than the fracture.
PRESS CONFERENCE ENDS
