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Playing the ‘What If?’ Game

We turn to Dr. James Andrews to see if injury-plagued careers from the past could have been saved by modern medicine.

What if?” is a question constantly asked in sports. It could be about missed shots, goal-line stands, trades … even injuries. That’s our question today. Not what if someone hadn’t gotten hurt, but what if certain athletes had access to the technology and advancements of today? Would it have helped?

Just look at what has happened today. We see players like Wes Welker and Adrian Peterson return to form only months after undergoing reconstructive knee surgeries. Even Kobe Bryant, the 34-year-old Kobe Bryant, is possibly going to return to the Lakers this preseason after tearing his Achilles in April. As recently as a decade ago, all these injuries would have been career death sentences or, best-case scenario, catalysts to early demises.

If you’re going to talk about what’s changed, there’s really only one person to speak with, Dr. James Andrews of the Andrews Sports Medicine and Orthopaedic Center in Birmingham, Alabama — otherwise known as the guy who fixes just about everyone who matters. If an athlete’s body is really screwed up, fans know just how bad it really is when they read this headline on “Source: [Insert favorite player here] to visit Dr. Andrews.” We had a chance to talk with Dr. Andrews to ask the “What if?” question about various injured athletes throughout history.

Mickey Mantle

The Injury: In Game 2 of the 1951 World Series, Mantle was called off of a popup in right center field by Joe DiMaggio. Mantle’s leg got caught on a drain grate while attempting to slow down. He blew out his knee, but no one ever really knew how badly. For her 2010 book The Last Boy: Mickey Mantle and the End of America’s Childhood, Jane Leavy had the original X-rays reexamined, revealing that on that day Mantle had torn his meniscus, his anterior cruciate ligament, and his medial collateral ligament.

The Aftermath: Mantle would go on to hit 536 home runs in his career, but would be plagued by knee problems (among other injuries) and would never again have his trademark speed.

Dr. Andrews: “There’s no question that there has been a lot of advancement to fix that type of injury. It’s not a guarantee he would be fine, but with modern surgical and modern diagnostic techniques it would have been different. The big revelation was the use of the arthroscope. With the arthroscope you don’t need to open the knee. You open the knee and right away that’s three months until you’re back. The arthroscope led us to modern rapid rehab. Mantle had a significant, complex injury. Still, with a complex injury like that, a high-level athlete can get his career back — not guaranteed, of course — but you could get his speed and career back.”

Gale Sayers

The Injury: On Sunday, November 10, 1968, Sayers tore the ACL, MCL, and meniscus in his right knee in a game against the San Francisco 49ers. Sayers missed the rest of the season (five games) but would miraculously come back in 1969 and lead the league in attempts (236), yards (1,032), and rushing yards per game (73.7). A second major knee injury, this time to his left knee, in 1970 led to his retirement in 1971.

The Aftermath: For almost 40 years, Sayers would walk (and even run) on those knees until he had the right one replaced in 2009. A 2010 Sports Illustrated piece on Sayers chronicles what orthopedic surgeon Dr. Mark Klaassen discovered during the operation:

Inside the knee Klaassen found carnage. Sayers’s anterior cruciate ligament was gone; the posterior cruciate ligament was stretched and frayed. There was evidence that the medial collateral ligament had been sewn or stapled at some point in an effort to create stability (a practice common at one time but later found to be ineffective). A half-inch wedge of his tibia had been sawed off in an osteotomy, a surgical procedure designed to redistribute weight away from an arthritic surface. Almost no cartilage remained, and as a result, the joint was filled with dust and fragments from bones rubbing together for many years.

Dr. Andrews: “This is the same thing for Sayers as Mantle, but that’s all we knew back then. A more modern example is Eric Dickerson. His situation was worse because modern techniques were just being developed in the late ’70s and mid-’80s. He didn’t get to benefit from the advancement of the arthroscopic procedures. If he had? He would have been the absolute all-time great. All that bone-on-bone contact wouldn’t have happened so much. I did one cleanup on Dickerson’s knee. One of the last ones. He played for a while, sure, but he was never the same again.”

Johnny Unitas

The Injury: In the final game of the 1968 preseason against the Dallas Cowboys, Unitas was hit while throwing sidearm to avoid a blitz. He got the throw off, but the hit tore the flexor and pronator muscles from their track in his elbow and forearm.

The Aftermath: Unitas played in only five games that season, attempting just 32 passes for a team that would notoriously lose to the Jets in Super Bowl III. Repeated damage to his elbow, including nerve damage from the injury and countless other hits, eventually left him without the use of his right hand until his death at age 69.

Dr. Andrews: “He also had to have injured the conjoined tendon. That protects your Tommy John ligament. That is hard to diagnose, but we would have found that today with MRIs and treated it. By the way, that’s what Terry Bradshaw had before anyone knew what it was. That altered his mechanics. Bradshaw threw the javelin in high school in Louisiana, had the national record, but later on he suffered from a chronic Tommy John injury because no one in football knew what it was.”

Bill Walton

The Injury: For Walton it wasn’t just one moment, but many — as in many stress fractures. The repeated breaking of his navicular bone (located on the inner side of the foot near the ankle) caused him to miss almost four seasons’ worth of games. His first break came in 1978 with the Trail Blazers, but he would return that season for the playoffs, only to rebreak the bone against the SuperSonics in the Western Conference semifinals. After sitting out the 1979 season rehabbing that stress fracture, Walton was a free agent and signed with the San Diego Clippers. In his fourth preseason game, he broke the bone yet again and played 14 games that season. Walton then missed the 1981 and 1982 seasons while undergoing surgeries to restructure his ailing left foot.

The Aftermath: After a rare injury-free year with the Boston Celtics in 1986 (when Walton captured his second NBA title), he would only suit up for 10 regular-season games and 12 playoff games in 1987 before retiring due to a return of his chronic injuries.

Dr. Andrews: “Some people just have brittle bones. Like Sam Bowie — he had stress fractures in his legs that were nagging. Genetics have a lot to do with this. You have these superathletes and you have a buffer in recovery. It’s easier to get them back than a run-of-the-mill person. Like Adrian Peterson. If you operate on someone like that, the right athlete, they make the surgeon look pretty good. Some people, even today’s rehab can’t help get them back.”

Bernard King

The Injury: In a game between the New York Knicks and the Kansas City Kings on March 23, 1985, King went up to defend a driving Reggie Theus. When King landed, he tore his ACL; it would take him almost two years to return to the Knicks.

The Aftermath: King played in parts of six more seasons, including being named to the NBA All-Star team in 1991 with the Washington Bullets, but never returned to his dominant form.

Dr. Andrews: “King’s main issue was he had a new procedure and no one knew how it would work. He struggled to come back, but he was never the same. Even today, an ACL repair is not a surefire procedure. With all these injuries, you can’t go back and criticize the procedures because that was the best knowledge we had. We have made tremendous progress, but [with] some injuries, on the other hand, we have stagnated — like anything involving injuries of the throwing shoulder. We’re still trying to figure that out. But we need to point out that the major advances have been in rehabilitation. That is now more important than the procedure. When someone gets their speed or their velocity back, that makes the surgeon look pretty smart, when it fact what got them back was the rehab. That’s what King was missing.”

Penny Hardaway

The Injury: Like Walton, Hardaway didn’t have a defining moment in which he dramatically blew out a knee or broke a limb. Hardaway’s issue was a chronic ache in his knees that eventually derailed his promising career. The issues started in 1997, his fourth year in the league. He described the injury and the negative publicity it garnered in an interview with Slam magazine in 2012:

To me, there was a lot of confusion. Back then you played hurt, so they were like, “Oh, it’s just in your mind.” It was hard to believe. They kept asking me, “Did you hear anything? Did you hear your knee pop?” I would tell them, No, but it really does hurt. All of a sudden there was pain and I was very frustrated. I went from being very athletic, one of the best guards in the NBA, to barely making it. No speed, no agility. I had to change how I played because I couldn’t exercise or train because my knee constantly hurt.

The Aftermath: Hardaway underwent four major surgeries in his career, including the then very new microfracture procedure in 2000. These surgeries and the lasting effects on his knees ended his career in 2008.

Dr. Andrews: “It was very difficult to explain what was wrong with Penny Hardaway. He was a great guy, a competitive guy, but he had an articular cartilage injury, an injury to the smooth lining of the joint that allows the gliding of the joint. Back then we didn’t really have MRIs to make the diagnosis. Today? Now you would see that on an MRI. It’s still a nemesis and the hardest thing in treatment because the body doesn’t have a way to regenerate it. Mother Nature can’t just fix that. That’s the next step, the biologics, where we determine how to jump-start the healing process and let the body, not the procedure, do the work. Also, for all these injuries, we need to emphasize that even in the ’50s sports medicine has always been on the cutting edge. What was being done for these elite athletes would trickle down to the average person. They all tie back to that. You can’t ignore what was done or that it was ahead of its time.”