The eight-month countdown to the start of the 2013 Washington Redskins' regular season began in earnest Wednesday when quarterback Robert Griffin III emerged from surgery. Renowned orthopedist James Andrews reconstructed the anterior cruciate ligament and repaired the lateral collateral ligament in Griffin's right knee. Now Griffin is rehabilitating against the clock.
"Robert Griffin III had successful knee surgery early this morning," Andrews said in a statement released by the team Wednesday afternoon. "He had a direct repair of his LCL and a re-do of his previous ACL reconstruction. We expect a full recovery and it is everybody's hope and belief that due to Robert's high motivation, he will be ready for the 2013 season."
Griffin now faces an intense rehabilitation that commonly requires six to nine months, according to three orthopedic surgeons not involved in Griffin's procedure.
Griffin is determined not to miss any regular-season games, but he almost certainly will miss the team's offseason program. While second-string quarterback Kirk Cousins works with the Redskins' first-team offense all spring, Griffin must rehab at a pace conducive for the long-term health of a knee in which the ACL has now been reconstructed twice.
"The peril is if you come back before you've gotten back to your level of endurance and strength that you need to play your sport at a level that you can protect yourself," said Rick Wright, professor in the department of orthopedic surgery at Washington University's School of Medicine and the head team physician for the NHL's St. Louis Blues.
"His game is predicated on speed and elusiveness and all that," Wright said. "If you were a classic dropback passer and just stood in the pocket and threw the ball, you could probably do it, maybe even without an ACL. But that's not the strength of his game. It's everything he brings to the package."
Coach Mike Shanahan drafted Cousins in the fourth round last April to provide stability at the quarterback position. That was tested during the 2012 season, as Cousins replaced an injured Griffin three times.
Cousins' finest moment was a 38-21 road victory over Cleveland on Dec. 16 in which he threw for 329 yards and two touchdowns to extend a winning streak that eventually earned the Redskins the NFC East division championship.
Cousins declined an interview request Wednesday at the direction of a team spokesman.
Andrews expects Griffin to be ready, though. Griffin tore the ACL in his right knee in September 2009 and started the following season for Baylor on time. He has three and a half fewer months to replicate that comeback in 2013.
"Nothing is ever written in concrete," said Marc Siegel, the orthopedic surgeon for Virginia Tech's athletic teams. "It's a matter of when the kid is ready to play when he's ready as far as his rehab goes."
Griffin, some family members and some team officials traveled to Gulf Breeze, Fla., on Tuesday to visit Andrews at his institute there. Tests on Tuesday prompted Wednesday's surgery.
"Thank you for your prayers and support," Griffin tweeted at 7:21 a.m. Wednesday. "I love God, my family, my team, the fans, & I love this game. See you guys next season."
Dr. Mark Adickes, coincidentally a former Redskins player, reconstructed Griffin's ACL in 2009 using a patellar tendon graft from Griffin's right knee. Another patellar tendon graft from the right knee would have been unavailable for Wednesday's surgery, three orthopedic surgeons said. When a reconstructed ACL is torn and must be reconstructed again, orthopedists call it a revision.
Andrews on Wednesday revised Griffin's first ACL reconstruction by using a patellar tendon graft from his left (healthy) knee, according to a source who requested anonymity because they were not authorized to speak publicly about Griffin's condition.
Wright, the Washington University professor, is the principal investigator of a leading ACL revision study that's funded by the National Institutes of Health.
"When I'm doing a revision in a young, active person like RG3, if they've had their previous patellar tendon, my choice is to go to their opposite knee, and take that graft and it has worked very well," Wright said.
The study is incomplete, but Wright said 5 to 8 percent of all primary ACL reconstructions fail. The failure rate for revisions is 13 to 15 percent.
"When you look at big groups, they just don't do as well as they did after their first one," Wright said. "We don't know why that is. It doesn't mean that any individual patient won't have a great outcome, but in general if you look at 100 re-dos, they don't do as well as 100 first-timers."
Even if Griffin returns to the level of performance that earned him a Pro Bowl nomination as a rookie, his knee is likely to suffer lasting physiological effects.
"Whenever you have this done, you never have a normal knee," said Siegel, Virginia Tech's orthopedic surgeon. "You never have a knee that's 100 percent. You may have an athlete that gets back Adrian Peterson-style and is able to compete and looks good, but I think it would be unusual for him to feel great, like he has a normal knee."
There are precedents for Griffin to return and play well. Pittsburgh Steelers nose tackle Casey Hampton, New York Giants receiver Domenik Hixon and Carolina Panthers linebacker Thomas Davis each returned to the NFL after ACL revision surgery.
Wright is eager to add Griffin's name to that list.
"I'm just like everyone else around the country watching this play out and hoping he defies the big-number statistics and is the person that does just well after this one as he did after his primary [reconstruction], which, obviously, he did fantastic," he said.
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