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Explaining Breeland Speaks’ injury and potential timetable to return

The Chiefs defensive lineman has injured his right knee. Let’s talk about what we know.

NFL: AFC Divisional Playoff-Indianapolis Colts at Kansas City Chiefs Mark J. Rebilas-USA TODAY Sports

On Monday, we learned that Kansas City Chiefs defensive lineman Breeland Speaks will have surgery for an MCL sprain and meniscal injury after he injured his knee during the Chiefs’ 17-7 loss to the Pittsburgh Steelers a week ago Saturday.

Since we had previously been told the injury was a hyperextension of Speaks’ knee, I was hopeful that this was a minor injury where no ligaments had been harmed. This is clearly not the case.

What lies ahead

We don’t know exactly which structures are being repaired (or addressed), but let’s take a look at MCL repairs since it is more unknown — and this may be one of Speaks’ issues.

In most hyperextension injuries, the ACL is usually the structure that is damaged. For the MCL to have been affected, there was probably more of a rotational component (that might also have led to meniscal damage) in the action that caused Speaks’ injury. Such a rotational component was not obvious in the video of the play, but sometimes we don’t get the full story from the video.

Isolated MCL injuries that require surgery are certainly rarer than others. Typically, non-surgical interventions are sufficient. If surgery is required, that usually means other damage has also taken place. That is consistent with the description of Speaks’ injury.

Normally these repairs are performed within a week or so of the injury — as is the case here. A ligament reconstruction in that time frame not only gives the athlete the best chance of healing but also a chance to return to action quickly.

These repairs are not done arthroscopically, but rather via a small incision on the inside of the knee. With newer technology, more and more surgeons are using an Internal Brace procedure for these isolated MCLs — mostly due to the added stability of the repair. Given that this player will be heavily leaning on his knee while playing in the trenches, the more stability, the better.

In the beginning, rehab is slow going because motion must be controlled; too much motion will inhibit the repair. So many protocols err on the side of caution by not allowing the full range of motion for up to six to eight weeks. Straight-line strengthening comes first. Lateral movement (like cutting) takes a good little bit of time.

Given Speaks’ size and positional demands, I would imagine that a cautious rehab will be in order. If the meniscus needs to be trimmed (a meniscectomy) or over-repaired (sewn back together) the timeline for that portion of the injury is pretty quick; I’ve seen as little as a 10-day turnaround with meniscectomy alone. But a repaired meniscus and return to play in the same season are pretty rare; I haven’t been a part of that process so I cannot comment on it. Still, it’s more likely this injury is the type that can be repaired with meniscectomy; rehabilitation could be relatively fast.

Possible return date

Since most protocols will tell you that return to play talk BEGINS at four months if everything goes correctly, for isolated MCL repairs, we may be dealing with a lesser injury than originally expected. We just don’t know. Given the timeline that we have seen in some outlets, it’s clear this player will miss significant time. Based upon what we have been told, I would expect this player to be out of action until at least late in the season.

Aaron Borgmann is the founder of Borgmann Rehab Solutions. He spent 12 years in the NFL as an assistant athletic trainer and physical therapist before joining Arrowhead Pride.

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