Football fans who witnessed the gruesome injury to the right knee of Gamecocks running back Marcus Lattimore immediately suspected that the injury was serious. As I suggested yesterday, the fact that Lattimore required urgent transportation to a nearby hospital added to those fears. This afternoon, University of South Carolina team physician Dr. Jeff Guy confirmed those fears.

As reported by Darryl Slater of The Post and Courier yesterday, Lattimore’s right knee buckled after Tennessee defensive back Eric Gordon hit him directly on the front of the knee. Athletic trainers immediately rushed to the field to evaluate his knee. Moments later, while the players of both teams surrounded him on the field, Lattimore was taken by ambulance to the hospital.

Lattimore missed the second half of the 2011 season after requiring surgery and extensive rehab for his ACL injury of his left knee. This injury looks to be much more serious.

Slater announced the official statement from the school and the team doctor via Twitter. “Official word from USC: Lattimore injured ‘several ligaments’ during hyperextension of knee. No fractures. Will have surgery.”

ACL tear
This arthroscopic photo shows a complete tear of the ACL. Knee dislocations usually involve tearing of the ACL, PCL, and ligaments on the sides of the knee.
Knee dislocations are by definition injuries where three or four of the major stabilizing ligaments of the knee are torn. They usually result from high-velocity trauma, such as motor vehicle accidents. I am not involved in Lattimore’s care, so I do not know exactly what ligaments are torn and if there is any other damage (such as injury to the peroneal nerve). As an orthopaedic surgeon specializing in sports medicine, I can comment on how these injuries are generally treated.

In a surgery performed in the first few days after these types of injuries, surgeons address the torn ligaments. The steps for ligament repair and reconstruction depend on the severity of the injury and other factors such as coexisting nerve damage. Often the medial collateral ligament (MCL) and ligaments on the outside of the knee are repaired initially. Some sports medicine surgeons will reconstruct the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) in that initial surgery. Others choose to come back several months later to reconstruct the cruciate ligaments once the knee motion has been restored.

Also listen to Dr. Geier discuss the injuries of Marcus Lattimore and the general nature and treatment of multi-ligament knee injuries on Sports Talk from October 29, 2012.

While I would urge that is far too early to speculate on whether Lattimore will recover and return to football, there is widespread talk that he might have played his last football game. Unfortunately stiffness of the knee, despite months of postoperative physical therapy, is not uncommon with these multi-ligament knee injuries.

Historically most knee dislocations were crippling lifelong injuries. In recent years, orthopaedic surgeons have become much more capable of providing a knee that allows a patient enough stability, motion, and strength to perform normal daily activities. If an athlete recovers without a limp and gets back to basic exercise, like jogging, we are happy with those results. Regaining pre-injury speed and cutting and pivoting abilities to play at an elite level, as would be needed in the NFL, is much less certain.

In this case, speculating on his long-term chances for returning to a sport where he excelled can come later. Football fans here in South Carolina and everywhere are hoping for the best for Marcus Lattimore.

Note: This post appeared in a modified form as an article I wrote for Bleacher Report Sunday, October 28, 2012, minutes after the University of South Carolina issued a press release about the nature of the injury to Marcus Lattimore.