Doctor says Palmer injury atypical

[oldschooler]

Doctor says Palmer injury atypical

By Peggy O'Farrell

Enquirer staff writer

If all goes well, Carson Palmer could be back on the playing field "in eight or nine months" after tearing two ligaments in his knee during Sunday's loss to the Pittsburgh Steelers, the Bengals team physician said.

Palmer tore the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) in his left knee, Dr. Angelo Colosimo said Monday.

Palmer will need surgery to repair both ligaments, as well as months of intensive physical therapy, Colosimo said.

"Carson's injury is a lot more complicated than the average ACL injury," Colosimo said. "There are multiple ligaments involved and he essentially dislocated his knee. It's a more complicated operation, and a more complicated course of recovery."

Colosimo and the Bengals are working to schedule Palmer's surgery.

The MCL can be surgically repaired, but the ACL will have to be reconstructed using a graft - usually from the patellar tendon in front of the knee cap or from a tendon in the hamstring.

Both repairs can be made during a single surgery, Colosimo said.

In order to reconstruct the ACL, the surgeon will make a 2- to 3-inch incision down the front of Palmer's knee to "harvest" the patellar tendon needed for the graft.

The surgeon can use that incision to repair the tear in the MCL, Colosimo said.

The ACL reconstruction can be done arthroscopically: the surgeon will drill two small tunnels - one to the shinbone and the other to the thighbone - and, through those tunnels, remove the damaged ACL, then place and attach the ligament graft.

The surgery itself is important, Colosimo said. But the physical therapy that follows will be crucial for an athlete of Palmer's caliber.

During rehab, patients have to first re-learn activities of daily living - standing, sitting, walking, etc.

As therapy progresses, they move on to the specific tasks they need to perform their jobs, said Mark Paterno, coordinator of orthopedic and sports physical therapy at Cincinnati Children's Hospital Medical Center.

For Palmer, that means a lot of running, planting the injured left leg and turning - all activities that contribute to knee injuries in the first place.

"Twenty percent of it is the surgery. But 80 percent of it is the rehab and the athlete's dedication to healing," Colosimo said.

And psychologically, Palmer and other athletes have to learn to "trust" their repaired joints again, Colosimo said.

Sometimes, the mental adjustment can take another six months, said Marc Galloway, an orthopedic surgeon with Cincinnati Sports Medicine.

ACL tears occur most commonly in soccer, basketball and volleyball. When they happen in football, they're more commonly associated with contact injuries - like Palmer being tackled.

Women are more prone to ACL injuries than men. Doctors aren't sure exactly why, but theories include women's wider pelvises making them more "knock-kneed" and fluctuating hormone levels affecting the strength of the ligament itself.

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[oldschooler]

Palmer remains focused

But rehab could take 9 months after surgery

By Mark Curnutte

Enquirer staff writer

Carson Palmer's presence in the locker room Monday morning, about 18 hours after suffering a serious knee injury, lifted his teammates' moods as they headed into the offseason.

Palmer, walking on crutches, talked with wide receiver T.J. Houshmandzadeh, left tackle Levi Jones and tailback Chris Perry, who had gathered near Perry's locker. Later, Palmer signed jerseys and traded them with teammates.

"He's in good spirits," said Bengals coach Marvin Lewis, who would not go into detail about the exact nature of Palmer's injury.

"We'll tell you details once he has surgery of what's wrong and how long his expected recovery time will be," Lewis said.

Palmer suffered tears to both the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) in his left knee, team physician Dr. Angelo Colosimo said. Palmer was hit from the side on his first pass play by Steelers defensive end Kimo von Oelhoffen in the 31-17 loss Sunday in the AFC wild-card playoff game.

Palmer said he was told not to discuss details of his case in a news conference, but said in an NFL Network interview Monday that he expected to undergo surgery within 48 hours.

Speaking to reporters Monday at Paul Brown Stadium, Palmer vowed to be back for the start of training camp in late July and lobbied for the Bengals to re-sign free agent backup quarterback Jon Kitna.

Palmer put his personal situation in the background to ease teammates' concerns.

"It's bad to see him (injured), but his attitude is unbelievable," right tackle Willie Anderson said Monday. "He always finds a positive in everything. He's already looking forward to getting back and keeping guys' attitudes up."

Palmer's rehab is expected to require eight to nine months.

"I'll be back. I'll be back," he said. "I'm not sure of the timeline, but I'm not going to miss anything at training camp, and I'll be ready to roll."

Von Oelhoffen hit Palmer in the side of the left knee after Palmer had thrown what would be a 66-yard completion to wide receiver Chris Henry. Palmer collapsed on the field, with von Oelhoffen motioning for help. Palmer was taken off on a cart.

"I don't know Kimo personally," Palmer said of the ex-Bengal. "From what I've heard he's a classy guy. Football is football. I don't think it was malicious at all. He's a guy with a high motor that plays hard. It just happened."

Palmer spent the night at home. Hospitalization was not necessary.

"Parts of last night seemed like minutes were hours," he said. "Looking back, some of last night flew by. But I don't think this thing is going to hit me until I get going on the rehab session, start battling the road back."

Palmer watched the replay.

"I saw it once," he said. "I didn't need to see it a whole bunch more than that."

He wore a brace on his left knee. He had suffered an MCL strain in Game 13 in 2004 and missed his final three starts.

Palmer watched the Steelers' game from the trainer's room.

"It wasn't hard," he said of sitting out. "I was fired up. We were (winning). Things were going great."

Kitna replaced Palmer and led the Bengals on two touchdown drives but threw two interceptions in the second half.

Kitna started all 16 games during Palmer's rookie season, 2003. He could leave as a free agent this spring.

"That is my No. 1 concern. We got one of the better offenses in this league, and we've got everybody coming back," Palmer said. "I'm not worried about anybody else other than Jon. He has some opportunities to go and play some other places. I know the organization wants him back. ... I want what's best for him. But I'm also selfish, and I want him back."

Palmer also said he would work as hard as possible to return as quickly as he could. He talked Monday with Jones and linebacker Nate Webster, both of whom have had knee surgery.

Palmer signed a re-negotiated nine-year contract Dec. 29 with the Bengals through 2014.

"I'm not going to be stupid about (rehab). I realize I've made a commitment to this organization for the future and I need to think about that, too," he said. "... I made a commitment, and this organization has made a commitment to me. I need to keep that in the back of my mind."

Q&A

Questions and answers about Bengals quarterback Carson Palmer and his injury:

How was Palmer on Monday? Palmer visited teammates at Paul Brown Stadium and held a short news conference. He said he would be healthy in time to start training camp in late July or early August.

Will he really be back by then? Nobody knows for certain. But Bengals team physician Dr. Angelo Colosimo expects Palmer to be competing in eight to nine months - if there are no complications.

When will the surgery be and who will perform it? The Bengals, Palmer's representatives and coach Marvin Lewis are not saying when, where or who might perform the surgery on Palmer's ligaments. Lewis said the team would comment again after surgery. Colosimo is the likely surgeon.

What exactly happened to Palmer? He tore the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) in his left knee. He was hit in the knee by Steelers defensive end Kimo von Oelhoffen after throwing a pass early in the playoff game Sunday.

What's an ACL and MCL? The ACL is the major stabilizing ligament in the knee. It prevents the knee from buckling by stabilizing the knee from front to back. Without it, the shinbone would slip too far forward when the knee is bent. The MCL stabilizes the inner side of the knee from side to side.

Has Palmer had knee trouble before? The MCL injury is the second one Palmer suffered in two seasons as the starter. He strained the ligament in Game 13 of the 2004 season at New England. Palmer vowed to do whatever is necessary to return on time for camp.

Have other quarterbacks come back from this? Yes. One of the most high-profile cases involved Trent Green, who as quarterback for the Rams tore the ACL, MCL and lateral meniscus in his left knee during a 1999 preseason game. He has since played in 88 games, starting 85 of those, and just finished his fifth season as the starting quarterback for the Kansas City Chiefs.

When will Palmer begin rehab? As soon as surgery is complete and he is strong enough to begin working out.

Will the Bengals' facilities help the process? The Bengals have underwater treadmills at their training facility at Paul Brown Stadium. The Bengals' strength and conditioning staff is equipped to handle Palmer's rehab.

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[HoosierCat]

According to doctor that Chick Ludwig talked to for the DDN, Palmer will likely wait a few weeks before having the surgery. The doc said that an MCL will in most cases heal on its own, so you take a few weeks to see if that's happening. If it does, then the only surgery will be to repair the ACL.

[shworge]

Palmer was on NFL Total Access last night and said he would have surgery within 48 hours.

[oldschooler]

Breaking news on Carson

By Mark Curnutte

Enquirer staff writer

Carson Palmer is undergoing surgery currently this afternoon in Houston, Texas.

Dr. Lonnie E. Paulos, a faculty member of the Methodist Sports Medicine Institute of Houston, is performing the surgery.

Dr. Paulos has a link to the Tristate. He did a fellowship in sports medicine at the University of Cincinnati Medical Center.

The Bengals quarterback suffered tears to the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) in his left knee Sunday. He was hit in the knee by Steelers defensive end Kimo von Oelhoffen after delivering his first pass of the game, a 31-17 Bengals' loss in the AFC playoffs.

There was no word where Palmer would perform his rehabilitation, which is expected to take at least six months, if not more.

Time is of the essence. The longer surgery was put off, the more tissue in the knee would have weakened.

It is common in the NFL and other professional sports for athletes to opt for surgeons not employed by or affiliated with the teams. Many agents do not want athletes operated on by a team doctor because they think the doctor has the team`s best interest in mind....not the athlete's.

[redsbengalsbucks]

Best news I have heard about this injury. Independent doctor!