Sports Rehab Write-Up: CB Jalen Ramsey, Part II
But isn’t this an unusually quick return?
It definitely is! Ramsey went down with his meniscal tear on July 27th this past summer — that’s just 3 months ago! We were under the impression that Ramsey suffered a fairly significant meniscal lesion & would have to undergo a meniscal repair. As we know, most athletes would have to spend 4 to 8 months in rehab for a post-operative meniscal repair! To take things a step further, when we consider the demands of Ramsey’s position, even that 4-month mark seems extremely ambitious!
So how is it possible?
Well apparently things went a little better than expected! According to NFL Insider Ian Rapoport:
While the assumption was that Ramsey had a displaced meniscus tear, which would necessitate a full repair as opposed to a trim, that was not the case. Sources say Ramsey suffered an outer rim meniscal tear, which is dramatically different than a displaced tear and can be repaired via a trim.
That’s a pretty in-depth breakdown by Rapoport!
As opposed to having a full on meniscal repair, it seems Ramsey ended up receiving a partial meniscectomy. We spoke briefly about the difference between the two procedures in the first write-up, but Rapoport’s right on the money — just a little trim!
While it may have been originally planned for Ramsey to undergo the meniscal repair, it’s not uncommon for an ortho to pivot to the less significant procedure once you’re on the operating table. The approach for meniscal injuries is interesting, because the outer rim of the meniscus has a pretty significant blood supply & thus, plenty of healing potential!
Certain tears are more amenable to repair including peripheral 1/3 tears (red-red zone), vertical tears. These tears have greater healing potential because of increased vascularity in the red-red zone and because vertical (longitudinal) tears do not disrupt circumferential hoop fibers. (Feeley & Lau; 2018)
Diagram Highlighting the Various Zones of Vascularity of the Meniscus, Chirichilla et al 2019
The expectation for any tear in that outer-rim, red-red region is that a little trim won’t hurt long term — it’ll actually help! For that reason, the meniscal repair is sortof a last ditch effort; even the meniscectomy is often forgone altogether in favor of conservative rehab (at least in the general population)!
So knowing now that Ramsey underwent a meniscectomy as opposed to a repair, the 3-month return makes a ton of sense! In fact, 3 months is somewhat on the conservative end of the return to sport timeline!
At our institution where NCAA Division 1 athletes regularly receive care, post-meniscectomy protocols range from 8 to 12 weeks, and incorporate a variety of modalities including electrotherapy, cryotherapy, and progressive resistance exercises. For an athlete, the authors recommend an 8-week rehabilitation program. During the first week postoperatively, patients wean off crutches as tolerated while performing a series of effusion-control and range of motion exercises. In the second week, athletes perform gait training, balance, stationary bicycle, and strengthening exercises. In weeks 2 to 4, athletes undergo gait normalization and progress through more advanced strengthening and range of motion exercises. In weeks 4 to 6, along with progressive strength, balance, and range of motion exercises, the athlete will begin running and cutting drills. If patients have full and painless range of motion, after week 6 they perform sports-specific exercises and gradually return to sport. The protocol is accelerated, decelerated, and modified as needed for individual athletes, particularly for those that are in season. (Hanna, Smith, & Sebastianelli; 2022)
So, to wrap things up — this is an extremely pleasant surprise for Dolphins fans! For a team with Super Bowl aspirations, there’s no replacement for a shutdown corner!
Looking forward to seeing Ramsey leaving his mark on the field this Sunday — we got together and wished Ramsey a speedy recovery & our wish came true!
Works Cited & Further Reading
Feeley, B. T., & Lau, B. C. (2018). Biomechanics and Clinical Outcomes of Partial Meniscectomy. The Journal of the American Academy of Orthopaedic Surgeons, 26(24), 853–863. https://doi.org/10.5435/JAAOS-D-17-00256
Chirichella, P. S., Jow, S., Iacono, S., Wey, H. E., & Malanga, G. A. (2019). Treatment of Knee Meniscus Pathology: Rehabilitation, Surgery, and Orthobiologics. PM & R : the journal of injury, function, and rehabilitation, 11(3), 292–308. https://doi.org/10.1016/j.pmrj.2018.08.384
Hanna, T., Smith, N. P., & Sebastianelli, W. J. (2022). Treatment, Return to Play, and Performance Following Meniscus Surgery. Current reviews in musculoskeletal medicine, 15(3), 157–169. https://doi.org/10.1007/s12178-022-09754-7
