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Brady has both ACL and MCL tears

Surgery expected in about a month

By Shira Springer
Globe Staff / September 11, 2008
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Patriots quarterback Tom Brady suffered torn anterior cruciate and medial collateral ligaments in his left knee last Sunday, NFL sources confirmed yesterday.

Medical tests on the knee, including an MRI performed Monday, indicated no damage to other ligaments, and no torn cartilage. In cases like this, doctors typically wait for the MCL to heal, then reconstruct the ACL. Brady will likely undergo surgery in approximately one month and face 6-9 months of recovery and rehabilitation, barring complications.

After coach Bill Belichick announced Monday that Brady would miss the rest of the season, the team released a statement that did not provide details of Brady's injury. Speculation and educated guesses pointed toward an ACL tear, considering the ACL is the most commonly injured knee ligament.

Athletes typically sustain damage to the ACL and MCL when there is a direct hit to the outside of the knee, as there was when Kansas City safety Bernard Pollard hit Brady during the first quarter of the Patriots' 17-10 win at Gillette Stadium.

On the Patriots' 15th offensive snap of the game, Brady, who had completed 6 of his first 10 passes, dropped back to pass on first and 10 from the Kansas City 42-yard line. Pollard blitzed, but was picked up and blocked to the ground by Patriots running back Sammy Morris. As Brady stepped into what would be his 11th and final pass of the season - a 28-yard completion to Randy Moss - Pollard made a desperation dive at Brady's legs, his shoulder clipping the quarterback's knee.

Brady screamed, fell to the ground, and immediately clutched his knee to his chest. He lay on the turf as Patriots team physician Thomas Gill and trainer Jim Whalen examined the injured leg. Brady limped off the field with help from Gill and Whalen, heading directly to the locker room with 7 minutes 27 seconds remaining in the first quarter.

Teammates who have text-messaged or spoken with Brady say the 2007 NFL MVP has been keeping a positive attitude as he prepares for surgery and the long rehabilitation ahead. Moss confirmed that Brady was at Gillette Stadium with his teammates yesterday.

"He's still upbeat," said Moss. "You would expect the guy to really be down. I think he was more down on Sunday. But just having a few conversations, a few text messages, he's still positive. That's what you can hope for in a guy like Tom.

"Unfortunately, he is gone for the season with a knee injury. He's still the same old Tom Brady, and I think that's what a lot of people really don't understand. A lot of times guys get hurt and you might not see them around the locker room for months at a time. We saw Tom today. I don't know how much longer we're going to see him, but he [was] here uplifted and still keeping a positive attitude. I think that goes a long way not just with him, but the team also."

It is uncertain where the surgery will take place. If Brady plans to remain in the area for the rest of the season and support his teammates in person, it is likely Gill will perform the operation at Massachusetts General Hospital. But Brady could opt for another East Coast location, or undergo surgery closer to friends and family on the West Coast. In any event, knowing the severity of the injury, Brady will likely seek a second opinion.

The ACL connects the femur (thigh bone) to the tibia (shin bone) and provides knee stability when jumping, cutting, and pivoting. It cannot be repaired by stitching the frayed ends together. ACL reconstruction usually involves replacing the ligament with the patellar tendon or hamstring tendons. The MCL stretches from the thigh bone to the shin bone on the inside of the knee. It is also essential to providing stability. MCL injuries alone rarely necessitate surgery and heal with rest and rehabilitation.

Once surgeons begin operating on the knee, they may discover cartilage damage that was not visible on the MRI and also would require repair. The common combination of ACL, MCL, and meniscus tears is referred to as the "unhappy triad" in medical circles.

When Cincinnati Bengals quarterback Carson Palmer suffered a left knee injury in a similar manner to Brady during an AFC playoff game against the Pittsburgh Steelers in 2006, he tore the ACL and MCL, damaged cartilage, and dislocated his kneecap. Surgery was performed on Palmer's knee Jan. 10, two days after he was injured. He returned to action in an exhibition game against the Green Bay Packers on Aug. 28, 2006.

"Carson had a few more issues," said Dr. Lonnie Paulos, who operated on Palmer's knee. "His was not as typical as some of them. That added crutch time. He came through it like a champ. He was seven or eight months. That's pretty typical."

Without any setbacks or unexpected complications, Brady will be ready to return to the field next preseason. Quarterbacks typically respond well after ACL surgery, in time regaining the muscle strength and agility to perform as effectively as before the injury.

Christopher L. Gasper of the Globe staff contributed to this report from Foxborough; Shira Springer can be reached at springer@globe.com.

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