January 2013

Out on a limb: RG3 – More than the knee

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Jordana Bieze Foster, Editor

The sports world can’t stop talking about Robert Griffin III and his injured knee. But nobody’s talking about his brain. And they should be, because it’s very possible the two are related.

The Washington Redskins’ exhilarating rookie quarterback suffered what was described as a mild lateral collateral ligament (LCL) sprain in his right knee on December 9 following a hit by Baltimore Ravens defensive end Haloti Ngata. Griffin missed one game and then played out the regular season wearing a brace. But in a first-round playoff game against the Seattle Seahawks on January 6, Griffin reinjured the knee on a fumbled snap, this time with no contact involved. Three days later he had surgery to repair both the LCL and the anterior cruciate ligament in the same knee, which had previously been reconstructed in 2009. The Redskins not only lost the playoff game to the Seahawks, they also lost their franchise quarterback for up to a year.

Since the reinjury, there’s been a lot of debate about whether the Redskins let Griffin return from the initial injury too soon. Count me among those who suspect he didn’t have enough time off. But for me, this is about more than just the knee.

Earlier in the Ravens game, Griffin was on the receiving end of another hard hit by Ngata—one that knocked the quarterback’s head against the ground with such force that his helmet came off. That play, to me, could be very important.

Remember, Griffin suffered a concussion earlier in the season, in an October 7 game against the Atlanta Falcons. He returned to play the following week after being cleared by the team physician and an independent neurological consultant.

If Griffin suffered another concussion on December 9—something that very well could have gone unnoticed amid all the furor over his LCL sprain—then it’s likely that he did return to play too soon, independent of the knee injury.

Repeated concussions within a single season dramatically increase the time needed to recover. Sports neurologist Robert Cantu, MD, recommends that an athlete suffering a second concussion wait at least two weeks before returning to play. That’s the best case scenario, in which the second concussion involves no loss of consciousness and signs or symptoms resolving within 30 minutes.

Griffin had practiced all week before starting against the Philadelphia Eagles on December 23, so he definitely returned to play less than two weeks after the Ravens game. This risk factor, coupled with his existing concussion history, means there’s ample reason to think his brain may not have been fully healed by January 6.

And as we have reported previously, there is also a growing body of medical evidence suggesting that impaired neuropsychological function may increase the risk of noncontact lower extremity injury (see “Brains and Sprains: Is there an extremity-concussion link?” October 2012, page 11). Griffin’s knee injury could be another case in point.

Sometimes a knee injury isn’t just a knee injury. Luckily for Griffin, both his knee and his brain should now have some time to heal.

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