Interview With Dr. David Geier: On Louis Nix, Knee Ligaments, And Sean Lee

With the news coming out today that David Quessenberry has been diagnosed with lymphoma, you might assume  this interview would be talking about cancer treatments and such. Unfortunately, this interview was conducted over the weekend, and DQ's condition falls well outside of Dr. Geier's expertise of sports medicine. We'll be monitoring any news that may come out of the situation, and in the meantime, will be sending out positive energy waves in Quessenberry's direction. As fans, this is one of those situations that takes us out of our daily escape into the realm of football and reminds us of the things that matter most.

Anyway, I emailed Dr. Geier last week hoping to gain some knowledge on our shiny, new nose tackle Louis Nix and the knee injury he suffered in college. Oh, and in case you were wondering:

Louis Nix III got banged up early in OTAs w/ a knee but has since returned. Crennel says he can tell Nix is a sharp guy. #Texans

— Deepi Sidhu (@DeepSlant) June 10, 2014

1. The Texans took Louis Nix III from Notre Dame in this year's draft. Even though he elected to have it surgically repaired, his knee injury likely dropped his draft stock into the third round. In your experience, how do athletes typically fare after this injury? What can you tell us about meniscus injuries in general?

Recovery from a meniscus tear depends on the exact nature of the surgery. Some meniscus tears can be repaired, meaning sewn back together, while others require the torn portion to be trimmed out. Trimming out the torn portion often allows an athlete to return to sports within 4-6 weeks, while it can take him 4-6 months to return after a meniscal repair. The concern after the trimming procedure is that there is less meniscus to serve as a shock absorber within the knee going forward. Over time, the athlete theoretically could develop degenerative changes with wear and tear.

[Nix chose the meniscal repair rather than the trimming option.]

Meniscus repairs involve a longer recovery period - often up to six months. The surgeon has to advance the athlete's motion, strength and possibly weightbearing slowly to try to avoid damaging the repair. Many surgeons limit knee motion to 90 degrees of flexion (bending) and limit weightbearing for about four weeks before allowing the athlete to progress to full motion and weight. Usually the surgeon limits repetitive impact, such as jogging, for two to three months.

The advantage of performing a meniscus repair, in the group of tears that actually can be repaired, is that if the repair heals, the entire meniscus is preserved to serve as a shock absorber.

Unfortunately not all repairs heal. Those surgeries are thought to have 10-25% failure rates, so second surgeries are occasionally needed for the surgeons to go back in and trim out the torn meniscus.

2. Nix is listed at nearly 330 pounds currently, but reportedly played closer to 350 while at Notre Dame. Obviously men of his size can be very useful to a football team, but should injuries to their lower bodies be expected as part of the package? How much can the human knee take?

Larger size and body weight is thought to add stress to the knees over time. Degenerative changes to the articular cartilage (the cartilage lining the ends of the bones) can occur.

3. Poor Sean Lee. If it's not one knee, it's the other. How is a man that unlucky? Or does it not have anything to do with luck at all? What factors could be involved that would make him that prone to knee injuries?

ACL injuries can occur among all athletes, so they might not be predisposed to these injuries. Retearing the ACL graft in the years after surgery can occur, but tearing the opposite ACL (which Lee reportedly did) is actually slightly more common. A report from ESPN at the time of Lee's most recent ACL injury suggested that he had suffered a partial tear of his ACL years earlier. It is possible that an athlete with a partial tear could be more likely to tear the intact portion and suffering a complete tear in the future. Without being involved in his care, I can't say if that scenario occurred in Lee's case.

4. On your website, you talk about neuromuscular training and how it can cut down on ACL injuries. Are there such programs in the NFL currently?

These programs are increasingly being used in female sports, especially soccer, since female athletes have a significantly higher risk of ACL tears than males. More and more sports teams are adding these programs into their daily warmup exercises. I don't know how many NFL teams currently use these ACL injury prevention/neuromuscular training programs, but I expect that they will become more common to try to cut down on the number of players suffering these season-ending injuries.

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One thing I appreciate about Dr. Geier is that he's not prone to speculating even though my questions encourage him to do so. He speaks about possibilities and circumstances without irresponsibly assuming anything.

We've learned that Nix's meniscus repair was the better option for long-term health. A man of his size will need every fiber of cushion for his knees, not only for playing time, but for quality of life when he retires. Houston Rockets guard Patrick Beverley suffered a similar injury to Nix's but opted to have the tear trimmed away rather than repaired. That's how he was able to return to the team in time for the playoffs.

Each injury is different, though, and that's something Dr. Geier seems to stress. We need to remember that when we make assumptions about a player's injury.

As always, we're curious to hear your thoughts. Check out his website for more information on sports injuries and the latest innovations in preventing them. Also, be sure to read my first interview with Dr. Geier.

Bio:

Dr. David Geier has served as a medical consultant for the U.S. Women's Soccer team and is the head physician for many high schools and recreational sports leagues. A graduate of the Medical University of S. Carolina, he completed his residency at the Campbell Clinic in Memphis and a sports medicine fellowship at Washington University, where he served as team physician and assisted in the orthopedic care of the St. Louis Rams. His sports medicine interests include knee, shoulder and elbow injuries, pediatric and adolescent sports medicine, arthroscopy of the shoulder, elbow, and ankle, and sports injury prevention.