Tannehill having surgery

Might as well get it over with.

 

Should've happened last fall.

 

I'm sure you're privy to everything he discussed with his world class surgeons and are basing this off of what you've seen in his MRI.

 

Yet here we are and here he is having to have the surgery.

Good luck with that though, thinking Ryan prioritized the right choice last fall over the one that got him back the fastest because of the fear of long term contract implications. I can't even recall the last time a player tore any portion of his ACL and chose to let it heal on its own.

 

Seems like Sylvestre is a nice cheap option, we could do worse. In case anyone was curious about Junior Sylvestre, here's Zierlein's take prior to the 2015 draft:


2015 draft analysis per Lance Zierlein via NFL.com
STRENGTHS Plays as fast to the perimeter as just about any linebacker in this draft. Smooth to flow and mirror running back when playing from on top. Outstanding at navigating through traffic and coming out of the other end to get to the play. Changes direction well and finishes with good form and a thud behind his pads. Able to cover running backs out of the backfield. Can glide and slide through crevices as a blitzer. Has acceleration to become a factor with blitz-happy team. Shows good awareness in zone coverage.

WEAKNESSES Fails to hit the 6-foot mark. Smaller than desired for the position. When he waits on linemen to climb up to him, he can be pushed around. Must work to become more proactive and aggressive as a downhill force to compensate for his lack of size. Can improve his play strength. Will get grabby in man coverage.

DRAFT PROJECTION Rounds 5-6
NFL COMPARISON Jonathan Casillas

BOTTOM LINE Likely 4-3 weakside linebacker as a pro who can run from sideline to sideline with the ability to heat the quarterback up as a blitzer. Had his weight up from the mid 220s to 233 for his pro day and still ran a sub-4.6 40-yard dash. While Sylvestre is smaller than desired, he plays with toughness and finds a way to keep himself clean and in more plays than expected. His ability to play fast and with focus gives him a legitimate chance to be taken on the third day of the draft with a shot at becoming an eventual starter.

 

You have no idea what he based his decision on so spare me the anguish of having to read stupid posts using hindsight and conjecture.

And no it doesn't count that your first thought was for him to have surgery because you know NOTHING about anything having to do with his specific injury.

 

Great. Thanks.

 

Here's a randomized clinical trial published in the NE Journal of Medicine from 2010 where people who were either in recreational or competitive sports but were not professional athletes had ACL tears and were randomly put into one of two groups: 1) ACL reconstruction surgery within 10 weeks, or 2) rehabilitation but no ACL reconstruction surgery unless it became obvious surgery was needed:
http://www.nejm.org/doi/full/10.1056/NEJMoa0907797#t=article

Two major findings: 1) neither approach proved to be better after 2 years, and 2) 60% of the group that had optional surgery ended up needing no surgery.

This shows that while it might currently be the standard to do surgery for professional athletes after an ACL tear, there's recent research out there that might have suggested no surgery until absolutely necessary is a viable option.

 

Wait a minute a Cbrad. You mean it may not have just been a cash grab attempt by a desperate failure of a QB?

 

Except, this study wasn't about professional athletes, a 2 year study also isn't really getting to the "next year" point, athletes have to play next year, waiting 3 months to see IF you need surgery isn't a good answer to a person that has a short career.

What studies that have been done as far as the pros go, is that not having surgery tends to lead to more problems, because once you have a tear like that, all the tendons and ligaments get stretched out and are more prone to injury, whereas reconstructive surgery covers all those bases as well.

Time is a big factor, non surgery can take a lot more time, one thing athletes don't have a great supply of.

 

Dude.. you gotta read the study before criticizing it. Look at Figure 2A. It clearly shows that at NO time from injury onset to 2 years afterwards was the "rehabilitation + delayed reconstruction" group worse off outcome-wise. Actually, at 3 months the group that got surgery was worse.

Secondly, you're not doing such randomized clinical trials with professional athletes so I don't know which studies you're referring to, except case studies where you find examples all over the place including olympians that competed with no ACL following injury. But case studies don't have the statistical power of clinical trials so they're not comparable.

 

People will go to great lengths to criticize Tannehill. Its sad.

 

However, case studies on avg joes aren't comparable to pros either, and I did read the study, it also said that those who got the surgery after 2 years tended to have sturdier ligaments.

After 3 months the guys who had surgery were recovering from surgery, while those that didn't were waiting to see if they needed surgery, and 40% of those needed the surgery, so now they are 3 months behind in getting back on the field, if that were the case.

If you don't get surgery, how many months until you can play again?

That study didn't answer that question, that wasn't the object of the study, so it doesn't pertain to pro sports.

Clearly, the non surgery way is not the way to go in pro sports, because of that 3 month delay on figuring out if you actually need it.

They also made it clear that these tests don't show one way or another which one is better, just that surgery isn't the only option, all the time.

 

I don't think your logic is so clear cut w.r.t choices for a professional athlete. Look at figure 2B. That shows that those who never got surgery (60% of the rehabilitation with optional surgery group) did significantly better from the 3 months to 12 months period than those who had surgery from the outset.

Thus, the calculus (based just on this study) for pro athletes is as follows: do you want a 60% chance of outperforming those that immediately opt for ACL surgery within the next 1 year period? If yes, don't opt for surgery. The flip side is that there's a 40% chance you'll end up worse than those that immediately opt for surgery during that period and ultimately require surgery. No matter which option is chosen, at 2 years you'll be the same.

I can definitely see some pro athletes choosing that no surgery option if that's the only information they're given, precisely because of what you pointed out: time is valuable. Who knows.. maybe that's why Tannehill chose it?


Oh, and regarding this type of study not being applicable to pro athletes, keep in mind that it's precisely these types of studies that inform which treatments are best for pro athletes and average joes alike, so yes it does apply. Like I said earlier, they're not doing clinical trials on pro athletes to decide what treatment is best for pro athletes. Of course, the criteria for deciding what is best will be different for pro athletes, but they do use the data.

 

Was reading about the history of ACL surgery (good read btw):
https://www.hindawi.com/journals/aos/2014/706042/

and it occurred to me that if that much experimentation was going on up until the 1990's when the Jones Procedure became the standard there MUST be cases of NFL players with torn ACL's that were never repaired, especially from before the 90's. And there are some famous ones on that list:

John Elway tore ACL in high school in 1978, never repaired.
Thurman Thomas tore ACL in 1986 in college, never repaired.
Joe Namath tore ACL in 1964 in college, never repaired.
Hines Ward apparently lost ACL in bicycle accident in 4th grade, never repaired.

More surprisingly, some players in the current era decided to forego ACL surgery during the season:
Logan Mankins played 2011 season (including SB) without ACL
Philip Rivers played 2008 AFC championship game (2007 season) without ACL

Oh and then there's this guy who actually played his entire NFL career with no ACL in either knee lol:
https://en.wikipedia.org/wiki/Jimmy_Hitchcock_(cornerback)

 

These people are not going out and putting massive stress on their knees, so no Brad, it doesn't compare, it's not giving pertinent data, pros have to concern themselves with how it will take tremendous stress, these subjects did not, so it's not very useful to them.

RT's injury is also more evidence that not having reconstructive surgery can lead to other local injuries, especially for pro athletes, which is the prevailing current medical theory, that does have evidence to back it up in this trial, as they said that those who did have the surgery tended to have sturdier results after 2 years.

 

I've posted this same study at least 3 times. It amazes me all of the "experts" who claim surgery should be the first choice. Lol

 

Oh... he's going to cry when he gets in the car. Lol

 

What makes you think that? Of course some of these people are going to go out and put massive amounts of stress on their knees. To state that they won't/didn't with any confidence is silly.

RT's current injury is not evidence of anything. At least not for anyone here. Why? Because no one here knows if he aggravated his previous injury or if he suffered a completely new injury.

 

You have no idea how much stress they're putting on their knees. It could be a lot, or not a lot. They say that participants had a median rating of 8 with a range of 5-9 on the Tenger Activity Score (TAS). This means that more than half are in competitive sports, including sports that put a good deal of stress on the knees like wrestling, gymnastics, down hill skiing, racquetball, and even lower division soccer, etc..

Also, don't confuse the word "professional" with "top level". All "professional" means is they're getting paid for it. You can very well have the top amateur wrestlers in this group because they're not "pro's".

Regardless, you can't dismiss clinical studies like this as not applying to professional athletes. How do you think standardized treatments for pro's are developed? Two ways: individual trial and error by various clinicians who report their studies in papers or at conferences, and clinical trials (reported the same way). This is half the equation.

 

My only issue with the study is how old it is. Remember how devastating ACL surgery used to be and now they're almost ho-hum. There have been great advances the past 30 years, and the beginning of this study (2002) is in the middle of that.

 

From your article:

"Third, we were unable to stratify study groups according to activity level, and our conclusions are best generalized to young adults who have high preinjury activity levels but are not professional athletes."

They also did a followup at 5 years, and by that time, half of the subjects needed surgery. They came to the same conclusion, but added this:

http://www.bmj.com/content/346/bmj.f232

 

I'm no scientist, nor statistician. So someone please explain to me. In that study, in Table 2, adverse events, in the surgical group, in the serious events, there were 2 reported instances of instability, and 1 instance of meniscal signs and symptoms (whatever that is).

In the non-surgical group, there were 19 instances of serious instability, and 13 meniscal signs and symptoms.

Am I reading that Table wrong?

 

Oooooops.

 

I read the report.

 

It's not old. Look at the link in post #17 for a history of ACL surgery:
https://www.hindawi.com/journals/aos/2014/706042/

The "gold standard" stabilized in the 1990's with the rate of improvement being much less since then. The last noteworthy change on the list was in 2003 but they still say the standard is the Jones procedure.

If I had to guess what the improvements are since then, it's probably more on the rehabilitation side, which should at worst affect both groups equally, and if anything help the rehab with optional surgery group.

Yeah all that says is they don't know specifically which kind of activities these people engaged in. The Tenger Activity Scale lists many possible activities for each level of the scale. For example, for the median of 8 you have: "Competitive sports- racquetball or bandy, squash or badminton, track and field athletics (jumping, etc.), down-hill skiing". All they're saying is they don't know which activity or how much of it people with the same TAS score were engaged in. Doesn't invalidate what I said before about so many in the study being in types of competitive sports that put a good deal of stress on the knee.

As to this quote:

That's how good researchers qualify their results in research papers. They can (or should.. because it's not always done) only claim their results apply to the specific cases they've demonstrated they apply to.

However.. clinicians will use results from studies done on groups of people that aren't perfectly representative of their target population because you often just don't have clinical trials (which cost a ton in many cases) done on the population you're interested in. You can bet with certainty that up-to-date recommendations for ACL treatment for pro's will at least take this study into account. Doesn't mean rehab without surgery is the recommendation, just that the info is applicable.

No you're reading that correctly.

 

That's what I thought. So 2 instances of "serious" instability for the surgical group, and 19 for the non surgical group.

Imagine a pro football player. I checked out another study (too lazy to link it) but thankfully, QB is the one where acl's have the least effect on their post surgery playing level.

 

You, and jang don't understand the clinical trial. That's the big "oops" you're looking for.

 

He and Rock don't understand what they're reading.

Does anyone want absolute proof that pro athletes and their physicians use these types of studies?

Ryan Tannehill didn't have surgery on his partially torn ACL last year because these types of studies show that there is a great chance he would not have needed it.<<<< PROOF

BTW, Rock, how many pro athletes didn't have ACL surgery following injury? "None" according to you, right? Did you just skip over cbrad's list of players?

"Oops"

Lol

 

The report detailed the daily activities of each subject? Please show me which part you "read".

If you're going to be a smart *** you should at least try to be smart.

 

This debate is a bit out of my depth but here's something to (maybe?) chew on about why he opted out of surgery in lieu of a more regenerative-dependant approach.

https://www.ncbi.nlm.nih.gov/pubmed/27311414
https://www.regenexx.com/nfl-acl-surgery-2/

 

And here's an article about Adrian Peterson's return, and his near 2000 yard season. His ACL was reconstructed by Dr. James Andrews, the doctor that advised Tannehill he would be fine without surgery.

http://allamericanorthopedic.com/adrian-peterson-leads-way-in-acl-recovery-in-nfl/

 

I understand the study just fine. They are essentially basing their conclusion on:

KOOS (patient reported outcomes)
radiographic OA
meniscus surgery

Which is fine. But to have 950% more serious knee instability events after two years is in my opinion, needed to be explained further. 1300% more meniscus signs and symptoms.

and these are not professional athletes. I'm no orthopedic surgeon, but this looks like a lot of stress

 

Not sure everyone can access the paper in that first link, but just to give a bit more information from the paper, the purpose of that study was to compare the effect on NFL careers of different orthopedic surgeries. Study involved 559 athletes from 2003-2013 with 2-year minimum follow up after injury.

Some info on ACL they provide:
1) 82.4% with torn ACL returned to play
2) Recovery time for ACL was 378 +-144 days
3) Average career length after return to play for ACL was 1.6 years
4) For those who returned after torn ACL, 1.6 +-0.6 fewer games were played in each of next 3 years
5) Recovery to baseline for those who returned was at about 2-3 years, same as with that clinical trial

 

Now that I've defended that clinical trial, let me criticize it from a methodological point of view. KOOS is typical of questionnaires in health care research in that it uses a rating scale:
http://www.koos.nu/koos-english.pdf

Well.. the proper mathematics for analyzing rating scale data is at minimum something called Rasch analysis (you can go further, but this should be the minimum). With rating scales the difference between two ratings doesn't in general represent the same thing. Like in KOOS the difference between "none" and "mild" is almost certainly not the same for a particular patient as the difference between "moderate" and "severe" or between "severe" and "extreme", etc..

Rasch analysis estimates what are called person measures and item measures from a whole bank of rating scale data (from many people rating the same set of items = questions on the questionnaire) and estimates the relative magnitude of a latent trait (e.g. severity of injury) on the real number line for every person and every item so that the scale is invariant no matter which two people or items you compare.

That means you have a true measure of baseline ability pre- and post-treatment, which you do NOT have the way these guys did their study. Rasch analysis is already used across many areas of medical research but it literally takes decades for improved statistical methodologies to be assimilated across different fields that could use them immediately. And apparently in this particular area of medical research (rehabilitation with/without ACL surgery) the proper statistical methodology isn't being used.

Trust me, there can be a MAJOR difference in conclusions you'd reach depending on whether you just use raw averages as they did, or you use proper statistical analysis (not just what is "standard" at that time in that field). So from that point of view I'd have a problem with this study. But this is the first such clinical trial in their field and things take time to change..

 

I can't believe THIS argument is still going on.

It's safe to say that NONE of us are orthopedic sports surgeons.
It's safe to say that none of us saw the MRI on Tannehill's knee last year.
It's safe to say that even if any of us HAD seen his MRI we'd know what was what.
It's safe to say that NONE of us examined Tannehill last year.

For all of you Monday morning sports surgeons, which makes you twice as ignorant as Monday morning quarterbacks, you have no idea what options were discussed with Tannehill, the pros and cons of either options discussed, courses of actions, rehab prognosis, etc...

For whatever reason, Tannehill and his doctor chose the path they chose. It obviously wasn't sufficient as Tannehill is now on IR and having surgery. The motivations for the path they chose, none of you have any idea and some of these baseless claims are ridiculous if not flat out stupid.

 

I'll go ahead and check out now.

I can't on good conscience read an online study that most of us don't even know if we properly understand, then second guess whether it was the right decision or not.

The only facts about his very specific situation is that Tannehill (a pre-Med student himself) discussed this life changing decision with first class, industry leading, world renown surgeons and made his decision to rehab.

Speculate and use hindsight all you want. I won't waste my time.

 

If you click that link that I posted, and in the responses you actually see a discussion regarding the very thin if you click that link that I posted, and in the responses you actually see a discussion regarding the very topics you mention.

As for a Tannehill look, Andrews is an expert. You gotta listen to what the doc says. Even he gets it wrong on occasion.

At the time they said his knee would not be at any extra risk of injury.

If true, Tanny injured his knee without it being an exacerbation, and the knee wasn't any more susceptible due to the prior injury. That's not necessarily a good thing.

If it was an exacerbation or the knee was more susceptible then they were wrong.

If it wasn't an exacerbation, if he did not suffer any significant injury, then why the surgery now?

Either way looks like the experts were likely wrong (except scenario 1 above).

Now, wrong advice is not the same as bad advice.