Tua Tagovailoa return for LSU game 'highly unlikely' under one scenario
TUSCALOOSA — With an already-lit victory cigar in hand, injured Alabama quarterback Tua Tagovailoa made a bold prediction inside the Bryant-Denny Stadium locker room after last Saturday’s 35-13 win over Tennessee.
“He said: ‘I’ll be back for LSU,’” junior outside linebacker Terrell Lewis told reporters last Saturday, sporting a wide smile that probably mirrored the reactions of Crimson Tide fans when they heard that statement too. “I know how Tua is, this is something he’s been through before, so I don’t doubt the fact. He’s a competitor, he’s going to get right back. He’ll be fine.”
That was a rather auspicious prediction from the Heisman Trophy contender, who underwent a state-of-the-art TightRope surgical procedure on his right ankle Sunday morning after suffering a severe high ankle sprain midway though the second quarter of last Saturday’s game against Tennessee. It’s the second time in the last 10 months that Tagovailoa has gone through such a process, the first of which saw him play against Oklahoma in last season’s College Football Playoff national semifinal 27 days after undergoing a similar procedure to his left ankle last December.
Of course, for Tagovailoa to be ready to play in No. 1 Alabama’s highly anticipated showdown against No. 2 LSU on Nov. 9 — which is just 20 days removed from surgery — it’s going to require an unprecedented and expeditious rehabilitation process that has almost never been attempted before.
“It is so extraordinary to get him back that quickly, it would be nice to get a window into exactly what they do,” Dr. J. Chris Coetzee of Twin Cities Orthopedics in Minneapolis, Minnesota, said of Tagovailoa’s rehab. “But they’re obviously trying to optimize his normal muscles and strained muscles and ligaments around the injured part to somewhat compensate for it, but also augment the injury while he’s healing.”
To better understand what Tagovailoa might be experiencing during his current rehab process, the Montgomery Advertiser sought the opinions of two prominent orthopedic surgeons with a history of performing the TightRope procedure on high-level athletes.
Coetzee is the Minnesota Vikings’ team foot and ankle specialist, while Dr. Nick Gates of OrthoCincy out of Cincinnati, Ohio, is a foot and ankle consultant for several colleges and high schools throughout Cincinnati and northern Kentucky.
Neither doctor reached for this story has any direct knowledge of Tagovailoa’s current medical information, his MRI results or any inside information on the condition of his current injury, but both are considered medical experts experienced with the TightRope procedure.
The TightRope involves a surgeon inserting a strong suture construct with metal buttons on either end through a drilled hole between the fibula and tibia above the ankle. The suture connects and stabilizes the injured ankle by effectively serving as a replacement ligament while the actual damaged ligaments continue to heal. This is what allows for accelerated returns to activity, and a quicker-than-normal rehabilitation process, because not only does it create opportunity for movement while the ankle heals, but the suture and connecting metal brace on the outside of the tibia provides a permanent reinforcement for the ankle, which greatly reduces the likelihood for reinjuring of the same ankle.
“The advantage of a dynamic fixation like the tightrope is you get compression across the ligament that allows it to heal while you maintain the normal function of the fibula, the ankle joint,” Coetzee said. “With this, you don’t have to take the device out, and because of that, you can start your rehabilitation almost right away.”
Added Gates: “The tightrope is doing a lot of the work while that ligament is healing. There’s still healing time, but we’re able to control that ligament during the healing time and let that ligament get exposed to stress earlier. … So, we’re letting athletes play during the healing process, because of this tightrope.”
Alabama head coach Nick Saban said Thursday during an appearance on ESPN radio that Tagovialoa’s current high ankle sprain isn’t nearly as “serious” or severe as last year’s but didn’t go so far as to set any legitimate timetable for his return. That said, Saban has mentioned both a four-day period where Tagovailoa would be non-weight-bearing and a 10-day window before he’s even able to engage in any “active-type rehab” away from the training room.
“It’s hard to predict, but we want him to be 3-4 days non-weight-bearing, and then he can sort of go as (he can) tolerate relative to his rehab,” Saban said Thursday morning on “Golic and Wingo.”
“He was back on the field in 12 days before the last one, and this one doesn’t seem to be quite as serious as the last one, and it’s not his plant foot to throw, so hopefully in a couple of weeks we’ll be able to have him back on the field. Now how capable he’ll be and how close to 100% he can get just kind of remains to be seen.”
Depending when he started his rehab, Tagovailoa should be in Day 5 or 6 and having transitioned from non-weight-bearing to walking with a boot and working on range of motion and balance, with minimal straight-line activity, including some potential jogging on an anti-gravity treadmill. By Day 10-11, which would be Oct. 30-31 in the midst of Alabama’s second bye week, Tagovailoa will likely begin engaging in more agility-based exercises to test how far along he is in the healing process.
“Alabama has an amazing rehabilitation facility, probably one of the best in the country, so what happens with (Tagovailoa) is not the standard,” Coetzee said. “The initial goal in the first few days is to get the swelling down, get the soft tissue to settle. And then you can start with range of motion and AlterG (anti-gravity treadmill) and all the stuff they do there to maintain movement and reduce swelling.”
Alabama’s trainers utilize state-of-the-art pressure censors and monitors that measure both balance and strength of the injured ankle in comparison to the other, healthy ankle. This allows the training staff to monitor how much progress the injured ankle is making in its recovery compared to the baseline strength of the other ankle. Coetzee said most doctors recommend the injured ankle be producing at least 80% capacity of the healthy ankle to return to the field.
“I saw some of his testings (from last postseason) at a presentation and it was amazing how quickly he recovered essentially back to baseline,” Coetzee said of Tagovailoa. “So, you basically get a printout with lines on it that shows how the injured side compares to the opposite side. It’s a very specific and scientific method to do it.”
For comparisons, Gates is currently treating a high school athlete from the Cincinnati area who recently underwent a similar tightrope procedure the week before Tagovailoa and is engaged in a similar “rapid rehab” process with an anticipated timetable of 28 days before he’s able to return to the field.
About 10 days out of surgery, Gates’ patient has been off crutches for the last several days and has begun strength and range of motion exercises in his school’s training room, along with ice treatments to reduce swelling, with agility work next on the table beginning next week.
“If he can handle some agility stuff between Week 2-3, then we’ll give him more football-like activities (between) Week 3-4, with the possibility of playing football (at the end of) Week 4,” Gates said.
Without any direct knowledge of Tagovailoa’s current medical status, Gates too expressed some reservations about whether Tagovailoa’s proposed three-week window between surgery and returning to the field in time to play against LSU was even within the realm of possibility.
“I think it’s feasible, but everything has to work perfectly,” Gates said. “Depending upon the severity of his injury, it’s possible. But it’s also possible 20 days won’t work. … In my experience, playing football 20 days after having that surgery would be as fast as I’m aware of.”
As with most injuries, there's varying severity for high ankle sprains, with the more damage requiring more time to heal.
“If you think about syndesmosis, there are three parts to the ligament — there’s one in the front, one in the middle and one in the back — if you tear only the one in the front, getting back 2-3 weeks later is definitely possible,” Coetzee said. “If you tear all three, I think it’s highly unlikely even under the best rehab situation that you can get him back in three weeks. Because even with the tightrope, you can’t cheat biology. It still needs to heal.”
Because of that fact, Coetzee prefers a far more cautious approach when it comes to his athletes’ recovery times after undergoing the tightrope procedure, recommending three-to-six months of rehabilitation before ever even returning to the field of play, even for his NFL clients.
“In a perfect scenario, it is a 3-month (recovery process), but psychologically one should be prepared for 6 (months). I know that might be more conservative than what they want to hear, but it is my experience having done hundreds of these (tightrope procedures),” Coetzee said. “We always want to showcase the few exceptional ones that beat the odds by playing in a month or two, but that is not the norm and should not be the expectation of the general sporting public.”
Whenever Tagovailoa does return to the field, he’ll undoubtedly also have the support of an external ankle brace and heavy taping to further stabilize the still-healing right ankle. But whether or not that is against LSU on Nov. 9 remains largely uncertain.
“They are superstars as well, people with better genetics than others, so he might be genetically gifted where he heals quicker than normal people,” Coetzee said of Tagovailoa. “But I personally think, if he plays in three weeks, it will be close to a miracle.”
Contact Montgomery Advertiser sports reporter Alex Byington at firstname.lastname@example.org. Follow him on Twitter at @_AlexByington.