Adam Milstead recovering from February ACL tear

This past February, UFC heavyweight Adam Milstead tore his right ACL during his fight vs Curtis Blaydes at UFC Fight Night 104. The injury happened while he was against the cage, attempting to defend a take down. In June, Milstead posted a video on Facebook, where he is shown moving around quite well, albeit with no contact. 

Most interesting to me is not his movement within the cage, but when he stops moving and shadow boxing, and starts walking at about the 30 second mark. I note that he has a subtle limp favoring the right leg, and he appears to lack full extension of the right knee when he is weight bearing. This video is about a month old, so this may no longer be an issue, if it even was an issue to begin with. Hopefully Milstead will have no complications with his recovery, and we can look forward to seeing him back in the Octagon early next year.

UFC 213: Looking at Robert Whittaker's knee injury

In the headliner bout at UFC 213, Robert Whittaker suffered what appears to be an injury to his left knee in the first round, thanks to a couple of well-placed push (or oblique) kicks by Yoel Romero. As of this writing, there is no word as to the extent of the damage, but Whittaker was apparently heard to tell his corner between rounds 1 and 2 "my leg is trashed." (I say 'apparently' because I was not able to watch the PPV portion of this card, and relied on media reports for the specifics of this bout. That, and I'm too cheap to buy the PPV after the fact on FightPass.) In an interview with an Australian news outlet posted July 11, Whittaker exclaimed "One more kick on that knee, I was gone." He is now facing a lengthy medical suspension, pending clearance by an orthopedic physician. 

On review of highlight video of this fight, it seems fairly clear what caused the damage. Romero hit Whittaker with at least one push kick placed right on the knee. Below is a screen capture of the kick. 

The full video highlight can be seen here.

The full video highlight can be seen here.

In the image, you can see the impact on Whittaker's left knee coming from an anterior and lateral direction. This forces his knee into an inward (valgus) and posterior (hyperextension) direction. The potential for damage to many structures of the knee is significant. The anterior and posterior cruciate ligaments within the joint capsule could both be at risk, as well as the medial collateral ligament that lies external to the capsule, on the inside of the knee.

Furthermore, Whittaker could have sustained damage to the posteromedial corner (PMC) of the knee. The location of this 'corner' is at the back and inside part of the knee, as shown in the picture below.   

The posteromedial corner of the left knee.

The posteromedial corner of the left knee.

We don't hear much about the PMC in injury discussions, but there are important structures here that, when damaged, can have a serious impact on the stability of the knee. These structures include (among others) the semimembranosus tendon insertion (which is one of the hamstring muscles), the posteromedial capsule of the knee joint, and the posterior horn of the medial meniscus. Damage to the PMC usually occurs in conjunction with damage to other structures of the knee, including the ACL, MCL, and/or PCL. From a functional standpoint, PMC injury can contribute to instability of the knee, particularly anteromedial rotary instability, or AMRI. This occurs due to excessive external (outward) rotation and anterior (forward) translation of the tibia in relation to the femur (see image below).

Anteromedial rotary instability of the left knee.

Anteromedial rotary instability of the left knee.

In summary, the tremendous force with which Yoel Romero kicked Whittaker's left knee has the potential to inflict serious damage, especially on a knee that had reportedly already been injured in training leading up to this fight. My goal here has been not to give a definitive diagnosis of Whittaker's knee injury, but only to analyze the injury possibilities and, hopefully, provide some education to the reader.


Reference

Lundquist RB, Matcuk GR et al. Posteromedial corner of the knee: the neglected corner. Radiographics. 2015;35(4): 1123-1137.

'Korean Zombie' recovering from knee surgery

UFC featherweight Chan Sung Jung has competed inside the Octagon only once since his 2013 loss to Jose Aldo. A combination of mandatory military service in his homeland and injuries have sidelined him. It is likely that his latest injury, sustained during training for his scheduled UFC 214 appearance,  will keep him out of action for the remainder of 2017 and most if not all of 2018.

The Korean Zombie suffered a complete rupture of the ACL and MCL ligaments in his right knee. He underwent surgical repair of the damage on June 28th, posting a post-operative picture on social media. 

In the initial report of the damage to his knee, he was also noted to have a discoid lateral meniscus. This was likely an incidental finding, unrelated to the traumatic ligament injuries. The discoid meniscus is a developmental variant, and is named for its unusual shape. A normal meniscus is shaped like a crescent moon. According to the American Academy of Orthopaedic Surgeons, a discoid meniscus is thicker than normal, and is more prone to injury. There was no indication that the discoid lateral meniscus was torn, but the surgeon may have trimmed it down during the surgery, depending on how complete the discoid deformity was. The picture below shows a comparison between normal and discoid meniscus.  

Given the extent of this injury, I do not expect the Zombie to be ready to fight before the end of 2018. What do you think? Will he step inside the Octagon before 2018 is up? Leave a comment here, or reach out to me on Twitter, @MMAInjury.