Thoughts on Cam Newton's Ankle Surgery

Why is Cam having surgery now? Is the four month timetable reasonable?

The Panthers announced today that quarterback Cam Newton will have surgery to address ongoing ankle soreness that hasn't responded to offseason rehabilitation. Jonathan Jones of the Charlotte Observer reported that a team source told him, "the ligaments in the ankle had been stretched out, and the procedure will tighten them." In their press release, the Panthers said they expect Newton to recover in time for training camp.

The announcement was understandably followed by a flurry of questions.

what does "tighten ankle ligaments" mean?

Newton's ankle problems haven't always landed him on the Carolina injury report, but there have been reports of soreness throughout his career. A single severe or repeated ankle sprains -- which are stretches and tears of ligament fibers -- can cause chronic looseness of those ligaments. Sometimes, the ligaments tighten up as they heal. Other times, the looseness remains. That's a set up for ongoing pain, especially when changing direction, additional ankle sprains and long-term arthritic changes.

Most athletes work through the looseness with rehab, rest, taping and braces, but some cases require a surgical procedure to tigthen the ligaments. If the report above is correct, that's what Newton has decided to do.

Newton's surgeon, noted foot and ankle specialist Dr. Robert Anderson, has a short video on this procedure on his website. The embed function isn't working; to watch the video, scroll down the procedure list to "Lateral Ankle Reconstruction" on the right side of the video frame.

During the procedure, the weakened areas of Newton's ligaments will be repaired and then allowed to heal in a more stable, tighter position.

why did Newton wait until the middle of March to have surgery?

There are three windows for offseason surgery for NFL players.

Some players have surgery immediately for conditions they know will not get better with rest and rehabilitation. This is often the case with players who have fought through nagging cartilage and joint injuries. The second window comes about a month after the season. These players may not have realized how significant their injury was, believing their soreness would improve with rest. Others may be rehabbing as preparation for surgery.

Then there's the long, nebulous third window that Newton falls into. Many players put off surgery as long as possible, hoping that rest and rehab -- even if unlikely -- will keep them off the operating table. When it becomes clear that rehab will not be successful and delaying surgery any longer would keep the player out of training camp or regular season games, surgery is scheduled. That's undoubtedly what's happened with Newton.

After the high profile saga of infection after surgery that Rob Gronkowski went through (and the less high profile MRSA cases in Tampa Bay) last year, it's not that shocking that Newton might put off surgery until he had no other option. Don't be surprised if there are other players with similar concerns. There may be more announcements to come.

what the success rate for this surgery?

Two studies, including one following "high demand" athletes, put the success rate above 90%. There are caveats here, however. Those with arthritic changes in the ankle have a lower success rate. And the study looking at athletic recovery scored success at yearly intervals. But the outcomes are optimistic. For an elite athlete having the procedure done by an elite orthopedic surgeon and with access to a top level NFL rehab team, there should be little long term concern.

is the four month timetable reasonable?

Assuming the sourced reports are accurate and Newton is having the procedure I believe he's having, the estimate is very reasonable. Most rehab protocols suggest a return to activity within 12 weeks. Newton won't make spring workouts or OTAs, but training camp -- a little over four months from now -- is a reasonable, if not conservative goal. 

Of course, while the timetable may work for Newton, it's not great news for an offense that has lost a vital offensive lineman and multiple wide receivers this offseason.

My spidey senses aren't tingling with Newton as they did Jonathan Stewart last summer. I don't think the reports today are misleading or inaccurate. But, if there's more to this story, e.g. there is significant arthritis in Newton's ankle and/or the procedure is more than "ligament tightening," all bets would be off.

I'll have more on Cam Newton as the offseason progresses. Follow on Twitter @JeneBramel and check the Second Opinion blog page for updates and analysis of injuries around the NFL.