Monday, July 07, 2008

Dontrelle and His Knee

Since the moment he slipped off the mound that rainy night in Chicago, I have suspected that Dontrelle Willis has been suffering from a torn anterior cruciate ligament (ACL). Now that he is going back to Detroit to have his knee examined again, I'm going to finally do what I've been wanting to do for a while: show why I've thought that.

First, we need some background information on the ACL and what it does. Believe it or not, wikipedia is a great resource for the human anatomy. We need to know first that the ACL is a ligament, and ligaments attach two bones together. In the ACL's case, it connects from the back of the femur (thigh) to the front of the tibia (shin). It's main job is to provide stability to the knee by preventing the tibia from sliding to far forward. One of the more common mechanisms for an ACL injury is a hyperextension of the knee.

I have long felt that the hyperextension caused the ACL in Dontrelle's right knee to tear. Unfortunately, I am not privy to his medical information or any internal information the Tigers have. I also only have the lessons learned from a Mechanicl Engineering dgree and a semester's worth of human kinetics under my belt. I am pretty interested in this stuff, but I don't consider myself the expert of the people who made the decisions regarding Willis, nor do I have all of the information about what was done to check his knee. I just know things have been fishy.

For a normal pitcher, the ACL is not stressed during pitching. Plenty of players in several sports have played through an ACL injury. Tiger Woods comes to mind, after playing for a year with a torn ACL. While he won several tournaments on the bad knee, he also had meniscus damage and a double stress factor in his knee that developed, probably as a result of the loss of stability in the joint. Unfortunately, Dontrelle Willis is not a normal pitcher. His leg kick seems to act as a timing mechanism. If anything is off in that knee, his timing well be too. This would seem to explain his inability to repeat his mechanics over the past few months.

The initial diagnosis of a hyperextended knee was, in a word, fishy. The hyperextension is what happened on the mound, but I don't see how an MRI can confirm that when an instant replay simply shows that. At that point, I assumed it was something worse until Willis proved otherwise.

Then came May when Willis was recalled from his rehab assignment as a precaution. There are contradictions in the article:

...Willis said he didn't re-injure it and that it's just a precaution.

"They want to make sure everything's OK," Willis said, "because they don't want me to go out there and hurt myself further and be out for three months."

...The play in question came in the first at-bat of the game. Willis fielded a ball along the third-base line and fired a throw to first off his left leg. According to reports, he seemed to be favoring the leg as the game went on.

So he was favoring his knee the whole game, but didn't re-injure it? If you say so. The worrisome part, apart from the blatant dishonesty, is when the play happened: a ground ball down the third base side when Willis likely pivoted on his right knee, thereby making a play where an okay knee

Then came the return, when Willis could not control where the ball was going against Cleveland. His landing was timid, his mechanics were off, and I did notice a slight limp in between pitches. If the Tigers seriously thought his knee didn't warrant a test at this point, I don't know what to say.

Finally, I want to show the dagger: photographic proof of his tibia translating too far in the posterior direction, courtesy of Roger Dewitt:

That just looks hideous. The lower leg is clearly extending past the knee. I will be shocked if Willis doesn't have at least a torn ACL. This time, I will not believe the Regardless, he needs to be shut down for a long time.

If this had been properly diagnosed three months ago, what could have been prevented?
  • I have no idea the mental effect pitching on a bum knee must have on Willis. With a motion that is so dependent on timing, will he ever be able to rediscover his mechanics? Will he ever be able to trust his knee during the landing motion?
  • Further knee damage? Think about any household object. When one piece breaks, other pieces will break because the broken piece is not giving the support it once did. Pitching so long on a torn ACL would cause the knee to do things it shouldn't. Just look at the picture above and imagine what else could be wrong. The tibia seems to be rotated too far to the inside, could his MCL be in peril as well? I don't even want to know what effect this could be having on his meniscus.
  • The credibility of the Tigers' Medical staff has been tarnished, but more on that later.
Please, anybody with better credentials who wants to tear me apart. Feel free.


Mark said...

until you mentioned it in the last part of the post, i was going to bet you a nickel that his MCL was affected as well.

Mike said...

There is no way you can tell from that picture that he has a torn ACL! If what you say is happening to his knee in that picture he would have crumbled to the ground. I have torn my ACL three times and when it "pops" that is not something you continue your pitching motion on. I also was able to play with a torn ACL and most of the time it was fine but when it gives, you go to the ground! The test for an ACL is so simple and an MRI would for sure have shown it.

Eddie B said...

For what it's worth, Yovani Gallardo finished a start on a torn ACL.