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How would knee surgery rehab be like for Christyn Williams?

We asked Dr. Matthew Harb from The Centers for Advanced Orthopaedics to learn more about what happens with an ACL tear, the timetable for recovery and who pays for the care when a player is cut after injury.

Mystics Media Day
Christyn Williams had a season ending injury which ended her rookie season before it could start.
Photo by Katherine Frey/The Washington Post via Getty Images

Christyn Williams, the second round pick for the Washington Mystics in the 2022 WNBA Draft, saw her professional career end (for now) before it could start. It wasn’t because of subpar performance. But rather, it was because she had a season-ending knee injury. While it is unclear exactly what was damaged, Williams had to have surgery which would have ended her season, even if she wasn’t cut.

Knee injuries are common in basketball due to the variety of movements players make on the court. And when injuries happen, they can alter where a player is on the rotation after returning to the court.

That has happened Washington Wizards center Thomas Bryant. He was the starting center before an ACL tear in the 2020-21 season. But after returning from his injury last season, Bryant largely fell out of the rotation.

It’s too early to see where Williams would fall in the rotation when she returns to the WNBA for training camp next year, hopefully for the Mystics. But we can get a sense of what recovery from a typical season injury is like — and what happens to players like her. And maybe to a similar extent, Bryant.

To help us with that, we spoke to Dr. Matthew Harb, an orthopedic surgeon specializing in hip and knee surgery from The Centers for Advanced Orthopaedics in Maryland. He works regularly with athletes, ranging from high schoolers and recreational athletes to semiprofessionals.

As a disclaimer, the answers Dr. Harb gave should be considered as general trends among people in a similar situation as Williams (and Bryant), and are not to be taken as medical advice. The information below is also not an indication of what Williams has experienced or is experiencing. Please consult your doctor for your specific situation.

Now, let’s get to the interview.

Bullets Forever: Thank you for taking time to speak with us Dr. Harb. We are not aware of exactly what was torn in Christyn Williams’ knee, but if she is out for the season (at least 4 months for the WNBA), it is likely an ACL tear, but there are also other ligaments that may be torn such as the MCL and/or the meniscus.

Could you give us an explanation on what the major ligaments are in the knee like the ACL, MCL and meniscus are and how they provide stability and proper movement? And next, how often are these ligaments injured in basketball?

Dr. Matthew Harb: The ACL is one of the most commonly injured ligaments in the knee. But there are other things that can be injured with that ligament at the same time.

I will know go a bit more in detail about the knee ligaments and where they are on the knee. So the ACL (anterior cruciate ligament) stabilizes the knee in a front-to-back motion. There is also the PCL (posterior cruciate ligament), along with the ACL. It adds more stability to the knee in a front-to-back motion.

On the inside of your knee (or toward your other knee), you have something called the MCL (medial collateral ligament). And on the outside part of your knee, you have the LCL (lateral collateral ligament) though two that are, um, most commonly injured.

How does the ACL get injured? It often happens when the knee pivots in an awkward direction. We sometimes say it’s a non-contact pivoting injury, meaning the knee is twisting or someone is coming down. The ACL tears when the knee actually undergoes a subluxation event, meaning the knee almost dislocates, and then it comes back. During that process, two bones, the femur and the tibia hit together. When these bones hit each other, that’s when the ACL and other ligaments can tear. Other parts of the knee can also be damaged.

One of those things is a piece of cartilage around the knee joint called the meniscus. Everyone has a medial and a lateral meniscus, and these are at risk of damage at the time of the ACL injury. The MCL can also tear, but that requires a lot more force. If the MCL is torn along with the ACL, it can, can lead to a longer healing time. If it is just an ACL injury then that recovery is generally for less time.

BF: How strong are the knee ligaments against tearing? Anecdotally, we hear of the ACL tearing more often on the news. We’ve also learned from past interviews with your colleagues that the part of the body which tears is often the weakest body part. Is that the case with the ACL?

Dr. Harb: Yes. The MCL is one of the strongest ligaments of the knee, so it takes a lot of force to disrupt that one. LCL strength can vary. The PCL is also stronger than the ACL, which is partly why the ACL tear happens more often after a subluxation event.

BF: What is the timetable for an athlete to recover from an ACL tear, whether by itself or if another ligament (PCL, LCL, MCL) or the meniscus is also torn/damaged?

Dr. Harb: The timetable to go back to, to professional sports, um, is usually around the nine-month to one year mark. We see most of these athletes after these big-type injuries being out for about a year to make sure they’re ready.

An athlete could push it and try and go back at nine months, but you know, the risk of reinjuring it and needing a revision-type procedure after a surgical reconstruction is much, larger. So most of the time we’re trying to get these athletes back in shape and ensure that they are fully recovered before playing.

BF: What is the process for an athlete’s recovery from ACL or other major knee surgery?

Dr. Harb: The initial surgery doesn’t necessarily happen right away to allow swelling to subside. But about two weeks after reconstruction surgery, the athlete will work on range of motion, just moving the knee again.

After the first four to six weeks, the athlete works on getting full extension, trying to get to zero degrees and then works on getting full flexion. This is when it’s important to build more strength and endurance around the knee, trying to activate those muscles and regain muscle control.

When someone has these injuries, your muscles around the area get pretty weak. They atrophy. They lose muscle fiber diameter and strength. So all, that’s what we have to work on rebuilding.

At the three-month mark, we can really work on more specific agility exercise and the athlete can start some running. A player like Williams can start jumping exercises, which is incredibly important in basketball. And a lot of that has to do with how the ligament is, is reconstructed. While players can appear ready to return to the court well before the one-year timeframe, it still takes time for the knee muscles to get back into pre-injury shape.

BF: With an ACL reconstruction, what replaces the original ligament?

Dr. Harb: The most common and effective way of doing ACL reconstruction surgery is with a proceduyre called a bone patellar graft from the patient. We generally reconstruct by taking a tendon from the patient. So it’s grafted from the same knee in many cases. We take a bone plug that is about 10 millimeters by 25 millimeters. Those plugs are put into bone tunnels that we made for them. So we’re creating these bone plugs from their, from their native bone and using part of their patella tendon to reconstruct that ligament.

There are other methods of reconstruction, such as an allograft, meaning it’s a ligament or tendon from a cadaver. And we can take a patient’s quad tendon, but that’s usually done in younger patients.

BF: Christyn Williams and Wizards center Thomas Bryant are in their early 20s, have or had season ending knee injuries. In Bryant’s case, he has made a successful return to play (which is different from him playing in his previous starting role). In the past, knee injuries and ACL tears often meant a player would never make a successful return to play, but full recoveries seem to happen more today. Why?

Dr. Harb: Two reasons. First, medicine has improved as we have learned what methods of knee surgery are more effective than others. Second, it’s anecdotal, but professional athletes have worked their entire lives to get to this point. So when they have a major injury, they are going to do everything possible to get back into playing shape.

BF: Finally, this is a health insurance-related question. Williams was injured while she was with the Mystics, but she is now no longer with a team. She was also a senior at the University of Connecticut (and was on their college team weeks earlier) at the time of injury. Who pays and takes care of her surgery and recovery in these types of situations (in a general sense, but not specifically hers)?

Dr. Harb: Most professional athletes sign with teams via a formal contract. And professional teams in major leagues, including the WNBA, have health insurance policies that cover the players whenever a work-related injury happens. So the Mystics’ insurer is responsible for covering Williams’ primary care because she was injured while working for them — even if the Mystics cut her soon after the injury.

There may be some specifics about what the team is not willing to cover with care. Professional and even high performing college athletes often have supplementary insurance to protect themselves specifically for this reason. And since Williams is under the age of 26, she could be listed on her parents’ personal health insurance policy as another supplement.

I’m doubtful that UConn, meaning their athletics department, would have their insurer cover it because the college basketball season was over when this injury happened.

Thanks again to Dr. Harb for his insights. While we hope that we don’t see any more player injuries, we will continue to get more from The Centers for Advanced Orthopaedics as they happen.