Francis Ngannou successfully defended his title against one of the most deadly heavyweight
contenders in the world with a catastrophic knee injury?
Yeah.
Francis Arms Up BROLL (This isn’t even my full power)
Sound impossible?
Well today, I am going to explain what was wrong with his knee and how he fought his
way to victory in spite of it.
On Jan 22, 2022 Francis Ngannou and Cyril Gagne fought at UFC 270 for the unified, undisputed
Heavyweight title.
This was a highly anticipated match between two dynamic, exciting fighters.
On the one hand, you had the genetically-gifted champion Ngannou, who was known for making
quick work of his opponents with heavy blows, that more often than not, lead to dramatic
knockouts.
At 6’4” and 250 lbs Ngannou had a frame that was crafted by his years of work as a
child labourer in sand mines in his native country.
Thick, dense muscle that allows him to swing a freaking bag of hammers with every punch
thrown in earnest.
It has been said that if Ngannou even touches you with one of these punches, you will instantaneously
find yourself in another dimension, wondering what year it is and how your were transported
there.
On the other hand, you had the undefeated, new challenger Gane, a well-decorated kick
boxer who was also know for finishing his opponents with strikes.
With a height and weight nearly identical to Ngannou, on paper he appeared to be well-matched
with the champion.
While Ngaanou was known for instantaneously teleporting opponents with individual sledgehammer
blows, Gane was instead recognized for breaking opponents with a combination of punches and
kicks, that ultimately proved only marginally less frightening.
Both fighters had the ability to knock each other out, and the world anticipated that
at UFC 270, one of these fighters was going to go to sleep early.
BROLL Throughout with Francis and Gane
However, apparently neither Ngannou, nor Gane got the memo, because the fight did not unfold
as had been expected.
In the first two rounds, Gane remained at range, kicking and punching Ngannou whenever
he came close.
He seemed content to repeatedly touch Ngannou with submaximal shots that would score points
on the judge’s cards, but do little to stop Ngannou in the fight.
Ngannou attempted to stop Gane’s motion by constantly coming forward, and cutting
off Gane’s movement whenever possible.
When close enough, he threw extinction-level swings at Gane’s head.
However, Ngannou missed frequently, and he appeared laboured and slow.
He plodded around the ring flat-footed unable to catch Gane, and unable to change direction
quickly or move with any of the explosivity for which he was known.
Slowly falling behind on the scorecards, it looked as though Ngannou, who was not known
for fights lasting any substantial length, might be tiring early.
Commentator Joe Rogan, wondered whether Ngannou’s knee sleeves spoke to a problem that may have
precluded Ngannou from adequately training cardio in the weeks before the fight.
Whatever the cause, it was clear that if the fight continued to progress in the same manner,
Ngannou would not be able to retain his championship belt.
Everything changed in the third round.
In the third round Gane threw a kick that Ngannou caught, and it quickly became clear
that Ngannou’s approach had changed between rounds.
With Gane’s leg cradled in his arm, Ngannou lifted all 250 lbs of Gane into the air and
then proceeded to decisively body slam him to the canvas.
He continued to wrestle and grapple with Gane for the remainder of the round, effectively
nullifying Gane’s compounding strikes game plan.
BROLL that
By the end of the third round, it was clear that the momentum had changed, with Gane now
looking bewildered and visibly dejected at the turn of events.
The fourth and fifth rounds proceeded in similar fashion with the fight ending with Ngannou
on top of Gane, accumulating more than several minutes of top time in the round, and leaving
the audience stunned by a side of Ngannou that had not previously been seen before.
When last seen in a grappling match, Ngannou had appeared uncomfortable at best and clearly
out of his element.
In this fight, Ngannou looked to be quite familiar and comfortable with grappling, demonstrating
that he had made effective use of his time training at Xtreme Coture’s Gym.
Which leads me to the question on everyone’s mind, “what prompted the change in strategy
on Ngannou’s part”?
In the post-fight interview, Ngannou provided some information that shed light on the reason
for his change of strategy.
Ngannou stated that 25 days prior to the fight, he had injured his knee while training.
He described the nature of the injury and stated that he did not feel mobile or comfortable
with change of direction during the fight.
He was forced to keep himself relatively still to maximize the stability of his knee and
to prevent any problems while fighting.
After two rounds it became clear that he was not able to deter Gane’s onslaught with
such a flat-footed approach.
A different tact was needed.
After the second round, his coaches advised Ngannou to switch to takedowns and grappling.
This approach would take his unstable knee out of the equation and at the same time,
nullify Gane’s mobility and fluidity.
With Gane ahead on the scorecard, and Ngannou falling increasingly behind, there wasn’t
anything to lose with the change in strategy.
Although Ngannou had not revealed his injury prior to the fight, commentators questioned
whether an undisclosed injury might be an explanation for the knee sleeves he wore on
both knees at the fights outset.
Ngannou had not been known to use sleeves in the past, so this change was sudden and
worrisome.
Talk about a way to draw your opponent’s attention to your weakness.
[Hey bro, don’t look at me limping and my wonky knee with the bullseye painted on it.
It ain’t nothing.
Everythings all good.
Wink wink].
To Ngannou’s credit, he was wearing knee sleeves on both knees, so there was some mystery
to the whole thing.
Either both knees were jacked, neither knee was jacked, or one knee was jacked and Ngannou
did not want to reveal which one.
If the latter was the case, then Gane had a 50% chance to determine which knee was the
weak link.
How to tell, how to tell.
Ngannou also stated during the interview that he was afraid to be kicked on the injured
leg, so he had protected that leg during the fight.
Given that Ngannou fought primarily using an orthodox stance with his left leg forward,
this leads me to believe that the injury was to his right knee, which would be less likely
to be kicked in this stance.
But why does this matter?
The nature of his injuries speak to the importance of his stance.
In the presser, Ngannou revealed that he had suffered a complete tear of his MCL, a partial
tear of his ACL, and an injury to his MPFL ligament.
These are three important ligamentous stabilizers of the knee that affect two of the three compartments
of the knee.
The major ligament stabilizers of the knee include the cruciate ligaments that cross
inside the knee, the ACL and the PCL, the collateral ligaments on either side of the
knee, the MCL and the LCL, and a number of smaller accessory ligaments on either the
front anterior, or the back posterior aspect of the knee.
The MPFL is one of the ligaments on the front of the knee.
The ACL resists posterior translation of the femur off the back of the tibia.
This means that it stops the thigh bone from sliding off the back of the shin bone.
It is damaged with hyperextension or rotation of the knee.
The MCL resists valgus opening of the knee.
This means that it stops the knee from opening sideways toward the midline, so it is damaged
when the knee collapses inward.
These ligaments, when damaged, will create a characteristic pattern of looseness or laxity
in the knee during direction change.
In an orthodox stance, any movement away from the right leg to Ngannou’s left, particularly
if in an explosive manner, would be problematic and would cause a pivot event, where the femur
and the tibia slide away from one another.
Anyone who has torn their ACL will recongnize the instability, and the nauseating sensation
that I am talking about.
A complete MCL tear, which would allow 10 mm or more of opening on the inside aspect
of the knee would make this instability even worse.
Yeah, not great for fighting….at all, never mind an undefeated upstart killer like Gane.
But don’t forget the MPFL injury which would make the whole situation worse.
The MPFL, or medial patellofemoral ligament, is the main medial stabilizer of the patella
that prevents the patella from being displaced laterally over the end of the femur.
Inclusion of this ligament injury to the other two speaks to the severity of the instability
that would be present in Ngannou’s knee.
This combination of injuries would make the stability of Ngannou’s knee nonexistent,
and the ability to fight in a championship match nearly impossible.
In fact, four days prior to the fight when medically examined, Ngannou was advised by
the clearing physician not to fight lest he risk irreversible damage to his knee, especially
if kicked in this knee from the outside.
UFC light heavyweight Modestas Bukauskas can attest to the damage that is caused by a kick
to the outside of a native knee after suffering a horrendous injury in his loss by TKO to
Khalil Rountree at UFC Fight Night: Brunson vs Till.
And that is with normal ligaments before the injury.
A similar kick to Ngannou’s already compromised knee would result in even more catastrophic
injury than was already present.
But not one to shy away from a challenge, Ngannou ignored the physician’s advice and
decided to fight anyway.
[WHy am i not surprised - snarky voice.
Does anyone ever listen to their doctor?]
But being a championship fight an all, I do get it.
Well the competitive side of me gets it.
The medical side of me thinks that this is absolutely crazy.
Ngannou’s knee would prove to be particularly susceptible to outside kicks to the right
calf and knee, and oblique kicks to the shin or knee.
There would not be any resistance to his knee collapsing inwards with one of these kicks.
Those rinky-dink knee sleeves.
Useless.
Direction change to the left would be 100% crap.
Which is pretty much what we saw during the fight.
Straightforward plodding, an absence of explosivity, and an inability to chase Gane in the ring.
Not what the crowd had expected and not really what they wanted to see from Ngannou.
However, it was exactly what Ngannou had to do to make the best of a bad situation.
To be honest, it is actually quite amazing that Ngannou was able to perform as well as
he did with this combination of injuries, and only 25 days after injury no less.
Normally, patients would not engage in any activity other than physical therapy for the
first six weeks after injury.
Ngannou both trained and then participated in a Championship fight against a trained
assassin in less than four weeks.
[mind blowing up here]
So what does this mean for Ngannou moving forward?
Well Ngannou has one more fight in his UFC contract that runs out in December 2022.
He has fought once in each of the last three years so a single fight in 2022 would not
be unusual.
Recovery from an MCL injury without surgery would take 3-4 months before training would
be possible and up to 6 months for serious competition.
Surgery to repair the MCL, which is not common, would delay progress slightly.
A partial ACL injury would likely not require surgery, if Ngannou did not have a frank pivot
shift or a significantly gross Lachlan, which both describe the degree of laxity associated
with the ACL injury.
However, a grossly unstable ACL would likely require surgery to allow Ngannou to return
to competition with the ability to move in a manner to which he was accustomed.
Without surgery, rehabilitation for this injury would follow a timeline similar to that of
the MCL.
With surgery, on the other hand, full recovery would be on the order of 9-12 months.
The MPFL could be treated non-operatively with physical therapy, if Ngannou did not
demonstrate further patellar instability.
Were surgery required, full recovery would be between 4-6 months.
Depending on what treatment options are available to Ngannou and how he decides to proceed,
he will be focusing on rehabilitation for anywhere between 3-12 months before we see
him in action.
If we see him in action that is.
As contract discussions between Ngannou and Dana White have stalled, Ngannou may just
let his contract run out at the end of 2022, without another title defense.
I guess we’ll have to wait and see.
So what do you think?
Would you have fought GAne with a jacked up knee, or would you have postponed the fight
to a later date?
Let me know in the comments below.
As always, that’s been a word from Dr. Chris, not your everyday ortho.