Hey there, it’s Raj from 3CB Performance.
Emerging Orlando Magic wing Jonathan Isaac injured his left knee on New Years’ day
against the Wizards, with the injury later diagnosed as a posterolateral corner injury
and medial bone contusion.
In this video, I’ll explain the injury, Isaac’s return timeline, and if it’ll
impact his career moving forward.
As Isaac planted his left leg on this drive,
his left knee significantly bowed outwards - known as knee varus
and pushed backwards into what’s called hyper-extension.
This combination force specifically gaps and stresses the lateral (outer) and posterior
(back) part of the knee, known as the posterolateral corner (PLC).
This corner is extremely rich in anatomy, including three major static stabilizers - the
lateral collateral ligament (LCL),
popliteus tendon (PLT), and popliteofibular ligament.
Four major dynamic structures - the biceps femoris hamstring muscle,
popliteus muscle,
iliotibial band (ITB),
and lateral (outer) head of the gastrocnemius (superficial calf muscle)
and numerous smaller ligaments and stabilizing structures as well.
A PLC injury involves damage to any of this anatomy and roughly 72% of the time also involves
concomitant damage to either the anterior cruciate ligament (ACL) or - more commonly
- the posterior cruciate ligament (PCL).
However, according to Orlando Magic president of basketball operations Jeff Weltman, Isaac
suffered no damage to the ACL, PCL, or medial collateral ligament (MCL). This unique injury
is often referred to as a “isolated” PLC injury but that’s a bit confusing considering
the PLC has so much anatomy in and of itself with lots of variability in terms of what
was injured.
Based on this information, the injury is likely a low to mid grade PLC injury without any
full tears or instability in the knee.
Additionally, Isaac has been diagnosed with a “medial bone contusion” aka bone bruise.
During acute knee varus force injuries, the two bones that make up the knee - the femur
(thigh bone) and tibia (shinbone) - can actually touch together on the medial (inner) aspect
resulting in tiny microfractures on the surface of the bone with subsequent build up of blood
and edema.
The team announced that Isaac will be re-evaluated in eight to ten weeks. He’ll likely spend
around the first four weeks in a knee brace that’s locked in extension to allow for
healing and week 5 and onwards undergoing physio.
The physio process will work on eliminating pain, restoring normal knee range of motion,
gradual progressive strengthening, neuromuscular and postural control, overall fitness, and
reducing side to side asymmetry which the research shows is a key indicator of recovery
and injury risk.
If rehab goes well, he’d be cleared at the re-evaluation for return to higher intensity
activities and return to play protocols. If he isn’t cleared, the next step depends
on the why.
If the medial bone contusion (bone bruise), is the major issue, then he’ll continue
in the physio process. The return timeline on knee bone contusions are extremely variable.
For example, on the shorter end of the spectrum, Andre Igoudala returned from one in roughly
two weeks during the 2018 playoffs and, on the other end of the spectrum, Robert Covington
missed nearly four months last season.
If upon re-evaluation Isaac is primarily limited by the PLC injury, then surgery is a distinct
possibility which the team has publicly acknowledged.
All in all, the key inflection point will be around the eight week mark. At that point,
If Isaac is responding very well to rehab, he could be back in early to mid March but
if he doesn’t and needs surgery on the PLC injury, he may not be cleared until training
camp next season.
Regardless of timeline, the very good news is that Isaac - with appropriate rehab and
ongoing strength and conditioning- very likely won’t have long-lasting effects from the
injury because bone contusions - albeit quite painful - typically have no long-lasting effects
and because his PLC injury was relatively mild without any ACL, PCL, or MCL involvement.
He’ll likely have soreness and some discomfort in the knee in the medium-term along with
having to overcome kinesiophobia (fear of movement and re-injury) but those are inherent
after any knee injury. In the end, Isaac came out quite fortunate as this could’ve been
far worse.
That’s a wrap for this video. Thanks for watching. My goal is to provide you with in-depth,
evidence based, narrative free analysis and you can always find me on IG and Twitter @3CBPerformance.
Make sure to sub to the channel and follow along on all social media for the latest updates.
3CB out.