Von Miller Knee Injury Explained

Von Miller suffered a lateral meniscal tear to his right knee against the Detroit Lions. The poetic return of Tre’Davious White was thwarted with a new Thanksgiving Day tragedy. Luckily for Von Miller, he did not tear his ACL, which was a major concern based on the mechanism of his injury.

Reports of his prognosis carry mixed emotion. Although it is fortunate that he did not tear his ACL, Von may still require season-ending surgery. Lateral meniscal tears are complicated, leaving his options vast and evolving.

Structures

The knee’s menisci lie between the thigh (femur) and shin (tibia) bones. They are essentially the cushion of the knee joint. Lateral meniscus injuries are more rare than medial injuries. In fact, the lateral side is less prone to injury unless the ACL is injured (1). The lateral meniscal tears also carry more adverse events (2). Important to note, Von Miller had an ACL reconstruction in his right knee at the end of his 2013 season.

Surgical Options

Von Miller may or may not play again this season. What is certain is he will eventually need surgery; options include a meniscectomy (trimming) or a meniscal repair. These surgeries carry stark differences in recovery time and long-term effects. 

A meniscectomy is a trimming of the damaged meniscus. Recover in ‘elite soccer athletes’ showed an average RTP (return to play) of seven weeks. Pain and swelling were prevalent in 69% of the cases in the early recovery period (2). When the lateral meniscus is removed, that compartment of the knee takes 2-3x more stress than the medial compartment would sustain when the medial meniscus is removed. This may explain why lateral meniscus injuries cause accelerated cartilage damage when compared to medial injuries (3).

A meniscal repair is different because the tear is sutured together, instead of just being trimmed out. The RTP is slower though, four to six months. This delay is mainly attributed due to tissue healing time. For an athlete, it is a superior option because it has better long-term outcomes for the knee (4). 

Next Move

Von will attempt to conservatively rehab his knee and play out the 2022 season. If he can return, he will likely still miss the next 2-3 weeks. Should Von opt to have a meniscal repair, he will be out for the remainder of the season. If Von opts to have a meniscectomy, he may only be available deep into the playoffs at best. In a best-case scenario, Von can finish the season, albeit hobbled, and undergo a meniscal repair in the off-season.

Citations

1. Lento PH, Akuthota V. Meniscal injuries: A critical review. J Back Musculoskelet Rehabil. 2000 Jan 1; 15(2): 55-62. doi: 10.3233/bmr-2000-152-302. PMID: 22388443.

2. Nawabi DH, Cro S, Hamid IP, Williams A. Return to play after lateral meniscectomy compared with medial meniscectomy in elite professional soccer players. Am J Sports Med. 2014 Sep; 42(9): 2193-8. doi: 10.1177/0363546514540271. Epub 2014 Jul 17. PMID: 25035175. 

3. Fox AJ, Bedi A, Rodeo SA. The basic science of human knee menisci: structure, composition, and function. Sports Health. 2012 Jul; 4(4): 340-51. doi: 10.1177/1941738111429419. PMID: 23016106; PMCID: PMC3435920.

4. Lee WQ, Gan JZ-W, Lie DTT. Save the meniscus – Clinical outcomes of meniscectomy versus meniscal repair. Journal of Orthopaedic Surgery. 2019; 27(2). doi:10.1177/2309499019849813

Featured Image: Duane Burleson/AP