When Will Von Miller Return?

Thanksgiving is becoming the next Billsy curse. Last year, Tre’Davious White suffered an ACL tear on Thanksgiving. Eerily, on the day Tre returned to action, Von Miller got injured.

Von Miller’s injury has been quite the roller coaster. Initial fears of an ACL injury were palpable as soon as he went down against the Lions.

The next day, reports surfaced that he only sustained a lateral meniscal tear. Without an ACL injury, Von was speculated to have a chance to return this season.

Last week, the team placed Von on the IR. This was conflicting because Von stated he might be back as early as the Jets game (Week 14). Regardless, there was still hope he was going to return later in the year.

Unfortunately, Von had surgery on December 6^th. He had his operation with Cowboys team doctor, Dr. Daniel Cooper. It was supposed to be exploratory to address his meniscus, but ultimately led to an ACL reconstruction. It is rare, but not unheard of, for imaging to be inconclusive. This was the case for Von.

Knee History

Von Miller had an ACL reconstruction on his right knee before. In 2013, he suffered an isolated ACL tear, which means there was no other trauma to the meniscus, cartilage, and/or other ligaments of the knee. He was able to return in nine months, finishing the 2014 season with 14 sacks and an All-Pro selection. To reconstruct his ACL in 2013, the surgeon took Von’s patellar tendon, from the same knee, to use as a graft for his new ACL. This is important to note, because you cannot take a graft from the same area for future reconstructions.

Current Injury

We now know that Von has suffered his second ACL tear to his right knee. He also sustained a lateral meniscus tear and cartilage damage. 

Von recently explained his injury and surgery on The Pat McAfee Show. For his most recent ACL reconstruction, they needed to harvest his patellar tendon graft from his contralateral knee. This squashed the speculation that this potentially was an ACL ‘repair’ instead of a ‘reconstruction’. A repair would allow an expedited return of (approximately) six months but does have a high failure rate (1).

It is currently unknown if they addressed his lateral meniscus with a meniscal repair or simply trimmed it (meniscectomy). It would be more beneficial for Von to have the repair, as it improves the longevity of his knee. The reports of cartilage damage are more concerning, as this is another blow to his longevity.

Prognosis

The return to play after an ACL is lengthy. It is more difficult when it happens a second time, known as a revision. The average return to play in the NFL after an ACL reconstruction is 10.8 months (2). Unfortunately, the return to play after a revision is 12.6 months (3). Von is a freak, but he has a lot of factors working against him. At an advanced football age of 33, with a revision ACL and meniscal/cartilage damage, this will not likely be a quick recovery. Look for Von Miller to start the 2023 season the PUP list. In a best-case scenario, he could return as early as October, but do not be surprised if his rehab takes as long as late November/December.

Citations

1. DiFelice GS, van der List JP. Arthroscopic Primary Repair of Proximal Anterior Cruciate Ligament Tears. Arthrosc Tech. 2016 Sep 19; 5(5): e1057-e1061. doi: 10.1016/j.eats.2016.05.009. PMID: 27909675; PMCID: PMC5124221.
2. Shah VM, Andrews JR, Fleisig GS, McMichael CS, Lemak LJ. Return to play after anterior cruciate ligament reconstruction in National Football League athletes. Am J Sports Med. 2010 Nov; 38(11): 2233-9. doi: 10.1177/0363546510372798. Epub 2010 Jul 7. PMID: 20610771.
3. Okoroha KR, Kadri O, Keller RA, Marshall N, Cizmic Z, Moutzouros V. Return to Play After Revision Anterior Cruciate Ligament Reconstruction in National Football League Players. Orthop J Sports Med. 2017 Apr 4; 5(4): 2325967117698788. doi: 10.1177/2325967117698788. PMID: 28451611; PMCID: PMC5400221.

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