Manny Machado's recovery should be complete in time for Opening Day

The injury:

Torn medial patellofemoral ligament (MPFL)

Expected recovery time:

4-6 months

What is the role of the medial patellofemoral ligament (MPFL)?

The medial patellofemoral ligament connects the patella (kneecap) to the end of the femur (thigh bone), and is important in preventing the kneecap from dislocating. During knee bending, the MPFL stabilizes the kneecap as it glides up and down along the femur. A torn MPFL significantly increases the likelihood of dislocating the kneecap and can be treated either non-surgically or surgically.

So if a torn MPFL can be treated non-surgically, why did Manny choose to have surgery?

Initially, it appeared that Manny was going to go with the non-surgical option, but that quickly changed. On August 22^nd 2014, only 11 days after his injury, it was reported that Manny would undergo season-ending surgery to repair the MPFL in his right knee.

If Manny had decided to go the non-surgical route, his rehab would have most likely lasted between 8-12 weeks. Conservative (non-surgical) treatment of a partially torn MPFL follows this basic progression:

1. Rest and reduce swelling

2. Increase mobility in the knee

3. Improve muscle function and coordination in the core, hips, knees, foot and ankle

Now, depending on the extent of the tear to the MPFL, it is possible that Machado could have been ready for the playoffs. Having our super-human third baseman making plays like this in the postseason would have been great, but making sure that the Orioles’ two most important knees are healthy in the long run is more valuable. Considering that the chance of dislocating the kneecap increases significantly even after conservative treatment, I’d say Machado made the right decision.

The Million-dollar Question: Will Machado be ready for opening day?

The short answer: It sure seems like it.

Hopefully, most of you decided to continue reading even though I just gave away the ending. Yes, I do think Manny will be healthy enough to play on opening day and here is why.

Lets take a look at what Manny has been up to over the past few months. Although it’s impossible for me to know the exact path of Manny’s rehab, the University of Wisconsin’s sports medicine department provides a useful protocol that I can use to breakdown a general MPFL rehab plan. For the first six weeks after surgery, Manny’s knee was braced for pretty much all activities. While in the brace, low level strengthening and mobility exercises are initiated in an effort to reduce swelling, gradually improve mobility in the knee, and prevent further loss of muscle function. If you are thinking to yourself "well, that sounds kind of boring," than you would be correct.

Once some of the more tedious aspects of rehab were completed, Manny was able to begin working on more functional activities. During the second phase of rehab, weeks 7 – 12, the goals are to normalize walking, improve balance, and strengthen the repaired knee. In order to reduce the stress applied to the surgically repaired knee, a lot of athletes will begin the second phase by exercising in the pool. Pool exercises such as mini squats, mini lunges, and single leg balancing eventually progress to land exercises by the end of the phase. Phase three of the rehab, weeks 13-16, can be viewed as a continuation of phase two. Some of the goals at the end of the third phase of rehab are: full knee mobility, single leg balance for greater than 15 seconds, and good control with both squats and lunges.

So, for those of you who have been able to pay attention through the length of this post, you’ll remember that Manny’s rehab should take between 4-6 months. We’ve now covered what he was doing the first four months, but what’s the plan going forward?

In short, the final phase of rehab for Manny focuses a lot on returning to baseball activities. These activities begin slowly with exercises like light jogging, and small jumps. As Manny and the O’s medical staff become more comfortable with his ability to appropriately execute the lower level movements, his rehab can progress to more dynamic movements such as sprinting, cutting, diving for a ball etc.

Manny’s injury timeline

• August 11^th 2014 Machado partially tears the MPFL in his right knee
• August 27^th 2014 Machado undergoes surgery to repair MPFL
• October 1^st 2014 Roch Kubatko reports that Manny has full motion in his right knee and that he will begin jogging in a pool in the next week
• January 14^th 2015 Machado tells reporters at O’s mini camp that he has been doing full baseball activities except for lateral agility work.

Machado appears to be in great shape heading into the spring and should, at the very least, be a partial participant in spring training when it begins. I expect to see Machado ready to go on April 6^th, 2015.

Conservative prediction for Manny’s first game back

4-4 with 2 HRs and 2 doubles