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From the Globe: (does not sound good - staph infection)
[I]Brady's recovery hits snag
By Shira Springer, Globe Staff | October 24, 2008
Tom Brady has been dealing with a "septic joint" since surgery earlier this month to repair a torn anterior cruciate ligament and medial collateral ligament in his left knee. In recent days, the infected knee was washed out multiple times, according to NFL sources, who cite such treatment as fairly common. When doctors wash out a septic joint, a similar action often must be done two or three times to help clear out the infection.
On his website, Brady acknowledged he underwent a second procedure Oct. 15 "to clean and test the wound." He is also being treated with a six-week course of IV antibiotics.
In the best-case scenario, the infection delays his rehab and recovery for a couple of months. If critical time elapsed before the infection was discovered and the septic joint did not respond to cleanings and antibiotics, the graft used to replace the ACL could be compromised. That would mean the reconstruction would need to be revised.
Regardless, the infection could create long-term knee problems, including reduced mobility, stiffness, weakness, and lingering pain. Patients who suffer an infection might never regain full motion, a serious consequence for a professional athlete.
But Brady's long-term prognosis also depends on what type of bacteria caused the infection. The most common cause of a post-operative septic joint is staph; if Brady has a staph infection responsive to antibiotics, he still has a chance at a good surgical result.
When Dr. Neal ElAttrache performed the ACL reconstruction at the Kerlan-Jobe Orthopaedic Clinic in Los Angeles Oct. 6, he used Brady's patellar tendon to replace the torn ligament. With professional athletes, it is preferable to use their tendons as a substitute ligament because they are believed to be the strongest. If a second ACL reconstruction is necessary, doctors would likely use donor material from a cadaver.
During the initial surgery, NFL sources said ElAttrache also repaired the MCL, which is usually done through a separate incision. In cases where patients have a torn ACL and MCL, orthopedic surgeons typically wait for the MCL to heal before repairing the ACL. While Brady and ElAttrache may have been eager to fix his knee, several orthopedic surgeons contacted by the Globe said the additional MCL repair did not necessarily increase the odds of infection.
"An ACL getting infected is extraordinarily rare," said T.O. Souryal, physician for the Dallas Mavericks, former consultant to the NFL Players Association, and an expert in ACL injuries. "I'm not sure the MCL adds to the risk, but it doesn't really take away from it. This can happen to any surgeon and with any procedure, whether it is a knee or a finger. Infection is a risk inherent in surgery."
Brady is still under the care of ElAttrache in Los Angeles. But NFL sources said the Patriots would have preferred the quarterback's surgery to have taken place in Boston with the team medical staff, simplifying logistics for post-operative care. In a statement released last night, however, the Patriots reiterated their support of Brady and his decisions regarding his treatment. NFL players have the right to choose their doctors. Several Patriots players have undergone surgery outside the team's medical staff. From the beginning, Brady planned to return to Boston for rehab, and that remains the case.
An infected joint following ACL reconstruction is a rare and major complication, occurring in less than 1 percent of patients. Along with blood clots, septic joints are the complication orthopedic surgeons fear the most. While infections can occur under the best circumstances, that has not lessened the second-guessing of Brady's decision to undergo surgery outside Boston and away from team doctors.
"The biggest concern is that the infection doesn't recur," said Dr. Lonnie Paulos, who operated on Cincinnati Bengals quarterback Carson Palmer's knee, but is not involved in the Brady case. "He's got ample time to get ready for next season. Overall, if it doesn't recur, he should still be on track to be back next year."
Mike Reiss and Christopher L. Gasper of the Globe staff contributed to this report. [/[/SIZE]I]
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