Philadelphia Eagles News

Head Athletic Trainer Rick Burkholder

Opening Remarks: "Thanks for being on here. Let's go back to where we ended yesterday. As some of the people on the call know because some of the information has been distributed, as (Monday) progressed, Dr. (Peter) DeLuca and myself as I told you would be consulting with other physicians and other athletic trainers around the league as well as within the Rothman Institute Group. It was decided yesterday that along with the arthroscopic procedure this morning on Jason (Kelce) that Dr. DeLuca would go ahead and repair Jason's MCL. The reason for that was that as you looked at the MRI you could tell that the MCL was rolled up a little bit away from its attachment point so he wanted to make sure that he had that secured. It would allow him to have just as quick of (a) recovery time if we weren't going to do the ACL and if he was going to do the ACL (it would) give him a real stable knee to do the ACL in a couple of weeks. That was decided yesterday afternoon as we progressed through things.

"This morning at Jefferson at the Navy Yard, Dr. DeLuca and Dr. Chris Dodson, who's also a physician at the Rothman Institute, they put Jason under anesthesia (and) they evaluated his knee as I told you they would and his knee was much looser than it was on the field (on Sunday) or in the training room yesterday. They figured he had a pretty good anterior-cruciate-ligament tear. When they scoped his knee they found that his anterior cruciate ligament was torn, not totally, it was partially torn but it was torn enough but in the wrong area of the ligament that they felt they were going to have to fix his ACL. They proceeded to fix his medial collateral ligament and secured that and closed him up. Then they consulted with him after the surgery and told him he was going to have to have his ACL fixed. Jason is back here at the NovaCare Complex now. He's already been treated back in our facility to get the swelling down and what will happen with him over the next three weeks, four weeks depending on how he does is we will just work his motion to try to get some motion and allow that MCL to heal down. Then he'll have the ACL reconstruction probably somewhere between three and four weeks if everything goes well and we can get everything set up.

"Then from there as you know we have had enough of them here as well as across the league, he'll have a very extended rehab time. Most of those ACLs go from anywhere from six to 12 months. We like to take about nine months if we can and that'll take us into training camp next year. We anticipate with his knee the way it looked in there this morning according to Dr. DeLuca, and his age, and everything that is going on he will have a really good surgery, rehab and recovery. That's where we're at with Jason Kelce this morning and I'm open for questions."

On whether there could be a shorter recovery time because it is only a partially torn ACL: "No. It's still the full recovery time. If you guys look at how they do ACLs, they take a tendon and put it in place of a ligament, and that generates back into a ligament. It's not that they'll actually repair his torn ligament that's (partially torn), they'll actually replace his ligament with a tendon."

On whether the procedure is the same as if it was a full tear: "Absolutely."

On whether it had been decided by the end of the day yesterday that Kelce returning was not viable: "What we decided yesterday was that if he had the MCL repaired, he would still have about the same amount of time off. We were looking at anywhere from four to six weeks. At six weeks, we thought he'd be pretty good with the MCL. There is a bye week in there and there is also some time in there with injured reserve/designated for return weeks. We had some time to play with it in there and that's why we thought it might be best to go ahead and fix his MCL now rather than take the chance of it not healing down over the next four weeks and then have to fix it later. We did go into the surgery this morning anticipating that he may not need the ACL surgery and just the MCL surgery. Once Dr. (Peter) DeLuca got in there, he decided he needed the ACL surgery."

On whether both the MCL and ACL were damaged more than they thought: "This is a little more technically than we all are ready for, but when you scope the knee, you don't get to see the ACL because it's outside the joint. When they scope, they only look inside the joint. We decided yesterday after we looked at the MRI more and shared some views with people that it was a little far away from its attachment point. There was some chance that it wouldn't heal down on its own like we thought. So at that point, we decided to the MCL only because of when we looked back at the MRI and kind of looked at the situation."

On whether they decided to do some sort of ACL procedure yesterday afternoon: "Right. When I met with you guys yesterday, we were just going to scope it as a diagnostic scope. Then, as the day progressed and we thought about it more, we viewed the options and looked at recovery times. (With) the benefit of fixing his MCL, we decided to do that no matter what. We consulted back with Jason to make sure he was a go with that, and he was, so we went that route. That was decided yesterday afternoon."

On whether his career is in jeopardy after sustaining this injury: "We never really compare these guys to any other player because they all play different positions, they have different body types, and they have different angles in their knees. They have different strengths and weaknesses. But, with everything we know about Kelce, we think that he is going to make a recovery. We think it's going to be an MCL repair, which takes six weeks to heal up, and then an ACL which takes nine months. We'll go from there. He doesn't have any other damage in his knee in terms of joint surfaces or his meniscus, nerves, blood vessels, or any of that. That's a good straightforward injury even though it's two ligaments. It does complicate things because it's two ligaments but it's not as complicated as when you have other types of damage."

On Kelce's reaction to the news: "I think he knew he had a knee injury that was pretty significant just from what he felt on the field and what he saw on tape. I think he was hoping for the best but prepared himself for the worst. One thing about all of our guys is that they know that there is risk of injury and they deal with that pretty well. We try and deal with that for them and help them out. You'll have to talk to Jason when he's available in the next couple of weeks and ask him that more specific question. Unfortunately for me, it was basically standard operating procedure. We go through this with everybody who gets hurt."

On whether ACL surgery has become something that is easier to recover from over the last few years: "I think overall, no, nothing's changed in terms of time frame because that tendon that they put in as ligament needs to go through a whole process where it goes from tendon, actually dies off and regenerates at ligament. We've known these studies since the 80s that it takes somewhere between six and twelve months for it to fully mature. I think what's happened is the surgeries have gotten better, there's been a few techniques that have changed that maybe could expedite it. But in our case, we're kind of sticking to that time frame. I think the rehabilitation has gotten better just because my field, with athletic training and rehabilitation, we've gotten more advanced. But the bottom line is, that tendon that they put in place of the ligament still needs to come back as ligament. We still look at those same numbers. At six months, you're safer than you were at three months, but at nine months, you're safer than six months. There's not a big, big increase between nine months and twelve months but there is some increase. I think the rehabilitation has gotten really good where a lot of players feel pretty good at six months and feel great at nine months and then you just have to go from there depending on where their season falls. We had to deal with that with Colt (Anderson). We were right at the eight-month mark when camp started and then the nine-month mark when camp ended. I think those things go into it. But the bottom line is, that tendon that they put in there has to come back as ligament and that hasn't changed since the beginning of the surgery back when they first started doing these."

On whether there is a likelihood for Kelce's ACL to tear again: "Yeah, I think anytime you're injured, you have a chance of redoing it. We try to take every precaution, whether it's Dr. DeLuca doing the surgery or whether it's us at rehabilitation that we stick to our guidelines and our process so that they have the best chance not to re-tear. But certainly in this game, you saw how Kelce got hurt. This wasn't a non-contact injury. This was a definite contact injury and you put a tendon in there and it becomes ligament and he gets hit like that again, there's a chance that he'll tear it. But it doesn't really have too much to do with age or anything like that in his case. The reason I stated about his age is because his joint services are so good and he's so young that he won't have all the arthritic changes that some older players have or older weekend warrior athletes that we worry about when they have their ACL done or not done."

On the rehab process for Kelce and what that entails: "Over a nine-month period, there's a lot that goes into it. For these first three or four weeks here with this MCL, we're just going to make sure we maintain his motion without disrupting the surgery, so that will be our main focus and we'll try to keep some muscle tone so that he has that when he gets done with the ACL. Then, once his ACL is done, we'll work his motion, try to keep a little bit of strength in that knee and calf, the quad, calf, hamstring area, just until we can get all of his motion. Then, you start to push the strength stuff and eventually you start to run. We have different apparatuses here where he can run non-weight bearing earlier, like in a pool, in an alter-g, which is an anti-gravity treadmill, and once he's able to be strong and run, then we start the cutting and more functional activity. Then the last couple months of the rehab process, he maintains his strength and continues to gain a little bit of strength and we work his football stuff, where we get him into positions that he would get in in the practices and games. We'll take him out and have him hit a sled and shadow and all kinds of stuff like that. We'll work his big part of the rehab is to be able to get his balance back. These guys are phenomenal athletes and their ability to know where their body is in space is what makes them great, so we really attack that in the middle of the rehab after the first couple of months where we get his range and get some of his strength going. We start to work on what's called proprioception and balance so he knows where his body is in space and he can feel where that knee is, whether he can go laterally or front and back, all that kind of stuff. We have a lot of work to do between now and next training camp, but I have top of the line staff and I've been through this quite a bit in the last 20 years, so we have a process that we follow. Jason Kelce is a process guy anyways. That's the way he's approached his football career. He takes it day to day, meeting by meeting, play by play, and that's how he's gotten so good as a player and he'll do the same thing in the rehab process. We've already talked about it the last couple of days, no matter whether he was just going to have the MCL or the ACL; he's got the right frame of mind. So, nine months seems like a long way away but it'll go day to day, week to week, month to month and all of the sudden we'll be at Lehigh again next year."

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