Understanding MCL injuries like the one Shaq Lawson suffered

Clemson’s Shaq Lawson missed most of the Orange Bowl after suffering a sprained MCL, but he is expected to play Monday night in the national title game against Alabama.

The only question I have been asked lately more than the status of Clemson defensive end Shaq Lawson, who is expected to play Monday night in the national championship football game against Alabama, “Have you seen many hoverboard injuries?”

On the second play of the Orange Bowl on New Year’s Eve, Lawson came off a stunt and felt his “knee buckle a little bit,” he described to TigerNet after the game. Lawson returned for the second possession and sacked Oklahoma quarterback Baker Mayfield before exiting the game again.

“When I moved, something in my knee felt kind of weird,” he explained to reporters. “I tried to give it a go with a new brace on, and I felt like I couldn’t go.”

The junior, who leads the nation in tackles for a loss, remained on the sidelines with his helmet off and an ice pack on his knee for the remainder of the first half. He came out of the locker room after halftime in sweatpants, and he was ruled out for the remainder of the game.

Lawson said after the Tigers’ victory that he thought he had suffered an MCL sprain but would know more after an MRI the next day.

As reported by The Post and Courier’s Aaron Brenner, Clemson head coach Dabo Swinnney addressed Lawson’s status heading into Monday’s title game in Glendale, Arizona. “So far, so good. We’ll see him out there today, but I think the prognosis is good at this point. We’ll get him out there and run around a little bit and kind of go from there. I’m very optimistic he’ll be able to play.”

To be perfectly clear, I am not Clemson’s team doctor, nor have I spoken to Tigers team physician Larry Bowman. I haven’t examined Lawson or have specific knowledge of the All-American’s MRI results.

My commentary here is intended only to educate readers as to the nature and treatment of an MCL injury for any elite athlete trying to return to play soon after the injury.

The medial collateral ligament (MCL) is a thick ligament on the medial side of the knee (inside or side closest to the midline of the body). It stabilizes the knee against side-to-side stress. Injuries to this ligament are graded 1 to 3 based on the severity of the injury. The time required for the ligament to heal may vary based on the grade. Grade 1 MCL sprains take up to two weeks. Grade 2 MCL injuries can take up to four weeks, and grade 3 MCL tears can take up to six weeks. Fortunately, patients with isolated MCL injuries rarely need surgery.

Generally orthopaedic surgeons treat athletes with MCL injuries with rest and a brace to limit stress on the ligament. Once a patient regains full knee motion and strength and the ligament has healed enough to allow activities, he works with physical therapists or athletic trainers to progress through functional drills. Depending on how those movements and exercises go, he can increase activity and then practice and play.

Often we will put an athlete in a custom-made brace that can protect the MCL while he tries to play. Those braces, which are worn by college and pro linemen to actually prevent MCL injuries, can help an athlete return to the field even before his knee is 100 percent healed.

Another treatment option for a top athlete trying to play quickly after an MCL injury is platelet-rich plasma (PRP). Former Pittsburgh Steelers wide receiver Hines Ward played in Super Bowl XLIII two weeks after suffering a grade 2 MCL injury in the AFC Championship Game. Steelers team physician Dr. James Bradley injected Ward three times with PRP to help decrease his pain and possibly speed healing of the ligament.

It can be hard to predict just how well the athlete can play soon after the injury. Straight-ahead movements like sprinting usually aren’t a problem. Since the MCL provides side-to-side stability, pushing off and cutting can be difficult early on, even in a brace. That is the reason athletic trainers put the athlete through drills in the days leading up to the game and even on game day to see if his knee will allow those movements.

Again, I don’t know the exact nature of his injury, so don’t use this column to speculate specifically if and how well Shaq Lawson will play Monday. Regardless, Tigers fans hope his knee doesn’t keep him off the field as Clemson battles for its first national championship since 1981.

Dr. David Geier is an orthopaedic surgeon in Charleston. For more information about football injuries and other sports medicine topics, go to his website at drdavidgeier.com.