When Manny Machado collapsed on the infield dirt at Tropicana Field, tears filling his eyes as he grabbed his left knee, three thoughts immediately sprung to my mind.
1. Is it his ankle?
2. Is his career in jeopardy?
3. Is this a chronic issue?
The first two questions became fairly easy to answer.
It wasn't his ankle, and my first clue was that whole grabbing-the-knee thing. But the ankle definitely turned.
Machado's career seems to be safe, considering the diagnosis and how surgery isn't in his immediate plans. He dodged a bullet the size of a zeppelin.
As for whether it's a chronic issue, well, we're looking at a small sample size, but Machado suffered a similar injury in 2011 while running the bases at Single-A Delmarva. He hyperextended the knee, and its stability was brought into question again on Sept. 23 when he tore the medial patellofemoral ligament.
"It definitely is (chronic)," said Gene Shirokobrod, a doctor of physical therapy and certified orthopaedic manual therapist based in Clarksville. "He's still a young kid, tall and lankly. When he walks, his knees point inward - it's called 'valgus' - which predisposes that. But he's still growing. He needs to increase the overall musculature of the leg, which will help him out a lot.
"It's always a little concern, but it's not a huge concern. If the kneecap continues to dislocate, the player usually gets surgery. There's a lot of ways to fix it, but rehabilitating it is fairly effective."
The term "valgus" is akin to being knock-kneed. As Shirokobrod explained, if you don't have good quadriceps control, you're more predisposed to this type of injury. But the patellofemoral is a smaller ligament than the ACL and MCL, "more like fiber than a full, strong ligament," Shirokobrod said. "It's common in adolescents."
And at least one 21-year-old third baseman.
"He's a super-young kid who's growing into his body," Shirokobrod said. "Most of us don't reach skeleton maturity until our late 20s or early 30s. He still has a ways to go.
"I'd be very surprised if they don't use this as a wake-up call. It happens once, that OK. It's kind of a fluke. It happens again, that's pretty much a red flag. He's got to start very stringent weight-training for his lower body."
Like many of us, Shirokobrod saw Machado's knee buckle and feared that he tore the ACL and maybe the PCL.
"Those are big structures of the knee," he said. "The ACL keeps the shin bone from sliding forward and the PCL keeps it from sliding back. Those are the main ligaments of the knee, stabilizers of the knee. Those are very serious injuries.
"The patellofemoral is a ligament by a stretch. It's barely a ligament. Its main purpose is to keep the kneecap from sliding laterally. The fibers from that muscle run into the kneecap and into the femur bone and into the lower leg bone. That's the main function, to keep the kneecap from sliding laterally and dislocating. Usually when that tear happens, it's because there's a dislocation of the kneecap."
The Orioles believe that Machado can rehab the injury and avoid surgery. Dr. James Andrews examined him on Monday and agreed with that course of action.
"For the first four weeks, you pretty much let the dust settle, let all of the inflammation go down and all the scar tissue build up," Shirokobrod said. "Once those four weeks are down and the pain's gone down and the swelling's down, he can start the rehab process and get the quadriceps strong."
Should Machado eventually need surgery, Shirokobrod said the third baseman would be faced with a recovery time of six to eight weeks, with the knee immobilized for the first four. Then, he'd have to get the kneecap moving again, since it would essentially be frozen at that point, and he'd start rehabbing the muscles around it.
"He'd be ready for spring training either way," Shirokobrod said. "The Orioles would probably have to make that decision in the next six to eight weeks. By then, they should know how it's healing up. That marks the typical healing time for ligaments."
Remember when a big story late in spring training involved Machado batting second in the lineup? Now, the Orioles are just hoping to get him back in it.
So far, so good.
Note: Best-selling author Tom Clancy, part of a local investment group that helped to finance the deal that allowed Peter G. Angelos to purchase the Orioles in 1993, died yesterday after a brief illness. He was 66.
Clancy is listed in the Orioles media guide this year as vice chairman of community projects and public affairs.
On Nov. 8, 2010, Clancy announced the "Send a Message to an American Hero" program, which encourages the American public to show its support by sending messages of gratitude to veterans and active duty soldiers who are recovering at Walter Reed Army Medical Center, the nation's largest military medical facility, and clinical center of gravity of American military medicine.