MedPage Today—October 24, 2008
Knee surgery on Tom Brady, quarterback for the three-time Super Bowl champion New England Patriots, has been complicated by an infection in the injured joint.
Brady suffered a season-ending injury to his left knee in a game on Sept. 7. It has been widely reported that the injury involved a ruptured anterior cruciate ligament, although neither Brady nor the Patriots have confirmed it.
He underwent surgery at the Kerlan-Jobe Orthopedic Clinic on Oct. 6, performed by Neal ElAttrache, M.D.
"Unfortunately, in the week following the surgery, I developed an infection," Brady said in a posting earlier this week on his personal Web site.
He said a second procedure had been performed on Oct. 15 "to clean and to test the wound" and has been receiving a course of antibiotics. "The infection is very treatable," he said.
But the Boston Herald has reported that the infection is more serious than Brady's posting suggested.
Citing an anonymous source, the Herald said Brady has actually undergone three washout procedures and that the infection stemmed from an unexpectedly complicated procedure.
In addition to the ACL tear, Brady's medial collateral ligament was also torn, the newspaper said. Dr. ElAttrache expected it to have healed in the four weeks after the initial injury, but discovered it was not when he attempted the ACL repair, according to the report.
The Herald said he made a second incision to repair the MCL and the infection started there. Brady is now on a six-week course of intravenous antibiotics, according to the report.
Riley Williams III, M.D., of Hospital for Special Surgery in New York, said this was a plausible chain of events.
Dr. Williams, who was not involved in the case, said the infection likely involved Staphylococcus epidermidis rather than the more serious S. aureus.
Infections are unusual in knee surgeries in any case, he said. He led a study in the 1990s that found an infection rate at Hospital for Special Surgery of 0.3%, he said, which had not changed much since. "I know it's less than 1%," he said.
S. aureus is the pathogen in a minority of cases, Dr. Williams said. Most infections in knee surgeries involve S. epidermidis, a relatively benign organism in normal skin flora.
He said the repeated washouts along with IV and oral antibiotics are the standard of care when infections do occur.
"You have to clear out the infection," he said. "That's paramount to save the graft."
He said there is no clear guideline on the best number or frequency of washouts.
If the pathogen is a drug-resistant strain, it can be a major problem, Dr. Williams added.
"Some bugs are much more difficult to clear ... they may not respond to that basic treatment strategy," he said.
He said the repair can be redone if the infection leads to graft failure, but second procedures are often not as successful.
Assuming Brady has no further complications, he can still recover fully before training camps open next July, according to Dr. Williams.
"We tell athletes there will be a six- to nine-month rehab," he said. The infection is likely to keep Brady from starting rehabilitation for another month, perhaps two or three, he said.
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