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  • Writer's pictureDr. Bruce

Injury Report: Knox Knox. Who’s there? Wrist. Wrist who? Wrist you wasn’t hurt

Alright I’m a little late on this but here is a relatively simple review of the possible injury to

Dawson Knox, surgery and recovery. First let’s start with some anatomy of one of the most complex joints in the body. The wrist is composed of multiple small bones and ligaments that attach the forearm bones(radius and ulna) to the bones of the hand(metacarpals). These multiple bones and ligaments allow the wrist to flex, extend, deviate laterally and medially, as well as well as pronate and supinate (roll over palm down or up). With all the small bones and ligaments multiple injuries can occur. With the fact that Knox played 2 games with his injury it is highly unlikely that he had a fracture of one of the bones. This would have led to an immediate stoppage of play and a probable surgery right away. This leads to ligament damage that either worsened with time or led to loss of function and increased pain leading to a decision for surgery.

The 3 most common ligaments that are likely be injured and require surgery are the scapholunate, lunotriquetral, and the triangular fibrocartilage complex (TFCC). An injury to one or more of these can lead to significant symptoms including loss of mobility, popping and clicking, and increasing pain. The most common injury is to the scapholunate ligament. The leads to limited movement to flexion and extension of the wrist along with decreased grip strength. This type of injury would also explain the dropped pass at the end of the Giants game as Knox wouldn’t be able to get his hand in the usual position and would be unable to grip the ball effectively. This would also explain his inability to effectively block because he couldn’t grasp and push with his wrist in an extended position. The lunotriquetal ligament is not quite as serious as the scapholunate since it is not as important in regards to stability of flexion and extension of the wrist. The TFCC is probably the second most common injury and deals with keeping the wrist in line with the forearm. It frequently can be damaged at the same time as the other ligaments. Because it is on the lateral side of the wrist it doesn’t hinder grip and strength as much as the scapholunate injury.

Traditional surgical repair of a complete tear of the scapholunate leads to a 4-6 month recovery period. Studies suggest that this repair gives a 90 percent chance of returning to full function. Similarly a standard repair of aTFCC tear would lead to a 10-12 week recovery period. Both of these timelines would preclude Knox from returning to play this season. With the fact that The team has not suggested that he is out for the season he may have had a newer technique of ligament surgery using a radio frequency technique. This is an electrothermal way to fuse the ligament fibers together and cause them to shrink. Think of it kind of like the way shrink wrap works when you heat it. The data I could find on recovery from this is limited but it could decrease recovery time for a scapholunate injury to 6-8 weeks and aTFCC repair to 4-6 weeks. This timeline would allow Knox to potentially return at the end of this season and for the playoffs. That is provided everything goes well and there are no setbacks in his recovery. This also goes along with the team/coach not ruling him out for the season.


Because of the limited specifics about his injury and surgery all of my comments are speculative. I can only hope that Knox will recover quickly and potentially return to his pre injury form either this season or next. Let me know if you have any questions and as always Go Bills.


Dr.Bruce

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