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  • Writer's pictureDr. Bruce

Injury Report: My take on the Milano situation

The new league year has started. Beane is doing his thing with the cap and free agents. Everyone has questions about what the team will look like in 2024. Some old favorites are gone and I’m sorry to see them go. We came to love Tre White, Mitch Morse, Jordan Poyer, Micah Hyde to name a few. There’s a transition movement at One Bills Drive. However there is a big unanswered question. What’s up with Matt Milano and his leg injury? This has been a question since he got hurt. In highly unusual fashion the Bills, the league, the sports media has been almost silent about it all. Recently Brandon Beane made some cryptic remarks saying Milano would not be ready anytime soon but should be ready when “the pads go on”. The pads don’t go on until training camp. That’s a long time to be laid up from a “lower leg injury without ligament damage “ that required surgery. So what really happened? What injury takes so long to heal and will he be ready to play opening day?

After rewatching the game where he got injured and the way his leg was forced side to side in the pile I am guessing he sustained a major tibial plateau injury. At this point I will also state that I have no inside information and all of what I am about to say about Matt Milano is conjecture. The medical information is for your information and education about a serious orthopedic injury.

The knee is a fairly complex joint composed of the lower part of the femur(thigh bone) ligaments, cartilage and the 2 bones of the lower leg ( tibia and fibula). The lower femur rests on the cartilage and the proximal tibia (shin bone). The fibula is attached to the lateral (outside) edge of the tibia. With a high impact injury the top part of the tibia can be compressed down, a piece or multiple pieces can be broken off or all of the above. The amount of injury depends upon the forces applied and how quickly they were applied to the joint. The Schatzker classification system is used to describe the injury and its severity. It ranges from 1 to 6 with 6 being the worst type of injury. Higher classification injuries are also at greater risk of damaging the nerves and arteries going to the lower leg. At times if the bones move too much there can be permanent damage which would lead to loss of function of part or all of the lower leg.

With significant injuries there is a need for surgery to hold the broken pieces of bone in place and reconstruct the surface of the bone to allow the joint to work properly. With the apparent way that Matt Milano’s leg was injured I suspect the lowest grade injury would be a level 3 a more likely he sustained a level 4,5 or 6 injury. These all require surgery to stabilize the bones. This is usually done using an open technique( cutting through the skin) and using screws, pins and plates to hold the bones together. This is a procedure called open reduction and internal fixation (ORIF). Following surgery there is usually a 6- 12 week period of no weight bearing and then a lengthy recovery time with physical therapy. Frequently after anORIF there is some long term residual pain. Sometimes the pain persists to to point of eventual need to remove the hardware used to fix the bones. In a review of the literature an athlete having this type of injury and surgery has roughly a 70-80 percent chance of returning to sports. This is concerning in regards to Milano’s injury. In general total rehabilitation timeline is usually 6-9 months without any setbacks. This would coincide with the statement from Brandon Beane and the timeline of training camp/preseason. The only question I have is will Milano have residual pain or restriction of movement of his knee/ leg. Time

will tell if he can play at the pro bowl caliber we are used to seeing.

Once again I reiterate that the Bills have been extremely quiet about this injury, surgery and potential recovery and I am making my assessment based on the video of the injury and the prolonged recovery time compared to other types of leg injuries or fractures. I truly hope we See one of our great playmakers return to form and help us get over the hump in 2024.

Let me know if you have questions or want me to touch on a specific topic in the future. Gooo Bills!

Dr. Bruce

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