Armando Salguero

Tannehill is taking time to address his torn ACL. The wise move is to have surgery

Dolphins Matt Moore (8), Jarvis Landry (14), new quarterback Jay Cutler, and Jakeem Grant (19), on the sidelines as the Miami Dolphins play the Atlanta Falcons in the first preseason game at the Hard Rock Stadium in Miami Gardens, Florida, Aug. 10, 2017.
Dolphins Matt Moore (8), Jarvis Landry (14), new quarterback Jay Cutler, and Jakeem Grant (19), on the sidelines as the Miami Dolphins play the Atlanta Falcons in the first preseason game at the Hard Rock Stadium in Miami Gardens, Florida, Aug. 10, 2017. ctrainor@miamiherald.com

The Dolphins’ sideline was packed with bodies Thursday night because the team has 90 players and no significant roster moves will be made for another couple of weeks. But a quick glance of that busy bench area failed to turn up one of the most important stories of this preseason.

Ryan Tannehill was nowhere on that patch of grass occupied by so many teammates and coaches.

The Dolphins starting quarterback — well, the starting quarterback until another knee injury determined otherwise — watched the game from a safe location elsewhere at Hard Rock Stadium.

And while we started to get answers about where the players on the field are going this season as this game progressed, questions about Tannehill still abound. And remain unanswered.

No, it’s no longer whether he’ll be out for the season. He’s done.

Yes, he is nursing another ACL tear after sustaining one last December.

But the question that looms is how Tannehill will manage his latest ACL injury. Will he do the safe, more orthodox thing and have reconstructive surgery? Or is he going to try to return to the non-surgical therapy route he followed last season that included stem cell treatment and a lot of hard rehabilitation.

Tannehill is asking a lot of experts their opinions, just as he did last year when he first injured that same ACL. And, obviously, he’s not asking my opinion because I’m no doctor or expert on the subject.

But you don’t have to really be an expert to know Tannehill went with treatment last time, avoiding surgery, and couldn’t get out of the second week of training camp without re-injuring the same ligament.

So it’s wisdom, Ryan, to have surgery this time.

Go all the way. Do the hard thing. Walk the difficult path. But give yourself the best chance of not being in the same awful spot you’re in now next year — for a third time.

That’s not just my opinion. There are folks within the Dolphins organization hoping Tannehill opts for surgery even though it’s mostly his decision.

There are also some decorated authorities on the subject who believe Tannehill would be wise to have surgery. One such authority is Dr. Shawn Anthony, an orthopedic surgeon specializing in sports medicine at the Icahn School of Medicine at Mount Sinai Hospital in New York City.

Anthony hasn’t examined Tannehill nor viewed his MRI, but he knows what has happened to the quarterback the past nine months. So what would he tell Tannehill, or any patient, who avoided ACL reconstruction once and is considering his options for treating a second ACL injury now?

“We have the most data, and the literature say there’s a successful outcome after ACL reconstruction,” Anthony said. “While the biological therapies, such as stem cell, have a lot of promise, we have less data to show they will have the same success rate as an ACL reconstruction.”

Anthony calls ACL reconstruction the “gold standard” for addressing the issue.

“For someone who’s already opted for therapy once for a partial ACL tear and is a high-level athlete returning to contact sports like he is, I think there should be serious consideration to proceeding with more the gold standard, which would be the ACL reconstruction,” Anthony said.

Anthony is well versed on all the non-surgical approaches to addressing a partial ACL tear as Tannehill had last season. And he seems leery of that path.

“There’s very limited short-term follow-up data that’s promising in that area,” he said. “But still more research is needed to understand what the long-term outcomes for patients are when you have these non-surgical treatments for that injury.

“Overall, treatment for a partially torn ACL is highly controversial. After years and decades of research, there still isn’t a definitive treatment for them. The gold standard for ACL ruptures remains ACL reconstruction and many patients who have partially torn ligaments have instability and therefore proceed with a reconstruction to restore the compromised mechanics of the knee.”

Anthony said if Tannehill has surgery — either grafting a ligament or tendon from his own body (autograft) or from a cadaver (allograft) — he can expect to return in time for next season.

“There have been large studies that have looked at the return-to-sport-rate in NFL athletes and the average is about 11 months — 10.8 months to use the exact number,” Anthony said. “There’s been several studies and it ranges anywhere from 10 months to 12 months. That’s the typical return to play time. Quarterbacks have a higher rate of return to sport than other players.”

By higher rate Anthony means more success. And that’s what Tannehill needs now — to find a successful answer to his second ACL tear in two years.

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