Dr. Blue's Health of the Franchise - Lilja

I knew at some point I would need to cover Ryan Lilja because of the number of times his return has been questioned on Stampede Blue.  What I didn't realize - until I focused on him - was why his situation was so mysterious.  I guess I need to knock my fandom card from Gold to Silver, because I didn't realize that Lilja has not played a down since January 13, 2008… our final fateful game of the 2007 campaign.  Apparently I was too focused on Peyton, Gonzo and Bobzilla this past year, and just not paying attention to the O-Line.  So for that, I apologize.  Now on to what we know…

Ryan Lilja, OG
Date of Injury: Probably sometime during the 2007 season
Nature of Injury: Knee injury - probably a meniscus tear, left/right unknown
Typical Rehab Process/Duration: arthroscopic surgery to either repair (trim) or remove the meniscus; maintain knee in brace for 1-3 months, do not bend knee in early days (ok another personal experience comment here - it's harder than you might think to start bending your knee after several weeks of not bending it).  Return to normal activity after 4-6 months.
Players who have suffered similar injuries: Sedrick Ellis, Reggie Bush, Osi Umenyiora

via www.colts.com

The first signs of real trouble came on March 9, 2008, when Lilja was scheduled for what was described as a "minor scope" of the right knee.  This is when they insert tiny holes around the knee joint, plunge in with a small camera and knife to rummage around, see what they can see, and snip what they can snip.  While a scope can indeed be minor (I've seen people go running within days after having one), I'm guessing that this scope was neither minor nor was it the end of the story.  My evidence?  he did not participate in any off-season practices during 2008, and five months later, Lilja was placed on the PUP list.  Move over, Angela Lansbury...

The move to PUP alleviated a roster spot for the Colts and gave Lilja time to rehab, but also offered the possibility of a return by Week 7-9 (per PUP rules).  Later that month, Lilja commented, "I'm trying to rehab it as best I can to get back as quick as I can.  That's the frustrating thing, that I've been doing that for six months." Based on this comment, we can conclude that he must have had full-blown knee surgery soon after the scope.

Two months later, on October 13, Coach Dungy offered us fans some hope: "I saw Ryan [Monday].  He feels a lot better. So we’ll talk to the doctors and see where they are [in their rehab].  But I think he will be excited to get out to practice on Wednesday."

Alas a return was not to be… on November 25, the final day Lilja would have been eligible to be back on the roster, he was moved back to the PUP list, ending his season.  His two off-season surgeries were confirmed and it came out that Ryan had made it back as far as the practice field so there were still reasons to be hopeful:

"The nice thing about watching him practice these last three weeks – and I shared this with him on Friday – was that he hasn’t lost an iota of quickness or athletic ability. For the long period of time he has been out and the difficult time he has had with his knee, he was quick, he was decisive. He was sudden. To use the athletic term – quick twitch . . . none of that has left him.  That would indicate that if we can get this knee squared away, he should be back and in terrific shape next year and that’s our hope." 

                                                                                            --Bill Polian, Nov 25, 2008

Of concern, however, was the report that the injury "just didn't heal as expected,"  and that he would undergo a third surgery.  Further, the third surgery would jeopardize his availability for offseason workouts (another 6-month rehab period takes us to at least late May 2009).

The comment about not healing as expected was what prompted me to assume meniscus tear.  The meniscus is the cartilage that sits in your knee joint and absorbs and disperses the friction between the top of your tibia (lower leg bone) and bottom of your femur (thigh bone).  Damage to the meniscus can result in those bones rubbing each other directly - OUCH!  There are two options to correct a meniscus tear: repair or removal ("meniscectomy").  Interestingly, a meniscectomy has a faster recovery period than repair.  Surgery to repair the meniscus not only has a longer recovery rate, but it also has a high (20-40%) failure rate, because of the potential lack of blood flow to the repaired area (if the tear is in the central part of the cartilage).

So putting on my sleuth hat again, my assumption is that - if the injury was indeed a meniscus tear - it was in that fringe area where repair might have been successful, but in Lilja's case, wasn't.  Additionally, we can't forget - every single one of the 6+ billion people on this earth is different, and how they react to medical procedures is a unique mixture of their age, height, weight, skeletal structure, muscular health, disease and injury history, genes, allergies, stamina, will and maybe a sprinkle of fairy dust.  For all we know our astrological sign and whether we like country music have something to do with it.  But it's simply a fact that someone will end up at the bad end of the bell curve when it comes to recovery time, and it appears that Lilja has fallen on that end.   I did find a comment that Lilja "has been hampered by knee issues throughout his career," but couldn't find any more information from his college or professional profiles to substantiate that claim.

In recent months, it's been a waiting game.  Polian commented on February 22 that Lilja "remains with us.  It's too early to tell.  We won't know until the spring, I think."  But the early March restructuring of Lilja's contract suggests that both player and team are maneuvering to protect themselves.  There is an excellent analysis on ColtsCap.net of what the restructure might mean in terms of Lilja's rehab and return.

I hate to be Debbie Downer on this one, folks, but so far there has just not been great news.

Dr. Blue's Prognosis - Likelihood of Game 1 Appearance: Low