New England Patriots quarterback Tom Brady recently underwent repair of his anterior cruciate ligament at the Kerlan-Jobe Orthopaedic Clinic in Los Angeles. His doctor was Neal S. ElAttrache, who’s a renowned orthopedic surgeon and former team physician of an NFL team.
Unfortunately, his post-op course has been complicated by an infection. On his website, TomBrady.com, he acknowledged this and said that the original procedure was “rock solid,” and that the infection was “very treatable.”
Apparently, more procedures had to be performed, according to the Boston Herald:
Doctors are so concerned about containing the infection in Tom Brady’s left knee they have performed three procedures in an attempt to eradicate it, according to a source familiar with the Patriots quarterback’s travails on the West Coast.
This is especially troubling since the infection may cause the ACL repair to fail:
If the infection is not brought under control, the patellar tendon graft used to replace Brady’s anterior cruciate ligament could become compromised, according to the Herald’s report. If that happens, he will have to undergo another surgery on the ACL. That would reset the clock on his rehabilitation.
He’s currently on a 6-week course of IV antibiotics, with close follow-up to monitor the infection’s resolution.
Arun Ramappa, chief of sports medicine at Beth Israel Deaconess Medical Center, speculates on the case, and is optimistic:
In all likelihood, they’ll be able to eradicate the infection, and be able to maintain the original surgery. What it sounds like, is they’re doing everything they can to try to preserve his knee, preserve the graft, so they don’t have to do another surgery. If he’s had three surgeries, they must be quite concerned about there being an infection.
ESPN cites another physician however, Dr. Rob Gotlin, saying that a repeat ACL repair is doomed to fail if the infection isn’t cleared out.
Anesthesiologist bookofjoe goes further, saying that the doctors better have gotten all of the infection, or else Brady will be dealing with this long-term:
It could be a one-time occurrence in which, as Brady stated above, surgeons were able to completely clear the joint space “” or there may have been subclinical traces left behind which won’t surface for a while, but might well go on to take up permanent residence in his knee.A chronically infected replacement ligament “” in effect, a foreign body in the joint space “” is a potential career-ender, as infection weakens the surgical repair and surrounding tissues, making re-injury more likely.
He goes on to cite the case of Cleveland Browns receiver Joe Jurevicius who also contracted an infection after his knee surgery.
The Patriots are unhappy that Brady went to Los Angeles for treatment, preferring that he stay in Boston:
The Patriots, as an organization, are upset with the situation because they were clear that they wanted Brady’s surgery done under the direction of doctors of their choosing in Boston, sources told ESPN.
Several issues arise from the story. First, the infection. This does seem like bad luck (or was it, as newspapers peg him thinking wedding reception in New York). With the rash of MRSA skin infections in the news, is this a possibility? Is the IV antibiotic he’s taking vancomycin, which is commonly used to treat these drug-resistant staph infections?
The second issue is whether the team has a right to be upset at Brady’s choice of doctor. Is there a contractual obligation for Brady to see a team-approved physician? If not, shouldn’t the patient have total say to be treated by a physician they are comfortable with?
The bottom line is that this is a grim situation for Brady. His knee cannot begin to heal without eradication of the infection, which will not even be known for another six or so weeks. If the infection persists, the ACL repair would need to be redone and may not even take.
This worst-case scenario puts next season, and perhaps his career, in jeopardy.
Update:
The Boston Globe comes out with a story that sheds more light.
i) Brady has a septic joint, with the best case scenario delaying rehab by several months.
ii) During the initial surgery, both the MCL and ACL were repaired.
iii) A septic joint as a complication of ACL repair is rare, and occurs in less than 1 percent of cases.
Update 10/24 -
Boston Herald:
“According to the source, during the process of the reconstruction, while Brady was under anesthesia, ElAttrache realized the knee was still unstable after moving it around because the MCL hadn’t fully healed. It was decided at that point to also repair the MCL, and, according to the source, that’s the incision that ultimately became infected.
To make the MCL more sound, ElAttrache had to make a separate incision from the portal hole used for the ACL repair, the source said.”
Famed sports orthopedist, Dr. James Andrews:
“Neal called me in confidence to run this problem by me to see what I thought . . . We went over that, one, he should be aggressive about going back in, don’t wait on it, don’t let [the infection] continue to declare itself. Get it washed out and scope it. And I said he’d probably have to re-scope it several more times to make sure he got it under control.”
Boston Herald columnist, Ron Borges:
“This is not to say that Dr. Neal ElAttrache of the Kerlan-Jobe Orthopaedic Clinic in Los Angeles has never fixed a knee before. He repaired a ruptured ACL and torn medial meniscus in present WBC heavyweight champion Vitali Klitschko in 2005. At that time Dr. ElAttrache said Klitschko would be unable to participate in professional athletics for six months. Klitschko, for reasons unknown, didn’t fight again for more than three years, choosing to retire instead.”
Update 10/25 -
New York orthopedic surgeon Riley Williams III, via MedPage Today:
“Dr. Williams, who was not involved in the case, said the infection likely involved Staphylococcus epidermidis rather than the more serious S. aureus.
Infectious are unusual in knee surgeries in any case, he said. He led a study in the 1990s that found an infection rate at the 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.”
Related posts:
- Knee surgeries
- Football player infections
- Scheduled for knee surgery, had a brain operation instead
- Clostridium difficile infection is spreading from the hospital to the community
- Notre Dame coach Charlie Weis’ malpractice lawsuit
- Poll: Do we need to hang up the white coat to limit infection?
- Infection control
{ 4 comments }
Imagine, the whole world is watching. The greatest football players going to the greatest surgeons at the greatest hospitals. And athelete at the top of his physical health.
And they can’t prevent billions of years of bacterial evolution from infecting the mans knee.
Yet the clowns at the Medicare National Bank want to make perioperative infections, specifically for orthopaedic surgeries, a never event.
You have just witnessed the ridiculous policies of a government agency gone mad. When you have the best surgeons treating the most physically fit patients at the best hospitals, with the whole world watching, and you STILL get an infection, you have no credibility as an organization when you suggest the rest of us hummble simpleton providers could be perfect in our outcomes. A never even is just that. Never. And that is simply not possible.
Hospital Acquired Infections are the 4th leading cause of death in this country. More than AIDS, Breast Cancer and homicides combined. It is the dirty little secret of a well bankrolled medical industry.
Yes, you are right even the greatest football player at a great hospital with a great surgeon is not immune…because germs are no respector of person. It is a well documented fact that even at the best facilities hand-hygiene rates are only about 40%. That means doctors and staff are running around spreading germs from patient to patient.
At the ‘top-rated’ hospital were I contracted ‘man-eating flesh disease’ we found out that an administrator did an equipment inventory of the OR in the middle of my surgery. An investigation by the Dept. of Public Health found that this ‘top-rated’ celebrity hospital was also in violation of no less than 10 federal regulations for infection control and surgical services. So much for reputation.
The Centers for Disease Control and Prevention,the Society for Healthcare Epidemiologist of America(SHEA)both admit when speaking in generalities that 70% of all hospital infections are preventable. It’s only when protecting the individual liability of a doctor who has erred that they back peddle to a position of ‘these things happen’
I hope that Mr. Brady will be okay. I had to have 6 additional surgeries due to my infection and nearly died. I hope that he will also consider being a voice and advocate for Patient safety when this is over. He is very blessed to not become one of the 100,000 people a year who die from Hospital Acquired Infections.
http://www.PatientSafetyASAP.org
http://www.AliciaCole.com
Happy, you rule again!
Survivor:
Believe it or not, it is indeed hard to determine which organisms were contracted in the hosptial and which were brought to the hospital by the patient. This is not the patient’s fault, but often it is not the hospitals’s fault. Speciating the culprit bacteria and determing a hosiptal source is very difficult/often impossible (in most cases but usually not the ones where the culprits are obvious poor staff hygeine as multiple patients come down with the same thing on a given floor…think about it). So therefore the hosptial is blamed whether or not it is the case. I am not excusing poor hygeine. Everyone should wash hands before/after touching a patient….period. Strep (”flesh eating disease in your words”) is indeed part of the normal flora on everyone’s skin. The issue is how does it cause disease in one individual and not another? Additionally, the stats you quote are from extrapolated early 1980’s data. Look at the actual article. Unfortunatately, what you blame on “hospital aquired infection” is in reality much more complicated issue related to resistent bacteria in the populace (due to antibiotic overuse caused by both MD overprescribing and layperson expectations of MD’s in the office), a less healthy and aging population, and yes hospital sanitary standards. HH brings up avery good point about how this can be a never event when it happens in such a patient who I am sure had class A care from start to finish. Trust me on this one. No doc is going to want to risk an infection on a QB who one 3/4 super bowls, yet he still had an infection complication. Good luck in your life.
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