Jan 18, 2019
Tua Tagovailoa’s innovative ankle surgery
By Training & Conditioning

In the days leading up to the College Football Playoff National Championship, much was said about University of Alabama star quarterback Tua Tagovailoa’s rapid return from ankle surgery to lead the Tide. According to Sports Illustrated, this was due, in part, to an innovative surgical procedure that’s now getting a great deal of attention.

Rather than going with the traditional methods of treatment following a high ankle sprain, such as rest and rehabilitation or the insertion of screws into the tibia and fibula, Tagovailoa opted for a procedure known as tightrope fixation. In this 25-minute procedure, surgeons slip a Knotless Syndesmosis TightRope (a high-strength suture) though small holes in the bone, fasten it with small metal buttons, and then tighten it as you would a zip tie.

Backup Alabama quarterback Jalen Hurts received the same surgery earlier in the season after also suffering a high ankle sprain. He and Tagovailoa both returned to play within four weeks. The typical recovery time for this type of injury is between six to eight weeks. While these high-profile players have brought the tightrope procedure into the spotlight, it has been a kind of secret weapon for Alabama in recent years.

Norman Waldrop, MD, an orthopedic surgeon at the Birmingham-based Andrews Sports Medicine Center who serves as an Alabama football team physician, introduced the tightrope to the team in 2014. Since then, at least six Alabama players have undergone surgery to insert a tightrope. At the Andrews Sports Medicine Center, Waldrop performs at least two tightrope procedures a week, treating players at all levels of college and high school football. This fall, he performed 30 tightrope surgeries on NCAA Division I Football Bowl Subdivision (FBS) players, a new personal record. He says that at least 20 FBS schools have contacted him with interest in the procedure.

Dr. Waldrop first learned about the tightrope in 2011 during a fellowship in Colorado, where he worked with Thomas Clanton, MD, Director for Foot and Ankle Sports Medicine at The Steadman Clinic. Dr. Clanton started using the technique in 2005, around the time of its inception, and popularized it in the NFL and NBA. He continues to be a vocal advocate for the procedure and hopes to convince trauma surgeons to switch from the standard method of inserting screws.

Some physicians, however, are resistant to moving away from the traditional methods, with some claiming that the tightrope surgery can be unnecessary.

“Those athletes Norm got to play so fast, people would say they didn’t need the surgery in the first place,” Dr. Clanton said. “That’s one of the negatives. I know Norm and I know that’s not true. We try to treat it non-operably and they’d have reoccurring problems with it.”

Dr. Clanton calls Dr. Waldrop a groundbreaker in the tightrope movement, as he has helped accelerate the recovery process with an aggressive rehabilitation. The post-surgery swelling usually subsides within three or four days, and patients can typically start running on an anti-gravity treadmill a few days later. They can then move to cutting while running within 12 days of surgery. Patients must perform 15 single-leg hops to test if they’re ready to return to practice. Tagovailoa passed the test on day 10.

The innovative tightrope procedure provides more than just quicker recovery times. Dr. Waldrop says that it has long-term health benefits, as the tightrope material remains in the person’s ankle and does not have to be removed with a second surgery.

“The tightrope,” Dr. Clanton says, “has changed things.”

Image by Derek Rose.

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