ESPN injury expert Stephania Bell on Manny Machado's surgery and recovery

I spoke with ESPN injury expert and senior writer Stephania Bell on Monday about her take on Orioles third baseman Manny Machado's knee surgery. She provided a lot of useful insight on the injury, the surgery and the rehab process, and even suggested that Machado's recovery would take toward the longer end of the initial four- to six-month timetable before the Orioles adjusted that approximate recovery time to six months following the surgery.

On Monday, Machado had successful surgery performed by Los Angeles Dodgers orthopedic surgeon Dr. Neal ElAttrache in Los Angeles. A tendon from Machado's hamstring was used to repair the ligament.


I used a few of Bell's quotes for today's story on Machado, but here are some additional quotes from our conversation that shed some more light on the injury and the recovery.

On the injury and how long Machado's recovery should take:


It's not super common, but it's not terribly uncommon either. They tend to do well after this. He should do well with this. It's probably [more] of a six-month recovery in terms of returning to full-bore baseball activities. It's pretty fluid depending on how he's doing, but he probably won't be released to do a ton before that. How he does will likely dictate when he can play in games. He won't have a normal spring training like everybody else would. An actual return date is somewhat fluid, but it should be sometime in the spring and on time, but not necessarily by Opening Day, I would say.

On how quickly Machado can begin rehab:

His rehab at the most basic levels will begin pretty immediately. The early thing is really protecting the reconstructed ligament. Dr. ElAttrache typically uses from the hamstring tendon for the reconstruction, so the early phase of rehab is really protecting the repair. You work on getting your swelling down, getting range of motion back, getting your strength and all those kinds of things. A lot of it afterward is retraining the muscles, which might have been weak, which might have contributed to being set up for an injury.

On Machado having previous related kneecap injuries:

Usually the guys who have this type of thing, there is something anatomical in terms of their alignment and some is functional in terms of their strength. You can be a really good athlete and still have some muscle imbalances and deficits. So you really want to strengthen hip muscles, core muscles. A lot of that will be happening throughout the rehab. The last thing you're released to do is hard cutting and turning, pivoting, rounding bases and surprise movements. They come later. It's a gradual progression, and I'm sure along the way, Dr. ElAttrache will be evaluating him and may allow him to do some more aggressive things sooner based on how well that strengthening is coming along. But in terms of the highest-level things, the most stressful things, it's probably going to be around five or six months before that happens.

On timing of the surgery and how rehab will correlate with spring training:

I think a little bit of it will be that he's not playing in games right away when other guys are. He may be a little bit behind on that end, but yeah, that's probably behind the decision to do it sooner rather than later and is also good because it adds to the timetable that he has to get ready. We're in October now. If he had gone the conservative route, which initially he was going to do, he would have felt pretty good after a while until he was stressing it. ... My worry would be that since he had an episode before this one that he might be at higher risk for reoccurrence. So if something had happened during the spring or into the season, think about all the time you lose there. From a proactive standpoint, since he's young, this is going to be really good for him.

On whether the surgery should alleviate the likelihood that he could dislocate the kneecap again:


One of the things they look at -- your knee sits in a groove on your femur. In some people, that groove is pretty deep, in others it's pretty shallow. So there are some things that can predispose you to anatomically to putting you at risk for subluxing or dislocating your kneecap and the more shallow groove is one. Sometimes people can have more of a knock-kneed posture, they are at a higher risk. So when you start adding up those risk factors, the biggest risk factor is a prior episode and we know he had that. So the ligament was probably already weakened before it tore. If he didn't do anything about it, it would seem that his risk would go up. You can't change your original anatomy, your bone structure, but you can definitely work on strengthening the muscles that may have been weak just as a function of that. Over time, your body just adapts and you're just strong where you're strong and weak where you're weak and until something happens, you don't always identify you have to work on that. All of that will help him.