Manny Machado had successful surgery to reconstruct a torn ligament in his left knee Monday, but barring an extraordinary recovery, the Orioles All-Star third baseman is likely to miss the beginning of the 2014 season.
Dodgers team physician Dr. Neal ElAttrache repaired the torn medial patellofemoral ligament in Machado's knee during the 75-minute procedure at the Kerlan-Jobe Clinic in Los Angeles, taking a tendon from the 21-year-old's hamstring to reconstruct the ligament.
While Machado can begin rehabilitation almost immediately — he will remain in Los Angeles for two weeks before continuing his recovery in Miami — the estimated recovery time is six months, which would place his return date two weeks into the regular season.
"The conservative end of the recovery time is six months," Orioles executive vice president Dan Duquette said. "Having said that, Manny has some work to do on the rehabilitation part of his recovery, which I'm sure he will do with enthusiasm.
"But Manny and the doctors will tell us when he's ready to play," Duquette said. "It's not going to be driven by the schedule. It's going to be driven by how well he comes along. … I'm sure Manny will do everything he can to be ready [for Opening Day], but it's going to be determined by how it comes along."
Machado said in a statement released by the team last week that he hoped to be ready for the beginning of spring training in mid-February, which is four months away. Orioles manager Buck Showalter said Friday he expected Machado to play in spring training games in March.
Stephania Bell, an ESPN injury expert and ESPN.com senior writer, said that procedures such as Machado's typically take six months of recovery time before a player can return to full 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," Bell said. "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."
Initially, the Orioles hoped Machado could avoid surgery. The initial plan called for Machado to rest and rehab the injury before being re-evaluated after four weeks and starting light activities after six to eight weeks.
But the nature of Machado's injury — the torn ligament created a dislocation of his kneecap — indicated a high likelihood that Machado would injure the knee again if he didn't have surgery, especially since he suffered a similar injury two years ago in the minor leagues.
Bell, a certified orthopedic clinical specialist and strength and conditioning specialist, said that some of the early stages of rehab will concentrate on strengthening muscles around the ligament that might have made Machado prone to previous kneecap problems.
"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," Bell said. "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," Bell said. "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."
In his first full major league season, Machado made his first All-Star Game and led the American League with 51 doubles while playing Gold Glove-caliber defense at third base. He had played in all 156 games during the 2013 season before the injury.