CHARGERS: Doctor: Merriman needs stable knee to play

+ Agility required at linebacker position would make it difficult to go without surgery

By JAY PARIS - Staff Writer | Saturday, August 23, 2008 2:33 PM PDT ∞

SAN DIEGO ---- The Chargers' medical staff is off limits to reporters. So the North County Times asked longtime North County orthopedic surgeon Dr. Robert Clifford, who specializes in sports medicine, to shed light on linebacker Shawne Merriman's knee injury.

Clifford, whose patients range from world-class to weekend athletes, doesn't underplay the seriousness of Merriman's injury.

Merriman said he has a loose ligament. Clifford said that's another way of saying the ligament is torn. One published report said it's the posterior cruciate ligament.

The PCL is located in the back of the knee and connects the thigh bone (femur) to the shin bone (tibia) to prevent the shin bone from shifting too far backward.

What Clifford doesn't know is the degree of Merriman's tear. The scale is 1 to 4, with 4 being the most severe.

It's apparent that Merriman is closer to 4 than 1, as the pain he is experiencing prompted him to consult with other surgeons this week to discuss his options.

"Next to the anterior cruciate ligament, the posterior cruciate ligament is the most important one in your knee," Clifford said. "You need your PCL because you can't do the day-to-day stuff, like walking down a ramp. If you did that without a PCL, your tibia would slide under your fibula."

Clifford said the injury is more critical to linebackers because of what is asked of them. If they get hit on the knee or they have to stop quickly, there is no support to keep the knee in place.

If Merriman were an offensive lineman, he could probably get by until after the season before getting the problem addressed. Clifford recalled that, when doing his fellowship with the Houston Oilers in 1986, a linemen didn't have a PCL. He was fine in games, but had to walk down the stadium ramp backward so his knee would stay in place.

But being a linebacker ---- especially one as active as Merriman ---- presents a wide range of problems.

"A linebacker has to go side-to-side, stop and accelerate," Clifford said. "For him, he needs a stable knee. If he was a lineman, it would be an easier choice. But where he plays, he can't afford not to have his knee be stable and have it slip on him."

If Merriman elects to play without getting it corrected, another set of problems could arise, Clifford said.

"That's the thing he has to weigh: risk versus benefit," Clifford said, "because the other ligaments, the secondary ones, can get stretched, and they are not strong enough to provide the stability.

"It's like with a house and you take out all the weight-bearing walls. The other walls might be strong enough to hold the house up, then again, they may not."

If Merriman does have his PCL replaced ---- likely from a cadaver ligament, Clifford said ---- what is his down time?

"The healing time is five-six months for impact sports,'' Clifford said. "But people always perform better at nine months, and better again at one year.

"With their rehabilitation programs, a person could be running in four months and look better than you and me. But there is still healing that has to be done and a new blood supply has to respond to stretch the ligament."

The key, according to Clifford, is to what degree the PCL is torn.

"If it's not completely unstable, the combination of a knee brace, strengthening it and other ways to stabilize it might allow him to play," Clifford said. "But if it's not stable, he needs to have it fixed."

Contact staff writer Jay Paris at jparis8@aol.com.