Trevathan’s “New Kneecap”: Answers About Broncos Linebacker’s Surgery

“I’ve got someone else’s kneecap.”

I’m used to hearing some odd things come from a player’s mouth when talking about injuries, but Danny Trevathan took me by surprise with this gem, reported by Mike Klis of the Denver Post. Trevathan does appear to be accurate and while the Denver Broncos wouldn’t comment on record about the specifics of Trevathan’s surgery, our team was able to piece together some of the specifics.

The fact is that Trevathan still has his own kneecap, augmented by a bone graft. FanDuel’s Michael Schottey spoke with sources in the Broncos organization, confirming Troy Renck’s report that Trevathan did not have a transplant or even an allograft, the introduction of bone from a cadaver.

Trevathan first injured his knee during training camp 2014. He had a small fracture of his patella (kneecap) and missed most of training camp, plus the first four weeks of the season while it healed. Once back, he didn’t stay healthy long, having the same knee dislocate, ending his season.

Patellar dislocation is extremely painful and damaging, but easily correctable. In most cases, the groove behind the patella needs to be fixed and the motion of the knee corrected. This can be accomplished a number of ways, shaping and augmenting the surface. In most cases, a fracture will need to be fixated with pins, screws, or even a cage. This latter was performed on Kyrie Irving of the Cleveland Cavaliers after fracturing his patella during the NBA Finals.

The real issue is normally the soft tissue surrounding the knee that complements its motion. The patellar tendon, especially, is involved and can be damaged when the patella goes rogue, stretching and tearing the connections and changing the biomechanics. If left uncorrected, the knee can lose function and stability.

For many, including older patients with degenerative changes, a partial knee arthroplasty is an option. Unlike a complete knee replacement, in a partial, one or two of the three components of the knee’s osseous structures are replaced. Many former NFL players will have knee replacement, including the famous knees of Joe Namath. However, none to this point have been able to play after having any type of arthroplasty.

In fact, there are very few athletes that have even attempted such a thing. There are three cases in baseball. Bo Jackson famously returned to MLB after injuring his hip playing football just a year after a complete replacement. Colby Lewis, a pitcher for the Texas Rangers, also returned after a modified hip replacement. A minor leaguer had a meniscal transplant and had no issues after the surgery, but did not make it to the major leagues on talent.

There is not a known case of the more common osteochondral allograft in major professional sports. This operation is about as involved as any currently performed, but even with the extensive use of microfracture, no players have elected for this type of procedure.

So did Trevathan even have an opportunity to have a first-of-it’s-kind procedure? According to one NFL team physician who could not speak on the record due to NFL rules, the answer is simple: no. “A patellar transplant? I think [Trevathan] skipped medical classes back at Kentucky,” he joked. The doctor explained that there’s an institutional resistance to unproven procedures in sports. “He’s too good to experiment on,” he explained.

Dr. Bert Mandelbaum, one of the top orthopedic surgeons in the country from Santa Monica Orthopaedic concurred. “I think it is imperative that we find out exactly what procedure was done on this athlete. Prior to that, it is difficult to create a hypothetical and respond accordingly. I think it is essential that we have the information of what a new kneecap means? Does it mean he had plastic and metal or osteochondral allografts? Does it mean he had a regenerative articular cartilage procedure? We need more information!”

Now that we know that Trevathan was confused about his procedure, it doesn’t change the fact that Trevathan has made a nice, standard recovery from a surgical procedure with an extensive track record. Rather than hoping that an experimental procedure would keep their linebacker healthy, the Broncos head into a key training camp with the expectation that Trevathan will be available.

And with his own repaired kneecap.

Michael Schottey contributed additional reporting to this piece.