Leading Expert In Achilles Tendon Repair Optimistic About Tatum Returning To All-NBA Form

Monday night at Madison Square Garden, in the blink of an eye, a Jayson Tatum masterclass turned into a nightmare scenario.

The Boston Celtics’ star had already registered 42 points, eight rebounds, four assists, four steals, and two blocks in a pivotal Game 4 against the New York Knicks.

But with 3:03 remaining and the visitors trailing 111-104, as Tatum pushed off his right leg in pursuit of a loose ball, he crumpled to the floor, writhing in pain.

Inside the bowels of the world’s most famous arena, the mood was somber and silent as the Celtics attempted to process the flood of thoughts and emotions they weren’t prepared to face.

They were already bracing for a summer of significant change. What they may have witnessed was a franchise-altering injury.

A defeat that pushed the NBA reigning champions’ season to the brink of elimination was a distant second to the concern for their teammate.

“The loss is the loss. More importantly, it’s Jayson I’m worried about,” said Al Horford post-game.

“I love him,” stated Derrick White. “That’s our brother, and you hate to see him go down.”

“Tonight is tough,” Jaylen Brown voiced during a media availability that required summoning a commendable strength to convey what was going through his mind. “I think everybody’s at a loss for words.”

As a prideful champion, who received words of encouragement from Tatum before prevailing 127-102 in an inspiring performance in Game 5 at TD Garden, fights for their season, the latter is moving quickly on the road to recovery.

The soon-to-be four-time All-NBA First Team selection underwent surgery for a torn right Achilles tendon a day after sustaining one of the most concerning injuries in sports, per ESPN’s Shams Charania.

As Tatum begins his journey to overcome an injury he vows won’t define him, Forbes spoke with Dr. Kevin R. Stone. The latter is an orthopedic surgeon at The Stone Clinic and a pioneer of advanced orthopaedic surgical and rehabilitation techniques to repair, regenerate, and replace damaged cartilage and ligaments.

Dr. Stone shared valuable insight about Tatum’s recovery timetable, advancements in treating an Achilles tear, returning to All-NBA form, the caution that comes with a speed bridge procedure to return faster, what the six-time All-Star can do to give himself the best chance of remaining healthy, and more in an interview lightly edited for grammar and clarity.

Bobby Krivitsky: There have been a lot of advancements regarding treating an Achilles tear in recent years. What can you tell us more specifically about what those advancements entail?

Dr. Stone: When an athlete ruptures their Achilles tendon, the first thing is to understand what type of rupture it is. That means it can be a simple one, where it’s just a straightforward tear of the tendon, or a complex one, where the tendon is degraded throughout and it’s a big, extensive tear.

People who have tendonitis going on for a while, inflammation in their tendon, or pain in their tendon, often, when they rupture the tendon, it’s a more complex, kind of uglier tear to repair than someone who is just perfectly normal and ruptures it. So, the MRI done immediately after a tendon injury is pretty critical to designing what the repair technique is and what the prospects are for healing.

The next thing is how the repair is performed. We designed a technique about 30 years ago, improved on someone else’s technique, to do a percutaneous repair, where we weave stitches underneath the skin and don’t make an open incision.

The advantage is that all of the blood clot and stem cells and growth factors surrounding the torn tissue are still there. That permits the tendon to heal, as opposed to normal Achilles tendon repairs, where a surgeon makes an open incision, weaves sutures through it, and may anchor it into the bone. They lose the natural blood clot that’s there, surrounding the tendon, and that takes longer to heal, has more scar tissue, more infection risk, and a host of other factors.

So, the type of repair influences the speed of recovery. And then lastly, we’ve learned a lot about how to add growth factors to damaged tissues these days. You hear about everybody getting PRP, some getting cells, some getting fat cells, some getting stem cells, and some getting birth tissues. These are all factors that we can use to accelerate tissue healing. And all of them can be added to help an Achilles tendon heal.

I shouldn’t have said lastly, because there’s one other part, but it’s lastly in the story. And that is, we’ve learned over the last few years that very early motion and rehabilitation accelerate the healing. It doesn’t slow down the healing. It doesn’t damage the repair. And so the sooner you have the injury, the sooner you have the repair. And then the sooner you start your recovery, physical therapy, in our hands, that’s the next day after injury and surgery, the faster you recover and the better you do.

So, all of that comes into play to answer the question, “How soon is the athlete back?” Which is the next question on everybody’s mind. And so, it depends on what type of tear, what type of repair, and how fast the recovery is. And how much is it augmented with anabolics to stimulate healing?

The concerns that come with a speed bridge procedure

Bobby Krivitsky: As I ask you these questions, there’s an understanding that this is not one of your clients. And there’s information we are unaware of right now that would be critical to making determinations.

We know definitively that Tatum suffered the injury late Monday night and had the procedure on Tuesday. The reports, including from Adam Himmelsbach of the Boston Globe, are that there were no further complications from the procedure. So, everything went smoothly on that front, which, to your point about treating this immediately, is encouraging.

An added detail from ESPN’s Marc Spears is that Dr. Martin J. O’Malley operated on Tatum in New York. He performed surgery on Kevin Durant and Tiger Woods when they tore their Achilles tendons.

I’m not sure if you’re familiar with him or if there’s any insight you can provide about Dr. O’Malley, but he is reportedly known for the speed bridge procedure. So, I was hoping you could tell us more about Dr. O’Malley and/or that speed bridge procedure.

Dr. Stone: I’m sure Dr. O’Malley is an excellent doctor. The speed bridge procedure tries to take what we’ve done with percutaneous repair and adds a device to it to add strong sutures. But unfortunately, it requires an open incision. And as soon as you make that open incision, you lose the natural blood clot, and you lose some of the factors that we believe go into speeding up the healing and creating a strong repair.

So, I can understand why a surgeon might choose to use it. It might be that’s what works well in their hands. And it’s obviously the surgeon’s choice and the patient’s choice. I just have a different philosophy about how to speed up the healing of these Achilles ruptures.

Bobby Krivitsky: So, if you were to look at Jayson’s timetable under a speed bridge procedure, do you think it’s more likely we’re talking eight to nine months? And if he went the other way with what he had performed on him Tuesday, it’s more likely it’s closer to 12 months?

Dr. Stone: I don’t know his tear pattern, and I don’t know exactly how it got repaired. And I don’t know exactly how they’re rehabbing or exactly which factors they’re using to augment growth. So, each of those will influence the healing.

I think, in general, people are going to tell a professional athlete like him to expect eight to 12 months. But in reality, we learn the most from our athletes who cheat. And many of our professional athletes cheat, which means they don’t follow our advice. They go much faster. They return to their sport earlier. And what happens is learned from them about what was really possible as opposed to what we thought it took.

When it comes to rehabbing, athletes cheat

Bobby Krivitsky: I heard an anecdote that it is common for athletes who sustain a major injury, including an Achilles, generalizing as this is, they might be stubborn about wearing the boot as often as they need to. Have you found that to be a part of your experience, and how much of an impact can it have on a rehab process if an athlete is not wearing the boot as often as they need to be?

Dr. Stone: As I mentioned, all our top athletes cheat because they all believe they can heal faster and that their superstar mentality provides them with a superstar body and a superstar healing. And sometimes, that is true. And we learn from them about how much they can go.

So, the boot is mostly a reminder to the athlete not to push the tissue past the limit of where the tension will permit healing. You don’t want to pull the Achilles apart again.

Depending on the repair technique, if it’s strongly anchored together, then the boot’s just mostly a reminder and to slow them down, and try not to have them out shooting hoops the next day. But I can assure you, knowing a little bit about him and other athletes like that, he’ll probably give it up pretty soon.

Bobby Krivitsky: We shall see what happens on that front.

And what can Jayson do when he returns to play to give himself the best chance possible to remain healthy?

Dr. Stone: The first thing all athletes should do, and this is true of athletes of all ages, is look at your injury as, look, bad luck had happened, but it’s an opportunity to train; to think about your body. To come back better, fitter, faster, stronger, as we like to say here, than you were before you got hurt.

We wrote a book about that called “Play Forever,” which you can find on Amazon. It goes through all the methods in which you can take that injury and come back a better athlete. And so there’s nothing about an Achilles rupture that should prevent him from coming back better than he was before.

What determines that is, as I mentioned, a lot about the tear pattern and repair, and other things. But a lot is in the head. How much can you take that and not get depressed by it? Use it as a chance to really train on parts of you that you might not have thought about.

Now that you’re not on the court, you are in the gym more, you have time to focus on things you didn’t have time to focus on before. You can optimize your education about nutrition, about flexibility, about performance. You can strategize about the game. You can really use the downtime, not to be downtime, but to be uptime on how to get better than you were.

Bobby Krivitsky: Jayson’s work ethic is exemplary and second to none, so I have a feeling he’s going to do everything in his power to heed your advice there and return to the same standard we’ve seen before what unfolded Monday at Madison Square Garden.

You understood that we were going to talk about the timetable, of course, and I think Celtics fans are going to take great comfort in you saying that he can return as the same player and improve on areas he has more time to focus on.

How long do you think it will take for him to look like the Jayson Tatum people are accustomed to seeing? The mental side of him feeling comfortable again, trusting his leg, is impossible to predict. But how long do you think it will take once he’s returned to play to get back to feeling physically, at least, like he did before this injury?

Dr. Stone: So, I want to remind you that my view is he can return better than he was before. And the timeline varies a lot. We do see some athletes who are back in the four to six-month window. We see many other athletes who take eight to 12 months to come back.

But if they’re really trained on it, if they have good luck, if they’ve had good surgery, if they use all the new tools, it’s not unreasonable to be back next season, and I suspect, knowing what we know about him, that he’ll try to do that.

Bobby Krivitsky: Lastly, is there any topic surrounding this situation that we didn’t cover that you’d like to provide insight and perspective on?

Dr. Stone: Yeah, I think many of your readers are hearing about all the things that we can add, all the anabolics that we can add, all the GLP [glucagon-like peptide] drugs, all the peptides, all the testosterone, all the growth factors, all the stem cells. It’s a fascinating time in sports injury and sports therapy. And we’re just at the beginning of learning how to accelerate the healing.

Why does it take an athlete a year to come back from an ACL or many Achilles injuries? When we know how to accelerate healing, we know how to make collagen mature faster. So, I think what you’re going to see over the next window of time is much more science around this and much more exciting information about how to heal injuries.

And I think the more we can encourage every one of your readers to both use any unfortunate injury as an excuse to come back better and also to pursue the new science, I think people will be less down and less depressed and more excited than they have been in years.