Tua Tagovailoa's Ankle Injury Pins Alabama in Familiar Territory

Tua Tagovailoa is the latest Crimson Tide player to undergo Knotless Syndesmosis TightRope treatment to repair an ankle injury ahead of a primetime matchup against LSU.

Five years ago, almost to the day, Alabama left tackle Cam Robinson sprained his ankle in a win at Tennessee. It was the worst kind of sprain, the high-ankle variety, to the worst kind of player, a mountain of a man whose lower extremities supported his 310-pound frame. The recovery time for such an injury is about a month, and it could linger into the six-to-eight week range. The Crimson Tide was scheduled to play LSU two weeks later in a top-25 showdown in Louisiana, Robinson’s home state. “Cam being a Louisiana guy, he wanted to play in that game,” recalls Alabama team surgeon Norman Waldrop. “We wanted to try to get him back as soon as we could. Not test it out but try to actually get him back. He played 13 days later.”

From an Alabama perspective, Robinson was the guinea pig for a new kind of surgical treatment for ankle sprains that expedite recovery. It’s called the Knotless Syndesmosis TightRope (from hereon referred to as the tightrope), and on Sunday morning, another Alabama football player underwent such an operation: quarterback Tua Tagovailoa. On Saturday night, he suffered a high-ankle sprain against the same opponent as Robinson, Tennessee, and is hustling to return in time for — you guessed it — a game with LSU. Only, Tagovailoa isn’t 310 pounds, and he’s got three weeks to recover, not two like Robinson. What’s more, we have actual concrete evidence when it comes to Tagovailoa and this surgery — the Heisman-contending junior underwent the procedure last December on the opposite ankle.

If you’re an LSU fan, the results are deflating. If you root for the Tide, they are uplifting. By Day 10 after his surgery, Tagovailoa had passed a physician’s strength test to return to running, even some cutting. He returned to practice 13 days out, and he played 28 days removed from the surgery in the Tide’s win over Oklahoma in the CFP semifinal. “It was quick,” Waldrop said in an interview last December with Sports Illustrated. Alabama coach Nick Saban has already ruled out his quarterback for the upcoming game against 2-5 Arkansas. Like No. 2 LSU (7-0), the top-ranked Tide (7-0) get a bye week before the first potential 1-verse-2 regular season duel in college football since their meeting in 2011.

If you’re wondering what these next few days will be like for Tagovailoa, Waldrop and fellow team physician Lyle Cain have the answers. In an interview last December, they explain the week-long recovery process, from that 25-minute surgery he had Sunday morning to that strength test, in which an individual must hop 15 consecutive times on the injured leg. Post-surgery swelling is usually gone within three to four days, they say, and running on an anti-gravity treadmill follows a few days later. Patients can usually move on to cutting while running within 12 days. Every player is different. Every knee might be different too. Some players have returned within a week’s time, says Jonah Williams, the Tide tackle who underwent the procedure in January 2018. “It’s usually seven days to play,” he told Sports Illustrated in an interview last year.

The procedure is described as amazing, unbelievable and even conjures up black magic for one physician — “It’s like voodoo,” laughs Cain — but it’s been around for a while. Arthrex, the Naples, Fla.-based company that manufactures the most widely-used tightrope devices, launched the mechanism in 2005. It has evolved and been passed down from surgeon to surgeon, spread across the country through medical clinics and surgical seminars — one group of physicians attempting to convince others to move away from the archaic method of treating ankle injuries. During a sprain, ligaments and tissues around the leg bones, the tibia and fibula, are loosened and become unstable. The tightrope replaces the traditional methods of treatment, which is to either rest and rehabilitate the ankle or insert screws into the tibia and fibula, bonding them like one would a pair of 2x4s with a nail. Instead, with the tightrope, surgeons slip a fishing wire-like product through small holes in the bone, fasten the wire with small metal buttons and then tighten the wire like you’d constrict a zip tie around two fingers.

The tightrope is the baby of Waldrop, a 38-year-old Mobile native who serves a dual role as an orthopedic surgeon at the Birmingham-based Andrews Sports Medicine Center and as an Alabama football team physician. He learned of the tightrope in 2011 during an internship in Colorado with Thomas Clanton, a longtime NBA and NFL team physician. Since Robinson’s surgery in 2014, at least six Alabama players have undergone the procedure, including Jalen Hurts last November who healed in time to lead the Tide to a second half comeback over Georgia in the SEC championship game. At the Andrews clinic, Waldrop performs at least two tightrope procedures a week, he said last year, treating football players from the high school, Division II, FCS and Division III levels. Last fall, he set a record for tightrope surgeries on FBS players at 30.

Five years ago this week was the first. Robinson, now a starting tackle for the Jaguars, played in the game against his home state Tigers in 2014, helping lead the Tide to a 20-13 overtime win. “He had a good game,” Cain remembers, and he didn’t have any complications. Back then, Robinson was an essential piece for the Tide. Alabama was in the first stages of an evolution to the full-fledged spread offense under coordinator Lane Kiffin. That squad, fielding one of the nation’s stiffest defenses, still leaned heavily on Robinson to pave the way for a bruising running attack. The 2019 Tide is different. This is a pass-heavy team with an athletic set of receivers and a young defense that’s shown vulnerabilities. They need their quarterback. “We knew it was a big deal,” Waldrop said last year about Tagovailoa’s first ankle recovery ahead of the College Football Playoff. “We knew we needed to do everything we could to get Tua back.”

Here they are again back in a familiar place.