Buffalo Bills injury analysis: Zack Moss’s ankle surgery

On Tuesday night, Buffalo Bills running back Zack Moss announced via social media that he had successful surgery on his left ankle. This was the result of a likely high-ankle sprain suffered against the Indianapolis Colts during Wild Card weekend.

ESPN reporter Adam Schefter later reported that he had a successful “tightrope” procedure and that he should be ready for offseason workouts and training camp. Dr. Anderson has become the premier doctor to go see when dealing with foot and ankle injuries in the NFL.

To better understand why Moss had surgery a quick review of the anatomy is necessary. A high-ankle sprain occurs when there is stress placed through the syndesmosis of the ankle, the fibrous portion of ligaments that connects the tibia and fibula together. This articulates with the talus of the ankle to create the ankle complex. This allows for weight-bearing through the legs and effective movement for all planes of movement for the ankle and activities such as walking, running, and jumping.

OakOrtho.com

The mechanism of injury for a high-ankle sprain that occurs for that stress to be placed through the syndesmosis is typically eversion along with dorsiflexion. There are other possible ways, but this is the most common one. In Moss’s case, his foot was pinned to the ground facing outward as his body was driven into the ground. The knee driving forward and the foot twisted outward and up placed enough stress on the syndesmosis that it disrupted the structural integrity of the joint.

High-ankle sprains can take some time to recover from, with non-surgical approaches taking 6-8 weeks with potential long-term instability or risk to re-injure. In the case of Moss, this injury was severe enough that surgery was warranted to help stabilize the area to ensure its healing. As mentioned above, Moss had the tightrope procedure to correct the damage.

While this is all great news, what is exactly a “tightrope” procedure? This is a procedure that has been popularized in recent years by the Alabama Crimson Tide football medical staff. While this was performed mostly for their players initially, this technique has increased in use and has become the gold standard as of recently. This is likely due to the research performed, outcomes, and techniques that have improved over the years.

This procedure allows for the surgeon to implant a fibrous band with a button that attaches to the medial portion of the tibia through small holes in the bone in the tibia and fibula. The band is pulled back through to help stabilize the syndesmosis between the tibia and fibula, similar to a zip tie. This allows for better healing, improved function for rehab, and overall faster recoveries.

Arthrex.com

Looking at the rehab protocol, there is to be non-weight bearing slowly progressed to partial weight-bearing over a four-week timeframe. They are able to progress to full weight-bearing after week five and begin progressive exercises to address pain, range of motion, and strength.

At week seven, they can begin running and perform sport-specific drills to start restoring normal function. Comparatively, there is limited weight-bearing up to roughly week six with syndesmotic screw removal occurring between two and four months or even later if it begins to irritate the structures around the area or motion is limited.

Between weeks nine and 16 is when full function can resume and the likelihood that there are complications is limited due to knot irritation from the rope inside. The older method of syndesmotic screws had poorer outcomes with less range of motion, potential hardware removal, and a prolonged healing time between three and six months.

Due to the procedure and the time of it, Moss should be a full go for OTAs beginning in April and training camp with no expected complications compared to if he had the screw fixation.

It is important to note that he would not be eligible to return for the postseason even if he had gotten this procedure immediately as going onto IR would have forced him to miss three games total, bringing him past the Super Bowl when he was eligible to return.

This is an unfortunate reality of playing in the NFL and we will expect to see further injuries requiring surgery in the coming weeks once the season is over. Hopefully, the end of the season for the Bills is early February bringing home a championship.