Patrick Mahomes has another hurdle to overcome going forward, but it’s yet known if it’ll be a mountain or more of a speed bump for the Kansas City Chiefs quarterback. The reigning league MVP reportedly suffered a dislocated knee in the team’s win over the rival Denver Broncos on “Thursday Night Football,” and was forced out of the game early in the second quarter because of it.

A whirlwind of concern swiftly and justifiably swirled about his status going forward, but early information suggests there was no fracture found in X-rays done at Mile High Stadium, and that was promising. It was not, however, the end-all as it relates to Mahomes’ injury, because that is yet to arrive and will come via MRI results on Friday. Mahomes took to social media to provide a promising update of his own, certainly more promising than how his injury was described by teammate Travis Kelce, but he also understands he’s not out of the woods by any stretch of the imagination.

I reached out to Dr. Rodney Benner, a trusted and licensed orthopedic knee surgeon, to get insight into what Mahomes is facing — both now and later. 

PW: Early reports are that Mahomes suffered a dislocated patella, but that there wasn’t a fracture, but an MRI is scheduled to be performed as early as tonight or Friday morning. What ligaments are involved in keeping the patella itself in place, that are now at risk of being strained or torn?

Dr. Ryan Benner: Yes, the video shows a member of the medical staff extending the knee and pushing the patella back into place from a dislocated position. The patella is held in a centralized location by ligament structures on both sides, medially (inside of the knee) and laterally (outside of the knee). In order for the patella to dislocate laterally, which is the direction it always goes, the medial retinaculum and medial patellofemoral ligament have to tear. An MRI scan will assess a few things. It can visualize the medial soft tissue and assess the extent of ligament tearing. Also, when the patella dislocates, a specific pattern of bone bruising is visible on the medial side of the femur and the lateral side of the trochlea, which is the groove on the end of the femur where the patella tracks. 

These bruises come about because those surfaces impact one another during the dislocation. Sometimes a piece of cartilage and possibly bone can break off and float loose inside the knee. This will be visible on MRI as well.

In addition to the MRI scan, X-rays will be ordered to assess if the patella came all the way back to a perfectly centered position or if it came back into the joint, but is still tilted to the outside. Furthermore, X-rays can assess if the patella is too high or tilted laterally just based on his anatomy. These factors can predispose to an athlete having dislocations. All of these factors must also be considered to determine treatment. 

PW: Assuming the best-case scenario, in that he only suffered a dislocated knee cap and no structural damage, what would you estimate is the timeline for his return — rehab included?

RB: If the patella came back to a perfectly centered position, it is likely that the medial ligament structures could heal without surgery. The timetable for return to play would likely be around 4-6 weeks.

PW: Flipping the coin a bit to the worst-case scenario, if any of the ligaments you described earlier are torn, what does his road to recovery look like?

If the patella comes back into the joint but stays tilted towards the lateral side, it is more likely to develop into recurrent dislocations.  Also, if the athlete has anatomy that predisposes him to dislocations, recurrence is more common. These factors that increase the risk of recurrence or the presence of a large loose piece of cartilage in the knee may necessitate surgical intervention.  Depending on what factors are at play, that can increase the return to play to more along the lines of an ACL tear, with several months to return as the worst-case scenario.

PW: Once Mahomes does return — be it in a few weeks or in 2020, contingent upon what the MRI shows — what type of limitations would you expect him to have, including the possibility of requiring a brace? And would that brace be one he’d need to wear permanently during games?

RB: It is possible that brace use may be needed. While many knee conditions are not amenable to bracing, sometimes patella bracing can provide lateral support and keep the patella in a centered position. As for the prospects of a full return, that would definitely be the goal, and it is a reasonable one. It is possible and expected for him to make a full recovery, even if surgery is needed.

PW: So, to be clear on an earlier point you made, is this an injury that can be easily suffered again if he were to take another hit to the knee in the future?

Yes, recurrent dislocations are possible. Every time the patella dislocates, it is more likely to happen again. 

PW: Considering Mahomes is a mobile quarterback that does a lot of his damage with his legs, what type of added challenges will he have in his attempt to return to prime form from an injury of this nature?

RB: I don’t know that he has any specific challenges that other players would have. I guess any player that displays the type of mobility and athleticism that he does would have a higher bar to reach with regard to returning to full function. However, if the patella is back where it should be and is tracking normally, a return to full function is possible.