FRISCO — Cowboys left tackle Tyrone Smith is due to undergo surgery Friday morning to reattach a torn hamstring tendon to his left knee, repairing an unusual sports injury that is expected to keep him out of action until at least December.
The team plans to put Smith on their initial roster of 53 on Tuesday afternoon and then place him on injured reserve. The sequence will enable a return with a late cause.
“I feel sorry for Tyrone,” Cowboys owner Jerry Jones said Thursday. “Why I do so much is because Tyrone doesn’t feel well about how it affects the team. …We’ll get him back in the playoffs. It is far. It gives it a positive connotation, but it’s also just the facts.”
Dr. Ralph Gambardella, an orthopedic surgeon at the Kerlan-Jobe Cedars-Sinai Institute in Los Angeles, can’t speak to the Cowboys’ playoff chances with or without Smith, and he didn’t personally evaluate the eight-time Pro Bowler.
He spoke with Dallas Morning News on Thursday to give insight into the injury, giving a skilled and outward look at Smith’s future.
In addition to the hamstring injury, Smith also suffered from what’s called an avulsion — when the tendon tore, part of the knee bone pulled away from the larger structure of the knee, a person familiar with the injury said. This medical condition is called distal biceps femoris avulsion.
Gambardella cited a 2021 study published in Orthopedic Journal of Sports Medicine it involved 22 elite athletes who suffered a distal biceps injury thought to match Smith’s injury. Nineteen of these athletes were rugby or football players. All 22 people made a full recovery, returning after just 16 weeks, while the process had previously taken eight more.
This range puts Smith on track for a possible return in December.
Obviously, the Cowboys should be prepared to go through most of the season without him.
“It would be unusual for someone to come back three months after this injury,” Gambardella said. – It’s too much. In other words, they may be truly functional, but they most likely don’t have full muscle strength. Risk [from an early return] is that you were once a good footballer and now you have three people who can do a better job than you because you don’t have that repulsion.
“When you get to the more elite level, you’ll need every little thing.”
Smith’s injury occurred around 7:00 p.m. Wednesday during the Cowboys’ final training camp session. He ran forward and tried to push linebacker Leighton Vander Ashe at level two when he fell to the ground and grabbed his left knee from behind.
Smith was able to leave the field under his own power.
The procedure will be carried out by Cowboys Chief Medical Officer Dr. Dan Cooper.
It requires an incision and involves moving the tendon back into place. This is usually done with suture retainers, Gambardella said, with the retainer placed into the knee bone to reconnect the tendon.
After the operation, Smith is expected to wear a leg brace for about six weeks. Rehab director Britt Brown will take over, as he did with wide receiver Michael Gallup after Gallup’s surgery for a torn ACL in February. Gambardella said Smith’s slow rehab will begin with mobilization and transition to aerobic work and strengthening.
Teams spend a lot of time and resources to avoid soft tissue injuries. Cowboys coach Mike McCarthy, Brown, and strength and conditioning coordinator Harold Nash Jr. meet in the evenings to fool the injury gods by evaluating player tracking data in training to determine a player’s performance for the next day.
Smith’s injury was to the hamstring, but it was not a soft tissue injury.
“This injury, if that’s what I’m thinking, is so rare that it’s not easy to attribute to other soft tissue injuries that can come from overwork, muscle fatigue, dehydration,” Gambardella said. “It wasn’t a muscle tear. In fact, it was he who tore the tendon from its attachment with a small piece of bone. …It looks like the tendon was strong enough to rip off a small piece of bone.”
Smith’s tendon will be reattached Friday morning.
Then his road to recovery begins.
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