Jason Kendall. Ruben Mateo. Cliff Floyd. These are not names that Manny Machado wanted to be mentioned with.

Machado, the Orioles‘ phenom, is more used to being in the conversation with Bryce Harper and Mike Trout, but a gruesome leg injury Monday in Tampa had many wondering if there’s a chance he’ll be mentioned with the former much more than the latter now.

The Orioles had an MRI conducted on Machado’s knee on Tuesday afternoon. Machado was diagnosed with an medial patellofemoral (MPFL) sprain, but the MCL and ACL are not sprained (or not sprained enough) to require immediate reconstruction, confirming the expectations from manual testing both on the field and after Machado returned to Baltimore.

Remember, a sprain is a tear, but in all likelihood, the MPFL is not ruptured (a Grade III sprain) while the MCL and ACL have a lower grade of damage. There was no word as yet on the meniscus. The “conservative treatment” means that they will try to help the leg heal through rehabilitation rather than surgery, though it does not rule out the possibility in the future.

Machado is unlikely to miss much, if any, of the 2014 season. His recovery could take him to midseason if it took a long time, but it’s not likely. While there is little doubt he will return, there is some concern about his range. Age is often cited as a positive for a young player, but youth really has very little to do with recovery. 

The video is tough to watch. There’s no clue prior to his leg buckling that there’s any problem. Machado is running hard to try to beat out a grounder that had drawn the first baseman away from his zone, but he’s not overextended. It’s not even clear exactly how he stepped on the bag, but it is obvious that something gave way.

The angle of the video makes it tough to see, but it appears that his knee buckles both forward and medially. Early speculation ranged from an ankle injury, like what we saw with Jason Kendall, to a knee hyperextension. The medial, or inward, movement of his knee recalls a football player getting rolled up from the outside, a common injury.

Machado had no known history of knee issues as far as I could find, going back into high school. His pre-draft physicals were “very clean,” according to a team source. The Orioles did say in their press conference that Machado had a previously unknown injury during his time at Delmarva (Single-A) that could have weakened the ligament.

If you are able to watch the video, there’s something interesting. Often, the athlete’s first, unconscious reaction is one of the best indicators of a problem. Machado’s first reaction is with his right hand, and it’s not what I expected or even noticed on my first few viewings.

Instead of reaching down, Machado reaches for his lower back. My speculation is that the twisting of his knee below him caused a quick and painful twinge in his back as his body tried to adjust to the sudden weight shift. It’s about like when your foot slips on ice and you catch yourself, but wrench your back.

Of course, Machado fell just after this and immediately pulled his knee up to his body. This was difficult to read. He could be reaching to stabilize his knee or protect his leg to minimize motion. (This is most commonly seen in ankle fractures.) 

Orioles Athletic Trainers Richie Bancells and Brian Ebel were out on the field quickly, as was Dr. Koco Eaton, the Rays team orthopedist, and other members of the Rays medical staff. Their quick and professional care will go a long way in getting Machado back and minimizing the damage as best they can.

One of the best things I saw was the way that Bancells and Eaton seemed to calm Machado down while he was on the field. With as much pain and fear as he showed, just getting him back to a focused point is a huge plus for everyone and worthy of notice.

While any knee injury is a negative for Machado or any player in baseball, it is clear that they can come back. Serious injuries like an ACL reconstruction are becoming relatively sure recoveries. Mariano Rivera had his ACL reconstruction last season and has shown no deficits, coming back in just nine months.

Even a catcher like Jason Castro was able to return and showed few problems after having his ACL repaired. A few years back, Brewers pitcher Yovani Gallardo came back from his ACL injury during the season. 

An MPFL sprain is rarer in baseball. In fact, my injury database does not have any comparable injuries. 

Dr. Tim Kremchek, one of the top sports surgeons around and the team doctor for the Cincinnati Reds, says he would repair this kind of tear. “He’s an infielder and needs the lateral stability. There was so much valgus stress on the knee that I think you would want to make sure it’s fully healed.”

Dr. Kremcheck was positive on the chances for a player to come back from these types of surgery. “With an ACL/MCL, I think it would be about six months for a full recovery. Just an MCL? That’s more like four.”

Both of those possibilities were ruled out by Tuesday’s MRI.

Expect Machado and the Orioles to seek a second opinion on this. That is very common and likely is already in motion. Dr. James Andrews is going to be the first name to come up, given his success with Adrian Peterson and Robert Griffin over the past year. Andrews is the Rays’ medical director and trained Dr. Eaton as one of his ASMI Fellows. Eaton’s firsthand knowledge of the injury could have helped guide the surgeon had it been necessary, so it wouldn’t surprise me to see him involved. 

While there is no positive to this injury, the fact that it came at the end of the season gives Machado four full months to recover before spring training without missing any action. The Orioles can focus on minimizing any time lost in the short term while making sure they get Manny Machado back to full function in the long term. 

In fact, Machado could be in the lineup on Opening Day. That would be amazing, but not a miracle. It’s a testament to modern sports medicine, plus the quick action of the medical staffs and doctors that treated the young star. 

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