1. ACL Injuries 

The ACL plays a crucial role in maintaining knee stability, especially during dynamic movements. An injury to the ACL, particularly when combined with a kneecap dislocation, can significantly impact an athlete’s career if left untreated. Continuing to participate in pivoting or contact sports with an ACL deficiency increases the risk of recurrent instability, which may lead to further damage to other structures, such as the meniscus and cartilage. This can accelerate the progression of knee osteoarthritis, posing long-term challenges to the athlete’s performance and quality of life.

Advancements in modern surgical techniques have greatly improved the prognosis for ACL injuries. ACL reconstruction is a cornerstone in Tank Dell’s recovery, providing precise treatment with minimally invasive techniques. This approach not only stabilizes the knee but also facilitates faster recovery and enhances outcomes, enabling athletes to return to peak performance levels.

2. Kneecap Dislocation Associated Injuries

It is important to note that Tank Dell reportedly did not experience a true knee dislocation (separation between the thighbone and the shin bone), as seen in cases like Zach Miller of the Chicago Bears. Instead, his injury involved a distinct patellar (kneecap) dislocation. Unlike a true knee dislocation, a patellar dislocation specifically affects the kneecap and is often related to injury of the medial patellofemoral ligament (MPFL), a key structure that helps prevent patellar instability. In some cases, an injured MPFL can heal without surgery, provided there are no associated bone abnormalities. This can be the case usually when other ligaments are injured such as the ACL in this case. 

Unfortunately, the possibility of cartilage damage — commonly associated with kneecap dislocations — requires a thorough evaluation, as addressing such injuries surgically may help mitigate the risk of developing early knee osteoarthritis.

3. ACL reconstruction (ACLR)

ACL reconstruction is the gold-standard treatment for ACL tears in professional athletes because it restores knee stability essential for dynamic movements such as pivoting and cutting — common in sports like football, soccer, basketball, and lacrosse. For athletes, the preferred graft is typically harvested from the patellar tendon of the same knee. This graft is favored due to its reliability, and mainly because it has been shown in multiple studies to re-tear the least over time.

The surgical procedure involves creating precise bone tunnels in the femur and tibia that intersect at the center of the knee joint. The harvested graft is then threaded through these tunnels and securely anchored to the femoral and tibial bones. This technique not only ensures optimal graft positioning but also promotes strong, durable healing, enabling athletes to return to high-performance levels post-recovery.

Additionally, based on recent randomized clinical trials, there is a “seatbelt procedure” for the ACL called a lateral extra-articular tenodesis. This involves harvesting a small part of the iliotibial band (ITB) and fixing it in the femur. This can decrease re-tear rates by three times in some cases.

4. MPFL Reconstruction

The medial patellofemoral ligament plays a critical role in limiting lateral patellar translation and preventing recurrent dislocations. Unlike the ACL, which has a limited healing capacity due to its intra-articular location, the MPFL’s extra-articular nature allows for the option of using a cadaver graft for reconstruction when the ligament is significantly damaged.

It is unknown if Dell will need to undergo an MPFL reconstruction. However, during an MPFL reconstruction, the cadaver graft is anchored to the inside aspect of the patella and secured at a precise anatomical location on the femur. This strategic fixation restores the ligament's function, significantly reducing the risk of patellar dislocations and improving overall knee stability.

5. Rehabilitation and Recovery

Post-surgery rehabilitation is essential for restoring function, rebuilding strength, and enabling athletes to return to their pre-injury performance levels. Customized physical therapy programs focusing on muscle strengthening, flexibility, and proprioception are critical to ensuring a safe return to sports while minimizing the risk of re-injury.

In Dell’s case, his recovery journey presents unique challenges. Having already overcome a fibula fracture that ended his season last year and a gunshot injury during the offseason, returning to play—especially at his previous high level—requires significant effort from both him and his rehabilitation team. Beyond the physical demands, psychological readiness will be a key factor in his recovery. Modern rehabilitation protocols increasingly address the impact of kinesiophobia (fear of reinjury) to prepare athletes mentally and emotionally for their return to competition, ensuring a comprehensive approach to their recovery. Most surgeons advocate for a milestone-based approach regarding rehabilitation with a return to sport estimated in around nine months.