Red Sox stitched together miracle

Medical staff improvised on Schilling's ankle before win in Game 6

October 21, 2004|By RAJA MISHRA | RAJA MISHRA,The Boston Globe

Late ALCS game: Last night's Game 7 of the American League Championship Series between the Boston Red Sox and New York Yankees ended too late to be included in this edition. A complete report can be found in later editions or on the Internet at www.baltimoresun.com.

The injured tendon near Red Sox pitcher Curt Schilling's right ankle joint flapped around painfully during Game 1 of the American League Championship Series against the Yankees. The ace M-y and his team's fortunes M-y appeared in jeopardy.

But on Monday, team doctors, laboring in a Fenway Park back room, jury-rigged a stunning and counterintuitive solution. Instead of fixing Schilling's injury, they, in effect, exacerbated it, using a few simple sutures to keep his loose tendon out of place but immobile, thus ending the snapping so bothersome to the pitcher. The makeshift procedure worked. On Tuesday night, Schilling pitched seven innings, giving up only one run, to lead the Sox to victory in Game 6.

And so another chapter in the storied history of the Red Sox was written, with comeback heroics on the diamond M-y and a brilliant flash of medical improvisation behind the scenes that made it possible.

Orthopedic experts said no similar cases had ever been recorded in medical literature. In fact, they said, they could not think of another situation where they would recommend such a procedure. However, they agreed that treating a big-time pitcher before a big-time game was that rarest of circumstances warranting it.

The author of the Schilling patch-up job, Red Sox medical director Bill Morgan, admitted he was treading new ground in devising the idea during the Division Series against the Anaheim Angels two weeks ago, when the extent of Schilling's ankle woes became apparent.

"It was totally unprecedented," said Morgan before Wednesday nightM-Fs Game 7. "It was a reasonable alternative when all else failed. And all else failed."

While improvisation is common in surgery, Morgan had an uncommon goal: simply to get Schilling out on the mound for as many innings as possible.

"Brilliant . . . it worked," said Dr. Tammy Martin, orthopedics chief for the Boston Veterans Affairs health care system and doctor for numerous college athletic teams. "If it hadn't worked, I'd be saying, 'He tried what?' " A week ago, Martin and other orthopedics experts interviewed by the Globe were skeptical that Schilling could perform at anywhere near his usual level without season-ending surgery.

A week ago, Martin and other orthopedics experts interviewed by the Globe were skeptical that Schilling could perform at anywhere near his usual level without season-ending surgery.

The medical drama began in earnest Oct. 5, when Schilling painfully stumbled while fielding a grounder against the Angels in the first game of that series. Morgan said Wednesday he quickly suspected a serious tendon injury, though in public Sox officials said Schilling suffered only from an inflammed tendon.

In actuality, his peroneus brevis tendon, in the back of his right foot, had been dislocated, as became clear in Game 1 against the Yankees, when Schilling pitched poorly and blamed a "popping" sensation in his ankle for distracting him.

The popping was his tendon flapping around. The tendon anchors the ankle's muscle and bone, crucial to movement. The tendon is held snug in a groove on the fibula bone by a thin, yet strong sheath. That sheath had ruptured, and the tendon was loose like a limp rubber band. In that state, it was tough for Schilling to fully use his right leg muscles to pitch M-y not to mention the pain he experienced every time he pushed off the pitching rubber.

During Game 1 against the Yankees, Morgan's medical team tried the usual approach: using tape and an ankle brace to keep the tendon snug. It failed.

"It was impossible," Morgan said. "We tried splints, high-top shoes, taping, everything possible to keep it in."

Morgan had already devised an alternate plan, and floated it with Schilling after the game.

"Curt understood the concept. He wanted to try it," said Morgan.

After the Red Sox won their first game of the series on Sunday, Schilling told Morgan he wanted to give the unorthodox plan a try on Monday, to be ready to pitch Tuesday, if necessary.

On Monday, Morgan and three assistants, working in a sterile back room at Fenway Park, applied a local anesthetic to Schilling's ankle. Then they stitched.

A "few" sutures, threaded through skin and the tissue beneath the skin, were placed in between the groove and the loose tendon, according to Morgan. This created a tiny wall of flesh that kept the tendon in place M-y about 2 centimeters outside its groove.

"We forced it to stay out of the groove so it wouldn't move around," said Morgan. "It's going to stay out until his (postseason) surgery."

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