COLUMBIA, Mo. • In 10 to 15 seconds of probing the distraught Henry Josey's knee on the sideline Saturday at Faurot Field, Dr. Pat Smith knew there was "a bad problem." But he had no way to know how bad.
"It's a tragic fluke, a one-in-a-million type of injury, and, unfortunately, to a guy who is so gifted with speed and mobility and agility," said Smith, the Mizzou athletics head physician, adding, "You don't see this. In 26 years, I've never seen this."
At least not all at once.
Josey, the MU sophomore who entered the game fifth in the nation in rushing, suffered a torn left patellar tendon and torn anterior cruciate and medial collateral ligaments. And then some.
"Because of where he tore it … it was not (even) a simple patellar tendon rupture, which made it even that much more complicated," Smith said. "Had to fix that, had to fix the meniscus, and the cartilages both were torn. And the MCL had to be both repaired and reconstructed."
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The approximately five-hour process on Sunday didn't include repairing Josey's ACL, which Smith will perform in "maybe three months" depending on the pace of Josey's recovery from phase one.
In essence, the physical therapy already has begun, with Josey's leg in a continuous passive motion machine to stave off scar tissue.
The emotional rehab aspects are well under way, too, including the efforts of MU's medical personnel, Josey's family, the MU coaching staff and a touching outpouring from his teammates.
Still, the psychological component of his recovery will be a crucial, deep and long-term matter for Josey.
"That's going to be the big thing, to really be honest with you," Smith said.
Josey certainly won't practice in the spring, and, in fact, it's unclear when he'll play again.
"Certainly, this is going to be a real challenge, " said Smith, who along with MU's athletic training staff was responsible for repairing the career-threatening knee injury to Jeremy Maclin in 2006. "We don't have a blueprint for saying, 'Oh, these three guys had this.' I don't know of anybody who's had it.
"But I feel like he's got inner strength, he's a fine young man and ... his body, hopefully, has great healing potential."
Just how the injury took place remains puzzling to Smith, who said it was more comparable to what might result from a car accident than anything on a football field.
"To have this happen just was a fluke, where you have just all the right forces," said Smith, who only once before, in August with tackle Elvis Fisher, had encountered a torn patellar tendon. "It looked like (Josey) was kind of grabbed as he went down and twisted down, and his knee was flexed. And ... he tried to pull out of it."
At a glance, it didn't immediately appear to be the traumatic event it would become.
Even Smith, who emphasized seeing many knee injuries in his time, said this one was particularly jarring.
"I'm human, too, and I'm a football fan, and I ... love the Missouri Tigers," he said. "It was hard on me. But you've got to separate the emotion of Henry being hurt from, 'I've got to fix this young man's knee as well as I can.' "
At least phase one is done.
"So far, so good, but we've got a long road ahead," said Smith, who doesn't rule out a full recovery for 2012. "I would say that I'm cautiously optimistic that if anybody can do it, it would be somebody like Henry.
"You just hate to have to say he has to go through this."