Andre Gomes’ right ankle fracture-dislocation: Explaining the injury, surgery, and return prognosis

Everton midfielder Andre Gomes suffered a devastating right ankle fracture-dislocation injury on 11/3 during the team’s 1-1 draw against Tottenham.

There were very emotional scenes following the injury because a dislocation is such a jarring visual. It completely disrupts our mental picture of the intact human body.

In this piece – for which I consulted extensively with a trusted sports-minded orthopedic surgeon – I detail the injury itself, the surgery, Gomes’ return to play (RTP) process and the unique mental challenge he faces in rehab, and his return timeline and long-term outcomes.

If you prefer a video format, look no further:

The injury

The injury is very likely what’s known as a “tibiotalar fracture dislocation”. The tibiotalar joint connects the tibia – shin bone – to the talus – the uppermost ankle bone.

A tibiotalar dislocation occurs nearly exclusively due to a sudden high force trauma that gaps and separates the two bones, destabilizing the joint.

Typically, this dislocation occurs along with a fracture to the higher part of the fibula – the outside bone on the lower leg – relative to the joint. The fracture is medically termed a “Weber type C ankle fracture”.

Additionally, there’s nearly guaranteed damage to the syndesmotic ligaments aka the “high ankle ligaments” and the deltoid ligament which is a very strong collection of four ligaments that sit on the medial (inner) aspect of the ankle. This damage serves to completely destabilize the ankle, which was obvious based on the position of Gomes’ ankle after the injury.

The Surgery

Gomes went into surgery the following day, 11/4.

The surgery involves reducing the joint and fracture, in other words bringing the out of alignment anatomy back into alignment to allow it to heal.

Most likely this was done via “syndesmotic fixation” with a relatively new technique called a “tightrope” procedure that’s increasingly showing to have the best outcomes.

Additionally, the deltoid ligament may also have been repaired if there was no fracture to the medial malleolus – the bump on the inner part of your ankle that signifies the end point of the tibia.

Return to play (RTP) process

After surgery, Gomes will require extensive physio to maintain ankle range of motion and strength, rebuild his fitness foundation and gradually get back to higher intensity activities. It’s a slow, methodical, grueling process.

Overcoming mental hurdles

One of the primary challenges for Gomes – and this is part and parcel with any major injury that requires an extended rehab – is mindset. It’s a long, winding journey to get back to full fitness and it can be a daunting task when you look up at the peak from the bottom.

In my experience with these severe injuries, the mental battle of extended rehab can be a dark and lonely place where you’re spending hours and days and months with the same person, away from your teammates, club, and what you love to do.

Accordingly, it’s key for Gomes to keep a positive, growth mindset that views the injury as a challenge rather than as a defeat. This mindset can positively influence every aspect of recovery and there’s more and more research substantiating this.

A key element of maintaining that mentality is support and encouragement from the club and fans. Gomes has seen that in spades and it’s been a beautiful thing to witness.

Timeline and outcomes

It’s quite difficult to put a definite timeline on Gomes’ return timeline and if/when he’ll be the same player because the research is, frankly, all over the place. Ankle fracture dislocation injuries involve multiple different variables so it’s difficult to group them together and create a sample size that actually leads to a meaningful conclusions and consensus.
That being said, you’re looking for some answers so we did our best to synthesize all of the information available. 

Timeline

It’ll take Gomes a minimum of fourt to six months to get back on the pitch and even then, many athletes don’t feel like their ankle is “100%” even at one year post surgery. It can take numerous years to regain that feeling and confidence.

That sentiment is further reinforced by research which shows kinesiophobia – fear of movement or reinjury – as one of the last things to dissipate after major injuries, especially traumatic ones like Gomes suffered.

An example of that extended process is Boston Celtics wing Gordon Hayward. He suffered a fracture dislocation on October 17th, 2017 and is just now – over two years later – starting to look comfortable on the court.

 In Gomes’ case, football is one of the few sports that places even more stress and demands on the ankle than basketball so it wouldn’t surprise me if his process takes even longer.

Will he ever be the same player?

The stark reality is that Gomes may never get back to his previous level. There’s no evidence whatsoever to support a “full recovery” and, in fact, we’ve only found evidence supporting that he’ll likely never make a full recovery.

That certainly doesn’t mean he can’t get back to being an effective player on the pitch but he will likely always have to manage persistent stiffness and discomfort in the ankle, be very disciplined in his strength and conditioning program, and continue to mitigate any risks for compensation and subsequent compensatory injury.

One significant positive for Gomes – you know I like to end on something positive – is that his injury primarily involved twisting – or “rotational load” – which tends to have far less damage to the ankle cartilage compared to compressive – or “axial load” – injuries. This preservation of the cartilage is key for function and longevity because cartilage is critical for distributing stress, absorbing shock, and reducing friction in the joint.

Additionally, Gomes has access to elite medical care which always bodes well for overall recovery, ongoing maintenance, and return to high level performance.

That’s a wrap for this article. Thanks for reading. My goal is to provide you with in-depth, evidence based, narrative free analysis and you can always find me on IG and Twitter @3CBPerformance. Make sure to sub to the blog below and to the YouTube channel for the latest updates. 3CB out.

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