Cam Rising’s surgeon says the Utah quarterback is ‘right on or ahead of schedule’

Dr. Neal ElAttrache explains why Rising’s ACL tear is more complex than many knew.

(Trent Nelson | The Salt Lake Tribune) Utah Utes quarterback Cameron Rising (7) throws the ball during halftime as the Utah Utes host the Florida Gators, NCAA football in Salt Lake City on Thursday, Aug. 31, 2023.

Cameron Rising roamed the sidelines at his old stomping grounds Friday night at Newbury Park High School looking on as his alma mater, led by the familiar No. 7 under center, rolled to a 35-14 win over Agoura. When given the opportunity to provide pointers for Newbury starter Brady Smigiel, Rising was there in the ear of the sophomore.

“He’s a warrior,” said Newbury Park coach Joe Smigiel. “My family was there sitting with his family when he got hurt at the Rose Bowl. It was shock and awe. It was never really publicized how badly he was hurt. It’s a very serious injury. To even be where he’s at with his rehab at this point, it’s unbelievable. I know he’s going to do everything he can to get back and help the Utes win some football games again.”

Rising, Utah’s starting quarterback, has led the Utes to back-to-back Pac-12 titles. Now he’s in the latter stages of a prolonged recovery that he detailed on local radio station ESPN 700 last Thursday. What was initially believed to be just a torn ACL from a tackle against Penn State in the 2023 Rose Bowl on Jan. 2 turned out to be much more severe. Rising explained that he suffered a torn ACL, MCL, meniscus and MPFL, a ligament that helps stabilize the kneecap.

“I’m doing everything I possibly can to make sure that I’m improving,” Rising said. “And at some point your body has to heal the way it has to heal. It’s unfortunate and not exactly the way I expected the season to go, and that’s just the cards I’ve been dealt and that’s what I’ve got to play.”

While Rising remains in the throes of a rigorous rehab to get back to play, there has been a groundswell of frustration from the Utah fan base for not knowing when exactly the star quarterback could be back. The messaging from Utah’s football program, which does not discuss details of injuries and reveals only season-ending injuries, has been that Rising was going to be in the mix to play as early as the opener against Florida on Aug. 31.

That has not been the case.

Yes, he’s made continual improvements and is on track. But the severity of the injury that Rising disclosed makes timelines once believed to be possible quite the opposite. Dr. Neal ElAttrache, considered one of the premier orthopedic knee surgeons in the country, performed the surgery on Rising on Jan. 16. Rising was back home in Southern California over the weekend during Utah’s idle week to see ElAttrache.

ElAttrache was given permission by Rising to speak to The Athletic to expand on the surgery, the rehab and where Utah’s quarterback is in the process of this tedious recovery. ElAttrache said Rising’s multi-ligament injury plus the meniscus tear usually takes top-flight athletes anywhere from 10 to 12 months to return to competition. So far, Rising’s knee “doesn’t have a lick of swelling in it” and has been responding to very continuous demand nicely, ElAttrache said. There has been no excess fluid buildup after practices or stiffness that limits his range of motion.

“With regard to where Cam is, he has been right on or ahead of schedule the entire time with what he was able to do and what we would let him do,” ElAttrache said.

Reconstructing a knee as damaged as Rising’s requires patience and understanding that benchmarks are reached by different athletes at different points in time. For example, early on Rising wasn’t cleared to sprint, decelerate and cut despite being able to do some football activities on the field. That would damage the repaired meniscus. To ensure the MPFL doesn’t aggravate itself in the kneecap, Rising had to have the muscles in his quadriceps and glutes close to what they were before, otherwise the knee would put too much pressure on the kneecap.

“He cruised through all of that and actually put himself in a position where, when you looked at him, you lost track of what kind of injury he had, how big it was and how big of a surgery it was,” ElAttrache said.

Progressing so swiftly doesn’t mean benchmarks are always cleared all at once. Rising was cleared to do certain non-contact drills in preseason camp, which ElAttrache said perhaps planted the idea that Rising was back and ready to go for the start of the season.

“Returning to play is one thing,” ElAttrache said. “Returning to performance and increasing the safety of the knee in a very unsafe sport … there’s benchmarks that we really like to have guys hit.”

What remains for Rising?

ElAttrache, who has been communicating with Utah’s medical and training staff from afar, said it’s down to endurance-type situations where Rising may be partially fatigued whenever he decelerates and cuts. He’s still training for the surgically repaired knee to return to overall strength comparable to his healthy knee. Ensuring muscles in both legs are at similar capacity and ability is required to alleviate pressure on the left knee blown out in the Rose Bowl.

“He’s gaining on it,” ElAttrache said. “I don’t know if it’s going to be a week or two weeks. Cam is close, but there’s a few things that we really need to still see before we can have him go back as safe as possible at this point. We’re not even going to be nine months from the surgery until the 16th of this month. Until he gets some of his power and mechanics refined, this last phase of the return to competition — or what I call return to performance — happens at different paces in different people.”

It also depends on what position the person plays, ElAttrache added. If Rising was, say, an offensive lineman, it’s possible that we would be able to tolerate different criteria for return to play compared to a quarterback whose offense is predicated on a high percentage of quarterback runs and his threat throwing the ball on the move.

“We need to take all that into consideration, too,” ElAttrache continued. “My interest is definitely getting him back to competition as safely and as soon as possible, but in addition to when he gets back, to give him every chance of him not re-injuring that knee because there was a deficit that we allowed him to go back to play with.”

During his radio appearance on ESPN 700 last week, the tone of Rising’s voice was almost apologetic. Expectations from a fan base that has elevated the long-haired quarterback to a legend within program lore were that Rising would be back under center by now. Utah head coach Kyle Whittingham said during last week’s bye that Rising hasn’t cleared or ruled out until late in the week as of late, which has been frustrating for game plan purposes. Rising has been splitting reps with the No. 1 offense with current starter Nate Johnson.

At his weekly news conference before the No. 16 Utes host Cal this weekend, Whittingham said Utah would find out Monday sometime whether or not Rising would be given the green light to play.

When asked if, in retrospect, he would change the messaging of the quarterback situation and Rising’s scenario, Whittingham said: “That’s a tough question. I don’t know if I have a good answer for that. I probably don’t have a good enough answer to waste your time with.”

When he was initially cleared to participate in portions of preseason camp, Rising routinely told ElAttrache how he felt a loyalty to his team and his coaching staff to get back as soon as possible.

“And he wasn’t saying it in a bitter way, it was just a matter of fact,” ElAttrache said. “I kept saying, ‘Cam, you’re forgetting where you are in this thing. The strength of that ligament healing and maturing is not where I need it to be if you do the types of things you’re going to need to do in an instant on the field.’ He has this inner feeling he’s got a responsibility to the team and to his coach and he wants to compete as soon as possible. He wants to do it. He’s counting on me and trusting me that I will look out for him and I’ll protect him from him, to some degree. That’s my priority.”

Rising has Utah’s most noteworthy injury, but the Utes have suffered loads of injuries to starters and contributors at all levels. Whittingham has said that he’s never experienced this many injured players at once in his nearly 40 years of coaching. While Rising is still healing, Utah is down to Johnson, its fourth-string quarterback entering preseason camp. The Utes are averaging just 297.6 yards of total offense per outing, which ranks 127th in the country.

With Rising leading the way, Utah’s offense was electric a year ago, averaging 42 points through the first five games of the season. So far this year, the Utes are averaging just 19.2 points per game.

The psychological portion of such a lengthy recovery process plays a more significant role than most would expect, too. ElAttrache calls it “the big black box.” There’s no way of knowing how a player will respond once they’re officially cleared. On top of that, there’s internal pressure from himself and external pressures from Utah fans to return soon — especially for a player the caliber of Rising, a team captain and 2021 first-team All-Pac-12 pick.

“I can hold his hand right up to the ledge before getting on the field, but that last step they take on their own,” ElAttrache said. “If they’re hesitant or reluctant for any reason, that’s as much of a symptom as anything. He may not be able to say, ‘I feel like I’m a tick slow on cutting to the left when I do X, Y and Z.’ They may not be able to verbalize the exact area of weakness they may be having, but their overall perception of their confidence to be able to be the player they’re familiar with, that gets scored, too. That’s psychological readiness. That’s an important score that tells you if, ‘Has this player regained all that wiring? Does he have his position senses and neuromuscular feedback that goes back into making you feel healthy?’ All that wiring has to heal in addition to the ligaments.”

Utah fans who expected Rising to be able to lead the Utes toward a three-peat in the Pac-12 are obviously frustrated with the paltry offensive production. Some have even targeted ElAttrache as the primary source of ire for Rising not being fully cleared. A Utah fan recently left a one-star review on Google for ElAttrache with a message: “Let Cam play.”

“The pressure on these college kids is a hell of a lot more than the pros,” ElAttrache said.

Truth is, unrealistic expectations were set when Rising wasn’t ruled out early in preseason camp and in the first few weeks of the season. Whittingham has long said he would happily submit an official injury report should it ever be mandated by the NCAA or a football governing body. But until then, Utah will not tip its hand and provide unnecessary insight to an opponent.

“If somebody can give me one reason why it would help us win more to announce it, then I’ll tell you everything,” Whittingham deadpanned Monday morning. “But I can’t think of one thing. If you think of one thing, let me know because I’d be excited to hear it.”

ElAttrache said timetables for return to play, practical or not, can suddenly take on a life of their own to the public.

“All of a sudden what’s in print becomes reality and becomes a real expectation,” he said. “I’ve seen it happen even at the pro level, too. I feel I need to protect him from being a target of people saying, ‘Hey you’re being selfish.’ But on the other hand, I’m looking at these numbers and I know that the relatively brief amount of time since his surgery and his numbers make sense to me and he needs a little bit more time to recover.”

Utah enters the gauntlet of its Pac-12 schedule in the coming weeks with matchups on the road at No. 10 USC and No. 7 Washington and a home date with No. 8 Oregon in the next month. If the Utes are to defend their crown, they’ll need Rising back. When will that be? ElAttrache wants to ensure the fearless quarterback is returning to perform like he has in recent years and not rushed back under any circumstances.

“When you look at where we expected him to be and where generally these guys are after this kind of an injury he’s doing remarkably well,” ElAttrache said. “I fully expect him to be the player he was.”

— This article originally appeared in The Athletic.