De Villiers's agony

The sight of Jean de Villiers, Springbok captain, rolling over,  face contorted and crying out in agony was the worst memory of November's rugby, indeed one of the worst of  rugby football's bad memories.

After Leigh Halfpenny goaled a penalty for Wales to make the score 12-6, Patrick Lambie dropped out high to his left.

Lwazi Mvovo chased and Jamie Roberts of Wales jumped and caught the ball. Roberts fell to the ground and De Villiers, who was behind Mvovo bent down to get the ball, his feet planted on the ground in a legal position to contest possession.

When De Villiers was in this position Wales No.8, Taulupe Faletau, arrived and attempted to dislodge De Villiers. Faletau's initial thrust failed and so he got a hold on De Villiers in the mode of a wrestler, and pulled De Villiers away from the contested area and to the side of it, and  De Villiers cried out in agony.

De Villiers had planted both feet firmly on the ground. Faletau pulled De Villiers towards his left and Faletau's right knee made contact with De Villiers's right knee and prevented De Villiers's left leg of going with the roll. It was here that De Villiers was injured.

Referee Johnny Lacey immediately stopped play, medics were brought on and De Villiers was eventually taken off on a mobilised stretcher.

Back in South Africa on Monday De Villiers underwent examination by well-known orthopedic surgeon Spike Erasmus, and surgery was advised.

Rugby365 consulted Dr Dirks Hoffman, a prominent orthopaedic surgeon who lives in Somerset West. In his day Hoffman played centre for Northern Transvaal, Natal and Western Province in seven seasons of provincial rugby, an outstanding, skilled player who did not have the multitude of opportunities to play for South Africa that modern players have but certainly a player of international class.

Hoffman saw De Villiers being injured when watching the television broadcast of the match and immediately recognised the seriousness of the injury. After all this was his field of medical expertise.

At the knee, three bones meet – the femur (thighbone), the patella (kneecap) and the tibia  (shin). These bones are connected by four main ligaments – two on the sides (the lateral ligaments), one in front (the anterior cruciate ligament) and one at the back the posterior cruciate ligament). The cruciate ligaments are inside the knee, the lateral ligaments on the outside.

The ligaments keep the joint together and when working well give it stability. A torn or stretched ligament causes the knee to be unstable, making it difficult or even impossible for a player to do cutting sports. Such a ligament needs to be repaired but ligaments cannot be stitched  together. The repair is done by transplanting suitable material from the hamstring or the quadriceps to form a bridge for new ligament to develop.

In the case of De Villiers this is more complex because he has used up his own resources in reconstruction each of his knees in the past and so material for this reconstruction may well have to be taken from another patient.

Repairing a torn ligament is likely to take a player out of the game for as much as a year, if not more, while the ligaments are growing back. If he again injures it – as De Villiers has done – the damage is more serious and the player is a likely candidate for osteoarthritis 10 or 15 years after the injury.

There is also the possibility of the terrible triad of O'Donoghue, named after Dr Don O'Donoghue who was an orthopedic surgeon in the 1950s.  The terrible triad is usually caused by a knock from the side, resulting in tears to two ligaments (medial lateral and anterior cruciate) and to the cartilage. The dislocated patella, which Schalk Burger suffered, is a further complication.

It is possible to stabilise and repair the damage in one operation though the complexity of De Villiers's injury to his medial collateral, posterior and anterior ligaments plus possible damage to his meniscus may require staged procedures, starting with the medial collateral ligament.

It is a terrible blow for De Villiers himself and for the team he was destined to lead in its quest for the World Cup, one of the very best of captains.