Colts, Anthony Richardson considering shoulder surgery; we asked a doctor what that means

UPDATE: The Colts announced Wednesday that Colts quarterback Anthony Richardson would undergo season-ending shoulder surgery.

Colts news: Colts, Anthony Richardson choose season-ending surgery to protect rookie QB long term

PREVIOUS: It's been one week since Colts rookie quarterback Anthony Richardson suffered a reported Grade 3 AC joint sprain in his throwing shoulder. Richardson has been placed on injured reserve, meaning he'll miss at least three more games, but any decision on Richardson's long-term availability has not yet been made.

The main decision the Colts and Richardson are weighing is whether to surgically repair the injured shoulder.

"We want to do what's best for him and this organization moving forward," Colts head coach Shane Steichen said of Richardson. "We’ll make the decision when the time’s right and we’re still evaluating."

IndyStar spoke to Dr. Robert Klitzman, an Orthopedic Surgeon with IU Health who specializes in sports medicine to learn more about the Colts franchise signal caller's options for recovery. Dr. Klitzman has not examined Richardson and is only speaking about the injury in general.

Is surgery common for an AC joint sprain?

"For Grade 3, more often than not, you don't need to have surgery," Klitzman said. "The ones that need to have surgery are the ones that either continue having pain or have instability, and it just doesn't seem like it's healing on its own."

When is surgery needed for an AC joint sprain?

A Grade 3 AC joint sprain means there was a disruption in the ligaments that hold the collarbone in with the AC (acromioclavicular) joint. There are two ligaments that go from the collarbone down to the coracoid process that help stabilize the shoulder. There are also stabilizing ligaments that go across from the collarbone to the acromion.

If surgery is needed to repair those ligaments, it's possible that the injury was more severe than a Grade 3 sprain.

"If you disrupt all of those (ligaments), that's where you'd have what's called a Grade 5 and it's a bunch of displacement or the collarbone is sitting really, really high relative to the acromion," Klitzman said. "With a Grade 3, there's not that much separation. ... The surgery is to reconstruct the ligaments that stabilize the bone just like you reconstruct an ACL to stabilize the knee. You're reconstructing the ligaments that stabilize the AC joint."

Can someone get the surgery preventatively?

Dr. Klitzman said yes. While it's not common, treating an NFL quarterback is different than treating a non-professional athlete. If a Grade 3 is treated without surgery, it will take longer to know whether it's healing properly.

If the shoulder is not healing properly, surgery may be needed after all, moving back the recovery timeline even further. Getting the surgery now instead of waiting moves up the recovery timeline, allowing Richardson to return to full health sooner.

How is the AC joint repaired?

There are multiple ways to repair an AC joint. One way includes adding internal hardware to increase stabilization and speed up the recovery process.

"It's an outpatient surgery. It'll take an hour to two hours," Klitzman said. "In addition to just reconstructing the ligaments, you can put some internal things in there to stabilize it even more that are like heavy suture.

"It's all about stabilizing it so that when it is healed it doesn't hurt and the mechanics are good."

Is this usually a successful surgery?

"With any surgery there's risks," Klitzman said. "There's risk of infection, there's risk of scar tissue, nerve injury, vessel injury, that's always there with any surgery. This is one that generally does well, especially at a Grade 3.

"I think the expectation would be in the 90s percent-wise of success."

When will Richardson be back on the field?

"In terms of getting back to playing with full contact, generally that could be about six months."

Colts news: Anthony Richardson will rehab shoulder before Colts make decision on surgery

What's the rehab process like?

"Generally speaking, you're going to be in a sling anywhere from about four to six weeks," Klitzman said. "You'll do just some light range of motion exercises that get going in physical therapy after just a couple of weeks. Building strength back up is really what it depends on.

"You give it enough time to heal and while you're doing that, you can't really be building or maintaining a lot of the muscles around that shoulder. After it's healed, you have to build that (strength) back up over several months."

Chances of re-injury?

"There's always a chance of re-injury," Klitzman said. "The AC joint he was born with was injured, and you won't usually say that after surgery something is better than what you were born with. But it will be very stable and so it should take another big force to cause the injury like this one did.

"It doesn't make you bulletproof. It doesn't make you better than you were before it all happened. But it does stabilize things and it should take a pretty big force to disrupt it again."