Rebuilding the Knee at Houston Methodist Orthopedics & Sports Medicine at Sugar Land

Darrin Staloch, PT; Chad Nicosia; Kyle Borque, MD; Siji Afolayan and Jasmine Debose, AT.

COVER STORY  |  Photos by Kelley Sweet Photography –

Complex multi-ligament injuries used to be devastating. Today, specialists at Houston Methodist Orthopedics & Sports Medicine at Sugar Land help both athletes and weekend warriors regain the strength and function they need.

Siji Afolayan’s injury occurred in the last football game of his sophomore year.

The game was almost over, and the Bush High School student was blocking on a kickoff return. As the play ended, he was pushed from behind. When he planted his left foot to try and maintain his balance, his knee bent awkwardly.

Siji Afolayan.

Right away, he knew something was wrong.

“I heard crunching sounds and then I felt tingling in my leg,” he recalled. “And then my knee started swelling. It was so painful.”

His injuries were severe – two torn ligaments; a damaged nerve running along the outside of his knee; and the complete separation of his femur and tibia. But Afolayan was persistent; he knew there was an opportunity to join the varsity for an upcoming playoff game, and he wanted to participate.

It wasn’t until the coaching staff at Bush noticed he was dragging his foot while walking – due to the nerve damage – that he let on about the extent of his injury.

“I didn’t want to believe it was as bad as it was,” said Afolayan. “I just wanted to keep playing.”

Complex Injuries Require an Advanced Approach

Complex multi-ligament knee injuries like Afolayan’s involve the tearing of two or more knee ligaments and damage to associated tissue – typically the result of sports activity or high-energy trauma.

“It’s not unusual to see an athlete tear an anterior crucial ligament (ACL), which is one of four ligaments in the knee, and return to play after surgery and rehabilitation,” said Kyle Borque, M.D., orthopedic surgeon who specializes in knee reconstruction surgery at Houston Methodist Orthopedics & Sports Medicine at Sugar Land. “Multi-ligament injuries are much less common and far more devastating.”

Fortunately, that’s changing, especially for patients at Houston Methodist Orthopedics & Sports Medicine, where a highly advanced approach to surgery and recovery is making it possible for athletes, active individuals and accident victims to regain full mobility.

“Twenty years ago, a multi-ligament injury would be career-ending for an athlete or life-changing for an individual,” said Borque. “Even 10 years ago, the likelihood of returning to sports or a strenuous hobby would have been small. But with advancements in technology, training and our understanding of the knee, today 75-80 percent of athletes with a multi-ligament injury can recover fully and return to sports, if they are treated correctly.”

Trauma in Everyday Life

Chad Nicosia 9 months post surgery.

Not all multi-ligament injuries occur on the playing field. Chad Nicosia of Richmond was in a remote area of Alaska, returning from a hunting and sightseeing trip, and hauling a 50-pound backpack down an incline on his way back to camp. As he stepped slowly, his left foot got stuck in a small depression on the ground, and he lost his balance.

“It wasn’t a spectacular fall or anything,” he said. “But my left leg up to my knee locked into place because my foot was stuck, and my body rotated as I fell. I heard the loudest snap I’ve ever heard, and the pain was immediate.”

Far from his campsite, Nicosia gathered himself for 10 minutes or so before he and his friend carefully maneuvered the remaining mile-long hike back to their all-terrain vehicles, with Nicosia using hiking sticks to steady himself. With his severe injury, it took more than two hours to cover the distance.

“I’d never experienced pain like that before,” Nicosia said. “I knew I needed to get on an airplane and come home as quickly as I could.”

Like Afolayan, Nicosia had multiple ligament tears – his ACL and MCL – as well as a torn meniscus. He was worried his days of trekking in the wilderness were over.

Don’t Wait – Clinic Offers Walk-In Specialist Appointments

The Houston Methodist Orthopedic Injury Clinic at Sugar Land makes it easy and convenient to be seen by a specialist with expertise in treating orthopedic injuries.
No appointment is necessary; office visit pricing and all major insurance plans are accepted. The clinic is ideal for:

• Acute orthopedic injuries (Injury happened within  the last three days)
• Fractures and broken bones   •  Sports injuries  •  Sprains and strains

Chronic conditions, concussions, hip injuries, motor vehicle accidents, spine injuries and workers’ compensation injuries are not treated at the Orthopedic Injury Clinic.


•   Monday – Thursday: 8 a.m. – 6:30 p.m.     •    Friday: 8 a.m. – Noon

Planning and Rehab are Key

Jasmine Debose, AT and Siji Afolayan.

Both Afolayan and Nicosia turned to Borque for treatment, who is uniquely qualified to handle such cases. Borque has extensive experience working with professional athletes, including a stint as team physician with the New England Patriots and other Boston-based teams.

In late 2019, Borque – who grew up in Sugar Land and graduated from Clements High School – was named to the medical staff of the U.S. Men’s Olympic soccer team.

“One of the keys to treating these complex knee injuries is planning, because you have multiple issues to contend with, and they are all important,” said Borque. “It typically requires a longer, more strategic approach than a single ligament tear.”

For example, Afolayan underwent two surgeries – the first to repair his nerve damage; the second to repair his ACL and LCL, along with the damage to other tissue. In Nicosia’s case, his surgery was delayed by several months to allow for swelling to subside and give him time to undergo pre-surgery physical therapy at Houston Methodist Sugar Land to strengthen surrounding muscles.

“Every case is different,” said Borque, “because of the trauma involved in a multi-ligament injury. Patients often have tears in their meniscus and other types of damage along with ligament tears. So, we’re basically rebuilding the knee and doing so in a way that creates a strong, resilient joint that can stand up to physical exertion and athletic competition.”

Another key to successful complex knee reconstruction is advanced post-surgical physical therapy.

Chad Nicosia and Darrin Staloch, PT.

Houston Methodist Sugar Land offers convenient on-site access to one of the country’s leading physical therapy/rehabilitation programs. Board-certified and fellowship-trained experts in sports medicine rehabilitation work directly with the orthopedic physicians to create and implement training plans that help patients overcome their injuries and regain their mobility.

Houston Methodist Sugar Land is one of just a handful of sites in the U.S. offering resident and fellowship training programs in physical therapy, which requires a highly skilled, experienced staff that stays up to date on the latest techniques and studies.

“Physical therapy is important not just for regaining strength and mobility in the knee, but it also gives patients the confidence they need to return to their chosen sport or hobby,” said Borque. “That’s especially important for athletes; the mental aspect is as critical to getting back on the field as the condition of the knee itself. Our physical therapists are great at building a rapport with patients and encouraging them in ways that maximize their recovery.”

Back to Doing What They Love

Following their knee reconstruction surgeries and rehabilitation, Afolayan and Nicosia are feeling great and moving forward – Afolayan is preparing for his senior year at Bush, where he’ll be a varsity receiver with a dream of playing college ball. And Nicosia was back in the wilderness less than a year after his surgery. Both say they feel stronger than ever, and both credit Borque, their therapists and Houston Methodist Orthopedics & Sports Medicine at Sugar Land with giving them a new lease on life.

“There is no other doctor I would go to again, and no other hospital,” said Nicosia. “Dr. Borque was fantastic – he is knowledgeable, talented and caring. His approach was always positive. He told me, ‘I’m going to do everything possible to get you back,’ and he did. I’m better than I was before.”

Afolayan, too, says he was energized by his medical team’s skill and support.

“Everyone I worked with at Houston Methodist Sugar Land was great,” he said. “From Dr. Borque to my physical therapists, they were all so positive and encouraging, and they helped me so much. Coupled with the support of my high school athletic trainer, I’m back on the field. I can’t thank them all enough.”

To schedule an appointment with Dr. Borque – or another specialist at Houston Methodist Orthopedics & Sports Medicine at Sugar Land – call 281.201.0409 or visit