Luis Garrido's reputation on the pitch is one of an enforcer. As Houston Dynamo's defensive midfielder, La Fiera (the Beast) is known for his powerfully strong and physical play - sometimes too physical. But after Tuesday afternoon, Garrido now faces the most difficult challenge of his career.

A chippy World Cup qualifier between Honduras and Mexico came to a head in the 38th minute when Garrido found his right knee bent forwards and the same leg pinned under the body of Mexican midfielder Javier Aquino. The image is a graphic one, not commonly found in the catalog of global football injuries.

The rundown is painful to read - knee dislocation, anterior and posterior cruciate ligament (ACL and PCL) ruptures, as well as damage to the remaining knee ligaments. It's an injury in a category of its own and certainly differs from the more common isolated ligament tears that fans witness throughout all of sports.

To help wade through the aftermath of Garrido's injury, we spoke with Dr. Robert G. Marx, an attending orthopedic surgeon with Hospital for Special Surgery in Manhattan. Dr. Marx specializes in many different sports surgeries (including multi-ligament knee reconstruction) and was able to provide insight on what happened in Garrido's knee as well as what to expect on the other side of his long recovery.

* * *

Dynamo Theory: Can you give us a brief overview of how the ligaments aid in the function of the knee?

Dr. Marx: Well, they're cruciate ligaments. "Cruciate" - they cross in the center of the knee. They basically stabilize the knee from front to back, the tibia below in the lower leg, and the femur [above] so that they don't move forwards or backwards and also in rotation.

In this case, what happens to his knee function?

When you dislocate your knee, by definition, you have to tear the ACL and PCL. The knee comes apart... Generally, you can't tear the ACL and PCL without tearing the other ligaments. It's a grossly unstable knee.

Isolated ligament tears can be common in sports. Is this multi-ligament rupture uncommon?

They do occur in sports but a knee dislocation or a multi-ligament knee injury is - although not super rare - it is relatively rare compared to other ligament injuries and other knee injuries in sports. It happens; I happen to see quite a lot of these but it's not as common as others.

Would an athlete like Garrido be prone to setbacks during such a long recovery period?

I think that's always a possibility but it's a much bigger operation, assuming what needs to be done is a lot more than just an ACL [tear]. It's a pretty significant procedure but I wouldn't expect setbacks.

Are there any other risks with this sort of injury?

With these complex multi-ligament injuries, there's a higher chance of vascular or nerve injury. Those can be limb-threatening. I'm assuming he didn't injure his artery... but if it's missed - which can happen - the person could lose their leg so it can be a limb-threatening injury. It's a very serious injury.

After the recovery plan is complete, would an athlete with this injury need to alter their style of play?

No, I think it's a question of whether they can get back their speed and agility to be able to compete. To compete as a professional athlete, they really need to be perfect basically. That's a question of whether he'll have that speed, agility, and acceleration to be able to successfully compete at that level and make a living playing soccer. It may not happen.

It's like with an isolated ACL injury, we just assume people are going to get back to playing. It's very rare they don't. With this, I think it's different. It's not as certain as an isolated ACL.

* * *

Garrido, for his part, remains determined. Javier Aquino has already reached out to apologize on Twitter, while Garrido views the injury as purely an accident. The outpouring of support from fans and Dynamo teammates has given the player resolve and he looks to his faith as he begins his long journey back to the field.

Stay tuned to Dynamo Theory as we receive more updates throughout the offseason.