Had the Orange Bowl been one week earlier last year, Tua Tagovailoa’s ankle may not have been healthy enough for him to play.

Having that extra week was a big deal.

It was the difference between Tagovailoa being questionable, at best, for the game and being healthy enough to throw for 318 yards and four touchdowns during Alabama’s 45-34 win over Oklahoma.

It’s different this time, though.

Tagovailoa likely isn’t going to need to that extra week to be ready to play. It’s taken a week less to get to the point of being game ready this time around.

The first-team All-American has been making rapid progress in his recovery from this latest high-ankle sprain, so much so that Alabama expects its star quarterback to play against No. 2 LSU on Saturday just 20 days after undergoing surgery, according to sources.

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Alabama and one of its team doctors, Norman Waldrop, are helping to change the expectation regarding the recovery time for bad high-ankle sprains.

Before Cam Robinson in 2014, Tide players would normally miss two months and sometimes even longer with a significant high-ankle sprain like the one Tagovailoa suffered against Tennessee Oct. 19.

That’s not the case anymore, thanks largely to Waldrop and a relatively new surgery — the “tightrope” — that Alabama has popularized in recent years.

“High-ankle sprains have always been an injury that’s typically taken much longer to heal than the traditional lateral ankle sprain,” said Thomas Clanton, a foot and ankle surgeon in Colorado who used to be a team doctor for the Houston Texans and Houston Rockets. “It’s fairly amazing to see the fact that you can get a player back doing things within three to four weeks sometimes that would typically have taken eight to 12 weeks.”

Clanton was one of the first doctors in the United States to begin using the tightrope surgery about 15 years ago. Waldrop learned about it during a fellowship with Clanton in 2011 and has since made tweaks to the surgery to improve the recovery process and cut down on future issues with the ankle.

Instead of using screws during surgeries for these bad high-ankle sprains — as had been customary — doctors can use this tightrope implant that’s developed by Arthex, a company out of Naples, Florida.

It’s a flexible, durable stitch that’s used to fix the joint between the tibia and fibula and to reconnect those two bones.

“With the tightrope, because it is flexible in the normal anatomic motion that it allows, it does tend to keep the bones together and still allow normal motion,” said Pete Denove, a senior director for product management at Arthrex. “I think that’s why you’re seeing a quicker return to play versus rigid fixation (with the screws), which was the original way to treat this. Allowing for normal motion is what gets a patient back sooner versus having his syndesmosis (the joint between the tibia and fibula) fixed with screws, which are obviously metal and very rigid.”

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While there seems to be a perception that the tightrope is a commonly used surgery for the Tide, only about 10 Alabama players have undergone the procedure over these last five years.

It’s only used when a player has a severe enough high-ankle sprain that the medical staff fears it could be a long-term problem without doing the surgery.

Robinson was the first Tide player to have the surgery in October 2014 and was able to play against LSU two weeks after sustaining a high-ankle sprain.

Anfernee Jennings, Jalen Hurts and Tagovailoa are among the Alabama players since then to undergo this procedure, which only takes 30 minutes to complete.

All of the players have been able to get back in four weeks or less, including Tagovailoa when he returned to play against Oklahoma just 27 days after surgery on his other ankle.

“Oftentimes when athletes were treated with high-ankle sprains, many times they were treated non-operatively and they would then get pushed back to play and then re-injure the ankle because it wasn’t stable,” Clanton said. “That was one of the things I had seen in my early team physician days is we’d have a player with a high-ankle sprain, we’d think they’d be ready to play, would put them back on the field and they’d re-injure their ankle and would then be out even longer. But the tightrope is a method that seems to work well. You can generally get the player back quicker. And typically they don’t re-injure the ankle once they go back to play if they’ve been rehabilitated properly.”

If the surgery is done with screws, the approach to rehab is more conservative. With the tightrope, rehab can start immediately, as it did with Tagovailoa after he underwent surgery Oct. 20.

Tagovailoa advanced to running on Alabama’s anti-gravity treadmill less than a week after surgery. And he returned to the practice field in a limited capacity last Wednesday, just 10 days removed from undergoing the procedure.

Tagovailoa has since gone through three more practices on a limited basis, including each of the team’s first two practices this week.

“That whole medical group in Birmingham is, they’re some of the top people in the country,” Tide head coach Nick Saban said of the Andrews Sports Medicine team that includes Lyle Cain and Waldrop. “They have a lot of NFL players that go see them. They’ve got a great rehab center over there. They have Major League Baseball pitchers that come to see them. They just have a really, really great reputation, and we always allow them to make what they think is the best medical decision for a player and his future. And we’ve had a lot of success with this surgery in the past. ... It really has enhanced the ability for our guys to come back and they haven’t had any issues or problems in the future. It’s amazing to me all the things that they can do in medicine now that I know back when I played, none of these things were available.”

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Helping Alabama get Tagovailoa back even quicker this time around is that the injury was to his right ankle and not to his plant ankle, like the one last year.

According to Saban, there was less swelling after this surgery compared to the one in December. In addition, Tagovailoa — according to sources — has been aggressive with his rehab to be able to get back for this game and seems more confident coming back from the injury after going through this same process less than a year ago.

It’s why he’s ahead of where he was at this same point with that last high-ankle sprain. And it’s why Alabama continues to be so optimistic regarding its star quarterback’s status for the LSU game on Saturday.

Tagovailoa had told teammates after injuring his ankle against Tennessee, “I’ll be back for LSU.”

It looks like he was right.

Matt Zenitz is an Alabama and Auburn reporter for the Alabama Media Group. Follow him on Twitter @mzenitz.