High School Athlete Makes Courageous Comeback After Major Knee Injury

The steely look of determination in the eyes of Josiah Saunders – after being informed of his devastating knee injury – provided a glimmer of hope to Cleveland Clinic sports medicine orthopaedic surgeon Michael Scarcella, MD.

“A lot of people don’t return to competitive sports after injuring that many knee ligaments,” says Dr. Scarcella, who specializes in the treatment of sports-related injuries. “And there are some people who would just give up when they hear the diagnosis. But not Josiah. He’s a special kid.”

When the then-sophomore defensive back, who at the time of his injury was playing on offense, for the Avon High School junior varsity football team was tackled during a game in September 2023, he remembers hearing a “pop” in his knee and feeling a burning sensation. He assumed the injury was minor, recalling “I guessed it was just a sprain or something.”

It was a lot more than a sprain. According to Dr. Scarcella, Josiah suffered a multiligamentous knee injury (MLKI), in which two or more ligaments are damaged. In Josiah’s case, he tore the anterior cruciate ligament (ACL), one of the more common major knee injuries football players experience. But he also tore one located just behind it, called the posterior cruciate ligament (PCL), which connects the thighbone to the lower leg bone.

Josiah also tore a third ligament, the lateral collateral ligament (LCL), which is a band of tissue located on the outside of the knee. The MLKI also impacted a variety of nerves and muscles. Explains Dr. Scarcella, “Not only do you have to reconstruct them, you have to take care so the nerves in the area that provide muscle and sensory function aren’t further damaged. It’s a very complex surgery.”

“When you see a multi-ligament injury like Josiah’s, we know a very low percentage of patients recover enough just to get back to participating in any type of sport,” says sports and exercise medicine physician Vikas Patel, DO. “That’s why Josiah is the epitome of courage.”

Because Cleveland Clinic Sports Medicine provides athletic trainers and physicians for many Ohio athletic programs, including Avon High School, Dr. Patel was among the first people to thoroughly examine Josiah after his injury. After reviewing X-ray and magnetic resonance imaging (MRI) tests he says, “This is one of the worst knee injuries you can get, a 10 on a scale of 1 to 10. That he was able to return to a football field is remarkable.”

Initially, after undergoing a four-hour surgery by Dr. Scarcella to reconstruct his knee, Josiah was eager to begin recovery and intense daily rehabilitation therapy with Jim O’Leary, an athletic trainer at Cleveland Clinic Sports Medicine who supports Avon’s athletic teams.

However, he required another inpatient stay at Cleveland Clinic, after he developed rhabdomyolysis, a rare muscle injury, and related acute kidney failure two weeks after his surgery. This condition can develop after a person experiences severe injury or trauma.

Despite difficult days and weeks of physical pain and mental strain, Josiah worked hard towards recovery and a comeback. He credits the support of his mom, Lakia Brown, – who slept near him, downstairs, on an adjoining sofa, during those initial weeks when Josiah was unable to make the trek upstairs to his bedroom.

“She’s my rock, actually, more than a rock,” says Josiah, “She’s everything you could ask for in a mom.” Lakia says, “He never gave up. I’m so proud of him, and I know the sky is the limit for him.”

As Josiah continued rehabilitation therapy, about seven weeks after his injury, Jim marveled at his grit, resolve and dedication to the effort.

“His leg wasn't weight bearing, he had no strength, and really couldn't bend or straighten his leg. That was our starting point,” explains Jim, who nominated Josiah for the courage award and who Josiah considers a friend. “Two hours a day, Monday through Friday, sometimes weekends, he was there. He never skipped a day, even during holiday break. We would have to hold him back sometimes from trying to do more.”

During those challenging months, Josiah was always there to cheer on his teammates. By then the 2024 season was underway. Josiah was a junior and itching to return to action. Jim and Drs. Scarcella and Patel gave him the green light to play on September 13, 2024, against Elyria. It had been 355 days since his injury.

While his game action was limited, his impact was still great, even blocking an extra point to help take the team to a victory. Josiah made appearances throughout Avon’s run to the state championship. For the 2025 season, his senior year, he has his sights set on helping the team become a two-time state championship.

According to statistics provided by Cleveland Clinic Sports Medicine Center, 19% of National Football League players who incur MLKI return to the sport. And those who do typically require a 12-to-18-month recovery and rehabilitation period.

For overcoming seemingly insurmountable odds to recover from significant orthopaedic injuries to resume the sport he loves, 16-year-old Josiah will receive the 2024 Jim Donovan Courage Award presented by Cleveland Clinic Sports Medicine during the 25th Greater Cleveland Sports Awards ceremony, held at Rocket Mortgage FieldHouse in Cleveland, Ohio.

“Josiah is the epitome of courage. When you look at everything that has been stacked against him that takes courage. And courage takes an extra effort to overcome significant hurdles,” says Dr. Scarcella.

“You know, God gives his toughest battles to his toughest soldiers, and he did that to me,” says Josiah. “I went through a lot of pain and everything. But it taught me a lot of life lessons. It helped me to grow as a young man, become better, work hard and strive for the better path.”