Just about every South African will be hoping that Springbok skipper Siya Kolisi can make it to Rugby World Cup (RWC) 2023, but the pragmatic view is that coach Jacques Nienaber will already be looking at contingencies.

Kolisi (31) sustained a serious knee injury playing for the Sharks during last weekend’s United Rugby Championship (URC) Round-18 clash against Munster. In one of those freak moments, Kolisi, marauding in the tramlines, stepped to evade a tackle by wing Calvin Nash and hyperextended his right knee in the process.

It was immediately apparent from Kolisi’s body language that he knew it was a serious injury. Players generally know, and even ­former skipper Jean de Villiers, watching from SuperSport’s studios, predicted it would be bad.

Although medics strapped his knee tightly, Kolisi looked unhappy. He played on for another minute or two but withdrew himself from the action.

With fewer than 20 weeks to go before RWC 2023 in France, in the next few days rugby watchers will be ­anxiously waiting for definitive news about Kolisi’s injury.

Sharks coach Neil Powell would not make any predictions about the state of the injury after the 22-22 draw against Munster. The Sharks earned an away quarterfinal against Leinster, which will be played in a fortnight without Kolisi.

“We’ll have to wait for the doctor to do a proper assessment on Siya’s knee and give the feedback to us,” Powell said after the match. “It was unfortunate that we lost Siya so early in the game. He is influential as a captain and as a player.”

Kolisi was in a similar position in 2019. He suffered a serious knee injury in May that year playing for the Stormers against the Highlanders in a Super Rugby match and was in a race against time to make it to Rugby World Cup 2019 in Japan.

He opted against surgery and chose an aggressive course of physiotherapy four years ago. It proved to be the right decision, as Kolisi made it to Japan, although he was nowhere near his best at the beginning of the tournament.

As the Boks progressed through the competition, however, Kolisi’s fitness improved and he was nearly back to his best by the time of the final.

Different circumstances

The Sharks and SA Rugby have issued no official update on the state of Kolisi’s knee, but enquiries to a wide range of sources indicate that the news is not good.

The longer the silence goes on, the more the likelihood that the Bok skipper will not make it to France, where he could become only the second captain after the All Blacks’ Richie McCaw to lead a successful defence of the title.

The Sharks and SA Rugby have declined to give updates on the state of Kolisi’s knee injury and what the prognosis might be. What is clear is that it’s serious.

What’s also clear, after speaking to multiple sources, is that Kolisi is not rushing a decision. He saw three specialists during the week to gain a wide range of opinions on the diagnosis, as well as future options.

One thing Daily Maverick has reliably learnt is that this knee injury is anterior cruciate ligament (ACL) damage.

The injury in May 2019 was damage to his medial collateral ligament (MCL), caused in the act of scoring a try.

Although every injury has its own unique circumstances, generally ACL injuries require a longer recovery period than MCL injuries. And, more often than not, the ACL needs surgery to repair.

The ACL lies in the centre of the knee connecting the femur to the tibia. This ligament keeps the shinbone from sliding forwards, which would otherwise result in the knee giving way or buckling. It almost always requires surgery to repair when it has been torn or severed.

Both ACL and MCL injuries are graded, with one being the least serious and grade three being the most severe. At this stage it’s unclear – at least publicly – what grade of tear Kolisi suffered.

“Due to the high blood supply to the exterior of the knee, conservative treatment is most common for MCL injuries. Rest and an immobilising brace allow the ligament to start its healing process,” says advanced­orthoandspine.com.

“Grade one ACL tears will heal with conservative treatments: an immobilising brace, rest, and physical therapy. This level of injury should heal itself through time.

“Grade two and three ACL tears may require surgery to reconstruct the ligament. After surgery, a brace and physical therapy to regain range of motion in the knee will still be required.

“Recovery time for grade one ACL injuries can be four to six weeks, while grade two or three injuries can require a recovery time of six to nine months.”

Options for the Boks

Everyone associated with the Springbok camp is hoping Kolisi makes a full recovery, but contingencies have to be made.

In the short term, coach Nienaber needs to consider a captain and replacement for the Rugby Championship in July. He can look to his final World Cup squad after that.

Centre Lukhanyo Am, flyhalf Handré Pollard, No 8 Duane Vermeulen, lock Eben Etzebeth and flank Pieter-Steph du Toit have all captained South Africa at senior level.

Am, Pollard, Etzebeth (who is in rehab for a shoulder injury) and Du Toit are all guaranteed Test starters if fit. Vermeulen has recently lost his place to Jasper Wiese and therefore is no shoo-in for the captaincy.

Stormers skipper Steven Kitshoff is another strong candidate for the captaincy job, but in the Bok setup he usually comes off the bench as one of the famed “bomb squad”.

Regardless, though, Nienaber has numerous leadership options.

What he doesn’t have is another loose forward as complete as Kolisi.

The current Bok skipper is a vital linking player, a brutal defender, a marauding tramline runner, a breakdown menace, an intelligent ball carrier and, of course, a respected leader.

Kwagga Smith brings most of those elements, but not all. Ditto Marco van Staden, whereas the ageing but effective Deon Fourie perhaps ticks more of those boxes than any other candidate.

The resurgent Sikhumbuzo Notshe might be given a chance to stake a claim during the Rugby Championship, and the uncapped Phepsi Buthelezi has performed well enough for the Sharks to be given a chance.

All this does, though, is underline what a special player and leader Kolisi is, and what a body blow it would be to the Boks if he is ruled out of the World Cup. DM168

This story first appeared in our weekly Daily Maverick 168 newspaper, which is available countrywide for R25.