Doctors said they had never seen his injury before and had to do an exploratory operation on Thursday, according to the Hearts manager Craig Levein. Ligaments have been put back in place but Souttar now faces a race against time to play again this year.
He will spend six weeks resting and recuperating and it is estimated he will require roughly another six to regain full fitness thereafter. The news is the last thing the Edinburgh club need with eight other players presently recovering from injury – Craig Halkett, Steven Naismith, Peter Haring, Jamie Walker, Conor Washington, Ben Garuccio, Craig Wighton and Euan Henderson.
“John got an op on Thursday afternoon. The surgeon has never seen anything like it before and it was very unusual,” explained Levein. “The point where his three ligaments are attached to the bone, the sheath that holds them in place is torn and it didn’t show up on scans - CT, ultrasound or anything.
“The surgeon had to, which is highly unusual these days, go into the ankle and explore and see what the problem was. He’s had to reattach the sheath and put the ligaments back in where they should be and then stitch it to the bone, which is quite a major operation.
“What does it mean and how long is he out for? He’s got a plaster on and that’s on for two weeks and he’ll wear a boot for four weeks. There’s six weeks immobile and generally you would have to double that for the time to come back to play.
“Again, I’m just plucking a number out of the air because with the surgeon saying he had not done anything like this in the past, then him giving us a timescale is difficult for him.”
Hearts were hoping after Souttar suffered the injury against Aberdeen that he would be back within three weeks. As the problem persisted, they had to go to great lengths to find a solution.
“This looked so innocuous. He just rolled his ankle and the scan showed grade one damage to his ligament, which is normally 12 to 14 days,” said Levein. “We just couldn’t get to the problem of why it kept on swelling up and why he was getting this pain. We had it scanned three times, x-rayed, everything. It explains why we couldn’t see anything.
“That was the frustration, for John, me and the medical team that we couldn’t get to the problem of it. We sent him to three different people and the best people in the UK and nobody could find the problem. They don’t like doing exploratory operations because every time you open somebody up there is a chance of infection.
“We eventually got the bottom of it and now John has some sort of peace in himself. He understands he’ll be out for a while and he knows what it is. He is on the road to recovery, whereas previously he never felt like he was improving and the surgeons could not get to the bottom of it.”
With Souttar and Craig Halkett both sidelined by injury for the foreseeable future, the Hearts captain Christophe Berra is likely to return to the starting line-up against Kilmarnock on Saturday.
He was rested at St Mirren last week but had to come on as substitute after 25 minutes when Halkett suffered a knee injury. Some Hearts supporters have criticised Berra this season but Levein stressed that no-one cares about the club more than the Scotland centre-back.
“Nobody is immune to it. Standing there myself, I try my hardest to focus on the game. Me focusing on the game allows me to help the team. I’m sure Christophe and all the other players are the same,” said the manager.
“They try hard to focus on the game and try not to get involved in what’s happening elsewhere. Christophe carries the extra burden of being captain. He cares an awful lot. Sometimes that can be almost damaging because he cares that much about the club.
“I took him out of the team last week because he had played a lot of football and I thought he could do with a break. I didn’t realise the break would be 25 minutes but that’s a different matter. I think it actually helped.
“When he came on, the fact he hadn’t had two days of getting himself up tight before the game meant he was more relaxed. I thought he did very well when he came on.”
Levein wants his team to reproduce the energy of last week’s Betfred Cup tie against Aberdeen when Kilmarnock visit Tynecastle. “I think the Aberdeen game is the benchmark, not just the way we started,” he said.
“The intensity stayed in our play for 90 minutes and beyond. That was helped by the atmosphere and Aberdeen’s contribution to the game. It was like a real game of table tennis, back and forward, and there was no time for thinking, it was reacting. I think that’s the type of situation we need to create again on Saturday.”