For 26 seconds inside the Octagon at UFC 323, Alexandre Pantoja was right where he always is, charging forward, pushing pace, daring the storm to meet him head-on. Then everything stopped. What should have been flyweight title defense number five at UFC 323 turned into one of the most gut-wrenching images of the year: Pantoja on the canvas, clutching his arm, his reign ending not from strikes or submissions, but from a sudden, violent twist of fate.

How bad is it, really? Days later, that question finally received a measured, sobering, but hopeful answer. Veteran journalist Ariel Helwani pressed sports medicine physician Dr. Brian Sutterer on the key issue in their recent conversation and asked whether surgery is inevitable or if there is a different route.

Sutterer’s response offered the first real optimism since the injury as he shared, “Yeah, definitely. So in fact, most elbow dislocations, unless there’s a large fracture, most elbow dislocations do not need surgery. In fact, a very, very small percentage of them need surgery.”

That point matters. Social media panic often assumes the worst. Sutterer pushed back on that thinking.

According to him, “You always assume there has to be some degree of tearing whenever it dislocates, but the body does a really good job, especially the elbow of, kind of healing those tears on its own, re-stabilizing the joint. So step one, is there a fracture? If there’s a fracture, that usually means it’s more likely to be persistently unstable and might need surgery. But if there’s no fracture, it’s very rare to need surgery for an elbow dislocation.”

He even offered precedent and pointed to NFL star Jayden Daniels as an example of an athlete who returned to action “after just four to five weeks after dislocating his elbow.”

That comparison doesn’t guarantee anything, but it proves recovery without surgery isn’t wishful thinking.

Even the newly crowned champion looked shaken at seeing Pantoja. “I didn’t know what happened. He just stopped. The ref was like, ‘something’s wrong.’ He’s one of the greatest of all time. I didn’t want the fight to go that way,” Joshua Van told Joe Rogan afterward.

Replays showed the arm snapping backward, but whether it was a fracture or a dislocation wasn’t immediately clear, only that it was gruesome and serious. The moment cast a shadow over the final ESPN-era pay-per-view and left fans asking a far more important question than “what’s next?”

Further, Dr. Sutterer explained that surgery usually depends on how the elbow is used. For athletes like baseball pitchers, who put extreme throwing stress on the joint, doctors often choose to reconstruct the ligaments right away. Combat sports are different, though. While fighters put heavy pressure on the elbow through grappling and ground fighting, they aren’t repeatedly throwing at full speed.

Because of that, Dr. Sutterer suggested that Alexandre Pantoja will likely first go through a period of immobilization to let the joint stabilize and heal naturally. From there, medical professionals would monitor the elbow’s stability over time, only looking at surgery if the joint continues to feel unstable, rather than as a default first option.

So where does that leave the former champion now? For the first time since the Octagon went quiet, hoping. If surgery can be avoided, the timeline shortens. If stability returns, the division’s most relentless force could be back sooner than feared. But perhaps the most telling reaction came from the man whose shadow still lingers over the flyweight division, Demetrious Johnson!

Demetrious Johnson points to the “clock” resetting for Alexandre Pantoja’s quest to make history

‘Mighty Mouse’ didn’t react with hot takes or breakdowns. He reacted with perspective. Posting a video to his YouTube channel after UFC 323, Johnson framed Pantoja’s freak injury as a brutal reminder that MMA never stops handing out twists and turns.

Johnson said, “That’s part of the game, guys. To keep going in, and doing it over and over, time and time again, over and over and over, it’s hard. It’s a sport where anything can f— happen.”

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Coming from the most dominant flyweight in UFC history, that carries weight. Johnson believed Pantoja wasn’t just defending a belt. He was charging into history.

“I truly felt that Alex Pantoja was going to be able to break my 11 consecutive title defenses,” Johnson admitted. Even with Pantoja sitting at five, Johnson explained why the threat felt real. “I didn’t see anybody on the rise that was going to give him a challenge.”

Then came reality. The injury didn’t just end a fight; it reset everything. Demetrious Johnson didn’t sugarcoat that either.

“Granted, Alex Pantoja is 35 years old, and now that he has lost the belt, that clock starts all over, baby!” he said with a smile.

With only six fighters in UFC history reaching double-digit title wins, and Johnson standing alone with 11 straight defenses, Alexandre Pantoja’s abrupt fall only sharpened the context.

Now the question isn’t whether he was on a GOAT trajectory; Johnson clearly believed he was. The question is what comes next once his arm heals. If stability returns and the body responds, this chapter doesn’t end in tragedy. It pauses.

In a division defined by speed and precision, Alexandre Pantoja now faces his toughest test away from the cage. Not to reclaim history overnight, but to earn the right to chase it again.