October 17, 2016 - Dr. David Chao
Monday Morning MD: All meniscus tears are not the same
Ben Roethlisberger will need surgery but his season will not be over. Big Ben has a meniscus tear like Adrian Peterson; however, the Steelers quarterback will return in short order. Not all meniscus tears are the same. A locked bucket-handle displaced meniscus tear like the Vikings running back had requires repair to prevent long-term problems. Sutures require healing time measured in months. By video, Roethlisberger has a simple smaller meniscus tear that likely will be trimmed without the option for repair and his return will be measured in weeks. When laying down new sod, one must “keep off the grass”; however, after mowing the lawn, one can play football on the grass immediately. The worst fears of injury were avoided. Roethlisberger described what he thought was a hyperextension injury but fortunately there was no serious ligament tear. Big Ben will have had knee arthroscopy surgery by the time this article posts. Expect confirmation of a trimming procedure and a definite return this season. With menisectomy (trimming) surgery, there is no wait for healing, thus, return is measured in weeks. Typically recovery is 2-4 weeks but given that Roethlisberger is not a position player and his recovery prowess is legendary, it is not impossible to return next week to play the Patriots. After all, Philip Rivers played New England in the 2008 AFC Championship game six days after a knee scope (and with a torn ACL). However, the most likely return is after the Steelers bye the following week. I fully expect to see Roethlisberger play the division rival Ravens in Week 9. There are many reasons to have immediate surgery. First, the tear can get worse. Second, playing on a meniscus tear can accelerate arthritis. Third, a cartilage injury limits playing effectiveness. Finally, with the quick recovery and the bye coming, there is no time like the present and Steelers doctors are acting quickly to make it happen. Big Ben returned to play in the second half but there is no way he should continue to chance further injury without surgery first. I am sure if Roethlisberger had clinical signs of meniscus tear or mechanical symptoms, he would not have been allowed to return to play. Now that the meniscus tear is diagnosed, there can be no thought of playing through the injury. Roethlisberger will return to 100% in terms of football. He will have some increased chance of long-term arthritis as a result of loosing some of the meniscus as cushioning, but less than without surgery. An operation is never good news, but this type of meniscus procedure is really a positive scenario for Roethlisberger and Steelers fans. With a trim, Big Ben will have a chance to return very quickly. MMMD 1: LeSean McCoy avoids serious injury Like Big Ben, McCoy had a scare and clutched his right knee. By video, the Bills RB averted disaster and only had a mild MCL sprain. The key is that his foot was not fully planted or trapped. Indeed, McCoy returned for the second half and I don’t expect issues going forward. MMMD 2: Odell Beckham, Jr. injures hip The Giants star WR was injured within minutes of Roethlisberger and McCoy. Fortunately he too avoided major injury and returned for a big game. By video, Beckham suffered a left hip pointer. The key is how swollen and sore he is this AM. Just because Beckham came back to play is no guarantee for next week. I expect the Giants to be aggressive treating this injury and thus a good chance to see Beckham in action next week in London. I do not expect the long flight to be a factor as teams fly on a chartered 747 and it's like spending six hours in your living room. In fact, the Giants medical staff can set up a mini-training room on the plane as well. MMMD 3: Terrell Suggs injured again The 34 year-old pass rusher recovered from his second Achilles rupture, now he will have to deal with his second biceps injury. By video, Suggs ruptured his left distal biceps tendon at the elbow and Jay Glazer has confirmed the injury. In 2012, he played through the month of December and into the Super Bowl with a right biceps tear. I suspect he will want to try to delay surgery and do the same now. Most players end up with surgery to re-attach the tendon to restore full flexion and supination (palm up rotation) strength. Suggs has proven to be a quick healer and still can be an effective pass rusher. His ability to wrap and tackle may be hindered by this injury, but given his experience compensating and playing hurt on the other elbow gives him hope that he can do the same now. MMMD 4: DeMeco Ryans sues over Achilles tear The former Eagles linebacker ruptured his Achilles tendon in 2014 at NRG stadium and is now suing the Texans, NFL and stadium operators. Originally the field was made up of natural grass pallets that were rotated into the sun for growth but the seams generated complaints. Subsequently the surface has now been switched to artificial grass. Reggie Bush sued the St. Louis Rams stadium over his knee injury slipping on concrete and the case is still pending. Ryans returned to play during a subpar 2015 campaign but is no longer playing and seeks over $10 million in damages. MMMD 5: Active does not always mean playing time A big pregame topic is who will and won’t be on the inactive list. This week there was much discussion of to play or not to play for Arian Foster and Will Fuller. Foster was called a game-time decision. The Dolphins RB was active but had minimal contribution with only 3 rushes for 3 yards. Fuller was reported by Adam Schefter to be out. The Texans instead activated the wide receiver but he essentially did not play. Seems the Texans had no healthy scratches so Fuller was activated even though his effectiveness from hamstring injury was limited. In the end, the ESPN report was not wrong even though Fuller was technically active. These are prime examples of where active does not equal effective. MMMD 6: Injury rundown Browns S Jordan Poyer was taken to the hospital with a concussion and diagnosed with a lacerated kidney. Expect a minimum one-month absence that could extend to season long. Seahawks DL Michael Bennett suffered a scary looking knee hyperextension injury. The hope is his ligaments were spared despite the gruesome appearance and only minor anterior bone bruise or posterior capsular stretch injuries. By video, Colts TE Dwayne Allen left with a right high ankle sprain. His status for next week is in doubt. Redskins TE Jordan Reed did not play as expected after his recent head injury. With his sixth reported concussion, it will be smart to take great care and consideration before return. The bigger concern is not when he will return but potentially if he will return. There is no absolute number of concussions when one has to retire but I hope Reed makes the right decision. Today, Chiefs LB Justin Houston can come off PUP from his ACL. He has been cleared for football activities. If he is activated, he has two weeks to practice before potentially playing in Week 9. Packers RB James Starks underwent an unusual Sunday AM knee scope surgery. The timing may have been necessitated by a family emergency last week. Usually in season arthroscopy are done early week to maximize return, as is the case for Roethlisberger (detailed above). MMMD 7: ProFootballDoc scorecard I am glad that this section generated some interest this week. A follower thought I should count Dez Bryant as a mistake as initially I only said MCL. His bone bruise is indeed related to the MCL but I will follow his advice and call that a mistake. It was correct that Big Ben did not have a major injury and returned to play; however, I will not count it as correct as he now has what I consider to be a minor meniscus tear. Despite three touchdowns last week, Martellus Bennett did show up on injury report with an ankle as expected. Eddie Lacy did play through his high ankle injury while Steve Smith was inactive as no player listed as doubtful has been activated in 2016. Trevor Siemian and Terrance Williams played with AC injuries. Jordan Reed was out with concussion and although limited, Sammie Coates was active with index finger fracture and laceration. There were three correct pure video impressions. Odell Beckham, Jr. was confirmed with a hip pointer. LeSean McCoy did avoid major knee injury. Terrell Suggs does have a biceps tear. This takes last week’s 73-2 (97.3%) mark to 83-3 (96.5%).