December 26, 2016 - Dr. David Chao
Monday Morning MD: Derek Carr and Marcus Mariota with similar season-ending injuries
The leader of the Raiders and Titans both were announced to have suffered broken fibulas. Unfortunately by video, the injury is more than just to the bone. Both were felled by the severest form of high ankle sprain where the syndesmotic ligament (holds the fibula and tibia together) is torn before the fracture even happens. Essentially both injuries are considered ankle fracture-dislocations where the talus (ankle bone) shifts out of place. The need for surgery is not for the fibula fracture as much as to reposition the bones due to the ligament tear. Derek Carr was reported to be having surgery on Christmas Day, but was delayed due to holiday staffing issues and he is now reported to travel to Los Angeles for the procedure. Marcus Mariota was set to have surgery in the next few days after injury. The procedure is not an emergency and can be done in the first week or two. The initial urgency for Carr’s surgery may have been born out of a desire to keep any slim hopes of a Super Bowl 51 return alive. Assuming the Raiders make it to the big game six weeks away, it would still be a considerable stretch to think that Carr would perform anywhere near his MVP candidate level. This is not just an issue of bone healing but one of the ligament and associated structures as well. Typically, this injury carries a six-month recovery, thus reports of earlier return seem optimistic to me. To cite the Charles Woodson or Terrell Owens early Super Bowl return from ankle fracture would be unfair comparisons as there is a dislocation component here for Carr. The good news is that this is not a career-ending injury and both should return to essentially 100%. A good example is Darren Sproles who had a similar injury/surgery 10 years ago and continues to perform at a high level and is still known for his quick cuts as a running back. Both quarterbacks should be ready for the start of the 2017 season. MMMD 1: Another broken leg Tyler Lockett suffered a gruesome tibia and fibula fracture (graphic video here). Teammate Earl Thomas broke only his tibia and did not need surgery. Lockett broke both bones and likely has an open fracture with the description of blood immediately on the field. This fracture is very unstable and requires early surgery. Fortunately the Seahawks were in Seattle, otherwise Lockett would have needed surgery before flying home. Despite how horrific the injury seems, this is not a career-ending injury. Many others, including Patriots fullback James Develin last season, have made full recoveries. This is a similar injury to NBA’s Paul George and UFC’s Anderson Silva who both have returned to their sport. Lockett may not be ready for the start of the season as there is typically a 6-9 month recovery. MMMD 2: Earl Thomas returning Thomas likely suffered a non-displaced isolated tibia fracture and thus did not need surgery. He contemplated retirement at the time. Medically, this was not an injury that ends careers. I would not begrudge any athlete who chooses to retire as I agree one needs to be “all in” to play effectively. Fortunately for us as fans, Thomas has decided to return next season. Since he tweeted retirement thoughts on his twitter account immediately after the injury, it was appropriate that he used twitter to announce his return. MMMD 3: Play or sit? Christian McCaffrey and Leonard Fournette started much discussion with their decision to skip bowl games to prepare for the draft. Skipping games is a precedent that already exists in the NFL. Many players choose to miss the Pro Bowl. Tyler Eifert hurt his ankle there last year and needed surgery, which affected his season. He would not go back if asked. Now the discussion of play or sit turns to the teams that have clinched post-season spots. For example, should the Cowboys sit their stars for rest and/or injury protection or keep momentum going? Does the season-ending injuries to Carr and Mariota make it more likely we see Tony Romo over Dak Prescott to finish the regular season? MMMD 4: Return to play decisions A.J. Green is unhappy he was not allowed to play. He made the trip to Houston for the Christmas Eve game with the expectation to suit up, while other injured players stayed behind. Green was pulled from a team meeting and informed of the ownerships decision to not risk further injury and he subsequently flew home. The decision was based on fear that the tendon portion of the hamstring injury had not fully healed and further damage might mean surgery. Return to play is always decided by a unanimous vote between the player, medical staff and the team. It is clearly within the ownerships rights to withhold the player, but perhaps communication of that intent prior to travelling to the game would prevent any hard feelings. MMMD 5: Team doctors care for more than players Todd Bowles was treated for kidney stones and gall bladder issues. With Gary Kubiak (complex migraine) and Mike Zimmer (retinal detachment), that marks the third head coach to be hospitalized this season which is a higher rate than for players. Line Judge Sarah Thomas was knocked down and taken to the locker room. She did return to finish the Vikings at Packers game. Head coaches and all team staff are cared for by team physicians. In fact, coaches’ physicals is a big part of a team doctor’s job. On game days, the home team medical staff is responsible for providing care to the game officials. MMMD 6: Injury rundown Aaron Rodgers left the game briefly with a stinger. This should not be a major deal if the Packers protection holds up. The calf injury seems to have progressed nicely. Ryan Tannehill came out of his cast which is certainly good news. Still with the partial ACL/MCL injury, he may not be ready to go for the wildcard round. Jay Ajayi fell on his left shoulder in overtime suffering a likely AC joint sprain that is hopefully mild and won’t have him missing time. Carlos Hyde injured his knee and will be done for the season. MCL sprains do not typically need surgery and he will be healthy for the off-season program. Justin Houston sat out, proving again that even though players return well from ACL surgery, the second season back is the fully healthy one. Robert Griffin III left with a concussion but the Browns notched their first victory. Jordan Reed did not play with his grade 3 AC separation which is usually a six week injury. Ryan Matthews is reported to have a herniated disc in his neck. Even if he needs surgery, return from single level cervical discectomy/fusion is reliable in the NFL. Derek Wolfe left with a neck injury that has plagued him in second half of this season. Kayvon Webster was blind-sided, but riding off in the passenger seat of the cart is a great sign that his spine was OK. Of course his head injury will need evaluation. MMMD 7: ProFootballDoc scorecard Unfortunately the significant injuries to Derek Carr, Marcus Mariota and Tyler Lockett were easily seen on video. Will Gholston did dislocate his elbow missing this week. Kayvon Webster suffered a concussion but was spared neck or back injury. Earl Thomas will play in 2017 as expected. The previous 181-10 (94.8%) record now improves slightly to 187-10, a 94.9% accuracy rate.