Monday Morning MD: Lightning strikes again

Baltimore 2015 first-round draft pick Breshad Perriman never played a down in his rookie season. History is likely to repeat itself as the Ravens wide receiver may miss his sophomore campaign as well. Perriman reportedly “partially” tore his ACL in offseason workouts on Thursday. Medically, partial ACL tears are rare. The knee is either stable or it is not. The term “partial” is overused when it comes to describing ACL injury. The vast majority of time, a partial tear leads to the same ACL reconstruction surgery as a “complete” tear. MRIs often properly call it a partial tear because typically the injury is not seen on all images but that doesn’t mean the ACL is not completely torn. Imagine if a rope frays and breaks, there are still normal looking portions of the rope but the rope no longer holds. In the same way, a MRI can show normal parts of an ACL, yet it is not in continuity. This is why I say a good orthopedic exam can be more accurate than imaging. The other reason teams use the term “partial ACL” is to give hope until the diagnosis of full tear is confirmed by second opinion. This is the same reason why teams say “MRI pending” when the team typically knows before the MRI that the ACL is torn. The same optimism was applied last season when the team remained hopeful of a Perriman return after in-season PCL surgery and stem cells, where I was more realistic. Perriman’s second opinion is coming today. I hope he beats the odds and it is found that his ACL is not completely torn. Apparently the wide receiver did finish practice after the non-contact injury before reporting with swelling the following day. This also favors an isolated tear without associated cartilage injury. His main chance is to hope the finding is a spurious MRI diagnosis and that his knee is stable. Unfortunately, I think that possibility is less than 5%, as in my 17 years as an NFL team physician I've never encountered a true partial ACL tear. The likelihood is that Perriman will need formal ACL reconstruction which would mean missing his second straight season. Sometimes compensation plays a role but there is no direct indication that there is any relationship to his PCL injury on his other knee. Raven’s fans can keep hope that last season Kiko Alonso returned to play for the Eagles with a partial ACL tear; however, he was largely ineffective. It would be great news and a big surprise if Perriman’s second season was not unfortunately over now. MMMD 1: Offseason injuries piling up I previously indicated that approximately half of NFL teams will suffer a significant/season-ending injury before OTAs and minicamps are done. Add three ACL tears to the list of teams already suffering injury. Besides Perriman, Saints pass-rusher Hau’oli Kikaha (3rd time) and Patriots TE Michael Williams both tore ACLs. We are shy of 50% of teams losing players (and I hope it stays that way) but with another week and many minicamps to go, it seems inevitable that history will repeat itself. MMMD 2: Jamaal Charles ready for minicamp? Reports surfaced that the Chiefs running back might participate in minicamp. When Charles tore his ACL eight months ago, I wrote how I expected a good comeback for 2016 despite his age. As well as he is doing, I sincerely doubt that Charles will be a minicamp participant. Things may be progressing smoothly, but there needs to be full medical clearance before participation in any practice. This is not to say Charles won’t be doing drills on the side. Charles made a great comeback last time from ACL surgery to have a career high 1500 yards rushing but was overshadowed by Adrian Peterson’s 2000 yards. He will be back for 2016, just not yet. MMMD 3: Megatron not coming back Calvin Johnson posted gruesome pictures of his finger surgery. Some speculated that perhaps fixing his finger which may have interfered with his ability to catch passes signaled a potential comeback. I think it indicates just the opposite and that Johnson will remain retired. In my experience, such extensive surgery and long recovery for a boutonniere finger correction is only done at the end of one’s career. To me, having the finger surgery ends any speculation about thoughts of returning to play. MMMD 4: Jalen Ramsey video Many Jaguars fans were overjoyed to see their top-five pick running after knee surgery. The video indicates good progress but he is still a long way from returning. Just look at how he limps when slowing down and one can see he is not ready to cut or change directions yet. Ramsey will be ready for training camp, but he is not there yet. MMMD 5: Oakland safety incidents In this health and safety era, one major reason for the Raiders needing a new place to play is injury concerns. Oakland is the only NFL city remaining that shares the field with a Major League Baseball club. Early season home games are played on a partial dirt field and this leads to additional injures. This weekend on SiriusXM NFL radio, I heard first-time host Brian Costello tell a story about Antonio Cromartie breaking ribs and having to be carted in a circuitous route outside the stadium through heckling fans to get to medical attention. I can corroborate that dangerous situation as it happened to me as I cared for NFL players as well. The locker room is up two flights of stairs from the field and the x-ray room is up an additional three flights of stairs and down a long corridor. Not to mention the locker rooms are so small that there is inadequate treatment areas where it forces players to be taped, examined and treated in the hallways and shower areas. MMMD 6: Real Football Network I am pleased to announce that I am joining Real Football Network. The number one SiriusXMNFL duo of Pat Kirwan and Jim Miller leads the effort to provide insider video and audio for the serious football fanatic or fantasy player. I will provide similar in-depth medical analysis as I have here, but in video and audio form. MMMD 7: ProFootballDoc scorecard I wrote last week that Broncos knew about Aqib Talib’s injury immediately, even while details of the shooting were sketchy. Although the Broncos CB was lucky the bullet avoided major nerves and arteries, there is still muscle damage and he will indeed miss the rest of the offseason program. Will count this group of assessments into one correct tally for 2016. This improves the previous 7-0 record to 8-0.
Dr. David Chao
Two decades of NFL team physician experience including two Super Bowls and two Pro Bowls. Providing unique perspective to injuries and the NFL sideline/locker room. Successful orthopedic surgery and sports medicine practice in Southern California.

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