January 16, 2017 - Dr. David Chao
Monday Morning MD: Who is healthy for the Championship Games?
Not all ACL surgeries go smoothly. Even ones done by renowned orthopedic surgeons can go wrong. After tearing up his knee last year, Dion Lewis flew to seek out who he thought was the best to perform the procedure but still had a serious complication. After his initial surgery, his kneecap developed a fracture from where the ACL graft was taken. He needed a second surgery with screws in his patella and missed a majority of this season. The Divisional Round was his come back party. Lewis triumphantly scored three touchdowns in three different ways: receiving, rushing and special teams. He was a passing TD away from a historic cycle. At the start of the season with Lewis missing, there were many questions why the Patriots could not get their star RB on the field. As I have always said, the truth comes out eventually. In fact, given the surgical complication, Lewis has made a tremendously quick recovery. Medical staffs and especially team physicians are quick to get the blame. Their names are rarely mentioned when credit is due. When a second opinion doctor performs the surgery, their name is often announced with the obligatory proclamation that “surgery was successful”. When the team doctor does it, it is usually done in anonymity. In many ways the medical team is like offensive lineman or long snappers. Their names are often mentioned with blame but rarely with kudos. I am glad this story has a happy ending but it serves a reminder that there is always risk in surgery and despite everyone thinking that return from ACL surgery is routine, there are definite pitfalls along the way. Here are how the teams look from a health perspective headed into the Championship Games as well as the medical rundown. MMMD 1: Packers injury outlook The Jordy Nelson good news is that he has no organ damage, did travel to the game, and was on the sidelines. The bad news is he was moving very gingerly and I saw him clutching his ribs as he congratulated players on the first touchdown. Reports also said his current goal was to breathe normally again. With a week to go there is a chance, but far from a guarantee, that Nelson would play. If Green Bay gets to the Super Bowl, he would have an excellent chance of playing. Morgan Burnett appeared to have a quad contusion. If the Packers can control swelling and maintain flexibility, he has a chance to play next week. By video, David Bakhtiari suffered a mild right knee MCL sprain. He returned after being taped/braced. He should be fine moving straight ahead but likely will have some limitations side to side. Slow motion showed DeVante Adams with a mild left high ankle sprain. He was taped and returned. Careful here with the swelling. I would expect a post-game boot and some missed practice but that he would try to go next week. LaDarius Gunter appeared to have the wind knocked out of him and finished the game. I don’t seen any issues with him being 100%, MMMD 2: Falcons injury outlook Julio Jones left with a foot injury late in the game. The presumption is a re-aggravation of his turf toe. His coach said he could have continued but was pulled for the score. Jones will likely be limited in practice this week. This bears watching but the hope is Jones will be just fine. Adrian Clayborn was reported to tear his biceps tendon at he elbow. Normally that is a season-ending injury that requires surgery. If Clayborn and the Falcons want to pull out all stops, he could try to play and have surgery after the season. It would be hard due to pain/swelling to play in the Championship game but he could play with some flexion and supination weakness in his elbow for the Super Bowl. Before you say this is far-fetched, ask Terrell Suggs. He played thru the second half of this season with a biceps tear. MMMD 3: Patriots injury outlook Chris Hogan appeared to have a thigh bruise and with good medical care should be good to go for the Championship Game. Martellus Bennett survived a hyper-extension injury scare to finish the game and should be healthy. Danny Ammendola continues his recovery from a high ankle sprain and another week should improve that. MMMD 4: Steelers healthy Big Ben is fine. The ankle scare when he was seen with a boot post-game last week is long behind us. As expected it was purely precautionary and he played and moved well. Hope no injury news pops up as sometimes happens, but right now the big news in Pittsburgh is all about Antonio Brown’s social medial locker room post. MMMD 5: Head coach younger than player The Rams have a very young team but new head coach Sean McVay (age 30) is still younger than one player on his roster and the same age as two others. I am not sure what the NFL precedent is for this. I don’t think this will be an issue. In my first eight years as a NFL team physician, there was at least one player on the team younger than me. That was an oddity but never an issue other than perhaps locker room banter. MMMD 6: Will medical staff move with the Chargers? Typically, the athletic training staff moves with the club. The doctors usually do not. NFL physicians all have full-time practices outside of the team that account for the majority of their income. With the move to Los Angeles, the UCSD medical sponsorship and the local team physicians will certainly change. MMMD 7: Injury rundown Chief WR Chris Conley took a vicious penalized hit to the head, yet returned to the game. Another example of how concussions cannot be judged by video. By the eye test, he certainly should have been removed from the game but the independent doctor allowed his return after examination. Seattle CB DeShawn Shead likely tore his ACL. Unfortunately, that means surgery and starting next season on PUP. Seahawk Germain Ifedi by video suffered a left high ankle sprain but will have plenty of time to recover for the offseason program Jimmy Graham has made everyone forget about his patella tendon rupture playing very well at season end. Mike Zimmer is just being honest on Bridgewater when he says “We don’t know when Teddy will be back”. Video posts show progress in rehab but he is a long way from a full return. A knee dislocation is among the severest of injuries. MMMD extra: ProFootballDoc scorecard I was on vacation with the family so I did not have my usual video capabilities in the hotel but thanks to the extra cameras and playoff coverage, many great replays were shown allowing me to still provide some input. Davonte Adams returned from left high ankle sprain. David Bakhtiari returned from a mild MCL sprain. LaDarius Gunter avoided injury from a bad looking hit. DeShawn Shead appears to have torn his ACL. C.J. Prosise did not play as expected and neither did Jordy Nelson. Big Ben’s foot/ankle was a non-issue. Blake Martinez was limited with his MCL. This improves the 203-10 (95.3%) record to 211-10 (95.5%)