Monday Morning MD: #1 priority of minicamps

‘Tis the season for rookie and team minicamps. The intent is to indoctrinate rookies, provide a primer on new terminology and get an early talent evaluation. However, teams have an underlying more important goal. Everyone’s main objective is to finish minicamps injury free. In my 17 years as a NFL team physician, it seemed that every other year my team suffered a significant season altering injury to one of our main contributors. Lead pass rusher Melvin Ingram tore his ACL in the 2013 Chargers mini-camp. Last season, Jaguars #3 overall pick Dante Fowler Jr. ruptured his ACL on the first day of minicamp and missed his entire rookie season. The Broncos suffered the same fate last year with tight end Jeff Heuerman. Clubs have a focus on trying to stay healthy. After last year’s loss, Jacksonville has made it a bigger priority to stay injury free and have changed their rookie minicamp. Statistically, over 50% of teams will have a season-ending injury during offseason activities. Last week, Ravens cornerback Jumal Rolle tore his Achilles tendon and will miss 2016. The most common offseason injuries are muscles strains including the hamstring, groin, quad and calf, which usually recover in plenty of time. ACL and Achilles tears are the feared ones that will lead to a loss of the upcoming season. These injuries are commonly high-speed non-contact injuries. Thus, even with limited contact practices, the new CBA has not resulted in lower numbers of these injuries. Achilles have become the new ACL with increased numbers and both are dreaded season-enders. The main priority has become staying healthy while accomplishing offseason goals. MMMD 1: Julian Edelman with a second foot surgery Early reports called the procedure minor and that he would be back for training camp. Edelman had revision surgery where a screw was reinserted into the same left fifth metatarsal bone. Also called a Jones fracture, this is a problem fracture due to its poor blood supply. Returning to play early increases the chance of needing a second procedure, which often is accompanied by bone graft. Needing a second surgery for a Jones fracture is not unusual and does not indicate mismanagement by the surgeon or Patriots medical staff. When hurrying back to play, this happens up to 20% of the time. Recent examples of needing redo surgery include Dez Bryant, Julio Jones and the NBA’s Kevin Durant. Healing after revision surgery typically takes 3-4 months. It is possible that Edelman will be ready for the start of training camp but is it more likely he begins on PUP and targets a return before the first real game. If the Patriots are unlucky, it is possible they could play early season meaningful games without Tom Brady and their #1 wide receiver. MMMD 2: Dez Bryant recovery from second Jones fracture surgery The Cowboys wide receiver returned six weeks from his initial fifth metatarsal screw placement but never really excelled, posting a maximum of five catches in a game and totaling three touchdowns in 2015. After revision surgery, he is reported to be recovering well and on target to participate in some of OTAs and the June minicamp. The key here is Bryant had his 2nd foot surgery in January and “isn’t fully cleared yet”.  If Julian Edelman follows this timetable, his May surgery will have him back in October. The take home message is to be careful with fifth metatarsal fractures. MMMD 3: Melvin Gordon microfracture surgery When the word “microfracture” is used, many jump to the conclusion that a player is doomed. I agree with Chargers GM Tom Telesco. Not all microfracture surgery is the same and the key is the size and location of the lost articular cartilage. I have not treated Gordon and do not know the circumstances of his surgery, but given the optimistic return guideline of 4-6 months and the reports of his workout progress, the running back should be on course for a much better 2016 than rookie year. The team knows the details of the January surgery, yet they did not draft a running back or add one in free agency. That likely speaks loudly to the Chargers’ confidence in their starting running back’s rebound for a strong year. MMMD 4: BFR and Le’Veon Bell The Steelers RB is among the latest new believers of blood flow restriction (BFR) training. I have written about this new game-changing rehabilitation technique. The question is will BFR be enough to get Bell back for next season. The Steelers have set no timeline. In general, MCL/PCL surgery is harder to recover from than an isolated ACL tear. Simply put, recovering from two torn ligaments is harder than returning from one. There is no guarantee that Bell will be 100% or even ready to play Week 1, but if he is, BFR will share in the credit for his return. MMMD 5: Ricardo Lockette didn’t have a choice Big news of the week was the Seahawks WR/ST retiring from football. Congrats to Lockette on his decision to walk away healthy. The reality is that the injury and subsequent surgery caused him to lose significant rotation in his neck motion. A spine fusion from C1-C4 leaves him with well under 50% of his ability to turn his head to the right and left. It would be unprecedented to return to football from a three-level fusion. Lockette made the right choice to retire, but the medical reality is that he didn’t really have a choice. MMMD 6: Kudos to NFL player engagement I personally know of dozens of players who have taken advantage of programs. From broadcast boot camp, finance workshops to coaching or scouting internships, there are many programs aimed at giving former players direction. I am not saying the NFL is perfect in all aspects related to former players but I see an honest effort to help players with life after football careers. MMMD 7: ProFootballDoc scorecard In the offseason, I have not updated the running 2016 scorecard each week as activity is sparse. I will still keep tabs this season and see if it is possible to continue the slight improvement from 92.6% in 2014 to the 94.3% in 2015. In early March, the Byron Maxwell and Kiko Alonso trade to the Dolphins was rumored to be off due to Maxwell’s physical, which noted sternoclavicular (SC) joint problems. I tweeted at the time it was likely the deal would still go through and it did. Despite worry about Tony Romo’s offseason surgery to decrease the chance of recurrent clavicle fracture, I correctly indicated that the Dallas QB would be fine and indeed he is already cleared and throwing 100%. Prior to Jaylon Smith’s Combine medical evaluation, he was universally thought to be a top pick. Seeing video posted by the player, I concluded nerve issues and indicated that unfortunately he would fall out of the first-round.  I even got lucky and predicted the Cowboys would draft him. Myles Jack is able to play football today, but an OCD lesion would drop him out of being a top 10 pick. Adding these four correct assessments to the 1-0 2016 record leaves us with a 5-0 start for this coming season.
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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