Monday Morning MD: 2016 NFL draft dominated by medical

Medical always plays some role in the NFL draft; however, the 2016 version would have a completely different look without two “red light” knee issues on two top players. If linebackers Jaylon Smith and Myles Jack were healthy, they would have been selected at the beginning of the first round, instead both fell out of the first day into the top of the second and the “dominos” fell differently as a result. The Cowboys gambled on Jaylon Smith out of Notre Dame who has been described as a generational linebacker. If he fully recovers from the multi-ligament knee injury and his peroneal nerve wakes up, he could be the steal of the draft. On the other hand, if he becomes the next Marcus Lattimore and doesn’t play a down, Dallas fans will surely lament the pick. It is hard not to root for Smith, who has done everything right, except have a bad luck horrific knee injury during the Fiesta Bowl game. He couldn’t have found a better landing spot as the Cowboys team doctor performed his surgery and he will be reunited with his older brother who is a running back on the team. Smith is still using an ankle foot orthosis (AFO) due to his persistent foot drop. It would be unprecedented to have someone play his career with an AFO, much less make a Pro Bowl while wearing one. His surgeon has shown great optimism for a full nerve recovery going against others who were more pessimistic. The Cowboys exhibited a lot of faith in their team physician by selecting Smith so high. His doctor knows best if the nerve will wake up, but no one knows for sure as nerve recovery is unpredictable. Even if the nerve recovers, the chance is small that it will return to 100% function. Without the nerve issue, an ACL, PCL and posterolateral corner injury is still career threatening. With the nerve issue, the odds are stacked against Smith. It takes three things to recover from any major injury. First, the injury has to be amenable to recovery. Second, one needs good surgery. Third the player needs to be motivated and have good rehabilitation. I compare it to needing a good snap, hold and kick to make any field goal. Smith certainly had good surgery as his doctor is tops. No one can question his work ethic in rehab. The remaining issue of the nerve is really out of Smith's or his surgeon’s hands. Smith remains optimistic saying he “absolutely” could play in 2016, but there is no guarantee he will ever play at all, much less perform to his potential. The best hold and kick may not be able to overcome a bad snap. Myles Jack is the other top linebacker with medical issues and his situation is the opposite of Smith. Jack is healthy and able to play today, but the question is for how long? The Jaguars were rumored to be interested in selecting Jack with their number one pick and overall 5th selection. With the medical issues, they nabbed him at the top of round two. Jack reportedly has an osteochondral defect (osteochondritis dissecans – OCD) lesion involving his knee articular cartilage and the underlying bone. This is essentially a separate issue from his meniscus tear and is likely congenital. The irony is the OCD may never have been discovered by teams absent the meniscus issue. There would have been no reason to X-ray or MRI the knee if there was no knee injury history. No one knows how long Jack will play. If, or some say when, the OCD lesion breaks off, microfracture type surgery with up to a one year recovery is needed. Regrowing articular cartilage is the “holy grail” of orthopedics as typically the new cartilage is not as strong as the original. If healthy, these two linebackers would be the stars of this draft. Jaylon Smith is the proverbial “start up company” with huge potential that may never get off the ground, Myles Jack is the “newspaper” that is popular today but needs to retool to the internet age to stay relevant. Best of luck to both. Here are some more draft medical observations: MMMD 1: No false medical info leaked There was suspicion that teams were leaking false information to drive down the values of Jaylon Smith and Myles Jack. Many teams leak false information about their interest in a player, but I have never seen a team tell lies about a player’s medicals. It just would be unethical. As it turns out, both of these players have real knee issues. MMMD 2: Jaguars defense to add three top-five players Dante Fowler, last year’s first round pick, tore his ACL at the first mini-camp and missed the season. Myles Jack is a first round talent who dropped to the second due to medical issues discussed above. No one questions the top-five talent of Jalen Ramsey. Fowler, Jack and Ramsey could turn Jacksonville’s defense into a force. When is the last time a team added three top-five level players at one time? MMMD 3: Shaq Lawson still says no surgery Despite my analysis, and a report from Adam Schefter that surgery is needed, Lawson still denies it. No one is panning the pick or saying he can’t play this year, but he will need a brace. In the end, the Bills are likely to recommend labral repair surgery after this season to give more time for recovery. If Lawson plays well with his shoulder brace, stabilizing the shoulder should make him an even better player as the harness keeps the shoulder in the socket but limits his range of motion. MMMD 4: Raiders top two picks with medical questions First pick Karl Joseph is coming off ACL surgery. Second pick Jihad Ward is said to need a knee scope. Joseph appears to be recovering well from October ligament reconstruction but don’t be surprised if he is not activated with the start of training camp. He will contribute this season but may not be in full form until the middle of the season. Ward has denied the need for surgery but his potential knee surgery should not prove to be a big deal. Anticipated recovery should not be more than four to six weeks and look for that to happen after mini-camp breaks. MMMD 5: Top 2 picks overcame throwing side injury An injury to anywhere on the throwing upper extremity of a quarterback is a cause for concern. This year the first and second overall picks beat their injuries. Jared Goff had shoulder surgery on his AC joint after his freshman year and has done well since. Carson Wentz missed the second half of last season with a scaphoid fracture. Both should be healthy. In the end, this is football. Players will get injured. What type of injury determines if there are any potential future problems. No issues with that on these two top picks. MMMD 6: 49ers follow recent tradition In the Trent Baalke era, there has been a penchant to get value by drafting players coming off ACL injuries. This year was no exception when the 49ers selected cornerback Will Redmond who tore his ACL in October. That makes a seventh player since 2013, which is essentially a normal full draft class. MMMD 7: End of the magnet era. There is no official count, but the day of draft magnets is ending. The small custom player magnets loaded with info were ubiquitous in war rooms for decades. Now most teams are in a hybrid system or switched entirely to an all-electronic draft board. sam-2686 The picture was from Mike Silver’s 2014 war room visit with the then St. Louis Rams. Images shared from this year’s Los Angeles Rams show a much different 100% electronic video board system. Things do change in the NFL
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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