Monday Morning MD: Two consecutive top-5 overall picks injured

The Jacksonville Jaguars now have the dubious distinction of having two consecutive top-5 overall picks injured early in the offseason program. Last year, Dante Fowler, Jr. tore his ACL in the first rookie minicamp practice. Now Jalen Ramsey has suffered a “small” meniscus tear. Last week I wrote how half of teams will suffer a significant injury program. With Ramsey for the Jaguars, Shaq Lawson (shoulder) with Bills and Jumal Rolle (Achilles) of the Ravens, that makes three of the potential 16 teams already. The size of Ramsey’s meniscus tear is not the biggest factor for a quick return. The type of tear and location (peripheral vs inner rim) determines the type of arthroscopic surgery needed: menisectomy (trimming) versus meniscus repair (sewing). A typical return from menisectomy is 4-6 weeks. A meniscus repair would mean 4-6 months out. Statistically, there is over a 90% chance that Ramsey’s tear will not be amenable to repair, thus dictating the trimming surgery with quicker recovery. Interestingly, a previous poll of NFL players showed they would overwhelmingly choose the menisectomy (earlier return) over a repair (less long term arthritis, longer recovery) even if their tear was a candidate for repair. Myles Jack’s knee situation with the osteochondral lesion is much different. He was another top-5 talent that fell to the Jaguars early in round 2 due to reports of needing future microfracture surgery. Jacksonville fans are understandably worried, but the two situations bear little resemblance medically. Concern for Ramsey’s knee in Jacksonville is high as it came to light that he had a microfracture surgery as a Sophomore in high school. A report surfaced that Jaguars may contradict that he ever had that procedure. Even if Ramsey did have microfracture surgery, at age of 15, the results are much better. I was not aware of Ramsey’s microfracture history, but I assure you the Jaguars medical staff knew the facts. For almost two decades I was in the same Combine medical room as Jacksonville and have worked with their current head athletic trainer. Yes, draftees conveniently “fib or forget” about their injury history, but team doctors know this and factor that in. Even without the operative report of the high school surgery, with portal scars on his knee, likely a MRI was obtained that would show any previous microfracture surgery. With Fowler and now Ramsey, the consecutive year injuries appear to be bad luck, not something missed by the Jaguars medical staff. The Jacksonville GM, now knows his team doctor very well given the three knee issues of Fowler, Jack and Ramsey. If all three work out, the Jaguars could have a formidable defense and make the biggest improvement of any team in 2016. If the three knee issues do not perform well, the GM could be looking for another job. MMMD 1: Shaq Lawson needs shoulder surgery after all Before the draft, I indicated that the team that drafted Lawson would either do surgery immediately or hope to get through the first season with a shoulder harness and then have surgery in the offseason. Despite the player’s previous denials of any need for surgery, a labral repair surgery was performed this week. Unfortunately, the procedure means Lawson will start the year on PUP and undoubtedly miss Week 1. If rehab is smooth, Lawson could return 4-6 months after surgery, which means he could miss half of his rookie campaign. This is not to say the Buffalo made a bad draft pick. There is no doubt the Bills medical staff was aware of the issue and the Lawson first-round selection was a calculated risk. The good news is that once healed, there should be no long-term issues. Lawson played three years with a shoulder brace. It is not unusual that as a player steps up to a higher level of competition, injuries they could play with before, now get unmasked. Reports say Lawson re-injured the shoulder doing a bag drill. Even though it was likely that he was not wearing brace when the shoulder re-dislocated, the Bills are making the right decision to get their prized rookie fixed now. MMMD 2: Wide receiver fracture The Jones 5th metatarsal fracture should be renamed the WR fracture. Sammy Watkins joined a long list of recent WRs to have a screw placed in his foot. Julian Edelman, Dez Bryant, Julio Jones and DeVante Parker all had a second screw in the same foot. Others to undergo surgery for Jones fracture include Hakeeem Nicks, Michael Crabtree, Marvin Jones, Demaryius Thomas and Quinton Patton. Other positions get the injury too: 49ers RB Carlos Hyde and teammate S Jimmy Ward among others. However, fifth metatarsal fractures are more common in wide receivers than any other position group due to the hard cuts they have to make. No one knows who Sir Robert Jones, the namesake for the Jones fracture is anymore. I propose we just call this injury a “wide receiver” fracture. MMMD 3: Another reason for Laremy Tunsil draft tumble? A report surfaced that Tunsil’s draft day fall may not have been exclusively related to the gas mask video. A “pre-arthritic” ankle may have contributed to the slide. Don’t forget that Tunsil had an ankle fracture/dislocation in the bowl game at the end of his junior season, but returned to play well. This injury could indeed lead to future arthritis but that typically takes decades. College teammate Laquon Treadwell had a similar injury and was a fellow first-round pick. Then again, Darren Sproles had a similar injury and surgery early in his NFL career and is beginning his 10th season since that ankle injury. MMMD 4: Cardinals with confidence in Tyrann Mathieu Teams are usually hesitant about a defensive back coming off an ACL tear (see Darrelle Revis and the Jets 2012). Arizona has no such fears and is rumored to be extending the contract of the “honey badger”. It typically takes longer for a DB to be fully effective after ACL surgery due to the demands to react to the offensive players moves. However, Mathieu already showed he could recover from a potentially career threatening ACL/LCL injury in 2013. This ACL recovery is easy compared to the last one. MMMD 5: James Harrison’s suspicions about NFL drug test unfounded The often-fined Steelers linebacker wondered why he wasn’t allowed to film his recent drug test. This was not a case of Harrison being singled out but it is against league policy for anyone to record the testing procedures. Recording a test would make it easier to study the process and circumvent future testing. In a recent Olympics cheating scandal, Russia was accused of substituting clean urine samples in look-a-like bottles. Filming what the bottles look like might help in this counterfeiting process. The NFL is often accused of acting suspiciously (see Deflategate), but this does not seem to be the case here. MMMD 6: Crazy stories We have gotten numb to off field stories from Aaron Hernandez to Johnny Manziel. Add two more unbelievable stories that involve two players I know, respect and wish the best for. Erik Kramer survived a suicide attempt where he shot himself in the head. Reche Caldwell landed in jail after casually ordering drugs over the internet. There are many positive stories about former players, we just don’t hear about them as often. This weekend was the Marshall Faulk Celebrity Championship that has raised hundreds of thousands of dollars for charity. What is unique is that Faulk primarily raises money not for his own charity, but for the Junior Seau Foundation. After the 2012 death, the NFL MVP of 2000 voluntarily stepped up to take the lead to continue to raise money in Junior’s absence. Faulk just wants to pay Seau back for his encouragement when the young running back starred at San Diego State. I would rather hear more about these great charitable acts from players than hear more crazy stories about former players. MMMD 7: ProFootballDoc Scorecard The 2016 record was 5-0 even though injury predictions/assessments are sparse this time of year. Prior to the draft, I indicated Shaq Lawson would need shoulder surgery, which he denied even after the draft. With his recent labral repair, that increases this seasons total to 6-0.
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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