Monday Morning MD: Tannehill ACL tear preventable?

The Dolphins were victorious staying in playoff contention, yet they lost big when their starting quarterback suffered a serious knee injury. Ryan Tannehill routinely stepped into a throw when Calais Campbell, who may have been pushed from behind, hit the QB’s lead leg. Miami fears an ACL tear for their star signal caller. By video, it was a classic lead leg hyperextension injury, the kind that has ended many quarterbacks’ seasons. Opposing QB Carson Palmer, back in 2006 when he was a Bengal, tore his ACL the same way on a long completion. Tom Brady had a near identical mechanism with his 2008 ACL. I was on the opposing team sideline in 1999 when Trent Green tore his knee ligament in similar fashion, after which Kurt Warner led the “greatest show on turf” to Super Bowl victory. All of these examples were routine completions where the QB steps into the throw and transfers weight to the front leg on follow through. None of them were broken plays or excessively violent hits, although intentional contact to a quarterback’s legs in the pocket is now illegal for just this reason. Would a knee brace have prevented these injuries? No one can be sure, but in college prophylactic bracing is largely mandatory on offensive lineman and often the lead leg for the quarterback. Some NFL players use it routinely as well, including Brady after he learned his lesson after his ACL tear. Studies have shown some ability to prevent ACL tears with knee bracing. However, due to small sample size, there are no definitive statistics on how effective lead leg bracing is on NFL quarterbacks. I am not definitively saying Tannehill would still be playing had he wore a prophylactic brace. The point is with known injury risk on such a routine play, wouldn’t it make sense to take the precaution? It might even give a QB more confidence to step into throws and keep his eyes up the field. Many quarterbacks, like Joe Flacco, routinely use a lead leg brace after their reconstructive knee surgery, but why not before to prevent the first injury? The team knows before the MRI. The Dolphins will get the results of imaging to assess associated damage and confirm the tear before the formal announcement is made today. Obviously, Tannehill’s season is over, but there is a likelihood to be ready for Week 1 of 2017. The question is would a brace on the lead leg have saved the rest of this season for the Dolphins QB. MMMD 1: Lions fans should not panic with QB finger injury Finger dislocations are common. In my experience, on average, there is one or more a game. However, when it happens on the throwing hand of the star QB, everyone is understandably worried. By video and reports, Matthew Stafford dislocated his middle finger PIP (proximal interphalangeal) joint. There should be no fracture or tendon injury. With every finger dislocation ligaments are torn, but once reduced, heal well with tape/support and do not need surgery. This injury should not have a big effect on Stafford. In fact, he stoically never missed a play, but did don a glove afterward to improve grip. Derek Carr recently dislocated his pinky finger and has continued to play effectively (outside of a poor team performance in the cold this past Thursday). Even if a description of mallet finger with tendon injury is true (which does not fit the video), expect him to play through effectively. Stafford played thru a 2011 broken index finger. If he can play through a fracture, which can be unstable on the 2nd finger, surely he can play effectively on a stable reduced dislocation on a less important for throwing 3rd finger. MMMD 2: Aaron Rodgers déjà vu? In December 2014, the Packers QB suffered what seemed at the time an innocuous left calf strain. The injury lingered and bothered Rodgers running ability throughout the playoffs. Sunday on the third play, Rodgers suffered a right calf injury and although he noticeably limped, led his team to a dominant win. The injury likely was due to compensation for the left hamstring. Calf injuries tend to linger so this one bears watching. Expect to see Rodgers throw well with his arm strength. He should be able to move in the pocket, but don’t expect Rodgers to take off and run anytime soon, including potentially during the playoffs if the Packers get there. This may be a repeat of the 2014 injury. MMMD 3: Melvin Gordon hip A star running back being carted off is always a scary sight. When the injury is to the hip of a young talented recent first-round pick, fears of a Bo Jackson career altering injury flash to mind. By video, Gordon’s injury has no similarity to Jackson’s other than both were hip injuries. The Chargers RB was injured with extreme flexion, adduction and internal rotational twisting. The end of Jackson’s career was a result of significant axial load trauma instead. With playoffs out of reach, the Chargers were smart to hold Gordon out pending a confirmatory MRI. I expect a posterior capsular sprain and it will be good to rule out any small avulsion fracture or labral tear. My guess is that Gordon will return without surgery to get his 1000 yards rushing (he is 3 yards shy), but also expect the team to stop making him the work horse to save him for next year. MMMD 4: JPP groin surgery Jason Pierre-Paul was having a resurgent season after his 2015 fireworks injury. Now he is out for an extended period of time. Nowadays, traveling to Philadelphia is a harbinger of core muscle surgery and indeed JPP has a sports hernia fixed. It would be optimistic to think JPP could come back and be effective unless the Giants made a deep playoff run. The recovery takes 6-8 weeks to return to play but several months to get to 100%. Don’t expect JPP back unless the Giants make a Conference Championship appearance. MMMD 5: Jamaal Charles return? Despite the disappointing ACL comeback earlier this season and now two knee surgeries, the Chiefs could get their star RB back for the playoffs. Charles is eligible to return off IR in Week 17. This is not far-fetched. Both knee procedures were arthroscopic clean ups and the eight week short term IR timeline would fit nicely. Look for Kansas City to have a playoff boost from Charles. MMMD 6: Injury rundown Matt Forte left the Jets game early with lateral popping/crunching. His ligaments are OK but a MRI is pending. Don’t be surprised if this veteran has a knee scope when his season ends. Jared Cook left with a chest injury after a hard fall to the ground. Hopefully there is no pneumothorax and he can return soon. Chris Harris Jr was chop blocked on his right knee and suffered a MCL sprain. Thankfully his foot was not trapped and the injury appears minor as he returned to play. Marcus Gilchrist collapsed onto his right knee. Unfortunately, he tore his patella tendon which is harder recovery than even ACL tear. Su’a Cravens was reported to have a biceps partial tear. If the distal tendon is torn, that could mean season-ending surgery. By video, Jack Mewhort left the Colts game with a MCL injury and I hope his ACL was spared. Joey Bosa was evaluated for concussion and later neck injury. I hope this to be a temporary setback for the potential rookie of the year. Derrick Johnson had Achilles surgery. Medically, this should not end his long and illustrious career. Brian Cushing is reported to be playing through two spine fractures, which are likely to the transverse process. MMMD 2: ProFootballDoc scorecard Cecil Shorts unfortunately did tear multiple ligaments in his knee. Braxton Miller did injure his AC joint. Julio Jones did miss with his turf toe. Trevor Siemian did play with his foot injury. Sammy Watkins and Robert Woods were far from themselves. Derrick Johnson did rupture his Achilles. Charles Johnson did miss time with a hamstring injury. Melvin Gordon hurt his left hip but it did not appear to serious. Joey Bosa appears to avoid serious injury. Randall Cobb has a mild high ankle sprain and returned. Ty Montgomery appeared to have a stinger. Chirs Harris Jr left temporarily with a mild MCL sprain. I am documenting an error on Marcus Gilchrist. His season is over but with patella tendon rupture, not ACL tear. I probably should not have opined off only one replay angle. The previous 161-9 (94.75) record for 2016 is now 174-10 (94.6%).
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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