Monday Injury Rounds: Week 10

Making rounds on this weekend's injuries, focusing on Ben Roethlisberger and Dion Lewis, with updates on Le'Veon Bell, Keenan Allen, Matt Forte, and others

NOTE: This column is a living document. I'll be updating as needed after team press conferences, imaging reports, Monday Night Football injuries, etc. Major changes to the content will be noted in red. I'll also be retweeting any key pieces of news and my own reaction and analysis, so make sure you're following @JeneBramel and checking my timeline on Twitter throughout the week.

INJURY ROUNDS

It was another week of potentially devastating injuries to the league's most talented players. As I write the first versions of these vignettes on Sunday evening, there remains uncertainty about the status of Ben Roethlisberger and Dion Lewis. Hopefully, we'll learn both avoided the most serious of the injuries on the list of possible diagnoses. Unfortunately, there's clear reason to be concerned about season-ending injuries with both.

ben roethlisberger | midfoot sprain | week-to-week

It's unusual to see clear video evidence of an injury mechanism with midfoot sprains. Often, these injuries happen in the pile or when a player lands on another player, obscuring the precise moment of injury.

That's not the case with Roethlisberger's injury. 

The image to the right is paused just before Roethlisberger's foot is crunched into the turf with his toes planted. This is the mechanism of a Lisfranc injury, an injury to a joint in the midfoot just behind the first and second toes.

Media reports since the injury have been all over the place. After a tweet from the Steelers' public relations account saying Roethlisberger left the stadium for further evaluation at the hospital (i.e. an MRI), multiple sources provided information to local and national media.

Adam Schefter tweeted the Steelers "initially suspected Lisfranc injury" and were "relieved" Roethlisberger only had a midfoot sprain that would keep him out a "few weeks." Hours later, Schefter updated his earlier report with a tweet stating, "Sounds like Ben Roethlisberger misses next Sunday's game vs. Browns, takes bye week to rest, then likely to return Week 12 at Seattle."

Tom Pelissero echoed Schefter's initial report, tweeting a diagnosis of "midfoot sprain" and a likely absence of a "few weeks."

Albert Breer first tweeted Roethlisberger's injury as a midfoot sprain with a likely multiple week absence. Shortly after, he amended his report with a tweet noting Roethlisberger's status was "up in the air" after the bye, implying a shorter recovery timetable.

Chris Mortensen tweeted Roethlisberger would miss just 1-2 weeks with a sprained foot.

I'm not sure what to make of the variability in these reports. Visually, Roethlisberger almost certainly has an injury to the Lisfranc joint. I think Schefter is implying the injury is not the most concerning fracture / joint dislocation -- which would make sense with the reports of a negative x-ray. Schefter's report of a midfoot sprain is still consistent with a Lisfranc injury, specifically one that involves damage to the ligament supporting the joint complex. Depending on the grade, that's still a multiple week injury.

I'm probably stubborn here, but I'm hesitant to buy any expectation of a 1-2 week absence here. Even a low grade ligament sprain in this area requires immobilization and rest to heal properly. With the violent mechanism above, it's hard to believe Roethlisberger got away with a low grade injury. Although Roethlisberger has proven himself a quick healer and willing to play through pain, recovery from a midfoot sprain has as much to do with stability of the joint and foot as pain tolerance. It's hard to beat standard recovery estimates here.

Expect to hear reports that Roethlisberger is immobilized in a walking boot on Monday. It's also likely we'll hear he's having a second opinion with Dr. Robert Anderson soon.

I have Roethlisberger listed week to week above, but will be watching closely for more information. I'll have more thoughts on Twitter as the situation develops further.

dion lewis | knee sprain | timetable pending

Lewis suffered a non-contact knee injury and was ruled out minutes later after a locker room examination. Television replays showed a mechanism concerning for an ACL tear, but locker room reports after the game suggested the Patriots were optimistic Lewis has suffered only an MCL sprain.

That would be odd. MCL sprains are usually contact injuries. And while a late evening Adam Schefter tweet might look optimistic, it's actually more ominous than it may seem.

Schefter tweeted: "Patriots RB Dion Lewis scheduled to undergo MRI on his knee. No swelling yet, a good sign. ACL loose, a bad sign. MRI to tell full story."

While it's true that the lack of swelling should be seen as reassuring, a locker room exam showing looseness in the ACL is a very bad prognostic sign. It's rare to find an intact ACL by MRI if a skilled examiner feels the joint move when testing the ACL. Multiple ligament injuries can be tough to diagnose when there's swelling and pain, but that doesn't appear to be the case here.

If Schefter's report is accurate, prepare for bad news on Lewis on Monday.

530 ET: Unfortunately, the early optimism on Lewis was unfounded. Lewis does have a torn ACL and was placed on injured reserve by the Patriots this afternoon. With a smooth, uncomplicated rehab, Lewis has a chance to return in training camp next season.

lesean mccoy | shoulder | day-to-day

McCoy went down on his shoulder and was unable to return. As often happens, McCoy told the media after the game he could have returned to the game but was held out for precautionary reasons. The video mechanism suggests an AC sprain -- similar to what Randall Cobb and Emmanuel Sanders have battled this year -- and Adam Schefter reports the team will send McCoy for an MRI on Monday.

McCoy is adamant he'll be available this Thursday night. That may prove true, but these injuries are usually more tender the following day and there's enough concern for an MRI already. I doubt we'll see McCoy practice much this week. Consider him a game-time decision for Thursday.

eddie lacy | groin strain | week-to-week

Lacy's conditioning has been in question for much of the season, particularly so since an ankle injury that lingered and left him unable to practice over the past few weeks. There's been little information from the Packers on Lacy's status. Poor signs would include the need for an MRI and/or a string of missed practices leading into Week 10. Either could suggest a multi-week absence.

teddy bridgewater | concussion | week-to-week

latavius murray | concussion | week-to-week

Bridgewater and Murray both looked to have briefly lost consciousness after helmet-to-turf and helmet-to-helmet hits on Sunday. Both will be in the concussion protocol this week. Loss of consciousness isn't a symptom that requires a slower progression through the protocol, but most teams have exhibited more caution than usual this year. Much will depend on how Bridgewater and Murray feel on Monday. If they are symptom free, they'll have a chance to move through the exercise protocols in time to play in Week 10. It's unlikely we'll know more on either player until Wednesday.


FOLLOW-UP APPOINTMENTS

le'veon bell | mcl / pcl sprain | out for season

The rest of the story finally came out late last week. Bell did in fact suffer a multi-ligament knee injury. While it wasn't the ACL injury most -- including me -- feared, it's not necessarily a less worrisome outcome. Bell will have surgery on his knee this week. The assumption is that he'll have a "badly torn" -- which may imply the ligament was pulled off the bone rather than torn in the middle of the ligament  -- MCL fixed. But the PCL may be the more concerning injury and may also need surgical intervention.

As we've seen with many players over the years (Keenan Allen and Breshad Perriman are two recent examples), recovery from PCL injuries isn't always smooth and without complication. Bell could be an example of a slow-to-heal PCL sprain himself. I'm still not convinced Bell's late 2014 "hyperextension" wasn't a PCL injury that caused him to report he wasn't 100% throughout the spring and early summer months of 2015. Players with PCL injuries often suffer stiffness or looseness deep in the joint for some time. To be clear, I'm not saying Bell cannot make a full recovery. But it's far from certain he'll be ready for OTAs and mini-camp.

keenan allen | kidney laceration | out for season

Scroll to the bottom of the page for a link to last week's Injury Rounds feature, which included frequent updates and details on Allen's injury and early week progress. On Tuesday, Allen had a "procedure" to address his injury. That procedure was likely an embolization, where a catheter is threaded near the area of injury and used to deliver a coil and clotting agents to stop bleeding. Unless there's more kidney damage than expected, this isn't a career-threatening situation for Allen, but it's an injury that needs much longer to heal than a bruise without active bleeding would.

Recovery times for a laceration average around eight weeks. There wasn't enough time in the season for Allen to recover and rehab to return in 2015. Expect Allen to be ready for OTAs and training camp next year.

matt forte | mcl sprain | week-to-week

Forte had a PRP injection last week to accelerate healing. Essentially, this is an injection of his own concentrated growth factor to supplement the ligament's naturally slower healing process. The need for PRP is confirmation Forte has a mid-grade injury. There's no reason to inject PRP for an injury you expect to heal in a matter of days. It's likely Forte's recovery was pegged at 3-6 weeks after the MRI. PRP takes time to work and won't impact the recovery immediately. The intent here is probably to shorten Forte's recovery to the three week range. There's an outside chance Forte could begin conditioning work this week, which would put his earliest realistic return as Week 11.

vincent jackson | knee | week-to-week

I'm growing more convinced by the week that Jackson suffered a PCL sprain when his knee hyperextended two weeks ago. Yet to practice with an early report of a multi-week absence, don't expect Jackson back for at least another week.

carlos hyde | stress fracture | week-to-week

This situation remains odd. It never made sense that Hyde was not risking more severe injury by playing through pain. It doesn't make sense that a couple weeks off will allow enough healing to prevent ongoing pain and limitation with this injury. What would make sense is a decision to fix the fracture surgically or acknowledge that Hyde needs to be shut down for 6+ weeks for healing. 

ladarius green | ankle | week-to-week

Green's mechanism of injury wasn't clear, but the brief glimpse on video was worrisome for a high ankle sprain. Green did not practice this week and is doubtful for Monday night's game. There's a slim chance he'll be a more active practice participant this week, but this has the looks of a multi-week injury.

austin seferian-jenkins | shoulder | day-to-day

Seferian-Jenkins fully practiced Friday but told reporters he wanted to be 100% before playing and was inactive on Sunday. The Buccaneers still haven't given specifics on the injury, but Seferian-Jenkins has now missed six weeks. The full practice last week implies Seferian-Jenkins is close. The inactive listing after the full practice implies we cannot trust practice participation until he is more optimistic about playing by the end of the week.

I'll also be watching for more information and practice participation clues on Anquan Boldin (hamstring), Kendall Wright (MCL), and Eddie Royal (knee), among others.

I'll be updating this feature throughout the day. Footballguys Insiders will get a full update with additional fantasy perspectives on Wednesday, with analysis of the week's game-time decisions early Sunday morning. Follow me on Twitter @JeneBramel for breaking injury news and analysis throughout the week.