Offseason Injury Rounds: Offense

Photo: Rich Storry, USA Today Sports

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Andrew Luck | Right shoulder surgery

No one wants to have surgery. That includes elite professional athletes, who often recognize that some surgical interventions are there's-no-good-choice-here situations.

Remove a fragment of torn meniscus rather than repairing it with stitches and you return more quickly but likely have a shorter career with an increase in the risk of arthritis and microfracture procedures. Choose to tighten up certain ankle ligaments rather than hope for the best with rehab and you're looking at a lengthy and frustrating rehab before you return to form. Address your herniated disc surgically and you'll likely have a good outcome but understand that it'll take longer than you expect/hope to regain core muscle strength and flexibility. Rush your rehab with any surgical procedure and you're at risk of setbacks or compensatory/cascade injury.

Andrew Luck has been fighting through a shoulder condition for some time. The Colts first acknowledged it on the injury report last season; Will Carroll reported last year Luck suffered a shoulder subluxation in Week 3. Luck's 2015 season was erratic. His completion percentage was just 55.3%, down from the 60-61% numbers the two seasons prior. But a strengthening and stability program seemed effective last offseason. In 2016, Luck's completion percentage soared to 63.5%, he looked much more comfortable in the pocket, and his adjusted yards per attempt and interception percentage returned to pre-2015 levels (or better). 

There were hints of a frayed labrum in 2015, which suggests normal wear-and-tear in an overhead throwing athlete. But the Colts kept Luck on a throwing program last season and the report of a subluxation event (partial shoulder dislocation) strongly argue that Luck had more than minor labral damage. January's surgery all but confirms that Luck had a labral tear that could put him at risk of further shoulder damage with future hits or increase his risk of ineffectiveness over time if his shoulder again became symptomatic with throwing.

Neither the Colts nor Luck have confirmed specifics on the surgery. They provided no timetable, other than to hint they do not expect him to return for offseason activities. Ian Rapoport tweeted a timeline suggesting three months of rehab before Luck is cleared to throw and six months for a full return.

All of the above fit the progression and decision-making process for a labral repair. RotoViz analyst and noted upper extremity orthopedic specialist Jeff Budoff speculated the same last year. There's good reason for Luck to have tried hard to avoid surgery -- there are many success stories but the overall track record for recovery in overhead-throwing athletes isn't great. Admittedly, there aren't many comps for elite quarterbacks. Drew Brees recovered from a similar surgery, but also had a complicating rotator cuff injury. Dr. James Andrews still talks about how impressive Brees' recovery was.

We're not likely to get much information on Luck's rehab in the coming months. For now, there's no reason not to be optimistic for a full recovery but don't expect to see Luck until the early days of training camp. The Colts will not rush Luck's throwing program in any way.

April 1 Update: Jim Irsay told reporters early last week Luck's labrum and bicep were "pristine." That didn't match with the totality of evidence over the past two seasons and Irsay walked back his comments shortly afterward, clarifying that Luck's surgery was to repair a slightly torn labrum in the shoulder. As discussed above, the timetable for Luck's recovery is in the 4-6 month range and, while the Colts will rehab Luck carefully, a full recovery by opening weekend is well within range.

Teddy Bridgewater | Left knee dislocation / Multi-ligament repair

Players are carted off the field often in practice and games. Some leave the locker room by ambulance for additional evaluation. It's thankfully rare for a player to need emergent transportation for injury -- and exceedingly rare for a joint injury. Unfortunately, Bridgewater's knee dislocation met that standard. Bridgewater reportedly avoided nerve and blood vessel injuries but required repair of multiple knee ligaments and continues his long and difficult rehab.

Bridgewater hasn't updated his status but the Vikings have been very guarded in their optimism since the season ended. Mike Zimmer told reporters in late January he was "worried about Teddy getting better" and acknowledged the difficulty of putting a timetable on Bridgewater's return because no two injuries of this severity are similar enough to estimate accurately. General manager Rick Spielman told reporters last week it would be "totally unfair" to put a timetable on Bridgewater's rehab and said the current focus was still on regaining range of motion. Former NFL team orthopedic surgeon Dr. David Chao tweeted that a 90% recovery after knee dislocation should be considered a "great result." 

Bridgewater wasn't a threat to lead all quarterbacks in rushing attempts and rushing yards but mobility was an important part of his game. Front leg stability is also critical to throwing accuracy. It's also fair to wonder how high the mental hurdle to climbing the pocket in the face of an NFL pass rush may prove to be for Bridgewater. The Vikings say they are "hopeful" for 2017 and it's too soon to put an accurate endpoint on Bridgewater's rehab, but an effective return this season is a very tough ask.

It's too soon to write Bridgewater off entirely. But physical recovery isn't the only issue of note here. Sam Bradford is not yet under contract for 2018. The Vikings must make a decision on whether to exercise the fifth-year option on Bridgewater before he's had time to fully recover. And Bridgewater's biggest supporter may have been now-fired offensive coordinator Norv Turner. Bridgewater may have to prove himself fully recovered with another team.

April 1 Update: Videos of Bridgewater doing some light positional work -- dropbacks and throws to receivers on the move -- surfaced last week. Though it's great to see Bridgewater cleared to weight bear and do light activity, there's not much to take from these videos. Bridgewater's knee was braced and he was moving in a deliberate and controlled fashion. There remains no specific timetable for Bridgewater's return.

Cam Newton | Right shoulder rotator cuff surgery

Newton's situation is typical of NFL injury timelines.

A player suffers an in-game injury that's limiting but not severe enough to take him out of play.

The team acknowledges an imaging study was done and minimizes the findings while the player continues to play.

The player/medical staff choose to rehab aggressively early in the offseason in the hopes of avoiding surgery.

The player isn't fully recovered before the point-of-offseason-no-return and has surgery.

Undoubtedly, all involved were cautiously optimistic Newton's partial rotator cuff injury would heal without surgery. But when you're franchise quarterback continues to feel pain while throwing after rehab, there's little choice remaining. Avoiding surgery at that point risks further damage to the rotator cuff and / or a cascade injury somewhere else due to a likely subtle change in Newton's throwing mechanics.

The Panthers are saying Newton will return in time for camp. They're also saying he won't be allowed to throw with the team until 16 weeks after his end of March surgery. Expect the Panthers and Newton to be very cautious with his rehab. Recovery from shoulder surgeries in overhead throwing athletes can be tricky. Four months before throwing with the team means the end of July, as training camp begins. If Newton meets that goal, it's a great indicator he'll be at full strength as the season begins. But I expect Newton will be brought along very slowly in the early days of camp and may well not participate in preseason games until late August.

May 4 Update: General manager Dave Gettleman told reporters in mid-April Newton is "on schedule" for training camp.

Derek Carr | Right fibula fracture / Syndemosis fixation

Carr bristled at any suggestion he had no chance of returning during the playoffs. His attitude is admirable but unrealistic. Carr's mechanism and injury and his brother's description of the surgery (broken leg requiring a plate near his foot) strongly suggest a high-grade high ankle sprain with fixation. Though there has been some recent discussion in orthopedics about shorter rehab schedules and allowing players to weight bear sooner, current consensus is athletes remain nonweight bearing after this surgery for 6-8 weeks and rehab/recovery can take as long as 4-6 months.

Unsurprisingly, teammate Donald Penn told NFL Network last week Carr texted him he was nearing 100% recovery. Carr's brother then reported Carr could return for offseason work.

Carr should be fully recovered for training camp. I'm presenting this vignette in this way so you'll not be confused if Carr doesn't participate in early OTAs and minicamp. His initial estimate was very optimistic and -- while it'll still be important to examine any future comments for signs of a setback -- any limitations in the early offseason months are well within expected rehab estimates. 

April 1 Update: Oakland GM Reggie McKenzie told reporters Carr will be a "full go" at offseason activities.

May 4 Update: David Carr participated fully in OTAs. 

Marcus Mariota | Right fibula fracture / syndesmosis fixation

Contrast Carr's injury and followup with Mariota's. While no two injuries and rehabs are the same, Mariota and Carr likely had very close to the same surgery. Copying and pasting from the Carr vignette above...Though there has been some recent discussion in orthopedics about shorter rehab schedules and allowing players to weight bear sooner, current consensus is athletes remain non-weight bearing after this surgery for 6-8 weeks and rehab/recovery can take as long as 4-6 months.

Unlike Carr, whose team was striving for a division title and Super Bowl berth, Mariota's Titans did not make the playoffs. It's probably no surprise the Titans were more willing to publicly share a slower timetable for recovery and have said Mariota is not expected to be available during OTAs. Expect Mariota to be ready for training camp.

Ryan Tannehill | ACL / MCL sprain

Tannehill reportedly had a followup MRI and manual testing in February showing good healing of both knee ligaments. The reassuring imaging means Tannehill is finally certain he'll be able to avoid surgical reconstruction of the partial ACL tear. The team will monitor him carefully, but Tannehill is expected to be available for offseason activities.

April 1 Update: Adam Gase told reporters Tannehill has no physical restrictions. He is expected to participate in offseason activities.

Matthew Stafford | Finger extensor ligament sprain

There were immediate indications Stafford's finger injury was more severe than the quarterback and team would initially admit. I was suspicious about a tendon injury after hearing the first descriptions of the injury but backed off a bit after conversations with multiple orthopedic surgeons and Stafford's quick return to practice. Stafford struggled in the weeks after the injury, wore a splint that suggested a tendon injury and then all but confirmed a tendon injury to reporters after the season. 

Stafford's injury will reportedly not require surgery and he'll have a full offseason to regain strength and range of motion. Expect him to participate in offseason activities and return to form next season.

Trevor Siemian | AC joint reconstruction

Brandon Stokely reported on a local Denver radio show in February that Siemian's injury was a higher grade sprain than previously suggested. The Broncos had termed Siemian's injury and surgery "minor" in January. Though there's a lower threshold for surgical intervention in overhead throwing athletes, surgery is usually now reserved for multiple ligament injuries and unstable joints. Stokely reported Siemian's injury was a Grade 5 injury. Ligament injuries are often graded as Grade 1, 2, or 3. AC sprains are graded on a six-point scale, with a Grade 5 injury describing injury to all three ligaments between the end of the collarbone and top of the shoulder blade.

I like providing a little extra context to less common injury descriptions, but the bottom line is this: Any AC joint surgery is significant. The higher grade doesn't necessarily change the rehab protocol or outcome. Rehab protocols for AC reconstruction usually aim for a functional return in 4-6 months. There are reports Siemian may be able to return before training camp but don't expect to see him doing much until later OTAs, if at all.

May 4 Update: Vance Joseph told reporters Siemian will be a "full go" for the offseason program.

Le'Veon Bell | Groin strain

Prepare for another offseason of uncertainty with Bell. After two consecutive offseasons of discussion and debate about recovery from knee injuries, Bell left the AFC Championship game after aggravating a groin strain. In early February, Ed Bouchette dropped a report deep into a chat session that Bell had sought multiple opinions on whether the groin injury required surgery. After a third opinion and no change in his status through the end of February, Ian Rapoport tweeted that Bell would had surgery "by now if necessary."

Most groin injuries today are considered part of the larger core abdominal muscle, a.k.a. sports hernia, family. Players often play through these injuries during the season and rest and rehab can be effective. Many others choose surgery, with a 3-8 week rehab timetable, during the season or shortly after. While Rapoport's belief that Bell would have chosen to have surgery by now if needed is logical, there's still time for Bell to choose surgery if his rehab does not lead to a full recovery by late spring.

March 25 Update: Yep. There was still time for Bell to choose surgery. Rapoport's tweet is in line with the expected: Bell's surgery was to repair a core muscle injury with an expected six week recovery period. Barring an unexpected setback, Bell should be fully recovered well in advance of training camp.

DeMarco Murray | Left plantar plate strain

Murray caused a small stir shortly after the season ended when he told reporters he had a torn plantar plate in his foot and was choosing to rest and rehab rather than have surgery. The plantar plate is a ligament than runs under the joint between the foot and toe. Though not precisely the same as turf toe, injuries to the plantar plate are similar. High-grade injuries to the ligament usually require surgery due to performance issues, instability, and deformity of the toe. Lower grade injuries are painful and limiting but can heal with time.

Murray played in the Pro Bowl the following week and there have been no reports of a pending surgery since early January. Surgical repair of injuries to this joint usually require 4-6 months of rehab and athletes can be limited longer than that. While we've seen players wait until the last possible week before having surgery -- Tyler Eifert's May ankle surgery last year is a great example -- the longer it stays quiet around Murray, the better.

David Johnson | Left MCL sprain

Johnson's injury was scary but later diagnosed as an isolated MCL sprain. Already feeling well enough to explode out of a pool to a standing position on the deck, Johnson should have no difficulty recovering for OTAs and training camp.

Eddie Lacy | Left ankle surgery

Specifics on Lacy's ankle injury and surgery were never reported. From the context of an Ian Rapoport tweet suggesting the injury was "more than an ankle sprain" and snippets of reports about a rehab that involved weeks of non-weight bearing status, it's clear Lacy's injury fits into the longer term 4-6 month timetables we've seen for players with higher grade ankle sprains of all kinds. Recent videos of Lacy doing rehab work in the pool five months after the injury would also fit into the 4-6 month recovery expectation. Lacy is a free agent, so I don't expect to hear anything about Lacy unless and until it's positive enough to frame an "I'm ready to go" narrative. For now, tentatively expect him to be ready for later offseason workouts and training camp.

March 4 Update: Lacy told reporters, "I messed up my deltoid [ligament] and widened the bone on my ankle, so I had to get two wires and a plate to fix it." This procedure is similar to what Tyler Eifert and others have rehabbed in recent years. 5-6 months is the common recovery timetable. He should be expected to return this offseason.

Melvin Gordon | Left PCL sprain / Left hip strain

Gordon's hip strain should be a non-issue this offseason. The knee injury, which I and others speculated was an MCL sprain during the season, has since been reported to be a PCL sprain. While there have been no reports of difficulty in rehab thus far, PCL sprains are tricky. Some heal quickly and without surprises, some (like Breshad Perriman) cause all sorts of trouble. There's no reason to worry over Gordon right now, but it would be reassuring to see him recover from the PCL sprain as he did last offseason's microfracture surgery and be cleared for OTA work.

C.J. Anderson | Right knee meniscectomy

Anderson believed he would be cleared by the end of February. The Broncos may limit him in early OTAs but he should be ready to return well in advance of training camp.

Latavius Murray | Ankle Ligament Repair

According to reports, Murray injured his ankle early last season and continued to play through it. He disclosed the injury during free agent visits and elected to have surgery. Adam Schefter says Murray had a "ligament repaired" and the team says Murray will be ready for training camp. Though that sounds matter-of-fact, we've seen how players who have ankle ligament repairs and reconstructions rehab and recover -- especially those performed by renowned foot and ankle surgeon Dr. Robert Anderson -- deliberately and with great care. 

It takes time to rehab the ankle joint and ensure strength and range of motion have returned before allowing return to sport-specific activity and risking aggravations or compensatory injuries. We don't know precisely which ankle ligament was repaired, but many players aren't themselves until 4-6 months after surgery. Watch the details on this one carefully. It's possible Murray isn't ready at the start of camp and gets off to a slow start in the regular season.

Gio Bernard | Left ACL reconstruction

Late February reports had Bernard progressing well in rehab and hopeful to be ready for the start of training camp.

Sammy Watkins | Left fifth metatarsal fracture surgical revision

Watkins was able to return from injured reserve late in the season and be productive but continued to have pain. Watkins continued to express his desire to avoid another foot surgery after the season. However, his ongoing symptoms after the first surgery and the high rate of successful return after a revision procedure (see also: Julio Jones, Emmanuel Sanders, Dez Bryant, Julian Edelman, among others) finally carried the day. Watkins had surgery in late January. Dr. Anderson usually recommends 12-16 weeks of rehab after revision procedures. Expect the Bills to remain careful with Watkins, but the presumptive four-month timetable should allow Watkins to return in advance of training camp.

Julio Jones | Multiple foot injuries

Jones was on the injury report seemingly every week in 2016. From knee contusions to various ankle sprains to toe injuries, Jones usually struggled to practice before the end of the week but often returned to play at a high level on Sunday. Shortly before the NFC Championship game, Jay Glazer tweeted that Jones was battling two ligament sprains near his toe and an injury to his mid-foot. Early on the morning of the Super Bowl, Ian Rapoport followed up with a report that Jones would have his injuries evaluated after the game to determine whether any would need surgery.

It's been quiet since Rapoport's tweet thankfully. Jones is likely debating the same questions facing DeMarco Murray and deciding whether to allow the ligaments around his big toe to heal while rehabbing or have them repaired in enough time to recover for training camp and the 2017 season. Glazer's mention of a mid-foot injury is troubling but Jones' prior foot fractures were to the right foot and video showed Jones' recent injuries to be to his left foot. Also, it's very unlikely Jones would have been cleared to play with a Lisfranc injury. 

I'll continue to watch Jones' status carefully, but there were no reports of a surgical procedure through February and there's nothing in any report to date to suggest he won't be ready for training camp.

March 4 Update: After a report from Ian Rapoport suggesting Jones would have "minor" foot surgery, Falcons' beat writer Vaughn McClure clarified that Jones was being evaluated by Dr. Robert Anderson for a bunion removal and no decision on surgery had been made yet. A bunion doesn't fit with the list of concerns given by Jay Glazer earlier this year but would be a minor procedure. It's likely that Jones will have a procedure given the travel to see a specialist in person. This is likely the evaluation that has been planned for some time, however, and Anderson will be re-evaluating Jones' toe and any other foot and ankle concerns. Expect to hear more details soon.

March 11 Update: Jones had surgery in early March, reportedly to address a painful bunion that has affected him for many years. Multiple reports set Jones' recovery time at 4-5 months, which is a few weeks longer than most athletes require to recover after bunion surgeries. That's probably because Jones likely had his foot bone adjusted and surrounding ligaments and tendons tightened or loosened as necessary. Unless there was more to Jones' surgery -- i.e. he had turf toe / plantar plate issues addressed -- he should be ready for training camp.

March 25 Update: Frequently, what looks like a small detail is critical to injury detective work. Julio Jones made a non-football related appearance last week and was seen in a walking boot two weeks after his surgery -- but no crutches. That eliminates the possibility of a more extensive turf toe / plantar plate repair which requires a four week period of non-weight bearing. Jones will still have a deliberate rehab but it's reassuring to see that Dr. Anderson did not need to address any plantar plate issues.

Josh Doctson | Achilles tendinitis

Doctson has been battling tendinitis -- now reportedly in both ankles -- since last May. When asked in January whether Doctson had made progress in his recovery, Jay Gruden had trouble hiding his frustration, saying, “Not really. I saw him running in the pool the other day, which is exciting. We’re going to take it slow with him. [The] month of February, I think, is very important for his progress and then we’ll see where he’s at.”

Gruden's comments have since been followed by beat writers projecting triple-digit targets and social media videos of Doctson doing individual position-specific drills. I'm frequently asked to speculate on Doctson's status and recovery. Unfortunately, I'm not going to be very helpful here. Given Doctson's chronic issues, it's impossible to set a timetable for recovery. Essentially, the team will continue to try to advance his rehab slowly and hope for no setbacks. February's notes suggest Doctson is no longer immobilized and has been cleared for change of direction and position-specific drills. That's reassuring, but Doctson has been at this point of rehab twice since May and been returned to an immobilizer. Despite Gruden's comments, there's no pressure in February. If Doctson cannot participate in early OTAs in April and May, it's time to worry...again.

Eric Decker | Left hip labrum repair / Right rotator cuff repair

Decker continues his complicated offseason. After successfully progressing to a stage of hip rehab in which he no longer required crutches, Decker had his rotator cuff repaired in November. It's an injury that requires 8-9 months of rehab -- in addition to the ongoing six-month rehab for his hip injury. His dual rehab will put him up against the start of training camp and there were recent reports the Jets could ask him to take a pay cut or release him.

Travis Benjamin | PCL sprain / Arthroscopic knee surgery

I attended an NFL-focused sports medicine conference last spring. One of the takeaways was that orthopedic surgeons disagree on how to treat PCL sprains but most prefer not to address the injury surgically unless the athlete has persistent pain or looseness in the knee joint. There were no specific reports that Benjamin's arthroscopic surgery addressed last year's PCL injury but Adam Caplan more or less connected the dots when reporting the surgery on Twitter. Recovery estimates for PCL surgeries range from 4-6 months but slow recovery of range of motion and stability can force rehab teams to adjust timelines. It's reasonable to expect Benjamin back for camp but it's a situation worth tracking.

Rob Gronkowski | Microdiscectomy

This is Gronkowski's third surgery to address a herniated disc (2009, 2013, 2016). Presumably, all three surgeries are to the lower back, though it's unclear whether the recent surgery is to the same level as a previous surgery. The commonly reported recovery timetable for a microdiscectomy is 12 weeks. However, that doesn't include the additional time it often requires to regain core strength and conditioning. Most players say they don't feel themselves for 5-6 months. Gronkowski himself took five months (June-October) to return from his 2013 surgery.

Gronkowski has plenty of time to recover for the 2017 regular season and has already said there's no doubt he'll be ready for opening week. However, career length is becoming a concern. At minimum, there are multiple levels of degenerative change in Gronkowski's back. Last season's quick injury-to-surgery turnaround may also be telling, i.e. the joint decision was made to address the injury surgically rather than with injection and rehab with a player critical to the prospects of a playoff team. Gronkowski will be 28 this year. It's hard to bet on him playing into his mid-30s as Antonio Gates and Tony Gonzalez and Jason Witten have.

Tyler Eifert | Microdiscectomy

As noted with Gronkowski, players are often cleared for football-related activity after microdiscectomy in 12 weeks. Eifert was telling reporters he expected to return for offseason activities in early January. Expect the Bengals to be cautious with Eifert, however. Though there were some reports of a quicker-than-expected return from last season's ankle surgery, Eifert ended up requiring the usual full five months of recovery. The Bengals will likely rehab Eifert deliberately and conservatively, ensuring his conditioning and core strength have returned to minimize the risk of any cascade injury in the offseason. We could see Eifert participate in early OTAs but it shouldn't necessarily be considered a setback if he's not available until summer workouts.

Jordan Reed | AC sprain

Reed fought to play through a painful high grade AC sprain at the end of the season and looked close to recovered in his final game (six targets in 34 snaps). Also, rest and rehab are Reed's offseason plan, with his sprain not necessitating surgery. All indications are that Reed will be available for offseason workouts.

Martellus Bennett | Ankle injuries

Bennett seemed to aggravate his ankle injuries every week and managed very little practice during the season. His original injury early in the season had a mechanism consistent with a high ankle sprain. Ian Rapoport tweeted in January that Bennett was playing through a cracked bone in his ankle and bone chips around the joint. Rapoport also suggested that Bennett would have surgery sometime this offseason, presumably an arthroscope to remove the bone fragments after his other bony injuries heal well enough to allow appropriate rehab. I'll update here should Bennett have surgery with thoughts on the procedure and his prospective recovery timetable. 

Ladarius Green | Concussion

Reports on Green continue to be weird. Last offseason, Green was nowhere to be found months after signing with the Steelers and it wasn't clear whether his absence was related to headaches or delayed recovery from ankle surgery. Green suffered another concussion in mid-December. Current reports suggest he's no longer in the concussion protocol but hasn't been cleared for contact and has yet to pass a physical. There's also a clear undercurrent of stories noting the Steelers' comfort level with other tight ends on their roster. I'll update here if there's any clarity from the Steelers or Green in the coming months.

Follow me on Twitter @JeneBramel for breaking injury news and analysis throughout the offseason.