Breshad Perriman: The Jury Remains Out

Why avoiding ACL surgery is only the first hurdle in Perriman's quest to return in 2016

Every offseason report on Breshad Perriman was positive after last season's prolonged recovery from a PCL sprain and surgery. Beat writers were impressed by how fluidly he was running in OTAs and noted his burst and separation on deep routes. Optimism turned quickly sour when Perriman suffered another sprain to the same knee late last week. This time, the Baltimore medical staff was concerned about Perriman's ACL. 

Perriman's exam and MRI studies did not clearly show the extent of his injury. The Baltimore medical staff clearly felt Perriman's knee was stable enough to consider rehab. If not, they would have immediately recommended surgery. Though it's rare, it can be difficult to provide a clear prognosis for partial ACL tears without actually visualizing the ligament. And Perriman needed certainty. So, on Tuesday, Perriman underwent arthroscopic surgery to look at the ACL and decide whether he would need an ACL reconstruction or try to rehab his knee without surgery.

Dr. James Andrews chose the latter path, injecting the area around the injured ligament with stem cells to stimulate healing rather than reconstructing the ligament. Given the alternative -- reconstruction would mean 6-9 months of rehabilitation and almost certainly another lost season for Perriman -- today's action was (rightfully) reported in a very optimistic light. But although Perriman now has a chance to return for the 2016 season, it's still too early to know with any certainty if he actually can return.

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Most athletes with partial ACL tears will require ligament reconstruction. It's rare for the ACL to have such minimal damage that the knee joint remains stable. It's a small ligament required to do a very important job. When there's enough force to damage the ACL, it usually is fully torn or damaged significantly enough it may as well have been fully torn. Perriman's ligament was damaged enough for multiple orthopedic surgeons to feel compelled to look at the ligament to decide it's fate. And while the NFL's most trusted set of eyes -- Dr. James Andrews -- felt the knee was stable enough to rehab, he still elected to inject with stem cells to assist in healing the damaged ligament.

A skeptic, then, might ask:

Is the stem cell injection and rehab seen as Perriman's only chance at a return in 2016 and worth a shot? Or does Perriman's medical team strongly believe his injury can be rehabbed successfully with the aid of stem cells?

It is, of course, impossible to answer that question today. But I think there's good reason to remain skeptical. The ACL has to heal for Perriman to return to play this season. Stem cell injections are promising but not universally successful. Perriman has already had a frustratingly difficult rehab with a ligament in the same knee. That injury eventually required surgery. While PCL sprains and partial ACL tears are different injuries with different sets of possible complications, last year's struggles are likely to lead to extreme caution from the Baltimore medical staff.

There are instances of successful rehab of partial ACL tears. Kiko Alonso, another Dr. Andrews patient, beat the odds last year and returned six weeks after spraining his previously reconstructed ACL. Many players have later required surgery, however. 

Expect the Ravens to be careful with Perriman, who is very likely to start the season on the PUP list. The Baltimore medical staff will not clear him for contact unless they are fully convinced Perriman's knee joint is stable and his surrounding muscles have regained full strength. There's no chance they'll put his knee in harm's way and risk additional injury (other ligament tears, meniscus injury, cartilage injury) until there's no concern. Whether he can successfully rehab and return for training camp is very much unknown. Despite all the optimism today, no national media member would say more than "expected to be ready for the regular season."

I hope to see Perriman return during training camp or early in the regular season. He would join Alonso as a strong recent positive data point in partial ACL injuries and stem cell treatment. But there's still good reason for caution as Perriman progresses through his rehab.

Check back for more injury analysis throughout the offseason and follow on Twitter @JeneBramel for breaking injury news, commentary and analysis of any injury news around the NFL.