An EDUCATED Guesses guide to being an injury savvy owner and dominating your other leagues…

Disclaimer: This information is based on the current medical research available to the public. In no way shape or form am I telling you that the information being provided is the end all be all. Remember I am not a medical doctor, but I have a medical background which allows me to interpret the medical information given to us (the public) as well as give you some insight as to a player’s ability to return to play from the injury.

This is what I hope to be a series of articles helping owners make informed decisions on players that will hopefully help you in future drafts or in determining your week to week starters. As much as I want to keep this information to myself, I want to do my part in making this league the very best and that means providing information that fellow league members may not have access to. Hopefully you gain some useful information from these articles…unless you’re El raven and have a difficult time reading…in which case go “through” yourself off a cliff.

Dat Knee Doh!!!

(For some reason I hear New England Mark’s voice for this man)

In today’s article, the injury we’ll be taking a closer look at is the dreaded meniscus tear. This has been a troublesome one for owners over the years as they have watched some of their top fantasy players go on the injury report with meniscal injury/tear, the most recent of which was Stevie Johnson. A few months ago, people were concerned when they heard the fifth overall pick Jalen Ramsey had suffered a meniscus injury during one of the Jaguars’ mini camps. So let’s start off with some background anatomy.

The knee has several major components that are worth mentioning, but we are going to zoom in and focus on two very important structures, the menisci. On the lower portion of the knee (the tibia) you have two similarly shaped structures that rest on the top of the bone; these are called the medial (inside) and lateral (outside) menisci. These structures are crucial to the knee’s durability (when injured or when sections are removed we potentially see more chronic issues and long term effects such as osteoarthritis that can limit a player’s overall career longevity). The Menisci perform several important functions, but are primarily responsible for providing shock absorption, lubrication of the joint, and strength to the knee. The wedge shape of the meniscus is what deepens the joint and provides the stability. Looking at Figure 1, we see the two distinct portions of the menisci.

Now that you understand the shape of the structures, one key thing to know about their anatomy and physiology is that they do not receive much blood flow. Meaning, when they get injured, they DO NOT heal well on their own. However, there are two distinct regions on the meniscus that tell you if there is blood flow or not, called red zone and white zone (Figure 2). The red zone of the meniscus indicates blood flow, while white signifies no blood flow.¹ So, you should already be able to tell that if the medical staff sees an injury in the white zone, we can assume that a surgical intervention is likely – or they will play through the injury until the knee locks up.

 (Figure 1)

  (Figure 2)

Currently, there are two main types of procedures performed for this type of injury: partial meniscectomy or meniscal repair (tears in the vascular region are usually repaired because they have the appropriate blood flow for healing). I would say (and this is from personal experience) partial meniscectomy is more commonly performed than repairs in the athletics world because they take less time for recovery and allow an earlier return to play. Essentially, for this procedure, the surgeon goes into the knee using a scope to find the tear, removes the torn section, and “cleans up“ or smooths out the area (Figure 3). For the meniscus repair, the surgeon again uses a scope to view the inside of the knee and find the tear. After the tear is found, the surgeon places a small suture to bring the tissues back together and promote healing (Figure 4). This technique usually comes with a longer rehabilitation period so that the tissue can heal normally, but has a very high success rate (80-92%).^2,3 The longer healing time is why, in athletics, this is sometimes the last choice. However, one of the main reasons this is an option is to preserve as much of the natural tissue of the body and decrease the chances of long-term complications.

 (Figure 3)

  (Figure 4)

So what does this all actually mean to me?

    Well, this is probably the point in this article that you all had wished you had skipped to in the beginning. But you made it! So with the information presented throughout the research, (at least the research I could get my hands on and not have to pay for) I am going to try and give you a few tips on what to expect when you see this injury pop up on Twitter, what to look for when you are monitoring players with this injury, and a few personal thoughts on the idea or things I look for (I really know this is going to come back to haunt me).

    Alright, so, first things first. When you see this injury pop up on your Twitter, don’t do as El Raven did and hit the panic button as quickly as possible (although now we know panic was the right choice poor Raven). Give it some time to develop, and see what happens over the next few days. You want to gather as much data as possible on the player as well as what the team is releasing as far as medical info. Please refer to the Reggie Ragland debacle that just happened. People were riding a roller coaster of emotions trying to figure out if he had torn his ACL or not. My tip is: don’t listen to anything that comes out of a coach’s mouth, especially Lil Pepper’s mouth (because you know he’s been sucking on some feet with that dirty mouth of his). As an owner, you want to look for anything about the player getting an MRI. Usually, this means that the player tested positive on one or more of the orthopedic tests performed most often by the teams Athletic Trainer (not orthopedic surgeon, especially when it occurs during practice. Contrary to some beliefs in this league there is not an orthopedic surgeon standing on the sideline at practice. I couldn’t remember who the owner was who said this, but there is your shout out buddy!). Personal experience here, but a lot of the time those orthopedic examinations are pretty good at getting it right, the good tests have strong specificity and sensitivity (that’s for you stats man Josh). In layman’s terms, that means the tests have a good chance of ruling in or ruling out the injury. If the team confirms that the player has a meniscal injury, next you want to determine whether or not they’re having surgery. A personal bit here, you can play on a torn meniscus. It is uncomfortable, but doable. Once the knee feels like it “locks up”, surgery is the next logical step. Once you have confirmed surgery, you’re going to want to look for the timeline. Current research suggests that with a partial meniscectomy the player can return to play in four to six weeks, but can be as long as six to eight weeks.^4,5 Research on the meniscal repair surgery has a much darker outlook on your fantasy football season. The current time frame for return to play is about four to six months.² However, there is some disagreement on how exactly to rehabilitate this injury, and is an area that requires further research. There are many conflicting rehabilitation protocols in existence, so it may be up to physician preference on time frame, as there are reports of an accelerated protocol lasting ten weeks.² Right now, my opinion is that you should assume the worst and expect the four to six month time frame. If the injury occurs close to the season, just assume your player will be out for the year.

    When players are returning from these injuries, look for the media to say that the individual was performing lateral movements or cutting activities along with sport specific motions during practice or that they were participating in team drills. Mainly what you want to see when you are hoping for them to return to play are cutting and change of direction drills. Those are the exercises that will irritate the injury if it is not ready for a return to play. These drills mean that the team is likely testing the player to see how they would perform if released into team activities.

    I hope this article provided you with a bit of insight on how to effectively evaluate your player’s timeline to return to play and what to look for in the media to help you make the best decisions for your team’s success. This is just another tool in your fantasy football arsenal to help you win your other leagues and make the IFL the most competitive league out there. If it did nothing for you, I am sure I will hear about it.

Below are names of players I could find that have suffered meniscus injuries in the past few years. The task of finding players that had suffered the injury was actually more difficult than I anticipated. The dates listed are they closet dates of surgery/injury and return to play dates that I could find. The surgery types are not 100% confirmed, but using the time tables I presented earlier in the article these are the best Educated Guesses.

Interesting names and time it took to return to play:

Player	Surgery Date	Date of Return	Surgery Type	Notes
Stevie Johnson	8/9/2016	Out for season	assuming repair
Myles Jack	9/22/2015	3/10/16 – 24 weeks or 5.5 months	repair
Jalen Ramsey	5/19/16	7/27/16 – 7 weeks	meniscectomy
Jadeveon Clowney	9/8/2014	10/25/2914* – 6 weeks	meniscectomy	*First date I could find where he was 100% playing no actual date when cleared
Scooby Wright	9/5/15	9/22/15 – 2 weeks*	meniscectomy	*This one surprised me…..
Chris Johnson	1/28/2014	7/24/2014 – 25 weeks or 5.75 months	repair**	**Johnson had an interesting case. From what I could find on the injury is that it originally was supposed to take 4-6 weeks, but because he had some underlying cartilage damage he received a stem cell injection which prolonged his recovery.
Devontae Booker	11/19/2015	no clear date on return	meniscectomy *	*Know this based on father stating recovery would be 4-6 weeks. And I am assuming he ran before his pro-day on 4/12/16

Wishing all of you an injury free training camp,

Rudolph Stormworth

References

1. Makris EA, Hadidi P, Athanasiou KA. The knee meniscus: Structure-function, pathophysiology, current repair techniques, and prospects for regeneration. Biomaterials. 2011;32(30):7411-7431. doi:10.1016/j.biomaterials.2011.06.037.
2. Pabian P, Hanney WJ. Functional rehabilitation after medial meniscus repair in a high school football quarterback: a case report. N Am J Sports Phys Ther. 2008;3(3):161-169. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2953330&tool=pmcentrez&rendertype=abstract.
3. Stein T, Mehling AP, Welsch F, von Eisenhart-Rothe R, Jager A. Long-Term Outcome After Arthroscopic Meniscal Repair Versus Arthroscopic Partial Meniscectomy for Traumatic Meniscal Tears. Am J Sports Med. 2010;38(8):1542-1548. doi:10.1177/0363546510364052.
4. Cavanaugh JT, Killian SE. Return to Play After Lateral Meniscectomy Compared With Medial Meniscectomy in Elite Professional Soccer. Curr Rev Musculoskelet Med. 2012;5(1):46-58. doi:10.1007/s12178-011-9110-y.
5. Frizziero A, Ferrari R, Giannotti E, Ferroni C, Poli P, Masiero S. The meniscus tear. State of the art of rehabilitation protocols related to surgical procedures. Muscles Ligaments Tendons J. 2012;2(4):295-301. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3666539&tool=pmcentrez&rendertype=abstract.