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Return to Sport: J.J. Watt Tibial Plateau Fracture

J.J. Watt is a defensive force, this we know, but he has been battling injuries of late with back surgeries and the latest, a tibial plateau fracture. Now what exactly is a tibial plateau fracture, how do they happen, and what are its long-term implications for a dynamic athlete like J.J. Watt coming off the edge as a pass rusher? I’ll cover all of these questions so  we have a good grasp on what to expect for his production in the upcoming season.

What is it?: A tibial plateau fracture is a fracture of the superior portion of the tibia, where the tibia articulates with the femur to make the knee joint. Often times, people experience this injury when they fall from a height and land on their feet such as off of a roof or a ladder. J.J. does not fall from a ladder, rather he is pass rushing and appears to lose his balance when his left leg reaches out in front of him bearing a full load of a 290-pound man mimicking the forces of a fall from a height. Result? Fractured tibia.

The rehab for this injury is extensive, but the good news is that this a bony injury, with no ligamentous damage. This translates to no instability in the knee, which haunts athletes like Watt that want to be able to make quick lateral cuts to get to the passer.

Timeline: Watt experienced this injury on October 8, 2017, and first walked 8 weeks later on December 1st, as he documented on his Instagram. Most likely, he was non-weight bearing for the time in between the injury and the walking. This time is important for bone healing after the surgery, which involves pinning the tibia to correct the fracture.  The x-ray looks scary, but once again, the silver lining is that there is no instability with this knee injury. However, with no weight being put through the leg, comes significant weakness that will be addressed throughout the coming months in rehab and workouts.

Once Watt is able to walk without restrictions, the rehab begins to focus on a progressive strengthening program before transitioning into running. On 1/18/18, Watt did post a video running in the Alter G, an unweighting treadmill able to reduce your weight to around 20% of your total body weight. The force through a person’s knees when running can be anywhere from 5 to 12 times their body weight, hence the need for a treadmill that allows Watt to run unweighted and pain-free. It is a good sign that he has begun running and working out with teammate Deshaun Watson. He has been quoted in interviews saying he expects to be back for training camp.

On-Field Expectations: When Watt returns to the field, I would expect some lingering effects of the injury early on, translating to decreased production. This is fairly common with an injury that requires significant time off, as it is very difficult to mimic game speed and game explosiveness. It may take a few weeks into the season for Watt to gain the explosiveness that he is known for. Yet long-term, Watt should recover full strength and not experience long-term deficits, as this is a fairly uncommon injury in the NFL. Once he gets back to game speed, which I would anticipate is within the first 6 weeks, it should be full speed ahead for Watt.


Physical Therapist. Craft beer drinker. Overly opinionated sports fan. Medical injury writer for @DFF_Dynasty #DFFArmy #FantasyFootball

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    • Tony James

      February 24, 2018

      Incorrect….. if this injury didn’t require internal fixation (metal hardware screwed into tibia) then his chances of coming back to his prior form would be great. However, he suffered a broken knee, torn meniscus, and cartilage damage. Fortunately, he didn’t suffer acl damage however, tibial plateau fractures are devastating to the knee. Your knee is never the same and it is unstable after you heal. He is now susceptible to a degenerative knee and may require a knee replacement in a few years time especially if he continues to play football. Unfortunately, (and I feel for him) he will never be the same player. His recovery will be at least 1 year. And if he removes the metal hardware it will be 2 years. I know this because I have the same injury as him and I worked extremely hard in rehab and then the gym. It’s been over a year and my leg has gotten much stronger and it still has a ways to go but my knee buckles and I can only jog certain days for short distances with pain. I’m nowhere near the size of JJ but running on that knee with his weight will be a mission. Good luck to him though I wish him the best.

      • Alex Habegger

        February 25, 2018

        Hey Tony! Thanks for the interest in the article! I have not seen any reports of their being any cartilage damage for Watt officially, which would include the medial or lateral meniscus. I will also link you to a table showing the return to sport evidence after tibial plateau fractures from a systematic review (the highest level of evidence for research) done by the World Journal of Orthopedics. It shows that the average return to sport is just under 7 months.

        He will definitely be at risk for degeneration and arthritis in that knee however given his age a knee replacement won’t be in the picture for awhile. It’s important to remember that everyone is not the same, but Watt is an elite athlete who will do better in most rehab situations than most people of the street.

        Also, good luck with your rehab Tony!


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