Dr. Eric Fjeldheim, PT
Another week and another budding star goes down. In this week’s Injury Wire, we will take a deep dive and discuss Carson Wentz’s injury/recovery and more. With a torn ACL, Carson Wentz’s season is over, and he will need surgery. (Editor’s note: Wentz reportedly underwent surgery on Wednesday.) What will his recovery look like? When will be back? What will he need to be able to do before returning to the sport? How will he perform when he returns?
There is a body of evidence suggesting that full return to sport should be delayed until at least 9 months post-surgery.1 While Adrian Peterson returned in 7 months, he was an exception, not the rule. Once the surgery is completed, and the new ACL graft is placed, the body starts to heal and change the tissue of the new ACL graft (tendon) into a ligament by a process called “revascularization.” During this process, the graft weakens before being built back up and is at its weakest roughly 8-10 weeks post-op. At this time the graft is about 1/10 the strength that it will be at nine months post-op. There is no way to speed up this process, and this is partially why there is such a long recovery time. Wentz will be able to throw long before he is cleared to return to full contact activities.
While he will potentially be able to play Week 1 of the 2018 season, he will likely be limited in his explosiveness when running. Players that rely on their explosiveness typically aren’t 100% until later the next season or the second season after injury. See Keenan Allen. The good news for Wentz is that the physical demands of QB are a much different than other skill positions.
Early goals for Wentz’s recovery include regaining full ROM and sufficient quad strength to be able to walk without a brace or crutches. For high-level athletes, this takes about two weeks. The rehab process will include strengthening (think squats/deadlifts), agility/plyometric drills, a running program, and landing/jumping mechanics. All in all the process of completing rehab takes about nine months.
There are six criteria that Wentz will need to meet before his full return to play from the perspective of a rehabilitation professional. They include: sufficient performance on a running t-test, hop testing (single leg hop for distance, triple hop for distance, cross-over hop for distance, and a timed 6-meter hop), and strength of the surgical leg (quads and hamstrings) at least 90%. Successful completion of these tests before a full return to sport decreases the risk of re-injury by as much as 4x’s.2 Images of the hop testing are seen below:
Likelihood of Recurrence
There is some variability in the data based on what study you find. However, on average around 10% of athletes that meet the return to play criteria re-injure their surgical leg, or have an injury on the opposite limb (see Keenan Allen). I fully expect the Eagles rehab staff to do a world-class job with their franchise QB. Carson Wentz is a professional, and his job is going to be to rehab like a beast. He didn’t seem to have a typical mechanism of injury based on the video footage as most ACL injuries are non-contact. Hopefully, there aren’t any underlying mechanical issues the predispose him to future injury, but if there are, he should be able to get them cleaned up during his recovery to further decrease the likelihood of re-injury.
Effect on Performance
When an athlete returns to sport after ACL repair, there is also a psychological component. Will he have the confidence to step into his throws with a history of left knee injury? He will likely wear a brace to help with this, and the NFL has done a good job to making rules to discourage players from tackling QB’s low in the pocket (see Tom Brady Rule). I think he will be good to go mentally as all reports on Wentz indicate that this guy has mental fortitude by the truckload. He will probably be limited with his mobility early on in the year, but we have seen other QB’s (Brady and Rivers) come back to have very successful careers, and Wentz has shown that he can be great in the pocket.
Wentz should be back and good to go *hopefully,* by Week 1, nine months from now will be right around that time. In the NFL there are many successful outcomes following an ACL tear, and I expect Wentz to be one of them. However, don’t be surprised if he misses a couple of weeks early in the season. Wentz should make a full recovery and have another great year in 2018. Hold on to him in your dynasty leagues!
Thanks for reading. You can find me on Twitter @DPT_fjeldy.
- Grindem, H., Snyder-Mackler, L., Moksnes, H., Engebretsen, L. & Risberg, M. A. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br. J. Sports Med. Epub ahead of print (2016). doi:10.1136/bjsports-2016-096031
- Kyritsis, P., Bahr, R., Landreau, P., Miladi, R. & Witvrouw, E. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with four times greater risk of rupture. Br. J. Sports Med. bjsports-2015-095908 (2016).