NFL Draft 2013: Risk or reward? (Part 3)

Football helmetWelcome to Part 3 of our series on injuries and medical conditions that could affect certain players’ selection in this year’s NFL Draft. In Part 1, Prateek Prasanna and I shared our perspectives on University of Alabama cornerback Dee Milliner, University of Utah defensive tackle Star Lotulelei, and University of Georgia outside linebacker Jarvis Jones. In Part 2, we explained the possible medical concerns with University of Houston cornerback D.J. Hayden and California wide receiver Keenan Allen. We conclude this series with discussions of USC quarterback Matt Barkley and University of South Carolina running back Marcus Lattimore.

Matt Barkley – University of Southern California quarterback
Concern: Type III acromioclavicular separation

• Against UCLA on November 17, Barkley received a crushing hit from UCLA linebacker Anthony Barr.

• CBS Los Angeles reported that Barkley suffered a separated shoulder.

• His senior season ended abruptly as he never took another snap of football at USC.

• Barkley did not throw at the NFL Combine so as to not risk re-injury.

• Mike Florio of Pro Football Talk reported that Barkley’s injury specifically was a Type III separation.

• Barkley’s Pro Day reviews were mixed. Some scouts were impressed, while others questioned Barkley’s arm strength.

• Consensus among draft experts was that Barkley would have been a Top 10 pick if he had entered the draft as a junior but might now not even be selected in the first three rounds.

• He returned to school to pursue a national championship and the Heisman Trophy. Even before his injury, his performance appeared to decline. He threw 15 interceptions. His completion percentage fell from 69.1% to 63.6%. His passing-efficiency rating fell from 161.2 to 157.6.

• The Philadelphia Eagles ultimately selected Barkley in the fourth round.

Analysis:

Acromioclavicular injury (AC injury)
Notice the vertical separation (orange arrow) between the tip of the acromion and end of the clavicle in this more serious AC separation.
The acromioclavicular joint is the small joint on top of the shoulder between the end of the clavicle (collarbone) and the acromion (tip of the shoulder blade). Injuries to this joint are often called shoulder separations.

Acromioclavicular joint injuries (AC injuries) usually occur with either a direct blow to the outside of the shoulder or landing directly on the shoulder. Quarterbacks hit by defensive players directly on the shoulder or driven to the ground on a tackle often suffer these injuries.

They are graded I-VI depending on the severity of the injury and the amount and direction of displacement between the bones. Type III injuries usually involve disruption of the ligaments that provide both horizontal and vertical stability to the AC joint. In Type III injuries, x-rays show 100% vertical displacement between the distal clavicle and the acromion.

Surgeons generally treat Types I and II injuries without surgery and instead advocate rest, sling or immobilizer, ice and physical therapy. Types IV, V and VI injuries require surgery due to the significant displacement of the joint.

Treatment of Type III injuries is controversial. A 2004 study in the American Journal of Sports Medicine looking at shoulder injuries specifically among NFL quarterbacks suggested that nonoperative treatment provided good results for Type III injuries. Other surgeons advocate surgeries for these injuries to help overhead athletes regain full strength and functional ability.

Marcus Lattimore – University of South Carolina running back
Concern: Multi-ligament knee injury

• Lattimore tore his left ACL in 2011. In the injury, coach Steve Spurrier told reporters that he also suffered “some cartilage damage.” He underwent ACL reconstruction on his left knee.

• Several games into the following season, he suffer a horrific injury to his right knee. A statement released by USC after the injury revealed that Lattimore “suffered significant impact to the front of his right knee” and that “the ensuing hyperextension of the knee resulted in injury to several ligaments. There were no fractures or additional injuries.”

• As reported by Darryl Slater in The Post and Courier, team physician Dr. Jeffrey Guy immediately assessed Lattimore’s peroneal nerve and determined that it was functioning properly.

• Months into his rehab, ESPN reported that Lattimore’s multi-ligament knee injury specifically involved tears of the ACL, PCL, and LCL.

• Dr. Guy, Dr. Lyle Cain, and USC team consultant Dr. James Andrews performed Lattimore’s surgery six days later. According to Slater, “During surgery, Lattimore required complete reconstruction of just one ligament, the anterior cruciate.”

• Dr. Andrews reported told NFL teams that Lattimore was months ahead of schedule in his recovery. About Andrews’s assessment, Lattimore told reporters, “He keeps saying I’m going to shock the world.”

• He is selected with the 34th pick in the fourth round by the San Francisco 49ers.

• Jim Harbaugh on the NFL Network on Lattimore: “We’re not going to put him on the field until he’s 100 percent and that may not be this year.”

Analysis:

I’ve written about the multi-ligament knee injury of Marcus Lattimore several times for The Post and Courier and Bleacher Report and discussed it on my podcast.

My concern after the ACL injury on his left knee in 2011 was the “cartilage damage” found along with the ACL. As I wrote in The Post and Courier as he returned to play the following season, coexisting articular cartilage damage or meniscus tear that required partial meniscectomy could lead to increased stress on the joint and lead to degeneration over time.

Torn ACL and PCL in the intracondylar notch
Torn ACL and PCL in the intracondylar notch
Return to sports after a multi-ligament knee injury is less predictable that an isolated ACL reconstruction. A European study looking at return to elite sports after these injuries showed that 19 of the 24 athletes returned to their sports after injury, but only 8 of the 24 returned to their pre-injury level. The biggest obstacles limiting the athletes were continued pain and loss of knee motion. The athletes lost an average of 10° of knee motion, which expectedly would hinder athletic ability.

As I wrote in The Post and Courier days after the injury, my concern is the very nature of football and what is required to play at an NFL-level. “Despite recovering adequate strength and range of motion, which would be acceptable for most of us, the ability to rapidly change directions and perform rotational movement is frequently altered. Returning to top-level sports that require exceptional power and agility is not impossible, but it is very difficult.”

Clearly Lattimore has an amazing work ethic. It sounds as if his rehab is progressing well. Hopefully the 49ers will allow Lattimore to progress and allow full recovery of his knee before pushing him out on the field. Football fans here in South Carolina and across the country will be pulling for him.

Summary:
This is a list of the players discussed in this series and their draft selections:

Dee Milliner – First round (#9) by the New York Jets
Star Lotulelei – First round (#14) by the Carolina Panthers
D.J. Hayden – First round (#12) by the Oakland Raiders
Jarvis Jones – First round (#17) by the Pittsburgh Steelers
Keenan Allen – Third round (#76) by the San Diego Chargers
Matt Barkley – Fourth round (#98) by the Philadelphia Eagles
Marcus Lattimore – Fourth round (#131) by the San Francisco 49ers

Read Part 1 and Part 2 of the series NFL Draft 2013: Risk or Reward?

If you were an NFL team general manager or coach, would any of these conditions or injuries worry you about drafting the players? How would you balance the risk and reward to make a decision? Share your thoughts below!

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