The short- and long-term outlooks for Patrick Mahomes, Tua Tagovailoa, and Zion Williamson

In a 4-day period over the weekend, I was asked to do four radio interviews. Normally, I do a number of interviews in various media each week, but these were more urgent requests. Three of the biggest stars in their sports – the NFL, college football, and the NBA – suffered serious injuries. For my latest newspaper column, I look at the injuries of Patrick Mahomes, Tua Tagovailoa, and Zion Williamson and examine when they could be back playing, as well as what the long-term effects of those injuries could be.

Three star athletes suffer serious injuries in five days

Within a five-day span, arguably the biggest stars of three different sports went down with injury. What can fans expect in the coming weeks – and years – from the injuries of Patrick Mahomes, Tua Tagovailoa, and Zion Williamson?

Kansas City Chiefs quarterback Patrick Mahomes suffers a dislocated kneecap

On Thursday night, Kansas City Chiefs quarterback Patrick Mahomes suffered a patellar dislocation (dislocated kneecap) on a quarterback sneak.

Chiefs athletic trainer Rick Burkholder told the media Monday that Dr. Paul Schroeppel popped the quarterback’s kneecap back in place. Initial x-rays were negative. Mahomes underwent an MRI Friday that “turned out as good as we could possibly imagine.” According to NFL Network’s Ian Rapoport, the MRI showed no additional damage other than evidence of the dislocation.

Rapoport suggested the Chiefs expect Mahomes to miss at least three weeks. Head coach Andy Reid confirmed to reporters that it would be a “stretch” for the 2018 MVP to play next week.

Return-to-play after a patellar dislocation

Generally, first-time patellar dislocations don’t require surgery unless there is additional damage, such as a piece of cartilage or bone breaking off into the knee. A return-to-play timeline of 3 to 6 weeks seems appropriate.

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Long-term outcomes for patellar dislocations

Most orthopedic surgeons feel these injuries have good long-term outcomes. Assuming no recurrent dislocations occur, surgery is rarely needed. In one study looking at six knee injuries leading to knee replacements among retired NFL players, patellar dislocations had the lowest risk. A 2017 study, though, found that only about one-quarter of athletes treated without surgery were able to play their sports with no limitations three years after this injury.

Alabama quarterback Tua Tagovailoa suffers a high ankle sprain and undergoes tightrope surgery

Two days after Mahomes went down, Alabama quarterback and Heisman Trophy frontrunner Tua Tagovailoa suffered a syndesmosis injury (high ankle sprain) when he was sacked in the Crimson Tide’s victory over Tennessee. Sunday, head coach Nick Saban confirmed that doctors performed a tightrope surgery that morning to stabilize Tua’s ankle.

Tightrope surgery for high ankle sprains

A tightrope surgery is a procedure in which surgeons pass high-strength suture through small holes drilled between the fibula and tibia (the bones of the lower leg). The suture is fastened to small metal buttons, and the surgeon tightens the suture like a zip tie. The device holds the bones in proper position until the ligaments heal.

Athletes who undergo tightrope surgery usually remain nonweightbearing for a few days to decrease swelling. They can start walking and progress to jogging on an anti-gravity treadmill within a few days. They can run with cutting maneuvers in about two weeks.

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Return to play after tightrope surgery

Tagovailoa’s injury and surgery were to his right ankle, the opposite side from the one he injured in December. Last season, he suffered a high ankle sprain in the SEC Championship Game December 1. He returned to play in the College Football Playoff semifinal December 29.

Whether Tagovailoa will take the field November 9 against second-ranked LSU, 20 days after surgery, remains to be seen. On Monday, Saban said there is “no real timeline for his return.”

New Orleans Pelicans forward Zion Williamson has arthroscopic surgery for a torn meniscus

Finally, the New Orleans Pelicans announced on Monday that Zion Williamson underwent arthroscopic surgery on his right knee to debride a torn lateral meniscus. They expect Williamson to return in 6 to 8 weeks.

Debridement of a meniscus tear means the top pick in this year’s NBA Draft underwent a partial meniscectomy. Essentially, doctors trimmed out the torn part of the C-shaped cartilage in his knee. Recovery from that surgery is fairly simple. Athletes work to decrease swelling and increase range of motion and strength over the first few weeks, and most athletes return to play in the Pelicans’ timeframe.

Long-term outlook for athletes after a partial lateral meniscectomy

The bigger concern with Zion is the long-term outlook. The meniscus is important for stability, loadbearing, and most importantly, shock absorption in the knee. Meniscus injuries are the most common knee injuries seen by orthopedic surgeons, and partial meniscectomies are the most common surgeries performed on elite athletes. We know they can lead to degenerative changes down the road.

A study of NFL players found athletes who had meniscectomy surgery were 1.6 times more likely to have shorter careers. Another study found 80 percent of patients who underwent a partial lateral meniscectomy had degenerative changes 12.3 years later. A third study showed that half of patients with meniscus tears had evidence of osteoarthritis 10 to 20 years later.

While most of our long-term outcome data on meniscectomy in athletes is from football players, it’s worth pointing out that the Pelicans list Zion at 6-foot-7, 285 pounds, essentially as big as most NFL athletes. While his surgery might not be a big deal now, it’s worth wondering how his knee will look in 10 to 12 years, when Williamson will enter his 30s.

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Long-term effects of these injuries?

For each of these three top athletes, none of their injuries is a huge concern now. What effect they will have on Patrick Mahomes, Tua Tagovailoa, and Zion Williamson in the future remains to be seen.

Note: A modified version of this article appears as my sports medicine column in the October 24, 2019 issue of The Post and Courier.

References:
Zion Williamson undergoes knee surgery, out 6-8 weeks. By Andrew Lopez. ESPN.com. October 21, 2019.

Zion Williamson undergoes knee surgery, out 6-8 weeks. By Andrew Lopez. ESPN.com. October 21, 2019.

Andy Reid: ‘Stretch’ for Patrick Mahomes to play this week. By Adam Teicher. ESPN.com. October 21, 2019.

Nick Saban: There’s ‘no real timeline’ for Tua Tagovailoa’s return from ankle injury. By Alex Scarborough. ESPN.com. October 21, 2019.

Rick Burkholder says Chiefs QB Patrick Mahomes MRI results came back ‘as good as we could possibly imagine’. By Charles Goldman. Cheifs Wire. USA Today. October 21, 2019.

Alabama’s Tua Tagovailoa has surgery to repair high ankle sprain. By Cindy Boren. Washington Post. October 20, 2019.

MRI confirms Patrick Mahomes out at least 3 weeks. By Kevin Patra. NFL.com. Oct. 18, 2019.

Zion Williamson, others may have different heights after new mandate. By Cody Taylor. Rookie Wire. USA Today. September 26, 2019.

Prevalence of and Risk Factors for Total Hip and Knee Replacement in Retired National Football League Athletes. Madeleine A.M. Davies, DPhil, Zachary Y. Kerr, PhD, MPH, J.D. DeFreese, PhD, Nigel K. Arden, MBBS, FRCP, MSc, MD, Stephen W. Marshall, PhD, Kevin M. Guskiewicz, PhD, ATC, Darin A. Padua, PhD, ATC, Brian Pietrosimone, PhD, ATC. American Journal of Sports Medicine. September 9, 2019

Tua Tagovailoa ankle injury puts tightrope surgery in spotlight. By Ross Dellenger. SI.com. January 06, 2019.

Primary patellar dislocations without surgical stabilization or recurrence: how well are these patients really doing? Robert A. Magnussen, Megan Verlage, Elizabeth Stock, Lauren Zurek, David C. Flanigan, Marc Tompkins, Julie Agel, Elizabeth A. Arendt. Knee Surgery, Sports Traumatology, Arthroscopy. August 2017.

Effect of Anterior Cruciate Ligament Reconstruction and Meniscectomy on Length of Career in National Football League Athletes: A Case Control Study. Robert H. Brophy, MD, Corey S. Gill, MD, Stephen Lyman, PhD, Ronnie P. Barnes, MA, ATC, Scott A. Rodeo, MD, Russell F. Warren, MD. American Journal of Sports Medicine. October 28, 2009.