In last weekend’s game against, Cowboys wide receiver Dez Bryant reeled in a pass and was breaking tackles toward the sideline when he sustained this injury to his right knee.
In this clip, Bryant is brought down by Bears ILB Christian Jones. As Jones slides to tackle him, the wide receiver’s right lower leg is struck by Jones and his knee bends in a valgus (bends inward) direction. A pure valgus stress on the knee most commonly leads to a sprain of the medial collateral ligament (MCL) of the knee. (for more on the anatomy of this please see my previous post More Week 3 Injuries) Bryant returned to the game 6 plays later with his right knee taped. This is a common treatment for acute MCL sprains. Mild sprains are mostly a pain tolerance issue, so bracing and possibly a shot of Toradol (strong anti-inflammatory) can help players return quickly. Bryant was pretty quiet the rest of the game, mostly just running decoy routes, until he caught a 20-yard pass for a touchdown in the 4th quarter.
Bryant seemed optimistic about his knee in a postgame conference. Everyone thought no news was good news on Monday and Tuesday when no MRI results were reported. Unfortunately, reports surfaced that Bryant had not shown up for treatment and MRI on Monday and the imaging study was finally performed on Wednesday morning. The MRI reportedly revealed a “hairline fracture” in his knee and estimates on return to play range from this Sunday to 6 weeks. Fans and media alike have questions – how was he able to continue to play on a fractured knee and how can an injury that the wide receiver played on for 3 quarters of a game possibly keep him out for 6 weeks?
(figure courtesy of humankinetics.com)
In the drawing above, the red arrow represents the linebacker striking the lateral (outside) aspect of Bryant’s knee. When this occurs, the knee is forced into a valgus position and the MCL (circled) is stretched. Simultaneously, the femur (thigh bone) and tibia (shin bone) strike together on the lateral part of the knee. This results in bruising of one or both bones in the lateral part of the knee. When the impact is significant, the bone can crack. In Bryant’s case, this crack was not visible on x-rays. However, his MRI revealed a “hairline” fracture in his knee, most likely in what we call the lateral tibial plateau, the lateral part of shin bone. This area is seen in white on the MRI image below. The white is bruising in the bone, and the darker line on this image may represent a fracture.
(MRI image from mypacs.net)
This finding was likely not suspected by team doctors, trainers, or Dez himself, most likely because all of his pain at the time was in his medial (inner) knee at the MCL. He was taped up and possibly given a shot of Toradol (a strong anti-inflammatory) and returned to the game. It is amazing what adrenaline and desire to win can do. Bryant really did not appear to be in much pain the rest of the game. Some are questioning whether or not the wide receiver was given narcotic pain medication. I think that is highly unlikely. Narcotic pain medications can slow reaction time and cause drowsiness and would likely have a negative impact on his performance ability. Reports are surfacing today that Bryant skipped his medical treatment on Monday because he was nervous an MRI would find a more serious injury. I would not be surprised if he awoke in much more pain on Monday.
Nondisplaced tibial plateau fractures heal very well in 4-6 weeks, so I suspect that he will be off the field for a minimum of 4 weeks. The main concern with rushing him back is that stress on fracture can cause the bone involved to collapse as in the images above. The white arrows point to the fracture line and you can see a wave-like appearance to the depressed bone above. When the fracture depressed the joint surface becomes uneven, which leads to major chronic knee issues in the future – not an injury a wide receiver wants to have.
This is why, even though Dez Bryant might feel well enough to play on Sunday, we likely won’t see him back on the field for a minimum of 4 weeks.
NOTE: Since I blogged about Dez Bryant’s knee injury, more information has become available. It has been reported that he will likely return to play before 4 weeks. This may be possible if Dez does not have a true “hairline” fracture in his knee. Often in MRI reports, radiologists refer to bruising in the knee as a “fracture.” While a bone bruise is technically microfracture of bone it is not the type of fracture that I was referring to in the above post. An NFL player can return to play on a bone bruise more quickly than 4-6 wks, so it is possible that, if Dez Bryant does not have a fracture, he may return to play sooner.
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