Two weeks ago Tom Brady took Kam Chancellor‘s helmet to his right leg. He visibly limped to the podium for his postgame press conference. The next week he underwent treatment with his body guru Alex Guerrero and was able to stay off of the injury report and travel to San Francisco. At the time, the Patriots downplayed the injury as a bruise to the thigh. Brady looked good against the 49ers, scrambling to prolong plays, particularly late in the game when the Patriots finally surged ahead to victory. After the game Julian Edelman nicknamed him “Brady-Vick,” a nod to the quarterback’s mobility both in and outside of the pocket.
Brady missed two consecutive practices on Wednesday and Thursday last week because of a knee injury. So, what happened to Brady’s knee between the 4th quarter of the San Francisco game Sunday and Patriots practice on Wednesday? It’s still a bit of a mystery. On Saturday, Adam Schefter reported that Brady had swelling and soreness in his knee but was likely to play against the Jets. On Sunday, we saw Tom limp off of the bus when he arrived at MetLife Stadium. Jeff Howe reported on Brady’s knee, saying that it was, in fact, Brady’s right knee that was injured during the Kam Chancellor hit and that swelling had settled from his thigh into his knee.
From this information I think there are two possibilities. One thought is that Brady has a separate injury in his right knee that he doesn’t want to address. If you believe the information that Jeff Howe has received, that Brady’s knee swelling is a result of the Chancellor hit, then another possibility is that Brady has something called traumatic prepatellar bursitis. If you look at the video of the Kam Chancellor hit you can see that his helmet strikes Brady’s thigh as well as the front of his upper knee.
Such a direct trauma to the knee can cause the layers of tissue beneath the skin but on top of the knee cap to separate. Think about a sheer force on layers of Saran Wrap – it would cause them to spread apart. When this occurs a space forms between the layers and it fills with fluid or blood. It looks swollen and…well…nasty. Swelling in this area does not technically “drain” from the thigh. It collects in the bursa – related to the thigh injury only in that it came from the same hit.
^^ area in grey is blood/fluid in bursa
In the diagram above, you can see a normal knee on the left. On the right, there is a grey shaded area which represents the fluid or blood that has filled the space between the patella (knee cap) and the skin. The photo below shows what prepatellar bursitis can look like. It often appears bruised as well.
The fluid in prepatellar bursitis is NOT in the knee joint. It’s on top of the kneecap, outside of the joint. While it can feel stiff and uncomfortable it is not associated with torn ligaments or cartilage inside of the knee. Therefore, once the swelling improves, the knee is not generally left with a chronic lingering injury. Fluid in the prepatellar bursa can be drained but it has about a 50% chance of coming back. We put the knee in a compression wrap after draining it and ask athletes to rest when possible to minimize re-accumulation of fluid.
We’ll likely never know exactly what happened to Tom Brady’s knee, but it was obvious that it impacted his mobility on Sunday. Did it cause him to sail a few balls or force releases too quickly? Probably. If it is prepatellar bursitis I expect that his knee mobility will continue to improve over the next couple of weeks as the fluid is reabsorbed by the body. On WEEI yesterday, Brady was asked about the condition of his knee. He answered, “It’s better than last Monday, so I’m very happy about that. Hopefully I’ll be feeling a lot better than yesterday come Sunday.”
Come on, New England. You didn’t really think Tom Brady was planning to skip a game to nurse his knee back to 100%, did you?