Bears quarterback Mitchell Trubisky returned to the lineup on Sunday with a brace on his non-throwing shoulder, just three weeks after dislocating the joint.
But would the same timing be right for a high school athlete?
Similarly, what about Notre Dame tight end Cole Kmet returning against Georgia just six weeks after surgery to repair a broken clavicle (collar bone)?
I was also wondering about Chiefs quarterback Patrick Mahomes not missing any time after a high left ankle sprain in week one that had clearly hampered him since. That was until Mahomes dislocated his right patella (kneecap) on Thursday, which will cause him to miss only three games. Really?
And speaking of high ankle sprains, Alabama quarterback Tua Tagovailoa now has a matching pair after Saturday’s injury. The more recent, to his right side, prompted another surgical “tight rope” procedure, that could allow him to return after missing one game and a convenient bye week.
Seems awfully quick to be back after going under the knife, doesn’t it?
Not as quickly, though, as Elena Delle Donne returned despite having three herniated discs in her lower back during the WNBA Finals earlier this month. Having exited Game 2 after only three minutes, Delle Donne returned for Game 3. She led her Washington Mystics to the championship, despite pain so severe that she was unable to sit on the bench when not in the game. Instead, she stood or rode a stationary bike behind the bench.
Was playing with multiple herniations too risky for an adult who is paid extremely well and who has chosen to do so? Probably not.
Orthopedic surgeon Dr. Michael Knesek of Bone and Joint Specialists and Community Care Network did not see a problem as long as the only issue for Delle Donne was low back pain and no neurologic signs, such as weakness in either leg.
For teenagers, however, Munster orthopedic surgeon Dr. Greg McComis had different advice. He said a disc injury at that age, and managed properly, will heal over the course of a year. If not allowed to heal, McComis warned of severe degenerative disc disease by age 25.
As for a high ankle sprain, the “tight rope”procedure was covered in this space eight months ago, in the wake of Tagovailoa’s first surgery, when he returned four weeks later. This time, the Crimson Tide are hoping he will be ready in three weeks for LSU.
That may be a risk worth taking for an Alabama quarterback. For a teenager after the same surgery, Community Care Network podiatrist Dr. Robert Clemency recommends 6-12 weeks of post-operative non-weight-bearing to allow for ligamentous healing.
For a high sprain not surgically repaired, as apparently was the case with Mahomes, McComis said high schoolers should not play for six weeks.
Mahomes has bigger worries now. The MRI following his patellar dislocation reportedly showed a “best-case scenario.” Nonetheless, the ligament that helps hold the kneecap in place had to tear for the bone to dislocate. Prolonged immobilization is necessary for that ligament to heal without surgery. Three games — as is projected for Mahomes — is insufficient.
“Money doesn’t dictate care,” Knesek said, “but it may accelerate it.”
To avoid the surgery in youngsters, Knesek recommends 10-14 weeks of immobilization.
Instead, the goal for Mahomes will be to restore full range of motion and strength, try playing with a brace, and win the Super Bowl.
“If he re-injures it, he probably needs surgery and that ends his season,” said orthopedic surgeon Dr. Brad Bookatz of Community Care Network. “But if he has surgery now, that ends his season, too. The demands and risks/rewards for a professional athlete are much different.”
Bookatz also has expertise with collarbone fractures, having co-written the chapter of a medical text on the injury. His chapter dealt with breaks that are sports-related. In it, he cited research that found surgical fixation of broken collarbones results in faster return to play (6-10 weeks), lower re-injury rate, and fewer complications than non-operative treatment. Still, he warned that, even with surgery, the bone does not fully heal for months.
As for Trubisky, his left shoulder held up on Sunday even if his performance did not. Bookatz, Knesek and McComis were not surprised by the timing of his return.
Yet for a high school athlete, McComis recommends surgical repair before a return to play and he suspects it is likely for Trubisky postseason. “If you look at the military literature,” he said, “guys his age have a 100 percent re-dislocation rate (without surgery) going forward.”
John Doherty is a licensed athletic trainer and physical therapist. This column reflects solely his opinion. Reach him at email@example.com. Follow him on Twitter @JDohertyATCPT.