DawgTalkers.net Forums DawgTalk Pure Football Forum Adrian Peterson hurt, again.

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posted: Wednesday, November 14, 2007 | Print Entry
filed under: Fantasy NFL, Adrian Peterson, Larry Johnson, Reggie Bush, Marshawn Lynch, LenDale White, Kevin Jones, DeShaun Foster, Brian Griese, David Carr, Steve McNair, Isaac Bruce, James Thrash


Why waste time with an intro? We all know what (and who) everyone is talking about heading into Week 11.



Running Backs


Adrian Peterson, Vikings: Coach Brad Childress announced on Monday afternoon that Peterson suffered a Grade II+ lateral collateral ligament sprain. And everyone was a bit unsure what to make of it. After all, this is not an ordinary, everyday injury. And Peterson has shown that he is not an ordinary, everyday player. All Day? Certainly. Ordinary? Never. Just ask my friend Merril Hoge, who has been singing his praises since the preseason on the "ESPNEWS Fantasy Insider" show. So what are concerned fantasy owners to make of a not-so-ordinary injury happening to an extraordinary player? Let's break it down.



The LCL is one of the four main stabilizing ligaments of the knee, situated on the outer aspect of the joint, and it runs from the far end of the thigh bone (femur) to the near end of the outer bone of the lower leg (fibula). It is opposite the medial collateral ligament, which occupies the same spot on the inner aspect of the knee joint, running from femur to tibia (larger lower leg bone). The main function of the LCL is to protect the knee from excess bowing outward (also called varus stress), or more simply, it helps control lateral stability. It is injured if a bowing or varus force is applied that exceeds what the ligament can handle, typically as a result of direct contact. Peterson told Minneapolis' Star Tribune that he felt a helmet or a shoulder hit his knee and then felt the pain.



It is far less common to sustain an injury to this ligament than to its counterpart, the MCL. The MCL, injured when the knee is forced inward excessively (valgus stress), has already been a source of pain for several key players this year (Brandon Jacobs, Travis Henry and J.P. Losman). There are a few possible reasons for this. First, it is simply more natural to either sustain a blow to the outer knee or cut toward the inside off a plant leg during sports, the two main mechanisms for MCL injury. It is far less common to sustain a blow to the inner knee, the primary mechanism for pure LCL injury. Second, the MCL sits very flat against the joint, so a minor unnatural stress puts it at risk for injury. The LCL has a little more room to tolerate movement because it does not lie flat against the knee. (Fun with biology: it is not really possible to distinguish the MCL by feel, but if you want to feel your own LCL, cross one ankle over the opposite knee, as if making a figure 4, and you can feel a tight ropy band on the outer knee. It is easier to feel because it is not flat against the joint.)



When the LCL is injured in isolation, as reports say is the case with Peterson, the result is instability in the lateral knee, or a decreased tolerance for bowing (varus) stresses. An even bigger concern would be if additional structures that make up the back outside corner of the knee were damaged simultaneously (not the case with Peterson, supposedly); this could mean significantly increased disability and more potential knee joint problems down the line. In the preseason we talked about grades of ligament injuries with Grade I (mild) representing minor injury or overstretching, Grade II (moderate), the most common, representing incomplete tearing, and Grade III (severe) indicating a complete tear or rupture. A Grade II+ LCL injury translates to extensive, but incomplete, ligament damage. Since a portion of the ligament remains intact, surgery is not necessarily indicated. Rehabilitation involves first letting the bruising and swelling settle while immobilizing the knee to let the ligament scar and prevent further injury. The focus then centers on strengthening the muscles (primarily quadriceps and lateral hip muscles) that can provide stability to the lateral aspect of the knee to help compensate for any laxity (looseness) resulting from the ligament damage.



So, now that you know what the injury is, let's get to the questions you really want answered.


How long will Peterson be out?
This is a tough one to gauge -- which is why Childress did not give a time frame -- because of the infrequent occurrence of this type of injury. You may have heard Childress' comment at his Monday news conference that if this were a lineman, he could be braced and come back and play the next game. But a lineman and an Adrian Peterson are two different species. One of the main challenges Peterson will face that a lineman would not is the need to make sharp directional movements with speed. Stability is critical in order for that to occur. In fact, I asked three orthopedic surgeons, all of whom have worked with professional athletes, what their expectations are for this type of injury with this type of player. Each of them had concern about Peterson returning too soon after such an injury, and each felt that the timetable was hard to judge (note that this was merely medical opinion; none of them examined Peterson). Lateral knee injuries are, in essence, more complex than medial injuries. Given that there has to be enough time to allow ligament healing (which typically takes up to six weeks), followed by strengthening, it is fair to expect Peterson's return to take several weeks. The biggest concern if Peterson returns too soon is that another incident, or even stress on a still unstable knee, could result in more severe damage, which could then translate to chronic problems. On the other hand, he is young and strong and could heal fairly quickly. His progression of activity will be determined on an ongoing basis, depending upon how his knee looks and feels day to day, again making it hard to project a time frame with any certainty. I know, I know. You want to have some idea of how to plan around this situation. For now, assume Peterson is out two weeks at an absolute minimum, with the stronger likelihood being at least four weeks. Don't be surprised if it takes even longer, in which case the Vikings may decide to shut Peterson down for the season.




How will he be affected when he comes back?
Peterson will be left with some decreased lateral stability in his knee; the ligament is forever altered based on the extent of his injury. However, his ability to compensate for it with muscular support (and he may wear a protective brace as an additional measure) could allow him to return looking like the same running back. Part of this answer depends on how well-healed his injury is when he returns.




Is he at more risk for injury?
Probably so, especially on the outer part of that right knee. It doesn't mean that he definitely will reinjure it, simply that it won't be as hard to do a second time. This is true for all incomplete ligament injuries however, so it is not terribly unusual. Again, the bigger concern would be that future stresses to this knee may put other stabilizing structures more at risk.



The bottom line is that if you have Adrian Peterson on your fantasy team, you should secure a backup now that you can plan to utilize indefinitely. There is no way of knowing for sure at this point how long Peterson will be out, or if he'll return at all. This may not be what fantasy owners or Vikings fans want to hear. But we have enjoyed his amazing talent for the first half of this season, and we would like to continue to enjoy it for years to come. Let's root for Peterson to come back healthy, even if it means we all have to wait just a little longer.

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There! That's what you people get for being interested