Carson Wentz: What’s The Hold Up & What To Expect

There have been a lot of questions (don’t ask Doug Pederson) surrounding Carson Wentz, his surgically repaired left knee, and timeline for return.  Currently, he still hasn’t been “cleared for contact”, won’t play in week 1 against the Falcons, and his timeline for return remains a mystery (“at least two more weeks” according to NFL Network).

In this piece, I’ll do my dardnest to clarify his status (from both his physical/mental and team risk/reward perspectives), what we can expect from him in the short and long-term, and lastly go through any long-term ramifications from his injury.

Before all that, lets start with a really quick review of his injuries and surgery:

I.  Carson Wentz Left ACL, LCL, Meniscus & IT Band Injuries

Carson Wentz injured his left knee during a week 14 ( on December 11th, 2017) win against the Rams. Here’s the play on which it happened:

Initially, the injury was thought just to be an ACL tear but during surgery, there was also evidence of a torn LCL, meniscus damage (not uncommon with ACL tears), and a slight tear of the illiotibial (IT) band (not uncommon with LCL tears since it inserts into the knee very close to the LCL).

Here’s a picture of the knee complex with these two ligaments and the meniscus:

Carson Wentz
Credit – 3CB Performance

The ACL (anterior collateral ligament) is a major stabilizer in your knee during any forwards, backwards, or rotational movement and the LCL (lateral collateral ligament) is a major stabilizer when the knee joint moves outwards aka a “varus movement”.

Carson wentz

Think of these ligaments like rubber bands that connect your thigh bone (femur) to your shin bone (tibia) and keeps the knee joint from moving outside its intended normal range of motion.

The meniscus is a dual-crescent shaped pad of cartilage (this is a tissue that serves to reduce friction and dampen force) that sits between the two knee bones (the femur and tibia).  It acts as a cushion that aids in gliding and absorbing force between the two bones.

carson wentz
Credit – OrthoInfo

The illiotobial (IT) band is a thick band of fascia (tissue) that originates at your pelvis and runs down the outside of the leg and connects to the outer (lateral) aspect of the knee.  It helps stabilize the hip and knee.

carson wentz

Carson Wentz went into surgery to repair the injuries…

The Surgery

During the surgery, the ACL and LCL ruptures were repaired (often termed a “reconstruction”) and the meniscus damage was “cleaned up”.

Here’s what an ACL reconstruction looks like (work-safe):

The meniscus “clean-up” procedure can either be stitching the damaged meniscus back together (termed a “meniscal repair) or removal of the damaged part (a “meniscectomy”).  The former is preferred because it keeps the structure intact but the surgery type depends on the location, type of tear, and quality of the tissue (for example, if the meniscus is already worn down in that spot).

carson wentz
Credit – Orthoinfo

So that’s the injury and surgery, but where does he stand with his rehab and when will he get back to the field?

II. Return To Play

On average, NFL players return from an ACL injury in a little over 10 months and the outcomes on ACL repair in elite athletes are quite good.  Recent high level evidence on return to sport after ACL surgery has shown that nearly 83% of elite athletes return to sport following an ACL surgery and most performed comparably to non-injured counterparts.

Carson Wentz is nearly at 9 months post ACL repair and his concurrent LCL tear throws another compounding factor into the mix.

Further, evidence shows that early participation and accelerated ACL protocols do carry some risk of re-injury. Athletes in accelerated rehab programs may have ongoing abnormal motion and relative weakness for up to 22 months following surgery, in addition to an increased risk for knee osteoarthritis (click here and here for more info).

In addition, the Eagles are in a very unique situation here when it comes to risk/reward.  They have a backup QB they trust in Foles (they upped his salary for a reason) aka BDN:

Carson wentz
Credit – Fox

Add in limited roster turnover (arguably a better team this year than last year) plus only one major coaching change (Frank Reich going to Indy to be the HC but even that’s mitigated because Doug Pederson calls the plays) and this gives the Eagles a lot of stability and continuity going into the regular season, to the point where they can be very conservative with Carson Wentz.

Wentz’ surgeon, Dr. James Bradley, summed it up perfectly when he said:

“Common sense should take over the day…it should be a cautious approach.  What’s a few games over 12 to 15 years”.

Completely agreed and I have no doubt the Eagles see it the same way.  There’s nothing about their brain trust that screams hasty or not methodical.

In the meantime, Carson Wentz will continue to go through his on field subjective assessments complemented by off the field return to sport medical testing.

The latter includes a battery of tests that compares side to side differences between the two legs.  Some of these tests include the single leg hop test for distance, triple hop for distance, crossover hop for distance, and 6-meter timed hop.

Here’s a video of the first 3:

And a video of the 6-meter timed hop:

The medical staff is looking for Carson’s surgically repaired left leg to be within 90% of his non-injured right leg (asymmetry has been associated with an increase in injury risk for high speed and cutting sports like football) while showing no indicators of compromised movement during on-field drills or significant residual soreness/pain after activity.

By many accounts, Carson is very close to meeting the parameters but the Eagles coaching and medical staff is taking the right approach and not taking any risks.  My educated guess is that he will be back around week 4.

So once Carson Wentz checks all those boxes, is medically cleared for contact, gets through practice and does return….

III. What to Expect When Carson Wentz Returns

Naturally, there’s going to be a re-acclimation process for Carson Wentz when he does get cleared for contact and actually gets into games.  There’s no replacement for the speed, intensity, and stress of live games.  Additionally, we know that kinesphobia (aka fear of movement or  reinjury) is one of the last things to dissipate for athletes (click here, here, and here for more info).

I expect him to re-acclimate quicker to structured, straighter line movements like dropping back in the pocket, climbing in the pocket, and designed roll-outs.

However, when it comes to unstructured plays that require spontaneous movements and cuts that put a high level of stress on the ACL, I expect those to return more gradually as he gets back to 100% confidence.

Plays like this:

Carson Wentz
Credit – Fox

I anticipate Coach Doug Pederson to initially over-emphasize the running game and quick route combinations that get the ball out of Carson’s hands quickly to help maintain a clean pocket and re-gain his rhythm and confidence.

Like this slant/flat combination (Agholor has to catch this):

Carson Wentz
Credit – Fox

Carson Wentz is on record saying this injury won’t change his style of play outside the pocket and although his ability to improvise and create is such a dangerous weapon, hopefully (regardless of whether he wants to admit it or not) this incident has been the impetus for a more conservative risk/reward calculation in his head (Russell Wilson always comes to mind when I think of a QB who has balanced those two things).

Lastly, there are three key advantages that bolster Carson Wentz in his initial return to action:

1 – Mental Speed

Carson’s incredible ability to anticipate and read the game has been evident from day 1 and it’s why I was raving about him to anyone who would listen.

In his first 4 games as a rookie, he led the league in completion % against the blitz (nearly 84 percent), making plays where he recognized the defensive coverage correctly pre-snap, made a check, and then nailed the throw.

Jason Kelce was raving about him:

“Immediately when he got here, you knew he was very in-tune to not just the line calls, but the protections, hots [hot reads], all that stuff and usually I feel like a lot of the times with young quarterbacks, a lot of that comes second; usually you have the routes and all that stuff first and eventually you get to that understanding.”

 

“The dude has been absolutely lights-out in terms of blitz recognition, checking plays, all that stuff. I don’t think he’s been like a rookie at all in that aspect.”

Additionally, he was using his eyes to decoy targets, move defenders, and create passing lanes. Here’s an example against Sean Lee and the Cowboys:

Carson Wentz
Credit – NFL Network & IgglesBlitz

I don’t expect that processing power to have changed – if anything, he may be even better at it because he had a lot more downtime to study film. This bodes very well for his short-term prospects as he can get the ball out quickly rather than opening himself up to higher risk situations in dirtier pockets.

2 – Resiliency

By all the accounts and stories I’ve heard and read, Carson Wentz has a very resilient and positive mindset.  He takes setbacks as a challenge rather than as a burden.  This lens is certainly critical at every mental and physical stage of rehab but also when you get back on to the field and things don’t go exactly as planned.

3 – Team, family, and fans support

The close-knit organization, family, and outpouring of support for Carson Wentz has been astounding.  Having that structure and ability to lean on others is another key aspect in coming back and getting through injury.

Here’s what Carson himself had to say about all the support he received:

It takes a very strong knit organization to suffer through numerous major injuries season in key position (Carson Wentz, Jason Peters, Darren Sproles, Jordan Hicks, Chris Maragos…if I missed any, my apologies) and still go on win Super Bowl.

In line with what I said above about resiliency, this support is key when dealing with minor setbacks while adjusting to on-field action.

Those are my immediate expectations but now lets switch over to a wider lens…

IV. Long-Term Ramifications

There are definitely some long-term consequences after an ACL rupture.

First and foremost, there’s nearly a 25 percent chance of re-rupturing the same ACL after surgical repair . It’s no coincidence that prior ACL injury is the best predictor for future ACL injury.

Here’s something even more alarming: The risk of rupturing the other side (“contralateral”) ACL after surgical repair is upwards of 20.5 percent!  Bio-mechanics, proprioception, and compensation are a love-hate relationship.

Additionally, research shows a higher degeneration rate of knee cartilage (think of this as cushioning in the knee) and nearly a 3.6x increase in developing osteoarthritis compared to an uninjured knee.

Osteoarthritis risk is even higher when the original ACL rupture also involves damage to the knee cartilage, like Carson Wentz had with his meniscus. Research shows anywhere from an 18% to 48% increase in osteoarthritis risk with this combined injury compared to only an ACL rupture.

If you’re an Eagle fan you might be thinking “oh %$&!”.  However, there’s no need to.

A research study specifically looked at NFL QB’s recovering from a torn ACL and it found that 92 percent returned to play with only one re-injuring the ACL and needing a re-repair.

Additionally, the study found that these QB’s performed just as well after the ACL injury as they did before AND there was no difference between these QB’s who tore their ACL and their injury free counterparts.

In other words, it’s highly likely that Carson Wentz gets back to the MVP path we saw last season…back on that road to victory.

carson wentz
Credit – FoxNews

Thanks for reading and until next time.

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Disclaimer: This is not medical advice and shouldn’t be taken as such. If you’re having medical issues, reach out to a medical professional.

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