01-16-2024, 05:36 PM
Reddit, so take it how you will, seems to be competent.
Orthopedic hand surgeon here. The positives:
1. Dr. Graham is amazing. Operated with him when he was at Curtis National Hand Center and dude is seriously skilled. JB no doubt had one of the most technically gifted surgeons in the country perform his procedure.
2. Given how this injury occurred, it would an acute injury (rather than something chronic occurring slowly over time). Acute SL ligament injuries may allow for a repair rather than a reconstruction. While there are not great studies evaluating outcomes, the existing evidence tells us that he has the highest likelihood of returning to previous level of play with a repair.
Bad news:
1. Even in the most gifted hands, the results of SL ligament repair can be mixed and even worse if the ligament was unsalvageable (for instance if the ligament tore midsubstance rather than off the bone). There are dozens of ways to perform a reconstruction (substitution/replacement) because none of them are very good. Even with a “successful” reconstruction most patients fail to ever regain full range of motion, strength, or endurance. The challenge lies in finding an adequate replacement for a ligament that is not only flexible, but also incredibly stout. So far there just isn’t a great substitute.
2. Time frame for recovery is likely this - he probably has pins holding the bones rigidly in place to allow the bones to heal for 6-8 weeks. After that, pins will be pulled, and he’ll go into a removable splint to begin gentle range of motion followed by strengthening - this is another 6-8 weeks. Around the 3-4 month mark is when he’ll likely feel confident enough in the wrist and will be hopefully cleared by Dr. Graham for more aggressive strengthening with something like throwing (something very dynamic and repetitive) on hold until his strength begins to normalize. It will be unlikely that we know how he feels throwing until about 6 months. So…. we really won’t be able to understand the impact of this injury on our franchise quarterback until Summer 2024 at best.
3. If god forbid things go wrong, there are NO good salvage procedures for this. They all involve disrupting the natural movement of the wrist which is a requirement for throwing a football.
My read on the situation is that he most likely had a ligament repair, and I would guess that they reinforced the repair w fiber tape (essentially rope) then pinned everything in place. After the pins are pulled IF everything is going to plan, we should hope to see him in a removable brace by mid-January, early February. We’ll want to hear news around March that his strength and conditioning is going well. They will be X-raying him every 4-6 weeks and if we hear absolutely anything about needing another procedure we’re absolutely ******.
ADDENDUM: Seeing a lot of downcast comments here
I think the best way to look at this is that the likelihood of a full, uneventful recovery is still higher than a shitty one. As orthopedic surgeons, most of the surgeries we like to do have success rates in the range >90% so when dealing with a procedure that has a 75-80% “success” rate we tend to paint gloomy pictures. Still, when predicting a patient’s likelihood of success we got some great stuff in our corner:
1. Kid is young. Tissues when you’re a healthy, 20-something just handle better. The difference between places stitches in a robust young dude vs. anyone 50+ is so noticeable that even most junior residents can sense it. Also, shit just heals way better. When you look at outcomes in active military populations, which is probably the closest to what we’re dealing with here, they’re considerably better than in gen pop.
2. JB is BIG. Wrist bones are relatively small structures, and sometimes doing an SL related procedure on small bones and ligaments in small patients with friable, frail ligaments the smallness just complicates the procedure. That is NOT Joey B. Dude is a 6’4” BEAST which means huge bones, huge ligaments which translates into monster, satisfying suture stitches which can help hold the repair more reliably. I’m guessing Dr. Graham was deeply satisfied with how the repair went.
3. Major X factor in our favor is JB’s grit and toughness. There are some patients that will do well almost no matter what. I’ve had patients where I’m so down because their X-rays or a particular aspect exam post op just don’t look good - everything seems to be falling apart - and yet because of who they are and their ability to cope they’re doing ***** awesome, blasting away, nothing stopping them. From observing his recovery from the ACL and the calf strain we KNOW he’s a badass MFer. I’ll never forget the story of him doing the tire war at OSU (https://buckeyeswire.usatoday.com/2018/03/28/must-watch-joe-burrow-goes-all-out-to-win-tire-tug-of-war/ ). When so much of recovery is a patient’s ability to understand that they may be feeling pain, but that it’s not necessarily harmful grit is huge. We saw him go through the ACL reconstruction and the mental hurdle of accepting that a certain body part may not ever be the same, but it’s good enough. Joey B has grit in buckets.
If you forced me to put money on the situation, I’d bet big that he’s back firing dimes next Summer.
Dr Jesse Morse adding his two cents:
One of my initial concerns after he injured his wrist was either a scapholunate ligament tear or a TFCC ligament tear.
• It was confirmed that the tore the scapholunate ligament, and Dr. Thomas Graham (Allentown, PA) performed the surgery to repair it (per @KelseyLConway)
• This injury occurs in approximately 10-30% of intra-articular distal radius fractures or carpal fractures.
• The ligament has 3 components that span between the scaphoid and lunate bones (dorsal, proximal and volar components)
What does the data show?
“The mid-term outcome after open subacute SL repair overall shows that > 70% of the patients will have a significant improvement in pain, grip strength will reach approximately 85% of the normal wrist and movement will become almost 80% of that of the normal side.”
With that being said, I’m not overly concerned about this injury as it pertains to Joe Burrow.
He should return for 2024 with no restrictions and back to 100% pre-injury.
Just some info I hadn't seen before and thought was interesting and wanted to share.
Orthopedic hand surgeon here. The positives:
1. Dr. Graham is amazing. Operated with him when he was at Curtis National Hand Center and dude is seriously skilled. JB no doubt had one of the most technically gifted surgeons in the country perform his procedure.
2. Given how this injury occurred, it would an acute injury (rather than something chronic occurring slowly over time). Acute SL ligament injuries may allow for a repair rather than a reconstruction. While there are not great studies evaluating outcomes, the existing evidence tells us that he has the highest likelihood of returning to previous level of play with a repair.
Bad news:
1. Even in the most gifted hands, the results of SL ligament repair can be mixed and even worse if the ligament was unsalvageable (for instance if the ligament tore midsubstance rather than off the bone). There are dozens of ways to perform a reconstruction (substitution/replacement) because none of them are very good. Even with a “successful” reconstruction most patients fail to ever regain full range of motion, strength, or endurance. The challenge lies in finding an adequate replacement for a ligament that is not only flexible, but also incredibly stout. So far there just isn’t a great substitute.
2. Time frame for recovery is likely this - he probably has pins holding the bones rigidly in place to allow the bones to heal for 6-8 weeks. After that, pins will be pulled, and he’ll go into a removable splint to begin gentle range of motion followed by strengthening - this is another 6-8 weeks. Around the 3-4 month mark is when he’ll likely feel confident enough in the wrist and will be hopefully cleared by Dr. Graham for more aggressive strengthening with something like throwing (something very dynamic and repetitive) on hold until his strength begins to normalize. It will be unlikely that we know how he feels throwing until about 6 months. So…. we really won’t be able to understand the impact of this injury on our franchise quarterback until Summer 2024 at best.
3. If god forbid things go wrong, there are NO good salvage procedures for this. They all involve disrupting the natural movement of the wrist which is a requirement for throwing a football.
My read on the situation is that he most likely had a ligament repair, and I would guess that they reinforced the repair w fiber tape (essentially rope) then pinned everything in place. After the pins are pulled IF everything is going to plan, we should hope to see him in a removable brace by mid-January, early February. We’ll want to hear news around March that his strength and conditioning is going well. They will be X-raying him every 4-6 weeks and if we hear absolutely anything about needing another procedure we’re absolutely ******.
ADDENDUM: Seeing a lot of downcast comments here
I think the best way to look at this is that the likelihood of a full, uneventful recovery is still higher than a shitty one. As orthopedic surgeons, most of the surgeries we like to do have success rates in the range >90% so when dealing with a procedure that has a 75-80% “success” rate we tend to paint gloomy pictures. Still, when predicting a patient’s likelihood of success we got some great stuff in our corner:
1. Kid is young. Tissues when you’re a healthy, 20-something just handle better. The difference between places stitches in a robust young dude vs. anyone 50+ is so noticeable that even most junior residents can sense it. Also, shit just heals way better. When you look at outcomes in active military populations, which is probably the closest to what we’re dealing with here, they’re considerably better than in gen pop.
2. JB is BIG. Wrist bones are relatively small structures, and sometimes doing an SL related procedure on small bones and ligaments in small patients with friable, frail ligaments the smallness just complicates the procedure. That is NOT Joey B. Dude is a 6’4” BEAST which means huge bones, huge ligaments which translates into monster, satisfying suture stitches which can help hold the repair more reliably. I’m guessing Dr. Graham was deeply satisfied with how the repair went.
3. Major X factor in our favor is JB’s grit and toughness. There are some patients that will do well almost no matter what. I’ve had patients where I’m so down because their X-rays or a particular aspect exam post op just don’t look good - everything seems to be falling apart - and yet because of who they are and their ability to cope they’re doing ***** awesome, blasting away, nothing stopping them. From observing his recovery from the ACL and the calf strain we KNOW he’s a badass MFer. I’ll never forget the story of him doing the tire war at OSU (https://buckeyeswire.usatoday.com/2018/03/28/must-watch-joe-burrow-goes-all-out-to-win-tire-tug-of-war/ ). When so much of recovery is a patient’s ability to understand that they may be feeling pain, but that it’s not necessarily harmful grit is huge. We saw him go through the ACL reconstruction and the mental hurdle of accepting that a certain body part may not ever be the same, but it’s good enough. Joey B has grit in buckets.
If you forced me to put money on the situation, I’d bet big that he’s back firing dimes next Summer.
Dr Jesse Morse adding his two cents:
One of my initial concerns after he injured his wrist was either a scapholunate ligament tear or a TFCC ligament tear.
• It was confirmed that the tore the scapholunate ligament, and Dr. Thomas Graham (Allentown, PA) performed the surgery to repair it (per @KelseyLConway)
• This injury occurs in approximately 10-30% of intra-articular distal radius fractures or carpal fractures.
• The ligament has 3 components that span between the scaphoid and lunate bones (dorsal, proximal and volar components)
What does the data show?
“The mid-term outcome after open subacute SL repair overall shows that > 70% of the patients will have a significant improvement in pain, grip strength will reach approximately 85% of the normal wrist and movement will become almost 80% of that of the normal side.”
With that being said, I’m not overly concerned about this injury as it pertains to Joe Burrow.
He should return for 2024 with no restrictions and back to 100% pre-injury.
Just some info I hadn't seen before and thought was interesting and wanted to share.
