Joe Burrow thoughts from a hand surgeon

[casear2727]

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.

[WeezyBengal]

I'm actually a bit concerned with the injury, more so than the knee.

Hoping for the best but bracing for the worst.

[*TheLeonardLeap*]

[QueenCity]

Would definitely be heart breaking if this surgery doesn't pan out... Not sure how the Bengals recover but they will.

Hopefully all this worry is just worry and he's back better than ever.

[Nepa]

Thank you, Caesar. That was very informative.

From this the hope is that it's a repair and not a reconstruction, and the first bullet point uses the word repair (via @KelseyLConway), so I hope that is correct. It would be nice if the team could let us know if it was a repair versus a reconstruction. A reconstruction looks really dicey and uncertain. The team doesn't owe fans anything in this regard, and they may have their reasons to keep us in the dark, but it will be a long off-season of concern without more official information.

[KillerGoose]

It is my understanding that hand and wrist surgeries are incredibly intricate and difficult. Anecdote here, but I have had two surgeries in my life. I fully ruptured my Achilles tendon back in June of 2023 and broke my finger in half with a spiral fracture on my left index finger in winter of 2016. The prognosis for my Achilles was pretty straightforward - it will suck and be a long recovery but I will get back to 100% within a year, roughly. In fact, I have already returned to sport back in December, so six months post-op. I was doing PT twice a week as well as 2-3 times per week on my own in the gym, so roughly five times per week. It feels great, but not perfect.

For my finger, however, the surgeon and my PT immediately let me know my finger will never be the same. It's not a major difference but there is some range of motion that I lost which I will never get back. I have some grip issues in that hand in comparison to my other, and there is still scar tissue build up in the knuckle the does not allow me to pop that finger. Also, it was significantly more expensive than my Achilles surgery, almost twice as much.

Now, neither of these injuries really pertain to Joe but I say this just as a point for how delicate these hand/wrist surgeries can be. Not only from my personal experiences, but family members who are doctors/nurses. Aside from neurosurgeons, hand surgeons are at the tippy top of the surgeon world. Hopefully Joe doesn't run into any issues. An 80%-ish success rate is still pretty solid.

[Bengalholic]

Does anyone know of any other NFL or college QB's that have ever had this same injury before...on their throwing hand? I looked around online for awhile and the only one I could find that's even similar was Jim Kelly's kid when he was in college. 

[Essex Johnson]

For sure a concern, just have Browning ready to go beginning of year just in case, we have learned we win with Browning over a non 80% Burrow

[KillerGoose]

(01-16-2024, 06:56 PM)Bengalholic Wrote: Does anyone know of any other NFL or college QB's that have ever had this same injury before...on their throwing hand? I looked around online for awhile and the only one I could find that's even similar was Jim Kelly's kid when he was in college. 

Not QB, no. However, there are other positions and sports where this has happened. Dawson Knox, the TE from Buffalo, tore this same ligament I think. Here is a fascinating article going over some of the information and possibilities. 

[*Nate (formerly eliminate08)*]

Interesting, sure hope everything goes well and Burrow is back 100% by the regular season. But if he isn't 100% I am very happy
we found a backup QB in Jake Browning who can win games.

[casear2727]

(01-16-2024, 06:56 PM)Bengalholic Wrote: Does anyone know of any other NFL or college QB's that have ever had this same injury before...on their throwing hand? I looked around online for awhile and the only one I could find that's even similar was Jim Kelly's kid when he was in college. 

Bradley Beal had an intricate wrist ligament surgery and he bounced back.  Wrong sport but he is the only other high profile player I know of.

[*michaelsean*]

Sounds good to me.

[sandwedge]

I would put my money on Joe!

[WeezyBengal]

(01-16-2024, 08:36 PM)casear2727 Wrote: Bradley Beal had an intricate wrist ligament surgery and he bounced back.  Wrong sport but he is the only other high profile player I know of.

Bradley Beal and Jaylen Brown both had it. NBA players. 

[guyofthetiger]

I personally am prepared for Joe to have his career cut short. I hope it doesn't happen, but better to be prepared. His injury has some risk and I feel there is a possibility that he might not fully recover. I would love to see 100 percent results though.

[CottonHill]

Thank God this isn’t baseball. Wrist injuries can sap power. I broke my scaphoid bone in high school and had to have a bone graft and screw put in. It completely changed the type of hitter I was and 20 years later I have about 60% range of motion.
That said, he is getting best of best treatment and rehab and should be just fine.

[2MinutesHate]

Hypothetically speaking, what if he didn't come back from injury?  I would think his salary would still be counted against the cap until it was manageable to cut him?  OverTheCap lists a potential out as being 2028 with a dead cap of $15 million.  

If he wasn't able to play, how would the team afford another QB?  Just find the cheapest option out there and take it on the chin for a few seasons?  I wonder if the state of Joe's wrist will be a factor in signing Tee?  I mean, Jake could bridge the gap for another year, but he's going to get more money in 2025 naturally.

Just makes me wonder though, not trying to be a debbie downer.  It's hard to believe Joe isn't playing for a title this year.  It's really hard to stomach.

[reuben.ahmed]

I remember reading from hand surgeons with knowledge of that injury and they mentioned "at the minimum, chronic pain". From someone who deals with chronic pain, life sucks lol. If that was the minimum, I'd take it because I think Burrow could handle that and still be successful.

[TecmoBengals]

This is an interesting read and as I have no qualifications in the field, I have no strong opinions. I hope Burrow heals up. He always comes off as a good dude in interviews and I think he deserves career success and a Super Bowl win. I hope he can accomplish it.

This medical information does make me nervous as a fan. I want to flash forward to training camps so we know how he performs once on the field.

[WeezyBengal]

It just sucks it happened to his throwing hand.

My worry isn't him not being able to initially come back - it's that he reinjures it now that it's compromised.

If he reinjures it, then he (and us) are basically ******. You aren't coming back from that same injury twice.

The impact IS going to happen again. He IS going to get knocked down and he's going to use that same exact hand to brace his fall. Chances of it holding up for 10 more years of these types of hits? I mean...