Dr. Flynn's Mailbag: On Hightower, Amendola, Pedroia and Hayward's timeline

Question on Hightower -- reports are that teams knew he had a partially torn pec in March. I would assume that the Patriots knew that also. Would it have been advisable to fix the issue in March, or if he had undergone surgery then would he have missed the season anyway? 
(Troy Anderson)



There are reports from sources around the league that the Jets and other teams shied away from Hightower because, in part, of a partial tear in his pec. I agree with you that, if other teams were aware of the injury, the Patriots likely were as well. Your question has both a medical and non-medical answer, and purely looking at Hightower’s injury, there's a lot of information that we don’t know. One important piece is where Hightower’s injury is. Is it in the pectoralis tendon, at the musculotendinous junction (where the muscle turns into the rope-like tendon that attaches to the upper arm). Or is in the muscle itself? These injuries most commonly are in the tendon, and repair of those injuries are straight-forward. If Hightower was known to have a tear involving more than half of the pec tendon, then yes, his risk of completing the tear during the season was high and surgery was an option. However, if the tear was in the muscle, those tears are less straight-forward to repair and surgery may not have been advised. We just don’t know enough details.

The other important point to remember is that injuries don’t happen in a vacuum. Although they look superhuman, these are real people with real lives, real families, and real bills to pay for many years to come. Hightower was in free agency last spring. It’s not a great look to show up for contract negotiations and team physicals in a sling. Realistically, the timing likely played some role in Hightower’s decision-making.

Guys, what is the longer term stuff to this (Hightower injury)? Could this be Mayo-like? Could he retire early? Does this happen again, etc.?

In my opinion, this pec injury will not be the cause of early retirement for Hightower. However, I do understand the concern. He has a history of issues in both shoulders, with the history of labrum surgery on the right, and has worn harnesses on both in the past. Hightower also was reported to have a meniscus tear in his knee last year. No reports of off-season surgery, which raises the question: Is there a more degenerative issue in that knee which made arthroscopic surgery a less appealing option? He re-tweaked that knee when he injured his MCL early this season and wore a brace for a game or two, but was back out of the brace last Sunday. So, your question about early retirement isn’t an easy one to answer. When the Patriots decided to re-sign Hightower, they must have been well aware he would not be available for every game. I don’t anticipate that will change. Right now Hightower is in the prime of his career -- I’ve been so impressed with how much he’s embraced the leadership role and his presence and authority on the field. I’m hoping this is just a bump in the road for a very physical athlete who is, sadly, pretty banged up at this stage of his career.

Amendola hyperextended his knee (again) but is practicing 2 days later - something to keep an eye on? (Josh Pilling, @joshpilling)

I have seen reports that Danny Amendola hyperextended his knee during a punt return Sunday. I was unable, however, to see the play itself because it was blanketed in a dense fog. (Have you seen the ad for fog machines in Foxborough on Craigslist? Hilarious). A mild hyperextension injury to the knee can result in bone bruising, which is a painful injury, but often, nothing more significant. Gronk had a hyperextension injury that scared the heck out of fans and the larger-than-life tight end himself, but he was back on the field quickly. It is definitely a good sign Amendola was back at practice Thursday, even on a limited basis. That indicates there isn’t concern for ligament injury or more significant bone bruising that could ultimately lead to fracture. Something to keep in mind? Amendola had surgery on one of his knees before last season. If this is the same knee, then it’s possible that an old injury could have been re-aggravated by a slight hyperextension. So, the answer to your question is that I’m not super concerned, but it’s something to keep an eye on.

Any insights on Rowe? (Anthony Curtis, @AnthonyCurtis68)

I don’t have many specifics on Rowe. I'm concerned this is a longer-term injury, however. He has been dealing with a groin strain that was re-aggravated. As recently as a week ago, he was seen in the locker room and reports were that he still had a considerable limp. That’s a long way from being about to play. We have sometimes seen longer-term groin injuries turn into “core muscle” surgery, so that’s something to keep in mind. Not a great situation for an ailing defense.

Is Dustin Pedroia’s surgery microfracture surgery? And if so, is that hard to come back from? (Jahmaal, @jahmaalbox)

No, Pedroia’s recent surgery was not a microfracture procedure. He had chondroplasty (microfracture) in his knee prior to last season. I wrote in detail about his injury and microfracture if you want to learn more about it here. Unfortunately, the fact Pedroia has already had and not responded to microfracture means he likely has areas of advanced cartilage thinning in his knee. Osteoarthritis is thinning of the shiny coating of articular cartilage that coats the bone on both sides of a joint. Chondroplasty involves the surgeon making tiny holes in the thinned area of cartilage to promote bleeding on the surface of the joint in hopes of growing a layer of scar-like cartilage. When athletes fail chondroplasty, the next option to consider may involve a “cartilage restoration procedure.” There are a few options, but the basic premise is that the area of missing or significantly diseased cartilage is removed and new patches of cartilage are inserted. These procedures are not meant for everyone -- they're more effective in younger patients with very focal areas of cartilage defects. The inserted cartilage can be grown in a lab from the patient’s own cartilage cells, transplanted from another part of the knee that doesn’t need as much cartilage, or from a cadaver donor. Recovery takes about 7-12 months, depending on how well the graft is healing and how extensive the surgery was. It’s a tough recovery in that it’s a long time for an athlete to stay off of the knee and wait to progress back into activity as the cartilage heals into place.

As far as Hayward goes, let me just say that I think it would be interesting to give us all a sense of the scope and stages of the recovery that Gordon Hayward will go through. I never think it's fair when the media and fans stand vigil on a badly injured player. Missing the whole season and letting everything get fully healed and back to full strength sounds like a much better idea to me than rushing him back on the court at 85 percent. Everyone wants a timetable, but few appreciate how speculative those things are: you have to see how it goes.  (Brian Keegan)

Guys, Brian has sent me some great questions and I haven’t been able to get to all of them due the recent Boston injury bug! I love this question because it reflects the same sentiment I’ve heard from a lot of fans. I think most people were just relieved to see his toes pointing in the correct direction on the stretcher out of the arena and happy to hear that Hayward will play again.

Right now, he is recovering from surgery, in a cast and unable to put any weight on his foot. That will likely last for 4-6 weeks and is meant to let the bones and ligaments heal. Around six weeks, he’ll start some exercises and work on regaining full range of motion and strength in his ankle and leg. This part of his rehab will last for a few months, and will gradually progress into more significant exercises like running, change of direction, and jumping. This is where the “we'll see how it goes” approach comes in.

When Hayward is allowed to progress his activities depends on how his ankle and ankle X-rays look to his doctors. There is some variability on how quickly different athlete’s tissues heal. I do not anticipate that we’ll see him on the basketball court until next season, unless it’s in the practice facility. I agree that it’s probably in the young athlete’s best interest to let himself heal fully and be at 100 percent before he returns to competition.

Dr. Jessica Flynn is a sports medicine physician at Lahey Hospital and Medical Center in Burlington, MA. She writes about injuries in professional sports on her blog, DocFlynn.com. You can follow her on Twitter @jessdeede.

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