Patriots

Dr. Flynn: Julian Edelman is reportedly dealing with a knee issue, what does that mean?

(Getty Images)

According to a report from NFL Network’s Mike Giardi, Julian Edelman is dealing with a tendon issue in his left knee. The wide receiver appeared to be hampered by a left leg injury in Sunday’s loss to the Chiefs. The main tendon in the knee is the patellar tendon, so this is likely either tendonitis in the patellar tendon — which became a bigger problem last Sunday — or an acute partial tear of the tendon.

The patellar tendon is the rope-like structure that connects the patella (kneecap) to the front of the tibia (shin). When the quadriceps muscles in the thigh contract, they pull on the patellar tendon and extend (straighten) the knee. This motion is used to jump, block, and explode into routes. When the tendon is over-stressed, the tissue can degenerate and sometimes tear. Inflammation and degeneration of the tendon is called “patellar tendonitis” or “tendinopathy.” It is also commonly called “jumper’s knee” because of its prevalence in basketball. Kyrie Irving and Al Horford have both reportedly dealt with patellar tendonitis.

Patellar tendon issues can limit an athlete’s ability to perform, but also carry a risk for bigger injury. Inflammation or degeneration of the patellar tendon is very painful. It is limiting for a wide receiver trying to explode off of the line or get separation.

If the tendon is weakened by tendonitis or partial tearing, there is a risk of worsening of the tear or complete rupture of the tendon. Unfortunately, we are unable to predict when or if that will happen, but it is often preceded by symptoms of tendonitis. A fully torn patellar tendon requires surgery, has a prolonged recovery, and a return to the previous level of play in the NFL is very very difficult. On average, a full patellar tendon tear is much more difficult to recover from than an ACL tear.

Edelman has dealt with at least three very painful injuries this season — ribs, shoulder, and now knee. Management of his knee injury will depend on whether this is tendonitis or a partial tear, how effective the team thinks he can be, and how risky it is for him to continue to play on it.

Best-case scenario: Edelman has mild patellar tendonitis. If this can be managed with treatments, Edelman could continue to play with some low-level risk for a tear. He would likely continue to be limited until he can get some rest. Unfortunately, patellar tendonitis is a stubborn injury to heal so a week off isn’t going to cure it. There is no protective brace that can prevent the worsening of the injury, and steroid injections are not an option because they can cause the rupture of the tendon and will halt the healing process. It will have to continue to be managed through the post-season.

Worst-case scenario: It depends what you define as “worst.” Worst for your offense, your fantasy team, or for the wide receiver’s knee? The Patriots could shut Edelman down because he has a partial tear and they are concerned that the tear will worsen or because they feel that he’s so limited by the injury that he’s not able to be effective. On the other hand, Edelman could continue to play and either his symptoms worsen or he develops/worsens a tear, causing him to be shut down. Of course, the true worst-case scenario is that the patellar tendon fully tears. This is the type of real risk that medical staff and athletes weigh when they decide how to manage injuries like patellar and Achilles tendonitis.

This isn’t a “nothing” injury. It will need to be managed for the rest of the season and post-season. It will likely limit his effectiveness and carries a risk of significant worsening. In sports medicine, we consider patellar tendonitis/tearing an overuse injury. Is there a receiver in the league who has been more over-used this season than number 11?

Every NFL athlete is playing through something in December, but Edelman has been more beat up than usual this year. On Wednesday, we heard that Edelman was being kept out of practice for “load management” reasons, but I think now we know that it was more than just that. Unfortunately, the Patriots’ offense may need to finish out the regular season with some “load sharing” to give Brady’s favorite target some time to heal.

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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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