Patriots

Dr. Flynn: Reading the tea leaves on Julian Edelman’s knee issue; Stephon Gilmore out vs. Buffalo

(Adam Richins for BSJ)

After weeks of being limited in practice and visibly struggling on the field, Patriots wide receiver Julian Edelman missed practice Thursday morning to have a procedure on his ailing left knee.

https://twitter.com/AdamSchefter/status/1321862930565156864?s=20

Edelman has been dealing with this knee issue for a while. At times late last season, he appeared to be in tremendous pain after every play. He fought through his symptoms for months, but eventually had off-season surgery to address a “loose body” in the joint.

A “loose body” is a small piece of bone or cartilage floating in the knee that can end up getting stuck in the wrong spot, causing pain, stiffness, and swelling. Loose bodies are often associated with arthritis and arthritis is common after traumatic injuries to the joint. Here is what Edelman said about his injury history (including the left knee) when he was featured in ESPN’s 2017 Body Issue:

I've broken both of my feet. I broke my forearm -- my radius one time and then my ulna, so I have two scars from that. I had labrum surgery on my right labrum when I was in college. I broke my jaw. I messed up my left knee a little bit back in the day. I tore my PCL. I've had hernia surgeries. I had adductor release surgery early in my career, so I had to get those ripped up, so I had bilateral hernia and groin issues going.

With a history of ligament (PCL) injury and a more recent scope for loose bodies, it is very likely that there is at least some arthritis in Edelman’s ailing left knee. While arthritis itself can be very painful, it can also lead to degenerative tearing of the disc-shaped cartilage called the meniscus. A meniscus tear could be what led to Edelman’s most recent knee procedure.

This is the part where I read the tea leaves, so if you’re not a fan of tea, you should probably stop reading.

I suspect Edelman went into training camp feeling a bit better after his offseason scope, but sometime during camp things, unfortunately, flared up again and they just haven’t been able to get it under control. While he has tried to push through the symptoms, it is possible that something happened this week in practice that ultimately made a mid-season procedure necessary.

One possibility is that he developed a worsening tear in his meniscus that suddenly started to jam or lock the knee, a situation that requires immediate arthroscopy to trim the offending cartilage and “unlock” the joint. A second potential scenario is that knee arthritis flared up so dramatically that the inflammation had to be addressed either with arthroscopy to wash out/clean up the joint or a platelet-rich plasma (PRP) injection to reduce inflammation.

But you want to know when he’ll be back, right? And if or when he does come back, will he look anything like the JE11 we’re used to seeing? Since I don’t know for sure what was done, I can only offer you a best-case/worst-case estimate. In both cases, putting him on three-week IR would make sense — which the Patriots did on Saturday.

Best-case: Edelman had PRP or a knee arthroscopy that calms down his knee symptoms in the next 2-3 weeks and he is able to return. In this case, he may or may not look like his typical self, depending on how much relief he gets. Regardless, he will still need to manage a chronic knee problem he’s seemingly been playing through since at least last December.

Worst-case: The procedure meant to address a degenerative situation does not work. This could mean that he returns after three weeks looking very similar (potentially still gutting out an occasional >100 yard game performance). But the absolute worst-case is that there is no significant improvement and Julian Edelman’s season is over.

That would be a tough pill to swallow. Edelman has always impressed me with what he has been able to do on the field in spite of his injuries. It’s almost like the chip on his shoulder that fuels his drive grows 10 times bigger with each and every physical scar he endures. No injury seemed to propel him more than his preseason ACL tear in 2017. Only 18 months later, Julian Edelman was named Super Bowl MVP. He had a career pinnacle performance when most younger athletes are still grinding to build themselves back up.

Regardless of what medical experts like me write or say, I will leave you with one non-medical piece of advice:

Don’t expect Julian Edelman to roll over and give up mid-season unless he has no choice. The guy is Relentless.

Stephon Gilmore, Kyle Dugger among three downgraded

The Patriots announced Saturday that CB Stephon Gilmore, safety Kyle Dugger and OL Justin Herron were downgraded to out for the Bills game on Sunday.

That means JC Jackson, who is questionable for the game, would assume a starting spot alongside Jonathan Jones and Jason McCourty. Joejuan Williams is in reserve, and Myles Bryant would be a likely practice squad addition.

— Greg A. Bedard

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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 @DocFlynnNFL.

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