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The Doctor Is In: Robert Spillane May Have MCL Injury

After losing rising star ILB Devin Bush to an ACL injury in Week 6 versus the Browns, fans of the Pittsburgh Steelers were first frantic and eventually relieved to see Robert Spillane step in as a starter, fulfilling Head Coach Mike Tomlin’s “next man up” mantra very capably.  Spillane was an undrafted free agent originally signed by the Titans and released during his rookie season.  He was signed by the Steelers the following February 2019 and activated from the practice squad to the 53 man roster in November 2019.  He has played well in Bush’s absence this year, making a statement with a one-man goal line stand against Derrick Henry and a pick-6 against the Ravens.

A mere 5 days after losing OLB Bud Dupree (half of the Steelers phenomenal edge rush and a key player on the defense), the Steelers saw Spillane go down in the 3rd quarter against the Washington Football Team.  We all groaned, seeing him grab his left knee.  The gods couldn’t be so cruel to take a third linebacker’s ACL from the Steelers defense, could they?

Turns out, Spillane and the Steelers seem to have dodged that bullet.  He popped up pretty quickly and was able to walk off the field and into the locker room.  While he was ruled “questionable” to return, his day was done.  After the game, Tomlin referred to it as a knee injury without any further detail, stating that he was still being evaluated (translation: Spillane was going to get an MRI).  Two days later, the team hasn’t provided any update but Jeremy Fowler tweeted that Spillane would not need surgery but would likely miss some time (as many of us predicted):

Obviously, this isn’t an ACL injury that Spillane suffered.  And for those who asked me on twitter: no, there is no such thing as an ACL tear so mild that it doesn’t require surgery.  Remember Ryan Tannehill’s ACL injury back in 2016?  Yes, the one that never healed and then required surgery at the beginning of 2017 and brought Jay Cutler to Miami.  Good times.

But I’m getting off track.  Back to Spillane.  What is his injury?  Based on the video, I would guess that he sustained a left MCL sprain.  Even with the All-22, there isn’t a really great view but you can see in this screenshot that his left leg sustains contact from the lateral aspect as he spins past Alex Smith and goes down.


We’ve talked about MCL injuries pretty recently, but for those who didn’t see that post, we’ll start with some quick background.

ICYMI: WHAT IS AN MCL INJURY?

Knee injuries are the most common injury in NFL players, and MCL sprains are the most common knee injuries.  Looking at the NFL database from 2012 to 2019, there were a total of 1076 MCL tears, or an average of 134.5 per season.  This includes preseason:

There are several ligaments that hold the knee joint together.  The MCL runs vertically along the medial side of the knee joint, securing the femur (thigh bone) to the tibia (shin bone), the larger of the two bones between the knee and ankle:

Figure 1 https://minhhai2d.blogspot.com/

The MCL provides stability to the middle side of the knee, particularly when the knee is flexed.  A sprain is a stretch and/or tear of a ligament, and it is classified by severity.  The MCL consists of superficial and deep ligaments. The superficial MCL is the primary restraint to valgus laxity at the knee. The superficial MCL has 1 attachment to the femur (thigh bone) and 2 attachments to the tibia (shin bone). The deep MCL is a thickening of the medial joint capsule and runs deep and parallel to the superficial MCL.

Here is the breakdown, courtesy of the American Academy of Orthopaedic Surgeons:

Grade 1 sprain (mild): Slight stretching and some damage to the fibers of the ligament.

Grade 2 sprain (moderate): Partial tearing of the ligament.  There is abnormal looseness (laxity) in the joint when it is moved in certain ways.

Grade 3 sprain (severe): Complete tear of the ligament.  This causes significant instability and makes the joint non-functional.

The other way to measure MCL grade is by the amount of medial joint gapping when a lateral force is applied during physical examination:

Grade 1: Less than 5 mm opening

Grade 2: 5-10 mm opening

Grade 3: Greater than 10 mm opening

Initially, pain, bruising and swelling are common.

WHAT IS THE TREATMENT?

It always starts with the basic RICE treatment: rest, ice, compression (with a brace), and elevation.  Pain can be treated with anti-inflammatory medication like ibuprofen and sometimes narcotics like Vicodin.

Assuming that this is not a Grade 3 sprain, Spillane won’t need crutches and can be weight bearing.  Based on how stable his knee looked when he walked to the sideline, I would guess it isn’t that severe.

WHAT IS THE RECOVERY TIME FOR NFL LINEBACKERS WITH MCL TEARS?

Virtually all MCL tears heal without surgery unless there is an associated meniscal tear or another ligament is also injured.  Return to play depends primarily on the severity of the tear but the position played is a factor as well.  QBs and linemen can sometimes return faster than RBs, WRs, DBs and LBs, who do more cutting.

Looking at a few linebackers who have sustained MCL injuries recently shows some variability in the number of games missed:

  • Eagles LB Kamu Grugier-Hill suffered a Grade 3 MCL tear in training camp in 2019 and missed 8 weeks.
  • Buccaneers LB Devin White had a Grade 1 MCL tear during Week 2 last year and didn’t miss a game.
  • Cowboys veteran backup LB Sean Lee (who has had 3 ACL tears and surgery each time), had a Grade 2 MCL during training camp last year and missed 4 weeks but was ready for the season opener.
  • Broncos Pro Bowl LB Von Miller also had a Grade 2 MCL tear last year, missing 1 game and breaking his 95 game streak going back to 2013.
  • Seahawks 1st round draft pick rookie LB Jordyn Brooks sustained a Grade 1 MCL in September and missed 3 games before returning.
  • And as Steelers fan may recall, star LB Ryan Shazier suffered MCL injuries in his rookie season (2014) and again in 2016. Both were considered Grade 2 tears.  In 2014, he missed 4 weeks.  In 2016, he returned after 3 weeks, which turned out to be too soon.  He missed another game the following week and then returned after the bye week.

So there’s obviously a wide range in return to play after an MCL injury.  The most interesting part of what Jeremy Fowler reported is that Spillane should be able to return this season.  With only four regular season games left to play, that would imply that Spillane will avoid IR and could return as soon as 2 or 3 weeks from now.  That would suggest that if Spillane does have an MCL tear, it is likely a Grade 1 or 2 injury.  Which means that he would be running and cutting at full speed in time for the playoffs.  This would be key for the Steelers, who are chasing a 7th Lombardi trophy.

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