Injury Report

The Doctor Is In: What’s Wrong With Zach Banner?

Zach Banner camp

When Zach Banner won the role of starting right tackle for the Steelers in 2020, fans were excited to see him in action. Unfortunately, we didn’t get to see much, as Banner left the Week 1 game with an ACL tear.  He underwent surgical repair and spent the rest of the regular season and off-season working hard on his rehab. The expectation was that he would be ready to rock by the beginning of training camp.

Things were going well…sort of.  While his “rehab buddy” Devin Bush, who tore his ACL over a month later than Banner, was a full participant in team drills, Banner was held back, doing individual work while the team reportedly eased him in. On August 9th, head coach Tomlin assured us that there had been not setback in the recovery process. And the following day, we had further confirmation that all was well.

Things seemed on course when Banner made his first start in the third preseason game versus the Lions, the only home game at Heinz Field. He played a mere 12 snaps in two series before he was done for the day.

In the fourth and final preseason game in Carolina, Dan Moore Jr. started at RT, presumably to get some experience on that side. Then we heard that Banner was left home in Pittsburgh to “receive additional treatment” according the Tomlin. No mention of a new injury, but no denial of one either.

Then things seemed…not so good. Earlier this week, it was reported that presumed starting LT Chukwuma Okorafor was practicing at RT, where he started every game last season and Moore was filling in at LT. No Banner at practice.

The hammer dropped yesterday, with the Steelers placing Banner on the Reserve/Injured list, committing him to at least three games out of action per the updated NFL rules. So what’s wrong with Zach Banner?

First, the usual disclaimer. I have no access to any of Banner’s medical records so what follows is information drawn from medical studies, patient databases, published reports and my speculation based on all of those.

We should start with Banner’s ACL repair. If you want a full review, check out the post I wrote when he first got injured here. When the ACL is torn, a direct repair is virtually never done due to the high failure rate. That means replacing the ACL with tissue from the patient’s body (autograft) versus cadaver tissue (allograft). In a review of 267 NFL and NCAA Division 1 orthopaedic surgeons, 99.3% of respondents use autografts (which have a lower re-rupture rate than allografts) and 86% use bone-patellar tendon-bone grafts.

This means a portion of the tendon that attaches the patella (knee cap) to the top of the shinbone (tibia) is removed and used to repair the ACL. Surgeons often prefer this graft to using a portion of the hamstring because the tissue is more similar to the ACL. The patellar tendon connects bone to the bone as the ACL does, as opposed to the hamstring, which connects muscle to bone. There is also a belief that the patellar tendon can heal to bone faster than soft tissue grafts can.

So most likely Banner had a patellar tendon graft to repair his ACL. And as we know from prior posts, the average recovery and return to play is approximately 11 months, which is why I thought he would be ready for training camp.  But as we also see with Giants RB Saquon Barkley, every player recovers at their own pace. It’s possible that Banner going on IR just means that he is recovering slower than expected. What about other potential issues?

1. Patellar tendonitis. Inflammation of the remaining patellar tendon can occur, causing pain and swelling. This is treated like any other tendonitis with rest, ice and physiotherapy and usually improves with time.

2. Anterior knee pain. This can occur with both patellar tendon repairs and hamstring repairs. It is seen in as many as 10-20% of cases. This is sometimes associated with a deficit in extension range of motion and is treated with additional rehab to improve the range of motion.

3. Knee instability. Sometimes the ligament doesn’t heal in a tight enough position, resulting in a lack of stability that is evident after return to full activity. This can be treated with additional rehab or a brace. Surgery is not always required but in some cases a revision is necessary.

4. Knee stiffness or weakness. There is always a loss of range of motion and muscle strength in the early recovery period following surgery. Sometimes this takes longer to improve.

5. Re-rupture of the ACL. Hoo boy, I really hope this isn’t it. We’ll know soon enough. If he resumes practice, we can cross this worry off the list. If he undergoes surgery again, this could be the problem, in which case he may not be back with the Steelers, or with any NFL team. But I don’t think this is the case.

6. Knee arthritis. This is typically a late complication that develops after years. Not the issue for Banner most likely.

7. Some other unrelated injury. I didn’t see anything during his limited participation in the game to suggest an injury but he certainly could have sustained an injury in practice. This is essentially impossible to guess.

So as you can see, there are a number is issues that Banner could be dealing with that don’t require surgical intervention and would allow a fairly quick return to play. If we’re playing the odds, I would guess that he is experiencing either anterior knee pain or patellar tendonitis. Let’s hope he improves quickly and can jump onto the proverbial moving train.

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