The Patrick Mahomes injury: When will he be back? Is he at risk for further damage?
Less than a week after the jarring image of a doctor popping his kneecap back into place, Chiefs quarterback Patrick Mahomes is throwing footballs on the practice field and participating in a collection of drills. After teammates slammed their helmets on the grass, glancing at what “didn’t look like a knee,” optimism has publicly flooded the Chiefs’ facility.
But what lies ahead? When might Mahomes actually be ready to return? Could it be as soon as this weekend?
Well, not so fast. Chiefs coach Andy Reid ruled out Mahomes on Friday.
And The Star spoke to medical experts — who, it must be noted, have not personally treated Mahomes — in a general sense about a patellar dislocation, the injury designation that Chiefs vice president of sports medicine Rick Burkholder provided Wednesday.
Their message:
• Mahomes’ movement observed at practice — during the portions open to the media, which lasts about 15 minutes — is part of rehabilitation for a patellar dislocation. It doesn’t signal that Mahomes is ready to play in an NFL game or absorb contact to the knee.
• Per the definition of a patellar dislocation, Mahomes’ injury would have included damage to his medial patellofemoral ligament (MPFL). The kneecap cannot be dislocated without impairment to that ligament, multiple orthopedic surgeons told The Star.
• Absent surgery to reconstruct that ligament, Mahomes faces an increased chance of re-dislocation, said Kirk McCullough, a Sporting Kansas City team physician and a member of an NFL Musculoskeletal Committee.
“The issue is not whether or not we think that ligament is going to heal on its own but rather where is he at functionally?” McCullough said. “Does he have enough of a decrease in swelling to where his thigh muscle is functioning just like his opposite leg? How is his range of motion? Does he appear to be hesitating or favoring the knee?
“Those are going to be some of the qualitative things you are going to look at that frankly becomes part of the art of medicine. That’s where experience like Rick has had throughout the years is going to garner him the ability to determine a risk-benefit ratio.”
It’s a loaded question that only those directly involved with Mahomes’ care can or should determine. But from a general scope, the greatest risk of returning too early from a patellar dislocation is the susceptibility of injuring the kneecap again. The threshold for another dislocation to occur has now been lowered, McCullough said, his words echoed by every medical expert who spoke to The Star this week.
“Something in there has to have been stretched or torn for the kneecap to be dislocated, so you’re already at a risk of re-dislocation,” said Rand McClain, a sports medicine doctor and the chief medical officer of LCR in California. “It might not affect him ever again. But the odds are now increased that it might.”
An operation would erase that increased risk, McCullough said, but that would likely end Mahomes’ season. It is possible instead to play through the ailment, but only because of the absence of more serious ligament or cartilage damage or a fracture. As Burkholder noted Wednesday, the MRI results “turned out as good as we could possibly imagine.” Teammates have lauded Mahomes’ toughness and determination. Coach Andy Reid said his quarterback is just wired differently than most.
Surgery can be delayed with a patellar dislocation — potentially into the offseason, for example — though it can only rarely be altogether avoided for professional athletes, doctors said in interviews with The Star.
“He might become comfortable moving on it again, but because of the damage that occurred when he dislocated his kneecap, this knee compared to his other knee will always be at an increased risk of spontaneously dislocating again until that ligament is reconstructed,” McCullough said.
Detroit quarterback Matthew Stafford was suspected to have sustained a similar injury in 2009, and nearly a decade later is showing no ill effects from it. He had surgery late that season after initially trying to play through the ailment, missing only two games. “I can’t say it was bothering me, but it hasn’t been 100 percent. It hasn’t been something that’s been a huge concern,” he told the website MLive at the time.
Stafford, of course, plays the position distinctly differently than Mahomes — he resides in the pocket, while Mahomes does much of his damage outside it on off-script plays. When Mahomes does return, the right leg is likely to include some form of taping or bracing to keep the kneecap in place, said Rick Lehman, the medical director for the U.S. Center for Sports Medicine who has served as the doctor for three NHL teams, including the St. Louis Blues. Because once the kneecap has been dislocated and not followed with an operation, it could be re-injured even without a collision. Like on a cut. Or a pivot within the pocket.
To be clear, it’s not a likelihood. But it’s now more of a possibility than before, Lehman said.
“They will do everything in their power not to let it shift again,” Lehman said.
The Chiefs’ medical team has quickly provided its courses of action — beginning with its immediate reduction of the kneecap on the field, an important factor to limit the swelling. The subsequent rehabilitation began quickly, too. Its primary objective is two-fold, as McCullough explained — to minimize swelling and to strengthen the neighboring muscles. The inside part of the quadriceps muscle (vastus medialis oblique) helps stabilize the kneecap in its appropriate position, so its strength is vital. If the knee is swollen, the quadriceps muscle is weakened and fails to adequately stabilize the kneecap.
“Getting him walking on it; keeping him off crutches; all of those things are minimizing atrophy of those muscles,” McCullough said.
Lehman said a natural progression after the decrease of swelling is to test the knee with footwork drills. On Wednesday and Thursday at Chiefs practice, Mahomes participated in such drills, rotating with other quarterbacks, including Matt Moore, who is in line to start in his place Sunday against Green Bay.
“You start the foot skills so he’s used to side-stepping, stepping up in the pocket,” Lehman said. “If his knee is functioning pretty well, you can progress him pretty quickly. If it doesn’t, you have to slow him down. But this all has to be doctor-directed.”
The patient, however, does have the opportunity to accelerate the process by completing the doctor-recommended work, even if slightly.
Along with the MRI results, therein lies an element of the Chiefs’ optimism.
“He’s been full-steam ahead,” Reid said. “That’s what he has been doing, but that’s the way he does everything. He is going to try to do it the right way and work hard.”
This story was originally published October 25, 2019 at 10:17 AM with the headline "The Patrick Mahomes injury: When will he be back? Is he at risk for further damage?."