The Dynasty Doctor: Cam Newton

Scott Peak Posted On March 30, 2014

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Editor’s Note: Dr. Scott Peak is an ABPN board certified neurologist and neuro-oncologist. He is also a dynasty football addict and huge friend of Dynasty League Football. He’s excited to lend his expertise in medicine with hopes he may help the DLF Team and its followers better understand medical conditions and injuries that may impact NFL players and dynasty football owners. If you have a question for The Dynasty Doctor, just click here. Please remember The Dynasty Doctor is geared towards questions regarding medical science, injuries to players and their collective impact in fantasy football.

Cam Newton recently underwent surgery for a left ankle injury, so we wanted to take the time to discuss how this impacts his dynasty value.

Lateral ankle sprains are the most common sprain athletes, elite or recreational, will endure. Estimates vary but 15 to 20% of all sports injuries are ankle sprains.¹ Lateral ankle sprains make up 75 to 85% of all sprains.²

The mechanism for a lateral ankle sprain is a combination of plantar flexion (heal raised, foot pointed down) and inversion (foot bends inward). An example is when a player jumps in the air, lands on the foot of another player, and the foot bends inward with great force. This injury can result in significant pain, swelling and limited mobility.

There are three main lateral ankle ligaments called the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL). The ATFL is the weakest ligament, is at its greatest tension with plantar flexion/inversion and is the most likely ligament to be torn. The CFL is the second most likely to be torn, while the PTFL is rarely torn, as it is the strongest ligament and most relaxed with plantar flexion/inversion. Here is a link to a diagram with pictures of these ligaments.

Treatment for lateral ankle sprains can be surgical or non-surgical, but there is consensus opinion that surgery is not necessary in the majority of lateral ankle sprains. Immobilization for 5-7 days is recommended with a cast or boot, usage of rest, ice, compression, elevation (RICE), non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin, followed by functional treatment (taping or bracing, range of motion exercises) and proprioceptive training (re-learning where the ankle is in space). Most athletes can return to play in 1-2 weeks, although severe sprains might take eight weeks before return to play is possible. A brace or taping may be required to help reduce risk of additional sprains or injury. Proper rehabilitation is crucial, as if not done right, weak collagen formation can increase risk of re-injury and chronic instability.³

Surgery for lateral ankle sprains is necessary in 10-20% of grade 3 sprains and this is important as chronic instability can arise from improperly treated ankle sprains in 20-40% of patients.³ Elite athletes cannot afford to miss game time, and surgery can help athletes reduce chronic instability in the ankle joint and lower risk of recurrent ankle sprains. The problem with surgery is a higher risk of limited mobility, and this is a sacrifice in trying to reduce laxity in the ankle joint. Surgery also has potential complications such as infection, wound healing issues and chronic stiffness/arthritis in the ankle joint. There is controversy over whether non-surgical or surgical approaches to lateral ankle sprains are recommended, and consensus is that surgery is not required for most cases. Still, athletes with chronic instability in the ankle joint or pain may opt to have surgery, or if their ankle sprain is severe enough, surgery may be done immediately. Return to play is approximately 12 weeks for most athletes after surgery for a severe lateral ankle sprain.³ Surgery to stabilize an ankle joint is successful in 85 to 90% of patients.⁴

A prior history of ankle sprains is a strong risk factor for recurrent ankle sprains, owing to residual instability and joint laxity from ligament damage. Surgery does help reduce risk of instability and recurrent sprains. Athletes with at least one lateral ankle sprain are twice as likely to get recurrent sprains.¹Estimates for risk of recurrent ankle sprains is reported to be as low as 4%, and as high as 20 to 30%.

Newton first injured his ankle in a week 10 game against the San Francisco Forty Niners, then aggravated it against the New Orleans Saints in week 16. This is important, as it highlights higher risk for recurrent ankle sprains in athletes with a prior history of them. If Newton had residual ankle joint laxity, that could increase risk for a recurrent sprain in the future. Athletes with significant lateral ankle sprains and resulting joint laxity often feel like their ankle is giving away, and this can impact performance. Rehabilitation is often tried first, and this involves functional ankle bracing, strengthening, coordination and proprioception exercises. Proprioception is a complex sensation that enables the brain to understand where a limb is in space, such as an ankle joint. Proprioceptive exercises might include a balance board program. It appears that Newton ultimately required surgery to “tighten up” ligaments in his left ankle, and that sounds like he had residual joint laxity from prior ankle sprains. Even though Newton injured his ankle game 9, he actually had better rushing numbers for the rest of the year.

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It appears the injury didn’t impact Newton’s mobility, and he dropped 54 yards on ten rushing attempts against the 49ers in the playoffs.

I don’t think this injury or surgery will adversely impact Newton’s value in dynasty. In fact, I would consider sending out offers to see if his owners are willing to trade him at a discount. The more important factor here is a Panthers roster that is bleeding talent, with holes at wide receiver and offensive line. Investments in DeAngelo Williams, Jonathan Stewart and Mike Tolbert continue to plague this franchise. Making matters worse, Newton’s contract is up after the 2014 season and Carolina will have to give him a huge pay increase. Newton needs playmakers surrounding him in the worst way, but it’s unclear how it will happen, given this team has salary cap constraints this year, and the Panthers won’t have Newton at a discount in 2015. Ironically, Newton might have to win games by himself, and that might improve his fantasy numbers, but not necessarily the fortunes of his franchise. Still, if you believe in Newton as an elite dynasty asset, now is the time to acquire him.

References

Peterson W, Rembitzki I, Koppenburg A et al. Treatment of acute ankle ligament injuries: a systematic review. Arch Orthop Trauma Surg 2013;Springerlink.com.
Richardson DR. Sports Injuries of the Ankle. The Foot and Ankle (Canale and Beaty: Campbell’s Operative Orthopaedics 12 Ed 2012); Chapter 89: 4213-4250.
Van den Bekerom M, Kerkhoffs G, McCollum G et al. Management of acute lateral ankle ligament injury in the athlete. Knee Surg Sports Tramatol Arthrosc 2013;21:1390-1395.
DeLee JC, Drez D and MD Miller. DeLee and Drez’s Orthopaedic Sports Medicine, Third Edition. 2010, Chapter 25: 1865-2205.