The Dynasty Doctor: Le’Veon Bell

Scott Peak Posted On March 20, 2015

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Editor’s Note: Injuries are a huge part of winning and losing each year in fantasy leagues. Staying abreast of the injury situations is key as knowing what to expect from your players health-wise in the short term can help you make educated decisions in managing your team. Lucky for us, we have a Doctor in the house. 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.

Jack Y submitted a question to the DLF Dynasty Doc and he asked if there is concern about the hyperextension knee injury Le’Veon Bell sustained last season. Bell is an elite dynasty asset and most would agree the RB1 in all formats, so naturally this injury has raised some eyebrows. We will take a closer look at it and decide if it’s time to hit the panic button or R-E-L-A-X.

[inlinead]Bell took a nasty shot to the right knee after making a 19-yard catch in game 17 against the Cincinnati Bengals. The injury looked bad, and initial concerns were rightfully a serious knee injury. Taking a closer look, Bell was very fortunate his right foot was not firmly planted into the turf, and that enabled much of the force from the hit to be dissipated as his right foot lifted off the ground. If his foot were firmly planted, we likely would be discussing torn ligaments and a much longer recovery. The NFL is truly a game of inches, and in this case, a few milliseconds. The hit looked gruesome, but the results of it weren’t so bad and not even close to what it could have been.

Bell did miss the final game of the season for the Pittsburgh Steelers, the Wild Card loss to the Baltimore Ravens. Clearly the Steelers missed him as his replacements, Josh Harris and Ben Tate, combined for 45 yards on 14 carries, 3.3 YPC and four receptions for 15 yards. Bell is more than a system running back and the Steelers offense is in trouble when he’s out.

A hyperextension of the knee stretches important ligaments and places them at risk for further injury. Stretched ligaments can have small tears in the ligament but no resulting instability in the knee (first degree), more tears in the ligament with abnormal motion in the knee (second degree) or a complete tear of the ligament and instability on exam (third degree).

Examination of an injured knee is a complex process, but the essence of it is to evaluate for stability in the joint in multiple planes of movement. If there is anterolateral (forward and outer motion) rotatory instability in the knee, this might suggest an injury to the ACL. Physicians and trainers look for excessive anterior displacement and internal tibial rotation of the injured knee. Posterolateral (backward and outer motion) rotatory instability presents as excessive lateral tibial rotation on examination and suggests an LCL injury. Excessive posterior displacement and external rotation suggest a PCL injury.

There are several more intricate tests that can be performed and parcel out ligamentous injuries, such as:

Valgus stress test: With the knee extended or flexed to 30 degrees, gently move the lower leg outward to check for instability or excessive motion. This evaluates the MCL.

Varus stress test: With the knee extended or flexed to 30 degrees, gently move the lower leg inward, toward the midline, to check for instability or excessive motion. This evaluates the LCL.

Anterior/Posterior Drawer Test: Flex the hip 45 degrees, while keeping the knee at 90 degrees. Pull the upper tibia forward (toward the examiner), checking for excessive anterior tibial movement. This could indicate a torn ACL. Conversely, when pushing the upper tibia backwards (away from the examiner), if there is excessive posterior displacement, this could suggest a PCL injury.

Lachman Test: Flex the knee 30 degrees, pull the upper tibial anteriorly (towards the examiner), and if there is an increase in anterior displacement this could suggest an ACL injury.

Ligament sprains: MCL ligaments usually heal on their own and usually do not require surgery. Grade 1 and 2 MCL sprains take 3-8 weeks to heal, and LCL injuries may take a few weeks longer. Recovery from grade 3 sprains can take 2-3 months or longer. Return to play for ACL tears is 6-9 months and PCL tears 6-12 months. Osteoarthritis can occasionally occur in athletes recovering from torn ligaments, especially if there is a torn meniscus added to the injury (meniscus is the shock absorber of the knee joint and has the consistency of an eraser).

In regards to Bell’s expected outcome, I am not concerned. Steelers head coach Mike Tomlin described the injury has “nothing major” and that suggests all above examinations did not show significant laxity or excessive displacement compatible with a more serious ligament injury. An MRI would have surely shown a significant ligament tear and there are no reports of it. Bell himself felt he was “85-90%” recovered back in January 2015. There is no mention of him having surgery for this injury and that suggests a lower grade injury (grade 1 or 2). He should certainly have enough time to recover in time for OTAs and training camp. I don’t think this particular injury will adversely impact his dynasty stock at all and I would target him heavily if his owners are nervous about it.

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