The Dynasty Doctor: Myles Jack and Jaylon Smith

Scott Peak

Editor’s Note: Injuries are a huge part of winning and losing each year in fantasy leagues. Staying abreast of 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 a Senior Writer for 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.

In this installment of the Dynasty Doctor, Larry asked us for an update on Myles Jack and Jaylon Smith. In IDP leagues, both are elite talents and potential high draft picks. Will Jack and/or Smith play in 2017? What does the future hold for them? Let’s take a look.

Myles Jack is an elite talent and was destined to be a top five pick in the NFL draft until he sustained a serious knee injury September 2015. The injury occurred during practice. UCLA head coach Jim More described it as an “anterior meniscus” injury, and Jack underwent surgery to repair it.

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The meniscus is an important fibrocartilage in the knee joint that serves many functions. The meniscus serves as a distributor of force, as vertical force directed from the upper leg/body is transmitted to the knee joint. The meniscus is crescent-shaped, and is present on both sides of the knee joint (medial and lateral). As force is transmitted down, it gets spread across the meniscus and functions as a shock absorber. The meniscus also helps to lubricate and supply nutrients to articular cartilage, which lies underneath it. Articular cartilage is smooth and helps the knee joint move in a fluid manner, protecting the underlying bone from degeneration. If the meniscus is torn, it can increase risk of degeneration of articular cartilage, and that ultimately ends with osteoarthritis, commonly referred to as “bone-on-bone” in the sports realm. If there is damage to articular cartilage, bone is exposed and can grind down. As bone degenerates, pain arises and that limits functional capacity.

The mechanism of injury is typically a twisting movement while the foot is planted, or hyperextension, that places excessive force on the meniscus, resulting in a tear. The athlete may feel pain, or a sense of his/her knee locking.

Healing of the meniscus is dependent on blood flowing into it. The outer third of the meniscus has a blood supply to it, but in the middle and inner meniscus, there is limited to no blood supply. The mid-to-inner meniscus gets its nutrients from synovial fluid that bathes the knee joint. As such, a tear in the mid-to-inner meniscus can prove challenging to repair, as lack of blood flow can limit long-term success. Tears in the meniscus on the outer third tend to heal better. Take note, when Mora described the injury, he called it an “anterior meniscus” tear, and that’s important. If he meant the tear is located on the outer meniscus, that’s a good sign as there is more blood flow in this region, and this promotes healing of tissue. Surgery is still necessary to suture up and repair the tear, but if it is located in the outer meniscus, blood flow can facilitate healing. An outer meniscus tear would be reason for optimism with Jack, if this is true.jack

Jack has now had seven months to rehabilitate the knee, and typical recovery from surgery for a torn meniscus is three to four months, so he is right on schedule.

There have been comments on his knee being a “ticking time bomb” and questions raised about his longevity as a football player. Translating hyperbole on this drama is concern about a damaged meniscus leading to articular cartilage degeneration and, ultimately, degeneration of the knee joint.

Jack reportedly has a “chondral defect” in his knee. This description would be concerning for a tear in the articular cartilage. If articular cartilage degenerates, it can create the dreaded “bone-on-bone” condition, and pain associated with it can limit functional capacity of athletes. Microfracture surgery can done to help stimulate cartilage growth, and while it isn’t quite the same cartilage (fibrocartilage not articular cartilage) it can be effective. Recovery is six to nine months, and results can be reasonably good. One study of 25 NFL players quotes 76% return to play for more than 4.6 seasons after microfracture surgery.1 Studies report return to sport in the 60% to 90% range after having surgery for a cartilage defect, with timing of return to play from seven to 18 months.

If Jack had only a repair of the meniscus, and it was on the outer area, he stands an excellent chance of recovery. So why the concern? If Jack had a tear extending into the mid-to-inner meniscus, his recovery may be more complicated. Furthermore, if parts of the meniscus had to be removed, as opposed to repaired, that could increase risk of a degenerative condition in the knee. The good news is, based on comments from Mora, he described the surgery as a “stitching” of the tear, rather than removal, so that is consistent with a repair rather than removal of torn meniscus. There have been other comments that the tear was on the outer third of the meniscus, and again that’s a good sign, as it gives the best chance to preserve it, reducing risk of osteoarthritis long-term.

One study described repairs of the outer meniscus with 94% classified as completely healed, whereas tears in the middle third were completely healed in 54%.2 Rates of re-operation varied based on the type of meniscus tear, and ranged from 12 to 28%.3 There is one study that reviewed risk of osteoarthritis with meniscal tears that were either repaired or partially removed (“meniscectomy”). Long-term follow-up (8.83 +/- 2.26 years) revealed 80% of those undergoing repair showed no radiographic signs of osteoarthritis, compared to 40% who underwent partial removal of the torn meniscus.4 More importantly, in the repair group, 96% reached their pre-injury activity level in contrast to 50% who underwent partial removal.4 More over 100% of athletes who underwent repair showed no signs of osteoarthritis on radiographic imaging in mid-term assessment (3.43 +/- 1.14 years).4

I am relatively optimistic about Jack. There may be some truth to a “smokescreen” that teams picking farther down the draft board want to create a negative perception of Jack’s injury to let him drop. However, I think it’s reasonable that some teams may have him either off their draft boards or dropped him down as a result of this injury, especially given news of the chondral defect. Keep in mind, Travis Kelce had cartilage damage in his knee that required microfracture surgery, and his dynasty/NFL value has never been higher.

I am a fan of Jack and hope to add him to my IDP teams. I think his chances of a full recovery are good, and I wouldn’t hesitate to spend a second round pick on him in all IDP leagues. He should have ample time to rehabilitate and play the 2016 season.

How NFL teams feel about Jack’s chance of recovery will be telling on draft day, and if he falls far, that will indicate significant concern about his injury. Regardless, I’m still a buyer in dynasty IDP leagues.


Jaylon Smith is another story.

Smith sustained a gruesome injury against Ohio State, hyperextending his left knee as he fell awkwardly to the ground. He underwent repair of an ACL and LCL injury. If that weren’t bad enough, he also injured his peroneal nerve, resulting in a foot drop. The peroneal nerve is injured in 13 to 35% of posterior-lateral column (PLC) injuries. The peroneal nerve is exposed around the lateral surface of the knee, wrapping around the fibula before it dives deep into the anterior lower leg. Smith significantly hyperextended his knee, and could have stretched the nerve in the process.

The peroneal nerve innervates muscles that help lift the foot off the ground. Think of a foot flat on the ground, and toes moving up towards the shin. Or, walking like a duck, on the heels, is due in large part from peroneal nerve innervation of muscles in the anterior lower leg. Problems arise when this nerve is injured, and the foot is no longer able to move upwards at the ankle joint. As a leg is lifted, the foot literally drops to the ground, and often a slapping sound is heard. Those with this injury will often lift up their legs higher to compensate, allowing for the dropping foot to clear the ground. Otherwise, patients will drag their foot and be at risk for falling. For an athlete, the biggest obstacle would be dragging the foot while playing, risk of falling as a result, and it would be hard to imagine maintaining an elite level of play with such an injury.

There is a video that recently surfaced showing Smith rehabilitating. The left foot appears to be holding its position as he lifts up his leg, but in that article, it was noted that he wears a brace to support his foot while working out. If that’s the case, then we can’t really gain much useful information from this video.

smith-3The surgeon who operated on Smith, Dr. Dan Cooper, made some interesting comments. While expressing optimism, he also was quoted saying Smith was “completely paralyzed” at one point. It’s also interesting that back in January, there was talk about Smith having a “full recovery” and the peroneal nerve “was healthy and in great condition”. It’s hard to imagine that degree of confidence when I read reports of paralysis and foot drop. Smith himself denied the nerve was stretched, but didn’t know when the nerve would heal. Dr. Cooper noted in a recent USA Today interview that “it’s even possible that Jaylon’s good enough to play in the NFL if he doesn’t get his nerve function back”, and mentioned “tendon transfers to hold the foot up”. Taken together, it doesn’t sound right. Then again, I’m not on his medical team, so maybe I’m missing critical information here.

There are studies describing peroneal nerve injuries associated with knee dislocations. Complete recovery of function was quoted as 30%5, while others note a range of 14 to 75% (average 40%).6 One study described complete recovery of peroneal nerve injury in 50% of patients with knee dislocations and ligament injuries.6

I hope Smith regains his left lower leg strength and returns to play. There are published reports to suggest it’s not impossible, but it’s also not a given. In fact, he’s less likely to regain complete function of the nerve based on published studies. It’s possible he could wear a brace to keep his foot from dropping and still play, but how effective he could perform is questionable.

If Smith is on the board when I’m picking in the fourth round of an IDP draft, I would consider taking him. But I won’t spend draft capital from the first three rounds on him. There is too much uncertainty surrounding his recovery to spend premium picks on him, and it will be interesting to see how far he falls in the NFL draft this week. I wish him the best, and he seems like a really nice person. I’ll be rooting for him.

  1. The microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players. J Knee Surg. 2003;16:83-6.
  1. Arthroscopic evaluation of meniscal repairs after anterior cruciate ligament reconstruction and immediate motion. Am J Sports Med; 1991, 19:489-94.
  1. Arthroscopic repair of meniscal tears that extended into the avascular zone. A review of 198 single and complex tears. Am J Sports Med; 1998, 26:87-95.
  1. Long-Term Outcome After Arthroscopic Meniscal Repair Versus Arthroscopic Partial Meniscectomy for Traumatic Meniscal Tears. Am J Sports Med 2010; 38:1542
  1. Traumatic Proximal Tibiofibular Dislocation: A Marker of Severely Traumatized Extremities. Journal of Orthopaedic Trauma 2015;vol 29(10):456-459.
  1. Risk factors for peroneal nerve injury and recovery in knee dislocation. Clin Orthop Relat Res. 2012;470:774-778.
  1. Common peroneal nerve palsy complicating knee dislocation and bicruciate ligaments tears. Orthop Traumatol Surg Res. 2010 Feb;96(1):64-9.


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