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29 Apr 2016

Teams Don't Know Jack

by Zach Binney

UCLA linebacker Myles Jack was a consensus top-10 draft prospect before plummeting all the way out of the first round last night. 31 teams passed on him because of medical concerns. Let’s first review what we know of Jack’s situation – little of which is certain because we haven’t physically examined him or his medical records – and then look at how players in similar situations have fared according to FO’s injury database.

What’s Wrong With Jack

In September 2015, Jack tore his meniscus – a “shock absorbing" pad of cartilage in the knee between the femur (thigh) and tibia (shin). That injury required surgery to repair and sidelined Jack for the rest of his junior season. He even withdrew from school to focus on rehabbing from the injury and preparing for the NFL draft. Fortunately for Jack, players recover from this sort of injury regularly, and it didn’t seem to hurt his draft stock.

Fast forward to this week. A flood of reports come out revealing Jack has an osteochondral defect in his right knee. This basically means there’s a problem with a piece of Jack’s articular cartilage – the smooth white stuff that covers the ends of bones and allows them to glide rather than grind past each other – and the underlying bone. I’m not a clinician, so I’ll let Dr. David Chao give his take [emphasis added]:

“Putting together various reports, Jack has an osteochondral defect (osteochondritis dissecans-OCD) which involves a lack of blood to the underlying bone, thus putting the overlying cartilage at risk. This condition is congenital and not directly related to the meniscus issue. There is no question that Jack can play NFL football today. How long his knee will hold up is the question. If this piece breaks off, there is no simple surgical fix as there is a divot left in the bone surface. Results depend on the size and location of the OCD lesion [the piece of damaged cartilage]. … All 32 NFL head team physicians will form their own opinions but any OCD lesion has to worry a team."

The reports culminated in Jack’s admission in the New York Post on Wednesday that he “Down the line, possibly…could have microfracture surgery" (though Ian Rapoport had suggested this possibility on Tuesday). Microfracture surgery basically means doctors would go into his knee, remove some damaged cartilage, make holes in the bare bone that’s revealed, and hope the healing response brings a renewed blood supply that encourages cartilage regrowth, once again allowing the bones to glide rather than grind past each other.

Of note, this is just one type of surgery that Jack might need at some point to repair this cartilage defect in his knee. The defect is certain – the need for and timing of surgery is not.

Suffice it to say, that all was not great news for Jack or his draft stock.

Teams’ Reactions

It’s difficult to tell how much of the steep drop in Jack’s draft stock came from this week’s revelations. The information about Jack’s osteochondral defect condition came from somewhere – NFL medical staff, Jack’s physicians, Jack’s agent, or Jack himself. The last three are extremely unlikely, so I’m assuming it had to be someone(s) with access to NFL medical data, such as team physicians or trainers. If so, then presumably the defect came to the attention of team physicians at least as early as the draft medical rechecks in mid-April. It’s possible that Jack’s draft stock was privately plummeting while he remained a consensus top-10 pick until this week. But then again, maybe not.

The only piece of information I could imagine being totally new to teams in the last few days is the microfracture admission. The rest of this article will work from the premise that this is what caused Jack’s draft stock’s sudden and precipitous decline.

Should the Microfracture Admission Have Dropped Jack This Far?

As FO’s loyal readers know, we have a pretty neat database of NFL injuries stretching back to 2000. I’d love to investigate knee osteochondral defects generally, but the level of detail in our data just doesn’t allow for that (and we don’t know enough about Jack’s particular condition to ensure good comparisons, anyway). As a proxy we’ll use microfracture surgeries, of which we’ve accumulated quite a few cases in players similar to Jack (I included defensive linemen and linebackers, as well as a handful of young guys at other positions). First, a note of caution: we’re likely not working from a complete list of microfracture surgeries in the NFL, just the ones we identified when collecting the data for this database. With that out of the way, let’s take a look, shall we?

Player Position Year of Surgery Experience Time Missed Injury Consequences Verdict
Kelly Gregg DL 2008 10th year 2008 Played 3 more years; 44 starts, 91 tackles, 4.0 sacks GOOD
Kevin Hardy LB 2001 6th year Last 6 weeks of 2001 Played 3 more years; 45 starts, 160 tackles, 7.5 sacks GOOD
Kenny Phillips DB 2009 2nd year Last 14 weeks of 2009 Still playing; played in all 18 games but only started 5 before
injury; in 3 seasons post-injury, played in 38 games (31 starts, 141
tackles)
GOOD
Travis Kelce TE 2013 1st year Last 14 weeks of 2013 Returned in 2014 and made 2015 Pro Bowl GOOD
Jadeveon Clowney DL 2014 1st year Last 3 weeks of 2014 Still playing (1 year so far), 13 games/9 starts, 27 tackles and 4.5
sacks in 2015
UNKNOWN
Marquis Johnson DB 2011 offseason 1st-2nd year First 7 weeks of 2011 Played 3 games (0 starts, 4 tackles) before lacerating spleen and
never playing again
UNKNOWN
Peter Boulware LB 2004 offseason 7th-8th year 2004 Played 1 more year; 15 games, 0 starts, 5 tackles, 2.5 sacks MIXED
Stephen Bowen DL 2013 7th-8th year Last 7 weeks of 2013, first 6 weeks of 2014 Still playing (1.5 years so far); 16-game starter before surgery,
but played in 8/15 and started 3/1 (10/4 tackles) in 2014/15
MIXED
Anthony Spencer DL 2013 offseason 6th-7th year Last 14 weeks of 2013, first 3 weeks of 2014 Regular starter before injury; Played 1 more year (last 13 games in
2014, 0 starts, 13 tackles, 0.5 sacks)
MIXED
Clint Ingram LB 2010 offseason 4th-5th year Indefinite Never played again BAD
Quinton Carter DB 2012 2nd year Last 14 weeks of 2012, entire 2013 Played 1 more year (2014), 11 games/0 starts, 17 tackles and 1.0
sack
BAD
Lamar King DL 2002 4th year End of 2002, first 7 weeks of 2003 Played rest of 2003 season (9 games, 3 starts, 12 tackles, 3 sacks) BAD
Paul Toviessi DL 2001 offseason 1st year Indefinite Never played BAD
Stephen Hodge LB 2009 1st year Indefinite (on IR through 2010) Never played BAD
Boss Bailey LB 2008 6th year Indefinite (on IR for last 9 weeks of 2008) Never played again BAD

I’ve organized the table by my (subjective) verdict on the outcome of each player’s surgery. Of the 15 players I looked at, four (27 percent) had a good outcome, three (20 percent) were mixed, six (40 percent) were bad, and two (13 percent) I couldn’t make a judgment on.

Let’s start with the good. If you’re looking for optimism, look no further than Mr. Travis Kelce. Kelce needed microfracture surgery and missed his entire rookie year, but he made the Pro Bowl last year. Kenny Phillips didn’t fare too badly either, and his surgery was also early in his career. Of note, though, his procedure was reportedly for patellofemoral arthritis, which may be different from what Jack has – I’m not sure we have enough details to know. Perhaps even more impressive were Kelly Gregg and Kevin Hardy, who appeared to recover just fine from microfracture surgery later in their careers. This might be the exact situation Jack is facing.

There’s a couple players we just don’t know enough about to make a judgement on the success of their surgery. Marquis Johnson had the surgery early in his career and didn’t do much after, but part of that may have been the lacerated spleen he got shortly after his return.

The comparable player that most likely came to most teams’ minds (recency bias!) is Jadeveon Clowney. Clowney has certainly been a disappointment relative to his expectations so far, but he was also a number one pick. Jack (no longer, anyway) faces those expectations. He’ll be a nice case study as his career progresses... or doesn’t.

There are a couple players I judged as having a mixed outcome: pass-rushers Peter Boulware and Anthony Spencer, and defensive lineman Stephen Bowen. They didn’t do much after their surgeries, but they were also deep into their careers, so perhaps they were already on the downslope regardless of the need for microfracture surgery.

Then, we get into the bad outcomes, which unfortunately are also the bulk of the outcomes. For early career surgeries, we can look at Paul Toviessi (second rounder) or Stephen Hodge (sixth rounder) – neither ever played a regular season down. Toviessi is the better comp here because of skill level. Linebackers Clint Ingram (surgery between fourth and fifth years) and Boss Bailey (surgery during sixth year) had the procedure later in their careers, but neither played again. Defensive lineman Lamar King, a first-round selection, had the surgery in his fourth year and managed just three starts afterwards – this could also be the exact situation Jack is facing.

My lukewarm take: Ultimately, I can’t blame teams for getting terrified at the word microfracture. Generally I think teams tend to undervalue injured guys, but with microfracture surgery I don’t think that’s happening. That said, Jack is only dealing with the possibility of eventually needing microfracture surgery. He might be fine for a year, or three, or eight. Or... not.

With what I know from the outside, I would have been tempted to take a chance on him anywhere from about 17-20 on…but I also don’t know it was totally unreasonable for every team to take a pass, either. I’m assuming general managers are consulting their medical experts who can give them more insight than I can glean from media reports and this table, influencing their decisions in ways I can’t see from the outside. That makes me loathe to second-guess their decisions without more evidence to support that. But it’s also entirely possible teams were responding irrationally to the word microfracture and being overly risk-averse about Jack. Add that to the list of things about the draft we don’t and may never know.

So What Should Teams Do in the Second Round?

There are a bunch of points to consider here:

  • The consensus seems to be that Jack is fine to play for now.
  • How long his knee articular cartilage will hold up is very much in question. He may get to the point that he needs microfracture (or other cartilage repair/replacement) surgery, but when is highly uncertain.
  • Jack is likely superior to other second-round linebackers.
  • According to Pro-Football-Reference data, the average second-round linebacker who makes the NFL (i.e. plays in at least one regular season game) will have a career of about 6.4 years; 84%/64%/12% will play more than 2/5/10 years. Players with longer careers, of course, were also probably better than your average second-round linebacker.
  • If Jack needs microfracture surgery, the odds are somewhat against him returning to form after that.

Looking at this, I see that I’m likely to get at least some period of high-level play from Jack, followed by a truckload of uncertainty. Among my unknowns:

  • Will he need microfracture or similar surgery at some point? Answer: more likely than not, if only because why would he have admitted it if it wasn’t a real possibility. But who knows.
  • If so, at what point? Answer: <b>¯\_(ツ)_/¯ </b> If – and this is a BIG if – the data in our table come from guys with diagnosable osteochondral defects similar to Jack’s at the start of their careers – we could say that about half of guys need the surgery in their first two seasons, with the remainder tending to cluster around their sixth-to-eighth seasons.
  • If so, will he recover? Answer: this is where we have the best data, and it’s a mixed bag trending towards no.
  • Will Jack be better than your average second-round linebacker, and if so, by how much? Answer: the consensus seems to be yes and a fair bit, but we know draft talent evaluation doesn’t come with a money-back guarantee.

Thinking about all this, I’d certainly take a flyer on Jack in round 2, especially if I’m a fairly strong team that’s likely to be competitive in the near term when Jack’s knee is most likely to stay healthy. Heck, I might even trade up a bit to grab him if I’m a good team with a low pick (analytic heresy alert!). The probability that he contributes at a high level for a period of time at least long enough to offset the contributions of an average second-round linebacker seems reasonably high – again, with a lot of uncertainty on either side. We could even put numbers or ranges of numbers to these uncertainty parameters and try to nail down a more precise estimate than “reasonably high," but I’ll leave that for another day.

Zach Binney is a freelance injury analyst and a Ph.D. student in epidemiology focusing on predictive modeling. He consults for an NFL team and loves Minor League Baseball. He lives in Atlanta.

Posted by: Zach Binney on 29 Apr 2016

15 comments, Last at 03 May 2016, 8:33am by Guest789

Comments

1
by jtr :: Fri, 04/29/2016 - 5:56pm

The microfracture surgery is pretty common in the NBA. The general trend there is that lumbering big men (Zach Randolph, Andrew Bogut) and crafty point guards (John Stockton, Jason Kidd) recover fine, while super athletic players (Chris Webber, Tracy MacGrady) have often never recovered. The exception is Amar'e Stoudemire, who recovered his athleticism and proceeded to have several great seasons interspersed with several injury-marred ones. Given that information, I would be more confident in a big run-plugger type LB to recover from the surgery than I would the ultra athletic Jack. Have to agree, though, that he's a bargain in the second round, even if you only end up getting three years out of him.

2
by JohnxMorgan :: Fri, 04/29/2016 - 6:40pm

Thank you for this.

That said, I have a few ... comments.

I do not have a personal injury database but know, for instance, Walter Jones had his career ended by microfracture surgery--or, better said, his career ended after the surgery. He retired. Marcus Tubbs never recovered. Jon Beason had microfracture too, iirc. So the database seems to be missing important information.

Seems odd to link to a Football Outsiders piece on Football Outsiders, but Kevin Pelton is an excellent analyst and someone I personally respect a lot.

http://www.footballoutsiders.com/ramblings/2007/microfracture-nfl

Another big problem: Injury is treated in a binary fashion. That is: injured or playing. A team drafting Jack would need to consider the strong possibility that injury has eroded his talent. Much like a pitcher who can pitch with some kind of structural injury, but cannot throw as fast or as accurately, Jack may not be the same player he once was. The division between standout athletic and middle-of-the-pack is often quite small.

I think teams do know Jack, and I think teams are fully justified in downgrading his potential and potentially avoiding him entirely.

3
by JohnxMorgan :: Fri, 04/29/2016 - 6:54pm

My poor memory--you didn't include offensive tackles! But I wonder, should you have? Why only linebackers and defensive linemen? But I assume Tubbs and Beason should have been included. And given that no correlation has been proven between recovery and position played, I see no reason to omit anyone. Kelly Gregg and Walter Jones seem equally dissimilar to Myles Jack, is what I'm saying.

9
by Zach Binney :: Sat, 04/30/2016 - 10:04am

Thanks for these comments, JohnxMorgan. You bring up some truly excellent points! Let me flail around below trying to respond:

1. Players not included in our microfracture list: Walter Jones is in our database, but he wasn't included because he didn't seem similar enough to Jack in my COMPLETELY subjective and arbitrary choice of who to include (that, to be fair, I did outline in the article). I decided to limit it to the most comparable players because the article was getting too long already, and I wanted to focus on Jack rather than microfractures in general.

Full disclosure: there were 13 microfracture surgeries in our database that I excluded from this analysis. The majority were offensive linemen. I probably should've mentioned that in the article, but here it is.

Marcus Tubbs is a complicated case I probably would've had to mark as "Unknown" anyway, since he had microfracture surgery in 2006, missing the last 8 games of the season, then tore his ACL and missed the entire 2007 season, as well, and never played again. It's possible the two were related, but it's also possible they weren't. But he wasn't in our data as having microfracture surgery, so that's a good thing to fix. Thanks! I owe you a Coke.

Jon Beason is another good one. We actually got pretty close with him - we identified he specifically had a cartilage issue in his knee. We didn't have that he specifically had microfracture surgery. I owe you two Cokes! Anyway, Beason's an interesting case. His career doesn't look very impressive after his surgery in 2012, but he had a broken foot that sidelined him for basically all of 2014 (he started 4 games, but he was badly hobbled in them).

2. Injury treated as binary: I think I hinted at it when I discussed the uncertainty around Jack's performance relative to another 2nd round LB, but I wasn't as explicit as I could be. All I could've really done, though, is to say something like "But Jack's injury may degrade his performance from what scouts and others saw in college," adding another (not-unimportant!) source of uncertainty. There's little we can do with the data we have publicly available to do finer gradations, other than maybe to adjust for practice status during the week and expectations of playing, but those have all sorts of problems and biases, themselves. If you have other specific suggestions, though, I'm always all ears. I can't think of everything.

3. The headline: the intention was to be funny and provocative because, y'know, headline. In my defense, I did state in my lukewarm take that I was loathe to disagree with the decisions of NFL GMs because they have access to way more information than me. I also said I have an opinion that's wracked with uncertainty and that NFL teams may be being reasonable here; I just happen to mildly disagree when it comes down to making a binary choice (draft or no draft) under conditions of extreme uncertainty.

Let me say for the record that I think teams know a heck of a lot more about Jack than I do; it's whether they're acting rationally (i.e. doing proper risk assessments) with what they know where I'm a little less certain.

NOTE: I'm not actually offering to buy a Coke for anyone who finds a small error or omission in our database.

4
by cantbelieve :: Sat, 04/30/2016 - 3:48am

Not that it has a major effect on your article, but I'm flabbergasted that you'd quote that drunk quack (if you don't know what I'm referring to, google david chao drunk quack).

5
by Andrew Potter :: Sat, 04/30/2016 - 5:12am

I can't speak for Zach, but here's my perspective as somebody who also makes use of Dr. Chao's expertise when writing injury articles for FO.

Whatever else David Chao may be (and the Deadspin article to which you allude is very detailed), he is an excellent video diagnostician and a very valuable source not only of medical knowledge, but of the very specific applications and implications of that medical knowledge as they pertain to NFL players. His articles and Twitter updates are usually insightful, highly accurate, and convey specialised knowledge in an easy-to-understand manner. Nobody else provides the same service as he does, with the same depth of expertise, for free, on the internet - the closest is probably Dr. Jene Bramel, and his main article is behind a paywall. If I have a query about an injury to a football player, I would have no hesitation in asking Dr. Chao about it.

That does not mean I would employ him as my team doctor, recommend him to my players, ask him to prescribe medication, or schedule him to perform surgery. It is entirely possible to be a very valuable source of knowledge and information, without being a person on whom I would rely to apply that knowledge outside of internet articles. (I am also not saying I wouldn't employ him; I do not expect to ever have to make such a judgement.)

I should also make it clear that he vehemently denies the allegations in the article, has never been convicted of anything as far as I am aware, and still has a license to practice medicine which suggests that none of those allegations have been proven against him.

Even if he had been, however, that wouldn't take away his knowledge. For the specific task of helping laymen like me understand what's really going on when a NFL player is injured, I simply haven't seen anybody better.

6
by Zach Binney :: Sat, 04/30/2016 - 9:16am

I pretty heartily agree with Andrew here. I share some of your concerns, cantbelieve, and I try to be very careful in vetting sources I use for anything in my writing, as anyone should be.

That said, for this particular application and the quote I used, I am very confident about what Dr. Chao had to say. I thought it communicated the issues well and, instead of trying to re-invent the wheel by writing it myself, I just yanked his block quote.

Indeed, I don't think anyone disagrees (or even could disagree) with anything Dr. Chao wrote here, except MAYBE "This condition is congenital and not related to the meniscus issue"...I think I've seen some mild debate on that (e.g. that the meniscal tear accelerated it). But that's a totally tangential point. Everything else is very much fact-based or taken from multiple other media reports.

7
by Will Allen :: Sat, 04/30/2016 - 9:24am

It seems to my 1000% ignorant way of thinking that the osteochondral effect, it having to do with decreased blood supply, makes Jack a really poor prospect for recovery from microfracture surgery. He'll be good until his next injury, and then it's over, whether that be a year from now or 10 years from now.

I've seen dumber risks in the 2nd round.

12
by Kaelik :: Sun, 05/01/2016 - 11:20pm

You mean like kicker?

8
by Bright Blue Shorts :: Sat, 04/30/2016 - 9:40am

Perhaps missing the point of the article but 31 teams passed on him?

Is that including the Jaguars themselves in the 1st round or thinking that the Patriots passed because they didn't traded up for him.

10
by Zach Binney :: Sat, 04/30/2016 - 10:11am

This article was written and posted between the 1st and 2nd rounds. 31 teams had first round draft picks (excluding the Patriots because, well, they didn't have a pick). 31 teams elected not to use their first round pick on Myles Jack.

11
by Bright Blue Shorts :: Sat, 04/30/2016 - 3:05pm

Thanks for clarifying.

13
by Johnny Socko :: Mon, 05/02/2016 - 4:04pm

Great article. As someone who has had microfracture surgery, I will add my two cents. First, I have a desk job and therefore my personal recovery (slow as it was) has essentially no commonality to an NFL player. However, I can add some tidbits about the surgery that were gleaned from my experience.

It was explained to me in great detail by my doctor that recovery from the surgery is largely dependent on the exact location within the knee of the incisions (aka the mircrofractures). If these incisions are made in a weight bearing location, the patient is typically required to remain on crutches for months after the surgery. Alternatively, if the incisions are made in a non-weight bearing location, the patient is encouraged to walk ASAP. Luckily, I was able to walk right away.

Bottom line, recovery time is greatly influenced by the location of the surgery within the knee. Therefore, it is considered dangerous practice to generically compare microfracture results, without having more detailed knowledge of each surgery.

Additionally, the surgery itself is viewed by many ortho surgeons as a "last resort" procedure when nothing else seems to work. The cartilage alternative that is produced by the microfractures is considered to be a poor substitute for the real thing, and typically has a rather short life span of 5 years.

As a final note, in the week leading up to my surgery, I ran into a spouse of a friend at a dinner party that happened to be an orthopedic surgeon. When I mentioned that I was scheduled for the surgery the next week, he scoffed and said "Good luck, but it'll never work". And with that ringing in my ears, I reluctantly went ahead with the surgery.

Well, its been 5 years and I'm happy to report my knee is probably 90% good as new. Granted, golf, tennis, and general fitness are about as complex as I get these days. But considering the negative connotations the surgery has among those in the field, I am never surprised when it ruins the careers of elite athletes.

14
by Jerry :: Tue, 05/03/2016 - 5:10am

Thanks for adding this to the discussion, and I'm glad your procedure is working out.

15
by Guest789 :: Tue, 05/03/2016 - 8:33am

Man, your friend's spouse sounds like kind of a dick.