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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.

Jay Ajayi, the former running back for Boise State University, has been a hot topic lately given his fall in the NFL Draft. While many had speculated he would get picked in second round of the NFL Draft, he ended up falling to the Miami Dolphins at pick 13 of the fifth round (#149 overall). Concerns were raised about a potentially significant knee injury and draft analysts termed it “bone-on-bone.” How should dynasty owners handle this situation? Is it time to stay away from Ajayi or take a chance on him?

Let’s explore.

Ajayi sustained a torn anterior cruciate ligament in his right knee in 2011. His right knee has been described as “shredded” – severely injured and with damage to the meniscus. Reports surfaced a few weeks before the NFL draft that Ajayi’s knee injury was a significant concern to NFL teams. Debate ensued on whether this was a legitimate concern or a rumor floated by an NFL team who wanted Ajayi. The truth was revealed, as NFL teams passed on him 148 times until the Dolphins grabbed him at pick 149.

It seemed a bit odd to me that no reports of a knee injury surfaced at the NFL Combine. While draftniks, fans and scouts obsess over 40 yard dash times and 3 cone drills, the NFL Combine gives all NFL teams a chance to evaluate the health status of its prospective draft picks. No concerning injury reports surfaced on Ajayi after the NFL Combine until a couple weeks before the NFL Draft. Rumors surfaced claiming Ajayi may have been re-evaluated at medical re-checks, but his agent denied it, and apparently Ajayi didn’t even attend. I’m sure Ajayi had his knee examined at the NFL Combine. I don’t know what was found on this exam, but clearly either something was discovered by a medical team or sufficient concern was raised by his 2011 injury to get an MRI. It wouldn’t surprise me if an MRI was reviewed and could explain the delay in releasing this information until two weeks before the draft. If an MRI showed signs of concern for damage to cartilage on his right knee, that could explain the current predicament for Ajayi. There is a lack of specific details, but that’s my best guess on how this whole process evolved.

[inlinead]?Mike Mayock used the term “bone-on-bone” to describe his one, but what does this mean? The knee joint is the meeting point of the femur (upper leg) and tibia (lower leg), held together by the anterior cruciate ligament, posterior cruciate ligament, medial collateral and lateral collateral ligament. The medial and lateral meniscus is a form of fibrous cartilage, and the surface of the lower knee joint is covered in articular cartilage. The medial and lateral meniscus help to absorb force applied to the knee, and articular cartilage protects the surface of the knee joint. Articular cartilage is smooth and slippery, helping to promote a fluid motion of the knee as it flexes and extends. Damage to the articular cartilage exposes underlying bone. Significant knee injuries can tear the meniscus, leading to damage of underlying articular cartilage. As the defect in the cartilage enlarges, bone is exposed, and that creates a “bone-on-bone” condition. A defect in articular cartilage can enlarge in time with repeated usage, exposing more of the surface bone to further injury. As bone rubs against bone, it results in pain that can limit mobility. Bones have pain receptors, whereas articular cartilage does not. As a result, joint movement with an intact articular cartilage surface should not result in pain, but bone rubbing on bone can be painful. In ordinary life, this can be tolerated, until it’s time for a knee replacement many years later. But for high-level athletes, it can impact their explosiveness just enough to adversely impact their performance. Reports of osteoarthritis after sustaining a torn anterior cruciate ligament are reportedly as high as 30-50% (11 year follow-up)1. Other studies report isolated anterior cruciate ligament injuries (i.e. no injury to meniscus) with osteoarthritis prevalence 0 to 13% compared to 21-48% for those that included an injured meniscus.2

It seems plausible that Ajayi could have osteoarthritis (i.e. “bone-on-bone”) given his anterior cruciate tear in the past, and again there are reports of an injured meniscus as well. Without having access to his medical records or confirmation from Boise State, it’s hard to be certain, but at the very least it would appear reasonable to think this is true, based on Ajayi’s fall in the draft verified the concerns of NFL teams on the condition of his knee.

If we assume Ajayi may have a “bone-on-bone” condition, this would raise concerns he might need microfracture surgery in the future. Now, to be fair, I haven’t heard or read anything that suggests Ajayi needs microfracture surgery. In fact, college coaches from Boise State have denied Ajayi ever missed practice or game time from a right knee injury once he returned from surgery. But, if he truly does have a “bone-on-bone” condition, microfracture surgery would be a common way to treat it. Microfracture surgery involves creating small fractures in the bone using instruments, and this allows blood and bone marrow to seep onto the joint surface. The hope is stem cells will generate cartilage on the surface bone and help restore protection from “bone-on-bone” friction. The new protective layer of fibrocartilage isn’t as good as articular cartilage, but it’s better than bone contact. Studies show 67% to 76% of NFL players are able to return from microfracture surgery, and such athletes competed in 56 fewer games, 3.3 fewer seasons and 3.2 fewer games per season.3,4 NFL athletes who returned to play averaged 4.6 seasons (range 1 to 13 seasons) and 56 games (2 to 183 games) after having microfracture surgery.4 Recovery averages 5 to 7 months.

How should dynasty owners proceed with Ajayi? If Ajayi is dealing with a degenerative knee condition, he sure didn’t show it judging from his production in college. In 2013, he rushed for 1,425 yards (5.7 YPC) and 18 touchdowns. In 2014, he improved to 1,823 yards rushing (5.3 YPC) and 28 touchdowns. He also has 73 receptions in his college career, with 771 yards receiving and five receiving touchdowns. It is certainly possible Ajayi’s career might be shortened from complications of his knee injury, but only time will tell. If it were to worsen, he might need microfracture surgery for it, but whether that comes to pass or not is unknown. His current ADP is 17 in rookie drafts, or mid-second round. I think that is a steal for a player with his track record and athletic profile. In the mid-second round, there is a drop in available talent and Ajayi is a perfect high-upside pick – there’s not much risk in taking him at that spot. I would rather take Ameer Abdullah and Devin Funchess, both of whom have higher ADP values (11 and 14), so the sweet spot for me with Ajayi is early-to-mid second round rookie drafts.

Harris KP, Driban JB, Cattano NM et al. Tibiofemoral Osteoarthritis After Surgical or Nonsurgical Treatment of Anterior Cruciate Ligament Rupture: A Systematic Review. J Athl Train (2015); Jan 6 Oiestad BE, Engebretsen L, Storheim K, et al. Knee osteoarthritis after anterior cruciate ligament injury: a systematic review. Am J Sports Med (2009), July; 37(7): 1434-43. Scillia AJ, Aune KT, Andrachuk JS, et al. Return to play after chondroplasty of the knee in National Football League athletes. Am J Sports Med (2015) Mar;43(3):663-8. Steadman JR, Miller BS, Kara SG, et al. The microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players. J Knee Surg (2003) Apr;16(2):83-6

The Dynasty Doctor: Jay Ajayi’s Knee

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