Bad luck. Worst-case scenario.
That was how some NFL team doctors, orthopedic surgeons, and other sports medicine experts around the country described the refractured left forearm that ended the season for Patriots tight end Rob Gronkowski.
Carried by momentum as he caught the football, Gronkowski tumbled out of bounds during Sunday’s playoff game. He secured the ball with his right arm and braced for the fall with his heavily padded left arm. Nearly the full weight of his densely muscled, 6-foot-6-inch, 265-pound body crashed down on his previously injured left forearm.
As he awkwardly hit the Gillette Stadium turf, nothing could protect Gronkowski, 23. Doctors who watched replays of the catch-and-tumble saw a fluke re-injury, a player sidelined by an unfortunate coincidence, not an unwise return to action.
“It was just an unfortunate fall for him,” said Dr. Elizabeth Matzkin, an orthopedic surgeon specializing in sports medicine at Brigham and Women’s Hospital. “Was the bone 100 percent healed? Probably not 100 percent healed. Was it as strong as it was before he broke it the first time? Probably not.
“Was it strong enough to let him get back to play? That’s a million-dollar question.
“He got a little unlucky. I don’t think there’s anyone to point fingers at or blame. That’s the risk you take when you’re taking care of an athlete at that level.”
Gronkowski refractured his ulna in a different place than he initially injured it Nov. 18 blocking on an extra-point attempt against the Colts. The new break is higher, closer to the elbow, than the original fracture, according to a team source. The same source added that the new break occurred just above the plate surgically inserted to fix the first fracture. The bone above the plate is potentially more vulnerable for breaking.
On Monday, Gronkowski again underwent surgery to repair his arm. All expectations are that the tight end will fully recover in the offseason and return for training camp.
Typically, a surgically repaired forearm takes 4-8 weeks to heal. Sunday’s playoff game between the Patriots and Texans marked eight weeks exactly since Gronkowski initially fractured his forearm. But even though the bone may have shown advanced healing at 4-8 weeks, that does not mean the forearm was back to its pre-injury strength. Full recovery may take 3-6 months or longer.
That said, doctors called the decision to let Gronkowski play medically sound.
“I looked at the replay where Gronk reinjured his arm,” said Mark Schickendantz, team doctor for the Cleveland Browns and Indians and director of the Cleveland Clinic Sports Health Center. “He comes down awfully hard on that arm.
“You hate to say bad luck, but you land on that arm just the right way and there you go. If he had landed on the other arm in that same manner, perhaps he’d have done something to that one.”
Asked how often he saw patients refracture forearms, Schickendantz said, “There is a small but known percentage of refracturing of forearm bones. It’s not something that is completely out of the ordinary.”
In determining when professional athletes should return from injury, team doctors weigh the pros and cons, looking at all the known percentages and more subjective measures.
While doctors might advise an average patient who suffers a forearm fracture to wait three months before resuming backyard football with friends, there are different considerations with a player such as Gronkowski.
For an NFL player whose X-rays indicated a healed bone at 4-8 weeks, and whose forearm doesn’t show swelling or feel tender, the importance of the game, the chance of re-injury, pain tolerance, and other factors come into play.
“It’s one complicated risk/reward equation,” said T.O. Souryal, the team doctor for the Dallas Mavericks who also treats professional football, soccer, and hockey players. “What are the risks of further injury vs. what are the rewards? The same exact injury carries a different risk/reward equation in preseason than it does in postseason.
“So an experienced team physician will have conversations with the player, with his agent, with management. You put all the facts together and come up with a risk/reward equation. The risk will never be zero and the rewards cannot be greater than winning a championship. On that spectrum, you use your best judgment to make a decision to allow a player to go out and showcase himself.”
Added Michael Gordon, team doctor for the Milwaukee Bucks, “When I’m talking to an athlete, the major deciding factor is whether it’s an injury that could potentially be made worse playing or is it something that’s just dealing with the pain of the injury? Professional athletes are so mentally tough, for the most part, that they can play with things that the average person wouldn’t play with.”
And that can make medical decisions tougher.
The combination of professional athletes and the playoffs places NFL team doctors under greater scrutiny at this time of year. Recently, the right knee injury suffered by Washington Redskins rookie quarterback Robert Griffin III raised concerns about sideline medical decisions.
Playing on an already unstable leg, Griffin suffered a severe right knee injury during a postseason game earlier this month against Seattle. He required major surgery to repair a torn lateral collateral ligament and to redo a 2009 anterior cruciate ligament reconstruction.
In the wake of the injury, there were questions about how Washington coach Mike Shanahan handled Griffin — whether he was right to let the obviously injured rookie return to the game. NFL commissioner Roger Goodell has said the Griffin injury may change the way non-head injuries are evaluated on the sideline. Souryal called sideline decisions “the most of difficult of all.”
“There’s mud, there’s sweat, there’s a lot of different pressures,” said Souryal. “It’s darn near impossible to get a good examination on the sideline. The conditions are less than optimal.”
While the Griffin situation could not be more different from the Gronkowski reinjury, they illustrate how every case is unique.
“It comes down to knowing your athletes and knowing your players,” said Schickendantz. “Most of us spend an awful lot of time with our players and get to know them as individuals. They have their own personalities and their own toughness and pain tolerances.
“It’s all very individualized. It is difficult [to make decisions about when players should return]. These guys put themselves through an awful lot, put themselves at a certain level of risk every time that they step on the field.”
And sometimes that means bad luck leads to a bad break.