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2018 NFL Injury Guide: Dalvin Cook

Jesse Morse M.D.

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Photographer: Stephen Lew/Icon Sportswire

Name: Dalvin Cook

Age: 22 years old (turns 23 in early August)

Team: Minnesota Vikings

2017 Stats: 74 rushes for 354 yds, 2 TD. 11 rec for 90 yds, 0 TD.

2018 Projections: 262 rushes for 1,127 yds, 7 TD. 45 receptions for 363 yds, 2 TD.

Projected 2018 Fantasy Rank (FantasyPros):  RB10

Injury:

Dalvin Cook came into the 2017 season like a bat out of hell, averaging almost 20 rushes and 89 yards per game in the Vikings’ first 4 games. He was on pace for more than 1,500 rushing yards, which would have led the league, and then in one second, his season ended. I’ll describe the events to you. It’s week 4 versus the Lions, Cook tried to make a cut to his right and his knee buckled. He immediately dropped the ball to grab at his knee, losing the fumble in the process. It was obvious that something was seriously wrong – we found out soon after that Cook had torn his ACL, and damaged a little of bit of cartilage as well. By this what is usually meant is that there is also some damage to the meniscus, as this occurs in about 60% of acute ACL injuries.

Cook had his surgery on October 9th, 8 days after he sustained the injury. That would give Cook, a rare three-down NFL running back, 11 months out from his ACL reconstruction surgery before week 1. This fits perfectly in the timeline of 9-12 months that we like to recommend for an athlete trying to return to a sport like football.

If you’ve read/heard any of the other profiles (I’ve published), there’s a good chance that you have heard the studies on revolving ACL reconstruction surgeries and how the players perform when they return. Well, just in case you haven’t, here is an overview: there is a 94% success rate after ACL reconstruction surgery, which means there is a 6% re-tear rate. There’s a 6x increased risk of a 2nd ACL injury when compared to healthy subjects. 30% of athletes suffered a 2nd ACL injury within 24 months of return to sport, and within those 21% had a contralateral ACL tear, and 9% had a graft re-tear.

About 20% of RBs and WRs never return to the NFL after an ACL tear. Two different studies demonstrated that NFL players experienced about a 33% performance drop after suffering an ACL tear. One study from 2017 demonstrated that NFL players experienced significantly shorter careers postoperatively than players in other sports (NBA, NHL), 2.1 years vs. 3.2 years. All athletes played fewer games 1 season postoperatively, and the NFL had the lowest rate of active players 2 and 3 seasons postoperatively.

There is some good news though. Taken from an article in NBC Sports from March of 2018 that reviewed ACL injuries in WRs, and the data states that high-level athletes who were around age 25 when they tore their ACL, and remember Cook was only 22 when he tore his, manage to do quite well upon return. The older you are when you tear your ACL, especially for RBs and WRs, the harder it is to return to the field, and the more their returning performance suffers. Remember, Adrian Peterson tore his ACL for this same Vikings team in week 16 of 2011 and then went on to play all 16 games the following season, finishing ONLY 8 yards shy of Eric Dickerson’s single-season rushing record of 2,105 yards, mind you AP was 27 years old at the time.

Questions

Despite his young age, is Dalvin Cook at an increased risk for performance drop? Yes. Age is on his side but unfortunately his new ACL will never be as versatile, strong and flexible as his original one.

2018 Health Outlook:

In his second-year campaign, Dalvin Cook has already reported to training camp healthy and even shed his knee brace. As we have seen in the past, many RBs and WRs who suffered ACL tears do not like to wear their knee braces, as they feel it hinders their performance. Despite a large 15-study review, there is very little confirmatory data that states these braces actually help decrease the rate of reinjury after ACL reconstruction surgery. One study did conclude that braces lowered ACL strain only 0.1% better (1.4% vs. 1.3%) in ACL reconstructed knees versus ACL intact knees. We know that movements that involve landing, cutting or pivoting pose the greatest threat to the integrity of the ACL, and that’s what Cook will have to do thousands of times in this upcoming season if he expects to be effective.

Risk of Re-Injury: 30% risk of having another ACL tear within 2 years, 6% risk of re-tear.

Recommendations: Dalvin Cook has the potential to be a top 5 RB in the NFL. The problem is the Minnesota Vikings’ offensive line ranks in the bottom third at nearly all 5 positions, last year ranking 28th in run blocking and 24th in pass blocking, and despite trying they didn’t get any better. I really like Cook; he runs really hard and is a three down back. The offense has tons of talent with Kirk Cousins leading the way, Kyle Rudolph, Adam Theilen and Stefon Diggs among those being targeted. The ACL injury scares me, but I would still draft him in late round 1 or early round 2. He is in the RB6-10 range for me. He’ll find his one on at least a couple of my teams.

Links:

http://www.nfl.com/news/story/0ap3000000942480/article/vikings-rb-dalvin-cook-sheds-knee-brace-before-camp

https://www.readbyqxmd.com/read/28510477/performance-based-outcomes-after-anterior-cruciate-ligament-reconstruction-in-professional-athletes-differ-between-sports   https://www.theguardian.com/sport/2017/may/11/acl-injuries-sports-athletes-careers

https://247sports.com/nfl/tennessee-titans/Bolt/51-NFL-Players-tore-ACL-during-2017-season-114750922/

https://www.nbcsports.com/chicago/bears/how-do-acl-tears-affect-wide-receivers-numbers-are-promising-allen-robinson-cameron-meredith

https://www.ncbi.nlm.nih.gov/pubmed/28195986

https://www.ncbi.nlm.nih.gov/pubmed/29188333

Jesse A. Morse, MD is a Sports and Family Medicine Physician originally from Worcester, Massachusetts, and currently living in Stuart, Florida. Dr. Morse specializes in fractures, sports-related injuries, joint injections, musculoskeletal ultrasound, regenerative medicine (stem cell, PRP) and concussion management as a non-surgical orthopedist. He grew up watching Wade Boggs, Pedro Martinez, and Larry Bird dominate the Boston sports scene before Tom Brady and David Ortiz came to town. In 2017-18 served Dr. Morse served on the medical staffs of the Philadelphia Phillies/Threshers, the Toronto/Dunedin Blue Jays, and the University of South Florida. Now he currently consults for the Miami Marlins and also serves as a MMA ringside fight physician. Dr. Morse enjoys staying up-to-date on all the latest injuries in sports, playing fantasy baseball and football, as well as DFS.

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Fantasy

NFL Draft Guide 2019-Chris Thompson

Jesse Morse M.D.

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When Chris Thompson is on the field and healthy, he’s quite effective. The problem is that he can’t seem to stay on the field. He’s missed 6 games EACH of the past 2 years. After reading his injury history, the fact that he is still playing in the NFL is quite impressive. Let’s review his injuries. In 2011, while at FSU, he suffered a compression fracture of both T5 and T6 in the middle of his back while fighting for a first down. Crazy. Then in 2012, likely while still indirectly dealing with his fractured back, he tore his left ACL and missed 6 games. Despite the recent ACL tear & previous back fracture, the Washington Redskins still rolled the dice on him in the 5th rd of the 2013 NFL draft. He ended up recovering from his ACL tear in less than a year, but managed to tear the labrum (cartilage) in his left shoulder, causing him to miss the final 7 games of the season. Returning for the 2014 season, Thompson ended up being released by the Redskins only to be resigned to the team’s practice squad, where he stayed most of the year until December when he was lightly used in a couple games.

 

One thing you have to understand is that labrum in the shoulder is prone to injury, think of it like the meniscus in your knee, once you tear it, it can easily tear again, regardless of the treatments completed. In 2015, Thompson chipped in 35 receptions for 240 yards and 2 TDs, missed 1 game with a bruised back, and ended up reinjuring his labrum in his shoulder costing him 2 additional games before having surgery in late January 2016. In the 2016 NFL season Thompson did something he had never done before: play all 16 games. Always been known as more of a receiving back than rushing, he rushed for a 5.2 YPC clip for 356 yards, but was targeted 62 times, managing 49 catches for 350 yards and 2 TDs. I remember getting really excited about his potential in the 2017 season, particularly as a flex play since his targets were higher than most RBs (at the time). Well, the year started off great, in the first 10 games he catch 39 passes for 510 yards (13.1 YPC), 4 TDs, and added almost 300 yards rushing, that’s 800 yards in 10 games, pretty good (for a flex RB3)! Unfortunately in Week 11, he broke his leg (right fibula), missing the final 6 games and requiring surgery in December. So it was safe to say most people had a bad taste in their mouth as Thompson helped most teams to a nice record only to miss the end of the fantasy season & playoffs. But the team and memories were there. Last year, 2018, Thompson was being drafted in the 7th round, around guys like Will Fuller, Tevin Coleman and Cooper Kupp. Guess what? Thompson got injured AGAIN. This time he missed 8 more games with both a rib contusion and a knee sprain. Woah! So in total, Thompson has missed 33-games since 2012, his last year at Florida State. That’s over 2 full seasons!

 

So how concerned am I about Thompson in 2019? I think a lot of these injuries have to do with his smallish stature, as he’s only 5’7”, and weighs 192-pounds. There’s not many RBs in the NFL under 5’8”. So which injuries may still linger for him? Predominately the shoulder for me. I’m not overly concerned about the ribs (freak injury), and leg fracture has been surgically stabilized. For the last two-seasons Thompson has been relied on as a flex option, because he is a good weapon out of the backfield. While he is reportedly still dealing with some soreness in his surgically repaired leg, he’s going to be relied on this year. While the Redskins drafted 2 RBs over the past 2 years with potential, both are coming off ACL injuries. I’m not sure how much Bryce Love will contribute this year, and if you’ve read my profile on Guice, you know that while the potential is there, the injury history scares me. That leaves future-Hall-of-Famer Adrian Peterson, who we know is not a receiving back. With Case Keenum, and eventually Dwayne Haskins at QB, there’s a good chance Thompson will get 60-80 targets this year. The best question with Thompson is IF he can stay healthy. The talent as a receiving back is there, think James White in 2018. For a late 13th rd pick, especially in a PPR redraft league, you could do worse. Personally I’m (likely) fading all the Redskins this year but for his cost, I don’t mind Thompson’s upside.

 

Injury Risk: Very High. 8/10.

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Fantasy

NFL Draft Guide 2019-Derrius Guice

Jesse Morse M.D.

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Alright, let’s talk about the talented RB who was drafted in the 2nd round of the 2018 draft out of LSU after falling out of the first round due to nebulous off-field concerns, including immaturity and being deemed ‘high maintenance.’ Oozing with talent, Derrius Guice is a physical, high-velocity runner that has drawn comparisons to Ezekiel Elliot (without the receiving abilities). Guice exited the Redskins’ 2018 preseason opener with what was initially called an MCL sprain, but unfortunately an MRI confirmed that he actually suffered a torn ACL. Ugh, and just like that his season, and potentially his career, changed. Ideally someone suffering an ACL tear either gets the surgery done within a day or two if there is minimal swelling, or more commonly waits a few weeks to let things calm down and then has the reconstruction done. Well, Guice’s journey wasn’t that straightforward. Unfortunately he suffered a infection that required 7 weeks of IV antibiotics through (likely a PICC line) in his arm. Infections complicate everything in medicine, especially reconstruction surgeries (after the graft has already been placed). This significantly pushed back Guice’s timeline and required a total of FOUR surgeries. This is SUPER concerning. This makes me question the integrity of the graft and also his timeline to return-to-play. If he had his reconstruction in late August 2018, then he would have been ready to return for preseason, as 9-12 months is a usual RTP protocol. However, with the additional complications and surgeries, his timeline has been pushed back and is much less clear. 

 

Guice’s rehab was complicated by a hamstring strain that it sounds like he suffered in May/June, although it was not reported until July 12. The hamstring is a protective muscle group for the ACL, and unfortunately very commonly injured in NFL players (likely because they don’t regularly do eccentric exercises like Nordic hamstring curls). So not only does he need to rehab a strained hamstring, which takes 4-8 weeks in its own right, but he is still rehabbing his ACL, which realistically takes closer to 2 years to get back to ‘normal,’ especially in RBs. Further complicating the thought of drafting Guice as your team’s RB2 or RB3, is the fact that the Redskins resigned Adrian Peterson to a 2-year deal. The aging vet, who seems like he’s never going to slow down, managed a respectable 4.2 YPC in the 2018 season, rushing for over 1,000 yards (only 1 of 9 RBs to do so). I don’t blame the Redskins though, I wouldn’t be able to trust Guice either. Add in the fact that their only other RB depth is the oft-injured Chris Thompson, who is more of a receiving RB, and rookie Bryce Love, who is a coming off a torn ACL of his own. 

 

What should we expect from Guice this year? Honestly, I don’t have much faith in him this season. Inherently there is a 30% risk of re-tearing his ACL again over the next 2 years, he already suffered multiple setbacks in his rehab, first the infection, now a hamstring strain. Based on where you would have to draft him, currently going in the early 7thround around guys like Rashaad Penny, Latavius Murray and Christian Kirk, I will happily let Guice be someone else’s problem this year. Dynasty leagues it’s a little bit of a different story, but he is still too risky right now for me to put too much stock in him. He has a better chance to have a significant impact in 2020 than in 2019. 

 

Injury Risk: Very High. 7/10.

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NFL Draft Guide 2019-Le’Veon Bell

Jesse Morse M.D.

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Set to be a top 5 fantasy pick in 2018, Le’Veon Bell destroyed early drafters’ hopes with his eventual season-long hold out. Let’s briefly talk about this decision before we move on to his injury history and outlook for the 2019 season. So the careers of most running backs in the NFL are short compared to QBs, WRs – hell most other positions. They take a beating, every Sunday, and comparatively don’t get paid their fair due. I get it. Not many people can afford to give up $14M to not play a game. However, financially speaking this may have been a stupid decision, but let’s speak in hypotheticals here. What if Bell tore his ACL in Week 14 of the 2018 season? Yes he collects his $14M in 2018 salary, but how much would this new injury in an RB with lots of ‘miles on his legs’ affected his future earning potential as a feature RB in the NFL? Knowing how ‘little’ free-agent aging RBs get paid (comparatively speaking), how much guaranteed money would Bell have gotten if he was set to miss some, if not most of the 2019 season and likely not truly be 100% for 18-24 months after the date of injury? $5M? Well, that brings us back to Bell signing onto the Jets with a guaranteed salary of $27M on a 4-year deal. Listen, not all running backs have nine-lives and are genetic freaks like Adrian Peterson (the guy continues to amaze me). You have to strike while the iron is hot, because once a major injury occurs, its likely all downhill from there (particularly for RBs). Bell did what was financially best for him & his family & I can’t blame him for that (and now we are seeing it with Melvin Gordon).

 

So, Bell sat out a year, which as long as he didn’t get too lazy/sedentary & injure his body, should end up benefitting him in the long run. There was a very good chance that the Steelers were going to run Bell hard in 2018, maybe between 350-400 touches. Doing that annually takes a toll on these guys, even if they are still in their 20s. Bell averaged 28.1 touches per game in 2016, and 27.1 in 2017. There were only a handful of RBs that had over 20 touches per game in 2018 in the NFL – never mind close to 30 touches. Injury-wise, for the most part, Bell has been pretty healthy (for an NFL RB with his level of use), which is especially impressive given the workload that he has carried. In 2013 he suffered a Lisfranc sprain (scary foot injury) that cost him 3 games, and also a concussion, which he was able to clear without missing any games. Then in 2014 Bell got lucky, and instead of tearing his ACL, he simply sprained it (think stretch as opposed to tear) in Week 17 against the Bengals, causing him to miss the Wild Card Playoff game. During the 2015 season, Bell suffered a grade 3 sprain of his MCL. The MCL is an important and commonly injury ligament in the knee. It runs north-to-south on the inside of your knee, is attached to the meniscus, and prevents the knee from collapsing inward, and is usually injured when getting hit on the outside of the same knee. A grade 3 is a full thickness tear, and nearly always requires surgery. This injury happened in Week 9 (November) and he missed the rest of the season. Bell’s only other reported injury was a groin injury that never actually caused his name to pop up on the injury report. Instead, he played through some (most?) of the 2016 season with it. He reinjured it (because he didn’t allow it to properly heal without missing any time) and he missed most of the 2016 playoff loss to the Patriots. The good news is that he had surgery in mid-March 2017 and this shouldn’t affect him anymore.

 

Let’s talk about Bell’s potential in 2019.  He’s 27, should be fresh after taking 1.5 years off since his last official in-game snap. In his last full season with the Steelers, Bell played in 15 games, rushed 321 times for 1291 yards, 9 TDs,  added 85 (!) catches on 106 targets for 655 yards and another 2 receiving TDs (he lead the league with 406 touches). Very impressive season. While I don’t expect the Jets to get Bell 400+ touches, between 275-325 would seem realistic. That’s the definition of a bellcow. How many RBs topped 300 touches in 2018? 5. Zeke (381), Saquon (352), CMC (326),  Gurley (315), DJ (308). Out of those 5, only Gurley is unlikely to repeat. Several others could join them, but it seems like a combination of injury plus shared-backfields, 300+ touches is becoming a thing of the past. For playmakers, the Jets have Darnold, Bell (with Elijah McGuire, Ty Montgomery, and Trent Cannon backing him up), Robby Anderson, Quincy Enunwa, Jamison Crowder and Chris Herndon (now suspended 4 games). Bell’s going to get his if the Jets want to win in 2019.

 

I think Darnold is going to rely on Bell, Enunwa and Crowder, with flashes of Crowder to take a big leap forward in 2019. The one wild card I haven’t mentioned yet is new Jets HC Adam Gase. Previously with the Dolphins, it is known that Gase wasn’t really on board with the Bell signing but he doesn’t have much a choice now.

 

Let’s briefly talk about Gase’s tendencies as a HC in Miami. In 2017, the Dolphins were LAST in rushing attempts with 360 and in 2018 they were 25th in rushing attempts with 371. So there is a good chance the Jets will find themselves in the bottom 1/3 of rushing attempts if Gase’s tendencies hold true. Use that data as you will. Bell is currently going as the 7th RB, at the 1.10 position, I think this will rise as the draft season rolls on. IMO Bell should be drafted before Melvin Gordon (hold out?), Todd Gurley (knees), but in the same tier as David Johnson, Joe Mixon, James Conner, and Dalvin Cook, which is a good spot for him. I’d draft him as my RB2, or RB1 if I decided to go WR first. I’m not overly concerned about his injury risk in 2019.

 

Injury Risk: Low. 3/10.

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