INDIANAPOLIS, INDIANA – FEBRUARY 25: Tua Tagovailoa #QB17 of Alabama interviews during the first day … [+]
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Former Alabama Crimson Tide quarterback Tua Tagovailoa will assuredly be a first-round pick during the upcoming NFL Draft (April 23-25), with most mock drafts selecting him somewhere inside the top five to 10. The most glaring question most teams have in regard to the Hawaiian quarterback revolves less around his talent and more about his health and durability moving forward.
Tagovailoa suffered five notable injuries during his three-year career – two as a starter – at Alabama:
- Broken left index finger (March 2018; no games missed)
- Sprained right knee (October 2018; no games missed)
- Left high ankle sprain (December 2018; surgery; no games missed)
- Right high ankle sprain (October 2019; surgery; 1 game missed)
- Dislocated right hip with posterior acetabular wall fracture (November 2019; surgery; missed final 3.5 games)
According to The Athletic’s Dane Brugler, writing in his latest mock draft published in early March, “[NFL teams] are taking a cautious approach” when evaluating and placing Tagovailoa on their respective big boards. This makes sense as the quarterback’s injury history is extensive; however, Tagovailoa was recently given a clean bill of health by his medical team and subsequently stated that he “[feels] 100%” after undergoing right hip surgery in November.
So, how concerned should NFL teams truly be about Tagovailoa’s injury history and durability moving forward?
It’s probably best to begin answering this question by developing a better understanding of the anatomy involved and biomechanics potentially impacted with each of Tagovailoa’s injuries – specifically those of his lower extremities; broken fingers happen frequently in sport and wouldn’t be of major concern to front office and medical personnel.
The term “knee sprain” is nebulous and nondescript. There are many ligaments and other soft tissue structures in and around the knee that can be sprained, so determining the importance – or lack thereof – of Tagovailoa’s right knee sprain is difficult. On one hand, he didn’t miss any game action when combating this injury, but on the other he did require an external knee brace to play.
As a left-handed thrower, Tagovailoa’s right lower extremity isn’t used for power production – other than while sprinting and cutting – but rather as his plant leg. The plant leg acts as a fulcrum during throwing and provides stability for the body as the force developed by the drive leg – Tagovailoa’s left – is transferred from the leg, through the core, and to the arm. It is important for the plant leg to be structurally sound and for the athlete to have confidence in its stability so as to not dissipate any of the force generated during the throwing motion.
Many of the structures in and around the knee provide stability against rotatory forces and shock, meaning that if these structures are injured, an external brace may be needed to provide the stability that is lacking. Injuries of the MCL and joint capsule often heal without need for surgery; however, tears of the ACL, PCL, and meniscus likely require surgical intervention. Outcomes involving knee sprains – regardless of whether they occur on the drive or plant leg – that do not require surgical intervention, such as the case with Tagovailoa, are often good and of injuries of this nature are of little long-term concern.
High ankle sprains – also known as syndesmosis sprains – occur when the foot is forcefully pronated (i.e. turned outward) and rotated. Most high ankle sprains heal on their own with time and targeted rehabilitation; however, if the injury is severe enough surgical intervention may be required.
High ankle sprains involve ligaments of the inner lower ankle and the syndesmosis – a ligamentous structure that helps to connect the tibia with the fibula in the lower leg. Traditionally, surgical intervention for these injuries involved the placement of screws within the ankle to help provide stability.
Lately, however, a procedure known as a suture-button – or “tightrope” – technique has gained popularity; both of Tagovailoa’s high ankle sprains were treated with the tightrope procedure. The so-called tightrope procedure allows for greater movement within the ankle and a quicker return to exercise and function, while maintaining the overall stability of the ankle. Tagovailoa returned to game action within two weeks after each of his tightrope procedures. Outcomes following tightrope procedures appear to be good overall, though more research – particularly involving athletes – is needed.
Posterior hip dislocations are the most common type of hip dislocation – they account for approximately 90% of all cases – and mainly occur with high impact trauma, namely car accidents. As occurred with Tagovailoa, fractures of the posterior wall of the acetabulum – the “socket” of the ball-and-socket hip joint – are common with posterior hip dislocations.
One of the largest fears regarding hip dislocation is the occurrence of avascular necrosis – also called osteonecrosis – which involves the death and degradation of bone secondary to a compromised blood supply; this is what famously ended Bo Jackson’s NFL career. However, if the hip is relocated within six hours of the initial injury, risk for avascular necrosis drops precipitously. Tagovailoa was seemingly able to avoid avascular necrosis as well as all serious complications after undergoing his procedure.
Stability of the hip – an inherently stable structure – is sufficiently established with surgical intervention and appropriate healing; the incidence rate of recurrent dislocation is 1%.
Perhaps the largest long-term concern regarding hip dislocation is the development of arthritis or other intra-articular injuries (i.e. labral tears, etc.) While minimal research has been completed on athletes, a study published in 2018 and focused on the lay population found an incidence rate of 4% for arthritis two-years after suffering a traumatic posterior hip dislocation.
Development of arthritis or other intra-articular pathology can lead to impaired range of motion. Limitations in range of motion – particularly at the hip – may alter the internal mechanics of the body, causing altered force distribution and increased risk for injury, particularly at the joint segments above and below (i.e. the low back and knee).
When looking at each of Tagovailoa’s injuries individually – and taking his medical team at face value when they say he has been cleared – it would be difficult to justify not taking him in the top 10. Each injury was acute in nature and has yet to show evidence of becoming a recurrent issue. All of his injuries can be directly tied to contact, with non-contact injuries traditionally being thought of as more detrimental for overall durability.
However, the best predictor for future injury is past injury and at this time it is impossible to know how Tagovailoa’s surgically repaired hip will impact his throwing and running mechanics as well as his overall athleticism. If he is ultimately selected by a team with a strong offensive line and his need to use his legs to evade pressure is limited, it’s not difficult to envision Tagovailoa having success and being healthy early in his career; fewer hits equals less risk for injury, after all. If not…well only time will tell.
All in all, Tua Tagovailoa should be a top 10, if not top five, draft pick, despite his injury history.