Checking in on Injured New England Patriots Stars Rob Gronkowski, Vince Wilfork

Dave Siebert, M.D.@DaveMSiebertFeatured ColumnistJune 10, 2014

New England Patriots tight end Rob Gronkowski leaves the field in a cart after being injured in the third quarter of an NFL football game against the Cleveland Browns Sunday, Dec. 8, 2013, in Foxborough, Mass. (AP Photo/Elise Amendola)
Elise Amendola/Associated Press

The New England Patriots lost a number of players to injury last year, but two staples—tight end Rob Gronkowski and lineman Vince Wilfork—are still working their way back to the field.

Vince Wilfork tore his Achilles tendon last October.
Vince Wilfork tore his Achilles tendon last October.Elise Amendola/Associated Press

Gronkowski went down with a torn ACL and MCL in early December—adding to his already-extensive injury history. Wilfork, on the other hand, suffered a tear of his Achilles tendon earlier in the season. Both injuries carry with them lengthy recovery times—very unscientifically nine to 10 months on average. That said, both can range from six months to well over a year.

With those timetables in mind, a nine-month recovery puts Gronk back on the field just about in time for Week 1 of the 2014 NFL season. Wilfork—who went under the knife in October—might be even closer to a return. Based on OTA media reports, both players are making significant progress—though several steps still remain.

The first truly good news about Gronkowski came on Sunday when The Boston Globe's Ben Volin saw the tight end "bursting, planting, and cutting during the early portions of (last) Thursday’s practice."

Why does that matter?

Simple. The ACL prevents the lower leg from moving forward or over-rotating with respect to the thigh. As a result, many ACL tears occur when the knee twists too far inward either due to direct contact—as was the case with Gronkowski's injury—or a non-contact combination of awkward positioning and momentum change. If the twist is too great, the ligament tears.

The job of a new ACL—as ACL surgery actually entails replacing the torn ligament with another piece of tissue, or "graft"—is to fill the void left by the torn ligament. However, an athlete cannot simply hop off the operating table and start cutting on his or her reconstructed knee. The body needs time to cement the new tissue into place—a process that requires months, not days or weeks.

In the interim, the athlete usually works on range of motion and strength to support the healing ligament. He or she then returns to jogging and running forward, as lack of a functional ACL does not necessarily limit straight-line movement.

The above motions are not only extremely difficult—if not impossible—without an intact ACL, performing them too early on a reconstructed ligament threatens the tissue's integrity.
The above motions are not only extremely difficult—if not impossible—without an intact ACL, performing them too early on a reconstructed ligament threatens the tissue's integrity.Wikimedia Commons.

Finally, after a few to several months—and only with the blessing of the athlete's surgical and physical therapy teams—lateral and multiple-plane movements come back into the fold.

In other words, Gronkowski planting and cutting implies he is well on his way just five months after surgery—an operation delayed approximately one month by his concurrent MCL injury.

Yet, make no mistake: Non-contact agility drills are one thing. Taking hits at full speed is another.

While Gronk appears to be making excellent progress, he likely still needs a few more months to return to full form. Furthermore, the threat of setbacks in the late stages of rehab—when an athlete feels at or near 100 percent but, in fact, is not—remains very real.

His teammate, Wilfork, faces a somewhat similar scenario.

At this point, the big lineman's surgically repaired Achilles tendon is far along in the healing process—he is roughly eight months out from his operation. In fact, Volin and his colleague Shalise Manza Young noted Wilfork participated in "about half" of last Thursday's OTAs.

Throughout the summer, Wilfork will likely continue to add reps until his medical team deems him safe for contact.

After all, his Achilles must first be able to resist tearing whenever he plants his toes behind him and loads his weight—all 300-plus pounds of it—onto them to push off the ground. Then, it needs to hold strong through an opposing lineman simultaneously pushing him back onto those planted toes—thereby adding more effective weight onto the tendon—a scenario he will face dozens of times per game while on the line of scrimmage.

However, like Gronkowsi, it seems Wilfork needs to clear a few more rehab hurdles.

Regrettably, his Achilles will also remain at risk of re-rupture even after he completes his rehab, and rushing the process only increases that risk. Even with the best care by the best professionals, Achilles re-ruptures occur in the general population a handful of times per 100 cases—and the general population isn't exactly taking snaps on an NFL field.

In the end, both Wilfork and Gronkowski may, indeed, receive medical clearance before Week 1. Nevertheless, given their importance to Bill Belichick's squad, New England's medical staff will surely move forward as slowly as necessary in the name of safety.


Dr. Dave Siebert is a resident physician at the University of Washington who plans to pursue fellowship training in Primary Care (non-operative) Sports Medicine. Medical information above is for informational purposes only.