When NFL Scouting Combine physicians examined University of Alabama left tackle Cyrus Kouandjio's left knee, trouble surfaced.
According to NFL Network's Ian Rapoport, several teams failed the former Crimson Tide on his physical, citing an arthritic knee as the main concern:
*UPDATE - March, 6, 2014*
It all began in 2011.
Tommy Deas of TideSports.com notes Kouandjio suffered both an ACL and MCL tear in his left knee that year during a game against the University of Tennessee:
Cyrus saw his season cut short with a knee injury sustained in the fourth quarter of UA's victory over Tennessee.
"I was blocking. We were running outside draw and I had the guy blocked, but a linebacker from the back side came in and kind of leg-whipped me trying to tackle the running back," Cyrus said. "I tore my ACL, my MCL, in my left knee."
Reconstructive knee surgery soon followed. Yet as is now evident, the damage may have already been done. The injury itself may be to blame.
Concurrent ACL and MCL tears often occur when forceful contact to the outside of the knee causes it to twist inward. The twisting motion overwhelms the ACL, and the inward stress tears the MCL.
New England Patriots tight end Rob Gronkowski fell victim to a similar mechanism of injury in 2013.
Depending on the angle and magnitude of the hit—as well as the strength of the surrounding musculature—additional injuries may also occur. For instance, one of the two menisci—the soft, shock-absorbing cartilage within the center of the joint—can fray or tear.
Additionally, severe blows can damage the knee's articular cartilage, which lies at the ends of the femur and tibia.
Articular cartilage damage can lead to arthritis, characterized by chronic pain and inflammation within the knee. In later stages, pain and swelling can become significant enough to limit the knee's strength and range of motion.
To make matters worse, much of the time, arthritis is progressive—not regressive.
For Kouandjio, therein lies the problem.
Fresh out of college, the 6'7'', 322-pound lineman is only at the beginning of a hopefully long career, but every single snap will place further wear and tear on his apparently already-ailing knee.
Furthermore, it seems some doctors are already foreshadowing serious problems.
For example, it's possible a knee X-ray showed an abnormally thin gap between the lineman's femur and tibia—though admittedly, radiographic findings do not necessarily correlate with the extent of arthritis symptoms.
Physical examination can also raise red flags—such as knee swelling or joint stiffness.
Fortunately, Kouandjio continues to work out, suggesting his condition is only minimally debilitating at the present time. Certain medical therapies can sometimes stem the tide of further progression, as well.
Yet the million-dollar question remains: How long will that hold true? And how much should NFL teams invest?
Luckily for Kouandjio, according to Dr. Matthew Matava—president of the NFL Physicians Society—medical grades are an inexact science.
"Each team has their own grading scale for players, and each medical team shares their grades with their general managers and coaches," Matava explained. "...At the end of the day, the coaches know that this is not a hard science and more of a subjective assessment based on imperfect information."
In other words, medical opinions may differ. While Kouandjio may completely fall off one team's big board, he may remain put on another's.
Matt Miller—Bleacher Report's NFL draft lead writer—similarly recognizes the wide range of possibilities.
"If every team has red-flagged him, it's a major issue," Miller offered. "If a few teams have, it could be something that never affects his draft stock."
Keep in mind that Kouandjio was—or is—a potential elite talent.
"Pre-injury concerns, he was a potential top-20 player with tremendous upside," Miller added. "That may still be the case."
Though it seems likely that all 32 teams will factor Kouandjio's long-term health into their draft evaluations, position needs come into play, as do salary caps and other factors.
Said another way?
For Kouandjio, all it takes is one.
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. Quotes were obtained firsthand.