Outlook for Packers OT Bryan Bulaga Following Latest Knee Injury

Worries about the durability of the right side of the Green Bay Packers offensive lines were answered quickly in Week 1, but not positively. Bryan Bulaga left in the first half with a knee injury. Further tests indicate that he has a sprained medial collateral ligament (MCL) and will be out indefinitely, as first reported by Adam Schefter and detailed in this ESPN.com article.

There are a couple key facts here that have to be understood. First, a sprain is by definition a tearing of the fibers that make up a ligament. The term "torn" is a colloquial term while "sprain" is the precise medical term. People often mistake "torn" for "ruptured," which is a complete tearing of the ligament. In Bulaga's case, the ligament is not ruptured and may in fact only have a low-grade sprain.

I'll say it again: A sprain is a tear.

The other is that the term "indefinitely" does not mean "a long time." It means the team simply doesn't know. Even with a more significant sprain, Bulaga would not have needed surgery. The MCL is not normally surgically reattached.

While it is a key ligament in the knee, there are enough secondary stabilizers that a full rupture is normally left alone. It is believed that Adrian Peterson, who tore not only his ACL, but also his MCL, is playing with no functional MCL. He's doing so pretty well.

The injury occurred when Bulaga was hit on the left knee. Replays showed what appeared to be a buckling of the knee, which led many to worry that Bulaga's recent ACL reconstruction had given way. Instead, the mechanism was more force to the inward (or medial) portion of the knee, resulting in the sprain. There are no indications that Bulaga has associated damage, either to the grafted ACL or to the meniscus, which can often be torn when the knee takes this kind of force.

Scott Eklund/Associated Press

Given the healthy (or relatively healthy) meniscus, the low-grade sprain of the MCL is reasonable. Sources told me earlier, as I reported on Bleacher Report Radio, that Bulaga has a Grade 1+ sprain. Sprains are normally graded on one of three levels, but doctors and athletic trainers often fudge to the middle—a bit more than a 1, a bit less than a 2 can be called many things.

A Grade 2 sprain of the MCL would normally put a player out for somewhere between four and six weeks, but the reduced damage could mean that Bulaga will be able to return sooner. If the knee is damaged but stable, the medical staff will have to make some hard decisions on how quickly Bulaga is able to return. 

Much of that will be based on stability and function. Bulaga may be fitted for a knee brace that is more focused on lateral stability. (The proper term here is valgus force, but let's not get too technical.) Braces have a mixed record in both research and practice, so Bulaga's only ability to stabilize will be key.

Using muscle strength and other secondary stabilizers should mean more than any brace. Note that Bulaga was already wearing a brace when he was injured, as you can see in the picture at the top of this article.

The situation is complicated by Bulaga's previous reconstruction on that knee, but in ways, the medical staff may have more knowledge of the knee. The doctors have been inside it recently and would have taken a look at the MCL. There was no indication of significant damage to the MCL last season after his knee injury or after the surgery, but there may have been some level of problem.

As well, the rehab team and the athletic trainers will know the knee well. They'll know how the knee feels, how stable it is and what works for Bulaga in terms of the rehab process. While this certainly isn't something that can be directly attributed to the previous knee injury and surgery, it's impossible to say how it will affect this new injury, positively or negatively.

The Packers now have a couple extra days to monitor Bulaga's situation. If Bulaga is able to show the knee is stable, even with an assist, the bigger test will be function. Whether he can he make the kind of quick lateral moves that a tackle needs in pass protection will be tested early. Look for any signs that this is happening for the clearest signal that Bulaga is ready to return.