Like clockwork, six weeks to the day after Houston Texans linebacker Jadeveon Clowney underwent an arthroscopic knee procedure that reportedly carried a recovery time of four to six weeks, toes started to tap.
That was over a month ago.
Now, according to The Houston Chronicle's John McClain, the rookie "is getting a second opinion from Dr. James Andrews," who "will examine Clowney's knee in Birmingham, Ala., and report back to the Texans." Andrews will likely offer his opinion on the necessity, or lack thereof, of the linebacker pursuing further surgical intervention.
Unfortunately, the nature of Clowney's injury set him up for that frustration from the get-go. Even with the best doctors practicing the best medicine—Dr. Walt Lowe and his surgical team undoubtedly fall into and even help lead said group—some injuries pose unique challenges.
A closer look at the underlying anatomy shows why.
Within each knee, two menisci, one lateral and one medial, help support the joint by distributing the body's weight over a larger surface area. The medial meniscus lies closer to the body's midline, and the lateral meniscus sits between the outer surfaces of the knee joint.
Meniscus tears occur frequently in the NFL as a result of sharp planting and twisting, but most do not reliably heal on their own. If a tear causes too much pain, swelling or catching in a player's knee, he may decide to undergo surgery to address the issue.
During the operation, a surgeon can either remove or repair the damaged portion of the meniscus. Repairs preserve the knee's long-term health at the expense of a longer recovery, while removals allow an athlete to return to play more quickly but come with a higher risk of problems years down the line.
The decision to repair or partially remove a meniscus depends heavily on the type and location of a tear, as a surgeon can only repair tears located in a meniscus' outer rim.
Which meniscus is torn—lateral or medial—also looms large, and shortly after Clowney went down, CSN Houston reported he suffered the less common lateral meniscus tear. The fact that Clowney returned to the field after seven weeks suggests doctors removed the damaged tissue rather than repairing it.
Nevertheless, the fact that Clowney's injury involved his lateral meniscus means the normal knee recovery rules come with a few caveats.
For example, a recent study published by Dr. Danyal Nawabi in the American Journal of Sports Medicine uncovered a median return-to-play time of seven weeks for elite soccer players following a partial lateral meniscectomy. Medial operations, on the other hand, required just five weeks.
Clowney's original recovery timetable of four to six weeks probably lied on the optimistic side.
Even more striking, Nawabi et al. identified 29 players, or 69 percent of the study's lateral group participants, who experienced knee pain or swelling in the early recovery period following a lateral meniscectomy—as Clowney is now. Just four patients, or eight percent of the medial group, developed said complications after a medial-sided operation.
Finally, zero patients needed further knee surgery during the study's follow-up period after a medial injury, while three athletes in the lateral group went under the knife a second time. Importantly, however, this particular finding did not reach statistical significance.
What does it all mean for Clowney?
Not surprisingly, it's tough to say.
While Nawabi's study suggests lateral meniscectomy recoveries go awry more frequently, the manuscript focused on elite soccer players, not NFL linebackers. Generalizing findings in one group of athletes to another is a slippery slope.
Nevertheless, the manuscript's overarching conclusion—one that lateral meniscus tears are generally more troublesome—is hard to ignore, as is the idea that Clowney had the deck of perception stacked against him the moment fans expected him back in four to six weeks.
After all, it's just not that simple. The rookie's long recovery is an unfortunate manifestation of a possible reality that was always there.
In the end, Andrews' opinion will represent the next piece of an already complicated puzzle. Clowney's eventual course of action will come down to an informed doctor-patient discussion between the linebacker himself and Drs. Lowe, Andrews and others, who, as mentioned, are some of the best medical minds in the world.
Dr. Adam Bitterman (@BittermanJAMB), an orthopaedic surgery resident physician in New York, contributed to this report.
Dr. Dave Siebert is a second-year resident physician at the University of Washington and a member of the Professional Football Writers of America. He plans to pursue fellowship training in Primary Care (non-operative) Sports Medicine.