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Knockin' on Valhalla's Door


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The 49ers’ worst fears were realized: Running back Jerick McKinnon will miss the season with a torn anterior cruciate ligament in his right knee, Ian Rapoport of NFL Media reports. McKinnon injured his knee during practice Saturday, and coach Kyle Shanahan said the 49ers hoped their initial diagnosis was wrong.

Shanahan: “He just made a cut on air and no one was around him and just went down. It looked awkward.”

https://profootballtalk.nbcsports.com/2018/09/01/report-jerick-mckinnon-will-miss-the-season-with-torn-acl/

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On 2018-08-12 at 4:46 PM, SemperFeist said:

 

Might not be a coincidence that McKinnon's worrisome-at-the-time but MRI-negative "muscle strain" injury from 3 weeks ago was in the same right knee as the ACL tear. 

I always remember RG3 in the playoff game against the Seahawks -- looked like he hurt his knee when he took a hit awkwardly in the pocket, but got up and seemed OK only to have his knee buckle untouched the next play. 

I still wonder if Teddy's knee injury actually happened -- or at least started -- during the Chargers game a couple of days before the actual dislocation. There was only play where he scrambled and juked a LB out of his shoes, and his knee twisted sharply as he made the cut (much as with Cook's ACL injury making a cut in the Lions game last year). Again he seemed fine, and played another series or two in that game. But I wonder if there was a partial tear there that left him more vulnerable to the full blown injury that happened that Tuesday, I think fairly early in the next practice they had after that preseason game. 

Really too bad for McKinnon. He was going to light it up in Shanahan's offense this year, expected him to be very productive. At least he got paid before he got hurt. 

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1 minute ago, Krauser said:

Might not be a coincidence that McKinnon's worrisome-at-the-time but MRI-negative "muscle strain" injury from 3 weeks ago was in the same right knee as the ACL tear. 

I always remember RG3 in the playoff game against the Seahawks -- looked like he hurt his knee when he took a hit awkwardly in the pocket, but got up and seemed OK only to have his knee buckle untouched the next play. 

I still wonder if Teddy's knee injury actually happened -- or at least started -- during the Chargers game a couple of days before the actual dislocation. There was only play where he scrambled and juked a LB out of his shoes, and his knee twisted sharply as he made the cut (much as with Cook's ACL injury making a cut in the Lions game last year). Again he seemed fine, and played another series or two in that game. But I wonder if there was a partial tear there that left him more vulnerable to the full blown injury that happened that Tuesday, I think fairly early in the next practice they had after that preseason game. 

Really too bad for McKinnon. He was going to light it up in Shanahan's offense this year, expected him to be very productive. At least he got paid before he got hurt. 

Small injuries can definitely lead to larger ones due to something called proprioception. Proprioceptors are essentially little sensors in your joints that allow your body to sense where your body parts are in relation to one another.

 

For example: do you ever start to roll your ankle, but at the last second your foot snaps back down onto the ground safely? That is because your proprioceptors sense that your ankle is about to go on a direction that it isn't supposed to, so if your ankle is rolling in, the proprioceptors tell the brain to fire the muscles on the outside of the leg to bring the ankle back to a neutral position.

 

These same principles can be applied to knees. Even if there isn't major tendonous or ligamentous involvement in an injury, proprioceptors can still be damaged. This limits the bodies ability to correct and protect itself from joints going in directions that they aren't supposed to. I am not sure if that had anything to do with Bridgewater, RG3's, or McKinnon's injuries, but it definitely could have contributed.

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Yeah I know what proprioception is, I'm a neurologist :). Good explanation though. 

I don't think these injuries are so much due to damage to a Golgi tendon organ (or whatever) as a partial tear/strain of the ACL that leave the ligament weak enough that it gives way soon after. Very minor damage to the ACL might not show up on MRI (as it didn't for McKinnon, though his symptoms at the time of the "strain" were thought to be very concerning for an ACL injury) but it could still alter the structural integrity of the knee and leave it vulnerable to a more dramatic injury soon after.

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2 hours ago, Krauser said:

Yeah I know what proprioception is, I'm a neurologist :). Good explanation though. 

I don't think these injuries are so much due to damage to a Golgi tendon organ (or whatever) as a partial tear/strain of the ACL that leave the ligament weak enough that it gives way soon after. Very minor damage to the ACL might not show up on MRI (as it didn't for McKinnon, though his symptoms at the time of the "strain" were thought to be very concerning for an ACL injury) but it could still alter the structural integrity of the knee and leave it vulnerable to a more dramatic injury soon after.

Hey, I thought u were an English teacher!? J/k doc, I believe you’ve been both. Nice explanation, thanks. Sometimes I wish I were a neurology Nurse, but ended up in the psychiatric business ?

Edited by marshpit23
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2 hours ago, Krauser said:

Yeah I know what proprioception is, I'm a neurologist :). Good explanation though. 

I don't think these injuries are so much due to damage to a Golgi tendon organ (or whatever) as a partial tear/strain of the ACL that leave the ligament weak enough that it gives way soon after. Very minor damage to the ACL might not show up on MRI (as it didn't for McKinnon, though his symptoms at the time of the "strain" were thought to be very concerning for an ACL injury) but it could still alter the structural integrity of the knee and leave it vulnerable to a more dramatic injury soon after.

It does make me wonder with McKinnon if he had laxity in his knee upon examination or if he just had a concerning mechanism of injury with his first injury that was diagnosed a calf strain.

Edited by vikestyle
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7 minutes ago, vikestyle said:

It does make me wonder with McKinnon if he had laxity in his knee upon examination or if he just had a concerning mechanism of injury with his first injury that was diagnosed a calf strain.

Obviously it wasn't a calf strain -- 

"McKinnon suffered the injury about halfway through Sunday's training-camp practice in Santa Clara, California, when he came up grabbing at his right knee. He limped to the side to receive attention from the medical staff and sat out the rest of the session."

They said it was a calf strain when the MRI didn't show damage to the ACL etc. But there's no diagnostic test for a muscle strain, so it's like the doctor saying you have a viral throat infection when the strep swab comes back negative -- there's no proof of the actual diagnosis, just ruling out the differential diagnosis. 

And of course people don't grab at the knee in a way that's worrisome for a ligament injury if they strain the calf muscle, which is in a different anatomic location. 

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