It is often difficult to separate fact from fiction in the weeks leading up to the NFL draft, but there seems to be growing concern among NFL teams about the knee of Clemson standout defensive end Da’Quan Bowers. Some scouts had projected the Tigers star as an early possibility to be the number one overall pick by the Carolina Panthers. Now rumors suggest that Bowers might be falling out of the top 10.

Bowers had surgery in recent months reportedly to treat a meniscus tear. If these reports are true, he likely had an arthroscopic surgery to trim out part of the meniscus, which is a C-shaped piece of cartilage that serves as a shock absorber in the knee. That surgery normally takes 2-6 weeks to return to running, lifting weights, and other sports activities, but for elite athletes to be completely healthy can take several months.

His knee clearly wasn’t 100% at the Clemson Pro Day April 1. As Travis Sawchik reported, Bowers appeared slow and seemed to fatigue with positional drills. His 40-yard dash times, vertical jump, and cone drill speeds were not as impressive as scouts had hoped for the former number one high school football player. Scouts present hoped that his performance was only a sign that he hadn’t fully recovered and returned to playing shape.

In his Monday Morning Quarterback column on SportsIllustrated.com Monday, sports columnist Peter King wrote that at least one NFL team removed Bowers from its draft board. King reported that the team’s physician was concerned about Bowers recent surgery and suggested that teams think Bowers might need microfracture surgery.

If rumors of his needing microfracture surgery are true, they likely came from one of two sources. First, Bowers’ surgeon would have seen the damage to the articular cartilage of the knee (the cartilage lining on the ends of the bones) when he scoped the knee for the meniscus tear.

Second, in a prior column I have discussed the nature of players’ medical evaluations at the NFL Combine. It is possible that teams wanted to know as best possible the status of Bowers’ knee and obtained an MRI of it. Damage to the articular cartilage likely would have shown up on an MRI and led to physicians’ concerns.

For this full-thickness cartilage lesion, I'm using a microfracture awl to create holes in the bone to stimulate bleeding, and hopefully, cartilage formation.
Microfracture surgery was very popular five to ten years ago, especially in pro athletes, but it has started to fall out of favor in recent years. The surgery involves creating small holes in the bone to try to help fill a cartilage defect with fibrocartilage. The concerns about the surgery come from studies that show some short-term benefits but less than optimal long-term outcomes. Also, several studies have demonstrated that return to pro sports, especially in the NFL and NBA, is unpredictable but that players are likely to have shorter careers. The problem for surgeons treating articular cartilage injuries is that no surgery exists that reliably creates new cartilage and guarantees a likely return to sports for significant lengths of time.

It is interesting to me that these rumors of Bowers’ draft hopes dropping are based on speculation. From what I can tell, he had a meniscus surgery that would not likely have had much effect on his draft status, as players frequently return to football uneventfully after these surgeries. And if an articular cartilage injury exists and if Bowers has no symptoms from it currently, teams are hesitating because he might need a procedure in the future.

And what about players who haven’t had MRI’s of their knees? How many players in this draft have cartilage damage in their knees and don’t know it because they aren’t currently having symptoms? We don’t know.

We likely will not know either the true condition of Bowers’ knee or whether fears of his future health affected his slide in the draft, if it occurs. We do know that there is a large amount of risk involved on both sides. Bowers obviously could lose millions of dollars. Any team who drafts Bowers with a high first-round pick not only potentially loses millions in guaranteed money owed to him if his knee doesn’t hold up but also loses a player who would be expected to be part of the team’s foundation for years. There is obviously a lot riding on his surgically repaired knee, so it will be interesting to see which team rolls the dice.

Note: The following post appears as a column in the April 13, 2011 edition of The Post and Courier.