After dislocating and fracturing his right hip during 2013 training camp, many fans and experts wondered whether Dennis Pitta would ever play football again. As we all remember, he made a miraculous recovery and even played in the final four games of that season. Expectations were high for Pitta in 2014, however, just three games into the season he suffered yet another fracture-dislocation to the same hip.

So with the start of football season just around the corner, Ravens fans are finding themselves asking an all-too-familiar question: Will Dennis Pitta play this year?

A CLOSER LOOK AT HIS LATEST INJURY

The most concerning aspect of Pitta's latest injury is how it occurred. He didn't take a big hit. He didn't get tackled. Hell, he wasn't even touched. Hip dislocations are very rare and unusual in sports due to the fact that the hip has such strong ligaments that help hold it in place. So a non-contact injury resulting in a hip fracture and dislocation is a major red flag.

It was originally reported after his first injury that his ligaments and cartilage weren't damaged in the process. However, the mechanism of his most recent injury certainly implies significant instability in the hip; making the validity of those reports questionable at the very least. Still, other than his doctors, none of us really know the extent and severity of his current injury. However, there is existing scientific research that could help give us somewhat of an idea.

A 2006 study examined the arthroscopic findings following traumatic hip dislocation in 14 professional athletes. These were the most significant findings from the study with corresponding definitions/descriptions:

• 14 had acetabular labrum tears: a ring of cartilage that surrounds the socket of hip joint (acetabulum) Its purpose is to provide cushioning and to keep the head of the femur (thigh bone) within the acetabulum, essentially providing stability to the joint.
• 14 had chondral defects: meaning damage to the articular cartilage. Its purpose is to protect the ends of bones and allow joints to glide without friction. This tissue has no blood supply so, if it gets damaged, there is little hope for healing.
• 11 of 14 had partial or complete tears of the ligamentum teres: ligament which runs from the femoral head to the acetabulum. Its function is still not yet fully understood.

POTENTIAL COMPLICATIONS IN REHAB

An athlete can control many factors when rehabbing from an injury. But one of the things they can't control is how quickly they heal, and certain tissues certainly repair at faster rates than others. Unfortunately, ligament healing is fairly slow and doesn't always heal completely. The hip has four major ligaments which are crucial to providing adequate stability. Significant damage to any of them could prove to be especially problematic. Research has shown that even a year after ligamentous injury a large percentage of patients still demonstrate signs of joint laxity and instability.

However, the most severe potential complication is avascular necrosis. This is the same hip condition which ended the playing career of Bo Jackson and is defined as the death of bone tissue due to a lack of blood supply. The femoral head relies on blood from the femoral neck (area between femoral head and femoral shaft) for survival. When the hip dislocates blood flow to the hip can be disrupted. If this blood supply becomes permanently compromised then the bone will begin to weaken and, eventually, will die. The only medical option at this point would be a total hip replacement.

SO WHAT ARE THE ODDS THAT HE RETURNS?

Pitta participated in individual and positional drills during minicamp, but still has not been fully cleared medically. Neither Pitta or Harbaugh have been particularly assuring or confident when questioned on the matter, though Pitta does claim to be "optimistic."

Nevertheless, even though their voices have been relatively quiet, the organization's actions have spoken volumes (three tight ends drafted in two years).

Perhaps that's all we need to hear.

- Bobby Esbrandt, PT, DPT, PES