Perriman's Injury and Past Medical History: Is There Cause For Concern?

Many Ravens fans have been panicking recently in response to media reports that Breshad Perriman battled Osgood-Schlatter disease as an adolescent. However, is there a valid reason for their concerns?

WHAT IS OSGOOD-SCHLATTER DISEASE?

To fully understand the condition one must have a general knowledge of the anatomy involved. The knee joint is comprised of three bones: the femur (thigh bone), patella (knee cap), and tibia (shin bone). The quadriceps muscle group is located on the anterior aspect of the femur and it consists of four muscles: vastus lateralis, vastus medialis, rectus intermedius, and rectus femoris. These muscles come together and form the quadriceps tendon which inserts at the superior aspect of the patella. From there it continues across the patella and forms the patellar tendon which inserts onto a bony prominence on the tibia called the tibial tuberosity or tubercle.

Research tells us that that Osgood-Schlatter disease is most prevalent amongst active boys from 12-15 years old. This is due to the rapid bone growth (growth spurts) that they experience during these periods. Essentially what happens is the bone growth exceeds the muscle growth which ends up placing excess traction upon the patellar tendon. This, along with overuse from sports, leads to increased pulling and tension at the tibial tuberosity which results in pain and swelling at that site.

WHAT IS THE LONG TERM PROGNOSIS?

The pain symptoms associated with Osgood-Schlatter's resolve on their own once the adolescent stops growing and reaches skeletal maturity. Given Perriman's age (nearly 22) and impressive stature (6'3", 210 lbs), I think it's safe to say he doesn't have another growth spurt left in tank.

It is important to understand that this is NOT a lifelong issue and Perriman's current injury and extended absence from practice is completely unrelated. The ONLY lingering side effect into adulthood is the presence of a more prominent tibial tuberosity.

PERRIMAN'S CURRENT INJURY IDENTIFIED

A little over a week ago I was asked by Baltimore Beatdown to provide an opinion on what type of knee injury Perriman might be dealing with. Given the mechanism of injury, I stated that he likely experienced either a bone bruise or a mild sprain of his posterior cruciate ligament (PCL). Jamison Hensley reported this afternoon that Perriman is, in fact, recovering from a PCL sprain. So what does this mean moving forward?

WHAT IS A PCL?

The posterior cruciate ligament (PCL) is one of 4 major ligaments that support the knee. The medial collateral ligament (MCL) and lateral collateral ligament (LCL) are situated at the sides of the knee while the anterior cruciate ligament (ACL) and PCL are located in the middle and run from front to back (see below). The main function of the PCL is to prevent the tibia from sliding posteriorly on the femur. This ligament is injured when a strong force is placed upon the tibia, shifting it posteriorly. In athletics, this is typically a result of falling onto a bent knee.

HOW LONG DOES IT TAKE TO RECOVER FROM A PCL SPRAIN?

Ligament sprains are categorized by severity and are classified via a grading system::

A. Grade I sprain: mild/minor ligament tearing

B. Grade II sprain: moderate ligament tearing

C. Grade III sprain: severe ligament tearing or fully torn (ruptured) ligament

The severity of Perriman's sprain will dictate how long he can be expected to be sidelined. Grade I and II PCL sprains are treated non-surgically and can take several weeks to recover from. Grade III PCL tears typically require surgical intervention. Given the handling of Perriman's injury thus far, I imagine he suffered a Grade I sprain. If this is true, I would anticipate seeing him back in action within the next two weeks.

- Bobby Esbrandt, PT, DPT, PES