Breshad Perriman's Road to Recovery

We've waited two months to hear the reason why Breshad Perriman has been sidelined for so long. News broke Thursday afternoon that Perriman re-injured his PCL during warm-ups of last Sunday's game against the Bengals and has since undergone arthroscopic surgery by Dr. James Andrews. He is now being deemed "out indefinitely". But before everyone begins declaring him a bust and a wasted draft pick, let's first review what his injury involves and examine what his recovery will entail.

WHAT IS THE ROLE OF THE 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 (shin bone) from sliding posteriorly (backwards) on the femur (thigh bone). This ligament is commonly injured when a strong anterior force is placed upon the tibia, thereby shifting it posteriorly. In athletics this is typically a result of falling onto a bent knee, which was the precise case with Perriman.

HOW ARE PCL INJURIES TREATED?

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

1. Grade I sprain: mild/minor ligament tearing

2. Grade II sprain: moderate ligament tearing

3. Grade III sprain: severe or fully torn (ruptured) ligament; often associated with damage to additional ligaments

Obviously the more severe the sprain, the more tearing there is involved. The vast majority of PCL sprains are actually treated conservatively, however surgery is sometimes necessary with Grade III sprains or if the knee does not respond well to non-surgical treatment.

It's important to note that numerous NFL players have suffered PCL sprains in the past and avoided surgical reconstruction. This list includes Reggie Bush, Andre Ellington, Felix Jones, Eric Decker, Brian Hartline, and our own Terrence Brooks.

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

If treated conservatively, it typically takes anywhere from 1 to 4 weeks for a Grade I sprain and 6 to 8 weeks for a Grade II sprain to heal. If surgery is required, it takes approximately 6 months to a year before a full recovery is made.

John Harbaugh clarified Thursday night that Perriman did NOT undergo surgical reconstruction of his PCL; he instead underwent a simple knee arthroscopy. Such a procedure should only keep him sidelined for a matter of weeks. Harbaugh added, "There's no new injury of any kind. It's just a slow-healing ligament for whatever reason. They're a little surprised to say the least that it's healing this slowly. So, it's just a matter of time."

It's hard not to notice the similarities between Perriman's injury and Keenan Allen's. For those of you who do not remember, Allen suffered a Grade II PCL sprain in October 2012 as a junior at the University of California. He declared for the NFL draft at the end of the season even though he continued to be hampered by his injury. His recovery was so slow that he was unable to participate at the NFL Combine that February. He was still not 100% at his Pro day in April, running an extremely underwhelming 40 yard dash in the process.

Ultimately, Allen's career has ended up just fine. All we can do is wait for Perriman to fully heal and hope for the same result.

- Bobby Esbrandt, PT, DPT, PES