While the Eagles are being guarded about the timeline for the quarterback's return from ACL and LCL surgery, two orthopedic surgeons told UPI what Wentz needs to do to be cleared for contact.
While nine months is a reasonable time to return from an ACL injury, Dr. Armin Tehrany -- founder of Manhattan Orthopedic Care and honorary surgeon for the NYPD -- said the additional LCL injury may be playing a role in why those tasked with clearing Wentz are taking a more cautious approach.
Dr. Derek Ochiai -- a leading board-certified hip arthroscopic surgeon and sports medicine expert in Arlington, Va. -- said the nine-month timeline is possibly "a little quick" to return to the field. Although Ochiai added that it's not outside a standard deviation of professional athletes coming back from that type of surgery.
Both surgeons have worked with numerous professional athletes and franchises.
"It could be that, the reasons that he's not back on the field right now could be either athlete driven, like he doesn't feel like...like what he's telling the staff might be different than what he's been saying otherwise and his knee doesn't feel normal enough to him," Ochiai said. "Like he feels he needs more rehab."
"It could be driven by the athletic trainers ... 'Yeah, he's moving around OK, but his knee swells up. We think that graft is not healing up and we gotta give him a little bit more time.' It could be that the head coach is like 'OK, I could clear him, but right now we are 1-0 and we could probably tread water for a little while with a Super Bowl MVP as a backup quarterback, which is a luxury to have.'"
Nick Foles and the Eagles slipped by the Atlanta Falcons in Week 1, despite the backup gunslinger completing 19-of-34 passes for 117 yards, no scores and an interception. After the game, Eagles coach Doug Pederson told reporters he wasn't going to get into a timeline for Wentz's return.
"Right now, as you guys are seeing, the defense is playing extremely well, so you lean on that just a little bit," Pederson said. "You keep moving forward with the offense. Obviously, with Carson and Alshon and the guys that are there, I'm not going to get into a ton of that right now, and that's something that we'll discuss and keep talking when the players get in here next week.
"But I think early in this season, defense, special teams kind of keep teams in ballgames and allows the offense to kind of get their legs and kind of catch up and start playing well. That's what we've got to do."
Foles posted a 106.1 quarterback rating in the Super Bowl, but his rating of 50.7 against the Falcons was more than 30 points lower than any rating Wentz posted during the 2017 season.
Wentz has worked out on the field before multiple games in the preseason and regular season, showing off his agility and flexibility.
Tehrany said most athletes in Wentz's age group want to go back earlier than recommended by surgeons and physical therapists. When he returns, it's possible Wentz could come back stronger than he was during his 2017 MVP campaign.
"When he's cleared to play, he should play the sport the way he plays it," Tehrany said. "To try to tell an athlete to be careful with certain things makes it difficult for that athlete to able to play to the best of their abilities. ... In many cases, patients feel even stronger afterward because they've been so committed to doing their physical therapy and getting in such great shape after surgery. Some patients will come back and feel even better than before they ever had the injury."
What it takes to get cleared
Different franchises have different infrastructures for clearing injured players to return. When Chip Kelly was the Eagles' coach, he was given control over all football-related decisions, including overseeing the team's medical staff.
"I remember he brought in sports medicine to be directly reporting to him," Ochiai said. "He changed the structure of the organization. I don't know if it changed back or what. There is a hierarchy. If I cleared someone for contact, it doesn't mean the athletic trainers and head coach would necessarily do that."
Ochiai said there are four factors to consider when clearing an athlete for contact, including a reasonable timeframe of return based on the type of injuries and whether the doctor says the athlete is ready. Doctors use basic scientific research to determine how long it takes the graft used in Wentz's ACL and LCL to incorporate and be structurally sound within his knee.
That process can take five to six months, depending on the type of surgery, technique and the graft used.
Other factors considered when clearing Wentz include pain, as well as wear and strength in the knee.
One exercise doctors use is telling patients to jump forward as far as they can and land on two feet. Then they turn around and get on their other leg and jump back the same way. If that distance is relatively the same, they the knee is relatively the same level of strength.
After that, the decision rests with the team's athletic trainers and other parties within the organization. Trainers get to see what Wentz experiences in his knee during closed practices and know if he has swelling or other setbacks.
Pittsburgh Steelers head orthopedic surgeon Dr. Jim Bradley performed Wentz's surgeries. He told NBC Philadelphia that a "cautious approach" in bringing him back is common sense. Ochiai and Tehrany agree.
"It's all the more reason to be careful that he is ready physically to proceed because that's more surgery than routine ACL reconstruction," said Tehrany, who has experience with the protocol of clearing athletes for contact.
Carson Wentz working on footwork in the pocket. Going through another extensive pregame workout— John Clark (@JClarkNBCS) August 30, 2018
It’s going to be close whether he gets cleared for contact to start the season opener#FlyEaglesFly pic.twitter.com/qE9WAEioHN
ACL and LCL surgeries can be done at the same time, but they are not the same surgery and are done with separate incisions.
Wentz is not the first athlete to have both tears at the same time.
Former Washington Redskins quarterback Robert Griffin III suffered a torn ACL and LCL on Jan. 6, 2013. He had surgery a few days later and returned to the field in time for Week 1 of the 2013 season, but his play never returned to the level of his Pro Bowl rookie campaign. Griffin also suffered an LCL sprain during the 2012 season and played with a knee brace. He tore his ACL during his sophomore year at Baylor.
Griffin went on to experience numerous other injuries before mounting his comeback. But Adrian Peterson might be the biggest success story when it comes to knee injuries. The seven-time Pro Bowler and 2012 NFL MVP missed just two games during the 2007 season after tearing his LCL. But his most notable comeback came in 2011 when he tore his ACL on Christmas Eve and led the league with 2,097 rushing yards the following season. Peterson started all 16 games during the All-Pro 2012 campaign.
"Some people go outside of the normal standard deviation of a bell-shaped curve," Ochiai said. "They are just way out there. Other people are off the bell-shaped curve, but in the opposite direction."
Former Chicago Bulls star Derrick Rose won the NBA MVP award in 2010-11. He went down to a torn ACL on April 28, 2012. Rose missed the entire 2012-13 season and later dealt with more injuries. He has never been the same player.
Pederson said Wentz was "close" to being ready on Sept. 4. Reports now indicate a timeframe of return spanning from Week 2 through October. The Eagles coach said Wentz was disappointed that he wasn't going to start in Week 1, but he is leaving the determination of when Wentz is ready up to the medical team.
Ochiai said there may not be a medical reason for it, but sometimes the decisions to bring a player back have an emotional component.
"It's 'if I brought Carson Wentz back this week and he re-injured his knee, then I feel awful or our season would be lost,'" Ochiai said. "Then you'd want to hold off in that decision, especially if the team doesn't necessarily need that player right then ... if you wait longer, it would be better, even though that may not be the case."
But Ochiai said if a player is cleared for contact based on his parameters, the difference between a Week 1 return and a Week 3 return is not a lot of difference.
"Thats not like waiting six months," Ochiai said. "If somebody is doing well and you hold off and bring them back in, the only difference is you are not allowing them to get re-injured in those one or two games, you are not overall decreasing the risk of injuries."
Ochiai said he's "almost positive" Wentz is going to play this season.
Carson Wentz will sit this one out, but is getting in some work pregame. His teammates have been raving about how he looks. pic.twitter.com/LU88GtgLwu— Tim McManus (@Tim_McManus) September 6, 2018
Dr. "Jim Bradley has a lot of experience treating athletes ... he certainly doesn't sound like he's pushing to say that he has to get back on the field," Ochiai said. "That's not really our job ... Our job is to optimize the athlete and then whenever he can go back on the field, he can be ready."
The Eagles face the Tampa Bay Buccaneers at 1 p.m. on Sunday, nine months and six days after Wentz suffered his injuries.