Horrible news came out of Pittsburgh on Thursday when Sean McDermott announced that LB Matt Milano would be sidelined indefinitely with a torn bicep in his left arm. This news comes on the heels of Milano returning from his devastating right tibial plateau fracture last season in Week 5.
Milano was observed with trainers on Tuesday checking out his left arm and even doing a push up. Nothing at the time of what we observed indicated the severity of the injury indicating the injury may have happened another way.
Adam Schefter reported shortly before the 12:30 press conference that Matt Milano tore his bicep and would be out indefinitely. It’s important to note that the report states that a December return could be possible.
Below is the anatomy, typical mechanism of injury, and timeline for Milano to return.
The Anatomy
The bicep connects distally to the radial tuberosity near the elbow and proximally at the shoulder at both the coracoid process and labrum of the shoulder. The biceps primary movements are to flex the elbow and supinate the wrist.
Mechanism Of Injury
There are various ways for the biceps to tear both proximally and distally, but in the case of Milano, this appears to be distal, closer to the elbow. The distal bicep tendon is torn when the elbow is partially flexed and a sudden load is placed onto the hand or arm, causing the tendon to tear under tension. This is commonly seen in weightlifting.
Another way includes the elbow being hyperextended and falling onto an outstretched hand. In football, this could happen when the arm is suddenly forced back during a diving tackle with the elbow partially flexed.
Bicep tendon tears make up between 3-10 percent of all bicep injuries and normally affect the dominant extremity.
In the case of Milano, he was observed performing tackling drills wrapping his arms around the tackling bag. This is not the mechanism of injury that we see which suggests the injury occured another way.
However, this is what the team says happened.
Update:
According to Sean McDermott, the thought was that his arm caught a coach’s leg which fits the mechanism of injury with the arm contracted and the arm suddenly extended.
Surgery
Milano will undergo surgery to repair the tendon in the coming day. Surgeons attach the tendon to a surgical button which is then taken through the radius and attached on the other side, allowing the tendon to heal back to the bone.
He will be in a sling for at least two weeks followed by a hinged brace restricting the amount of elbow extension available so as to not stress the healing tendon. He will progress through rehab in order to return to the field.
Update: Brandon Beane confirmed when Milano underwent surgery which establishes a timeline.
Return to Play
This is the part that everyone wants to know. Based on the research available, it is all over the place. One source indicates that it takes nearly a year for a player to return to the field but gives several months leeway, as low as seven months.
Other articles are more aggressive stating that players could return in as little as two and a half months, though the average is just under four months.
I do not expect the Bills to be super aggressive with Milano’s return as they stated that December could be a goal, I would clarify that as late December given the timelines we have. That would put him at the four month mark with extra time since it is mid-August. When he does return, he will have to wear a hinged brace to protect the still healing area. When he does return, he may have some difficulty in wrapping up tackles like we saw with his pectoral injury in 2020.
However, upwards of 94 percent of players do return to play and there is not a drop off in performance once returning. Career lengths are shortened somewhat, playing up to three years after the injury, but this may be a natural progression for Milano as he is getting older.
Fellow Bills defensive player DaQuan Jones also suffered a biceps tear in 2017 with the Tennessee Titans and has come back to play at an incredibly high level.
Update:
I was unable to find anyone in season that suffered the injury and returned within the same season. However, two recent examples were close. The first one is former Patriots LB Matt Judon who tore his right biceps in Week 4 during the 2023 season.
He had said he would return in two months and after the season stated he was on track to play but the Patriots shut him down. He went on to state he would have been ready in 19 weeks later.
The other person is Chargers OT Rashawn Slater. He tore his left biceps in Week 3 of the 2022 season and was removed from IR ahead of the playoff game versus the Jacksonville Jaguars. Had they won, he would have played.
A return can be done but the timing of the injury is key.
UPDATE: November 30, 2024
Final Thoughts
This is incredibly unfortunate especially after all the work that Milano did in returning from his leg injury. The leg injury and this latest one have no correlation but his body may be breaking down from all the years of high level football.
Let’s hope that he beats the odds and can return in a shorter timeframe for the Bills to make a deep playoff run. I wish Matt Milano the best of luck in his recovery this season.
Top Photo Credit: Getty Images
