Injury wise, things are slow right now at One Bills Drive and I couldn’t be happier!! If you read my last post, you were able to see that the Buffalo Bills have so far been very fortunate keeping the injuries to a minimum. Jury is still out on whether it is the practice habits of Sean McDermott and company or if the football gods have mercy on all that is Buffalo. If the fans have to suffer through 2 preseason losses with 10+ penalties a game or a star player going down with a season ending injury, I’ll gladly take the former. As there have been no serious injuries to report, I have been able to look at nagging injuries such as Cordy Glenn and recoveries such as Reggie Ragland. Today’s post will evaluate TE Charles Clay knee complaints.
Charles Clay was drafted by the Miami Dolphins in the 6th round of the 2011 NFL draft out of Tulsa. Clay spent four productive years in Miami, after which time, during the 2015 off season, signed a five-year, $38 million contract with the Bills to add a new dimension to the passing game. Going into his 3rd year with the Bills, Clay has managed to play 27 of a 32 possible games for the Bills, bringing in 105 receptions for 1,060 yards and 7 TD’s. However, since Clay has come to Buffalo, the games and practices that he has missed have been due to knee complaints.
The fact that Clay only misses practice and occasional games immediately eliminates the possible serious injuries such as fractures and ligament tears. This allows creates the possibility of chronic conditions leaving several to consider. Sports Injury Predictor lists all of Clay’s significant injury history and Fox Sports lists when he has been on the weekly injury report. Most of his injury history consists of his knee along with occasional back, hamstring, and calf injuries. Knowing what is published from media reports, this is a chronic condition. Reports from various sources that can be found from ESPN, The Phins Insider, and Palm Beach Post all indicate that this has been an ongoing issue, that there have been complications, but never identify the exact injury.
Diving into the differential diagnosis of the possible complaint, there are several options. I have already ruled out serious ligament damage or fractures. There are other possible diagnosis that do not warrant consideration at this time due to unlikelihood or rarity. This leaves 3 potential diagnosis to consider: Osteoarthritis, meniscal injury, or knee bursitis. Osteoarthritis, known generally as arthritis, is a degenerative condition in where the ends of the joint are covered in a smooth material called articular cartilage. This material is found on the ends of every freely moving joint surface in the body. Over time, this cartilage can wear down due to injury and poor management/healing. Studies have been performed demonstrating that consistent exercise and proper injury recovery over time can help keep these joint surfaces healthy. This supports why not everyone requires knee replacements once they hit a certain age. In addition, my clinical experiences have shown that arthritic knees do not swell up rapidly and often, especially at Clay’s young age. Unfortunately, this may be an expected outcome once Clay’s playing days are completed. He may already have some degenerative changes, but I can say with strong certainty that this is not the source of Clay’s complaints.
Another diagnosis that is a strong consideration is meniscal injury. This diagnosis is possible due to his known surgical history from 2012 to repair a torn meniscus which sent him to the IR while with the Dolphins. The meniscus acts as a shock absorber in the knee, helps disperse weight between the femur and tibia, and maintain structural integrity during movement. However, a repaired meniscus typically would not cause chronic issues for 4+ years in my professional experience. Clay did have an arthroscopic surgery during the 2014 off season to clean out his knee which most likely cleaned out any loose bodies or shaving down the meniscus due to fraying. He was cleared to practice shortly after, but then began experiencing further complications limiting his practice during the preseason. However, if he were to have a meniscal tear or fraying, the surgery would have corrected it and would not continue to have chronic issues.
This leaves knee bursitis as the reasonable diagnosis. Bursitis is a condition in where the bursa in the joint becomes inflamed. Bursa are fluid filled pockets in the joint that secrete a fluid known as synovial fluid which helps keep the joint lubricated and reduce the friction between joints. Think of the effects of motor oil in an engine. Sometimes, when a separate injury occurs, the bursa in the injured joint can become inflamed as a result. Returning back to practice sooner than expected could add extra stress to the joint and cause swelling. Direct blows to the knee can also cause the bursa to become inflamed, such as falling directly on the knee or striking it against a helmet/body part. There are multiple bursa around the knee resides that could be damaged. Surgery could be performed to remove the offending bursa, but this may cause the player to miss more time than expected and is rarely performed. This can be a chronic condition that takes some time to resolve.
I believe this is the appropriate diagnosis due to this supporting articles from ESPN and The Buffalo News. This indicates that it is knee bursitis due to repeated swelling and drainage, the lack of immediate concern, and his ability to play most games despite the current complaints. At worst, it is an annoyance which can cause pain, swelling, and keep Clay from producing on the field. If you would like additional information on knee bursitis, you can find them here, here, and here.
Having been to Bills preseason practice along with observing game film and pictures, Clay has not been seen wearing a bulky brace, indicating possible joint instability. Instead, he is seen wearing a neoprene sleeve, allowing for compression of the joint and reducing the possible incidence of recurring swelling during strenuous activity. Clay’s production has not been significantly slowed compared to others at his position. Considering the amount of money that Clay is paid, it is the public expectations that he produces at a greater output. It would also be beneficial if Tyrod Taylor were able to improve his passing abilities, but that’s a discussion better left to my friends at The Rockpile Report.
Considering that Clay hasn’t missed any games yet this preseason and has only been slowed at practice, this is not a cause for concern. However, the team must continue to effectively manage the knee so as not to exacerbate it and cause further complications. He may be dealing with something that is not aware to anyone but him, the coaches, and his doctors which if known, could drastically alter my thought process and discussion. I believe that Clay will be able to perform at a consistent level this season, occasionally requiring down time to ensure that he does not create further damage to the knee.