Orthopedic surgeon explains the intricacies and long-term outlook of Joe Burrow's wrist injury

In a perfect world, Burrow is never taken to the ground by pass rushers and is just using his wrist to throw touchdowns. Even then, soreness will persist for the next several months purely from throwing. 

The real risk involves reliving the same scenario that caused the torn ligament in the first place.

Bracing for contact against the ground on sacks is what can really complicate Burrow's long-term outlook. The force applied to the recovering ligament is a lot more stressful than throwing thousands of passes throughout practices and games.

"That's why his contact is going to be limited," Dr. Kutsikovich said. "That's why it's a gradual return to throw and the good thing for him is that throwing is a little less force on the wrist. It's going to be the body weight fall contact — that's going to be the first test.

"Throwing is not high stress on the wrist, per se. But bodyweight contact on the wrist? The first joint that gets stressed is the wrist. Ultimately the wrist kind of bears the brunt of a fall and the question is how is his body going to respond to the first few hits? The first few preseason games or scrimmages that they have with other teams in the preseason, how is he going to respond to that?" 

Burrow mentioned to media members that he'll be cleared for contact "within the next month," but actually taking on contact until the preseason at the absolute earliest is not happening short of Burrow being assaulted in a non-football setting. It's a scenario the team can be patient with for at least a few more months as he builds back confidence throwing. 

No one could've questioned Burrow if his confidence in going through the recovery wasn't 100%. He revealed that he couldn't find any other quarterbacks who've gone through this kind of injury, only linemen and some linebackers. That's not too surprising considering how it usually happens on the field. 

"The reason why not a lot of other players or quarterbacks have experienced this [injury] is usually it's a much higher energy-type injury," Dr. Kutsikovich said. "Linemen, obviously [their] body weight, another lineman fallen on them, you'll experience a lot more force versus his own body weight or just another person coming down on that wrist. That's why it's a little bit more rare of an injury and in general, this is a little bit more rare of an injury than let's say a fracture or other types of ligamentous injuries in the wrist. So that's why he hasn't really encountered any quarterbacks with this."

A rare injury for Burrow's position is just one layer of complexity. The other is a smidge more concerning.

"The big long-term problem with this specific injury is the results of the repair are not as consistent with the results of repairs in let's say, other joints," Dr. Kutsikovich said. "If we're talking about let's say his knee, he had an ACL tear, the results are pretty consistent and especially in a quarterback with an ACL repair can still function at pretty much the same level they were at before the ACL. That's because the results of reconstruction of ACLs are very consistent. They're successful, it's a good surgery."

Dr. Kutsikovich explained that orthopedic surgeries usually have 90-95% success rates. A scapholunate ligament repair surgery is a bit lower at about 75-80%.  

"The scapholunate ligament is a very small structure," Dr. Kutsikovich said. "So when you're talking about repairing small structures or even reconstructing small structures, it just makes it a little more challenging because it's a lot harder to repair those smaller structures. You're putting stitches in something that's a lot smaller, it has to heal down to a smaller space. You don't have this broad healing footprint. That means the results of the surgery are a little bit mixed."

A successful surgery varies depending on what motion parameters you're working with, and what type of labor the patient conducts.

Burrow being able to throw with what appears to be his regular form and velocity is a great sign towards his recovery being a success, but the journey is far from over.

On top of inflammation from the ligament stretching out, a re-tear of the ligament would lead to reconstructive surgery, which is more severe compared to the operation he already had done.

"The results of the reconstruction are a lot worse than the results of the repair on the front end," Dr. Kutsikovich said.

Re-tearing the same ligament, no matter what ligament it is, is typically an unfortunate outcome. Burrow and the Bengals already deal with this fear regarding his left knee that got tore up four years ago. It's a physical game, and Burrow's already been put through the ringer. 

But while there are risks with him re-damaging his wrist with the hits to come, the notion that he won't be able to throw like he did prior to the injury is unfounded. 

"The good thing about this overall is that a lot of wrist injuries can be temporized and managed, without necessarily affecting him long term," Dr. Kutsikovich said. "Because so much of the power in the throw comes from the other joints in the body. So I do think that he'll probably be able to manage long term any sort of issues that arise in the future." 

Toeing the line between getting ready for the season and keeping his wrist in good shape will make for an interesting four months for Burrow.

If all goes to plan, there should be zero doubt about him making the same throws he's accustomed to making.