TUSCALOOSA — Optimism seems to surround Alabama quarterback Tua Tagovailoa, even as he was in a hospital bed this weekend awaiting a potential career-altering surgery Monday morning.
His own head coach couldn't help feel better about everything after talking to the former Heisman Trophy runner-up.
"I don’t think there’s any way that any of us can say we won’t miss that spirit that he has," Nick Saban said Monday. "The first thing he says to me (Sunday) night when I tell him, ‘Good luck with your surgery,’ he said: ‘Well, I just can’t wait to get back and see the game on Saturday.’"
While many remain hopeful regarding Tagovailoa's successful future in football — including Alabama team physician Dr. Lyle Cain describing his prognosis as "excellent" — other orthopaedic experts acknowledged the lengthy and complicated recovery process involved for him to achieve his lifelong dream of playing in the NFL.
“Even with the perfect surgery and all that kind of stuff, there’s still some sort of questions about the outcome and that he doesn’t have any of the complications that can come with it,” Dr. Walt Lowe, the chief of orthopaedic surgery at Memorial Hermann in Houston, where Tagovailoa underwent his surgery, told the Montgomery Advertiser on Saturday.
“We’re all eternal optimists as surgeons that take care of these guys, (but) I always tell my fellows — and this is a little tongue-in-cheek — that it’s better to have great genes than a great surgeon, though it's best if you have both,” Lowe added. “And this is one of those situations that even with a great surgeon and a great surgical result, you don’t know the outcome of it for a while.”
Also potentially helping Tagovailoa’s case is that it was a low-energy or low-speed injury as opposed to it occurring in a high-speed motor vehicle accident, “because the traumas aren’t as extreme,” Lowe said, “so there’s no reason not to be positive about it. It’s just there’s some uncertainty that comes along with it.”
It’s the potential complications that make predicting a complete or full recovery back to pre-injury conditions difficult to determine at the moment.
“The thing that makes it uncertain is that when the hip dislocates and it fractures off part of the cup part of the hip joint,” Lowe said Saturday. “Sometimes it disrupts the blood supply to the end of the femur — the lower leg part of the hip joint.”
That is what is called avascular necrosis (AVN) and is what forced legendary Auburn running back Bo Jackson to retire from both football and baseball in the early 1990s, and eventually led to severe arthritis and the need for a hip replacement at the age of 29.
"The Bo Jackson (situation) is the outlier, not the norm. That is a possibility," said Dr. Mark Adickes, a former NFL offensive lineman, practicing orthopedic surgeon and medical expert for ESPN and DirecTV's FantasyZone. "And for a guy that is the potential No. 1 pick in the NFL Draft, that's a scary thought."
AVN is certainly the worst-case scenario for Tagovailoa, and one of the reasons for the quick response by doctors. It is believed that because Tagovailoa’s dislocated hip was reduced within minutes of the injury occurring Saturday, it’s less likely there was much or any disruption of the blood supply to the femur.
That said, even the slightest reduction in proper blood flow to the femoral head — the upper end of the thigh bone — can still result in AVN and lead to rapid degeneration of the bone itself, which in turn causes the articular cartilage surrounding the ball joint to collapse and leads to severe arthritis unless the joint is repaired/replaced.
"That might ruin his hip joint and make playing football impossible," Adickes said. "Anytime you injure your hip, particularly there's a dislocation where the ball comes out, it can damage the blood vessels that feed the femoral head. Then what happens is the ball changes shape and your hip join degenerates very quickly."
Another complication is the fact that AVN isn’t immediately noticeable and can take three to six months to develop, requiring regular MRIs to monitor the hip's progress.
“The most critical time is the first six months, then after that, if he looks great, the odds get better and better that he’s not going to have that problem,” Lowe said. “But there’s some worry about it (as far) out as probably a year to a year and a half to two years, I’d guess.”
Whether or not his potential yearlong recovery timetable negatively impacts Tagovailoa’s potential draft stock, should the junior elect to turn pro after the season as many predicted he would prior to the injury, is yet to be fully realized.
Especially because, even under ideal circumstances, Tagovailoa isn’t expected to resume normal football activities for another six to nine months.
"It's an understatement to say that this affects his draft status, because it certainly does," Adickes said.
Tagovailoa will likely remain on crutches for roughly six weeks before progressing to weight-bearing rehabilitation and then an exercise program roughly three months out from surgery, which would be about the time of next year’s NFL Combine.
“This may be one of those things that makes you think that, hey, let’s let this heal and come back for a fourth year and let everything take care of itself from there too,” suggested Lowe, who acknowledged the complexities of such a decision. “The other side of that is, even with this injury … there may well be a whole lot of teams that are willing to take the risk that he’s going to be fine.”
While being the No. 1 overall pick might be out of the question at this point, Adickes believes Tagovailoa can still be a potential first-round option, or at worst a high supplemental draft pick next summer.
"Although he's a very athletic quarterback, he's also just an amazingly accurate passer with a strong arm and a great head on his shoulders. ... He has everything else going for him that would make him very desirable (to NFL teams)," Adickes said. "... (But) any time you have surgery, you're going to know you've had surgery. So it's not like his hip's going to be normal, but that doesn't mean he can't function normally — and I'm including his tremendous mobility. I think that can return as well."
Former Baltimore Ravens tight end Dennis Pitta suffered a similar right hip dislocation and fracture that Tagovailoa experienced during training camp in 2013 but managed to return to the field in Week 14 of that season and even caught a touchdown against the Minnesota Vikings. He suffered a second significant hip injury in a 2014 game against the Cleveland Browns, according to the Baltimore Sun, and went on to miss the entire 2015 season recovering. Pitta returned and played all 16 games in 2016, including 12 starts, but his career was never the same, and ended abruptly after a third hip injury in the summer of 2017.
But given the amount of money potentially at stake — this year's No. 1 overall pick, Arizona quarterback Kyler Murray, drew a $35 million deal with a $23 million signing bonus — Lowe suggested that the sheer timetable involved could open the door for Tagovailoa to ultimately return to Alabama as a senior to potentially ease any concerns NFL teams might have with the oft-injured quarterback.
“The thing that’s easy to say is if it healed and he’s done great, he’s come back and played starting in the 2020 season and has a great season," Lowe said. "By the time the Combine and the draft gets here for the 2021 season, if that was the case, all this stuff is water under the bridge and not an issue, for the most part.”
Contact Montgomery Advertiser sports reporter Alex Byington at email@example.com. Follow him on Twitter at @_AlexByington.