NFL Injury Analysis: Ankle Injuries Abound in Week 13

Kenny Pickett and Rhamondre Stevenson

The Steelers quarterback will be out for an extended period of time after suffering a high-ankle sprain that required surgery to stabilize. The term high ankle is used when the damage occurs at the distal tibiofibular (tibfib) joint. Here the distal ends of the two lower leg bones form a roof over the talus. The joint is fortified by ligaments and connective tissue known as the syndesmosis. If these structures are sprained, then the injury is classified as a syndesmotic or high-ankle sprain. 

Pickett's injury was significant enough to require a surgical procedure known as a TightRope Fixation. In the approach, a specialized type of surgical cord is used in lieu of surgical screws. The TightRope is placed across the tibia and fibula, fortifying the tibfib joint and closing any separation that occurred at the time of injury. With the bones properly aligned, the soft tissue injuries are better positioned to heal.

Pittsburgh has opted not to place Pickett on the injured reserve, making it possible for the quarterback to return in under four weeks. The current estimate is two to four weeks, though a return on the latter end of the window remains most likely. Quarterback Tua Tagovailoa underwent a TightRope procedure while at Alabama and returned in 28 days. Just this season Georgia tight end Brock Bowers returned 26 days after his surgery. The most comparable NFL case occurred in late last year when Titans quarterback Ryan Tannehill underwent surgery to address a high-ankle sprain. Unfortunately, Tannehill was unable to return in-season with the injury happening in late December.

Mitch Trubisky will start at quarterback with Pickett sidelined.

Stevenson also suffered an ankle injury in Week 13, leaving the Patriots' loss to the Chargers in the first quarter. The Patriots remain unsurprisingly tight-lipped on specifics, though the mechanism of injury suggests a possible high-ankle sprain. There has been no mention of surgery, though Stevenson did not participate in Monday's practice, and his availability for Thursday's game against the Steelers is in doubt. Ezekiel Elliott would start in Stevenson's absence, though he has been limited by a thigh injury recently. Elliott is worth a speculative add if you are in need of running back depth, but expectations should be scaled back. The former All-Pro has rushed for more than 55 yards just once this season and has not scored since Week 7.

Turf Burns

Derek Carr: The Saints quarterback is back in the concussion protocol for the second time this season. As discussed last week with Carr's teammate Chris Olave, the effects of multiple concussions are accumulative. As a result, an injured individual may exhibit more serious or longer lasting symptoms. Furthermore, Carr also suffered a rib injury that only complicates his already tenuous overall health. Jameis Winston seems likely the probable starter for New Orleans in its Week 14 games against Carolina. 

Amari Cooper: The veteran wide receiver is also in the concussion protocol after sustaining the injury in the Browns' loss to the Rams. Like Carr, Cooper does have a history of concussions though his last head injury occurred in 2017. He will have a full week to complete the protocol, though the majority of receivers to sustain the injury miss at least one week of action. 

Derrick Henry: Unlike Carr and Cooper, the Titans running back avoided the concussion protocol despite leaving with an undisclosed head injury in Week 13. Coach Mike Vrabel told reporters Henry reported no symptoms Monday morning and was able to work out. As a result, Henry will not be required to complete the five-step return-to-play protocol and will be able to prepare for the team's Week 14 game in Miami on Monday night without limitations. 

Tank Dell: The Texans receiver suffered an ankle injury, though his issue involved a fractured fibula. The break required surgery to mend, and Dell will not return this season. Dell's absence is a big blow to quarterback C.J. Stroud, who will finish the year without his fellow rookie. Robert Woods and Noah Brown should see an increase in targets.

Trevor Lawrence: After spending most of Monday writing about multiple ankle injuries, I wasn't surprised when the Jacksonville quarterback limped off the field on Monday night. The preliminary findings on Lawrence's ankle confirmed a sprain, though he will undergo additional testing Tuesday to determine the severity of the damage. Sprains are graded on a scale based on the amount of damage accrued by the involved ligament. A low-grade or mild sprain occurs when the ligament fibers are stretched but remain intact. Damage in these sprains is often isolated to the microfibers of the ligament. Grade 2 or moderate sprains are also called partial tears, as true fibers that make up the ligament are torn. Anything higher often means a rupture or total tear and can require surgery to mend. A low-grade sprain would be a best-case scenario for Lawrence but could still result in a multi-week absence. Keep an eye out for more specifics here, but C.J. Beathard is the likely starter for Week 14.

Justin Jefferson: The return of Jefferson has finally arrived. The Vikings receiver is expected to return to action after missing seven games with a hamstring strain. The team wisely slow played his recovery and that should help mitigate the risk of reoccurrence. Even with the slight uptick in risk, Jefferson remains a must start in all formats.

Christian Watson: Just as Minnesota preps to get back Jefferson from his hamstring strain, its division rivals have lost their top receiver to a similar injury. The Packers wideout went down with a hamstring strain on the final drive of the team's win over the Chiefs. The injury is Watson's second of the season as he strained the same hamstring in September. He missed Green Bay's first three regular-season games recovering. Tests are ongoing on the injury, though a multi-week absence should be anticipated. Even if the strain is mild and he is able to practice this week, the Packers play the Giants on Monday, making him a risky investment for Week 14. Romeo Doubs and rookie Jayden Reed would move up the depth chart if Watson is out.

Brian Robinson: The Commanders running back also suffered a hamstring strain in the team's blowout loss to the Dolphins. Though Robinson does not have a lengthy history of lower extremity strains, his availability for Week 15 will depend on the severity of his strain and how the muscle responds during the bye week.

Zach Charbonnet: The Seahawks running back suffered a knee contusion against the Cowboys and has been limited in the subsequent practices. There has been no confirmation if this is a bone contusion or a soft tissue contusion, but both can be limiting due to the biomechanics of the knee. He will need to log a practice or two before I would feel confident using him, and even then, he will be facing a tough 49ers defense. Only Philadelphia has surrendered fewer points per game to opposing running backs. Teammate Kenneth Walker is also progressing from his oblique strain and could be available as well.