Jaylon Smith: A Dark Prediction?

[plasticman]

I maintain my consistent position:

Show me.

 

[waldoputty]

"Complete palsy" includes several types of nerve injury ie severed nerves or where the outer nerve is damaged. Given the outer nerve was intact he had axonotmesis and not the more severe type 3+ injuries which you're including.

What does the literature say about axonotmesis because the literature I read had a much better prognosis that 1 out of 3?

I found the study: http://orthodoc.aaos.org/immerman/LE Nerve Trauma - Immerman HJD Bull 2014.pdf

Its prognosis for axonotmesis is stated as variable but in a table it states prognosis is good (not full).

It further states "The rate of full recovery of partial peroneal palsies ranges from 76% to 87%, and the rate for spontaneous recovery of complete lesions ranges from 20% to 35%. Caution should be used when interpreting these outcome studies, as none of these series specified the extent of “partial” recoveries or specifically defined what is meant by “incomplete” injuries, which makes it difficult to compare results"

It goes on to mention the study some of us are familiar with:
"A recent large series by Kim and coworkers reported excellent results for neurolysis alone; there was an 88% rate of functional return in all neurolysis cases and 93% (65/70) in cases of nerve stretch or contusion.26 Direct repair had an 84% rate of useful functional recovery, and grafting resulted in a 75% success rate for graft lengths less than 6 cm dropping sharply to 16% to 38% with increasing graft lengths"

I presume Jaylon falls under spontaneous recovery since I do not believe neurolysis or direct repair was needed. That makes the paper seem really strange in that only spontaneous recovery rate of 20%-35%, but yet surgical repair resulted in 75%-84% rate of useful functional recovery in probably more serious cases.

The big question is really what spontaneous recovery means.

 

[waldoputty]

you ignore the recent reports on Smith. So trying to claim NOW the odds are against him playing is frankly weak.

The study he quotes is real and please no one accuse this member of anything unfair. He is almost definitely a professional in the field.

I do question the interpretation of the study in Jaylon's specific situation however given the way the paper reads. Specifically, the study seems to indicate the prognosis for worse injuries with surgery than less severe injuries that do not need surgical intervention.

 

[Joe Realist]

I predict he will play in the last 3 games of 2017

 

[speedkilz88]

I predict he will play in the last 3 games of 2017

I predict he'll be playing in game 1.

 

[JBS]

you ignore the recent reports on Smith. So trying to claim NOW the odds are against him playing is frankly weak.

This post makes no sense...

He's going against what all the other reports are saying..so his stance isn't weak whatsoever..it's strong

 

[Wood]

Not sure how credible this is . . . but some of the analytical points are worth noting . . . .

"Recovery from nerve injury is usually early or not at all.
At this point medically, it appears there is no way for the nerve to ever be 100 percent.
Smith has blown through the reported recovery estimate already, as his doctor initially indicated a three-month timeline from April of 2016. No question he had a top surgeon, who happens to be the Cowboys team doctor, but there is not much one can do about a nerve. It either does or doesn’t recover."

http://www.sandiegouniontribune.com...oys-nerve-update-minicamp-20170509-story.html

really not worth debating until training camp. Everyone has spoken.

 

[speedkilz88]

No.

And by that statement alone, he identifies himself as ignorant of traumatic neurologic injury syndromes, which have been presented and discussed on this site ad nauseum.

Doc nails it here. //end of thread

 

[big dog cowboy]

Training camp can't get here soon enough.

 

[waldoputty]

I'm a doctor (though not an orthopedist) and I've looked into the subject a bit. Things I would note:

1. Dr. Chao is very qualified to discuss this topic, however, complete peroneal nerve palsy after total knee dislocation is a rare event, even for an orthopedic surgeon specializing in sports medicine. A 2014 meta-analysis of all published studies found only 214 documented cases in the literature. Of course, most cases are not published, but even still Dr. Chao has probably not personally seen enough patients with this condition all the way through their rehabilitation process to be able to statistically give an accurate assessment of their outcomes.
2. Looking through the literature, in a pt with complete peroneal palsy clinically there is about a 1/3 rate of adequate (not FULL) recovery. However, this includes patients that have persistently negative findings on EMG/NCS and clinical exam (which does not include Jaylon). Furthermore it includes pt with known severing of the nerve (this does not include Jaylon).
3. If patient demonstrated no neurologic recovery on EMG/NCS, they would not have continued to observe him for as long as they did. Jaylon mentioned early on that they did a test that had good news, likely implying that there was detectable nerve conduction even if there was no clinical improvement. That is why they continued to observe him. The prognosis in these patients is considered "good" in the literature I saw, but I'm not sure there is any study to document an exact rate of recovery. He now has FNC 1-2 reportedly (can move toes); 3 is considered "good" recovery

I think Jaylon has a good chance of reaching FNC 3 (meaning he can lift his foot off the ground against gravity). His chances of reaching full strength I think is pretty low. To what degree he is able to play football and at what level is also completely unknown. Dr. Chao notes that very few players have come back from this injury in the NFL. He fails to note that very few players have HAD this injury in the nfl. So who can and can't come back is not completely known.

I agree that people need to pump the brakes. The odds are still very much AGAINST Jaylon Smith. But I think he is exaggerating the degree of pessimism.

I have a couple questions about your post.
It has been reported that Jaylon has already been able to lift his foot.
Does that not already put him in FNC-3?
The additional information is that he is quickly improving - quoting a test that improved by 5X in one week.
I presume that is an EMG that is improving by 5X a week (but we dont know the starting point) - but does that not actually suggest he is heading to a good or complete recovery (FNC-4 to 5)?

 

[Section446]

Honestly not expecting for him to ever contribute at this point.

 

[FuzzyLumpkins]

I found the study: http://orthodoc.aaos.org/immerman/LE Nerve Trauma - Immerman HJD Bull 2014.pdf

Its prognosis for axonotmesis is stated as variable but in a table it states prognosis is good (not full).

It further states "The rate of full recovery of partial peroneal palsies ranges from 76% to 87%, and the rate for spontaneous recovery of complete lesions ranges from 20% to 35%. Caution should be used when interpreting these outcome studies, as none of these series specified the extent of “partial” recoveries or specifically defined what is meant by “incomplete” injuries, which makes it difficult to compare results"

It goes on to mention the study some of us are familiar with:
"A recent large series by Kim and coworkers reported excellent results for neurolysis alone; there was an 88% rate of functional return in all neurolysis cases and 93% (65/70) in cases of nerve stretch or contusion.26 Direct repair had an 84% rate of useful functional recovery, and grafting resulted in a 75% success rate for graft lengths less than 6 cm dropping sharply to 16% to 38% with increasing graft lengths"

I presume Jaylon falls under spontaneous recovery since I do not believe neurolysis or direct repair was needed. That makes the paper seem really strange in that only spontaneous recovery rate of 20%-35%, but yet surgical repair resulted in 75%-84% rate of useful functional recovery in probably more serious cases.

The big question is really what spontaneous recovery means.

It was not a complete lesion. The exterior was intact.

 

[FuzzyLumpkins]

93% (65/70) in cases of nerve stretch or contusion.26

That is what applies.

A complete lesion would not leave the exterior intact.
He did not have a repair because of the above.
There was no need for a graft.

 

[waldoputty]

That is what applies.

A complete lesion would not leave the exterior intact.
He did not have a repair because of the above.
There was no need for a graft.

i think you are right.
what the heck was that spontaneous recovery thing then?

 

[waldoputty]

That is what applies.

A complete lesion would not leave the exterior intact.
He did not have a repair because of the above.
There was no need for a graft.

if you look in the paper, it goes into it some more.

of course no need for a repair or a graft but there was something else.

 

[speedkilz88]

i think you are right.
what the heck was that spontaneous recovery thing then?

I'm guessing here, but I think it's meaning severed or extreme damage and the nerve repairing itself. Which would explain the low percentage.

 

[FuzzyLumpkins]

i think you are right.
what the heck was that spontaneous recovery thing then?

Basically it was saying that if the entire nerve is damage ie interior and exterior then it will only repair itself to functional strength on its own 1 out of 3 times or whatever it was. At that point you would expect physicians to recommend surgery.

 

[waldoputty]

Basically it was saying that if the entire nerve is damage ie interior and exterior then it will only repair itself to functional strength on its own 1 out of 3 times or whatever it was. At that point you would expect physicians to recommend surgery.

1 out of 3 in that case is pretty darn good.
i dont think they broke out the different categories in the stats.
the paper is reads slowly so only pulled what i thought were the relevant sections.

 

[waldoputty]

I'm guessing here, but I think it's meaning severed or extreme damage and the nerve repairing itself. Which would explain the low percentage.

yes i think you and fuzzy agree. it is rather strange how the paper presented the data. it is almost strange to talk recovery when you combine all these different scenarios in the stats...

but the poster did point it out also.

 

[SportsGuru80]

I'll take this with a grain salt....