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Analyzing Buffalo Bills tackle LaAdrian Waddle’s quadriceps tear

A deep dive into the injury

NFL: Buffalo Bills-OTA Timothy T. Ludwig-USA TODAY Sports

The first casualty of Buffalo Bills training camp has occurred. Offensive tackle LaAdrian Waddle suffered a season-ending right quadriceps injury during Sunday’s practice. Reports indicated that he went down awkwardly during team drills and had to be carted off, unable to place weight through his leg. Adam Schefter of ESPN reports that this injury could take 4-5 months to recover. While not ideal, this is unfortunately one of the downsides of training camp.

The quadriceps is made up of four muscles on the anterior thigh region that work in unison to extend the knee straight using the patella or kneecap as a fulcrum. The top muscle, rectus femoris, assists with hip flexion but is not a primary muscle for this function. The quadriceps are vital for walking, running, jumping, kicking, squatting; nearly every football activity possible.

While there is no video showing how Waddle tore his quadriceps, based on the few details we have, there are several mechanisms of injury to choose from. They are:

1. Sudden deceleration of the leg (e.g. kicking),

2. violent contraction of the quadriceps (sprinting) and

3. rapid deceleration of an overstretched muscle (by quickly change of direction).

Reports indicate that he was performing a team drill—which doesn’t give us much. My assumption is that he suffered the injury working on a line drill, changed direction or lost balance, and went down. The foot was most likely planted and the knee was bent with a force being placed through the leg eccentrically that led to the sudden rupture.

This may have occurred due to blocking and pushing against someone/something else. The person or thing didn’t give, leading to Waddle being possibly pushed backwards, the quad muscle eccentrically contracted or tried to lengthen under tension. As a result, the tendon failed and the tear occurred, leading to the awkward fall. We do not specifically know if this was a quad tendon tear or a quad muscle tear but this appears to be more of a tendon tear given the timeline provided by Schefter.

To note, all of Waddle’s previous injuries did not have an impact on this current injury. This was simply forces greater than what his body could handle occurring and the tendon ruptured.

Unfortunately, he will have a lengthy recovery with surgery to repair the tendon that connects the quad muscle to the patella followed by immobilization to the knee for about four weeks with weight bearing allowed as tolerated along with the use of crutches. This is progressed to light exercises and gentle range of motion to work the healing tissues but not over-stress the area.

As rehab continues, increases in activity are allowed with greater ROM, more active range of motion within the limits of the bracing, strengthening and balance activities are incorporated. The main goal is to slowly increase the tissue loads but not overwork the quad tendon and cause further problems.

Criteria to return to running and sport specific activities after 16 weeks include equaling the ROM to that of the other knee, increase strength to at least >70% of the uninvolved side, no gait deviations, pain, or swelling during activity. Considering that once he is cleared to run and return to football activities, he would be at roughly five months—just as the timeline indicated.

Considering Waddle’s age and previous injury history, I expect that he makes a full recovery with no long-term complications. While this is an awful injury, the other possibilities such as ACL/PCL tear, tibial plateau fx could have been much worse and a longer recovery. As NFL studies on specific injuries are limited, this study from 2013 followed ten quadriceps tendon ruptures over ten years. Overall, 50% of those that suffered the tear returned to play in a regular season NFL game. However, with poor chances to make the Bills’ roster prior to the injury plus an entire year out of football it doesn’t bode well for him finding a home in 2020 if the Bills decide to move on.

Even though the Bills’ offensive line has been rife with injuries the past two weeks, there is still depth available and injuries are a part of the game. The Bills have been relatively lucky the past two seasons, avoiding most major injuries during preseason. Even the best training staff, the best medicine, and facilities can’t prevent all injuries. Best of luck to LaAdrian Waddle in his recovery and look forward to next season.