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Injury analysis: new Bills OT Daryl Williams

Is there concern for Williams following his season-ending knee injury in 2018?

Washington Redskins v Carolina Panthers Photo by Jacob Kupferman/Getty Images

As most Buffalo Bills fans know, team owner Terry Pegula made his fortune in natural gas and has a long history in the oil business. Natural gas made the Pegulas a lot of money and they have the pipelines to show it. If this Carolina to Buffalo pipeline pans out, it could play a key role in the Pegulas hoisting the Lombardi trophy soon—the ultimate jackpot. The latest payoff from that pipeline: former Carolina Panthers OT Daryl Williams. The veteran tackle signed a one-year deal on Thursday afternoon.

Below is a medical breakdown of Williams and my take on his signing.


Drafted out of Oklahoma in the fourth round by the Panthers. Appeared in ten games, starting two. During Week 1, he suffered a right sprained MCL injury that cost him five games early on in the season. In the article, it states that he had someone fall into the back of the knee, causing the sprain. The article also states that he suffered a similar injury during his time at Oklahoma and that his college injury was worse. He was able to return midway through the season and helped Carolina reach the Super Bowl.


Appeared in 13 games, starting ten. An ankle injury during Week 11 against the Oakland Raiders appeared to be a left ankle sprain. He required a walking boot following the injury that ultimately cost him three games, but he was able to return to finish out the season. Considering he missed three games, it could have been a mild high-ankle sprain but, ultimately, no way to tell now.


Following seasons where knee and ankle injuries cost him a total of eight games, Williams was finally able to grab a hold of a starting position and not let it go. He appeared and started in every game that season. In addition, he also managed to avoid any reported injuries, making it through the season healthy. As a result, he garnered second-team All-Pro honors.


Despite 2017 being such an excellent year for Williams, 2018 was the complete opposite. Early in training camp, Williams tore his right MCL and dislocated his patella. Surprisingly, he recovered well enough to start Week 1 before re-injuring the knee in the fourth quarter. Following the game, he was placed on injured reserve, ending his season.


Williams was able to appear in all 16 games and started 12, suffering no known injuries. He demonstrated the ability to return to form prior to his season-ending knee injury.

Bills Impact

Overall, Williams has had an ankle injury and two knee injuries that have cost him a total of 23 games over four seasons. The ankle injury appears to a garden variety of ankle sprain or mild-high ankle from the sources available and isn’t a big deal.

Suffering two similar injuries to the right knee that cost him 20 games is somewhat concerning. Fortunately, both times he sprained his MCL—which is the big, thick ligament that runs on the inside portion of the knee. This provides medial stability to the knee during valgus forces such as cutting or pivoting and helps ensure the knee acts as a hinge joint.

This is a commonly injured ligament in the knee and heals up exceptionally well. It typically doesn’t require surgery except in severe cases. Chronic injuries are classified as instability lasting more than three months to the area that can occur, which can increase the incidence of future injury. If this occurs, then there is a greater likelihood that there is an ACL tear present. If there’s not an ACL tear present, further injury to the MCL could put the ACL at a much higher risk. Fortunately, Williams had several years in between the injuries, decreasing the concern.

Obviously, the big concern is the dislocated patella. This is an injury very similar to what quarterback Patrick Mahomes suffered last year. We know the patella slid out laterally due to the forces required to sprain the MCL. The knee buckled inward and due to the ligaments that help keep the patella in place, pulled the patella laterally to the outside of the knee. As a result of the forces, the medial patellofemoral ligament was either completely torn or severely damaged.

While the MCL typically does heal well on its own without surgery, the patella in some cases can heal on its own—which is the route Mahomes took. Williams was able to rehabilitate the injury through training camp, taking six weeks to recover. Though he was able to return for and start Week 1 against the Dallas Cowboys he re-injured the knee late in the game and wound up on injured reserve, having surgery to the area.

Rehabilitation can take anywhere from 4-7 months following the surgery according to rehab protocols and associated damage in the area. The medial patellofemoral ligament acts as a stabilizer along with the other patellar ligaments that allow the patella to act as a fulcrum in the knee during flexion and extension. If that fulcrum is not steady, then the patella is more likely to dislocate and prevent the knee from functioning properly.

Williams could have taken more time off to rest and recover following the second injury, but then he would have just been pushing his recovery timeline and possible surgery later, risking his ability to return fully healthy the next season. Furthermore, once a dislocation of the patella occurs, 15-44% of people suffer another dislocation. Once two dislocations occur, the rate of incidence increases to 49% for future dislocations. Once surgery has been performed, the rate to re-dislocate drops to a mere 2%, indicating excellent outcomes.

I do recall performing research on Williams last year when the Bills were kicking the tires on him. I wasn’t crazy about him following the 2018 injury, but the research above indicates that he was going to heal fully. His 2019 season allowed him to prove that and also showed his versatility playing along the line at left tackle and both guard positions.

His history of MCL injuries is not concerning; knee sprains happen, especially in the trenches. The research shows that the patellar dislocation has been addressed and should not cause problems going forward. Finally, the signing for one year allows him to earn a bigger contract if he plays well but also minimizes the risk if he doesn’t pan out. Ty Nsekhe is getting older and Cody Ford is still very raw. The guard positions are strong in Jon Feliciano and Quinton Spain, but the team did at times have to shuffle the line around due to injury. A veteran who can play multiple spots and has shown to play at a high level is invaluable.

Despite the injury history, this is a great signing all around and even if he doesn’t make the 53-man roster, he could still be traded later for assets if needed. Say what you want about the Carolina pipeline, but it continues to pay out in dividends.