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Medical analyst: Pain likely biggest factor in return of Taylor, Benjamin

Bills quarterback Tyrod Taylor and top wide receiver Kelvin Benjamin will attempt to return from knee injuries this weekend as the team looks for a win against the Colts to keep its playoff hopes alive.

Limitations from pain – as opposed to risk of reinjury or reduced function of the knee – will likely be the biggest factor in each player’s return to action, according to NBC Sports Medicine Analyst Mike Ryan, who spent more than 30 years in the NFL as an athletic trainer.

Taylor was carted to the locker room during last Sunday’s game with a patellar tendon contusion, which was caused by a hard fall on a bent knee in the first quarter. Bruising the structure, which connects kneecap to the tibia, is a bit unusual, Ryan said, because more often that not the kneecap takes the brunt of the blow, but the tendon is known for its strength.

“The important thing there is the tendon’s strong,” Ryan said in a phone interview. “There’s a lot of force going through that tendon, so maintaining quad strength is key, and that typically will come down to pain management – keeping it quiet to do what he needs to do, because especially in his position as a stop-and-go, change-of-direction, burst-of-speed kind of guy, pain is going to be a big issue.

“A lot of times,” Ryan added, “when they reconstruct the ACL, they use a third of that patella tendon, so that just shows that it’s a very strong structure. If only one-third of that is able to stabilize what the ACL would do, that gives you a sign of how strong that tissue is.”

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Benjamin’s meniscus tear, suffered on Nov. 19, is potentially a more complex injury. The meniscus is shaped like a ‘C’ on both sides of the knee and is thicker on the outside, so the size and location of the tear can have a significant impact on the degree it affects an athlete. Benjamin said last week that he did not have surgery for the injury, which Ryan said only happens in a limited number of cases.

“The best analogy I use it is, it’s like a tear in the carpet,” Ryan said. “If you have a tear in the carpet and it’s right in front of the front door and every time you hit it, you trip on it and a flap gets loose and it starts tearing up and fraying, that’s a problem. But that very same tear over in the corner by the dresser that you may step on once a month is not a big deal.

“Just to have a meniscal tear does not mean you need to have surgery on it. And even if you did, a very small percentage of those are actually repairable. So when someone has surgery on the meniscus, the question is, did they trim it or did they repair it? Easily, nine of out 10 of them are going to be trimmed and not repaired.”

An above view of a knee meniscus, which is C-shaped on both sides (Via Wikipedia, through public domain)

A repair to the meniscus is only possible if the tear is on the outer rim, Ryan said, because that is the only area that receives enough blood supply to heal itself. Otherwise, surgery would only be used to clean up a piece of the torn cartilage that is getting in the way.

“So a majority, a vast majority (of tears), are in the main part of the meniscus that cannot repair itself,” Ryan said. “So you kind of play with it as-is, or if it really becomes symptomatic, you got in and get it trimmed down. But you’d be surprised how many people – us too, general laymen – as you get older, have meniscal tears that are very manageable.”

Differences in the size and location of the tear, as well as previous injuries to the area, make each meniscus tear unique, Ryan said, but competitive athletes can usually return from them close to 100 percent with an ailment that is very manageable.

“If you did surgery on every meniscal tear you have, you’d be doing a whole lot of surgery,” he said. “It’s very much about, you get the quad strong, you work on the range of motion, you control some of the things he’s doing, compression sleeves, sometimes a brace; there’s a lot of little ways, tricks of the trade, that you can work to manage that.”

Benjamin is under contract with the Bills for one more year. Could he require surgery in the offseason because he played on the injury? Not exactly, Ryan said.

“To say you’re going to play on it and it will definitely get worse and you’ll definitely need surgery? No,” Ryan said. “Each individual meniscal tear you treat individually based on the player and how they handle it. Does it limit them? Is it symptomatic? … When players say something keeps catching in the joint, getting in the way, that’s usually a telltale sign that it’s usually a bigger flap and now it’s mechanically interfering with the joint.”

Benjamin will be a limited participant in Wednesday's practice, coach Sean McDermott said. Taylor will be held out, leaving Nathan Peterman to take the first-team reps and Joe Webb to work in with the backups.

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