Analyzing Lucas Niang’s patellar tendon rupture — and his potential return

The last time Kansas City Chiefs fans watched offensive tackle Lucas Niang on the football field was over eight months ago during the 34-31 loss to the Cincinnati Bengals in Week 17.

Niang suffered a ruptured (torn) patellar tendon six plays into the game — and since then, the Chiefs have said little about the injury. Niang did not practice with the team in the offseason or at training camp, as he had been placed on the offseason’s Active/PUP (physically-unable-to-perform) list — and then as the season began, on the regular-season’s Reserve/PUP list. Under NFL rules, the earliest Niang could return to the 53-man roster is after Kansas City’s Week 4 matchup against the 2-1 Tampa Bay Buccaneers on Sunday.

Given that the Chiefs’ offensive line has been performing under preseason expectations, curiosity regarding Niang’s recovery is high. But we should keep in mind that a torn patellar tendon is a very significant (and often career-altering) injury.

Let’s take a closer look at the injury — and when we could expect Niang to return.

Patellar tendon anatomy

Although the knee is a hinge joint — meaning that like an elbow, it can only flex and extend — it is a very complex joint. It consists of several ligaments, muscle attachments and two distinct joints within the entire knee joint capsule complex. Think of the patellar tendon as you would the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL): as a stabilizer for the knee joint. The patellar tendon should not just be seen just as connective tissue.

The tendon connects from the patella (commonly called a kneecap) to the tibia (shin bone), merging with the quadriceps tendon emanating from the quadriceps muscle group, which consists of four distinct muscles: the rectus femoris, vastus medialis, vastus intermedius and vastus lateralis. The patellar tendon functions as an additional stabilizer for the knee joint, strengthening the anterior (front) of the knee and preventing excessive knee flexion. Due to its connection with the quadriceps muscle complex, it is a vital component in extending the knee.

Similar to other soft tissue of the body, the patellar tendon can be injured due to eccentric overload. Eccentric contractions occur when the tendon is lengthening. This tendon can also be torn by extreme direct force or deep knee flexion.

On the field, a patellar tendon rupture can be differentiated from other soft tissue injuries because the athletic trainer is able to palpate for a divot or defect at the injury site. Other ligamentous structures of the knee are not as easily palpated by medical staff. After a rupture of the patellar tendon, the player is also unable to actively extend his knee because of its connection to the quadriceps muscle complex. This is a telltale sign of the injury.

But nothing in the medical field is cut and dried — so when initially diagnosing Niang’s injury, the Kansas City medical staff likely did its due diligence in testing other structures of the knee not just on the field, but also with imaging. This way, they could fully assess potential damage to other structures.

Unfortunately, the Chiefs are notoriously reluctant to divulge specific information regarding injured players; we don’t know whether Niang’s injury is just a patellar tendon tear or if other structures are also involved. So this is where the guesswork begins for Niang’s recovery and return to the field.

When will Niang return?

For football players, a patellar tendon tear is a serious injury — one that is more rarely seen than those to the knee’s other ligamentous structures. Unfortunately, the data on recovery and return to play for this injury is not optimistic. A 2016 study found that the return to play rate for patellar tendon tears was just 50%, which is the lowest rate of any soft tissue injury of the knee or lower body that was addressed in the study.

But despite that alarming statistic, the panic alarm should not automatically go off.

First, not all athletes are the same. Different positions on the field will obviously put different forces on the body. Wear and tear (and direct impact on the knee joint) for an offensive lineman is significantly different than it is for other positions. Different body types, age, and previous injury history are other factors that are involved in estimating recovery.

Second, not all injuries are exactly the same; there are different grades and severity. Athletes in the study may have had other structural damage Niang did not suffer — or vice versa.

Third, medical procedures continue to evolve and improve. One current surgical method for repair of a ruptured patellar tendon involves the surgeon drilling small holes in the patella and using sutures to reattach the tendon to the bone. Surgery is followed by several weeks of the player putting no weight on the joint, allowing it to heal (and for sutures to adhere to the bone).

There are several high-profile NFL players who have suffered this injury and returned to the field — all with varying timelines and degrees of success:

The common thread when comparing each player’s recovery is at least a 10-month rehab from the date of injury to the player’s return. Here, Conklin should be viewed as the guideline when gauging Niang’s return to the field — given they play the same position and that Conklin’s injury occurred less than two months prior to Niang’s; so surgical methods were likely to be similar.

Conklin returned to the field and started every snap for the Cleveland Browns last week, nearly 10 months to the day following his injury. It also should be noted that Conklin did practice with the team in training camp; he was not immediately rushed back to a regular- season game.

Given the recent history of this particular injury in the NFL — and the fact that Niang has not yet returned to the practice field — the most realistic return timeframe would most likely be late October to early November. This should be viewed as a best-case scenario. Anything sooner than this would be bucking the recent NFL trends.

Given the importance of depth at Niang’s position — and especially considering the team’s hit-or-miss offensive line play to begin the season — this might be unsettling news. In the long run, however, it is more important that Niang isn’t rushed back to the playing field too soon. In the past, this has been a devastating injury for other players. So it is in the best interest of the player (and the team) to make sure Niang is fully recovered before he returns.