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Analyzing the ankle injury of Chiefs’ safety Bryan Cook

In Week 13, Kansas City’s second-year safety suffered a severe ankle injury — but it could have been worse.

NFL: Kansas City Chiefs at Green Bay Packers Mark Hoffman-USA TODAY Sports

The Kansas City Chiefs limped away from last Sunday’s 27-19 loss to the Green Bay Packers with notable injuries.

Linebacker Drue Tranquill (concussion) and safety Bryan Cook (ankle) left the game and did not return. Both were held out of this week’s practices — and declared out for Sunday’s game against the Buffalo Bills.

Tranquill is now in the NFL’s concussion protocol, which is a five-step phased program in which players must complete each phase of rehab without exacerbated symptoms before proceeding to the next. There is some variance in how quickly players progress through the protocol, but Tranquill could be ready to play before the Week 15 game against the New England Patriots. Fortunately, it appears that linebacker Nick Bolton is ready to return from his dislocated wrist (and subsequent surgery) before this Sunday’s game.

Cook’s ankle injury, however, is likely to keep him off the field for much longer. It appeared to be a gruesome injury to his left ankle; the NBC broadcast chose not to show the replay. Still photos weren’t encouraging, either.

NFL: Kansas City Chiefs at Green Bay Packers Dan Powers-USA TODAY Sports

In the moment, it was obvious the worst was feared. Cook’s teammates surrounded him to offer their support before he was carted off the field.

As the week began, however, there was good news: negative X-ray results indicated there was no fracture. While additional details have not yet become available, Cook has certainly undergone further imaging and testing to assess any soft tissue damage.

Given the appearance of the injury, it would not be surprising to see Cook miss extended time; in all likelihood, he will miss the rest of the regular season. Depending on the results of the latest testing (and his rehab) there is a possibility he could return in the postseason.

The mechanism of injury — that is, the way Cook’s foot planted and turned — could be indicative of a high ankle sprain, which most commonly occurs when the foot is externally rotated (turned outward) in relation to the rest of the lower leg. A high ankle sprain differs from a traditional (inversion) sprain because the injured tissue is the syndesmosis (connective tissue) between the tibia and fibula, rather than the ligaments at the ankle joint.

The rehabilitation time for high ankle sprains can differ drastically depending on the severity of the injury — not to mention the physical demands of a player’s position.

Given what we know, we can reasonably infer that Cook’s injury is at least a Grade II sprain. With these, there is partial tearing of the ligament and moderate joint laxity (looseness or increased instability). But it could easily be a Grade III injury, too. In these, we see complete tearing of the ligament and gross joint laxity.

While Cook’s injury could have been much more severe, initial indications suggest there is a chance he could return to the team before the season ends. We have already seen the Chiefs’ medical staff display their expertise in dealing with severe high ankle injuries — such as the one quarterback Patrick Mahomes suffered during the 2022 postseason.

Still, Kansas City will have to rebound from its weakest defensive performance of the season without Tranquill in the short term — and without Cook over the long term.

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