What Should We Expect of Tua Tagovailoa?

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Alabama Crimson Tide quarterback Tua Tagovailoa was a consensus top-two quarterback in the 2020 NFL draft prior to a severe hip dislocation he suffered last November. Should he still be one? That’s a difficult question for such a rare injury, but we can get some context on his range of likely outcomes by looking at other plays with hip dislocations in the Football Outsiders injury database. This process is pretty much just identifying player “comps” — no fancy analytics here.

Let’s first review what we know of Tagovailoa’s situation — which is limited because we haven’t physically examined him or his medical records — and then look at how players in similar situations have fared according to FO’s injury database.

What’s Wrong With Tagovailoa

In a November 2019 game against Mississippi State, Tagovailoa was tackled. As his right knee hit the ground, his thigh was forced backwards violently. This caused a posterior hip dislocation — in layman’s terms, the top of his femur (thigh bone) was forced toward his backside and popped out of the socket where it normally sits. During that violent movement, his femur hit the acetabulum — a side part of the pelvis — and caused a fracture as well.

Athletic trainers and physicians reacted quickly, “reducing” the dislocation (putting the hip back into place) on the field and airlifting Tagovailoa to a hospital for further care and surgery.

In the four months since the injury the news has been largely good. Tagovailoa’s medical assessments at the Combine went as well as could be expected, and he has been cleared to return to football activity.

Tagovailoa had two big post-injury concerns. The first was avascular necrosis (AVN, a loss of blood supply to the top of the femur leading to the death of the bone), which he seems to have avoided so far. The second is osteoarthritis, which would be a longer-term issue that could restrict his athleticism and shorten his career. The jury is still out on that one and likely will be for some time.

How Teams Are, and Should Be, Reacting

So far Tagovailoa’s draft stock is holding up well. He is projected to be the second quarterback off the board, probably around pick three to five. Is that smart?

As FO’s loyal readers know, we have a pretty neat database of NFL injuries prospectively collected since 2007. Unfortunately for this analysis, hip dislocations are very rare in football (they’re more common in car accidents). We have only four records of hip dislocations, plus four more of fractures, to give us an idea of the range of likely outcomes for Tagovailoa. It’s important to note we’re likely not working from a complete list of hip dislocations and fractures in the NFL, just the ones we identified when collecting the data for this database. An earlier study using the NFL’s own Injury Surveillance System identified 14 hip fractures and nine dislocations in ten seasons from 1997 to 2006. Assuming rates are similar today, over the 13 seasons in our database (2007 to 2019), we would expect around 18 fractures and 12 dislocations, but we only see four of each. The most likely explanation is that we coded some fractures and dislocations as “hip” injuries due to a lack of additional information. Even if we had caught them all, that’s not a big pool of comps. To beef up our numbers I’ve added three other known hip dislocations from 2000 to 2006; I did not search for isolated fractures during this time. If you’re working internally for a team and trying to decide what to do about Tagovailoa, I recommend going into the NFL’s Injury Surveillance System and repeating the analysis below for all the hip dislocations you can find, which should be more complete. If you’re a reader and know of one we’ve missed, shout it out in the comments and I’ll update everything!

Additionally, not all of these are likely to be good comps — some injuries, particularly the fractures without dislocations and those not requiring surgery, are less severe than Tagovailoa’s, and teams shouldn’t put as much weight on those guys. The athletic demands of linemen also probably aren’t a close reflection of what Tagovailoa will be asked to do. Finally, the main comp that everyone was talking about right after Tagovailoa’s injury was Bo Jackson, whose hip injury ended his football career — but Bo suffered from AVN, which Tagovailoa isn’t, and sports medicine has improved considerably in the ensuing decades. Assuming Tua will go the way of Bo is too pessimistic.

With those caveats out of the way let’s take a look at some comps, shall we? I’ve listed these players by my (subjective) verdict on how comparable each injury and player is to Tagovailoa.

Player: Dennis Pitta
Position: Tight end
Hip Injury Type: Dislocation and fracture; surgery required; three dislocations in five seasons
Year of Injury: 2013 offseason; recurred in Week 3 2014 and in 2017 offseason
Experience: Initial injury between third and fourth years
Time Missed: First 13 weeks of 2013; last 14 weeks of 2014 and all of 2015; career-ending
Known AVN: No
Post-Injury Career: Out for the better part of three years, then played one full 16-game season with 86 catches for 729 yards (career highs) before the career-ending recurrence
Verdict: BAD

Player: Hiram Eugene
Position: Safety
Hip Injury Type: Dislocation; surgery required
Year of Injury: 2011 offseason
Experience: Between fourth and fifth years
Time Missed: Career-ending
Known AVN: No
Post-Injury Career: Did not play again; had played 60 of 64 games in four prior seasons
Verdict: BAD

Player: Lamar Thomas
Position: Wide receiver
Hip Injury Type: Dislocation and fracture; surgery required
Year of Injury: 2000 offseason
Experience: Between seventh and eighth years
Time Missed: Career-ending
Known AVN: No
Post-Injury Career: Missed 1999 with shoulder dislocation; did not play again, but may not have been partially due to other injuries, age, and skill
Verdict: BAD

Player: Thomas Tapeh
Position: Fullback
Hip Injury Type: Dislocation; surgery required
Year of Injury: 2005
Experience: First year
Time Missed: Last three weeks of 2014 and all of 2015
Known AVN: No
Post-Injury Career: Returned to play in 16 games, starting eight, in each of the next two seasons
Verdict: GOOD

Player: Olindo Mare
Position: Kicker
Hip Injury Type: Dislocation; surgery required
Year of Injury: 2007
Experience: 11th year
Time Missed: Last three weeks of 2007
Known AVN: No
Post-Injury Career: Played 64 of 64 games over the next four seasons, without substantially degraded accuracy
Verdict: GOOD

Player: Az-Zahir Hakim
Position: Wide receiver
Hip Injury Type: Dislocation and fracture; no surgery required
Year of Injury: 2002
Experience: Fifth year
Time Missed: Last six weeks of 2002
Known AVN: No
Post-Injury Career: Appeared in 48 of 48 games over the next three seasons, with similar reception and yardage totals to pre-injury period
Verdict: GOOD

Player: Kevin Vickerson
Position: Defensive tackle
Hip Injury Type: Dislocation; no surgery required
Year of Injury: 2013
Experience: Seventh year
Time Missed: Last five weeks of 2013
Known AVN: No
Post-Injury Career: Played one more season (2014), with 15 games but only one start; in prior two seasons had played 27 games with 25 starts
Verdict: MIXED

Player: Mike Pouncey
Position: Offensive line
Hip Injury Type: Fracture; surgery required
Year of Injury: 2016 offseason
Experience: Between fifth and sixth years
Time Missed: Weeks 1-4 and 11-17 of 2016
Known AVN: No
Post-Injury Career: Played 16 games each of next two seasons; missed 11 games in 2019 due to unrelated neck injury
Verdict: GOOD

Player: Chris Carson
Position: Running back
Hip Injury Type: Fracture; no surgery required
Year of Injury: 2019
Experience: Third year
Time Missed: Last week of 2019
Known AVN: No
Post-Injury Career: Unknown; expected back for 2020
Verdict: UNKNOWN

Player: Frank Gore
Position: Running back
Hip Injury Type: Fracture; no surgery required
Year of Injury: 2010
Experience: Sixth year
Time Missed: Last five weeks of 2010
Known AVN: No
Post-Injury Career: Still playing, unbelievably; has played in 142 of 144 possible games
Verdict: GOOD

Player: George Johnson
Position: Defensive end
Hip Injury Type: Fracture; no surgery required
Year of Injury: 2016 offseason
Experience: Between fifth and sixth years
Time Missed: 2016 plus the first two weeks of 2017
Known AVN: No
Post-Injury Career: Played seven games in 2017, released before 2018 season; had played 27 games, with five starts, the prior two years
Verdict: MIXED

I looked at seven dislocations with or without fractures, and four fractures without dislocations. Of the seven dislocations, I could confirm five required surgery. Those are likely the best comps for Tagovailoa. Of those five, three were career-enders — two (Lamar Thomas, Hiram Eugene) immediately, one (Dennis Pitta) following two recurrent dislocations of the same hip in the ensuing several seasons. Pitta missed almost three full seasons with those hip injuries before finally retiring. Of the others, one was to Olindo Mare, a kicker — as a mobile quarterback, Tagovailoa has a steeper hill to climb. The other was to Thomas Tapeh, a fullback, and while his recovery offers the greatest reason for optimism, even he took well over a year to return and only played for two seasons once he did. On the plus side, Tapeh suffered his injury in his rookie year, making him by far the youngest player to suffer a surgical dislocation while having arguably the best outcome; Tagovailoa is four to eight years younger than any of the other players who suffered surgical dislocations were at the time of their injuries.

The other two dislocations were to wide receiver Az-Zahir Hakim and defensive tackle Kevin Vickerson. Neither required surgery, so their relatively good outcomes may be a bit too optimistic for Tagovailoa.

Each of the four players who suffered fractures without dislocations missed significant amounts of time but returned or are expected to return at a level similar to how they played pre-injury.

Interestingly I could not identify a single confirmed case of AVN outside of Bo Jackson. It’s possible some players on this list had it but we just didn’t know about it, though.

So What Should Teams Do About Tagovailoa?

There are a bunch of points to consider here, some that make me more worried about Tagovailoa and some that lessen my concerns. Points in Tagovailoa’s favor:

  • He’s young, and younger players might be better able to recover.
  • Before his injury he was a consensus top-two quarterback, so in an injury-free vacuum he is somewhat more likely to be good than other options this year, non-Joe Burrow division.
  • He has so far avoided AVN.

Points against Tagovailoa:

  • He’s a highly athletic mobile quarterback, and the physical demands of his position make a full recovery more difficult.
  • He’s still at risk for arthritis in the long term that could shorten his career or lessen his running ability.
  • He had a dislocation and fracture that required surgery, putting him in the more severe end of our list.
  • He’s likely to miss most or all of the 2020 season as he continues his recovery, which could be a positive or negative — it delays his debut, but if it forces a team to leave him on the bench to learn behind a veteran it might help his development.

My lukewarm take is that you should balance the risks of long-term changes to Tagovailoa’s athletic ability from the hip dislocation with his potential. There’s no right answer here. No one really knows how he’s going to recover and perform in the long term — there’s just not enough data, though the evidence we do have is on balance worrisome. On the other hand, prior to this injury (and LSU quarterback Joe Burrow tearing it up late last year) Tagovailoa was the consensus best quarterback in the draft. Heap the injury uncertainty on top of the normal uncertainty in assessing college players, and whether (and where) you draft Tagovailoa is just a question of risk tolerance and the timeframe in which you need a quarterback. If you feel like you’ve got one shot at getting a serviceable to good passer right now and won’t tolerate downside risk in favor of upside potential, maybe go another direction than Tagovailoa. If you thought Tagovailoa was going to be a great NFL quarterbacks and want to take a home run swing and hope you get the guy he was pre-injury, that’s not crazy either — as long as you are prepared to wait it out at least a couple of years and spend another pick down the line if it doesn’t work out.

In the end, I would probably downgrade Tagovailoa some from wherever a team had him prior to the hip dislocation, but I can’t say with any confidence how far he should drop. Most observers expect the Cincinnati Bengals to take Burrow first overall and Washington to follow by taking Ohio State edge rusher Chase Young. The Detroit Lions have the third pick, and might be willing to trade it to a team that wants Tagovailoa. I would not trade a king’s ransom to move up into that spot, though.

Source: footballoutsiders.com

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