Dr. Kharrazi interviewed on the loss of the Bills’ Linebacker for the start of the season with torn biceps.
Article Link: O’Halloran: Bills have options in wake of Matt Milano injury (buffalonews.com)
Since they started meeting in February to plot a course for 2024, the revamped Buffalo Bills defensive coaching staff undoubtedly had linebacker Matt Milano as a key brick in the foundation.
Bills linebacker Matt Milano sustained a torn biceps tendon during Tuesday’s practice and is out indefinitely.
Milano would be 11 months removed from a broken leg for the Bills’ season opener Sept. 8 against Arizona. That would allow head coach Sean McDermott and defensive coordinator Bobby Babich to avoid using a dime package (six defensive backs) because Milano could cover, blitz and play the run.
Not now.
Milano’s torn biceps tendon, suffered in practice on Tuesday, will shelve him indefinitely.
What now for McDermott and Co. minus their best defensive player?
Option 1: Give Dorian Williams a chance.
The Bills will lean into the narrative that linebacker Terrel Bernard barely played in 2022 (110 regular-season snaps), using his rookie year to learn the system, allowing him to be a terrific player by 2023 (143 tackles).
Williams played 211 regular-season defensive snaps last year, and he figures to get an every-down opportunity minus Milano.
Williams is fast and physical, two traits that can’t be taught. Can he cover? Can he blitz effectively? We’re going to find out.
Option 2: Play more dime personnel, taking Williams off the field in those situations. The Bills played dime on 11.4% of their snaps last year.
Three weeks after Milano broke his leg in last October’s loss to Jacksonville, the Bills started to sprinkle in more dime in the win over Tampa Bay, using safety Taylor Rapp for 26 of 68 snaps. Later in the season, Cam Lewis played 16 snaps in an overtime loss at Philadelphia and 11 snaps in a win at Kansas City, and Rapp played seven and 13 snaps in the final two regular-season games (wins over New England and Miami).
Rapp is now an every-down safety. Entering camp, a good plan for the Bills had Rapp and Mike Edwards as the Week 1 starters, allowing rookie Cole Bishop to grow into a role, preferably as the dime player. Scratch that. Edwards (hamstring, July 26) and Bishop (shoulder, July 30) haven’t practiced at all in August.
Until Bishop and Edwards return, the Bills’ dime candidates are Lewis or maybe a true cornerback like Ja’Marcus Ingram.
The obvious concern in using six defensive backs is whether the Bills can effectively stop the run. Williams on the field is a better run defender than any defensive back.
Option 3: How about Baylon Spector?
After playing only 16 of a possible 37 regular season/playoff games in his first two years, Spector had participated in every training camp practice this summer … until Thursday.
Spector sat out the joint workout with Pittsburgh because of a calf injury that will shelve him for at least a week.
Option 4: An unlikely option – re-signing safety Micah Hyde. The Bills could start Rapp and Hyde in their regular defense and use Rapp’s versatility to move him into a dime role in those situations, teaming Hyde with Bishop (when he’s healthy).
The NFL calendar doesn’t stop for injuries, and the Bills have three weeks to again figure out how to play without Milano.
Veteran linebacker Matt Milano suffered a torn biceps and will require surgery that will take him out of the lineup indefinitely, a league source told The Buffalo News. Milano, 30, was hurt during Tuesday’s practice in Orchard Park.
Milano’s timetable
I asked Daniel Kharrazi, an orthopedic surgeon at Cedars-Sinai’s Kerlan-Jobe Institute in Los Angeles, for a Milano Recovery Road Map. 
Kharrazi said when it comes to recovery from biceps injuries, a player’s arm will be in a sling for “generally” six to eight weeks (which includes starting “gentle motion” after three to four weeks). The final stage of rehabilitation is eight to 12 weeks.
Using that timetable, here’s a hypothetical best-case scenario for Milano, splitting the difference in Kharrazi’s estimates: Surgery on Aug. 20. … Rehabilitation starts at seven weeks (Oct. 8). … Cleared after 10 weeks (Dec. 17). That would make Milano available to play in the final three regular-season games if there were no setbacks.
Kharrazi said there are two types of biceps tendon tears – proximal, in which the tendon tears away from the shoulder, and distal, when the tendon tears away from the elbow. The tear is diagnosed via MRI. When a patient tears their biceps, Kharrazi said: “It’s not really a confusing type of injury. That minute, they say they can feel a strong pain and burning sensation, and they see and feel the tendon retract.”
When Milano has his surgery, which will last 60-90 minutes, Kharrazi said doctors will create a tunnel in the bone and use biocomposite screws to re-anchor the tendon with bone.
