Dr. Kenton Fibel weighs in on treating the star running backs injury with orthobiologics.
Article Link: Why might 49ers’ RB Christian McCaffrey miss ‘a couple months’? (sfchronicle.com)
What might visit to Germany indicate about 49ers’ Christian McCaffrey’s return? By Eric Branch,49ers Beat Reporter Sep 25, 2024
Running back Christian McCaffrey could fully recover from his bout with Achilles tendinitis and flash his All-Pro form this season.
That’s the good news for the San Francisco 49ers. The rest of the story: They shouldn’t expect the NFL’s reigning Offensive Player of the Year back on the field any time soon.
That’s according to Dr. Kenton Fibel, the medical director of the NHL’s Anaheim Ducks who specializes in orthobiologics, a non-surgical field in which stem-cell and platelet-rich plasma injections are used to accelerate healing for a host of injuries that include Achilles tendinitis.
Fibel’s expertise provides him with a unique perspective on the potential significance of McCaffrey’s recent visit to Germany to see a specialist for his condition that has lingered since at least early August. In Germany, orthobiologic treatments are allowed that have not been approved in the United States by the Food and Drug Administration, although the treatments aren’t banned by professional sports leagues.
McCaffrey’s visit, Fibel said, suggests he has a more serious injury, perhaps an issue that includes microscopic tears in the tendon, that hasn’t responded well to initial treatment methods and won’t resolve within a few weeks with rest. Given the nature of the Achilles, a weight-bearing tendon, Fibel said McCaffrey would likely be sidelined for at least a month and “probably closer to a couple of months” if he had an orthobiologic procedure.
“I think it more suggests this is an injury that they think they are going to need something more to augment his healing that may require weeks or a couple months rather than a week or two,” said Fibel, a sports medicine specialist at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles. “This may be something where you realize the pathology is a little bit more serious and reserve a way to allow him to return this season, even if it does take a month or two with him needing a longer recovery.”
McCaffrey, who has missed the season’s first three games, is on injured reserve and isn’t eligible to return until the 49ers visit the Seahawks on Oct. 10 in Week 6. Fibel’s most optimistic timeline, in which McCaffrey could return in a month, would allow McCaffrey to make his season debut when the 49ers host the Cowboys on Oct. 27 in Week 8. A two-month timeline would have McCaffrey returning for a visit to Green Bay on Nov. 24 (Week 12) or a trip to Buffalo on Dec. 1 (Week 13).
“Usually whenever you’re having some sort of a biologic procedure for a tendon, particularly an Achilles tendon, typically that’s going to require you to have enough time to rest and protect the tendon after the procedure,” Fibel said. “And then start to progress things forward while the tissue has a chance to biologically start to heal and restructure … With some of these more important weight-bearing tendons, it’s pretty safe to say that they’re not returning within the first four weeks of the procedure.”
McCaffrey is the latest in a long line of prominent athletes to visit Germany for orthobiologic treatments, with many visiting Dr. Peter Wheling in Dusseldorf, where patients have included Kobe Bryant and Alex Rodriguez. In 2011, Peyton Manning traveled to Germany to receive a stem-cell treatment on a chronic neck injury.
Platelet-rich plasma injections are a blood-spinning treatment in which red blood cells are separated from plasma and platelets. The mixture of plasma and platelets are believed to accelerate the healing process. In Germany, the blood can be heated prior to being spun to increase the level of anti-inflammatory proteins. In Germany, with stem-cell treatments, the cells, which can regenerate and repair tissue, can be taken from another person. Both blood and cells can be cultured in these treatments, which isn’t allowed in the U.S.
Fibel referred to the “perceived” benefits of the treatments allowed in Germany, pointing to the lack of studies on their effectiveness.
“I do think that some of the regulations in the United States are trying to protect some patients from maybe what we don’t know as far as negatives,” Fibel said. “We don’t really know the long-term effects of some of these biologics and how they may work on the tendons … I think it’s a double-edged sword. You do have some of these interesting and theoretically better biologics. But you also don’t know some of the long-term data as far as efficacy and side effects.”
Fibel isn’t overly concerned that McCaffrey is dealing with a career-threatening injury, noting that Achilles tendinitis is common among professional athletes. But the nature the injury is why it could threaten to sideline him for much of the season.
“His tendon has to be able to absorb a load and then explode and have that burst of energy,” Fibel said. “When these tendons become (damaged), the blood flow and the overall integrity of the tendon changes.
“So, one, you’re trying to stimulate more of the normal tissue restructuring of that Achilles tendon so it’s not painful. And, two, you need to get to the point where those properties are restored that make someone like McCaffrey so dynamic and explosive.”
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