Sensational Alabama QB Tua Tagovailoa was poised to bring the Crimson Tide back to the College Football Playoffs, collect some individual hardware including a Heisman, and enter the 2020 NFL Draft as the potential top pick. But his season and college career ended on a Saturday in mid-November in Mississippi. Despite being up 35-7 right before the half, Tua was scrambling out to the left with two Mississippi State defenders close behind. They managed to tackle him and cause him to scream out in pain. The result, a confirmed dislocated hip with an acetabular posterior wall fracture. The worst that could happen did. The article below will explain exactly what happened, the structures involved, his rehab and recovery, his associated high ankle sprains, and his draft prospects heading into the 2020 NFL Draft. 

Looking at hip anatomy, the hip is made up of the femur bone and pelvic bones. The head of the femur articulates with the acetabulum within the pelvic bone. This creates a ball and socket joint seen commonly around the body. The acetabulum is a deep socket to allow for the head of the femur to sit inside to effectively allow the body to accept weight in standing. The hip joint is an incredibly difficult joint to dislocate due to the depth of the acetabulum and the labrum helping to deepen the socket and hold the femur in place. In addition, there is a blood supply that feeds the bone, the medial and lateral circumflex arteries, which help keep the bone alive. 

While the hip is a stable joint due to the depth, it is still very mobile, providing movements in flexion, extension, abduction, adduction, and internal/external rotation. These motions are all vital for all our daily activities and athletic-related movements, regardless of sport.

The injuries for Tua Tagovailoa the past few years have been brutal. pic.twitter.com/VUNdMzxos0

— Jeff Nowak (@Jeff_Nowak) November 16, 2019

Breaking down the Tua injury, as mentioned above, he was pursued by the Mississippi State defenders before getting tackled. The reason his right hip was dislocated was a number of factors:

• First, his right leg got caught under him as he was getting tackled. This put the hip into end-range flexion and, based on how he went down, placed the leg into adduction, or crossed mid-line.
• Along with the leg being placed into this position, having the leg in contact with the ground prevented the leg from re-positioning to reduce pressure on the hip.
• Add in the body weight of two Division I defenders, plus the energy of tackling, and it forced the head of the femur into the back of the acetabulum.
• Like any material, it has a breaking point. The femoral head was under so much pressure from the distal femur fixed on the ground and the body weight coming from above, and it pushed the femoral head into the acetabulum and dislocated the femur out of the joint, breaking a portion of the socket with it, specifically the posterior wall. Most hip fractures are posterior in nature (90%) due to high-force actions such as vehicle accidents when the knee strikes the dashboard and force the femur into the acetabulum. It’s the same concept here when Tua was tackled. 

Statement from Dr. Lyle Cain regarding #Alabama QB Tua Tagovailoa: pic.twitter.com/pggm6FH0Jx

— Charlie Potter (@Charlie_Potter) November 17, 2019

Considering the extreme reaction of pain Tagovailoa was in and the drastic leg length difference, it showed that the hip dislocated and stayed dislocated. It was later revealed that his hip was reduced at the stadium, which significantly decreased his pain and then was flown to the hospital via helicopter for further evaluation. The major concern to get the hip reduced was to minimize the time frame the blood supply was compromised, which could have led to avascular necrosis. This is where the femoral head of the femur dies due to a lack of blood supply, which is more commonly seen in older individuals and eventually requires a hip replacement. This is also the condition that ended Bo Jackson’s NFL career. The difference was that the Raiders didn’t realize what had happened until it was too late, and he eventually required a hip replacement, ending his career.

Reports have confirmed that Tua suffered a posterior wall fracture in the acetabulum, as seen in picture A above, lengthening his recovery time. The hip has already been reduced and, if there were any bone fragments from the fracture in the joint space, these may need to be removed. He required surgery to repair the acetabulum to ensure stability in the area, placing plates and screws to maximize proper healing, as seen below.

His recovery timeline could be minimum 4-6 months to return to normal day-to-day activities but longer due to the nature of the injury, the unknown severity of the concurrent damage, and getting back into football shape, which could take up to a year. Literature does support returning to sport at after about 9-12 months, though that timeline may vary with the resources Tua has available to him. It’s possible that he has his acetabulum and supporting labrum repaired with several months of progressive increases of weight-bearing to ensure proper healing. It’s possible that he could restore full weight bearing by 12 weeks to maximize land-based rehab. He will likely have available to him aquatic therapy when the wound is healed and AlterG treadmills in order to restore muscle strength required for walking more quickly.

.@AlabamaFTBL has released a statement from Dr. Lyle Cain on the outcome of Tua’s surgery this morning. The surgery was “successful” and the prognosis is “excellent.” pic.twitter.com/biRSUiEcER

— LaurenSisler (@LaurenSisler) November 18, 2019

Once he regains full weight-bearing, he will have to strengthen all of the muscles of the hip in order to regain support in the area. This would be necessary in order to resume running, pivoting, throwing, and jumping, though this won’t come for many months after weight-bearing is resumed, closer to 6-9 months. This was a severe injury to a major bone; it takes the body a while to restore full function and get strong enough to withstand hits, operate at full speed, and perform the activities that make Tua Tagovailoa great.

Despite all the work that he has done, he could still have complications, including infection or improper healing of the acetabulum or the femoral head dying, or sciatic nerve pain due to the original injury with the bone pushing out against the nerve, causing loss of sensation and possible motor function in the lower extremity, though these rates of incidence are low. He may also develop post-traumatic arthritis, which could abbreviate his long-term availability. 

Despite the severity of the injury, many people may question whether his previous high ankle sprains played a part in this hip dislocation. Outside of mobility with not being able to run as effectively, the high ankle sprains had no effect on the severity or cause of the hip injury. 

However, these are concerning from a draft perspective, as he’s now had the same injury to both sides with the resulting Tightrope surgery not performed much outside Alabama. As a result, we were able to see that Tua was able to return to playing at a high level, but we don’t know long-term how his ankles will hold up. This is due to the fact that the surgery isn’t widely used and they don’t appear to have long-term outcomes backed by research. Reviewing his size, 5’11” and 200 lbs, he’s not exactly the biggest prospect ever, comparable to Saints QB Drew Brees and Seahawks QB Russell Wilson. This indicates that Tua could play at the next level, but both quarterbacks had concerns about their durability due to their size, and they didn’t come in with the injury baggage that Tua has. 

All the tanking for Tua has suddenly stopped, and there are questions about how far his draft stock will tumble. Fortunately, these severe injuries likely won’t prevent him from getting drafted but will impact him financially. While I am no draft expert, I do not anticipate that he is a top-5 or even top-10 draft pick due to the needs of the top teams and the injury history. Comparables for Tua draft-wise would be former RB Willis McGahee (late 1st), LB Jaylon Smith (early 2nd), and, to a lesser extent, TE Jake Butt (5th round) and DT Jeffery Simmons (late 1st). All were drafted, but their draft stocks took a major hit due to injury. Even though they all had different injuries, McGahee and Smith still went on to have productive careers, indicating that Tua isn’t toxic. Professionally, Ravens TE Dennis Pitta suffered recurrent hip dislocations throughout his career, which ultimately ended his playing days. Recurrent dislocations are rare, occurring in 2% of all cases, but they are still a distinct possibility. 

Noting that the injury occurred in mid-November, he won’t be able to demonstrate any athletic feats during the NFL Scouting Combine due to the nature of the injury. He will still participate in interviews, medical checks, and Wonderlic testing. He will have to go through the medical re-checks prior to the draft to allow teams to evaluate his healing progress. In order to get drafted, he will have to let his tape and rehab dictate his draft position. 

If he has a solid rehab and tests well in interviews and Wonderlic, I could see him going later in the 1st round or 2nd round with essentially a medical redshirt year. I believe that he is such an elite talent that a team will take a chance on him as a developmental project from an injury standpoint, similar to what the Buffalo Bills did with McGahee in 2003. If he’s not looking good, he could drop even further to the 3rd or 4th round. Considering he is a quarterback, he would not drop as far as other position players in the draft. He could also return for his senior season at Alabama to restore his draft stock. However, if he stays and doesn’t produce or has complications, he’d be playing for free and could watch his professional career evaporate. 

Tua Tagovailoa has the ability to play in the NFL and be an effective starter, but this injury puts a shelf life on his career. He may be able to play 5-8 years as a rough guess, and with the right team, he could be an effective signal-caller, but I do not anticipate that he will be a franchise guy for 15 years. There are teams that can afford to draft him and let him rehab/learn until he is ready. He may also be a guy who can plug and play for a team that is uncertain about their current quarterback but has the other pieces in place for a championship run. We’ve seen crazier things happen during the NFL Draft, but he could be a steal later on Day 1 or early on Day 2 for the right team. 

Overall, Tua lost a lot of money on a Saturday afternoon in Mississippi. It was a freak accident that even the best preventative medicine and doctors couldn’t have stopped. Tua will have a long road to get back to baseline and answer a lot of questions about his durability and health, not just with the hip, but also with his ankles. Here’s to hoping that he gets fully healthy and has another chance to play football at the next level.