Purdue Boilermakers LB Markus Bailey had a collegiate career that has two sides. One side consists of 200-plus tackles, 13.5 sacks and 28 tackles for loss over his time in West Lafayette. The other side consists of two season-ending knee injuries along with a hip injury that leaves a lot of questions unanswered. Depending on what side NFL teams look at could dictate what day his name is called at the end of April.

Bailey has had his share of ups and downs while at Purdue. Below is his medical breakdown.

2015

Bailey arrived as a three-star recruit and second-team all-state from Hilliard Davidson out of Columbus, Ohio. He quickly found playing time as a freshman, appearing in three games before suffering a season-ending left ACL tear against Virginia Tech. Bailey managed to suffer a direct contact ACL tear, which comprises 30% of all ACL tears. In the article, Bailey describes it as a freak accident, but that incident cost him his entire true freshman campaign.

2016, 2017, 2018

After fully rehabbing his left knee, Bailey had three incredibly productive seasons. He was able to tally over 200 solo tackles, with another 100-plus combined tackles, 26 tackles for loss, 12.5 sacks, and six interceptions. It appeared that Bailey had left his mark. He was able to appear in 38 games over that timeframe and did not appear to suffer any known injuries during that time frame. Outside of his ACL tear, he appeared incredibly durable.

2019

After leading the Boilermakers with 115 tackles, Bailey missed the spring practice with a torn right labrum in his hip. In the linked article, he revealed that it was bothering him at the beginning of the 2018 season, but elected to play. He eventually had the surgery and was able to return to full form for the season opener. Cover 1’s Russell Brown interviewed Bailey at the beginning of April and noted that the hip injury was a reason that he did not declare following his junior year when his stock was higher. 

Prior to the 2019 season, Bailey was viewed as one of the top linebackers in the 2020 NFL Draft class. He continued to be on track until suffering a torn right ACL early in his senior season in practice prior to the TCU game. Regrettably, Bailey tore the opposite side ACL from his freshman year, once again ending his season early. Reports state that he jumped to defend a screen pass and got hit as he landed. While he did get hit, I would classify this more of a non-contact injury due to the inability to land with control which caused the tear. 

ACL mechanism of injury review

Bailey has several concerning injuries most notably torn ACL’s in each knee and the right hip labrum tear. To quickly review, the mechanisms of an ACL tear are below. 

The ACL is a thin band of ligament that runs lateral to medial and prevents anterior translation of the femur over the tibia. This ligament also helps with rotational stability, preventing the knee from rotating at the tibia, ensuring that the knee acts as a hinge joint. The ACL contains mechanoreceptors that assist with detecting changes in direction, speed and tension. It is the most commonly torn ligament in the knee during sporting activities.

Risk factors for injury include a sudden change of direction, jumping and poor landing, deceleration or direct blows to the area. There is usually but not always associated damage to the area during an ACL tear including damage to the meniscus, articular cartilage and MCL. Damage to the PCL and LCL is also possible along with nerve and vascular damage in severe knee injuries. 

It is not known whether there was associated damage in the knee following each ACL tear. Bailey was able to return to excellent form following his 2015 tear, but the unknown is his most recent tear. He still has several risk factors that weigh against him with regards to re-tearing the knee that include. He is still under the age of 25 (currently age 23) and he is still at risk to tear the left ACL again with about a 15-30% increased risk as compared to a healthy knee for up to two years. For up to five years following an ACL injury, the re-injury rates are anywhere from 6 to 12% with a higher percentage on the contralateral side. Unfortunately, Bailey fit into that small percentage of players that suffered that injury despite a prolonged time in between.

Hip labral tear mechanism of injury review

The labrum is a ring of fibrocartilage that helps deepen the socket for the femur to stay in place during movement. Much like the labrum in the shoulder, the labrum is required in order to maintain stability in a ball and socket joint. The hip area is comprised of the head of the femur and parts of the pelvic bones of the pubis, ischium, and ilium. The three bones of the pelvis form the acetabulum which is the socket that the head of the femur (ball) articulates with.

In order for the hip to function, numerous muscles attach to the surrounding areas that allow the hip to perform flexion, abduction, adduction, extension, internal and external rotation. These functions allow the human body to do regular activities in our day to day lives.  

There are a number of ways that a labral tear can occur. It can be torn via trauma, specifically when the leg is forced into a shearing motion, specifically hyperextension, hyperabduction or externally rotated. These types of motions would be seen with twisting, pivoting, falling or motor vehicle accidents. This puts stress on the labrum and can tear with excessive force. Most tears occur in the anterior or front portion of the hip and can result in a radial flap tear, radial fibrillated which is fraying or unstable in which the labrum becomes detached.

More often, there is microtrauma in the area that eventually leads to the worsening and breakdown of the labrum. This could be sustained through activities such as running, weightlifting, jumping, etc. It’s common to find that the injury is present and a clear mechanism of injury is not known. 

However, 90% of tears involve some bony pathology known as femoroacetabular impingement or FAI. This occurs when there is either a congenital defect or previous injury that could lead to a bone spur. Early exposure to repetitive activities involving the hip can also contribute to this condition by forcing the bony structures around the area to remodel and form the spurs. They can present as pincer lesions sitting on the acetabulum, or as a cam lesion sitting on the femoral head. Both can be present in the hip at the same time as seen below. Up to 30% of the population is believed to have these variances which indicate how prevalent it really is. 

When these bone spurs occur, this leads to the hip joint wearing irregularly and eventually leads to a breakdown of the surrounding tissue including the articular cartilage and labrum. Despite these irregularities naturally occurring, there isn’t much that can be done unless it causes a problem. Typically, an injury weakens some of the surrounding muscle or overuse can allow the irregular wearing to begin, causing further problems. 

Bailey’s major limitations would have been pain and possibly experiencing locking, popping, clicking in the area during activities. He would have experienced these issues getting in and out of his stance, along with shifting towards where he needed to cover and squaring up to tackle. This would have forced his leg into external rotation and extension, further placing stress on the already weakened structure, causing further discomfort. He had noted that he had difficulty pushing off the right side and running downhill with speed. 

Literature supports football players who have entered the NFL Combine with this exact injury had no differences in playing time or availability upon being drafted after their first year. However, those that entered the league with these injuries were not drafted before the third round, but this may have been more on talent than medical concerns.

Further research also indicates that 80% of the players who had this surgery were able to return to playing in the NFL with no changes in career length. Other studies showed that 87% and 92.5%, respectively, were able to return to play following surgery which did not affect their NFL careers in length or from a financial perspective. There also is research indicating that once a player suffers this issue, the rate for recurrence is relatively low. The rates are even lower once the bones fully mature which would be the case with most NFL draft prospects. 

NFL Draft impact

Despite two season-ending knee injuries and a right hip injury, Bailey’s NFL future is brighter than expected. From what I can gather, none of the injuries are related to each other. When I say that, the ACL tears were far enough apart that he wasn’t at an increased risk of tearing the other side due to the original injury. The rates for re-tears five years apart were merely a set timeline and not a predictor of injury. Despite suffering the right hip labral tear, it did not appear to cause any issues for the ACL tear as he had the labrum repaired shortly after the 2018 season ended. 

While there is a multitude of players who have suffered two ACL tears during their NFL careers, it does not preclude someone from effectively playing. Two comparable players that Bailey can compare to with regards to at least the ACL tears include running back Frank Gore and linebacker Thomas Davis. Gore suffered both of his ACL tears prior to getting drafted in the 2005 NFL Draft. Davis tore his ACL three times in successive seasons and remains the only professional player to suffer an ACL tear that many times and return to play. While Bailey does not necessarily project to have the career that either had, this merely states that these injuries are not a cross to bear or prevent him from playing at the next level.

Due to the September ACL tear, Bailey was unable to participate in agility drills at the combine, only performing the bench press for 15 reps at 225 pounds. He was, fortunately, able to have team doctors assess both of his knees and right hip to get a better idea of how his body will handle NFL competition.

As someone that is trying to improve his draft stock, he released a montage of training drills at the Fischer Sports Institute in Arizona on April 4. Watching the 80-second video below tells you that he is moving incredibly well for someone that is six months out from an ACL tear. 

#Purdue LB Markus Bailey, 6 months after tearing his ACL, had his Combine recheck, seeing #AZCardinals Dr. Gary Waslewski. Bailey, one of the country’s top LBs heading into 2019 after started 40 straight games pre-ACL, was cleared. This video of LB Combine drills went to teams. pic.twitter.com/OSblsiFKcD

— Ian Rapoport (@RapSheet) April 4, 2020

My eyes may be slightly biased, but he does appear to favor that right knee ever so slightly during the drills, but it is not consistent or does it slow him down considerably. With more rehab and training, I fully expect any deficits to be abolished come training camp. Considering he has been medically cleared, the more information teams can get on him the better. 

Cover 1’s Brown likes what he sees on tape, grading Bailey as a Day 2 pick, but due to the injuries, projects him to be a Day 3 pick in the fourth to fifth round range. Cover 1’s Christian Page shares the same sentiments with a Day 3 projection. Bailey has shown he can be productive when on the field and shown he has the intelligence as evident with his three-time All-Big Ten Academic selection. 

Despite the injury concerns, Bailey is someone I’d pull the trigger on to go get in the draft. He appears to be an effective and intelligent football player when healthy and his injury history does not scare me. I believe he is someone that a front office can be confident in selecting. He does pose a higher injury risk than normal but should be available when called upon regardless of the situation.

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