Thoughts on Dustin Fowler’s severe debut injury

Last night, during the Yankees-White Sox game at Guaranteed Rate Field, Yankees rookie Dustin Fowler ran into the short wall in right-field foul territory while chasing down a flyball off the bat of Jose Abreu.

The wall is padded, for the most part; Fowler's right knee struck a metal utility box that had not been covered or padded, suffering an open rupture of his right patellar tendon. It was gruesome, to be sure.

As he sat on the field awaiting medical staff, one could make out the tell-tale “drawing upward” of his right patella, an indication that the tendon had been severed below the patella and had drawn the bone upward toward the quadriceps muscle.

This was Fowler's MLB debut; indeed, it was his first appearance on an MLB field, altogether. He hadn't even made it to his first at-bat.

Fowler's emergence as a prospect was somewhat of a surprise, in the sense that he was originally an 18th-round pick out of high school. Whether he was affected by his new life as a professional athlete, it didn't seem to show in the box scores. Fowler batted .241 in 30 games for the GCL Yankees in his first season, with eight doubles and four triples.

Not world-beating totals, of course, but he was moved up to full-season ball in 2014 with the Charleston RiverDogs, where he batted .257 with 25 extra-base hits (13 doubles, 6 triples, 9 homers) and drove in 41 runs. His speed and gap power were already beginning to show.

He began the 2015 season with Charleston, where he showed significant improvement in his second go-round (.289, 11 2B, 3 3B, 39 RBI in 65 games) before moving to the High-A Tampa Yankees in the pitcher-friendly Florida State League. Fowler didn't miss a step there, batting .307 with nine doubles, 3 triples and four homers to go along with his 31 RBI and 18 steals.

By 2016, Fowler was definitely outperforming the earliest projections. In the Double-A Eastern League with the Trenton Thunder, he put up his best numbers by far, batting .281, with 30 doubles, 15 triples, 12 homers and 88 RBI, while stealing 25 bases. It was an outstanding performance, especially for a low-round pick.

In 2017 Fowler was in Triple-A with the Scranton/Wilkes-barre RailRiders, and doing much the same thing as before (.293, 13 HR, 43 RBI, 13 SB in 70 games) when he was called to the Majors. He had to wait through a rain delay that lasted nearly three hours just to take the field.

Then, this happened.

Patrick Gorski-USA TODAY Sports

And just like that, his debut and his season were both finished.

So, what does this injury mean for Fowler? Patellar tendon rupture is a serious injury for anyone, perhaps more so for athletes who rely on superior mobility, speed and agility to perform.

The patella, or “kneecap”, attaches to the quadriceps (top of kneecap) and the top of the tibia (bottom of kneecap). These tendons allows for leg extension, and are also responsible for stabilizing the tibia. When the tendon is ruptured, the patella tends to contract toward the quadriceps (as shown in Fowler's video) and the patient is unable to extend the leg to walk. The knee buckles and the leg will collapse if the patient attempts to walk.

A complete rupture or tear is always a surgical concern, and the quicker the patient can reach an O.R., the more favorable the outcome. This sort of injury can't be treated with arthroscopic methods; it requires a long mid-line incision down the front of the knee to expose the injured tendon for repair.

The edges of the tear are then sewn together and the knee is ultimately placed in a cast or a brace for at least 6 weeks. This is followed by rehab, of course, which may vary in length but is often at least 3-4 weeks.

Some patients will re-injure their patellar tendon, though this is more often seen with athletes in professional/amateur weightlifting, football, soccer, or martial arts. Some patients also experience instability in the knee, which may manifest as a patellar dislocation. This can be accompanied by a partial tear or sprain of the tendon.

Post-operative patients will follow up with their doctor for as long as one year, depending on how well their post-op rehab progresses. Progress is partially measured by therapists using the Tegner-Lysholm Scale, which helps to quantify knee pain or weakness on a numerical scale.

In Fowler's case, he was sent to the hospital and in surgery as quickly as he could have been. The White Sox medical staff saw to that, as Fowler was sent to Rush University Medical Center to have the tendon reattached.

He is already athletic, so he has that going for him in terms of his rehab. Even so, it will be at least 6 months before he can return to the field. That's six months after the cast/brace is removed, and that will be on his leg for about a month and a half. If you had to pick a return date at this point (which would be premature, obviously), you'd be looking at the beginning of Spring Training, next year.

This is a serious injury, especially for a pro athlete. Best-case scenario is that he has no post-op complications (swelling, infection, stiffness, blood clots), gets through rehab on schedule, loses no strength or stability in his right knee, and can return to the outfield next Spring.

Worst-case, of course, would be that his days as a ball player are over. That is highly unlikely, of course. He could still lose some mobility and speed even after he returns to the field, but after pushing himself through the minors and drawing so much attention as a prospect, I would expect him to get through this and take his place in the Yankees lineup in 2018.