Photo: Imagn Images

What You Need to Know

• Saquon Barkley needed a meniscus repair in addition to his ACL reconstruction and may not be ready for the start of training camp
• Joe Mixon is recovering well and is unlikely to have any lingering effects from a 2020 midfoot sprain
• Marlon Mack is "killing it" in rehab but recovery from Achilles repair is rare for a running back
• Trey Sermon and Najee Harris will be ready for offseason activities

Saquon Barkley | Right ACL reconstruction / meniscus repair / MCL sprain | Mid-Sep 2020 | Questionable for training camp

Whenever an athlete is diagnosed with an ACL tear, it’s critical to know whether the injury is isolated – only the ACL is involved – or includes other structural damage.

Players with isolated injuries often have surgery sooner, begin rehab sooner, and return to play sooner. Those with additional injuries may need time to recover before surgery, may need additional surgical procedures, and are at risk of shortened careers.

Unfortunately, Barkley suffered what’s referred to as the Unhappy Triad of knee injuries – an ACL tear, MCL sprain, and torn meniscus. It’s very likely Barkley also suffered some cartilage damage around the joint. Barkley and his surgical team chose to allow the MCL sprain to heal without surgery and work hard to strengthen his stabilizing knee structures before surgery.

Though a standard rehab approach, Barkley’s ACL reconstruction was delayed for six weeks. Further, Barkley had a meniscus repair at the same time his ACL was reconstructed. Repairing the torn meniscus is critical to the long-term health of Barkley’s knee but protecting the repair after surgery requires a brace and limits the initial rehab from the ACL reconstruction.

In short, Barkley’s rehab is complicated and longer than if he’d only had an ACL reconstruction.

Barkley told reporters he fully expected to return to his pre-injury form. But he isn’t yet ready to put a timetable on his return. 7-9 months of rehab is a reasonable expectation. After a late October surgery, it’s likely Barkley is targeting a return during training camp.

If there are no rehab setbacks, it’s possible Barkley starts camp on the active roster and can be ready for a full Week 1 workload. Don’t expect clarity on Barkley until early summer at the soonest.

Joe Mixon | Right midfoot sprain | Mid-Oct 2020 | Ready for training camp

Mixon sprained ligaments in his midfoot in Week 6. Although he never returned to individual drills and eventually moved to injured reserve in November, the Bengals routinely described Mixon’s status as week-to-week.

Specifics on Mixon’s injury were never reported but the consensus presumption was a Lisfranc injury. A tricky condition to manage, the Bengals and Mixon had no incentive to bring him back at less than full strength after the loss of Joe Burrow to a season-ending knee injury and serious deficiencies along the offensive line.

A Lisfranc sprain requiring multiple weeks of rehab always raises concern. But there are multiple reassuring signs in Mixon’s recovery.

Mixon didn’t require surgery on the injury and there were never any reports of an immobilizing boot during the early stages of his rehab. This strongly suggests a lower-grade injury and a stable joint, carrying a better long-term prognosis.

Zac Taylor wasn’t forthcoming with details on Mixon’s injury during the season, but told reporters in March that Mixon was “feeling really good” and looked “healthy and ready to go.” And it is unlikely Cincinnati would have released Gio Bernard if Mixon’s recovery was still uncertain.

Mixon may only see limited offseason reps but expect him to be ready for training camp.

Marlon Mack | Right Achilles repair | Mid-September 2020 | 8-9 months | Ready for training camp

Advanced surgical techniques and rehab schedules mean an Achilles injury is no longer a career-ending injury. Over the past 10-15 season, NFL athletes – from explosive edge rushers to agile wide receivers to athletic offensive tackles – have returned to play effectively after Achilles’ repair.

But we’ve yet to see a running back sustain production after Achilles’ surgery.

Arian Foster briefly showed signs of returning to form after his Achilles injury before his career slowed and ended with a rash of other soft-tissue injuries. And while the list of other running backs to suffer Achilles’ injuries isn’t exactly a who’s who of elite talent, no other running back has come close to regaining form.

Mack says he’s “killing it” in rehab and expects to return to 100% soon. But no NFL team was willing to offer him a lead back role in free agency, leaving him to return to Indianapolis on a one-year deal where he’ll complement Jonathan Taylor and Nyheim Hines in a smaller, supporting role.

Standard rehab timelines should have Mack ready for training camp. Whether he will recover well enough to add much to the Colts’ running back depth chart remains to be seen.

Zack Moss | Left high ankle sprain surgical repair | January 2021 | 6-8 weeks | Ready for training camp

One of multiple approaches – both surgical and non-surgical – to address mid-grade high ankle sprains, the “tightrope” procedure chosen by Moss has gained favor in recent years as a method to improve stability in the joint without the plates and screws used in more extensive procedures.

While recovery time is usually in the 6-8 week range (or sooner), Moss was ruled out of the rest of the postseason. He is expected to be available for offseason workouts.

Trey Sermon | Left sternoclavicular dislocation | January 2021 | Ready for training camp

The sternoclavicular (SC) joint connects the breast bone (sternum) and collarbone (clavicle). It’s less commonly injured than the AC joint which connects the collarbone and shoulder blade at the top of the shoulder. While it’s can be complicated and worrisome at the time of injury, there are no long-term healing concerns.

Sermon went to the hospital to have the dislocation reduced but no underlying structures were injured and he did not need surgery to stabilize the joint. Although he did not lift, Sermon performed all running and agility drills at his April Pro Day and is expected to fully participate in offseason workouts.

Injured Players on Active Roster

Follow me on Twitter @JeneBramel for breaking injury news and analysis throughout the off-season.