UPDATE: This article has been edited from the original version published in April 2020.
Tua Tagovailoa was the single biggest question mark and risk — if NFL teams are to be believed — of the 2020 NFL Draft.
His talent and throwing accuracy are hard to deny, but some teams had cooled on Tagovailoa, once considered the clear top choice of the 2020 NFL Draft, until he was selected fourth overall by the Dolphins. The most notable reason for that, of course, is his injury history.
In particular, a dislocated hip and posterior wall fracture Tagovailoa suffered against Mississippi State on Nov. 16 — one that ended his college career — caused several NFL scouts and teams to question whether he was worth the risking of a high draft choice. The severity of that injury, only the latest of a well-documented history, has become the defining subject of Tagovailoa’s early professional career and will remain until he makes his first NFL start and proves doubters wrong.
Sporting News in early April spoke with Dr. Lyle Cain, a sports medicine specialist at the Andrews Sports Medicine & Orthopaedic Center and Alabama’s team orthopedic surgeon, to shed light on Tagovailoa’s injury and his recovery process leading into the 2020 NFL Draft.
With that, here’s everything you need to know about Tagovailoa’s injury history, his latest injury, his recovery process and whether he will be ready for the 2020 season.
Tua Tagovailoa injury history
— March 2018: During a spring practice before his first full season as Alabama’s starter, Tagovailoa hits a lineman’s helmet while throwing a pass and suffers a broken left index finger. The injury requires a quick surgery, but he misses no practice time.
— October 2018: Tagovailoa tweaks he knee during a win over Missouri. It’s later revealed that he suffered a knee sprain, but he misses no time and is back in the lineup the following week against Tennessee.
— November 2018: During a late-season game against Mississippi State, Tagovailoa in the third quarter takes a hit to his left quad, the same leg of his knee injury a month prior. He sits out the rest of the game, an Alabama win, and returns the following week against The Citadel.
— December 2018: This is the game in which Jalen Hurts saved Alabama’s chance to make the College Football Playoff. In the fourth quarter of the SEC championship game against Georgia, Alabama left tackle Jonah Williams accidentally steps on Tagovailoa’s right ankle and causes an injury. Tagovailoa sits out the rest of the game and eventually has a tightrope procedure performed on his ankle so he can return for the College Football Playoff.
— October 2019: Tagovailoa suffers another right ankle injury, this time a high ankle sprain during a win over Tennessee. He again opts to undergo a tightrope procedure for a quick recovery. He misses one game (a win over Arkansas) before returning to start in Alabama’s loss to LSU.
— November 2019: Toward the end of the first half of a blowout win against Mississippi State, Tagovailoa suffers the nasty hip injury that prematurely ends his college career. More on that injury below.
What is Tua Tagovailoa’s latest injury?
Tagovailoa suffered a dislocated hip and posterior wall fracture against Mississippi State; the dislocated hip in particular is a high-impact injury not often seen in football, and more likely to occur in car crashes.
The dislocated hip is also notable in that former Raiders running back Bo Jackson suffered it during the 1991 AFC divisional round matchup against the Bengals. He never played football again after suffering the injury. The difference between Tagovailoa and Jackson’s respective prognoses was the speed of diagnosis and treatment. Whereas no one understood the severity of Jackson’s injury, Cain said he was able to diagnose a hip dislocation on the field.
“And so the next point of that is to get as urgent a reduction (as possible), and to get it back in place as quickly as possible,” Cain told SN. “I actually thought for a split second about doing it on the field, but thought it wasn’t probably the right medium to cause a bunch of trauma.
“So we get him on the cart, we got into the tunnel and as soon as we got into the X-ray facility, we put his hip back into place with the help of our medical staff and the Mississippi State medical staff. So I put his hip back in place, we got X-rays and imaging to confirm everything’s in the right position, and that was about as quick as it could be. It was probably in within five minutes or less from the time it happened.”
In so doing, Cain said any potential blood flow issues or future long-term effects were mitigated. Had the injury been less traumatic it might have caused even further damage.
“Tua’s was more traumatic, which sounds worse but may have actually may have ended up in a better position because we knew we had to treat it from the initial moment of injury.”
What is a posterior wall fracture?
An early potential complication for Tagovailoa’s recovery was the report of a posterior wall fracture (another similarity to Jackson’s injury).
Here is the definition of a posterior wall fracture, from the American Academy of Orthopaedic Surgeons:
“Fractures of the posterior wall of the acetabulum (hip socket) are the most common type of acetabular fracture, accounting for approximately 25 percent of all acetabular fractures. The simple appearance of the posterior wall fracture on plain radiographs underestimates its potential complexity. Rather than having one simple fracture fragment, most posterior wall fractures are comminuted or have areas where the articular surface along the margin of the primary fracture line is impacted into the underlying cancellous bone. In general, posterior wall fractures are amenable to nonsurgical treatment if the remaining, intact part of the acetabulum is large enough to maintain hip joint stability and congruity; however, this situation is often difficult to determine. Clinical outcome has been shown to be directly related to the accuracy of reduction, but accurate repositioning of all of the small posterior wall fragments is frequently a challenging task.”
Tua Tagovailoa injury timeline
Tagovailoa’s recovery and rehab process began immediately following his injury, starting with the first of several “hurdles” he would need to clear: getting his hip surgically repaired. Two days after he dislocated his hip, Dr. Chip Routt — who specializes in orthopedic surgery, particularly trauma, pelvic and hip socket fractures — repaired Tagovailoa’s hip in Houston.
“Tua underwent successful surgery on his right hip Monday morning in Houston,” Cain said in a statement following surgery. “The procedure went as planned, and he is resting comfortably. Tua’s prognosis is excellent, and we expect him to make a full recovery. He will return to Tuscaloosa in the next several days to begin his rehab.”
The resulting recovery from that surgery took three months. During that time, Cain and the medical staffs at Alabama and Andrews Sports Medicine placed Tagovailoa on a conservative rehabilitation process (so as to reduce the stress placed on his hip).
Said Cain: “Essentially, the initial part of the process was just working on getting his muscles activated — your muscles kind of shut down and atrophy after an injury like that — getting his range of motion back in position so he can rotate his hip correctly.”
Tagovailoa underwent several rehab exercises a day, including gluteus muscle strengthening; hip range and motion work; abductor strengthening, training and activation; and quads and lower body work, to get leg control back. Cain said the rehab process also included preventative exercises to keep his core and upper body from atrophying.
On Feb. 10 — nearly three months after Tagovailoa dislocated his hip — a CAT scan showed Tagovailoa’s hip “looked about as good as it could.”
The second hurdle in Tagovailoa’s recovery was his ensuring there were no blood flow or cartilage issues. Around the time Tagovailoa got his CAT scan — just before the start of the NFL Combine — he received an MRI that suggested he had no such issues, allowing him to increase the intensity of his rehabilitation.
On Feb. 26, Tagovailoa received “overwhelmingly positive” feedback on his scans from teams at the NFL Combine. He did not participate in drills there, but was cleared to resume football activity on March 10. He showed off his recovery in a March 23 video that showed him going through drills.
On April 10, he conducted a personal pro day, throwing 72 passes to receivers:
On July 28, Tagovailoa was given the “all-clear” by Dolphins doctors to begin practicing with the team. He was a full participant in training camp, working as the second-string quarterback behind place-holding starter Ryan Fitzpatrick.
Will Tua Tagovailoa start in 2020 NFL season?
Tagovailoa has expressed optimism he would be healthy enough to play in 2020. While he has been given a clean bill of health, his surgically repaired hip has yet to be tested in live game action.
“I’ve told people before in previous discussions that just because the bone is healed and the hip looks good doesn’t mean he’s ready to play football,” Cain said. “He has to rehab and get back in shape and get the muscles strong, and it’s just like any other injury. It takes quite a while, sometimes several months, to get the body back into highly competitive shape.”
The Dolphins, to their credit, are operating out of an abundance of caution and have so far resisting forcing Tagovailoa under center with Fitzpatrick holding down starting functions.
Tua Tagovailoa injury updates
April 10 — Tagovailoa throws 72 passes at personal pro day.
March 23 — Tagovailoa shows recovery in video going through drills.
March 10 — Tagovailoa medically cleared for football activities.
Feb. 26 — Tagovailoa receives positive reports from teams that examined him at NFL Combine.
Feb. 23 — Tagovailoa arrives in Indianapolis for NFL combine.
Feb. 10 — Tagovailoa receivers three-month checkup on hip; results reported as “positive as possible.”
Jan. 30 — Tagovailoa, at press events at the Super Bowl, tells several outlets he expects full recovery.
Jan. 14 — Tagovailoa’s agent tells AL.com Tagovailoa expects to be healthy enough by April to host separate pro day workout.
Jan. 6 — Tagovailoa declares for the 2020 NFL Draft, saying he feels optimistic he’ll be healthy enough to play in 2020.
Jan. 3 — Tagovailoa, family members and Alabama trainers meet with doctors in New York.
Nov. 22 — Tagovailoa returns to Tuscaloosa.
Nov. 18 — Tagovailoa undergoes “successful” surgery on his hip; Cain labels his prognosis “excellent.” Rutlege reports Tagovailoa will be on a six-week partial weight-bearing recovery plan, followed by resumed athletic activity. He is expected to be able to throw again by the spring.
Nov. 17 — Tagovailoa is flown to Houston to undergo hip surgery the following day.
Nov. 16 — Tagovailoa suffers a hip injury against Mississippi State. Aaron Suttles of the Athletic reports Tagovailoa has a dislocated hip and posterior wall fracture. In a statement, Alabama orthopedic surgeon Dr. Cain says Tagovailoa is expected to make a full recovery, making no mention of a fracture.
Contributing: Tadd Haislop