Boston Sports Doc Injury Blog

Dr. Christopher Geary, your source for info on the latest sports injuries with a bit of a Boston slant…

Ok, that’s a terrible pun. But the Houston defensive star’s latest injury is no laughing matter 


By now, everyone knows that JJ Watt, All-Pro defensive end for the Houston Texans, suffered a season-ending left knee injury in the Sunday Night Football game against the Chiefs. Watt went down awkwardly while rushing the passer in the first quarter and had to be helped off the field, unable to bear weight on his left leg. It was later announced that he had a tibial plateau fracture which underwent surgical fixation, resulting in Watt being placed on Injured Reserve and ending his season. But what is this injury and what does it mean for Watt’s future?

A tibial plateau fracture is a fracture of the top of the tibia, where it makes up the bottom half of the knee joint.


A fracture of the tibial plateau, by definition, involves the knee joint itself, as opposed to a tibial shaft fracture, which is a fracture of the mid-portion of the bone between the knee and the ankle. This is an important distinction, because a tibial plateau fracture also impacts the structures inside of the knee, including the articular (surface) cartilage, and potentially the meniscus and ligaments of the knee.


Like most things in orthopedics, there is a classification system for tibial plateau fractures, from type 1 to type 6, with the severity of injury basically increasing the higher the number.

Most likely, based on the mechanism of Watt’s injury, he sustained a type 1 or 2 fracture – that involves the lateral, or outside, plateau. Early this week he underwent surgery to fix the fracture with a plate and screws, resulting in fixation that likely resembles this x-ray:


Following this, Watt will be on crutches for 8-12 weeks, with gradually increasing range of motion in a brace. He won’t be able to start significant strengthening until a month or two after that, and won’t be able to resume full football activity for 6 to 9 months after his surgery.

How about the prognosis for Watt’s leg moving forward – will he be the same player he was before the injury?  That’s a question that can’t really be answered based just on his x-rays – the most important factor is the status of the cartilage in his knee, both the surface cartilage and the meniscal cartilage. When a bone fractures into a joint, as is the case with a tibial plateau fracture, the surface cartilage is also injured. The degree of cartilage injury and the ability of the surgeon to precisely align the bones to allow the cartilage to heal as well as possible are important determinants of how Watt will do in future seasons. A significant degree of cartilage injury can be a source of ongoing pain and can even cause early arthritis.

The meniscus cartilage is also commonly injured in the setting of a tibial plateau fracture – most studies estimate between 30-50 percent of patients with lateral tibial plateau fracture also tear their meniscus. If the tear is significant or cannot be repaired, this can also be a source of ongoing pain.


Blue oval shows meniscus tear in a knee with a tibial plateau fracture 

No doubt JJ Watt will put as much effort into his recovery as he has with his previous injuries, including major back surgery last season. How his knee responds, however, will depend largely on factors beyond his control – the status of the cartilage in his knee due to the injury and how his body responds to any damage to those structures. The hope is that his leg heals well and he returns to being the same dynamic player that he was, but the cartilage in his knee will likely be the final determinant of how well he does.

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