Under The Knife: Berkman's knee injury a tale of two diagnoses

Are there more ACL sprains this year in MLB? Yes. There have been six diagnosed ACL sprains significant enough to put a player on the DL this season. Lance Berkman would be seven, but more on that below. In 2011, it was zero, which is as much a fluke as six. In '10, one -- Chipper Jones. The problem with saying the numbers are up is not that it's not true, but it's not instructive. The six injuries this year have nothing in common besides being as random as lottery numbers. Position? Nope. Mechanism of injury? Nope. A third of them (two, that is) happened outside competition. People like to see patterns and have simple explanations. There may be no pattern, but traumatic injuries happen. Baseball isn't like Strat-O-Matic, but there is an element that seems like someone's rolling those weird dice and getting weirder results. ACL injuries might be able to be reduced, but then again, they were at zero last year. One of the things we all love about baseball is that it's unpredictable. That means sometimes, we don't like the results. Let's focus on the injuries we can't prevent or reduce and be glad that ACL reconstruction has become far more science than art.

Powered by Leinenkugel's Summer Shandy, on to the injuries:

MRIs are not perfect. Neither am I. The information streaming out about Berkman on Monday had twists and turns, highlighting how tough it is to make solid diagnoses even when you have your hands on an athlete. Berkman injured his knee on Sunday and was examined by athletic trainers on the field and in the clubhouse, then by Dodgers team doctors. (This isn't unusual -- team doctors are there for both teams since doctors don't travel with their teams.) All of those manual tests indicated that there was a possible ACL sprain. Remember, this is a sprain, not a rupture. Those manual tests -- ones with technical names like anterior drawer test, Lachman test, MacIntosh test, jerk test, flexion rotation drawer test, Slocum test and the Losee test -- showed a laxity that was more than normal, where normal is usually the opposite, uninjured knee. (Want to see what a couple of these tests look like? Jesse Dimick from Sports and PT Associates demonstrates two.) Also recall that this is the knee that Berkman had reconstructed a few years back.

An MRI did not show evidence of a sprain, but Berkman isn't so sure. He'll head to Vail to let Dick Steadman scope his knee. There's clearly some meniscus damage, which will be handled, but the scope will let Steadman get a look at the ligament. Forget tests and MRIs in this case. It's all going to come down to what Steadman sees when he gets the camera inside Berkman's knee.* If it's just the meniscus, Berkman will be back in 6-8 weeks. If it's more, this could be the end of the line. I'm still leaning negative on this, but I'm not willing to put an ERD on it just yet.

(* You might remember Dustin Pedroia having a needle arthroscopy a season ago, which allowed him to get back on the field quickly after it was determined his knee didn't have significant damage. I don't know why that's not done more. Doctors I spoke with were very mixed in their opinions on this. It is a new technology.)

Indications are that Feliz has a flexor strain in his elbow. The Rangers aren't taking any chances and have shut down the young pitcher for a minimum of four weeks. Once the pain and inflammation are completely gone, he'll start up a throwing program. That puts the timeline at around the All-Star break, but there are issues beyond this. The Rangers may elect to push him back to the pen, especially if they move Alexi Ogando to a starting role. Feliz would likely just swap places with Ogando as far as role, but Feliz does like the closer role. If that's the way they go, Mike Maddux and Ron Washington are going to need to keep Feliz engaged. The elbow issue is very concerning, especially given his age. This doesn't rule out him returning to starting -- we saw a similar scenario with Chris Sale in ways -- but the key for the Rangers is winning and keeping Feliz healthy and productive. Of note, the push to the DL for Feliz was the team's first roster move on the season. Trainer Jamie Reed and his staff deserve a lot of credit, as does a flexible roster that can play a man down at times.

Braun's legs aren't right. He left Monday's game with an apparent groin strain and has been gimpy at times with a sore Achilles. None of it is enough to keep him out of the lineup. He's been productive, but the big concern is that all the little injuries take a toll, or worse, set up a cascade injury. A nasty hamstring strain could cost him a month and if the Achilles let go, that's a DFS. The Brewers don't seem too worried, though I'm sure trainer Dan Wright has a moment before every game where he looks at Braun, takes a deep breath, and ticks the box next to "able" on his screen. Braun looks like he feels better when he hits, so seeing him back in the lineup on Tuesday didn't surprise me.

The movements of a catcher are like nothing else in sports. Who else squats that much? That leads to some awkward movements, overtaxed muscles, and injuries. Montero strained his groin as he spun to chase a ball. Watching the play, it looked as if his cleat got stuck, but instead, it was just an awkward placement of his foot and a violent adductive movement on the turn. The strain isn't serious and a couple days of rest should have Montero back out there, but they'll watch it closely.

Hudson will start on Sunday for the D'backs. He's shown no issues in coming back, including a great outing at Reno (AAA). Hudson's shoulder appears to be back where they want it to be, though there's going to be some question about stamina early. The D'backs will watch him closely over his first few starts. You'll likely see Ken Crenshaw on the top step a lot of those starts, which is a big positive for Hudson going forward.

Youkilis returned to the Sox lineup and promptly homered. He can still hit and the SI joint strain appears to be under control. This is a situation that's going to require maintenance and constant vigilance, but for many players, the first situation with the back is a wake-up call.

Back in '03, during the NLCS -- actually before the game we now know as the "Bartman Game" -- Ivan Rodriguez was greeting friends and well-wishers on the field, but stopped and ran down to right field to be stretched out and do some exercises to keep his back loose and functional. Youkilis is going to have to do that, everyday, in order to keep doing things like hitting homers. Scouts from at least five teams (White Sox, Indians, Phillies, Reds and Rockies) are watching him, but that back is part of any trade. We seem to be talking as much about inconclusive MRIs as injuries these days.

Ross was headed for a long-term stay on the DL after an MRI showed a fracture in his foot. The navicular bone is a small one, but the fracture usually means six to eight weeks. A second opinion led to comments that the Sox thought they could get him back more quickly, though there was no indication as to why they thought that. He's out at least a month in the best case, so we can revisit this in mid-June.

Aroldis Chapman was clocked at 93 mph. That's a problem if it's his fastball, but a bigger problem since it was his Mercedes S63 ... Evan Longoria is jogging more and taking batting practice. He's still at least two weeks away from a rehab assignment ... Yankees prospect Manuel Banuelos is back on the DL with elbow issues. I'm sure the Yankees are trying to figure out why they keep losing young pitchers, but they don't seem to have the answers yet ... Erick Aybar left Tuesday's game with a bruised knee. No word on severity at deadline ... Brad Lidge is throwing again. He's still a couple weeks away after hernia surgery ... Chien-Ming Wang was activated for the Nats. He'll go the pen, but is starting depth ... Vernon Wells will need surgery to repair a torn ligament in his thumb. August 1 is a good target date for him ... Brett Morel goes to the DL after injections didn't ease up his back issues. Orlando Hudson will fill in while the Sox try to get Morel functional ... Daisuke Matsuzaka was placed on the 60-day DL with a trapezius strain. This is secondary to Tommy John, so it's a bad sign, but the 60-day move is more about the roster ... I was on the Cards pregame with Bob Ramsey Tuesday night. He asked me whether Adam Wainwright's season was a product of the Tommy John process. I said I thought it was mental. If so, I like the results ... Brilliant work from Bill Petti ... Ramon Hernandez is dealing with very painful tendinitis in his hand. Gripping a bat is the issue. You can see why that's important. He could be headed to the DL ... Mark Ellis had a second surgery on his leg. The serious situation contrasts with the six week return timeline ... I mentioned last time out that there was discussion of Stephen Strasburg's innings limit. It appears that Mike Rizzo isn't saying there's any hard limit, calling it a "media creation." We'll have to keep an eye out on this since the Nats aren't offering any sort of guidance for how they'll limit Strasburg, if at all.