Dougherty: To play or not to play? Packers weighing risk-reward with Aaron Rodgers' knee

Aaron Rodgers doesn’t need to prove anymore how tough he is. At a certain point, Brett Favre didn’t, either.

But Rodgers is an NFL quarterback, and if NFL quarterbacks can play without undue risk that they might make their injury worse, then they play. It’s what leaders do and part of what makes the great ones great.

Rodgers' status against the Minnesota Vikings will come down to whether he has pocket mobility despite his injured left knee. He had enough last week in the second half against Chicago to slide around like Tom Brady. That’s enough for him to play this week, too.

The question is whether he still can maneuver now that the adrenaline is long gone, and his left knee has swollen and stiffened from the sprain and collateral damage. The Packers can’t put him on the field if he’s a statue. That would invite disaster.

This is another gray-area decision for Rodgers, coach Mike McCarthy, general manager Brian Gutekunst, and of course, team doctor Pat McKenzie. It’s one they probably won’t make until Saturday or even Sunday morning.

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And though it’s hard to believe anything you hear from NFL teams about injuries, I tend to think McCarthy was speaking the truth when he said Thursday, “This is no layup.”

Keep in mind, too, that McKenzie is conservative by NFL standards. As one source who knows both men put it, McKenzie will not allow Rodgers on the field if there’s a significant risk of making the injury worse.

As strong-willed as Rodgers is — he played four years in high school and college with a torn anterior cruciate ligament (ACL) and ignored a doctor’s advice at the University of California to quit playing football after reinjuring his knee his first year there — he clearly respects McKenzie. To hear Rodgers speak of their relationship, it’s highly likely he would heed the doctor’s advice if McKenzie advised against playing.

“A great friendship and a lot of trust in one another,” Rodgers said of McKenzie this week. “… He’s a fantastic doctor. He’s a great communicator and we’re talking about a lot of things. We had a great conversation at halftime Sunday night and came to the conclusion that I could go back out there if I could deal with the pain.”

As for that pain, Rodgers was open after the game and again this week in saying it was “super” painful. But that’s not an indication of the severity of the ligament damage. Rodgers has described the injury only as a knee sprain.

“(There) is not a direct association with (pain and) the degree to which the ligament is torn or the knee is unstable,” said Dr. Bert Mandelbaum, physician of the U.S. Men’s National Soccer Team and sports medicine specialist at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles. “The pain is more a question of, he was hit and (maybe) he’s got a bone bruise as an associative injury. You can have a mild sprain and a bone bruise and it hurts like the dickens.”

We don’t know exactly what Rodgers’ injury is, though we probably can rule out a partially torn ACL. Yes, Rodgers played without an ACL when he was young. But the reason doctors didn’t reconstruct his left ACL after he tore it in a pickup basketball game as a high school sophomore in January 2000 is that he was still growing, and surgery would have required drilling into a growth plate in his knee, creating the risk his left leg would end up shorter than his right. Nobody at that time had an inkling he was going to become Aaron Rodgers.

At this point in Rodgers’ career, there’s no good reason to think McKenzie and the Packers would risk putting him out there with a ticking time bomb in his knee, which is what a partially torn ACL is. If he then totally blew out his knee, he could do a lot more damage than just severing the ACL, and that really could end or at least badly diminish his remaining years of football.

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So he probably has a sprained medial collateral ligament (MCL), lateral collateral ligament (LCL) or posterior cruciate ligament (PCL). MCL is the leading candidate — it prevents the leg from bending too far inward, which is what appears to have happened when Bears defensive lineman Roy Robertson-Harris fell on Rodgers in the second quarter Sunday night. But it could be one or more of the others, as well.

Mandelbaum said he prefers grading knee injuries on a continuum of 1 to 10, rather than the more common Grade 1 (mild) through Grade 3 (severe). Where a sprain falls on the continuum depends on how much the ligament is stretched or torn, and whether there’s collateral damage such as bone bruises and cartilage tears.

Without knowing the specifics, Mandelbaum wouldn’t comment on Rodgers’ injury. But based on the possibility that Rodgers might play this week, it’s highly likely he’s a lot closer to one than 10.

The risk of Rodgers playing Sunday is that the stretched or partially torn ligament tears completely and sidelines him, in the case of an MCL, for six weeks or more. The risk increases the further you go toward 10 on the spectrum.

“If he’s way down to the left of that spectrum, he’s going to play very soon,” Mandelbaum said.

The Packers’ and Rodgers’ decision is very much in the gray area that NFL teams operate in on a weekly basis. It’s just that there’s a lot more at stake for the franchise when it’s the quarterback.

They went through it last year when Rodgers became what’s believed to be the first NFL quarterback to return from a broken collarbone on his throwing side in the same season. He played nine weeks later, and though he didn’t reinjure his collarbone, it was clear his throwing strength hadn’t returned.

This time, it comes down to whether he can move against one of the best defenses in the NFL. Rodgers has to at least be mobile enough to slide around the pocket, even if he can’t step into his throws.

The argument for not playing him even if he can move in the pocket is that it’s a long season, and one game, even against the team the Packers figure to be battling for the NFC North title, isn’t worth the risk of a worse injury. Especially against that defense. Let him heal at least another week.

The argument for playing him is that there are only 16 games, they all matter, and it sends an important message to the rest of the team. If the injury is on the lower end of the 10-point spectrum, then he should play. You protect players in the preseason, but when the games count, they play.

Count me as a play him.

That, of course, doesn’t mean the Packers can be reckless with the health of the most important person in the franchise. But Rodgers’ knee was stable enough to return against the Bears, and if he can slide in the pocket like he did in that game, then he should play this week, too.