Fantasy basketball injury outlooks: Kawhi Leonard, Klay Thompson and more

This week we once again welcome Stephania Bell into the Hoops Lab. She does outstanding work helping us to understand and better estimate injury absences and return prognostications. Together, we'll look at some of the major injuries in the NBA right now, give some added context about the recovery process, and estimate what this might mean for the player's potential availability this season. Today, we'll start with the large number of impact players returning from ACL injuries before branching out from there.

ACL Reconstruction: Kawhi Leonard, Jamal Murray, Spencer Dinwiddie, Jonathan Isaac, Markelle Fultz, Thomas Bryant

There was a time when a torn Achilles tendon or a torn ACL meant the end of an NBA playing career. Medicine has advanced through the decades to the point that this is typically not the case anymore, and players are able to recover enough to resume their careers in most circumstances. Return to play following ACL reconstruction averages 10-12 months.

ACL tears are generally more prevalent in the NFL than the NBA, but this season there are an unusually high number of NBA impact players recovering from ACL injuries. Every situation is unique and recovery time can be affected by a number of variables. For instance, was it an isolated ACL tear or were other structures involved? What is the patient's individual rate of healing? And there are also other, non-physiological considerations, such as the seasonal calendar, and whether it makes sense to push to return versus taking more time to recover.

Let's go through some of the more prominent cases.

Kawhi Leonard, LA Clippers
Date of injury: June 14, 2021
Date of surgery: July 13, 2021

Leonard injured the ACL in his right knee in a non-contact play, landing awkwardly while making a move on a dribble drive during the fourth quarter of Game 4 of the Western Conference semifinals. ACL tears can be tricky because they are not always immediately incapacitating. Occasionally the player can appear to be fine because they are walking around and going through daily activities. This appears to have been the case with Leonard, who was initially considered game-to-game. However, his knee was ultimately not functionally stable enough to perform athletic tasks and Leonard underwent ACL reconstruction surgery about a month after the injury.

There are different grafts used to reconstruct the torn ligament in an ACL surgery. The most common method is to harvest the graft from the central third of the patellar tendon (the broad tendon that connects the kneecap to the shinbone), to create the new ACL. The incision results in a vertical scar on the front of the knee. When Leonard attended the NBA Summer League in Las Vegas about a month after his surgery, he wore shorts and had just such a visible scar on the front of his right knee.

There may be a silver lining for Leonard through all of this. His history of tendinopathy in both his quad and patellar tendons is well documented. While it sounds counterintuitive, an incision into the tendon can stimulate blood flow and a healing response to the area which, in turn, can improve the long-term health of the tissue.

In addition to restoring functional stability to his knee, the procedure could have ancillary benefits for the chronic knee issues that have plagued Leonard in recent years. Unfortunately for fantasy basketball managers, the timeline of his injury and surgery make it unlikely he will return to play during the 2021-22 regular season. Ten months post-surgery will fall in the middle of May 2022 and the regular season ends in mid-April. Thus, we shouldn't expect for Kawhi to play during the fantasy basketball season, and the safest bet would be to avoid him outside of dynasty leagues.

Jamal Murray, Denver Nuggets
Date of injury: April 12, 2021
Date of surgery: April 21, 2021. Surgery performed by Dr. Neal ElAttrache

Murray tore his left ACL with less than a minute left in a game against the Warriors and had his surgery just over a week later. While there is still no timetable for his return, Ohm Youngmisuk reports that the Nuggets medical staff is thrilled with Murray's rehab so far. With the standard 10-12 month estimated recovery period, if he is indeed on pace for the earlier side of that window he could potentially return just after the Feb. 20 All-Star game.

If he meets this target, Murray will be available for the stretch run of the fantasy basketball season. His return will probably entail a ramp-up to normal minutes and responsibility. The Nuggets have championship aspirations this season, and those would depend on having Murray as close to full speed as possible by playoff time. Health permitting, Murray might be back to a reasonable approximation of his usual value in time for the fantasy playoffs at the end of the regular season. This makes Murray an intriguing late-round stash candidate for fantasy basketball, particularly in leagues with either deep benches or injured lists where he can matriculate until healthy.

Jonathan Isaac, Orlando Magic
Date of injury: Aug. 2, 2020
Date of surgery: Aug. 7, 2020

Isaac tore his left ACL and meniscus more than a year ago, and does not have a scheduled return date. He has yet to be cleared for contact, so he has been unable to return to full basketball activities with the Magic. During training camp, he's only been seen doing simple shooting drills after practice. Isaac's injury was more complex than an isolated ACL given the meniscus injury; he also has a history of leg injuries, which may factor into why there has been no rush to return him to action. In fact, he was playing in only his second game back after missing 31 games with a hyperextended left knee when he tore his ACL. Add to the equation that Isaac's game is built on the excellent lateral quickness that allowed him to be a strong defensive player, and that the Magic are a rebuilding team with no real aspirations to make the playoffs, and it behooves them to take their time with their injured players and be sure they are full strength before letting them return to the court. Isaac will be the Magic's highest-paid player entering next season, and he is at the center of the team's long-range hopes to return to contention.

Expect Isaac to return this season but perhaps not in the immediate future. The uncertainty about his return would make him a risky player to draft in fantasy leagues, but his upside as perhaps the best source of defensive stats in the NBA makes him worth the risk as a draft-and-stash in later rounds.

Markelle Fultz, Orlando Magic
Date of injury: Jan. 6, 2021
Date of surgery: Jan. 20, 2021, by Dr. Neal El Attrache

Fultz tore the ACL in his left knee almost five months to the day after teammate Isaac had his ACL reconstruction surgery, but unlike Isaac, Fultz was not reported to have torn his meniscus as well. During media day, Fultz told reporters that he hasn't had any setbacks and that he is "doing amazing."

There is currently no stated timeline, but the standard estimate would place Fultz's likely return window between late November and late January. As noted with Isaac, the Magic are a rebuilding team with the impetus to make sure their young star players are fully healthy before bringing them back. Even the more conservative end of the 10-12 month window would have Fultz back on the court by the halfway mark of the season. For fantasy basketball purposes, this makes Fultz a solid draft-and-stash candidate in the later rounds of most leagues.

Spencer Dinwiddie, Washington Wizards
Date of injury: Dec. 27, 2020
Date of surgery: Jan. 4, 2021, by Dr. Riley Williams III at the Hospital for Special Surgery

Dinwiddie tore the ACL in his right knee last season while playing for the Brooklyn Nets, and underwent successful ACL reconstruction surgery just after New Year. He signed with the Washington Wizards this offseason, and has already returned to the court and played in the NBA preseason. This is a bit earlier than the standard 10-12 month window, which would have had him potentially returning around early November. This would seem to indicate that Dinwiddie's rehab and recovery went well, and the medical staff felt comfortable that he was healthy enough to compete.

As the big offseason acquisition for a Wizards team that wants to be competitive enough to keep star Bradley Beal invested in the team, Dinwiddie will be relied on to play well as soon as he is physically able. Dinwiddie has averaged 21.3 MPG during three preseason games thus far, which has allowed him to work off some of the rust before the season begins. He may not be quite back to full speed and responsibility by the time the regular season begins, but it would appear that he's on pace to be at or near full speed relatively early in the season.

For fantasy purposes, there is still risk in drafting Dinwiddie. He is not only coming back from major injury, but he's doing so on an entirely new team with a different set of responsibilities than he had with the Nets. He's no longer the offensive spark plug off the bench, but instead will be expected to be a full-time starting floor general. That said, managers can take Dinwiddie in the middle rounds of the draft, knowing he has the upside to be an impact player to help justify the risk.

Thomas Bryant, Washington Wizards
Date of injury: Jan. 9, 2021
Date of surgery: Approximately three weeks later, confirmed in early February 2021

Bryant tore his left ACL just after New Year, less than two weeks after new teammate Dinwiddie experienced the same injury. However, while Dinwiddie is already back and playing for the Wizards, Bryant is still away from the team rehabbing. Wizards GM Tommy Sheppard indicated he hopes Bryant can return to game action sometime in December. Part of the reason for the delayed timeline is that Bryant waited a few weeks after his initial injury to have his surgery. Thus, the clock on his estimated 10-12 month recovery period didn't begin until early February, and would push the anticipated return window to between early December and early February 2022. Based on Sheppard's statement, it sounds like Bryant is doing well with his rehab and they are projecting his return within the next couple months. On the fantasy front, Bryant was in the midst of a breakout season when he was injured. The Wizards have since brought in more big man talent, including 2020 Sixth Man of the Year Montrezl Harrell, but when he's healthy Bryant should still have an impact role on the team. He is therefore a viable draft candidate late in drafts to keep on the bench/IL until he completes his recovery.

Klay Thompson, Golden State Warriors. Torn Left ACL, Torn Right Achilles tendon
Date of injury: Tore left ACL June 13, 2019 in Game 6 of the NBA Finals
Date of knee surgery: Tuesday, July 2, 2019. Performed by Dr. Neal ElAttrache
Date of injury: Tore right Achilles tendon Nov. 18, 2020
Date of knee surgery: Nov. 25, 2020. Performed by Dr. Richard Ferkel

Thompson missed the entire 2019-20 season while recovering from his torn left ACL, then tore his right Achilles tendon during a pickup game in November 2020 and missed the entire 2020-21 season. The rehab process following ACL reconstruction is long. The first part of ACL rehab is slow as the focus is on decreasing swelling, improving muscle strength, progressing off crutches to walking without a limp and other basics. However, once through those things, as athletes ramp up activity and feel better, the body is still recovering and muscle balance is not yet back to 100%. Elite athletes tend to unconsciously compensate to mask these deficiencies, often not regaining full strength and muscle balance until they are near to a return to competition. Sometimes, when we hear about significant injuries happening back-to-back, it may be due, at least in part, to that early compensation while increasing activity. And in those situations, it's often the contralateral (opposite) side of the body that bears the brunt of it. There is no way to be certain that this played a role in Thompson's subsequent Achilles tear, but it is notable that he tore his right Achilles while recovering from a torn left ACL.

The recovery timeline for an Achilles tear is similar, perhaps slightly longer, than for an ACL tear. Until recently, there were fewer examples of NBA players fully recovering from Achilles injuries than there were for ACL tears. However, several prominent players, including Thompson's former teammate Kevin Durant, have recently shown that it is possible to recover full basketball function -- including quickness, explosiveness and jump height -- after tearing an Achilles. That said, Durant did contend with a hamstring injury that cost him multiple weeks when he returned to action. One of the concerns for Thompson he has dealt with before: the risk of compensatory issues. As the Warriors are no doubt taking into consideration, it will be important for them to bring him along gradually to minimize the risk of another compensatory injury.

Another element of note in Durant's recovery was that his return to game action came almost 18 months after his initial injury, part of which was because of an altered schedule due to COVID-19 and the seasonal calendar. We are currently only 11 months from the time of Thompson's Achilles injury. The Warriors have not released an official timeline for Thompson's return, but Nick Friedell reports that Warriors GM Bob Myers is hopeful that Thompson may return to game action in December or January. Thompson recently estimated that he is about "75 or 80 percentile" of where he needs to be to play, and he has been able to participate in some light basketball work with the team during training camp.

The best news is that Thompson can make a full recovery. He is 31 years old, which is no longer young but still in his physical prime, and he doesn't overly rely on vertical athleticism in his game. Thompson is long for a wing, which makes lateral quickness more important to his game than explosiveness. Also, as a shooter in the Reggie Miller school of running marathons in the half court where he rubs his defender off a constant barrage of picks, Thompson can use endurance and angles to get up his inevitable 3-pointer without having to worry so much about beating his man off the dribble. Therefore, there's a good chance that when that time comes we'll get to see him recover most if not all of his effectiveness. As he gains confidence in his legs on the court, the performance will reflect that as well.

Fantasy-wise, Thompson is another draft-and-stash candidate. Keep in mind, though, that he'll probably be brought along very slowly even once he returns to game action. The Warriors have added enough talented young scorers on the wing that they shouldn't have to hurry Thompson along, and he is likely to be load-managed for an extended period upon his return. However, the team does hope to have him closer to full strength by the time the playoffs come around, so his minutes and role will probably increase as the season goes along. Put together, Thompson is worth taking in the middle-to-late rounds of fantasy drafts, not during the early-to-mid rounds that would be his healthy norm.

Victor Oladipo, Miami Heat. Ruptured Quadriceps tendon
Date of injury: second rupture of his right quadriceps tendon, approximately April 8, 2021
Date of surgery: May 13, 2021 by Dr. Jonathan Glashow

Oladipo originally tore his right quadriceps tendon in January 2019, and went through the entire process of surgical repair and rehab before returning to game action in January 2020. He was unable to play consistently, or at his normal level, for the entirety of the 2019-20 season, and he played only 19 games overall. He played closer to his typical level during 2020-21, but was still only able to play 33 total games across three different teams before having to shut down his season again because of a re-rupture of the same quad tendon.

It should be noted that a ruptured quad tendon is relatively uncommon, and re-rupturing a surgically repaired quad tendon is an injury from which, to date, no NBA player has ever returned. It is fair to wonder how healthy the tendon tissue actually is given a secondary injury requiring another surgical repair. Reports are that Oladipo is healing and rehabbing well, but two major injuries and surgeries in the same area have undoubtedly resulted in both soft tissue trauma and scar to the area.

Friedell reported that neither Oladipo nor the Heat wanted to put a timeline on when he'll return to game action, though Oladipo told reporters he wants to "have one of the best comeback stories ever."

To achieve that comeback, Oladipo and the rehab staff working with him will have to focus on properly loading the tendon during the recovery and return to play process. Even beyond the recovery and return to play, maintaining tissue in this twice-injured tendon suggests Oladipo will need to continue to keep stressing it with a balanced workload. A balanced workload does not just come in the form of minutes played and rest but also in targeted exercise to the area. This will be an ongoing management issue for Oladipo, perhaps for the rest of his career.

It is difficult to estimate when Oladipo may be ready to return to game action. His situation may be unprecedented in NBA history, and his comeback story will indeed be amazing. From a fantasy perspective, it is a risk to expect him to return before 2022, and when he does get back it isn't clear when he might be able to play to usual levels. As noted, his initial return from his first quad rupture came at a level beneath his norm with fewer minutes played, more missed games and less production. It would be very risky to expect fantasy-worthy production from Oladipo this season. He is still a potential draft-and-stash candidate, but if you choose to do so, take him in very late rounds with the understanding that his return to fantasy relevance might not happen until next season.

Zion Williamson, New Orleans Pelicans. Fractured foot
Date of injury: unknown
Date of surgery: Prior to Summer League (Summer League began Aug. 7, 2021)

Zion Williamson broke the fifth metatarsal in his right foot this summer, and had it surgically repaired sometime before the Summer League began in early August. This injury was reported in the lead up to training camp, well after it happened, and Pelicans general manager David Griffin gave an estimated timeline that Zion could return for the start of the NBA season. However, Andrew Lopez reported on Monday, from Pelicans coach Willie Green, that Zion hasn't started even running yet and that they were getting "some scans" of his foot this week that would determine how they proceed from here. The scans came back with no additional damage, but no new timetable was released for his expected return. He will receive a new set of scans in two weeks, so he will miss the start of the regular season.

Zion has a history of lower body injuries on his right side. He suffered a hamstring injury and right knee injury while at Duke when his shoe famously blew out on the court. He had meniscus surgery on his right knee prior to his rookie season. And now, he has a fractured bone in his right foot. There is no evidence or indication that these injuries are directly related, but a lot has been made about Zion's physical mechanics. Zion and the Pelicans have each spoken on it throughout his tenure on the team, and it was one of the stated emphasis points for Zion going into last season. Stephania did some excellent analysis on Zion's mechanics, including the difference in good vs bad mechanics and why the effects they have on his body could contribute to injury risk.

For operative treatment of the fifth metatarsal/Jones fractures in the NBA, history shows us that if the injury occurs in-season players often return to play in 6-8 weeks. We don't have exact dates for Zion's injury and surgery, but it was reported they occurred prior to the Summer League that began Aug. 7. It has already been more than nine weeks since then, so the given timeline of Zion returning for the start of the season is generally plausible. The reporting that he isn't running yet suggests he may not quite meet that timeline, but barring complications it is reasonable to expect that Zion should be able to return early in the season. It should be noted, though, that there is some risk of re-injury with this type of fracture, a figure that within the literature has reportedly ranged from as low as 10% to as high as 30%. The further the return date extends from the date of injury, the more bone healing has progressed and the risk appears to decrease. However, even with the best imaging there is microscopic bone remodeling that continues to occur that is not visible. For this reason, it is typically a combination of positive imaging results and a player reporting being completely symptom-free with each level of activity progression that ultimately dictates a return to action. Even then, re-injury cannot be completely ruled out although the risk may be minimal. As with most injury situations, it becomes a risk-reward assessment. Typically, if such a re-injury does occur, it will be during the first year after the initial fracture, so Zion will carry a bit more risk than usual this season.

From a fantasy perspective, unless new complications or an extended timeline is announced, Zion can be drafted comfortably in the early rounds where he is projected to go with only a slight penalty due to missing the first few weeks. Know that he does have increased injury risk, but based upon what we've been told thus far, there's a reasonable chance that he will be healthy and able to play relatively early in the season.

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