Manchester United captain and centre back Harry Maguire injured his left ankle vs Aston Villa on May 9th, having rolled his ankle under the weight of an opponent while challenging for the ball.
The player was forced to leave the pitch and has been seen in a CAM protective boot since the injury. United and manager Ole Gunnar Solskjaer provided an update on the English defender, stating scans didn’t reveal any fractures to the ankle but there is ligament damage.
Further, Solskjaer believes Maguire will miss the remaining three Premier League games but hopes to have him back for the Europa League final on May 26th.
So the question becomes: can Maguire return for the final against Villareal?
What kind of injury has Harry Maguire suffered?
To answer that question, we first need to have a basic understanding of the injury. Based on the mechanism of injury with Maguire’s ankle having been forcibly pushed outwards (external rotation), this is very likely a syndesmotic tear, colloquially known as a “high ankle sprain”.
This group of ligaments are a major stabilizer of the distal (far) ends of the tibia (shin bone) and fibula (outer lower leg bone) and damage is categorised into three grades. Based on Maguire not being ruled out for the Europa League, it’s very likely he has a grade 1 tear.
Return-to-play timeline ahead of Man Utd vs Villarreal
The average return to play timeline for grade 1 high ankle sprains is four to six weeks, which would obviously rule Maguire out for the final. However, there are examples of expedited return-to-play protocols for high ankle sprains which average around fourteen days (there are 17 days between Maguire’s injury and the Europa League final on May 26th) and in extreme cases, there are examples of players playing straight through a high ankle sprain without missing any time. For example, Golden State Warriors guard Klay Thompson played through this injury during the 2018 NBA Finals.
Risk vs. Reward calculus
The key concern with these expedited returns is significantly higher re-injury risk and impaired performance upon returning due to stiffness and pain. I have little doubt Maguire can play through the pain. He reportedly did so through a hip complaint for two months, taking injections to battle the pain, but Manchester United cannot afford a limited Maguire in a tournament final and potentially having to take him out early.
Further, with Euro 2020 around the corner, Maguire will have to consider how returning from this injury early may affect him heading into the tournament with England. If there is a reaggravation, he could potentially have to miss it altogether.
All in all, this a really fine tightrope of risk vs reward to walk and there are so many different push-pull factors at play here. There’s a chance Maguire is able to play but it will come at significant risk. These calculations are often the crux of medical decision-making in football and why it can be such a difficult job.
For a video version of this article, you can find that here.
Dr Rajpal Brar, DPT, is a physiotherapist, movement and mindfulness coach. He runs the LA-based wellness and athletic development/performance clinic 3CB Performance, and you can subscribe to his Youtube channel (which posts analyses of Lionel Messi and more) by going here.