Lane Johnson’s left ankle saga began two years ago, and the Eagles' Pro Bowl right tackle might be embarking on yet another chapter, at a critical time for his 1-3-1 team.

Head coach Doug Pederson said Monday that Johnson is getting a second medical opinion, after having to leave Sunday’s 38-29 loss at Pittsburgh on a cart. Johnson played 37 snaps before giving way to rookie Jack Driscoll, who played 27.

Once Johnson went down, the Eagles' offensive line consisted of center Jason Kelce and four backups, none of whom could claim more than a few games' NFL experience before this season. The Eagles’ second-half running game was nonexistent, 9 yards on 6 carries.

The Eagles already were without right guard Brandon Brooks (Achilles), left tackle Andre Dillard (biceps), Dillard replacement Jason Peters (toe), and left guard Isaac Seumalo (knee). Taking the field without Johnson would not be an optimal setup for this week’s meeting with the 4-1 Baltimore Ravens, who are giving up a league-lowest 15.2 points per game.

Johnson missed the season opener after undergoing “tightrope” surgery in August to stabilize a high-ankle sprain while ligaments healed that hadn’t gotten better in the offseason. Presumably, this was because the bones they connected to were not in alignment after a Dec. 9, 2019, reinjury to the ankle, which first was damaged early in the 2018 season. Johnson, who returned for the second game, against the Rams, said then that his ankle felt unstable all last season, before he made it much worse against the Giants.

Maybe in a normal offseason, Johnson would have figured out during OTAs or minicamp that he needed the tightrope procedure, which usually requires four to six weeks of recovery time. Johnson said he trained diligently on his own, but he wasn’t pushing against defenders, and when the Eagles held an August practice scrimmage, Johnson said, he realized his ankle hadn’t healed.

A medical source has said that this was something the Eagles might have figured out at the end of last season. But they did not, amid another reshuffling of the medical/training staffs.

On Oct. 28, 2018, in the Eagles' victory over Jacksonville in London, Johnson worsened a high-ankle sprain he was playing with and sprained the MCL in his left knee.

“So basically, ever since that Jacksonville hit, I had a high-ankle sprain and an MCL and I played through it,” he said last month. “And then really, last year, it felt unstable, but I was able to play effectively. … This was kind of a ‘fix-it’ for me, so I finally got it addressed, got it taken care of, and I think it will only get better as the season goes on.”

In the tightrope procedure, a polyethylene band is fastened to the tibia and fibula to stabilize them. Theoretically, if Johnson got enough recovery time before playing against the Rams, he should have been OK. He was not. He left the Oct. 4 game against the 49ers, went to the locker room, and returned to play, the interlude apparently made necessary because a shot to numb the ankle didn’t take.

On Friday, Johnson told reporters: “It turns out there was a cyst in there, and I ended up getting that drained Monday after the game. So it was about 6ccs of fluid that was just kind of sitting there and becoming inflamed.”

Jack Driscoll, who came in for Lane Johnson Sunday at Pittsburgh, started the opener at Washington in Johnson's right tackle spot. Here he blocks Montez Sweat.
YONG KIM / Staff Photographer
Jack Driscoll, who came in for Lane Johnson Sunday at Pittsburgh, started the opener at Washington in Johnson's right tackle spot. Here he blocks Montez Sweat.

Johnson said the inflammation made it hard for him to push off on his left foot. He said that it was feeling much better, that he was “starting to walk around with no pain.”

Obviously, Johnson was not pain-free Sunday in Pittsburgh, though early on he body-slammed Steelers edge rusher T.J. Watt.

The medical source said it made sense that Johnson developed a cyst, if he was still experiencing pain in the ankle.

“When an ankle is unstable, you rely on the surrounding tendons to compensate,” the source said. “When a tendon is overworked, it becomes inflamed, which can lead to the formation of a ganglion cyst. Inflammation can also lead to weakness and difficulty pushing off.”

If Johnson’s pain is caused by continuing instability in the ankle, the only way to fix that would be through surgery, which would sideline him for a good while, the source said.

He has been dealing with inflammation throughout his attempts to recover. The Eagles didn’t declare Johnson out of the Sept. 13 opener against Washington until his ankle swelled up on the bus ride down to Landover, Md.

“It swelled up pretty big, ballooned up on me,” Johnson said after watching that loss from the sideline.

On Monday, Pederson didn’t say where Johnson went for the second opinion. The NFL’s go-to ankle and foot expert is Robert Anderson, who works out of Green Bay, but that doesn’t mean Johnson would have to go there; in second-opinion cases, it’s typical for a doctor to be able to make a diagnosis by looking at tests.

Driscoll, 6-foot-5, 296, is a fourth-round rookie from Auburn who has played 106 offensive snaps this season, some at guard, and some as an extra blocking tight end. His only NFL start was in the opener, in Johnson’s spot. Pro Football Focus gives Driscoll a lackluster 48.6 overall grade -- 61.4 in pass blocking and 42.7 as a run blocker. Johnson is graded at 70.9 -- 80.9 protecting Carson Wentz and 63.6 in run-blocking.