J.A. Sherman asks orthopaedic surgeon Dr. David Geier about Russell Westbrook's second knee surgery

Dr. David Geier, M.D.

The news of Russell Westbrook's knee rehab setback was vexing, so WTLC once again discusses the issue with Dr. David Geier, an orthopedic surgeon and expert, on what the second surgery on Westbrook's knee means.

Yesterday, the Oklahoma City Thunder released the news that Russell Westbrook had undergone a second surgery on his right knee.  It had been approximately 5 months after he suffered an injury in the 2013 playoffs and the subsequent repair of his meniscus. Since this is a new kind of experience for Thunder fans, watching a star player have to deal with a prolonged injury for a length of time, uncertainty abounds.

The best way to deal with uncertainty is to seek out expert advice. Previously, we brought to you an in-depth interview with Dr. David Geier, an orthopaedic surgeon and sports medicine specialist in Charleston, South Carolina who is an expert in the area of meniscus repair and athlete recovery from such injuries. If you want to have a solid understanding of Westbrook's initial procedure, you can't do much better than start with this interview.

We turn once again to Dr. David Geier to get some questions answered about Westbrook's 2nd procedure, both to arm us with the knowledge we need to understand what is going on, and hopefully quell some of our frayed nerves.

Here are our questions for Dr. Geier, followed by his responses.

***

J.A. Sherman: Westbrook was injured in late April, and now is in his 5th full month of recovery. You initially estimated that the standard rate of recovery was 3-4 months. Is this breaking news a surprise to you, and what is your initial reaction?

Dr. David Geier: When a surgeon performs a meniscus repair, he uses sutures to hold the edges of the meniscus tear together until they heal. That meniscal healing often takes 3 to 4 months. Recovering from the entire surgery can take much longer. Surgeons often delay weight-bearing and jogging for many weeks to protect the repair. Then the athlete has to regain motion and strength before progressing to functional activities. While it is possible to return to sports within 3 to 4 months after meniscus repair, it can often take 4 to 6 months or more before players return to their pre-injury levels.

JAS: The Thunder stated that a 'loose stitch' was a cause for the swelling. Can you give us some greater detail on what might have possibly happened, what the doctors did in this 2nd procedure, and whether there is any possibility of medical negligence?


Dr. Geier: A meniscus repair essentially means that a surgeon sews the meniscus back together. The repair can be performed with just stitches or stitches and meniscal anchors. Occasionally one of the stitches that holds the repair together can become loose, even if the repair is healing. The stitches are made of a non-dissolvable material, so if part of that stitch is prominent, it can irritate the joint. Without being involved in this particular case, irritation from a stitch after meniscus repair can occur for normal reasons and does not inherently suggest anything done incorrectly.

JAS: Despite the swelling, the team confirmed via the 2nd procedure that the initial one was a success. Can you explain how they are able to establish this, especially since on a surface level this 2nd procedure could indicate that everything did not go well the first time around?

Sherman: Can Westbrook make a full recovery?
Dr. Geier: Definitely.


Dr. Geier: When an orthopaedic surgeon scopes a knee, he looks at all the structures within the knee. For each meniscus, he uses a probe to inspect them for tears. Again, without being involved in this specific case, I expect that the surgeon probed the prior meniscus repair. If he was not able to find evidence of a persistent tear where the prior one occurred, that would suggest that the repair held the meniscus together until it healed.

JAS: Westbrook is expected to miss the next 8-10 weeks of action, putting him on a time-table for about mid-December for when he returns. What kind of rehab will he need to do now, how does it differ, and what additional potential risks are present now?

Dr. Geier: Recovering from a knee arthroscopy surgery, even if no structural damage was found and treated, requires time for recovery. The patient must get rid of all the swelling in his knee and regain full strength and range of motion. Once he has done that, he can start jogging and progress to sports activities. Recovery from a simple knee arthroscopy would likely be much quicker and more straightforward than after a meniscus repair.

JAS: Lastly, here is the big question. Can Westbrook still make a full recovery?

Dr. Geier: Definitely. If his meniscus repair truly did heal, he should have the entire meniscus to serve as a shock absorber in the future.

***

Many thanks to Dr. Geier for lending his time to help us understand Westbrook's situation more clearly. Dr. Geier is a great source for understanding these types of injuries and more, and he can be found at:

Twitter: @DrDavidGeier

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