The news of Russell Westbrook's 3rd surgical procedure on his right knee shocked the NBA world. Shortly after posting a triple-double on Christmas Day, the Thunder front office announced that Westbrook's medical team had observed swelling in the knee and took steps to reduce it via surgery. From the press release:
"On the most recent MRI it was determined by the surgeon that there was an area of concern that had not previously existed, nor was detectable in the previous procedures, and it was necessary to evaluate Russell further. The consulting physician determined that arthroscopic surgery was necessary to address the swelling that was taking place. We know that Russell’s work ethic and commitment will help him return to the level of play that we have all come to appreciate."- Sam Presti
This is a carefully constructed piece of information not only for what it reveals but for what it does not reveal. What does it not reveal? That they went in to further repair the meniscus, which is what they did before when they revealed the swelling was the result of a loose stitch.
To try and discern what is going on, we turn once again to Dr. David Geier, an orthopaedic surgeon who is an expert in the area of meniscus repair and rehabilitation. Please note that Dr. Geier is NOT the surgeon who worked on Westbrook's knee, but since he has experience dealing with top flight athletes, his medical opinion is worth noting.
J.A. Sherman: As noted, the Thunder press release was vague in regards to what the doctors had sought to repair. Can you speculate on what are some of the things that the doctors may have found that could have been previously undetected? Do you think it is chronic or acute?
Dr. David Geier: The most likely candidate would seem to be a small area of damage or wear and tear to a small area of articular cartilage, the cartilage lining the ends of the bones. A loose piece of articular cartilage can cause swelling or a catching sensation within the knee. Arthroscopic surgery to remove the loose piece of cartilage and smooth out the area can be effective in helping athletes return to sports. Another cause could be an inflamed plica, a band of tissue within the knee that can cause swelling when it's inflamed. An issue with one of the menisci in the knee, either the repaired meniscus or the opposite one, could be possible as well. Without knowing what the damage is, it is hard to know if the problem developed acutely or represents a chronic issue.
Sherman: Westbrook previously returned to action way ahead of schedule, after a 2nd surgery revealed a loose stitch that caused swelling. Do you think Westbrook came back too early and made his long term health worse?
Dr. Geier: It is hard to know without knowing exactly what the surgeon found in each procedure. His return when he did after a procedure to remove a loose stitch would seem appropriate for any athlete undergoing that type of arthroscopic knee surgery.
Sherman: To what degree should we be concerned that he's now had 3 surgeries in less than a year? Can you explain the impact of these successive surgeries? Does the re-injury mean that something was botched in the initial repair? Is his ability to return to full health now compromised?
Dr. Geier: To my knowledge, the team has not given any indication that this surgery dealt with a problem from his meniscus repair, so it doesn't seem like anything was botched. Also, even if the surgery involved his meniscus, it wouldn't necessarily indicate the surgery was not performed appropriately. A small percentage of meniscus repairs don't heal and require another procedure.
Since I am not involved in his care, I can't really say too much about his long-term health. If an athlete does have an area of articular cartilage damage, it can be a concern over a long-term career. Even surgeries where we smooth out areas of cartilage damage don't make that cartilage surface completely normal. It is smoother than it was with the defect or loose piece in the knee, but the defect still could cause discomfort, swelling or other symptoms. Plus articular cartilage damage can progress with repetitive impact over time.
Sherman: Westbrook is now expected to return to the court in February. Given the recent bad news about Derrick Rose missing the rest of the season after his own meniscus tear, should the team doctors be even more cautious about Westbrook's return this season? In the alternative, should he be deactivated in order to protect his long-term health?
Dr. Geier: Return to play should be based on the nature of the damage or the surgery performed, as well as how quickly an athlete regains full motion, strength, and functional ability. It differs for various arthroscopic knee surgeries. For example, a meniscal repair takes much longer than trimming a meniscus tear out or smoothing out an area of articular cartilage damage. Often multiple surgeries can influence the decision somewhat, and we might be inclined to go slower in returning an athlete back to play.
Many thanks once again to Dr. Geier. He can be reached at the following:
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