Remove or Repair? Derrick Rose Must Take Cautious Approach After Meniscus Tear.
Published by Daniel Lewis (Featured Contributor) on November 24, 2013 at Yahoo! Sports.
Steve Dykes/USA TODAY Sports
After sitting out the entire 2012-2013 NBA season to recover from a tear to his left anterior cruciate ligament (ACL), Chicago Bulls guard Derrick Rose has suffered another knee injury, his second in the past 19 months.
Rose suffered the non-contact injury in the third quarter of a 98-95 loss to the Portland Trail Blazers on Friday night. He hobbled off the court and left the arena on crutches.
Bulls fans immediately feared another ACL tear, but an MRI on Saturday revealed that he instead tore the medial meniscus in his right knee.
A torn meniscus is the most common surgically treated knee injury. The meniscus is a C-shaped piece of shock-absorbing cartilage that, if torn, does not heal without surgery.
Rose will undergo one of two surgical treatment options. He could either have the torn portion of his meniscus removed, a procedure known as a meniscectomy, or have it repaired by sewing it together with stitches.
Meniscectomy is considered a more straightforward procedure and involves a shorter recovery time. However, without a fully intact meniscus, Rose would face an increased risk of developing osteoarthritis in his right knee. Conversely, repairing the meniscus is more a difficult operation, but Rose could make a complete recovery if the procedure and healing is successful.
Even if Rose wants to repair the meniscus, the orthopedic surgeon will not know if such an approach will be possible until he or she observes the tear through an arthroscope. In fact, even an MRI cannot predict if repair is an option.
Only a small percentage of meniscus tears can be repaired. Whether repair is an option depends on the nature of the tear and its location within the meniscus—specifically, whether or not it occurred in an area with a sufficient blood supply.
Rose could receive a meniscus repair if the tear is in the periphery, an area of the meniscus that is vascular; on the other hand, repair would not be an option if the tear lies in the inner rim, where there is no blood supply. In addition, if the tear is not a clean one or does not occur at a single place in the meniscus, then it will not heal and thus needs to be removed.
If Rose undergoes a partial meniscectomy, he could see the court again in as few as three to four weeks. He would face no restrictions on motion or weight-bearing activities because there is no healing process following a meniscectomy. However, the procedure would carry the risk of accelerating degenerative changes in his knee because of the removal of cartilage.
Rose need only hear the recent remarks from Dwyane Wade to learn about the long-term risks of a meniscectomy. The Miami Heat shooting guard opted for the procedure 11 years ago while at Marquette, and he believes the surgery has contributed to the ongoing knee problems he has encountered as a member of the Heat.
Indeed, Wade has battled chronic knee issues throughout his NBA career. He underwent a second surgery on his left knee in 2012 and has also experienced bone bruises and suffered from tendinitis. Additionally, he has appeared progressively less explosive and more limited during his team's playoff runs in 2011-2013.
If Rose instead receives a meniscal repair, his recovery would last at least four to six months, extending deep into the postseason or into the offseason. Rehabilitation would entail limiting knee motion and weight-bearing to allow the meniscus to heal. If it heals completely, it would essentially return to its pre-injury state, and he would theoretically avoid arthritic changes.
However, healing of the meniscus is far from guaranteed following the repair procedure. In fact, a recent study from the Hospital of Special Surgery in New York demonstrated failure rates of approximately four percent. Unfortunately for Rose, medial meniscus repairs exhibit a higher risk of failure than those of the lateral meniscus, such as the one Oklahoma City Thunder guard Russell Westbrook underwent in April. Specifically, an Australian study reports that more than 36 percent of medial meniscus repairs fail, compared to a failure rate of only 5.6 percent for lateral meniscus repairs.
A failed repair is a result for which Rose should be mentally prepared. Such an outcome would parallel that of the Minnesota Timberwolves' Chase Budinger, who had surgery on the lateral meniscus in his left knee last November. He later experienced knee discomfort prior to the start of training camp, and instead of having the knee repaired again, he had the offending part of the meniscus removed.
An athlete can also damage the repaired meniscus if he or she pushes through the rehabilitation too quickly.
For example, Gilbert Arenas underwent surgery on his left medial meniscus in April 2007, but he overworked the repair in an attempt to make an early return to the court. The former Washington Wizards star ultimately needed two more surgeries on the same meniscus the following season, robbing him of his trademark quickness and explosion when he finally did return.
The cases of Budinger, Arenas, and to a lesser degree Wade all serve as cautionary tales and highlight why all parties involved in Rose’s injury should exercise caution.
The orthopedic surgery team should attempt to repair the meniscus if the tear makes it possible, and Rose should shut himself down for a second consecutive year if he is able to have the tear repaired. Similarly, the Bulls should continue its cautious and patient approach with Rose, a franchise cornerstone who is in the second year of a five-year, $94 million contract.
This cautious approach will be the key in enabling Rose to return to his MVP level of play while also minimizing the possibility of him joining the likes of Brandon Roy, Greg Oden, and Penny Hardaway, whose careers were derailed by chronic injuries.
Rose suffered the non-contact injury in the third quarter of a 98-95 loss to the Portland Trail Blazers on Friday night. He hobbled off the court and left the arena on crutches.
Bulls fans immediately feared another ACL tear, but an MRI on Saturday revealed that he instead tore the medial meniscus in his right knee.
A torn meniscus is the most common surgically treated knee injury. The meniscus is a C-shaped piece of shock-absorbing cartilage that, if torn, does not heal without surgery.
Rose will undergo one of two surgical treatment options. He could either have the torn portion of his meniscus removed, a procedure known as a meniscectomy, or have it repaired by sewing it together with stitches.
Meniscectomy is considered a more straightforward procedure and involves a shorter recovery time. However, without a fully intact meniscus, Rose would face an increased risk of developing osteoarthritis in his right knee. Conversely, repairing the meniscus is more a difficult operation, but Rose could make a complete recovery if the procedure and healing is successful.
Even if Rose wants to repair the meniscus, the orthopedic surgeon will not know if such an approach will be possible until he or she observes the tear through an arthroscope. In fact, even an MRI cannot predict if repair is an option.
Only a small percentage of meniscus tears can be repaired. Whether repair is an option depends on the nature of the tear and its location within the meniscus—specifically, whether or not it occurred in an area with a sufficient blood supply.
Rose could receive a meniscus repair if the tear is in the periphery, an area of the meniscus that is vascular; on the other hand, repair would not be an option if the tear lies in the inner rim, where there is no blood supply. In addition, if the tear is not a clean one or does not occur at a single place in the meniscus, then it will not heal and thus needs to be removed.
If Rose undergoes a partial meniscectomy, he could see the court again in as few as three to four weeks. He would face no restrictions on motion or weight-bearing activities because there is no healing process following a meniscectomy. However, the procedure would carry the risk of accelerating degenerative changes in his knee because of the removal of cartilage.
Rose need only hear the recent remarks from Dwyane Wade to learn about the long-term risks of a meniscectomy. The Miami Heat shooting guard opted for the procedure 11 years ago while at Marquette, and he believes the surgery has contributed to the ongoing knee problems he has encountered as a member of the Heat.
Indeed, Wade has battled chronic knee issues throughout his NBA career. He underwent a second surgery on his left knee in 2012 and has also experienced bone bruises and suffered from tendinitis. Additionally, he has appeared progressively less explosive and more limited during his team's playoff runs in 2011-2013.
If Rose instead receives a meniscal repair, his recovery would last at least four to six months, extending deep into the postseason or into the offseason. Rehabilitation would entail limiting knee motion and weight-bearing to allow the meniscus to heal. If it heals completely, it would essentially return to its pre-injury state, and he would theoretically avoid arthritic changes.
However, healing of the meniscus is far from guaranteed following the repair procedure. In fact, a recent study from the Hospital of Special Surgery in New York demonstrated failure rates of approximately four percent. Unfortunately for Rose, medial meniscus repairs exhibit a higher risk of failure than those of the lateral meniscus, such as the one Oklahoma City Thunder guard Russell Westbrook underwent in April. Specifically, an Australian study reports that more than 36 percent of medial meniscus repairs fail, compared to a failure rate of only 5.6 percent for lateral meniscus repairs.
A failed repair is a result for which Rose should be mentally prepared. Such an outcome would parallel that of the Minnesota Timberwolves' Chase Budinger, who had surgery on the lateral meniscus in his left knee last November. He later experienced knee discomfort prior to the start of training camp, and instead of having the knee repaired again, he had the offending part of the meniscus removed.
An athlete can also damage the repaired meniscus if he or she pushes through the rehabilitation too quickly.
For example, Gilbert Arenas underwent surgery on his left medial meniscus in April 2007, but he overworked the repair in an attempt to make an early return to the court. The former Washington Wizards star ultimately needed two more surgeries on the same meniscus the following season, robbing him of his trademark quickness and explosion when he finally did return.
The cases of Budinger, Arenas, and to a lesser degree Wade all serve as cautionary tales and highlight why all parties involved in Rose’s injury should exercise caution.
The orthopedic surgery team should attempt to repair the meniscus if the tear makes it possible, and Rose should shut himself down for a second consecutive year if he is able to have the tear repaired. Similarly, the Bulls should continue its cautious and patient approach with Rose, a franchise cornerstone who is in the second year of a five-year, $94 million contract.
This cautious approach will be the key in enabling Rose to return to his MVP level of play while also minimizing the possibility of him joining the likes of Brandon Roy, Greg Oden, and Penny Hardaway, whose careers were derailed by chronic injuries.