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Thursday, November 09, 2006

Microfracture Surgery 101

Less than two weeks ago, the retooled NBA Shootaround looked at microfracture surgery and how it has impacted the careers of several prominent players. On Wednesday, NBA Shootaround delved even further into this subject, getting the perspective of several players and even interviewing Dr. David Altchek, who performed the procedure on Jason Kidd in 2004. Altchek explained that microfracture surgery treats "defects in articular cartilage." He said, "The final and most important part of the procedure is that we make multiple puncture wounds in the surface of the bone." That is why it is called "microfracture"--the surgeon actually punctures (fractures/breaks) the patient's kneecap, with the idea being that this will stimulate the development of scar tissue that will replace the damaged, non-functioning cartilage. Kiki Vandeweghe (who is not a doctor--but his father is) added that microfracture surgery was originally designed with older patients in mind, not young, large athletes.

It used to be that ACL tears ended careers; now guys have reconstructive surgery and come back as good as new (or pretty close). That is not yet the case with microfracture surgery. Making little fractures in someone's kneecap sounds a lot more traumatic even than a knee reconstruction (although the surgeons who developed microfracture say that this is not the case), but I'm sure that with time the procedure will become more and more refined and--more importantly--it will become better understood how these athletes should rehabilitate. I've spoken with many NBA players who injured their knees in the 1970s and back then the importance of active rehabilitation was not understood. With ACL injuries, it is important to build up the surrounding musculature as quickly as possible and to get rid of adhesions in the knee joint. Watching the struggles of so many microfracture patients, though, I wonder if active rehab is being overdone in some cases; perhaps a different approach should be taken. I'm not a doctor, nor do I play one on TV, but I find it interesting that former microfracture patients Allan Houston and Jason Kidd both suggested that current microfracture patient Amare Stoudemire should not push himself to do too much too fast. Bernard King basically willed himself back from his ACL tear with an incredible workout program but I'm not sure that that approach works with microfracture patients. Of course, vigorous rehab must take place at some point but the question is when should it be done. My understanding is that one of the major possible complications of the microfracture procedure is that the newly formed scar tissue/cartilage can lose its stability or dissolve; it would seem like the newly created tissue needs time to "congeal" before the knee can withstand the rigors of training--and how much time that takes probably varies depending on age and the condition of the rest of the knee.

After the microfracture surgery piece aired, NBA Shootaround showed a graphic of the scoring averages of several players before and after they had the procedure done. Every single player--Jason Kidd (14.8; 13.9), Jamal Mashburn (21.8; 17.9), Allan Houston (17.4; 16.6), Chris Webber (22.2; 19.5) and Penny Hardaway (18.7; 10.0)--saw his average go down. Stoudemire is averaging 7.7 ppg in the handful of games that he has played since he had microfracture surgery--he averaged 37 ppg versus Tim Duncan and the Spurs in his last five games before he was injured. Kidd is the only player in that group who has even come close to returning to the level he played at before the injury.

posted by David Friedman @ 12:55 AM


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