The NBA season is only three weeks old, and already it has lost one of its biggest names to injury. Greg Oden, the first pick in the 2007 NBA draft, will undergo surgery Friday. He reportedly will have a microfracture procedure performed on his left knee.
The microfracture surgery is the latest in a series of medical setbacks for the Portland Trail Blazer center. He missed his entire rookie season after undergoing microfracture surgery on his right knee. He sprained his foot in his first NBA game and missed six games. Later that season, his knee collided with the knee of another player, chipping his patella. Last December, he landed from a jump and fell to the ground. That jump fractured his left patella and ended most of last season.
According to multiple reports, his return from his left patella fracture had not progressed well. He recently complained to the team’s medical staff of swelling, leading to the MRI, which revealed his latest problem. Just like his microfracture surgery on his right knee, the procedure and its recovery will end this season.
Microfracture surgeries are among the least commonly understood knee surgeries, despite the fact that many athletes have had it. It is a surgery designed to treat injuries to the articular cartilage in the knee. This is the cartilage lining on the ends of the bones – or as one of my colleagues describes it to patients – the white stuff on the end of a chicken bone. Arthritis occurs when that cartilage breaks down.
Unfortunately, as orthopaedic sports medicine surgeons, we have no way to rebuild or regrow articular cartilage. And osteoarthritis often progresses, so it makes sense that much of the population undergoes knee replacement if and when arthritis spreads throughout the knee and when symptoms and activities become limited. Medical treatment for cartilage damage, such as ice, anti-inflammatory medicines, etc. treat symptoms like pain and swelling, but they do not rebuild cartilage. There are several procedures we perform to try to treat early cartilage damage, but even these do not “reverse” cartilage damage or arthritis.
Microfracture is a surgical procedure performed to treat damage to small areas of articular cartilage in the knee. Imagine the articular cartilage as pavement on a road. The cartilage damage is like a pothole in the road. In this case, Oden likely has a small area of cartilage, likely in a weight-bearing area, where the cartilage is missing and the bone is exposed. Surgeries to “clean up” the cartilage, where the surgeon uses a shaver to remove loose flaps of cartilage, might help relieve catching sensations and swelling short term, but studies have shown that arthroscopies like these provide little long-term relief. It would be similar to trying to smooth out the edges of the pothole. The hole is still there.
Microfracture aims to try to fill the hole. The surgeon uses what looks like a fancy ice pick to poke holes in the exposed bone. The holes allow blood to escape and collect in the defect. The patient is not allowed to put weight on that side for 6-12 weeks, and the rehabilitation involves motion machines and aggressive therapy for many months. Over time, the hope is that the blood and subsequent inflammatory reaction creates the formation of fibrocartilage in the defect.
The concern about microfracture is that the fibrocartilage is not as durable as the hyaline cartilage that makes up healthy articular cartilage. Microfracture might provide benefit for several years, but in active patients who put a lot of stress on their knees, the success might be short lived. In fact, a recent study in The American Journal of Sports Medicine revealed that 1/3 of NBA players never return to play after microfracture, and most that do return suffer a severe decline in performance. And other procedures designed to take healthy bone and cartilage from other parts of the knee and put it in the defects (osteochondral autografts or allografts) or injecting chondrocytes grown in the lab from samples of patients’ cartilage (autologous chondrocyte implantation) have been even less reliable for high-level athletes.
I wish Greg Oden luck in his current recovery. Unfortunately, it is hard for me to be optimistic that this often-injured star will have a long NBA career.
The following column will appear in tomorrow’s edition of The Post and Courier.