http://www.sacbee.com/content/sports/story/13732172p-14574959c.html
By Joe Davidson
Worst-case scenario
The procedure can rob a player of athleticism
The mention and explanation of it - "microfracture" - had Bonzi Wells raising his eyebrows and headband and pressing a bit harder on the ice packs that encased his knees. The Kings guard with sound joints wasn't sure what sort of knee surgery was performed on Amare Stoudemire of the Phoenix Suns. Surely at that kid's age - 22 - it was just a scope, a simple exploratory procedure and he'd be out wreaking havoc on the nearest rims within weeks, right?
No, much worse.
Where the anterior cruciate ligament injury - also known as the ACL - was generally viewed as the NBA player's kiss of death in the 1980s, it is now the microfracture surgery that causes franchises to shudder. It sounds barbaric in description - a drilling deemed a "salvage procedure" - but it often becomes necessary, career-saving surgery. Or in some cases, not nearly enough of a miracle.
Microfracture means holes are drilled into the knee at the end of the femur, around the damaged or missing cartilage. The goal is inducing bleeding and clotting and using that scar tissue to replace the material that serves as shock-absorbing cushion between joints. Cartilage doesn't grow back when damaged, and it cannot be plucked from other parts of the body like a ligament can be taken from a cadaver. Cartilage is vitally precious, because without it, a player doesn't have a chance to run or jump, cut or stop, or even compete without acute pain.
There aren't more frightening words in the NBA than "bone-on-bone," which is exactly what happens when cartilage wears away, like older people who become arthritic. Microfracture didn't save guard Terrell Brandon. Jamal Mashburn, a one-time All-Star forward, told The Bee two years ago that his knees were too far gone, that he'll be a bone-on-bone guy the rest of his life.
Others are still waiting for more positive results, including Chris Webber, Penny Hardaway and Allan Houston. Matt Harpring hopes to be back on opening night for the Utah Jazz, six months after enduring his second microfracture.
Poking holes into a knee can alter players, franchises and conferences. It can make the seemingly invincible become vulnerable. In Stoudemire's case, the Suns All-Star center/forward who just signed a five-year extension for $7 million is expected to miss up to four months. Stoudemire was already an MVP candidate, and his absence could affect the entire Western Conference as the Suns could struggle without him.
Is his loss enough to give the the Kings the inside track to the Pacific Division title that Stoudemire and the Suns claimed last season?
"I imagine 14 other (Western Conference teams) are going, 'Oh yeah!' " Suns coach Mike D'Antoni told the Arizona Republic. "It gives hope to everybody now."
Of more concern, will Stoudemire recover fully and be the player he was last season, when he averaged 26 points and nearly nine rebounds, and exploded through the lane with power dunks? According to Suns head physician Dr. Tom Carter, Stoudemire's knee had a small lesion, located in a less weight-bearing area, and that the rest of the knee was pristine.
And they caught it just in time, after Stoudemire had complained of knee discomfort throughout the summer. He didn't put it off for months or years in trying to play through the pain - thus creating more cartilage trouble.
Still, Stoudemire's age initially raised red flags. Tarek Souryal, a noted orthopedic surgeon based in Dallas and the head team physician for the Mavericks, said microfracture for anyone this young is a concern.
"There are plusses and minuses," he said by phone. "The minus is he's awfully young to have exposed bone in that knee. The plus is, at that age, he has a better than good change to recover fully."
The Kings can relate to microfracture anxiety, the domino effect and the way it throws a team off course.
Webber's final chapter in Sacramento will always be underlined by his knee, how it was often swollen and robbed him of much of his lateral movement. He is now in Philadelphia, with the 76ers hoping that more than two years after he had his surgery he can regain some of that old form.
Webber has said that he experienced considerable knee pain well before he went down in the 2003 playoffs against Dallas. He had been icing his knees before games. The knee finally gave way. He returned, and though he still produced solid numbers, he hasn't been the same. The two seasons before the surgery, his field-goal percentage was .495 and .461; in the two seasons after the surgery, he made 41.3 percent and 43.3 percent of his field goals. He was traded last February to the 76ers.
Doug Christie in 1992 had microfracture surgery before it was known as such (it used to be called "drilling"). Apparently, he made a full recovery because he was so young. He played his best ball with the Kings. He now plays for Dallas, and Souryal said after a full physical this summer, Christie's knee remains sound.
In 2000, Hardaway was the first NBA star of recent note to undergo microfracture surgery. Back-to-back games became a painful chore for the guard, with the aches and swelling. The Suns unloaded him to the Knicks, ridding themselves of the constant worries and a monstrous contract. Hardaway contemplated retirement. He had a tattoo put on his right arm that reads "The Storm is Over," a reference to his hope that his knee problems are over.
Hardaway has been a shell of his former All-Star self since. He hasn't averaged more than 12 points a game since the surgery; pre-surgery, his previous low was 15.8 points a game.
Allan Houston of the Knicks had his microfracture surgery two years ago. He rushed back too soon and announced his retirement on Monday.
In Portland, the Trail Blazers don't want a Webber remake. Power forward Zach Randolph signed an $84 million contract last summer, then missed the last part of the season due to a troublesome knee. He's trying to bounce back from microfracture surgery.
Carter, the Suns' doctor, told the East Valley Tribune in Arizona that it is important not to lump one microfracture surgery with others. Some athletes, like Hardaway and Webber, had a knee that was breaking down before they had their microfracture procedures.
"Not all defects are the same - it's like comparing apples and oranges," he said. "You try to compare it to (surgeries of athletes) and some of those results have been abysmal. But (in some cases) you're talking about patients with arthritic knees, or kissing lesions (bone-on-bone). Those are degenerative lesions compared to (Stoudemire), which is an isolated lesion where the rest of the knee is OK."
Stoudemire's road back, like so many before him, will include crutches at first and hours of workouts. And patience.
"The rehab is as important as the surgery itself," said Souryal. "You want as thick a layer of scar tissue as you can get. If you're too quick in coming back, the layer becomes too thin and it won't be protected and it won't last."
Souryal said microfracture will continue to be a rescue operation for those with cartilage tears. Though there are now ways to harvest and grow cartilage, it is expensive - up to $10,000 just for lab work and considerably more for the surgeries - and still not a proven solution.
For now, cartilage problems mean having a microfracture.
"There's nothing else to do," Souryal said. "You can play in pain at 50 percent efficiency or quit. Or you can do this."
By Joe Davidson
Worst-case scenario
The procedure can rob a player of athleticism
The mention and explanation of it - "microfracture" - had Bonzi Wells raising his eyebrows and headband and pressing a bit harder on the ice packs that encased his knees. The Kings guard with sound joints wasn't sure what sort of knee surgery was performed on Amare Stoudemire of the Phoenix Suns. Surely at that kid's age - 22 - it was just a scope, a simple exploratory procedure and he'd be out wreaking havoc on the nearest rims within weeks, right?
No, much worse.
Where the anterior cruciate ligament injury - also known as the ACL - was generally viewed as the NBA player's kiss of death in the 1980s, it is now the microfracture surgery that causes franchises to shudder. It sounds barbaric in description - a drilling deemed a "salvage procedure" - but it often becomes necessary, career-saving surgery. Or in some cases, not nearly enough of a miracle.
Microfracture means holes are drilled into the knee at the end of the femur, around the damaged or missing cartilage. The goal is inducing bleeding and clotting and using that scar tissue to replace the material that serves as shock-absorbing cushion between joints. Cartilage doesn't grow back when damaged, and it cannot be plucked from other parts of the body like a ligament can be taken from a cadaver. Cartilage is vitally precious, because without it, a player doesn't have a chance to run or jump, cut or stop, or even compete without acute pain.
There aren't more frightening words in the NBA than "bone-on-bone," which is exactly what happens when cartilage wears away, like older people who become arthritic. Microfracture didn't save guard Terrell Brandon. Jamal Mashburn, a one-time All-Star forward, told The Bee two years ago that his knees were too far gone, that he'll be a bone-on-bone guy the rest of his life.
Others are still waiting for more positive results, including Chris Webber, Penny Hardaway and Allan Houston. Matt Harpring hopes to be back on opening night for the Utah Jazz, six months after enduring his second microfracture.
Poking holes into a knee can alter players, franchises and conferences. It can make the seemingly invincible become vulnerable. In Stoudemire's case, the Suns All-Star center/forward who just signed a five-year extension for $7 million is expected to miss up to four months. Stoudemire was already an MVP candidate, and his absence could affect the entire Western Conference as the Suns could struggle without him.
Is his loss enough to give the the Kings the inside track to the Pacific Division title that Stoudemire and the Suns claimed last season?
"I imagine 14 other (Western Conference teams) are going, 'Oh yeah!' " Suns coach Mike D'Antoni told the Arizona Republic. "It gives hope to everybody now."
Of more concern, will Stoudemire recover fully and be the player he was last season, when he averaged 26 points and nearly nine rebounds, and exploded through the lane with power dunks? According to Suns head physician Dr. Tom Carter, Stoudemire's knee had a small lesion, located in a less weight-bearing area, and that the rest of the knee was pristine.
And they caught it just in time, after Stoudemire had complained of knee discomfort throughout the summer. He didn't put it off for months or years in trying to play through the pain - thus creating more cartilage trouble.
Still, Stoudemire's age initially raised red flags. Tarek Souryal, a noted orthopedic surgeon based in Dallas and the head team physician for the Mavericks, said microfracture for anyone this young is a concern.
"There are plusses and minuses," he said by phone. "The minus is he's awfully young to have exposed bone in that knee. The plus is, at that age, he has a better than good change to recover fully."
The Kings can relate to microfracture anxiety, the domino effect and the way it throws a team off course.
Webber's final chapter in Sacramento will always be underlined by his knee, how it was often swollen and robbed him of much of his lateral movement. He is now in Philadelphia, with the 76ers hoping that more than two years after he had his surgery he can regain some of that old form.
Webber has said that he experienced considerable knee pain well before he went down in the 2003 playoffs against Dallas. He had been icing his knees before games. The knee finally gave way. He returned, and though he still produced solid numbers, he hasn't been the same. The two seasons before the surgery, his field-goal percentage was .495 and .461; in the two seasons after the surgery, he made 41.3 percent and 43.3 percent of his field goals. He was traded last February to the 76ers.
Doug Christie in 1992 had microfracture surgery before it was known as such (it used to be called "drilling"). Apparently, he made a full recovery because he was so young. He played his best ball with the Kings. He now plays for Dallas, and Souryal said after a full physical this summer, Christie's knee remains sound.
In 2000, Hardaway was the first NBA star of recent note to undergo microfracture surgery. Back-to-back games became a painful chore for the guard, with the aches and swelling. The Suns unloaded him to the Knicks, ridding themselves of the constant worries and a monstrous contract. Hardaway contemplated retirement. He had a tattoo put on his right arm that reads "The Storm is Over," a reference to his hope that his knee problems are over.
Hardaway has been a shell of his former All-Star self since. He hasn't averaged more than 12 points a game since the surgery; pre-surgery, his previous low was 15.8 points a game.
Allan Houston of the Knicks had his microfracture surgery two years ago. He rushed back too soon and announced his retirement on Monday.
In Portland, the Trail Blazers don't want a Webber remake. Power forward Zach Randolph signed an $84 million contract last summer, then missed the last part of the season due to a troublesome knee. He's trying to bounce back from microfracture surgery.
Carter, the Suns' doctor, told the East Valley Tribune in Arizona that it is important not to lump one microfracture surgery with others. Some athletes, like Hardaway and Webber, had a knee that was breaking down before they had their microfracture procedures.
"Not all defects are the same - it's like comparing apples and oranges," he said. "You try to compare it to (surgeries of athletes) and some of those results have been abysmal. But (in some cases) you're talking about patients with arthritic knees, or kissing lesions (bone-on-bone). Those are degenerative lesions compared to (Stoudemire), which is an isolated lesion where the rest of the knee is OK."
Stoudemire's road back, like so many before him, will include crutches at first and hours of workouts. And patience.
"The rehab is as important as the surgery itself," said Souryal. "You want as thick a layer of scar tissue as you can get. If you're too quick in coming back, the layer becomes too thin and it won't be protected and it won't last."
Souryal said microfracture will continue to be a rescue operation for those with cartilage tears. Though there are now ways to harvest and grow cartilage, it is expensive - up to $10,000 just for lab work and considerably more for the surgeries - and still not a proven solution.
For now, cartilage problems mean having a microfracture.
"There's nothing else to do," Souryal said. "You can play in pain at 50 percent efficiency or quit. Or you can do this."
