Surgeon gives details of Smith's pending procedure

Steve Smith moved to injured reserve today, and the Giants wide receiver will undergo surgery on Tuesday at the Hospital for Special Surgery. A person with knowledge of the injury said that he would need microfracture surgery and mosaicplasty to the injured knee cartilage.

Dr. Neal ElAttrache, an orthopedic surgeon at Kerlan-Jobe Orthopaedic Clinic in Los Angeles, has performed these kinds of procedures and said given the nature of Smith’s injury, he could be back with the team next season as Giants coach Tom Coughlin said he hoped.

"The doctor (Russell Warren of the Hospital for Special Surgery) said he expects him to make a full recovery [by next season]," Coughlin said. "Non weight-bearing for a while and then progress very slowly. Hopefully if it all goes well, then what the doctors are projecting will be true. I am sure there will be restrictions."

ElAttrache said the microfracture part of the surgery usually occurs in the middle of the injury, where smooth cartilage has been removed or scraped off the surface of a bone. Using an instrument that functions like a dental pick, a small hole is made in the exposed bone that allows marrow to leak out and form a layer over the bone. The stem cells in the jelly eventually become cartilage.

Toward the edges of the injury, a physician transplants small pieces of cartilage to make it even with the remaining healthy tissue in a patient. It’s called mosaicplasty because it is similar to the artistic technique of that name, where tiles are fitted together to make a picture.

Because of the delicate nature of the surgery, ElAttrache said he has his patients on crutches for six weeks to allow the tissue to become strong and smooth again.

“You’ve got to be pretty conservative,” he said.

If the injury is on a non-weight-bearing part of the joint, which Smith’s is, ElAttrache said he could be doing light running on an anti-gravity treadmill in three to four months. That is the best-case scenario time wise, but ElAttrache also said this technique has been successful in professional athletes.

“Any time you damage the joint and you are a skill player the question is, will it ever feel normal again after a full season?” ElAttrache said. “But it definitely has a reasonable track record getting guys back to playing in the NFL and NBA.”

Giants safety Kenny Phillips had a similar procedure last September. Phillips has patellofemoral arthritis -- a deterioration of the cartilage between the kneecap and femur -- in his left knee. It worsened and required microfracture surgery last September. It has been called a degenerative condition in his knee that was considered by some as career-threatening.

“I been through it, I know what it’s going to take to get though it, so I’ll definitely help him out along the way” Phillips said.

The Giants eased him back into the practice routine very slowly. He didn't start really practicing until training camp in August, and even then the Giants allowed him to do only limited reps, building slowly to the start of the season. Now, Phillips said he feels strong.

“Feeling pretty good,” Phillips said. “Still have to rehab it and do a lot of extra things but back on the field where I’m happy to be.”