Even in the injury-laden Week 1 of the football season, this basketball story is just too big to ignore. The NBA's No. 1 overall draft pick, Greg Oden, formerly of Ohio State and now of the Portland Trail Blazers, is going to be only the second No. 1 pick in the modern draft era to miss all of his rookie season. The first, David Robinson, fulfilled a military commitment, making Oden the first to miss his rookie year due to injury.
Oden underwent a surgical microfracture procedure on his right knee, and the recovery will sideline him for months. The topic of microfracture came up in football last week when Dallas Cowboys wide receiver Terry Glenn announced he was evaluating surgical options for his ailing knee, one of the options being microfracture. In Glenn's case, one of the issues he has been weighing is the very fact that the microfracture procedure, while likely to give him the best long-term solution for his knee, would cause him to miss the entire season. In Oden's case, the choice was much clearer. Oden is young, despite the fact that he has the appearance of a seasoned veteran, and he needs to be managed medically in a way that optimizes his chances of having a successful NBA career, not to mention knees that will hold up for years to come.
So, what exactly is microfracture? Microfracture is a surgical technique in which small holes (fractures) are made in a defective joint surface to stimulate the growth of new cartilage. This procedure is used when there is a "full-thickness" cartilage defect, meaning the lesion extends through the cartilage to the bone. The small fractures stimulate bleeding, which combines with growth factors from bone marrow to form a clot that covers the area. The clot matures over time into firm, new cartilage. Although the new cartilage is not identical to the original, it is a close approximation that is highly functional, and many athletes have successfully returned after this type of surgery.
There are several variables, however, that factor into the likelihood of a positive outcome from this procedure. As it happens, Oden has several of these variables working in his favor.
Age. At a mere 19 years old, Oden has the power of youth on his side when it comes to tissue healing. The body repairs itself better when we're young, and because the very essence of this procedure requires the body to undergo a healing process to stimulate new cartilage growth, youth matters.
The size of the cartilage defect. According to Dr. Don Roberts, the Trail Blazers' team physician who performed the surgery and was quoted on the team's Web site, "The area where the damage was is small and the rest of his knee looked normal." There actually are two bits of good news here. The smaller the defect, the better the likelihood of successful healing. Additionally, with the rest of his knee looking normal, the other contact points of the joint should be smooth. Think of it as a roadway with a newly paved, smooth surface that develops one minor pothole. The pothole is filled in, and although it's not quite as pretty as the original, it keeps your car from falling into the hole every time you drive over it.
The history of these procedures. Because these procedures have been in place since the mid-80s, there have been enough of them done for surgeons to know how to optimize the surgical management and for therapists to understand the best ways to rehabilitate patients who have undergone such procedures.
So, what does Oden have in store in the next few months? Not much at first. The critical element in the first six to eight weeks is ensuring that the new tissue that is forming is not disrupted. Oden will not be allowed to put weight on the leg, so that the new cartilage cells do not get crushed or dislodged, and he will be on crutches. Oden also will spend many hours a day in a continuous passive motion machine that will repeatedly bend and straighten his knee so as to provide a constant source of lubrication for the new tissue. The natural fluid in a joint, the synovial fluid, must constantly be circulated around the joint to maintain a healthy environment for the new cartilage cells. In a healthy individual, frequent movement and exercise help perform this function. Since Oden will be limited in what he can do physically, the machine will help ensure that his knee gets the motion it requires. Dr. Mark Davies, an orthopedic surgeon in San Jose, Calif., who trained under the renowned Dr. James Andrews in Birmingham, Ala., adds that the early repeated passive motion is thought to play a part in stimulating these cells toward their role in joint protection, minus the damaging impact of body weight.
Once Oden is allowed to bear weight, he will be brought along very gradually in a rehabilitative program that will work toward strengthening all of the leg muscles to help support the knee. The last step will be introducing impact activities (running and jumping, pivoting and cutting) and getting back into game simulations. There are strict recommendations against a player performing any type of impact activity before four to six months post-surgery in order to achieve a successful outcome. It is easy to see why it takes several months for a player to return to activity, but it truly can take up to a year (sometimes longer) to regain full strength.
It is worth noting that both Chris Webber and Jason Kidd returned to play after microfracture surgery but fared differently early on. Webber appeared to have decreased mobility, but he also reportedly had a relatively arthritic knee at the time of his surgery. Kidd had a generally healthy knee, except for the cartilage injury, and seemed to bounce back to where he left off, returning approximately seven months after surgery.
Oden's path will be his own unique experience, but all signs seem to point in a favorable direction for his recovery. If the lesion is as small as Oden's surgeon indicates, and his knee is otherwise healthy, it would not be unreasonable from a medical perspective that he could (emphasis on "could") make an entrance in the very latter part of the season. Most importantly, however, Oden will need to resist the temptation to hurriedly make his impact on the NBA and will need to adhere to all of the rehab guidelines issued by the medical staff, particularly in the critical early phases.