Brandon Roy Does Not Have "Bone-on-Bone" Knee Arthritis
by odenator69 on Nov 15, 2010 8:40 PM PST
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PrintMy disclosure: I am an Orthopaedic Surgeon, currently a Sports Medicine Fellow affiliated with a D1 University program. I have not spoken to any of the Blazers medical staff and I have not seen Brandon’s radiographic imaging. I have provided the following information for educational purposes only.
There has been a lot anxiety in the BEdge world recently with the continued trend of knee injuries to the players, most recently and concerning being that to Brandon Roy. In a recent Jason Quick interview with Brandon, "the problem is bone-on-bone there," Roy said. "Dr. Roberts calls it 'arthritic knee."
Here is the problem with that statement. "Bone-on-bone" can refer to a considerable range in the severity of arthritis. The common perception is that literally the femur bone is grinding on the tibia bone. In some severe cases that is an accurate description. However, this is not always the case and this is especially true when dealing with young individuals. Part of the problem lies with physicians like myself who "dumb-down" our explanation so that the patient can understand the concept of arthritis. It is hard enough to try and describe the difference between an Outerbridge grade 2 vs Outerbridge grade 3 chondral lesion to one our non-orthopaedic colleagues, but to try and explain that to a layperson is even more difficult. So we just say that the bone is rubbing on bone, people can visualize that and understand immediately that it is a bad condition.
Here is what normal cartilage should look like during an arthroscopy of the knee:
Here is what a grade II lesion looks like:
Here is what a grade III lesion looks like:
Here is what a grade IV lesion looks like:
As you can see, there is a big difference between these cartilage lesions.
What does Brandon Roy have? I don’t know. Since I have never examined Brandon nor seen his MRI, I can only speculate to the best of my ability based upon the information that is released to the public. We all know that Brandon has cartilage damage. If he had a grade IV injury, it is very likely that surgical intervention would be required. The problem with these lesions is that their depth causes significant loading on to the rim of remaining cartilage and this leads to rapid progression to osteoarthritis. These lesions are often managed with either microfracture or osteoarticular transfer system (OATS) if small. Larger lesions can not be microfractured. These either can have mosaicplasty (multiple osteoarticular pegs) or autologous chondrocyte implantation (ACI) where they harvest cartilage cells and grow them in a lab for reimplantion at a later time. Since none of Brandon’s surgeons have recommended surgical treatment, this is unlikely.
Does Brandon have a grade I lesion(s)? Maybe. Grade I is defines as softening or blistering of the cartilage. This is an early form of arthritis and is commonly associated with pain and swelling. Because the articular surface is still intact, this condition is not associated with mechanical symptoms such as locking or clicking unless another intra-articular lesion is associated such as a meniscal tear. I am not aware if Brandon has any of these complaints. But none the less, the treatment is conservative and surgery is not indicated.
Does Brandon have a grade II injury? Or even a grade III lesion? Maybe. As long as these lesions do not cause significant mechanical symptoms, they can be treated conservatively with rest, ice and NSAIDs. An acute inflammatory episode may benefit from a course of intra-articular steroid injection, but multiple doses are not recommended in the young due the chondrotoxic effects of steroids. The most common surgical treatment for these lesions is irrigation and debridement. Some surgeons will go ahead and remove the damaged cartilage entirely and perform either microfracture, OATS or ACI but that is left to the discretion of the surgeon.
Brandon has had multiple arthroscopies and (I assume partial menisectomies) within the last few years. All the press releases did not refer to problems with the cartilage back then. However, accelerated cartilage wear can be expected with less menisci to provide shock absorption in the knee. And here is another issue. We don’t know how much menisci remain in both knees and which ones were debrided. The lateral meniscus carries most of the load in the lateral compartment. The medial meniscus shares more of the load with the articular cartilage. This is why lateral menisectomy accelerates degeneration more so than a medial menisectomy. Also, if more than 50% of the meniscus remains, it is still mostly functional.
So my final point is this. We (and I mean us fans) don’t have enough information to truly know exactly what is going on in Brandon’s knee. However, I do know enough to know that if Brandon indeed have "bone-on-bone" in his knee, he would not be playing and would either be booked for surgery or contemplating medical retirement (e.g. Darius Miles).
Does this make more sense?
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Thank you so much for writing this
Extremely informative.
We should bring in more scrub big men; they make good curse fodder.
by dan_the_man on Nov 15, 2010 9:01 PM PST reply actions 1 recs
agreed thanks o69
Please, for the love of all that is holy, please stop using the following: "Book it.", "FTW", "Epic" & "Fail".
...no seriously--stop.
Thanks for chiming-in.
Are you saying then that there may be some bone-on-bone contact in Roy’s knee but probably nothing as severe as literally no meniscus remaining, as we’ve been hearing?
Doubtful that there is actual bone on bone after 2 years of a relative benign knee
Only way I can imagine Brandon having a bone on bone lesion is if he knocked off a large piece of cartliage during a game or practice. But this would cause significant pain and swelling and most likely also have mechanical symptoms such as locking or catching and would have been visible on an earlier MRI.
His meniscus was removed due to multiple tears.
How is this not clear?
A professional won't take the word of a lay person
as they shouldn’t. I’m sure if he heard a colleague say that, he’d believe them.
Half of a doctor’s job is to interpret what they heck his patient is trying to tell him into medical terms. Since most people don’t speak medicine and think they can, it can be a tough job.
I'm a really really ridiculously good looking orange mocha frappaccino drinking manhammer sandwich
Here's a question that is not easy to answer, given all the information we don't have
Given the information that we do have, can you give a range of best and worst case scenarios going forward? Is there a chance (very likely?) that he can perform for a number of years at his highest level? Is there a likely chance that he will be forced to become a low minute jump shooter, or worse?
We should bring in more scrub big men; they make good curse fodder.
This why I like BEdge.
Good post … thanks for taking the time to make this.
"KD is an alleged loser and a bad defender."
by Lexi Sparx on Nov 15, 2010 9:20 PM PST reply actions 3 recs
That was my first reaction
You don’t see stuff like THIS on Blog-a-Bull.
Odenator — thanks so much for putting this together. You probably noticed that the uncertainty and lack of information has been driving fans a little nuts.
Wiggada Wiggada Zers!
True, but to be fair, Blog-a-Bull would have more, ummmmm, colorful opinions about an $82 Million man getting hurt...
"A bizarre and extremely rare hybrid Blazer/Laker fan, Timbo has always struggled to contain the Beast Within, like Dr. Jekyll, Bruce Banner, or Ted Kennedy." — Miled Animal
We have doctors on BaB!
… Hopefully we never have to utilize their services for our basketball posts … [crosses fingers]
This is good stuff, though.
WEAVER! NOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
This is one of the best posts I've read on Blazersedge.
We still don’t know the severity of Roy’s injury, but this is a good briefing on what is likely going on.
Of a related note: could Greg’s tendinitis be due to the hardware still in his knee from his surgery last December? Is patellar tendinitis something to worry about long-term?
Disagree
Yes a comprehensive review of the pathophysiology involved in degenerative knee issues. But what WE all want to KNOW is what does he actually have. We are not going to be told for many reasons. What we also want to see is The Magnificent 7 out there crushing the opponent on a night in night out basis. We aren’t getting that. What we also want to know is to whether Gregs patellar “chip” fracture was incompletely healed when it came apart last December. I believe it was but nobody is talking about it.
by doomsdaymachine on Nov 16, 2010 5:55 AM PST up reply actions
What does the chip have to do with this? And what could be done about it now? Paul Allen isn't going to fire his training staff about it if he hasn't already.
The poster didn’t claim to have any first hand knowledge of BRoy’s injury, in fact he claimed just the opposite. What he did was increase most readers knowledge about meniscus conditions and give a reasonable estimate of the severity of brandons condition based on what he’s seen as a professional, and what we’ve heard of Brandons prognosis so far. This is a much more informative analysis than anything else we’re likely to hear on the subject, and if the medical staff actually announce the grade of his injury, we now have a baseline understanding of what they’re talking about. Great post.
Sure things might not be looking great right now, but look on the bright side. I have liquor.
by Tyler Durrden on Nov 16, 2010 6:49 AM PST via mobile up reply actions 3 recs
Thank you for posting
It’s always great to get facts on a situation.
This doesn’t mean that Roy is automatically going to be “OK”, nor does it mean that he is automatically going to be one step away from retirement. It means that there is still gray area and that the future is still unknown.
Rec!!!!
someone stayed at a Holiday Inn last night
I’d meet BRP at the airport, not flee!! - fanfaraway
by broyposse on Nov 15, 2010 9:50 PM PST reply actions 6 recs
Huh, I never saw it there. But good move. THAT WAS WORTH IT
I'm a really really ridiculously good looking orange mocha frappaccino drinking manhammer sandwich
Solid information,thanks
in general is the no one size fits all factor is one of the hardest things to communicate about medicine and biology
by southern oregon on Nov 15, 2010 10:09 PM PST reply actions
a post like this carries certain obligations
for instance, I have this clicking in my shoulder…..
j/k – kind of – because now no one at Blazersedge is going to be content with typical fan commentary. Orthopedic commentary has raised the bar, considerably.
Law of Logical Argument
Anything is possible if you don't know what you are talking about.
by blacknoiseNW on Nov 15, 2010 10:17 PM PST reply actions 1 recs
Um, I hope I'm not overstepping my bounds here, but this is one of the greatest posts that has ever happened here.
The timing of this, and the information that was so desperately needed by us laymen, is something I’m truly thankful for. Please feel free to write these speculative, informative, medical analyses whenever we are completely losing our minds over the players we so desperately want to see succeed.
Thank You.
Sure things might not be looking great right now, but look on the bright side. I have liquor.
by Tyler Durrden on Nov 15, 2010 10:19 PM PST reply actions 1 recs
Remaining Mensicus
You said, “We don’t know how much menisci remain in both knees and which ones were debrided”.
We actually do: http://www.oregonlive.com/blazers/index.ssf/2010/11/blazers_insider_no_surgery_for.html
There’s no meniscus left to operate on in Roy’s left knee.
“Nah. None. Not in my right, either,” Roy said Friday.
That article Roy states he has no meniscus remaining in both knees. This is why people are freaking out and rightfully so. It’s bad.
If true,
and not something to the extent this poster suggests that this could be words a lay person like Brandon might use. I wonder if our good Orthopedist might be able to enlighten us on the efficacy of meniscal transplant. I have never before heard of this and I believe it was suggested on another post on this site. Actually I’ve never heard of any basketball player receiving one?
On another note if no meniscus is left and we take Brandon literally on this, what is the likely-hood Brandon ever is able to perform again at a high level in the NBA? I can see a couch potato like myself doing pretty well with no meniscus but the NBA???
Disagree
Brandon is a smart guy, a collage graduate but I doubt he knows exactly how much was taken out of his knee. I assume that Brandon is paraphrasing what he was told by Dr. Roberts. Show me an operative report that states “total menisectomy” or “subtotal menisectomy” and I’ll believe it then.
Well...
Considering he’s had two surgeries on both knees dealing with meniscus tears I don’t think it’s out of the question to believe there’s none remaining whether you hear what you want to hear or not.
What we know is Roy has had his knee drained twice already and the pain is getting worse. He went from moving slower and slower to finally taking himself out of the game because he said he felt a “deeper” pain, this time in a totally different spot. It just doesn’t sound good at all.
Let me get this straight: you guys just heard an actual orthopedist say that there's no way that Roy could actually play with zero meniscus in his knees...
And you’re still holding onto that idea because Roy said it?
It never made sense to me, and I’ve been questioning it for days at this site. I’m just a layman, but as someone who’s had multiple knee surgeries, I know you can’t play basketball at the NBA level with zero meniscus in your knees.
I’ve heard of bigs back in the day lumbering around down in the paint towards the end of their careers with bone-on-bone knees (thanks to incredible toughness and lots of painkillers). But to do what Roy does on the court without any meniscus is not physically possible. We just heard a bonafide expert confirm that.
I was born in '52, and I believe in #52. Hang in there, GO.
You too, Przy: everyone knows you're the heart & soul of the Blazers.
by hurryup09 on Nov 16, 2010 3:54 AM PST up reply actions 4 recs
Brandon Roy can play NBA basketball (somewhat) with no menisci
…because he is a baaaaaaad man!
Brandon Roy can play NBA basketball with no menisci
Because he borrowed Nico’s. And Nico can play NBA basketball with no menisci because he’s Nicolas Batum.
When the world knows Nico Batum as "The Inevitable", I'll be very happy with where he is as a player.
"Batum, who stands 8 feet tall with a 9-foot wingspan and never makes mistakes..." - Posting and Toasting
by ictoagsn on Nov 16, 2010 2:26 PM PST up reply actions 3 recs
Because I talk so much nonsense about Batum already
That everybody just ignores me now. They might actually be smart for doing so.
When the world knows Nico Batum as "The Inevitable", I'll be very happy with where he is as a player.
"Batum, who stands 8 feet tall with a 9-foot wingspan and never makes mistakes..." - Posting and Toasting
Alonzo Mourning
Took so many NSAIDS it killed his kidneys and he had to have a renal transplant.
by doomsdaymachine on Nov 16, 2010 5:58 AM PST up reply actions
So, you're showing that it IS possible
to play through the pain in the knees.
"Coach said to always be careful around Greg, because Greg costs a lot and even the slightest amount of basketball can damage him." -- The Onion
pain in the knees is one thing
No mensicus whatsoever is another thing entirely, as I believe the poster explained.
Can you drive on four completely flat tires? Certainly—at least for awhile. But you’re not going to be able to compete in a NASCAR race.
I was born in '52, and I believe in #52. Hang in there, GO.
You too, Przy: everyone knows you're the heart & soul of the Blazers.
by hurryup09 on Nov 16, 2010 12:57 PM PST up reply actions 2 recs
It is wonderful that we have a doctor's opinion and participation in this discussion.
However, he is one doctor who is armed with no more information than the rest of us when it comes to Roy’s particular case. Yes, he has a much deeper understanding of the basic underlying physiological principles in this case, but until the Blazers release information that corroborates the good Doctor’s opinion and rather positive spin on this situation, we have no reason to believe this situation can do anything but get worse.
Roy’s condition is DEGENERATIVE. Regardless of whether 90% of 100% of his meniscus is gone, this isn’t something that is going to improve with “rest and medication”.
Furthermore, the Doc’s own argument would seem to support surgical intervention as this is a condition that is best operated on and achieves best results when it is caught “early.” The question at this point is whether it is too late for an MT or microfracture to be able to help, i.e., has osteo-arthritis set in.
Therefore, one has to consider any surgical alternatives which might be able to improve the situation. Rest and medication is simply palliative care that does nothing to improve a situation that will likely rapidly degenerate and end his playing career.
you're being an extremist
You could just as easily say that every NBA players knees are degenerative. That’s the whole point of treatment vs surgery, where treatment will hopefully keep it “good enough” for “long enough” and surgery is considered an extreme albeit sometimes necessary option. Each case is different, but there are plenty of other NBA guys dealing with knee issues other than Roy, and they’re all following similar paths.
Advice from a medical expert, usually followed by rest and treatment, and in a few cases surgery. I think at this point, Roy’s condition has flared up and will be dealt with accordingly, and it’s very likely that it could just as easily “disappear” for the remainder of the season.
Other players (just off the top of my head) with seemingly similar knee issues THIS year that are either playing or will be playing: Antawn Jamison, Baron Davis, Maurice Evans, Jermain ONeal. All of them experienced some discomfort followed by swelling followed by treatment and none have yet opted for surgery.
I'm being a realist. How do those rose colored glasses fit?
Face it, many people on here – apparently including yourself – have a difficult time accepting reality when it comes to the Blazers.
I’m not a doctor yet, but I’m a med student and plan to specialize in this area. What training do you have?
As for your list of players, how many of them have had multiple menesectomies on both knees?
The idea of saying that every NBA player has a “degenerative condition” when it comes to each and every injury is beyond ignorant and medically clueless.
It’s fine to have your own opinion, but not your own facts.
swoosh, I tend to agree with you,
but, allow me to say, you need to work on your bedside manner ….
:-)
Nate broke his Roy toy.
by Berkeley on Nov 16, 2010 10:45 PM PST up reply actions 1 recs
LOL Fair enough...;)
I suppose the frustration of the Blazer’s situation brings out sadness & occasionally aggression. ;)
Deep breathe…meditate on…puppies, rainbows, hot girls in bikinis, blazers in the championship…:)~
And none of those guys are going to lead their teams to a championship
That’s what all the doom and gloom is about. It’s not that people don’t think Roy can be a serviceable starter/vet, and a great guy to have on the team.
But he was the player we were building around. He is/was our star. Oden was scheduled to be that guy for a few months between when we drafted him and when he had season ending surgery before his first season, but it was Roy that’s carried the team for the last 3 years, and was going to be the heavy lifter on the way to any championships in the near future. We tied up the star money for the next 5 years on him.
All of this isn’t news, of course, but this is freaking doom. There are just too many examples of bad knees halting promising careers. For every Grant Hill, there are a dozen Penny Hardaways, Alan Houstons, Tim Hardaways, etc.
You're 100% wrong about the doctor having no more info than the rest of us
That’s a common mistake in todays entitled, know-it-all society. The years spent in medical school and practicing medicine give knowledge that we simply do not possess. It may not be about this specific instance, but his perspective would be far keener than ours.
You say that immediately after saying the opposite.
Painful reading, my friend.
I'm a really really ridiculously good looking orange mocha frappaccino drinking manhammer sandwich
So you're saying some BEdgers are overreactive?
I agree, Doc. I agree.
chk yrslf bf u rec yrslf
by Hipster Olympic Team! on Nov 15, 2010 10:23 PM PST via mobile reply actions
Thank You...
Thank You for your educated attempt at speculation. Unfortunately by your own admission the ultimate conclusion is we do not know what is going on with Brandon Roys knee…however I now know it’s not as simple as “bone on bone”.
Your information leaves me with a few questions. The primary one being, you present different “grades” of potential lesions of the cartilage. I’m assuming…yes dangerous, but I’m assuming none of these potential “grades” is necessarily static and unchanging. In other words my question becomes could Brandon of had a grade 2 lesion 6 months ago, and have a grade IV today? And Or even if he has a “milder” degree of damage, what if any cause for optimism do we have that the damage won’t become progressive. Especially since we are dealing with an athlete called upon to place above average stress on the Knee as a course of practicing his career?
I sincerely thank you for this information even if admittedly I feel I know more about the different degrees and definition of knee cartilage deteriation but precious little more about how this may or may not apply to Brandon Roy.
"Mother Nature started this fight, I think it's about time we ended it!"
Well
we know he has had his knee drained quite often. Remember the recent interview with Monty before the NO game where he said he saw Brandon have his knee drained just before dropping 30 in an NBA game. Most likely he has had his knee drained a lot more than we will ever be privy to. Probably grade II or III, anything greater equals sure surgery as our resident ortho doc is telling us.
Sorry...
…I confused the issue. My question isn’t so much what grade does “odenator69” given his education think Brandons knee damage is likely to be….
But more why should we expect it to be static?
I would think a key, key difference for Brandon with deteriating knee cartilage and almost 98% or more of everyone else on the planet, is the simple fact that as a professional athlete, whatever degree of damage or deteriation that exists..Brandon can’t really slow down and rest it.
For myself? If I discover or develop a degree of knee damage, I can get a handicap parking permit, cut back on hikes and use a cane….simply slow down…thus potentially slowing further damage.
As a professional athlete, while a certain amount of cutting back is possible in the form of less minutes per game and/or no back to backs…ultimately as long as Brandon is a professional athlete he will be called upon to stress the knee. There is simply no way around it.
So even with a more educated definition of what might be going on, seems to me we still are basicly at square one.
Speculating as to what level of deteriation Brandon currently has, and speculating as to what level of therapy and what form of therapy would best let him perform as a professional athlete.
"Mother Nature started this fight, I think it's about time we ended it!"
yeah, there is a direct conflict between rest and go easy for the knee (conservative treatment),
and maximim energy, explosive athleticism (championship play).
Bedgers inquiring minds want to know – is there another treatment plan that doesn’t curtail competitive play?
.
Nate broke his Roy toy.
We may never get a real definition of what is really going on.
But we can come to the conclusion that there must be some damage to the cartilage? What degree is debatable but my question is, and I think yours is also, can cartilage repair itself (if not damaged too much) with simple rest and conservative therapy since surgery does not seem to be needed in this case?
Cartilage can repair itself, but it is among the slowest tissues to heal.
Odenator69 has a very good point that we don’t know if Roy even has cartilage damage right now.
We are just worried about it because Brandon’t first line of defense (the menisci) are gone from both knees.
#20
by dario argento on Nov 15, 2010 11:37 PM PST up reply actions
While its nice to have some A&P info on the front page, this doesn't change anything...
…Brandon’s situation is obviously degenerative and WILL get worse. The question of how far along it is does not change the need to seriously consider alternatives to giving him pain killers and resting him every other game until the pain is no longer manageable and he is forced to retire.
In fact, if the doctor’s theory is in any way correct, it would strengthen the argument for surgical intervention.
Absolutely awesome!
Epic post! Good stuff and very timely!
Thanks for the reality check, doc.
obviously a lot of details required for an accurate understanding of what’s up with Brandon’s knee. I appreciate the education. One comment I took note of was Brandon stating he didn’t have any meniscus left, which, of course, may have not been exactly accurate. This leads me to view playing pro ball as in direct conflict with the normal treatment of rest. Plus, I figure the rigors of really playing his best game significantly accererates deterioration of his condition. But, we have no real justification for concluding that anything other than the best possible course has been taken so far, given our lack of information. We are just curious how bad our star player is handicapped. Ultimately, we will have to just wait and see. If I was on the verge of being a world class champion athlete, I would be pretty motivated to be freed from a physical ailment holding me back, hence the interest in possible treatments.
Nate broke his Roy toy.
So my final point is this. We (and I mean us fans) don’t have enough information to truly know exactly what is going on in Brandon’s knee. However, I do know enough to know that if Brandon indeed have “bone-on-bone” in his knee, he would not be playing and would either be booked for surgery or contemplating medical retirement (e.g. Darius Miles).
I agree we don’t have enough info but we are talking the Blazers here. I am not saying it is bone-on-bone but I am not putting it past them to keep things quiet. I don’t blame them either.
100% agree.
Interesting information.
Yet, however informative it is, Roy’s circumstances are certainly dire.
gross pics
I can’t say any of those situations are too optimistic though. basketball players seem to need those knees an awful lot
They are gross
For the purpose of these descriptions, gross pictures are probably more useful than microscopy.
;-)
We should bring in more scrub big men; they make good curse fodder.
by dan_the_man on Nov 15, 2010 10:48 PM PST up reply actions 2 recs
lololololololol
Go Blazers! Secure the Win!
by GiantBlazer on Nov 17, 2010 12:34 AM PST up reply actions
Gross?
I would have to disagree with you. The idea of looking inside people’s knees doesn’t appeal to you? What strange people these Bedgers are.
When the world knows Nico Batum as "The Inevitable", I'll be very happy with where he is as a player.
"Batum, who stands 8 feet tall with a 9-foot wingspan and never makes mistakes..." - Posting and Toasting
by ictoagsn on Nov 16, 2010 2:28 PM PST up reply actions 1 recs
Ehhhh, written by an orthopod. You know what they say..."In order to be an Orthopod you have to be as strong as an Ox and half as smart." ;)
Seriously though, great great post. I love working with (and talking to) docs who take the time to teach and you appear to be one of those good guys. Keep up the good work :)
Nice reminder that people don’t have the full story. We are not aware of the full situation and are unfamiliar with Brandon’s case, ergo we are not in a position to judge the care he is receiving. Blazer fans have a tendency to question medical decisions with our abhorable injury history as an organization, so this is probably why there is all this armchair quarterbacking going one.
Thanks again for the post and stick around! With this team I have a feeling we will need more calming words from an orthopod!
#20
Hey...
weren’t you the guy who always writes those medical comments to some people?
So I guess I wasn’t wrong when I said it.
Bedgers, odenator69 is OUR team doctor. (Applauses and cheering takes place)
why do blazer fans expect an immediate resolution?
I mean, couldn’t we unite and look at the potential our team still has?
LaMarcus aldridge went 19-17, andre miller can take a more comfortable role on the team.
I think batum can be a scottie-esque player…with more defense!
I am not ready to give up on Broy, I think we has a career altering issue here… but he has a high bbiq and I believe he can adapt to a new style, I hope to get a grant hill out of him…
and also… anyone down to donate their miniscus to broy?
Grant Hill
didn’t have post-knee injury success until he was traded to a new team.
Just sayin’.
"Coach said to always be careful around Greg, because Greg costs a lot and even the slightest amount of basketball can damage him." -- The Onion
Grant Hill never had knee surgery
And the primary reason he eventually came back okay was simply overcoming a life-threatening MRSA infection. He actually played a fair amount during his last few seasons in Orlando, people just remember his first three years when he had to sit out due to ankle surgery (from an injury with the Pistons) and the resulting infection.
#52
Exactly
Roy’s situation, unfortunately, is very different than Hill’s was. Roy could be traded to a team staffed with the greatest team of doctors & trainers ever assembled. They could have shaman & witchdoctors to boot. None of it would matter if his knees are anywhere NEAR “bone on bone.” His condition isn’t going to magically improve.
I was born in '52, and I believe in #52. Hang in there, GO.
You too, Przy: everyone knows you're the heart & soul of the Blazers.
And even if it were
Grant Hill eventually came back as a completely diminished player. Grant Hill and Brandon Roy were roughly equivalent players at age 24, Grant Hill on the suns is a good role player (one of these things is not like the other).
So even if he were to somehow make Grant Hill-like come back, it would be far more “John Salmons” than “Brandon Roy”. At least assuming this is as bad as being reported.
#52
Good stuff, thanks.
Message: Chill out, everyone, chill out.
We need AT LEAST one of the following to be playing healthy, regular minutes to win a championship this season:
Greg Oden
Brandon Roy
"Coach said to always be careful around Greg, because Greg costs a lot and even the slightest amount of basketball can damage him." -- The Onion
That's what she said.
PS Note the word “if”, hater.
"Coach said to always be careful around Greg, because Greg costs a lot and even the slightest amount of basketball can damage him." -- The Onion
Thanks
for the info Odenator. I’ve been tired of listening to fans wanting to trade Roy or saying he’s done. It is very true we do not know the whole story or all the details so at least give him more than 10 games before demanding a trade for crying out loud. I came from a different forum where it was a bunch of drama, this place seems to have more level headedness. Think I’ll like it better here.
You missed out.
For awhile we were in all-out turmoil here on the edge. Things have finally calmed down.
LOL True.
On the other hand, the people calling for trading Roy are living in a fantasy land if they think he’s tradeable at this point. Given the severity of his knee problems, there are few teams who would give back anything coming close to equal value.
Here's a question
I called up the local sports med clinic in Eugene today to ask about the costs for an MRI that had been recommended to me about a year and a half ago (instability, clicking, patella tracking funny).
$1200? For a freaking picture or two?
They didn’t quote exact dollars on the surgery without the images on hand but were talking in the $20-60K range.
Is that for real?
by dwaynebillybob on Nov 16, 2010 12:59 AM PST reply actions
Uh...
…you do realize that for Paul Allen $1200 is like ordering off the value menu at the drive thru? Yes for most of us that’s a lot of money. But incase of The Blazer organization, inwhich Brandon Roy already represents an 85 million dollar investment…a $1200 additional cost…is nothing. The decision to either have an MRI or not have an MRI should not be based on cost. I’d also expect that The Blazers wouldn’t be walking in off the street looking for an MRI.
"Mother Nature started this fight, I think it's about time we ended it!"
That's awesome
This question is basically why doctors often don’t reveal themselves as such publicly.
I'm a really really ridiculously good looking orange mocha frappaccino drinking manhammer sandwich
Thanks for educating us, odenator. Rec'd
I was born in '52, and I believe in #52. Hang in there, GO.
You too, Przy: everyone knows you're the heart & soul of the Blazers.
Roy injury history as far as I can reconstruct it. Maybe you can deduct something from the details though as you said without examining the patient and the images it will always remain based on quotes and hearsay from journalists
Roy had 4 meniscus injuries that were significant enough to be reported and require surgery.
1 in high school
1 in college (some sources say 2 but I can’t nail down the year)
2 in the pros
In high school the left knee was affected in 2002. The extent is unknown to me. It was reported by Scout.com that he played a tournament in Vegas on a “slightly torn meniscus”.
In 2004 (junior year) he had what was reported as a longitudinal tear of the lateral meniscus in his right knee. According to a Seattle PI report he returned to action “3 weeks after surgery” and allegedly a few weeks ahead of schedule to play in a big game against North Carolina. He missed another 2 games after that before resuming normal activity again, so it’s anybody’s guess if he was potentially rushed back or had really fully healed. He appeared in 26 games total, and played most of the year at a high level however in a “sixth man role” losing his starting spot. Roy stated that “once the season ended my knee was 100%” though scouts still considered it a potential red flag leading up to the draft.
In the 2007 NBA season he missed games 3 in April with what was officially reported as “left knee tendinitis” and “sore right knee”.
In the 2008 offseason (August) he had “surgery on left knee to repair a torn meniscus”, and returned for training camp.
“Roy underwent a 20-minute procedure in Vancouver, Wash., during which team physician Don Roberts removed a piece of cartilage that was causing irritation in Roy’s left knee.”
Before the 2010 playoffs in April 2010 he had what was reported as a “torn meniscus in right knee”. One article in the Oregonian called it a “slight tear” (I assume based on a text message the Blazers sent out containing this diagnosis). Initially it seems to have been diagnosed as a just a severe bone bruise before Dr. Roberts was able to review new MRIs and identified the tear. As we all can remember, he came back extremely fast within 10 days after surgery but unable to fully contribute.
Most recently he experienced (at least more than “usual” for him) swelling and pain again in his left knee, then left the New Orleans game favoring his left knee with what was simply reported as “sore”. That’s where we stand now. Safe to say he has done significant damage to his menisci – especially the left leg which is the one he as most people usually jumps off – and that is now a weak spot, unknown how bad it really is.
If you can make such generalizations I would also be interested in what the likely best surgical options going forward would be (allograft transplantation, autologous chondrocyte implantation, etc.) assuming he has e.g. less than 50% of meniscus substance remaining to prevent “true” bone-on-bone/grade IV defects. Could he prolong his career at this level if he took off one season for a surgery like that? Or would that only be a last resort to enable him a healthy life post-sports? Also, could his nagging right hamstring problems be a side effect of the meniscus problems, with the quadriceps muscles trying to stabilize the right knee (or him “overtraining” those)?
Unfortunately as I’ve said in previous posts, I don’t know of many comparable cases. Most that got cited as successful comparisons around here are “just” athletes with microfracture surgeries and no prior reported meniscus surgeries. Nate McMillan himself had two but ended his career shortly thereafter. A few others have washed out as well. Among currently active NBA players, Brad Miller and Nene still play at a high level (Nene also had significant ligament damage yet is no worse than before) while Farmar, Nelson and Powe got worse and Chris Paul like Roy is unknown so far after missing a lot of last season (and now wearing a very visible knee brace). And all of those had just 1 knee affected.
by Norsktroll on Nov 16, 2010 4:20 AM PST reply actions 3 recs
Do I dare trust a doctor who goes by the username Odenator69?
ughh… I want to believe this.
Blazers basketball? Just basketball you say? More like a way of life
Maybe he was born in '69?
Sure things might not be looking great right now, but look on the bright side. I have liquor.
by Tyler Durrden on Nov 16, 2010 6:55 AM PST via mobile up reply actions
We can only hope...
"A bizarre and extremely rare hybrid Blazer/Laker fan, Timbo has always struggled to contain the Beast Within, like Dr. Jekyll, Bruce Banner, or Ted Kennedy." — Miled Animal
I want to believe it too
But we really don’t know what is happening.
Nevertheless — this post is exhibit A on what makes blazersedge the best.
If there was no mensicus (or almost none) in either knee
you simply have to give the benefit of the doubt to the organization that they did enough homework before handing out an extension to Roy. Plus, if he really had almost no meniscus, do you think a guy who has had MRI’s on at least an annual basis on his knees just now become aware of it? He’d have known in the past and consequently wouldn’t have gone so hard and much during the summer + preseason.
Thanks to Odenator shedding yet another angle which makes me think his knee simply flared up from excessive use because he does have some meniscus wear, but that it is most likely anywhere close to being career threatening.
He has had multiple meniscus operations to REMOVE pieces of his meniscus.
It is most certainly NOT impossible to play on a knee without meniscus. What happens in that case is that the articular cartilage begins to wear down, which is what docs typically refer to as arthritis in the knee. If arthritis has begun (meaning the wearing down of the articular cartilage) then at this point there is very little that can be done for Brandon unless he undergoes some kind of experimental treatment.
As I've commented elsewhere...
Back in the day, you heard about long-in-the-tooth NBA bigs laboring in the trenches with bone-on-bone knees. Those guys lumbered along with the aid of copious amounts of pain pills, regular steroid injections, and out-of-this-world toughness. Assuming those tales are true, then I guess you’re right: it’s possible to play NBA basketball, at least for a time, without any meniscus in one’s knee.
But to play the way Brandon Roy plays—with quick cuts, full-out running, jumping and landing after contact, etc: I just don’t see it. A knee with no mensicus whatsoever just wouldn’t be able to perform like that. As I wrote above, that’d be like competing in a NASCAR race in a car with four flats.
That’s been my non-expert assumption, anyway. Now we have an actual orthopedist saying the same thing. But a lot of BE folks still believe Roy has no mensicus, apparently because Roy himself said so. I’m not buying it. As someone who’s had multiple knee surgeries, I know that all the will power in the world won’t get your knee to do what it’s incapable of doing.
The human knee is a remarkably complex joint—one that rotates as it hinges & unhinges. If it doesn’t have all its parts in proper working order, it just won’t function. And when our knee isn’t functioning, our mobility takes a serious nose dive. Sad but true. The true “Achilles Heel” of the human anatomy is our knees. It’s been our curse ever since we began standing upright.
I was born in '52, and I believe in #52. Hang in there, GO.
You too, Przy: everyone knows you're the heart & soul of the Blazers.
I think what needs to be clarified here is Roy's definition of "no meniscus"...
…taken within the context of what he said re: potential menesectomy, it could be inferred that what he meant to say is that there are no longer any pieces of meniscus that COULD BE REMOVED in order to alleviate his ailing knee(s), which would certainly allow for a certain amount of gray area in terms of how much actual meniscus is left in his knee.
That said, if we take what Roy said at face value, then we have to assume his surgeons took a look at his knee and said there is nothing left to remove, period.
What we have on BEdge is one doctor offering a lot of factual physiological information and one opinion. And that is a wonderful resource and should certainly be taken into account. However, you can easily do a little bit of research on your own and find out that there is a sliding scale of opinion on nearly every medical issue, including this one.
It is difficult to take one doctor’s opinion as gospel when I know for a fact that there are other specialists who have a different philosophy on this very injury.
Now, we know that Roy has had multiple menesectomies on each knee.
We also know there are various opinions on what this might mean and some confusion as to what the underlying science says is the best course of action.
The nice thing is you don’t need to go to a med school library to find relevant info (though it wouldn’t hurt). There is some good stuff available online. Will Carrol who works as an injury consultant for NBA Prospectus & NFL Prospectus wrote an article on Microfracture here:
http://www.basketballprospectus.com/article.php?articleid=923
It’s an interesting article you should definitely read.
The relevant part insofar as we are concerned here reads: "And we know one reason teams are so quick to allow this surgery is that the players come back so quickly, usually in a matter of weeks. But surgeons don’t repair the meniscus in most cases; they just take it out, either in part or in WHOLE depending on the size of the tearing. That leaves the athlete with no shock. Eventually, with the remaining meniscus overstressed and aging, they end up with the bones grinding together. Yes, that’s as bad as it sounds in a game of running and jumping."
The bottom line is there there is no one way to interpret any medical situation.
Good comment
We’re all speculating as to exactly what’s actually going on in Roy’s knees. We’ve heard that Roy had a considerable amount of meniscus removed in college, and still more at the end of last season. Personally, I strongly doubt that he’s currently got none left at all. I think it’s more likely that, as you suggest, there’s simply nothing left to remove that would improve his condition.
Can you play on at a high level with no meniscus whatsoever as long as the articular cartilage is still intact? Perhaps so: this isn’t literally “bone on bone.” But it’s getting close, isn’t it, and I shudder to think what playing NBA basketball in that condition would do to one’s long-term health. Sounds like a sure prescription for early retirement and early knee replacement surgery.
Hopefully we’ll all learn a lot more tomorrow, following today’s MRI. Personally, I’m braced for grim news: that Roy is shutting it down for this season and possibly beyond.
I was born in '52, and I believe in #52. Hang in there, GO.
You too, Przy: everyone knows you're the heart & soul of the Blazers.
Here's what annoys me...
What little I know about this issue, based on my own experience with micro-fracture surgery, and after having watched video of it, was how crazy the media went when they were told it was “bone on bone”. My reaction was “just because he doesn’t have any meniscus doesn’t mean it’s bone on bone” and nobody (until now, thanks doc) took the extra step to think about the what about the quality of his cartilage. If it were truly bone on bone he wouldn’t be able to play, period.
For what it’s worth, from what I saw in my case and what the doc said, I have heaps of cartilage left, the micro-fracture was used for a small lesion. That was almost eight years ago and my knee still swells up at the slightest overuse and can be very painful and debilitating. Not all that encouraging when it comes to Oden and/or Roy, but I DO get tired of hearing dimwits say either of them just needs to man up and get out on the court.
by LaughingJon on Nov 16, 2010 6:52 AM PST reply actions 3 recs
Exactly. This is VERY serious, painful and career threatening.
Which is why the wait and watch approach is lunacy.
The word means something
Waiting for information rather than compulsively acting is rational. It has nothing to do with insanity caused by the moon.
I'm a really really ridiculously good looking orange mocha frappaccino drinking manhammer sandwich
Thanks for saying that LaughingJon..
“Not all that encouraging when it comes to Oden and/or Roy, but I DO get tired of hearing dimwits say either of them just needs to man up and get out on the court.”
That is one of the best statements I’ve ever read on this site. It expresses exactly how I feel. Ironically, the people who are saying “man up” are probably ones that have never gotten off of the couch long enough to participate in the sport much less suffer a knee injury.
Amen. Rec'd
Anyone who’s been thru knee surgeries and arduous rehabs gets steamed hearing athletes slammed for allegedly not manning up or rehabbing hard enough.
I’ve always said I wouldn’t wish the pain and frustration of a serious knee injury on anyone. But I think I’d make an exception for folks that rag on hoopsters who are struggling to get back on the court.
I was born in '52, and I believe in #52. Hang in there, GO.
You too, Przy: everyone knows you're the heart & soul of the Blazers.
You don't need to have been through knee surgery
I’ve never had any kind of surgery, but I really get frustrated when people keep saying that they simply don’t care enough. Say it to their face, and then come back and tell us about it. After you’ve said it to that person’s face, then it’s one thing, but unless you are willing to tell a player to their face that they don’t care enough, then in effect you’re just bullying, and hiding behind internet anonymity to do so.
Brandon Roy came back EIGHT DAYS after surgery to help his team when they were struggling in the playoffs. Do you really think he doesn’t care?
Greg Oden has dealt with more than one long rehab, and he’s still out there trying to get back on court. Don’t tell me that he would be back already if he cared more, caring doesn’t stop tendinitis.
Blake tried to play through pneumonia. Don’t tell me he doesn’t care.
I could go on, but I think you get my point. These players DO care.
When the world knows Nico Batum as "The Inevitable", I'll be very happy with where he is as a player.
"Batum, who stands 8 feet tall with a 9-foot wingspan and never makes mistakes..." - Posting and Toasting
Agreed
I think even Darius Miles probably got a bad rap. It never looked to me like he was dogging it so much as dragging around a bum knee. Having gone thru that myself, I know what it looks like.
My impression was further reinforced when the Blazers declared Miles medically unfit to play. Yes, the Griz signed him and played him just enough to cost the Blazers a lot of money. But it seems clear to me that Miles was wrongly accused all along: he was hurt, and hurt to the extent that the injury couldn’t be rehabbed.
No, I haven’t forgotten about Mile’s infamous tirade against Maurice Cheeks and his off-the-court transgressions. But as for all the heat he took for not trying hard enough to get back on the court, I think that was unfair and unwarranted. Blazer fans should be ashamed of themselves on that one. (Fat chance, I know.)
I was born in '52, and I believe in #52. Hang in there, GO.
You too, Przy: everyone knows you're the heart & soul of the Blazers.
Hot damn
Thanks! Although you already have 46 rec’s here’s another!
Just waiting for the Ducks to lose.
the record is
so rec away
Disclaimer: There is an 80% chance this comment contains sarcasm, so please just chill out.
First
Thank you. and now maybe Nate should bring BRoy off the bench for seven min. each qrt. or start him and only play him seven min. each qrt. Until the playoffs then play him 9 min. each qrt. Think about it thou Roy comming off the bench going against other teams second unit, he could win the smoy award.
Thank you
Very helpful, and to me, much more optimistic for BR than I’ve been in the last week. Best wishes to him!
Clarify the terminology?
For us lay people…I’m wondering if you can clarify the terms, since it seems there’s still some confusion. When you say “meniscus” and “cartilage”, do these refer to the same thing? Or is the meniscus an extra cushion in addition to the cartilage – i.e., if it’s gone, does that mean the cartilage is now sustaining damage?
there are two kinds of cartliage
the meniscus is a pad between the bones.
the articular cartliage is a coating on the ends of the bones that are then resting on the meniscus pad….
they have been cutting out damaged meniscus cartliage in Roy’s knee for years.
there is some debate as to how much meniscus pad he has left
then there is debate on whether the articular cartliage is damaged, and how much (pictures above)
at least that is what I am gettin’…
Nate broke his Roy toy.
Yep, that sums it up.
We should know more tomorrow, following today’s MRI.
I was born in '52, and I believe in #52. Hang in there, GO.
You too, Przy: everyone knows you're the heart & soul of the Blazers.
With all due respect...
…for a very thought out presentation. Why do I think this post got 60+ Recs primarily because the Title is what most of us want to hear?
"Mother Nature started this fight, I think it's about time we ended it!"
Well, I appreciate the effort and insight from an expert
so I rec-ced it, but you’re right. The sad part is that it’s only really refuting that he has one specific condition, not the idea that his knees aren’t completely done while most posters here are taking this as amazing news. It’s almost like wildly celebrating that you only have Hodgkin’s disease and not non-Hodgkin’s lymphoma. It’s good that it’s not technically “bone on bone”, but I can’t say this makes me feel optimistic at all about his knee.
#52
I may be wrong, but I don't think the poster's intent was to cheer us up
He was just attempting to correct the prevalent misconception that Brandon Roy’s knees are literally “bone on bone.” Not that he persuaded that many people, judging from comments in this thread.
I was born in '52, and I believe in #52. Hang in there, GO.
You too, Przy: everyone knows you're the heart & soul of the Blazers.
Oh, I agree
It just seems like a majority of people here are taking it that way.
#52
I didn't want to say anything to spoil the party,
but yeah, its not like “no problem”. The good doc was really just helping us get out terminology right, and pointing out that Brandon’s knee is not totally toast just yet. Aparently “bone on bone” refers to the stage 4 condtion above, not just no meniscus, which could have been what Brandon was referring to with “bone on bone”. But even that is being challenged.
But, with Brandon’s play being significantly impacted (or just eliminated, as in DNP) we are real interested in the extent of his injuries and the prospects for his return to all star form. I have certainly found the discussion educational.
To no surprise Brandon is scheduled for MRI now. I just hope conservative treatment did no make it harder to fix. I am admittedly fascinated with the more creative approaches that have shown success, like the cadaver meniscus transplant.
Nate broke his Roy toy.
The title of this article almost seems deliberately misleading...
…and may be factually/medically incorrect.
Onset of osteo-arthritis is when the meniscus has been fully removed or worn down to nothing and the knee action begins grinding down the articular cartilage.
Give the information released so far by Roy’s camp, this seems to be EXACTLY what is going on with his left knee and is therefore in direct opposition to the opinion put forth in this thread.
Is microfracture the option for Roy or not?
Right now it’s not, but I wanted to know why…
I’ve done several hours of research online to find an answer to no avail.
Most of what I’ve found said:
1) MF is for “articular cartilage repair”
2) Surgical treatment for “meniscus” doesn’t include MF.
This image shows anatomically “articular cartilage” and “meniscus” are 2 different things:
However, I’ve found 2 articles here and this one by Will Carroll linked torn meniscus and MF together.
My hypothesis is – Yes MF is not for torn meniscus. But if one’s meniscus is completely gone, then MF is an option to develop some kind of cartilage-like tissue to “replace” it.
Am I right?
those are good articles
This sounds reminiscient of Roy’s history
So why are we seeing more of these? One theory is that the answer lies in previous problems. Arthroscopic surgery has been with us since the mid-1980s as a first choice for meniscus tears and defects. If a player today has a small meniscus tear that is symptomatic—painful with popping or clicking—it won�t be long before a surgeon has a scope in him. One reason teams are so quick to allow this surgery is that the players come back so rapidly, usually in a matter of weeks. But the surgery itself could be part of the issue. Surgeons don�t repair the meniscus in most cases; they just take it out, either in part or in whole depending on the size of the tearing. That leaves the athlete with no shock. Eventually, with the remaining meniscus overstressed and aging, they end up with the bones grinding together. Yes, that�s as bad as it sounds in a game of running and jumping.
It sounds like micro fracture creates a kind of compromise cartliage – not real articular, not a meniscus, but offers some padding to relieve the impact stress in the joint. The idea of replacing the meniscus, if possible, seems so appealing to pervent future damage to the irreplacable articular cartliage. Of course, it would be best to do initially.
Nate broke his Roy toy.
give him a year off
and develop artificial padding for his knees.
Microfracture creates what is called fibrous cartilage, not the same as the original hyaline.
However, it is much, much better than nothing or “bone on bone”.
^ This is essentially correct.
I linked to the same Will Carroll article above & quoted the relevant portion insofar as meniscal tearing/removal may be linked to microfracture.
The key to probability for successful microfracture is whether or not there is long-term onset of oster-arthritis (articular cartilage breakdown) prior to the procedure.
Microfracture is not a panacea, but given what information we have so far (and taking into account the Doctor’s cautionary information in this thread) it is most definitely a viable option for Roy.
However, I’d rather see him consult with someone like Dr. Kevin Stone in SF for potential meniscus transplant (MT).
ok, what I am wondering,
is it possible you would want to go with BOTH microfracture, then, persumably subsequently, add the miniscus transplant.
Or are we dependent on the damage to the articular cartliage being not too bad to go ahead with the meniscus transplant. Also, I am thinking that a failed meniscus transplant would not be all that catastrophic, in that is protects the bones while it works, and would be pretty easy to remove if it did break down, or cause discomfort. That really sounds interesting.
However, I am expecting the next announcement from the Blazers to be that Roy had microfracture. We’ll see.
Nate broke his Roy toy.
That was fantastic
thank for the information….
Thank you for taking the time to post this
As a surgeon, I’m sure that you’re incredibly busy. That you took the time to give us all this perspective is what makes this site worth checking everyday.
I’m sure you’re insight won’t go as noted as it should, but I’d imagine this information is worth about a grand or so.
Thank you very much for taking the time and posting this. Should be on the front page.
I'm a really really ridiculously good looking orange mocha frappaccino drinking manhammer sandwich
Oh, and after reading all the comments,
It’s totally understandable why you’ll never post anything on here again. It’s sad that so many simply cannot recognize their competency level and learn from another with a higher level of competency.
I'm a really really ridiculously good looking orange mocha frappaccino drinking manhammer sandwich
No one is denying this contributes a great deal to the underlying physiological knowledge on this topic.
What is up for debate is the title of the thread declaring he doesn’t have “bone on bone” or “arthritis”.
In light of the facts released to the public, this seems factually incorrect and seems to be giving a lot of people an unintended sense of false hope.
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