FanPost

Brandon Roy Does Not Have "Bone-on-Bone" Knee Arthritis

My 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:

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Here is what a grade II lesion looks like:

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Here is what a grade III lesion looks like:

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Here is what a grade IV lesion looks like:

Cartilage_medium

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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