Evaluating Oden's "Ligament" Issue

What we know:

  • One of Oden’s four primary ligaments in one of his knees is affected by something that concerns the Blazers with concurrence from Oden’s camp.
  • Diagnosis was made by MRI

What we do not know:

  • Which ligament is affected
  • Which knee is affected
  • How the ligament is affected
  • To what degree the ligament is affected
  • Whether symptoms detected by MRI were confirmed by tests (place a knee in a position and test for laxity (looseness/stiffness), etc.) MRI is not a test, per se. MRI does not measure performance. Knee diagnostic “tests” measure performance (flexibility/stiffness/pain).

What we might know (gleaned from comments that are not authoritative or are ambiguous):

  • The affected ligament is “non-weight bearing”
  • Oden is asymptomatic (whatever is causing the concern causes no pain or instability)
  • Oden may or may not be cleared for limited basketball activities
  • McMillan anticipates Oden returning “soon”
  • Management does not expect Oden sooner rather than later, but does not rule Oden out sooner rather than later

What we can deduce:

  1. Which ligament is affected
  2. How the ligament is affected
  3. To what degree the ligament is affected

If the notion of “non-weight bearing” has any credibility at all – it probably means that Oden has an issue with one of his Medial Collateral Ligaments (MCL). “Non-weight bearing” is not an anatomical term with regards to knee ligaments. However, we do know that the knee has two cruciate ligaments and two collateral ligaments. The cruciate ligaments are on the inside of the joint – and they are the primary stabilizing ligaments. Being on the inside of the knee means they are in direct line with the load-bearing axis (when a person is standing straight up, the force of weight passes through the cruciates to the bone below). The cruciates do not bear all the weight – but they are in that load-bearing path.

The collateral ligaments are on the outside of the knee joint – one on each side. When standing straight up, the collaterals would not be in the direct load-bearing path.

Of the two collateral ligaments (medial and lateral), injury to the MCL is by far the most common – and easily the primary candidate for any concern by the Blazers or Oden. The MCL is on the inside of the knee – the LCL on the outside.

*for the purposes of this exercise, I have disregarded the Patellar Ligament, typically referred to as the Patellar Tendon. If there was damage to the Patellar Ligament, it would probably have been referred to as a Patellar Tendon issue rather than a ligament issue. This is a strange fact in knee anatomy, where a specific ligament is actually called a tendon.

Severity of injury to the MCL is tested by measuring joint separation when pushing sideways from the outside of the knee (valgus stress) when the knee is straight (0 degrees flexion) and bent (30 degrees flexion). Incidentally, valgus stress is the most common means of injuring the MCL – but the tests will not cause injury. How much the knee joint separates at each flexion tells us something about the nature of the injury.

Per Brigham and Women’s Hospital Dept. of Rehabilitation:

Opening of 0-5 mm indicates a Grade I tear, 6-10 mm a Grade II tear and more than 10 mm a Grade III tear. The amount of laxity [looseness] in each position of flexion is indicative of the number of medial structures injured. Valgus laxity at 30 degrees of flexion but not at 0 degrees of flexion suggests an isolated MCL injury. Valgus laxity at both 30 and 0 degrees indicate injury to the MCL, posterior oblique ligament (POL) and most likely the ACL.

These are the types of tests that Oden would have been subject to at his Thursday physical. Ostensibly, those tests did not indicate damage to any of his ligaments that would preclude basketball activities (from Brigham & Women’s Hospital):

  • Pain: typically well-localized to medial aspect of knee
  • Palpation: localized soft-tissue swelling and tenderness over medial knee1
  • Range of Motion (ROM): Active and passive ROM of knee joint
  • Joint Mobility: patellar glides, femorotibial glides
  • Strength: hip and knee musculature; note quality of VMO recruitment
  • Sensation: may be impaired to light touch due to localized swelling
  • Girth measurement: to assess for swelling, atrophy
  • Special Tests: ligament stability tests, especially valgus stress at 0 and 30 degrees, Lachman, anterior drawer; McMurray
  • Posture/alignment: note any varus or valgus deformities at knee joints; knee hyperextension; weight bearing avoidance or intolerance on affected lower extremity.
  • Proprioception: if possible, assess single leg stance, compare to uninjured leg
  • Gait: note if antalgic, uneven stride; decreased stance on affected limb; cadence;
  • ask patient to increase speed to brisk walk and note further impairments; note balance and safety with locomotion; assess stair climbing ability. Note, if any, type of device(s)- cane, shoe lift.
  • Functional Outcomes: using the Lower Extremity Functional Scale (LEFS)

Instead, we know that whatever is driving the current concern was detected by MRI. MRI detects lesions – or tears in the ligament. Based on the assumption that Oden passed the tests described above, the MRI may have detected lesions less than Grade I. This is consistent with reports that Oden is asymptomatic. Whatever the MRI discovered – it wasn’t severe enough to be detected by tests or cause pain, instability, loss of function, etc. Also, MRI is about 90% accurate – meaning that diagnosis of small lesions less than Grade I may be a simple case of erring on the side of caution.

What it means:

  • Oden’s rehabilitation/recovery to date has been with regards to his microfracture surgery and the reestablishment of articular cartilage. We have no reason to believe that this process has been anything but a success.
  • Small lesions in MCL ligaments can be treated with therapy and will repair
  • The chance that Oden will play this season based on this diagnosis is high.
  • If we see Oden on the court with a knee brace – we will know more.
  • If we find out the terms of Oden’s contract – we will know more.
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