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Dr. Michael Kaplan on Andrew Bynum's knee

February 4, 2009 | 12:10 pm

Ever since Andrew Bynum's MRI results revealed a torn MCL, BK and I have been flooded with questions about the knee, recovery time, rehab, etc.  Unfortunately, all of our medical knowledge has been shaped through...

a) Watching episodes of ER (both of us until the show ran out of steam around 2001 or so), M*A*S*H* (me, mostly) and Grey's Anatomy (Only BK, who claims he started watching The McDreamy Hour because his wife "made" him.) 

b) Growing up with a doctor as a dad, which didn't so much teach us about medicine as hammer home the fact that both of us were too dumb to pursue a career in it.

c) Playing games of Operation.  (And by the way, how much does that commercial reflect skyrocketing medical prices?  Two hundred bucks for funny bone surgery?  Please!  You'd be lucky these days if a consultation cost that little.)

d) Staying at a Holiday Inn Express at various points in our lives.

Basically, that's about it, and nothing terribly legit.  Which is why we felt someone- maybe anyone- else could possibly be more qualified to discuss the particulars of Andrew Bynum's injury.  Thankfully, ESPN correspondent Dr. Michael Kaplan, an orthopedic surgeon/knee specialist (fellowship trained by the renowned Jim Andrews) fits that bill and was kind enough to give me some phone time yesterday.  After reading a recap of our talk, you might have a better idea of Drew's situation.   It is important to stress that Kaplan IS NOT Drew's doctor, nor has he seen the MRI film.  But he's been in the biz long enough to shed some opinion on the situation. 

  • The good news about the MCL, as opposed to the anterior cruciate or posterior cruciate, is that it's located in the capsule of the knee joint.  Because of the excellent blood supply in that area, Kaplan said that "more than 90% don't require any kind of repair or surgery."  He explains further.

    "Essentially, they rarely tear in continuity, meaning there are still some fibers that are touching," explains Kaplan.  "The whole thing scars together.  Because it's in a capsule and has a very good blood supply." FYI.  The hit Bynum took was very similar to the one endured by New England Patriots QB Tom Brady, just not as severe.  Brady's MCL injury also came in conjunction with damage to another ligament (ACL), which necessitated the need for surgery.
  • While stressing that he hasn't seen the MRI film and that Bynum's tear grade (1-3, three being the worst) hasn't been made public, Kaplan thought it was "relatively safe" to guess that the 8-12 week time line for recovery was "rather conservative."  That's not surprising, since, as BK and I have often reminded readers, teams ALWAYS provide a window that bears on the side of caution.  Better to have a pleasant surprise with a speedier than expected return than everyone wondering why the player is "behind" schedule (when, in reality, he may be on target).  Working in Drew's favor is his age and his other ligaments being theoretically fine, which reduces the chance of stiffness.   Said Kaplan, "My bet is that he'll be back in advance of that, not knowing, of course, the specifics of his scan and having the liberty of examining him."  Obviously, no promises are being offered, but that's certainly a reason for hopeful smiles. 
  • I asked Kaplan what specifics might account for a quicker or slower return. That's actually very difficult to answer.  As frustrating as this may be to hear, medicine isn't an exact science. Conscientious care, diligent rehab, and good rest can all help get Drew on track, but if the body isn't cooperating ahead of schedule, it's simply not going to happen.  "At the end of the day, you can't fool nature," acknowledged Kaplan.  "You can't accelerate 'the healing process,' per se.  But what you want to do is give them every advantage to the extent that you don't hinder that process."  The biggest red flags Drew will be dealing with on the road to recovery is stiffness, chronic pain and re-injury.  And the best way to ensure backward steps?  Returning too early.  "You don't want to get him so soon that he tweaks it, bleeds and does some further damage," cautioned Kaplan. 

    If I might take the liberty of making up a phrase to sum up the approach, "aggressive patience."
  • I wondered if Drew's size made the recovery more difficult, given the stress additional weight puts on his legs.  Unfortunately, bulk can equal stress, which doesn't make Drew's life any easier, but it's not a deal breaker, either.   The potentially bigger problem Drew's height offers this injury is that he's simply more susceptible to it.  His leg is a bigger, longer, lankier target with an easier middle point to collapse.  Curse Drew and his lack of corn fed stumps!!!

  • The MCL, by the way, is gi-freaking-normous.  It runs from the end of the thigh bone all the way down about five inches into the tibia (shin bone).   Whole lotta ligament going on.
  • Readers have expressed concern that two straight seasons of knee injuries could signal Bynum being injury-prone.  They should stop worrying.  Having seen the impact of the collision between Kobe and Bynum, Kaplan wasn't shocked at all that an MCL tear was the result.  That wasn't exactly a love tap.  "It was a completely legitimate hit. The injury and mechanism well support the findings.  It wouldn't be anything where I'd say, this kid is more susceptible than others.  He got hit hard enough. There was significant contact.  And that's a horrible place.  It's a vulnerable area." 

    Throw in the fact that the injuries weren't on the same knee and the way Bynum got hurt was almost the very definition of a freak accident- as opposed to say, Greg Oden, who's been hurt more during routine elements of competition- and I'm holding off before labeling Bynum injury-prone.  Unlucky?  That might be a distinct possibility.  But Drew's got a long way to go before I slap him with the "T-Mac II" tag.
  • Drew taking longer than expected to recover from last year's injury shouldn't necessarily raise anyone's concerns about a prolonged ETA in 2009.  The subluxation was "in some respects a worse injury," according to Kaplan.  "It's a much more difficult injury to recover from and I was not surprised that he had the downtime he did from that.  This is a different ball of wax and I'd be surprised if he's not back by that eight week mark, unless something else is going on that we're not aware of."
  • And finally, the key to a return is that Bynum can regain 85% or better of his muscle strength.  I don't know how big a Cincinnati Bengals fan the average reader is, but in the spirit of helping out Drew, Viva Ocho Cinco!!!

AK 


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