Lakers Now

Round-the-Clock Purple and Gold

« Previous Post | Lakers Now Home | Next Post »

Dr. Michael Kaplan on Andrew Bynum's knee

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 

 
Comments () | Archives (32)

The comments to this entry are closed.

AWESOME DUDES! sounds good. Hopefully 8 weeks.

i like that aggressive patience.

I don't know why, but I was wincing throughout the good doctor's explanation. Need injuries -- not fun. It's one thing to sustain an injury like that, and it's quite another to go through it and then, on the other end of rehab, having to take to the court against some of the biggest, fastest, most athletic people in the world. Judging from last year's injury, my guess is that Drew takes longer than eight weeks to return to the court. Of course, back then he was still hoping to sign a contract for a lot of money. Now that he's going to be making the big bucks, maybe he's exercises caution, but not too much.

If Farmar, whose injury is also estimated to be 8 weeks can return in just 4-5 weeks , why not Bynum?

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


HAHAHAHAHA

do you guys share a salary too???

Amazing Happens:

Oh if Clyde The Glyde was wrong then consider Tex Winters and Joe Dumars wrong too??

Article: The Death of Defense??

"Dumars of the “Bad Boy” Detroit Pistons, the league’s two-time defending champs, looked like a gaucho corralling the ultimate toro, his feet moving furiously (maybe the best defensive slide in the history of the game), one forearm firmly barred into Jordan to keep contact, the other bent arm thrust into the air, giving Dumars his only hope of keeping his balance while trying to ride the Jordan whirlwind.

Asked in July if he could defend Jordan under today’s interpretation of the rules, Dumars first laughed, then offered a long pause before replying, “It would have been virtually impossible to defend Michael Jordan based on the way the game’s being called right now.”

“It’s more difficult now to guard the quick wing player who can handle the ball,” (Rod) Thorn (of the New Jersey Nets) said of the change. “I think it helps skilled players over someone who just has strength or toughness. What the NBA is trying to do is promote unimpeded movement for dribblers or cutters.”

Thorn said the change was made because muscular defensive players had gotten the upper hand.

“My opinion is that the game had gone too much toward favoring strong players over skilled players,” Thorn said. “The NBA felt there was too much body, too much hand-checking, being used by defenders to the detriment of the game. There was a feeling that there was too much advantage for a defensive player who could merely use his strength to control the offensive player.”

But not everyone is enthused about the changes.

Tex Winter, now 84 and the veteran of more than a half century of coaching, has serious misgivings about what the league has done.

“It’s brought all these 40-point scorers,” Winter said. “They can’t score 40 points unless they get 15-20 free throws.”

And that’s exactly what they were getting on their big nights.

“They should be protected, but not that much,” Winter said of the current generation of talented offensive players. “I don’t think that just touching a player should be a foul.”

Yet there were key foul calls in the playoffs last year that came down to touch calls, which in turn sent the offensive player to the line for bonus points that ultimately decided games.

Ironically, this attempt to pick up scoring also slowed the pace of NBA games last year because numerous foul calls mean a parade of free throws on many game nights, Winter said.

“The fans are not going to like that whistle blowing all the time. It’s slowed down the pace of the game.”

Winter’s other complaint with the new officiating is that the game now allows the same old physical play in the post while turning the perimeter and wing into a no-touch zone.

“That doesn’t make sense to me,” Winter said. “If you can do all that tough stuff inside, why can’t you do it outside?”

“Defense has basically stayed the same in the low post. Out on the court there’s no doubt that the interpretation has changed,” Thorn conceded.

“I think you have to play more of a containing defense,” explained Winter. “You can still put some pressure on the offense. You can contain them and slow the ball up.”

But the new guidelines “change how you force turnovers,” Winter explained. “You can’t be as aggressive as you’d like to be with your hands. You can’t be ‘into’ the guy as much.”

As a result, defense now becomes a matter of waiting for the offensive player to make a mistake, rather than forcing a turnover, Winter said.

Dumars knows he’s got to find defenders who know that they can move their feet and look the opponent in the eye. They just can’t touch."

Source: http://tinyurl.com/2ln6gk

-Kobeblitz

Yes, it was a freak accident of Kobe hitting Drew's Achilles or weakness. My Gosh how many Achilles that Drew has? Odom bumped him by accident, went on leave for 6 months. You can't compare him to NFL players. If he were a football player, he would crumble in pain just on the first game. OK, I may be judgmental on Drew injuries which are fatal to him but he cannot be a soccer player nor a football player. Based on his history as b'ball player, he's becoming like Bill Walton who has a long history of weak knees, however Bill gave the Blazer fans as well as the Bruins something to cheer about. In the case of Drew, when Laker fans were starting to reach their climax, AB suddenly withdrew due to weak body parts. LOL!

Thanks for the post AK. It made me feel a lot better

AK,

It's like pushing in with the Andrew Kamenetzky hand (that would be big slick) and then getting called by the big blind.

You're sitting there thinking, oh darnit, I'm dominated. Then he flips over pocket jacks and you're thinking "alright, not so bad"

You couldn't get one of the actors from "Grey's Anatomy" to discuss this?

Aside from the physical aspects, one of the biggest questions is how quickly Drew can get back the mental aspect of his game.

I think most bloggers believe that it was the mental aspect that kept Drew from playing like he did previous to his last 5 games. Worrying about the first injury, etc.
Question is has he finally learned not to be worried about all injuries?
Will all the worries that affected him after the first injury now going to be on his mind after the second injury?
If he comes back right before the playoffs how many games does he need to come all the way back mentally?

Very positive news. I've found that Andrew's injury has given me some resolve, I'm almost peaceful these days. Weird I know, I'm not exactly sure why, but since his injury I'm taking games less seriously and taking wins and losses(we havn't lost since his injury)for what they are....just another check mark on the win or loss column. With that said, I can't wait to have him back!!!

This was excellent in terms of bringing home some points I've been trying to stay hopeful about ...

plus I'm a Bengals fan so it all ended on an excellent note.

Andrew Kamenetzky...

EXCELLENT interview with Dr. Kaplan, and BIG kudos...as well as Double Fist Bump...for the depth and breadth of your MCL research.

Liberty taking is certainly your prerogative. I like the phrase, "aggressive patience." Just seems to roll off the tongue...and dovetail nicely into...cautiously optimistic. Or, cautious optimism. What say you?

Lakers Nation...let us all kneel down and send our heartfelt wishes, thoughts, prayers, and good vibes towards AB17 for a speedy and complete recovery!

P & G R

KG is rapidly recovering from the flu, and is feeling much better.

In other words, Dr. Jack Kevorkian is the only doctor the Lakers will need tomorrow night in Boston.

The Flu? hahahah KG was out cuz of the flu, seriously? What a joke. So much for the tough warrior guy.

Great article. A good explanation is worth its weight in gold.

exhelodrvr - LOL! So funny.

I'm really hoping for that 8 week mark. That puts us about beginning of April - enough time for Drew to get back on the court and start getting his rhythm back. This is good news! Not for sure news, but we can hope. I'm definitely GHF on this.

What kind of medicine did papa Kam practice?

Even if we lose tomorrow night we will have still split the series, and considering the clovers swept the series last year I'm not too broken up about it.

But of course, anything can happen. God forbid, but Pierce could actually really and truly injury his knee this time instead of faking it. KG could actually show some class on the court. Perkins could grow a few inches. Big baby could actually have KG come and put his arm around him when he makes a mistake.

Please. *rolls eyes*

Cough!, cough!, Look at me, i'm KG, and i'm in bed coughing, but i'm getting better! and i'm tough, no doubt about it! and i will play... if i feel good enough

(meanwhile, Kobe dropped 61 with 8 fingers...)

FACTS:

KG mainly is a jump shooter now.
Ray Allen can NOT drive to the hoop.
Paul Pierce FLOPS like crazy!

We`ll never really know...Maybe Pierce was being a bit "dramatic" regarding his knee last June?

Afterall, he IS from Los Angeles.

AK...

Good job! Thanks for going the extra mile.

Kobeblitz...

One thing you forgot to mention about that article, "The Death of Defense", is that it was written in October 2006. A lot has changed since then. One has only to look at last year's Finals to see that. The Celtics were allowed a lot more leeway in their perimeter defense of Kobe than the Mavs were against DWade in the Finals of '06. The "no hand checking" rule has lost its steam. It's become like the 55mph speed limit...seldom enforced.

Why did'nt PJ put a legit Center to relieve Andrew during the game. That always crossed my mind, in fear of another injury to Andrew. Gasol does a decent job at center, but not strong enough. 8 weeks will come and go quickly, i hope we can keep our winning ways.

When we can expect Drew to be "back" isn't very specific. I suppose what we really need to know is when we can reasonably expect for him to be cleared to actually play in a game. I imagine there are milestones. How long is the average rest period (I've heard anywhere from 7-10 days to 4 weeks). How long does he have to rehab? When can we reasonably expect him to begin practicing again. After that, you can only hope he gets cleared quickly for full contact practices and games. So, when Kaplan says 8-12 weeks is a conservative estimate for him to be "back" does he mean "back on the court"?

Also, has anyone else seen the iphone commercials where they talk about "there's an app for this... there's an app for that..."? They actually talked about an app that enabled you to read an MRI. I think both Altchek and the Lakers need to download that one.

Paula Pierce should call Dr. Ruth and find out why his testicles haven't dropped yet. Seriously. Crying into Scalabrine's chest after "injuring" his knee last year? I would rather crawl off the floor and into the locker room than have them wheel me out in a wheelchair. The Celtics have been a non-issue for twenty years. They're about to disappear into obscurity again.

Go Lake Show!

Who is this "Red" anyways? Isn't that name from the 50s or something?

Great article, AK. I, too, feel that the recovery time of 8-12 weeks is on the conservative side. It's encouraging to know that the MCL is located "in a capsule and has a very good blood supply". This is very good news. The reason why it took very long for Drew to get back from his first injury is because the patella subluxation resulted in a bone bruise. Bone bruises take a long time to heal because there's very little blood supply. Here's hoping that Drew will have a successful rehab (no setbacks) and come back soon.

should have hired a med student intern haha, jk

Good shtuff as AK would say. Certainly encourages me. And is bound to talk some others off the ledge.

AK,

I now understand why BK is so weird in discussions of medical evaluations and the healing process.

Thanks for the interview. Nice to get some good, authoritative news.

Good job.

Lakers Today... Lakers Tomorrow... Lakers Forever.

GO LAKERS!

A concern I have is that Bynum has had three knee injuries that I know of, including a torn ACL in his RIGHT knee early in his senior year of high school (the same knee). I haven't seen this addressed except in the following link: http://www.collegefanatics.com/boards/showthread.php?t=12270

Broderick Turner's article http://www.latimes.com/sports/basketball/nba/lakers/la-sp-bynum-lakers4-2009feb04,0,6492743.story
cited experts saying that Bynum may be loose-jointed, and that this may increase the risk of injury:

"Bynum will not walk away from back-to-back knee injuries completely unscathed...his kneecap injury suggests that he is a bit loose-jointed... both knees probably will be sensitive to contact injuries in the future...Bynum's previous injury, the dislocated kneecap, was more serious and may reflect a tendency toward that type of injury...some people are more prone to have a kneecap that slips out. It's just how your body is built. He was probably a little bit predestined to that injury...DiNubile said."

"Bynum's right knee could be a bit more vulnerable to injuries in the future, however, especially in the first few weeks after he returns...Those knees are often a bit looser...The ligament heals in a lengthened position. So it's more lax, Matava said"

I hope, primarily, that more knee injuries don't follow, jeopardizing Bynum's career and the Lakers' fortunes...while the Celtics add more titles and cushion their overall lead in titles won, and that the Lakers aren't, in the process salary-cap limited.


Oops sorry tinyurl format for Bynum article

http://tinyurl.com/c8g8h7

Red's Bastard sayz: "We`ll never really know...Maybe Pierce was being a bit "dramatic" regarding his knee last June?"

O, you think? Can you imagine what would have happened if Kobe (or even LeBron) had pulled that stunt?

That was some of the most ridiculous sports theater ever. I hope they put that wheelchair in the Hall of Fame.

Anyways, no one is worried about the Celtics if they have been paying attention. The Green Stinkies have NO ONE who can check LeBron. He and his striped buddies are going to eat the C's breakfast, lunch and dinner. "You make keep your afternoon snack." says LeBron.


Connect

Advertisement

In Case You Missed It...

Video

All Things Lakers »

Your database for all things purple and gold.

Find a Laker

Search a name

Select a season

Choose one of our lists



Categories


Archives
 

About the Bloggers


Bleacher Report | Lakers

Reader contributions from Times partner Bleacher Report

More Lakers on Bleacher Report »



Get Alerts on Your Mobile Phone

Sign me up for the following lists:


In Case You Missed It...