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February 14, 2017

What type of injury are the Sixers and Joel Embiid dealing with?

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Saturday night was a busy one down at the Wells Fargo Center, with the news of Jahlil Okafor being held out of action due to trade discussions as well as Joel Embiid having a torn meniscus in addition to the bone bruise in his left knee (#GODNERBOMB).

For now, let’s go back to the Embiid news.

"The MRI [after the Portland game] revealed obviously what we had thought to be a bone bruise," Sixers president of basketball operations Bryan Colangelo said that night. "And there was also the recognition that there was a very minor meniscal tear. But it was not thought to be acute and it was not thought to be the source of the pain, inflammation or symptoms."

"It's not thought to be an acute injury, meaning likely or could have been pre-existing," Colangelo said. "But again, he's being treated for the bone bruise”

Yada, yada, yada, Colangelo’s explanation was that the bone bruise, and not the meniscal tear, is what is keeping Embiid out of action and thus what the Sixers are targeting in his rehab.

“It’s a very important structure, the meniscus,” Dr. Larry Miller, Chairman and Chief of Orthopaedic Surgery at Cooper University Health Care told me. “Most of the transfer of weight between the thigh bone and shin bone goes through the meniscus, so it can take a toll on the joints.

“It sounds like if he’s been able to be active on it now, maybe the knee has quieted down enough. What they’re waiting for is for the swelling in the bone to go away and then start to bring him back again and see if he can play and hope that the bruising doesn’t come right back again. I assume that’s what their game plan is.”

I am not a doctor and nor do I play one on TV, so Dr. Miller was nice enough to educate me about the meniscus. It’s very important to note that neither I nor he has access to Embiid’s medical records, so we talked generally about the meniscal tears. The conversation has been edited for length.

PhillyVoice: Bryan Colangelo said that many NBA players can play with minor meniscal tears. Is that true?

Dr. Larry Miller: There’s lots of people in the world, if you put them in an MRI unit, they’re going to show a meniscal tear and they never even knew they had one. So it’s absolutely possible to have some problems with your meniscus and play.

The flip side is there are some people that get an injury to their meniscus and have so much trouble afterward that they can’t play. So both sides of the coin, unfortunately, are real.

PV: When I first hear “meniscus tear,” my first thought is “surgery.” But the Sixers, who say that Embiid has a minor tear, seem to be trying another option. Is that fairly common?

LM: It depends what type of meniscal tear you’re talking about. The meniscus is a structure that has several areas that can get injured.

In general, in a small injury, a small meniscal tear, you’re going to wait it out. The tear itself may not heal and repair, but the knee can quiet down and if the tear is small enough to have very little effect on the function of the meniscus, then you can go back and start playing and in many situations not have any pain at all.

And then what happens over time is the area where you got the little rip, the body just kind of recontours it. It never goes back to looking perfectly normal again, but the sharp edges go away and it kind of gets buffed. Like if you have a diamond stone and a corner gets chipped, a jeweler could buff out the edge of it never was like what it was before, but you’d be hard-pressed to tell the difference. So that’s certainly possible.

Larger meniscal tears usually require surgery to sow it back to together in a younger person.

PV: What are some of the ways to differentiate between meniscal tears?

LM: There’s tears that are defined with respect to the zone of the meniscus and then there are tears defined by how long the tear is. So, whether it’s a large tear involving a third or half of the meniscus or only 10 percent of the meniscus. That will also dictate how much function you lose if you injure it.

Basketball players tend to get tears in what is called the lateral meniscus, the outer meniscus, and depending on the shape of that tear, they can be a problem. It’s typical to come down from a layup and have your weight on your leg come down in such a way that there’s more force that goes on the outside than the inside. They can get a pretty unique type of a tear that you see in basketball players.

But again, I don’t know if that’s what he has or not.


PV: From what were told, this could have been a pre-existing injury. The idea of that, how such a big man can perform at such a consistently high-level night in and night out with a meniscus tear, is still kind of amazing to me.

LM: Yeah, sometimes people can. Say you have something that’s not quite perfect, and the knee can take a beating up until 40 runs up and down the court and then on the 45th run it’s just a little bit too much and it’s time to stop.

And you go to 44 and it’s too much load, and it overloads the bone, which starts to bleed a little bit, a so-called bone bruise. And if you’re not running 43 or 44 trips up and down the floor and stop at 35, you’ll never know you had a problem. You may be able to perform without any difficulty. And then his knee may quiet down and he may play another 10 years without any difficulty whatsoever.

***

The Sixers, who definitely seem to be waiting for the knee to “quiet down” (become asymptomatic), sure hope that they can get a decade of basketball from Joel Embiid. But like Colangelo said on Saturday night, even if the Sixers don’t believe the bone bruise/meniscal tear is a long-term injury, it sure has been a complicated one.


Follow Rich on Twitter: @rich_hofmann

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