Tag Archives: basketball

Tearing and repairing the meniscus

How does someone go from being the youngest NBA MVP one year to barely making headlines the next? Ask Derrick Rose. After being named the youngest MVP in the NBA, Derrick Rose tears his ACL the next year and then tears his right meniscus twice in the span of three years. Knee injuries have not been kind to Derick Rose, but how does one tear their meniscus and how does it get repaired?

The meniscus is shown in Figure 1.

Showcases the location of the meniscus in the knee. Gives the user an image of how the meniscus works, and where it is located.
Figure 1

According to Sports Health, the meniscus is a type of cartilage that provides cushioning between the bones in the knee. The meniscus main role is to absorb shock and the impact on the leg and knee when it is in motion. It allows for stability and smooth motion between the joints.

In a game of basketball, one of the biggest sports in the United States, there is plenty of running, jumping to shoot the ball into the basket, jumping up to catch a rebound, and doing sharp cuts during the game to shake off a defender. All these movements cause high loading on the knee, and if there is an over-rotation on the knee during these movements, then it can cause a tear in the meniscus. The video below shows when Derrick Rose tore his meniscus.

In the video, it shows Derrick Rose doing a relatively easy movement, he plants his foot in order to change direction to chase after the ball. It is a non-contact movement, but due to an awkward landing on his foot, he gets injured and misses games for the rest of the season.

When the meniscus is torn, there are two options in terms of healing the tear. The options are getting the meniscus removed or getting it repaired. Both options have their own recovery time. If you get the meniscus removed, then the recovery time would be from four to six weeks. However, there are setbacks to getting the meniscus removed such as leading to early arthritis. If the meniscus is repaired, then the timetable to return to play is around six months. According to USA Today , he chose to get the meniscus repaired in order to not have future complications around his knee, which is why he had to sit out for the rest of the season. Going this route also gave Derrick Rose the chance to return to his playing form before injury. According to Stein, 96.2% of athletes that undergo meniscal repair go to pre-injury level of activity after the repair, which is good news for Derick Rose.

However, Derrick Rose tore his meniscus again the following season in 2015. He would then have surgery to remove the damaged part of the meniscus and would return in a couple of weeks. This would then be his third surgery to repair his knee, and his surgeries must have an effect on his playing performance. After these surgeries, the world waits to see if Derrick Rose can reach MVP status again during his career. It would be tragic to see that these knee injuries would ruin someone’s career.

Sources and Additional readings:

General information about the meniscus

Meniscal Injuries in the NBA

Injuries in the WNBA

Back Against the (John) Wall

What would you do if you went to the doctor expecting to get back to work, only to be told you might not ever be able to go back to work again?

According to ESPN, on February 4, John Wall visited his doctor regarding an infection in his heel after a previous operation. The doctor checked the infection, but upon further analysis, realized that Wall had suffered a partial Achilles tear. Unlike former teammate Boogie Cousins, he did not suffer the tear on the court, but at home. It was reported that while at home he fell and experienced extra discomfort in his heel. His doctor reported that he will undergo surgery and will likely rehab for the next 11 to 15 months.

Achilles Ache

The Achilles is a tendon (tissue that attaches muscle to bone) connecting the bottom of one’s calf to the back of the heel, as shown in Figure 1. It is famously named after the Greek hero whose only weakness was the back of his heel.

An Achilles tendon attached to the heel and calf (Soleus).
Figure 1: This shows the lower half of a human’s leg, where the Achilles tendon is attached to both the heel and calf (Soleus). Modified from Wikimedia Commons.

According to “The Achilles tendon: fundamental properties and mechanisms governing healing” by Freedman et al, the Achilles tendon is the strongest and largest tendon in the entire body, and can bear up to 3500N, or almost 800lb, before completely rupturing. This is a result of the materials that the Achilles is made of. The tendon is 90% collagen, which forms a structure full of fibers that are bound together by other molecules. The tendon is 2% elastin, which like the name suggests, adds some elastic, or stretchy, properties. The tendon is sometimes characterized as a viscoelastic material, meaning it has both viscous (slow to deform) and elastic properties. However, the Achilles is mostly elastic, allowing it to bear relatively high impacts and loads.

Healing the Heel

The Achilles, much like other tendons and ligaments, has interesting healing characteristics and procedures. There are two common recoveries for a tear in the Achilles: a surgery that stitches the ends of the tears together followed by rehabilitation, or a period of rest followed by rehabilitation. For a full tear, surgery is very common, as the torn tendon ends are not always spatially close enough for natural healing processes to occur. For a partial tear, a doctor in consultation with the patient will decide which of the two options will be best.

Experimental Excitement

While there is much more to study with regards to Achilles tear recovery, there is a lot of exciting research being performed on animal models. One study shows that stretching and compressing the Achilles at certain angles during recovery may lead to better long term health of the Achilles. Another study shows the efficacy of stem cell therapies. A third study shows the usefulness of incorporating a 3D printed structure to integrate the ends of torn Achilles. Essentially, this would connect each end with a scaffold that allows for the reintegration of the tendon. This is very similar to an experimental ACL reconstruction technique called BEAR. A video about BEAR can be seen below.

Although John Wall’s career may be in doubt, the future for effective therapies in treating Achilles related injuries is promising. This is exciting for the future, and hopefully will make for a better patient experience. To read more about the Achilles, click here or here.

What Happened to Markelle Fultz’s Shot?

What happened to Markelle Fultz? This is the question on the minds of many basketball fans who have watched a promising player slip into a sharp decline in his first two seasons in the NBA. The former 1st pick in the 2017 NBA draft was known in college for his ability to score; however, so far in his career, his shooting statistics have fallen dramatically as he seemingly forgot how to shoot the ball. A couple of painfully awkward shots can be seen below as Fultz tried new methods of shooting the basketball:

A few months ago, his difficulties were diagnosed as neurogenic thoracic outlet syndrome (TOS). But what is neurogenic TOS and how does it impact Fultz’s shot?

Male figure shown with location of thoracic outlet between the base of the neck, the clavicle and the arms.
White shaded area shows the position of the thoracic outlet on the body. From University of Washington School of Medicine in St. Louis.

A paper by neurosurgeons Jason Huang and Eric Zager of the University of Pennsylvania on TOS gives insight into Fultz’s diagnosed condition. The thoracic outlet is an intersection of nerves and blood vessels that run through the gaps between the base of the neck, the clavicle, and the arm. Neurogenic TOS occurs when there is compression of the brachial plexus, a bundle of nerves that run between the scalene muscles, the clavicle (or collarbone), and the subclavian arteries. When certain arm motions are performed, the space in the thoracic outlet can become smaller, leading to increased compression.

A picture shows the muscle, nerves, arteries, and bone that make up the thoracic outlet.
Representation of the thoracic outlet including the scalene muscles, the brachial plexus nerve bundle, the subclavian arteries, and the clavicle bone. From Huang and Zager, in Oxford Academic.

Particularly in men, it is common for the scalene muscles to cause TOS, and research has shown that it can happen through repetitive use or sports. There have been reports of baseball pitchers diagnosed with TOS because of the awkward arm motions from throwing the ball.  Often TOS is accompanied by a dull pain in the neck, shoulders and arm where affected, but is not sharp and is often characterized by discomfort, especially with overhead motions. This would explain why Fultz’s shooting motion could be uncomfortable and cause his brain to focus on the pain caused by the nerve compression.

 

So what is the treatment and what is Fultz’s timetable for return?

Sometimes for patients with TOS, surgery is an option, but not often for the type Fultz is likely experiencing, since they are tricky and carry high risk due to the presence of major nerves and arteries. Often a more conservative treatment is prescribed, and it seems as though Fultz is doing physical therapy. His initial timetable for return was listed at 3-6 weeks, but there is no indication of an immediate return, and there is little data to predict the length of recovery with physical therapy.

Because of the unpredictability of the treatment, the uncertainty surrounding Fultz seems to be just as thick with the diagnosis of TOS as it was before. However, the ability for Fultz to recover and relearn how to shoot will be imperative in determining whether he will return to his original form as an elite scorer or become one of the biggest busts in the history of the NBA.

 

Further reading on this topic can be found from The Washington University School of Medicine and In Street Clothes.