The idea of Microfracture giving out after 5 years is actually not necessarily true. STAT got his operation when he was young and before his knee had deteriorated to a large degree. He only had a 1 centimeter area of damage. The fact that he has played so long after with no serious setback is a good sign. The new cyst injury is a concern, but we have to see just what it means. No way to know although the comments we've seen is that it's something he should be able to recover from without a problem. Let's remember that Jason Kidd is still playing on knees repaired by Microfracture.
Who’s Afraid of Microfracture Surgery?
By HOWARD BECKIn N.B.A. circles, there might not be a more terrifying medical term than “microfracture surgery.”
There might not be a more ominous roster than Penny Hardaway, Terrell Brandon, Chris Webber, Jamal Mashburn, Allan Houston and Tracy McGrady — star players who went into rapid decline after the operation.
There might not be a procedure with a greater stigma attached to it. But it might be time for a reassessment.
Amar’e Stoudemire is five years removed from microfracture surgery. He is still playing at an elite level, this season for the Knicks. Although doctors may debate his career longevity, there is no debating his continued dominance on the court.
Stoudemire is living, leaping proof that there is life after microfracture — or, at least, the possibility of life.
Both the operation — which spurs cartilage growth in damaged knees — and the rehabilitation regimen have evolved over the past two decades. Teams are armed with greater knowledge and deeper, more sophisticated training staffs. There are many variables that can affect each patient — his age, the severity and location of the injury, the player’s diligence in rehabilitation — but microfracture is not an automatic death sentence for elite players.
“A lot of the group you’re talking about are almost a prior generation of players,” said Dr. David Altchek, the co-chief of sports medicine and shoulder service at the Hospital for Special Surgery in Manhattan.
Hardaway was almost 29 when he had the operation in 2000. Brandon was 32 when he had it in 2002. Webber was 30 and Houston 32 when they had it in 2003.
Stoudemire, by contrast, was just 22 when he had the operation in 2005. It is one among many factors that can influence the outcome.
Microfracture surgery, which was developed in the late 1980s, involves creating tiny holes (or microfractures) in the bone, releasing bone marrow that helps build new cartilage.
Altchek said that doctors have become more adept at identifying risk factors before performing the surgery — in other words, they now know in advance when the operation might fail.
In the past, doctors often viewed microfracture as a last resort — waiting until a player “was practically crippled,” Altchek said — when, in fact, performing the operation sooner might have yielded a better result. Now lesions in the cartilage are generally treated earlier, before they become too large.
“A lot of those guys were doomed before they started,” Altchek said.
Additionally, postoperative management and rehabilitation “is a lot more rigorous now,” he said.
But every microfracture case is different, depending on the athlete and the injury. Altchek listed the following factors in determining whether a player fully recovers:
¶The size of the lesion. Defects greater than two centimeters “have been known not to do well after microfracture,” Altchek said. (Stoudemire’s, for example, was said to be one centimeter.)
¶Whether the cartilage loss is limited to one side of the bone. If both sides are damaged, “then microfracture doesn’t work,” Altchek said.
¶The quality of the underlying bone. If the bone itself is damaged, it can inhibit cartilage growth.
¶The length of time the knee has been damaged. A more recent injury has a better chance of being treated than a long-term injury.
¶The athlete’s ability to heal, which can vary.
Reflecting on his own painful experience with the surgery, Houston said: “I think it was early. I think that surgery was new for the N.B.A. I think a lot of the rehab, the research, things that are going into the process of rehab from surgery, are a little bit more advanced now.’’
Houston had also experienced knee problems for years, and by the time he got the surgery, “it was like the tire had worn so thin,” he said.
Dr. Richard Steadman, the Vail, Colo.-based surgeon who pioneered the procedure, said there have been many advances in the last 15 years, and some in just the last five years.
Yet even if all goes well, there is a 15 percent chance an operation will be unsuccessful, Steadman said. A lot depends on the patient and his adherence to the rehabilitation program. Steadman generally recommends six to eight months before an athlete returns to full activity. Some players have simply tried to come back too soon.
Steadman seems sensitive to the stigma attached to the term “microfracture” (which he coined) and the list of players whose careers were seemingly ended by it.
“You don’t know how they did their rehabilitation, whether they did it for the right length of time, how the procedure was done,” he said. “If it’s really called a microfracture, you have to do it the way I described it and rehabilitate it the same way.”
That is why the Knicks are optimistic about Stoudemire’s future. Stoudemire is famously diligent about his training and his diet. Stoudemire regularly reports to the Knicks’ training center 90 minutes before practice to work on corrective exercises.
“We knew that he really did work at keeping his knees, his body, in perfect condition,” said Donnie Walsh, the Knicks’ president. “And since he’s been here, it’s even more than I thought. So I feel very good about that.”
Stoudemire has effectively rehabilitated his knee. If he can defy the Phoenix Suns’ dire predictions and play at a high level for another 8 to 10 years, he might just rehabilitate the word “microfracture,” too.
10/27/2012 12:44 PM