Remove or repair? Medical experts mull options for Beverley’s meniscus

Patrick Beverley's torn meniscus isn't necessarily a season-ending injury.

Patrick Beverley’s torn meniscus isn’t necessarily a season-ending injury, according to a former NFL lead doctor.

With the diagnosis of a torn meniscus now confirmed and surgery seen as likely, Patrick Beverley and the Rockets have two possible outcomes.

Remove or repair?

For Beverley and the Rockets, each contains a major downside. If the torn part of the meniscus is repaired with stitches, Beverley’s long-term recovery and prognosis would be excellent, but it would end his 2013-14 season and significantly damage Houston’s shot at a championship this year.

Meanwhile, if torn part of the meniscus is simply removed or trimmed, Houston’s starting point guard could return within weeks or even days. However, his knee would be more vulnerable to future problems.

It’s often framed as a choice for the player and the team pitting short-term desires against long-term health. But in reality, it seems to be less of a “choice” and appears more conditional on the specific results of the MRI or even the exploratory surgery.

“The vast majority of meniscus tears are trimmed,” said Dr. David Chao, currently an orthopedic surgeon in California and formerly the head doctor with the San Diego Chargers. Chao has also handled numerous injured NBA players, including a brief stint with the Minnesota Timberwolves.

“Most tears have no real option to sew.”

The trim scenario could have Beverley back to the Rockets within weeks, possibly even by the start of the playoffs in late April.

For Dr. Chao, it all comes down to the specifics of the tear, which the Rockets should know more about early next week. Beverley’s agent, Kevin Bradbury, told the Houston Chronicle that he expected clarity in the coming days and would list Beverley as “out indefinitely” until more is known.

“The periphery of the meniscus is vascular,” Dr. Chao said.  “If you have a clean tear that is in the periphery, even if it’s a larger tear, you want to sew those because it preserves your knee long-term.

“But if you have a tear that’s not clean and not in one place, then it’s not going to heal and you have to take it out. Another scenario is if it’s a smaller tear but in the inner rim, where there’s no blood supply. And only tears with blood supply can heal.”

“In the end, you end up trimming much more often than sewing.”

As far as a timetable for Beverley’s return, that would very much be up in the air. Houston head coach Kevin McHale said it would be 7-to-10 days before the team would know a possible timetable.

“[Recovery] can be very short,” said Will Carroll, lead writer for sports medicine at Bleacher Report and author of The Carroll Guide to Sports Injuries.  “A lot depends on their response to rehab and swelling. In 1984, Mary Lou Retton came back in weeks. Ten-to-14 days is an accepted standard.”

On the other end of the spectrum is Phoenix Suns guard Eric Bledsoe, who had a torn portion of his meniscus removed in January of this season and did not return until mid-March.

“It’s harder in basketball [to return] because of all the cutting,” said Dr. Chao. “Especially for a point guard. It’s not uncommon for football players come back in 1-to-3 weeks, but basketball is harder.

“It comes down to how big the tear is, as well as the associated damage that’s inside. Three-to-six weeks is not unreasonable, but it could also be two months.”

In the past year, Oklahoma City’s Russell Westbrook and Chicago’s Derrick Rose each had their meniscus repaired — rather than removed — in procedures that would sideline each for at least four months. That outcome would undoubtedly end Beverley’s 2013-14 season with the Rockets.

Dr. Chao said those decisions had less to do with a trend toward choosing repair and more to do with the simple fact that they could be repaired, unlike many other meniscus tears.

“From a medical perspective, I don’t think there’s a trend toward repair,” said Dr. Chao. “It’s always been a focus. But because the media is getting smarter and reporting it more these days, fans are learning more about the difference. For me, I repaired about the same amount of meniscus tears 10-to-15 years ago as I do today.”

Miami’s Dwyane Wade, however, said in training camp this year that he regretted having the meniscus in his left knee trimmed in May 2002 when he was a college star at Marquette.

Wade, who has battled chronic knee injuries since then including bone bruises and tendinitis, said that if more of a long-term approach was used in 2002, he may not have had as many issues.

“My knee problems and the things I’ve dealt with started from that,” Wade told reporters at Heat training camp this year. “That was [11] years ago and technology was different and the way you approach things was different.

“At that moment, if everyone looked ahead and said, ‘Dwyane’s going to have a 20-year career, maybe we should do something different,’ maybe I wouldn’t have [knee issues]. At that time it was to get me back on the basketball court and do what is best.”

But even among NBA stars, there seems to be little consensus. As a freshman at Oklahoma, Blake Griffin – one of the most athletic players in the league — had his torn right meniscus trimmed and actually played just six days later.

Four years later, Griffin tore a portion of his left meniscus in July 2012 while preparing for the Olympics. Griffin’s meniscus was again trimmed rather than repaired, and he returned quickly and has shown no ill effects since.

“It’s different for every athlete, but it’s something we’re learning more and more about,” said Carroll. “Everyone has to measure the consequences and make an informed decision.”

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