Dime Q&A: Expert Surgeon Talks Gilbert Arenas & Knee Injuries

It’s been nearly four years since Gilbert Arenas started down this dark path of injuries. He’s had three operations on his left knee, and seen his star, as well as his scoring average (from 29.3 to 8.0 with Orlando), plummet. Still only 29 years old, can Arenas ever make it back to what he once was? Orlando’s GM Otis Smith wants him to, and recently told Agent Zero he doesn’t want him playing any basketball this summer…just rest up and rehab.

Last week, I spoke with Dr. Bal Raj (he will be a regular contributor here at Dime), who’s been named “one of the Leading Physicians on the World” by the International Association of Orthopedic Surgeons(American & Canadian) and has experience as a Board Certified Orthopedic Surgeon specializing in sports & fitness procedures, working with both athletes, Hollywood execs and A-Listers.

We talked Kobe Bryant and advances in medicine, as well as plantar fasciitis and Tyreke Evans. Here is an excerpt from our conversation that centered around Arenas and what repeated knee injuries can do to an athlete.

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Dime: Talk to me a little bit about knee injuries. Gilbert Arenas was told by Orlando that they really didn’t want him to play at all this summer and to just rest/recooperate. He’s had a bunch of knee surgeries for maybe three or four years now, tore his left medial meniscus. When an athlete has this many injuries to one part of their body, does it normally become arthritic? What are the effects?
Dr. Bal Raj: After multiple injuries, your cartilage is there protecting your knee joints and even though it’s a meniscus injury, what happens is each and every time you sustain an injury, it’s usually an aggressive force of impact, flexion and rotation. So what happens is each and every time you injure your meniscus, you end up damaging your cartilage. You wear (down) your cartilage. So the more times you injure your cartilage, the more arthritic your knee gets because the definition of arthritis is wearing of your cartilage.

Dime: You can’t get your cartilage back if you damage it right?
DBR: Nope. There (are) ways that people are experimenting in terms of regenerating cartilage, but realistically on your own, you can’t really get it back. Once it’s gone, it’s gone. Once you have a cartilage tear…cartilage has no internal blood supply so what’ll happen is you see this scar tissue filling in these bases where cartilage is void which certainly doesn’t function to even a quarter of the capacity of regular cartilage.

Dime: Sometimes with athletes, it seems like as they get older all of a sudden their legs just give out on them. With these injuries, are there ever warnings signs or is it pretty sudden?
DBR: While here’s the problem with athletes. Athletes put their bodies through the extremes, especially basketball players with jumping, twisting, turning and direct impact. What happens is when you’re younger, we can bounce back because our muscles are more dynamic, meaning they contract quicker. So we have more proprioception, it protects our joints a lot quicker. As we get older, with overuse, our tendons start to erode. We start to get tendonitis and our repair mechanisms aren’t the same, as well as our proprioception.

Normally, your quads or your hamstrings will contract quickly because your proprioception and your nerve fibers are functioning very quickly to protect your knee. That’s why athletes when they get older, are more prone to injuries. That’s one reason. The second reason they are more prone to injury is because a lot of times they assume and forget the basics. The basics are if you’re putting one body part through so much activity, you need to be constantly, constantly training that part. For example if it’s your knee, you need to constantly stretch and strengthen your hamstrings and your quads in order to keep them active because if you don’t, you’ll lose strength as well as proprioception.

Dime: With Arenas, his team told him to rest and not play. With a knee injury, is that always a good thing? Won’t it atrophy all his muscles?
DBR: 100 percent. When a team says generally rest all summer, as a general concept, even now after surgery I never tell my patients to rest. The goal is immediate and aggressive physical therapy, in most cases, especially with meniscule-type surgery. Because once you ask them to rest for too long, what happens is that your muscle groups atrophy and then you’re more prone to injury.

So although their inflammation may settle down in their knee, it’s a cycle that starts at a lower level now.

Dime: To kind of go away from all of that, I also wanted to quickly ask you about microfracture surgery. Is that the worst surgery you can have?
DBR: Ahhhh…you know it is a painful surgery. What microfracture surgery is supposed to do is again when you have areas where cartilage is void and the blood supply is void, what we do is basically stimulate that area by causing microfractures in the surface so that it will fill up with scar tissue. So scar tissue will fill these void areas. Again, it’s not the same degree (as cartilage), especially if the lesion is in a weight-bearing area. This is not the best, best option, but it’s one of our only few options in this day and age for this type of issue.

What do you think?

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