In Street Clothes...
By Jim Russo
RotoWire Injury Expert
Andrew Bynum - LAL [C]
Two days after a monster double-double and maybe his best game as a pro, Andrew Bynum injured his left knee going up for a rebound and landing on teammate Lamar Odom's foot. A day later the Lakers learned he would miss at least the next eight weeks with a subluxed patella and bone bruise.
A subluxation is a temporary dislocation of a joint, in this case the patella-femoral joint. The femur, at its distal or far end has a groove in which the patella or kneecap slides up and down when the knee is flexed and extended. Sometimes the patella quickly pops out of that groove and then shifts right back in. In a dislocation, the kneecap pops out of that groove and stays out. The bone bruise is most likely a result of the back of the patella banging up against the front of the femur as it was forced out of the joint. Either way, the injury usually causes a considerable amount of swelling and pain, as well as a feeling of instability when walking. It can also cause damage to the retinaculum; a band of connective tissue on both the inside and outside of the knee which prevents the kneecap from sliding side to side, maintaining its alignment moving straight up and down. Treatment starts with a lot of ice and light stretching exercises. He'll probably be in a brace for at least 3 or 4 weeks, but quad strengthening exercises will start right away.
Usually, the patella subluxes laterally, or to the outside of the knee. This happens for a number of reasons, one of them being that the muscles on the outside of the quadriceps that pull the patella up are usually stronger than the muscles on the inside of the quad, resulting in the patella being forced laterally. To combat this, strengthening is focused on the medial, or inside muscles of the quad to help the kneecap stay aligned. After the brace comes off, he'll start more aggressive strengthening and balancing exercises for the whole lower extremity and then test it out on the court, usually with a smaller, more functional brace that helps prevent the patella from moving laterally. The problem with the injury is a high recurrence rate and the danger of developing loose bodies or OCD's (osteochondral defects). Loose bodies are small pieces of cartilage that tear off and float around in a joint. They are usually a result of a traumatic injury but can also develop chronically (see Ron Artest's elbow). OCD's are defects in the cartilage that covers the end of long bones like the femur leading to inflammation and pain in the bone underneath. Treatment for an OCD may lead to microfracture surgery, which put number one pick Greg Oden on the shelf for the entire season. Now I'm not saying Bynum has either of these; there is nothing to indicate that yet, but they are a possibility in the future so watch the updates to make sure there are no setbacks in his rehab. If all goes well, expect him back towards the end of March.
Stephon Marbury - NYK [PG]
Stephon Marbury will likely be out the remainder of the season after an MRI revealed bone spurs in his left foot which will require surgery. What may be a blessing to Isiah Thomas and Knick fans could definitely hurt fantasy owners. Bone spurs develop when chronic inflammation in a joint wears away the cartilage that protects bones. As the cartilage erodes, the body produces extra bone tissue in response to the chronic rubbing and stress of bone on bone contact. Also called calcium deposits, spurs can form in the ends of ligaments like the plantar fascia, which makes up the arch of the foot. The constant pull of the ligament on the bone it attaches to (the calcaneus) causes the bone to grow out from its normal shape, sometimes even forming a sharp end or hook. Spurs can also develop in the Achilles tendon, in the big toe and in the joint that makes up the hinge of the ankle. The two long bones of the lower leg, the tibia and the femur connect with the talus. The talus sits on top of the calcaneus and with it, forms the subtalar joint. Basically all the weight of the body is translated through the subtalar joint so chronic inflammation from running and jumping can lead to bone spurs there as well. Surgery to shave down the spur and reattach the tendons and ligaments that surround it will force him out of action for at least two months, and all but end his season. The latest comments from Steph may lead you to believe that he'll be back this year, but the way his season has gone to this point, I'll believe it when I see it.