When 'Air' Descended, Knees Paid The Price
By Shankar Vedantam
Washington Post Staff Writer
Wednesday, February 27, 2002; Page D07
Every time Michael Jordan returns to Earth from an aerial assault on the basket, one of his knees picks up the check.
Over time, said experts who have treated hundreds of knees like Jordan's, parts of his knee joint probably have begun to wear out and a tendon may have become frayed. Today or Thursday, Jordan will undergo exploratory arthroscopic surgery, a procedure that will give doctors a look inside his knee and a chance to clean out any debris.
"If you think of the number of times he's landed on his knee from altitude -- he obviously achieves high altitudes -- it's cumulative wear and tear," said Robert Stanton, an orthopedic surgeon at Yale University who provides medical care to the U.S. ski team.
Stanton said that Jordan's recovery would depend on what exactly is done during the procedure but could take three to six weeks. Other experts said recovery could range from 10 days in a best-case scenario to as long as six months.
"From what I know of his type A-1 personality of getting back fast, he's going to push that," Stanton said. "The key is muscle rehabilitation."
Over the past few months, Jordan has complained of pain and swelling after games. His knee has filled with fluid and been drained -- a procedure called aspiration.
The fluid build-up was a sign that something was wrong, said knee specialists who have followed Jordan's career. Like all joints, the knee produces fluids that aid in lubrication. When something goes wrong, extra fluid is produced, limiting mobility and sometimes causing pain.
In every instance, the fluid build-up is a symptom of an underlying problem. Draining the fluid can ease pain, increase mobility and allow an athlete to play again -- but it will not fix the problem.
Possible problems include a tear in the meniscus, the knee's shock absorber, or degenerative arthritis.
Doctors fill the knee with water during the arthroscopic procedure and some water can be absorbed by the quadriceps, temporarily affecting the muscle after surgery, said Joseph Bernstein, an assistant professor of orthopedic surgery at the University of Pennsylvania.
But "if someone has a loose piece of cartilage it's like taking a pebble out of his shoe," Bernstein said. "They are so relieved that they don't perceive any discomfort."
Knee injuries are among the most common sports injuries and the joint has the infamous track record of having the largest number of things that can go wrong during sports. The knee is basically a hinge, with limited rotational ability -- fundamentally at odds with the gyrations, swerves and thuds of athletics.
While Jordan's exact diagnosis is not yet known, he reportedly has been suffering from tendinitis, an inflammation of the thick band over the front of the knee that connects the kneecap with the shinbone.
"What happens with an aging tendon is it becomes less strong and less flexible," said Randall Wroble, a team physician for the NHL's Columbus Blue Jackets. "When it's subjected to the same levels of stresses that a young tendon is subjected to, it is more easily injured. Its healing abilities become slower and poorer."
During arthroscopic surgery, doctors make one-to-three incisions and insert small instruments with which to look inside the knee. A normal patellar tendon will have a smooth, shiny appearance, like a cable with many fibers. Tendinitis produces a tendon that can be frayed, less shiny and rough.
For an athlete like Jordan, Wroble said the tendon would be thick -- two inches wide and as much as three-quarters of an inch thick. In most cases, tendinitis affects only a part of the tendon.
"So usually the part with the problem is removed," said Wroble, a member of the American Orthopaedic Society for Sports Medicine. "Sometimes we see a bone spur at the bottom of the knee cap pushing into the tendon and that could be removed."
James Garrick, an orthopedic surgeon and head of the center for sports medicine at St. Francis Memorial Hospital in San Francisco, guessed that Jordan was not suffering from tendinitis, since arthroscopic surgery was not very good at detecting tendinitis.
He said doctors probably had suspected that cartilage at the back of Jordan's knee had started to wear. "It would come as no surprise that he's beginning to get some arthritic changes in the knee," said Garrick, sounding the most cautious note about the athlete's chances of recovery.
"If he's getting big-time changes to the joint surfaces, then coming back may not be in his best interests," he said.
© 2002 The Washington Post Company