Surgery on a meniscus, the shock-absorbing cartilage in your knee, is the most common orthopedic procedure performed in the United States. Surgeons take out pieces of torn menisci about 700,000 times each year, often in older people who have suffered degenerative damage, but quite regularly for tears suffered by athletes and others, usually in a twisting motion of some kind.
Perhaps we should start calling this procedure the "Derrick Rose surgery" (like the ulnar collateral ligament reconstruction known as "Tommy John surgery," named after its most famous recipient, the Major League Baseball pitcher ). Because the hard-luck Chicago Bulls guard is headed back for his second operation on the same structure -- the medial meniscus in his right knee.
To be technical, Rose had his meniscus sutured in 2013, a very different surgery with a rehab that can take six months or more. We don't know yet whether he'll do that again, or have the torn cartilage trimmed away instead, almost like a torn piece of fingernail. That procedure could put him back on the floor in a matter of weeks. But it is the same meniscus, and if you know anything about Rose, who also tore the anterior cruciate ligament in his left knee in 2012, you've got to feel for him.
(If you don't know the first thing about Rose, this description from my colleague, Michael Lee, says it all: "If you had never seen him blend overwhelming power with breathtaking grace, scorch courts with that blazing speed and leave opponents dazed and dizzy with dexterity and gravity-defying levitation, then the devastation and disbelief wouldn’t feel so fresh every time Rose goes down with another knee injury.")
The medial and the lateral meniscus provide cushioning where your tibia (shinbone) meets your femur (thighbone) in the knee. If you could touch the meniscus, says Volker Musahl, medical director of the Center for Sports Medicine at the University of Pittsburgh Medical Center, it would feel a lot like the cartilage in your ear. But it has very little blood supply.
If you tear it, says Chris Kaeding, a professor of orthopedic surgery at Ohio State University's Wexner Medical Center, you'll feel some instability, but mostly pain. And it may be that Rose -- or you or me -- will have to live with some pain after the surgery and rehab are complete. (This interesting study, by the way, shows that surgery for people with the degenerative form of the condition was no better than "sham surgery.")
But the bigger issue is long-term arthritis. Surgeons would like to leave you with as much of your meniscus as they can. That cushion keeps bones from rubbing and creating arthritis, which can be really debilitating as an athlete, or a lesser mortal, ages. And there is little they can offer beyond injections and braces.
"If they're 40, and they have some early arthritis, what's he going to look like at 50, when he has advanced arthritis?" Kaeding asked. "Now you're looking at a knee replacement."
Or maybe not. Ohio State and five other medical centers have just begun trials on a plastic implant that replaces the medial meniscus. Developed by a biotech company, Active Implants, the cushion has been implanted about 100 times in Europe, said Kaeding, who installed his first about five weeks ago. The patient is doing well, he said, already walking without a limp.
"I think it is promising," he said. "I get approached all the time" to try new orthopedic devices. "This implant, I'm really excited about."