What’s a team doctor to do?

Note: The following post appears as a column in tomorrow’s edition of The Post and Courier.

Since I wrote my last column about Greg Oden’s microfracture surgery, I have been following closely the criticism directed toward the Portland medical staff, and team doctor Don Roberts in particular. Including Oden, the team has 4 players out for the season due to injury. What is most concerning to Blazers’ fans, however, is the status of the team’s superstar Brandon Roy and the knee surgeries he has undergone.

Note: This column is in no way an attempt to support or criticize Dr. Roberts and decisions made with respect to Roy. My only knowledge of his injuries comes from being an NBA fan and hearing commentary about the medical decisions made. I think Roy’s knee surgeries and his limited ability to play despite having recently signed a long-term contract illustrate that being a professional team physician is not always as glamorous as fans think.

The surgeon uses scissors to trim out the part of the meniscus that is torn.

Roy’s problems stem from injuries to the meniscus in each knee. The meniscus is a C-shaped piece of cartilage between the femur and tibia. There is one on the medial (inside) side and one on the lateral (outside) side of each knee. They serve as shock absorbers to protect the bone and articular cartilage of the knee. If an athlete tears a meniscus, treatment involves either sewing it back together or, more commonly, trimming the torn part out. If a large amount of meniscus has to be removed, presumably the athlete is likely to endure more stress on the bone and articular cartilage, leading to arthritis in the knee. This damage is unfortunately irreversible.

The torn part of the meniscus has been removed, leaving less to serve as a shock absorber.

Roy had surgery on his left knee for a meniscus tear in August 2008. With 2 games left in the 2009-2010 season, the Trail Blazer shooting guard injured his right knee. Roy had arthroscopic surgery with removal of part of the meniscus. Initially he was thought to be out for the NBA playoffs, but he returned 8 days later to play in Game 4 of the team’s playoff series against the Phoenix Suns. He also reportedly had a torn meniscus while playing at the University of Washington.

Some of the criticism of Dr. Roberts seems unfair. There is no real way to prevent a meniscus tear. It typically occurs with a twisting injury, and with the nature of sports, no brace or exercise program will eliminate the chance of that happening. The repetitive stress on the knee with jumping and running up and down the court night after night will cause too much pain to play for long without surgery. Also, the surgeon has no ability to determine if the meniscus can be repaired or if part of it needs to be trimmed out. Yes, we would like to sew all meniscus tears and save that meniscal shock absorber, but most tears are not amenable to repair.

More curious is the team’s decision in the offseason to offer Roy a 5-year, $82 million contract after multiple surgeries. The franchise superstar is beloved by Blazers’ fans and no doubt sells countless tickets and jerseys, but he has seen limited action in the last month due to swelling and pain in his left knee. The team had Roy evaluated by Dr. Neal ElAttrache in Los Angeles. According to The Oregonian, Roy says he was told that he had no meniscus left in either knee. “The problem is bone-on-bone there,” Roy said. He told the paper that he couldn’t do more harm but not much could be done to help either.

It is difficult to determine what advice Dr. Roberts and the athletic trainers gave team management regarding Roy’s knees and signing him to a long-term contract. But if his knees truly had no meniscus and had damage to the articular cartilage, Roberts would have seen it first hand with the arthroscope. Maybe he did recommend against the team signing Roy for medical reasons and the team signed him anyway out of loyalty. We have faced difficult decisions like this one at the beginning of Charleston Battery seasons, where we discussed whether the team should sign an older player who was popular with fans but whose body clearly had its best days behind it. Clearing a player with these issues can backfire, and the player may be paid to sit on the bench.

Finally, much criticism has been made regarding Roy’s return to play 8 days after the surgery. Any time this decision is faced, the team and medical staff have to weigh the benefits of helping the team win against the risk of worsening the injury. I have faced that both with the Battery players hurt during the season and Family Circle Cup tennis players hurt during the tournament. Fans have paid a lot of money to see star athletes. Teams have a lot of money invested as well and want to win championships. The players have the rest of their careers – and the quality of life after that – to consider as well. And the team doctor is often caught in the middle.

One Response to What’s a team doctor to do?

  1. Jonas says:

    Why can’t Brandon Roy simply go to Europe or perhaps even in the US, get some sort of cartilage scaffold-like implant; perhaps combined with ACI or Microfracture (to reduce any friction that might develop, given he has articular cartilage irregularities) and play longer than he might have otherwise?

    Odd to me that the team doctors, or anyone affliated with these great athletes don’t advise them, that there are some procedures that could get them quasi- back to the same player they used to be.

    They really have nothing to lose.

    And a lot of $ and maybe even glory to gain.

    Go for it!

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