Sims: Breaking Down Stoudemire’s Knee Debridement
By Abby Sims
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The NY Knicks started the season on a winning tear in spite of a rash of injuries. Now, as playoffs approach, they are relying on some strong performances by their supporting cast while their biggest stars warm the bench. Amare Stoudemire is set for more right knee surgery, while Carmelo Anthony remains day-to-day after missing his third game due to right knee soreness and inflammation. Despite it all, the Knicks have won six of their last eight.
Stoudemire’s surgery will reportedly be an arthroscopic debridement, which essentially involves washing out the involved joint (lavage) and then clearing it of loose fragments of bone, cartilage or other tissue debris that remains in the area. Bony surfaces may also be smoothed in the process. At one time debridement was considered to be a first line treatment option for many with osteoarthritis of the knee. Over time, because of questionable or unfavorable outcomes, it has lost favor, particularly for those with a loss of joint space due to severe arthritic changes.
These days, debridement may be employed primarily to postpone a total joint replacement (are you listening Amare?). Less invasive and more commonly used treatments for this population entail a series of injections of hyaluronic acid (HA) to enhance joint lubrication. However, there are occasions when debridement is a viable option. Predictors of good outcome with debridement include: preoperative pain that is present for only a short time, normal alignment, minimal x-ray findings, and evidence of crystal deposits in the joint (CPPD). Debridement may also be followed by HA injections to enhance outcomes.
The presence of distinct loose bodies in a joint – such as bone chips in the elbow – is usually the impetus for a debridement procedure in the sports medicine population.
As for Amare returning at full capacity in six weeks, I’m skeptical. Though his rehab will undoubtedly begin in the immediate post-op period, in the short term, surgery is likely to result in some swelling, and the joint must be rested while treated for inflammation. The presence of swelling and disuse from rest promotes muscle atrophy – a loss of muscle bulk translating to weakness. The muscles controlling the knee, particularly the quadriceps, must then be sufficiently strengthened, while also addressing all other muscles of the lower extremity. It is only then that movement and agility drills (quick change of direction) and plyometric activities (power moves like jumping) will be added to the rehab program. Returning to full competition only six weeks after surgery on what appears to be an arthritic joint will likely compromise Stoudemire’s surgical outcome. I’m just sayin’…
How concerned are you with Stoudemire’s injury woes? Let us know…