What Exactly Happened to Greg Oden's Knee?

Portland General Manager Kevin Pritchard says that the team did MRI's on Greg Oden's knees before the draft, and they were "absolutely pristine."

But then last Thursday, his knee was swollen, and they did further MRI's and saw a defect in the cartilage.

Pritchard also made clear that microfracture was not a total shock. They sent that more recent MRI to several top experts. The doctor most famous for this surgery is Colorado's Richard Steadman -- and Pritchard said that Dr. Steadman saw the MRI and thought that microfracture would be needed. Other doctors, Pritchard said, weren't so sure. The arthroscopic surgery would make the situation that much clearer.

But, certainly, before Greg Oden underwent microfracture surgery, he would have signed a consent that included permission for that kind of surgery. (So, maybe pre-surgery we didn't get quite the full picture of what was happening here -- although certainly the team has been very straightforward about it afterwards.)

The surgery took place early this morning, and was performed by the team surgeon, Don Roberts, M.D., who also conducted Zach Randolph's microfracture surgery. Pritchard said the knee was otherwise found to be perfect, and that the affected area was about the size of a fingernail. It was also good, says Pritchard, that there was not "flaking" of cartilage.

Michael Kaplan, M.D. is a renowned Connecticut-based orthopedic surgeon in sports medicine, and a medical analyst for ESPN. He has conducted hundreds of microfracture knee surgeries, and says that it's important to remember that this is major surgery. "The fact that they did the surgery demonstrates it was not a negligible lesion," he explains.

Microfracture has been around for about twenty years. It is only used when the articular cartilage (that's like the clear cartilage you see in the joint of a chicken on your table -- it keeps everything moving nice and smoothly in your major joints as you move around) has been pierced or torn all the way through. Such an injury would typically occur in a single incident, he says, although it can occur with many small injuries over time.

Loose cartilage is removed, the edges of the lesion are cleaned up with laser tools, and a small pick is used to make little holes, or "microfractures" in the bone.

Where those microfractures are made, marrow cells and blood form a clot. That clot matures into what Dr. Kaplan calls "a fibro-cartilaginous cap ... It's not real cartilage. It's not as good as what God gave you, but with proper recovery it can often perform at a similar level."

These days it seems everyone from John Stockton to Barry Bonds has microfracture knee surgery. What used to happen to the Greg Odens of the world twenty years ago when the procedure didn't exist? Is there some other treatment out there that might have been tried? Dr. Kaplan says there are various other options (some include cadaver parts!) but none are simple. And twenty years ago they would have likely done a cruder version of the very same surgery, where instead of using a pick to make holes in the bone, they would have used a drill. And instead of lasers to clean up the edges, they would have used traditional surgical implements.

Of course we know that plenty of people can play at a high level after getting this surgery. But can they play at a high level for as many years as someone who has not had this kind of injury and surgery? Again, Dr. Kaplan: "That's a very legitimate concern: what effect may this have on his longevity? The truth is nobody knows. But it's certainly not a good thing."

As the Blazers stressed in their press conference today, Greg Oden has many things on his side: his youth, his strength, his knee that is reportedly healthy otherwise. But recovery requires a lot of stamina. "We can only assume," says Dr. Kaplan, "that he has the psychological wherewithal to get through it."