Houston's Tracy McGrady, here in a game last January, has yet to play a game this season.
Microfracture? What's that?
Those probably were the first words out of Tracy McGrady's mouth when he heard the news. I know they were the first out of mine. The short answer is that microfracture surgery is a medical procedure on the knee that creates new cartilage. And it can potentially prolong an athlete's career. Of course, there's a lot more to it than that.
Before I give my perspective on the surgery, let's delve into why it's so prevalent in professional sports. It's not just me or T-Mac or even basketball players in general. This surgery is performed on football, baseball and hockey players, too.
Microfracture is aimed at fixing the articular cartilage that covers the surface of your bones, much like enamel on teeth. The cartilage of a knee joint is like a bar of soap. Every time that soap is used, the bar gets a little smaller. The harder you scrub, the more the soap erodes.
Years of pounding on the basketball court takes its toll. Combine training -- not just working out to stay in shape, but working out to be in tip-top shape all year -- with a potential 100-game season and we have the recipe for a worn out knee joint. The cartilage simply is rubbed away until raw bone that is full of nerve endings is exposed. PAIN!
All professional basketball players have knee pain at some point in their careers. But the pain from rubbing an exposed bone is so unique, it's something that I'll never forget. It's similar to a bad experience at the dentist.
It's the same sensation that pierces through your body when a drill hits a nerve in your tooth.
Many athletes try to push through the pain knowing that a season or a roster spot is in jeopardy. Managing pain is one thing, but managing your performance -- and your expectations of how you should perform -- while you're in excruciating pain is another. Frustration sets in. And then reality takes over.
The NBA, and professional sports in general, can be cutthroat businesses. Once you can't perform, you're in jeopardy of losing your job.
A knee injury can make an All-Star like T-Mac into an average player, and it can make an average player into one that will be cut. Playing in the NBA is hard enough when healthy. If forced to play on one leg, it's virtually impossible.
So faced with a knee injury like mine or T-Mac's, the choice is clear: Retire or elect some kind of surgery. No athlete ever wants to hear that. But many do, all the time, and those with an injury like T-Mac's have to make that choice. It's not that easy.
So why choose a surgery like microfracture that requires up to a year of grueling rehabilitation and, in the end, has no guarantees? In my case, it was the best option. In order to return to the game at the elite level, to continue playing a sport that is my livelihood, I had to undergo the surgery.
Microfracture surgery is a career saver, potentially. It also, unfortunately, may mark the end of a career cut too short.
Cartilage doesn't simply grow back. It has to be coaxed. Microfracture surgery is not the only option for an exposed bone injury, but it seems to be the one that many pro athletes are choosing.
Microfracture starts out like all other arthroscopic surgeries. The surgeon works through three tiny holes in the knee. Once in, the doctor finds the area where the cartilage is missing, the raw bone. He uses an instrument a lot like a rock pick, a strong, sharp utensil that knocks tiny holes in the bone. After the numerous tiny fractures are created, the doctor waits to see if the all-important ingredient emerges. Blood!
Blood has to start oozing from the holes if the surgery has a chance to work. The bleeding eventually forms a clot that covers the injured area. This clot is very delicate, and very crucial. If it is dislodged, the surgery will fail. If the clot stays in place for those first couple of hours, then days, then weeks, it will eventually form into scar tissue. It's all an attempt to trick the body into healing itself.
The very thin protective shield will now act as the protectant for the bone. This newly formed scar tissue isn't nearly as good as the real cartilage. But it's a lot better than raw bone.
It's hard to say to someone who goes through that surgery that the worst is yet to come. Looking back, though, the surgery was the easy part. Rehab is another story. It's mentally and physically draining, the most grueling eight months imaginable.
Rehab really starts before the anesthesia wears off. I found myself in the CPM machine when I woke up. The machine moves the knee passively, flexing and extending it over and over. Eight hours a day for eight weeks are spent strapped into this machine. Gradually, I was allowed to touch my toes onto the ground, then to begin to bear weight, then to use a crutch -- just to walk!
The goal in the first months of rehab is to maintain some leg strength and range of motion but be careful not to dislodge the clot that was formed. Too much stress too soon will lead to failure. But not putting enough stress on the area will result in a very weak foundation that will not hold up when activity increases.
An athlete is taught from a very young age to push his body's limits and to not let pain be a barrier. Now, it's necessary to re-program the mind to not push. This requires extreme patience and self-control, both of which are incredibly hard and mentally exhausting.
Not knowing if your rehab is working is extremely tough after spending countless hours in rehab. Hope, faith, trust and prayers can get you through. Small goals are achieved, like finally running or jumping. They are quickly overshadowed with pain , swelling and doubt. Building leg muscles and trusting the knee again take time and hard work. There is no easy way out, no cheating, pills or drugs that will help.
And even if everything goes right, there's the realization that a knee that undergoes microfracture surgery will never be the same.
Before going into something the magnitude of a microfracture surgery, athletes hope for the best and prepare for the worst. There are no guarantees in any surgery, and no one can absolutely predict the outcome.
Everyone heals differently. It can prolong a career, but it can also leave an athlete a fraction of what he used to be.
In the very best-case scenario, the scar tissue forms strong enough and durable enough to withstand the demanding forces a pro athlete puts on his knee. It is extremely rare for an athlete to regain his full athleticism after this surgery. In most cases, the surgery will dull the pain enough to make it manageable to return to the game.
For an NBA player, managing the pain and taking care of the knee is paramount. That might mean missing back-to-back games or missing practices throughout the year. And then there's managing the expectations. Hardly ever is the athlete as explosive or as athletic as he once was. In the best case, though, he'll be able enough to perform.
On what level? That's the real question. Could an All-Star like Tracy McGrady return to All-Star form, or will he turn into an average player, or worse? Not all athletes have successful microfracture surgery. Some get well enough to run and jump again but are no longer able to do it at a professional level.
We'll see what happens with McGrady. The success of his surgery and his rehab will have a direct correlation on how well he plays once he comes back. His game will most likely change with the limitations his newly repaired knee puts on him.
By making it this far, McGrady already has proven he has the mental toughness. Now he will have to answer the question of how well he is physically. If the pain is too great to overcome, if the knee simply doesn't respond, it may mean a too-early retirement.
Let's hope not. I pull for Tracy and am looking for a very successful return.
Matt Harpring, a veteran of 11 NBA seasons, first experienced severe knee pain in 2001-02 while playing with the Philadelphia 76ers. He underwent a microfracture surgery in January 2004, played in 78 games the following season for the Utah Jazz, then had another microfracture surgery the day after the 2004-05 season. In the four years after that, he appeared in 287 games for the Jazz. He's out this season because of injuries to his knee and ankle.
Seven-time All-Star Tracy McGrady had an arthroscopic surgery on his left knee in May 2008, then underwent microfracture surgery on the same knee in February 2009. He was limited to just 35 games last season. He's currently practicing, but the Rockets have set no timetable on his return.
Source: Matt Harpring, NBA.com
Those probably were the first words out of Tracy McGrady's mouth when he heard the news. I know they were the first out of mine. The short answer is that microfracture surgery is a medical procedure on the knee that creates new cartilage. And it can potentially prolong an athlete's career. Of course, there's a lot more to it than that.
Before I give my perspective on the surgery, let's delve into why it's so prevalent in professional sports. It's not just me or T-Mac or even basketball players in general. This surgery is performed on football, baseball and hockey players, too.
Microfracture is aimed at fixing the articular cartilage that covers the surface of your bones, much like enamel on teeth. The cartilage of a knee joint is like a bar of soap. Every time that soap is used, the bar gets a little smaller. The harder you scrub, the more the soap erodes.
All professional basketball players have knee pain at some point in their careers. But the pain from rubbing an exposed bone is so unique, it's something that I'll never forget. It's similar to a bad experience at the dentist.
It's the same sensation that pierces through your body when a drill hits a nerve in your tooth.
Many athletes try to push through the pain knowing that a season or a roster spot is in jeopardy. Managing pain is one thing, but managing your performance -- and your expectations of how you should perform -- while you're in excruciating pain is another. Frustration sets in. And then reality takes over.
The NBA, and professional sports in general, can be cutthroat businesses. Once you can't perform, you're in jeopardy of losing your job.
A knee injury can make an All-Star like T-Mac into an average player, and it can make an average player into one that will be cut. Playing in the NBA is hard enough when healthy. If forced to play on one leg, it's virtually impossible.
So faced with a knee injury like mine or T-Mac's, the choice is clear: Retire or elect some kind of surgery. No athlete ever wants to hear that. But many do, all the time, and those with an injury like T-Mac's have to make that choice. It's not that easy.
So why choose a surgery like microfracture that requires up to a year of grueling rehabilitation and, in the end, has no guarantees? In my case, it was the best option. In order to return to the game at the elite level, to continue playing a sport that is my livelihood, I had to undergo the surgery.
Microfracture surgery is a career saver, potentially. It also, unfortunately, may mark the end of a career cut too short.
What Has to Be Done
Cartilage doesn't simply grow back. It has to be coaxed. Microfracture surgery is not the only option for an exposed bone injury, but it seems to be the one that many pro athletes are choosing.
Microfracture starts out like all other arthroscopic surgeries. The surgeon works through three tiny holes in the knee. Once in, the doctor finds the area where the cartilage is missing, the raw bone. He uses an instrument a lot like a rock pick, a strong, sharp utensil that knocks tiny holes in the bone. After the numerous tiny fractures are created, the doctor waits to see if the all-important ingredient emerges. Blood!
Blood has to start oozing from the holes if the surgery has a chance to work. The bleeding eventually forms a clot that covers the injured area. This clot is very delicate, and very crucial. If it is dislodged, the surgery will fail. If the clot stays in place for those first couple of hours, then days, then weeks, it will eventually form into scar tissue. It's all an attempt to trick the body into healing itself.
The very thin protective shield will now act as the protectant for the bone. This newly formed scar tissue isn't nearly as good as the real cartilage. But it's a lot better than raw bone.
And Now the Hard Part
It's hard to say to someone who goes through that surgery that the worst is yet to come. Looking back, though, the surgery was the easy part. Rehab is another story. It's mentally and physically draining, the most grueling eight months imaginable.
Rehab really starts before the anesthesia wears off. I found myself in the CPM machine when I woke up. The machine moves the knee passively, flexing and extending it over and over. Eight hours a day for eight weeks are spent strapped into this machine. Gradually, I was allowed to touch my toes onto the ground, then to begin to bear weight, then to use a crutch -- just to walk!
The goal in the first months of rehab is to maintain some leg strength and range of motion but be careful not to dislodge the clot that was formed. Too much stress too soon will lead to failure. But not putting enough stress on the area will result in a very weak foundation that will not hold up when activity increases.
An athlete is taught from a very young age to push his body's limits and to not let pain be a barrier. Now, it's necessary to re-program the mind to not push. This requires extreme patience and self-control, both of which are incredibly hard and mentally exhausting.
Not knowing if your rehab is working is extremely tough after spending countless hours in rehab. Hope, faith, trust and prayers can get you through. Small goals are achieved, like finally running or jumping. They are quickly overshadowed with pain , swelling and doubt. Building leg muscles and trusting the knee again take time and hard work. There is no easy way out, no cheating, pills or drugs that will help.
And even if everything goes right, there's the realization that a knee that undergoes microfracture surgery will never be the same.
The Final Step
Before going into something the magnitude of a microfracture surgery, athletes hope for the best and prepare for the worst. There are no guarantees in any surgery, and no one can absolutely predict the outcome.
Everyone heals differently. It can prolong a career, but it can also leave an athlete a fraction of what he used to be.
In the very best-case scenario, the scar tissue forms strong enough and durable enough to withstand the demanding forces a pro athlete puts on his knee. It is extremely rare for an athlete to regain his full athleticism after this surgery. In most cases, the surgery will dull the pain enough to make it manageable to return to the game.
For an NBA player, managing the pain and taking care of the knee is paramount. That might mean missing back-to-back games or missing practices throughout the year. And then there's managing the expectations. Hardly ever is the athlete as explosive or as athletic as he once was. In the best case, though, he'll be able enough to perform.
On what level? That's the real question. Could an All-Star like Tracy McGrady return to All-Star form, or will he turn into an average player, or worse? Not all athletes have successful microfracture surgery. Some get well enough to run and jump again but are no longer able to do it at a professional level.
We'll see what happens with McGrady. The success of his surgery and his rehab will have a direct correlation on how well he plays once he comes back. His game will most likely change with the limitations his newly repaired knee puts on him.
By making it this far, McGrady already has proven he has the mental toughness. Now he will have to answer the question of how well he is physically. If the pain is too great to overcome, if the knee simply doesn't respond, it may mean a too-early retirement.
Let's hope not. I pull for Tracy and am looking for a very successful return.
Matt Harpring, a veteran of 11 NBA seasons, first experienced severe knee pain in 2001-02 while playing with the Philadelphia 76ers. He underwent a microfracture surgery in January 2004, played in 78 games the following season for the Utah Jazz, then had another microfracture surgery the day after the 2004-05 season. In the four years after that, he appeared in 287 games for the Jazz. He's out this season because of injuries to his knee and ankle.
Seven-time All-Star Tracy McGrady had an arthroscopic surgery on his left knee in May 2008, then underwent microfracture surgery on the same knee in February 2009. He was limited to just 35 games last season. He's currently practicing, but the Rockets have set no timetable on his return.
Source: Matt Harpring, NBA.com
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