http://www.sacbee.com/content/sports/story...p-9316758c.htmlMore down time is a possibility, says a noted surgeon
By Joe Davidson -- Bee Staff Writer
Published 2:15 a.m. PST Tuesday, March 2, 2004
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Tarek Souryal hasn't peered inside Chris Webber's body, but he knows a thing or two about the inner workings of a knee.
Souryal is the Dallas Mavericks' head physician, one of the most respected orthopedic surgeons in the country and host of ESPN's "Inside Sports Medicine." He saw Webber crumple in agony on the baseline at American Airlines Center in Dallas during last May's Western Conference semifinals, wincing when Webber clutched his left knee.
No one knew then the seriousness of the injury, or that it would eventually raise questions about the future effectiveness of the Kings' All-Star power forward.
On June 10, Webber's knee was operated on by Dr. James R. Andrews, a prominent orthopedic surgeon based in Alabama. Webber had what's called "microfracture" knee surgery. Andrews wasn't available for comment, and the Kings' medical personnel have declined to talk about the surgery in any detail.
Souryal has performed dozens of microfracture surgeries, including some on athletes such as the Mavericks' Eduardo Najera.
Souryal said Monday that Webber's road back will be arduous and include difficulty in logging back-to-back games, managing practice time, potential soreness that could sideline him for stretches of games and possible overcompensation - when an athlete subconsciously favors a bad knee, leading to injuring the other.
"It's a shame more people don't know about this procedure and what it means," Souryal said by phone. "Fans might think, oh, Webber had a scope on his knee. No big deal. It's way more serious than that."
In simple English, the micro-fracture procedure involves drilling holes at the end of the femur, around damaged cartilage. This causes bleeding and the growth of scar tissue, which replaces the cartilage. Webber's surgery also included trimming and repairing the torn lateral meniscus on his left knee.
Once damaged or removed, cartilage doesn't grow back, and it can't be taken from other parts of the body, where it works as a cushion in the joints.
In contrast, damaged knee ligaments can be repaired with other ligaments, either from a person's own body or a cadaver.
"Cartilage is about an eighth of an inch thick, and over time it erodes," Souryal said. "When you're in your 70s or 80s, arthritis sets in because the cartilage is wearing thin and there's a bone-on-bone friction. For athletes, this process can start much sooner, but if you're in your 30s and you have cartilage problems, that's not a good thing.
"The new scab or scar tissue from the microprocedure isn't as good as the original cartilage, and it doesn't last forever. ... In another three, five years, you'll need another scope."
In 2000, Penny Hardaway was the first NBA star to undergo microfracture surgery. Hardaway said last week that he's just now starting to return to his old form. The New York Knicks' swingman said it pains him that he's not the same player he once was, not as explosive, nor as quick, nor as fast to heal.
He's 32 now, determined to regain more of his old form and pulling for Webber to recapture his own game.
Hardaway was with the Phoenix Suns when he had the surgery, and he played just four games in the 2000-01 season. He played 80 games the following season, and the back-to-back games were brutal, the soreness constant and the doubts plenty. He contemplated retiring.
Hardaway's scoring average dipped to a career-low 12 points in 2001-02. He was down to 10.6 points last season as a role player, appearing in only 58 games due to an assortment of ailments, including sore knees.
Hardaway wrestles with who he once was, a star player. Along with Shaquille O'Neal, he led the Orlando Magic to the 1995 NBA Finals - remember all the L'il Penny commercials?
Hardaway said he can relate to what Webber might soon experience, emotionally and physically.
"I think Webber's coming back way too soon," Hardaway said. "I still felt like I was missing something when I came back. I would have sat out longer, but I wanted to get back out there.
"My knee and my health, it was a nightmare for me. I'm finally feeling good this season after all this time.
"I still want a shot at being the player I once was. I think Webb wants the same thing."
Knicks guard Allan Houston had microfracture surgery on his right knee in June. But rather than wait several months to return, he chose to begin his season in October. He played in pain and finally took nearly a month off, admitting he came back too soon.
"When you have surgery, 90 percent of the people who have surgery have six months to rehab, and they're not jumping every night," Houston told New York reporters last month. "It's that simple. When I came back to training camp, I think I just came back too soon."
Among NFL players who have undergone the same surgery as Webber, there are success stories, including those of former Washington Redskins defensive end Bruce Smith and Raiders free safety Rod Woodson.
However, former players Andre Wadsworth and Eric Swann had microfracture surgery that didn't extend their careers.
Webber said after practice Monday that "I've done so many things to get my knee right."
"It's not really doubts I have, it's just time to do it. I've been doing ... monotonous, tedious drills, and this is going back to the summer when I couldn't even walk. I was shooting jump hooks in the gym when I was on crutches, just to touch the ball.
"Right now, more than excitement ... it's more so to get out there and release."
From afar, Souryal believes Webber has taken ample time to recover. Rehabilitation time, he said, is anywhere from four to six months. Six months for Webber was Dec. 10. His return would have been Feb. 17 if not for his eight-game suspension.
The Kings and Webber maintained all season that there was no rush for a return to action, the price simply too steep to risk.
"From the scientific standpoint, the scar tissue takes four to six months to mature, but during that time, you're also working the other parts of the legs to get strong, the (quadriceps), the (hamstrings)," Souryal said.
Najera, a 6-foot-8, 235-pound forward, had his microfracture procedure done early in the 2001-02 season. He returned late that season, albeit gingerly. He has missed games this season due to soreness in his repaired knee, Souryal said.
Heavier athletes, he said, have more weight pounding down on the damaged joints, meaning more potential wear and tear. Webber is 6-10 and 245 pounds. He turned 31 Monday.
"Players (who have undergone microfracture surgery) have issues with soreness, and on some occasions basketball players may have to sit out of several games at a time because of the knee," Souryal said.
Hardaway, in his 11th season, said he feared back-to-back games when he first returned. He said he can now play back-to-backs without much effort, although his knee is stiff the next morning. He finishes no workout, shootaround or game without icing down.
Hardaway has a new tattoo on his right arm. It reads, "The Storm is Over," a reference to his hope his knee trouble is behind him.
"I'd love to be the same Penny that everyone knew several years ago," Hardaway said. "I still have a window left. I'm still young, and so is Webber."
