Andrew Bynum out 5 more weeks; injured bowling
Posted November 25, 2012 - 12:45 AM
"Bottom line is Andrew is out indefinitely," DiLeo said before the Sixers played the Oklahoma City Thunder. "There are no timelines; we just have to wait and see how he reacts."
Bynum has bone bruises in both knees and is dealing with what his doctors call a "weakened cartilage state." He is believed to have done some additional damage by bowling two weeks ago.
DiLeo said the state of Bynum's knees has worsened since the team traded for him and it's changed the team's risk outlook.
"His knees now and the MRIs are not the same; it's a different type (of) situation," DiLeo said. "At the time of the trade, we had four doctors look at his MRI; we knew it was a calculated risk. We also knew we were getting the second-best center in the league, a franchise-type player. We took that risk."
Bynum is still doing low-impact rehab and the team is hoping that rest will heal the cartilage. DiLeo said the team is consulting experts around the world and examining Bynum's rehab closely. There will be no more bowling, and DiLeo said Bynum has been instructed to avoid any activity that could cause stress on the knees.
"(The bowling injury) is an unfortunate situation; when the cartilage is in a weakened state anything can happen," DiLeo said. "Basically, you can't do anything that is going to jeopardize any kind of rehab."
Neither the Sixers nor Bynum have talked about a surgical option to repair the cartilage, a move that could knock Bynum out for a year. Last week, Bynum said: "There's no surgical procedures that will really help or are safe to do at the moment. I've just got to bide my time."
Bynum is in the final year of his contract that pays him $16.5 million. The Sixers traded All-Star Andre Iguodala, young prospects Moe Harkless and Nikola Vucevic and a future first-round pick to get Bynum and veteran guard Jason Richardson. They had hoped to sign him to a long-term contract next summer.
DiLeo said the team is still hoping Bynum will heal but admits it is already having to look at other scenarios.
"We hope he will back; we're anticipating he will be back at some point," DiLeo said. "We have plans for the future if he is not back with us but we want to plan on him being here long-term."
Edited by MDI, November 25, 2012 - 12:45 AM.
Posted November 25, 2012 - 12:46 AM
Posted November 25, 2012 - 12:57 AM
Posted November 25, 2012 - 02:41 AM
Posted November 25, 2012 - 08:17 AM
I love how DiLeo (who is the Sixers' GM) called Bynum the second-best center in the NBA. That's fantastic.
That's like Pat Riley calling Wade the second-best SG.
Posted November 25, 2012 - 12:37 PM
The truth is that the 7-foot, 285-pound former All-Star center who has yet to play a game as a Sixer may be out for the season and will learn in December, at the earliest, whether he’ll require surgery that could sideline him for up to a year.
If that’s the case, the market value for the soon-to-be unrestricted free agent is likely shot.
One internationally respected orthopedic surgeon, who is not involved with Bynum’s treatment and has not seen his MRIs, told The News Journal that all of the information that has been released by the player and the Sixers points to a likely diagnosis of osteochondritis dessicans lesions. The surgeon said that if this is the case, there’s a small chance that Bynum’s knees could heal sufficiently on their own in time for him to return for the playoffs this season, but called that scenario “wishing on a star.”
“While they can heal non-operatively, they can take a long time [four to six months] to heal, and in adult athletes, frequently they will require surgical intervention at some point if there isn’t adequate healing within the first several months of treatment,” the surgeon said.
He added that if the 25-year-old returns to the court too early and the lesions become large enough, the condition could become career threatening. The surgeon spoke on condition of anonymity because Bynum is not his patient, but this probable diagnosis, given the player’s symptoms and treatment thus far, is backed up by reams of medical literature.
On Friday, Bynum for the first time seemed genuinely, publicly worried about his long-term health as he described “a little bit of a setback.”
He said a bone bruise in his left knee has developed, identical to the bone bruise in his right knee that has kept him from playing and practicing since the Sixers acquired him from the Los Angeles Lakers in a four-team deal in August. The Sixers shipped All-Star swingman Andre Iguodala to the Denver Nuggets, while the Lakers received center Dwight Howard from the Orlando Magic.
“I don’t know what’s going on,” Bynum said Friday. “The doctors are pretty much saying I’m in a weakened cartilage state. And we’ll kind of wait, I guess. They’re not giving me anything real definite. I’ve just got to wait for the cartilage to get stronger.”
Bynum said he’s experiencing pain and swelling in both knees, but that his low-impact workouts in the pool and on the elliptical are “not degrading the cartilage, as far as I know.” He called it a “weird issue” that intensified since he last spoke with reporters last Monday. He since returned to visit his longtime orthopedist, Dr. David W. Altchek of the Hospital for Special Surgery in New York, to have an MRI on both knees. Bynum said there is no issue with his ligaments or surrounding meniscus.
Altchek did not immediately respond Sunday to a request seeking comment and confirmation of the diagnosis of osteochondral lesions, which can form in joints when the bone underneath gets weakened, such as in the case of Bynum’s bone bruises. The bruised bone then starts to crack, and if it gets too weak and collapses, the cartilage sitting on top becomes unsupported and collapses, too.
Bynum and the Sixers are hoping that his bone bruises, underneath the now-weakened cartilage, begin to heal on their own and create a stronger foundation. But the condition will worsen with additional trauma, hence Bynum suggesting Friday that he may give up working out on the elliptical and, for the time being, confine his exercise to the pool.
He maintains this type of low-impact conditioning to keep his muscles from becoming atrophied.
“It’s frustrating,” Bynum said. “And it’s an issue that’s going to take time to resolve. There’s no procedure or anything that can be done.”
When asked prior to Sunday’s game about whether Altchek mentioned anything about lesions in his knees, Bynum briefly paused before responding, “No.”
Time will tell
Bynum, who has a history of knee injuries, has already submitted to an Orthokine blood-spinning treatment in Germany during the offseason (it is not approved in the U.S.) and subsequent lubricating injections in his chronically arthritic knees. Those procedures would have only helped his current condition improve, the surgeon said.
Osteochondral lesions come in four classifications, with the fourth stage being the worst-case scenario, and without seeing Bynum’s MRIs or receiving confirmation from Altchek, we don’t know the extent of the damage.
Type 1 lesions have a chance to heal on their own. Type 2 and 3 lesions often require surgery to stabilize the joint. Bynum, who has been walking around the Wells Fargo Center without the aid of crutches, is likely not at stage 4.
“I’m a little bit worried, bluntly, that it’s more advanced and the guy probably does need surgery. But if he needs surgery, then the year is completely written off,” the surgeon said. “But if he doesn’t have surgery and they think they can demonstrate healing in about four months, then he could potentially still come back for the playoffs.
“That’s what it sounds like they’re thinking about.”
Sixers general manager Tony DiLeo didn’t say it in so many words, but the rehab schedule the team outlined in a press release Nov. 12 – that Bynum would return to practice around Dec. 10 and then need one to four weeks of conditioning before appearing in a game – is out the window with news of the setback with his left knee.
“His body will be the indicator,” DiLeo said. “When he’s feeling good, when the pain subsides from his knees, when he can step up in his rehab and do more strenuous activity, that will be the indicator. And to try to put a date on it is very difficult, as you know.”
Non-operative treatment for the lesions involves avoiding high-impact activity for between four to six months, but in adults, more often than not, the condition ends up requiring arthroscopic surgery that can sideline a patient for up to a year.
Bynum was first diagnosed with the bone bruise in his right knee in September. Bynum said the latest setback won’t change the timetable for his return, but that’s highly unlikely.
DiLeo said Friday that the Sixers now expect to update Bynum’s condition in mid-December, which is different from the team’s previous statement that Bynum would be able to begin practicing at that time.
f Bynum is diagnosed with the lesions, he has a 30 percent to 60 percent chance of needing arthroscopic surgery on both knees, according to medical textbooks.
If there isn’t adequate healing in his right knee by mid-December or possibly January, it is likely that he will need surgery. Should the right knee exhibit adequate healing by that point, Bynum would still have to worry about the left knee, which he confirmed Sunday began swelling after bowling last week.
“It would be another two months before he could eventually be at a point where he could return [from the injury to his right knee], so now they found something in his left knee, so add four months to that,” the surgeon said. “You’re looking at around the end of March or April as potentially the earliest that he could come back, assuming that the MRIs show healing.”
Throw in the time needed for conditioning and to get into game shape, and it’s becoming increasingly unlikely that we’ll see Bynum in a Sixers jersey this season. Or, potentially, ever.
Even though his left knee only started bothering him last week, Bynum may have had that bone bruise and lesion since at least the time his right knee was diagnosed.
“He’s had it in the other knee all along, but they just MRI’d the one knee,” the surgeon said. “Now it hurts because he’s been favoring it. The other knee is bothering him and they MRI’d that. It’s on the medial side of the lateral femoral condyle, and it’s frequently bilateral [or in both knees].
“And I can tell you, Altchek isn’t surprised,” he said. “If I was his orthopedic surgeon, I’d say, ‘Yeah, he has the same thing on the other knee as well.’ … Because he’s jumping up and down. That’s how he makes his living.”
Why wouldn’t doctors have checked Bynum’s left knee?
“If he wasn’t having pain and it wasn’t swollen,” the surgeon said, “you wouldn’t necessarily get an MRI on your other knee.”
It is unclear what the Sixers knew about Bynum’s knees and when they knew it.
Sixers coach Doug Collins said after the team’s victory over Utah on Friday that he was unaware of the specifics of Bynum’s condition, only hours after Bynum spoke publicly about his latest setback.
“We just got to hope and pray that he’s going to respond. … And hopefully he’ll be able to come back and help us,” Collins said.
DiLeo, pressed for clarification on Bynum’s medical issue, repeatedly responded by asking, “What did Andrew say?”
The team originally said that Bynum would be available to play in the season opener on Oct. 31, a timetable that has been repeatedly delayed. And the organization has little recourse at this point other than to play nice and hope that either Bynum can return this season or that they’re able to re-sign him at a significant discount.
“Our main concern is Andrew’s health. Our main concern is big picture,” DiLeo said. “We want to have a long relationship with him.”
Edited by Gotrings?, November 25, 2012 - 12:38 PM.
KOBE. #VINO. BRYANT.
Posted November 25, 2012 - 07:15 PM
Posted November 25, 2012 - 07:37 PM
it would be funny if bynum never sees the floor with the sixers. if he leaves through FA then imma laugh so hard
why would you laugh
the sixers helped us out in the trade, i know its not our problem, but it would suck if they got nothing in return for this bum
Posted November 26, 2012 - 08:02 AM
it would be funny if bynum never sees the floor with the sixers. if he leaves through FA then imma laugh so hard
Actually they'd probably not care too much. Supposedly they really wanted out of iguodalas contract so that still happened
Posted November 26, 2012 - 11:17 AM
Bynum is a bust!
Edited by epicwolf, November 26, 2012 - 11:19 AM.
MDA is an offensive genius. I hope he sticks to his guns and keeps doing what he does best: Run and Gun. That's the only way to coach.
Posted November 28, 2012 - 05:58 AM
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