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View Full Version : Insight into Maggs' knee injury and possible rehab time.


PavanoBeltran'05
10-05-2004, 09:11 PM
Today at the hospital, I was talking to one of the orthopaedic surgeons about the situation regarding Magglio Ordonez and his knee. He immediately asked about the surgery, and I told him about his knee being arthroscopically repaired. It was a meniscal tear, as we all know.

He told me about the incidence of this happening as being very near 0, and that the area around the injury was probably becoming necrotic (rotting). He then led me to an article on the American Journal of Sports Medicine that explains what goes on, what the symptoms are, etc. I'll leave a link at the end.

Anyway, the case study shows a guy getting his meniscus torn (which is a cartilage pad in the knee.) and talks about his routine operation.

Then (and doesn't this sound familar):
"Postoperatively, at approximately 3 weeks after initiation of physical therapy, the patient complained of left knee pain, with worsening of his symptoms as his activity level and weightbearing increased. Physical examination revealed significant tenderness along the medial joint line. An MRI arthrogram obtained 9 weeks after surgery showed bone marrow edema throughout the medial femoral condyle, with subchondral flattening."

So, we're seeing pretty much exactly what Maggs is dealing with, almost to the timeline. So, this patient gets re-examined, they find the necrosis, and do a procedure where they drill into the lesion that was left. And, rehab went as follows.....
"At 16 months after the drilling, the patient demonstrated improved overall function and decreased pain. He has returned to playing golf."

His rehab was extensive, and was outlined in the article.
One of the leading areas of research in osteonecrosis is...........drum roll.....Vienna, Austria. They are leaders in imaging and diagnosis of these injury types.

One of the leading theories as to what may cause this type of edema at a joint is corticosteroid use, which is probably what was continually given to him to calm pain down at the joint and control swelling.

Don't take this as God's absolute truth as to what is going on, but this was pretty right on. A 16 month rehab schedule is what was very intriguing.

PavanoBeltran'05
10-05-2004, 09:19 PM
He could probably heal quicker, but cutting the rehab time that has been discussed previously in half would probably be very very difficult. 8-9 months, maybe?

nodiggity59
10-05-2004, 09:20 PM
Wow.......speechless.

shagar69
10-05-2004, 09:23 PM
if what you say is true, this is pretty much means that his career his over. he may play again, but wont be close to the player he was

PavanoBeltran'05
10-05-2004, 09:26 PM
I wouldn't say that his career is over, he's just going to be out a while.
That is, like you said, if this is definitely similar to Maggs' case. In any type of medical situation, we always say, "EVERY CASE IS UNIQUE"

Flight #24
10-05-2004, 09:30 PM
How can that be when everyone knows Sox medical staff couldnt appropriately diagnose a paper cut?????


On a serious note, it all fits the available evidence, and while I feel sympathetic to Maggs, it certainly looks like at best a year away followed by a reduction in ability. That makes me VERY glad the Sox didn't sign him, possibly the one piece of good luck the team had this year.

PavanoBeltran'05
10-05-2004, 09:36 PM
How can that be when everyone knows Sox medical staff couldnt appropriately diagnose a paper cut?????


On a serious note, it all fits the available evidence, and while I feel sympathetic to Maggs, it certainly looks like at best a year away followed by a reduction in ability. That makes me VERY glad the Sox didn't sign him, possibly the one piece of good luck the team had this year.I believe that the Sox probably have a great staff. I would kill to be on the Sox medical staff, though I'd never get any cases. This Maggs injury is the ultimate freak thing. Even if cortisone shots are somewhat of a culprit, everyone in the orthopaedic surgery field (let's not forget our podiatrists, either!!) uses this method of pain and inflammation control.

Flight #24
10-05-2004, 09:49 PM
I believe that the Sox probably have a great staff. I would kill to be on the Sox medical staff, though I'd never get any cases. This Maggs injury is the ultimate freak thing. Even if cortisone shots are somewhat of a culprit, everyone in the orthopaedic surgery field (let's not forget our podiatrists, either!!) uses this method of pain and inflammation control.
Yeah, that's something I was curious about too - whether this might cause a bit more reluctance to use cotrisone shots since they seem to be so common & prevalent. Pretty tough to blame Sox medical staff for something as freaky as this and apparently as hard to diagnose if you're not looking for it.

One more reason I respect the judgement that good medical professionals have to exert every day. Making decisions that impact people's health & wealth based on hints and implications can't be very comfortable!

PavanoBeltran'05
10-05-2004, 09:53 PM
Yeah, that's something I was curious about too - whether this might cause a bit more reluctance to use cotrisone shots since they seem to be so common & prevalent. Pretty tough to blame Sox medical staff for something as freaky as this and apparently as hard to diagnose if you're not looking for it.

One more reason I respect the judgement that good medical professionals have to exert every day. Making decisions that impact people's health & wealth based on hints and implications can't be very comfortable!It absolutely sucks. Like walking on a tightrope without a net.

Flight #24
10-05-2004, 10:03 PM
It absolutely sucks. Like walking on a tightrope without a net.By the way - can you post a link to the article you mention at the top? I'd be interested in the specifics of this condition.

Thx in advance.

beckett21
10-05-2004, 11:16 PM
Yeah, that's something I was curious about too - whether this might cause a bit more reluctance to use cotrisone shots since they seem to be so common & prevalent. Pretty tough to blame Sox medical staff for something as freaky as this and apparently as hard to diagnose if you're not looking for it.

One more reason I respect the judgement that good medical professionals have to exert every day. Making decisions that impact people's health & wealth based on hints and implications can't be very comfortable!Cortisone shots have become so commonplace that I think they fail to get their proper respect. What I mean by that is that they only treat SYMPTOMS, they do not treat a condition. Eventually they wear off. And by giving their temporary pain relief, they block one of the body's most important protection mechanisms--that of pain.

So oftentimes, the athlete is causing more damage to the affected area because he/she is not feeling the pain which would ordinarily stop them from doing the particular activity in question. In the long run, the damage is actually worse. If used carelessly around tendons, they can actually cause a tendon to rupture.

There is a place for cortisone shots in medical practice. They are very valuable in relieving acute pain. However they should be used judiciously, and the recipient should be aware that once their effects wear off, the underlying condition may actually become worse. Multiple cortisone shots to the same area are not advisable. If you need a cortisone shot every couple weeks just to function, guess what, you have a problem. And the cortisone is not going to fix it. On the contrary.

As far as your article PB'05, while I was not aware of that fact about Vienna it certainly doesn't surprise me given the circumstances here. I don't think Maggs just picked up the Vienna, Austria phone book for a random second opinion. For someone with unlimited resources at their disposal (relatively speaking), and with so much at stake for his future, this makes perfect sense. More than likely one of his physicians here in the US referred him there, or his agent was doing his homework. Hey, whatever works. I wish him all the best.

beckett21
10-05-2004, 11:25 PM
I would kill to be on the Sox medical staff, though I'd never get any cases. No thanks. To have to submit to such round the clock scrutiny and have to answer to know-it-all armchair docs like that beckett character--I have enough problems already. I'll just hang out here in my cornfield in relative anonymity, thank you very much.:bandance:

(let's not forget our podiatrists, either!!) Why not? Everyone else usually does! :redneck

(Podiatrists usually have inferiority complexes by nature due to our low position on the food chain.) :tongue:

GiveMeSox
10-06-2004, 01:30 AM
mercy

MisterB
10-06-2004, 02:01 AM
By the way - can you post a link to the article you mention at the top? I'd be interested in the specifics of this condition.

Thx in advance.I think this is it:

Osteonecrosis of the Knee after Arthroscopic Meniscectomy and Chondroplasty (http://journal.ajsm.org/cgi/content/full/31/6/1013?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&searchid=1097045270322_38&stored_search=&FIRSTINDEX=0&sortspec=relevance&volume=31&firstpage=1013&journalcode=amjsports)

Vernam
10-06-2004, 02:04 AM
I wish nothing but the best for Maggs, but since I heard about the leakage of marrow, my main thought has been "Sounds like Bo Jackson's injury." The necrosis reference is the same. :(:

Ol' No. 2
10-06-2004, 09:15 AM
:hawk Not good.

Tekijawa
10-06-2004, 09:26 AM
No thanks. To have to submit to such round the clock scrutiny and have to answer to know-it-all armchair docs like that beckett character--I have enough problems already. I'll just hang out here in my cornfield in relative anonymity, thank you very much.:bandance:
I remember an article or a television special where the Crack medical staff actually has to pay the White Sox to be the official medical staff of the team. Doesn't sound like a good deal to me at all!

Rush20
10-06-2004, 09:49 AM
I predict a 1-year contract with the White Sox loaded with incentives. I can't imagine any team risking a long-term, $15M/year deal on Maggs.

In hindsight, he has got to be reeling about not signing the original deal the SOX proposed. If this is truly career-ending or very least career-limiting, this could cost him and his family close to $50M! Ouch!

Paulwny
10-06-2004, 10:43 AM
I remember an article or a television special where the Crack medical staff actually has to pay the White Sox to be the official medical staff of the team. Doesn't sound like a good deal to me at all!
Also a thread and an article
http://www.whitesoxinteractive.com/vbulletin/showthread.php?t=36570

maurice
10-06-2004, 01:08 PM
Nice investigative work, PB. I wish more members of the media were willing to make this kind of effort to clarify and verify highly relevant information.

PavanoBeltran'05
10-06-2004, 05:14 PM
Also a thread and an article
http://www.whitesoxinteractive.com/vbulletin/showthread.php?t=36570Yeah, that's what I've heard as well. I guess it helps with publicity for your overall practice. You're not actually paying them to do the work, but you pay for "privileges".
Beckett's right, though. It wouldn't be the ideal glamourous postition people may think it'd be. Some of the guys on the staff barely get seen at all. For instance, I wouldn't get a sniff of playing time unless someone got hit in the face or the jaw with a ball. Yet, I'd be paying to be there on call if it did. Kinda sucks.