Dr. Flynn: On Kyrie Irving’s knee, and what could trigger season-ending surgery

Depending on the issue at the root of his knee issues, the surgery option for Celtics’ Kyrie Irving could keep him out two weeks to four months.

(Gary A. Vasquez/USA TODAY Sports)

I hope you don’t have Kyrie Irving overload. It’s been over a week since Brian Robb and I spoke about Irving’s knee injury, so I wanted to summarize and put into perspective the news that has surfaced since then.

Let’s start with a summary of what has been reported in the past about Irving’s knee injury.

Irving has had issues with patellar tendonitis in his left knee since playing for the Cavaliers. The patellar tendon is part of what we call the “extensor mechanism” of the knee. This includes the quadriceps (thigh) muscles, quad tendon, patella, and patellar tendon, which attaches to the front of the tibia (shin bone). When you contract your quad muscles, they pull on the quad and patellar tendon, which causes the knee to straighten out. The extensor mechanism is under a lot of stress when athletes jump, and the patellar tendon is the most susceptible to injury. Patellar tendonitis is also called “jumper’s knee” and is very common in basketball players.

Irving sustained a fracture in his left patella on June 5, 2015. His injury was likely a culmination of repeated stress on the patella — a stress fracture that finally broke through. I can deduce this because there was no clear contact to the patella during the play. Clinically, Irving likely had increasing pain over a period of time that eventually led to one painful step that broke the patella. Irving had surgery to repair his patellar fracture, which can be done using a combination of sutures, wire, and sometimes screws. After recovery from the surgery, Irving returned to the court and has intermittently missed time with knee pain since.

Danny Ainge recently said that when the Celtics acquired Irving, they were well aware of Kyrie’s knee injury history and the chance that it may need to be dealt with surgically over the next few years. They expected to have to manage the condition. The question has been: is Irving’s nagging knee issue purely irritation from hardware from his surgery? Or is this a combination of hardware discomfort and chronic overuse issues within the extensor mechanism of his knee (ie patellar tendonitis)?

Yesterday, Tony Massarotti reported the following:

Let’s assume Tony is correct — hardware is the main issue and removing it will make him feel better. If that’s the case, there are two possibilities:

  1. He has pins/wire/sutures. Recovery from the removal of this type of hardware is usually dependent on giving the soft tissues tie to heal. Usually around two-to-three weeks;
  2. Tony is right, Irving has screws in his patella that are causing pain. Removal of screws leaves stress risers in the patella that could potentially lead to re-fracture if he is allowed to return too quickly. Return to play after screw removal closer to six weeks.

Given Irving’s history of both chronic patellar tendonitis and a fracture that puts him at risk for patellar arthritis, there is a chance that he may be contemplating surgery to address either of these issues. Surgery for either of these issues could be performed at the same time he has his hardware removed.

If Irving’s knee pain is deemed to be partially related to chronic patellar tendonitis, then he may plan to have patellar tendon debridement during his hardware removal procedure. This could significantly lengthen his recovery period. Depending on the degree of debridement, his return to play could be closer to four months.

Yes, Irving’s recovery could be anywhere from two weeks to four months.

Should he just have the surgery now? A lot depends on which surgery we’re talking about. If this is purely hardware removal, then most likely it’s a pain tolerance issue. If Irving can play effectively (which he hasn’t been able to do when knee issue flared up), then the surgery could likely wait until the offseason. No concern for further damage to the knee.

However, if this is a chronic patellar tendon issue combined with some hardware issues, it could be smarter to have surgery now. The reason is this: Irving has played through the pain of patellar tendonitis in the past. It more than likely resulted in a stress fracture of his patella. So that part isn’t just an issue of pain tolerance. Can you understand why he might want to be really sure that this is something he can play through before he does it? If he has significant patellar tendonitis and is at risk of tearing his patellar tendon, then that might be a reason to call it quits and fix this issue before it does further damage. Again, that surgery would be closer to a four-month recovery.

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Dr. Jessica Flynn is a sports medicine physician at Lahey Hospital and Medical Center in Burlington, MA. She writes about injuries in professional sports on her blog, DocFlynn.com. You can follow her on Twitter @jessdeede.

Have a question for Dr. Flynn’s weekly mailbag? You can send those to her at any time via email (docflynn@bostonsportsjournal.com), or you can Tweet them to her here.