What's going on with Al Horford's knee? Checking in with Dr. Flynn

The Celtics shut down Al Horford for a few games earlier this week due to constant knee pain. Given the importance of the All-Star to the C's title chances, we decided to check in with our BSJ medical expert Dr. Jessica Flynn for more information about his condition and what comes next for the veteran in his recovery.

Q; So we heard about patellar tendonitis and patellofemoral pain syndrome for Horford's knee? What was it? Could there have been some confusion about it?

Dr. Flynn: I don't think this was something that there was any confusion about when it comes to the medical staff. This is an easy distinction and diagnosis (with the syndrome), just the term used was probably wrong (earlier in the week)

Q: Horford doesn't have a history with knee issues, but what's the level of concern at age 32 for a condition like patellofemoral pain syndrome?

Dr. Flynn: Patellofemoral pain syndrome is probably the most common cause of knee pain that I see in my office. What it means is the kneecap joint, the joint that the kneecap tracks in, is inflamed. Another common term for this is runner's knee. It can be aggravated by running or just being active. It depends. Because it's so common, it's something that who knows, he may have had symptoms of in the past, but the syndrome really is a pain tolerance issue. It's something where the joint gets inflamed but you can't really do damage by playing through it. The issue is that you can really inflame the joint and with a really long season, it's not something that you want to ignore. You really want to quiet it down so it's something that is manageable for the rest of the year.

Q: So if he rests it enough now, it could go away entirely? Or will it be an injury that is going to be tough to get rid of entirely until the offseason, in which case it's just calming it down as much as possible?

Dr. Flynn: Most patients I see, this is something that they've had on and off throughout their life. It can get irritated and get better. This is something that can quiet down with some rehab and rest. Unlike patellar tendinitis in a basketball player, it's not something that is going to lead to something super harmful if he continues to plays through it. With patellar tendinitis, you worry about the rupture of the tendon, but with this syndrome, you just worry about the joint getting more and more inflamed and that causes problems with just returning to play.

So this diagnosis is much better news than tendinitis it sounds like?

Dr. Flynn: This is good news since it's manageable and generally isn't something that would need surgery or anything like that.

Q: Any extreme cases where it could need surgery if it doesn't get better from a pain standpoint?

Dr. Flynn: I tend to see that more in young athletes who are playing their sports for years and are dealing with pain that is keeping them away. Sometimes, surgeons can re-align that joint and change the way it tracks, because the problem is really based on the mechanics of the league and how the kneecap is tracking in its joint. In some people, that joint is kind of off and we need to fix it. That would generally not be something that would pop up in a 30-year-old athlete. In an older athlete, it's possible that this gets so inflamed that it requires a cortisone injection to quiet down and eventually this can progress to arthritis of the kneecap joint. However, nothing like that would be imminent or worrisome for Al Horford's case.

Q: So is this just a situation where the team will monitor him day-to-day. How much would just reducing his minutes over the rest of the season when he's back to help improve it?

Dr. Flynn: It certainly can and also just responding to his symptoms. If he's having a day when he's sore, he plays less. If he's feeling better, he can play a little more. It will be a finesse kind of a call that the medical staff and the coaching staff will have to make. It makes sense for him to miss a short period of time now to get a nice solid rest to quiet it down. Hopefully, they can play it by ear and manage him depending on his symptoms.