Kemba Walker missed his third straight game on Tuesday night with soreness in his left knee after having the knee drained and injected with Synvisc last week.
The Celtics' guard, who has been slowed by knee soreness for much of the season, experienced increased swelling and discomfort in the knee after returning from All-Star weekend. Brad Stevens told reporters recently the sudden increase in swelling after the All-Star Game was unexpected and indicated that the swelling was much more than he had been dealing with all season.
“The difference between how his knee presented on Wednesday (and) how it presented throughout his period of soreness that we had sat him with, was he just had a lot more swelling," he said. "Obviously, that was an indicator that we needed to check it. He had another scan. Knee looks good structurally. But he’s going to be managing it and dealing with it, as he has all year.”
Let me make some sense of all of this for you because I have seen a lot of inaccurate information about what Synvisc is and what this means for the Celtics guard going forward.
Walker has dealt with left knee issues for much of his professional career. His first reported left knee surgery was in January 2015 for a lateral meniscus tear. His second reported surgery was in May 2016 and it was another arthroscopic surgery (“scope”) to trim more lateral meniscus. A third surgery in May 2017 was reportedly another “minor arthroscopic procedure.”
With a history of three surgeries on the knee, at least two of them to address lateral meniscus tearing, it is very common to have focal arthritis in that part of the knee. In order to address the meniscus tears, surgeons had to remove part of the meniscus … potentially three times. That makes the remaining meniscus much smaller, brings the joint surfaces closer together and messes with the mechanics of the joint, causing the articular cartilage that coats the bones to thin. Localized knee arthritis is common in the NBA and is often an injury that athletes are able to manage and play through.
Commonly, when a professional athlete with chronic meniscus tears and articular cartilage injury has an acute flare-up with pain and swelling, an early consideration for treatment is a steroid injection. Steroid injections are the most effective and quick way to reduce swelling and discomfort, but they also carry a risk. The medicine that we inject with the steroid is somewhat toxic to the cartilage cells, so it is commonly thought that repetitive injections can actually make arthritis progress more quickly.
Kemba did not have a steroid injection last week, though. He had an injection of Synvisc, which is a brand of hyaluronic acid (HA) injected to treat symptoms of mild to moderate arthritis. HA is something that is found naturally in joints with healthy cartilage. Arthritic joints have lower concentrations of HA.
Simply put, HA injections are meant to supplement HA back into the joint to try to make the surviving cartilage more healthy. Synvisc does seem to have some anti-inflammatory effects, but it is not a slam-dunk way to reduce pain and inflammation within a few days in the way that we think of steroid injections. In fact, it usually takes about 4-6 weeks to get a maximum effect from HA injections. Kemba most likely had a Synvisc injection instead of a steroid shot either because he had recently had a steroid injection and it was too soon for another one or because doctors decided that the risk of steroid injection was not worth the benefit due to Kemba’s age and injury.
The fact that Kemba had a Synvisc injection likely means that he has some arthritis in his left knee. However, the fact that Kemba had a Synvisc injection does not mean that he needs a knee replacement today, tomorrow, or next year. While we sometimes do use Synvisc to treat advanced arthritis pain in patients who are delaying joint replacement surgery, the medication is thought to be most beneficial for knees with minimal to moderate arthritis. Contrary to what you are hearing on the radio and reading online, Synvisc injection does not mean imminent joint replacement!
In the short-term, I anticipate that the Celtics will take it slow with Kemba’s return in order to allow the knee to fully calm down and get him healthy for the postseason. My best guess is that he will return to game play after 1-2 weeks of rest if all continues to go well for him.
Long-term, I look at an injury like this as something that Kemba Walker will continue to manage throughout his career. He may have flare-ups from time to time. As arthritis gets worse, the flare-ups could become more common, but every athlete and every knee is different. If the knee ever flares up and does not respond to conservative treatment then surgery could be a possibility down the road, but there is no sign that that is a concern currently.
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