Greg Oden is getting closer to a comeback. How close is up for debate. At least four teams have made informal offers, while several others have checked in just to see where the former No. 1 pick is with his rehab.
This is fraught with difficulty, as microfracture surgery continues to have mixed results. Besides the three procedures that Oden has had, former teammate Brandon Roy's results provide a strong argument against taking a risk.
This isn't a tug of war. Oden is in the middle of a lot more than two sides. Several sources tell me that Oden intends to play again once he is able and once he feels comfortable with the team. This will depend largely on the medical staff, who will be as big a part of Oden's success or failure as any coach or teammate could be.
That has put several surprising teams into the mix, including the Cleveland Cavaliers.
"Cleveland has one of the two or three best medical staffs around," said a source with knowledge of both Oden's situation and the NBA's medical landscape. That's surprising, since the Cavaliers are not often brought up with the Thunder, Spurs or Suns—the "usual suspects" at the top of NBA medical rankings.
The problem is that even with the best medical techniques, a top-notch rehab staff and comparable players who have returned, any single player—especially one with Oden's unique strengths and challenges—faces a tough road to recovery. While most players have some keys to look for in gauging their recovery, Oden's is simply going to be playing the game.
Every step he takes on the floor could be his last.
Cleveland, or any other team looking at Oden, should take a quick look at Brandon Roy. Roy may not be a perfect physical comparison for Oden—who is?—but his issues with both knees mirror Oden's.
Roy originally had a minor knee surgery—one in high school that removed one of his lateral meniscus and one that took some cartilage out in 2008. While Roy quickly came back, he was never the same, with his injuries leading to several more surgeries, including microfracture.
Roy retired in 2011, citing a complete lack of cartilage in his knees and the inability of the "blood bed"—the surgical resultant of microfracture—to adequately cushion his knees. This kind of long-term failure is not uncommon. Surprisingly, Roy tried to come back in 2012, undergoing Regenokine therapy at the advice of Kobe Bryant.
Roy's return to the floor was short-lived, lasting only five games before the knee began to disintegrate. Roy required more surgery to clean up the debris of the bone-on-bone grinding. He continues to rehab from that surgery, though he has admitted that he is unsure whether or not he can ever play again.
It is this kind of short-term setback that has to be considered by any team bringing in Oden.
Importantly for anyone considering Oden, the breakdown in Roy's knees didn't just come quickly—it came with almost no external warning. Roy needed the regular maintenance for his knees that many players do after every game and practice, but the cycle of recovery could never be firmly established.
Teams may think that the Timberwolves have had back luck with knees and that they could do better with a player like Roy or with Ricky Rubio, who is returning from ACL reconstruction. However, the return rate from microfracture surgery appears almost random. While there are more than a handful of players who have returned well, such as Amar'e Stoudemire and Jason Kidd, there is not enough of a sample size to give any real insight into what kind of player returns well or what teams do better in helping them to return.
In this article I did in 2010, I investigated whether there was a type of player that was more able to come back. You can see from the chart that there is no single type, though there were several comparisons in both age, size and position for Oden and for Roy. All had mixed results, though most were able to return. Stoudemire is the oft-cited "best-case scenario," but a player like Zach Randolph or Kenyon Martin is a better Oden comparison physically.
Microfracture itself is often considered a "halfway" surgery. Dr. Richard Steadman created the procedure to try to force the knee to heal itself. By drilling small holes and creating a rich stream of blood inside the knee, where it is normally difficult to get nutrients and healing, Steadman was able to get very good results.
The ideal would be to replace or regrow the cartilage, but procedures of this type have yet to be performed on a high-level athlete, though Brandon Roy was said to consider a meniscus transplant in 2011.
Despite occasional reports to the contrary, there is no known athlete at the professional level who has had this type of procedure. Much of the confusion surrounds former NFL running back Marshall Faulk, who had a meniscal allograft, but it was not done until he had been retired a few years.
Oden's challenges are magnified by his size and weight. There's simply more weight and force on Oden's knees than for someone like Roy, though those forces are often quite different than those generated by someone with more quickness or leaping ability. Oden's knees are not going to take the shear forces, but that type of thing wasn't the problem in the first place.
Indeed, it has merely been staying on the court.
Teams are once again considering whether or not Oden's unique size and ability could help them win. His knees are just part of the story, but like most things with Oden, it's a big part—and a big "what if."
All quotes were obtained firsthand unless otherwise noted.
Will Carroll has been writing about sports injuries for 12 years. His work has appeared at SI.com, ESPN.com and Rotowire.com.