Biggest Questions and Answers Surrounding Derrick Rose's Not Returning

Will Carroll@injuryexpertSports Injuries Lead WriterMay 7, 2013

Biggest Questions and Answers Surrounding Derrick Rose's Not Returning

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    The Chicago Bulls made it into the second round of the NBA playoffs without their star point guard, Derrick Rose. Rose remains out after having ACL reconstruction done on his left knee in May of 2012. His absence is becoming more controversial as his team continues to play and as his teammates continue to play through pain.

    With Joakim Noah hobbled by painful plantar fasciitis, Kirk Hinrich felled by a calf strain, Luol Deng watching games from his hospital bed and Nate Robinson vomiting on the bench and going back into the game, Rose is nattily dressed in a suit and an indifferent expression. 

    What are the continuing medical questions that are keeping Rose on the bench and how will they affect the Bulls this year and next? Let's look at those in more depth.

Was Rose's Knee Injury Particularly Complex?

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    Rose, who was injured in late April 2012 (photo), had a normal ACL reconstruction. The surgery was performed using standard procedures, using an autograft from his own patellar tendon. Rose also had a PRP (platelet rich plasma) injection, a commonly used modern technique.

    The surgery was done using the same procedure as other athletes, including Adrian Peterson, Rajon Rondo and Iman Shumpert. There were no indications, at the time or later, that there was anything unusual with Rose's surgery. 

Did Rose Select His Surgeon?

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    Yes. While Dr. Brian Cole is the team orthopedist for the Bulls, Rose could have elected to go elsewhere for his surgery.

    There is no indication that Rose visited other surgeons, though consultations could have been done by phone. This would not be uncommon, nor would it be uncommon for the team physician to do his own consultations with colleagues to help determine the proper course. Rose's injury and surgery were relatively straightforward—there was never a real debate on whether surgery was necessary, as there is in some cases—so this consultation process was likely quick.

    Rose did at some point make the decision to go with Cole and signed the informed consent form allowing the surgery. It is the same for any patient undergoing a non-emergent procedure. 

Why Did Rose Not Go to a More Known Sports Surgeon, Like Dr. James Andrews?

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    Rose had that option, but there is no indication that he pursued this strongly. That indicates a satisfaction level with the team physician and a comfort with the process. While Rose's brother and manager has been very vocal during the rehab process, there was never any indication that the Bulls or Bulls' doctors were an issue to Rose. 

    The Celtics' Rajon Rondo specifically wanted to have Adrian Peterson's doctor (James Andrews) perform the surgery, after seeing how quickly and effectively the Vikings running back came back from knee surgery. But Rose didn't have Peterson's situation to compare with his own. While Andrews was certainly well known prior to  Peterson's speedy recovery, Peterson was still a few months from playing on his repaired knee at the time Rose was injured. 

    All that said, Cole is very well thought of, working with not only the Bulls but the Chicago White Sox. He has been given several awards, including NBA Team Physician of the Year as well as being listed on several of the various top doctor lists. 

Were There Any Complications in His Surgery or Recovery?

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    There have been no known complications in either the surgery, the rehab and recovery, or any issues on the practice court.

    At all points, Rose (working out in January, in photo) has hit the normal milestones for the rehab, though it should be noted that he tended to be at the late end of the recovery window during most stages, at least those that could be determined publicly. 

    Rose did not have any infections or processes that seemed to delay the rehab. There is no known section of the rehab that had to be repeated and the doctor's clearance at the nine-month mark is very common. (For more on the rehab process, including specifics on date and function, see this recovery timetable).

What Does Iman Shumpert Have to Do with Derrick Rose?

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    Iman Shumpert, the Knicks guard (guarding Paul Pierce in photo), injured his knee in much the same fashion as Rose and on the same day. While their surgeries were not performed the same day, they were within days of each other. Shumpert is younger, had a different doctor and rehab process, but all in all, it is fair to call this comparable, if not identical.

    The difference is that Shumpert is playing in his series, having returned to the Knicks in January. Shumpert's recovery is not without issue. Shumpert says he is still not at 100 percent, but he is able to contribute while waiting for full function. 

    The presence of a near-perfect comparable for Rose's injury has provided a counterpoint to Rose's reluctance, one that has been on the court for four months and is helping his team in the playoffs. Even the reason for the delay in Rose's surgery is interesting here. Rose was given a "pre-hab" routine to prepare the knee for surgery. 

What Does "Medically Cleared" Mean?

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    A player is returned to play in two stages. First, he is cleared by the attending physician, in this case the orthopedic surgeon that both performed the surgery and oversaw the rehab. Second, the player will be cleared by the team, usually involving both the medical and coaching staffs. This clearance means that they both feel it is the proper time for the player to return to play.

    The first clearance is the most important, of course. The doctor will not clear a player if there are significant physical deficits. The affected area will be tested. In terms of a knee, there will be strength tests measuring the knee against the unaffected knee and against the healthy condition of the knee prior to surgery, if known. Since Rose (the photo shows him on April 25) has been with the Bulls since entering the NBA, it is likely he was examined closely during the pre- and post-draft process, which would have included testing of his knees and other physical traits.

    The team's clearance will be more focused on sport-specific function. Instead of objective measures of physical strength, the team will look at subjective abilities of running, jumping and playing basketball. Since this is a much fuzzier process, much more weight is given the to doctor's clearance.

    It should be noted that at most points, the athlete is driving the clearance, asking the team to get out on the floor. Teams often have to "tug the reins" to slow an athlete, hoping to prevent re-injury from the athlete doing too much too soon. 

Does an Athlete Have the Right to Not Play?

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    No sport is slavery. The player always has the right to not participate if he feels it is against their best interests for any reason. The question in this case is does Rose have any valid reason to continue to sit out?

    With no evidence that Rose has any physical deficits, given both the medical clearance and his ability to perform in non-game settings, it is difficult to call this anything but malingering more than two months after that medical clearance.

    Rose has the bargained right to request a second opinion on any injury. This is regularly used in sports, with the team paying or sharing costs in order to see an expert in the field. There can often be multiple second opinions if doctors do not agree. In some cases, this is required to "break a tie." In others, the doctors will negotiate. In almost all cases, the player will have significant influence on this process since the final right of medical decisions always lies with the informed patient.

Could the Bulls Do Anything More to Rose to Make Him Play?

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    The Bulls have been very quiet during this process. Rose is a very talented player and is signed long term, so breaking down a relationship with their star is counterproductive.

    In theory, the Bulls could demand that Rose play and if he refused, they could take disciplinary action. This could be fines or suspensions. It is not believed that the NBA would allow a contract to be terminated outside their amnesty process, but that would be extreme and unlikely.

Is Rose Going to Return in the Postseason?

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    The interesting thing is that neither Rose nor the Bulls have ever given any indication that Rose is not going to return. This fuels the speculation on a game-to-game basis, as it has for the past three months.

    The Bulls have very specifically left the door open to Rose's return, making it clear that this is Rose on the final decision to play. Tom Thibodeau has left the door open and NBA playoff roster rules are flexible enough to make it possible for Rose to return at the beginning of any game. Rose has given occasional updates on what he felt he needed to do before returning. That included "dunking off his left foot." Rose was seen doing that in April. That said, there is no clear indication that Rose is going to return during any stage of the playoffs. 

Is Rose Going to Return Next Year?

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    There is no indication that Rose is not planning to play. He is on record several times as saying that the best thing for him to do is wait until next year, but then again, he's not going to be more medically cleared than he is now. The extra time off and perhaps a full camp to regain his confidence may be helpful, but there is also no guarantee that things will change.

    Rose refusing to play next season, nearing the 18-month post-surgical point, would be a far different situation and one where both the Bulls and basketball fans would likely be more pointed in their dismay.