Derrick Rose's MRI confirms medial meniscus tear to his right knee, which will require surgery: http://t.co/pLx8jsZORp— Chicago Bulls (@chicagobulls) November 23, 2013
UPDATE: November 24, 3:15pm
The Chicago Bulls announced that Rose will have surgery on Monday with team physician Dr. Brian Cole, according to the Chicago Tribune and others. It is still not known what the surgical plan is, so a timeline for his recovery remains indefinite. Expect more news early tomorrow once the surgery occurs. The difference between meniscectomy and meniscus repair is significant. The details are explained below.
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UPDATE: November 25, 11:30am
The Chicago Bulls announced that Rose had successful surgery on Monday morning in Chicago. Dr. Brian Cole performed an arthroscopic repair of the medial meniscus, meaning that he debrided and then sutured the damaged section of the meniscus.
According to the Hospital for Special Surgery, this type of surgery has a recovery time between 12 and 16 weeks. However, the Bulls have announced that Rose will miss "the rest of the season" and have previously said his absence would be indefinite.
During the surgery, the doctor is also very likely to have visualized the ACL. Early indications were that Rose had sprained the ACL, so it's hard to believe that Dr. Cole would not have taken the opportunity to check the integrity of the ligament. The fact that the Bulls made no announcement about associated damage found is a positive for Rose in the short and long term.
Multiple sources, as well as other media reports, have indicated that there was some debate about both the surgery and the expected recovery time. In the end, Rose chose to go with Cole, the Bulls team doctor who performed his previous ACL reconstruction.
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In the 18 hours since Rose injured his knee in Portland, there has been nothing short of panic regarding his knee. Early speculation centered on damage to his ACL. Jordan Bernfield of WGN had the most devastating possibility:
Good source tells me #Bulls fear it's a torn right ACL for Derrick Rose. If so, unlikely he will ever be the same.— Jordan Bernfield (@JordanBernfield) November 23, 2013
A source confirmed to me similar information: that the manual exam performed after Rose went back to the locker room raised concerns for an ACL sprain. That type of manual exam is usually tests known as the Lachman test or the drawer test. Both of these can give very accurate results when performed by trained personnel. They were no doubt performed by both Bulls athletic trainer Fred Tedeschi and the Portland team doctor in attendance. (NBA teams normally do not travel with their doctor.)
Even trained orthopedists who observed the way Rose's knee buckled believed he had torn his ACL for the second time:
Viewed film on #Bulls Derrick Rose's knee injury. Worrisome for ACL tear given knee buckling. Could be something minor however. Await MRI.— Dr. Mark Adickes (@jocktodoc) November 23, 2013
There is a slightly increased risk for tearing the opposite ACL after ACL reconstruction. To some extent, there is a worry that minor changes in gait lead to increased risk for problems on the contralateral side. There was increased worry for this given Rose's previous hamstring strain. There is also a theory that some people simply have weakened tissue that makes up their ACL (and other ligaments) that shows up as another tear. Unfortunately, we don't have any prospective tests for this.
The diagnosis is a positive, but there are a lot of possible complications. First, while the Bulls announced no other associated damage, the surgeon will surely visualize the ligaments to make sure there is no significant damage. It's quite possible that there is a minor sprain—and remember, a sprain is a tear—that would not necessitate a repair.
That sprain, if it exists, could be significant enough to require repair. This recently occurred with NFL receiver Leonard Hankerson of Washington. He went in for surgery to repair his LCL, and when surgeons saw his ACL damage, they reconstructed that as well. This is not uncommon. Even with manual tests and MRIs, it is still best to actually see the ligament itself.
Even with the meniscus damage, we do not know how the damage will be repaired. What the surgeons decide to do will go a long way in determining when Rose can return. The most common technique is simply removing the damaged section or even the entire lobe of the meniscus. This procedure is called a meniscectomy and has a normal return range from 10 days to four weeks.
While this is simple and can return a player quickly, there are longer-term issues. Removing the meniscus can lead to increased friction and a lack of cushion that can create problems and even arthritic issues. Dwyane Wade's current knee issues come from a meniscectomy he had in 2002. We've seen many other players that even at a young age have degenerative damage after a meniscectomy in high school or college.
A more complex technique is to repair the meniscus, as shown in the video above. This requires very fine debridement and then stitching it back together. This was used recently on Russell Westbrook. The point guard returned after a complication (a loose stitch) held back his return and required additional surgery. Normally, a player would return somewhere between six and 12 weeks. Both techniques are performed arthroscopically.
In either scenario, it's likely Derrick Rose can return to play this season, perhaps even during this calendar year. Of course, Rose's extended rehab is going to raise questions, but make sure that when people discuss this, they're comparing apples to apples. If Rose has a meniscus repair, don't compare him to players that had a meniscectomy. The procedures have far different times and far different long-term issues.
The Bulls and Rose's camp will hash out where to have the surgery over the next few days. At this time, it's expected that Rose will have the surgery in Chicago with Dr. Brian Cole, the Bulls' team doctor who performed his ACL surgery.
There's a chance that Rose will choose another doctor, such as Dr. Neal ElAttrache, who he may have already seen in Los Angeles. ElAttrache performed the second knee surgery on Russell Westbrook and Kobe Bryant's Achilles reconstruction.
We'll know much more after the surgery is scheduled and performed. For now, the diagnosis announced by the Bulls gives fans hope that Rose will be seen on the floor sooner rather than later. Rose has to be relieved that he'll add a couple small scars to his collection rather than another big one.