Russell Westbrook is doomed.
A third knee surgery in the last eight months has him back on the bench, making a seemingly insignificant play—being bumped as he tried to call timeout—a potential career changer. The entire course of the Oklahoma City Thunder and two potential Hall of Fame careers could tip on one play, one nudge, one knee.
That bump during the opening round of the 2013 forced Westbrook out of the postseason, where the Thunder were considered one of the favorites to make the NBA Finals, and onto the surgeon's table. The Thunder and Westbrook made a long-term decision, having the torn meniscus repaired rather than removed.
This cost Westbrook the rest of the playoffs and forced an offseason of rehab rather than rest. In return, the idea was that the knee would hold up better in the long term, which is key for a player who is just 25 years old.
However, there was a complication, albeit a minor one: Westbrook felt something in his knee. The discomfort was met with slight inflammation to go along with the irritation. After weeks of working on it, Westbrook headed back to surgery. Dr. Neal ElAttrache removed a loose stitch that was floating inside the knee. This is a very unusual occurrence and hardly the "failure" that has been implied.
The second surgery was very minimal, and Westbrook had immediate relief. Because there was very little done inside the knee, his body only needed to heal itself from the surgery rather than anything else, which resulted in a very quick return.
The third surgery came as a surprise.
Westbrook refuses to discuss the details of the surgery—he's not the best interviewee in the world—but details given by Thunder GM Sam Presti match with what sources are telling me. Presti says that scans showed an "area of interest." All indications are that this is a problematic area of articular cartilage.
To vastly oversimplify, this cartilage covers the head of the bones and is responsible for both smooth movements and cushioning. When this cartilage is damaged, the bone is exposed, leading to bone-on-bone contact in extreme cases. This grinding is painful and usually results in both inflammation and further damage, such as bone chips.
Keeping this articular cartilage as healthy and intact as possible is the most key part of keeping any player's knees healthy in the long term. Once again, it appears that the Thunder are taking the longer-term view in trying to get ahead of any major issues with Westbrook. They're willing to sacrifice weeks or even months in return for years.
There are questions about why the Thunder would do this surgery now. Even Westbrook denies having any pain or issues when they discovered the problem.
I have a hard time believing this. Teams don't do MRIs for no reason, so at best, they were watching in hopes of ruling out an issue like this. Given two previous opportunities to look inside the knee and see problem areas, it's more likely that they had worried about the articular cartilage.
It's certainly unusual that Westbrook would report no pain and no deficits, but again, I'll point to his relationship with the press. The team can't tell him he's having surgery if he doesn't agree. The most likely scenario is that Westbrook is being disingenuous and laying the success or failure onto the team and its medical staff.
Clearly, the hope is that by preserving the meniscus and cartilage, Westbrook can avoid microfracture surgery. Over and over, we've seen that microfracture doesn't work well in the NBA. It works, and as an interim therapy, it has extended careers. Amar'e Stoudemire is the key example, though he's hardly a physical or stylistic comparison for Westbrook.
Microfracture is a brutal procedure, but it is effective. It's a short-term solution and likely one that will be thought of as an interim procedure. At some point when there are meniscal transplants or implants, sports medicine surgeons will shelve microfracture.
That day might not be far off. Dr. Walt Lowe, who works with both the Houston Rockets and Houston Texans, regularly performs meniscal transplants, though none yet on an elite athlete. The closest case we have to an elite athlete was surgery performed on Chicago White Sox minor leaguer Jose Martinez. Martinez is still in the minors, playing at the Double-A level for the Atlanta Braves, but is not considered a top prospect. It's still interesting to note that he's had no real knee problems since the transplant.
As yet, no one in the elite levels of basketball has had this surgery. Some have considered it, such as Brandon Roy, who met with Dr. Lowe but decided against it. No one ever wants to be the Tommy John of a new surgery.
Westbrook's timeline after this latest surgery is hard to pin down, but we're starting to get some signs.
He's off crutches and doing weight bearing less than two weeks in. This matches with what we know about articular cartilage resection, so Westbrook could be back to running in weeks and back on the court shortly after that. My sources tell me that Westbrook could be back much sooner than most indications, though they hedge on possible setbacks, such as what happened with his second surgery.
The key for Westbrook and the Thunder is that his knee is effective. That would mean that the maintenance is kept to a minimum and that the knee isn't adversely affected by play or practice. If Westbrook becomes like Dwyane Wade or Andrew Bynum, unable to play back-to-back games, that would be a major negative.
I'd expect that Westbrook will look as he did coming back from his meniscus surgery, which is to say pretty much the same.
Russell Westbrook is doomed, but that means something very different today. His knee will not be the same, but hard work, maintenance and medical technology may give him a chance he wouldn't have had just a few years ago. In fact, Westbrook and Bryant may be perceived as exemplars of a transition in sports medicine, from the palliative to the restorative. We can't grow knees in a jar or have jetpacks in 2014, but I know which one is closer.
Doctors and the training staff will be watching Westbrook's knee closely, and it will likely require daily treatments for the rest of his career. He'll spend his offseasons trying to keep the knee in shape and hope that new techniques can add years to his career the way they have for others, or perhaps better.
He'll never be what he might have been, but that's not to say that he can't remain an elite NBA player.