Joel Sherman of the New York Post had the news today that New York Yankees pitcher CC Sabathia would be out until July. Sabathia had inflammation of his knee that required a draining, but a trip to see Dr. James Andrews was for more than an exam. A procedure on the knee is hoped to help, but the Yankees have to be concerned about the long-term outlook for Sabathia.
Sabathia had an experimental injection of stem cells into the knee and was kept off the knee for a few days, according to Sherman. The procedure is done to try and stimulate healing inside the knee, which indicates that the doctors are worried about the cartilage. The meniscus is known to have issues, but the articular cartilage that covers the bones is another problem spot. The Yankees have stated that their MRI showed no meniscus involvement, but what they didn't say was more important.
Sabathia will be off the knee and away from pitching over the next few weeks while the treatments take hold. The healing response should take a couple weeks to see some effect, and it's at that point where further decisions will be made. If things go to plan, Sabathia will begin throwing again in early June and work his way back through a rehab throwing program and a couple rehab starts.
Part of the initial hassle is the stem cells are drawn from the hip. While the damage is minimal, it's important to let that heal and not create more issues. Since the knee needs to have the weight taken off it as well, this is normally not an issue. The injection often has anti-inflammatories and analgesics added in to make it more comfortable in the short term.
There is a downside scenario where the treatments and rest don't help and Sabathia needs more time off. Chronic and degenerative issues like this are often tough to get control of and can extend the expected timeline. Surgery really isn't an option unless this gets really desperate. If so, microfracture is a possibility, but the success rate in baseball is terrible. That will be avoided at all costs.
There are some advanced techniques that are possible, but again, these would only be used if Sabathia gets worse from this point. A minor league player in the White Sox organization had a meniscus transplant. While it was successful to a point, it's hard to gauge the success on a baseball level because the player has made no progress. Some doctors are using meniscus implants with some success, but never on a high-level athlete.
The stem-cell injection is still largely untested. Brian Cashman acknowledged this in his comments to the media, saying "in the small sample of stem cell procedures, the results are very successful." The sample size is very small, though as with the similar platelet rich plasma (PRP), there's very little downside or negative reaction after the injection.
In the long term, Sabathia's knee becomes a maintenance concern. The medical staff will have to watch for any signs of inflammation and make sure that the knee is kept as close to normal as possible. Sabathia may have to make some mechanical changes in order to take some stress off the knee, while at the same time trying to keep his effectiveness.
The knee already appears to be degenerating to some extent. As it grew more problematic, Sabathia lost velocity, so that will be a key factor as he goes forward. Sabathia has two more years and a large option/buyout on his contract, but while the Yankees need to get production there, the lack of pitching depth in their organization makes losing Sabathia a bigger danger.
The Yankees medical staff gets one more task to add to its already extensive list. Keeping Sabathia healthy has to be pushed to the top, and how they do with this could decide how the Yankees do over the next couple seasons. His reaction to this treatment and a continued commitment to keeping himself in condition will be key.
While the team has shown it's willing to spend, even that has an upper end. While there are top-tier starters available after the season, such as Max Scherzer, James Shields and rival ace Jon Lester, they'll also have to make a decision on 39-year-old Hiroki Kuroda. Having Sabathia healthy and productive for the money they've already spent is a better plan.
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