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Covering sports injuries from the perspective of a certified athletic trainer and backed by analytics.

Injury Profile: Russell Westbrook

The Thunder are set to play the Heat Thursday night in a potential Finals preview.  Normally the battle between Kevin Durant and LeBron James would be the primary focus but the majority of buzz is coming from the potential return of Thunder guard Russell Westbrook. Westbrook has missed the team’s last 27 games recovering from his third arthroscopic knee surgery in eight months.

Westbrook’s initial injury occurred in the 2013 playoffs when he collided with Houston guard Patrick Beverley. The collision left Westbrook with a torn lateral meniscus in his right knee and ended his season. Injuries of this magnitude often leave a young player with two options, removal or repair.

In a removal, the surgeon arthroscopically removes the damaged fibrocartilage from within the joint. A removal allows for a quick return to play, as the source of pain and inflammation is no longer present. However the long-term implications of a removal are significant. Without the meniscus or a portion of the meniscus available to serve as a cushion in the knee, players that opt for this route often see problematic changes to the cartilage within the knee and become vulnerable to conditions like arthritis or osteoarthritis. Multiple players including Dwyane Wade and Brandon Roy have undergone a meniscus removal only to later admit they regretted the decision. Both players have endured multiple knee problems following the surgery with Wade yo-yoing in and out of the Miami lineup this year.

The second more conservative option is the meniscus repair. In the procedure the surgeon sutures and anchors down the injured area, preserving the meniscus. Doing so requires a much lengthier recovery time but has a better long-term outlook. Westbrook, under the advisement of head athletic trainer Joe Sharpe and the rest of the OKC medical staff, wisely opted for this operation. Westbrook spent the summer rehabbing his knee and was poised to return in time for the start of the regular season. Unfortunately he suffered an unexpected setback in late September.

During the middle of training camp Westbrook began experiencing persistent swelling within the knee. In-depth evaluation determined the swelling was being caused by a loose suture at the injury site and a second arthroscopic surgery would be required to fix it. Westbrook had the operation on October 1 and was back in action on November 3 having missed just two regular season games. The All-Star guard not only returned quickly but did so playing at his usual high-level of play. In 25 games this season Westbrook is averaging 23.3 points and 7.6 assists per game. His Player Efficiency Rating (PRE) has dipped a bit from the previous season, down to 21.6 from 23.9 in 2012-13. However the number is still good enough for 21st in the NBA. Data provided by SportsVU on NBA.com show the knee hasn’t altered Westbrook’s approach either as he maintains his aggressiveness and currently ranks 17th in the league in drives per game with 7.1. Continuing to play in a familiar fashion actually decreases the chances of an additional injury occurring.

However the impressive play was offset by another bout with persistent inflammation. Just two days after Christmas, Westbrook was back on the operating table for his third surgery. This operation was likely a debridement that is relatively common following a meniscus repair. Often after knee surgery players will require routine maintenance procedures to clear out debris that has slowly developed. This debris can be a variety of things including loose fragments of cartilage, scar tissue, or a cyst.  Fortunately, the Thunder never hinted at a possible, more serious cartilage defect and the term microfracture never came up in regards to Westbrook’s knee. The fact that Westbrook needed such a procedure so soon after his repair is a bit alarming but his progression over the last few weeks is a good indicator it is not career altering.

Now Westbrook is finally set to return and Thunder fans have plenty of reasons to be optimistic. As previously detailed, Westbrook’s level of play has not drastically fallen off. Any lingering doubts should be quelled by the tripe-double he posted on Christmas, just days before his third surgery. Second, recent studies have shown lateral meniscus repairs have a lower failure rate than medial repairs further strengthening Westbrook’s decision to opt for the repair.  Furthermore the MVP-caliber play of Durant will allow OKC to ease Westbrook back into the rotation. Under the watchful eye of Sharpe and his elite team of medical experts,  Westbrook will likely be on a minutes restriction to insure the knee responds well to an increase in workload.  Sharpe has had success handling knee injuries while leading OKC, extending the careers of players like Desmond Mason, Kevin Ollie, Nate Robinson, and Kendrick Perkins. Finally Westbrook’s age and limited injury history also play in his favor. Other than a handful of ankle sprains to both his left and right ankles, the 25 year-old Westbrook had avoided the injury bug for the majority of his career. Without years of damage to his legs, he can focus his energy on maintaining the strength in his lower extremities to hopefully prevent a subsequent injury from occurring.

With a healthy Westbrook the Thunder are the odds-on favorite to represent the Western Conference in the Finals and secure the ever-elusive championship. While the last eight months have been anything but smooth for Westbrook, his current situation sets up favorably for him to succeed. Hopefully he can remain healthy for the remainder of the year and enter the offseason without any lingering question marks.

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