Understanding Steph Curry’s Grade 1 MCL Sprain

The 2016 NBA postseason took a dramatic turn Sunday evening when Warriors guard Stephen Curry suffered a right knee injury as the first half came to a close. He attempted to return to the start the third quarter but quickly retreated to the locker room before being ruled out for the game with a sprained knee.

The reigning MVP and heartbeat of a record-breaking Warriors team underwent a MRI on the injured joint Monday where it was determined he suffered a Grade 1 MCL sprain.

The injury occurred after Curry appeared to slip on a wet spot left by Houston big man Donatas Motiejunas, who also slipped just seconds before Curry hit the ground. Curry’s left leg extended backward while his right knee bent forward. His right foot appeared to remain planted on the court and the resulting valgus force of the fall overloaded the inside aspect of his knee, the location of the medial collateral ligament (MCL).

The MCL, along with the ACL, PCL, and LCL, serves as a primary stabilizer of the knee. Given its location, the MCL is critical in lateral or side-to-side movement. Damage to the medial meniscus often accompanies a MCL sprain as fibers of the ligament adhere to the fibrocartilage disc. Fortunately Curry appears to have avoided any meniscus involvement.

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When a ligament like the MCL is sprained, the injury is often assigned a grade based on the amount of associated damage. A minor or Grade 1 sprain is given when partial or micro tearing of the effected ligaments has occurred. A more moderate Grade 2 sprain is more commonly referred to as a partial tear and is more painful and limiting. Grade 2 injuries are often accompanied by a considerable amount of swelling and require rest and more intensive treatment. A Grade 3 sprain is relatively uncommon in sports but is a devastating injury. Grade 3 injuries result in a loss of function and mechanical stability and often require a long period of inactivity and in some cases surgery.

Fortunately for the Warriors, Curry’s mild MCL sprain can heal without surgical intervention. Instead conservative treatment and modalities will be used to address the associated symptoms and help stimulate the body’s natural healing process. The amount of time needed varies from person to person though the team has already determined he will sit for at least two weeks. When he does return expect Curry to wear a protective brace to help stabilize the area. Lateral movements, particularly on the defensive end, will be his biggest obstacle moving forward.

While Curry recovers, the inevitable questions regarding whether or not he should have been playing or if the ankle injury contributed to this latest injury will be asked. Determining a definitive answer is problematic but there is reason to believe his ankle was a non-factor in the knee injury. To start, Golden State’s medical team is one of the most proactive teams in the league, using various degrees of injury analytics and data to help shape their decisions regarding a player’s availability. Their partnership with Catapult Sports is well documented and was considered a major advantage in last season’s run to the title. It’s hard to imagine a medical team risking the health of the team’s MVP with these valuable tools at their disposal.

Furthermore the injury itself was a bit of a fluke. Even if a limitation at the ankle created a small breakdown in the kinetic chain of his right lower extremity, it seems unlikely that Curry could have avoided slipping in the wet spot created by Motiejunas. Additionally, the side of the ankle that was involved in the fall was the side opposite Curry’s lateral ankle sprain.

The estimated recovery window guarantees Curry will miss a part of the second round but how many games that will be remains unknown. During the 2015-16 regular season at least 11 MCL sprains were publicly diagnosed. The list includes several notable point guards including Washington’s John Wall and Dallas’ Deron Williams. Both players sustained low-grade MCL sprains and missed minimal time. Williams sat out just one game while Wall played through the injury without missing any action. However these two appear to be exceptions as the average missed time for the other low-grade sprains was roughly 15 days. The numbers are in line with Golden State’s initial estimated timeline of two weeks.

Closing out the series against the Rockets becomes top priority. Any additional recovery time the team can buy themselves and Curry between now and Game 1 of the second round of the postseason is a much-needed luxury. Furthermore the Warriors will hope the Trail Blazers can extend their matchup with the Clippers to further delay the start of the next round.

While the Warriors may not be “the most healthy team” in league history as LeBron James suggested in November, they did catch a major break Sunday. By avoiding a catastrophic injury, it seems likely that Curry will be able to rejoin his Golden State teammates at some point this postseason and help them cap off a record breaking season with their second consecutive NBA title.

Decoding Anthony Davis’ Medical Report: What is an Ultrasonic Debridement?

After being notoriously tight-lipped regarding injury information all season, the New Orleans Pelicans opened the floodgates Thursday night. The team released a full medical report from Dr. Neil ElAttrache of the Kerlan-Jobe Orthopaedic Group regarding Anthony Davis and his current shoulder and knee injuries.

The report revealed Davis’ labrum tear occurred to the posterior region of the fibrocartilage rim allowing for the three-time All-Star to avoid surgery. He will continue his daily routine maintenance and is not at risk while performing basketball activities. These findings are encouraging for Davis’ long-term future and should erase any doubts that the Pelicans medical staff mismanaged this injury.

The injury information provided on Davis’ problematic knee is even more intriguing. Dr. ElAttrache’s notes disclose that in addition to Davis’ previously noted tendinosis, he also had a patellar stress reaction. A stress reaction is a precursor to a stress fracture, a much more significant injury.

The patella or kneecap is considered a sesamoid bone, meaning it is embedded within the tendon of a muscle, in this case the tendon of the quadriceps muscles. As a result of this location, the kneecap is mobile. This mobility allows the patella to increase the moment arm of the tendon throughout the knee’s functional range. This subsequently enhances the torque in the area and improves the range of motion of the knee. However for the patella to smoothly move and adequately complete this process, it is forced to come in contact with multiples aspects of the leg bones, particularly the femur. The associated compressive forces put the bone at risk for injury especially when subjected to high repetitive loads. Any additional muscle limitation or muscular weakness can further contribute to the problem.

To treat Davis’ injury Dr. ElAttrache utilized an “ultrasonic debridement” on the patellar tendon. The relatively new treatment option, known as the Tenex Health TX FAST technique, is less invasive than an open debridement. In the procedure, a small surgical probe is inserted into the damaged or diseased tendon under the guidance of ultrasound imaging. Once inserted the surgeon uses ultrasonic energy to break up and remove the problematic tissue.

In addition to the debridement, Davis’ also received a regenerative injection derived from bone marrow aspirate. These injections, similar to the platelet-rich plasma (PRP) injections that have gained popularity over the past few seasons, utilize stem cells taken from the affected individual’s bone marrow. The stem cells are harvested, often from the hip, and introduced to the injury site with the intent to stimulate the body’s natural healing response.

Davis isn’t the first NBA player to utilize ultrasound debridement and stem cell injections. Former Laker and current Bulls center Pau Gasol underwent the technique on both his knees in the summer of 2013. Dr. Steven Yoon, also a member of the Kerlan-Jobe Orthopaedic Group, performed Gasol’s procedure. Gasol has since put together two All-Star campaigns and earned All-NBA Second Team accolades and, until recently, did not report a single issue with his knees.

This is a promising precedent for Davis though the procedure shouldn’t be viewed as a cure. Discovering any underlying biomechanical issues or functional limitations that contributed to both his tendinosis and stress reaction will be key in his long-term health. Look for New Orleans to invest heavily in Davis’ recovery and take the necessary steps to insure the face of their franchise returns healthy and ready for the 2016-17 season and beyond.

Examining the Injuries of Anthony Davis

The 2015-16 season will go down as a lost season for the New Orleans Pelicans as the team was overwhelmed by injuries from the start. Five Pelicans players have already been ruled out for the season, including the face of the franchise Anthony Davis. The three-time All-Star will undergo two surgeries in the coming days to address two reoccurring issues.

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NBA Injury Report Through 62 Games of the 2015-16 Season

The 2015-16 NBA season is nearing a close and the push for the postseason has begun. Injuries have played their part in determining the standings, despite the overall number of games missed continuing to be lower than in previous seasons. Through 62 games played by each NBA team, the total number of games missed due to injury is 3,182 games. The total continues this season’s trend of coming in lower than the previous two seasons’ marks, though an onslaught of injuries made this the most costly quarter of the season and narrowed the aforementioned gap.

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Understanding Marc Gasol’s Navicular Fracture

The Memphis Grizzlies will be without the services of their All-Star center after the team confirmed Tuesday that Marc Gasol underwent surgery on his fractured right foot. In the release, the team revealed the injury to be a non-displaced Type II fracture of his navicular bone. Unfortunately the precedent set by those who have previously broken this bone suggests Gasol is in for a lengthy recovery process.

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