CPP Curiosities: Kyrie Irving’s Knee Injury

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Welcome to the third and final installment in a series of articles written by students in the Karabots Junior Fellows Program. Previous articles by our students covered nineteenth century mental health and the 1918 influenza pandemic. Today, we’re shifting away from medical history to some current affairs.

On April 8, 2018, the Boston Celtics announced star point guard Kyrie Irving would miss the remainder of the 2018 NBA season following a surgery on his surgically repaired knee. The loss of Irving, the nature of his injury, and his subsequent recovery were highly-publicized topics in the world of sports punditry, and today we’re offering our own hot take. Allow me to introduce Al Ly. Al is a student in the Karabots Program, who is combining his interest in sports medicine with his love of basketball to share his thoughts on Irving’s injury.

Al, the floor is yours!

Cleveland Cavaliers point guard Kyrie Irving goes for a layup against a defender.

Kyrie Irving in 2015 Photo Credit: Erik Drost (Flickr Commons)

During the 2015 NBA Finals, Kyrie Irving, point guard for the Cleveland Cavaliers, fractured his left knee. He underwent a surgical procedure where doctors implanted two screws to keep his kneecap in place. About 2 ½ years later, on March 24, 2018, Irving, traded to the Boston Celtics during free agency, had to undergo additional surgery. Doctors went to remove the tension wire in his left knee, but they noticed that there was an infection. The infection came from the screws he had implanted after the injury in 2015.

The knee is the largest joint in your body. It is made up of bones, cartilage, ligaments, and tendons. The three bones that form the knee joint are the femur, tibia, and patella. Tendons connect the knee bones to the leg muscles that move the knee joint. Three main ligaments provide stability to the knee. The anterior cruciate ligament (ACL) prevents the femur from sliding backwards to the tibia. The posterior cruciate ligament (PCL) prevents the femur from sliding forward to the tibia. The lateral collateral ligaments (LCL) prevents the femur from sliding side to side.

Anatomy of the knee, identifying the major parts of the knee

Anatomy of the Knee
Image Source: Bruce Blausen (Wikimedia Commons)

Your knee works like a door hinge. When you open and close a door hinge, it uses a threaded bolt secured by two nuts at the top and bottom of the hinge called acorn nuts. There is also a piece called a sleeve that protects the threaded bolt. Door plates are also part of the hinge with one connected to the door and the other to the wall. With a human knee, the threaded bolt is your knee and the sleeve is the muscle around the knee. The muscle around your knee is patella ligament and your quadriceps femoris tendon. The door plates are your bones that are around the knee, so every time you open or close a door, it’s like bending your knee. The knee is one of the easiest joints to receive an injury, especially for professional athletes who are running and jumping, and, in some sports, making full contact, on a regular basis.

When a person receives an injury like the one Irving suffered in 2015, doctors support the knee using tension wires and screws; Tension wires hold broken bones in position. When a person receives them, it can cause pain and stiffness and a sense the knee is not the same as it was before the injury. People with knee injuries go through physical therapy to regain movement and can take medication for the pain. Keeping the leg elevated will also reduce pain. In the case of Kyrie Irving, doctors discovered the wires in the Irving’s knee were causing him pain. This can happen if the wires are being knocked around, and he had been knocking them around on the court for 2 ½ years while diving for loose balls, colliding with other players, and falling to the ground.

Doctors successfully removed the two screws that had infected Irving’s knee. His season was over; however, his doctors cleared him to be healthy by training camp next season. It could have been much worse due to the infection. Osteomyelitis is an inflammation of the bone or bone marrow due to an infection caused by bacteria, mycobacteria, or fungi. It affects roughly one out of every 5,000 people. There are multiple ways to treat osteomyelitis, including antibiotics and a procedure where doctors remove unhealthy tissue. During treatment, doctors perform blood tests to monitor for signs of infection and to ensure that the treatment is effective, with follow-up visits roughly every two weeks. It usually takes 6 weeks to recover.

The areas of dead bone are hard to treat because it’s difficult for the body’s white blood cells to fight off the infection. Without adequate blood supply, some parts of the bone may die. According to Dr. Derek Ochiai, orthopedic surgeon at Nirschl Orthopedic Center in Arlington, VA, “We don’t know everything obviously, but when you have an infection with hardware, that has the potential to cede the bone. So the infection goes to the bone, which is called osteomyelitis. That can be really difficult to treat.” Left untreated, the infection could have led to swelling, fever, and life-threatening sepsis, a condition where harmful bacteria or toxins infect the bloodstream. It can also lead to fractures in the infected bone, stunted growth (in children), and gangrene. Gangrene is a condition that occurs when body tissue dies. It’s caused by loss of blood supply due to an underlying illness, injury, or infection. The most commonly affected areas are fingers, toes, and limbs. Gangrene can also occur inside your body and it damages your muscles and organs.

Depictions of gangrene's progress from an 1835 book Source: Historical Medical Library of the College of Physicians of Philadelphia

Depictions of gangrene’s progress from an 1835 book Source: Historical Medical Library of the College of Physicians of Philadelphia

Irving’s surgery attracted a lot of attention from basketball fans and the sports press. In his first public comments following the announcement of Irving’s surgery Celtics head coach Brad Stevens said of Irving, “He’s really disappointed…Obviously, after the initial surgery, the thought was he’d be back in three to six weeks. We thought it would be closer to three than six, the way he was initially progressing. Just one of those things out of his control. But he’s bummed as you can imagine.” The Celtics thought he’d would be back in about a month, but they realized he had a bone infection in his left knee so it took longer than expected. Celtics fans were devastated to hear he would miss the rest of the 2017-2018 season, although the Celtics did manage to reach the Eastern Conference Finals, where they lost to the Cleveland Cavaliers (Irving’s former team).

Thanks, Al. Great job! If you are interested in learning more about medical history from our students, check out the links at the top of the article. Click here to learn more about the different youth programs the College of Physicians of Philadelphia has to offer.

As always, catch you on the strange side!

Sources:

Maloney, Jack. “Kyrie Irving’s knee injury and second story, explained by an orthopedic surgeon.” CBS Sports (April 10, 2018).

Weiss, Jared. “Brad Stevens explains Kyrie Irving bacterial infection knee surgery.” CelticsWire (April 6, 2018).

“What is Osteomyelitis?” Summit Medical Group.  

Zillgitt, Jeff. “Celtics star Kyrie Irving will have another knee surgery and miss the rest of the season.” USA Today (April 5, 2018).