It is understandable that Pelicans fans might be a bit concerned over the health of prized rookie and top draft pick Zion Williamson, given recent history in New Orleans. Few teams have had such bum luck over the past decade or so when it comes to injuries and seeing Williamson added to that pile could trigger some cases of PTEGD—post-traumatic Eric Gordon disorder.
But fear not. The surgery Williamson had is fairly common in the NBA. Williamson had a tear in a piece of the meniscus in his right knee and the torn piece is being removed. He will have less meniscus in place than he had before, but that piece of the meniscus was causing him pain and was irreparable anyway. Better to just lop it off.
Plenty of players have had productive careers after meniscus surgery. Russell Westbrook had three surgeries in eight months around his 2013 meniscus tear, but he has missed only 14 games in the last four seasons combined. Jimmy Butler had a piece removed from his meniscus in February 2018. He returned for the playoffs.
Dwyane Wade played 16 seasons without a meniscus in his left knee, having had it entirely removed while in college in 2002. Wade will be at risk for arthritis as he ages, and there were times when the knee bothered him. But he still managed a Hall of Fame career.
Still, there are a lot of questions around Williamson’s injury and his surgery. We checked in with Dr. Derek Ochiai, a leading surgeon at the Nirschl Orthopaedic Center, for insight on some of those questions.
What does a meniscus do, anyway?
Each knee has two menisci which are made of cartilage and sit between the femur (thighbone) and tibia (shinbone) and prevents the two from bone-on-bone contact. There’s a misconception that the meniscus is like a pillow, passively offering comfort between the bones. But there’s more to it than that.
“It doesn’t act like a pillow,” Dr. Ochiai said. “Everyone thinks it is like a cushion, but it is actually a spring. So when you put weight on it, when you walk, when you jump, anything that puts impact between what you think of as a classic skeleton—the thigh-bone-connected-to-the-shin-bone—every time you put stress on that, the meniscus squeezes, it stretches and it bounces back. It changes the pressure on the knee joint, like a shock absorber for the knee.”
Did Williamson have the meniscus fully repaired?
No. Ideally, for a 19-year-old leaper like Williamson, the surgery would have repaired his meniscus, which means it would have been stitched up whole and left to heal for three or four months before he returned to action. That way, all of the meniscus would be intact.
That would have been the Pelicans’ first preference. It’s relatively rare, though, that a meniscus can be repaired.
“If the meniscus is repairable and it heals and it’s fine, that’s better than a debridement,” Dr. Ochiai said. “But there are only a few tear patterns that are really great to repair. In most cases, you don’t have a choice. In a young athlete, you’d want to do a repair if at all possible because they’re going to be putting a lot of stress on the knee going forward. But that’s not always an option.”
There’s also the chance that a repair won’t heal right and will require more surgery, which is a risk of repairing vs. debridement. That’s what happened with Westbrook in 2013. He had a repair surgery in April and six months later he was experiencing swelling because of a loose stitch, requiring another surgery.
What did Williamson have done, then?
Most often, the meniscus tears in such a way that the only recourse is to remove the torn piece. That’s called a debridement (it’s pronounced dee-BREED-mahnt, not deh-BRIDE-ment if you want to sound like you know what you’re talking about) and while it is not as complete a solution as a repair, it will adequately address the problem and let the player return to action within two months.
Williamson had a debridement, according to the Pelicans. He’ll have less of a meniscus in his right knee, but he should return at about 100 percent by Christmas. Hopefully, it was only a small piece that needed the debridement.
“If you have a tiny little tear, you just clip that out and you decreased the meniscal strength by, say, five percent overall,” Dr. Ochiai said. “It’ can be almost negligible. If it is a small tear, nobody would repair that, you would just take out the affected part of the meniscus.”
What are the short-term concerns?
Not too many.
“It’s a really quick recovery,” Dr. Ochiai said. “The only thing that has to heal is the skin. There is not much internal healing you are waiting for and as an athlete, you can be back ready in two months, maybe less. You can be back at a high level, too.”
What are the long-term concerns?
This is where it gets tricky for Williamson. It’s impossible to say without knowing how much of his meniscus was removed but having less of a meniscus in his knee will reduce the shock absorption as he puts stress on his knee and, over time, that will put him at greater risk of arthritis in the knee, though the risk of a repeat injury is quite small.
“They used to think the meniscus was an appendix, like you did not need it, it didn’t do anything,” Dr. Ochiai said. “So they would just take it out. There is clinical data and biomedical data going back to 1948, though, and they found that patients who had it removed were getting arthritis at much younger ages. That’s when there became this understanding that if you have this meniscus, how much it distributes force.
“If you have an impact meniscus, that is protecting the cartilage in the knee. If that is compromised, it doesn’t transmit or act as a spring as much. The risk is, you start getting arthritis at a much younger age than you’d want to. There is somewhat of a risk of further meniscal injury, but it’s not that much. The major risk is early-onset arthritis in your 30s or 40s. But if it is minor, it might never show up.”
Early arthritis, if it comes at all, won’t be pleasant for Williamson. But the good news is, those types of symptoms are probably a decade or more away. Breathe easy, then, Pels fans. Williamson will be back and likely around 100 percent soon.