My Final Thoughts on Derrick Rose’s ACL Injury

by Steve Caronia

The Bulls season ended on May 15th at the hand of the Miami Heat, a disappointing end to a gritty, hard fought season.  The Bulls battled through injuries all season, and none was as drama-provoking and spoken about as Derrick Rose’s ACL reconstruction and prolonged absence while rehabilitating his knee.  I wrote about it back in March, essentially stating my position that once Rose was cleared to play by his medical staff he should have gotten back on the court.  As we all know, this never took place and Rose missed the entire 2012-2013 season.  There’s lots of varying opinions on this, ranging from angry to absurd.  Here’s my last few points on Rose’s recovery (or lack thereof).

1. Again, Rose was medically cleared to play.

Pro-teams don’t clear their multi-million dollar investments to play until they are medically ready.  With ACL tears, there is a battery of strength, balance, endurance, and structural tests the player must pass in order to be cleared.  Rose passed them. He was rightfully cleared.  Which brings us to…

2. Painting the Bulls’ medical staff as incompetent is unfair and misguided.

I’ve read multiple people’s scathing remarks about the Bulls medical staff and Dr. Brian Cole, their head physician, of course by people who know literally nothing about medicine (eg, Jason Whitlock and Tom Ziller).  Here’s an explanation as to why for each scenario I’ve read about:

A. Luol Deng’s Spinal Tap – This was not a “botched” spinal tap.  There was no associated infection from the procedure. It was a side effect that occurs in about 1/3 of people who get them done. No reason at all to blame the medical staff. It is unfortunate and very painful for Deng, but this is a necessary risk for undergoing a spinal tap.

B. Luol Deng’s stress fracture – This is the closest thing to a mistake by the Bulls’ staff and Dr. Cole, but I still don’t fault them.  I know it’s hard for people to believe , but stress fractures are incredibly difficult to diagnose, even with x-ray and MRI.  When the diagnosis is questionable, as it was in Deng’s case at the time, the athlete can attempt to play if symptoms allow.  People are up in arms that Deng had to seek out a second opinion from a Miami based MD, but the Bulls encouraged him to do so and shut him down once his symptoms were persistent.

C. Omer Asik’s fibula fracture – This is another case of “I know it’s hard to believe” but players can actually play on a fractured fibula.  It has happened a number of times in the past (most famously, perhaps, with Jack Youngblood in Super Bowl XIV and the Pro Bowl afterward) and is rare but not impossible.  It depends on where the fracture is – if it is too close to the knee or ankle, you can forget it.  If it is more in the middle of the bone (mid-shaft) and doesn’t move around (non-displaced) then it is possible.  This is because the fibula does not bear much weight in the leg – that job belongs to the Tibia.  The fibula primarily is designed to serve as an attachment point for muscles. It’s really a matter of pain tolerance. Asik tried to play, couldn’t, and was shut down. Simple as that.

D. Joakim Noah’s plantar fasciitis – Really, we’re going to blame the Bulls’ staff for Noah sustaining one of the most common injuries in basketball? I guess the Nets and Lakers medical personnel should be on trial too for Joe Johnson and Pau Gasol.  This is also a pain tolerance injury. It hurts like hell, but if you can muscle through and be effective, there’s plenty of time to rest in the off-season. This is in no way related to anything other than Noah being a basketball player.  Maybe he has flat feet (pez planus).  Let’s blame the Bulls for that too.

E. Kirk Hinrich’s bruised calf – I’m not even going to honor this with a response, but Whitlock and Ziller mentioned it, so I did. He bruised his calf. Let’s move on.

F. Taj Gibson and Nate Robinson were ill – I’d also like to file this under the not giving it a response but Whitlock mentioned it category. They got sick. Let’s move on.

G. Rip Hamilton’s assortment of injuries –  Rip Hamilton claims he has been healthy the whole year, but that Thibs had him glued to the bench.  Let’s even say he was injured the whole year.  He has been hurt on and off incessantly since 2009 when he was on Detroit.  Let’s move on.

H. Derrick Rose’s minor injuries “culminating” with an ACL rupture.  This is not even remotely how this works.  If you look through the annals of sports history, you will find zero correlation between players sustaining minor injuries and ACL ruptures.  ACL injuries happen at any time due to many other factors.

Can we please not give credence to a few sports writers questioning the decision making of medical professionals with years of experience and training?

3. Stop comparing ACL reconstruction to other injuries.

This is another one of my favorite tactics, employed regularly by Bill Simmons. He keeps comparing Rose’s injury to others with knee woes like Magic Johnson, and Gilbert Arenas.   I’ve even seen some others compare it to Grant Hill’s ankle problems, which isn’t even the same joint. Let’s see why this is so silly.

Magic Johnson tore his meniscus, which is a cartilage injury.  The meniscus serves as a shock absorber and lubricated surface for the bones of the knee to glide on as we move our leg.  When it becomes torn, typically with some sort of planting and twisting, surgeons opt to either cut a piece out (debridement) or repair what is torn with sutures.  Magic had debridement done, and the typical recovery time is about 8-10 weeks (in 1981 anyway).  He underwent surgery on November 24^th and returned on February 27^th, missing about 12 weeks with the injury.  Maybe a tad longer than expected, but being a little conservative with a player that important is a good thing. Repeat – a LITTLE conservative.  Anyway, I understand the point about Magic experiencing similar pressure to return, but he only stayed out a couple of week longer than expected.

Gilbert Arenas also tore his meniscus, but that wasn’t the only reason his path was totally different than Derrick Rose’s.  In April 2007, Arenas tore his lateral meniscus, underwent arthroscopic surgery, and returned in October 2007, a totally normal time frame considering the surgery he underwent. However, he was experiencing soreness and swelling while playing in the preseason, forged ahead, and wound up reinjuring the knee in November.  This time, he had the dreaded microfracture surgery, a procedure which is still not performed perfectly to this day and has laid waste to many a career.  He returned in 4 months, at least 2 months less than normal return time, and – guess what – got injured again.  He winds up getting a third surgery in September 2008 and he is officially never the same. Arenas’ injuries were handled way too aggressively, as he ignored symptoms and returned faster than normal.  Is this what happened with Derrick Rose in any way? Derrick Rose had no reported symptoms, didn’t even try to play, and was well within the normal time frame for recovery when he was first cleared to play. In addition, cartilage injuries are completely different than ligament injuries, and I will explain why in another post.  The only thing about Arenas’ story that is similar to Rose’s is that his troubles were in his knee. That’s not much.

4. Derrick Rose greatly exceeded the current typical expected time frame for return from ACL reconstruction.

It’s very interesting to me how some people want to compare Rose to people with completely different injuries but DON’T want to compare him to people with the same injury.  ACL reconstructions are, in general, the same.  There are other structures that may be damaged, like other ligaments, cartilage, etc. (Rose tore his ACL only, which makes things a bit easier).  Today, we say the recovery time for a pro-athlete is about 8-12 months. However, a look at recent history will tell you that time frame is getting shorter. Look at Ricky Rubio and Iman Shumpert for starters.  Go to the NFL and look at Jamaal Charles, Rashard Mendenhall, and Adrian Peterson.  All of these guys were back playing within 10 months.  This is becoming the norm as surgical technique and rehabilitation improve.  Hell, we’ve seen a pro soccer player return after 90 DAYS.  I’ve had minor league football players return in 6 months and hockey players return in 5.  The point is: people don’t take over a year to return from ACL reconstruction anymore.  It just doesn’t happen.  This isn’t Magic taking an extra few weeks.  This isn’t Gilbert Arenas coming back more than 2 months earlier that the norm.  This isn’t Grant Hill being misdiagnosed and rushed back.  I’m not sure what it is, honestly, because I don’t know Derrick Rose.  But what can glean from everything I’ve read is…

5. Derrick Rose is afraid and misinformed, not a “pussy” as some have eloquently called him.

I can’t really comment honestly on what advice Derrick Rose is getting or how he is interpreting it.  But what I think is this: Rose has a lot of people in his ear right now, not the least of which is his outspoken brother.  He’s under tremendous pressure.  Players, fans, coaches, trainers, doctors, family, and friends.  It’s a phenomenon we as mere mortals can’t really understand.  So who knows who he’s trusting? Maybe he is listening to his brother above everyone else, who has made it pretty clear he isn’t rushing Derrick back to play for a team who he thinks failed to adequately build its roster.  No matter the answer, we can’t judge the man.  I can say with 99.9% certainty that Rose is physically ready to play.  He just doesn’t know it.  Mentally and emotionally, Rose isn’t ready.

6. His interview with GQ is the only narrative you need to know about, in my opinion.

You don’t think Rose’s feelings about fame are dictating his fear of returning? Fear of failure? Fear of letting his team and city down? Fear that he can’t “jump of his left foot?” Why no one is talking about this aspect of his personality that he has openly revealed is beyond me.

7. Rose is going to come back for 2013-2014, and is going to struggle early.

Everyone struggles when they return from ACL reconstruction, especially pros.  It takes months to get back to speed, no matter how much rehab and training you undergo.  I’ve already read an article by one genius who was trying to use Ricky Rubio’s early struggles in January to support the idea that Rose shouldn’t come back, not waiting for Rubio’s performance to elevate dramatically about 6 weeks later after he got his legs under him.  The same will happen with Rose.  He will have problems early on just like everyone else.  How he handles it mentally is going to be all the difference. I think he may have convinced himself that practicing enough will make him feel 100% his first game out.  I have news for him – the best he’ll ever feel is 99%. What’s he going to do when he fully realizes this?

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