Kyrie Irving isn't damaged goods
 
This promising campaign began with season-ending surgery for Gordon Hayward and ended with one for Kyrie Irving. Neither will return, and with them went the Celtics’ chances of reaching the Finals. It would be downright depressing, if their teammates weren’t still fighting for them.

After we covered the challenges Irving has faced in the years since fracturing his kneecap in Game 1 of the 2015 Finals, Irving underwent one knee surgery last month and will undergo another on Saturday, and the C’s provided further detail about the road ahead for their superstar:

This Saturday, Celtics guard Kyrie Irving will undergo a procedure to remove two screws implanted in his left patella after the patellar fracture he suffered during the NBA Finals in 2015. Following a mid-March procedure to remove a tension wire that had been implanted at the same time as the screws, pathology indicated the presence of a bacterial infection at the site of the hardware. To ensure that no infection remains in the knee, the screws will be removed. The fracture in Irving’s patella has completely healed, and his knee remains structurally sound. He is expected to make a full recovery in 4-5 months.

There’s been some confusion in the aftermath of this announcement — the gloom and doom of those who say another surgery to the same left knee signals a career-threatening issue and the natural questions about how a projected playoff return was pushed closer to training camp and why this matter wasn’t addressed earlier — so we circled back with Dr. Christopher Geary, Chief of Sports Medicine at Tufts Medical Center, if only in search of some optimism about the future.

Essentially, that minimally invasive surgery to remove the tension wire that was irritating Irving resulted in one of two scenarios: 1) the surgical team saw some tissue that gave them fair warning, they took a culture, and it returned the bacteria they suspected; or 2) the surgical team routinely takes a culture, even if what they saw looked fine, and it reflected a bacterial infection.

Why so much bacteria talk, you say? Well, there’s an important distinction there. Under the latter scenario, there is a rate of false positives, largely due to contamination. But false positive or not, once the culture suggests there’s a bacterial infection caused by the screws still remaining in the knee, there’s no going back to double-check. A second surgery is required

“It’s all speculation on my part,” said Dr. Geary. “It may have been the kind of surgery where they saw some tissue they didn’t like the way it looked before they sent the culture off, but at this point you’ve got this data that says he does have an infection, and you kind of have to act on it.”

Given that Irving was three years removed from the initial knee surgery, it seems unlikely but not impossible that a bacterial infection lingered so long without earlier post-operative symptoms, so there’s a possibility this surgery to remove the screws is all for naught, which is less than ideal. 

“It’s just weird to think that he’s had an infection that’s just kind of hanging out there for three years and not causing any symptoms,” added Dr. Geary. “It’s possible, because there are some bacteria that aren’t that aggressive ... but I really think it’s unlikely. I really think it’s probably a false positive and they kind of hosed themselves by taking the cultures.”

That’s the bad news.

The good news: Irving is expected to make a full recovery. Let Dr. Geary explain, with the usual caveat that he has conducted this same surgery but has no direct knowledge of Irving’s status.

X-rays of a fractured kneecap with the screws and tension wire in place. 

Parquet Post: Walk us through the procedure.

Dr. Geary: “In 2015, he had the surgery to fix it, which involves putting two screws in through the bone to hold it together, and then the wires actually go through the screws and around the bone. It’s a standard way of fixing the fracture. A frequent complication is this hardware irritation. The wire tends to be a little prominent, especially in someone thin like him. It’s not uncommon to have to go back and take that out, which is what he had done in the previous surgery [in March.]

“The rationale for going back and taking the screws out is that, if there is an infection or you presume there’s an infection, it’s not the kind of thing you just treat with antibiotics. You can suppress the infection … but someone who is young and healthy like him, you go in there, you take the screws out, then you give him antibiotics, and that should really cure the problem. ...

“There’s no blood supply to the screws, and you can give all the antibiotics in the world, but if there’s bacteria hanging out inside the screw or on the screw, you’re never going to clear the infection, so that’s the rationale for needing all the hardware out. And at this point, all the hardware is superfluous. The fracture is healed, so you don’t need the screws in there.

“You don’t routinely take them out, because the recovery is longer than if you’re just taking the wire out, and that’s why they didn’t do that the first time. When you take the wire out, it doesn’t really destabilize the bone at all. The four-millimeter screws are actually going through the bone from top to bottom or bottom to top, and when you take them out, there’s a four-millimeter hole in the bone that needs to be filled in over time. And that’s why you can’t just go back and play this season, even if there wasn’t an infection. The screws out means a longer recovery time than the wire, because the holes in the bone actually have to fill back in with bone over time. It will, but it takes a number of months. It will, but it’s not the kind of thing where you can go right out and starting running and jumping on it, because you can refracture at that point.”

Parquet Post: How common is it for the screws to cause a bacterial infection?

Dr. Geary: “It’s not super common, but it’s not wildly uncommon either. It’s not like he’s going to be in some medical textbook because of this. The rate of infection after something like that in a healthy young person like him is probably like 1-2 percent or something like that.”

Parquet Post: Is there any reason why they wouldn’t have removed the screws earlier?

Dr. Geary: “I’ve had patients who I’ve done this on, and they’ve never had their hardware out. It doesn’t bother them. If patients have a little more soft tissue coverage and they just don’t feel it, they might just say, ‘Hey, it doesn’t bother me that much. I don’t want to have it taken out.’ It can be more of a problem in thinner patients, and obviously he’s one of them, but the reason for not doing it is it’s not medically mandated. It’s not like you have to take it out.

“A lot of guys if you say, ‘Look, we can take this out, and then you have to shut yourself down for basketball activities for 2-3 months,’ he might’ve been like, ‘Well, it doesn’t bother me enough to justify that. I don’t want to spend my whole offseason riding the bike and sitting on my couch. I want to keep playing.’ That’s why he might’ve elected to not have it done then — if it was just bugging him a little bit, but not enough to justify the off time that removing the screws entails.”

Parquet Post: Does the recovery timeline of 4-5 months sound accurate?

Dr. Geary: “For the kind of aggressive stuff he’s doing, yeah. The last thing you want to do is go back too soon and this thing breaks again. Part of it is rehab and that kind of stuff. Part of it is based on time. If I have a patient I do this with, I’d just say, ‘Look, I don’t want any running or jumping for at least three months or so.’ You could do low-impact stuff earlier — bike, elliptical, that kind of stuff — which I’m sure he’ll be doing.

“In his case, they may even at some point do a CT scan to evaluate how much that bone is filling in. Most of the time we just go by time. That’s kind of a surrogate for healing. So, we’ll say after X number of weeks you can start doing more aggressive stuff, and after four months you can go back to full basketball stuff. In his case, if he’s treating an infection, that might be a little slower, so that might be 4-5 months as opposed to 3-4 months, because maybe they’re going to shut down rehab a little bit while they treat this presumptive infection for awhile.”

Parquet Post: What’s the long-term diagnosis for Irving?

Dr. Geary: “The good news from a Celtics standpoint is this really should get rid of the problem. This isn’t something that should be an ongoing problem. Now that all the hardware out, they’re going to treat this infection, whether it is an infection or not. I don’t think his knee is damaged goods at this point. When he gets back next year, that knee should basically be 100 percent.

“All the inciting factors for him to have more pain there, whether it was the tension wire or some lingering smoldering infection, that should all be gone, so his knee doesn’t give me worries going forward. It’s different manifestations of the same issue, and none of it should be a problem at all. Now, it really should be in the rearview mirror. The bone is healed, the cartilage is fine, the ligaments are all fine. He should be good to go next year.”

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