Bynum: Is it over?

After months of speculation littered with countless doctor’s visits, setbacks (and hairstyles), the Sixers confirmed this week what we've all suspected—Andrew Bynum’s 2012-13 season is over before it even started.

How could this have happened? How could the franchise invest so many resources into a player with one year on his contract, only to have him never step on the court? Dr. Arthur Barotlozzi, MD says that with cartilage injuries, you just never know.

“Cartilage is the holy grail of sports medicine,” he summarizes. “Once we figure it out, we'll be able to solve everything.”

Dr. Bartolozzi is the director of sports medicine at Aria 3B Orthopaedic Institute in Langhorne and formerly worked with the Eagles and Flyers. He says that no matter how thorough the physical examinations before acquiring a player, some things are a matter of chance. Players have failed physicals and gone onto thrive in the professional ranks, while others pass with flying colors and suffer through injury-plagued careers.

“I examined a player once who had a terrible knee,” he says. “I told the coach not to take him under any circumstances—the coach told me he didn’t want to hear it, because he knew the guy would play his heart out.”

That player went onto become an All-Star. Over the past 20-30 years, immeasurable strides have been made in the area of ACL reconstructoin in the sports medicine community. As Dr. Bartolozzi says, the great question now is knee cartilage.

“You can sit there as a coach or a GM and say ‘I only want players with perfect knees, no cartilage injuries.’ That’s not too easy, but there are a fair number of players in the league with cartilage damage who are playing just fine. Some people can play with the damage, some players can’t.”

Differentiating between the two groups isn't just a question of a MRI. There’s also the physical exam, but the most important factor that outweighs all others is also the simplest—can this particular athlete play in his condition?

“That’s the hard part—some people can play with it, some can’t,” says Dr. Bartolozzi. “Some people have terrible damage and play tennis with no pain at all. Others have minimal damage and can’t walk. It really is a great unknown.”

Dr. Bartolozzi scoffs at the idea of any professional athlete who ‘doesn't care’ or ‘doesn't want to play.’ “Skin heals in seven days. If you break a bone, that’s eight weeks. If you injure cartilage, sometimes the healing can be up to 18 months,” says Dr. Bartolozzi. “You don’t get to that level in any profession if you don’t want to be there, if you’re not willing to work,” he says. “There’s a component of the healing process that does take time—that’s the part we don’t like.”

In Bynum’s case, he flew to Germany before the season for Orthokine treatments but saw no improvement. He aggravated one knee in a freak bowling mishap, the first of many seemingly small setbacks that culminated in Tuesday’s announcement.

But Bynum doesn’t even turn 26 until the start of the 2013-14 season, and has repeatedly stated his commitment to coming back healthy. On the other hand, he’s now missed almost half of the total number of games for the Lakers and Sixers the past half-dozen years. Is it worth the risk of bringing him back—even at a potentially reduced price?

“Obviously, any decision would be made after a great deal of assessment of performance,” Dr. Bartolozzi clarifies. “I examined a wide receiver one time in a similar situation—a talented player coming off of a surgery that brought his asking price down. I told the coach that the outcome for that surgery was unknown, and that it was high-risk. There was a chance of serious or catastrophic injury.

“Any player with a cartilage injury, there’s always going to be a question of whether he can play. The team willing to accept the risk will have to weigh all those factors and make their decision.”