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Andrew Bynum's Knee: Devastating Possibility of Osteochondritis Dissecans

Nov 16, 2012; Philadelphia, PA, USA; Philadelphia 76ers center Andrew Bynum (33) during the third quarter against the Utah Jazz at the Wachovia Center. The Sixers defeated the Jazz 99-93. Mandatory Credit: Howard Smith-US PRESSWIRE
Howard Smith-US PRESSWIRE
Dave Siebert, M.D.Featured ColumnistNovember 22, 2012

Yes, it was not Andrew Bynum's doctor.

And yes, he or she has not seen Bynum's MRI.

However, according to Jason Wolf of the Delaware News Journal, an internationally renowned orthopedic surgeon has suggested that Bynum's knee issues stem from a condition known as osteochondritis dissecans (OCD).

Even the mere suggestion of OCD should make the Philadelphia 76ers take pause, as trying to pronounce the name of the condition is only the beginning of the problem.

What goes on in a knee with OCD?

No one really knows.

For still unclear reasons, small areas of subchondral bone, or the very end of a long bone such as the femur (thigh bone), lose their blood supply.

This phenomenon may be due to repeated trauma, genetic factors or other causes.

Regardless of why the blood supply is cut off, the lack of blood prevents vital nutrients and oxygen from reaching the affected areas of bone.

As a result, the areas die.

When bone dies, it leaves extremely weak points in its place.

This compromises the supportive ability of the surrounding bone and cartilage.

In the case of Bynum, one can speculate that the orthopedic surgeon previously mentioned believes this is occurring at the end of Bynum's femur.

In other words, he or she thinks that parts of the lowest point of Bynum's femur are dying, causing decreased support between the rest of his femur and his knee cartilage.

This lack of support is then causing further knee cartilage and femur damage.

In fact, small fragments of healthy bone or cartilage can actually break off as a consequence of OCD.

Depending on how large and mobile they are, the fragments may move around within the knee joint and do additional serious damage.

In some cases, bone can crack or begin to form a flap, similar to peeling an apple.

All of this results in severe and debilitating pain, as well as an increased risk for knee arthritis.

In chronic or advanced cases, knee joint locking, stiffness and immobility may result.

This, of course, would make a career as a center in the NBA impossible.

There is treatment—but the treatment is no walk in the park, either.

After rest, if anti-inflammatory medication and physical therapy have failed, the next step is surgery.

Depending on the severity of disease, surgery can include one or all of the following:

  • Removing loose bone fragments
  • Reattaching separated bone
  • Replacing damaged or missing cartilage with synthetic material

Unfortunately, cartilage replacement material is only so good.

Additionally, as both the bone and cartilage need to heal and strengthen following surgery, the post-operative recovery time can be extensive.

As Jason Wolf also reports, it could be up to an entire year.

To make matters worse, after a full recovery has been made, it is impossible to say if Bynum would return to his normal self if this is indeed the path he ends up taking.

In short, OCD would be a devastating diagnosis.

It could even be a diagnosis that has the potential to ruin Bynum's career.

Let's hope the surgeon is wrong.

 

The author of this article is a soon-to-be Family Medicine resident physician with plans to specialize in Primary Care (non-operative) Sports Medicine.  The information above is based on the author's own anatomical and clinical knowledge and was supplemented by online articles on osteochondritis dissecans here and here.

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