Bruised Knee Keeps Chris Paul Sidelined, but for How Long?

Will CarrollSports Injuries Lead WriterJanuary 23, 2013

OAKLAND, CA - JANUARY 21:  Chris Paul #3 of the Los Angeles Clippers puts up a shot after being fouled by the Golden State Warriors at Oracle Arena on January 21, 2013 in Oakland, California. NOTE TO USER: User expressly acknowledges and agrees that, by downloading and or using this photograph, User is consenting to the terms and conditions of the Getty Images License Agreement.  (Photo by Ezra Shaw/Getty Images)
Ezra Shaw/Getty Images

Los Angeles Clippers point guard Chris Paul missed another key game this week, his fourth of the last six. In the two he was able to play, he showed a marked limp. The Clippers have said that Paul has a bruised kneecap, an injury that should keep him out a matter of days, but there are several less likely possibilities that could hold him out longer.

Update: Wednesday, Jan 30, at 6:45PM by Will Carroll

Chris Paul remains out, missing his fifth game in a row on Wednesday. The Clippers believe he will be back as they start a road trip, but the continued absence raises some new possibilities.

Jeff Stotts, an athletic trainer that writes at Rotowire, explained that he is more worried about "the time necessary for a bone contusion to the patella to heal. The pathway the kneecap takes while tracking forces it to come into contact with the femur, creating a less than ideal environment for healing."

Simply put, it seems the bruise was worse than the Clippers initially thought and Paul needs more time. Whether there's a biomechanical component as well remains to be seen. 

—End of Update—

The anatomic term for the kneecap is the patella. Anyone who's played hoops at any level knows how exposed the patella is, often injured when two players run into each other or by a simple fall where the knee is the first to hit the hardwood. This is a simple injury that requires nothing more than time and rest to recover. Since Paul has a known trauma, making contact with J.J. Reddick back on January 12th, this is the most likely scenario.

The worry is that this goes beyond a true bruise and that there is underlying damage inside or behind the patella. If there is damage behind the patella, even if it is a roughness or slight swelling, the bone ceases to glide normally and can cause further damage and inflammation in structures surrounding it, such as the patellar tendon. If the patella is damaged, the patellar tendon is almost always involved, and one of the first signs is that the tendon loses some of its leverage in knee extension (straightening the leg).

Patellar tendinitis can be very painful and could account for some of the reported swelling that Paul has. In the long term, this type of inflammation can compromise the tendon itself, a condition known as tendonosis. This is what has kept Indiana Pacers player Danny Granger out so far this season.

If the patella is significantly damaged and has lost some structural integrity, it could be a fracture. Indiana University basketball player Maurice Creek has missed nearly two seasons with stress fractures to his patellas, as well as an Achilles' rupture. This is a very unlikely scenario for Paul. The Clippers have access to world-class medical care and have surely checked closely for this type of issue.

The other key question with the extended absence is whether there is any underlying damage in the joint itself that was "shaken loose" by the collision or exacerbated by Paul playing and limping. Even a small change in the gait can cause serious issues. Holding Paul out after his play was compromised is likely a guard against this.

I spoke with an NBA athletic trainer who could not speak on the record due to Paul playing for a different team, and he agreed that the most likely scenario is that this is a simple bruise and that Paul is rested until the symptoms are gone. This should be just a matter of days, with a topside risk of two weeks.

Jasen Powell and his staff are undoubtedly watching this situation very closely and using all the resources at their disposal. Of course, the hardest tool to use in the training room is the clock on the wall.