Breaking Down Dwyane Wade's Knee Injury: What Exactly Is He Dealing With?

Will Carroll@injuryexpertSports Injuries Lead WriterMay 14, 2013

MIAMI, FL - MAY 08: Dwyane Wade #3 of the Miami Heat is knocked down by Nazr Mohammed #48 and Daequan Cook #14 of the Chicago Bulls during Game Two of the Eastern Conference Semifinals of the 2013 NBA Playoffs at American Airlines Arena on May 8, 2013 in Miami, Florida. 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 Mike Ehrmann/Getty Images)
Mike Ehrmann/Getty Images

Dwayne Wade is hobbled by a knee injury just as the Miami Heat are ready to blow through the injury-riddled Chicago Bulls.

What is going on with his knee, and will the rest between the end of this round and the next give Wade time to heal? Let's take a look:


A bruise? Really?

When I say "bruise", you likely think of a black and blue mark on the body. While a contusion is often followed by the discoloration, pain and swelling if on the surface, it's not the only kind of bruise that can be found. 

Wade's issue is on the surface of the patella, as well as inside the knee joint. There is very little cushion in the area, and the kind of hard contact that took place between Wade and Bulls guard Jimmy Butler can be both drastically painful and damaging. Bruises are the body's mechanism for rushing blood and healing substances to the area. 

The pain is also a signal, telling Wade to slow down, if not stop. The downside is that he'll likely take a painkiller in order to play, stopping the signal and perhaps allowing the knee to take more damage. It's a fine balance, and one that Wade will have to understand. His position and paycheck should allow him to have a level of comfort most players this side of Derrick Rose don't have.


What causes the bruising?

The bruise is caused by trauma. In this case, the known contact is the likely culprit, though there are chronic issues inside Wade's knee as well. For internal bruising, the tibia usually takes the worst of it as the femur comes down, but there is also force transferred up the leg. The actual trauma is likely unknown, though the location and direction (vector) of the contusion would give more clue about what's actually the problem.


What is the medical staff doing to help?

There are a number of modalities that the medical staff can use, but the most effective weapon they have is time. The Heat are using "extensive modalities" according to ESPN's Michael Wallace. These start with simple things like ice and heat. It also likely includes more complex things like phonophoresis, which is the introduction of substances forced into the body through ultrasound, and more intrusive medical techniques like draining the area.

Massage is normally avoided in cases of severe bruising. Using techniques like "milking" can create further long-term problems such as myositis ossificans. (This shouldn't be an issue given the location, but it is still standard practice.)

The draining is problematic but common. For athletes, the body's natural guarding of a damaged area with pain and inflammation has to be short-circuited to get them back on the court. Wade had his knee drained last season and underwent offseason surgery to correct the issues inside it. It is possible he will need this again.

Wade is also having his patella repositioned. The use of a custom tape job that shifts the floating bone over to a comfortable position sounds more extreme than it is. 


Is this a long-term problem?

The proper medical term for this would be acute over chronic. There is a current (acute) problem caused by a longer-term (chronic) issue. Wade has the traumatic bruising that must be treated while at the same time, has a chronic internal issue that has been exacerbated by the pain and inflammation secondary to trauma. 

Given the internal damage that Wade had last season and again this season, the knee issue is chronic and likely degenerating. Any additional trauma is accelerating the problem, creating new ones and making it harder to get any sort of production from Wade. It is definitely a problem, both in the short and long terms. 


Is Wade facing microfracture surgery in the near future?

Microfracture surgery, which was in vogue back when Amar'e Stoudemire had it, is losing some of its luster, especially at the highest levels of basketball. The success rate hovers around 50 percent, and more doctors are shifting away from the technique as alternatives become available. The procedure is still a medical miracle when it works, but there are new miracles coming.

Regrown meniscus and cartilage is on the horizon, as are meniscal transplants. It's unlikely that Wade wants to be the first NBA player to have one of these still-new treatments, but the day somebody tries it is coming soon. 

Given Wade's age and contract, it's more likely that he would opt to walk away from the game at the point that he simply cannot play any further than it would be taking extreme surgical measures to extend his career. Many years down the line, Wade is likely to face knee replacement, which is a very common operation for ex-athletes. 


How will it affect his play when he does come back?

The injury is more likely to affect Wade's minutes than his actual play. Assuming there's a lowest possible level at which a player can play, he'll need to be able to do most of his needed activities—running, jumping, stopping. Within those limits, there will be some additional force inside the knee, but Wade can play to pain tolerance.

It would be easier to let Wade play to that point than it would trying to totally eliminate any problems. While the Heat likely have a lengthy layoff, it won't be nearly enough to clear up the internal issue completely. Wade has twice had two-week layoffs that failed to completely clear up the problem. The medical staff and coaching staff will focus on keeping the external, acute issue from causing more headaches.

Visually, you probably won't spot much change in Wade's game. I'd expect a bit less aggressiveness or driving to the basket, where there's a tangle of bodies, but players, even injured ones, have a tendency to play instinctively. That's often directly counter to what is best for them.

The Heat have to hope that Wade can get out there and not think about his knee enough to play well, but think about it just enough to play smart.