I'd argue the opposite. Tendon repairs can be done multiple times to the same joint. They can result in a completely healthy joint (as long as the cartilage is intact). It is cartilage damage that is the most serious injury for an athlete. It cannot be repaired, only mitigated. There is no current technology to replace cartilage. This sort of degenerative damage is what leads to knee replacement. It is becoming obvious that this is where Buxton is at, unfortunately.
I have heard rumblings (I have no specific information or anything like that) that the issue in his knee is as you say- damage to the surface cartilage. I have heard the area is in what's called the trochlea, which is the area in the front of the knee where the patella (kneecap) glides.
You are mostly correct about the current technology. We do have some different methods to 'replace' the cartilage, but none of them make it 'good as new'. And there have not been too many instances where these procedures have been able to stand up to the rigors of professional sports for any considerable length of time.
Some people, for reasons unclear, can tolerate even large cartilage lesions in their knee with minimal or no symptoms. Other people can have significant symptoms from even a small area of cartilage injury. It's highly variable.
With the majority of these lesions in elite level athletes, we often attempt a 'clean-up' type procedure first, which is what I suspect Buxton had last year. This includes shaving some loose cartilage away and removing any floating pieces, etc. But this procedure does not 'fix' the root cause of the issue. The irregularity of the gliding cartilage remains. In many cases, people do well despite the irregularity (I don't always understand why it happens that way, it just does sometimes). In other cases, people continue to have trouble with the area, in which case the choices get more difficult. You can treat with rest/rehab/injections (as he has been). You can try to repeat the same surgery hoping for different results (always risky). Or you can try one of a handful of types of cartilage restoration surgeries. Without knowing the details on exact size, location, depth and several other factors, it's hard to say which of these would be best for someone like Byron. But they all require fairly lengthy recoveries. (A recent athlete with something like this is Lonzo Ball, who will miss the entire upcoming NBA season).
From my perspective, it's also hard to know if this current issue he is having is actually patella tendinitis (totally possible from trying to ramp up activity) versus 'he is having pain in the front of the knee, and we are going to use the term 'patella tendinitis' to report it, but in reality he is having pain due to the cartilage damage area.' These two things will often result in similar symptoms, and it can be hard to differentiate which is the true cause of pain.
In any case, a big bummer for Byron. I sure hope he can get things settled down and get back to roaming CF at 100mph like we all love to watch him do.
As always, that's my $0.02. I am not a Twins team physician and have not examined Byron or seen any of his imaging or anything like that. This is purely speculative on my part.
Speculation from an expert is worth more than speculation from a non-expert
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Posted by Heezy1323,
I have heard rumblings (I have no specific information or anything like that) that the issue in his knee is as you say- damage to the surface cartilage. I have heard the area is in what's called the trochlea, which is the area in the front of the knee where the patella (kneecap) glides.
You are mostly correct about the current technology. We do have some different methods to 'replace' the cartilage, but none of them make it 'good as new'. And there have not been too many instances where these procedures have been able to stand up to the rigors of professional sports for any considerable length of time.
Some people, for reasons unclear, can tolerate even large cartilage lesions in their knee with minimal or no symptoms. Other people can have significant symptoms from even a small area of cartilage injury. It's highly variable.
With the majority of these lesions in elite level athletes, we often attempt a 'clean-up' type procedure first, which is what I suspect Buxton had last year. This includes shaving some loose cartilage away and removing any floating pieces, etc. But this procedure does not 'fix' the root cause of the issue. The irregularity of the gliding cartilage remains. In many cases, people do well despite the irregularity (I don't always understand why it happens that way, it just does sometimes). In other cases, people continue to have trouble with the area, in which case the choices get more difficult. You can treat with rest/rehab/injections (as he has been). You can try to repeat the same surgery hoping for different results (always risky). Or you can try one of a handful of types of cartilage restoration surgeries. Without knowing the details on exact size, location, depth and several other factors, it's hard to say which of these would be best for someone like Byron. But they all require fairly lengthy recoveries. (A recent athlete with something like this is Lonzo Ball, who will miss the entire upcoming NBA season).
From my perspective, it's also hard to know if this current issue he is having is actually patella tendinitis (totally possible from trying to ramp up activity) versus 'he is having pain in the front of the knee, and we are going to use the term 'patella tendinitis' to report it, but in reality he is having pain due to the cartilage damage area.' These two things will often result in similar symptoms, and it can be hard to differentiate which is the true cause of pain.
In any case, a big bummer for Byron. I sure hope he can get things settled down and get back to roaming CF at 100mph like we all love to watch him do.
As always, that's my $0.02. I am not a Twins team physician and have not examined Byron or seen any of his imaging or anything like that. This is purely speculative on my part.
Speculation from an expert is worth more than speculation from a non-expert
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