Depiction of microfracture surgery. Image courtesy of Steadman Hawkins Sports Medicine Foundation

Sorting Out Reports of Da'Quan Bowers' Knee Injury

If you search Bowers knee injury in Google, you get a myriad of different results, and all sorts of reports about the injury itself and what it means for his career. Here is my personal take on his knee injury based upon my experience and knowledge of the subject.  It comes with the usual disclaimer that I have not examined his knee and have not seen the MRI or surgical pictures.  My assessment is based upon what I can find on the internet, and from Mark Dominik‘s press conference.

The first point I would like to address is what the injury itself is.  What seems to be universal is that Bowers had an arthroscopic surgery shortly after the season for a torn meniscus.  This is a relatively common procedure and what usually is entailed in a routine “knee scope”.  The meniscus is a c-shaped structure which sits between the end of the femur (thigh bone) and the tibia (shin bone), and there are two in each knee.  This structure is made of cartilage and it’s primary function is to provide a cushion between the two bones.  This is often confused with the articular cartilage, which is on the surface of the end of the bone and provides a smooth surface for motion.  A good example is articular cartilage is the shiny white stuff on the end of a chicken bone.

What is not clear is if he had a meniscal repair or if they just resected a torn portion of the meniscus.  Typically, small tears are resected and only large tears at the edge are repaired.  Either way, recovery for these procedures is typically good without many problems.  Occasionally, major tears in the meniscus are not repairable and this represents a large problem in the knee.  I have not heard any reports that the “big problem” with his knee is the meniscus, so i won’t go into this further at this point.

What appears to be the problem with the knee is with the articular cartilage of the knee.  Dominik stated that it was just a torn meniscus, but multiple reports have indicated that he also had a chondroplasty and that there was articular cartilage damage in the knee.  One report I read stated that he had arthritic and degenerative changes within the knee.  This would be very unusual in a 21 year-old.  Pro Football Weekly reported that thee NFL team doctors reported he would need microfracture surgery.  These have lead to all sorts of speculation regarding why he fell in the draft and what this means for his career in the NFL.  A reporter in San Diego even said his career is “done” already.

Some definitions are in order here.  Chondroplasty is specifically defined as repairative or plastic surgery on cartilage.  Unfortunately, many surgeons will use this term to describe any surgery of the articular cartilage and quite often this means removal of loose areas or flaps of the cartilage and debridement or “cleaning up” softened or damaged areas.   The surgeon in this situation likely found areas of the articular cartilage in the knee that were damaged and removed the loose or frankly damaged areas in the knee.  Second, microfracture most commonly refers to making small holes in the bone (with a small pick or drill) where the cartilage was damaged or removed.  This will stimulate bleeding in the area and the body will often heal the area with fibrocartilage.  Fibrocartilage is not as good on articular surfaces as articular cartilage, but is better than the bare bone in the joint.

There are other procedures that are true replacements of cartilage in the knee which involve either taking articular cartilage from one part of the knee and moving it the the damaged area, using cadaver articular cartilage, or trying to grow articular cartilage in the lab and implanting it into the damaged area.  These are all still relatively new procedures and the outcomes have not shown them to be vastly superior to microfracture surgery, but they may turn out to be better procedures with time.

My feeling is that Da’Quan likely has a large cartilage deficit within the knee and while he has been able to play on it this last year, he may need to eventually have either microfracture surgery, or one of the other options listed above.  He can likely try and play this year on the knee, and if it becomes too painful for him to go, then he has these surgical options to try and help.  I think this is not a death sentence at all for him as all of these have been shown to have good results in most people over time.  Some people can tolerate defects, and he is still very young, which is a very good thing in regards to healing.  One prominent example in sports of an athlete returning to a high level of competition after a similar injury is Amare Stoudemire of the NBA, who had microfracture surgery of the knee in 2005, and has continued to be an NBA all-star.  But for every Stoudemire there is a Greg Oden, but he has had other injuries also which affected his recovery.  The reality is, one just does not know to what level each individual can get back to, and there is no way to predict this.

I can only make two absolute conclusions from what I have read.  1) Bowers‘ knee has more than just a small meniscus tear, and 2) he has a increased chance for arthritis in the knee later in life when his playing years are over.  Every other report about how this injury will effect his career is purely speculation.  Obviously, his free-fall in the draft indicates that every team felt like taking him with a first round pick was too much of a risk, but his talent is too great and the Bucs felt like he was worth the risk in the second round.  I don’t think this was that big of risk, because even if he can only give you 4-5 good years, that is probably as good as your average late second round selection.  He cannot be any worse than Dexter Jackson, who made it a whole year after being picked in the second round.

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  • Doug

    Nice article and I appreciate the intent to clear the fog on this topic. Being a huge Bucs fan, I couldn’t be more interested in getting to the bottom truth on what has really been done to his knee from the specifics of his injury to the actual proceedure that was done to repair it. Mark Dominik did call it a meniscal tear, however, I’m not sure that he didn’t make a mistake on this. If you recall when he was asked, he, in so many words, stuttered a bit calling it a meniscus tear, indicating a degree of uncertainty at that point. I would like to refer you to Mac’s Football Blog and comment, if you will, on the statement issued by Bowers agent, Joe Flanagan of BTI Advisors, regarding a few specifics of Bowers injury, the arthroscopic proceedure performed, and some comments months later from Team GM’s, and Physicians opinion on the healing status at that time.
    In Brief, he described the chondroplasty as “Very Small” and “To a NON-WEIGHT Bearing area of the knee”. The surgeon, Dr. Larry Bowman observed arthroscopically, a very healthy knee with NO signs of arthritis. The surgery involved “Scratching” rather than drilling indicating the small degree of damage to the knee. At the re-check, according to multiple GM’s, it showed good healing with absolutely no acute or remote ill-effects(swelling) as a result of the April 1 pro-day workout. The weakness in his Right/surgically repaired knee and his lack of explosiveness during his pro-day workout, as he stated, and I can reasonably understand to be true, was due to “Detraining Effects” caused by the limitations of his rehab protocols.
    I understand his agent at that time was still trying to sell his client to teams and GM’s in attempt to achieve the best draft status possible. However, concidering the fact that all teams, GM’s, team physians and staff had access to his health profile including the injury to his knee and the proceedure done on January 4, 2011, wouldn’t it seem likely that he would tell the simple truth regarding these details. If he didn’t, they would all know and deem his statement as non-credible.
    Assuming all this to be true, it could be understood that his injury is not nearly as severe as feared by teams and fans and that most of what we are hearing is misinformation. I can understand teams not wanting to take a chance on him in the first or second round of the draft due to the large numbers of reports indicating his proceedure was “Microfracture In Nature” in one article. Others mention a degenerative condition already existing or furture microfracture surgery will be needed, to name a few. I’m sure teams were a bit uncertain and didn’t want to take a chance too early in the draft with all the money dedicated to a high draft pick.
    Thank you and I would appreciate your thoughts.

  • Mark McKenna MD

    First, thanks for the comment and the reference to the agent’s statement. I try not to put much stock in agent comments regarding a guy that hasn’t signed a contract, but it is reasonable to address. As for the agents credibility, I think agents often ride a fine line of stretching the truth to put their clients in the best light.
    Second, Dominik may have paused for a moment, but I hesitate to read much more into this as he may have just been wanting to say the words right as “meniscus” is not something you throw around every day. Interesting point, though.
    As for the comments about the chondroplasty, the “scratching” would fall under the small debridement which I talked about in the article, and another way to stimulate healing in the area. Technically, this would be like a microfracture, so that statement made by another source is not that far off. If the area is truly in part of the knee that is “non-weight bearing” than there is really nothing to worry about and I think someone would have taken a chance earlier on him, but that is my opinion. GMs may over-analyze to the point where they don’t want to take any major risks in fear of losing their tenuous jobs.
    Knees are weak after surgical procedures and that is absolutely a valid reason why he may not have looked very good in the pro day. Especially if he was kept off of it to allow the chondroplasty to heal, which is what is typically done.
    Overall, I agree with your points and I hope that this is a fairly minor injury as it would be great to see him dominating the left side of the D-line in a Bucs uniform.

  • BuccoBill

    Thank you so much for this write up Dr. McKenna. This has to have been the most informative story on Bowers and the knee situation. I realize that you are just making an edjucated guess at what the real deal is because of the fact that you don’t have access to his records, but it’s still good to see that someone who knows what they’re talking about, is taking a deeper look at this situation. I think, weather Bowers is ready to play this season or next, he will be a dominant force on our D for a number of good years. Raheem Morris doesn’t come off to me as the kind of coach that will rush a player onto the field to satisfy fan or management pressure, and that will play to Da’quan’s benefit. Go Bucs!

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  • Mike j

    I concur with Bill, many thanks for this detailed,knowledgable analyis.

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