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Feb 20 2013

Crack in the Foundation: A History of Andrew Bynum’s Knees

As a senior at St. Joseph’s High School in Metuchen, N.J., Andrew Bynum was misdiagnosed with an ACL tear in his right knee.

“They were ready to cut into him and everything,” his brother Corey Thomas told the Courant.

The injury came when he was bumped in a scrimmage (though his AAU coach tells me it happened during a game) and fell to the ground. But it turned out, it wasn’t a tear. Bynum saw a second doctor and the subsequent MRI revealed just a deep bruise on his kneecap and minor ligament damage. The anterior cruciate ligament was intact—his hoops death sentence was overturned.

“This was a big-time relief,” Thomas said. “We went from thinking it was a real serious injury that would cause him to miss the whole season to him having a chance in the county and the states.”

Crisis averted.

Image by Anthony Bain (Photo credit: AP)

Chronic knee injuries have dogged Bynum throughout his playing career. Though he was healthy during his first two seasons with the Lakers, since dislocating his left kneecap in January 2008, he has missed 123 games due to knee ailments of various stripe and another 26 to an assortment of bumps, bruises, and suspensions. He might miss 31 more before the season is out.

His injuries have come to define him. While Dwight Howard leads the NBA in rebounds and Kevin Durant in points, Bynum paces the sport in “knee” mentions on Wikipedia. The center’s two problematic joints have multiple accounts on Twitter, the most popular of which has amassed 253 followers—impressive maybe, but not the kind of numbers you want to put up in a contract year.

Not surprisingly, his recent medical file reads more like that of an old catcher than a putatively in-his-prime 25-year-old.

The next five years might not be any better. According to Orthopaedic Surgeon and former 76ers consultant Dr. Nicholas DiNubile, Bynum’s joint cushions may have permanently damaged areas called chondral defects. If the doctor’s right, this would make the center’s knees more susceptible to bone bruise-like symptoms (which as a practical matter, and on an MRI, are indistinguishable from actual bone bruises) following not just rigorous workouts like a professional basketball game, but even low-key activities. Like, say, bowling.

“From my standpoint, his situation is pointing to chronic issues causing a reaction in the bone because the cushion is damaged,” DiNubile told me.

His history points to a chronic problem as well. When he was twelve, Bynum had precautionary surgery on his right knee “because I was growing too fast,” the then rookie told Sports Illustrated in a 2005 profile. Doctors were concerned about his wide Q angle, which could have negatively affected his kneecap and foot pronation.

But despite this possible predisposition, Bynum managed to stay knee-injury free in the period between his first operation and the high school scare, according to AAU coach and mentor Larry Marshall. And while that kneecap bruise could have put an initial crack or focal area of damage in Bynum’s knee foundation, it’s impossible to say without access to his complete medical file.

“That’s one way it can start. You take a whack, and the cushion gets damaged, and then it can deteriorate over time,” DiNubile said.

 

Larry Marshall describes Bynum as “logical” and “analytical.” He builds computers and race cars.

“His best friends are not basketball players,” says Marshall, who started mentoring Bynum when the center was 13. “They’re geeks. Guys in computer industries.”

When Bynum was misdiagnosed with an ACL tear, Marshall said the level-headed teen took it well.

“He was really mature and understanding about what he’s up against. Most guys would get emotional and depressed. Andrew’s never been that type of guy.”

He has also never been the type of guy who succumbs to public pressure. As a senior in high school he signed a letter of intent to join Jim Calhoun’s UConn Huskies before declaring for the draft in May. He left his name there past the June deadline, ignoring the patronizing fatherly advice to stay in school from Calhoun and the Courant.

In the 2010 offseason — after he helped the Lakers win a title playing on a hyperextended knee — he went to South Africa for the World Cup which delayed his arthroscopic surgery. He would end up missing the first month of the following season. Lakers fans and media members were not content.

Yesterday, Bynum guaranteed a return but admitted that he’d have to play through pain. “Just deal with it without any type of intervention or any surgery,” Bynum said. “You have to deal with it. I just think this is something I have to get used to. I don’t know if I will ever play without pain. I can play with a considerable amount.”

He understands exactly what’s at stake, which might explain why he underwent Orthokine treatment (a non-invasive procedure) last summer, and why Microfracture surgery – which DiNubile says might be the solution long-term – is off the table for now.

Bynum will continue managing his chronic knee condition in a way that protects his health and financial well-being, just as he has done in the past. Whether that means suiting up in March or sitting out the season remains unknown, but this much is clear: He couldn’t care less about what people think of his plan.