I covered Dustin Pedroia in my injury update article a month ago. At the time I had written that he most likely had a cartilage repair procedure on his meniscus which is the “cushioning” cartilage between the femur and tibia in the knee. Today’s report by David Shoenfield of ESPN makes me believe that that assumption was wrong. In this article Pedroia is quoted stating he wished he never had the procedure. The article states that he had “a cartilage restoration procedure on his left knee that involved grafting cartilage from a cadaver to fit in the damaged area”. This is not the same procedure as a meniscal repair. It is a procedure that very difficult to recover from and does not bode well for his long-term outlook.
As I wrote about in my injury update a few weeks ago “I would venture a guess that Pedroia has an arthritis issue also causing constant pain when he runs or cuts. Arthritis is when the cartilage that covers the bone comes off and leaves the bone bare. This is a different type of cartilage, and again, one that is very difficult to repair.” Seems I was correct in this regard. The damaged area that is mentioned has to be the articular cartilage of either his tibia or femur, the cartilage that covers the bone. There are a few ways to try to fix this, but none of them are good at returning someone to full health. They may delay the inevitable knee replacement down the road, but to return to being an elite athlete is very difficult. Dave Dombrowski, the Red Sox GM, was reported to have said earlier this week that the team was hoping for 120 games from Pedroia this year.
Pedroia’s surgery involved taking a piece of cartilage from a cadaver, cutting it to the size of the defect in his knee, and then either “gluing’ or “fixing” it in place. “Fixing” it means it is either stapled or pinned with small plastic screw-like devices. This takes a very long time to heal. The cartilage and the surface of the bone has very little blood supply so the healing process is prolonged. For an athlete, this is the best option of the possible procedures as it provides the best chance of returning to the field.
There are at least three other options that I am aware of in this case. One is to drill small holes throughout the exposed bone where the cartilage is missing. This causes a reaction that forms a layer of fibrinous material to cover the exposed bone. This helps in relieving the pain but is not something that will allow a return to the field. The second procedure is called an OATS procedure. This involves taking “plugs” of bone and cartilage from non-weight-bearing parts of the knee and transferring them to the weight bearing defect. In a way this is similar to what Pedroia had but again, not the ideal thing for an elite athlete trying to return to the field. The other procedure is one that involves using a graft made of infantile stem cells that is glued over the defect. Over time the cells grow and form new cartilage. This takes time, is a relatively new procedure, and I’m not sure if there is enough history to show it is something that an athlete can return to the field afterwards.
Bottom line is that Pedroia had the best procedure to allow him to return to the field. Would I bank on him getting 120 games in this season? It would definitely surprise me. If someone is saying that he wished he never had a procedure done, then he must not be happy with the outcome. It’s not that anything went wrong, I just don’t think he was prepared for what the reality was. So, if you’re thinking about drafting or bidding on Pedroia in mid March when he’s looking ok in spring training, think again and don’t do it.