Dustin Pedroia Update, 10/25/17 – Microfracture, Most Likely, for Miniature Midfielder

It has been known for several weeks now that the Red Sox’ second baseman has been wrestling with his options for his painful left knee. With the announcement today that Pedroia had undergone a “cartilage restoration” procedure on his knee yesterday, the logical question is – what does this mean for Pedroia in 2018 and moving forward? 

Image courtesy of edraft.com

As has been detailed in a previous post here, http://chrisgearyortho.com/2017/10/11/pedroias-patellofemoral-pain-potentially-problematic-possibly-permanent/, the Sox’ second baseman had been considering non-surgical and surgical options for his painful left knee, which had undergone previous knee arthroscopy but had continued to cause him issues throughout the 2017 season. The downside of another surgical procedure on the knee was the long rehab, with a good portion of his 2018 season likely being sacrificed to rehabilitation for his knee and getting back into playing shape. The drawback of not going under the knife was the specter of another season of on-and-off knee pain, with additional trips to the disabled list likely if not definite. With this in mind, Pedroia yesterday elected for a “cartilage restoration” procedure at the Hospital for Special Surgery in New York City.

If this story sounds painfully familiar to Sox fans, it should- it is the same type of surgery that Steven Wright underwent earlier this year, at the same hospital. While it has not been announced exactly what kind of surgery Pedroia underwent – “cartilage restoration” is a broader category of surgeries which includes multiple different potential techniques- he most likely had a microfracture to address his cartilage injury. In this procedure, multiple holes are poked in the exposed bone of the knee joint in an effort to stimulate new cartilage growth and thereby remove the source of pain.

Arthroscopic image of a microfracture of the femoral condyle of the knee (image courtesy of mayoclinic.org)
This is a well-established procedure with a proven track record for returning players to action – depending on the study you read, between 75-90% of patients have good results with this surgery. There are several examples of players in MLB who have had the procedure and returned to play – in the last few years, examples include Carlos Beltran (2010), Victor Martinez (2012), and Brad Ziegler (2014). There are also cautionary tales such as Grady Sizemore (2013), who had the surgery but never fully recovered to being the player he was before. It’s also possible that Pedroia underwent a different type of cartilage surgery – possibly the insertion of a plug of cadaver (allograft) bone and cartilage (OATS procedure). This is different from a technical standpoint but has the same goal (the growth of new cartilage) and largely the same recovery. 

The downside of the procedure is the long and arduous rehab – Pedroia will be fully non weight-bearing with crutches for up to two months, and will be in a continuous passive motion (CPM) device for 4-6 hours a day during that time. The CPM will bend his knee for him, with the goal of more successful cartilage growth. Following this will be a gradual return to weight-bearing, strengthening and eventually full activities.  The Sox have announced a goal of seven months for Pedroia to return to full baseball activities, a timeline which would potentially have him back at Fenway by mid-May. The caveat to this projection is that every rehab is different, and depending on the particular area of the knee affected -the patella (kneecap) and femur are the most common areas to undergo this type of surgery- the timeline may vary. It’s also important to not be too quick to compare Pedroia to Steven Wright, as the demands of playing second base (especially the way Pedroia plays it), batting, and running the bases are substantially different from throwing a knuckleball. That being said, the odds are in Pedroia’s favor that following his long rehab, he will be able to return with a knee which should allow him to stay on the field more reliably than in 2017.

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