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November 18, 2010
Greg Oden Sidelined Again

by Kevin Pelton


Even in the context of his history of knee injuries, Wednesday's news that Portland Trail Blazers center Greg Oden will need microfracture surgery on his left knee, ending his 2010-11 season before it ever began, was stunning. While Oden's recovery from a fractured left patella suffered nearly a year ago continued at its own deliberate pace, the more problematic left knee in Portland had been Brandon Roy's, which has hampered him lately. Mere hours after Wednesday's MRI revealed relatively promising news--Roy will miss the next two games before being reevaluated--it was overshadowed by the pall cast by Oden's third season-ending knee injury in four years as a professional.

Basketball Prospectus delves into the ramifications of Oden's most recent injury on his career and the Blazers' immediate and longer-term future.

Is There a Precedent for Multiple Microfracture Knee Surgeries?
Yes, though it is limited. My extensive microfracture research has found just one other NBA player--Denver Nuggets forward Kenyon Martin--who has undergone microfracture procedures on both knees. Martin had surgery on his left knee in May 2005, then had the same surgery on his right knee in November 2006. After missing the balance of the 2006-07 campaign, Martin returned as a starter the following year and has been productive the last three seasons while playing no more than 71 games in any year. Knee injuries have continued to hamper Martin, who is currently recovering from surgery on his patella tendon.

In the NFL, former Denver Broncos offensive lineman Matt Lepsis underwent microfracture surgery on both knees nearly a decade apart. He returned to play one season following the latter procedure, which was performed in conjunction with an ACL repair, before retiring at age 33.

Can the Blazers Still Compete in the Western Conference?
Maybe. Doing so was not contingent on Oden's availability. One of the obvious questions about SCHOENE's gaudy prediction for Portland was how much it was driven up by the assumption that Oden would stay healthy. As a result, at one point I ran a projection that did not include Oden whatsoever, giving his minutes to a combination of Marcus Camby, Dante Cunningham and Joel Przybilla. The Blazers dropped by five wins, though their projection remained tops in the Western Conference. Portland demonstrated last season the ability to win 50 games without Oden for much of the year (or even any legitimate NBA starting center between Przybilla's torn patella tendon and the addition of Camby).

Roy's injury, however, changes the math. No longer can the Blazers count on being carried by Roy and LaMarcus Aldridge alongside a group of solid role players. In the short term, Roy's ability to play at an All-Star level will be at least as important to the team's success as Oden's presence. Not having Oden does put more pressure on Camby--who has a history of nagging injuries--and Przybilla to stay healthy. The drop from those players to Sean Marks (or smaller lineups with Aldridge at center) is considerable.

What Lies Ahead for Oden?
If there is a bit of good news in this injury, it is that the timetable following surgery should put Oden back on the court in time for training camp next fall (assuming there are training camps next fall). What is unclear is whether the fact that Oden will be coming back from a pair of injuries to his left knee--first the fractured patella and now microfracture, which the Portland medical staff indicated did not appear to be related--will complicate this process.

From what we know about microfracture, it has important implications in the short term--player performance suffers the first season back from surgery--but can be overcome thereafter, especially in the cases of young players like Oden who suffered articular cartilage injuries through sudden trauma (this is the case even though there is no specific play or fall to which either of Oden's cartilage injury can be attributed) as opposed to because of significant wear and tear on their knees. So it is certainly possible that Oden can return to play at the high level he demonstrated early in the 2009-10 season.

However, Oden must be able to trust that he can play his game without pain and danger of re-injury, a point he never quite reached during his current rehabilitation. There iss also a cost associated with the time Oden has spent off the court the last four years. Virtually his entire career, with the exception of 2008-09 and the summer of 2009, Oden has been rehabbing to get back from injury rather than working to expand his game. Over time, that is surely problematic.

Will Oden Ever be Able to Stay Healthy?
Maybe. Generally speaking, I think people want more certainty about injuries than history or science can provide us. There is no binary distinction between "prone to injuries" and "not prone to injuries." As Blazers head athletic trainer Jay Jensen put it during Wednesday evening's press conference, "There are a lot of things in medicine that aren't black and white. There are gray areas."

The fact that so few players have needed microfracture surgeries on both knees tends to suggest, to me as a layman, that there is no structural aspect that predisposes players to cartilage injuries. However, given the variety of knee-related injuries Oden has suffered during his brief professional career, it is increasingly difficult to argue against the notion that his size puts him and fellow troubled young big man Andrew Bynum at a higher risk of injuries.

The key there, however, is that higher risk is not the same as guarantee. Players like Grant Hill and Zydrunas Ilgauskas have shed the "injury prone" label in the past. Ruling out that possibility in Oden's case would be premature.

That said, having microfracture surgery on both knees figures to catch up with Oden down the line. Microfracture remains relatively new to widespread use, and there is limited data on how long the fibrous cartilage it creates will hold up years after surgery--a topic Will Carroll touched on in his definitive microfracture essay in Pro Basketball Prospectus 2009-10.

What Happens When Oden Becomes a Free Agent?
As fascinating as LeBron James' free agency was for obvious reasons, Oden's may be even more interesting to watch. Suffice it to say that there has never in NBA history been a free agent quite like Oden--a player whose talent justified the No. 1 overall selection but whose future remains murky at best. After passing on the opportunity to negotiate an extension with Oden, Portland general manager Rich Cho must decide on an $8.8 million qualifying offer that would make Oden a restricted free agent (assuming a new Collective Bargaining Agreement does not blow up the entire RFA system).

The easy answer there is that the Blazers would pass on the qualifying offer, especially because they are over the luxury tax, despite the fact that it carries no long-term risk. That's not to necessarily say that Oden's career in Portland is finished, since the team could still negotiate a smaller deal with him as an unrestricted free agent.

What would other teams be willing to offer for Oden? For the next few months, that will make a fascinating topic for debate. My gut reaction is that the most I would offer for Oden, assuming a relatively stable marketplace under the new CBA, is $15 million over three years. Such an offer would carry a significant deal of risk, certainly, but would also stand the chance to potentially be a bargain should Oden be able to stay reasonably healthy.

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Kevin Pelton is an author of Basketball Prospectus. You can contact Kevin by clicking here or click here to see Kevin's other articles.

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