Commentary

Injury update: Which players should you be concerned about?

Updated: September 25, 2008, 10:52 AM ET
By Stephania Bell | ESPN.com

One of the key factors to consider in preparation for your fantasy basketball draft is the health of players. With that in mind, let's look at some of fantasy's best who are either currently rehabbing an injury or whose past injuries may give fantasy owners a reason for concern.

Kobe Bryant, SG, Lakers
Bryant's injury is nothing new. His decision to forego repairing it is. Days ago, it seemed as if Bryant planned to proceed with the surgery, which would give him the best window in which to recover while missing minimal time at the least critical point of the season. But Bryant said on his website, "When the doctors told me recovery from a procedure could be 12 weeks, I just decided now was not the time to have surgery."

Bryant initially suffered radial collateral ligament damage and an avulsion fracture (where a piece of bone is chipped off as the ligament tears) to the fifth finger of his right hand in February, and it impacted his availability for the NBA All-Star Game. Bryant postponed any surgical intervention at that time so that he could finish the season with his team, and proved that he could function quite well, helping lead his team to the NBA Finals and earning the league's MVP award. Bryant was also adamant about participating in the Olympics and was well rewarded with a gold medal performance by Team USA. Bryant was expected to undergo surgery to address his ligament injury and recovery was projected from 6-8 weeks. Bryant said he consulted with "numerous hand specialists" prior to making his decision, and the fact that recovery could have extended to three months helped him decide against it.

Kobe Bryant, 2007-08 Season
Before and After Pinkie Injury

Kobe Bryant's numbers after the injury were nearly identical to those beforehand. In fact, Bryant vastly improved his assist-to-turnover ratio.

Before
After
Games
46
36
PPG
28.5
28.2
FG Pct.
46.1
45.6
FT Pct.
83.6
84.4
RPG
6.3
6.3
APG
5.2
5.6
TO PG
3.4
2.8
So what are the ramifications of not proceeding with surgery? As mentioned, Bryant clearly managed to play and play well, despite the injury. Certainly some of the credit should be extended to the Lakers' athletic training staff who managed to tape Bryant's finger enough to support it while still allowing him his natural shot. Nonetheless, contact with the finger that forces it in an unnatural direction (especially hyperextension, the direction of the original injury) is bound to be painful, but as Bryant told the Los Angeles Times, "It just throbs & for five minutes or so. You just kind of have to endure it and wait until the pain subsides."

Bryant has proven he can play through some pain but are there long-term consequences? According to Dr. Jeffrey Guy, medical director and team orthopedic surgeon for the University of South Carolina, it's possible that Bryant could develop some arthritis in the joint in the future as a result of instability. But, as Guy says, "there's no guarantee that he wouldn't develop arthritis anyway, even without the surgery. And fingers don't like surgery. They almost always end up losing some of their range of motion." Guy points out that the "buddy" taping that Bryant has been using to support the finger provides plenty of stability, with the ring finger essentially becoming the new collateral ligament for the pinkie. Furthermore, given the time since the injury, there has probably been some development of scar tissue which actually serves to stabilize the joint. In other words, proceeding with surgery, although it provides some positives, also comes with its own set of challenges, total recovery time clearly being one of them.

The bottom line? If you were satisfied with Bryant's performance last season after the injury, there is no reason to be concerned heading into 2008.

Dwyane Wade, SG, Heat
Wade entered the 2007-08 season coming off injuries to two major body parts: his knee and his shoulder. Wade dislocated his left shoulder in February 2007 and although he returned in April, it was clear that he was not himself. Offseason surgery to stabilize the shoulder and the subsequent rehab helped him restore confidence in using that left arm. Wade also struggled with chronic patellar tendinitis, also called jumper's knee and common in basketball for obvious reasons, and underwent a debridement surgery to address that issue. The knee, in particular, continued to bother him during the season and he ended up being shut down early as a result. Wade's continued absence due to injury is no doubt due, at least in part, to his hard physical play and willingness to attack the basket. After a few months of rest, however, Wade's performance in the Olympics showcased a healthy and extremely talented athlete, a good sign heading into the fall.

Manu Ginobili
Timothy A. Clary/AFP/Getty ImagesManu Ginobili reinjured his ankle during the semifinals in the Olympics.
Manu Ginobili, SG, Spurs
Ginobili originally injured his ankle during the Spurs-Suns series in the 2008 NBA playoffs. The ankle bothered him throughout the remainder of the postseason and hampered his effectiveness. Ginobili underwent a trial of conservative rehabilitation, which included an injection into the painful area, immobilization of the ankle in a walking boot, and structured activity designed to regain strength to support the ankle. He was able to then function well enough to represent his home country, Argentina, in the Olympics, but suffered a setback during the semifinals.

The Spurs reported that Ginobili underwent subsequent surgery to address a posterior impingement, a condition whose name pretty well explains the problem. The impingement, or "pinching," results from injury to the soft and bony tissue in the posterior ankle region. Compression of the soft tissue in the posterior (back) of the ankle occurs during repeated plantar flexion, or pointing of the foot (which happens during pushing off, running and jumping), as the soft tissue gets pinched between the two bones that form the joint surfaces. This repeated pinching can lead to pain, inflammation and thickening of any of the associated tissues. Impingement can occur for a variety of reasons, including ankle instability resulting from prior sprains, which causes excessive motion within the joint and places strain on nearby tissues.

According to the San Antonio Express-News, Ginobili will be in a splint and on crutches for three weeks. Ginobili's recovery, provided there are no setbacks, is expected to take two to three months, meaning he is likely to miss the early part of the regular season. It is also important to bear in mind that Ginobili's explosiveness and power had been limited for some time by the condition, meaning it may take additional time once he is back on the court for him to return to preinjury form.

Yao Ming, C, Rockets
Yao has had his share of tough breaks during his NBA tenure. In April 2006, he broke the fifth metatarsal (long bone of the forefoot that connects to the fifth toe) in his left foot. In 2007, he suffered a serious tibial plateau fracture in his right leg and missed 32 games. His latest injury (February 2008) was a stress fracture in the tarsal navicular bone, one of the bones of the midfoot on the inner aspect, just anterior to the ankle joint.

A stress fracture is the microscopic breakdown of bone in response to the stresses placed on it, and it occurs when the bone cannot heal itself at a fast enough rate to keep up with those demands. Combine the repeated stress of impact loading with the sizable frame and mass of Yao, and it becomes easier to understand why he seems to be particularly susceptible to these types of injuries.

Yao began having some pain and soreness in the ankle/foot area around the time as the All-Star Game. As is usually the case with these types of injuries, there was no specific incident or trauma that anyone could point to as the "cause" of injury. Rather, it was likely developing over a period of time. The Rockets' team physician, Dr. Tom Clanton, performed surgery to place screws in the navicular, creating reinforcement to help strengthen the bone. Yao was able to participate in the Olympics, but was seen limping a bit after the Chinese national team's final game. Enough to worry Rockets fans and fantasy owners? Not according to Yao. Yao told the Houston Chronicle that the bone in his foot is fine; the limp was just due to some blisters. Breathe easy everyone, breathe easy.

Tracy McGrady, SG/SF, Rockets
McGrady's chronic back issues have been well-publicized. He missed 35 games in 2005-06, and although his condition improved, he continued to miss time intermittently in 2006-07. In 2007-08, he discovered other areas of his body to injure. McGrady suffered a shoulder injury, initially called a bruise, which gave him obvious trouble late in the season.

His left knee also presented a problem for him throughout much of the season, as he dealt with patellar tendinitis, a strained popliteal tendon (which inserts on the outside back corner of the knee and can result in pain and occasionally a feeling of instability) and a bone bruise. His knee swelled from time to time and the pain in the shoulder made it difficult for him to extend his arm at times.

In the offseason, McGrady dealt with both areas, undergoing arthroscopic surgery on the knee and the shoulder. A small labral tear was repaired in the shoulder. During the knee scope, reportedly no major structural damage was found. He can still contribute and these injuries appear to be on their way to resolution. But it is hard to overlook the fact that McGrady has missed significant time every season as a result of injury, and the back problem is one that has the most potential to resurface. There is reward with McGrady on your roster when he's healthy, but there is always the risk that he misses valuable playing time.

Elton Brand, PF, 76ers
It doesn't take a medical degree to appreciate that the repeated jumping required in basketball is going to ultimately strain the tendons most responsible for that vertical leap. The patellar tendon, which anchors the quadriceps muscle (the large muscle that constitutes the front of the thigh) and the Achilles tendon, which anchors the calf muscle, are the two that are at most risk for failure. We've seen how chronic patellar tendon problems can limit a player (see Dwyane Wade), but the acute failure of an Achilles tendon, which can sound like a shotgun blast as the tendon snaps off the heel like a broken rubber band, typically results in the loss of a season in basketball.

And so it was for Brand, who tore his left Achilles during a routine workout in August 2007. That injury required surgery to reattach the tendon, followed by immobilization to allow the repair to heal. Then there is the extensive rehab required to get back into the game. The Achilles is in demand for every jump shot, every dunk and every rebound; there is no getting around it. Brand was able to return for the final eight games of the season, showcasing his talent and his health enough to earn a new contract with a new team. Brand told the Orange County Register in June that his Achilles was "100 percent" and he appeared to back it up with his eight rebounds and 17-plus points per game in his shortened season. Given his solid performance at the end of the season, there is no reason for concern about Brand headed into this season.

Greg Oden
AP Photo/Rick BowmerThe Blazers hope Greg Oden's hard work rehabbing will result in a huge rookie season.
Greg Oden, C, Trail Blazers
It was a shock and disappointment for everyone, including Oden himself, when he found himself sidelined for his entire rookie season as a result of cartilage damage to his right knee. The damage required that Oden undergo microfracture surgery, a delicate procedure designed to help the knee establish an alternate cartilage surface (not quite as good as the original, but protective of the underlying bone surface nonetheless). The procedure can be quite successful, but in basketball players it presents a special challenge because the combination of large physical frames taking a repetitive pounding from running and jumping adds extra stress to those joints.

To see a player so new to the game be subject to this serious of a procedure is definitely cause for concern, but not all-out despair. Just think, were it not for a procedure such as this, Oden might not have a future at all. And as it happens, his youth and diligence appear to be paying off. Trail Blazers general manager Kevin Pritchard told the Portland Tribune that "the thing we worried about was, would he have his explosion back? I think the answer is yes, and [the knee] is coming back maybe stronger than it was before."

Although he still has a ways to go to be ready for regular-season NBA action, Oden continues to make progress and given the timing of his injury, has been able to progress at a very deliberate pace, well structured by the Blazers' medical staff. How his knee holds up over the long haul has yet to be determined, but all signs are good for him getting off to a great start in 2008-09.

Andrew Bynum, C, Lakers
All the right folks are on the Bynum bandwagon. His agent, David Lee, told the Los Angeles Daily News that Bynum is in great shape. Lakers general manager Mitch Kupchak went to Atlanta in August to check out Bynum's progress for himself. According to the Orange County Register, Kupchak was pleased with what he saw.

"I could see improvement in his body, his conditioning and mobility," Kupchak said. "I didn't see any signs of effects from the surgery." As for Bynum himself, he told the Los Angeles Daily News just this week, "The knee's good. Everything's ready to go, 100 percent. I've been training, getting stronger."

Bynum was originally injured in January when he landed awkwardly on teammate Lamar Odom's foot while going for a rebound. He suffered a patellar subluxation, where the kneecap slips partially out of place but does not dislocate. The subluxation itself can result in tearing of soft tissue and cartilage damage on the undersurface of the kneecap, and in Bynum's case, persistent pain and inflammation prevented him from returning after a standard course of conservative treatment. He subsequently underwent surgery in May which was performed by Dr. David Altchek in New York, one of the best in the business, and Bynum has been steadily making progress ever since. In addition to his rehabilitation, Bynum sought the services of a personal trainer in the summer to improve his fitness. The combination of rest and recovery has put him in a strong position heading into training camp.

Bynum's issues that prevented him from returning last season are not altogether uncommon after a patellar subluxation. Most importantly, the problems that he was having were addressed with surgery and he has had ample time to rehab, strengthen, condition and prepare for the upcoming season. His time away has no doubt made him hungry to return, and the $80 million contract extension his agent is seeking on his behalf can only serve as extra motivation. Expect Bynum to have a productive season.

Monta Ellis, PG/SG, Warriors
Ellis underwent surgery in late August following a severe high ankle sprain and a ruptured deltoid ligament in his left ankle. The matter of how he injured the ankle is still unclear, but at least we have an idea of what his rehabilitation will entail. The prognosis is for Ellis to miss three to four months, but expect his return to be on the long side of that.

Ellis will have his ankle immobilized for six weeks following surgery, and then he will have another six weeks of off-court rehab before becoming eligible to return to basketball workouts. That puts Ellis at mid-November before even setting foot on a court and his official return won't be announced until sometime afterward. The key to Ellis' return is how long it takes his ankle to recover from the stiffness and weakness that naturally follows being in a cast for six weeks. Simply returning to a normal gait takes some time, much less returning to an explosive, aggressive sport. He is going to need full mobility and power in his ankle to be effective in playing his style of game, including quick lateral cuts and jumps. (Read: December return, if all goes well.)

Gilbert Arenas, PG, Wizards
Arenas initially tore the lateral meniscus in his left knee in April 2006. Thus began the knee problems that plagued him into 2008. Although he made a few appearances in the spring, the knee was never really 100 percent. And recently, Arenas surprised everyone by undergoing yet another surgical procedure on his problem knee. So what should we expect in 2008?

It helps to first understand everything Arenas' poor knee has endured. The meniscus is a fibrocartilage disc which serves as a cushion within the knee joint. There are actually two menisci; the medial meniscus rests in the inner (medial) aspect of the knee and the lateral meniscus is located in the outer (lateral) aspect. They help to enhance the stability of the knee joint and absorb some impact during all weight-bearing activities such as walking, running, pivoting and jumping. Once a portion of the meniscus is damaged, the remaining meniscus is subjected to increased shearing forces, which it tolerates less due to its altered condition. Lateral meniscus tears are notoriously more difficult to rehab than medial meniscus tears and they typically do not respond as well postsurgery. Arenas underwent surgery in April 2007, yet continued to struggle with persistent swelling. Arenas had the knee drained multiple times, a reasonable step, but that failed to yield any long-term results.

Ultimately, he found himself back in surgery to address a medial meniscus injury in the same knee. Dr. Marc Connell, the team physician who performed the surgery, also performed a microfracture procedure on the trochlea, the groove in the femur (thighbone) where the kneecap rests. The words microfracture and basketball player in the same sentence always prompt concern, but in this case some comfort could be taken in the fact that the microfracture-treated surface was non-weight bearing, making it slightly less delicate.

The fact that the Wizards shut down Arenas' season early when it became obvious that he would not be at his best, as well as the fact that they invested significant money into his new contract, seemed to bode well for him. The combination of a happy athlete and the reassurance that the team believed him healthy enough to warrant such an investment, as well as an extended offseason to rehab, all pointed to an improved outlook for 2008-09. But in an announcement that took many by surprise, Arenas indicated that he underwent yet another procedure on the knee September 17.

According to the Washington Post, Arenas underwent an arthroscopic lavage, a fancy term for a cleanout type procedure on the knee. Given the amount of work Arenas has had done on this knee, such a procedure is not uncommon, and was performed to help remove some residual debris within the joint. As Arenas had been working on ramping up his rehab activities, the knee began to swell and he experienced some discomfort. In a statement released by the Wizards, Dr. Connell described the rationale behind the procedure.

"[An] MRI showed that the knee was surgically sound." Dr. Connell said, "The decision was made to perform an arthroscopic lavage procedure, during which a moderate amount of debris was removed after saline solution was washed through the knee. The presence of the debris is common with the nature of his previous injury. This was a proactive procedure that will enhance his rehabilitation process."

In other words, the debris might otherwise have continued to prolong his return, and although he has to recover from the procedure itself, ultimately this should improve the overall health of Arenas' knee and allow him to steadily progress. For their part, the Wizards told the Post that they always understood that Arenas might not be ready for the 2008-09 season, but that they always had the "big picture" in mind. He is just 26 years old and they feel he has plenty of game left.

Arenas' knee will never be the "perfect" knee again, simply because the landscape is forever altered as a result of his injury. But can he be functional? Yes, although it may mean intermittent rest throughout the season to protect him. And don't expect him to be available any time soon. Arenas, who via his blog on NBA.com explains his injury in detail from his perspective as a frustrated athlete trying to return to the game, says that his return timetable falls somewhere between mid-December and January 1, if all goes well. He calls that the "Christmas/Hanukkah/Kwanzaa present" he's hoping for. Fantasy owners may be looking for a holiday gift on the waiver wires around that time as well. It just may come in the form of one Gilbert Arenas who, once he's back, hopes to provide a spark for his team, and yours.

Brandon Roy, SG, Trail Blazers
Roy is recovering nicely from arthroscopic surgery on his left knee in August to address a torn meniscus. As of the first week of September, Roy was riding a bike and even doing some shooting for the first time since surgery. He has not yet returned to running, which is appropriate for his post-surgery rehab timetable, but remains on schedule according to coach Nate McMillan's comments in The Oregonian.

If you believe in past performance as a predictor of future success, which is often useful in evaluating injury recovery, you can be encouraged when it comes to Roy. He underwent a similar procedure on his right knee in 2004 while at the University of Washington and returned three weeks later. Not all meniscus tears are created equal, but reports in The Oregonian shortly after Roy's surgery indicated that the damage was minor. This was not a traumatic injury, but rather the result of wear and tear on the knee which is a natural byproduct of playing in the NBA.

The downside for Roy is that he has been challenged by injuries in his relatively short career, including a heel problem that caused him to miss 20 games as a rookie. At least you could argue that Roy understands the value of rehab. Although he does pose an injury risk, this particular knee surgery does not appear to present a major concern.

Jermaine O'Neal, C/PF, Raptors
Maybe the cool weather in Toronto will be a good change for O'Neal.

He has had his share of health challenges, most recently a bone bruise in his left knee which forced him to miss significant playing time in 2007. Originally, O'Neal underwent surgery in April on the knee and was expected to require a 4-6 week rehabilitation. By October, he was still having soreness with running and struggled to return in November, even while on a playing time limit for the knee.

Forget the stinger and the concussion he suffered in the interim, O'Neal continued to have troubles with the knee, which was later revealed to have a deep bone bruise. After missing 33 straight games, O'Neal returned for a few games but had his minutes limited to about 20 per game. Interestingly, the Raptors still completed the deal, so there must be some confidence that O'Neal's knee has improved to the point where he can play on a regular basis. But we have yet to see it on the court. Keep that in mind come fantasy draft time.

Stephania Bell is ESPN.com's injury expert. She is a physical therapist who is a board-certified orthopedic clinical specialist and a certified strength and conditioning specialist.