Recently the Boston Celtics drafted Robert Williams with the 27th pick of the 2018 NBA Draft out of Texas A&M. A 6’9” center, Williams has not had the best introduction as part of the Celtics organization. Initially he overslept causing him to miss an introductory conference call. Then he missed his flight, and had to skip his first Summer League practice with the Celtics. Unfortunately, things have not gotten much better for Williams once he started playing in the NBA summer league games.
Williams sustained a left knee injury in the first half of the Celtics win over the 76ers, where he scored four points and grabbed a pair of rebounds before banging knees with a 76ers player. The initial diagnosis was a left knee bruise/contusion, which could’ve definitely explained his discomfort and continued time off the court. Sometimes bone bruises can be very painful, especially in the knee area, just ask NFL quarterback Sam Bradford.
Then last night, MassLive broke a story stating that Williams reportedly has an artery condition in both of his legs, a condition known as Popliteal Artery Entrapment Syndrome (PAES). Apparently NBA teams interested in Williams were aware of this condition at the time of the draft, including the Celtics, as was Texas A&M, where Williams played his college ball. The L.A. Clippers’ doctors, who performed Williams’ pre-draft physical, reportedly disseminated the results to the other organizations (a common practice) after discovering this condition. Obviously this did not deter the Celtics from drafting Williams, which should give you an idea of how significant of a concern of this condition presents.
So what is Popliteal Artery Entrapment Syndrome? As a sports medicine doctor I see all types of unique variants of the normal human anatomy, and PAES is one that I have read about but not personally seen in my practice – yet. This condition is probably misdiagnosed, as the complaints are often very vague, sometimes described as cramping, numbness, tiredness, and calf pain during exercise (this is called intermittent claudication).
In PAES, symptoms typically go away after about 3 to 5 minutes of rest, and if they do not then there are other conditions that need to be taken into consideration. PAES occurs because of an abnormal configuration of the muscles and tendons behind the knee, which when engorged with blood compress a vital blood vessel that delivers blood to the lower legs – the popliteal artery. This is basically the main artery that runs through and behind the back of the knee. Compression of this artery restricts blood flow to the lower leg, resulting in poor cell nutrition and slow development of symptoms.
So how do you get PAES? There are basically two options; either you’re born with it or you develop it. If you were born with it, this is secondary to large calf muscles (gastrocnemius or popliteus muscle). The condition can also develop over time, secondary to exercise and training, which in turn causes hypertrophy of the calf muscles, thereby compressing the popliteal artery.
Who is at risk for PAES? This condition most commonly occurs in male athletes under the age of 30 – Williams is 20. Certain sports increase the likelihood of developing the condition, including soccer, football, rugby, and runners. Reportedly less than 3% of people who are born with the muscle variant/defect that can lead to PAES develop the symptoms, consider it a case of bad luck for Williams.
How is this condition diagnosed? This is not something your typical family medicine doctor or orthopedic surgeon will usually diagnose. While many of them will be aware of the condition, typically the patient is referred to a sports medicine specialist or vascular surgeon for a complete work-up. Evaluation begins with checking the pulses of the foot and popliteal artery, first at rest. Certain diagnostic tests can be used to diagnose the condition including an ankle brachial index (ABI) with and without exercise – this test basically measures the blood pressure in the arms and legs before and after exercise. Another options include Duplex Ultrasound, Computed Tomographic Angiography (CTA), or Magnetic Resonance Angiography (MRA). Each of these options uses a form of imaging to evaluate the arteries and sometimes even the muscle and tendons as well.
Once diagnosed, what are the treatment options? The most common treatment is careful observation, along with modifications to lifestyle and exercise. Surgery can also be done to correct the problem, where the muscles and tendons are surgically released to alleviate the compression of the popliteal artery.
In Williams’ case, I completely expect the Boston Celtics medical staff to carefully observe him with serially monitored ABI’s of his lower extremities. If this issue continues to bother Williams, especially in the event of a situation where he has to play on back-to-back nights, surgery may be the best option. Surgery for this is typically pretty straightforward and often involves a quick hospital stay. A normal follow-up protocol includes serial ultrasounds of the repaired artery as well as lower extremity blood pressure checks at 4 weeks, 8 weeks and 1 year.
In review, new Boston Celtics draft pick Robert Williams was diagnosed with a condition called popliteal artery entrapment syndrome, which causes an aching, numb and tired pain in the calves after exercise and resolves with rest. The expectation is that Williams will be monitored closely, and his exercise schedule will be adjusted accordingly.
Magic center Mo Bamba diagnosed with stress fracture
How will the Lakers adjust without Lonzo Ball?
Not one, not two, but a total of three Lakers have been sidelined with impactful injuries, just within the past thirty days. First, it was four time MVP, Lebron James, just weeks after, it was veteran back-up point guard, Rajon Rondo, and now as we speak, starting point guard, Lonzo Ball. Ball’s injury was sustained moments after the second year point-guard caught a skip pass, coming from the far, right corner to the top of the key. After receiving the pass, Ball headed straight towards the rim but when cut off by Houston Rockets wing, James Ennis, his ankle gave out as he gingerly fell onto the court. Ball had to exit the game for its entirety and was unable to walk off the court under his own power.
Quite frankly this injury comes at an inopportune time for both parties- the Lakers and Ball. Not only will Ball’s inherited gifts such as his length, size, and athleticism be missed, but also the incessant improvements to his outside shooting and defense that have shown through, recently. From an X’s and O’s adjustment standpoint, look for the Lakers to utilize Brandon Ingram more as a primarily ball handler in the starting lineup. His length and adept ball-handling skills advertise him as a viable candidate to get the ball up and the down court in an efficient manner. Ingram is also a worthy interim-replacement because he sticks to the script when it comes to getting his team into their offensive sets. In other words, his game doesn’t embody many selfish tendencies which makes it easier for other players to involve themselves in the offense. That being said, even though Ingram may be their best option, it doesn’t take away from the fact that the main approach will be to move the ball via competent passing. Ingram isn’t equipped with nearly as much speed in the open court like Lonzo; therefore, it is more feasible to put emphasis on passing as the main mode for movement because the ball always outruns humans.
In regards to the future, news has already broken out that the severity of the sprain is viewed as a grade 3. The protocol for Ball realistically will be wearing an ankle brace for 2-3 weeks. It is important the Laker’s training staff takes the ultimate amount of precaution, with Ball being regarded as a piece of the posterity for this this team. Ball has the chance of suiting up to play in about 6 weeks. Lakers fans are going to have to hold tight for a little while to see their young stud suited up.
How bad is the Lonzo Ball ankle injury?
Los Angeles Lakers point guard Lonzo Ball suffered a left ankle inversion sprain in yesterday’s game against Houston. He was not able to bear weight on the ankle and had to be carried off the court. He underwent an MRI, which revealed a grade 3 ankle sprain. This means a complete tear of the lateral ankle ligaments. He will be treated in a walking boot for 2 to 3 weeks, followed by an ankle brace.
A realistic return to play after this injury is about 6 weeks although it could be even longer. Surgery is rarely required but may be necessary in the future if he develops permanent ankle instability.
Until Rajon Rondo returns, the Lakers will likely rely on Brandon Ingram and Josh Hart to cover the point guard position.