Denver Nuggets rookie Michael Porter underwent a second lumbar surgery, just a few months after having a microdiscectomy. Details on the second surgery are scarce, but it likely was one of two things. The first, and more likely possibility, is that there was recurrent or residual disc material near the nerve, and Porter was having ongoing symptoms that were not resolving. This surgery would be very similar to the initial microdiscectomy, and will set his timeline back. Return to play would probably be around 3-6 months. The second possibility for the surgery is that he had a spinal fluid leak. Surgery for this is rare, but sometimes necessary (this is the surgery that Steve Kerr required twice). This has a shorter timeline to return to play, likely 6-8 weeks.
A closer look at the Robert Williams diagnosis-Dr. Morse
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.
Video: Celtics rookie Robert Williams has arterial condition
Celtics rookie Robert Williams has artery condition in his legs. Our Dr. Selene Parekh breaks down this condition and what it means for the rookie. Watch below:
The Marvin Bagley lll injury puts the Kings in precarious position
Former Duke standout, Marvin Bagley III, has suffered a right hip and groin strain which will keep the high flyer sidelined for two to four weeks. This injury occurred just around the mid-way mark of the fourth quarter in a summer league matchup between the Kings and Suns. Bagley attempted to front first overall pick, DeAndre Ayton, in the post, but ended up not succeeding in doing so. Bagley’s long, athletic frame at 6’11” 235 pounds wasn’t able to move stalwart, DeAndre Ayton, standing at 7’1 260, out of the paint. On the play, Ayton had his way with Bagley, pinning him low to the ground. Once the ball was thrown in the air, Bagley took off from a disadvantageous position and made contact with a brick wall.
The injury comes at a bad a time for Bagley and the Kings because of the short evaluation window that comes with summer league. Even with earning the second overall pick, there are still some concerns with Bagley’s game. Though he is an elite athlete, there are questions about who he matches up with on the defensive end because of his slender frame. On top of that, Bagley still needs to show the ability to consistently knock down shots from deep and then develop the knack of finishing at the rim with his right hand. However, in limited summer league action, Bagley was able to show flashes of potential with some ball handling repsonsibilities as well.
Sacramento also needs to see Bagley play to feel how he fits in the rotation. Second year big man from Duke, Harry Giles, has stepped up for the Kings on the block. He is now fully recovered from his knee injury and has extended his range to the three point line. The two fellow Dukies could develop into a fierce duo on both ends of the floor, but Bagley must be healthy. The Kings having an aging Zach Randolph and could really use the young big men to step up to their potential in large roles.