Adam’s Journal
Like every Thunder fan, I was horrified by Jalen Williams’ gruesome ankle injury. And then we learned that in the same game, Cason Wallace had torn the labrum in his shoulder.
Williams has undergone surgery, and as of this writing, Wallace is set to do so. The Thunder have not issued any timeline for when they might return to the court, though many experts have said both injuries could be season-ending.
Why does recovery from joint injuries take so long, even after surgeons have repaired the damage?
Dr. Scofield Prescribes
Most of us don’t think about them on a day-to-day basis, but our joints are engineering marvels.
A joint is a place in the human skeleton where two bones meet. Throughout our bodies, we have more than 250 of them, and they vary in complexity. The shoulders and ankles are two of the most complicated joints: each has a very wide range of motion and relies on a network of other structures for stability and function.
The ankle joint is where three bones come together: the tibia, fibula and talus. They’re held together by a complex network of ligaments, bands of fibrous connective tissue.
When Williams fell, he both broke his fibula – the outer of the two long bones in the leg – and dislocated his ankle. Dislocation means that both the fibula and tibia (the other bone in the lower leg) moved out of their normal alignment with the ankle bone, known as the talus. In the process, the ligaments holding the bones together were torn.
With surgery, bones can be reset. Bone is living tissue with a substantial ability to regenerate. With proper alignment and stability, new bone will remodel into a structure much like the original.
Twenty years ago, I broke both my fibula and tibia. I was non-weight-bearing for 14 weeks, which wasn’t fun. But the recovery was so complete that to remember what side it was on, I now have to take off my shoes and socks to find the surgical scars.
I was lucky: my ligaments were spared. Williams wasn’t so lucky, and the ligament damage he suffered may well turn out to be the bigger issue.
Even though the ligaments have been surgically repaired and reattached, they now require extensive time to heal and regain full function. This is due to the lack of blood supply to ligaments, the time it takes the collagen that makes up ligaments to repair itself, and the slow process of regrowing ligament-to-bone connections.
With Wallace’s torn labrum, the story is similar, although his path to recovery could be somewhat quicker.
The labrum is a ring of tough, fibrous cartilage that surrounds the shoulder socket. When torn, surgery can restore the labrum’s integrity relatively quickly. But, as with Williams’ ankle, the repaired tissue requires significantly more time to recover and regain the strength necessary to withstand the rigors of NBA basketball.
Like ligaments, the labrum enjoys only limited blood supply, which slows healing. And while surgeons can reattach a torn labrum to the bone, it can take up to a year for that connection to solidify to the point that it more or less recreates the original, pre-tear attachment.
Our joints perform miraculous feats of strength and agility. When we damage them, surgeons often can restore anatomical structure in a matter of hours. But the restoration of function, even for world-class athletes, can’t be rushed.
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Dr. Hal Scofield is a physician-scientist at the Oklahoma Medical Research Foundation, and he also serves as Associate Chief of Staff for Research at the Oklahoma City VA Medical Center. Adam Cohen is OMRF’s senior vice president and general counsel. Send your health questions to contact@omrf.org.
