Late Thursday evening, Adrian Wojnarowski tweeted, “ESPN Sources: Minnesota Timberwolves star Karl-Anthony Towns will undergo surgery to repair a torn left meniscus and will be re-evaluated in a month. It’s expected Towns will return by early in the Western Conference playoffs.”
This was hours after the news broke, shocking the NBA landscape that Towns would be out indefinitely with the tear. The report devastated fans and the team, but the news that Towns should be ready for the playoffs inspires hope. With that in mind, it’s important to understand Towns’ injury and what his recovery could entail.
First, what is a meniscus?
The menisci are two C-shaped pads of cartilage in a knee joint. These are called the medial and lateral menisci. The medial is located on the inside portion of the knee, sitting on top of the tibia and protecting the bone from the femur and articular cartilage. The lateral meniscus sits nestled on the outside of the tibia. Both pads are made of thick connective tissue called cartilage and serve as shock absorbers for the knee joint.
Picture a car going on a bumpy road, the wheels wobbling up and down but never allowing the vehicle to hit the ground. As they bob up and down, a closer look shows the shocks compressing and springing back, allowing the wheels to keep the car up. It’s similar to how the meniscus works. It protects the car (your femur) from bottoming out on the pavement (your tibia). If we didn’t have meniscus, during a jump, it would be possible on landing for bones to rub against each other or knock into each other.
Meniscus tears are the most common knee injury orthopedic professionals see. As a nurse, I have also seen quite a few meniscus tears, including my own knee. To tear this important piece of the knee, a person typically has an incident in which a foot is planted to the ground. The knees are bent to alleviate pressure on the menisci, and a twisting motion is applied to the knee. That allows the surrounding joints and structures in the knee to pull against the meniscus in opposite directions. This results in a tear, much like how someone tears a piece of paper, with forces pulling in the opposite direction.
Meniscus tears are often considered a severe injury because of the cartilage that makes up the meniscus. Think of a shark swimming through the ocean with the fin peaking about the waves. Focusing in on the fin reveals scratches and that something has taken a bite out of it. The bite looks like it happened years ago but remains. A shark fin is made of pure cartilage, as is the meniscus. Due to poor blood flow to cartilage tissues, the tissues cannot heal itself.
Therefore, a scratch on the shark fin can repair itself, but a bite or a chunk of the fin missing will never regrow or repair. That’s a good analogy for a meniscus tear. A meniscus can repair itself if the tear is small or superficial and close to the surface. It may take much longer than a similar injury to the skin or muscle, but it’s possible. However, a large tear or a tear that completely goes through the meniscus will likely never heal. In most cases, the lack of blood flow will never provide enough material for the joint to repair itself.
That’s the main issue that menisci present for athletes. The shock absorption it provides in a knee is imperative, but the menisci’s ability to heal is poor. It leaves athletes with few options for treatment. For minor tears, they can rehab to strengthen muscles around the knee and allow less stress on the menisci while giving them time to heal. Sometimes, injections of platelet-rich blood can be used to speed the process, but the recovery is never guaranteed due to the cartilage’s ability to heal. The prognosis for this route is typically four to six weeks. After evaluation, they may need further treatment.
The other option is surgical. Depending on the size of the tear, this can be done arthroscopically with small incisions and cameras. In this procedure, doctors trim the torn areas of meniscus or put internal stitches to link the cartilage back together. That leaves a small area in the knee joint that does not have cartilage to absorb shock or is held together with sutures.
People can use therapy and rehab to strengthen the muscles around that area to protect and lessen the strain on the knee. Prognosis for this procedure is much longer, expected to be two to six months. This could be longer depending on how the knee responds to sutures or secondary treatment, such as the use of platelets.
The most major surgery involves removing larger parts of the meniscus or the meniscus in its entirety. That’s the case for complete tears and the most severe cases. Think back to the shark fin with a bite in it. The fin still heals, but the missing part will never return. Like the shark fin, the knee can heal but will never have the shock absorption of the missing meniscus. This procedure, called a meniscectomy, is often the most common recommendation to the general public. Rehab for this surgery is just four to six weeks. Although, it can lead to long-term arthritis and potential knee pain.
Based on the timeline that Wojnaroski’s source gave him, it’s likely that Towns is electing to have the meniscectomy because the recovery fits with the playoff timeline. However, the verbiage of to repair in the tweet may suggest that the injury could take longer. It may have been a lack of understanding between the procedure and the prognosis, but it leaves Wolves fans conflicted because they don’t know what procedure Towns is undergoing.
The good news for Towns is that regardless of treatment, orthopedic professionals agree that someone suffering a tear will regain all of their athletic abilities if assisted by therapy and rehabilitation. Towns is in the midst of perhaps his best professional season, and the Wolves would welcome his return in the playoffs.
