Microfracture No Death Sentence for Stoudemire
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Kevin Pelton, SUPERSONICS.COM | January 8, 2007
When Phoenix Suns center Amaré Stoudemire underwent microfracture knee surgery in October 2005, just months after his breakout season earned him All-NBA Second Team honors and helped lead the Suns to the Western Conference Finals, Stoudemire's future was cast into doubt. Immediately, thoughts throughout the NBA turned to past microfracture patients, like Penny Hardaway, Allan Houston and Jamal Mashburn, who had seen their careers derailed at best or ended at worst by the serious operation.

Publicly, the Suns hoped for a return at the All-Star break and remained upbeat. However, Jack McCallum, who was working as a member of the Suns coaching staff at the time, presented a more grim outlook in his book about Phoenix's season, :07 Seconds or Less.


"I don't think we envisioned that Amaré would be this good this quick." David Sandford/NBAE/Getty
"A general atmosphere of optimism permeates the franchise on a surface level," wrote McCallum. "... But no matter what everyone says, dark thoughts creep in. Similar knee injuries, to NBA stars such as Penny Hardaway and Chris Webber, are dire precedents since neither player was the same after his procedure."

In late March, Stoudemire's attempted comeback was cut short after just three games, including just the second scoreless outing of his career. He underwent surgery on his other knee, pushing back his return to the start of 2006-07 season. McCallum's book also details serious questions inside the Suns organization about Stoudemire's work ethic. Would Stoudemire be able to return at anything near full strength?

Now we have our answer: Yes.

As the Seattle SuperSonics prepare to take on the Suns for the first time this season, Stoudemire looks a lot like the dominant Amaré of old - except for changing his jersey number from 32 to 1. After a slow start to the season, Stoudemire averaged 20.5 points, 9.6 rebounds and 1.6 blocks during the month of December, recording 10 double-doubles in 15 games. Stoudemire's minutes are still somewhat limited, but he has shot 60.5% from the field.

"I don't think we envisioned that Amaré would be this good this quick," Suns Coach Mike D'Antoni told the Arizona Republic after Stoudemire dominated a matchup with Orlando's Dwight Howard in December, outscoring Howard 30-4.

Stoudemire is not alone. All around the league, microfracture success stories are starting to become even more commonplace than the well-known tales of horror.

Zach Randolph of the Portland Trail Blazers may be the first player to come back from a microfracture surgery better than he was before. After going on the operating table in March 2005, Randolph was able to come back for 74 solid games in 2005-06. Fully healthy this year, Randolph is averaging 24.0 points and 10.3 rebounds per game. Fifth in the NBA with 19 double-doubles, Randolph is making a strong case to earn the first All-Star appearance of his career.

Microfracture has been almost a non-issue for New Jersey guard Jason Kidd, who missed the first 16 games of the 2004-05 season after off-season surgery but has continued to play at an All-Star level. At age 33, Kidd still ranks second in the NBA with 9.1 assists per game, and his 8.2 rebounds per game are a career high.

Matt Harpring has never been a star, but the veteran forward has survived not one but two microfracture procedures on his right knee. Harpring is averaging 10.3 points and 4.5 rebounds on 49.8% shooting for the Northwest Division leaders.

Described by the media as "controversial" as recently as the time of Stoudemire's surgery, microfracture has now become remarkably commonplace. Since March 2005, nine players have undergone the procedure, including two - Denver's Kenyon Martin and Portland's Darius Miles - so far this season. (Click here for a list of NBA microfracture surgeries.) And, more so than conventional wisdom would have you believe, those players have returned successfully.

As the following chart shows, the six players to return from microfracture surgery over the last three years (including Harpring twice) have actually improved their per-minute rebound rates, one of the first places you'd suspect reduced athleticism would be apparent. Overall, their PER ratings have declined, on average, by just 6.2%. The biggest difference has been in terms of stamina, with Kidd the only player who was able to come back and play more minutes per game the season after undergoing microfracture:

COMING BACK FROM MICROFRACTURE SURGERY
Microfracture
MPG
P40
R40
A40
S40
B40
TO40
TS%
PER
Before
34.5
19.0
8.1
3.3
1.2
0.6
2.4
.537
17.9
After
28.8
18.3
8.4
2.8
1.2
0.6
2.3
.540
16.8
TS% - True Shooting Percentage
PER - ESPN Insider John Hollinger's rating of player performance

None of this is to say that microfracture surgery is not serious. Martin's athleticism was limited after he underwent microfracture in May 2005, and he missed 36 games in 2005-06. Early this season, Martin went in for knee surgery and would up with microfracture on his left knee. He is believed to be the first player ever to have microfracture on both knees, and how Martin will respond next season is anybody's guess.

BEFORE AND AFTER
Performance of players who have recently undergone microfracture surgery before and after the procedure, as measured by PER:

Player
Before
After
Pat Garrity
11.2
9.1
Matt Harpring 1
16.1
15.5
Matt Harpring 2
15.5
16.2
Jason Kidd
19.7
19.5
Kenyon Martin
17.5
16.7
Zach Randolph
18.6
16.9
Amaré Stoudemire
26.6
23.6
Click here for complete statistics for all microfracture patients.

There are some lessons to be taken from the data. The most important of these may be that age matters. Players like Houston and Mashburn were already in their 30s and had plenty of wear and tear on their knees before undergoing microfracture. Before Randolph and Stoudemire, no NBA player 25 or younger was known to have undergone a microfracture procedure. (Around 1990, Doug Christie may have a surgery that we would now call microfracture while still in college at Pepperdine.) Kidd is the only player over 30 to return successfully from microfracture surgery in recent years.

Understanding of the microfracture surgery has also improved in recent years. Hardaway had two microfracture surgeries. The well-known procedure came in 2000, while with the Suns, that cost him nearly the entire 2000-01 season. Hardaway also had a microfracture done while still in Orlando in 1997, and he recently told the Memphis Commercial Appeal that the early surgery was not treated as seriously as it would be now.

"My microfracture was handled like a routine arthroscopic surgery," Hardaway said. "They thought it was a 6-to-8 week deal. Now we know, from Amaré Stoudemire to Kenyon Martin, that it's a longer deal."

It's also worth remembering that not all microfractures are created equal; microfracture is a procedure, not an injury, and it is used to treat knee injuries of varying severity. The size of the damage to a player's knee cartilage can be critical.

After performing microfracture on Stoudemire, Suns team doctor Thomas Carter made note of these factors, saying, "Given Amaré's age and the nominal size of the location of the defect, I am confident the microfracture procedure performed will allow a healthy and normal return to action." With the benefit of hindsight, that attitude wasn't optimism for the sake of the public but instead prescient.

Time will still be an important test for Stoudemire. The Suns boast the NBA's second-best record at 24-8, and their goals relate not so much to the regular season as the postseason. Stoudemire's knee will be tested by the lengthy grind of the playoffs, when his minutes will likely go up. In the 2005 Western Conference Finals, as he averaged 37 points per game, Stoudemire played 41.4 minutes. By contrast, he's played 40 minutes in a game just once this season.

For now, however, Stoudemire is just one of the players proving microfracture surgery is no longer a death sentence.