Kobe Bryant: Not Your Typical Knee Injury

Written by admin on January 28, 2014 – 1:11 pm -

As a result of his most recent bite from the injury bug, NBA superstar Kobe Bryant is expected to miss six weeks after sustaining a lateral tibial plateau fracture on December 19th. If you’ve never heard of this type of injury, you are not alone. Tibial plateau fractures are not among the most common injuries in sport.

The tibia is the shinbone that runs the length of the lower leg and is part of both the ankle joint and the knee joint. The tibial plateau is the top of the bone that flares out and widens to create a weight-bearing “seat.” There are two portions, one on the inner (medial) portion of the knee and one on the outside (lateral) aspect. There are many different types of tibial plateau fractures, but the main differentiating factor that determines treatment is the alignment of the fragments. In a displaced fracture, the bone is broken in two or more places and the edges are not lined up properly.

The most common mechanisms of injury are hyperextension of the knee and direct contact (say from a helmet in football, or in a car accident involving a pedestrian which has given this injury the nickname of “bumper fracture”). Replays of Kobe’s incident confirm his to be a non-contact injury. He plants and hyperextends on the soon-to-be-injured leg, which then buckles.
The injury results when the femur and tibia come into forceful contact with one, sometimes resulting in a bone bruise or, as in this case, a fracture. Tibial plateau fractures often result in acute swelling, stiffness, deformity, and inability to bear weight on the extremity. X-rays, CT scans, or MRI are used to diagnose this injury.

Often, the treatment for this type of injury is a surgical procedure which brings the edges of the fracture into close approximation and uses surgical screws and plates to hold them in place; a procedure known as open reduction and internal fixation. Smaller fractures that are not displaced often respond to conservative treatment of immobilization and non-weight-bearing on the affected leg. Kobe’s fracture is believed to be relatively minor and so his recovery spectrum is 6 weeks. More severe or complex injuries (such as those with vascular or nerve damage) or larger fractures require much longer recovery. In addition, tibial plateau fractures are often associated with injuries to the meniscus or ligaments in the knee. These associated injuries require additional treatments and rehabilitation. Fortunately for Kobe and the Lakers, this injury is (by all reports) relatively mild and with a majority of the regular season still ahead, Kobe has a chance to return and contribute meaningfully to the Lakers’ season.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon and adjunct Clinical Professor, specializing in sports medicine, practicing in Wake Forest and Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com, or on twitter @drmarkgalland.

Alex Vitek is a nationally Certified, state Licensed Athletic Trainer and post-graduate Resident in training at The Galland Orthopaedics and Sports Medicine Athletic Training Residency– a 12 month immersional program allowing ATCs to maintain and hone clinical skills while developing those talents necessary to be effective in the clinical setting as an ATC/physician extender. Find out more at www.atcfellowship.com

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