April 30, 2001 -- What separates the rest of us from the Latrell Sprewell's, Shaquille O'Neal's, and Kobe Bryant's of this world may be more than our heights and salaries; it may be our knees, new research on this year's NCAA champions suggests.
A study of 2001 NCAA basketball winners, the Duke University Blue Devils, found that the bone bruises and tears that some doctors may consider "abnormal" are actually quite common among college basketball players and do not affect their ability to play.
"If we saw these type of abnormalities or bruises in a weekend warrior, we'd say 'rest and take time off,' but what we found in basketball players is that this is kind of a normal thing for them," says researcher Nancy Major, MD, an assistant professor of radiology in the musculoskeletal division at Duke University Medical Center in Durham, N.C.
The findings, slated to be presented Monday at an annual meeting of the American Roentgen Ray Society in Seattle, Wash., suggest that for these reasons, such athletes should undergo a baseline MRI to document the insides of their knee. This way if the player is injured, the baseline MRI can be compared to a post-injury picture to see what treatment if any is necessary.
MRI scans, or magnetic resonance imaging, uses magnetic fields and radio waves to get clear pictures of the human anatomy. The American Roentgen Ray Society is a group of more than 14,000 diagnostic radiologists who regularly use such technologies as the MRI.
Duke's basketball coach, Mike Krzyzewski, says he would like to continue having pre- and postseason MRI scans so his players will get the appropriate treatment if they are injured. Soccer players in Europe undergo screening MRIs before they get drafted.
Major says that she thinks it's feasible to perform baseline MRI exams on college basketball players because many things will come out of it including improvements in training regimen and playing conditions.
"Overall, such baseline MRI scans will help players improve their training and therefore decrease the outcome of any injury," she says.
For example, basketball jumpers tended to have an abnormality in one of the tendons in their knee. Perhaps they may benefit from using a special, spring-loaded floor that decreases the amount of impact on the joints when they jump up for a rebound. "These floors provide an additional cushion over wood or cement," Major says. "Such floors are not widely distributed in colleges, but they allow for a better cushion when a player jumps about four feet and comes down because they absorb the stress that goes through the knee."
Majors looked at MRIs of the knees of 11 Duke basketball players before basketball season and again after the season ended. She found that 16 of 22 knees had bone bruises, nine had cartilage abnormalities and three had abnormality in the patellar tendon, a central tendon in the knee. However just one of the players complained of knee pain and that patient's MRI showed another knee problem.
"And then in the pros, if you know what is considered 'normal' and then the player gets an MRI for knee pain, you are not as likely to attribute the knee pain to what is 'normal'," she says.
John E. Madewell, MD, professor of radiology in the diagnostic imaging division at the University of Texas M.D. Anderson Cancer Center, in Houston is familiar with Major's work.
"What she is concerned with is that if a patient sustains an injury and you don't know if what you see on the MRI is related to the injury or something that is preexisting," he tells WebMD.
"It's feasible to do baseline MRIs on all college basketball players [but] MRI is costly so there would be a financial impact," he says. "More studies would be needed if something like this were to take place in all college athletes."
He says that studies would have to clearly show that the benefits of such screening outweigh its costs.
Ronald P. Grelsamer, MD, chief of knee and hip surgery at Maimonides Hospital and an orthopedic surgeon at the Hospital for Joint Diseases, both in New York has this to say: "I agree with the premise that a lot of tears are really not tears. People are very commonly told that they have tears, and because of that they need surgery," he says.
But in reality, "it's not a tear and the necessity for surgery is incorrect," says Grelsamer, author of the forthcoming book "What Your Doctor Won't Tell You About Knee Pain and MRIs," due out from Warner Books in February 2002.
"The concept of getting an MRI prior to athletic activities is theoretically reasonable. Whether or not it's cost-effective is a different story," he says. "Is it worth the money to get MRIs in all these people before hand?"
Grelsamer adds that "an experienced knee doctor can recognize on the MRI many of the so-called false-positives or tears that aren't really tears," he says.