Microfracture knee surgery and its impact on the NBA

Amare Stoudemire is an expensive bundle of generously damaged goods, so it comes as no surprise that the New York Knicks are guarding their most recent investment with a desperate passion that only a team weeks removed from the biggest heart-break in franchise history could.

Give them credit first of all, for putting their free agency sorrows behind them and taking advantage of the consolation prize they were fortunate enough to land. He's big, he's powerful and he looks good with a beard. Just never mind that under that chiseled armor of sleek athleticism is a frame that doesn't hold up well under stress. Not everybody can be as big, as powerful, as handsomely bearded and as durable as LeBron James, after all.

This week the Knicks announced that said investment would sit out the biggest tournament of the international basketball year for insurance reasons, leaving both stakeholders of American basketball and Mr. Stoudemire himself out in the cold heading into the longest months of the already tiresome NBA off-season. Sure Team USA lost some of its depth at the power forward position and Stoudemire lost an opportunity to showcase his talent for a new legion of fans, but that doesn't matter; the preventative damage control exercised by the suddenly committed Knicks more than justifies the decision, especially considering all the work that has been done in order to keep those knees in functional shape.

You wouldn't necessarily expect a team that had so recently hit rock bottom to turn around and demonstrate caution with their de facto franchise stud after failing the biggest and longest transaction gamble in NBA history. It's an uncharacteristic 180, but more importantly, it's a sign that maybe this whole free agency saga is one of the best things that could have happened to the franchise. They're ready to put down that tub of ice cream and get on with their life.

When Stoudemire underwent microfracture knee surgery in 2005, doctors performed one of the most mysterious surgeries available to our generation's professional athletes. You can understand New York's concern. The list of those who have underwent the procedure and bounced back to the level they were pre-surgery (or at least near it) is Nate Robinson-small. Stoudemire and perhaps Jason Kidd are the most notable examples of players who've had close to or similar success, while players like Anfernee Hardaway, Chris Webber and Allan Houston make up a far more depressing list of stars that would never again return to their pre-surgery form.

But this isn't some questionable witch doctor solution for restoring expired cartilage, as every year passes more and more peer-reviewed literature and knowledge surrounds the potentially career-altering procedure.

Championed by Doctor Richard Steadman in the late 1980s, microfracture surgery involves the use of stem cells to rebuild articular cartilage. As Steadman himself put it in 2000, "(the) goal is to recreate the structures of the knee that protect it from impact and provide stability".

In layman's terms, it taps into a joint surface in the knee that releases a substance that oozes out and forms new cartilage where the old, broken down stuff used to be. Healthy cartilage, of course, lines the bones that make up the athlete's joints and plays a major role in the pain-free movement of basically every part of the body.

Stoudemire, much like Webber, Houston, and Hardaway before him, had already been playing on worn down or damaged tissue and though the microfracture procedure is a far cry from a guarantee, it's often the only option for athletes whose cartilage is more or less defective.

In a 2003 article posted in the Journal of Rheumatology, Doctors James Hoi Po Hui and Anthony Marchie described how cartilage-related injuries are some of the most debilitating injuries in North America. Management of cartilage lesions and defects not only help minimize pain, but can get athletes back in game condition.

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