What If Dirk Needs Knee Surgery?

As the saying goes, ‘It's only ‘minor surgery' when it happens to somebody else.' As it applies to Dirk's troublesome knee? You've read the quotes suggesting the possibility of an ‘arthroscopic procedure.' Inside, with the help of certified trainer Jeff Stotts, we do our own examination: the nature of the procedure, the history of Dirk's knees and what it all means to the Mavs:

The Quotes

"We're we're still hopeful that this is a temporary thing,'' Dirk Nowitzki said after skipping the Dallas Mavericks' Barcelona exhibition due to a swollen right knee. "If we relax and rest it for a week and see how it goes, then we'll have a better idea. ... We'll see how it responds."

"Rest and relax'' may indeed be what the doctor eventually orders here. Last season, Dirk took four games off in the middle of the year and received treatment on the knee (while also doing conditioning work). That prescription worked; The UberMan did not report problems with the knee during the second half of the season.

Dirk's History

However, this is the second training camp in a row Dirk's endured a sore right knee. Last year -- maybe in part due to Nowitzki not coming into camp in prime shape -- it took nearly two months to get fully healthy.

Much of this is due to simple basketball wear-and-tear. Chalk some of it up to Dirk being 34, too.

After openly discussing how great his legs felt entering training camp, it was a bit surprising to see Nowitzki sit the team's preseason exhibition with a knee issue. The team is calling the injury a "right knee effusion,'' meaning an abnormal amount of fluid has surrounded the joint. Before we can talk specifics we need to review the history of Dirk and his knees.

Part of Dirk's greatness has always been his durability. He has been able to overcome numerous ankle sprains throughout his career but it's the occasional knee injury that has cost him the most games. The most infamous knee injury likely came during the 2003 Western Conference Finals against the Spurs. Nowitzki suffered a sprained left knee in Game 3 and would not play again in series. He managed to avoid any other problems until the championship season of 2010-2011 when he sprained his right knee during a December game against the Thunder. He would go on to miss nine consecutive games before returning to the lineup. The knee held up for the remainder of the season and throughout Dallas's playoff run.

However, after a lockout extended summer and a rushed training camp, the right knee flared up just one month into season. He took time off, missing four games, as he got the swelling under control and reconditioned his body.

And now this.

Clearly there is something going on with the right knee. Despite Dirk returning to his normal routine the knee still swelled and has limited his availability in practice and now preseason action.

The Procedure

Dirk and the team have two options at this point, conservative treatment or surgery.

Let's start with some good news. The conservative approach has worked in the past for Nowitzki and it could once again. His previous successes are the result of multiple factors, largely Nowitzki's commitment to conditioning and the Casey Smith-led Mavs medical staff. It is likely that the hours Nowitzki put in at the gym, performing all the unusual exercises concocted by Holger Geschwindner have increased his flexibility and strength, decreasing his inherent injury risk while preparing his 7-foot frame for the grind of an NBA season. Nowitzki entered the season with improved strength in his legs that should give him an edge in recovery from this particular flare-up.

Furthermore, Smith will be able to aid Nowitzki with state-of-the-art treatment and an educated eye for biomechanics. Smith holds multiple certification from the National Academy of Sports Medicine that are designed to help assess things like muscle imbalances or muscle deficiencies that may be contributing to the problem. If the root of the problem is not internal, Smith and his staff can isolate the issue and work with Nowitzki to correct it.

We believe the team plans on giving Dirk the next week or two to see how the knee responds before considering the alternative, surgery.

Minor arthroscopic knee surgery is generally warranted when small pieces of cartilage, tissue, or meniscus are the cause of the chronic swelling and the only way to guarantee the problem subsides is removal. In the procedure tiny incisions are made in the knee to allow surgical instruments, roughly the size of a pencil, into the area to examine and clean up the structures of the knee.
Recovery from the procedure would depend on the extent of the damage in the knee but generally takes between four to six weeks. For example, Jeremy Lin underwent surgery to repair a small tear in his lateral meniscus and missed the five remaining weeks of the Knicks season. Crossing sports, rookie running back Trent Richardson made his NFL debut with the Browns one month after undergoing an arthroscopic procedure to remove loose cartilage in his knee.

The Impact

When Dirk says, "The longer we wait, obviously the worse it is. If we have to do something, it'd be better to do it quick,'' he's talking not about the knee itself but about its impact on his team.

We'll address that in a soon-to-come article. For now, know this:

If Nowitzki needs surgery, he would be almost certainly be unavailable to start the season. However if the surgery does fix the problem it may be worth sacrificing several games early in the season to have a pain-free Dirk for the majority of the year. Expect the Mavs to explore all their options before putting the face of their franchise under the knife ... but keep in mind it may ultimately be the best option.

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