July 11, 2011

Collateral Damage

Knee-Death Experience

by Corey Dawkins and Ben Lindbergh

Chipper Jones, ATL (Right knee meniscus surgery) [AGL: 48, ATD: -.035]
Alex Rodriguez, NYA (Right knee meniscus surgery)
Simply put, Jones and Rodriguez were not improving enough to delay surgery until the end of the year, so they decided to address their meniscal tears surgically now.

Going in arthroscopically, the surgeons will first take a look around each knee to ensure that nothing else is causing pain, such as loose bodies. Chronic meniscal tears can lead to damage to the articular cartilage and can be a precursor to arthritis years down the line. After the entire knees are evaluated, the surgeons will return their attention to the meniscal tears. Care will be made to preserve as much meniscal tissue as possible, but often the torn tissue is too degraded to be stitched back together and instead must be shaved out. Players are almost always able to return more quickly from having the torn portions trimmed rather than fully repaired.

Jones and Rodriguez are both expected to miss at least a few weeks after their knees are cleaned out. Players have typically returned from similar surgeries in between three and six weeks, and all indications point toward the lower end of the range for Chipper and A-Rod.

Lonnie Chisenhall, CLE (Facial fracture) [AGL: 23, ATD: -.023]

Chisenhall's reaction to his beaning wasn't quite the same as Marlon Byrd's several weeks ago, but that doesn't mean that he wasn't injured. Chisenhall suffered a fractured maxillary sinus when the pitch from Carlos Villanueva ricocheted off the right side of his face after hitting his helmet before traveling into foul ground.

The glancing nature of the blow allowed the majority of the force to be directed elsewhere instead of being absorbed by the body, but the maxillary sinus still fractured. The maxilla is a bone that forms the lower part of the face (not the jaw) and extends to become part of the cheekbone. With the All-Star break here, there are no plans to put Chisenhall on the disabled list at this time, but he may have to wear a shield to protect the area while hitting upon his return.

Ramon Castro, CHA (Right hand and index finger fracture) [AGL: 32, ATD: -.001]
Certain injuries are a little easier to explain than others, and Castro summed up this one best later on when he said “my knuckle was all the way [into the hand].” As long as the fractured pieces are well-aligned and not significantly displaced upon reduction, surgery can often be avoided. The average number of games missed, including surgical cases, is a little over one month. However, production appears to be fairly consistent before and after the injury.

If surgery is needed, some type of hardware (ranging from plates to screws and nails) will be inserted, depending on the type and location of the fractures. One factor complicating an easy recovery is that Castro fractured both the finger and the hand, making the 32 games missed more likely than the minimum 15 games.

Andres Blanco, TEX (Low back stress fracture) [AGL: 37, ATD: TBD]
Blanco is the second infielder to go on the disabled list this year with a stress fracture in his back, and the first—David Wright—still hasn't returned from his stint. Stress fractures result over time from a bone's inability to rebuild itself faster than it’s broken down. The closest comp to Blanco is Bobby Crosby, who missed 37 games with a stress fracture at the end of his 2006 season for the Athletics.

Depending on the exact location of the stress fracture, there is a chance that it might never fully heal, although it will become less painful. A strong fibrous healing that provides stability to the fracture site occurs in these cases, but that is not quite as strong as true bony healing. No positional players have returned from this injury before the end of a season, so it remains to be seen how Blanco’s and Wright’s production will be affected in the first few weeks after their returns.

Placido Polanco, PHI (Bulging disc low back) [AGL: 53, ATD: +.006]
After further testing last week, it was confirmed that a bulging disc was the major cause of Polanco's symptoms. It may seem surprising that there are more herniated discs than bulging discs in our database, but this is likely because many cases of bulging discs don't cause a significant loss of time. The symptoms of a bulging disc can be managed conservatively through physical therapy and neutral core stabilization exercises, which limit the degree to which the body flexes and extends.

Polanco's case progressed to the point where his bulging disc was pushing on the nerve root and sending pain and numbness down his leg. We don't expect Polanco to require the two months alluded to above to recuperate; in fact, he could miss roughly the minimum 15 days.

Flesh Wounds: Peter Bourjos strained his right hamstring and gave Mike Trout an opportunity for a cup of coffee, at least... David Price will miss the All-Star Game with turf toe... Nick Hundley underwent surgery to clean out his right elbow on Friday and will be out for roughly a month... Cole Kimball will have surgery on his torn rotator cuff this week... Ike Davis is making progress and has been able to tolerate running on the treadmill... The Brewers expect Ryan Braun back on Thursday from his left calf strain... Mark Reynolds and Vladimir Guerrero both suffered hand contusions after being hit by pitches in Sunday's game against the Red Sox.

Corey Dawkins is an author of Baseball Prospectus. Follow @CoreyDawkinsBP
Click here to see Corey's other articles. You can contact Corey by clicking here
Ben Lindbergh is an author of Baseball Prospectus. Follow @benlindbergh
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