September 9, 2011

Collateral Damage

Dodger Damage

by Corey Dawkins and Ben Lindbergh

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Andre Ethier, LAN (Right knee loose bodies) [AGL: TBD (TBD DL), ATD: TBD (TBD DL)] (Explanation)
Manager Don Mattingly confirmed that Ethier is out for the remainder of the season because of continued pain in his right knee. Ethier has experienced this pain since last season, and it’s proceeded to the point where it has affected his power at the plate, preventing him from continuing. The culprits are loose bodies in the knee that have been lingering in the area underneath the kneecap and causing a lot of inflammation.

It's hard to imagine what loose bodies actually do to a joint, especially if they have been present for a while. A loose body can get stuck between the joint surfaces, causing pain, swelling, inflammation, and even true locking of the joint. While this is going on, the joint surfaces become damaged, as well as the meniscus, depending on where the loose bodies are located.

Loose bodies underneath the kneecap are similar to grains of sand underneath the eyelid. The movement of the patella back and forth causes grinding along the articular surfaces of the patella and the femur. The cartilage wears down as a result, which can also lead to arthritis.

The location of the loose bodies in Ethier's knee made it difficult for him to preserve his power, which clearly showed this year. When the left-handed Ethier strides at the plate, the injured right knee is his front knee. A rotational force is transmitted up from the ground through the knee before traveling into the hip and torso. With the knee in a flexed position, any rotation of the knee will cause some compression of the patella within the groove. In this position there is also the least amount of joint space available underneath the kneecap, so the loose bodies have nowhere to go. As a result, Ethier's stride and hip rotational velocity was compromised, since he was not able to rotate his legs and hips quickly.

By themselves, loose bodies do not pose too much of a problem, as they can almost always be removed without any difficulty at all. If the loose bodies compromise the cartilage enough, either in a single episode or over time, a surgical procedure may be needed to be done to smooth out the cartilage or repair the defect. Smoothing out the cartilage involves burring out the torn pieces, but if there is a clear defect in the cartilage, microfracture procedures can be performed, among other things.

Assuming Ethier does undergo surgery, the prognosis is positive. Position players miss an average of 26 days after the procedure, with no change between pre- and post-injury TAv.

Chase Utley, PHI (Concussion) [AGL: 3 (29 DL), ATD: -.002 (-.008 DL)]
Scenario's like Utley's would be viewed much differently if not for the new concussion protocols put in place this year. On Wednesday night, another potentially catastrophic incident occurred when Eric O'Flaherty's pitch bounced off the back of Utley's helmeted head. Utley remained in the game but was suffering from a headache during the next inning while playing in the field. Consequently, he was removed from the game and began the process of being evaluated for a head injury.

After the game, GM Ruben Amaro said Utley may have suffered a mild concussion, signifying that he was automatically following baseball's new head injury protocol. Utley will remain out at least until the weekend, by which time he’ll have been able to take the ImPACT test and compare it to his baseline test results from this spring. Considering the timing of the injury, he is unlikely to be placed on the seven day disabled list.

Jason Isringhausen, NYN (Herniated disc—low back) [AGL: 2 (44 DL), ATD: +.052 (-.002 DL)]
Isringhausen has dealt with degenerative changes in other parts of his body—including his left hip in 2004 and 2005—so it's not surprising that he also has some degenerative changes in his low back. Isringhausen has dealt with low back pain before but recently started to experience numbness in his right foot. He has been suffering from sciatica episodically throughout the season and had been able to manage it conservatively until now.

However, things have reached the point at which Isringhausen will need at least a few days off to be able to manage the sciatica and right foot numbness that he developed recently. Unless he starts to experience incontinence or true groin numbness—indicative of a much more severe injury—he should be able to manage this conservatively until after the season, when a decision will have to be made regarding surgery.

Flesh Wounds: The Mets confirmed that Ike Davis will not need surgery on his troublesome ankle... Logan Forsythe will have season-ending surgery on the torn meniscus in his left knee... Jason Kubel has been dealing with a sore left foot the last few days. This is the same foot that caused him to miss almost two months with a mid-foot sprain earlier in the year... Juan Uribe had surgery performed by Dr. Craig Smith on Thursday to repair his left-side sports hernia but should be back in time for spring training without any restrictions... Brent Lillibridge was diagnosed with a right hand fracture after being hit by a pitch. He's most likely out for the remainder of the season.

Corey Dawkins is an author of Baseball Prospectus. Follow @CoreyDawkinsBP
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Ben Lindbergh is an author of Baseball Prospectus. Follow @benlindbergh
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