The latest Paul George knee injury has been quickly evolving, from near- devastating live to a declaration that major ligaments were “spared” during the current reevaluation limbo. But what does it mean that major ligaments were spared if we know there’s a knee sprain? Isn’t a sprain a tear?
I do primary care for my day job, and there are few things that frustrate me more than watching people walk away from a situation with nearly full comprehension but accepting it’s just something they cannot totally understand. Very often this happens with bad backs, tight shoulders, and, you guessed it, painful knees. The Clippers are notoriously tight lipped, and the injury is still fairly fresh in all of our minds. But make no mistake about it: this injury very well could define this season and possibly this era of Clipper basketball. Having a comprehension of what is happening with the information we have could go a long way into putting this out of sight and out of mind during Paul George’s rehab period on his knee.
It helps thinking critically a bit about the nature of Paul George’s injury in the first place, and how the trail of updates that followed places us where we are now. Let’s start from the injury itself and how the nature of it, while graphic in its nature, did leave some hope too. The lack of side to side on his knee movement and moreso his knee being bent backwards (or, you know straightened beyond its means which is what a hyperextension is) made me hopeful that his ACL was spared, as that subtle side to side was noted on Kawhi Leonard’s injury to Joe Ingles. With enough extension, however, it’s hard to say whether the ACL was spared at the time. Hyperextensions do notoriously look worse than they sometimes are structurally. I’m a big fan of Dr. Brian Sutterer’s work and he had a great video of this quickly after the injury:
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Soon after the injury, we got some updates from ESPN writers, the night of and the morning after:
Paul George just left the arena on the back of a cart with his right leg extended. He nodded on his way out. Clippers not expecting to have an update on George tonight.
— Ohm Youngmisuk (@NotoriousOHM) March 22, 2023
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ESPN Sources: After imaging today, Clippers star Paul George has a sprained right knee and will be re-evaluated in 2-to-3 weeks. pic.twitter.com/jgYytDarfs
— Adrian Wojnarowski (@wojespn) March 22, 2023
Considering the nature of the injury and the length before reevaluation, initially it seemed to fit alongside a PCL injury in my head, and possibly a rare isolated one. Two weeks of hypertextension is standard of care in PCL injuries. It definitely wouldn’t be the worst case scenario: We’ve seen other players, notably Rudy Gobert, deal with it in the past, and he dealt with a Grade 1 sprain and a 4-6 week timeline.
Sidenote: It is worth noting that the higher the grade, the worse the sprain, Grade 1 and 2 are partial tears, and Grade 3 is either a complete or near complete ear (and Grade 3, due to it’s inherent severity, often features injuries to other major ligaments of the knee and a trip sooner than later to an operating table). All graded sprains are tears, it’s just a matter of how badly torn something is! Remember this when someone asks you if a player had a sprain or a tear!
Following the vagueness of the timeline and left wondering if this was indeed a PCL sprain, the Clippers did give a bit of information about what was injured.. Or perhaps more importantly, what wasn’t injured. Per many of our great beat writers, major ligaments were apparently spared:
Paul George won’t be at Crypto tonight as he begins his rehab. There’s an optimism as it begins: The imaging showed PG avoided damaging the ligaments in his knee. Surgery isn’t something that is expected to be needed for George.
— Andrew Greif (@AndrewGreif) March 24, 2023
Now, if the ACL/PCL/MCL/LCL were all spared, where exactly is the knee injury? Why are we even calling this a knee sprain? This is where things get a little bit more foggy since the team has not directly provided us with more than “he’s hurt, but avoided catastrophe.” To think about what could be happening if major ligament damage was avoided, it’s worth remembering the first player that came to my mind and many people’s minds when seeing George’s injury: Giannis Antentokounmpo.
As Dr. Sutterer mentioned in the video linked above, before you hit your major ligaments, zooming out there is a protective knee capsule that aids in movements, including extension. In the capsule, there’s an outer fibrous layer, just as fibrous cords compose major ligaments you are familiar with, and an inner synovial membrane that secretes synovial fluid to reduce friction on movement at the knee joint. So essentially, an outer tough layer and an inner friction reducing one. The knee capsule can indeed be sprained, and has had some famous sprains in the past.
Jeff Stotts is a certified athletic trainer and had this nice quick rundown of the Giannis injury. Giannis had a mild knee capsule sprain that caused him to miss a week. He also mentioned Rudy Gay having a similar injury that took him out one game, but Jimmy Butler had an injury in 2016 that took him about 11 games and nagged him through the rest of the season. However, if the Paul George knee injury is indeed to this surrounding capsule rather than the ligaments/bone beneath it, it could be promising for his return. Isolated capsule strains are also rare, so George indeed would have been fortunate.
Of course we have not been told directly that this is the specific injury, and even if it was, it may be severe enough like any of these injuries that it might hold him back from a return even if the Clippers do make it to the playoffs. Paul George even mentioned on his podcast that he doesn’t know the timetable of his return at this point. But it’s good to have an idea of what possibly could be happening with Paul George and his knee, especially taking faith in that update that major ligaments were not harmed. We all share trauma of many unfortunate knee injuries in Clipper history, here’s hoping that the team finally stumbled into some luck with this one.
