The Boston Celtics will attempt to complete their sweep of the Dallas Mavericks in the NBA Finals tonight, likely without the help of their starting center Kristaps Porzingis, who suffered a rather strange and unique injury during the second game of the series.
As NBA insider Shams Charania first reported, Porzingis suffered a “torn medial retinaculum allowing dislocation of the posterior tibial tendon.” The injury is a mouthful in and of itself, and even those in the healthcare industry may have a tough time understanding exactly what’s going on with Porzingis. Thankfully, Dr. Silverman is here to break it all down for us. Here’s Dr. Silverman’s take on Porzingis’ injury and his likely course of treatment.
Dr. Silverman Explains Porzingis’ Injury
This type of injury is typically identified when a patient suffers a major ankle trauma. For example, a severe ankle fracture can present with damage to the soft tissues around the joint, including a tearing to the medial retinaculum. When the retinaculum tears, it leads to instability in the tendon that relies on the retinaculum to keep it in place, and as you can probably guess based on the Shams reports, it is the posterior tibial tendon that bears the brunt of this instability. The retinaculum helps hold the tendon in place, much like a rope within a groove, and if the retinaculum is damaged, the posterior tibial tendon can pop out of place.
For this to have occurred in isolation, Porzingis must have experienced a combination of increased ankle dorsiflexion and resisted foot inversion, with the ankle in a twisted-out position. Many are saying that this new injury is not related to the calf injury that Porzingis suffered in the first round of the playoffs, and while on the surface that could appear to be true, this also overlooks the total impact of an injury on the body. Porzingis injured his right calf at the beginning of the playoffs and tore the retinaculum in his left leg during the Finals, so while it’s easy to say that an injury in one leg is not directly related to an injury in the other leg, that overlooks how our body naturally compensates to protect an injury from additional strain. It’s certainly possible that his left leg was enduring more stress as his body attempted to protect his recovering right calf from injury.
And while we’ll never know for certain how much the calf injury truly affected his body prior to his latest injury, there’s no denying that a history of injuries during his time as a pro played a role in this unique injury. Porzingis has dealt with left ankle sprains, left calf issues and even tore his left ACL during the course of his pro career. All of these injuries take their toll on a body, and even after rehab techniques are pursued, the effects of these injuries can leave their mark. Coupled with natural degeneration from years of stress and the regular forces a 7’2” center puts on their feet as they jump and run around the court, and it puts the player at a heightened risk for a non-contact soft tissue injury like we saw on Sunday.
Moreover, people with lower extremity injuries often adopt a twisted-out position to avoid excess strain. Think of how someone hobbles down a hallway, their leg twisted to the side to prevent joint movement and decrease stress. Unfortunately, this position puts them at risk for other injuries. Typical injuries from a twisted leg or externally rotated foot include fractures, anterior cruciate ligament (ACL) tears and medial collateral ligament (MCL) tears of the knee. We often see basketball players with a history of ankle injuries sustain an ACL rupture. If Porzingis were to return too early and his gait is affected, he’s at risk for a much more serious lower body injury.
I agree with the move to pull Porzingis from Game 2 and keep him out of Game 3. He’s clearly still pushing to play, as he was seen at the team shootaround on Thursday, but at best it is incredibly risky. If that posterior tendon tears because it absorbs excessive stress while out of place, it could be a career ending injury for the big man. I understand that it is the Finals and this is what every NBA player dreams of, but given the fact that the Celtics are up 3-0 and the increased injury risk if he tries to play through the discomfort, there really is only one smart decision here, and that’s to sit out Game 4 and beyond.
Nonsurgical treatment for this type of injury has a very low success rate and quite frankly, is just delaying the inevitable. Surgery is far and away the best treatment, not only to address the issue but to stabilize the tibial tendon and greatly reduce the risk of a more severe injury down the road. Given the stakes, surgery is actually the more conservative option, and I think we’ll see him go under the knife in the coming weeks. He can certainly make a full recovery, but if he and his medical team have his best interests at heart, we won’t see him in another game this season. It seems likely that the Celtics will be able to cross the finish line and bring home a championship without him. Here’s hoping surgery and his rehab go well so that he can be healthy and help Boston defend their title next fall.
