NY Yankees’ pitcher CC Sabathia returned to pitch yesterday after a period of rest and rehabilitation for his arthritic right knee. Sabathia underwent a knee arthroscopy for a debridement (“clean out”) of his arthritis in 2014. He has been battling the knee arthritis for the last few seasons and, not coincidentally, his performance has significantly diminished throughout that duration. He has endured serious pain this season and underwent a knee drainage of fluid at one stage. The questions remain whether his pain will improve enough so that his performance can also improve. Afterall, he has been one of the best pitchers in Major League Baseball until his arthritic knee caught up with him.
Osteoarthritis (OA) is a degenerative disease of the joints which causes the erosion of the cartilage that lines ends of the bone (articular cartilage). The incidence of knee osteoarthritis is 240 per 100,000 people per year. As a result of wear and tear, the incidence increases with age. The risk factors for OA include obesity, trauma and a physical labor occupation. The typical symptoms are pain, stiffness, swelling and, eventually, joint deformity. The common presentation on X-rays include narrowing of the space between the bones, bone spurs, sclerosis (hardening of the bone) and cyst formation.
The first line of treatment is typically non-operative. This includes anti-inflammatory medications, weight loss and physical therapy with an exercise program focusing on strengthening and range of motion. A brace can be used to try and diminish pressure on the narrowed part of the joint. Unfortunately, they are often cumbersome and many patients do not tolerate it.
Cortisone injections may give some temporary relief, particularly, for severe acute flair-ups. Viscoelastic injection is another treatment option. This is the injection of hyaluronic acid, a lubricant, in all joints. The benefits from this injection may last up to 6 months and it can be repeated.
Surgical options are considered when conservative treatment is exhausted. One option is a knee arthroscopy (which Sabathia underwent). This is most beneficial when there are mechanical symptoms which are locking and buckling the knee as a result of a degenerated meniscal tear. Most recent studies reveal that arthroscopy of the knee exclusively for arthritis is not recommended because the benefits have shown to be similar to physical therapy. The case of Sabathia is unique since he is a professional athlete and his livelihood is at stake.
Other surgical options include a high tibial osteotomy. This is a procedure that involves cutting and re-aligning the bone. This is most commonly performed for younger patients. A partial knee replacement may be of benefit if the arthritis is limited to one part of the knee. Finally, a knee replacement is very commonly the last option for patients suffering from OA that have not improved with conservative treatment.
There is no doubt that CC Sabathia is suffering and enduring an enormous amount of pain. His heart and integrity are evident by his efforts to contribute to his team during this important stretch run. Moreover, his hunger to continue his impressive career is clear, as well. Unfortunately, as of yet, there is no true cure of osteoarthritis. Very often the disease progresses, which further limits function for anyone let alone a professional pitcher.
There are certain extraordinary intangibles that great athletes possess that allows them to perform exceptionally and overcome great obstacles. Therefore, there is still hope that CC Sabathia will be able to contribute in some way to the Yankees. Unfortunately, we can not expect him to perform at that same high level that we have come to expect. Moreover, it will, likely, continue to be more and more difficult for Sabathia as he continues to play and time progresses. It is no doubt that he has sacrificed much of his body and is withstanding great pain to help the Yankees.