Experts explain what Gabe Landescogg’s knee surgery means for his career

Gabriel Landescog, 92, of the Colorado Avalanche catches his breath during the third period of Arizona’s penalties win on Tuesday, Feb. 1, 2021.

When Dr. Rachel Frank explains cartilage grafts to her patients, she tells them that the goal is to improve quality of life by reducing pain at the site of injury and improving function.

That’s why the surgery Avalanche captain Gabriel Landescog underwent on Wednesday was “incredibly successful in the vast majority of patients,” said an orthopedic surgeon who specializes in cartilage and joint repair and a team physician for the Colorado Rapids. Mr Frank said.

The $42 million question in the Avalanche case is whether Landescogg’s surgery will be effective in achieving its more ambitious end goal.

“For elite and professional athletes, the definition of success certainly includes those things, but also the ability to return to the ability to play the sport at that (elite) level,” Frank said. Told.

Landescogg is one of the most elite competitors in the sport when he is healthy. Avs Wing, however, has been battling a cartilage injury in his right kneecap since 2020, when he cut his knee with a skate blade. He has had three surgeries so far, most recently an arthroscopic surgery in October 2022, and a cartilage transplant on Wednesday that will keep him out of at least the 2023-24 regular season. .

Surgery in October was supposed to start a 12-week rehab. Rather, Landescogg never felt comfortable stepping up his skating. he missed a full season.

“I think this is the best way for us to move forward and[optional]the best solution for me to come back and play hockey again,” Landskog said Tuesday.

The Times spoke to three doctors with expertise in orthopedic surgery to understand what Landescog’s surgery means and what it means for his future on the ice. . Major consensus: If an athlete has exhausted other options, cartilage transplantation is the best course of action, but the modernity of the surgery and the lack of data suggesting its effectiveness for athletes returning to increasing physical demands. As such, it is difficult to judge Landescogg’s ultimate impact on the game.

“When it comes to professional athletes, juries are still making long-term decisions,” said Daniel Karaji, M.D., a Los Angeles-based orthopedic surgeon who once worked for the Lakers. “…the option is to retire or do something to get back on track?”

“We’ve seen this done with patients and athletes at all levels, including high school, college, and professional athletes,” Frank said. According to a team news release, she was trained in Chicago by Dr. Brian Cole, who performed Landescogg surgery. “But at the elite level, frankly, it’s not as common, so it’s a little less predictable.”

Landskog found solace in a modern man who had gone through the same process. Chicago Bulls guard Lonzo Ball underwent a left knee cartilage transplant in March. Mr. Landescog told reporters that he contacted Mr. Ball during an investigation into the surgery.

“I’m sure he’s the guy I’ll be checking in with from time to time,” Landescogg said. “It’s nice to be involved and to hear what I’m saying.”

There are two common ways to perform porting. Implants are intended to repair essentially a kind of eroded cartilage hole that causes pain in the joint. One approach is to use donor cartilage from cadavers. Another is to first complete a biopsy of the patient’s own healthy cartilage, which is taken and transplanted into the damaged area. In any case, this surgery, which exists thanks to advances over the last two decades, requires new cartilage to be sculpted into a film or membrane to match the shape of the defect that it needs to fit.

Doctors say the kneecap is one of the most difficult areas to operate on because of its irregular shape.

“It’s not just round. It’s not just flat,” said Dr. Matthew Mataba, a St. Louis Blues team physician who specializes in sports medicine and cartilage repair at the University of Washington. In his experience, some insurance companies were hesitant to approve patella cartilage grafts for that reason.

Mataba said she usually braces her knees after surgery and keeps them in a straightened position. On Thursday morning, Mr. Landescog posted a photo on Instagram, saying the surgery went well and showing a similar brace on his right leg. The reason is to avoid compressive and shear stresses on the patella.

“The patella hits the end of the femur. …it doesn’t resist normal smooth surfaces,” Mataba said. “The way[a hockey player]kicks off and slides across the ice, even though he’s not jumping or running like a basketball player, when he bends his knees and explodes and pushes him off the ice. It creates a lot of shear fore and aft. Skating.”

Kharrazi explained that minor injuries can grow behind the patella and get worse. Doctors interviewed by the Post did not know the exact details of Landeskog’s injury and could only speak generally about the nature of the injury, which likely was the case for Landeskog. After the initial skate blade incident, the captain continued to play in recent seasons. He returned from surgery in March 2022 to the start of the playoffs a month later, scoring an astounding 22 points in 20 games despite a knee injury, helping the Avalanche win the Stanley Cup.

“It’s like the paint on a wall or a car is peeling off, and the (damaged) area gets bigger,” Karaji said.

During the rehabilitation process, new cartilage grows into the affected area. For the transplantation to be successful, the transplanted cartilage must form a biological bond with the patella. “It’s like cells growing into bone, and bone growing into cells,” Mataba said.

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