David Chao, MD: Damian Lillard Injury Likely To End His Time in The Bubble

It is highly unlikely that Damian Lillard will be back this season.

The all-everything Portland Trailblazer suffered a non-contact right knee injury Monday and despite an "inconclusive" MRI -- with repeat imaging scheduled for the today -- I don't see how he can return to play Wednesday (even with his team down 3-1) or even later in this series, if his teammates can win to extend the playoff.

By video analysis of his injury, there are several scenarios and worries. None of which do I see him playing in a short period of time. No, I have not examined or treated him, and if I had, I would be prohibited from commenting due to HIPAA privacy laws.

During a 3rd quarter drive to the basketball, Lillard took a hop step just inside the elbow of the key and lands awkwardly on his right foot causing his knee to almost buckle while shifting inward. He finishes the play with a missed shot and then limps slightly. He did stay in the game for a couple of plays while walking gingerly on the right knee but doesn't do much before exiting.

The worst-case scenario (hope not) is an ACL tear. Yes, Klay Thompson in last year's NBA Finals walked it off after tearing his ACL and even shot free throws. Jordy Nelson and others have walked off the field after ACL tears too. Although the video could be consistent with ACL tear, let's hope not. Additionally, the clinical examination would have shown laxity and I doubt the MRI would have been inconclusive. This would be devastating as the recovery after surgery would cause to miss most if not all of next season, too.

The middle scenario is a partial ACL tear. Partial tears are not that common but that could be what was "inconclusive" and thus necessitating a repeat MRI this afternoon. If so, he might be able to avoid surgery but there is no way for a short turn around to return to play.

The best-case scenario would be to have his ACL spared but there would still be a high likelihood of a bone bruise from the impaction and shift. This could explain the inconclusive MRI and the need for repeat. Often the swelling/edema that is indicative of a bone bruise is not detected with immediate MRI but can be seen by the next day. If this were the case, the soreness would get worse before it got better. Also the team could not risk long term damage to the overlying articular cartilage or collapse of the bone and this typically needs to a 4-6 week timeline for return at a minimum.

This was not the first injury this series versus the Lakers. In Game 2 on Thursday, by video, Lillard dislocated his left finger PIP joint yet returned for the next game as expected and logged 34 points in a Game 3 loss. 

Without their star point guard and top scorer, things look bleak for the Trailblazers to win three straight in this seven game series. Even if they did, it seems clear to me they will be without Lillard the rest of this season. The hope is the injury doesn't leak into affecting next season. Let's hope for the best.