David Chao, MD: Sixers Should Opt For Simmons Surgery, Long Term Stability

Immediately after the first reports of patella subluxation on 76ers guard Ben Simmons came out we indicated this is a significant injury and would lead to at least weeks off. 

Now comes a report of a loose body and surgery.  What does that mean and what are the implications for this season and his future?

A loose body is a chip of cartilage and/or bone floating free in a joint. When Simmons patella subluxed (or shifted transiently out of the groove), it knocked a piece of articular cartilage possibly with attached bone underneath. The surgery to remove it is necessary like one needs to stop and take that pebble out of your shoe as it can get caught and cause pain.

The surgery to remove it is quick and easy but the size of the defect where the chip came from will determine if there are long term ramifications. If the piece is small and there is no other ligament tightening surgery needed, he could be back in several weeks which is the best case scenario. If the Sixers make a deep playoff run, a return is not impossible.

It is possible the Sixers would consider cutting their losses to get Simmons preventative surgery for a more long term fix if the resultant loose body were large and involved a significant piece of cartilage/bone and/or additional ligament damage. Often the medialpatellafemoral ligament (MPFL) is torn or stretched and surgery to tighten this ligament that holds the patella in place is needed. If this is the case, that would mean a 6-9 month minimum recovery and have Simmons missing a significant portion if not all of next season.

Even though Patrick Mahomes dislocated (popped out of place) his patella and required it to be relocated (put back in place) and suffered what seems to be a more severe injury, he returned in three and a half weeks and subsequently was the Super Bowl MVP. A similar return is the best case for Simmons now with the need for surgery.

Bear in mind that basketball is a very kneecap dependent sport and could have lingering effects.

Sixers fans and the team itself are understandably worried given their recent history of medical problems with top draft picks Joel Embiid, Jahlil Okafor, Markelle Fultz and now Simmons.

Given this pandemic shortened season is likely derailed, look for the Sixers to do the best thing long term. Let's hope a simple scope to remove the bone chip does the job and nothing more is required.