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JaDeveon Clowney

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It seems that the Texans medical staff seems to have a long history of picking the wrong possible outcome. In fact that seems to be what they're expertise is.

1. Boselli
2. DDW
3. Joppru
4. Spencer
5. Schaub
6. etc........

you probably have to put Cushing on that list.
 
Walt Lowe is the Texans Surgeon.

For how much longer?
impatient.gif
 
A00422F01.jpg


Steps of the microfracture technique. Left: Damaged cartilage is removed. Center: Awl is used to make holes in the subchondral bone. Right: Healing response brings new, healthy cartilage cells
.

The cartilage produced by microfracture surgery is anything but healthy TRUE cartilage cells. It is less vascular and more eraser rubber-like and ultimately forms a FIBROCARTILAGINOUS mass that heals the tissue. Without getting real technical, it produces mostly type I collagen rather than type II collage, rendering it biologically and biomechanically very much inferior to hyaline cartilage (normal joint cartilage). Studies have shown that fibrocartilage does not tend to stand up to high stress load-bearing and may actually further cartilage deterioration and arthritis.

The final step should read: "everyone crosses their fingers and hope that the healing process brings some new, healthy cartilage cells." Micro fracture surgery is the orthopedic version of a Hail Mary. The most optimistic forecasts is that there is a 50%chance of enough new growth to stall or delay crippling arthritic grinding for a few years... If it is localized to the outer 1/3 of the knee joint, as it appears it is (instead of the entire knee surface) the odds of a positive outcome are significantly better.

This is not entirely correct. The lateral (outer) meniscus carries at least 70% of the load-bearing of the knee and would tend to therefore have a worse prognosis than a defect localized to the medial (inner) meniscus. If he was found to have pre-existing (prior to the injury) cartilage damage/deficiency as being reported now, this would most likely go along with a more diffuse degenerative arthritic process (in addition to that caused by his acute injury) consistent with his long standing bone spurs and mechanical problems. And referring to this, as I stated before we were told anything about the findings:
CloakNNNdagger said:
It's difficult to believe that, given the history of Clowney, they have not encountered significant already-existing arthritic changes in his knee.
 
Greetings.

My apologies to those who tried to PM me. I suck at cleaning out my PMs regularly. It looks like my desk. This week is crazy town and I have a stomach sick person in the house who I hope has food poisoning and not a virus that the rest of us might get because nobody's got time for that.

The entirety of 2014 has given me more medical crap I never wanted to know and I am ready for it to be ovah.

Here's a cut and paste of relevant tweets in my TL. Info I'm trying to convey is what I legit understand, no spin, just trying to pass along to fans info I have with the context I understand. Knew about this before today. Was surprised it waited until tonight to break.

Tweeted some this morning without saying microfracture because 1 I knew folks would freak with just that word 2 my understanding of it is that healing from it is different than it used to be because of the way procedure is done now. Tried to get more info about it from my understanding of what was done online, but much of that information is proprietary/subscription only stuff.

Most microfracture info/studies online is dated.

Of course, bc I'm a JD and not a MD (dammit Jim!), it was hard for me to get the sort of detail that people want, and also because this info is all sorts of sensitive, I don't want to dump anyone in the grease who gives me ish. But I trust it.

Here's some cut and pastes tweets, read from bottom to top:



Stephanie Stradley retweeted
Tania Ganguli @taniaganguli · 1h 1 hour ago
Not about toughness, more about knee response “@jbh_1970: why didn't Texans seek Dr Andrews earlier? See how tough he is?"

Stephanie Stradley @StephStradley · 2h 2 hours ago
@SFHCommissioner @ProFootballDoc @DaveMSiebert Nobody is describing the microfracture procedure JDC had. His involved stuff I never heard of

Stephanie Stradley @StephStradley · 2h 2 hours ago
"Conservative" in medical context meaning avoiding avoidable surgery if possible. Can always do more, can't do less after done @ShaneNFL

Stephanie Stradley @StephStradley · 2h 2 hours ago
People sending me old articles on microfracture. My understanding is Clowney's procedure is a new type that deals w/issues w/ old kind FWIW

Stephanie Stradley @StephStradley · 2h 2 hours ago
JDC cartilage damage old, hard to detect w/o cutting. Seen during meniscus surgery. Conservatively thought could avoid 2nd surgery to play.

Stephanie Stradley @StephStradley · 2h 2 hours ago
I know what microfracture surgery is. What I understood JDC getting wasn't the exact same thing as traditional kind. /not med dr so...

Stephanie Stradley @StephStradley · 2h 2 hours ago
@Rottweiller2000 @TXCleaver @Zepp1978 Not what I understood. It was something I'd never heard of before. But not TMac kind of mf

Stephanie Stradley @StephStradley · 2h 2 hours ago
@Rottweiller2000 @TXCleaver @Zepp1978 It involves donor stuff and own body stuff to create new cartilage. Better results I understand.

Stephanie Stradley retweeted
Jene Bramel @JeneBramel · 2h 2 hours ago
Truth. Ignore other narratives. RT @RapSheet: When Clowney tore meniscus, was also cartilage damage. Texans knew microfracture was possible.

Stephanie Stradley @StephStradley · 2h 2 hours ago
@mrMeenor @Rottweiller2000 @TXCleaver @Zepp1978 From my understanding, new procedure meant to improve that issue. Good results. We'll see.

Stephanie Stradley @StephStradley · 2h 2 hours ago
@Rottweiller2000 @TXCleaver @Zepp1978 Not med dr but understand new advanced procedure. Will have grown cartilage.

Stephanie Stradley @StephStradley · 2h 2 hours ago
From what I understand, team did extra medicals on JDC predraft, & this particular issue hard to detect w/o cutting @Zepp1978

Stephanie Stradley @StephStradley · 2h 2 hours ago
re: Clowney. What heard: Saw old, hard to detect injury while doing meniscus surgery. Hope was he could avoid 2nd surgery/play. Couldn't obv

Stephanie Stradley @StephStradley · 2h 2 hours ago
@Zepp1978 What I was told is that this injury was old, seen, hard to detect but thought was that he may be able to avoid the surgery. Wasn't

Stephanie Stradley @StephStradley · 3h 3 hours ago
@JR_Grif long story. Understand this issue was old but hard to detect. But seen during first surgery.

Stephanie Stradley @StephStradley · 3h 3 hours ago
FWIW, I heard that Clowney's procedure done w/ newish form of microfracture. Heard prognosis better than old but I'm no med doc.


Overall, was given info that his prognosis is good. I hope that information is correct. I have no doubt that where I got there info, it is believed.

Hate to overspeculate about any of this stuff. I think where we are now is waiting and seeing. So there you go.
 
Greetings.

My apologies to those who tried to PM me. I suck at cleaning out my PMs regularly. It looks like my desk. This week is crazy town and I have a stomach sick person in the house who I hope has food poisoning and not a virus that the rest of us might get because nobody's got time for that.

The entirety of 2014 has given me more medical crap I never wanted to know and I am ready for it to be ovah.

Here's a cut and paste of relevant tweets in my TL. Info I'm trying to convey is what I legit understand, no spin, just trying to pass along to fans info I have with the context I understand. Knew about this before today. Was surprised it waited until tonight to break.

Tweeted some this morning without saying microfracture because 1 I knew folks would freak with just that word 2 my understanding of it is that healing from it is different than it used to be because of the way procedure is done now. Tried to get more info about it from my understanding of what was done online, but much of that information is proprietary/subscription only stuff.

Most microfracture info/studies online is dated.

Of course, bc I'm a JD and not a MD (dammit Jim!), it was hard for me to get the sort of detail that people want, and also because this info is all sorts of sensitive, I don't want to dump anyone in the grease who gives me ish. But I trust it.

Here's some cut and pastes tweets, read from bottom to top:



Stephanie Stradley retweeted
Tania Ganguli @taniaganguli · 1h 1 hour ago
Not about toughness, more about knee response “@jbh_1970: why didn't Texans seek Dr Andrews earlier? See how tough he is?"

Stephanie Stradley @StephStradley · 2h 2 hours ago
@SFHCommissioner @ProFootballDoc @DaveMSiebert Nobody is describing the microfracture procedure JDC had. His involved stuff I never heard of

Stephanie Stradley @StephStradley · 2h 2 hours ago
"Conservative" in medical context meaning avoiding avoidable surgery if possible. Can always do more, can't do less after done @ShaneNFL

Stephanie Stradley @StephStradley · 2h 2 hours ago
People sending me old articles on microfracture. My understanding is Clowney's procedure is a new type that deals w/issues w/ old kind FWIW

Stephanie Stradley @StephStradley · 2h 2 hours ago
JDC cartilage damage old, hard to detect w/o cutting. Seen during meniscus surgery. Conservatively thought could avoid 2nd surgery to play.

Stephanie Stradley @StephStradley · 2h 2 hours ago
I know what microfracture surgery is. What I understood JDC getting wasn't the exact same thing as traditional kind. /not med dr so...

Stephanie Stradley @StephStradley · 2h 2 hours ago
@Rottweiller2000 @TXCleaver @Zepp1978 Not what I understood. It was something I'd never heard of before. But not TMac kind of mf

Stephanie Stradley @StephStradley · 2h 2 hours ago
@Rottweiller2000 @TXCleaver @Zepp1978 It involves donor stuff and own body stuff to create new cartilage. Better results I understand.

Stephanie Stradley retweeted
Jene Bramel @JeneBramel · 2h 2 hours ago
Truth. Ignore other narratives. RT @RapSheet: When Clowney tore meniscus, was also cartilage damage. Texans knew microfracture was possible.

Stephanie Stradley @StephStradley · 2h 2 hours ago
@mrMeenor @Rottweiller2000 @TXCleaver @Zepp1978 From my understanding, new procedure meant to improve that issue. Good results. We'll see.

Stephanie Stradley @StephStradley · 2h 2 hours ago
@Rottweiller2000 @TXCleaver @Zepp1978 Not med dr but understand new advanced procedure. Will have grown cartilage.

Stephanie Stradley @StephStradley · 2h 2 hours ago
From what I understand, team did extra medicals on JDC predraft, & this particular issue hard to detect w/o cutting @Zepp1978

Stephanie Stradley @StephStradley · 2h 2 hours ago
re: Clowney. What heard: Saw old, hard to detect injury while doing meniscus surgery. Hope was he could avoid 2nd surgery/play. Couldn't obv

Stephanie Stradley @StephStradley · 2h 2 hours ago
@Zepp1978 What I was told is that this injury was old, seen, hard to detect but thought was that he may be able to avoid the surgery. Wasn't

Stephanie Stradley @StephStradley · 3h 3 hours ago
@JR_Grif long story. Understand this issue was old but hard to detect. But seen during first surgery.

Stephanie Stradley @StephStradley · 3h 3 hours ago
FWIW, I heard that Clowney's procedure done w/ newish form of microfracture. Heard prognosis better than old but I'm no med doc.


Overall, was given info that his prognosis is good. I hope that information is correct. I have no doubt that where I got there info, it is believed.

Hate to overspeculate about any of this stuff. I think where we are now is waiting and seeing. So there you go.

Thanks for the update, Steph.

The procedure you must be referring to is the OATS procedure (or osteoarticular cartilage transplantation). In extreme simplistic terms, it is like a counterpart to hair transplantation.

The improvement over the traditional microfracture surgery is that the multiple holes created by the drill are filled with plugs of cartilage that are still attached to underlying bone (taken from a less important little weight-bearing donor site). Because of its lack of blood supply, cartilage grafts have a miserable take percentage and poor track record for joint reconstruction. By actually placing raw bone in direct contact with raw bone, 2 well blood supplied surfaces can grow together, and the piggy backed cartilage remains viable and intact on the joint surface.
The results in some limited studies have shown significant improvement over traditional microfracture surgery.
 
The results in some limited studies have shown significant improvement over traditional microfracture surgery.



I didn't understand the rest of your post, but that part sounds promising at least. Thanks for the info
 
Have to ask...how does that make it different? As pointed out Tuggle was not drafted and came the previous year. X hasn't been playing so how that is looking better I have no clue. He doesn't start and lately has gotten less than 10 plays. When he played significantly he was rather horrid. Fiedo, no different. Struggles holding his block and hasn't been a receiving threat.

Now not saying these guys can't develop but they have done nothing to say they have been making the draft look better other than putting their shoes on correctly.

X has been playing more lately. I remember BOB talking about how they kept moving him all over the line which slowed his progress, so now he is just playing guard and has been doing okay now. Fiedo has been blocking well. I wish he would be more of a receiving threat, but i also don't know how much of that is on him, or on Fitz.

The point I'm trying to make is that it is still just year one. Not time to write them off yet.
 
I didn't understand the rest of your post, but that part sounds promising at least. Thanks for the info

A cored out bone plug with overlying joint cartilage attached taken from a non weight-bearing area and placed in a deep hole cored out in the affected area of weight-bearing (so that the cartilage sticks out on the joint surface to try to replicate the damaged or lost cartilage joint surface).

cartilage-transplantation-oats-procedure.jpg


oats_plug.gif


images
 
Why can't someone with team come out and say what was wrong and what was done to correct. Too much to ask?
 
Thanks for the update, Steph.

The procedure you must be referring to is the OATS procedure (or osteoarticular cartilage transplantation). In extreme simplistic terms, it is like a counterpart to hair transplantation.

The improvement over the traditional microfracture surgery is that the multiple holes created by the drill are filled with plugs of cartilage that are still attached to underlying bone (taken from a less important little weight-bearing donor site). Because of its lack of blood supply, cartilage grafts have a miserable take percentage and poor track record for joint reconstruction. By actually placing raw bone in direct contact with raw bone, 2 well blood supplied surfaces can grow together, and the piggy backed cartilage remains viable and intact on the joint surface.
The results in some limited studies have shown significant improvement over traditional microfracture surgery.

Hmm. That doesn't sound like what I understood.
 
Thanks for the update, Steph.

The procedure you must be referring to is the OATS procedure (or osteoarticular cartilage transplantation). In extreme simplistic terms, it is like a counterpart to hair transplantation.

The improvement over the traditional microfracture surgery is that the multiple holes created by the drill are filled with plugs of cartilage that are still attached to underlying bone (taken from a less important little weight-bearing donor site). Because of its lack of blood supply, cartilage grafts have a miserable take percentage and poor track record for joint reconstruction. By actually placing raw bone in direct contact with raw bone, 2 well blood supplied surfaces can grow together, and the piggy backed cartilage remains viable and intact on the joint surface.
The results in some limited studies have shown significant improvement over traditional microfracture surgery.

Another explanation with a picture:

During the 1990s, orthopedists began using plugs or cylinders of bone and articular cartilage taken from a healthy area of the patient’s knee (one that does not have to bear much weight) and transplanting them into the damaged area of the knee. This method, called Osteochondral Autograft Transplantation Surgery (OATS), allows placement of mature, durable articular cartilage in the damaged area. Placement of these bone-cartilage cylinders, known as autografts, can be used to resurface an area of the knee that lacks a cartilage cover.

3part2-image2-OATS.jpg

Link

So the cylinderical plugs are bone on one side, which will be inserted into the holes at the repair site so that the bone side of the plug eventually fuses with the knee bone.

The first question I have is if the repaired but imperfect cartilage surface interferes with mechanics at all.

EDIT: Just saw your follow up post. I like my picture better.
 
Hmm. That doesn't sound like what I understood.

The only other thing that I can think of would be articular cartilage paste grafting.

An articular cartilage paste graft is a procedure where a small amount of the patient’s own bone, stem cells, and cartilage is taken out of the non-weight bearing intercondylar notch of the knee, ground into a paste, and impacted back into an arthritic defect in the joint (as opposed to the technique I mentioned above that uses solid bone/cartilage plugs placed into the arthritic defect). From there, the knee grows replacement tissue, right inside the joint, promoting the healing ability of the patient’s own bone marrow derived stem cells. It is easier and more cost-effective that other techniques requiring cells to be grown in culture.
 
The only other thing that I can think of would be articular cartilage paste grafting.

An articular cartilage paste graft is a procedure where a small amount of the patient’s own bone, stem cells, and cartilage is taken out of the non-weight bearing intercondylar notch of the knee, ground into a paste, and impacted back into an arthritic defect in the joint (as opposed to the technique I mentioned above that uses solid bone/cartilage plugs placed into the arthritic defect). From there, the knee grows replacement tissue, right inside the joint, leveraging the healing ability of the patient’s own bone marrow derived stem cells. Since the technique is a single step outpatient procedure, it is far more cost effective than similar procedures that require cells to be grown in culture.

From the link I posted, this procedure is also explained:

Cell and Scaffold Technology

One such technique that came into use around 2005 involves the placement into the articular cartilage defect of two to five plugs of synthetic material that mimic natural bone and cartilage and serve as a scaffold. The patient’s own cells can then migrate to the area of damage and facilitate a repair by growing inside the scaffold. More than three hundred patients who have had the procedure at HSS have been tracked, and early results suggest that the method may be superior to microfracture over the long term.
 
Why can't someone with team come out and say what was wrong and what was done to correct. Too much to ask?

They will never ever do that. Not with this sort of specificity. I would fall out of my chair.

Players don't want their business out there. Teams don't want their business out there. If it doesn't help winning, they don't want to talk about it. I can see that point.
 
From the link I posted, this procedure is also explained:

Sorry, Brisco, but the technique that you last listed is a synthetic foreign body scaffold that surrounding tissue would simply be encouraged to grow into. The foreign body aspect would increase the chance of infection which in a joint could be devastating.
 
They will never ever do that. Not with this sort of specificity. I would fall out of my chair.

Players don't want their business out there. Teams don't want their business out there. If it doesn't help winning, they don't want to talk about it. I can see that point.

While I agree with you, what would it hurt to let the fans know what is going on? It's not like Clowney will have any effect on the Texans winning or losing.
 
While I agree with you, what would it hurt to let the fans know what is going on? It's not like Clowney will have any effect on the Texans winning or losing.

They did. They told us Clowney was going on IR and was going to have another surgery. Anything more would be violating Clowney's privacy.
 
Sorry, Brisco, but the technique that you last listed is a synthetic foreign body scaffold that surrounding tissue would simply be encouraged to grow into. The foreign body aspect would increase the chance of infection which in a joint could be devastating.

While reading about the various articular cartilage procedures, I can't help but wonder why these weren't used on Brennan Williams.
 
While reading about the various articular cartilage procedures, I can't help but wonder why these weren't used on Brennan Williams.

Because none of these techniques have truly contemporaneously proven themselves with any consistency in the arena of elite athletes, especially NFL players. Many of the studies are in pediatrics groups, college players, multiple different sports, 30-45-60 (to geriatric) year old groups, weekend warrior groups and couch potatoes. And the problem with most is that their comparison (pre and post injury) performance ratings techniques have not been valid, reliable, or have been nonexistent......relating only return to play % and length of playing years/games (ignoring level of play upon return and in subsequent years). The injuries that these techniques are meant to treat remain quite treacherous in general to those who have sustained them.
 
I will just mentally count Clowney out as a Texan. Any contribution to the team winning games will be a shock. I foresee moments of "recovery going well" tweets to raise my hopes only to later crush them. 2-14 for nothing.
 
I will just mentally count Clowney out as a Texan. Any contribution to the team winning games will be a shock. I foresee moments of "recovery going well" tweets to raise my hopes only to later crush them. 2-14 for nothing.

Just goes to show that the notion of "tanking" is stupid as hell. We didn't do that last year, just a general point to those people in sports over the last years who have hit the "just tank!" narrative hard.
 
While reading about the various articular cartilage procedures, I can't help but wonder why these weren't used on Brennan Williams.

After reading Stephanie's tweets and Docs posts, I did some research on various medical techniques used to target and stimulate new tissue growth. Then, I cross-checked all of those procedures with the areas of expertise, reputation, and medical experience of the Texans' medical/surgical staff, beginning with Dr. Lowe.

Based on my research, here is what was done to Clowney's knee:





33699.jpg


leeches_4.jpg


Using these guys to stimulate cartilage growth in the knee is cutting edge... I'm not sure how many leeches were surgically attached and also unclear if they simply dissolve inside the knee over time or if another surgery will be required to detach them from the knee.
 
It is too soon to start joking about this. Wait, that was serious?

OTA's are out, but limited participation in training camp seems to be on the optimistic side of the spectrum.

Just don't rush things physically and get the mental part down NOW! It's not a 9 month vacation. Get to know all defensive responsibilities like you had to go into coaching. OLB, DE and even ILB as positions of focus. Learn the scheme and adjustments. Then if it takes you half of next season, so be it. You'll be ready to go when you are ready physically and mentally sharp enough to overcome any lingering effects physically.

I'm a patient fan. But optimizing his chances of as complete a recovery as probable is likely the prudent choice.
 
You generally have to work the phones for deals. I have serious doubts in our GM's ability to work such deals.

And yet he was ABLE to move up to get a value pick in Louis Nix. Whether he turns out to have that value is another matter entirely, but he got the pick for perceived value.
 
Does anybody really believe the Texans had any choice but to pick Clowney?

Its for this reason that I was, and remain, fully behind the pick. This guy was far and away #1 overall from that draft class. His potential even made trading back a questionable deal.

No team ever passes up a talent as good as that.

I'm just hoping now that Clowney recovers well and uses that time to become NFL ready over the offseason, and comes back a vet in training camp, ready to wreak havoc alongside JJ next season.

I've seen enough from this team already this season to feel like, given all the missing pieces, we're on the right track to make a run year after year if we can draft well and develop what we have in training camp.
 
Does anybody really believe the Texans had any choice but to pick Clowney?

Its for this reason that I was, and remain, fully behind the pick. This guy was far and away #1 overall from that draft class. His potential even made trading back a questionable deal.

No team ever passes up a talent as good as that.

He had the most hype, that's for sure. I posted and linked a source somewhere a few weeks ago that in the last 20 drafts only three of the 1/1 picks were defensive players. Two of those picks were by the Texans brain trust. I doubt that trend would have been bucked by most of the teams in the league this year.

I don't buy the "once in a generation" hyperbole either, unless we are talking fruit flies. Mario was also a "once in a generation player" too. "Generations" are coming around as fast as the Texans having the first pick in the draft. That's been a fairly quick cycle.
 
Walt Lowe is the Texans Surgeon.

Is he the same one who checked Clowney and did whatever procedure and missed him needing this operation, which Andrews had to diagnose? That guy?

If you are billionaire, in a billion dollar league, you hire the best to operate on your 1.1 pick.

You don't let the in-house guy do it.

You let Dale Jr. drive your new stock car, not your nephew who won a go-cart race ...
 
I'm aggravated, but I think everyone should calm down and give the kid time to heal. Anyone saying we should have taken someone else is hind sighting things. Who should they have taken? Manziel? Bortles? Clowney was the across the board consensus number one pick, you don't pass that... and you can't control injuries.
 
Does anybody really believe the Texans had any choice but to pick Clowney?

That we are hearing reports that his was an old injury, it makes complete sense that he played with in 2013.... explains why he wasn't making the impact plays people were expecting, yet he was still able to wow everyone at the combine & pro days.

Just like Nix & Brennan Williams, this is the kind of stuff that would have made him a late 3rd... maybe even late 4th round pick.
 
Is he the same one who checked Clowney and did whatever procedure and missed him needing this operation, which Andrews had to diagnose? That guy?

Walter Lowe is extremely respected around the country in this field. He may not have the visability of Dr Andrews, but he's up there.

The reports read like Lowe noticed it & informed the Texans. They decided not to address it at that time & if it were my knee, or my daughter's knee (I say my daughter because he did fix here ACL) & he saw that I would definitely not want to make the decision of how to fix it at that time. Not with the options we are hearing about now.

The thing that gets me, is if they did know about this other condition, then what in the world made them push him out there at six weeks. That doesn't make any sense.
 
I'm aggravated, but I think everyone should calm down and give the kid time to heal. Anyone saying we should have taken someone else is hind sighting things. Who should they have taken? Manziel? Bortles? Clowney was the across the board consensus number one pick, you don't pass that... and you can't control injuries.

It isn't hindsight if your opinion before the draft wasn't with the supposed "consensus" pick.

I think that "consensus" pick is incorrect anyway. I doubt that most teams would have picked him 1/1. Every time I hear that he was a no brainer pick, it reminds of the time McNair was so happy that the other owners (also known as his competitors) supported the idea he was "on the right track". In other words, it was bullshit.
 
I would have been happy with Watkins or Mack at this point, which I really wanted them to draft. Never was a Clowney fan before the draft, but he's our pick now so no point in getting upset. just hope he goes on to recover and becomes a good DE at this point.
 
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