Why isn’t Al-Farouq Aminu having surgery for his torn meniscus?

Orlando Magic forward Al-Farouq Aminu has a torn meniscus in his knee. But why isn’t the versatile defender undergoing surgery right away?

ESPN’s Adrian Wojnarowski reported Sunday morning that the Orlando Magic’s Al-Farouq Aminu has a torn meniscus in his right knee and it is unknown at this time when he will return.

Aminu, who signed a three-year, $29 million contract during the offseason, was brought on by the Magic to provide a veteran presence and defensive versatility to an otherwise young, promising team. While he had struggled offensively up until his injury — he’s averaging career-lows in field goal percentage and free throw percentage while shooting 25.0 percent on two 3s per game — Aminu was still valuable defensively. Of the three most utilized lineups that Aminu has been a part of, Orlando — who owns the league’s 10th-best defense — has a defensive rating of 100.0, 102.0, and 84.7 in 49, 46, and 34 minutes respectively.

What makes Aminu’s injury more intriguing than most meniscus injuries was that Wojnarowski reports that the Magic are trying to determine if surgery will be needed or not.

The meniscus is a disc of dense, fibrous cartilage, of which there are two in each knee — a medial and a lateral. Both menisci sit on top of the tibia — or shin bone — and serve two purposes: to work with the ligaments of the knee to provide stability as well as to function as a shock absorptive and dispersive structure. The lateral meniscus is the more mobile of the two and slides forward and backward when the knee is flexed and extended. The medial meniscus is connected to the MCL via the laters deep fibers and is often torn with significant MCL injuries.

Both menisci can be torn acutely or chronically, each of which is a common injury for NBA athletes to suffer. Acute tears of the meniscus are usually more debilitating as they usually result in pain, swelling, and impaired range of motion of the knee; many chronic meniscus tears go undetected as they frequently don’t produce any symptoms.

Acute tears of the meniscus can be treated in one of three ways — surgical repair, surgical excision, or conservatively — and each option has its positives and negatives.

Surgical repair of the meniscus involves sewing the torn tissue back together. The recovery for this procedure is typically in the four-to-six month range as most surgeons require a long period of non-weight-bearing with the surgical knee. However, not all tears of the meniscus are eligible to be repaired. The meniscus loses its blood supply during the aging process, so by the time of adulthood only the outer third of the meniscus has adequate blood supply for a repair procedure to be successful. Additionally, longitudinal tears — those that run from the front to the back of the meniscus — repair more successfully than their horizontal counterparts. Due to the long recovery time and persnickety nature of which can even be repaired to begin with, true meniscal repairs are infrequently completed in NBA athletes.

Meniscectomies are the much more common procedure, with many NBA athletes going under the knife every year. A meniscectomy involves cutting out the small tear of the meniscus as well as removing any loose bodies — free-floating soft tissue or bone chips — from the knee. This procedure is done arthroscopically with a small incision, so athletes are often able to return relatively quickly; the average time missed is four-to-six weeks. However, the biggest downside to this procedure is that it inherently decreases the stability and cushioning of the knee. In the short-term, this isn’t too big of a deal, but cutting out part of the meniscus does increase the chance that the athlete may suffer not only another acute meniscus tear but also persistent knee pain and arthritis.

Treating the injury conservatively (i.e. physical rehabilitation without surgery) focuses on improving range of motion of the knee and decreasing pain during basketball activities. While the tear will not heal on its own, there is increasing evidence that treating tears conservatively may be just as effective as treating them with a meniscectomy, though more data is needed, particularly involving elite athletes, before conclusions can be made. Similar to meniscectomies, the recovery timeline for meniscus tears treated conservatively is typically four-to-six weeks, however, there is always the chance that conservative rehabilitation fails; failed treatment would essentially involve pain that does not diminish during basketball activities (i.e. running, jumping, cutting) or an inability to regain full range of motion and lower extremity strength. Athletes and teams run the risk of an additional four-to-six weeks being added to the recovery timeline if conservative rehabilitation fails.

Luckily — or unluckily, depending on your perspective — for the Magic and Aminu, they have the option to wait and thoroughly consider all their options before deciding whether or not surgery is the route they will choose. Picked by many to be a surprise team in the Eastern Conference after their successful 2018-19 campaign, Orlando has struggled to meet expectations early on this season; they currently find themselves in eighth place, one game ahead of the Charlotte Hornets and 1.5 games behind the Brooklyn Nets.

Orlando will not be competing for a championship, and with the lack of depth in the East, they should be able to stay in the running for a playoff spot with or without Aminu. If treating Aminu’s injury conservatively is possible, it should at least be thoroughly investigated, and it sounds as if Orlando will be doing just that. It is the smart way to go about deciding what is best for the player and the team.