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The Philadelphia Inquirer Interviews Dr. Mandelbaum About Philadelphia 76ers Joel Embiid’s Torn Meniscus


THE CATCH PHRASE started years ago, when it was apparent that the NBA was becoming a point-guard-driven league and the style of play veered away from an isolation game to one that included big men shooting threes and midrange jumpers mightily frowned upon.

"Head of the snake" is how point guards have been labeled, and for teams to succeed offensively, that position had to be the facilitator, and if success was to be reached defensively, that area had to be stopped.The question right now concerning the Sixers is, who is the head of the snake? Not on the basketball court, but off it.
They went 10-5 in January. Then, a mostly healthy Joel Embiid tantalized fans' hopes with his stellar play. A proven stretch-four in Ersan Ilyasova showed he was the perfect complement to Embiid. Rookie Dario Saric showed he is a blossoming NBA star. While surrounded by NBA talent, T.J. McConnell showed how effective a point guard can be in Brett Brown's offense. Overall, the team showed an ability to play admirable defense, seemingly built a solid foundation on which to grow. Top overall draft pick Ben Simmons was still waiting in the wings, hopeful of a late-season return. Numerous draft picks lay in wait and the future seemed to come into focus.

How things can change in a month. The foundation is now cracked, as if the ground beneath had shifted, and many tremors that followed left the construction site more unsettled than anyone could have imagined only weeks ago.

The first shaking began Jan. 20, when Embiid landed awkwardly in a game against the Portland Trail Blazers and hyperextended his left knee, which caused a bone bruise and, as an MRI later revealed, a slight meniscus tear. That has since become more significant, and he is now out for the season. That news came only days after the team said that Simmons' surgically repaired right foot, which suffered a Jones fracture on Sept. 30, the final day of training camp, hadn't healed properly and that he will miss all of his first season.

When asked last Friday whether more procedures or surgeries were planned for Simmons, president Bryan Colangelo responded, "Not yet," but he did say the team will do whatever is best for Simmons to promote healing. They will do the same for Embiid for his "more pronounced" meniscus tear. It could mean more surgery for both.

Speaking generally about meniscus tears, Dr. Bert Mandelbaum, an orthopedic surgeon at Santa Monica Orthopedic & Sports Medicine Group, said: "Most physicians would recommend arthroscopic surgery to assess and do whatever repair they need to do to get back to sport, then work a progression from there. It is a concept of scalability. Some are (ranked) 1, where repair and recovery can be done in about four to five weeks, and some are a 10, where recovery could be in the eight-month range. A 21-year-old who has never had knee surgery is a lot better off than a 31-year-old who has had a few surgeries.

"The devils are (in) the details. Ones are rapid recoveries and good prognosis. At the higher end of the spectrum, the eights to 10s, that is six to eight months." It appears to be yet another flub in the handling of injuries. That's not to say the Sixers' medical team is incompetent or that current or past injuries have not been handled properly. But it remains a cloudy environment.

Against his wishes, Nerlens Noel was held out his rookie season after having a repair done to the ACL he injured in college. Caution was the reasoning. Yet, Noel missed the first 23 games of this season as another procedure was performed.

Embiid missed two seasons and needed a second surgery on the navicular bone in his foot, which hasn't had any more problems. But after his misstep against Portland, he played in another game and was working out hard in trying to get back on the court.

When Jahlil Okafor tore the meniscus in his knee last season and ultimately had surgery in March, the team deemed it minor and said he'd return in six weeks. It was seven months before he was able to resume on-court activities.

Days go by before the Sixers provide results of MRIs or CT scans, yet the Golden State Warriors were able to reveal the results and a game plan for superstar Kevin Durant less than a day after he hyperextended his knee this week against Washington.

Are too many doctors overseeing the wellness of the players? Are opinions on courses of action so varied that it's decided by majority vote after days of discussion? Are the players being kept apprised of course of action? Embiid questioned just that a week ago. Someone has to become the head of the snake and get a handle on all things Sixers.

In fairness, Colangelo came into a storm when it came to injuries and probably didn't get the proper guidance on what the sports landscape of this town is about. Perhaps he's never been around what appears to be a medical staff that is overflowing with people and opinions and diagnosis. Still, fans and players need this organization to be run better. When questions are always circling, doubt about direction is close behind.

On-court problems are easily recognizable. The team is suffering now with Embiid, Ilyasova and Noel not around anymore (the last two via trade). But now the behind-the-scenes capabilities are coming into question, and that could be as bad as injuries, bad trades, failed draft picks or inactivity in free agency.

To get Noel shipped to Dallas, the Sixers had to agree to take on Andrew Bogut and his $11 million salary. That did the Mavericks a favor in dumping his salary and helped the Sixers to get to the salary-cap floor of just over $94 million. Teams are required to get to 90 percent of that floor, or close to $85 million. If a team doesn't reach the floor, the amount they are short is divided among the players on the roster.

This is the second season in a row management decided to make such a move. Last season, the Sixers took on over $22 million in combined salary for JaVale McGee ($12 million) and Gerald Wallace ($10.1 million). So, for the second year in a row, players who, for the most part, have suffered through insurmountable losing while playing their butts off have had money, in a sense, taken out of their pockets. Don't think that hasn't soured some, if not most.

The curious activity that surrounds the organization isn't good. It's as toxic as injuries, a depleted roster and failed draft picks.


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