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May 11, 2010

Under The Knife

The Beltran Saga

by Will Carroll

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Carlos Beltran (arthritic knee, ERD 5/20)
The Beltran saga is getting confusing. Earlier today, MetsBlog.com's Matthew Cerrone and I had a conversation regarding the situation. I've been following it medically while Cerrone covers the Mets like white on rice. Instead of summarizing our discussion and the many points, we thought it was better just to bring it to you, so here it is, in slightly edited form:

Matthew Cerrone: What are the chances Beltran actually had microfracture surgery in January? If you recall, that is what was initially reported the day news broke, though the team was quick to say he did not. I did see him walking around during spring training, but it's been close to four months since the surgery. What gives?

Will Carroll: Darn good question, but I don't think he had microfracture surgery. There's a couple reasons here. First, teams, players, and agents don't often flat-out lie. All three in this case, plus the doctor, Dr. Richard Steadman, put out information saying there was no microfracture. That's a lot of reputations at stake and a lot of possible leaks. Second, if he'd had microfracture, he would have spent a lot of time on crutches just after. I never saw that, but you follow it more closely. Did you?

MC: I agree, I don't see any benefit for any one involved to be lying, nor do I think anyone would, especially since there are things like insurance and workman's compensation on the line. To answer your question, no, when I saw him in spring training he was not on crutches. In fact, he was walking and putting weight on his knee, though it was wrapped quite heavily. In fact, in one instance, I saw him standing at a mirror with Angel Pagan giving Pagan instructions about his batting stance, while doing a full demonstration, minus the bat. But then why the delay? From what I can gather, Beltran is still dealing with some sort of osteoarthritis issue, bone bruises and something to do with cartilage, all of which will forever give him manageable pain in his knee, unless it overwhelms his performance in which he case he will need microfracture surgery. Does that sound right?

WC: Exactly. With that new fact (no crutches) out there, I think we can just about put the microfracture surgery theory to bed. The rest remains a question. What we know is that Beltran's cartilage is gone. He's had bone bruises caused by the femur banging into the tibia/fibia area—it's like taking the shock absorbers off your car and driving down a cobblestone road. You can do it, but it's going to be a rough ride. Every time he steps, runs, jumps, or even just stands, it's going to hit. The surgery was designed to try and even things out, probably shaving down the bone to smooth it. Grinding is as bad as the pounding they're taking. Add in two other facts—he's wearing a brace specifically designed to reduce the effects of osteoarthritis and he had a Synvisc injection to lubricate the joint—and everything fits with the diagnosis. It still leaves us with the delay. Was the surgery successful and he could have come back had he not had continued symptoms, such as the bruising? That's possible. There's also a big issue that I haven't heard many people bring up—insurance. What do you know about that situation?

MC: In the days after the surgery, Beltran's agent, Scott Boras, told 1050 ESPN Radio that Dr. Steadman's office received workman's compensation paperwork to pay for the procedure from Mets trainer Ray Ramirez. I believe the New York Post reported that the Mets had looked into filing some sort of insurance claim with the commisoner's office, but, from what I understand, that never happened.

WC: Right. Beyond that, there's the question of whether or not the contract is insured. I'm not sure on whether or not there's a disability policy, but those can have an elimination period of 90 days for those out there that need or want a conspiracy theory. It's that pain that's key, though. When he runs, he ends up with the bone bruises that ended his season last year. Obviously, it's the running that's an issue, and absent a more effective cure—they've done everything short of microfracture at this stage—I have to wonder if the Mets can shift him and keep their lineup productive. Can they move Jeff Francouer over to center field? Would they shift Beltran to first base and put Ike Davis somewhere? There are some platoon issues as well, if I remember, but can Jerry Manuel figure those out... or at least read Ben Baumer's report?

MC: The word from St. Lucie on Monday was that Beltran is able to swing a bat, and though he's been doing light jogging, he still feels pain in the knee when he tries to run full speed—and so, until that happens, we wait, right? If so, Gary Matthews Jr. stays on their roster, because  Pagan has suffered more than a few injuries during his career, and so if Pagan gets hurt, Matthews has shown he is more than able to roam center field in Citi Field. Frankly, to me, defense at that position for the Mets—at this point—is actually more important than the bat.

WC: I'm not sure. If he's ready, they have to try to get something out of him since no one knows how long that will last. I can't see them waiting around, especially with the media all over this one. What comes next is what's in question. Can Beltran's knees hold up to any level of activity? Will they be able to find a way to maximize his production or even find a trading partner with an open designated hitter slot? It's a really interesting theoretical problem for us, Matthew, but for the Mets, this could be the difference between watching the playoffs and playing in them.

---

Jimmy Rollins (strained calf, ERD 5/18)
Phillies fans can breathe a bit now. Rollins—who it should be noted didn't have a setback last week despite reports to the contrary—is now headed to Clearwater to start his rehab. He'll play in controlled extended spring training games, but should be in the lineup for the high-A Thrashers before too long. Rollins' calf is "pretty close to 100 percent" according to my sources and he's not having trouble with the "slide, slide, turn and run" move that was giving him some issues last week. Sources tell me that it's still tight under certain circumstances, but that they feel like the team medical staff can stay ahead of this. It's also going to involve Rollins not running as much, if at all, for the first few weeks. The team is more focused on having him in the field and at bat, so for now, they're perfectly willing to see Rollins' running come to a stop. If Rollins has no setbacks, he could be back in the Phillies' lineup by this time next week.

Nelson Cruz (strained hamstring, ERD 5/13)
The Rangers are sending Cruz out for a quick two-game rehab assignment, starting Tuesday at Triple-A Oklahoma City. He ran well on Sunday, convincing athletic trainer Jamie Reed and manager Ron Washington that he'd be ready for this next step. The hamstring seems to have healed up nicely while on the DL, so the rehab assignment is more to get him at-bats than to test the hamstring. Cruz should be back on Thursday without real limitations, though it's likely that he will be red-lighted on the basepaths. Cruz has deceptive speed, in addition to his well-known power, so this is a concern with his leg injury. My guess is that he'll be working on trotting around the bases rather than stealing them through the end of May.

J.D. Drew (vertigo, ERD 5/12)
The entire city of Boston seemed to be playing that word association game. They heard "vertigo" and all said in unison, "Nick Esasky." Esasky is perhaps the best-known case of vertigo and the most serious, but there's no need to jump that far ahead. Drew did miss Monday's game with what was described as vertigo, but sometimes a cigar is just a cigar. Drew will be monitored, but usually these types of events are transient and usually involve some sort of ear infection. The other major cause is concussion, though I dont think there's any suggestion that Drew has gone head-first into anything lately. With Drew, who has dealt with this before, it normally takes a couple days to clear up with little or no residual effect. This is the very definition of day-to-day, but there's not much concern past the short term.

Troy Tulowitzki (strained quad, ERD 5/12)
Huston Street (strained shoulder, ERD 5/25)
The Rockies didn't take any chances with  Tulowitzki after he came up lame over the weekend. He was sent for images on his strained quad and while they came back as expected, with just a mild strain, the Rockies are going to hold him out until at least Wednesday to make sure that his hard-nosed style doesn't cause this to turn into something worse. Sometimes, the trainer's biggest job is to protect the player from himself. This shouldn't have long-term consequences, in large part because of the way the medical staff didn't allow there to be. Over on the pitching side, Troy Renck got all the details about how Street will work his way back to the Rockies' closer job. He'll throw on Thursday, Saturday, and Tuesday for Double-A Tulsa, then he'll head to Triple-A Colorado Springs where he'll go back-to-back next Friday and Saturday. If there are no setbacks, he'll be back in Denver the following Monday. So, two weeks from now, he'll be closing again. The team had hoped to ease him back in, but the struggles of Franklin Morales have changed Jim Tracy's mind, and it doesn't seem that the front office is arguing against such a move. Street's shoulder held up well in his extended spring training team game and seems to have gained strength during his throwing program. The back-to-back part of this is the one to really watch, as the stamina is probably the biggest concern at this point.

Chipper Jones (strained groin, ERD TBD)
Chipper did it again. He put himself back in the lineup, declaring his groin strain to be sufficiently healed, only to end up re-injuring himself. He did it on, of all things, an infield single. Give Jones points for effort, but subtract them for intelligence. Just coming off a groin strain and he's trying to leg one out. Jones left the game limping, and there are questions now as to how long he'll be out. The Braves will wait to see how he responds over the next day or so before making any decision, so don't expect quick resolution here. If nothing else, maybe it will remind Jason Heyward to be more careful... or maybe the Braves will start taking this supervision thing a bit more seriously.

Dallas Braden 

Braden isn't Bud Smith and he's also not Curt Schilling. He's probably not Johnny Vander Meer, either, but next time out, those are three names that should come to mind. Braden's perfect game is one of those quirks of history, but recent history has shown us that there's an additional stress created by even coming close to a no-hitter. Schilling's arm was never the same after he was allowed to go deep into a game chasing history, while Smith was never the same after he made it through 27 outs. Braden is past the injury nexus, a plus on his side, and he only went 109 pitches, but just how stressful were those pitches? Braden was efficient, but in the eighth and ninth, he was showing both a better fastball (likely the result of increased effort and adrenaline) and some control issues. I'm sure the Athletics will be watching Braden closely when he takes the mound on Friday. Let's just hope his perfect game moment isn't the only one we remember in his career.

Quick Cuts: Brad Lidge wasn't available yesterday due to stiffness in his repaired elbow. There's very little detail, but it certainly bears a close watch, especially with Ryan Madson down. ... Jair Jurrjens had a "mild setback" with his hamstring. It tightened up on him while jogging, so he won't be back on Saturday as expected. ... Dontrelle Willis was scratched at the last minute yesterday with an illness. It's the second time this season, which is raising some eyebrows, but sources tell me this is on the up-and-up. ... While the Mets are focusing on Beltran, Daniel Murphy is also getting closer to a comeback. The former first baseman is working at DH but expects to move to the field soon. It's not clear where that might be, but the knee might make first base the only option. ... Felipe Lopez has been cleared to resume baseball activities. He should be back pretty quickly from his elbow sprain. ... Knucklballer Charlie Haeger hits the DL with plantar fasciitis. This isn't something pitchers normally get, so we'll have to watch this one for a while to get a better idea of just how long he'll be out. ... Nice to see the topic of pitcher workload is getting some mainstream attention. ... Josh Beckett will start Friday instead of Wednesday, due to tightness in his back, though it was originally presented as a way to keep Tim Wakefield sharp. There's a chance that Beckett won't be able to go on Friday either, but there's time for rest and treatment. ... The Red Sox will get Mike Cameron back this week, but Jacoby Ellsbury is still not quite to the point where he can go to Pawtucket just yet. ... I doubt it's scientific, but the new "MLB pulse" makes it look like Twitter can be used like WPA.

---

 Thanks to Matthew Cerrone and MetsBlog.com for a great discussion.  

Related Content:  Back,  Surgery,  Dallas Braden,  Strained Groin,  Quad-a

15 comments have been left for this article. (Click to hide comments)

BP Comment Quick Links

Hoff

WRT Murphy, its not like with carter matthews jr cora and cattalano carrying the met's primary pinch hitting bats getting murphy back for hitting only is such a terrible thing. He's a high contact guy too, so thats nice.

May 11, 2010 08:11 AM
rating: 0
 
SC

Is Ledley King (Tottenham Hotspur) a good comp for Beltran's injury? Both seem to have nothing left in their knee to absorb shocks, and it sounds like for both it's about managing pain rather than curing the ailment.

May 11, 2010 09:33 AM
rating: 1
 
BP staff member Will Carroll
BP staff

YES! Very good comp.

May 11, 2010 10:04 AM
 
mglick0718

Call me a pessimistic Mets fan (which I am), but really? Beltran, or anyone else for that matter, can really play a professional sport with his "femur banging into the tibia/fibia area"? I've never experienced that thankfully, but unfathomable to me that would create merely a "manageable" level of pain from anything more strenuous than walking.

May 11, 2010 11:57 AM
rating: 0
 
Patrick M

On a less pessimistic note, while Beltran perhaps can tolerate the pain long enough to play a few more years, is it possible that his days or roaming center field are essentially over?

May 12, 2010 06:17 AM
rating: 0
 
BP staff member Will Carroll
BP staff

Yes. Anyone that's had microfx surgery is dealing with that, albeit with a surgically altered tib/fib head.

May 12, 2010 09:53 AM
 
mglick0718

Oh, and as a not-quite-so pessimistic NY Giants fan, how similar are Beltran's and Kenny Phillips injuries? I know that KP had microfacture surgery, but sounds like his injury is similarly a degenerative arthritic condition.

May 12, 2010 12:18 PM
rating: 0
 
BP staff member Will Carroll
BP staff

Similar, but the function of both athletes is different and the weight is a major difference.

May 12, 2010 12:49 PM
 
jonjacoby

Could Beltran have a degenerative condition in his knee simillar to what Bo Jackson had with his hip? This is based on nothing other than my recollections of the the aftermath of Bos' surgery/ rehab.

May 11, 2010 13:39 PM
rating: 0
 
fireants

I believe Bo had necrosis at the head of the femur bone requiring surgery. Avascular necrosis is basically the bone dying due to lack of blood flow. I believe the vascular supply to the knee is much better than at the hip. I highly doubt this is the problem with Beltran. Agree Will?

May 11, 2010 19:45 PM
rating: 0
 
BP staff member Will Carroll
BP staff

You're right, fireants. Bo's was the result of a known trauma - heck, that's probably one of the most re-played videos in the history of football. Necrosis is not the problem for Beltran.

May 12, 2010 09:54 AM
 
JukeboxHero

Osteoarthritis is one of those nagging injuries that can end up grading on your psyche as well as your tibial plateau. I wonder if someday there will be full time psychologists on every team trained to aid players who must deal with limitations placed upon them by injuries. I know that having had roughly the same thing since I was 22, it's hard not to play the "what if" and "why me" game. The pain is a constant throbbing intermixed with shooting pains. Also leads to overcompensation and cascades easily. I hope he is able to manage and play.

May 11, 2010 19:41 PM
rating: 3
 
JoshC77

Just curious, in regards to Rollins, you mention 'controlled' extended spring training games. Controlled in what manner? Is it the game itself that is controlled or Rollins' participation that will be controlled?

May 12, 2010 04:43 AM
rating: 0
 
Patrick M

Both, really. In extended spring training, anything goes in terms of the "games" that they play. I use the quotes not to say that people aren't expending effort--they are. The quotes are used to indicate that these are not normal baseball games as played by pros.

For example, if the Phillies want Rollins to bat every inning, then he simply bats every inning. If they want him to work on something with people on base, then they simply put people on base for him.

And of course, the Phillies would keep a close eye on Rollins's participation level.

May 12, 2010 06:15 AM
rating: 0
 
BP staff member Will Carroll
BP staff

Both. They can do anything - Rollins could lead off every inning if they wanted. It's basically a scrimmage, so they can set up situations, as opposed to a "real" minor league game, where it's played by standard rules.

May 12, 2010 09:55 AM
 
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