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Analyzing the potential long term effects of Kyrie Irving's patellar fracture

Kyrie Irving will be out for 3-4 months after fracturing his patella. What is his long-term prognosis?

Kyle Terada-USA TODAY Sports

So......a long rest period evidently was not enough.

Kyrie Irving will miss the rest of the NBA Finals after fracturing his left kneecap in overtime of Thursday night's Game 1 loss to the Golden State Warriors. Irving will have surgery in the coming days, and is expected to be out 3-4 months. It's the unfortunate end of over a month of worry about Irving's knee, which was bruised in the regular season against the Oklahoma City Thunder, and flared up with patellar tendinitis during the Cleveland Cavaliers' series against the Chicago Bulls, causing him frequent issues throughout the playoffs.

The injury sucks for the Cavs and Irving. The former lose their second-best scorer and playmaker, who was in the midst of having a vintage 23 point, 7rebound, 6 assist effort for them, and now will likely have a tough time keeping the series competitive without him. The latter suffers yet another injury in a Playoffs and career full of them, and now faces being laid up in a hospital bed while his team competes without him followed by a summer of rehabilitation. It's awful for everyone involved.

The bigger question for Irving now centers on his return to play. No matter how crushing a fashion it occurred in, Kyrie's 2014-2015 season is over, and his long-term health must now become his primary focus. Can Irving recover fully from this?

The important thing we must first understand is how this injury relates to his ongoing bout with patellar tendinitis. It is both unclear whether the injury is a direct result of the ongoing problem, and if the injury is the result of contact with Klay Thompson's knee or a non-contact injury, as it's also been reported. However, it's likely the fracture is at least partially resultant from the tendinitis. As I've explained before, the inflammation caused by tendinitis can irritate other parts of the joint. Because the patellar tendon connects directly to the patella, tendinitis can in rare cases cause inflammation of this bone, and if prolonged without rest, that can cause the bone and it's articular cartilage to deteriorate. It's the same mechanism that causes stress fractures in the lower leg, although the inflammation does not occur to the same extent. Still though, it can make the bone more fragile and the tendon less malleable, both of which can lead to fractures. The bone is less able to withstand the force of direct contact, and the tendon doesn't lengthen appropriately when the knee is flexed rapidly, the resulting force of which can cause a non-contact fracture.

In either case, the tendon inflammation plays a factor, and is going to have to be the important factor to address in his rehabilitation. The nice thing is, Kyrie now has a perfectly good reason to sit for a few weeks and let the tendon rest. With the inflammation receding in combination with bone healing, Kyrie should be able to begin rehab without worry of another flare-up. Once that rehabilitation begins, it will likely focus on quadriceps re-education and strengthening, as the quad will atrophy during immobilization. There will also be focus on correcting biomechanical abnormalities in alignment, musculature, or running gait that could have contributed to, or resulted from, the tendinitis. These are likely subtle little things that, if corrected, can prevent future issues with the tendon.

From there, when Kyrie resumes full basketball activity, he should be fully functional pretty quickly. Almost every player who's suffered a fractured patella in the last decade, per, has made a full return from the injury. This includes an obvious star in Blake Griffin, who missed his entire rookie season with the injury after delaying surgery, but (#Hottake) appears to have suffered minimal longterm deficits in his athleticism because of it. Ditto for John Wall, who missed the first couple of months in 2012-2013 with a patellar stress fracture. Jarvis Hayes, Jeff Foster, A.J. Price,  and Randy Foye have all suffered the injury, and all missed little more than a couple months after surgery and returned at nearly the same level of play. Greg Oden and Antonio McDyess both were never really the same after their patellar fractures, but in both cases, that was the last in a long line of serious knee issues they had suffered from. Nick Young, this year and last,  is the only player to have suffered the injury twice in the last decade, so there's the precedent that it could happen again. However, the norm appears to be a full recovery with minimal effects on the player's effectiveness.

This injury is the end of the road for Irving's season, but from a long-term health perspective, he should be able to make a full recovery. If that comes on a team that's the defending champion, that would be fantastic, of course; but either way, if he rehabs the injury correctly and thoroughly, Kyrie should be fully ready to chase titles in 2015-2016 and beyond.