The Cleveland Indians were set to kick of Spring Training 2020 looking to rebound from a 2019 season that was largely defined and marred by injuries, particularly to their starting pitching corps.
Well, those aspirations were threatened Friday afternoon when Zack Meisel of The Athletic reported that starting pitcher Mike Clevinger would undergo an arthroscopic procedure to address a torn medial meniscus in the pitcher’s left knee. Meisel later reported that Clevinger is expected to miss 6-8 weeks, placing the electric pitcher’s return around the beginning of the regular season.
Each knee has two menisci – a lateral and a medial – which are comprised of dense, fibrous cartilage. The menisci sit atop the tibia – or shin bone – and help increase the stability of the knee by broadening the contact between the tibia and femur – or thigh bone. The menisci also have a cushioning effect on the knee as the structures are largely comprised of water which aids in the dispersion and absorption of force.
The lateral meniscus is “O”-shaped and is the more mobile of the two. The medial meniscus is “C”-shaped, is more stable, and is connected to the medial collateral ligament (MCL) of the inner knee. Each meniscus is susceptible to athletic injury.
The menisci are most vulnerable to injury when the involved leg is bearing weight while twisting; this occurs in the landing leg during the arm cocking to follow through phases of throwing. Clevinger, being right handed, lands on his left leg when throwing.
There are three treatment options for a torn meniscus: conservative care (i.e. rehabilitation), meniscal repair, and partial meniscectomy, and all three have their positives and negatives.
Conservative care involves strengthening the muscles of the thigh and hip while regaining any lost range of motion. The recovery timeline for meniscal tears treated conservatively varies, though most athletes return to play in 4-6 weeks. The downside, however, is that if conservative treatment fails, the athlete will miss more time after they undergo surgery.
The two surgical procedures utilized to address a meniscus injury vary significantly, but the best way to discuss them is by starting with a more in-depth discussion about the anatomy involved.
The menisci lose their natural blood flow during the aging process; by the time an athlete is an adult only the outer third of each meniscus has good blood flow. Tears in the meniscus that are located in this region – known to surgeons as the red-red zone due to the relative preponderance of blood – as well as the red-white zone – located closer to the middle of the meniscus – may be eligible for surgical repair. Surgical repair involves sewing the torn meniscus back together, however, the repaired tissue cannot heal without adequate blood flow.
However, size and orientation of the tear are also major factors in determining whether or not a meniscus injury can be repaired. Because of the number of variables present as well as the lengthy recovery time of meniscal repairs – they usually sideline athletes for 4-6 months – the most common procedure for athletes to undergo is an arthroscopic partial meniscectomy.
This procedure is minimally invasive – meaning a small incision is made rather than opening up the whole knee – and involves cutting out the piece of the meniscus that is torn. The recovery after a partial meniscectomy is quicker – athletes usually return in 4-8 weeks – however, the kicker is that the knee now possesses less cushioning and stability. In general, athletes commonly return to high levels of play after undergoing a partial meniscectomy, but it is not a procedure that is absent of risk.
Cleveland has had one of the more dominant starting pitching rotations – when healthy – in the majors over the last five seasons, and an argument could be made that Clevinger has been the club’s most impactful starter over that time. Since debuting in 2016, Clevinger has accumulated 11.0 WAR, according to Fan Graphs, and struck out 563 batters across 500 innings (10.1 K/9).