Doctor weighs in on Jimmy Butler and, yes, the Heat could have diagnosed the MCL sprain without an MRI

There have been a lot of questions and reports about Jimmy Butler’s MCL sprain and how long he is expected to be sidelined, so I decided to call an expert.

Is there a chance Butler can return in the playoffs? Would he have known he sprained his MCL before undergoing an MRI? Are we talking weeks or months?

To get some answers, I spoke with Dr. Daniel Kharrazi of Cedars-Sinai Kerlan-Jobe Institute in Los Angeles and former orthopedic consultant to the Lakers. Dr. Kharrazi says Butler should be out 4-6 weeks with the injury and that, yes, they could have known about the MCL sprain the night it happened. He certainly did.

This interview has been lightly edited and condensed for clarity.

AUCH: Did you see the injury to Jimmy Butler?

Dr. Daniel Kharrazi: Kelly Oubre landed on him, and I was actually watching the game when it happened so I knew what the injury was immediately. 

How surprised are you that he played 30 minutes after the injury? How could he have done that?

I’ve taken care of pro athletes for 20-plus years. One thing you realize is that sometimes they are superhuman and the things that normal people can’t do, they can. So I’m sure he was in pain, I’m sure he had some sort of reservations about jumping and pivoting and twisting, but somehow he was able to continue to play at his level. 

I’m not surprised that he did it because I know he’s a big competitor. I think that probably just having the energy and excitement of the game made him forget some of that stuff. But, longterm, obviously it has to heal. And the more force there is on it, and pivoting and twisting, it creates more inflammation. The MCL is a main structure that needs to heal and get better and if you play on it, it won’t be able to heal correctly.

Is there a chance he made the sprain worse by staying in the game against Philadelphia?

Theoretically, yes. Is it likely? No. Once you have that sprain pattern, unless there is direct trauma again – let’s say that exact incident with Kelly Oubre happened again – then yes that’s a possibility that it could make it worse. I didn’t see anything in the ensuing time he was playing where that could have happened. 

The report immediately after the game was that there was a fear he suffered a serious MCL sprain, but that was before the MRI. Is there a way to diagnose a sprained MCL without an MRI?

Don’t forget, years and years ago there were no MRI machines and MCL sprains still occurred. MCL sprains have traditionally been diagnosed by clinical exam. Clinical exams can be pretty precise based on the location of the pain. What you want to make sure when you get the MRI is that there is no meniscal issue, cartilage issue or ligament issue with the ACL. So those are three things you are also ruling out. The MRI also gives you more clarification of the grade of the MCL sprain, that way it allows you to have more of an idea of how long the recovery will be. So can a diagnosis be made clinically? Absolutely. But I think the MRI gives you invaluable information.

What test would somebody do in the locker room after a game to determine whether it could be an MCL?

So the MCL runs on the inner aspect of the knee. So if you palpate along that region, you’ll feel tenderness, which is the classic example. There would also be some localized swelling. Also when you put valgus pressure – when you give inward pressure to the knee – with the knee flexed about 15 degrees, typically people who have an MCL sprain begin to complain about a lot of searing, sharp pain where the MCL is. So those are the two classic tests that are done: One is by palpation on examination and the other one is what is called valgus testing of the knee.

What’s usually the typical timeline for the recovery process?

Pretty straightforward. If it’s a Grade 1, a more minor MCL sprain, usually 1-2 weeks. A Grade 2 is generally 2-3 weeks, and a Grade 3 is 4-6 weeks. From what I understand from the more recent updates his injury was more severe, so I suspect it was a Grade 3 sprain and that would probably sideline him anywhere from 4-6 weeks.

Is he limited functionally with what he can do on that leg or does it come down to pain management?

Pain management is an issue generally the first seven days or so because it’s a searing pain on the inner part of the knee, like almost somebody is stabbing a knife in that area if there is any sort of pressure on the injured ligament. But the pain tends to get better. But the healing is what’s critical and allows the inflammation, edema and swelling that surrounds an MCL sprain to calm down and then obviously heal. That process is what generally takes 4-6 weeks.

When you say 4-6 weeks, as someone who has treated pro athletes, is the expectation that after 4-6 weeks that player can get on the court?

If he’s doing some rehab exercises that don’t put any strain on the MCL, he’s going to be close to game shape. Not quite there, but close to game shape. There are specific exercises and physical therapy things they can do without putting any additional pressure on the MCL. Things like electrical stimulation, muscle stimulation, don’t let you get as much atrophy as if he didn’t do those factors. But the bottom line is I do think that there is some time that will be required to get him in game shape, but it’s not going to be another four weeks. It should heal, and hopefully, he’ll be close to game shape in about 4-6 weeks.

Is a full recovery expected?

If you’re going to have an injury that is going to heal on its own, without surgery, and has a very good outcome, then MCL sprains are the one to have. If it’s an isolated MCL, even a Grade 2 or 3, it has a very good prognosis that he should be up and running. Obviously, this is an unfortunate time because of the playoffs, but this is actually a reasonable injury to have because there tends to be a very good prognosis for its healing. Somebody of Jimmy’s conditioning, somebody of his strength, and he’s young, so it has very good healing potential. My worry about additional [injuries] in the future is extremely low.