Paige Bueckers’ injury: What is a tibial plateau fracture, what does recovery look like and what are the long-term implications?

The college basketball world received disappointing news Tuesday, when it was announced that UConn women’s basketball star guard and reigning national player of the year Paige Bueckers will miss six to eight weeks of the season after suffering a tibial plateau fracture in her left knee at the end of UConn’s win Sunday over Notre Dame.

While there was widespread relief that the injury wasn’t more serious, several questions remained: What is a tibial plateau fracture in the first place? How serious is that type of injury, and does Bueckers need to be concerned about any long-term issues concerning her knee?

To answer those questions and more, The Courant spoke to Dr. Michael Miranda, Chief of Orthopedic Trauma at Hartford Hospital, and Jeff Stotts, an injury analyst and certified athletic trainer who has an extensive background covering sports injuries and has his own NBA injury database.

What is a tibial plateau fracture?

In layman’s terms, Stotts describes a tibial plateau fracture as the result of “bones kind of knock[ing] together,” which occurred in this case from Bueckers hyperextending her knee. The plateau refers to the top of the bone, in this case the tibia (a.k.a. the shin bone).

The bone is spongy around the knee joint, Miranda says, allowing the thigh bone and knee bones to typically glide smoothly over each other. But when Bueckers hyperextended her knee, it became a situation of “two really hard objects hitting, and the spongy nature of the bone allows it to get pinched, very much like you’re pinching the rim of a Styrofoam cup, and it stays pinched. That’s what happens with the bone there. … It’s really sort of a gentle crush of the spongy part.”

UConn’s press release on Bueckers’ injury, and the timeline for her return, indicate there was no ligament or soft tissue damage associated with the injury – a “very big thing,” according to Stotts. When he first saw the replay of Bueckers’ injury, her knee hyperextension made him fear it could be an ACL tear.

“Those soft tissue structures [think: ACL, MCL, meniscus] are a little bit more problematic, don’t heal as smoothly as bone, and they often take a little bit longer as well,” Stotts said. “So, the fact that we didn’t hear anything like that, that they’re giving a 6-8 window, is a pretty good indication there’s not anything significantly wrong with those soft tissue structures.”

How common is this injury?

Tibial plateau fractures can occur as part of more traumatic knee injuries – say one where an ACL is also damaged. In that case, the fracture may be viewed as secondary to the more serious ligament damage.

It is a relatively uncommon basketball injury to happen in isolation, though stars Kobe Bryant, Yao Ming and Lindsay Whalen, as well as football player J.J. Watt, are among famous athletes who have dealt with them. Miranda says it’s more common to see the injury with skiers or among people who have suffered motor vehicle accidents or falls from great height.

“That’s kind of why you don’t hear that term, why a lot of people were like ‘wait, what’s a tibial plateau fracture?’” Stotts said. “Everyone knows ACL, everyone knows Achilles. But it does happen. It’s scary to talk about, but maybe not as bad as it could have been.”

How did it happen?

Stotts thought the Bueckers’ injury occurred from “just kind of a weird step.”

“If you think about it, literally hundreds of thousands of moves that she’s made during the course of her season, this is just one move where things didn’t go perfectly,” Miranda added. “I mean, she’s so incredibly graceful. This is a situation where things didn’t go smoothly.”

Watching the replay of Bueckers’ injury, it looks like she went to attempt a jab step as she was bringing the ball up the floor, and her ankle may have turned first before suffering the fracture. It’s possible that the ankle maneuver led to the knee hyperextension, Stotts and Miranda said, as ankle and knee movements are closely linked.

Does a 6-8 week recovery timeframe make sense?

The average recovery time for NBA players who suffered a tibial plateau fracture, according to Stotts’ database, was closer to 10 weeks. In part, a player’s size may determine the severity of the break, as the bigger the player, the more force they put through their knees. Bueckers is obviously smaller than, say, Ming.

Miranda said these injuries should be thought of happening on a spectrum. Some people may not feel less severe impact, a bit more serious they’d just get a little sore, a bit more serious than that they’d experience a bone bruise. The next level of injury could be macro factures or, most seriously, a break where the bone moves out of position – the latter isn’t what UConn is suggesting here.

“What they’re suggesting is that it got to the point where there’s a little crack and [the bone] crushed itself,” Miranda said.

What does recovery look like?

For non-athletes, rest is the most important ingredient to recovery. But for Bueckers, that won’t be as much the case, Miranda said.

“She’s going to start rehabbing this thing as soon as she possibly can, which means that they’re going to first focus on decreasing the swelling, decreasing the inflammation, regaining her motion, all at the same time trying to keep her muscles strong,” Miranda said. “And then the last part of that is also agility and balance. … It’s gonna be a lot of hard work.”

Depending on how UConn approaches her recovery and how much weight bearing she can manage, Bueckers could potentially do some work in the pool and maybe the stationary bike, Stotts added. The degree of the fracture would also determine how quickly she returns to on-court activity.

Are there any long-term implications?

Miranda says there’s a “small but not zero” chance she develops arthritis in her knee later on. Otherwise, she should probably be OK.

“Bone is a durable tissue,” Stotts said. “Once an injury occurs, it is fully capable of returning to its previous strength. Sometimes that isn’t the case with ligaments or muscles. They often might even take longer to get close to that same [strength as before] but they might not ever have the same biomechanical properties as they did before.

“Bone can. And as long as, again, we don’t hear about any accompanying ligament damage or cartilage damage, she should be fine moving forward once this area is healed up and she’s good to go.”

Alexa Philippou can be reached at aphilippou@courant.com