Bone Graft Intermission -- the World Cup

I probably won’t have any updates on my bone graft for a few more weeks. I’m in the middle of meeting with 3 separate surgeons to discuss the pros/cons of using BMPs vs. borrowing bone from my hip. I already met with one, and he confirmed what my research suggested -- BMPs have a similar success rate as using bone from the iliac crest, with, of course, the added benefit of not needing to cut my hip. My new motto: why cut twice when once will do. The doctor also didn’t think there are any obstacles to using BMP on me. I’ll see what the next 2 surgeons have to say. I hope to make a final decision and schedule the surgery by the end of July.

Meanwhile, let me entertain you with my thoughts on soccer and the World Cup.

I love soccer. Growing up, I played competitive soccer. I’m also a big fan. I attended one of Pele’s matches for the Cosmos. I celebrated with the crazy Brazilians and Dutch after their classic ’94 World Cup quarterfinal match. I’ve been to the 200,000-person Maracana Stadium in Rio de Janeiro to catch a club match between heated rivals, Flamengo and Botafogo. And just like the circle of life, I coach my kids’ teams, just like my dad did for me.

Basically, I feel qualified – and comfortable – to say this: Soccer is NOT about to take off in the US.

People who insist otherwise are almost as annoying as those f*cking vuvuzelas. By the way, they’re horns, people! Calling them vuvuzelas doesn’t make them any cooler.

Anyway, I say this even after watching the US’s thrilling win over Algeria to advance to the knockout round. In my opinion, that game was just as exciting as Game 7 of the NBA Finals. After Donovan scored, I screamed so loudly that my dog sprinted around the living room looking for somebody to bite. But even this victory, and perhaps even if Team USA keeps advancing, won’t convert Americans into regular soccer watchers. Just ain’t happening.

And that’s ok. Let’s just embrace soccer as a niche sport, somewhere behind football, hoops, baseball and even hockey. Actually, it’s probably even less popular here than Mixed Martial Arts (the UFC).

Some soccer-lovers question why folks feel the need to point out soccer’s “place” in the American sports hierarchy, which they liken to soccer bashing. Simple. Many people, including soccer fans like me, are sick and tired of all the “American soccer has reached a tipping point” chatter. Dude, let’s just enjoy the current matches. I don’t need some false soccer prophet telling us that Americans are “finally ready” to love “futbol” as much as the rest of the world does. Loosely translated, they’re saying, “Hey hoosier. If these games weren’t exciting enough to keep you interested in soccer after the Cup, you’re an un-cultured caveman.” Yeah, that’s a good way to get people to jump onto the soccer bandwagon long-term. Thanks for ruining the moment, buddy.

Americans simply don’t want to follow this sport on a regular basis; soccer just doesn’t match up with “American sports.” I’m not trying to denigrate the game or the talent of soccer players (though most of them ARE douchebags), just making an observation.

First, the American culture will never accept soccer or soccer players. We’re a macho society. Guys who kick a ball? Pansies. Plus, Americans hate floppers, soccer players who agonize on the ground, insist on a stretcher to cart them off, and then immediately sprint back onto the field. It’s no coincidence a European – Vlade Divac – brought flopping to the NBA. But not even Paul Pierce getting carried off the court in the 2008 Finals compares to the worst soccer flopper. And don’t even get me started with the whining. Imagine Tim Duncan’s bug eyes on steroids for 90 minutes. Anyway, there’s a reason why every American movie features the star QB getting the girl, not the midfielder.

But our ambivalence with soccer goes beyond cultural objections. Soccer’s usually slow-paced; there’s not enough scoring; and the athletes aren’t nearly as spectacular as guys like Kobe or LeBron. Plus, Americans can’t stand sports in which playing for a tie is accepted. I’d rather get season tickets to the WNBA than suffer through some of these 0-0 draws.

And yet every four years during the World Cup, we hear the US is ready to embrace soccer. FINALLY! REALLY! We’re not kidding this time!

Well, guess what? It hasn’t happened. It didn’t happen when Pele played for the Cosmos. It didn’t happen after the US made the 1990 Cup. It didn’t happen after the US hosted the ‘94 Cup and advanced to the 2nd round. It didn’t happen in 2002 when the Yanks made a surprising run to the quarters. It didn’t happen when David Beckham joined the MLS. And it won’t happen after this World Cup, no matter how far the US advances. Please. Stop saying it’s gonna happen. You’re embarrassing yourself. For the past 20 years I’ve heard folks insist America was ready to embrace soccer. The boy didn’t even cry wolf that long.

Here’s my solution. Instead of demanding that we follow and discuss soccer like it’s a major sport, let’s treat it like a special event. That works, right? Let’s treat soccer more like the Olympics. There are lots of similarities, besides the every 4-year thing. Two years ago, I was mesmerized by Usain Bolt, and religiously followed Michael Phelps gunning for 8 gold medals, like I’m sure a lot of folks were. But am I going to follow track & field or swimming on a weekly basis? F*ck no. In fact, I don’t even want to see Michael Phelps hawking Subway right now. America should impose a rule requiring all swimmers to retreat to their aquariums 2 weeks after the Olympics.

Yet Americans dig these sports during the Olympics. The ratings are fantastic, as I expect the World Cup’s will be. Why? Because we watch them only every 4 years, capitalizing on the novelty factor. Combine that with jingoistic pride, and bingo, you’ve got gold.

Same with soccer. Every four years works. It’s infrequent enough to retain the novelty factor, and not often enough that Americans get tired displaying their patriotism. And we get to root against France. Never underestimate the value of booing the Frogs. That never gets old.

Personally, I think soccer’s best chance soccer of catching on here in the US has nothing to do with the actual game but with the changing demographics of the country. Most Americans will never give a sh*t about soccer, unless their kids are involved. But the fastest growing population segment? Hispanics. They’re immigrating here, and once they’re here they multiply like rabbits. And these people really, really like soccer, about as much as Texans love their guns. Of course, this influx of soccer fans won’t necessarily make US soccer more popular. Mexican-Americans – even those born and raised in the US – still tend to favor Mexico over the US. Hey, it’s better than nothing.

Soccer’s next best hope – a longshot, really – is the emergence of an American Pele. Some man-child who decides he doesn’t want to be the next LeBron but the next Pele. If an American somehow became the unquestioned world’s best player – a guy with dribbling skills that make Brazilians look pedestrian –Americans probably would rally around soccer. I call that the Tiger Woods effect. One guy is such a phenom that average folks tune in just to see what the big deal is. However, I can’t imagine a 6’5”, 235lb inner city kid choosing soccer over hoops or football anytime soon.

In the meantime, let’s enjoy the World Cup, and hope the US can make an unlikely run. But when the Cup ends, let me resume my normal sports obsessions (football training camp! Whoo hoo!) without a slew of “soccer is here to stay” articles. Just like the Olympic torch gets extinguished when the Games close, so too will American’s passion for soccer. But don’t worry, soccer lovers. In four years, there will be even more Americans waiting for the next Cup, including me.

Bone Graft Deliberations

I’ve been radio silent for much longer than usual. Earlier this month, my wife and I spent some time in Maui without the kids. Good times. For a short time, at least, my knee/leg issues didn’t hover like a guillotine above my head. It was just blue skies, cocktails and sand between my toes. Now it’s back to the gallows, er, reality. Anyway, while I was bummed to read about some of your setbacks, it was still nice to hear from my “ACI friends.”

Ok, I’ve spent several weeks researching the bone graft options, probably more time than I spent researching the ACI. Yes, there are synthetic alternatives to the iliac crest, and I’m furiously educating myself about them. When my OS first told me I needed a bone graft from my hip, I asked about other options. He acknowledged others existed, but was adamant they didn’t compare. In fact, he seemed pretty dismissive of them. And it’s true – everything I’ve read since my visit described the iliac crest as the “gold standard.” My second opinion OS also said the hip was the best graft site, and I don’t recall him mentioning other bone graft options. Critically, both surgeons downplayed the negative side effects to my hip.

My research, however, suggests a far greater % of patients suffer drawbacks. Anywhere from 10-25% experiences some type of chronic hip pain or serious limitations. I’m not gonna lie. That scared the cr*p out of me. Now, most bone graft recipients are older and generally undergo the bone graft to fix their spine, or repair a leg mangled in some horrific car wreck. It’s fair to say these patients were likely in worst shape. On the other hand, the failure of my leg to heal the first time suggests I’ve got weak bones, meaning my hip’s probably brittle. In any event, I’m steadfastly opposed to borrowing bone from my hip unless absolutely necessary. I’m scared I could create a brand new set of problems if my hip gets cut.

I’ve learned there are 2 less-invasive options than borrowing bone from the iliac crest. The first involves BMP-7, a type of osteogenic putty. Turgeon mentioned mixing this or similar material with the iliac crest bone graft, but nixed the idea of using it alone. BMP can also be mixed with cadaver bone.

The second option appears to be even less invasive. It involves a bone marrow injection from the iliac crest. I still don’t completely understand this procedure, but it appears the surgeon draws the bone marrow from your hip, and then injects it into the area of tibial nonunion. No cutting involved. Obviously, this would be the preferred route, though I have the sneaking suspicion this procedure remains somewhat experimental or won’t be covered by insurance.
I don’t know whether the TTO or ACI eliminates me as a candidate for either option. No clue. And I’m still trying to pin down the success rates for the different options. Some of the medical journals I’ve read suggest success rates for the BMP bone graft – whether alone or combined with cadaver bone – are 5-10 points lower than the iliac crest bone graft. I haven’t located comparable numbers for the bone marrow option.

Assuming these numbers are accurate, a 10-point decreased success rate seems like an acceptable trade-off to avoid getting my hip cut.

While I sort out the bone graft options, I’ve scheduled a PT visit with the guy the 2nd opinion OS uses. My quad remains weak, even after 16+ months. I’m not sure why. Even though the nonunion in my leg probably limits how hard I can push things, I think an updated PT session might be helpful. Plus, I’ll get a third set of eyes to check out my knee. Even as I stare down another surgery, I remain hopeful that my knee might approach something close to normal if I can eventually build up my quad after I fix the tibial nonunion. I’m probably clinging to hope at this point, but still . . .

Two days after my PT session, I meet again with Turgeon. I plan to question him about the non-iliac crest options. Assuming he disfavors the bone marrow injection and the synthetic bone graft and/or lacks experience with these procedures, I’ll seek out another OS. The problem is that I probably need to get my knee scoped, too, though the knee scope can wait. I prefer to schedule both operations at the same time to avoid multiple surgeries and recoveries. But I only feel comfortable getting my knee scoped by guys familiar with ACI, which pretty much is limited to Turgeon and Berman.

I also want to get a sense for what it would take for my bone and screws to shatter inside my leg. A kick? Getting sacked by LT? Just bumping into the corner of the kitchen table? If I learn my tibia is a ticking time bomb waiting to shatter inside my leg, I’ll need to make a decision asap.