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The Mystery of Carlos Beltran's 2010 Knee Surgery

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Last week the St. Louis Cardinals reportedly agreed to a two-year deal with free agent outfielder Carlos Beltran that will be worth approximately $26 million. A proven veteran coming off one of the best offensive seasons of his career, Beltran was available on a relatively short deal of two years at a fair price largely because of the recent history he has with knee troubles and corrective surgery. To put the risk Beltran's health poses in the proper context, I thought we might take a look at the nature of Beltran's right knee injury and the surgical procedure he underwent to repair it.

The initial reporting on Beltran's surgery was rather cloudy. This is likely due to a combination of the race to be first that Twitter has created against the MLB gossip columnists and the fact that Beltran did not accept the Mets team doctor's assessment and opted to seek out the opinion of a doctor recommended by the outfielder's then-agent Scott Boras. It seems that the Mets were not exactly sure what surgery Beltran underwent and the initial concerns were echoed by media types dependent on Mets sources for their information. The opening salvo came from Joel Sherman of the New York Post with the conditional language that so often accompanies the tweeting of unsubstantiated rumor:

Trying to get 2d confirmation, but hear that Beltran had microfracture knee surgery today without #Mets permission

Even though Passan later revised his initial tweet and reporting an arthroscopic cleanout, the "Beltran had microfracture surgery" news raced around the internet at full speed. I don't follow the Mets all that closely so, since the beginning of the Cardinals' courtship of Beltran, I had been operating under the belief that Beltran had undergone microfracture surgery. It seems that Derrick Goold, the excellent journalist for the St. Louis Post-Dispatch, was operating under the same assumption. In the must-read follow-up to his article that broke the story of the signing, Goold writes the following:

More than a full season removed from prolonged knee troubles and microfracture surgery on his right knee in January 2010, Beltran embraced the opportunity to appear in center, an associate said.

When I first read this article, I did not bat an eye at the report of Beltran having had microfracture surgery. Indeed, the idea for this post was to put together a little bit of information on microfracture surgery for Cardinals fans. As I began working on a post about Beltran's microfracture surgery last weekend, I came to the conclusion that Beltran did not have microfracture surgery on his right knee.

Back in January 2010--after the Sherman tweets and a Mets press release--Ben Shipgel of the Times reported that Beltran underwent "arthroscopic surgery, making him unlikely to play in April." The Shipgel piece in the Times also explains the Mets' anger over the decision, that it was performed by Beltran's personal physician--Dr. Richard Steadman, who pioneered microfracture surgery--without the club's permission, and that the Mets had sought legal advice from the commissioner's office about whether the club could penalize Beltran for receiving unauthorized medical care.

In a 2011 Spring Training post on injured players with a fantasy baseball focus, Will Carroll--he of the Twitter tag "@injuryexpert"--addressed Indians center fielder Grady Sizemore, who had microfracture surgery in 2010, and Beltran.

People lump Beltran and Sizemore together, but they're actually on two sides of similar issue. Sizemore had microfracture surgery last year to try and correct his chronic knee problem, while Beltran has done everything in the book to avoid a similar fate.

David Waldstein further addresses Beltran's knee injury and 2010 surgery in the New York Times in July of last year. Waldstein quotes Beltran at length in the article, beginning with Beltran's recollection of the prognosis given to him by the Mets team physician.

"It wasn't like I wanted to have the operation," Beltran said. "But when I met with the doctor in New York, the team doctor, he told me there was nothing he could do for me. The team doctor is saying there is nothing he can do for you. I was thinking: 'Well, that's the end of my career? I'm not going to play baseball anymore?'

"No, no. Come on, man. For a bone bruise? I'm not going to be able to play this game anymore? I wasn't going to give up. I felt that I needed to search for the best doctor in the world, and Scott was able to find the doctors, and thank God I feel good."

Waldstein reports that Dr. Steadman gave Beltran the option of either undergoing microfracture surgery or "an arthroscopic procedure to clean out loose bodies in the knee, then allow ample time for the knee to heal." Beltran explained to Waldstein his rationale for opting to undergo arhtroscopic surgery:

"I wasn't going to do microfracture because microfracture is 12 months of rehab, and you don't know what you are going to get," Beltran said. "I wanted to get scoped and be safe. If the scope doesn't work, then we move on to the next one."

The invaluable "Injury History" chart at Baseball Prospectus is in line with the New York Times reports. According to Baseball Prospectus, Beltran missed time in 2009 due to a right knee contusion to the tibia. Beltran then underwent a "scope and chronoplasty" on January 13, 2010, which caused him to miss significant time--114 games total in 2010--before his return in mid-July.

I compared Beltran's injury history to that of Sizemore, the only MLB player I could recall offhand who has undergone microfracture surgery; in June 2010, Sizemore was placed on the 60-day DL due to "microfracture patella." In October 2011, Sizemore underwent another knee surgery that is specifically labeled "not microfracture" on his injury history chart. Thus, it seems unlikely that Baseball Prospectus mis-labeled Beltran's procedure.

In 2011, Beltran spent no time on the disabled list, played in 142 games, and posted a line of .300/.385/.525 (for a wOBA of .389) in 598 plate appearances. While his defense in right field was not of the caliber one once saw from Beltran, the Cardinals plan on playing Beltran in center field, according to the Goold article, due to "confidence in Beltran's knee" and the assessments of scouts who believe "Beltran moved well enough to handle center." With Beltran now approximately two years removed from arthroscopic surgery--as opposed to microfracture surgery--I feel much more confident that the Cardinals' assessment is the correct one.