They Shoot Horses Don't They?

Apparently Alfonso Soriano's cranky left knee was bothering him enough during his outfield play this past Friday that his plans to get an elective MRI (magnetic resonance image) in a few weeks got moved up to Saturday morning since he wasn't going to start today. In this video interview he says it's been sore for four months but with (approximately) 40 games left why can't he keep playing with the same pain? The pain seems to bother him more when he runs (rather than when he hits) so it's affecting his limited outfield abilities and I expect it's been a factor regarding his on and mostly off offense this season too.

Soriano was in no hurry to get the MRI as recently as this week.  He originally expected to take the time to get it on their next day off, Sept 10th (after returning from the trip to NY and Pitt), but his limp became more noticeable after his game winning 3 run HR on Friday so they moved it up to Monday and when it was clear he couldn't start today they sent him for the test this morning.

Carrie Muskat from cubs.com reports that the MRI results just showed inflammation and the outfielder will likely get a cortisone shot (based on the manager's postgame comments) and be sidelined a few days. From the horses mouth, in the postgame interview, Lou Piniella said  the team orthopedic specialist (probably Dr. Gryzlo) will look at Soriano on Sunday, and he most likely will get a cortisone shot to alleviate the pain.

I've heard some recent mention that Soriano's knee symptoms started after bumping into the outfield wall in April and (props to Navigator for the link) here is the mlb page from the April 22nd, 3-0 loss to the Reds, that shows some of the possibilities. The most likely is a Joey Votto HR where Soriano doesn't actually hit the wall with his left knee but he does come up limping on the warning track. The other video, which is a Jay Bruce double off the wall has Soriano hit the wall with his knee. Unfortunately, I've watched it repeatedly and it's his right knee that whacks into the wall so maybe he just twisted the left knee on that one. I'll chalk it up as something happened during that Reds series at Wrigley,  and give it an April 22nd date mark.

There are mentions in the press (and TCR) about his sore knee at the end of May/early June but those mentions didn't include a specific injury and were more prompted because Soriano stopped hitting in May. From Tribune writer, Paul Sullivan's Hardball blog on June 2nd:

Soriano has not homered since May 17th. He hit .216 in May with five home runs and 11 RBIs, striking out 32 times in 111 at-bats. Since Aramis Ramirez went down, he's regressed at the plate instead of stepping up.

Will the knee soreness force manager Lou Piniella to sit him?

"He might have a little discomfort with it, but I've talked to the trainer about it, and I've talked to Soriano about it, and it's nothing that precludes him from playing," Piniella said. "I mean, if he was hitting the ball real well, I don't think we'd be having this conversation."

I'm not sure if Soriano had a previous MRI in May/June when we first heard about the sore knee but it does seem odd that it's taken this long to get such a basic test done, if this is his first MRI for a problem lasting months.

Inflammation in the knee (as seen on an MRI) can be localized to a specific part of the knee (i.e. patellar tendon) or it can be generalized as in increased joint fluid (an effusion). By telling us the MRI shows "inflammation",  we're getting (again) a very limited and non-specific amount of information. Still, if Soriano had a meniscus or ACL tear (aka something significant aka "structural") they probably would not have omitted mentioning those as specific findings.

If there was a direct impact to his knee in April, the problem may be something called chondromalacia. This translates as soft, blistered or frayed articular cartilage (arthroscopic image). If he banged his knee against the outfield wall, it probably is by the kneecap (patella) or the femoral condyle (trochlea) opposite the patella. Unless the damage is extensive it's often difficult to see mild chondromalacia on MRI imaging but it is a reasonable speculation as to the source of inflammation if the MRI isn't showing any structural damage, especially with symptoms persisting over 4 months.

At 33 years of age and with several more years on an $18M contract, I'd expect it will be recommended to have the knee looked at arthroscopically in the off-season, even if it's just to make sure they know more precisely what is causing the knee soreness this year. A cortisone shot might get him through the season but repetitively it can adversely affect the joint so it's not like they would be willing to do that time after time without a more precise diagnosis.

We all know the cliche that the season is a marathon. I know director Sydney Pollack should have ordered the MRI before shooting any of the contestants (with cortisone) in his 1969 film:

This is a sad tale of desperate people in desperate times trying to make a few extra bucks during the Great Depression years. Dancing in pairs, they literally risked their health by trying to stay on their feet by dancing longer than every other couple.

Actually, MRI's were just a twinkle in some physicists eye back in 1969. Studies on MRI's done on humans weren't  published until 1977. They didn't become accessible to most patients until the early 1980's.

OK, this was a goofy analogy but Soriano's desire to stay in the lineup at any cost seems to fit. Wasn't Soriano dancing with some Braves fan (Jane Fonda) in that movie? At least back then he could run and hop. Ah, that seems so long ago. Sori, please get your knee well for next season's marathon. When your bat is missing, it's tough on every one of us Cubs fans and I don't want the patented Soriano "hop" morphing into the Soriano wheelie in a wheelchair.