Coming into the new NBA season, the Sixers' title hopes were once again hanging upon Joel Embiid, but moreover, his health and ability to make it through a full season along with the playoffs.
It just turned out that the Sixers had way more problems than only their MVP center's health.
They've been spiraling, through early-season injury, incohesive play, and now behind-closed-doors challenges of accountability – of which Embiid has been the reported center of.
It's been bad. The Sixers might turn it around, or continue to just keep imploding, but regardless of what happens next, "left knee; injury management" will remain a tag tied to Embiid throughout the year – and likely for fans, a consistent point of frustration.
At its core, and before the Sixers devolved into a complete mess, the organization's idea of keeping a watchful eye over Embiid's health and making sure they could keep him on the floor when it matters most – at the cost of sometimes taking him off of it for extended stretches – isn't a bad one.
But it is one that exists in uncharted territory for the Sixers, that has caught the NBA's ire, and was provoked by years worth of previous issues that hampered their top star at the worst time and ultimately played a role in stopping them short.
Dr. Dinesh Dhanaraj, the chief orthopedic surgeon at St. Mary Medical Center in Langhorne, offered his outside perspective on where the Sixers' logic might have been coming from, but even he admitted, this one's a bit unheard of.
"I don't think I've seen that before," Dhanaraj said. "It's kind of unique to see."
Before getting fully into it though, a note: The views and opinions expressed in this article are those of the author and guest authors and do not reflect any official policy or position of any NBA team or a team's athletic physicians.
The crux of the whole situation goes back to February of last season, when Embiid underwent meniscus surgery in his left knee after injuring it on Jan. 30.
He returned in time for the playoffs against the Knicks, posting some heavy minutes and point totals, but his knee remained a lingering concern all the way until the Knicks beat the Sixers in six games. He also didn't give himself the benefit of a full summer to recover afterward, opting to join Team USA for the Summer Olympics.
When Embiid reported to camp, the term "left knee; injury management" came into play. He didn't play through the preseason because of it, nor the Sixers' regular-season opener, nor any of their other first nine games. Embiid suggested during training camp he may never play in both legs of a back-to-back again. On Nov. 1, when he met with the media after a weeks-long stretch of silence and mystery, Embiid said the following about whether there had been any sort of setback regarding his knee:
"No. I had surgery in February. I did come back early to fight for the team and to play and try to give us a chance, and unfortunately, we lost. I had time to recover, so really still been managing since the last surgery, been managing and trying to figure out the best approach."
There is a history to that left knee, however.
Back in 2017, Embiid suffered an initial meniscus tear that at first had him sidelined indefinitely due to swelling, then soon after ended his 2016-17 season when the Sixers realized that surgery was unavoidable.
Then the second tear was sustained last season.
"I hate to say, but whenever you have an injury, things are always changed," Dhanaraj said. "It's never the same as the day before when you have an injury, no matter what you do, whether it be surgery, treat it, rest it. There's always some sort of permanency to any injury."
Embiid's age (30), size (at a billed 7'0" and 280 pounds), and years of wear from running and jumping up and down on a hardwood floor aren't exactly doing him any favors either.
"The size matters," Dhanaraj said. "There's more forces called joint contact forces that go through any player's knee, hip, or ankle when their size is increased.
"It's just a matter of physics," Dhanaraj continued, pointing to New Orleans Pelicans star Zion Williamson as another example of a massive athlete with a litany of injury issues that have stemmed from that.
"There's more mass," Dhanaraj said. "There's more forces going through that joint and sometimes it's hard to rehab those because it's a matter of physics."
So the Sixers, at least from the outside coming into the season, looked like they were getting inventive about how they would roll out Embiid throughout the year.
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Basically, it looked like they were trying not to even give him a chance to get hurt. His usage and minutes would be monitored, he wouldn't play in back-to-backs anymore, and essentially, he would've been on a track to ramp up seriously around February and March, when the playoff race heats up.
In other words, Embiid's real start to the season would've been way later on, in the hopes that the approach would keep him fully healthy through an extended playoff run and that Paul George and Tyrese Maxey for the most part would be enough on their own to get the Sixers there.
The problem, however, is that the plan has been a total mess so far.
The NBA investigated and then fined the Sixers at the start of the season for making public comments which the league deemed "inconsistent with" the status of Embiid's knee; George got hurt in the preseason and missed the start of the regular season as well; Maxey went down with a hamstring strain after leading the league in minutes per game out of the gate; and the Sixers spiraled into a 2-11 hole where health seems to be the least of their problems now.
At the starting line though, trying to preserve Embiid wasn't a bad plan.
"Hypothetically, it's an effective strategy because you limit injury risk and you let him heal," Dhanaraj said. "Are you allowed to do that [in the NBA]? I don't know. You've never seen that really before, but it is something that, hypothetically, is advantageous to let him heal and rest.
"It's not like they're having him sit on the couch and eat potato chips, too. He's probably still exercising and rehabbing, working on some technique and stuff like that. But is it allowing him to heal? Yeah, it's an effective strategy."
It's just that the Sixers might have to re-adjust it now.
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