"Hesitant to be optimistic", "Return at a very high level.”: Medical experts divided on Kawhi Leonard's return  (EXCLUSIVE) 

The visual became both a source of hope and uncertainty.

LA Clippers star Kawhi Leonard practiced with the team in full-contract five-on-five drills on Monday, but the Clippers still ruled him out for at least the next four games.

Clippers coach Ty Lue told reporters that Leonard still needs to practice more in full contact five-on-five settings, and that the team officially ruled him out for when the Clippers (17-13) play the Golden State Warriors (15-14) at Intuit Dome on Friday (7 pm PT). While the Clippers play on the road next week in New Orleans (Dec. 30), San Antonio (Dec. 31) and Oklahoma City (Jan. 2), Lue told reporters that Leonard will practice with the Clippers’ G League team.

Perhaps when they host the Atlanta Hawks at Intuit Dome on Jan 4, the Clippers will have clarity on issue that has yielded uncertainty for the past sevcen months. With inflammation in his right knee limiting him during last season’s playoffs and sidelining him for the Paris Olympics and the 2024-25 NBA season thus far, how will Leonard look when he returns? After experiencing various injuries to his right ACL (2021) and right meniscus (2023), can Leonard finally stay healthy?

Sportskeeda spoke with three outside medical experts to tackle those two questions and more. They have not worked with Leonard and don’t have access to his medical files, but all three doctors are familiar generally with Leonard’s injury and follow the NBA closely.

The panel includes:

Dr. Zahab Ahsan, orthopedic surgeon and sports medicine specialist at Endeavor Health

Dr. Alan Beyer, executive medical director of Hoag Orthopedic Institute

Dr. Joshua Wright-Chisem, orthopedic sports medicine surgeon at Endeavor Health

Editor’s note: The following one-on-one conversations took place separately. The interviews have been condensed and edited.

What are your expectations with Kawhi once he returns?

Ahsan: “I think he’ll get to a point where he’ll be able to perform similar to what he did previously. But the challenge will be if he will be required to play fewer minutes or continue to have load management if he takes a few games off. I foresee something like that in his return. And then in several parts of this season and all of next season, he can start to play more minutes than he did in the past prior to his injury. But it’s hard to say.”

Beyer: “Kawhi has always been one of those ones where injuries seem to lag and nag. He has the quad injury when he was in Toronto [in 2018-9] and the partial ACL tear that wound up getting an ACL reconstruction [in the 2021 NBA playoffs]. Kawhi doesn’t push himself the way that LeBron [James] pushes himself. So I’m always hesitant to be optimistic about Kawhi’s return and coming back to really be a vital part of their second half of the season. He just doesn’t have a track record for that. He gives in to his injuries a bit more easily than other players do and doesn’t push himself the way that other players do. I would be less than honest if I said I was optimistic that he would have a good second half of the season.”

Wright-Chisem: “It’s a really good question. There’s a feeling that there’s pessimism about Kawhi having another prolonged period of being out. But I personally don’t think that’s necessarily appropriate. He’s had two major injuries with the ACL where he had surgery and the subsequent meniscal injury. When you have knee injuries, it’s appropriate to have a very systematic return-to-play protocol that most teams and trainers implement. With him, Kawhi has an injury with the same knee. You look at athlete’s symptoms, swelling, pain and on-court performance and objective strength managements. Every time that Kawhi Leonard has returned to play, he has played at an extremely high level.”

What are the reasons for your concerns or optimism moving forward?

Ahsan: “A lot of these NBA players start to play at a very early age. Then they play 82-game seasons in the NBA. Typically when they have an injury, it is the beginning of a degenerative process in the knee. When you have ACL reconstruction and delays with return with inflammation in the knee, that inflammation most often correlates with cartilage wear within the knee. Then it becomes an issue with load management in how much that knee can tolerate to perform at the level athletes need to perform.”

Beyer: “His head. Kawhi has never had the drive and headgame that LeBron has. It’s not as important to him. It’s not a means to an end. It’s not a legacy that he’s more worried about.”

Wright-Chisem: “There is a prolonged period, but there are expectations that he will return this season. The team has also been doing much better than expected given his absence. I expect him to return with limited minutes to begin with, but with a team that has been mostly thriving in his absence. And I expect him to do well. Once you injure your knee twice the same way he has, you do expect some setbacks here and there. But I personally think the team has a great medical staff and great trainers. I expect him to return at a really high level once he graduates from their return-to-play protocol.”

Based on your outside medical expertise, what are both the positive and negative things you take away from Kawhi not playing in an NBA game since May in the NBA playoffs to heal his right knee inflammation?

Ahsan: “The data points with his return are, ‘Is he practicing? Is he practicing in full capacity?’ And if so, that suggests he will be able to return to play. Once he plays, I think it’s just about assessing the number of minutes that he’s playing and how his knee is responding and adapting to that return. That will guide the trajectory with what happens next.”

Beyer: “The more time you take off, the more time it takes to shake off the rust and get back your timing and get back into the flow of things. It’s not just a physical aspect. At this stage of the game, it’s more the mental aspect.”

Wright-Chisem: “These are things that we see consistently. Often, an injured knee that has been injured multiple times may experience some swelling. Frequently, you will see players that are limited because that is a setback that has to resolve before you can really return to play without any restrictions. So it’s not surprising, and it’s something we see with a lot of players that have had a knee injury multiple times. It’s not encouraging, but it’s not surprising. I don’t think it has long-term implications. Will this be the last time the knee experiences any swelling? Probably not. But I still would say it’s not necessarily a surprise, and I don’t think it has long-term implications.”

What are the usual things players have to deal with when they have inflammation in their knee?

Ahsan: “Using the word ‘degenerative” is a good way to think of it. The cartilage inside your knee is the soft cushioning that provides you the ability to perform basketball movement. If that’s worn away to some extent, the knee limits your ability to perform at the level that you would like. That’s probably what he’s dealing with – finding a balance to allow him to use the knee at the capacity that he would like.”

Beyer: “The old song that ‘The hip bone is connected to the thigh bone,’ that’s true. Look at Jarred Vanderbilt on the Lakers. He goes out with bilateral foot surgery. Then when he starts rehabilitation and tries to come back to play, he winds up having swelling in his knee. That’s because he had been doing usual stuff on his knee while he was healing from the foot surgery. That’s always a possibility, especially with somebody who has had significant knee problems over the years. [Kawhi’s] certainly more prone to having that happen than a guy who has never gone through it.”

Wright-Chisem: “In general, the inflammation or swelling in a knee is an increase in joint fluid. It naturally exists in a knee. But along with that, there is increased pain and decreased function. It isn’t common for any player in any sport to have their knee drained, to have cortisone injections and to treat the maintenance of a knee that has gone through significant wear and tear. There is a question on how much you can deal with, what’s appropriate on a day-to-day basis and what is too much. Clearly, the Clippers are identifying inflammation that he’s experiencing has passed a limit on what’s appropriate on a day-to-day basis.”

What are your expectations on how the rest of Kawhi’s season plays out both with his play and health?

Ahsan: “Based on that data and knowing he has had previous injuries and surgeries on the same knee, that adds more concern for the longevity with his return and performance as a basketball player. That is to be seen going forward. But with the amount of time that he’s taken off, historically if you look back at other NBA players with similar circumstances, it shows it’s hard to return with pre-injury performance.”

When you look at his injury history and how he’s approached injuries, Kawhi has always been more conservative. He has his own medical team and people that he trusts. In comparison to other players that have had similar injuries to him, he’s taken a more conservative path with return to play. That’s probably something that will guide him in his return to play.”

Beyer: “Certainly, the potential is there for him to make a big impact on a team that really needs him. The questions are, ‘Will he? Will there be another injury on top of this one?’ The NBA is a grind. Every year that you have on the calendar makes it harder to come back and play through that grind and time manage yourself as you get older. I’m cautiously hopeful that he’ll remain healthy and that he has conditioned himself well enough to come back. But history doesn’t necessarily say that’s going to be what happens.”

Wright-Chisem: “It’s tough to say. That particular part is the most difficult. The team has been appropriately guarded with that information. One of the big reasons is the natural state of inflammation is unpredictable. You have good periods and unpredictable inflammatory responses. That’s far by the most difficult part to guess. I would even say for people that are in the know would find it difficult to predict. You have unpredictable setbacks. For Kawhi, it wouldn’t shock me at all if he's frustrated by some of these things.

But I would say I’m optimistic because he has consistently proven that he can come back from these injuries and continue to play at a high level. There is this unfair label on him as being somebody that misses games, even unnecessarily. But everyone close to him says he’s one of the absolutely hardest workers when it comes to returning from rehab and that his fitness and workout regimen is on a totally different level. I think that’s not fair. He’s shown he can return at a very high level.”

Mark Medina is an NBA insider for Sportskeeda. Follow him on X, Blue Sky, Instagram, Facebook and Threads.