PITTSBURGH -- Even as Major League Baseball commissioner Bud Selig reiterated yesterday he was irritated with Manny Ramírez's no-show at the 77th All-Star Game, a report purporting to offer details of the injury to Ramírez's right knee emerged.
Industry sources, both with direct knowledge of Ramírez's condition, had conflicting reactions to a report by Will Carroll posted on the Baseball Prospectus website, in which Carroll wrote that Ramírez has a small tear in the medial meniscus of his right knee. ``It's an injury he can play with," Carroll wrote, ``but one that can `grind' a bone-on-bone situation that is unpredictable and painful."
One source, although not offering direct confirmation of Carroll's report, acknowledged some degree of accuracy. Another source, however, said neither the Red Sox medical staff nor an outside entity have administered an MRI to Ramírez and have not indicated they intend to do so. Without an MRI, the source said, the Sox would only be guessing there is a tear.
The medial meniscus is toward the inside of the knee joint and refers to a thickened, crescent-shaped cartilage that rests between the thigh bone and shin bone, acting as a shock absorber. The injury is fairly common in baseball and depending on the severity, many players continue playing. Red Sox outfielder Trot Nixon played all of last season with a meniscus tear before undergoing arthroscopic knee surgery. Barry Bonds continues to have trouble with his knees after multiple surgeries to repair the meniscus.
Carroll has a solid reputation in the industry for his reports on player injuries in the big leagues. The Red Sox have consistently maintained that Ramírez bowed out of the All-Star Game to rest his right knee, and last Friday, when MLB announced Ramírez's withdrawal, a statement attributed to Ramírez was released by the player's agent, Greg Genske, saying Ramírez has been playing ``most of the season" with soreness in his knee.
``You know Manny has been having a problem with his knee," said David Ortiz, one of three Red Sox All-Stars here, when asked if he was disappointed Ramírez had elected not to come. ``Manny's not a baby anymore [Ramírez turned 34 May 30]. So he needs time off. I think three days will be good for him to shut it down, especially after those long games in Chicago."
Ramírez's reason for skipping the All-Star events has been openly questioned for a variety of reasons. One is his history of excuses, including dying grandmothers and hamstring problems. Another is his season-long public silence, which only increased the aura of mystery around the injury and extended to his communication with MLB officials. One high-ranking MLB executive said last night that in his conversations with Red Sox officials, they never told him Ramírez was injured, only that he didn't want to come.
Jeffrey Dugas, an orthopedic surgeon in Alabama and associate of noted orthopedist James Andrews, said an MRI is definitely the ``gold-standard test" for determining a meniscus tear. ``But even if an MRI showed a tear, unless it clearly and significantly keeps a player from performing, there's no reason to do anything with it," Dugas said. ``If he can play his position, hit, run on it, he can continue to play. An MRI is such a sensitive test, sometimes you can overread it."
Dugas said it is unusual for a player of Ramírez's size and athletic level to have a small tear. ``It's usually a bigger injury," he said.
Red Sox officials will not offer details on Ramírez's injury, saying they are prevented from doing so by the Health Insurance Portability and Accountability Act (HIPAA), which protects the privacy of medical patients.
Perhaps the most significant reason for skepticism has been the high level of Ramírez's performance, and how little time he has missed. Ramírez has played 82 of Boston's 86 games and played left field in 685 1/3 innings, all but 84 of the innings played by the Red Sox this season. He played all 19 innings of the Red Sox' 6-5 loss to the White Sox Sunday in Chicago, and the day before had three hits, including two doubles in which he ran hard out of the batter's box, and also tagged up on a fly ball and slid headfirst into third base.
Ramírez ranks 27th among major league outfielders in innings. He has made just one error in left field, but ranks 211th, near the bottom, in range factor. Range factor is determined by adding the total number of putouts and assists, multiplying by nine, and dividing by the number of innings played.
Ramírez has never been known for his defense. But at the plate, he is putting up numbers that would seem to belie the suggestion that he is injured. Ramírez ranks third in the league in on-base percentage (.434), fourth in slugging percentage (.615), sixth in home runs (24), and 10th in RBIs (65).
MLB would have preferred that Ramírez, who led American League players in fan balloting, be here, even if he could not play.
Other players who are here but did not play include Tom Glavine and Jose Reyes of the Mets, Jose Contreras of the White Sox, and Robinson Cano of the Yankees. The only other player chosen but not in attendance is Pedro Martínez of the Mets, who is on the 15-day disabled list.
``Maybe I'm old-fashioned, but if you are voted on the team, it's a privilege," Selig said. ``You ought to be here. He's the only person who did not participate this year. Everybody else has been here and has been terrific."
Nick Cafardo of the Globe staff contributed to this report.