I actually thought about this as well. But there has to be some reason why more teams don't utilize the zone to defend pick-and-rolls more. I'd imagine the defensive 3 seconds rule and illegal defense rules have something to do with it but someone with a better pedigree in coaching will have to help me out here.
i think it's the defensive 3 mostly ... in college and in europe you can play zone, clog up the middle and force a team to shoot jumpers. Here, any zone still leaves that opening. That said, a matchup zone can work - and almost every team's defense has some zone concepts in how the help works and when switches take place.
If you look at the Jim O'Brien Celtics teams for instance, they basically zoned the middle by fronting the post and blasting the pick.
A full zone ultimately has holes that quick passing can exploit ... in a basic 2-3, if you can get the ball to the high post, either via pass or via dribble, you can create open shots just about everywhere.