Vonn is not a normal patient with an ACL tear, which is why doctors believe she can compete just nine days after suffering a debilitating injury.
MILAN — When sports fans hear an athlete has torn their ACL, the immediate assumption is a year out of competition. Maybe nine months if everything goes well.
Lindsey Vonn is trying to win an Olympic medal in a matter of days.
“No doctor could endorse a normal person to go skiing, let alone competitively so,” said Dr. Yair David Kissin, an orthopedic surgeon and knee specialist at Hackensack University Medical Center.
But Vonn is not a normal person — or even a normal competitive athlete, which explains in part why sports medicine practitioners interviewed by Yahoo Sports said it is within the realm of possibility for her to race in the women’s downhill in Cortina on Sunday, just nine days after a devastating fall that required her to be airlifted to a hospital after a crash in Switzerland.
“From a purely physical or biomechanical standpoint, it’s possible if you’re an elite Alpine skier like Lindsey is to perform at that Olympic level,” said Dr. Catherine Logan, an orthopedic surgeon at the Joint Preservation Center in Denver who also works with U.S. Ski and Snowboard. “Alpine skiing is very different from your traditional field, cutting, pivoting sports. The movement patterns are relatively predictable in comparison so there’s less demand on the ACL when we’re trying to decelerate or change directions. There’s still an increased risk for secondary injury to the meniscus or her cartilage, but really her ability to generate force, maintain her edges and tolerate those speeds is not eliminated inherently just by having that ACL deficiency. So, despite all those things, she still has a great chance to perform well.”
Of the four main ligaments in the knee, the ACL is the one with the most impact on stability. It also doesn’t heal very well on its own, which is why the normal course of action is reconstructive surgery and a long period of rehabilitation for an athlete to regain the ability to plant and twist and change directions.
“Think about being in your car and knowing when you make turns, it will stay on the road,” Kissin said. “If you take off a front wheel and make a turn, it’s kind of what the knee does where it isn’t there for you. It’s not trustworthy.”
But Vonn’s situation is atypical for two reasons.
First, people who tear ACLs typically suffer some type of loss of neuromuscular control in their surrounding muscles, according to Darin Padua, an athletic trainer and professor in the Department of Exercise and Sports Science at University of North Carolina with a research emphasis on ACL injuries. Vonn, thanks to her physical gifts and years of training as a world class skier to develop her quadricep and hip muscles, likely has enough strength built in to retain some control of them and provide compensation for the loss of stabilization the ACL was providing.
Second, Vonn at age 41 is likely looking at her last chance to compete in an Olympics. So while most people, or even most professional athletes, would have to factor in long-term considerations for their career and weigh risk of further injury, Vonn is in a different situation. It really comes down to whether she feels like she can do it.
“This is going to be difficult, but she’s as tenacious as they come,” said Dr. Samuel Ward, a professor of orthopedic surgery at UC-San Diego. “There’s a little bit of mind over matter here, too. The combination of those things either provides her enough stability where she can do it or it doesn’t, and I think she’s going to figure that out. The average human being would be like, ‘I hurt my knee and I’m afraid of it.’ In her situation, she has the capacity to push past that whether or not the knee itself has the intrinsic stability to do what it needs to do during the race. I think nobody knows the answer to that until she races.”
Ward said that although the headlines made Vonn’s crash last week sound catastrophic, he interpreted it as good news that she managed to ski to the bottom of the hill before getting on the helicopter. All things considered, the fact she wasn’t immobile is a decent baseline to start from. And in her news conference Tuesday, Vonn said she was not suffering from any swelling.
That’s key since Ward characterized knee swelling as the “circuit breaker” that shuts off the quadriceps and would make it difficult to compete.
“When your knees are bent like when you’re skiing, your quadriceps are the shock absorbers of your knee,” he said. “They’re allowing you to crouch down in that position and manage the terrain of the course. So without strong quads, that’s not a reasonable task. That’s why the focus is on managing the swelling. The tendency after you get injured is to try to protect it and she’s going to have to go after it instead of protecting it.”
Logan said the key from now until Vonn competes will be round-the-clock therapy and a testing protocol to ensure she has enough knee stability get out of the starting gate confidently. That starts with land-based assessments of her ability to jump, land and twist before getting onto the mountain and replicating movements she would make in the race.
“It’s a progression from testing on the table to dry land to the snow,” Logan said.
Still, trying to compete in a race so quickly after such a devastating injury isn’t the norm. Padua said it’s the shortest turnaround he’s aware of.
“There’s not a lot out there in terms of prior cases where you can look and say these three or four people have done something similar,” he said. “She’s certainly an outlier in the sense of what an amazing athlete she is. If there’s anybody who can be able to manage this injury and still compete at the highest level, she is that type of individual. Unfortunately, she’s had these injuries in the past so she knows kind of what to expect and how to manage it internally. She’s probably in that very, very rare group of individuals with that capability.”
By attempting this, Vonn is probably risking some further damage to her knee, particularly to her meniscus or cartilage. But that’s where medicine is both art and science, with doctors providing both the best- and worst-case scenarios and ultimately working with her to come to a decision.
“It’s not always one answer is the only answer,” Logan said. “She’s consulting with multiple physicians and that’s a normal thing. There’s not just one voice, but the athlete should be in the end the driver of the decision.”
Ultimately, it just comes down to one thing: When it’s time to race, does Vonn feel her knee is stable enough to get her to the bottom of the mountain?
“Her body is so conditioned that most likely she’s got the compensatory mechanisms very few people in existence ever have and she may be able to do it,” Kissin said. “If she doesn’t feel like it’s a good idea I hope she has the wherewithal to stop and not risk something that is inevitable. In her case, if she thinks she can do it and her doctors may not disagree with her completely — I wouldn’t want to be them but at the same time I envy them — because she’s a different level of ACL patient and it’s a great example that every case needs to be individualized.”
If Vonn were at the beginning of a long career, the calculation may be different. But after coming of retirment for one more run at Olympic glory, the risk-reward equation probably favors giving it a try.
“I’m not a betting person,” Ward said, “but I wouldn’t bet against her.”
Category: General Sports
