MILAN — When sports fans hear that an athlete has torn their ACL, their first instinct is to miss a year. Maybe nine months if all goes well.
Lindsey Vonn is trying to win an Olympic medal in a matter of days.
advertise
“No doctor would support a normal person going skiing, let alone competing in a ski race,” said Dr. Yair David Kissin, an orthopedic surgeon and knee specialist at Hackensack University Medical Center (N.J.).
But Vonn is not an ordinary person, or even an ordinary competitive athlete, which partly explains why sports medicine practitioners who spoke to Yahoo Sports said there is a chance she will compete in Sunday’s women’s downhill race in Cortina, just nine days after she suffered a serious fall in Switzerland that required her to be airlifted to a hospital.
“From a purely physical or biomechanical standpoint, if you’re an elite alpine skier like Lindsay, it’s possible to perform at an Olympic level,” said Dr. Katherine Logan, an orthopedic surgeon at the United Preservation Center in Denver who also works with the U.S. Ski and Snowboard Association. “Alpine skiing is very different from traditional field, cutting, spinning movements. In contrast, the movement patterns are relatively predictable, so there is less demand on the ACL when we try to slow down or change direction. There is still an increased risk of secondary injury to the meniscus or cartilage, but her ability to generate force, hold an edge, and tolerate those speeds doesn’t go away naturally with an ACL deficiency. So, she still has a good chance of performing despite those factors. OK.”
Of the four major ligaments in the knee, the anterior cruciate ligament is the ligament that has the greatest impact on stability. It also doesn’t heal well on its own, which is why it’s normal for athletes to undergo reconstructive surgery and long-term rehabilitation to regain the ability to stand, twist and change direction.
advertise
“Imagine being in your car and knowing that when you turn, it’s going to stay on the road,” Kissing said. “If you take the front wheel off and turn, it’s like your knees are doing what they’re doing without serving you. It’s not trustworthy.”
But Vaughn’s situation is atypical for two reasons.
First, people with ACL tears often experience some type of loss of neuromuscular control in the surrounding muscles, said Darin Padua, an athletic trainer and professor at the University of North Carolina, whose research focuses on ACL injuries. Vonn used her physical gifts and years of training as a world-class skier to develop her quadriceps and gluteal muscles, and she likely has enough strength to maintain some control over them and compensate for the loss of stability from the ACL.
Doctors say Lindsey Vonn’s ability to ski down a mountain after an accident that tore her anterior cruciate ligament is a good sign she will be able to compete in the Olympics. (Reuters)
(Reuters/Reuters)
Second, Vonn, 41, is likely looking for one last chance at the Olympics. So while most people, even most professional athletes, have to consider the long-term factors of their career and weigh the risk of further injury, Vaughn’s situation is different. It really depends on whether she feels like she can do it.
advertise
“It’s going to be difficult, but she’s very tenacious,” said Dr. Samuel Ward, a professor of plastic surgery at UC San Diego and co-director of the Wu Tsai Alliance for Human Performance. “There’s some thought about substance here as well. The combination of those things either provides her with enough stability that she can do it or she can’t, and I think she’ll figure that out. The average person would say, ‘I hurt my knee and I’m scared.’ In her case, she has the ability to move beyond that, whether or not the knee itself has the inherent stability to do what she needs to do during a game. I don’t think anyone knows the answer until she competes.”
Ward said that while the headlines made Vaughn’s crash last week sound catastrophic, he thought it was good news because she managed to glide to the bottom of the mountain before boarding the helicopter. All things considered, the fact that she’s not motionless is a good place to start. At a news conference Tuesday, Vaughn said she didn’t have any swelling.
That’s key because Ward described knee swelling as a “circuit breaker” that shuts down the quadriceps and makes it difficult to compete.
“When your knees flex like skiing, your quadriceps are the shock absorbers for your knees,” he says. “They allow you to crouch in that position and manage the terrain of the court. So without strong quadriceps, it’s not a reasonable task. That’s why the focus is on controlling swelling. Your tendency after an injury is to try to protect it, and she’s going to have to chase it instead of protect it.”
advertise
Logan said the key between now and Vonn competing will be a round-the-clock treatment and testing regimen to ensure she has enough knee stability to walk out of the starting gate with confidence. It starts with an on-the-ground assessment of her jumping, landing and twisting abilities before heading up the hill, and replicating her movements in competition.
“It’s a progression from desk testing to dryland testing to snow testing,” Logan said.
Still, it’s unusual to try to compete so quickly after suffering such a serious injury. Padua said it’s the shortest turnaround time he’s ever known.
“There’s not a lot of previous cases where these three or four people have done anything similar,” he said. “She’s definitely an anomaly in the sense of how good an athlete she is. If anyone can handle an injury like this and still compete at the highest level, she’s that person. Unfortunately, she’s had these injuries in the past, so she knows what to expect and how to handle it internally. She’s probably one of the very, very rare people that has that ability.”
advertise
By trying to do this, Vaughn could risk further damage to his knee, specifically the meniscus or cartilage. But this is where medicine is both an art and a science, with the doctor providing the best and worst case scenarios and ultimately making the decision with her.
“It’s not always that one answer is the only answer,” Logan said. “She is consulting with multiple doctors, which is normal. It’s not just one voice, but the athlete should ultimately be the driver of the decision.”
Ultimately, it just comes down to one thing: When it’s time to race, does Vonn feel like her knees are stable enough to get her to the bottom of the hill?
“She’s in very good shape, and it’s possible that she has compensatory mechanisms that few people in the world have, and that she might be able to do it,” Kissing said. “If she feels like this is not a good idea, I hope she has the wherewithal to stop and not take some of the inevitable risks. In her case, if she thinks she can do it, and her doctors may not totally disagree with her — and I don’t want to be them, but at the same time I envy them — because she has a different level of ACL. “Patients, this is a great example of how each case needs to be individualized.”
advertise
Had Vaughn been at the start of a long career, the math might have been different. But after retiring and regaining Olympic glory, the risk-reward equation may favor giving it a try.
“I’m not a betting person,” Ward said, “but I wouldn’t bet her.”
