Winter Olympics: Why doctors say Lindsay Vonn has ‘great chance to perform well’ despite ACL tear

MILAN – When sports fans hear an athlete has torn his ACL, the immediate assumption is a year out of competition. If all goes well, it could be nine months.

Lindsey Vonn is trying to win an Olympic medal in just a few days.

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“No doctor can advocate for a normal person to go skiing, let alone competitively,” Dr. Yair David Kissin, an orthopedic surgeon and knee specialist at Hackensack University Medical Center (NJ).

But Vonn is no ordinary person — or even a typical competitive athlete, with sports medicine doctors interviewed by Yahoo Sports saying she is within the realm of possibility to race the women’s downhill in Cortina on Sunday, just nine days after a devastating fall that required her to be airlifted to hospital following a crash in Switzerland.

“From a purely physical or biomechanical standpoint, it’s possible if you’re an elite alpine skier like Lindsey to perform at the Olympic level,” said Dr. Katherine Logan, an orthopedic surgeon at the Joint Protection Center in Denver, who also works with US Ski and Snowboard. “Alpine skiing is very different from your traditional field, cutting, pivoting sports. The movement patterns are relatively predictable so there’s less demand on the ACL when we’re trying to slow down or change directions. There’s still an increased risk for secondary injury to the meniscus or his cartilage, but not really strengthening his ability to sustain and pull off those motions. Naturally just because he’s lacking that ACL, despite all those things, he still has good performance. There is a chance to do it.

Of the four main ligaments in the knee, the ACL is one of the most influential in stability. It also doesn’t heal very well on its own, so the usual course of action is reconstructive surgery and a long period of rehabilitation for the athlete to regain plantar flexion and the ability to rotate and change direction.

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“Think about sitting in your car and knowing that when you turn, it stays on the road,” Kissin said. “If you turn the front wheel open, it’s like kneeling where it’s not there for you. It’s not reliable.”

But Vaughn’s situation is unusual for two reasons.

First, people who tear ACLs usually suffer some type of neuromuscular control loss in their surrounding muscles, according to Darin Padua, an athletic trainer and professor in the Department of Exercise and Sports Science at the University of North Carolina, who emphasizes research on ACL injuries. Vonn, thanks to her physical gifts and years of training as a world-class skier, has developed her quadriceps and hip muscles, probably enough to maintain some of their control and compensate for the loss of stability the ACL is providing.

Second, at age 41, Vonn is likely looking at her last chance to compete in the Olympics. While most people, or even most professional athletes, must factor in long-term considerations for their careers and weigh the risk of further injury, Vonn is in a different situation. It really comes down to whether she thinks she can do it.

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“It’s going to be tough, but he’s as tough as he is,” said Dr. Wu Tsai, professor of orthopedic surgery and co-director of the Wu Tsai Human Performance Alliance at UC-San Diego. Samuel Ward said. “There’s a little bit of mind involved. The combination of those things gives him enough consistency where he can do this or not do that, and I think he’s going to figure that out. The average person would be like, ‘My knee hurts and I’m scared.’ In his position, he has the ability to push past whether or not the knee itself has the internal stability to do what needs to be done during the race. I guess no one will know the answer to that until he races. “

Ward said that although the headlines made Vonn’s crash last week devastating, he interpreted it as good news that he was able to ski to the bottom of the mountain before boarding a helicopter. All things considered, the fact that she wasn’t stable is a decent baseline to start with. And at her press conference on Tuesday, Vonn said she was not suffering from any inflammation.

This is key because Ward describes knee swelling as a “circuit breaker” that shuts down the quadriceps and makes it difficult to compete.

“When your knees are bent like when you’re skiing, your quadriceps are the shock absorbers of your knees,” he said. “They’re allowing you to hang in that position and manage the terrain of the course. So without strong quads, it’s not a proper job. That’s why the focus is on managing inflammation. When you’re injured the tendency is to try to protect it and he’s got to go after it instead of protecting it.”

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Logan said the key until Vonn competes will be a round-the-clock therapy and testing protocol to ensure she has enough knee stability to confidently step out of the starting gate. That starts with a land-based assessment of jumping, landing and turning ability before hitting the hill and simulating the moves he makes in the race.

“It’s a progression from testing on a table to snow on dry land,” Logan said.

Still, it’s not normal to try to compete so quickly in a race after such a devastating injury. Padua said it’s the shortest turnaround he knows of.

“There’s not a lot in terms of prior cases where you can look and say these three or four people have done this,” he said. “She’s definitely an outsider in the sense that she’s an amazing athlete. If there’s anyone who can manage this injury and still compete at a high level, she’s that type of person. Unfortunately, she’s had these injuries in the past, so she knows what to expect and how to manage. She’s in that group with a lot of potential.”

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By attempting this, Vonn is likely causing further damage to her knee, specifically her meniscus or cartilage. But since medicine is both an art and a science, doctors provide best- and worst-case scenarios and work with him to ultimately come to a decision.

“It’s not always the same answer that’s the only answer,” Logan said. “She’s been consulting a lot of doctors and that’s normal. There’s not just one voice, but the athlete has to be the driver of the decision in the end.”

Ultimately, it comes down to just one thing: When it’s time to race, does Vonn feel her ankle is stable enough to make it to the bottom of the hill?

“Her body is so strong that she probably has compensatory mechanisms that very few people in existence have and she’s able to do this,” Kissin said. “If she doesn’t think it’s a good idea, I hope she has a way to stop and not risk the inevitable. In her case, if she can do it and her doctors don’t totally disagree with her – I don’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 necessary to set a great example in every case.”

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If Vaughn were at the beginning of a long career, the calculation might be different. But after retiring for one more run at Olympic glory, the risk-reward equation favors giving it a try.

“I’m not a betting man,” Ward said, “but I wouldn’t bet against him.”