Does Lindsey Vonn Knee Injury Put Her 2014 Olympics in Jeopardy?

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Does Lindsey Vonn Knee Injury Put Her 2014 Olympics in Jeopardy?
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With almost exactly a year to go before the 2014 Winter Olympics flame is lit in Sochi, Russia, Lindsey Vonn's knee injury could put her medal hopes in jeopardy. Her horrific crash at the Alpine World Championships in Austria has her heading for knee surgery rather than the podium. 

Photo via http://vaduzuvunt.blogspot.com/2008/09/knee.html

In a statement, the US Ski Team said that it expected Vonn to return for the Olympics. We have seen faster and faster returns from knee injuries in other sports, but let's take a deeper look as to whether this is possible for a skier. 

A report, via Yahoo's Charles Robinson, notes Vonn's injury is to the ACL (anterior cruciate ligament) and MCL (medial collateral ligament.) If this is the case, this would actually be a bit easier to come back from than some other possibilities, due to the rehab. The ACL-MCL combo tends to be slightly shorter, though in skiing, the MCL does normally need to be repaired due to the lateral-stability demands. 

If this is correct—and if there are no other serious injuries—then Vonn's chance at a fourth Olympics will come down to her rehab.The major complicating factor will be a fractured tibial plateau. CNN reports that Vonn did have a fracture in this area, a typical injury that goes with this type of mechanism. This will heal, but if it needs to be fixated, it delays the rehab process, sometimes significantly.

The best-case scenario for this type of repair is six-to-eight months. Many noted the comeback of Adrian Peterson, who was back on the field in eight months but appeared ready to play at the four-to-six-month mark. Peterson had a high-grade ACL sprain, as well as an MCL sprain that was not repaired.

This type of rehab is being quoted as six-to-nine months, and while no two rehabs are the same, it is a positive indicator for Vonn. The demands on the knee due to their specific sports are vastly different. Skiers are going to have constant lateral forces on their knees, whether it is from the hard turns of the slalom or the fast, sweeping turns of the downhill.

Doctors often quote the six-to-nine months as the rehab time for a simple ACL sprain, but that is often aimed at recreational skiers. The reduced demands on their knees often equal out the physical condition and 24/7 rehab that is done for world-class athletes.

Initial reports from the Austrian Ski Foundation President (via FOX Sports) indicate that Vonn has only ligament tears. Reports use the European terms of "cruciate" and "lateral" ligaments. The lateral ligament is what is often referred to as the LCL, or lateral collateral ligament. The "cruciate" is normally the anterior cruciate (ACL), rather than the posterior cruciate (PCL), which is normally referred to there as the "posterior" ligament. 

I spoke with Dr. SangDo Park, one of the top knee specialists, from Good Samaritan's Comprehensive Orthopaedic Center in Los Angeles. His rehab expectation was not dissimilar.

"Recovery from ACL and MCL surgery can take about seven-to-nine months, though it can often take up to a year," he said.

Much will depend on techniques used and the strength of the surrounding structures. Vonn is a world-class athlete, so we should assume that she's in pretty good shape.

USA Today called downhill skiing one of the 10 hardest things to do in sports, pointing to the 3.5 g-forces that would be applied to the skier. Not all of this force is directly on the knee, but more is applied now than previously. Rule changes in 2011 to the ski itself took some of the edge off the ski, which redirected that force to the body. 

The US Ski Team is normally treated at the Steadman Clinic in Vail, Colo. One of the top orthopaedic facilities in the world, athletes from all sports have come to Steadman-Hawkins for treatment, but they built their reputation on skiing. Dr. Richard Steadman's development of microfracture surgery came from his involvement with skiing and the need to rebuild knees that had lost their cushion.

However, the doctor that formerly treated Vonn, Dr. Bill Sterett, left the clinic in June, so this could complicate things. Sterett stayed in Vail, but at a different hospital. He remains the head physician for the US Women's Ski Team. 

Vonn is no stranger to injury or to Dr. Sterett. She has had low-grade ACL sprains at least twice in the past and tends to heal well from other injuries. In the 2006 Olympics, Vonn came straight from her hospital bed to the mountain, though she did not medal. She has had numerous other injuries, but none requiring an extended rehab.

Another positive comp for Vonn is one from her own sport, Bode Miller. Miller had a high-grade ACL sprain that was repaired in early 2001 and he returned for the 2002 Olympics, a time frame very similar to what Vonn is facing. Miller was helped by one of the first applications of Steadman's new microfracture techniques, which both surgeon and patient say helped with his recovery time. Surgical and rehab techniques have evolved since then, so that's more positive for Vonn. 

Getting back in time for the Olympics is going to be a tough journey for Lindsey Vonn, but medical science has made it possible. The next six months will be hard ones for Vonn, but if we see her on skis by November, there's definitely a good chance we'll also see her in Sochi. 

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