I remember when Brett Basanez played with a broken leg.
OT: Lindsay Vonn crashes, knee likely permanently wrecked
- Thread starter CatManTrue
- Start date
Me too, was on the team. He’s tougher than a two dollar steak. Don’t recall him crying either
Speaking from experience, sadly, I would assume this is a complex tibial plateau fracture, which is a severe knee (joint) injury. Extremely common traumatic ski injury, and I think Vonn has had several before this, hence the partial knee replacement at 40 years old.
No just a freaking reminder of how tough he was. Everybody was shocked when they said he had a broken femur but could be back the same season for a 3-9 team
The only thing tougher is when corbi and No Chores say mean stuff behind an internet message board. They were legends in our locker room
I had assumed her partial knee replacement was due to cartilage damage and lots of wear and tear. I had mine done 30 years after tearing my meniscus, and being extremely active.
If her tibial plateau is that bad, I assume they just would do a knee replacement
I worked as a principal engineer for Stryker’s advanced technology group supporting their robotic Mako hip and knee compatible implant products. The ACL tear would have created additional joint instability and laxity that would have placed extra stresses on the implant-bone interface. Even with only a partial resurfacing, not a good idea to be competitively racing like that. Jack Nickolas could golf on Stryker knees but the dynamic forces from skiing are a whole other order of magnitude.
I am pretty sure that the recent ACL tear was in the knee other than the one that had been partially replaced.
I have a Stryker partial, installed last September. How long is my warranty?
Well she’s now had her fourth or fifth surgery since she crashed.
Brutal injury. Hope she gets back on her feet soon so she avoids too much atrophy.
Vonn had a hemiarthroplasty (partial)on the opposite knee , probably necessitated by degenerative changes as the result of a meniscal injury when she originally tore the ACL years ago. It is likely the old ACL reconstruction stabilized the knee and allowed her to foolishly return to competition, although the risk was certainly less than if she had a total knee replacement(TKR)
The new ACL injury compromised the stability of her other knee. There is no brace that can completely compensate for an ACL tear, associated with anterolateral instability. The decision to race was foolhardy, although the fall was caused by clipping a gate.Conjecture suggests that she suffered a complex fracture resulting in gross instability, possibly threatening the popliteal artery. Immediate surgery suggestedan external fixator was applied but the above x-ray shows that immediate ORIF was performed
The X-rays show a beautiful reduction with preservation of the medial and lateral joint spaces. Her long term prognosis depends on the status of her menisci , congruity of the joint surfaces and stability.
I would guess that ORIF will not fully restore joint congruity. Degenerative arthritis will develop and a stabilized TKA will be required to address multidirectional instability . My concern for her future is that a TKA will be required but her skin coverage could be compromised by multiple parallel skin incisions, unless the plates were inserted though small incisions and screws were inserted under image intensification
My most recent similar case (without a fracture)was a 40 y/o man with severe medial compartment arthritis that dislocated his knee, tearing both cruciate ligaments but fortunately not damaging his popliteal artery(arteriogram confirmed). Once the reaction to the injury quieted, a stabilized TKA was performed , since addressing ligamentous instability in the face of preexisting DJD was not a realistic alternative. He missed about 2 months of work and I could follow his progress since he was the greeter at the local Sam's Club.
I am not sure how the above X-ray was released but possibly privacy laws are different.
Modern internal fixation was developed in Switzerland and I am sure that the Treviso surgeons were experts in the application of AO techniques
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What is her recovery time?
Will she be able to walk normally anytime soon?
I imagine skiing - even for pleasure- is out of the question now?
My boss has literally three major knee surgeries, including replacements, per leg, all from skiing. He's a lot older than Vonn. It took him until the last one before the doctors were like "no, seriously, you absolutely positively cannot do this any more. She can ski if she wants.
This is an elite athlete. Injuries happen. It's unfortunate her career ended this way, but her reckless bravery to attempt one last shot at an advanced age by athletic standards while already injured was memorable and she has an all-time-great type career to look back on. She's going to be fine.
In other words…what the hell was she thinking? Why race in her condition? Was it worth the ten million in nil she got from advertising??
She’s a competitor and a champion. It’s in her DNA.
$$$ + pride + desire to compete > personal health/safety
Maybe she should have been taken into some version of “the blue tent” prior to being allowed to compete in Olympic trials/games. Did she really get good medical advice about competing? Seems even if she did she was going for it anyway.
Maybe she should have been taken into some version of “the blue tent” prior to being allowed to compete in Olympic trials/games. Did she really get good medical advice about competing? Seems even if she did she was going for it anyway.
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I can't believe any orthopedic surgeon would have signed off on her competing. Considering the stress on her knee going 70mph with the required turns on an unstable knee , her decision was foolish .
The only possibility was that she was a "coper". This was a term coined by Kaiser Permanente to justify avoiding surgery in ACL patients, certainly a less costly form of treatment that KP was willing to recommended
I magnified the xray and the lateral tibial plateau is compromised , which does not bode well for her long term prognosis .
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Exactly. It was her last dance, and she rolled the dice. The toughness and combination of drive and ambition, bordering into insanity and recklessness, which combined with god-given ability to generate a superlative champion is the same quality that drove her to make a nuts decision like this at 41 years of age. By any sensible measure, she’s too old to compete HEALTHY, and yet there she was. Most of us will frankly never truly understand the psychology of a person like this, but most of us will never achieve what she did. The attitude that got her there was the horse she rode to the end. I respect the hell out of her, the total maniac.
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If personal safety is your overriding factor you never got into a sport that involves going like 100 miles and hour down an icy hill.
I have no doubt her doctors told her the decision to compete was totally insane. And yet, she finished third in the final preliminary heat. On a shredded knee! At age 41! This is a champion, this is a person to celebrate and consider. Probably not a person to EMULATE exactly, but a person to push and inspire. This is why we love sports!
So that’s good for Stryker since it’s the other knee, although they laid me off and rif’ed my entire team. That is a pretty x-ray and looks like she’ll at least save the leg and walk again. Everyone walks or skis their own path. All the best for her recovery.
Doc, what's the likely prognosis? Lots of old people I know, most older, have gotten knee replacements with satisfactory results at least relative to walking and mild exercise. I have no doubt that some push the envelope much further. Here Ms Vonn broke her leg also and based on the number of surgeries that doesn't sound good. I am reminded of Alex Smith, 49er QB, who almost died from complications related to a broken leg. He had a terrible loss of muscle and deformation to his leg.
I had a friend in grad school at NU who played way too much basketball in high school and her undergrad with injuries and wound up with her knee completely fused. Can't say we found it inspiring.
The tibial plateau looks like it will support aTKA when pain is intolerable. The location of the incisions from ORIF could be problematic though. The current implants will have to be removed and a delayed TKA performed and hope the skin survives another.
I would anticipate 5-10 years on existing reconstruction then a TKA , traditional or stabilized depending on level of instability.
I was peripherally involved with Alex Smith's case as it was presented at Fairfax Hospital's conferences. He was treated by immediate ORIF , followed by severe complications necessitating flap coverage of his wounds., leaving a grotesque appearance. Another player I would not havre allowed to return to competition
Fusion was recommended as the definitive treatment in younger patients40-50 years ago , now TKAs are performed routinely in very young patients , knowing that revision surgery has improved.
Fusion is still done for failed TKAs in some cases involving infection.
Wasn’t Alex Smith’s injury worsened due to a major infection (flesh eating bacteria or staph IIRC) following a compound fracture?
Hopefully Vonn avoids that type of situation.
The controversy was that an extensive ORIF was performed immediately in an open fracture. Trauma surgeons have become very aggressive with ORIF in open fractures. Traditional protocol would have been to debride the wound , possibly apply an external fixator , then perform ORIF after repeated wound debridements
Sadly I and my family have had enough orthopedic surgeons to know what some of @docrugby1 ’s acronym’s mean off the cuff. The Internet is always your friend for those you don’t.
Vonn is receiving the best of care and always will be. But she never should have been allowed to compete on a torn ACL.
If she were my daughter , niece, or sister… I would have told her she should have gone for a full repair and competed for $15-20M in 4 years.
Now, she is done @AdamOnFirst
Who benefits?
In 4 years? She’s already 41. She was - and still is - the oldest woman ever to medal in downhill skiing when she did it at 33 8 years ago. One man also did it at 41, but he was the only older than 36. She was a high outlier to compete even at 41, this was her last dance either way.
An unnecessary comment but some may find interesting. In Googling Doc's comment, I found out that maggots are still a treatment for open wounds. I also found out a bit about the treatment for my sister's severely broken lower leg from an auto accident that refused to heal because of her diabetes. Eventually had to amputate as the foot basically died. Couple all this with Alex Smith's experience and you begin to realize how difficult and potentially dangerous Vonn's recovery will be. In some respects she has a bit more in common now with Tiger Woods with all his physical issues. All my prayers.
Jeebus. Turns out she had compartment syndrome after the crash. Damn near lost her leg.
Good Lord. She is lucky to have kept it.
Hopefully millions of kids avoid competing on major injuries as a result. Just a brutal injury:
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Vonn, 41, said the trauma from the crash led to compartment syndrome in her leg. Compartment syndrome involves excessive pressure building up inside a muscle from bleeding or swelling. High pressure restricts blood flow and can lead to permanent injury if not treated quickly.
"When you have so much trauma to one area of your body so that there's too much blood and it gets stuck and it basically crushes everything," Vonn said.
Vonn credited Dr. Tom Hackett, an orthopedic surgeon who works for Vonn and Team USA, for conducting a fasciotomy to salvage her leg.
"He filleted it open [and] let it breathe, and he saved me," she said.
Vonn noted that Hackett was in Cortina only because she was competing after tearing the ACL in her left knee shortly before the Olympics.
"If I hadn't had done that, Tom wouldn't have been there [and he] wouldn't have been able to save my leg," she said.
Vonn, who said she has been discharged from the hospital, also broke her right ankle in the crash.
These types of things raise the question about what is an appropriate role for sport in society and culture. Working hard and taking reasonable risks to achieve a personal goal seems admirable to me. Taking that chance for other people's entertainment sounds foolish to me. Already rich, and taking that chance just for some more money, sounds foolish to me. When firefighters, the police, medical professionals in the face of an epidemic, or soldiers take those kinds of risks, they are, hopefully, doing it for the common good - super admirable. She's tough, but I'm afraid that's about what I can give her in the larger picture. Taking those kinds of risks because you don't think you can live without the rush sounds more like a mental health issue than a great competitor.
I think you are projecting a pathological condition onto her