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Woods' woes shouldn't preclude more wins, docs say
2008-06-19
CHICAGO - Doctors who treat the kinds of knee and leg injuries that ended Tiger Woods' victorious season have one word for his U.S. Open victory -- remarkable. "The fact that he had surgery two months ago and seemed to visibly be in pain with certain shots ... I find it remarkable that he could play as well as he did and win a major tournament," said Dr. David McAllister, a UCLA sports medicine specialist. Still, there's no reason to think it will be Woods' last -- despite needing surgery to repair a ruptured left knee ligament and treatment for a double stress fracture in the same leg's shinbone, experts said Thursday. But even if Woods returns to playing championship-level golf next year, as expected, his prospects further down the road are uncertain. The repeated wear and tear on his knee, including an operation that will be his third in five years, could result in early arthritis that might eventually slow down his career, said Dr. Charles Bush-Joseph, the Chicago White Sox' team physician and an orthopedic surgeon at Rush University Medical Center. "Given his natural ability and athletic talent, I think his chances are excellent. He should be able to get back and compete at the same level. How well he holds up long-term over the next five to 10 years, that's what's in doubt," Bush-Joseph said. Woods, 32, announced Wednesday that he will have surgery to reconstruct the anterior cruciate ligament he ruptured last year while running. It will sideline him for the rest of this season's PGA Tour and likely will require up to nine months of recovery, experts said. He also revealed he needs time off to recover from stress fractures discovered after his April surgery to clean out cartilage damage from the ACL injury. The ligament is a band of fibrous tissue at the center of the knee that helps stabilize the joint. When the ACL is injured, cartilage, the knee's natural shock-absorber, can tear, said knee specialist Dr. Nicholas DiNubile, a spokesman for the American Academy of Orthopaedic Surgeons and consultant to the Philadelphia 76ers. Reconstructive ACL surgery typically involves replacing the damaged ligament with a piece of tendon taken from another part of the patient's knee. Ligaments from cadaver donors also are sometimes used. Surgeons generally make a small cut below the knee, insert a narrow tube and thread the tendon or graft up the tube and position it into the knee joint. Woods' decision not to have surgery last year when he first injured the ACL wasn't necessarily misguided, doctors said. The initial rupture likely was extremely painful, but soreness and swelling typically subside. McAllister said he has treated older, amateur golfers who opted not to have surgery for ACL injuries and continued playing without any problems. But when swelling and pain recur, it suggests the knee is unstable and probably at risk for damage to cartilage, McAllister said. DiNubile said delaying surgery might have worsened the damage, but having the surgery would have ruined Woods' season and his thrilling U.S. Open win on Monday would never have happened. Added Dr. Riley Williams, an orthopedic surgeon at Hospital for Special Surgery in New York: "One could say he had a mixed result. He obviously made millions of dollars and had seven or eight more wins on tour. So it's hard to argue with his decision. "But ultimately -- as I'm sure his doctor told him -- that knee problem is going to win," Williams said. Woods' doctors said his intense rehabilitation after his April cartilage operation and preparing for the Open likely caused the stress fractures. For right-handed golfers like Woods, the left knee takes the brunt of stress from the swing. But the high speed and torque of Woods' well-known "violent" swing puts even more stress on that left knee, said Dr. Sherwin Ho, a University of Chicago sports medicine expert. Ho said that could have contributed to the stress fractures and other damage. Stress fractures are cracks in bones typically caused by overuse. They can be mild or pretty serious, depending on the location, McAllister said. Treatment includes rest, avoiding the activity that caused the fractures, or surgery in severe cases. ____ Associated Press Writer Stephanie Nano contributed to this report. ___ On the Net: American Academy of Orthopaedic Surgeons: http://www.aaos.org
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