An Orthopaedic Surgeon Answers 8 Questions About Tiger Woods' Arthroscopic Knee Surgery, Golf and the Knees, and More
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April 16, 2008 — Golfer Tiger Woods had arthroscopic knee surgery on his left knee yesterday to correct cartilage damage. The surgery was successful, and Woods is expected to return to competition in four to six weeks, according to Woods' web site.
"I made the decision to deal with the pain and schedule the surgery for after the Masters," Woods says on his web site, which notes that he had been having knee pain since the middle of last year.
This is the third time that Woods has had surgery on his left knee. In 1994, doctors removed a benign tumor from that knee, and in 2002, Woods got arthroscopic surgery in that knee, according to his web site.
WebMD spoke with Allan Mishra, MD, about arthroscopic knee surgery, the rehabilitation process, and how golf and other sports affect the knees. Mishra is a clinical assistant professor of orthopaedic surgery at Stanford University Medical Center and spokesman for the American Association of Orthopaedic Surgeons. Mishra isn't familiar with the details of Woods' diagnosis or treatment.
What is arthroscopic knee surgery?
I think the easiest way to say it is it's a minimally invasive procedure that can be done to affect significant changes within the knee. So if you had a torn piece of cartilage, you would remove or partially resect that, possibly repair it. [Woods] may have also had something called chondroplasty that's like a smoothing of the cartilage. I don't know what Tiger had.
His web site says that the surgery corrected cartilage damage.
Right. We don't know what that means. It could be either the surface or the meniscus cartilage.
[Right-handed golfers] pivot on your left knee with a golf swing, so it's not surprising that it's his left knee vs. his right knee. We've all seen Tiger and he puts an incredible amount of torque around his body, and he's pivoting on his meniscus, on his knee. I'm just speculating, but that may be part of what's happening.
I'm not a golf swing coach. He's got the world's best golf swing; how am I going to criticize Tiger Woods' golf swing? That's impossible. But maybe he's putting too much torque around his knee.
He's a very powerful golfer, and I think it's a testimony to Tiger's toughness that he was able to finish second in the Masters and then two days later have surgery. Just as a golf fan, I'm impressed.
Woods is known for doing a lot of conditioning. Do you think that helped him?
He's in phenomenal shape, and I think that also was part of the reason why he was able to overcome that. Can you imagine yourself finishing second in a major golf tournament knowing you needed surgery? He's just physically and mentally amazingly tough.
What is the rehabilitation process like for the procedure he had?
Since I don't know what he had, I don't know what they're going to do. There are about eight to 10 different things they can do inside in a knee arthroscopy.
My guess is that he had something called a meniscectomy and chondroplasty. If that's what he had, and that's a big if, he would likely progress to what are called isometric knee exercises, try to reduce swelling, keep the leg iced and elevated over the first week or so. And then likely begin working on an exercise bike with limited tension and then progress to more weight-bearing and more loading over the course of the next three or four weeks.
I don't know Tiger, but my guess is that his goal is to get back for the U.S. Open at Torrey Pines in San Diego in mid-June, which is about six weeks or eight weeks away. And if he had what we're speculating he had, he should be able to be back for that.
We've seen with all types of athletes, however, that the rehab processes depend upon what happened yesterday in the OR. So the only two people who really know that are his surgeon and Tiger.
So it's something you could come all the way back from?
We all know Tiger. This is more as a golf fan — he'll probably do anything he can to be ready for the U.S. Open. And I'll make a bet — he'll be better. His physical conditioning prior to the surgery was spectacular. He's going to rehab a lot faster than most of us. Elite athletes simply just do better.
For the rest of us, at what point should someone be talking to a doctor about knee pain?
There's a spectrum of injuries that can occur.
If you have mild pain without a lot of swelling, you can see how that goes over a week or two, talk to your primary care doctor, maybe do some physical therapy. But the concerning things that lead to surgery are persistent swelling, persistent clicking, catching, locking, or sensation of instability in your knee.
The best ways to avoid injuries to your knee is to maintain excellent strength and flexibility — stretching exercises for your hamstrings, your Achilles [tendon], your quads ... The use of an exercise bike is a phenomenal way to strengthen your knee without impacting it. I do this myself three or four times a week — I will either ride a regular bike or an exercise bike to maintain strength and fitness around my knees. And I've taken hundreds, if not thousands, of my own patients through an exercise bike program that I think is very valuable for maintaining that.
What about sports other than golf?
Soccer and skiing knee injuries are often traumatic — you fall, you get taken out by a slide take. Those are usually more severe.
Overuse injuries can be made better or prevented by flexibility and proper training ... Figure out how to maintain the flexibility of the tendons around your knee but also change your training. Don't run in the hills five days a week. Run on a treadmill or try to bike every other day vs. running five straight days.
With sports, is it the same knee risks for men and women?
Women's knees — there's sort of an epidemic of injuries in women, especially who play things like volleyball and basketball and soccer. I've operated on more young women in the last five years because of soccer injuries probably than almost anything else.
It's not 100% clear why. It may be more women participating at higher level sports. It may be anatomically where their ligaments are in the knee or it could actually even be hormone-related. People are trying their best to figure out how to stabilize women's knees better in a preventive fashion, so they're teaching balance and coordination preseason. There's a lot of time and effort going into trying to better understand that question. I don't think we have a great answer right now.
What we do have is a lot more active women, which, ironically, I'll say is better because the more active women are, especially at a younger age, the better they're going to build their bone. Weight-bearing or load-bearing exercises, especially for women from their teens to probably their early 30s, is crucial for building that bone mass for later on. So I wouldn't want them to be less active. I'd like us to figure out how to prevent them from hurting themselves.
SOURCES: Associated Press. Tigerwoods.com. Allan Mishra, MD, clinical assistant professor of orthopaedic surgery, Stanford University Medical Center; spokesman, American Academy of Orthopaedic Surgeons.
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