Does anyone else glue themselves to the TV during Olympic season?
Was anyone else super excited to watch Lindsey Vonn return to the slopes as a 41 year-old who had just become the oldest skier ever to win a World Cup?
I was.
She came out of retirement after a RIGHT knee replacement that relieved the terrible pain she had been experiencing on the slopes for so many years.
On January 30th, the week before her Olympic run, she blew out her LEFT ACL and bruised the bone and tore the meniscus in her left knee. I'll talk more about ACL injuries in a future blog post. But for now let's say it's an injury that requires reconstruction through surgery, and usually requires 6-9 months of rehabilitation before someone can do any strenuous activity. It's a ligament that gives the knee stability, and without it, the knee will buckle and "give out." Lindsey was skiing without it.
When she injured her left ACL on January 9th, Lindsey Vonn was no stranger to ACL injuries and knee instability.
I was stunned that she was racing without an ACL in her knee only 9 days after tearing it. I was watching eagerly when she launched out of the gate.
A few seconds later I was really bummed when she fell, as skiers often do.
But then she didn't do what most skiers do when they fall. She didn't get up with an angry or frustrated expression and glide off the run in disappointment and defeat. 
No. She just laid there on the mountain and screamed.
The rest of the mountain was silent.
...until the helicopter entered the area, and deployed an emergency team that packed her up and flew her in for emergency surgery.
At the time of her crash they didn't have a lot of information. A bit later they announced that she was in stable condition with a fractured leg. But they were still very short on details. Which leg bone? The femur would make sense, based on how she was screaming but wasn't moving at all. Femur (thigh bone) fractures are very painful, and people generally stay very still when they break a thigh bone. Maybe it was a boot-top fracture, which is common for skiers. A ski boot keeps the ankles very stable, but with skis acting as extended levers, any twisting of the leg will put all the torque above the boot. The result is commonly a fracture of the leg right at the top of the boot.
Lindsey Vonn's leg didn't break like a stick. It broke like a vase. It didn't crack. It shattered. It didn't need a cast. It needed pins, screws, plates, and rods, over the course of a six hour bone reconstruction surgery.
That kind of bone-shattering injury is horrible enough, but that wasn't the worst of it in this case. The biggest problem Lindsey Vonn faced was the compression syndrome that nearly caused doctors to have to amputate her leg.
In the first installment of Oh My Aching Body, I talked about the benefits of compression when there's an injury. When an ankle is sprained and starts to swell, we wrap it with an elastic wrap to keep the swelling to a minimum. We wrap the injury with elastic wrap, not inelastic wrap. We don't wrap the elastic wrap too tightly, and we keep checking circulation to the toes with a quick squeeze of the toe at the toenail, to look for the quick return of color, and therefore circulation, to the toes. Compression can have benefits, but too much compression can cause tissue death.
Compression is both the result and cause of significant injury when there's damage to tissues in the leg. There are ten muscles in the lower leg, and they are grouped into four separate compartments, each surrounded by a layer of fascia. No other part of the body has this compartmentalization. If a muscle in the leg is injured and begins to swell, there's nowhere for the swelling to go because of the inelastic fascial layer surrounding the muscles. Blood collects in the compartment, squashing all the encapsulated muscles, nerves, and blood vessels.
For Lindsey Vonn, the biggest problem she faced was not the serious damage to the bone, but the swelling within the compartments of her leg. To relieve the pressure, doctors needed to make incisions to the fascia, to open the leg compartments in what is known as a fasciotomy.
Those of us who were checking the news were hearing that Vonn had six surgeries before being flown out of Italy. The first several surgeries were just at attempt to prevent the amputation of her leg.
It worked. The first doctors saved her leg. Then the reconstruction of the bones began. That worked, too. She's on the road to recovery and posting Instagram reels of her physical therapy routine.
Some people have guessed that this injury happened because she's an older skier and her bones are less equipped to handle that kind of impact.
- It didn't.
- Lindsey Vonn was in peak physical condition, and her bone density was epic, thanks in great part to the impact her bones have sustained over the many years she has been on skis. If you read "Dem Bones, Dem Bones" in a previous blog post, I mentioned a study where third graders simply stomped their feet 100 times per day and had noticeable increases in bone density. Imagine flying through the air and landing on your feet at 40-60 miles per hour repeatedly. Lindsey's bones weren't frail.
Some people have surmised this injury happened because she had already blown out her ACL 9 days earlier.
- It didn't.
- She explained that she was cutting the flag tight because the previous skiers had put down such amazing times, and by cutting the flag too close she ended up with her ski getting caught up in the flag pole. That kind of collision could have thrown any skier, and the torque from the twist on her left leg could have destroyed anyone's bone.
In summary, what we saw on February 9th was a once-in-a-generation bad-ass on the slopes in Cortina. Her preparation was impeccable, her comeback was incredible, her crash was terrible, the emergency response was perfect, the emergency fasciotomy surgery saved her leg, and the orthopedist reconstructed her leg beautifully. Thanks to all of those things, Lindsey Vonn will be walking and running and probably skiing again on both of her own legs someday soon.
But we probably won't get to see her in the Olympics anymore, according to her dad.
...We'll see.
