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Newly Revealed ACL Injury Ends 2008 Season for Tiger Woods

MedpageToday

ORLANDO, June 18 -- Tiger Woods, the world's best golfer, announced today that reconstructive surgery for an anterior cruciate ligament rupture in his left knee will force him off the course for at least the rest of the year.

In a statement on his Web site, Woods said the ACL rupture accounts for a year-long problem with the knee, complicated more recently by a double stress fracture of his left tibia. No special treatment is planned for the stress fractures, he said.

Action Points

  • Explain to interested patients that Tiger Woods suffered a rupture of the anterior cruciate ligament in his left knee.
  • Explain that such injuries create instability in the knee which, if not repaired or reconstructed, damages other joint structures and accelerates the development of osteoarthritis.

Woods said he developed the ACL tear last July while running near his home here, although the injury had not been revealed until now. Woods had hoped that arthroscopic meniscal surgey in April -- two days after a second-place finish in the Masters -- would improve the knee function enough to allow him to delay ACL reconstruction until after the 2008 season.


Joseph Bosco, M.D., an orthopedic surgeon at New York University and spokesman for the American Academy of Orthopaedic Surgeons, said that articular cartilage damage, the result of the ACL rupture, was the likely focus of the April surgery. Dr. Bosco stressed that his only knowledge of Woods' case came from press reports.


"The natural history of anterior cruciate ligaments treated non-operatively is that patients go on to develop cartilage damage," he said, affecting either the meniscus or the articular cartilage.


He disagreed with speculation that Woods may have tried to come back too soon after the April cartilage surgery.


More likely, according to Dr. Bosco, is that the knee simply remained too unstable because of the ligament injury. The cartilage surgery would not have addressed the fundamental instability, he said.


He added that Woods probably did not jeopardize his long-term health by delaying the ligament surgery until now, rather than having it immediately after the original injury.


"It depends on how much cartilage damage he sustained to his knee by waiting, but probably not," Dr. Bosco said.


Woods did not say when the ACL repair would take place. However, he said, his doctors have assured him that he can expect "no long-term effects."


Dr. Bosco was less sanguine, however. "Full recovery is a misnomer," he said. "Anyone who has an ACL reconstruction never has a normal knee. ... If you ask those patients, they're not the same."


But he said that 90% of professional athletes who undergo ACL reconstructions resume their careers. He added that golf is different from football, a sport where ACL tears are common.


Dr. Bosco predicted that Woods will not only return to the pro tour, he will again dominate the game.


On the other hand, Dr. Bosco said the normal rehab time after ACL reconstruction is six to 12 months, which could mean the 2009 season will be well under way before Woods can rejoin the tour. As it is, Woods will miss the 2008 British Open and PGA.


The announcement followed his dramatic victory on the 19th hole of a playoff Monday at the U.S. Open. The knee injury was glaringly apparent. He limped through much of the five days of the Open, wincing at times while making shots and sometimes using a club as a cane.


Thomas Rosenberg, M.D., of Park City, Utah, the surgeon who performed the April surgery and two earlier procedures on the same knee, had no comment on Woods' condition, according to a receptionist in his office.


Dr. Rosenberg had removed a benign tumor in 1994 and performed a cyst removal and drainage in 2002, both in Woods's left knee, according to the golfer's Web site.