June 23, 2008

What's Ahead For Tiger?

His knee injury won't likely threaten his career, but how well Tiger Woods will play after his surgery and rehab isn't clear

The extent of what Woods faced at Torrey Pines was known by only a small circle.

The extent of what Woods faced at Torrey Pines was known by only a small circle.

After walking halfway across his kitchen floor, Tiger Woods stopped in his tracks, overcome by the sharp pain in his left knee. Bent over at the waist for 30 seconds before he could continue, Woods was two weeks from returning to the PGA Tour at the U.S. Open and anticipating a visit from his doctors. It was then that swing instructor Hank Haney thought, "I don't see how this thing is going to happen."

Woods' medical team arrived at Isleworth that day to assess not only the condition of his knee, but also a double stress fracture that occurred while training earlier that week at his Florida home (and which was still a secret to all but Woods' closest advisors). The Memorial was being played at Muirfield Village in Dublin, Ohio, and Woods wanted to be there as a tuneup for the Open at Torrey Pines, but doctors suggested he spend the next three weeks on crutches. Woods had other plans.

"I'm playing," Woods announced. "I'm winning the U.S. Open."

Woods then lived up to his prophecy, going 91 holes after not walking 18 since the Masters, beating Rocco Mediate in an 18-hole playoff that went to sudden death before it was decided -- all the while grimacing, wincing and occasionally doubling over in pain from his knee. It wasn't until two days later, in a statement posted on his website, tigerwoods.com, that Woods revealed the full extent of the details behind his miraculous performance.

Woods won despite a ruptured anterior cruciate ligament in his left knee and a double stress fracture of his left tibia. According to the statement, the fracture was probably caused by the intense rehabilitation program he subjected himself to in trying to recuperate from April knee surgery in time for the national championship at Torrey Pines. The ACL tear was an even older injury. In the statement, Woods said he tore the ligament while running at his home in Orlando shortly after the 2007 British Open.

In the immediate aftermath of his win at Torrey Pines, Woods admitted he played against the wishes of his medical staff ("I'm bad at following doctor's orders," he said). Last week, Woods showed he is taking a more pragmatic approach. Treatment for his injured knee and leg are now his top priority, and playing golf isn't -- Woods will sit out the rest of the 2008 season, which means he will miss the British Open, PGA Championship, Ryder Cup and the FedEx Cup playoffs. Said Woods, "Now it is clear the right thing to do is listen to my doctors, follow through with this surgery, and focus my attention on rehabilitating my knee."

Surgery to reconstruct Woods' ACL will be the fourth to his left knee, which the golfer has said he originally injured while skateboarding as a child. (He had a benign tumor removed in 1994 while a student at Stanford. In December 2002 he had benign cysts removed and fluid drained from around the ACL. And on April 15 earlier this year, two days after he finished second to Trevor Immelman at the Masters, he had a one-hour operation to clean out cartilage damage in the knee. That operation was performed by Salt Lake City orthopedic surgeon Dr. Thomas Rosenberg, who also presided over the 2002 surgery.) The ACL reconstruction surgery has yet to be scheduled, perhaps because swelling from the injury must subside and the stress fractures in the tibia must be given time to heal. An ACL reconstruction also requires a graft and bone plugs into the tibia. Once the surgery is performed, Woods faces a much longer rehabilitation program than the one he went through after his April cartilage surgery. Medical experts say the rehabilitation process for a reconstructed ACL can take up to a year.

The biggest question after Woods revealed the extent of his injuries was whether he risked long-term damage by playing at Torrey Pines. Neither Woods, his doctors, nor his spokesmen would comment. But Dr. Jim Bradley, orthopedic surgeon for the NFL's Pittsburgh Steelers and NHL's Pittsburgh Penguins, told Golf World that although he wasn't treating Woods, he didn't believe the golfer could have damaged his ACL tear any further if it was already torn. The stress fractures might have been another matter. (In one painful incident, European Tour golfer Richard Boxall tried playing with a stress fracture in his leg at the 1991 British Open. While hitting a tee shot in the third round, the broken bone shattered and he had to be removed from the course by medical personnel. Boxall faced a long recovery and never regained his playing form. He now works as a broadcaster for Sky Sports.)

"Tiger is a smart guy," Bradley said. "The U.S. Open is at Torrey Pines, he's got a great chance of winning and he probably said, 'Screw it. I'm going to deal with everything after [the Open is over].' All you can do as a doctor is give him the information. It was his body, and he made a decision on what he was going to do. We have this discussion with NFL and NHL players all the time. It's usually determined by where they are in their contract, whether they're at the end of their career, whether a Super Bowl or a Stanley Cup is coming up. You let them make the decision."

But Bradley, a golf fan as well as an orthopedic surgeon, doesn't think anyone should push the panic button. "This is not career threatening," he said.

Another question was why Woods didn't have the ACL reconstructed last year after he first tore it, or in April, when he had the cartilage work done. The answer in both cases, say sources, was that Woods was trying to postpone what he knew would be a long layoff from competition.

At least one source in the Woods camp thinks Woods' knee problems are a byproduct of more than jogging -- his love of skydiving and extreme training methods, some adopted by U.S. Navy Seals. After the jogging accident last summer, Woods was forced to limit his practice time and warm-up routines -- not to mention playing in pain that he did not reveal -- yet still won nine of 12 tournaments starting at the 2007 Bridgestone Invitational. He did this, as Haney said last week, "playing on one and a half legs."

"It was," admitted Woods' former coach, Butch Harmon, "an incredible feat. Was it smart? Only time will tell."

Roughly 100,000 people have reconstructive ACL surgery every year and for athletes in other sports it isn't as career-threatening as it once was. English soccer player Michael Owen has returned to star for Newcastle United, Cincinnati Bengals quarterback Carson Palmer returned to make the NFL Pro Bowl and Chipper Jones of the Atlanta Braves has played almost his entire career after having ACL surgery in 1994. But the knee can be reinjured if an athlete returns to competition too soon. NFL wide receiver Jerry Rice, for example, had ACL surgery in 1997 and tried to return to action 14 weeks later. He scored a touchdown against the Denver Broncos, but broke his left kneecap in the process.

As Kenny Perry said from the Travelers Championship, "I had my right knee scoped, and it took me two full years to recover. Woods needs to stay out as long as he needs to stay out."

Brad Faxon is a case in point, having had his second ACL surgery in a three-year period just before Christmas. Faxon had targeted last week's Travelers, where he won in 2005, for his comeback, but decided to wait after rounds of 77-79 in U.S. Open sectional qualifying, "I'm not going to play Hartford if I'm shooting scores like this," he said at the time.

In fact, knee injuries have become something of an epidemic on the PGA Tour. Besides Perry and Faxon, Brett Quigley, Peter Jacobsen, Stuart Appleby and Fred Funk have had various forms of knee repair since last September. While Woods' situation is far from the total knee replacement the 54-year-old Jacobsen went through, he also is faced with the potential of more prolonged interruptions -- in what are supposed to be his prime years. "He has got a weak link," said one noted swing instructor. "The problem is, it could happen again."

Opinions vary on whether those pain levels will subside entirely after the surgery. Dr. Neal ElAttrache, director of sports medicine for the Kerlan-Jobe Orthopaedic Clinic -- who, like Bradley, is not treating Woods and has not reviewed his medical records -- told the Los Angeles Times Woods might eventually need another form of knee surgery. "ACLs can be fixed and stabilized, but the cartilage surface of the joint, that's unforgiving," ElAttrache said. "It can sometimes be improved by microfracture surgery, but that part of his knee is always going to take a beating. This will be something he [will deal] with the rest of his career."

Finally, there is the emotional aftershock. Ernie Els' former coach David Leadbetter says Els is still not mentally recovered from the ACL injury he suffered in a 2005 innertubing accident, not only to his surgically repaired knee but to his "donor leg" as well. (Els chose to have his injured ACL reconstructed using a graft from a tendon from his healthy leg rather than from a replacement ligament harvested from a cadaver. Woods will have to make the same decision.)

So while many hope Woods returns for next year's Buick Invitational, or even the 2009 Masters, he may not be back until daughter Sam is close to her second birthday -- or just in time to defend his U.S. Open title at Bethpage Black. What will it be like for him to miss that much time? "Anybody who's a warrior is going to have trouble taking a [sustained] break from competition," says sport psychologist Bob Rotella. "It is not only the winning they miss, it's the way they feel starting out Thursday, or being in contention on Sunday."

Woods already is restless. After filming a Buick commercial last week, he called Haney requesting a list of areas that he could improve upon during his time away from competition. The instructor tried to tell Woods that he hadn't even had surgery yet, but Tiger pressed. "I want to think about it," he said.

Tiger's ranking