Lindsey Vonn's Titanium Knee Fuels Olympic Comeback at 41

Lindsey Vonn is many things. An Olympic champion. A sports icon. An inspiration to countless fans who have watched her rise and fall, and then fall some more, only to rise again. As Vonn sets her sights on Olympic glory at 41, five years after she retired with a broken body, she has also become one of the great guinea pigs in sports medical history, a live-action experiment in the possibilities of orthopedic reincarnation unfolding at 80 miles an hour down some of the steepest, iciest downhill skiing courses in the world. There is a block of titanium in Vonn’s right knee, the result of the partial knee replacement surgery Vonn had in April 2024. Before the surgery, Vonn walked with a limp and couldn’t walk without pain or limping. She underwent the procedure so she could enjoy an active lifestyle during the second half of her life. Her goals didn’t go beyond that. However, two months later, she felt good enough to wakeboard in the waters off Miami, and not long after that, with her knee feeling better than it had in decades, she began to toy with the idea of making a comeback to elite ski racing. She asked her doctors, Martin Roche at the Hospital for Special Surgery in West Palm Beach, Fla., who operated, and Thomas Hackett at The Steadman Clinic in Vail, Colo., what they thought of the idea. Usually, when surgeons get questions like this, they can point to longitudinal studies and lean on the experiences of former patients with similar experiences. They can cite statistics and reduce a patient’s chances of success down to a rough percentage, based on what others have gone through. In Vonn’s case, that wasn’t an option. They didn’t know of another human who had undergone a partial knee replacement, then subjected the joint to the kinds of unique stress and force that an elite downhill skier endures during the two minutes of daredevil lunacy that nearly every race brings. “I am testing it out in a lot of ways,” Vonn said during a recent interview, just before she began blasting out of starting gates across the Alps, landing on podiums nearly every weekend and reasserting herself as the dominant figure in her sport. “Considering how I feel, I’m not worried about it at all.” Roughly 20 months since Vonn climbed out of her hospital bed for what she can only hope is the final time of her illustrious, injury-riddled career, Vonn is among the favorites for the Olympic gold medal in downhill and super-G and as a partner with a slalom skier in the combined event. She has achieved a level of success that has amazed some of the people most familiar with her anatomy, simply because they’ve never seen anyone do this with the sort of artificial materials she has in her knee. “The thing always for us in orthopedics is, what can the bearing take and what is the long-term survivability of that implant?” Roche said after watching Vonn open the World Cup season with a win, a second-place finish and a near-miss of the podium in fourth place in St. Moritz, Switzerland, in December. In eight World Cup races this season, Vonn has two wins and seven podiums. She leads the downhill standings. “We’re learning things from Lindsey,” Roche said. Pretty much everyone is. Chris Knight, Vonn’s longtime coach, had no idea what to expect when Vonn returned to the snow roughly a year and a half ago. He’d worked with plenty of skiers who had gone through all kinds of high-tech repair jobs on their knees. Vonn herself had torn up the primary scaffolding of her knee, her anterior cruciate and medial collateral ligaments and fractured her tibial plateau, which is the top of her shin bone, in a 2013 crash. However, this was something else entirely. “It was kind of a process where you didn’t even know what you were going to be doing the next day to start with,” Knight said of working with Vonn in 2024 as she started her comeback. Not knowing what she was capable of, he struggled to plan her training. He didn’t know how many consecutive days of hard practice her repaired joint could take. As it turned out, it could take a lot, far more than the previous version of that knee could endure. “We’ve been able to test so much during the last six months and get a lot of volume on snow as well, which we didn’t have last year going into the competition period,” Knight said ahead of the season. “We’re so much further ahead than we were.” At the time, Knight and Aksel Lund Svindal, the former champion skier who is also coaching Vonn, felt optimistic about what might unfold. Still, no one could have predicted this level of success, especially given where Vonn was when she and Roche began this latest journey into the world of modern medicine that has helped Vonn become as good as she has ever been, if not better. The way she is skiing, it’s enough to imagine hordes of skiers looking to add a little titanium to their knees rather than struggling with the flawed god-given material the human race uses to trudge through life. “I wouldn’t be doing this if everyone told me it’s not safe or if even my doctor told me it’s not safe,” Vonn said. “Everyone said that, you know, we believe that this is going to work. And so, I guess I am testing it out in a lot of ways. But considering how I feel, I’m not worried about it at all.” That responsibility falls to others, like Roche. He watches her races with a mix of inspiration and anxiety. “She’s hitting 80 miles an hour plus, so we’re always anxious to make sure she comes down safe,” he said. However, Roche trusts the science and technology he has been working with for nearly two decades, which have changed the way physicians and surgeons think about knee repair. Surgeons have been performing total knee replacements for several decades, but no one would ever recommend that someone with an entirely replaced knee compete in elite skiing. Chess, yes. Curling, perhaps. Not downhill skiing. It’s unlikely the plastics used for those artificial joints could endure the forces of high-level competition. However, partial knee replacement allows people to retain the healthy parts of their knees, which have three so-called compartments — one on each side and then the patellar compartment under the kneecap. In a partial procedure, doctors repair and replace only the damaged compartment. That allows patients to retain their natural ligament, which provides greater stability and enables them to use their muscles around the knee more effectively. There was also less risk of infection and blood clots. The challenge was doing the repairs correctly and getting the titanium replacement pieces to lock in place like Lego pieces. Human eyes and hands aren’t great at the intricate work required. “Each knee is different, each knee rotates differently, each knee has different bone quality, different alignment, different tension in it,” Roche explained. In 2006, he began working with a Florida company called MAKO Surgical Corp., which was developing a robot that could read a scan of a person’s knee, remove only the damaged bone in a minimally invasive way that limited muscle and tendon damage. Then the robot inserted a titanium implant designed to replace the damaged bone. Over time, the technology and the materials have continued to improve. When Vonn arrived on Roche’s examination table, she was in rough shape after two ACL surgeries, including one failed procedure. She had significant cartilage damage. She had bone spurs that were locking her knee so she couldn’t get it fully extended, and she had a meniscal tear. “If you get simplistic, the threads on her tire were gone, and she was down on her rim,” Roche said. However, the undamaged parts of the joint and the bone retained considerable integrity. Roche used a scar from a previous surgery to access the joint. The robot removed the damaged cartilage and bone, then placed the implant exactly where her knee needed it. Very quickly, Vonn was able to straighten her knee for the first time in years and use her thigh and calf muscles as she wanted to. She then hit the gym and her physical therapy routine as hard as she could. About two months later, she texted Roche to ask him if she could get her knee wet. He said, of course. Later that afternoon, a video of her wakeboarding landed on his phone. “She is not the norm,” Roche said. “But it also tells us that patients that put the time in before surgery and after surgery to really strengthen their muscles, that’s what’s really controlling your healing.” Vonn and her medical team remain in constant contact. Hackett and Roche both plan to be in Cortina d’Ampezzo, Italy, the host city for women’s Alpine skiing at the Olympics. It’s a chance to watch medical history and the ultimate orthopedic guinea pig in real time. It’s not the path Vonn would have chosen. Life would have been a lot simpler without all the surgeries. But now, for the first time in more than a decade, she finally has two working knees, and it’s allowed her to dream big. “There’s a lot of unknowns, but from a functional standpoint, like my replacement is titanium, and it’s not going to crumble under pressure,” she said. “Everyone said that, you know, we believe that this is going to work. “And so, I guess I am testing it out in a lot of ways. But considering how I feel, I’m not worried about it at all.” Plus, it all plays into the story Vonn has been living for a long time now, that fall-and-rise tale that never gets old, and even people who don’t know what it’s like to tear down a mountain at 80 mph can understand. “I like that connection,” she said. “I know people are watching what I’m doing, and I do hope that I leave something behind that’s more than just, you know, being a ski racer.”