Lindsey Vonn races with an artificial knee. So why bother keeping your own?

Here’s another (at least vaguely) ski-injury–related topic. By now, most people know that Lindsey Vonn tore her ACL — but that’s not really what I want to focus on. What her story reminds me of is that she’s a great example for discussing joint preservation versus joint replacement. A few years ago, she underwent a partial knee replacement, and it clearly worked remarkably well — she even returned to Olympic competition. That’s essentially unprecedented.

So that raises a question: Why don’t we always replace knees? Why do we bother with cartilage transplants, meniscus transplants, or osteotomies, which often involve a more demanding recovery?

The reason is that a mechanical solution like a joint replacement limits future options. If you’ve had a replacement, I can usually predict your next surgery — it will be another replacement, typically a larger or more complex one. You move from partial to total, from total to revision total. And revision surgeries generally don’t perform as well as primary replacements. Each step tends to become more complicated, and outcomes may decline over time.

If you begin this process in your 50s or 60s, that progression is often acceptable. For example, you might start with a partial replacement, keep it into your mid-60s, then transition to a total replacement and do well long-term. But if you start in your 20s, you could face three or four revision surgeries over your lifetime — and that’s far less ideal.

That’s where joint preservation comes in. These procedures act as a bridge. I can’t promise that an osteotomy or cartilage procedure in your 20s means you’ll never need further surgery — in fact, you probably will. And you may ultimately require a knee replacement. But the goal is to delay that step. You start the replacement “clock” later in life, when the number of revisions needed is likely smaller.

Another advantage of joint preservation is flexibility. Unlike replacement, it doesn’t burn bridges or limit future choices. Your next step could be anything — an injection, a biologic therapy, a medication, or perhaps a next-generation replacement that’s significantly improved compared to what’s available today. Even delaying replacement by 10–15 years means benefiting from advances in implant design and surgical technique.

That’s the value of joint preservation: managing symptoms, maintaining activity, and buying time — allowing you to take advantage of future innovations while postponing irreversible mechanical solutions.

Thanks very much.

Lindsey Vonn competes with a torn ACL. Why that may work for some.

Anyone with even the faintest interest in winter sports has likely heard about Lindsey Vonn’s ACL injury. What’s remarkable is that she has said she’ll attempt to compete in the Olympics with a torn ACL. That often surprises people — I hear from friends and patients all the time — because the common assumption is that if you tear your ACL, reconstruction is mandatory.

She’s a very special case. So let’s talk more generally, about typical patients. It’s not necessarily true that you must have your ACL reconstructed. The primary reason we consider ACL reconstruction is to restore stability to the knee — and stability matters for several reasons.

In the short term, most people simply don’t like the uncertainty of an unstable knee. Pivoting or twisting activities — soccer, tennis, pickleball — or even everyday situations like navigating a crowded sidewalk and changing direction quickly can lead to buckling. That unpredictability affects quality of life and confidence, and reconstruction can allow people to return to the sports and activities that are part of their social and physical routine.

There’s also a joint-preservation aspect. An unstable knee that buckles repeatedly places the meniscus at risk. I often compare it to jumping a curb with your car — each impact increases the chance of damaging the tire. Similarly, each episode of knee instability increases the risk of meniscal injury or further damage. And meniscal health plays a major role in the long-term development of arthritis. If your meniscus is intact, preserving it is valuable — and you’re more likely to preserve it with a stable knee.

On the other hand, if you don’t participate in higher-risk activities — perhaps you prefer cycling or other low-impact exercise — and especially if you’re older or have a partial tear, non-operative treatment may be reasonable to consider.

But if you’re younger, want to return to cutting or pivoting sports, and your meniscus is still intact at the time of injury, my general recommendation is to restore as much stability to the knee as possible — both for current function and long-term joint health.