DR RAY Moran had just completed one of his daily anterior cruciate ligament (ACL) surgeries yesterday evening when he heard the news about Tiger Woods. Straight away he realised not only was it the highest-profile injury in golf history but also that the entire sporting world would be wondering if Woods would return after reconstructive surgery as great a player as before.
Moran is medical director of the Sports Surgery Clinic in Santry and performs over 300 cruciate-ligament surgeries a year. He believes Woods won't lose any prowess on the course. There is a small chance of some long-term side-effects, but also the chance he'll come back even better.
"It's an exceedingly rare injury in golf," says Moran, "but what we don't know is how exactly Tiger got it. He has had problems with that left knee going back to 2002. So there was some background problem, which he had been managing but has now come to the fore. And there could be an acute injury in the background as well that we don't know of.
"But we could all see the very dramatic manner in which he was buckling during the US Open at the weekend. That looked like an instability problem. If that is the case, and there's nothing else going on, the ligament reconstruction should work very well for him."
Several elite Irish sportsmen, including Roy Keane, Niall Quinn and more recently Henry Shefflin, have undergone ACL surgery and made a full recovery. The injury is however, more associated with contact or impact sports, and Moran says there are some uncertainties as to the exact nature of Woods's injury.
"He almost certainly didn't damage it as a result of a golfing episode," says Moran. "But then the one thing about Tiger Woods is the ferocity of his turn, which he applies to his knee, and the speed at which he follows through, which probably has no equivalent in professional golf.
"So whether he injured it in golf or another episode, it's more likely to be manifested with him playing golf, because of the way he rotates into his left knee and throws all his weight on that, mainly on his drives.
"It's a complex scenario, but if we take it at face value, and it is predominantly a ligament problem, he should do very well. I can't envisage the guy not getting back to full activity. They seem confident enough it is ligament predominated, but you never know."
Moran explains ACL surgery, while not a major operation, is highly specialised. It only takes about an hour, but it's not a repair process, rather a reconstruction, and therefore requires the transfer of tissue. The most common technique is to take a strip of ligament from the knee patellar tendon or lower hamstring and graft it into the knee joint (an autograft); alternatively, ligament from a cadaver can be used (an allograft).
"One of the issues with Tiger is that he's had two surgeries already for cartilage, on the outside of his knee, and that could be a bit of a lingering problem for him. There could be some wear and tear which has been going on for a while. And quite often the ligament isn't the whole story.
"But the success rate is that 90 per cent return to full activity. Usually the ones that don't are those that don't get around to doing the surgery, or aren't able to do it. But it's a predictably successful operation in the majority of cases, once the rehab is right, and that won't be an issue for Tiger."
Woods is still looking at rehab of between six and ninth months:
"You can get players back in six months, but there's no real pressure on him to get back earlier. He'll be thinking the US Masters next April, I presume. He won't be rushing back for the Ryder Cup."
