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'Knee detective' says Tiger's injury is not career-threatening, but are we getting the whole story?

Does Tiger Woods have a career-ending injury? Not according to an orthopedic surgeon known to his colleagues as "the knee detective."

I've been wearing out my cell phone batteries the past week talking with Dr. Ronald Grelsamer, a knee surgeon at Mt. Sinai Medical Center in New York City.

"His recovery could take a long time," Dr. Grelsamer told me a while ago, as the news came out that Woods needs reconstructive surgery on his anterior cruciate ligament and rehabilitation time for a previously undisclosed double stress fracture of his left tibia. He will miss the rest of the season.

"But this should not be career threatening," Dr. Grelsamer said. "He would still be able to play golf."

But the doc isn't sure that the Woods camp has been completely forthcoming about the famous patient's condition. "There's a couple of things that still don't make perfect sense," he said. "There's no such thing as a double stress fracture in a young, healthy person. I've been a knee surgeon for 25 years, and I've never heard of that, although it happens in old people.

"Furthermore, it's extremely hard to tear an ACL just running. It happens mostly in women — say, from running up and down a basketball floor. And a non-contact ACL, that's not likely to cause bone or cartilage damage."

And Dr. Grelsamer didn't believe for a minute that Tiger winced on his tee shots last week because of a torn ACL. "An ACL tear doesn't hurt," he said. "It hurts the day you tear it, but not days later. John Elway is rumored to have played his whole career with a torn ACL.

"I respect Tiger's right to privacy, and I'm not criticizing him, but I have a sneaking suspicion we're not being told the whole story."

So what is going on? Dr. Grelsamer, while making it clear that he has not seen Tiger's medical file, said that the pain he endured through four rounds and a playoff at the U.S. Open suggests that the problem lies in the golfer's articular cartilage and the underlying bone.

"If you look at the end of a chicken bone, you see that white, shiny stuff? That's articular cartilage. It covers the end of the bone, and it's eight times smoother than ice. It's what allows the joint to move without making popping and scraping noises. Under that cartilage is bone that's hard, like oak, and under that is spongy bone, which is like balsa wood. When they say he has a stress fracture, they're probably trying to make it understandable for people. It's probably a problem with the articular cartilage and the sub-condral bone that lies beneath it."

Dr. Grelsamer, while again making the disclaimer that he hasn't gazed into Tiger's knee, repeats that this probably isn't a stress fracture in the traditional sense. "It's practically impossible that he has a stress fracture from overuse." That kind of break, caused by repetitive pounding, is often found in the feet and shins of runners and basketball players.

"There may be a problem with his circulation. Bone is a living tissue, full of blood, and if the flow is cut off, it's like a stroke. The bone can become soft and crunch down a little. It's very painful, but it isn't due to trauma.

"He could also have OCD, or osteo chondritis dissecans. That's where a piece of cartilage and bone want to separate themselves and break off. That occurs in teenagers and young adults, which means he could have had it for a long time."

Tiger's prognosis? "Hard to tell," says the doc. "These things can be tricky, and I'm handicapped not knowing what it is and where it is. You'll see some basketball players have surgery and come back good as new, like Jason Kidd. Other players are never the same. I'd have to say the outcome is unpredictable."

But Dr. Grelsamer quickly adds, "It still shouldn't end Tiger's career. If worst comes to worst, he has a knee replacement, and that's not the end of the world. Knee replacement is really a misnomer because you don't lop off the knee and put in another. It's more like capping a tooth."

The doctor's final word: "A motivated guy like Tiger is not going to let a little knee replacement get him down."

Judging from what Woods did last week in San Diego, the doc is not going out on a limb.

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