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The first couple of years, Fry and Steadman dealt mainly with broken bones on an emergency basis. Today, Steadman says, "We all tend to specialize in different kinds of orthopedics. My own practice is 80 to 85 percent involved with knees. I do from eight to 12 knee operations every week. I've narrowed my practice enormously. I wouldn't do an appendectomy at this point. I don't regret narrowing my specialties, not at all. I'm able to maintain a high educational level in the areas I've chosen. Most of what I've learned about athletic injuries isn't from medical school, it's from experience."
Obviously, no single source has offered more in terms of high-grade experience than the U.S. team. As Steadman says ruefully, "We have had the opportunity—fortunately or unfortunately—to do a lot of work on the knees, ankles and legs of first-class athletes. Skiing produces more joint injuries than almost any sport but—possibly—football. When you're skiing at a high speed at the absolute edge of your control, as these kids are, you get hurt when you fall."
Have U.S. skiers suffered more serious injuries than those on other national teams? After a pause, Steadman says, "No, I don't think our ratio is much higher. However, we might have suffered more injuries to our best people. Also, because we have less depth than other teams, we probably have more pressure to recycle people, to get them back out there sooner and in better shape."
The "recycling" of American ski racers has become Steadman's major professional preoccupation—although obviously the vast majority of all the knee operations he performs are done on far more ordinary mortals. "The growth of our clinic's practice is a direct result of the fitness boom," he says. "Most of the people I operate on are undergoing corrective surgery by choice, not necessity. They like to jog or play tennis or participate in some active recreational sport, and they have decided that rather than adjust an active life-style to fit a bad knee, they will repair the knee to fit the life-style."
Of course, the repair of injuries to World Cup-level ski racers isn't a mere matter of life-style but of livelihood. Being sidelined costs money—tens or even hundreds of thousands of dollars for each skier.
Steadman's most celebrated piece of surgical recycling was his work on Phil Mahre's shattered left ankle. The injury was freakish in the extreme. Mahre skied into a giant-slalom gate during a World Cup race on the Lake Placid Olympic course late in February 1979. There was nothing spectacular about the accident, but he was in extreme pain; when he was taken to a local hospital for X rays, doctors and technicians were surprised by what they saw. Bones were shattered and broken as if they had undergone tremendous impact. Three days later, after Phil had been flown to California, Steadman cut the ankle open, and he could scarcely keep from exclaiming at the mess he found. Because Phil had elected to have a spinal anesthetic and was awake on the operating table, Steadman saved his expletives for later. The operation itself, which was the subject of much media attention during the 1980 Olympics, mainly involved placing an intricate and super-strong fixation device in the joint that included seven screws and a metal plate.
Steadman had warned Mahre that it was most unlikely that he would be back skiing at world-class level in less than 11 months. Nevertheless, the day after surgery the doctor had him doing exercises involving his good ankle, all other parts of his body and the freshly repaired ankle. Phil then moved into Steadman's home, which is open to all injured ski-team people. By the time he returned to his home in Yakima, Wash, two weeks later, Mahre was able to ride a stationary bike for 30 minutes, using both legs. Eight weeks after the operation, Phil had recovered 80% of flexibility in the shattered ankle. Five months after the operation he was skiing. Three months later, on Dec. 8, 1979, at the first World Cup event of the season, he finished 14th in the giant slalom, 29th in the downhill and got a first-place in the combined. And in February of '80 he won a silver medal in the Olympic slalom, a bit more than 11 months after his ankle was pulverized.
Nearly as amazing was the rehabilitation performance of Steve Mahre last year. Because of his fervent commitment to the joys of motorcycle riding, his knee injuries pre-date his world-class skiing days. In December, 1981, as the World Cup season began in France, both of Steve's knees kicked up, causing him trouble on turns. When Steve came back to the U.S. at Christmas, Steadman did arthroscopic surgery on both knees, taking out cartilage, and adjusting synovial plica, the bands of thickened tissue that line the joint behind the kneecaps—this despite the fact that the FIS world championships were less than five weeks away. "I knew he had a capacity for excellent recovery," says Steadman, "so I wasn't too concerned that he would be ready." Steve was very ready, winning that historic FIS gold, the first ever for an American male.
That wasn't the last of Steve's knee problems. Steadman recalls with a smile, "About three weeks after he won the medal he was back in the States and he was playing basketball when his left knee locked. He flew to Tahoe, and I did another arthroscopy. He stayed with me two days doing exercise, then went back to Europe. I guess it was maybe 10 days after I had operated when someone said to me, 'Hey, did you hear that Steve won a race today in Czechoslovakia?' That was the biggest surprise I've ever had with these kids."
Over the years, Steadman has had plenty of opportunities to be surprised by various members of the U.S. team. For the record: Nelson, 27, has had three knee operations—two arthroscopic, one open—plus surgery on a fracture and ligaments of her left ankle, yet she had her best season in 1982 with a silver in the FIS downhill. Cooper badly broke an ankle skiing in South America in 1978, and required surgery by Steadman; she was back scoring in the Top 10 within 10 weeks. Last season she got those three FIS medals and finished third in the overall World Cup standings. She was coming on strong again this year when, on Jan. 28 at Les Diablerets, Switzerland, she severely injured her left knee and broke her tibia in a freakish way—so badly that Steadman had to graft a bit of bone from her hip to it. Last week, immediately after the operation, the doctor had her using a passive-motion machine to bend and straighten her knee, and two days later she was hobbling about on crutches, her recovery speeded by the use of a trans-cutaneous muscle stimulator, a little black box that sends small electric charges through four electrodes attached to the muscles of her thigh. Cooper is out for the season but, typical of Steadman's patients, is planning to compete again next year. McKinney dislocated a kneecap in 1981, an injury Steadman treated without surgery; she won the World Cup giant-slalom title that year. Holly Flanders, who finished a very impressive second in World Cup downhill racing for 1982, had both kneecaps rearranged and some cartilage removed last spring.