How Surgery Won Gold Medals

By Anastasia Tonfexis

Putting the spring back into Benoit's and Retton 's knees

Like all top athletes, Joan Benoit is accustomed to pain. But one day last March, more than halfway through a routine 20-mile run in Maine in preparation for the Olympic marathon, she felt a sharp stab on the outside of her right knee. Within the next mile, she recalls, "the knee completely prevented me from running another step." Her doctor, Orthopedic Surgeon Robert Leach of Boston University Medical Center, gave her an injection of cortisone. After a week's rest Benoit resumed training, but in early April she again had to "walk out of a run." This time Benoit was referred to Orthopedic Surgeon Stan James, in Eugene, Ore., whose roster of patients with knee problems reads like a Who 's Who of running: Jim Ryun, Frank Shorter, Joaquim Cruz and Mary Decker. James first prescribed drug and physical therapy. Six days later, on April 23, a depressed Benoit was back in James' office; that morning the pain in her knee had forced her to pull up three miles into a run. James presented her with two options: she could stop training altogether and give the injury time to heal, which would mean missing the Olympic trials, could undergo an operation for diagnosing and treating knee problems known as arthroscopy.

Gymnast Mary Lou Retton faced a similar dilemma last June when she injured her right knee during an exhibition. "I thought, 'Oh my God, it's all over for me,' " she remembers. According to her doctor, Orthopedist Richard Caspari of Richmond, a fragment of cartilage from her knee joint had broken off and lodged in the joint, locking the knee.

Both athletes chose arthroscopy, partly because it offered at least an outside chance of competing in Los Angeles. The decision was wise: both went on to earn gold medals in their events, Benoit by winning the first women's Olympic mara thon and Retton by beating out the top Rumanian and Chinese gymnasts for the all-around championship.

Retton flew to St. Luke's Hospital in Richmond for the surgical procedure. Benoit stayed in Eugene, where on April 25 in Sacred Heart General Hospital she was placed under general anesthesia. Surgeon James made a 1/4-in. incision in her right knee and inserted a thin tube through which a saline solution was injected to flush away pieces of tissue and distend the joint. He then made another small cut and inserted the arthroscope, a 10-in.-long instrument as thin as a drinking straw, with optical fibers on its tip that throw a bright light inside the knee. The image can be viewed either directly through the tube or magnified on a color-television screen. Through a third small hole in the knee, James threaded special tools for exploring and repairing the joint. Guided by the TV image, and deftly handling the instruments--maneuvers that require such acute eye-hand coordination that arthroscopy has been dubbed "videogame surgery"--James located a piece of cartilaginous material about 1 in. long. As the surgeon snipped the taut, rubber bandlike tissue with his scissors, there was an audible snap. The entire procedure took 40 min. Two days later Benoit was exercising on a treadmill. In Richmond, Retton checked out of the hospital the day of her operation and was back training in a Houston gym the next day.

Less than ten years ago, Benoit's and Retton's careers might well have been cut short by the disorder. Their knees could have required exploratory surgery just to diagnose the problem. Open-knee surgery would have meant at least a week's hospital stay and eight to twelve weeks of rehabilitation. In contrast, arthroscopy, which costs around $1,500 to $3,000, the same as open-knee surgery, necessitates at most an overnight hospital stay, and patients are usually on their feet the next day.

The technique, popularized in the U.S. in the 1970s after a Japanese surgeon perfected the arthroscope, is increasingly being used for repairs to the shoulder and elbow. But the fact that arthroscopy now accounts for 90% of all knee surgery in the U.S. is proof of its major application. Dr. James Nicholas, director of the Lenox Hill Institute of Sports Medicine in New York, calls the knee the body's most vulnerable joint, "the most complicated and the least suited to perform what it is asked to do." Ligaments joining the femur and tibia wrap around the knee to keep the bones together; the only cushion between these bones is two thin bands of cartilaginous tissue called menisci. Unlike the shoulder and hip joints, which are buried under layers of muscle, the knee is protected only by the kneecap and a thin layer of tissue. The knee bears great weights, helps propel and stop the body and acts as a shock absorber--and that is just normal wear. Many sports put added strain on the joint. The worst: football, basketball, skiing, soccer, weight lifting and wrestling. And a runner, says Dr. James Hill, co-director of sports medicine at Northwestern Memorial Hospital in Chicago, "takes an average of 1,000 to 1,200 steps a mile, with two to three times the body weight on the knee at each step."

Despite its popularity, arthroscopy, some doctors complain, is being overused, especially in diagnosis. It does have some drawbacks. Its primary use is in removing torn tissue and bone chips, but doctors must still open the knee to work on ligaments and tendons. Also, patients seeing the small wounds and feeling little pain after the operation may be tempted to exercise too soon. James was surprised when Benoit arrived for a checkup only a week after surgery and told him that she had already completed two one-hour runs. Says he: "I've operated on a lot of other runners, but I haven't seen anything as dramatic as that." James was in the stands when Benoit made her memorable entry into the Los Angeles Coliseum. "I got a little teary-eyed toward the end. I couldn't even cheer," he recalls. --By Anastasia Tonfexis. Reported by Dick Thompson/San Francisco, with other bureaus

With reporting by Dick Thompson