Lindsey Vonn thinks her new titanium knee could start a trend in skiing. And pro sports in general

ST. MORITZ, Switzerland — When Lindsey Vonn last raced on the World Cup circuit nearly six years ago, the constant pain in her knee left her in tears and led to retirement.

Flash forward to Vonn's comeback race on a titanium knee at age 40 last weekend, and the American skiing standout couldn't have felt more different.

No more pain. No more swelling. No more tears.

''The last few years of my career were so much different than they are right now. I'm skiing without thinking about my knee, which I really haven't done since I first tore my ACL in 2013. So it's been a long time that I felt this good,'' Vonn said Saturday after placing 14th in a super-G in St. Moritz. ''I'm a little bit older, but honestly I'm a hell of a lot stronger than I once was.''

So much stronger that she's talking up her knee replacement surgery — the first of its kind in World Cup skiing — as a new frontier for the sport.

In April, Vonn had a robot-assisted replacement performed by Martin Roche, a South Florida-based orthopedist specializing in complex knee disorders. Part of the bone in her right knee was cut off and replaced by two titanium pieces. A month later, she was planning her comeback.

''It's a lot better than my non-existent cartilage,'' said Vonn, one of the most successful skiers of all time with 82 World Cup wins. ''I've talked to a lot of skiers already about it and I really think that it could be something that should be considered.

''I feel amazing. I mean, obviously not everyone responds the same way to surgeries. For some reason, I bounce back pretty well from surgery. But I think it's something to seriously consider for athletes that have a lot of knee problems.''

Knee replacements are usually reserved for older people

Andrea Panzeri, the Italian Winter Sports Federation's head physician and an orthopedist who has operated numerous times on Vonn's good friend and fellow downhiller, Sofia Goggia, said knee replacements are usually performed on patients older than 50.

''This is definitely the first time in World Cup history that such a young athlete has raced with one," Panzeri told The Associated Press. ''And I'm not aware of any other elite-level athletes in other sports competing with one, either.''

Panzeri performs knee replacements. But he had never even thought about doing one on a World Cup skier — until he saw Vonn competing with one.

''Partial prosthetics, like the half-knee ones, are definitely the ones that offer the best performance and we're seeing that (with Vonn)," Panzeri said. ''I don't think her decision is going to change pro sports. But it could provide more motivation for so-called ‘normal' people to try a prosthetic."

Three-time Grand Slam tennis champion Andy Murray played with an artificial hip at the end of his career. Vonn's former skiing teammate Julia Mancuso also redid her hip a few months after she retired in 2018 and maintains an active lifestyle.

''I, for sure, would have considered a comeback if I didn't have kids," Mancuso told The AP recently. "So I can totally relate to Lindsey.''

But Panzeri said that ''hips have different biomechanics than a knee and many more people are able to play sports with a hip prosthetic than a knee prosthetic."

Knee replacements are not likely to become like Tommy John surgery

Elan Goldwaser, a sports medicine physician at Columbia University Medical Center who works with the U.S. Ski Team, has seen many athletes come to his clinic for knee replacements but not elite-level competitors.

So, is Vonn's operation going to be a trend-setter in skiing?

''I wouldn't say it's the go-to like in baseball with Tommy John surgery,'' Goldwaser said in St. Moritz. ''But if it's necessary, it's a good procedure to do.''

Vonn's coach says her fitness level helped her deal with the replacement

Chris Knight, Vonn's personal coach, said they had questions over whether her titanium knee would hold up to the forces required to navigate downhill skiing turns at 80 mph (130 kph) as she hurls herself down steep mountains.

''There was not a lot of research out there with high-level athletes and partial knee replacements," Knight said. ''It is a new frontier. But so far everything's working really well... And I would not be surprised if other people do it because the results that Lindsey's had, with no pain and no swelling, have been unbelievable.

''Granted, she stayed in great shape the entire time she hasn't been racing. So, that probably helped. I mean, if you're sitting around as a non-active skier and not doing anything with your fitness, then maybe it wouldn't be as effective. But if you're an athlete who's got some knee problems, from what I'm seeing, I wouldn't be saying no to them.''

Vonn's new knee also left an impression on U.S. Ski Team head coach Paul Kristofic.

''I'm definitely due for one myself,'' Kristofic said. ''I'm going to talk to her."

Still, there are doubters.

Four-time overall World Cup champion Pirmin Zurbriggen told Swiss tabloid Blick last week that ''there is a risk that Vonn will tear her artificial knee to pieces.''

But Panzeri said the titanium does not rupture.

''Absolutely not,'' he said. ''It's a small prosthetic that doesn't break.''

Vonn will race next in St. Anton, Austria, Jan. 11-12.

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AP skiing: https://apnews.com/hub/alpine-skiing