Who decides? Vonn crash exposes tensions over athlete autonomy

(adds dropped letter to Monsen in paragraph 15)

By Julien Pretot

CORTINA D'AMPEZZO, Italy, Feb 8 : The question of whether Lindsey Vonn should have started the Olympic downhill race on Sunday has expanded beyond a single athlete or race, exposing a deeper tension at the core of elite sport: who decides when an injured competitor is fit to compete and what message that choice sends.

The 41-year-old American started the race at the Milano Cortina Games despite having ruptured the anterior cruciate ligament in her left knee in a World Cup event in the Swiss resort of Crans-Montana little more than a week ago.

With a brace on the knee, she set the third fastest time in training on Saturday but suffered a horrific crash on Sunday and was airlifted to hospital for surgery on a broken leg.

Vonn was determined to start the race, saying earlier this week: "... we've been doing extensive therapy and consulting with doctors, been in the gym and today I went skiing. And considering how my knee feels, it feels stable, I feel strong."

For former French national football and ski team doctor Jean-Pierre Paclet, the issue of athletes competing while injured blends medicine with ethics.

"Anterior cruciate ligament injuries are extremely common, both among elite athletes and the general public," he said. 

"You can tear it very easily. You don't need an ACL in every skiing movement, which is why surgery is performed, but the real question concerns the athlete's long-term future."

Repeated trauma in sports such as skiing or football can lead to degenerative joint damage later in life, he added.

"Many athletes who continue for years do not have healthy joints when they are older. Does a doctor have the right to allow a career to continue if it risks