The secret surgery and 'brutal' journey that's given Kyrgios comeback hope

The pain in his wrist had become so bad the tennis star had all but given up on holding a racquet again, let alone being able to get out of a car without wincing.

So a clandestine surgery organised like a James Bond undercover mission was the last shot. If it worked, Dr Michael Sandow could help Kyrgios get back on the court. If it didn't, Kyrgios was ready to retire.

"He was quite disabled when I first saw him," Sandow says.

"Now he's playing tennis again. If you talk to anyone in the wrist specialist world they would be quite amazed. You just don't get these results."

This is the untold story of Kyrgios' comeback journey - the wrist injury that had him unable to open doors or jars, the secret operation to save his career, and a fresh start after playing just one match in nearly two years.

Most people have seen Kyrgios mingling with celebrities on podcasts or dabbling in commentary. But after a knee injury, then a worse wrist problem brought his tennis to a halt, few people know about the musician exercises he's doing to get back, or the different density practice balls that have helped his recovery.

Kyrgios and his team invited The Canberra Times inside his rehabilitation sessions this week, opening up about fears he would never play again and the medical problems he has faced.

"This has been a really challenging time - the hardest of my career," Kyrgios said.

"People aren't expecting me to come back, especially after an injury like this, so I would love to do that and play again."

In a small underground gym in Deakin, bass-heavy music is pumping as a sweaty Kyrgios is busting his gut on the rowing machine flanked by some mates and his physiotherapist, Will Maher.

Kyrgios is holding back from checking the Celtics-Mavericks score in the NBA Finals, but shouts of "Go Celtics!" help drive that extra rep.

This is the environment in which Kyrgios has grown most as an athlete and person in the last 10 months since surgery, putting in endless hours to get back to match fitness, regain strength and flexibility in his wrist, and revive his stalled tennis career.

As the group move to a new station, Kyrgios' trainer at The Den, Mick Mackell, notes: "See how he's first to the bike? That wasn't the case when he started."

"I've probably learned to love this a bit which is scary," Kyrgios later admits.

On this day, it's a slightly lighter session with the 29-year-old feeling some calf tightness, and his team don't want to jeopardise his rehab progress.

But four times a week for an hour of specifically tailored training at up to 12 stations, the gym with black chalkboard walls scribbled with countless sets and a wolf mural is where Kyrgios has embraced the grind.

"I'm still building up... it can be tough, but it's an absolute necessity," he said while assessing the built-up scar tissue on his wrist.

"I definitely struggled with this my whole career. I wasn't big on doing conditioning or anything that got me out of my comfort zone, but you've got to build that resilience in your body, and in here, it's just mental.

"I'm here with a good group of guys and we all push each other."

Despite the intense work-out, Kyrgios confidently says he doesn't feel pain in his wrist anymore - a minor miracle considering where he was - but, there's still a lot more work to do before he can face the best tennis players on tour. Hitting practice at Lyneham awaits immediately after his gym session.

Just under a year ago Kyrgios was struggling to even open a door without feeling excruciating pain. He was facing severe wrist arthritis before the age of 30, unable to do the simplest of everyday tasks.

It was after a fall in a match against Grigor Dimitrov at Indian Wells back in 2015 when Kyrgios first sprained the wrist.

Though able to play at a high level for the seven years that followed, it was during a hitting session at Wimbledon just last year that Kyrgios felt things had gotten far worse.

He flew to the US to seek treatment and even tried stem cell therapy, but with no success.

When he returned to Canberra to see specialist Dr Kylie Shaw, Kyrgios had an MRI which gave a dire diagnosis - a full rupture of the scapholunate ligament.

While tennis stars have faced wrist injuries before - like the tendon issues experienced by Rafael Nadal and Dominic Thiem - the scapholunate ligament is as important in stabilizing the wrist as an anterior cruciate ligament (ACL) does in the knee.

It's rarely seen in tennis, and more associated as a trauma injury from contact sports. Surgery was the only option - not just to play tennis again, but to regain the proper use of his hand.

In September last year, it was a carefully-planned mission to get Kyrgios in and out of Adelaide for clandestine surgery on his injured wrist.

After consulting medical experts in the US that had worked on NBA and NFL stars, Kyrgios was actually pointed back to his home country, to see one of the best wrist surgeons in the world, Dr Michael Sandow at the Wakefield Orthopaedic Clinic.

"When I first talked to Nick, he was very depressed and looking at never playing tennis again," Dr Sandow said.

"He had very nasty wrist instability with a tear that can create significant wrist bone collapse and leads inevitably to arthritis.

"He was quite disabled when I first saw him.

"All he wanted to do was feed himself and do light activities, and the ANAFAB was to be the solution."

Anatomical front and back (ANAFAB) reconstruction of the wrist was the suggested route.

Unlike other "hit and miss" wrist operations, the innovative ANAFAB option used unique and patented three-dimensional animated software to allow Dr Sandow to accurately pre-plan the one-and-a-half hour procedure, define exactly where the injury was, its extent, and then use the necessary tools to repair the wrist.

Drilling holes in the trapezium, scaphoid, lunate and radius and using artificial ligaments, the suture-like material kept the many bones in place to allow Kyrgios' injured ligaments on the front and back of the wrist to properly heal.

"It was funny, we actually snuck him in for the surgery and nobody knew," Dr Sandow said.

"We brought him into the bottom carpark, snuck him to the top floor ward, then to theatre and back to the ward, and no media found out he was in Adelaide for wrist surgery."

There were no guarantees given before the operation. Outcomes for surgery on severe wrist injuries were notoriously hard to predict, but it would be "impossible" to expect a better result with any other procedure.

Still, the results have stunned Dr Sandow.

"Nick's now playing tennis again. If you talk to anyone in the wrist specialist world they would be quite amazed. You just don't get these results," he said.

"If he was playing football you could tape it up, but in tennis he's putting huge amounts of load through the wrist, and you're looking at a 12-month return date - he's hitting balls at nine months.

"There's no reason he won't have a pretty normal wrist for the rest of his life."

When the swelling post-op came down, Kyrgios had a hard cast put on, then a splint for another six weeks after that, until finally, nearly four months following the surgery he could start building strength and movement back in his wrist, grip and arm.

At the indoor courts at Canberra Tennis Centre, Kyrgios fires forehand after forehand over the net, then two-handed backhands on repeat to his hitting partner.

To the untrained eye, Kyrgios looks more like the player he was at the height of his career in 2022 when he won a grand slam doubles title and made a Wimbledon singles final.

Serving 200kph bombs, though, is still a little while away, and without that, so is playing all-out competitive matches - at least for now.

It's a long journey and Kyrgios and his physiotherapist Maher, must continue to be patient to get him back to his best.

"The process has honestly been brutal," Kyrgios said.

"The surgery was almost 10 months ago and it's not a very common injury, so we are experimenting how much we can push it. No-one has really come back from an injury like this before.

"To now, being back on court, it's pretty surreal."

When he started hitting again, Kyrgios had to use 25 percent density tennis balls before he could graduate to 50 percent, 75 percent, and eventually standard tennis balls.

More patience was required in regaining his forehand than his backhand because of the top-spin involved too, which meant gradual load progression as his wrist became more flexible again.

There was also the loss of feel following the surgery - an essential for any professional player - which led to Kyrgios' team suggesting he do specific hand exercises used by musicians that require precision and endurance.

And of course, while recovering after surgery, Kyrgios had gained weight and lost his match fitness.

Throughout the ups and downs of Kyrgios' tennis career on tour, and especially during his recent rehab, Maher has been his rock and become a close mate too.

During the tennis session at Lyneham, in between working on top-spin, the pair bond over their love of basketball. Kyrgios checks the NBA scores again, the Celtics are 20 points up - and he's planning a new tattoo if they win.

In addition to his physiotherapy expertise, Maher is in tune with Kyrgios' emotions, and always careful not to push too hard, or not enough. But he's not a coach, and that's probably why their relationship works so well.

Maher will even travel with Kyrgios when he heads to Wimbledon doing commentary work, just to help keep the former world No.13's rehab on track.

"Without Will I probably would have retired last year," Kyrgios said. "I can't work with anyone else.

"My family and partner don't really understand all the work that's gone into this... whereas Will has seen how much it's taken to get to the point where I was one or two sets away from winning a grand slam."

Maher said he can read Kyrgios' moods without either of them saying a word, and at this hitting practice, the mood is very good.

"In 10 years I've worked with Nick, I have his unequivocal trust," Maher said. "I've never seen him this dedicated.

"But there's good days and there's the dark days that no-one sees.

"Two weeks ago there was unbelievable frustration after he hit a forehand and lost the racquet.

"My job is to be a constant calming energy because this sport is so frustrating that if Nick doesn't have that backstop, he probably would have given up."

The questions of when Kyrgios will return to playing competitive tennis on tour have not stopped in the last year.

Others can put expectations on him - and they have - however, Kyrgios' mentality has shifted through this latest injury hurdle.

"I'm expected to go win, which is bulls--- in my opinion," he said.

"There will be players on tour that are ranked 40th in the world and if I play them in a first round they'll say, 'Oh Kyrgios should win in straight sets'.

"The majority of people don't understand. Everyone else is like, 'Play for another five years'. They couldn't last one day.

"I'd say come train with me for a week and see how you enjoy it and then tell me to do that for another five years. It's not like I hit for half an hour and then go win matches."

"Just getting out there and playing at a decent level again would be a bonus," he added.

Kyrgios still wants to win of course and he feels that will "come naturally" as long as he keeps doing the right thing.

The only tournament Kyrgios has locked in for the near future - tentatively - is the 'Ultimate Tennis Showdown' event in New York in August.

The US Open could be an option if he can get a wildcard entry too, though it all comes back to how his wrist will feel. Kyrgios is also considering whether a doubles return before singles tennis might be an easier route back to court.

First, Kyrgios will return to commentary duties at Wimbledon next month, with the news of his gig with the BBC igniting a war of words in England.

But there's also another element to Wimbledon Kyrgios is looking forward to - he may tap Novak Djokovic on the shoulder for a practice hit to test himself.

"If he wants to have a hit at Wimbledon I wouldn't mind at all," Kyrgios said. "That's where my level was when I left. It'd be good to get back into it.

"Just to be in that environment, not necessarily participating in the tournament, but getting around it again and feeling like normal, it would be great."

Maher believes Kyrgios has already overachieved considering his injury battles, but also thinks his talent can see him return to being a top-20 contender on tour. The real question is whether Kyrgios' body will hold up.

"He's got his life back, now it's about his tennis," Maher said.

"Mentally he wants to prove he can climb up to that top level again and then he can choose what he wants to do with his life. Nothing would make me happier than to see him have the choice.

"He deserves to come back, play, and have some success."