She had done all the hard work – the three- to four-hour-long volleyball practices, the hours and hours in the weight room – for three solid years. It was August 2018, and Naghede Abu, 21, the University of Colorado’s brilliant blocker, was on the cusp of her senior season and in the best shape of her life. Her expectations, as well as those of her coaches, were as lofty as the 6-foot-4-inch athlete’s outstretched arms when her elbows shadowed the top of the eight-foot net.

Then at practice, she landed wrong.

Her right knee didn’t hurt so much as feel strange and unstable. She played through it for a couple of points until one of the trainers noticed her favoring her right knee and pulled her aside. Ice didn’t help; an MRI scan spotted a problem: a meniscus tear.

Soon Abu sat down with Dr. Jonathan Bravman, a University of Colorado School of Medicine and UCHealth orthopedic surgeon and sports medicine specialist.

Abu knew Bravman all too well. During off-season training after her freshman season, Abu had come up limping after a suicide sprint at the end of a practice. Bravman, the orthopedic consultant to the CU Volleyball and other teams, had diagnosed a meniscus tear in her left knee and performed arthroscopic surgery to clean it up (technically, a debridement).

Abu had come back quickly from that setback; her play in the subsequent two years had established her as one of CU’s best volleyball players ever. Now, her opposite knee threatened to derail her crowning season. It would all depend on the nature and location of the tear, which only truly reveals itself when the arthroscopic camera enters the knee during meniscus surgery.

Low flow around the meniscus

The meniscus – the shock absorber between femur and lower leg – is a complicated bit of cartilage, not only in terms of its figure-eight shape and the sharp slope of its walls, but also with respect to blood flow. Blood supply is never great in the meniscus, but it’s best around the periphery. As one moves toward the meniscus’s center, the flow abruptly stops. Under the guiding principle of preserving as much meniscus as possible, Bravman strongly prefers to repair meniscus injuries to areas with decent blood flow. Areas with little or no blood flow – the majority of the meniscus – he debrides for the simple reason that, as he said, “it doesn’t respond to a repair because it doesn’t have enough blood supply to heal.”

Meniscus surgery involving meticulous stitching and shaping and then a month or more on crutches. A careful rehabilitation process after that can add up to perhaps four months before return to play. That would end Abu’s senior season before it started, but it would preserve her knee and reduce long-term osteoarthritis risk.

With debriding, the surgeon removes torn meniscus tissue that can act in a variety of unpleasant ways – from serving as a sort of pebble in the shoe (irritating and painful when it slides into the wrong spot) to acting as a door stopper in the middle of the knee joint that causes hitching or locking, Bravman said.

“The decision to debride or repair is not a cavalier or light one,” Bravman said.

Even with young athletes such as Abu, who may be so eager to return to the court, rink or field that they’re willing to risk long-term pain for short-term gain, he strongly advocates repairing the damage. As hard as the idea was to stomach, Abu agreed with him. If repair were possible, he would repair. If the injury was in an avascular part of the meniscus, then Bravman would debride.

“The decision would be made for us based on the nature of her injury,” Bravman said.

Back fast after meniscus surgery

When he went in, Bravman saw a tear that stitching wouldn’t fix and proceeded to clean up and clear out the tear. There would be no four weeks on crutches. But neither Bravman nor Abu expected her to be back off crutches after a single day. She dove into an intensive rehabilitation program with CU Volleyball trainer Marissa Holliday, who in addition to injury rehabilitation, strength, and fitness work helped Abu adjust her jumping technique and landing mechanics. Holliday worked with Abu despite being on maternity leave and used baby Aidan as a sort of carrot during the process.

“She’d say, ‘You don’t get to hold him until you finish this,’” Abu said.

Missing eight games is a lot if you’re a football player; in early-season college volleyball, those games happened within three weeks. On September 14, Abu convinced CU Volleyball coach Jesse Mahoney to let her dress for the first game of the Colorado Classic against Portland State. She hadn’t practiced with the team since the injury. Then, during the game, she convinced Mahoney to put her in. She played a set, and was, by her high standards, “tentative,” as she put it. She played more the next day against Indiana State and the entire third game later that day against Colorado State. CU won them all. And the tournament MVP? Naghede Abu.

Bravman would have been happy had she played a few minutes at some point during the tournament and experienced no pain.

“She far exceeded our expectations. I couldn’t be more proud of her,” Bravman said. “She’s just such a fine young woman, and it’s a testament to her hard work, her self-motivation and who she is.”

Abu didn’t let up as the season went on. She led CU Volleyball to an NCAA tournament berth and wrapped up her career as the team’s all-time leader in career blocks (582) and hitting percentage (.334). She was honored as an All-Pac-12 selection and third-team All-American – just the fifth All-American in CU Volleyball history. Along the way, she completed her undergraduate degree and this spring wrapped up her master’s degree in tax accounting. She’s interning at PwC in Denver and has opted to start full-time there in July over the uncertainties of professional volleyball overseas.

She credits Bravman and Holliday for saving her season.

“Without him or Marissa, I wouldn’t have been able to do anything I did or achieve anything. I’m just very fortunate to have had him as a surgeon.”