On an afternoon in May last year, Mike Day was in the mountains near Buena Vista, enjoying a favorite pastime. He was astride his motorized dirt bike, racing along hilly, rocky trails that challenged his upper-body strength and ability to tame the machine against the tough terrain.
The rough riding was a labor of love for Day, who says he grew up “like any other kid,” tooling around on two wheels with his friends for hours after school and on weekends.
“Any time we could, we rode bikes,” he said.
His love of biking intensified after he left his childhood home in suburban Boston for Colorado to live as a self-described ski bum 20 years ago. Day regularly rode off-road bikes with friends and sometimes raced competitively. He settled in tiny Alma, in Park County, close to the back country, where he not only biked, but also regularly hiked, hunted and cross-country skied.
“It’s what kept me in Colorado,” Day, now 42, says.
The devastating knee injury
He’s still here, but Day continues to battle back from a devastating knee injury that threatened to push him off the bike and away from his home in Colorado’s high country. He endures, thanks to aggressive medical care and stubbornness that he says he still needs to conquer the steepest uphill climb of his life.
The mishap occurred as Day completed a series of loops along a mostly single-track trail. He was riding slowly when he says he let his guard down and pushed too hard on his front brakes. The bike slid on a patch of sand, Day’s right foot caught in the ground, and the bike rolled onto and over it. His right knee folded.
“I knew immediately I had done some kind of catastrophic damage,” Day said.
He began calling and texting friends and family for help, but cellphone service was spotty, and his pleas went unanswered. In the meantime, Day splinted his leg with bandages, duct tape and aspen tree branches. He also managed to heave his bike upright, hoping that he could struggle on to it and coast downhill to his truck – a plan foiled because his ruined right leg couldn’t kick-start his ride.
“If I ever get another one, it’s gonna have a push-button starter,” he said ruefully.
Surveying the wreckage
Several hours after the accident, a friend got one of Day’s texts and arrived to help. She got him on her bike and walked alongside, steadying him as he rolled down the hill. An examination at emergency care in Salida quickly showed that Day needed immediate help from an orthopedic specialist.
That turned out to be Dr. Rachel Frank, an orthopedic surgeon and assistant professor of Orthopedics with the University of Colorado School of Medicine. Frank is director of CU’s Joint Preservation Program and practices at UCHealth CU Sports Medicine, UCHealth Steadman Hawkins Clinic Denver, and the UCHealth Orthopedics Clinic on the Anschutz Medical Campus.
She surveyed the wreckage in Day’s right knee. His patellar tendon, which anchors the patella (kneecap) to the tibia (shinbone), was completely and devastatingly torn in the middle. He also sustained complete tears of the anterior cruciate ligament (ACL), the medial collateral ligament (MCL) and the meniscus (the cartilage that cushions the shin and thigh bones). He also partially tore the lateral collateral ligament.
Frank noted that “any one of these injuries in isolation can make it such that you can’t function very well.” But Day’s devastating knee injury was to “every single structure from the patellar tendon to the ACL and to and through the MCL, and much of the soft tissue supporting the knee was torn.”
The nature of Day’s patellar tendon tear further complicated his case, Frank said. Patellar tendon tears typically occur at the kneecap or the shinbone, which can be repaired “very reliably,” with sutures or implants to reattach the torn tissue to bone, she explained. In Day’s case, the tear through the middle of the tendon shredded the tissue, leaving pieces like frayed strands of rope that somehow had to be pulled back together.
Straight talk
Frank gave Day a candid assessment of his devastating knee injury. Fortunately, she told him, he had not damaged blood vessels and nerves sufficiently to put him at risk of losing part of his leg, which can happen severe multi-ligament injuries. But the combination of damage did threaten Day’s ability to walk, let alone get back on a bike.
“The goal was to get him a knee that would function,” Frank said. “If at the end of all this, he had a knee that allowed him to walk normally and go up and down stairs, that’s a win, and if we could get more out of that, that’s icing on the cake,” Frank said.
Frank’s surgical strategy prioritized repairing the patellar tendon and MCL to stabilize Day’s knee and allow him to stand and walk. His physical therapists could then help restore range of motion. She would also trim damaged tissue from the meniscus but delay treating the ACL tear until later.
For his part, Day described the discussion with Frank as “super emotional” as she explained the knee injury and her plan to repair it. She expressed confidence, but made no guarantees of the outcome and told him he could expect a long recovery and pain. He would have to set realistic expectations for recovery.
Hard as that was to hear, Day said he appreciated the lack of sunny promises.
“I liked how direct and to the point Dr. Frank was,” he said.
Another facet of Frank’s resume impressed him: she had played soccer competitively and endured seven knee surgeries herself.
“It was important for me to hear that she wasn’t speaking out of just medical training experience, she was speaking out of personal experience,” Day said.
“I love working with athletes and tackling their problems because I have been there myself as a patient,” Frank said. “I completely understand how they feel, and where they want to get to.”
Extensive repairs
Frank repaired the patellar tendon and MCL in a single surgery in June 2018. In the most challenging portion, Frank gathered strands of torn patellar tendon tissue and brought them back together using different sutures, including a special type that functions like a piece of tape. She repaired the MCL with sutures and bone anchors secured to the shinbone.
“By restoring the anatomy of the knee and producing a biomechanically stable construct, we hoped the torn tissues would have the potential to heal,” she said.
The surgery was successful but it hardly signaled a quick, happy ending. Day said he spent the first week after the procedure sleepless and in pain that reduced him to tears.
“I learned what a 10 means when they ask you about your pain on a 1-to-10 scale,” he said.
Long road back
The pain lessened after the first week, but the challenges had only begun. Day had to keep his knee immobilized for six weeks and was frustrated by the strict range-of-motion limitations required after the surgery. He struggled to descend stairs one step at a time. “I was peg-legged, basically,” he said.
He then began arduous work with two physical therapists in Breckenridge and in a home gym with his girlfriend, who is also a PT. During early sessions in Breckenridge, he seethed in self-imposed frustration as he watched others recovering from recent ACL surgeries spin the wheels of a stationary bike while he couldn’t turn the pedals at all. He regained range of motion in his knee in agonizing 5-degree increments.
“It was super-slow progress that was hard to deal with,” Day said. His PTs and his girlfriend urged him to stick with the work and that it would eventually pay off, but it was hard to take their advice and remember the cautions Frank had given him in his impatience to recover.
But he soldiered through the regimen, which included hands-on manipulation by the PTs to loosen scar tissue, calf raises, and steady work to improve his range of motion. He also got dry-needling treatments to stimulate and restore feeling in the quadriceps, which helped him to flex his knee. Day described the work as “getting to the basics”: walking without a limp and getting back on a bike and riding without favoring his injured leg.
He’s come a long way. He’s returned to work, building trails and handling excavation and other earth-moving projects, and has the strength for long hikes in the back country. But Day disdains feel-good stories of personally conquering adversity. The example of others in his intensely athletic community countered feelings of discouragement and helped spur him down the path of recovery.
“My friends are out there, living their lives and doing the sports that they do,” Day said. “People get knocked down and they get back up. That’s just how people do it up here. I feel that’s what needs to be done.”
Back on the bike
A little more than a year after the accident, Day got back up too. Wearing a knee brace, Day traveled to Powderhorn Resort in Grand Junction to participate in the Enduro Revolution, a downhill mountain bike race.
“I did it as a test and to reunite with my peers,” he said.
The four-stage race involved 3,000 feet of descent – about the distance from the summit to the base of Breckenridge Ski Resort – at top speed, Day said. He and his knee more than met the challenge: he finished first in the 40-and-over category and 13th overall.
“It was exciting to see that I could compete,” he said. “It was a good feeling and a confidence booster.”
In a September email he thanked Frank for helping him get back to the activity that has given him both satisfaction and meaning.
“You literally saved my life, and happiness,” he wrote. “I don’t know who I would be without my bike.”
His success was also exciting for Frank, who said she considers herself her patients’ biggest advocate.
“I try to put them in a position to get back to what they were doing before the devastating knee injury. There is no better feeling than that.” she said. “In Mike’s case, I would have considered a good result [that he got] back to living a normal life. The cherry on top is him being able to ride his bike at such a high level.”
A year and a half ago, Mike Day looked at his devastated knee and wondered about the direction of his life – what he would do if he couldn’t bike or back-country ski again. Today, his future, while still uncertain, is no longer bleak.
“I feel confident I will continue to try to make progress,” he said. “I can’t say how it is going to go, but I have to keep moving and keep going no matter what if I want to stay at least where I am at and not go backwards. I am going to keep pushing and trying to make it better with realistic goals.”