When flip becomes flop, a surgeon’s skill – and empathy – make all the difference

Success of young athlete’s complex knee repair hinged on body and mind
July 3rd, 2019
A young man does a back flip on skis
Jeremy Lieber was doing flips in the air on skis less than a year after serious knee surgery. Photo courtesy Jeremy Lieber.

Hit the slopes healthy

When: Tuesday, Nov. 12 | 6 to 7 p.m.

Where: Steele Creek, 3222 East 1st Ave., 5th floor lounge, Denver, Colorado 80206

What: Hear from Dr. Rachel Frank on how to stay healthy on the slopes this season and participate in some winter conditioning exercises that you can do from the comfort of your home.

Details:

During this free event you will learn about:

  1. Injury prevention techniques
  2. Knee health and safety on the slopes
  3. Winter conditioning exercises

Our Sports Physical Therapy team will be onsite to coach you through exercises designed to keep you in shape and on the slopes.

Casual or athletic attire recommended for your comfort during exercises. Exercises not mandatory.

It was a typical day skiing with friends out in the woods at Beaver Creek – typical for Jeremy Lieber and his friends, at least. Lieber, a 17-year-old Boulder Fairview High School junior, had been carving turns about since he could walk. Now, in January 2018, the group had found a nice boulder from which they could land backflips amid the trees. And indeed, Jeremy landed a backflip, as he had countless times before.

But he had sent it long – “maybe five feet further than I had anticipated,” he said – and his left foot landed on a rock hard enough that the ski broke. He wondered if his ankle had broken, too, but he clicked the damaged ski back on and skied down anyway. By the time he got back to Boulder later that day, the ankle was fine. Unbeknownst to him, his left knee, which hadn’t hurt at all, probably wasn’t.

For years, his left kneecap, or patella, had dislocated. He had learned to pop it back into place – a painful thing to do, but the knee was fine again after an hour or two. A couple of days after that backflip, he was on the basketball court with friends. He had misplaced the brace he typically wore, but it might not have mattered anyway. Jeremy got bowled over taking a charge, and ended up on the floor with his left knee at an odd angle, the entire joint dislocated now. As his toes went numb and his panicked friends looked on, he grabbed his own ankle, pressed hard on his knee with the opposite hand, and wrenched the joint back into place. This time, the pain wasn’t going to subside in an hour or two, and he wasn’t going to be back on the slopes without help from the likes of Dr. Rachel Frank.

Headshot Dr. Rachel Frank
Dr. Rachel Frank

Frank, a University of Colorado School of Medicine orthopedic sports medicine specialist and surgeon who practices at UCHealth CU Sports Medicine, saw Jeremy the following week. X-ray and MRI images showed a thin, roughly square-inch piece of bone and cartilage to have been sheared off the bottom of Jeremy’s femur – possibly because of a fracture sustained on landing that backflip, though Frank couldn’t say for sure. Two knee surgeries had to happen, she told him, and there was a chance that she could do both at once.

The first would involve using metal screws to secure the sheared-off piece of femur back in place. The second would be to reconstruct his torn medial patellofemoral ligament (MPFL), which connects the kneecap to the femur, with a donor graft. If there was good movement in the knee after she screwed the dislodged piece of bone and cartilage back into place, she could reconstruct the ligament during the same surgery. If there wasn’t good movement, the MPFL reconstruction would have to happen later, she said – otherwise, the lack of mobility could hamper his rehab.

Two for one

Jeremy’s surgery happened a week after the basketball game. The broken bit of bone and cartilage fit back into place “like a jigsaw puzzle piece,” as Frank put it, and the knee moved well. So she did the MPFL reconstruction, too, which also went well. The knee was surgically repaired. But it was still a long way from being healthy, and Jeremy faced a long, difficult recovery – starting with nearly three months without putting any weight on the knee. It would be his first surgery. Frank knew what he was up against all too well.

Before she did surgery on others, she had been a patient herself. She had played soccer well enough to do so at the University of Illinois, and along the way had endured seven knee surgeries.

“It’s important that patients know there’s a light at the end of the tunnel,” she said.

It’s also about knowing what’s a normal part of one’s recovery and what’s not, she added.

a young man water skiing
Just six months after surgery, Jeremy was back on his waterski, which he’s continued to do this summer, when this photo was taken. Photo courtesy of Jeremy Lieber.

“Is the pain expected or is something wrong? If it’s swollen, should it be swollen? I think, having been a patient so many times and having gone through most things one could go through with my own knee – good, bad and ugly – I have a good understanding as to what’s helpful and not helpful,” she said.

What’s helpful, she knows from personal experience, is the surgeon being available to answer questions quickly, so the worry – even if it’s based on something that shouldn’t be a worry – gets addressed. She gave Jeremy her cell phone number and meant it when she told him he should reach out, day or night, if something seemed amiss. And reach out he did.

“It seemed like we were calling her every 20-30 minutes – we were being pests,” Jeremy said. “But we needed that help. And it was just incredible to see her commitment to my recovery. For me it was a source of strength, because I knew she wanted me to get better as much as I did.”

The recovery was tough for a high school junior or anyone else. Being unable to ski, play lacrosse or basketball or work out eroded more than 30 pounds from his five-foot-ten-inch, 155-pound physique. He missed school and, when he was there, found himself fogged by pain medications. He spent long days alone in the house with parents off at work. But a goal he and Frank had agreed upon kept him going. Normally, Frank would keep him off the repaired knee for a full 12 weeks. Jeremy promised to pour himself into rehabbing the knee, but he wanted to be back on his feet in 10 weeks – in time to take his girlfriend to the Boulder High senior prom. Frank said OK.

He couldn’t just drop his crutches at week ten. The three metal screws that had held the bone-and-cartilage fragment in place had to come out. Otherwise, the screws could gouge into his knee cartilage. Jeremy went back into surgery on March 26, 2018; the screws came out and Frank cleaned out some scar tissue to improve his flexibility. He walked his girlfriend into the prom a few days later.

‘More than a scar’

Jeremy continued his rehabilitation through the summer with CU Sports Medicine physical therapist Chelsea Holt. By October, he was on a lift at Arapahoe Basin. He found himself crying at the top. He was back on the mountain. He skied down a blue run, nice and easy.

By December, he was doing flips again. He had skied about 30 days, a lot of it back in the terrain park, within a year after the screws came out. His withered left leg had bulked up to nearly the strength of his right, and his body had followed suit: thanks to many hours in the gym, he weighed 167.

“Knowing that he feels comfortable and confident after two surgeries in a short period of time and is living his life and getting back to all these activities within a year – it’s just incredible,” Frank said.

Jeremy is grateful for Frank’s care and attention.

“Anything that was happening, she wanted to know. Anything we wanted help with, she wanted to do,” he said.

The six fading scars around his knee are easy to miss, and they’ll continue to fade as he studies business at CU Boulder starting this fall. The surgery left indelible marks in a different sense, though.

“This injury’s taught me more about myself than I’ve ever learned before. I learned that I can recover from anything with help from those around me. I relied on a lot of support, and I learned that it’s O.K. – I’m going to get through it,” he said.

And he grasped something few his age do.

“I learned that there’s more behind a scar than what most people think,” he said.

About the author

Since 2008, Todd Neff has written hundreds of stories for University of Colorado Hospital and UCHealth. He covered science and the environment for the Daily Camera in Boulder, Colorado, and has taught narrative nonfiction at the University of Colorado. He was a 2007-2008 Ted Scripps Fellowship recipient in Environmental Journalism at CU.

His latest book, "The Laser That’s Changing the World," tells the story of the inventors and innovators who saw, and ultimately realized, the potential of lidar to help solve problems ranging from smokestack-pollution detection, ice-sheet mapping, disaster recovery, and, ultimately, autonomous-vehicle guidance, among many other uses. His first book, "From Jars to the Stars," recounts how Ball Aerospace evolved from an Indiana jar company - and a group of students in a University of Colorado basement - to an organization that managed to blast a sizable crater in the comet 9P/Tempel 1. "Jars" won the Colorado Book Award for History in 2012.

Todd graduated with a business degree from the University of Michigan, where he played soccer, and with a master’s degree from the Fletcher School of Law and Diplomacy at Tufts University. Before becoming a journalist at the turn of the millennium, he was an IT and strategy consultant. He once spoke fluent Japanese and still speaks fluent German.

When not writing, he spends time with teenage daughters and wife Carol, plays soccer, and allows himself to be bullied by a puggle he outweighs by a factor of seven.