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.

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.

“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.