{"id":27905,"date":"2019-11-27T09:22:29","date_gmt":"2019-11-27T16:22:29","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=27905"},"modified":"2022-11-16T10:31:52","modified_gmt":"2022-11-16T17:31:52","slug":"repair-of-devastating-knee-injury","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/repair-of-devastating-knee-injury\/","title":{"rendered":"Repair of knee injury gets outdoorsman back on the bike"},"content":{"rendered":"
<\/div>

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.<\/p>\n

\"mountain
Mike Day bikes in the high country of Summit County. A devastating knee injury last year threatened his ability to ride. Photo courtesy of Mike Day.<\/figcaption><\/figure>\n

The rough riding was a labor of love for Day, who says he grew up \u201clike any other kid,\u201d tooling around on two wheels with his friends for hours after school and on weekends.<\/p>\n

\u201cAny time we could, we rode bikes,\u201d he said.<\/p>\n

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.<\/p>\n

\u201cIt\u2019s what kept me in Colorado,\u201d Day, now 42, says.<\/p>\n

The devastating knee injury<\/strong><\/h3>\n

He\u2019s 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\u2019s 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.<\/p>\n

\"black
Day taking on a challenging downhill run. Photo courtesy of Mike Day.<\/figcaption><\/figure>\n

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\u2019s right foot caught in the ground, and the bike rolled onto and over it. His right knee folded.<\/p>\n

\u201cI knew immediately I had done some kind of catastrophic damage,\u201d Day said.<\/p>\n

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 \u2013 a plan foiled because his ruined right leg couldn\u2019t kick-start his ride.<\/p>\n

\u201cIf I ever get another one, it\u2019s gonna have a push-button starter,\u201d he said ruefully.<\/p>\n

Surveying the wreckage<\/strong><\/h3>\n

Several hours after the accident, a friend got one of Day\u2019s 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.<\/p>\n

\"profile
Dr. Rachel Frank undertook aggressive surgery to repair Day\u2019s badly injured right knee. Photo by UCHealth.<\/figcaption><\/figure>\n

That turned out to be Dr. Rachel Frank<\/a>, an orthopedic surgeon and assistant professor of Orthopedics with the University of Colorado School of Medicine<\/a>. Frank is director of CU\u2019s Joint Preservation Program <\/a>\u00a0and practices at UCHealth CU Sports Medicine<\/a>, UCHealth Steadman Hawkins Clinic Denver<\/a>, and the UCHealth Orthopedics Clinic on the Anschutz Medical Campus<\/a>.<\/p>\n

She surveyed the wreckage in Day\u2019s 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.<\/p>\n

Frank noted that \u201cany one of these injuries in isolation can make it such that you can\u2019t function very well.\u201d But Day\u2019s devastating knee injury was to \u201cevery 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.\u201d<\/p>\n

The nature of Day\u2019s patellar tendon tear further complicated his case, Frank said. Patellar tendon tears typically occur at the kneecap or the shinbone, which can be repaired \u201cvery reliably,\u201d with sutures or implants to reattach the torn tissue to bone, she explained. In Day\u2019s 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.<\/p>\n

Straight talk<\/strong><\/h3>\n

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\u2019s ability to walk, let alone get back on a bike.<\/p>\n

\u201cThe goal was to get him a knee that would function,\u201d Frank said. \u201cIf at the end of all this, he had a knee that allowed him to walk normally and go up and down stairs, that\u2019s a win, and if we could get more out of that, that\u2019s icing on the cake,\u201d Frank said.<\/p>\n

Frank\u2019s surgical strategy prioritized repairing the patellar tendon and MCL to stabilize Day\u2019s 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.<\/p>\n

For his part, Day described the discussion with Frank as \u201csuper emotional\u201d 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.<\/p>\n

Hard as that was to hear, Day said he appreciated the lack of sunny promises.<\/p>\n

\u201cI liked how direct and to the point Dr. Frank was,\u201d he said.<\/p>\n

Another facet of Frank\u2019s resume impressed him: she had played soccer competitively and endured seven knee surgeries herself.<\/p>\n

\u201cIt was important for me to hear that she wasn\u2019t speaking out of just medical training experience, she was speaking out of personal experience,\u201d Day said.<\/p>\n

\u201cI love working with athletes and tackling their problems because I have been there myself as a patient,\u201d Frank said. \u201cI completely understand how they feel, and where they want to get to.\u201d<\/p>\n

\"Three
Mike (center) celebrates his first place finish in the 40-49 age category at the Revolution Enduro. Photo courtesy of Mike Day.<\/figcaption><\/figure>\n

Extensive repairs<\/strong><\/h3>\n

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.\u00a0 She repaired the MCL with sutures and bone anchors secured to the shinbone.<\/p>\n

\u201cBy restoring the anatomy of the knee and producing a biomechanically stable construct, we hoped the torn tissues would have the potential to heal,\u201d she said.<\/p>\n

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.<\/p>\n

\u201cI learned what a 10 means when they ask you about your pain on a 1-to-10 scale,\u201d he said.<\/p>\n

Long road back<\/strong><\/h3>\n

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. \u201cI was peg-legged, basically,\u201d he said.<\/p>\n

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\u2019t turn the pedals at all. He regained range of motion in his knee in agonizing 5-degree increments.<\/p>\n

\u201cIt was super-slow progress that was hard to deal with,\u201d 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.<\/p>\n

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 \u201cgetting to the basics\u201d: walking without a limp and getting back on a bike and riding without favoring his injured leg.<\/p>\n

He\u2019s come a long way. He\u2019s 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.<\/p>\n

\u201cMy friends are out there, living their lives and doing the sports that they do,\u201d Day said. \u201cPeople get knocked down and they get back up. That\u2019s just how people do it up here. I feel that\u2019s what needs to be done.\u201d<\/p>\n

Back on the bike<\/strong><\/h3>\n

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>, a downhill mountain bike race.<\/p>\n

\"mountain
Mike Day races in the Revolution Enduro at Powderhorn Resort in Grand Junction in June, about a year after his devastating knee surgery. Photo courtesy of Benjamin Saheb.<\/figcaption><\/figure>\n

\u201cI did it as a test and to reunite with my peers,\u201d he said.<\/p>\n

The four-stage race involved 3,000 feet of descent \u2013 about the distance from the summit to the base of Breckenridge Ski Resort \u2013 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<\/sup> overall.<\/p>\n

\u201cIt was exciting to see that I could compete,\u201d he said. \u201cIt was a good feeling and a confidence booster.\u201d<\/p>\n

In a September email he thanked Frank for helping him get back to the activity that has given him both satisfaction and meaning.<\/p>\n

\u201cYou literally saved my life, and happiness,\u201d he wrote. \u201cI don’t know who I would be without my bike.\u201d<\/p>\n

His success was also exciting for Frank, who said she considers herself her patients\u2019 biggest advocate.<\/p>\n

\u201cI 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.\u201d she said. \u201cIn Mike\u2019s 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.\u201d<\/p>\n

A year and a half ago, Mike Day looked at his devastated knee and wondered about the direction of his life \u2013 what he would do if he couldn\u2019t bike or back-country ski again. Today, his future, while still uncertain, is no longer bleak.<\/p>\n

\u201cI feel confident I will continue to try to make progress,\u201d he said. \u201cI can\u2019t 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.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

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 […]<\/p>\n","protected":false},"author":2143,"featured_media":27906,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[2863,67,183,9167,3681,455],"class_list":["post-27905","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-knee-injury","tag-orthopedic-care","tag-orthopedics","tag-specialized-services","tag-uchealth-steadman-hawkins-clinic-denver","tag-university-of-colorado-school-of-medicine"],"acf":[],"yoast_head":"\nDevastating knee injury: patellar tendon to ACL and MCL - 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