She wanted so badly to compete in the soccer championships that she took a chance. Six months later, Nicole Albano still is battling back from a bad knee injury, hoping to play soccer again next spring.
It's been a rough half-year.
May 10
Nicole, 17, a junior at Hillcrest High School, charges in to stop an opponent during a regional soccer tournament in Pocatello, Idaho. "I went to side-tackle and just got wrapped around this girl," she says. "My left leg bent wrong, I guess, and it tore the ligament."
A sport trainer wrapped her knee and gave her ice to hold on it. He told her to keep moving the leg so the knee would not stiffen.
Nicole's mother, Suzanne Albano, said the team had won two games in a row in the finals, and Nicole wanted to play again that day in the championship matchup. So between games she unwrapped the knee and headed back onto the field with her team.
"During the warm-up, I went to kick the ball and I put all my weight on the leg, and it just collapsed under me," she said. Her soccer-playing was over, at least for the season. Nicole had torn her anterior cruciate ligament, the tough elastic fiber that is essential to the knee's function. The team took second place.
May 13
Except for her left leg, Nicole lies hidden under voluminous blue sheets in an operating room of The Orthopedic Specialty Hospital, Murray. Unconscious, her eyes kept closed under plastic tape, a breathing tube down her throat, she is undergoing a ligament reconstruction. It is an operation in which one of her hamstring tendons is removed and grafted into the knee to replace the ripped ligament.
The left leg is brownish-orange because it is covered with an antiseptic iodine solution. Dr. Lonnie Paulos stares into a monitor, watching an arthroscope's view as he chips away at torn cartilage with a tiny instrument that he moves inside the knee. Blood drips down her leg and onto heavy bands of tourniquets.
Clear irrigating fluid flows through the knee, offering a view that is free of the haze of blood. On the screen, Nicole's knee cartilage looms like a snowy hillside. Doctors and technicians in green robes are busy throughout the operating theater.
Surgical technician Kerry Darveau works at a small table a few feet away, strengthening the semitendenosis tendon for its new job in the knee.
Using a tendon stripper - a stainless steel tube that slipped along the girl's leg muscle - the operating team had removed the tendon from a cluster called, collectively, the hamstring. Without the semitendenosis the hamstring is weaker, but only by a few percent.
Darveau has mounted the tendon on a "graft board" that was invented at the hospital. It grips the smooth gray band while he works on it. He has cut the tendon in half and brought it back onto itself, and now connects its ends with whip stitches. When he is finished it will be a quarter as long and much stronger, ready for its new role holding Nicole's knee together.
Paulos will attach the tendon inside her knee with a biodegradable plastic screw. It will grow in place, replacing the torn ligament. She will have a stable knee again because of a graft from her own body.
The night of May 13-14
Nicole left the hospital in Murray a few hours after the operation. Now she is feeling miserable. "I wish I had stayed at the hospital overnight, because in the middle of the night the anesthesia wore off and it was extremely painful," she says.
She was in pain when she awoke after the operation, too, but nurses gave her analgesics and she felt all right until the night. Even though she had painkillers and took the pills, "they didn't seem to be really strong enough."
May and June
Nicole hobbles around on crutches for four weeks during the end of her junior year. She is unable to play in any sports.
When she was able to walk without crutches, she limped at first. "I lost a lot of muscle when I had surgery. My leg was really small. So now I really work on strength, to get it back the same as my other leg."
Three times a week she attended a physical therapy clinic at Cottonwood Hospital. She began with "wall slides," training the knee to bend again, strengthening the leg's quadriceps muscle.
"You lay on your back and your foot is against the wall and you pull your foot down until your knee bends. I did that, and I worked a lot on flexing my quad, trying to get it going again."
But for some reason, scar tissue built up in her knee and made movement more difficult.
June, July and August
A summer job in a Sandy bagel store requires her to stand all day. "That didn't really work out because the eight-hour shifts were hard on my knee. It got really stiff and swollen."
Under her doctor's advice, she drops the job.
She visits the Lagoon amusement park with her friends, but "walking that much was really hard on me." Her leg grew sore and "it's hard to keep up, and it didn't make it as enjoyable (to visit Lagoon) because it was kind of painful to walk around that much."
In August, she returns to the hospital.
While she is under anesthesia, doctors perform a "manipulation," bending the knee. This procedure is needed "to break up all the scar tissue so my knee would bend better. . . . I was sore for about two weeks after that."
She works out in a swimming pool, walking in the water and swimming with a kickboard to build up her leg muscle. "I felt that it didn't really help me as much as the regular therapy did. It just cost a lot extra." She quits going to the pool.
Much of the summer she concentrates on physical therapy in an exercise room, lifting weights with her legs, riding a stationary bicycle. "The therapy consisted of a lot of different exercises for my motion," under the guidance of a physical therapist.
"It's been extremely hard. It's been a lot of work. It just took up my whole summer," she said.
Growing discouraged at the slow pace of her recovery, she begins to neglect her exercises. "I didn't work on it, like, all of the time, like I was supposed to," she said. "I didn't realize how much I needed to work on it."
She never missed any of her therapy appointments. "But it was the home stuff that I slacked off on."
On days she did not go to therapy she was expected to exercise at home, half an hour at a time, twice a day.
"It would just go in phases. Like sometimes I would be really motivated to do it at home and the next week I wouldn't be. So it was really off and on."
Spetember, October, November
After months at Cottonwood's physical therapy unit, Nicole has switched to a health spa in Sandy, near her home, which she visits every day.
She recently turned 18, and she has transferred to Skyline High School for her senior year. She takes only five classes, which means she has less homework - therefore, more time for physical therapy.
"I try to do it two hours a day. I don't always get it done," but usually she does.
She has not yet fully recovered, but no longer walks with a limp. "I'm definitely getting stronger," she says. Also, now that she has made progress her attitude is much more hopeful.
Nicole had hoped to play soccer this fall, but that wasn't possible. "The doctor said I can't do any sports until January," she said. Maybe in spring she will be able to return to soccer, she said.
She may get back to sports before then. Some of her friends are psyched for the winter snowboard season, and Nicole wants to whoosh down the slopes too.
Paulos told her, "Not until January," she said. "I asked him if I could get a season pass, and he said no, because that's too much (stress) on my knee."
The improvement is so marked that Paulos did not outright forbid her to go snowboarding, once January rolls around. "He just said I'm probably going to be sore if I go very often."
Nicole's left leg still does not quite match the right in size and strength, "but it's getting there. . . . It's a lot better."