Part two of a series. Part One, published on June 28, showed how in her senior soccer season Middlebury Union High School three-sport athlete Andi Boe suffered an anterior cruciate ligament knee injury, how common it is, how Middlebury surgeon Ben Rosenberg treated it, and how Boe faced some of the psychological challenges that come with being a sidelined athlete.
MIDDLEBURY — Five days after surgeon Ben Rosenberg operated this past November on Andi Boe’s right knee to repair a torn anterior cruciate ligament (ACL), Boe, a three-sport all-state athlete who had played in four state finals, faced a new challenge.
One of Vermont’s quickest high school female athletes, Boe struggled to meet her first post-op target when she met with Physical Therapist Matt Horne at Wells Physical Therapy in Middlebury.
“Matt had his hand two inches over my foot just trying to get me to touch it, and I couldn’t even pick my leg up,” Boe recalled. “But by the end of that day I could pick my leg up and down. It was so painful, but when I got out of there I felt like so satisfied because it was the first thing I accomplished.”
That was Boe’s first physical step in rehabbing a knee injured back on Sept. 19 during a soccer game. Her medial collateral ligament (MCL) was also strained, but not torn, and she also suffered a tear in her meniscus cartilage, which helps cushion the knee joint. Rosenberg had determined the MCL would heal itself, and that he should leave the meniscus tear alone because it was small, hard to reach and near a nerve.
After the injury, Boe remained on the sidelines with her sports teams. It was a step experts recommend and that, while difficult at times, helped her get support for the psychological challenges of being a sidelined athlete. 
Boe said what also helped her keep a positive frame of mind was dedicating herself to rehab, including physical therapy, stationary biking and eventually running. She recommended that others recovering from ACL tears or other major injuries try to channel energy and frustration into rehab.
“I completely threw myself into doing everything I could to get better,” Boe said. “I never considered I wouldn’t give the same amount of effort that I had given to sports to my rehab.”
As Boe progressed, Horne did something experts also recommend to help athletes recover from major surgery: He incorporated activities that allowed Boe to feel like an athlete again.
“We would pass the soccer ball to get me on my toes, and do things that were applicable to what I like to do,” Boe said.
But PT sessions are just a tiny part of the post-surgery work required to recover athletic ability. Boe spent hours lifting weights, stationary biking, lunging and squatting, and jogging — “probably as much as I would have spent practicing sports.”
Sometimes friends would join her. Most often Boe was alone.
“Biking especially was tedious, when I would go down to the basement and it was just me and the walls, essentially,” she said. 
Boe met milestones and checkpoints. She remembered being cleared for resistance biking, meaning it was harder to pedal.
“I was so sweaty. I hadn’t felt like that since before the injury, and that was the best feeling in the world,” Boe said. “I actually felt physically tired, not mentally from dealing with this.”
Then she was cleared to run, just for two minutes. It felt great, but reminded her what she couldn’t do.
“At the same time I was annoyed at myself for celebrating two minutes of running. I was like, c’mon, I used to be able to go forever,” Boe said.
THE SETBACK
In the meantime, she had regular appointments with Rosenberg to monitor her knee. Its report card read as well as Boe’s at high school, nothing but As. Her rehab graphed straight up the chart.
Then came a Tuesday morning in late February.
“I had a normal workout on a Monday afternoon, and went to bed feeling great. And woke up on Tuesday and my knee was stuck in one position, like a little bent. I couldn’t straighten it at all,” she said. 
It didn’t improve overnight, and she went in to Rosenberg’s office on Wednesday.
“They drained an ounce of fluid and it was still swollen,” Boe said. “That’s when we realized the meniscus still might really be an issue.”
Rosenberg, who has performed close to 700 ACL surgeries over 30 years, found himself second-guessing his decision not to repair Boe’s meniscus tear in November.
“The only thing that was hurting was the meniscus,” Rosenberg said. “And I was thinking maybe I made the wrong call, maybe I should go back in and fix it.”
But it was still a gray area. Rosenberg did not feel he could just tell Boe he should operate. And Boe felt she was back at square one, facing another procedure, crutches and baby-steps rehab.
“The worst thing about that setback was I felt like this whole thing was starting over,” Boe said. 
She and Rosenberg came close to deciding to operate, meaning she would be ready by the time she went to Tufts University this fall to try out for the school’s lacrosse team. But they agreed she should first get a second opinion from a Burlington specialist. But that visit would not come for a month — meaning weeks of uncertainty for Boe.
“It was really frustrating. It was kind of being left up to me, and I was the least qualified person to be making this decision to some extent,” Boe said. “I just wanted someone to tell me, ‘This is what you need to do.’”
But by the time she got to Burlington it was early April. The pain and swelling were all but gone. An MRI came back clean. The surgery option was taken off the table.
“I had backed off most of my hard workouts, and it was feeling better when I went up to see someone else in Burlington. I still was feeling it, and I still do now. But he said, and Ben agreed, that if it’s really going to bother you you’re going to feel it and you’re going to be in so much pain that you’ll know you have to do something,” Boe said. 
BETTER OUTLOOK
She began rehabbing again, and in early May met with Rosenberg again.
“The pain had largely abated, and there were no swelling issues, and everything really looked good,” Rosenberg said.
Boe asked if Rosenberg thought she could play in the annual Make-A-Wish senior all-star hockey game on June 30.
He did one better.
“I said, you know that’s pretty reasonable. Hockey is not that stressful for an ACL,” he said. “And I don’t know if you are going to ask me this, but I tell you, your senior (lacrosse) game is going to be in a couple weeks. If you want to put the uniform on and run out and take a couple shifts, and kind of run around a little just so you can feel like you did it one more time in your high school career, I’d be OK with that. And her eyes light up.”
Boe had no idea lacrosse was on the table.
“I was going in to ask about hockey,” Boe said. “That was the best news I’d had in eight months.”
Boe quickly spoke to lacrosse coach Brandi Whittemore.
“Brandi looked at me and said, ‘Say that again and tell me you’re not kidding,’” Boe said.
Rosenberg said later he had secretly hoped all along Boe could return before the end of her senior year, but typically does not want to give patients an optimistic timetable.
“I prefer not to get people’s hopes up and then dash them,” he said. 
Rosenberg also described what he thought to himself back in November: “If anybody can do it, she can.”
LOOKING BACK, AHEAD
It turned out Boe could and did do more than a few shifts, scoring within two minutes in the first game of her return, and contributing four goals during the Tigers’ successful playoff run. (She came back strong in the larosse playoffs, pictured at right. Independent file photo/Trent Campbell.)
But as successful and dramatic as that return became, Boe is not at full speed. In previous years Boe played midfield and defended tenaciously from end to end. On her return she played attack, limited to a third of the field when the Tigers were playing offense.
And after the title-game win, as happy as Boe was and as well as she had played, she summed up her abilities succinctly: “I’m not fast.”
Rosenberg explained the long-range recovery curve. If athletes are injured playing their primary sport, he said, they will still not be at full strength when the calendar flips to their sport again.
“I tell them, next season they’re going to be 80 percent at best. It really takes two years to get all your quickness back, all your confidence back,” Rosenberg said. “Six months is early.”
Rosenberg advised Boe to be patient when she started playing again, for example telling her to avoid heavy battles for loose balls. In general he said that determining when athletes should get back in action is always a tough question. After ACL surgery the risk of an athlete suffering a re-torn ACL is 15 percent higher than an original tear, per sports-health.com.
“We’re constantly trying to balance the athlete’s desire to return to the sport with the need to put the brakes on them because we know the knee is not 100 percent,” Rosenberg said. “It’s a huge debate in the sports medicine world, when is the right time to come back from surgery, and nobody has the right answer.”
Boe will be a walk-on to the Tufts lacrosse team, and said the coach understands her situation and has said she will get a second chance in the 2019-2020 academic year if she does not make the team this time around. At the very least Boe plans to play intramural sports; she admits not liking to sit around.
But her forced inactivity has given her perspective. She recalled Oakley Gordon, another three-sport standout who was two years ahead of her at MUHS and lost most of his senior year to an ACL injury.
She saw Gordon’s injury at a Tiger football home semifinal.
“I didn’t know him that well. And I had my couple days of feeling sorry for him, and then kind of I went on with my life, just like everyone else did,” Boe said.
She sees these injuries differently now. For example, Boe’s mother, Kathy Boe, said her daughter reached out to support another ACL victim last fall, Vergennes Union sophomore soccer player Emily Rooney.
As Andi Boe put it, “I felt so much more empathy for people like Oakley Gordon.”
Boe stayed with her teams after the injury, rarely missing a game and attending most practices, and she emphasized her friends and teammates supported her. She hopes all who know athletes in a similar position will do the same, and pledged herself to do more in the future. 
“I definitely realized how much I brushed off everyone else’s injuries before I was hurt, for sure. Even just like seeing someone out for a week, I got it,” Boe said. “I know how much that is awful. It wasn’t, you’re out for a week and I’m out for nine months. I understand how hard it is to be out for a week for you.”
And she recommends to those in her shoes they devote themselves to rehab, both for their physical and mental health.
“Someone told me before I had the surgery it’s one-third what your doctor does and two-thirds what you do,” Boe said. “I think it’s good to know a couple things. One of which is obviously physically you need that to be able to come back at all, never mind six months or nine months or however soon you want to be back. And just like mentally, if you’re a high-level athlete who releases frustration and stuff through playing sports, then you still need to get from somewhere, and exercise and rehab is where I got that.”
Rosenberg, who had been watching Boe play soccer and lacrosse with his daughter Isabel since elementary school, called providing medical care for Boe both a special privilege and a responsibility.
And Rosenberg was there on the sideline, as he often is with his camera during Isabel’s games, when Boe scored 1:51 into the first game of her return.
“I went nuts. I yelled and she looked up at me and I gave her a fist pump and she gave me a big smile. It was awesome,” he said. “Honestly it was one of the most rewarding moments of my career.”
 Andy Kirkaldy may be reached at [email protected].