Pamela Swaney will step on the stage of the Touhill Performing Arts Center at 2 p.m. Sunday and dance the principal character in the ballet "Romeo and Juliet."

"I'll be there," said Dr. David King, the orthopedic surgeon who put Swaney's right knee back together after her ACL was torn in a rehearsal last year. "I just want to see her dance."

Continuing her dancing career wasn't a certainty last year. In a rehearsal as principal dancer in Swan Lake at Touhill, she was descending a lift during a pas de deux.

As she touched the floor, she heard a loud pop from her knee. "Everyone in the theater heard the pop," she said. She tumbled and her first thought was not about the pain or even the fall.

"Was this the end of my career? What about the performance?" she said. "I knew it was a ligament, but I didn't know it was the ACL."

The ACL is the anterior cruciate ligament. It helps ensure stability in the knee. The ligament is in the center where the thigh and leg bones connect.

She was able to get out of her costume. "I didn't show up at the emergency room dressed like a bird," she said with a laugh. Tests revealed the ligament had snapped in half.

"I was devastated, a wreck," she said. "I couldn't even go to the performances that weekend.

"I'm a petite little dancer. This happens to football players, soccer."

Women athletes most frequently suffer the injury — four to one over male athletes. About 80 percent of ACL injuries don't involve contact, just taking a step or bending causes the rupture.

The St. Louis Ballet Company's insurance company sent her to King, a partner with Orthopedic Associates in Des Peres. He is a specialist in sports medicine.

Dancers are common in his practice, he said. The most common problems for dancers are in the knees and hips, he said.

King was optimistic. He let her know it with a pep talk or two. Swaney was in top physical condition, flexible, strong, healthy.

"This was a one-time injury that was simply a combination of the right impact and twisting motion that created the ACL tear," King said. "Ballet dancers are petite and thin, but they're very, very strong. They're better conditioned sometimes than some of my female high school athletes."

The other ligaments and padding between the bones were in good shape, he said.

So, "She'd have a long rehabilitation, but there was the expectation that she'd dance again," he said.

King used a technique called the "ACL Tightrope."

He took a slice of ligament from her hamstring, doubled it and made a new ACL. He inserted the new ACL into the holes where the injured ACL had been. Then he anchored both ends of the ACL with surgical string.

"This suspends the ligament; it leaves the entire graft in contact with bone to allow more area for healing."

ROAD TO RECOVERY

Healing was more of a challenge than enduring the surgery, Swaney said.

She began physical therapy the day after the surgery. But she forgot to take it easy.

"She was a little too aggressive to get back," King said, "so aggressive in her therapy she may have been creating inflammation."

Still, she worked through the aches and pains determined to get back on stage and reclaim her position as a principal dancer with the troupe.

Swaney has been dancing since she was 5. She recalls going to a ballet in her hometown of Pittsburgh with her mother and after the program saying, "Mom, I want to do that for the rest of my life." Her mom didn't blink or ruffle, Swaney recalls, and soon after, the lessons began.

Fresh out of high school, she fell short of a professional position with the Pittsburgh Ballet. She opted to attend the dance program at Mercyhurst College in Erie, Pa.

The education helped her when she auditioned for the St. Louis Ballet because the company also runs a dance academy in west St. Louis County, where she and other troupe members teach.

"She was fantastic; her maturity level and athletic ability ..." said Gen Horiuchi, artistic director of the company.

By 2009, Swaney got her chance to be a principal dancer in "Cinderella." She had other performances as a principal dancer since then, until that rehearsal two days before the performance of "Swan Lake."

Just as the principal dancer in the recent film, "Black Swan," Swaney was to dance both roles, the white swan seeking innocent love, and the devious black swan, who took it away.

She'd heard about the movie, "but I've been too afraid to see it," she said. "From what I've heard, it sounds a little too close to reality."

SCARY RETURN

Family members joined her in St. Louis and stuck with her for the months of rehab. "I couldn't even drive," she said. "I had to butt-climb the stairs to my apartment. I live on the second floor."

The return had it's scary parts. Swelling, atrophy, weeks and weeks of physical therapy, pain, sometimes scarey.

But about six months after the accident, she was back at the bar, stretching and elongating muscles, one-leg knee bends, regaining her balance, her strength.

As she fixed the outside, the inside needed some healing.

She recalls a flashback to when she was a fledgling student doing her first en pointe, the same way she felt when she did her first after the injury. Every time she tried another routine ballet movement, it might as well have been her first time.

Then, in March, "I told (Horiuchi) I was ready to get back up again," she said. "It as a strange feeling. The first time for the choreography. I was tearing up.

The knee "was swollen, but it didn't hurt at all when I was on stage."

But to regain a lead role, she had to prove herself again.

"You could see her commitment," Horiuchi said. "I literally could see her muscles coming back every day.

"When we had rehearsals, any preparation, we'd show up and she'd already be here, an hour beforehand, practicing.

"But it was always a question, 'Could she dance, anything?' "

King said there's no reason the graft can't last a lifetime.

"The main thing, maintain your strength, that's the key. Conditioning. Practice. It's paramount that she maintain her fitness and strength."

"I'm so excited to dance Juliet," Swaney said. "It's a good place to start again. There's more acting as well as dancing.

"I have everything. I'm back."