During high school marching band practice, the trumpet player lunged into a set with his left foot – and fell straight to the ground. Around him, the rest of the band did as they were trained to do, and continued the performance.
Michael, 15, said he felt a sudden “pop” in his knee. “I thought, ‘Did I break my knee?’” he said.
X-rays showed his knee wasn’t broken. But something wasn’t right. Michael visited the walk-in sports medicine clinic at UK HealthCare, which is Shriners Children’s Lexington’s academic and medical partner. From there, he was quickly referred to Ben Wilson, M.D., an orthopedic surgeon at Shriners Children’s Lexington.
Dr. Wilson determined that Michael had dislocated his kneecap. Dislocation of the patella is one of the most common knee injuries for adolescents, and despite treatment, 50% of patients end up dislocating their patella again, Dr. Wilson said. “In Michael’s case, the patella had also knocked a section of weight-bearing cartilage off of his femur bone.”
Bone and cartilage injuries like Michael’s are more rare, with significant implications for the long-term health of the knee joint. He would need surgery.
While marching band is considered a performing art, it’s a highly physical activity that uses the leg and hip muscles as well as neck, back, shoulders – and knees. Injuries incurred can be similar to sports injuries. There is a rise in pediatric injuries like these, said Fran Farley, M.D., Shriners Children’s Chief Medical Officer. Shriners Children’s is one of the largest networks of hospitals, medical centers and outpatient facilities in North America that specializes in treating these types of injuries.
Left untreated, injuries like Michael’s can have serious complications and can contribute to the development of early arthritis in the knee.
“I knew we had to get him back to surgery quickly, because the longer we waited, the harder it would be to fix,” Dr. Wilson said. “We don’t want to end up seeing arthritis in a 16-year-old. So, we went in and cleaned up the spot where the cartilage came from and repaired it back into place with absorbable tacks. Then, I reconstructed his kneecap ligament with a donor tendon, so we could ensure it wouldn’t come out of place again.”
Shriners Children’s experienced and talented medical teams know children and teens are not just small adults, and they work hard to reduce fear and answer questions, with the goal of getting patients back to what they love as quickly and safely as possible.
Surgery and recovery weren’t easy for Michael, who has been playing the trumpet since fifth grade. Michael’s recovery required a month and a half using a wheelchair and crutches, forcing him to sit out the rest of the marching season. “I was very disappointed that I couldn’t be on the field with my band,” Michael said. “We had worked so hard for months to compete, so it was frustrating to have to watch from the sideline.”
After surgery, Michael completed physical therapy, and a month before the marching season began his junior year, he was cleared to head back to the field.
Advanced technology for faster healing
To help support young athletes’ recovery and return to the game, advanced technology can be essential. For Daniel, a two-sport high school athlete who injured his knee during a wrestling match, that meant spending time in an anti-gravity machine.
He didn’t need to step into a spacecraft for that – instead, he found the Boost Treadmill at Shriners Children’s Spokane. It’s an anti-gravity treadmill that allows patients to run or walk using as little as 20% of their bodyweight, creating less impact on the body and the ability to achieve a higher range of motion with less effort. When a patient is restricted to non-weight-bearing activities, the Boost gives Shriners Children’s rehabilitation staff a safe solution for fitness without the risk of re-injury.
As he recovers from his sports injury, Daniel has been receiving care from the sports medicine rehabilitation team. Kelly Bartleson, MPT, OCS, CMPT, a sports medicine physical therapist at Shriners Children’s Spokane, included the Boost Treadmill in Daniel’s treatment plan to increase his strength and endurance, and to test out his tolerance to sprinting.
“When running or walking is limited due to pain, weakness or confidence, recovery can be slower, and other parts of the body may compensate, potentially creating other challenges,” Bartleson explained. “We can get kids moving sooner because the Boost Treadmill makes moving easier and is lower impact.”
Daniel agrees the anti-gravity treadmill has been an integral part of his custom recovery plan. “It has definitely helped me to return to regular activity faster,” he said. “I get the benefit of running, but it takes less effort, which has helped my recovery and gives me confidence that I won’t reinjure my knee when I get back to full activity. I am looking forward to heading off to college, pain-free and recovered from my injury!”
Playing the long game
While some youths sustain injuries that need immediate treatment, like Michael, other patients have a longer journey that may include a multidisciplinary medical team watching and monitoring and investigating possible conditions that could be exacerbating the symptoms, eventually moving forward with treatment. That’s what happened for Sammy, a high school senior who came to Shriners Children’s Northern California with a history of knee dislocations.
Sammy’s first knee injury happened when he fell and twisted his left leg playing Nerf basketball when he was 11. Since he had almost no pain, and the knee moved back into place quite easily, his family didn’t seek treatment. A couple years later, a hard fall on his right leg sent Sammy to the emergency room, and his pediatrician referred him to Shriners Children’s Northern California.
“At that point he had had two major dislocations but almost no pain,” said Sammy’s mom, Jill. “The doctors were worried he might have Marfan syndrome, a condition that affects the connective tissues that hold the body together, causing weak joints to easily dislocate.”
At Shriners Children’s Northern California, a medical team led by orthopedic surgeon and sports medicine specialist Nicole Friel, M.D., was able to rule out Marfan syndrome. They recommended Sammy resume normal activities with monitoring by Dr. Friel and the team.
When Sammy was 15, a high school football injury to his right knee left him facing the need for a serious, complex surgery. An MRI revealed Sammy’s medial patellofemoral ligament (or MPFL) was extremely stretched. Without surgery, the ligament would most likely remain too long, the kneecap slightly out of place, and the knee weak and injury-prone.
“Dr. Friel took the time to explain all the pros and cons with Sammy, of having surgery or not,” said Jill. “She treated him as an equal; someone who is part of the education and decision.”
Sammy opted for surgery. Dr. Friel performed the complicated MPFL reconstruction procedure on Sammy’s knee, using donor tissue – the same surgery Michael, the trumpet player, had. This procedure requires a high level of surgical skill and attention to detail for optimal results.
Sammy made a full recovery and was cleared for a full return to athletic activities after seven months. In golf, he was designated an all-league player and competed in the playoffs, and he’s back on the football field training for his senior season this fall.
The reach of the sports medicine program
Specific sports medicine programs can be found at several Shriners Children’s locations around U.S. In addition, the specially trained teams at any Shriners Children’s facility that offers orthopedic services can treat young people with sports or play-related injuries.
Michael is thankful for the care Shriners Children’s provided him. “I had a lot of fear, but once they told me that I would see a specialist at Shriners Children’s the next day, I knew I was going to be in good hands.”