Laura could only watch in grim anticipation as a competitor barreled directly for her son, Dean, on the soccer field. Then, from the sidelines, she heard a loud crack and saw Dean crumple to the ground.
“It was the worst pain I’ve ever experienced,” Dean says. “My knee was just mangled. I couldn’t make my leg straight.” Dean’s family rushed him to a local hospital near the soccer tournament in Washington Township, N.J., where doctors were able to stabilize his leg.
Laura began making calls to sports medicine specialists before they’d even left the community hospital. She started with a well-known adult orthopaedic group, but doctors there strongly encouraged the family to go to the Sports Medicine and Performance Center at Children’s Hospital of Philadelphia – and specifically recommended the family speak with J. Todd Lawrence, MD, PhD.
Dr. Lawrence is an orthopaedic surgeon who specializes in ACL reconstruction in young, high-performance athletes and was available to see Dean at CHOP Specialty Care at Virtua, near the family’s home in New Jersey.
Unlike adults, teen and young adult athletes are still growing. They require clinicians who are both experts in pediatrics – particularly growing bones, muscles, tendons, ligaments and cartilage – as well as sports medicine. Even after a young athlete has stopped growing, a pediatric sports medicine specialist will better understand the nuances of their care and provide additional resources to help them optimize their skills and talents.
CHOP has more specialty-trained sport medicine physicians, physical therapists and athletic trainers than any other pediatric orthopaedic facility in the region and is nationally recognized for its innovative treatments to support young performance athletes.
Planning a complex surgery to repair a torn ACL and meniscus tear
Dr. Lawrence examined Dean and confirmed substantial damage to Dean’s knee. The detailed evaluation and imaging tests revealed that Dean had two major injuries in his knee – a complete tear of the anterior cruciate ligament (ACL) and a special kind of meniscus injury, called a root tear. Along with his open growth plates, this combination of injuries would make his surgery more complex than a typical ACL or meniscus tear.
After further testing and in consultation with Dean’s family, Dr. Lawrence determined the best solution would be to use a piece of tendon from Dean’s upper thigh to replace the badly damaged ACL, and then repair the meniscus tear. Both structures are essential to the knee’s stability and ability to move properly. Repairing the damage was essential, especially for a high-performance athlete who relied on his ability to quickly run and cut in different directions during play.
Safety in Surgery
Dean’s outpatient surgery was completed in July 2019 at CHOP’s Philadelphia campus, and he was back on his feet the same day – albeit with crutches and a stabilizing knee brace. In the first two weeks, Dean worked hard to practice bending his knee – slowly stretching his muscles and ligaments so they didn’t atrophy. As time went on, his range of motion increased.
“I had very little swelling or pain,” Dean says. “And I never needed any prescription pain medication.” He spent the first few days after surgery playing Xbox and talking with friends, but he was itching to get moving again.
Physical therapy following ACL and meniscus repair
A week or two after surgery, Dean began physical therapy with Eli Epstein, PT, DPT, OCS, a sports medicine physical therapist at CHOP Specialty Care Center at Virtua.
“I felt like I had a new leg,” Dean says. “I couldn’t stand on it yet – which frustrated me – and I kept thinking about how I could have prevented the injury.”
Physical therapy helped Dean both physically and mentally. “Eli helped me feel stronger, like I was doing what I needed to do to get better.”
Dean continued regular appointments with Eli, and grew stronger. With Eli’s help, Dean learned new ways to stretch, strengthen his joints, muscles and tendons and ways to better protect himself against possible injuries in the future. Injury prevention exercises included ongoing strengthening of his knee, hip and core muscles, balance and stability exercises, as well as sport-specific jumping and cutting drills, ensuring good control and alignment of the knee with all of these.
Eventually, Dean was allowed to lift weights and practice with his team – but full contact play would require an in-person assessment. In March 2020, Dean’s PT appointments went virtual as COVID-19 flooded the United States and all but the most essential in-person services at CHOP were delayed.
Cleared to play, with some limits
In July 2020, Dean was able to physically meet with Dr. Lawrence and Eli. After Dean passed a battery of tests demonstrating he had full strength and safe movement patterns, he was officially approved to return to competitive soccer.
Dr. Lawrence cleared Dean to play, but also strongly encouraged him to limit his play to one sports season that year. He cautioned Dean against returning too soon to year-round competitive play.
When soccer began in September, Dean was back in tip-top shape. He led his high school team’s starting line-up, made the greatest number assists for the season, and was named both a New Jersey Tri-County Conference 1st Team All-Star, and New Jersey All-State All-Star in 2020.
One highlight of the season was when Dean scored the game-winning goal during double-overtime against his school’s rival.
“I played the entire 80-minute game, but I was getting so tired,” Dean says. “My coaches said, ‘just score Dean so we can get this game over with.’ And I did. I could barely walk, but somehow, I was running. It was pure adrenaline.”
Planning for the future
As Dean considers his senior year, colleges and his future, he says he would love to take the next step in his soccer career by competing at the collegiate level. He also knows that wouldn’t be possible if not for the care, treatment and support he and his family received at CHOP.
“Dr. Lawrence and Eli were with me every step of the way – during surgery and afterward,” Dean says. “Eli helped keep me motivated and gave me hope. Dr. Lawrence kept me grounded and helped me see – and appreciate – my progress. I really can’t thank them or CHOP enough.”