The Comeback Kid
Cover story previously published in Rite Up, 2021 – Issue 3.
by Hayley Hair
The Comeback is Bigger Than the Setback
On the wide-open field under the scorching summer sun, soccer player Lillian lines up her kick and launches the soccer ball through the air hurtling toward the goal. Today she’s in practice leading up to her select soccer team’s upcoming season. Last fall’s season looked dramatically different as an anterior cruciate ligament (ACL) rupture and meniscus tear took 12-year-old Lillian and her parents not only by surprise but also, unfortunately, out of the game.
“I was in the far corner and a girl hit me from the side,” Lillian says. “I heard several pops, and then I was on the ground in tears. It was just the most painful thing.” Lillian was able to limp away after the injury, but it hurt, and the pain persisted. Lillian’s mother, Debbie, set up a doctor’s appointment to have Lillian’s knee examined. “I had this vision that an ACL injury was excruciating, and you couldn’t walk,” Debbie says. “She was in pain, but not what I thought it would look like. It hurt, but she was mobile.”
Following X-rays and an MRI, Lillian’s injury was confirmed. “Just hearing the doctor say, ‘torn ACL,’ I couldn’t think of anything. My mind just stopped,” Lillian says. Later that day and feeling overwhelmed about her future sports goals, Lillian searched online to find out what professional athletes experienced injuries like hers. Then she saw her soccer idol’s name pop up on the list. “It’s happened to a lot of professional players, like Alex Morgan, who I’ve looked up to my entire life. That kind of comforted me.”
The Ins and Outs of ACL Injuries in Children
The ACL is a stabilizing ligament in the central part of the knee that stabilizes translation and rotation of the joint and is typically injured in pivoting, twisting and agility sports. Over the last several decades, recognition of ACL injuries has increased, and rupturing the ACL is particularly common in female soccer.
One hears about torn ACLs frequently in adult sports, but what happens when the injury presents in children? Lillian’s X-rays showed that her growth plates were still open, signaling plenty of growing in her future, so her best bet for care would be provided by a pediatric orthopedic specialist. She was referred to Scottish Rite for Children’s Orthopedics and Sports Medicine Center in Frisco and into the care of pediatric orthopedic surgeon Philip L. Wilson, M.D., assistant chief of staff and director of the Center for Excellence in Sports Medicine.
For a growing athlete, the experts at Scottish Rite for Children have unparalleled experience providing non-operative and arthroscopic care to treat common sport-related injuries including concussions, ligament injuries and cartilage conditions in the knee, ankle, shoulder, elbow and hip.
“Some ACL injuries may not need to be reconstructed if there are no cartilage injuries or shifting or instability of the knee,” Wilson says. “Unfortunately, this is less common, and despite rehabilitation, many children need surgery due to laxity in their ligaments and their high activity levels.” For Debbie and Sergio, Lillian’s parents, Wilson was the perfect fit for determining their daughter’s care.
“Dr. Wilson sat with me and my daughter and answered every question I had under the sun about the data, his experience and his research. He was an open book about everything,” Debbie says. “The whole team was positive. They made us feel like we had a great plan in place and that it’s all going to be just fine.”
The Right Surgical Technique for Patients Like Lillian
That research Wilson reviewed with the family is the novel ACL surgical technique for growing athletes that he and pediatric orthopedic surgeon Henry B. Ellis, M.D., created and subsequently published in the American Journal of Sports Medicine and presented at the annual meetings of the Pediatric Orthopedic Society of North America and the American Orthopedic Society of Sports Medicine.
“We have found in our research at Scottish Rite studying a particular technique that we developed that this can cut ACL reinjury rates in half,” Wilson says. “Female adolescent soccer players, like Lillian, have a particularly high risk of reinjury, sometimes as high as 25%, which is the highest that we have recorded in youth and young adult sports. Adding the stabilizing ligament helps reduce that reinjury risk. She also had cartilage repair, which is common is 70% in our ACL injury population.”
Lillian had a quadriceps tendon autograft for her ACL repair. She also had a lateral tenodesis with her iliotibial band, which means Wilson used a strip of tissue from the side of the knee to add a secondary stabilizing ligament that helps control rotation and protect the knee.
“There’s nothing you can tell a parent to put them at ease when their child is going through the actual procedure,” Sergio says. “There’s nothing routine when someone puts your child under anesthesia, but when you are in a facility like Scottish Rite, in a place where the doctors are proven performers, that gives you peace of mind.”
Scottish Rite provides world-class care for patients including access to psychologists, nutritionists, physical therapists, athletic training staff, specialized nurses, advanced practice providers and many others who play a significant role in ensuring complete physical and mental readiness to return to play. “We are fortunate to have the resources to take care of the whole patient,” Wilson says. “We also have a keen interest in the research surrounding these injuries and contribute to that research in terms of factors predictive of injury, surgery techniques, patient outcomes and potential complications of treatment.”
Returning to Sports After Surgery and Physical Therapy
Finding the proper treatment and completing the surgery are a huge jump start to recovering from an ACL injury, but getting back on the field and ready to safely return to competitive game play takes time. For Lillian, it was nine months.
“When you see your child be very physically active, and then one day, it all comes crashing down, that for me as a parent was deeply concerning,” Debbie says. “I knew the journey to get anywhere near that level of activity again was going to be many, many months.”
By helping Lillian understand that recovery could take up to a year, Wilson worked alongside the family to get her healthy both physically and mentally to return to soccer. “Every time I went to visit him, he said I was doing great and healing ahead of schedule, and that made me want to work even harder,” Lillian says. “I pushed my hardest through every single drill and activity I did, and here I am, and I feel better than ever.”
Wilson says the biology of internal healing in the knee takes at least nine months. That time allows for the new ligament graft to heal to the bone and grow a blood supply. That also includes building back the muscle and strength to regain control of the leg to protect the surgically constructed knee. “Return prior to that time leads to increased reinjury rates,” Wilson says. “Scottish Rite has a stepwise progression of strengthening, agility and neuromuscular control activities to help prepare patients to return to sports.”
Following Scottish Rite’s well-established, highly successful physical therapy program, Wilson recommended Lillian participate in Scottish Rite’s training classes to foster further recovery and prepare for the functional testing and physician’s clearance required for her to safely return to soccer. Following months of rehabilitation, many patients need additional strengthening and emotional support to trust their injured leg, beyond what can typically be received during traditional physical therapy. “I just felt so much comfort even though I didn’t know anyone there,” Lillian says. “Being around the people who have had an injury and who are around my age, it just felt so heartwarming. We would help each other no matter what, and it was just an amazing feeling.”
Back on the Field
Lillian followed her sports medicine team’s instructions very closely. With a great deal of hard work, and added support and encouragement from her parents and her teammates, she successfully passed her functional test.
The new soccer season has arrived, and Lillian’s parents love seeing her back out there. “Whenever you have to see them take their first tumble to the ground, you kind of hold your breath, but she popped right up,” Debbie says. “She just needs to be playing and doing what she loves. For the longer term, the more she’s out there, the more she’s going to learn to trust that knee.”
Lillian has learned a great deal during her ACL injury recovery and from her care at Scottish Rite for Children. “Throughout my entire recovery, I always had one quote in the back of my head — ‘the comeback is always stronger than the setback,’” Lillian says. “I carried that with me throughout my entire recovery. It’s been quite an experience, but I think it’s going to all be worth it.”
Nutrition Tips for Young Athletes in Stop-and-Go Sports
A stop-and-go sport, also known as a high-intensity interval exercise, includes baseball, softball, football, volleyball, basketball, ice hockey, soccer and tennis. These sports require coordination, agility and concentration. Quick reactions in these sports demand bursts of energy, speed and power.
Alternating periods of intense power and speed, with short or long periods of rest, involve all of the major energy systems in the body. Therefore, meals and snacks throughout the day for these athletes should include appropriate mix of all foods and nutrients.
“It’s easy for busy young athletes to not make food a priority, showing up for practices and games under fueled and thinking they can power through”, says certified sports dietitian Taylor Morrison, M.S., R.D., CSSD, L.D. “However, the reality is that food and nutrition are very important components to optimal performance and injury prevention. The good news is that this food and nutrition doesn’t have to be complicated. An athlete can incorporate simple meals, snacks and fluids throughout the day using some general guidelines thereby reducing concerns and optimizing health and performance”.
CONCERNS FOR THE YOUNG ATHLETE IN STOP-AND-GO SPORTS
Burning Out Early
Because of the intensity of some stop-and-go sports (like basketball, soccer, tennis and hockey) and because of the length of some games (like baseball or football) and tournaments (like basketball, soccer, tennis and volleyball), young athletes can use up their energy stores before the event is over. This especially becomes a problem if the athlete has not eaten a proper meal or snack earlier in the day or prior to the event and does not bring appropriate snacks for during the event.
End of the Season Injury
If this pattern of burnout continues, the constant fatigue during events can put the athlete at increased risk of injury due to decreased motor skills and performance. Poor nutrition or under-fueling can also lead to a lack of important nutrients like protein, fat, iron, calcium and vitamin D, which can also increase an athlete’s risk of injuries like stress fractures.
Dehydration
Dehydration is another contributor to fatigue, but also a cause of headaches and muscle cramps in the young athlete. Either of these can lead to decreased performance and injury. Of special concern are those young athletes playing in the heat or with extra gear like football, softball and hockey. Dehydration in these young athletes can lead to heat illness if it is not properly recognized and addressed.
NUTRITION SOLUTIONS FOR THE YOUNG ATHLETE IN STOP-AND-GO SPORTS
Proper Fueling Before and During Events
Eat a balanced meal at least three to four hours prior to the event and a small snack just before. Make sure to offer easy-to-digest carbohydrates to keep energy levels up until the very end of games and tournaments. More popular suggestions are fruit slices, dried fruit, crackers, pretzels, fig bars or sports drinks.
Balanced Meals Throughout the Day
Remember that the exact amount of food and nutrients needed vary depending on gender, height, weight, stage of development, sweat rate, sport played and position played. However, overall a young athlete’s plate should consist of:
- Variety of Carbohydrates – Mix it up with sources like milk and yogurt, whole grains, fruits and starchy vegetables. Carbohydrates provide short and long-term energy to fuel for a practice, game or tournament.
- Lean protein – Protein is important to repair any torn muscles and build tissue.
- Healthy fats – Fat is important for the growing brain and has potential anti-inflammatory benefits.
- Healthy fats, such as mono- and polyunsaturated fats, are important for brain development and function, aid in the absorption of vitamins A, D, E, and K and may have anti-inflammatory benefits. Learn more about healthy fats for the young athlete.
Getting carbohydrates, protein and fat from a variety of sources ensures that the athlete is also getting proper amounts of other nutrients like calcium, vitamin D and iron, among many others. Eating enough calories from carbohydrates, protein, fats and these nutrients helps promote optimal recovery and prevents injuries.
Hydrate
Drink fluid consistently throughout the day. Most of the time, an athlete should choose water and milk. Make sure to bring plenty of water to events adding a sports drink (for electrolytes and carbohydrates), if needed and encourage sips during timeouts, breaks and halftime. For heavy sweaters, salt can be added to drinks or salty snacks can be incorporated into breaks and halftimes.
Visit our sports hydration page to learn more about nutrition and fueling the young athlete.
A Soccer Injury Won’t Slow This MVP Down for Long
During a soccer game this spring, 14-year-old “Coppell FC” midfielder, Thomas, blocked a shot and fell to the ground. His father, Michael, didn’t think too much of it. Thomas often puts his body on the line to make shots and blocks, and most of the time, he quickly bounces up and continues to play. “When he didn’t get up, I realized that something was different,” says Michael. “We hit the ball on opposite sides at the exact same time, so that twisted my knee, and I heard a pop,” says Thomas recalling the play. Michael ran to Thomas on the field and could see that his knee was already swelling.
The family had taken their children to the Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco for other injuries in the past, so Michael knew who to call. Thomas was examined by sports medicine physician Shane M. Miller, M.D. The X-ray and MRI confirmed that the “pop”, immediate pain and swelling were caused by the tearing of the medial patellofemoral ligament (MPFL) when his kneecap temporarily dislocated. This ligament helps to prevent the kneecap from slipping to the outside of the knee.
While going over nonoperative and operative treatment options, Miller informed them that without surgery, there was a 50% to 80% chance that his kneecap would dislocate again while participating in sports. They decided to meet with pediatric orthopedic surgeon Philip L. Wilson, M.D., who reassured them that surgery was the best option for long-term recovery and healing. A couple of weeks later, Wilson and certified pediatric nurse practitioner Chuck W. Wyatt, R.N., M.S., CPNP, RNFA, performed an MPFL reconstruction. “Dr. Wilson and his team did a great job!” says Michael. Thomas was happy too and says, “Dr. Wilson was very nice, and so were all the people who helped me, like Dr. Kelly who helped with my IV and pain medication.”
Ten days after surgery, Thomas started twice a week physical therapy at Scottish Rite with physical therapists, Madelyn “Maddie” White, P.T., D.P.T., and Rushi Patel, P.T., D.P.T. He and his father are very pleased with the progress. “Physical therapy has been great!” says Thomas. “Maddie and Rushi are both great. Right now, therapy includes mostly basic exercises, but I can now bend my knee past 90 degrees. I started at like 70 degrees, which is pretty bad, so it’s improving.” Maddie agrees, Thomas is improving. She says, “After most surgeries, the first stage of rehabilitation is to protect and regain motion in the joint. Soon, Thomas will progress to exercises and activities that will improve strength and control in his legs and trunk.”
In addition to soccer, Thomas also plays baseball. His previous experience with physical therapy at Scottish Rite was for Little Leaguer’s shoulder, which helped him to commit quickly and fully trust in the postoperative rehabilitation plan. Thomas will miss this year’s baseball season and playing in one of his favorite events, Middle School Matchup (MSM) Summer Smash. As a Scottish Rite patient and alumni of the MSM, Thomas was invited to throw out the opening pitch for the 2021 tournament. It’s no surprise that Thomas loves this event. The fun-focused tournament brings together unlikely baseball and softball teams formed through middle school affiliations, reminiscent of sandlot play where skill isn’t a deciding factor.
Thomas is very focused on what he can do instead of what he can’t. Thomas is looking forward to trying out for the soccer team his freshman year at Coppell High School. “I’m doing a lot better,” says Thomas. “I’m walking without crutches, and hopefully, the brace will be off my leg soon.” He is already thinking ahead about exercises that he can do once the brace comes off to strengthen the muscles around his knee to help reduce the chances of reinjury. As he heals and progresses in rehabilitation stages, his physical therapists will introduce exercises that include more functional and soccer-specific movements. When he completes his formal physical therapy, Thomas will be a good candidate for our bridge program, designed to progress the patient back to sports safely.
Thomas encourages young athletes to stick with physical therapy and to do what their trainers say. “They know what is best,” he says. “You want to be back on the field as soon as possible, and if that means taking things slow now, it’s worth it in the long run.” Michael wants parents of young athletes to know that it is hard when your child is taken out of the sport that they love because of an injury. It hurts to see your child in pain, but he says it is important to have a positive attitude and to work closely with your medical team.
“Their advice is the best we can get, so open communication with your medical team is going to help your child make progress,” says Michael. “With Scottish Rite’s help, Thomas is getting better every day. Not just physically, but emotionally and mentally too.”
A Soccer Injury Won’t Slow This MVP Down for Long
During a soccer game this spring, 14-year-old “Coppell FC” midfielder, Thomas, blocked a shot and fell to the ground. His father, Michael, didn’t think too much of it. Thomas often puts his body on the line to make shots and blocks, and most of the time, he quickly bounces up and continues to play. “When he didn’t get up, I realized that something was different,” says Michael. “We hit the ball on opposite sides at the exact same time, so that twisted my knee, and I heard a pop,” says Thomas recalling the play. Michael ran to Thomas on the field and could see that his knee was already swelling.
The family had taken their children to the Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco for other injuries in the past, so Michael knew who to call. Thomas was examined by sports medicine physician Shane M. Miller, M.D. The X-ray and MRI confirmed that the “pop”, immediate pain and swelling were caused by the tearing of the medial patellofemoral ligament (MPFL) when his kneecap temporarily dislocated. This ligament helps to prevent the kneecap from slipping to the outside of the knee.
While going over nonoperative and operative treatment options, Miller informed them that without surgery, there was a 50% to 80% chance that his kneecap would dislocate again while participating in sports. They decided to meet with pediatric orthopedic surgeon Philip L. Wilson, M.D., who reassured them that surgery was the best option for long-term recovery and healing. A couple of weeks later, Wilson and certified pediatric nurse practitioner Chuck W. Wyatt, R.N., M.S., CPNP, RNFA, performed an MPFL reconstruction. “Dr. Wilson and his team did a great job!” says Michael. Thomas was happy too and says, “Dr. Wilson was very nice, and so were all the people who helped me, like Dr. Kelly who helped with my IV and pain medication.”
Ten days after surgery, Thomas started twice a week physical therapy at Scottish Rite with physical therapists, Madelyn “Maddie” White, P.T., D.P.T., and Rushi Patel, P.T., D.P.T. He and his father are very pleased with the progress. “Physical therapy has been great!” says Thomas. “Maddie and Rushi are both great. Right now, therapy includes mostly basic exercises, but I can now bend my knee past 90 degrees. I started at like 70 degrees, which is pretty bad, so it’s improving.” Maddie agrees, Thomas is improving. She says, “After most surgeries, the first stage of rehabilitation is to protect and regain motion in the joint. Soon, Thomas will progress to exercises and activities that will improve strength and control in his legs and trunk.”
In addition to soccer, Thomas also plays baseball. His previous experience with physical therapy at Scottish Rite was for Little Leaguer’s shoulder, which helped him to commit quickly and fully trust in the postoperative rehabilitation plan. Thomas will miss this year’s baseball season and playing in one of his favorite events, Middle School Matchup (MSM) Summer Smash. As a Scottish Rite patient and alumni of the MSM, Thomas was invited to throw out the opening pitch for the 2021 tournament. It’s no surprise that Thomas loves this event. The fun-focused tournament brings together unlikely baseball and softball teams formed through middle school affiliations, reminiscent of sandlot play where skill isn’t a deciding factor.
Thomas is very focused on what he can do instead of what he can’t. Thomas is looking forward to trying out for the soccer team his freshman year at Coppell High School. “I’m doing a lot better,” says Thomas. “I’m walking without crutches, and hopefully, the brace will be off my leg soon.” He is already thinking ahead about exercises that he can do once the brace comes off to strengthen the muscles around his knee to help reduce the chances of reinjury. As he heals and progresses in rehabilitation stages, his physical therapists will introduce exercises that include more functional and soccer-specific movements. When he completes his formal physical therapy, Thomas will be a good candidate for our bridge program, designed to progress the patient back to sports safely.
Thomas encourages young athletes to stick with physical therapy and to do what their trainers say. “They know what is best,” he says. “You want to be back on the field as soon as possible, and if that means taking things slow now, it’s worth it in the long run.” Michael wants parents of young athletes to know that it is hard when your child is taken out of the sport that they love because of an injury. It hurts to see your child in pain, but he says it is important to have a positive attitude and to work closely with your medical team. “Their advice is the best we can get, so open communication with your medical team is going to help your child make progress,” says Michael. “With Scottish Rite’s help, Thomas is getting better every day. Not just physically, but emotionally and mentally too.”