Emily Claire’s Transformation: A Pain-Free Knee and a New Life Path

Emily Claire’s Transformation: A Pain-Free Knee and a New Life Path

Cover story previously published in Rite Up, 2024 – Issue 3.

by Kristi Shewmaker

Emily Claire, of Plano, spends most of her time raising two pigs — Dolly and Kenny, named after Dolly Parton and Kenny Rogers. Like the country legends, Dolly and Kenny are not related. Every morning and evening, the 17-year-old drives to the barn to take care of them where they show their affection for her in different ways. “Dolly gets the zoomies,” Emily Claire says. “She’ll run laps in her pen, but Kenny just sits there with puppy dog eyes looking at me. He also likes to cuddle. Dolly, not so much, but Kenny will lay across my lap.”

Emily Claire is president of the FFA Plano chapter and secretary of Area V’s District VII for the state of Texas, which is part of the National FFA Organization, historically known as Future Farmers of America. She recently attended the Texas FFA State Convention in Houston. “It’s a lot more than just showing animals or being a farmer,” she says. Through FFA, she has engaged in leadership and career development events that will serve her throughout her senior year of high school and beyond.

Dr. Henry B. Ellis

As a young teen, Emily Claire had her heart set on playing softball. She played for school and select teams and had dreamed of playing at the collegiate level. But, she started experiencing pain in her knee, leading to multiple incidents of partial dislocation. The first time, she was crossing the street. “My kneecap slipped out, and I fell to the ground, literally in the middle of the street,” she says. “It was embarrassing.” The second time, she fell at softball practice, but each time, her kneecap went back into place. Then, in the fall of 2021 during her freshman year of high school, her kneecap fully dislocated at catcher practice. “I was in my squat throwing down to second base, and I popped up to throw, and my kneecap just locked out,” she says. “I couldn’t move it. I didn’t know what was happening, and I was freaking out.”

TREATING KNEECAP INSTABILITY
An established patient at Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco, Emily Claire was initially treated with a brace and a specific exercise program. Unfortunately, she experienced increasing episodes of instability in her kneecap, or patella. Recurrent episodes of patellar instability often require surgery. Henry B. Ellis, M.D. — pediatric sports medicine surgeon, sports medicine fellowship director and medical director of clinical research — performed medial patellofemoral ligament (MPFL) reconstruction surgery on Emily Claire’s left knee.

“MPFL reconstruction is common for us in pediatric sports and those that take care of kids because kneecap instability is very common in kids,” Dr. Ellis says. “In our practice at Scottish Rite, it is one of the most common conditions that we treat.”

When Emily Claire’s kneecap dislocated, it tore an important ligament that holds the patella in place. In surgery, Dr. Ellis replaced the torn ligament with a new one to give her kneecap stability. However, patellofemoral instability is complicated. Sometimes, it requires more than simply replacing a ligament. At the end of the femur, or thigh bone, is a groove called the trochlear groove. The patella fits into this groove, and when the knee bends or straightens, the patella slides up and down in the groove. Emily Claire’s kneecap was not aligned in the groove because of the position of her tibial tubercle, the bony bump on the upper part of the shin where the patellar tendon attaches. “Her kneecap was living off to the side,” Dr. Ellis says. To mitigate this problem, he performed a procedure to shift Emily Claire’s tibial tubercle, which aligned her kneecap in the groove and ensured that it would track and glide correctly.

REHABILITATING BODY, MIND AND SPIRIT
MPFL surgery stabilized and corrected Emily Claire’s kneecap. What came next would change the direction of her life. Her knee injury and rehabilitation served as a catalyst that led her to discover her dream career. Throughout her care journey, she received treatment from Dr. Ellis and a multidisciplinary team, including physician assistant Ben Johnson, registered nurse Tammy Norris, physical therapist Katie Sloma, child life specialists, psychologists and athletic trainers, among others.

After surgery, Emily Claire met physical therapist Katie Sloma for a physical therapy evaluation. “I remember talking to Katie and asking her questions,” Emily Claire says. “I was really curious about her job.” For weeks, Emily Claire was on crutches, wore a brace and could not bear weight on her leg. “I got a really good tan line at the softball field with stripes going across my leg,” she says. “It was very humbling having two different size quads.”

Katie worked with Emily Claire on quad strengthening, range of motion and mobility through manual therapeutic exercises and aquatic therapy.

“Emily Claire always came in with a smile and ready to work,” Katie says. “She was curious about the process and liked to remain informed, which was cool for us to see.”

For several months, Emily Claire could not play softball. Then, slowly, she was reintroduced to the game part time, but ultimately, her team broke up during her sophomore year. “I was like, ‘OK, I don’t know what I’m supposed to do now,’” she says. She recalls trying out for other teams, but her knee had not fully recovered. “I wasn’t getting called back,” she says. “It was like nobody wanted me, and that was really degrading, and I was like, ‘Am I even supposed to play softball anymore?’”

Things began to change in 2023 when Emily Claire attended the FFA Collin County show. “Everybody there was just so nice and comforting. It felt like a place that I belonged,” she says. “So, I went home and cried about it a lot, and I was like, ‘I just don’t think softball’s for me.’”

OPTIMIZING CARE THROUGH EXPERT TEAMWORK
Emily Claire continued to gain strength and increase athletic conditioning by working with athletic trainers while participating in Scottish Rite’s Bridge Program.
“In our care of any youth athlete, one of the biggest advantages that we have at Scottish Rite is the ability to work together,” Dr. Ellis says. “When someone presents a problem, we offer solutions, but we do it not just as a physician to patient, but as Scottish Rite as a whole.”

Physician assistant Ben Johnson agrees. “The care we provide is a team-based approach with all team members focused on a singular goal of getting patients like Emily Claire back to doing what they love to do without limitations,” he says. The exceptional dynamic of Scottish Rite’s continuum of care results in optimal outcomes for patients. “The key to Emily Claire’s success is the fact that she had an opportunity to work with our team together,” Dr. Ellis says.

Emily Claire liked the team she worked with so much she decided to join it. Over the summer, she interned at the Frisco campus’ Movement Science Lab, processing data for a neurocognitive research study. “I have received so much at Scottish Rite — and not just care,” she says. “Everybody here is so kind and loving, and they want to help you not just get better and achieve your goals, but they’re willing to help you learn.”

Emily Claire’s time at Scottish Rite has inspired her to become a physical therapist. “Instead of something that I had to go to, physical therapy became something that I looked forward to,” she says. “Everyone was there for me.” Katie shares that Emily Claire’s interest in the field of physical therapy was rewarding to her as a provider. “It shows that her time at Scottish Rite made a positive impact on her even when things got hard,” Katie says.

Upon reflection, Emily Claire explains that her care journey also changed her mental health. “It showed me that I was more unhappy than I was happy playing softball, and that softball wasn’t for me,” she says. “I thought I was going to let so many people down
if I didn’t play, but it opened my eyes and showed me that I like doing FFA a lot more.”

Recently, Emily Claire received the news that she was accepted to her college of choice, Tarleton State University, where she will pursue a degree in kinesiology. Upon graduation, she plans to attend physical therapy school. But for now, she is enjoying her senior year, beginning this fall, when she shows her superstars, Dolly and Kenny, at the State Fair of Texas.

Read the full issue.

How to Help Your Kids Prevent Football Injuries

How to Help Your Kids Prevent Football Injuries

Even as awareness of concussions and other problems has grown, football remains the most popular sport for adolescent boys. While participation has dropped, Texas still has the most high school football players of any state – totaling more than 170,000. That’s almost double the number of players in California, which has the second largest population of players. It’s no surprise that the sport remains so popular in a state known for “Friday Night Lights.” Yet while rule changes have modified risks, football injuries are still common. Scottish Rite for Children has advice to help your kids avoid some of these common sport injury problems.

Common Injuries in Football

Football has the highest injury rate among school sports. Most youth sports injuries are muscle, joint or bone injuries including:

Other common injuries in football are concussions and heat-related injuries, such as dehydration and exertional heat stroke.

Protective Equipment Is Key

Tackle football players wear pads for a reason. If your child is playing on a team that does not have the resources of a varsity-level squad, make sure they practice with the correct gear including:

  • Properly fitting helmet approved by the National Operating Committee on Standards for Athletic Equipment
  • Leg (thigh and knee) pads
  • Mouthguards
  • Cleats that are the correct size and fit
  • Shoulder pads
  • Protective cups

Some players may also wrap their wrists, ankles or knees with tape or bracing. Protective braces (i.e. knee brace or ankle brace) may decrease the risk of injury in some athletes. However, custom outer knee braces have not yet been proven to lower injury outcomes.

Practice Makes (Almost) Perfect

Proper training may also reduce injury risk. While your child’s coach determines what happens at practices, you can help your child learn ways to reduce the risk of football injuries all year long by:

  • Encouraging moderate off-season conditioning. Staying in shape throughout the year with cardiovascular exercise and strength training is great for your child’s health overall and may reduce the risk of injuries when they head back to the field.
  • Getting a physical. A pre-season assessment by your child’s pediatrician or sports medicine specialist can ensure that your child is healthy enough to play and raise any areas of opportunity for addressing musculoskeletal complaints before training begins.
  • Promoting hydration. Not only does proper hydration help prevent heat-related injuries, it’s also important for peak performance and maintaining a proper tackling technique

Encouraging your child to play different sports during the offseason can also help prevent overuse injuries while keeping them active and conditioned. Playing multiple sports has been shown to be associated with improved performance and reduced injury risk.

What About Concussions?

Whether your kids are linemen or quarterbacks, concussions are a risk during games and practice. Although some full contact drills have been banned from youth practice to reduce concussion risk, 63% of concussions in high school football players do happen from tackling, even during practice. Helmets do not prevent concussions, regardless if they are the best rated helmets on the market. Delaying tackling until the age of 14 is advised by some, however, there are ways to make the sport safer for young athletes. If your child is playing tackle football, make sure the coaches:

  • Limit tackling during practice.
  • Teach safe tackling tactics.
  • Remove the child from play immediately whenever a concussion is suspected.
  • Always follow established return to play guidelines after a concussion.
  • Have a doctor and/or athletic trainer on the sidelines to evaluate players during games after a possible concussion.

Talk to the Coaches

Coaches are an important part of football injury prevention. Before signing your child up for a league, ask the coaching staff questions to ensure injury prevention is part of their philosophy such as:

  • Do you encourage injured players to keep playing or take time off to recover?
  • If my child has a possible concussion, what is the protocol at the time of the injury and when it is time to return to play?
  • Does your child have their own water available?
  • How do you teach sportsmanship and fair play?
  • What type of tackles and drills do you run during practice?
  • Will practice be rescheduled or held indoors if the weather is extremely hot or severe storms are expected?

Only you can decide if a coach’s temperament and attitude toward the game is the right fit for your child — or if football is even a good option for your family. But with a proactive coaching staff, a supportive home and your sports medicine team at Scottish Rite, you can help limit the risk of a sports injury in football for your child.

Want more advice on preventing or treating football injuries for your child? Call 469-515-7100 to schedule an appointment with one of our sports medicine specialists at Scottish Rite for Children Orthopedic and Sports Medicine Center.

Does my child need surgery to fix an ACL tear?

Does my child need surgery to fix an ACL tear?

Anterior cruciate ligament (ACL) injuries, continue to challenge young athletes, many calling it an epidemic. Because of the high cost of care and loss of playing time, Scottish Rite for Children’s Sports Medicine team is actively looking for answers to prevent these injuries. As we study the conditions that may contribute to the risk with programs like the Sports-specific Assessment and Functional Evaluation (SAFE) program, we also continue to evaluate and contribute to the available evidence for caring for ACL injuries in young athletes.

Medical director of clinical research and pediatric orthopedic surgeon Henry B. Ellis, M.D., led a multicenter team including others from the Scottish Rite Sports Medicine team just published a critical analysis of the literature pertaining to the management of pediatric ACL injuries. The article is available on the Journal of Bone and Joint Surgeries (JBJS) Reviews site.

Here are some key messages you should know when considering surgery for an ACL tear:

» Even though these are happening at a high rate, there is very little published evidence for managing ACL injury in a pediatric or skeletally immature case.

Studies suggest that as many as 3 out of 4 athletes return to play after completing a nonoperative plan of care after ACL injury, but there are times that surgery is necessary. A physical therapist or athletic trainer can guide rehabilitation with a comprehensive exercise program to prepare an athlete to return to competitive sports with an ACL tear.

» This review suggests that surgery for an ACL reconstruction is recommended when another condition is present. These include:

  • Repairable injury to the cartilage, soft tissue that covers the surface of the bone.
  • Repairable injury to the meniscus, a disc between the two major bones in the knee joint.
  • Symptoms of instability even after high quality rehabilitation.

Since both paths for care can be successful and come with some risk, a decision for surgical or nonsurgical approaches to care for a pediatric ACL reconstruction should include a broad team considering many aspects of the circumstances.

Learn more about individualized care for ACL injuries at Scottish Rite for Children.
 

Ellis, H. B., Jr, Zak, T. K., Jamnik, A., Lind, D. R. G., Dabis, J., Losito, M., Wilson, P., & Moatshe, G. (2023). Management of Pediatric Anterior Cruciate Ligament Injuries: A Critical Analysis. JBJS reviews11(8), 10.2106/JBJS.RVW.22.00223. https://doi.org/10.2106/JBJS.RVW.22.00223

Scottish Rite Is Advancing the Use of Musculoskeletal Ultrasound in Pediatric Orthopedics and Beyond

Scottish Rite Is Advancing the Use of Musculoskeletal Ultrasound in Pediatric Orthopedics and Beyond

In many practices, musculoskeletal ultrasound (MSK US) is housed solely in radiology. At Scottish Rite for Children, we are fortunate to also have two practitioners with advanced training and certification in using this tool in clinic. Sports medicine physician Jacob C. Jones, M.D., RMSK, and rheumatology practitioner Heather Benham, D.N.P., APRN, CPNP-PC, RHMSUS, use ultrasound to diagnose and treat patients for a variety of conditions.

Together, Jones and Benham have developed a comprehensive course to teach health care professionals the fundamentals of MSK US. Their extensive ultrasound backgrounds and genuine interest in teaching have come together to produce an impactful experience for the attendees.

More than 70 participants from professions including orthopedic surgeons, sports medicine physicians, orthopedic and emergency medicine fellows, physical therapists, advanced practice providers and research personnel have completed the program. Traveling from more than 15 states and two countries, the attendees have all indicated they would be interested in returning for an advanced course and many have referred others to the program.

There are several elements that make this program one-of-a-kind.

  • All faculty have expertise in the use of MSK US in pediatrics.
  • Guest faculty are invited from institutions such as Boston Children’s Hospital, Nationwide Children’s Hospital and Texas Children’s Hospital.
  • Pediatric models participate in the scanning sessions.
  • Injection sessions integrate a variety of tools including custom-made joint models.
  • Didactic and scanning sessions alternate throughout the day.

Jones and Benham look forward to developing an advanced course to offer in conjunction with the fundamentals course. Join our wait list to hear about it first!

What to Expect If Your Child Has a Stress Fracture

What to Expect If Your Child Has a Stress Fracture

If you have a young athlete in the family, you probably know that bumps and bruises are part of the game. A more severe injury, like a stress fracture, however, can be worrisome for any parent. Being informed about the nature of stress fractures and how to help your child heal can ease your mind.

What Causes Stress Fractures in Kids?

A stress fracture, sometimes called a hairline fracture, is a tiny crack in a bone caused by physical stress. This type of injury often occurs when a specific muscle or joint is overused or strained, known as an overuse injury.

Stress fractures commonly occur when a child performs the same movements over and over again, for example, running, jumping or throwing a ball.

Telltale Signs of a Stress Fracture 

Stress fractures develop over time, and one of the first signs you may notice is your child frequently complaining of pain after playing or practicing their sport. 

Your child may experience other symptoms, including:

●      Pain during exercise that doesn’t always go away with rest

●      Redness

●      Swelling

●      Tenderness

Swelling or bruising may develop around the bone in the early stages of the injury when it’s considered a “bone stress reaction.” As the injury worsens, it develops into a stress fracture, causing a crack or tiny break in the bone.

Stress Fractures Commonly Seen in Kids

Stress fractures are most common in the weight-bearing bones in the legs and feet, including the tibia bone (shinbone). However, young athletes can experience stress fractures in many other parts of the body. 

Gymnasts, for example, can develop stress fractures in the wrist, while softball and baseball pitchers may experience stress fractures in the arms or shoulders. Stress fractures affecting the lower extremities are common in nearly all sports since most activities place stress on the legs and feet. Rarely, stress fractures can develop in the spine or ribs.

How Are Stress Fractures in Kids Diagnosed and Treated?

If your child has symptoms of a stress fracture, check in with a medical provider. A sports medicine specialist can help determine the cause of your child’s discomfort and provide a treatment plan.

To diagnose an injury, the provider will first gather your child’s medical history and then conduct a physical examination, focusing on the area of discomfort. If the provider suspects a stress fracture, he or she may order imaging tests, such as an X-ray, CT scan or MRI, to confirm a diagnosis.

The primary treatment for a stress fracture is rest. Because the injury is most often the result of overuse of a bone and the surrounding muscles, taking the stress and strain off that part of the body is essential. Your child should take a break from activity, and if the injury is in the lower body, your child may also need to wear a boot or use crutches to take weight off the injured bone.

In rare cases, bones that don’t heal after a long period may require surgery to heal correctly.

Prevention 101

To reduce the risk of a stress fracture, have your child avoid repetitive movements as much as possible. Also, encourage cross-training. Having your young athlete do activities that require different muscles and movements not only limits stress on a single joint, but it can also strengthen other muscles and improve their performance in their primary sport.

You can also help your child prevent stress fractures by having them prioritize rest between games and practices, using proper sport-specific equipment and eating a balanced diet rich in vitamin D and calcium. Finally, teach your child never to play through pain.

Think your child may have a stress fracture? Call 469-515-7100 to schedule an appointment with one of Scottish Rite for Children’s sports medicine specialists.