From Knee Injury to Softball Scholarship

Thanks to sports medicine at Shriners Hospitals, Jessica is back in the game

Jessica is a talented athlete with a bright future in competitive softball. The 17-year-old recently signed a national letter of intent to play at the next level, earning an athletic scholarship to Ball State University in Indiana. The honor is more meaningful now because a knee injury in 2019 took her off the field for almost a year. Jessica relied on a team of sports medicine specialists at Shriners Hospitals for Children — Chicago to help her return to sport with a knee that is strong enough to safely compete again.

Jessica’s knee injury

The collision happened during a softball game in March 2019. “She was running to first base when the first baseman slipped on the base, falling into Jess as she was running by,” said Jessica’s mom, Kimberly. “Jessica’s knee was unstable and would give out. She also had a decrease in her range of motion.” A softball coach who also works at Shriners Hospitals as a physical therapist, suggested the family go to the sports medicine specialists at the Chicago location. The program offers a team approach of pediatric orthopaedic surgeons, on-site physical therapy and return to sports testing in the motion analysis center, an on-site gait lab. The entire team is dedicated to getting a child playing on their own team again.

Kimberly made an appointment for Jessica with pediatric orthopaedic surgeon Kelsey Elaine Davidson, M.D. “During play Jessica ended up twisting her knee and falling,” said Dr. Davidson. A physical exam showed instability in the knee. “An MRI confirmed Jess had a tear of her anterior cruciate ligament (ACL), one of two strong rope-like tissues inside the knee that hold the knee bones together, and keep the joint stable. “Sometimes a child feels a pop but typically he/she will have immediate pain and swelling in the knee and can’t put weight on the leg right after the injury.”

ACL reconstruction and physical therapy

For an ACL tear, Dr. Davidson typically recommends a surgical procedure, an ACL reconstruction, for children and teens who participate in sports. “The reason to have surgery for an ACL tear is to make the knee feel stable, to return to the same level of activity as before, and to prevent additional injury to the knee.” Jessica had arthroscopic same-day surgery using a patellar tendon graft of her own tissue. After the surgery, physical therapy is the next important step in both recovery and protecting the child from additional injury in the future. Jessica worked one-on-one with a physical therapist in the on-site rehabilitation services department at the Chicago Shriners Hospital.

“For patients with injuries that require surgery, our therapists are able to see kids the day they have surgery to teach them how to use crutches, provide initial exercises, and help determine any equipment they might need to help them be independent at home,” said Nicole Viverito, PT, D.P.T., Jessica's physical therapist. “Then, the therapists are able to work in compliance with the orthopaedic surgeons’ protocols in regular physical therapy visits to progress children towards getting back to their sport.”

The PT program also includes home exercises. “Nicole and Jessica had a strong connection from day one. She created a program that improved her strength, power and endurance,” said Kimberly. "She worked with Jessica’s coaches to ensure that everyone understood where Jessica’s recovery stood and what limitations she had.”

“When the athlete is ready, the physical therapists will help the athlete get back to running, sometimes starting out on specialized equipment like the AlterG anti-gravity treadmill or in the hospital’s warm water therapy pool; and eventually the therapists provide sports-specific functional movement training particular to their sport,” said Viverito.

The hospital also offers sports medicine group therapy programs that bring friendly competition into play after young athletes have progressed towards higher level sports-specific training with their one-on-one physical therapy program. “Children generally do 4–6 months of therapy, and then gradually begin exercises to return to their sport,” Dr. Davidson said.

Return to sports testing

In addition to physical therapy, the Chicago Shriners Hospital offers data-driven evaluations of children with knee injuries. High-tech motion and force testing is offered in the motion analysis center at the Chicago Shriners Hospital. The multi-activity test of squats, jumping and balance testing is conducted by Angela Caudill, PT, MPT. “You don’t want children to return to sports too soon and risk re-injuring a knee,” said Caudill. Results are shared with the child’s doctor and therapist. The team uses the data to help evaluate when the child is ready to safely get back in the game.

“Return to sports testing at Shriners Hospitals provides a lot more info than what we can obtain in a quick office visit. How strong is that leg compared to the non-injured leg? We use data to evaluate the control they have on the injured leg when we’re making them do jumping and pivoting tests,” Dr. Davidson said. Caudill also uses Biodex strength testing to determine how strong muscles are on the injured leg compared to the other leg.

See video of Jessica's return to sports testing:

The data-driven approach is part of a national effort by Shriners Hospitals to better protect young athletes with growing bones and joints. Caudill, Viverito and Dr. Davidson are part of the Shriners Sports Consortium, comprised of staff members at ten Shriners Hospitals locations. The group plans to share data and conduct research to clarify what tasks younger athletes should focus on during recovery to return to sports in the safest manner. “The literature says athletes with ACL tears have a 5-25% chance of re-tearing or tearing on the other side. 25% is an incredibly high re-injury rate. So we’re looking at how to minimize that number,” Dr. Davidson said.

Jessica’s family is very happy with her results. “After our first meeting with Dr. Davidson, we knew that this was where our daughter needed to be. Her calm temperament and excellent communication skills put us at ease,” said Kimberly. “Dr. Davidson always had Jessica’s best interest in mind and wanted to ensure that she was adequately prepared to return to play.”