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Broken Kneecap and Tibia: Antonio’s Story

Meet Antonio


After Antonio Briscoe played his first season of basketball in the seventh grade, he was smitten. He loved the game, the camaraderie, shooting, but most of all, scoring.

So, the next year, he was all in—signing up to play for a local AAU boys basketball team. Unfortunately, before Antonio’s eighth-grade AAU season ever started, it ended with a devastating injury on May 14, 2018.

“We were practicing when I went for a layup,” Antonio said. “I was trying to dunk the ball, but when I landed, I broke my left tibia, then I came down on my right kneecap, and broke it, too.”

In excruciating pain, Antonio was carried off the court, and taken by ambulance to Children’s Mercy Hospital Kansas. After being evaluated, he was transferred to the Children’s Mercy Adele Hall Campus, home to one of the nation’s most highly ranked pediatric orthopedic surgery programs.

There, Dale Jarka, MD, a pediatric orthopedic surgeon, repaired his broken kneecap using an implant, and put his left tibia, or shin bone, in a cast.

Once back home, every move Antonio made was a struggle. “At the time, we lived in a townhome with a lot of stairs,” explained Denise Briscoe, Antonio’s mother. “It took two of us to carry him up the stairs from the driveway to our front door.”

Inside their home, Antonio used a walker, but needed help getting to and from the bathroom, to his bedroom, and up and down the stairs. “He was totally dependent on our family after the surgery for everything,” Denise added.

Then, at a check-up 10 days later, there was more bad news. Donna Pacicca, MD, also a pediatric orthopedic surgeon at Children’s Mercy, discovered the shin bone fracture in his left lower leg had come out of alignment. That’s when he underwent a second surgery, this one as an outpatient to repair the broken bone.

Physical therapy, round one...


A few weeks later, Dr. Pacicca released Antonio to begin physical therapy with Nathan Apple, PT, physical therapist at Children’s Mercy Hospital Kansas.

Nathan worked with his patient for nearly six months, helping him regain his strength and flexibility.

“Because his injury involved both legs, Antonio’s rehabilitation was more extensive and took a little longer than most,” Nathan said.

“We worked from June to November 2018,” Nathan said. “Antonio deserves credit for fighting through this. He’s a hard worker and was determined to get back to the basketball court.”

But first, Antonio had to have a third surgery—this one to remove the implant originally placed in his kneecap to help it heal.

“Sometimes the implants we use can be bothersome or uncomfortable for the patient, so we remove them once the bone has healed,” Dr. Pacicca explained. “Antonio was experiencing some discomfort.” 

After removing the implant, Dr. Pacicca referred Antonio to Tiffany Whitney, PT, MPT, SCS, a physical therapist with Children’s Mercy Sports Medicine Blue Valley who specializes in working with young athletes.

Physical therapy, round two...

 

When Tiffany first met Antonio in March 2019, she noticed he was having a tough time getting his right quad muscle to fire, the major muscle associated with the kneecap injury.

“Functionally, Antonio was doing okay, but after performing his Biodex testing, I could see how significant his muscle balance was,” she said.

Biodex is a device used to evaluate strength, endurance, and power of the major muscles in patients before surgery and throughout the rehabilitation process.

“Antonio had figured out how to adapt to his injured right kneecap throughout the long recovery process,” Tiffany said. “He was using his glutes and hamstrings to compensate for not having the appropriate strength in his quads, and because of that, was overcompensating with his left leg. These compensations were putting him at risk for another injury.”

Tiffany began Antonio’s physical therapy by helping him re-learn how to activate his right quad, starting with proper squatting and jumping techniques. But in his case, general squats and leg presses weren’t getting the job done.

“We had a lot of work to do to get the right leg caught up to the left so that he could use it to push off and jump for basketball,” she explained. To make that happen, Tiffany had to get creative with Antonio’s physical therapy.

“We used our Biodex machine a lot to work on activating his quad to both shorten the muscle (concentric contraction) and control the lengthening of the muscle (eccentric contraction) so that he could better control his landing,” she said.

Tiffany also used electrical stimulation on his quad for muscle re-education, as well as Pilates equipment for improved body awareness and stability and the IsoStrength bike to improve his quad muscle activation and endurance.

“Antonio received very individualized attention during his rehabilitation,” Dr. Pacicca said. “Tiffany really thought about him as an individual, not just a protocol, and when he needed extra time, he got it. She took Antonio’s goals into consideration, and found a way to help him achieve them.”

But, that also meant Antonio had to buckle under and work harder than ever.

“Tiffany makes her patients work,” Dr. Pacicca said. “I’m not sure Antonio realized how much he was going to have to do to get back to playing form, but Tiffany is very good at figuring out how to engage young athletes in physical therapy and motivate them.”

Tiffany gives Antonio the credit for making the most of his physical therapy. “After all he had been through, it would have been easy for Antonio to give up. He’d had three surgeries and months of therapy, but instead of getting down, he pushed himself harder so he could play basketball again.”

“In the beginning I was like, ‘I can’t do this,’” Antonio admitted. “But on a scale of 1 to 10, I missed basketball a 10. My goal was to get back to play my freshman year, but Dr. Pacicca and Tiffany wouldn’t release me. They said I wasn’t ready.”

Though Antonio said he was disappointed initially, he realizes now that Dr. Pacicca and Tiffany had his best interests at heart. “I still had a lot of work to do on my own, and I worked harder once I learned that’s what it was going to take,” he said.

Back on the court!


Antonio has experienced what few young adults ever have. In a matter of minutes he went from being an active teen to being immobilized by his injuries. He slowly graduated to walking with a walker, then crutches, then leg braces, and finally undergoing months and months of physical therapy.

“Antonio’s determination is rare,” Denise said. “I know there were times when he wanted to quit, but I told him God gives you obstacles; it’s up to you to figure out a way around them.”

And that’s just what he did. After more Biodex and functional testing to be sure he was strong enough to play basketball again, Dr. Pacicca and Tiffany released Antonio to return to sports just in time to try out for the sophomore basketball team at Olathe East High School, and he made it.

“I’m playing point guard,” he said. “The thought of getting back on the court was a little scary, but in our first game, I played 16 minutes out of 32 and my legs felt great!”

Antonio hopes he’ll move up from the sophomore team to junior varsity this year. Next year, his goal is to play varsity ball, but he knows he has to continue training hard to stay healthy so he can make the team.

Antonio credits Tiffany, Dr. Pacicca, and his family, especially his brother Darious, with pushing him so that he could get back on the basketball court.

“I worked with Tiffany twice a week and Darious literally made me get up and go to the gym every day, even when I didn’t feel like it. He really had a lot of faith in me,” Antonio said. “Thanks to all their support, I’m very confident I’m back.”

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