Dr. Pacicca diagnosed Lauryn with patellar instability. “In the general population, it occurs in about six out of every 100,000 adolescent patients, including traumatic injuries,” Dr. Pacicca explained. “We don’t know the cause of atraumatic dislocation or instability, but suspect alignment of the limb may play a role.”
To correct the problem, Dr. Pacicca recommended Lauryn first have a surgery called an osteotomy to address alignment issues in her right leg.
“We discussed the possibility that realignment might help her by itself, but Lauryn’s surgery was planned as a staged procedure,” Dr. Pacicca said. “We wanted to make sure her limb alignment would not contribute to increasing the risk for re-dislocation.”
Dr. Pacicca’s former colleague, Bradford Olney, MD, pediatric orthopedic surgeon, performed the osteotomy on June 3, 2019 at the Children’s Mercy Adele Hall Campus. During the surgery, Dr. Olney cut and reshaped Lauryn’s femur, or lower thigh bone, taking pressure off the knee joint and improving alignment.
Six weeks later, Lauryn began physical therapy at Children’s Mercy Sports Medicine Center Village West, working with Michael Denning, DPT, CSCS, sports physical therapist.
Michael focused on traditional physical therapy exercises, helping Lauryn regain the strength and flexibility in her right leg, but he also recommended she see his colleague, Kayla Greiner, PT, DPT, OCS, physical therapist at Children’s Mercy Sports Medicine Center Village West, to incorporate a few sessions of aquatic therapy into her rehab.
Working in the Village West state-of-the-art therapy pool helped Lauryn feel like she was making progress during the early stages of her recovery. The buoyancy of the water reduced the weight on her right knee.
“The pool was really cool,” Lauryn said. “The pool floor raised up so I could get in easier. It was like something out of a science fiction movie. Plus, they were able to put a stationary bike on the floor and lower it down so that I could ride the bike under water. It was pretty impressive.
“I wasn’t able to fully walk or ride a bike on land, but in the pool I could. It was a nice change after being on crutches for so long, and It helped me get my confidence back,” Lauryn said.
Michael added techniques like blood flow restriction training, or BFR, to Lauryn’s therapy regimen. BFR training involves wrapping a restrictive device, similar to a large blood pressure cuff, around a limb during different forms of training and movement. Studies show BFR increases muscle growth.
“By using BFR, you get similar benefits to the muscles that you would from traditional strength training,” Michael explained. “It stresses the muscles so they get stronger, but protects the joints since it is typically just body weight exercises.”
After several months of rehabilitation at Village West, at the end of 2019, Dr. Pacicca evaluated her patient and delivered the news—Lauryn was still going to need the second surgery.
“Dr. Pacicca didn’t like how loose Lauryn’s kneecap still was, and she didn’t think it was going to get better, so we decided to move forward with the second surgery,” Chelley said.
In this arthroscopic operation performed at Children’s Mercy Hospital Kansas, Dr. Pacicca reconstructed Lauryn’s medial patellofemoral ligament, placing a graft that acts as a check rein to prevent the patella from sliding out of place to the outside of the knee.
Lauryn returned home the same day, and a couple of weeks later started rehabbing her knee again, just about the same time the COVID-19 pandemic hit.