Procedure provides hardware-free alternative to young, aspiring professional soccer player suffering with torn ACL.
Jose Palomo, an eighth-grade student at Edgewood Junior Senior High School on Merritt Island has been playing soccer since he was about 6. But while playing in a game in April 2012, his cleat got stuck in the ground and he injured his knee. Or, more specifically, he injured his anterior cruciate ligament (ACL), one of four main ligaments in the knee. For Jose, the damaged ACL made it impossible to run — his knee would give way when he tried.
Anthony Allotta, D.O., a fellowship-trained sports medicine physician in the Parrish Multispeciality Group in Port St. John, first saw Jose. He realized the ACL tear, especially in an athlete, would not be treatable with a simple brace, but he gave him one to stabilize the knee until surgery could be performed.
That’s when Dr. Allotta referred the youth to Julie Chevillet, D.O., an orthopedic surgeon who has been part of the PMC team since 2010. She specializes in pediatrics, having completed a fellowship in pediatric orthopedics at Nationwide Children’s Hospital in Columbus, Ohio.
Dr. Chevillet says that Jose’s growth plate, or physis, is still open, as skeletal maturity typically occurs in males at age 18 (and girls at 16). She adds that he and his mother, Sandra, wanted a reconstruction technique that would not destroy the growth plate, so that ruled out the traditional method used for adults, which requires drilling a hole through this region to place a graft. Nor did they want any hardware (i.e. implants). Among the few growth plate sparing options — and the one they opted for — is an Arthroscopically Assisted Growth Plate Sparing Anterior Cruciate Reconstruction.
The procedure has been around for a few decades, according to Dr. Chevillet. She explains that it was originally developed to be a temporary measure to get youth to that point in time when his or her growth plates are closed and he or she could undergo a more traditional ACL reconstruction procedure. However, what was discovered over time is that very few of these procedures needed to be redone. In other words, it is a permanent fix.
“A physeal-sparing ACL reconstruction does, in fact, spare the physis, which then avoids deformity and unequal lengths ultimately, not to mention post-op infection of the growth plate by avoiding it completely,” says Dr. Chevillet.
She explains that the procedure performed on Jose on March 25 called for two incisions over the outside of the thigh to harvest a graft from the iliotibial band, a large, flat tendon that attaches from the hip down to the knee. Dr. Chevillet took the central third of it. Once freed from the underlying soft tissues, she delivered it down toward the knee. There, it was inserted into the Gerdy’s tubericle, which she noted is a permanent insertion site. Using the scope, the iliotibial band was fed around the knee to the femoral condyle, or the bump on the back side of the bone, through the inside of the knee and then out the front of the knee over the tibial growth plate. Lastly, it was sewn into the tibia’s peristeum, or lining.
“It is what’s called a non-anatomical repair. It’s not exactly the same anatomy you were born with, but it simulates it and provides a restraint for the tibia so that it will not move forward on the femur when he is running,” explains Dr. Chevillet.
This procedure is not risk free. The biggest risk, according to Dr. Chevillet, is damaging the neurovascular structures on the back side of the knee when passing the graft. Over the long term, there is the possibility that it will not work due to the method, which primarily requires sutures to the bone.
“I want to get better. Then I want to go back to playing soccer,” says Jose. And so far so good. In late April, he already had the bandages removed and he was two weeks from going back to PMC for another post-op examination. He was also just weeks from beginning physical therapy. If all goes smoothly, he could be back on the soccer field in six to 12 months.
Although his mother was a little nervous about the procedure — her main concern being the dangers associated with general anesthesia — she says, “I feel confident and safe with the surgery. And believing in God and the surgeon, I know everything is going to turn out well.”