Rady Children’s orthopedic surgeons help an injured player get back in the game
Kamryn Middleton, 12, is the picture of confidence, but a knee injury could have cut her playing days short. ACL reconstruction at Rady Children’s and her dedication to a strict physical therapy regimen got her back on the field.
By Sarah Sapeda
The first spring of the pandemic put a pause on team soccer, but as the weeks wore on, the girls of the Rebels Soccer Club in Ramona got restless. In May 2020 they began practicing ely at each other’s homes. For now-12-year-old Kamryn Middleton, it was an opportunity to make up for lost time and catch up with her teammates.
“The kids were going stir-crazy,” says Kamryn’s dad, Scott. “We started getting in contact with the girls on the team and asked them if they wanted to work out in some backyards and hone their skills. Every single girl on the team came.”
Things were looking up for the Rebels that October when they learned that scrimmages were back on the table, but the excitement quickly turned to horror for Kamryn and her family. Just a few minutes into a game against a boys’ team from the same club, Kamryn was dribbling the ball toward the goal and stopped to make a turn. A rival defender clipped the back of her right leg and it buckled beneath her. She tried to get up and couldn’t. They knew something was definitely wrong.
“My cleat got stuck in mud, so when I tried to turn and get away with the ball, my foot was stuck,” Kamryn says. “Then a player came behind me—they don’t mind tackling me because I used to practice with them—fell and pushed into the back of my knee and it popped.”
The first doctors she saw took X-rays and recommended ice and rest. “We tried that a couple rounds, and each time she went back, her knee would give out on her,” Scott says.
A subsequent MRI revealed the source of the problem: a torn anterior cruciate ligament in Kamryn’s knee and injuries to the meniscus cartilage that surrounds it. The anterior cruciate ligament, or ACL, connects the bones in the thigh and the shin. It’s one of four ligaments in the knee that help stabilize the joint.
ACL injuries are common in contact sports, especially those that involve pivoting and rapidly changing direction. Female athletes seem to be more susceptible—and soccer is the most popular sport for girls in San Diego. Kamryn was referred to Rady Children’s, whose sports medicine specialists are uniquely qualified to treat young patients. Rady Children’s physicians are board certified in sports medicine and undergo pediatric orthopedic fellowship training.
Kindred Spirits
When the Middleton family was introduced to the surgeon who would be repairing Kamryn’s knee, Rady Children’s pediatric and sports medicine surgeon Andrew Pennock, MD, they could tell she was in good hands.
“I’m always nervous around adults and doctors, but he was joyful and wasn’t scary at all,” Kamryn says. “He was just comfortable to be around, and when he talked about the surgery, it didn’t even seem that bad anymore.”
It also helped that Dr. Pennock had a personal connection to the case. As a former collegiate-level skier and club soccer player himself, he’d dislocated his knee and torn three ligaments when he was 17. He had surgery, and after about a year of recovery was able to compete again in both sports.
“Having that common shared experience, especially in high school—I missed my whole senior year—allows you to with patients and families,” he says. “I went through the same thing these young kids are going through and I experienced that frustration firsthand, but I also experienced the joy on the backside.”
Dr. Pennock explained the surgery to the Middletons and let them know what to expect, which further eased their minds. To reconstruct an ACL, surgeons remove the damaged tissue and replace it with a graft (made from tissue taken from her own body, in Kamryn’s case), then secure the new tendon to the femur and tibia. The procedure is typically done using minimally invasive arthroscopy as opposed to open surgery, meaning surgeons use a camera inserted through a small incision to guide their instruments.
“Dr. Pennock was a soccer player,” Scott says. “He had knee surgery himself and gave her an idea what to expect in the big picture and was very honest about it. It’s been that way the whole time.”
Kamryn’s surgery was scheduled for January 2021. Everything went well and she handled it like a superstar. ACL tears are most common in adolescence, so pediatric surgeons have their work cut out for them. When doctors plan their procedures, they must take into consideration whether the patient is done growing, usually around age 14 for girls and 16 for boys. Those who aren’t still have open growth plates where new bone is growing, which requires an approach that will allow them to finish growing safety. Fortunately, Rady Children’s physicians undergo specia ltraining to treat growing bodies.
“Getting to the most appropriate facility is important,” says Dr. Pennock.
The Road to Recovery
Diligent physical therapy is essential after ACL surgery. Kamryn began working with physical therapists in Ramona twice a week and was fitted with an adjustable orthopedic knee brace. At first her leg was locked in place, but as she progressed and movement became less painful, she was given a greater range of motion. Her physical therapists guided her through a series of exercises to gradually strengthen her leg and eventually regain her agility.
“You have to basically teach your brain again to use that leg,” says Scott. “That was the hardest part of the therapy, but as time went on she got her range of motion back fairly quickly, and she was walking and putting some weight on the leg within three months.”
In October 2021, Dr. Pennock gave Kamryn the go-ahead to start noncompetitive training on the field with her coaches, and in early February 2022 he gave her clearance to finally play again. There’s a multifactorial analysis to determine when someone’s ready to go back to playing, and he made the call for Kamryn based on her mental and physical readiness and the progression of her healing. The whole time, her intentions were to get back into soccer.
“I was really excited to play soccer again,” she says, “I got into watching soccer games, people play soccer, was obsessed with soccer players. I even started playing FIFA.”
Kamryn does have a little catching up to do on the field after more than a year on the sidelines. She also has to be extra careful to avoid reinjuring her knee. People who’ve had an injury are at much higher risk of having another in the future. She’ll also have to keep up the hard work at home— Dr. Pennock says if you stop doing the exercises, you’ll lose the benefits:
“There’s now pretty compelling data from multiple institutions showing that if you really continue with the dedicated ACL prevention program, about a third to half of particularly female ACL injuries can be avoided or prevented, so it really becomes an essential part of not only their rehabilitation, but their long-term priorities.”
Now Kamryn is champing at the bit to get back on the field. She’s been watching team scrimmages and working with a trainer who’s also a former soccer player. She’s working on her stability and balance and building up the muscles around her knee with exercises like lunges and squats using a Bosu ball. And her hard work is paying off.
“I was surprised that I actually pushed through it,” she says. “It feels good knowing that I actually was able to get through all this.”
Scott adds, “She’s ready to get back out there. She pushes herself with everything. She definitely has the drive.”
Published in the Spring 2022 issue of Healthy Kids Magazine