BY G.N. Covella
Publisher, GolfStyles New Jersey
When my daughter Caitlyn crumpled to the floor holding her right knee during a high school basketball game on January 18, 2013, the sight was all too familiar. As a former sports editor, a long-time coach in basketball and lacrosse – and a sports fan for a lifetime – I have witnessed serious knee injuries all too many times. And in that millisecond when Caitlyn’s knee buckled, I knew that her high school sports career was over.
As a parent of two girls who enjoyed athletic competition throughout their school years, I am well aware of statistics that show serious knee injuries in females are occurring at a record pace across the country. ACL, MCL, LCL, PCL … name a ligament and chances are good that a young lady has either seriously strained or torn one. According to many published reports, one key reason for this epidemic
CASE STUDY: Young athlete chooses PRP treatment over surgery after tearing ACL; returns to sports 7 weeks later
Caitlyn Covella receives PRP injection from Dr. Brian Shiple, DO. in his Springfield, PA office. The treatment helped Covella avoid reconstructive knee surgery and return to play her senior lacrosse season after injuring the joint in a January basketball game.
For those golfers who face the reality of joint replacement surgery, Dr. Brian Shiple, DO, said PRP or stem cell therapy is certainly a viable alternative. “Yes, absolutely, if the joint is not too far gone. Generally bone-on-bone arthritis has about a 50-to-60 percent chance of getting better enough to return to pain free or nearly pain free golf. Moderate and milder forms of arthritis have an 80-90 percent chance of feeling great and doing well for a long period of time.”
of injuries is quite simply the design of the knee in women: the joint through which the anterior cruciate ligament passes, along with the actual size of the anterior cruciate ligament, is significantly smaller in women than in men, causing incredible stress on the knee and a higher risk of injury. That’s a fact.
For Caitlyn, who was a three-sport star in high school – her favorite sports being soccer and lacrosse - the MRI confirmed our fears: tear of the Anterior Cruciate Ligament, possible tear of the Meniscus along with the bone bruise that occurs at the moment when the ACL gives way, causing the bones of the knee to shift out of place, rub against one another causing a bruise on the joint. The orthopedist recommended reconstructive surgery, taking a piece of Caitlyn’s Patella tendon and using that to create a new ACL. She would need eight months to a year of rehabilitation before returning to serious athletic competition.
No more high school basketball. No more spring lacrosse. No fall soccer in college.
Caitlyn was not ready to accept the reality of her situation.
“Dad, is there a way that I can still play without having the surgery?” Caitlyn asked when hearing the doctor’s prognosis. “Is there a way to play lacrosse?”
I looked at the doctor. There was no hesitation as he spoke.
“Caitlyn, the fact is you have a torn ACL. You can attempt to strengthen the knee and play with a brace but chances are with the extent of the injury it will not allow you to play at a high level,” he said. “I know this isn’t what you want to hear. I’m sorry.”
But Caitlyn would not be deterred. Spring lacrosse season was coming up. She had her sights set on breaking the school’s all-time scoring record. There had to be a way for her to compete.
A Glimmer of Hope
As soon as we returned home from the orthopedist’s office, we searched the Internet for alternate therapies for ACL injuries. While most recommendations centered on surgery and specific rehabilitation on the knee, we were intrigued by online stories about stem cell therapy and something else called Platelet Rich Plasma (or PRP) therapy. In reading more about stem cell and PRP treatments, we were fascinated by the testimonials of many athletes who claimed full recovery from joint injuries through these cutting-edge procedures.
“Dad, I think this might be something that will help my knee,” Caitlyn said. “Can we look into this?”
“Sure,” I told her. “If there is a chance to heal your knee without surgery ...”
After looking into more than a dozen facilities that specialized in stem cell and PRP treatments for athletes, we contacted Dr. Brian J. Shiple, DO, of The Center for Sports Medicine in Springfield, PA, just west of Philadelphia. Doctor Shiple was one of the area’s foremost experts on stem cell and PRP therapies and had received recognition for his work with athletes of all ages in their recovery from serious joint injuries.
We forwarded Caitlyn’s MRI to Dr. Shiple’s office, set up an appointment, and prayed for a miracle.
The Doctor’s Opinion
Upon meeting Dr. Shiple in late February, he carefully examined Caitlyn’s knee, checking for the instability in the joint that is a signal of a tear or strain. He then scanned the dozens of MRI images of Caitlyn’s knee and confirmed the original orthopedist’s opinion: tear of the ACL and bone bruise. As for a tear of the Meniscus (the rubbery, c-shaped disk that cushions the knee), Dr. Shiple wasn’t convinced that an injury existed.
But there was a reason to be optimistic, Dr. Shiple pointed out.
“It doesn’t appear to be a complete tear (of the ACL),” he said. “If that is the case, PRP could repair the ligament and I believe that Caitlyn will have a complete recovery.”
“Without surgery?” Caitlyn asked.
“Yes, without surgery,” Dr. Shiple said. “You are young, strong and with this type of injury a perfect candidate for PRP.”
“Is there a chance I can play lacrosse?” Caitlyn asked.
“When is your season?” inquired Dr. Shiple.
“Well practice starts in a week but the regular season games don’t begin until mid April,” Caitlyn said.
“That leaves us about seven weeks,” he said, glancing at his calendar. “We get the PRP done as soon as possible and I believe you will have a chance to play.”
While celebrating in this news, Dr. Shiple also pointed out the reality of any medical treatment.
“Of course, whether it’s surgery or (non-invasive) PRP, we are still talking about the human body and there are no guarantees,” he said. “But I do feel strongly that PRP will provide the necessary healing to allow Caitlyn to resume her athletic career.
With that news, we decided as a family to try the PRP therapy and prayed that there would be a healthy outcome. By choosing this option, it provided Caitlyn a glimmer of hope that she could compete in spring sports and “if the PRP doesn’t work, I’ll have surgery,” Caitlyn said.
A week after her evaluation with Dr. Shiple, Caitlyn was back in his office for the PRP treatment. As we waited for the doctor, his assistant Julia Barnett explained the process: she would draw two large syringes of Caitlyn’s blood from her arm, then place the blood into numerous small glass tubes which would then be placed in a centrifuge. The centrifuge would separate the platelets of the blood from the plasma and the platelets, which contain hundreds of proteins called growth factors which are very important in the healing of injuries, would be injected by the doctor into both the general area of the injury and, more specifically, directly into the remaining ACL fibers to promote healing. If all worked well, this injection would help promote healing in the damaged ACL and, hopefully, allow Caitlyn to resume her sports career.
As Julia returned with the vials of harvested platelets she explained that the centrifugal process was a success and Caitlyn’s platelet count was nearly two times the norm.
“She’s definitely healthy,” Julia smiled. “The more platelets the better.”
“Platelet count is great,” Dr. Shiple echoed. “Let’s get it done.”
With that, Caitlyn’s procedure began. First, with Caitlyn on the treatment table, Dr. Shiple used an ultrasound machine to locate precise locations in the joint and then injected the platelets into these regions of her knee. Approximately five minutes later, Caitlyn was moved into a nearby treatment room with another treatment table and large x-ray machine.
Using the x-ray machine to see Caitlyn’s knee, Dr. Shiple then injected a dye into the damaged ACL. Almost immediately, Caitlyn’s damaged ACL showed up as a large dark strand on the x-ray monitor. Using this as his guide, Dr. Shiple injected the remaining platelets into the ACL, more specifically, into the area of the ligament that connected to the bone where the tear was most severe.
No more than 15 minutes later, the treatment was complete and Caitlyn was wheeled to our car. Her directive from Dr. Shiple: with the knee reacting to the treatment, Caitlyn should expect swelling for a few days. Once the swelling subsided she could begin moving on the leg. In three to four weeks, she could begin more active rehabilitation and, in six weeks, could begin running.
As for lacrosse, “put a brace on and work your way back as your knee feels stronger,” Dr. Shiple advised Caitlyn. “Let your body tell you how much you can do.”
Success on the Field
Less than seven weeks later, with a special ACL brace to protect the healing joint, Caitlyn played in her team’s first lacrosse game of the year, scoring six goals and an assist. As to be expected, she was tentative making hard, cutting moves on the knee but reported no problems with the knee.
She played in every game during the year and in the process established a school record for career points, goals and assists. All the while, the knee held up and, with icing after each game, Caitlyn experienced no discomfort in the joint.
The Follow-Up MRI
Caitlyn had an MRI on her knee in early June. The results showed almost miraculous healing of the ACL and little evidence of the bone bruise. There was no sign of any damage to the meniscus.
Upon Dr. Shiple’s recommendation, Caitlyn underwent a second PRP treatment in early August “as an insurance policy to make sure the ligament continues to heal and strengthen,” the doctor explained.
The second treatment went well and Caitlyn entered the University of Connecticut as a freshman in August.
With no lingering effects from the ACL injury, she has her sights set on playing club soccer at UConn this fall and, in the spring, will accept an invitation from the lacrosse coach in an attempt to make the varsity team as a “walk-on.”
While there are certainly no guarantees that she will realize her dream of playing major college soccer or lacrosse, the simple fact that she has an opportunity to compete on a knee that suffered a substantial injury one year earlier - without reconstructive surgery and long rehabilitation – speaks volumes about new-era treatment options available to men, women and children in America today.
... IN THE AC CHALLENGE
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