Back on the Court Teen undergoes orthopedic surgery to repair severe cartilage damage and bone decay in elbow
arter Gresham already had an orthopedics appointment scheduled at CHKD when his elbow gave out in the middle of tryouts for Coastal Virginia Volleyball Club. The Western Branch High School junior felt a sharp pop while serving the ball and was overcome with excruciating pain. In that moment, Carter realized he could no longer go on playing volleyball. For the past two years, the Chesapeake teen had pushed through constant pain in his elbow so he wouldn’t have to give up the game he loved so much. At Carter’s first appointment with Dr. Stephanie Pearce, a sports medicine and orthopedic surgeon at CHKD, he couldn’t straighten his left arm at all. It was permanently bent as if he was trying to flex his bicep. Imaging tests revealed why: His capitellum – the end of the upper arm bone that creates the elbow joint – had broken into two pieces. He learned the damage was caused by osteochondritis dissecans (OCD), a condition that occurs most often in children and adolescents, who may experience symptoms for years before seeking treatment. “It is less of an injury and more a disease process,” Dr. Pearce says. With OCD, bone and cartilage can break loose from a joint, causing pain and limiting motion – and in severe cases, the bone can die from lack of blood flow. Once the bone becomes unstable, only surgery can help repair the joint and improve its function. Although the idea of going under anesthesia scared him, Carter agreed to the surgery. Like many high-level athletes, Carter, a quiet teen, got much more out of volleyball than just being a competitive player. He enjoyed the confidence that came from his position as the team’s setter, controlling the pace of the game and making quick decisions on the court. If he wanted to pursue his dreams to play volleyball in college, Carter knew his best shot was to have the surgery and work with sports medicine physical therapists to regain his strength and mobility.
Operating on the elbow can be tricky due to the small treatment area, says Dr. Pearce, who specializes in complex knee, elbow, shoulder, and hip conditions. During her fellowship at the renowned Steadman Clinic in Vail, Colorado, Dr. Pearce focused on cartilage preservation and advanced arthroscopy, honing the skills necessary to help athletes like Carter. To remove the damaged cartilage and repair Carter’s elbow, Dr. Pearce used arthroscopy, a minimally invasive technique that involves inserting a tiny video camera and other tools into the joint through small incisions. During the procedure, she discovered Carter’s OCD was so advanced that a portion of the bone was gone, creating what looked like a pothole. “Dr. Pearce told me it was the second-worst case she had seen in her life,” Carter says. After drilling holes in the damaged area to encourage blood flow, Dr. Pearce filled the space with donor cartilage that works like scaffolding and allows cartilage to regrow into the area. Due to the size of the defect, Dr. Pearce planned for a second, larger surgery after the arthroscopy procedure if Carter’s symptoms continued through his postoperative recovery. Carter went home that same night. Only time would tell if he would need any further procedures. Three days after surgery, Carter had his first of many visits to CHKD’s Sports Medicine Physical Therapy Center at Harbour View in Suffolk, where he worked with physical therapists specially trained to help young athletes recover and get back in the game. Each time Carter would visit Dr. Pearce during his recovery, he would ask about playing volleyball again. It wasn’t until his brace came off that he finally heard
WRITTEN BY Alice Warchol • PHOTOGRAPHY BY Ken Mountain
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Children’s Hospital of The King’s Daughters