For her entire life, Emilie Miller was an athlete. She still is. But the road to return from a severe injury that interrupted her sports career was a long one. The trouble began in Miller’s sophomore year at DeSales University in Pennsylvania. One of a family of five athletes, Miller, majoring in early childhood education, was also a member of the basketball team. During a practice, she took a bad fall, her legs tangling with other players’. It caused a dislocated patella (kneecap), damaging the surrounding cartilage and throwing off the knee joint’s tracking alignment. The knee is guided by a complex joint that connects the two bones of the lower leg with the thigh bone. A tracking disorder, which can be caused by damage to surrounding cartilage or ligaments, means that the kneecap moves out of place, preventing its usual smooth gliding motion.
A Second OpinionAt an appointment with an orthopaedist, Miller was presented with stark options. One was extensive surgery with an unclear promise of desired benefit; the second was to do absolutely nothing and stop playing sports. “As active as I am, I didn’t like either of those options,” she says. In fact, she emphasizes, “hearing them crushed me.” Discouraged by that appointment, Miller sought out a second opinion. She had been a patient four years prior at University Orthopaedic Associates (UOA), when in high school she had injured the same knee. Her sister, a competitive gymnast, had also benefitted from the services at UOA. Miller wanted to return to the same medical practice, and her faith was immediately restored when she explained to Dr. Hosea the prior options given to her. Following an MRI, she was told that neither of those two options were viable: she was too young for the surgery described, and “doing nothing was not an option.”
The First SurgeryToday, the 24-year-old Metuchen, New Jersey native and elementary school teacher and basketball coach explains, “I felt like he really listened to me, who I was and what my plans, goals and dreams were going forward. I was an athlete. I played sports my whole life. I was not going to say, ‘OK, I’m done.’ I trusted the doctor right away. In fact, I appreciated every person there (UOA).” In January 2014, Miller underwent same-day surgery with a patella lateral release and realignment to repair the alignment issues. Following the procedure, her knee was immobilized for six weeks, after which she underwent physical therapy.
The DeNovo TrialBy June of that year, however, she says, “things didn’t feel right.” A follow-up MRI revealed a hole in the kneecap cartilage. It was then that the experts at UOA recommended Miller become part of a study for a DeNovo® NT Graft. This entails donor cartilage tissue used for the repair of joint cartilage. The DeNovo NT®, an FDA approved cartilage repair technique, is used on athletes from professionals to recreational. At least one study has found that among subjects tested, the DeNovo NT® used on the patella provided pain relief and improved outcomes.
Critical SupportAfter agreeing to be part of the study, Miller was introduced to Patricia Seuffert, MS, APN, the Research Coordinator at UOA. Patricia would prove to be a crucial support system for Miller. That’s because even with successful surgery, while she could do other sports (swimming, biking, running), she had to absorb the fact that her basketball career was over. The news was devastating, but she progressed from that devastation to hope. And she still had sports goals. “I was comforted both by Dr. Hosea and Patricia. I believed in them 110 percent. They deal with athletes all the time, even professionals. That was what I wanted going forward.” She waited the required year following her previous surgery, focusing on her studies and becoming a manager of her college basketball team to stay involved. Finally, the date for surgery was set. “We’re spending New Year’s together!” Patricia Seuffert emailed her. On December 30, 2014, she underwent the DeNovo procedure. It was followed by more knee immobilization, more time on crutches and more rehab. But her faith in her medical team helped sustain her.
Patients Come First at UOAThroughout regular check-up appointments, including at one and two years, Emilie Miller’s follow-up care was closely coordinated by Patricia. She scheduled appointments to accommodate Miller’s travel time from college in Pennsylvania to New Jersey. She was always in contact, and very supportive. “Every time I came into the office, it was a very pleasant experience,” relates Miller. “I knew they were giving me their best.” As time clicked by, the anxious athlete would ask Dr. Bechler and Dr. Gatt what activities she could try. She had a dream: to do an Ironman 70.3 (half Ironman). “At two years, they told me that everything looked good.” But how to proceed with exercise? She was counseled, “You won’t know until you try. Just listen to your body.” And listen she has. Progressing very carefully in training, she and her father have trained for and done two Ironman 70.3 events together, with a third planned. After the first one, in June 2017, Miller says that when she crossed the finish line, “I was overwhelmed to think of where I had been, and where I was at that moment.”
Ongoing SupportThrough it all, Miller remained close with Patricia Seuffert. “We’d communicate by phone and email. I felt it was not just about the medical appointments, but that the staff cared about me overall. They knew my end goals were big.” Next up for Miller and her dad: another Ironman 70.3, scheduled for June 2019. Following both of her Ironman events, Miller reached out to Patricia, “just to let her know how great everything was,” she said. “I always think of her and the UOA sports medicine doctors as such a big part of me getting to the finish line.”
UOA: Cutting-Edge Procedures, Human TouchIf you have sustained a sports injury, request an appointment with one of the sports medicine experts at UOA. We’ll determine the nature of your injury and provide treatment options that work for you and your lifestyle. We’ll work around your schedule, and you’ll be able to schedule appointments at the UOA locations that are most convenient for you.
When the state finals were over, Bridgewater Raritan High School senior Allison Lynch knew her high school soccer career was over, too. But she wasn’t dwelling on that. Allison, who was sidelined by a knee injury earlier in the game, was worried she wouldn’t be able to play at Rutgers in the fall as planned. “I was going into a tackle, my leg got twisted, a girl fell on it and my knee just popped,” said Allison, 17. She headed for the bench, tried to walk it off and re-entered the game a few minutes later. She took one step sideways and her leg collapsed. That was it. “My trainer said it wasn’t looking good, but I was stubborn,” said Allison. “I kind of knew in my head that something was wrong, but once I fell I knew for sure.”
The Diagnosis: ACL TearAllison and her mother, Jennifer, went to a walk-in clinic for an MRI, which confirmed what the Lynch family and the BRHS athletic staff feared: a complete ACL tear. Thinking quickly, Jennifer and Allison called the Rutgers coaching staff, who recommended they see Dr. Charles Gatt at University Orthopaedic Associates. Once they arrived at UOA, Jennifer and Allison knew they’d made the right decision by choosing Dr. Gatt. “He was super nice and he made me feel a lot better,” said Allison. “He told me a lot about the knee’s structure and the injury. It seemed like he had a lot of experience. He was honest but still made me very comfortable.” “Dr. Gatt was very thorough,” added Jennifer. Allison’s MRI showed a complete tear through the ACL, so surgery was the only option. It was scheduled for December 6—not quite three weeks after the November 18 injury—to allow the swelling in the knee time to go down.
About the ACLAnterior cruciate ligament (ACL) tears are some of the most common sports injuries. The ACL connects the femur (thigh bone) and the tibia (shin bone). Its job is to keep the tibia from sliding out in front of the femur and to provide side-to-side and rotational stability. Allison fell when she stepped to the side because her ACL was in two pieces and couldn’t provide the necessary stability to the knee joint.
ACL Reconstruction: Bone-Patellar Tendon-Bone Graft“Dr. Gatt knew right from the get-go that Allison would need surgery,” said Jennifer. He decided the best way to help Allison would be to perform an ACL reconstruction using a technique known as bone-patellar tendon-bone graft. This procedure used tissue from Allison’s own body—called an autograft—in this case the patellar tendon (actually a ligament), which normally connects the kneecap (patella) to the tibia. Dr. Gatt first removed Allison’s damaged ACL. Then he drilled small holes in both Allison’s femur and her tibia. He removed part of the patellar tendon and threaded it through the holes to connect the two bones. In this patellar tendon autograft procedure, the tendon acts as a scaffold for new tissue to grow and reinforce the bond between the femur and the tibia.
Recovery and RutgersAllison will attend Rutgers University in the fall, where she plans to play soccer and study exercise science and special education. “Right when my injury happened, I was thinking of my college career and recovery,” she said. “Will I be ready and strong enough for pre-season?” It’s looking likely that she’ll be ready. “They say recovery can take six to 12 months,” said Allison. “I’m really shooting for six months. That would take me right to preseason.” Allison needed no painkillers stronger than Tylenol after her surgery. “It was more discomfort than pain,” she said. “The worst pain was 24 hours after the surgery, and even that wasn’t so bad.” Dr. Gatt prescribed the ON-Q Pain Relief System to Allison, which he believes helped enable her to have a painkiller-free recovery. The ON-Q is a pump that gradually delivers a local anesthetic for three days after surgery, which will keep the worst of the pain away as healing begins. “It is used for knee and shoulder surgeries and has proven to be very effective,” said Dr. Gatt. Allison said she kept as active as she could in order to distract herself, and that having her mother and father close by was a big help. “I had good company,” said Allison. “I iced my knee a lot. Every time I would get uncomfortable I would crutch around the house, then sit down and ice again. It helped.” Allison and Jennifer credit the ease of Allison’s recovery so far to the team at UOA. She said the physical therapy team and Dr. Gatt have been in constant contact both with her family and with each other. “It’s all connected at UOA,” she said. “I’d be in PT and Dr. Gatt would swing by to make sure everything was going well. It’s been really great and I highly recommend rehab at UOA.” Jennifer agrees. “Dr. Gatt has been very accessible and responsive,” she said. “We got a little nervous about Allison’s incision at one point, but Dr. Gatt called and let us know everything was fine.” “They’re so great at UOA,” Allison said. “The PT team sets goals for you week by week. About two weeks after surgery I had full range of motion. I was able to bike a week after surgery. Six weeks in, I see a big difference already.” If you’ve sustained a sports injury, request an appointment with the sports medicine specialists at UOA. We’ll diagnose your injury and create a treatment plan that works for you and your lifestyle, from conservative therapy or surgery to recovery and beyond.
I went to the Center For Rehabilitation & Sports Excellence on advise from a neighbor. I first had to rehab my achilles heel and was extremely satisfied with the program and results with Ryan Kay. A true professional. A few months later, I fell and dislocated my shoulder. I elected to wait a week to get evaluated and onto Ryan's schedule. The best decision I made. The progress has been steady and results are excellent. The shoulder is complicated and takes time. He evaluates your progress and makes needed adjustments. In working with Ryan, you become confident you are on the right track. You want to work and you become diligent at home with his prescribed program. The facility is state of the art with all equipment. The support staff is extremely accommodating and courteous. I have and will continue to recommend to anyone Ryan Kay for your rehab needs.
…That’s how Dr. Jeffrey R. Bechler of UOA describes his role as head orthopaedic consultant for Princeton University’s football team. And that’s exactly what happened during Mike Zeuli’s freshman year game. When the pile on top of Zeuli dismantled, Bechler could see the player’s leg bent at an unnatural 90-degree angle from all the way across the field. Watch the story of Zeuli, who with Bechler’s help, went on to become the 2014 Ivy League Co-Defensive Player of the Year and then later sign a rookie minicamp deal with the NFL Philadelphia Eagles in 2015…
“I am forever indebted to Dr. Doumas. I think he is an amazing doctor. He saved Ariana’s opportunity to compete. He will now be on board our team as she grows in the sport.” Read Ariana's Story
Dr. Gatt is awesome. Love his approach to my recovery. Recommended PT over surgery & meds 1st. UOA PT @Monmouth is unbelievable - from my very 1st encounter w/ Kendall over the phone. Super friendly & knowledgeable. Lynn & her staff are wonderful especially Jess who attended my PT. She was patient and kind. She always answered all my questions with her knowledge and was always understanding. I really will miss seeng these girls every week. This is a very friendly and fun atmosphere aside from all the hard work that needs to be done but they make it bearable and actually enjoyable. I recommend UOA to anyone without hesitation.
This is my daughter Shannon’s second time at physical therapy for a knee injury from gymnastics. She worked with Neveen who was awesome! After her evaluation of her injury Neveen work with Shannon to provide her with the best exercises to help her. She gave her challenging skills to strengthen her knee which truly helped. During her time at PT Shannon did have to have her knee taped and Neveen was so helpful in showing my daughter how to tape when she couldn’t be at PT. I would highly recommend this organization and Neveen to friends and family. It was easy to work with her and the staff for scheduling and appointments. Thank you to Neveen for everything!
Jake Bobal keenly remembers a pivotal high school football game during his junior year. It was the third quarter in a regular season game against Somerville. The Montgomery High School middle linebacker planted his foot during a tackle. He continued to fall, but his leg stayed rooted to the ground. “I first heard the pop, and I was helped up, took one wobbly step and my whole leg collapsed. I realized it was not good.” [...] Read Jake's Story
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