Avery runs into a healthy future

A few weeks before she woke up and couldn’t straighten her leg, Avery Ricks had been a standout runner on her school’s cross-country team in Idaho. Avery, then 11, had been a little sore toward the end of the cross-country season. One morning, the pain suddenly intensified to the point where she couldn’t even put weight on her leg.

An x-ray revealed a lesion on her knee bone. Avery was seen by pediatric orthopedic surgeon Kevin Shea, MD, who diagnosed her with osteochondritis dissecans, an injury to the knee cartilage.

Cartilage wraps around every joint in our bodies to protect our joints and help them move easily. A knee injury can sometimes block the flow of blood to that cartilage, which makes the bone soften. Over time, the cartilage becomes damaged, and this can cause intense pain like what Avery experienced.

Further examination revealed that Avery had osteochondritis dissecans in both knees, which happens in about 30 percent of cases. Although the condition is uncommon, Dr. Shea is an expert in diagnosing and treating osteochondritis dissecans.

“It’s not a very common condition, but we’re starting to see it more and more in highly active young athletes,” Dr. Shea said. “Since it’s a rare condition, it frustrated me that there wasn’t a lot of data available to help us make the best recommendations to our patients. In 2010, I co-founded the Research on Osteochondritis Dissecans of the Knee (ROCK) study group, which now has more than 50 doctors and researchers around the world sharing their research so we can offer the best evidence-based treatment.”

In Avery’s case, Dr. Shea recommended non-surgical treatments first. He had Avery wear braces and try to reduce pressure on her knee joints. That didn’t solve the issue, so after consulting with Dr. Shea, Avery and her family decided on surgery.

Dr. Shea operated on Avery’s left knee in February 2018. Avery’s mom, Angela, said it was a challenging time for Avery, but her positive spirit got her through it.

“It was hard for Avery to get around with two leg braces and to be on crutches in middle school,” Angela recalled. “But the first surgery went well and her knee healed. Avery has handled it really well. She’s been extremely positive.”

In the time between Avery’s first surgery on her left knee and the second surgery for her right knee, Dr. Shea joined the team at Stanford Medicine Children’s Health.

The Ricks family had built such a good rapport and established so much trust with Dr. Shea that when it came time to operate on Avery’s second knee, they gladly made the trip from Idaho to Lucile Packard Children’s Hospital Stanford in California. “Since he did the first surgery and it was so successful, we wanted to go back to him for the second surgery,” Angela explained. “He’s also an expert in osteochondritis dissecans, so we felt most comfortable with him doing the surgery.”

Avery had her second surgery at Lucile Packard Children’s Hospital Stanford in July 2018, and Angela said she appreciated how much the care team focused on the needs of their patients.

“Everyone was extremely kind,” Angela remembered. “Avery is super scared of needles, so when the nurses brought in a needle to start her IV, she started crying. The nurses said they could do it after they put her to sleep instead, which was very helpful. They didn’t do that in Idaho, and it was a little traumatic for her.”

After the second surgery, Avery was back to using crutches and then wearing a leg brace. She is hoping to get her second brace off next month.

“She’s doing well. Her knees still get pretty sore because she hasn’t used them, but we’re hoping physical therapy can help with that,” Angela said. “She’s pretty healthy and happy to be able to do normal things like ride her bike.”

Dr. Shea and Avery are both optimistic that she’ll be able to get back to running once she has fully healed. Even though she’s back in Idaho now, Dr. Shea has continued to check on Avery’s progress.

“Doctors can’t solve these problems by ourselves. Everything we do is a team effort with the patient, the parents who support their children through these tough times, and the physical therapists and trainers who help kids recover,” Dr. Shea noted. “Injuries are hard on kids and parents because they can’t do the activities they love. Forming this really powerful team to solve these problems means it’s more likely we’ll be successful and everyone will get back to a lifetime of healthy movement.”