Teen Athlete as Strong as Ever After ACL Tear

Nora Whelan, age 16, is happiest when she’s playing basketball or volleyball.

“She has never once said that she didn’t want to go to practice,” says her mom, Trine. “She’s very self-driven.”

The Fremont High School sophomore lives and breathes sports, and basketball is her favorite. She plays on her school’s varsity basketball and volleyball teams, and for Team Norcal Basketball Club.

That’s why, when Nora tore her anterior cruciate ligament (ACL) going for a layup and landing wrong the summer before starting high school, she never once gave up. She was determined to get back on the court, which meant overcoming knee surgery and long months of physical therapy.

“It was terrible timing, right before joining her new high school teams,” Trine says.

When the injury happened, Nora left the court saying her knee hurt and felt funny. She figured she had sprained it and applied ice that evening. The next day, she attended the first day of an outdoor summer camp. Her knee didn’t hold. “I went for a short hike, but my knee was sore, and I couldn’t really bend it,” says Nora.

The Sunnyvale family brought Nora to Stanford Medicine Children’s Health – Pediatrics in Los Altos to see their pediatrician, Amy Oro, MD. Dr. Oro recommended an innovative rapid MRI that’s unique to Stanford Children’s, thanks to research by Shreyas Vasanawala, MD, PhD, chief of pediatric radiology. It provides fast, high-quality 4-D images of the knee and ankle. The rapid MRI takes just 15 minutes and often can be done on the same day or within a few days of injury, so families don’t have to wait for results.

With the MRI in hand, Charles Chan, MD, pediatric orthopedic surgeon with the Stanford Children’s Sports Medicine Program, took a look and saw that Nora’s ACL was definitely torn. She would need surgery, and she would miss playing with her new teammates over the summer.

“Nora doesn’t ask for much, but she had one request. She didn’t want to start high school on crutches,” Trine says.

Getting ACL surgery at Stanford Children’s

The family was able to quickly consult with Dr. Chan and schedule surgery. “Receiving all of her care with us meant everything fell into place and there were no roadblocks,” says Dr. Chan. “We schedule surgery as soon as possible and make sure patients never have to wait for physical therapy (PT). Our wait list for PT can be long, but our commitment is that once a child has a surgery, we make sure they start on time and move along consistently, because healing cannot wait.”

Dr. Chan performed a quadriceps tendon graft surgery for Nora, a method that has been shown to provide excellent outcomes. He harvested a piece of a tendon from her quadriceps and used it to replace the torn ligament in her knee. The quadriceps has strong tendons that help provide strength and stability to the knee after surgery, and since it came from her own body, there was a low risk of rejection.

“We do a large number of this ACL surgery as a team, because research shows it has good outcomes, including a stronger hamstring and less pain in the anterior knee in the long term for patients,” Dr. Chan says.

The Stanford Children’s pediatric sports medicine doctors are active in national research on ACL tears that involves dozens of pediatric centers. “The power of the ACL research registry is access to a large pool of data across multiple centers, not just ours, so we can objectively see which surgical methods give children the best outcomes,” Dr. Chan says.

Nora’s surgery was performed on an outpatient basis, and she returned home that evening. During the surgery, she was cared for by a pediatric anesthesiologist, an extra that only dedicated children’s hospitals tend to offer.

Just as Nora wished, she was able to start her high school career without crutches, but months of physical therapy lay ahead. Instead of being on the court with her classmates, she watched them from the stands.

“I still wanted to be a part of the team,” Nora says. “I went to every practice and watched them play and learned what I could bring to the team.” Her coach was very understanding, reassuring her that she had a spot on the team when she was ready.

Enduring physical therapy with perseverance and grace

ACL tears often take months of physical therapy to rehabilitate, so finding the right fit is important. “We toured several clinics in our insurance network and saw a lot of older people rehabbing. When we came to Stanford Children’s, it was full of young, teenage athletes working out in a wonderful gym. It was a game changer,” Trine says. She appreciated the integrative approach of Stanford Children’s, and how all of the providers communicate with each other and were very aligned on Nora’s care.

Dr. Liu and Nora

Timothy Liu, PT, DPT, worked with Nora two times a week for over eight months to restore her strength. He progressively focused on basketball moves, such as running, jumping, landing, and other exercises to help strengthen the ACL, which helps athletes make quick cuts and twists.

Dr. Liu introduced Nora to weight lifting and was impressed by her commitment. “Nora enjoyed resistance training and worked out on her own outside of rehab. That was a huge plus for her recovery,” he says.

Nora also tapped into Stanford’s Success in Youth Sports Clinic, which provides mental health support to kids, helping them build confidence and feel ready to return to sports.

“Rehab can be especially tough on kids early on, when the end point seems so far away,” Dr. Liu says. “Nora did a great job staying focused on short-term goals and on her ultimate goal to return to basketball at a high level.”

Dr. Liu also credits Trine and her husband, Chad, for supporting Nora in just the right way—providing encouragement while giving her autonomy so she could take ownership of her recovery.

“It never felt like work,” Nora says. “I wanted to go and get better. Tim made it fun, so it kept me wanting to come back.”

Movement testing at the Stanford Children’s Motion Lab

One advantage of Stanford Children’s is the Motion Analysis and Sports Performance Laboratory. The lab is loaded with high-tech equipment to provide precise measurements of joint motion and muscle activity. A video analysis also shows a young athlete’s movements and helps guide physical therapy and readiness to return to sport. There’s nothing quite like it in the Bay Area and very few comparable labs on the West Coast.

“We have advanced tools to objectively quantify movement patterns and see imbalances after surgery,” says Deborah Callahan, ATC, athletic trainer with the lab. “Nora’s tests looked really good, even when we zeroed in on her knee.”

Traditionally, physical therapy clinics use 2-D measures, such as jump tests, to see weaknesses and imbalances after an ACL injury, but subtle shifts in weight can get missed by the naked eye and set athletes up for more injuries down the road. “We offer the ability to look at movements in 3-D, do full body scans, and analyze kinetics for both sides of the body independently,” Callahan says.

Nora had her Motion Lab testing 10 months into her expected 12-month rehabilitation. Because she did so well, Dr. Chan felt comfortable letting her return to sports early. Nora was happy to get back on the court with her team.

“Since I got great results on the Motion Lab tests, I could take a breath and say: I am healthy and I can go back to basketball,” Nora says.

A surprise in the stands after recovery

During physical therapy, Dr. Liu becomes very invested in his patients’ successes, so much so that he often goes to watch them play after recovery. “It’s my reward to see them back doing what they enjoy,” he says.

Dr. Liu and Nora

Dr. Liu came to one of Nora’s basketball games, relishing her quick movements and skill on the court. Afterward, he met up with Nora and her family for a picture.

“It was really nice to see him in the crowd, and afterwards,” Nora says. “After tearing my ACL, I worried I was at the end of my basketball career, but with his help, and the rest of the care team, I’m running and jumping great, and I feel stronger than before.”

While she missed her freshman season, Nora got to play her entire sophomore season of varsity basketball, including a recent trip to playoffs.

“I am not worried about my knee. I trust it,” she says. “The whole experience made me mentally stronger. It was devastating, but I persevered. I had people in my corner that I could trust—my family, my friends, and providers at Stanford Children’s.”