Soccer Star’s Hard Work Helps Her Recover From ACL Tear in Record Time

Alessandra came back for her senior night, and she came back stronger

When 18-year-old Alessandra Hartwig stepped onto the soccer field for the last home game of her high school career, she had a strange goal: to earn a yellow card.

To Alessandra, getting a yellow card—a warning for aggressive play—would mean she had fully recovered from tearing her anterior cruciate ligament (ACL), which stabilizes the knee.

The injury occurred less than a year earlier, when Alessandra played in her team’s last league game before the playoffs. She plays outside back, a defensive position, and was running to stop an approaching player from the opposing team.

“As I stepped, before I even touched the ball, everything felt really weird,” she said. “I fell to the ground and was in so much pain for 10 seconds and then it was gone.”

Alessandra with Stephanie Mock, ATC

After Alessandra was taken off the field in a golf cart, Stephanie Mock, ATC, an athletic trainer (AT) with Stanford Medicine Children’s Health, helped her get fast access to needed care. Mock is part of a team of 14 ATs who provide emergency medical support, education, and injury prevention training as part of the Stanford Children’s Young Athletes Academy.

When Alessandra met with Kevin Shea, MD, a pediatric sports medicine surgeon at Stanford Children’s, she was crushed to learn she had torn her ACL and needed surgery.

“They tell you the average amount of time it takes someone to recover because they don’t want to get your hopes up, so they told me I wouldn’t be able to play soccer my senior year,” she said. “I was so sad because I was really looking forward to being a leader on the team and senior night.”

And so began Alessandra’s quest to get back to soccer as quickly—and safely—as possible.

While Alessandra waited for the swelling in her knee to go down so she could have surgery, she exercised with Mock every day to increase her mobility and strengthen her leg muscles. Mock had discussed Alessandra’s injury with Katie Susskind Risso, MAT, ATC, another AT who works with Dr. Shea in the clinic.

Dr. Shea, a surgeon for almost 30 years and a prolific researcher on pediatric knee anatomy, recommended a quadriceps graft for Alessandra because data shows they have lower risks of retearing and chronic pain, although rehabilitation takes longer.

After the surgery, Alessandra was in considerable pain and stayed in bed or a recliner for two weeks. She struggled with the loss of independence and ability to move. It was frustrating trying to navigate her school’s large campus on crutches, and especially hard when friends would ask her when she could play soccer again.

“In my head, it felt like everything I wanted to do, I couldn’t do,” she said. “I couldn’t walk my dog, or run, or play soccer, or ski, or even run up to someone and hug them when I was excited to see them. I’m a super-bubbly person, so it was really hard not being able to express that physically.”

Two weeks after surgery, she started physical therapy.

Alessandra with Robert Pardue, PT, DPT

“After someone has had an ACL injury, they enter a high-risk category,” said Dr. Shea. “The risk of retearing the ACL that has been reconstructed, or the other ACL, is as high as 35% within three years. We also know that patients who are optimally rehabbed have a lower risk of repeat injury.”

Alessandra and her physical therapist at Stanford Children’s, Robert Pardue, PT, DPT, connected over their shared love of soccer.

“I also played soccer in high school and beyond, and also went through rehab due to soccer injuries, so that helped us build rapport,” he said.

At first, a lot of Dr. Pardue’s exercises focused on strengthening her quadriceps muscle.

“It was frustrating at first,” Alessandra said. “I was flexing my quad and nothing was happening. Then slowly, it was like, ‘Oh my gosh, I have some muscle definition.’”

Alessandra pushed every member of her care team to keep the momentum going.

“I asked everyone, ‘I know one year is the normal recovery timeframe, but if I were to be ready before then, what would I be doing?’” she said. “I really wanted to make sure I was doing the most I could do.”

Alessandra’s consistency and hard work started paying off as she celebrated milestones like walking without crutches or bending and touching the floor. Dr. Pardue and Mock were her cheerleaders, knowing the work that went into every achievement.

Alessandra soon tried jogging with Mock’s encouragement. By the end of a summer trip, she was running a mile without stopping.

“I was so happy, I skipped afterwards through the streets, beaming,” Alessandra said. “I was so proud because I worked up to it and did it earlier than anyone said I would be able to.”

When she resumed physical therapy at Stanford Children’s, she was rewarded with starting soccer-related movements, including exercises that would prepare her for contact.

“I remember one exercise where I was sprinting back and forth between these giant weighted balls and body-slamming them, and I was giggling the whole time,” she said.

Dr. Pardue said Alessandra always brought her “light-up-the-room personality” to PT sessions and helped inspire other patients.

“One of the biggest benefits of our rehab gym is that teenage patients are surrounded by other teenagers who are also high-level athletes,” he said. “Being here feels more like a community.”

As one of the last stops on her recovery journey, Alessandra visited the Stanford Children’s Motion Analysis and Sports Performance Laboratory. The lab uses technology to capture an athlete’s strength and motion and translate it into data to inform decisions about whether they are ready to return to sport.

The lab’s “numbers don’t lie” approach helped Alessandra’s care team feel confident that she was prepared to return to soccer.

“Our role is to objectively determine if patients are both physically and psychologically prepared to return to their sport while minimizing reinjury risk,” said lab supervisor Chao-Jung Hsu, PT, PhD.

Armed with the lab results, Alessandra met with Dr. Shea, who cleared her to return to soccer if she and Dr. Pardue developed a plan to do so safely.

Just 10 months after surgery, Alessandra started attending soccer practices again. Derek Asilo, ATC, another Stanford AT who works at Alessandra’s school, was there to connect how Alessandra was doing on the field and her care team in the clinic and to address any issues immediately.

Asilo also taught Alessandra and her teammates injury prevention techniques, especially with the rising rates of ACL tears among young female athletes.

“I always try to educate the athletes I work with on how they can warm up more effectively, how they can strengthen their muscles, and why this is important,” he said.

Alessandra was soon back to contact drills and then games, first a few minutes at a time and working up to an entire half. When her senior night game rolled around, she played the whole game and even earned the yellow card she had hoped for.

“I was so proud because it showed that I was back to being aggressive, that I wasn’t scared of hurting myself again; I was back exactly how I was, if not stronger,” she said. “My team knew I wanted the yellow card, so when I got it, the whole bench jumped up and celebrated.”

Dr. Pardue cheered on Alessandra from the stands.

“It was so awesome to see her in her element,” he said. “She’s so bubbly and energetic, but has this other super-competitive side as an athlete. Seeing her play—getting into tackles, not backing down—these are the highlights of my job.”

Alessandra’s team made it to the semifinals of the playoffs to cap off the season.

“It was so much further than any of us thought we were going to go,” she said. “I’m so happy to have so many wonderful teammates who helped me and cheered extra-loud for me because I had been through so much.”

Alessandra is graduating this spring and will attend college next fall. While not planning to play on her college team, she may play club or intramural soccer. She’ll continue to run, dance, and do yoga.

Whatever Alessandra chooses to do, she’ll have a whole team at Stanford Children’s cheering her on.

“We’re just really proud of her recovery and the way we were able to provide start-to-finish care for her,” said Risso.

Everyone on Alessandra’s care team agreed that her commitment and motivation will take her far in life.

“A recovery like that doesn’t happen spontaneously,” said Dr. Shea. “She was the model patient, highly motivated and really committed to optimizing her fitness. I know that she’s going to excel at whatever she puts her energy into.”