Andrew DiMauro is a typical eighth-grade boy who lives for sports and having fun with his friends. But when a knee malformation he was born left him on the sidelines one too many times, he and his family turned to an expert at Connecticut Children’s Medical Center.
Dr. Lee Pace, an orthopedic surgeon with the Elite Sports Medicine program at Connecticut Children’s, made medical history on October 19th by performing the first arthroscopic trochleoplasty in the United States. Andrew, a 13-year-old from Portland, Connecticut, was one of three patients scheduled to undergo the groundbreaking procedure that day. Trochleoplasty is a surgical procedure in which a groove is created in the malformed part of the knee joint, or trochlea, so that the knee cap, or patella, fits securely in place. It has never been performed arthroscopically in the United States until now.
“I’m kind of excited that I’ll be able to actually go and do things now without worrying about having these big bulky knee braces on,” he explained during a visit with Dr. Pace before the procedure. “I can actually hang out with my friends now.”
Life on Hold
Doctors are not really sure why some people are born with trochlear dysplasia, but the effects of the knee instability caused by the condition can have a profound effect on everyday life, especially for an adolescent in what should be their most active years. In Andrew’s case, the condition had worsened in the last year or so, landing him in a hospital emergency room on a family trip to Maine and prompting a frantic call from a friend’s mom when Andrew’s knee popped out at her son’s birthday party.
Lately, the episodes had become a weekly occurrence. Andrew gave up sports, couldn’t run and got sore just going up a few flights of stairs.
That wasn’t okay with his mom, Dana. She took Andrew to an orthopedist who worked primarily on adults, but wasn’t comfortable with the treatment he recommended. Then a friend whose daughter had been treated for a similar problem, recommended Dr. Pace.
“It’s hard to see your child go through that,” says Dana DiMauro. “He wants to do sports and track and ride dirt bikes and now he’ll be able to do that.”
Finding the Right Doctor at Connecticut Children’s
Dr. Pace is a trailblazer in the treatment of the trochlear dysplasia and spent time in Germany in 2016 to learn how to perform open trochleoplasties from one of the two surgeons who pioneered the procedure in 2008. Both the open and arthroscopic procedure are widely used in Europe, but Pace is one of only a few surgeons in the northeast performing the open procedure and the first and only surgeon in the United States to perform an arthroscopic trochleoplasty.
By the time Andrew got to Connecticut Children’s he had already tried a variety of non-surgical measures typically used to compensate for kneecap instability, which in addition to restricting activity and using a knee brace, included physical therapy. None of it worked.
Living with the condition has been known to cause depression in extreme cases. And the longer people live with it, the greater the chance it will cause arthritis, a very painful condition. Other compensatory procedures are available and may provide good results in the short-term, but trochleoplasty is the only procedure that creates a more normal trochlea in the knee joint, Dr. Pace says.
Recovery time from a trochleoplasty procedure depends on the individual, but some of Dr. Pace’s patients have returned to sports within three or four months. Advantages of the arthroscopic procedure include less pain and knee stiffness during the recovery phase and, of course, the cosmetic benefit of having small holes made in the knee instead of the broader, longer incision associated with the open trochleoplasty.
Never Too Many Questions; Family-Friendly Care
Dr. Pace and the other providers at Connecticut Children’s have done a great job explaining the procedure and answering all his questions, Andrew says.
“If they are using a bunch of big words that I don’t understand and I ask them what it means, they give me a better definition that I can understand,” he says. “They are really nice.”
His mom agrees.
“The last time we were here, we sat for an hour and went through everything with Dr. Pace. We asked every question we could think of. I never felt like he was in a rush to leave to go on to something else. It’s been really, really good.”
Knowing they are at a hospital dedicated to the care of children is a comfort, says Dana, as is knowing that Andrew will no longer be living with pain.
“After a day of using his legs, doing his daily routine, he’s sore at night when he goes to sleep. I’m looking forward to being with him when he wakes up from the anesthesia and discovers what it feels like to have a knee that feels normal.”