Pediatric Matters - Connecticut Children`s Medical Center Foundation

Diabetes &
Endocrinology
Comprehensive
Lyme Disease
Program Launched
Urology
UTC Funds Family
Resource Center
Studying ACL
Tears in Young
Athletes
Vol. 8 Issue 1
Spring 2015
A PUBLICATION OF CONNECTICUT CHILDREN’S MEDICAL CENTER
Rotsen’s Loss is a Big Gain for the
Children of Connecticut
17-year-old Rotsen Pizzaro, of New Britain, underwent Gastric Sleeve surgery at Connecticut
Children’s following a year of unsuccessful weight loss interventions. She is the first pediatric
patient in the state to undergo this life changing procedure. Also shown is Christine Finck, MD,
one of Rotsen’s surgeons.
Rotsen Pizzaro, 17, always knew
she was different. From a very early
age, Rotsen remembers never quite
‘fitting in.’ Rotsen was much heavier
than her friends and admits she was
always a ‘chubby child,’ but she says
things took a turn for the worse
right around her 10th birthday.
“I remember the kids in school
started teasing me about my weight
and bullying me because of it.
Before no one really said anything
even though I knew I was so much
bigger,” Rotsen recalled. “It started
getting hard when kids starting
making fun of me to my face.”
Rotsen’s weight has been a lifetime
struggle for her. She’s tried dieting,
counting calories and exercising
regularly, but nothing was working.
“I wanted to lose weight because I
wanted to change my lifestyle. It was
important to me. I was so desperate
to lose the weight, not because
anyone told me I had to, but because
I wanted too,” said Rotsen.
She’s not alone. Childhood
obesity rates have quadrupled in
adolescents in the past 30 years.
More than a third of kids are
overweight or obese.
Her weight-loss journey landed
her at the Connecticut Children’s
Pediatric Obesity Center in December
of 2013 where a team of specialists
including endocrinologists, surgeons,
psychologists, dietitians, and physical
therapists used a comprehensive
approach to try and manage
her weight.
“Rotsen is like many of the
adolescents who are candidates for
bariatric surgery. They are extremely
focused on having surgery. But surgery
alone doesn’t help someone lose
weight. It’s a patient’s healthy lifestyle
changes that make a lasting difference.
We spend a lot of time restoring our
patient’s confidence in their own ability
to make changes and have it lead to
good outcomes,” explains Melissa
Santos, Ph.D., Pediatric Psychiatrist at
Connecticut Children’s.
After nearly a year of appointments
and trying different ways to lose
weight, tragedy struck Rotsen and
her family. Her New Britain home
caught on fire in the early morning
hours of September 11th, 2014.
Although no one was hurt, Rotsen’s
family escaped with only the clothes
on their backs. What impressed
her team of weight-loss experts
the most was Rotsen’s resilience
and commitment to losing weight
despite such a traumatic event.
continued on page 3
Connecticut Children’s and Baystate Children’s Hospital
Collaborate to Advance Pediatric Care in Our Region
Connecticut Children’s Medical
Center and Baystate Children’s
Hospital have launched a new
collaboration addressing potential
ways to improve access to highquality and high-value healthcare
for children in Connecticut and
western Massachusetts.
Both
organizations,
which
provide
high-level
inpatient
pediatric and neonatal care as
well as comprehensive outpatient
services for children and adolescents,
are working together to determine
whether we can increase the
availability, sophistication and
coordination of pediatric services
throughout
the
Connecticut
River Valley, and collaborate with
community pediatric providers to
improve the overall health and
wellness of children in the region.
“We
recognize
that
an
opportunity exists to bring
together the talent, vision, and
expertise of some of the leading
health care providers in western
and southern New England,”
said Fernando Ferrer, MD, Chief
Physician Executive at Connecticut
Children’s. “As the pediatric health
care environment becomes more
complex, the responsible approach
is to consider what is in the best
interests of our children and families.
We are committed to working
together with this in mind.”
“Our two organizations have a
lot in common: similar cultures
of placing the patient at the very
center of our focus, and strong
commitments to the health of our
communities in the broadest sense,”
said John Schreiber, MD, Chief
Physician Executive of Baystate
Health. “In these common traits
we see the foundations of a very
successful collaboration.”
“We believe that by finding ways
to share resources, partner more
closely with community pediatricians
and position caregivers from each
institution more flexibly between
Springfield and Hartford, we can
meet more of our patients’ needs
for outstanding medical care close
to home, no matter where in the
Connecticut Valley they live,” said
Laura Koenigs, MD, interim Chair of
Pediatrics at Baystate.
“In order to continue to deliver on the
promise of providing exceptional health
care to the region’s most vulnerable
patients, the demand for creativity is
clear,” said Juan C. Salazar, Physicianin-Chief, Connecticut Children’s and
Chair of Pediatrics at the UConn
School of Medicine. “Together with
our colleagues at Baystate Children’s,
we have an opportunity to advance
pediatric care, innovative pediatric
research and collaborative training for
medical students and residents, in a
way that could provide the ultimate
level of care for children and families
in the region and keep our brightest
and best health care professionals in
our region.”
This unique collaboration allows
us to improve access and quality
of care in pediatric neurosurgery,
ophthalmology, pulmonology and
urology, all areas where current
provider shortages can make getting
care difficult for patients and families.
For instance, a recently announced
partnership in pediatric neurosurgery
will allow children who require
evaluation for brain and nervoussystem-related surgical care to
receive services at both hospitals.
Baystate Children’s Hospital recently added a
new Playdeck, shown above.
2
www.connecticutchildrens.org
Spring 2015
Matters
Upcoming
Events
Serata di Cibo –
A Celebration of Fine
Food & Wine
Monday, June 1, 2015
Carbone’s Kitchen, Bloomfield
Join us at Carbone’s Kitchen and
enjoy delectable Italian hand passed
hors d’oeuvres; grill, pasta, carving
and dessert stations, along with
selected fine wines. Proceeds to
benefit Connecticut Children’s.
What Others Are Saying About Connecticut Children’s
ON FACEBOOK
ON TWITTER
“Rylan and his family want to say thank you to
the doctors and nurses on the PICU floor and
Med/Surg 7 floor. You are all AMAZING and we
are forever grateful.” – Isabelle Casker
Ryan Kristafer‫@‏‬RyanKristafer:
Looking forward to doing some
good work with @ctchildrens and
their inspiring, young patients. #ct
“Jen Wheaton is AMAZING. We love her and are
so very thankful for her everyday!!”
– EMILY RICKER SULLIVAN
alex berube☼@alexberubex:
It’s #GivingTuesday donate to @
ctchildrens! https://www.connecticutchildrensfoundation.org/give CT
Children’s has saved my life, help
save other kids too!
“Connecticut Children’s is a wonderful hospital.
The Neurosurgery team and the staff of MS6
were wonderful to our Sam. We are forever
grateful to Dr. Bookland and Dr. Martin for the
amazing job they did to make it possible for her
to walk again. We will never forget any of you.”
– MELISSA HUBBARD
“Wonderful experience here with our 10 month
old daughter who needed emergency care!”
– AMANDA LAPRIME
Only the best for my girl!! CT Children’s is the
best !!!! – MARYANNE FLOOD L
Cycle of Life – Cancer
Survivor Celebration
advocacy initiatives to help adults
and children with the disease live a
better quality of life.
University of Saint Joseph, West Hartford
This event is a special celebration for
pediatric cancer survivors and children
who are undergoing treatment for
cancer. All proceeds benefit our REACH
for the STARS Survivorship Program.
Wheel of Fortune Presents
Connecticut Children’s
with Secret Santa
Sweepstakes Donation
Barbara Edelheit, MD, speaks during the
Greater Hartford Walk to Cure Arthritis at
the University of St. Joseph.
Monday, June 22, 2015
Hartford Golf Club, West Hartford
This event, which has raised more
than $1 million for Connecticut
Children’s, benefits the Department of
Orthopaedics.
Concorso Ferrari & Friends
Sunday, June 28, 2015
LaSalle Road, West Hartford
Join us for Concorso Ferrari & Friends,
a premiere car show hosted by the
Ferrari Club of America/New England
Region. For one day only, West Hartford
Center is transformed into an amazing
display of exotic Italian automobiles.
All to benefit Connecticut Children’s
Medical Center!
Sonar Wolf Pack @SonarWolfPack:
Thank you to @ctchildrens for having
the guys out yesterday! It was gr8 to
put so many smiles on the kids faces.
CONNECTICUT CHILDREN’S IN THE NEWS
Sunday, June 7, 2015
Geno Auriemma’s Fore
the Kids Charity Golf
Tournament
Shannon Hughes-Brown @
smhughesbrown:
Tubes are in!
Thank you
@ctchildrens
for taking
such good
care of us
and our little
patient
Karen Haslam @karenhaslam:
@ctchildrens thanks so very much for
taking such great care of our little guy!
This helicopter made his day!
Barbara Edelheit, MD,
Named Medical Honoree
of Greater Hartford Walk
to Cure Arthritis
Congratulations to Connecticut
Children’s Dr. Barbara Edelheit for
being named this year’s Medical
Honoree of the 2015 Greater
Hartford Walk to Cure Arthritis,
which took place May 3rd at the
University of St. Joseph.
“I feel fortunate to be able to
care for children with Juvenile
Arthritis and related conditions,”
says Dr. Edelheit, “and am
grateful for the discoveries of
successful medications which
have made a huge impact in
helping adults and children with
arthritis. I am appreciative of the
Arthritis Foundation and other
organizations which raise money
and awareness to fund this
important research.”
As Medical Honoree, Dr. Edelheit
stood up to help the Hartford
Walk to Cure Arthritis reach its
fundraising goal of $110,000.
Proceeds for Walk to Cure Arthritis
benefit numerous research and
In March, WTNH News 8’s Jocelyn
Maminta stopped by Connecticut
Children’s Medical Center on
behalf of Wheel of Fortune to
present CEO Marty Gavin with
proceeds from the show!
The generous donation of
$11,650 was all part of Wheel’s
Secret Santa Sweepstakes, which
ran weeknights from December
8-19. The contest matched the
winnings of select Wheel Watchers
Club members and donated that
amount to various Children’s
Miracle
Network
hospitals,
including Connecticut Children’s.
In total, Wheel of Fortune’s
sweepstakes raised more than
$435,000, allocated among 28
Children’s Miracle Network Hospitals
selected by winning viewers!
Jacqueline McGrath and
Cheryl Hoey Named
Diamond Jubilee Recipients
Jacqueline McGrath was honored
with the Virginia Henderson
Award
for
outstanding
contributions to nursing research
and Cheryl Hoey received the
Doris Armstrong Award for
outstanding
contributions
to
nursing administration.
Established in 1980 by the
Connecticut Nurses Association,
the Diamond Jubilee awards
recognize
only
the
most
distinguished leaders in the state’s
nursing history. These prestigious
awards represent the highest
honor that the nursing profession
in Connecticut can bestow on one
of its own.
Together Jacqueline and Cheryl
continue to advance the nursing
profession and our mission in
making Connecticut’s children the
healthiest in the nation.
WTNH’s Kierstin Pupkowski & Jocelyn Maminta happily present a check to Connecticut
Children’s Marty Gavin, President and CEO & Scott Organek, Children’s Miracle
Network representative at Connecticut Children’s, after one lucky Wheel of Fortune
winner claimed more than $11,000 for herself and the hospital.
Connecticut Children’s is grateful for the dedication provided by many individuals, clubs and organizations who host events to support and promote the mission of
Connecticut Children’s. If you are interested in learning more about events that support the Medical Center or hosting an event, please visit the
Connecticut Children’s Foundation website at www.connecticutchildrensfoundation.org
To comment on any articles appearing in this publication, please visit our website at www.connecticutchildrens.org. If you have a change of
address or do not wish to receive future issues of Pediatric Matters, please call (860) 837-5700.
Credits Editor: Robert Fraleigh; Contributors: Monica Buchanan, Rachel Smolin, Michelle Wade, Teresa Riccio and Ed Jalinskas; Design: Dornenburg Kallenbach Advertising; Photography: Michael McCarter
3
Connecticut Children’s and U.S. Senator Chris
Murphy Work Together for Vaccination Education
Chances are if you turned on a
television this past winter you were
inundated with news about the
measles outbreak. As the measles,
thought by many to have been
eradicated, spread across the
country, it brought to light the critical
importance of children receiving
vaccinations to guard against highly
contagious diseases. “Outbreaks, like
the measles outbreak this year, are
completely predictable as participation
in vaccination programs drop. The
minor risk associated with vaccines
has been exaggerated, while the risk
of the disease itself remains very real
— and for some children, deadly,”
says Nicholas Bennett, MBBChir, PhD,
Medical Director of Pediatric Infectious
Diseases
and
Immunology
at
Connecticut Children’s Medical Center.
In February, U.S. Senator Chris
Murphy stepped into action and
announced efforts to help parents
better understand the risks of
refusing vaccinations for their
children. During a news conference
at Connecticut Children’s Medical
Center, Senator Murphy proposed
legislation to require a doctor
visit before a parent/guardian can
seek a non-medical exemption for
vaccinating their children. States that
don’t comply would lose 5 percent of
their federal vaccination budgets.
The proposed bill would provide
incentives and guidelines to be sure
a parent is fully knowledgeable
before making a decision. It would
not force states to eliminate nonmedical exemptions.
Senator Murphy, joined by
Dr. Bennett and State Representative
Matt Ritter, Chair of the Connecticut
General Assembly’s Public Health
Committee, stressed the importance
of addressing the misinformation
surrounding
vaccinations
and
autism, which has led many
parents not to vaccinate their child.
Dr. Bennett stated, “Vaccination
programs only work when most
parents comply. Should parents
choose not to comply, they must
accept the risk to which they expose
their children. But most of the time
these parents don’t realize they are
putting other people’s children at
risk too. Many of the children we
treat at Connecticut Children’s have
compromised immune systems due
to a disease or from treatments
like chemotherapy. These children
are put at extraordinary risk by
the unimmunized children in their
school and community.”
“We have known for a long
time that vaccines are effective,”
said Dr. Bennett. “There have been
many studies, tracking hundreds of
Nicholas Bennett, MBBChir, PhD, of Connecticut Children’s and United States Senator Chris
Murphy host a press conference at Connecticut Children’s to help promote improved vaccine
education among parents of young children.
thousands of children. Studies also
demonstrate that the more parents
know about vaccines the more
likely they are to have their children
vaccinated. We want to find ways
to make sure parents always get
accurate and current information.”
Within the last several months
more than 100 people contracted
A Big Gain for the Children of Connecticut
continued from page 1
“Everyone responds differently to
life-changing events like this, but
through it all Rotsen was determined
to lose her weight,” said Santos. She
never lost her focus or her spirit and
was determined to see this through
even though we typically see others
in similar situations fall back in bad
habits and old ways.”
After a year of attempting
different weight loss interventions,
Rotsen was presented with another
alternative: bariatric surgery.
“My first impression of Rotsen
was the desperation with which
she wanted to lose weight. She
seemed committed and honest
with herself,” said her surgeon,
Meghna Misra, MD. “She had a very
mature attitude about losing weight
and wanted to be healthy, which
made her an excellent candidate
for surgery.”
In order to be considered for
bariatric surgery, kids need a
BMI>40 or BMI>35 with a medical
co-morbidity like pre-diabetes or
HTN. In Rotsen’s case, she also had 6
months of intensive screening prior
to her surgery.
“In Rotsen’s case, Gastric Sleeve
surgery was the best option,” said
Christine Finck, MD, who also
worked and consulted on Rotsen’s
case. “This surgery is irreversible,
unlike the gastric band procedure.
Furthermore, the weight loss is more
rapid which helps motivate the child
to continue on the right course.
The average weight loss is 60% of
excess weight loss in the first year.”
In February, Rotsen became the
first pediatric patient in the state
to undergo Gastric Sleeve surgery.
It’s a technique that’s thought to be
safer than Gastric Bypass and more
effective than Lap Bands. Surgeons
removed 75% of her stomach and
created a tube or “sleeve-shaped”
stomach. The effect of this surgery
is to make you feel full more quickly
and therefore helps weight loss.
In another first, Connecticut
Children’s also live-tweeted Rotsen’s
Gastric Sleeve procedure on Twitter
in order to highlight bariatric surgery
as an option for kids. The live tweet
went from 7:30am-12:30pm and
was seen by more than 720,000
Twitter users!
“Live tweets are a great way
to increase awareness and to
educate,” said Chris Carroll, MD,
PICU intensivist and social media
medical editor. “More and more,
people are turning to social media
to inform their medical decisions.
It’s important that hospitals and
healthcare providers help to lead
the conversation on social media.
By highlighting the ongoing efforts
of our staff, Connecticut Children’s
provides a strong and informed
voice on social media.”
After just 3 days in the hospital,
Rotsen went home and even back
to school the following week. As
part of her commitment to weightloss, Rotsen must have a fruit and
vegetable at every meal followed by
a lifetime of regular healthy eating.
“I wanted to share my story
because it’s difficult to be a teenage
girl who is overweight and have
people in school look at you like
you’re a joke. There’s no one who
understands how it feels at home
for me when I look at my brother
and sister who are thin.”
Rotsen is looking forward to
her new life and plans to use it by
advocating for kids like her with a
very important message that serves
as a greater lesson for all.
“Overweight kids aren’t a target
for a ‘funny joke.’ They have a
lot in their head already and that
‘funny joke’ could just drive them
over the edge,” said Rotsen. “So,
please think twice before you bully
someone because you never know
just how badly you are hurting that
person whether they show it or not.
I can’t thank Connecticut Children’s
enough for giving me a second
chance at life and a chance to show
the world who I really am inside.”
measles - most of them unvaccinated.
Health officials, including our own
Dr. Bennett, will continue to raise
the alarm about preventing the
reappearance of measles and other
potentially fatal diseases but advise
that the solution is, simply and truly, a
vaccine away.
4
www.connecticutchildrens.org
Spring 2015
Matters
Connecticut Children’s Launches the Country’s Only
Comprehensive Lyme Disease Program
This spring, Connecticut Children’s
Division
of
Rheumatology
introduced a Comprehensive
Lyme Disease Program that is
a unique resource for families
with patients who either don’t
respond to treatment or who have
complicated Lyme disease.
Lawrence Zemel, MD, Chief
of Rheumatology, directs the
program, which is staffed by a
multidisciplinary team that includes
pediatric
subspecialists
from
neurology, infectious diseases,
orthopaedics, cardiology, pain
medicine and behavioral health.
Patients can expect to see the
appropriate subspecialists, and
the entire team meets monthly to
discuss complicated patients. “This
is the first time anyone has put
together a comprehensive program
like this,” says Zemel. “I have not
heard of another pediatric program
like it in the country.” Zemel notes
that primary care providers today
typically recognize early Lyme
disease, especially if the patient has
a rash. The primary care physician
will
provide
evidence-based
treatment, and, most often, the
patient will be successfully treated.
“We generally don’t need to see
those straightforward patients,”
Zemel says. “However, if patients
don’t respond to treatment or if
there’s a question about diagnosis,
we want to see those patients.”
Connecticut
Children’s
is
encouraging the general public
and inviting families to contact the
program directly. Zemel says that’s
because there’s an abundance of
misinformation about Lyme disease
available on the Internet and from
advocacy groups and other sources.
Because of this misinformation,
families may bypass their own
primary care physicians and,
instead, consult so-called “experts”
who are over-diagnosing and overtreating Lyme disease. “We’re
trying to attract this group of
patients, as well, so we can use the
best-available evidence to diagnose
and treat them, regardless of what
their ultimate diagnosis is,” says
Zemel. “We provide families with
scientific information that allows
them to make informed decisions
about care for their children.” Zemel
stresses that, whether patients come
to the program directly or through
a referral, the program’s staff will
work closely with the patient’s
primary care provider. “We will take
calls directly, but we will always call
the PCP’s office and involve them,”
he says.
A single call to a central
phone number, 860.545.TICK
(8425), accesses the program.
A staff member will gather basic
information, request any prior lab
results or physician reports and
schedule an appointment. At the
initial appointment, either a pediatric
rheumatologist or pediatric infectious
disease specialist will examine
the patient, collect additional
information and, if necessary, order
Led by Lawrence Zemel, MD, Connecticut
Children’s Comprehensive Lyme Disease
program provides children and families
battling the disease with educational
resources and a wide range of multidisciplinary treatment options.
tests. If Lyme disease is diagnosed,
a treatment plan will be developed,
and the child may be referred to
another member of the team. If
the patient does not have Lyme,
other diagnostic tests will be done,
and findings may lead to a referral
to other disciplines. The important
point, says Zemel, is that “all children
will be treated with comprehensive
and compassionate care.”
Beyond Clinical Care: The NEW United Technologies Family Resource Center
When a family walks through the
doors at Connecticut Children’s,
there are teams of people who
become
invaluable resources
to them throughout their care
experience. Some of the most
important staff work with families
outside of the exam room,
surgical suite or bedside. They
are our talented team of more
than 30 Child and Family Support
professionals.
When Connecticut Children’s
opened its doors 19 years ago,
the Medical Center’s main
building was designed with
dedicated spaces for this team
of professionals to work with
families. As our patient care
visits have grown from 135,000
less than a decade ago to nearly
325,000 last year, we reallocated
those dedicated spaces to
accommodate
our
growing
clinical needs.
At the core of our growth in
clinical capacity has been the
expansion of our faculty, from 65
to 165 pediatric subspecialists,
spanning the spectrum of pediatric
expertise and caring for the most
medically
complex
patients.
Therefore, there is a greater need
to provide extensive training and
support to parents before, during
and after their care experience.
This is perhaps best illustrated
with the story of a cardiology
patient. Luis was born at 39 weeks
with a diagnosed single ventricle.
After he was stabilized and moved
to the surgical intensive care unit,
Luis underwent his first corrective
open heart surgical procedure.
This condition requires at least
three corrective surgeries before
the age of one and the child would
typically
remain
hospitalized
throughout that first year due to
the high risk factors and level of
care required.
Daily care necessary for these
newborns includes daily weigh-
ins, measurement of daily oxygen
saturation,
administration
of
multiple medications, identification
of “Red Flag” symptoms and CPR.
Now, thanks to a generous
$1.5 million donation from United
Technologies Corporation (UTC),
the UTC Family Resource Center
will provide Luis and others like him
the state-of-the-art environment
needed to train and empower his
family to care for him at home
while he awaits his second open
heart surgery.
The UTC Family Resource
Center will be located centrally
in our main building at 282
Washington Street, and will serve
as an important space for the
more than thirty Child and Family
Support professionals to meet
with families, providing them with
tools necessary to manage their
children’s health and medical care.
Additionally, the Center will be
staffed by two Resource Center
specific positions including a
Medical Resource Librarian and
Educational
Specialist.
These
skilled professionals, as well as
highly trained volunteers, will
guide families through dedicated
resources and support offerings.
Classroom
The classroom will be used as both a
traditional learning space, conducive
to group and individualized
educational classes, in addition to
a learning lab. The classroom will
have state-of-the-art technology
through smart board and streaming
video technology to facilitate both
interactive and evidence-based
education to children, families
and community. The learning lab
component will utilize hands on
demonstration with an Education
Specialist and simulation as
an educational tool to provide
families a detailed understanding
of the medical equipment and
procedures needed to manage the
The United Technologies Family Resource Center will serve as a valuable resource for patient
families looking to learn more about their child’s healthcare needs. Construction has already
begun on the state of the art facility, which is scheduled to open later this year.
complex care necessary for their
child. The simulation component,
utilizing a simulation mannequin
and actual medical equipment will
provide families the confidence and
competence they need to care for
their children at home, including
assessment skills, and well-child care.
The Family Learning Center
The Family Learning Center will
provide general education classes
meeting the diverse language and
reading levels specific to health,
wellness and injury prevention.
Classes will be taught by clinical
experts from across all disciplines
of the Medical Center (Dieticians,
Pharmacists, Therapists, Physicians,
and Nurses). The goal is to use
content experts to educate
and make our families and the
community successful in their ability
to care for children, from keeping
them healthy, to caring for them if
they have a medical challenge.
Family Library
The library will provide a quiet,
comfortable place where families
and caregivers can learn more about
their children’s health care needs.
Children’s Library
Designed with patients and
children in mind, the Children’s
Library, located within the
Family Library, offers families a
broad range of children’s books,
including those written to help
children and siblings understand
and cope with the health care
experience. The Children’s Library
computers will be loaded with fun
educational games.
Information Center
Designed with an inviting and
comfortable environment, the
Information Center will be resourced
by a specially trained Hospital
Volunteer. This role will help visitors
navigate the resources available
to them, such as information
on local and national resource
organizations, links to community
services,
Information
about
health related community events
and classes.
5
With ACL Injuries, Knowing When It’s Safe
to Go Back to Play Can Be a Tough Call
The frequency of ACL tears among
young athletes (18 years and
under) has grown at an alarming
rate in the last decade. Even
more alarming, is the re-injury
rate in those who return to sports
after such an injury. This has lent
new urgency to the matter of
determining exactly when it’s safe
for an athlete to return to play.
The anterior cruciate ligament,
or ACL, is one of four main knee
ligaments. The ACL plays a critical
role in knee stability (you may
hear people with an injured or
damaged ACL complain about
their knee suddenly “giving out“
under them). Surgical techniques
to reconstruct the ACL have
become very sophisticated, and
orthopaedic surgeons at Elite
Sports Medicine at Connecticut
Children’s routinely reconstruct
torn ACLs with a high degree of
success. And yet, national statistics
show that a young athlete who’s
had ACL surgery is fifteen times
more likely than the control group
to either re-injure a knee or injure
the healthy knee. But why?
“The ACL is by far the most
studied ligament in the human
body. We know that children’s
ACL injuries take longer to heal
than adult’s with similar injuries.
We know that a girl is much more
likely to injure her ACL than a boy,
no matter what sport she plays.
We know these statistics to be
true and, although there are lots
of theories out there, we don’t
know precisely why these things
are true,” said Matthew Milewski,
MD,
Orthopaedic
Surgeon,
Elite Sports Medicine. “We are
particularly worried about the rate
of re-injury. And so we started to
wonder what was going on here
that is not visible to the naked
eye? What could we discover
through data collected right here
in Connecticut Children’s Center
for Motion Analysis?”
Dr. Milewski and Sylvia Ounpuu,
MSc, are in the second year of
an ongoing study to identify
and describe decision-making
components that could help
physicians and physical therapists
more precisely evaluate the timing
for return to sports (RTS) for young
athletes. The research protocol
includes current standard of care at
Elite Sports Medicine (clinical exam,
KT-200 assessment and isokinetic
testing), but also incorporates
simultaneous,
comprehensive
motion analysis during running,
hopping, jumping and cutting.
“Although there may be many
causes for re-injury, one possible
cause
might
be
premature
return to activity,” said Ounpuu.
“Typically patients are cleared to
return to sports post ACLR at 6
months post-op. Patients must
meet specific functional test
criteria deemed sufficient by their
Matthew Milewski, MD, Orthopaedic Surgeon, Connecticut Children’s Elite Sports
Medicine, is searching for new data to help surgeons determine when it’s safe for injured
athletes to return to sports.
surgeon, but functional criteria and
measurements of knee function
vary from clinic to clinic. In addition,
observations
by
experienced
professionals looking for symmetry
in form and function of the
knees, lack objective measures
of loading during common athletic
movements such as running
and jumping.”
Dr. Milewski continues, “At
Connecticut Children’s we have
a unique opportunity in that we
treat over 70 adolescent patients
who require ACL reconstruction
annually. We also have access to
a comprehensive motion analysis
system. The goal of our research is
to better understand how current
clinical practice can be informed
with more objective measures of
knee loading during functional
activities.”
The study describes and
compares loading kinematics and
kinetics between the ACLR and
healthy knee in adolescents who
have been deemed ready to return
to sports. 3D joint kinematics are
computed for the trunk, pelvis,
hips, knees and ankles. The team
looks for statistically significant
differences in motion and loads
between the ACLR and the
healthy knee.
“We also collect data to
determine whether RTS patients
demonstrate larger asymmetries
than an age matched control
group. Small asymmetries in weight
bearing, turning or gait, could be a
contributing factor in the high rate
of re-injury for ACLR patients,”
said Ounpuu. “Of course some
asymmetry could be common
among growing children. We
believe that building a large data
base of healthy children will give
us more tools to understand what’s
going on with the injured children
who are returning to vigorous,
sports related activity.”
“Lastly, we determine if the initial
RTS assessment changes two or
more years post-surgery. We would
like to see if our RTS patients with
pronounced asymmetry move
toward greater asymmetry or toward
symmetry. And do more symmetrical
patients return to statistically normal
symmetry?” Dr. Milewski concludes,
“With more than 200,000 new ACL
tears diagnosed in the United States
each year, this is a serious problem
that is becoming epidemic. As I
mentioned earlier, Sylvia and I are
in a unique position at Connecticut
Children’s because our Elite Sports
Center treats so many children
and the Connecticut Children’s
Center for Motion Analysis is
so conveniently located at our
Farmington offices. Our study is
adding new tools to help doctors
get it right in determining when it’s
safe for a young athlete to return to
participating in competitive sports.”
Sylvia Ounpuu, MSc, above,
demonstrates the jumping and
hopping tasks as performed by the
patient in the photo, left.
282 Washington St.
Hartford, CT 06106
Happenings at Connecticut Children’s
In January, officials from United Technologies Corporation presented a check to Connecticut
Children’s to fund the new UTC Family Resource Center. Pictured (l-r) are Glen Greenberg,
Connecticut Children’s Medical Center Board member; Greg Hayes, president and CEO of UTC;
Geraud Darnis, president and CEO of UTC Building & Industrial Systems; Hope Feliciano, Family
Advisory Board member at Connecticut Children’s; and Marty Gavin, president and CEO of
Connecticut Children’s Medical Center. (Story on page 4)
6-year-old Madisen Valentin of Waterbury cuddles up to “Toby,” a golden labradoodle during
a recent pet therapy visit at the Medical Center. Pet therapy has been proven to reduce pain,
anxiety and fatigue in patients of all ages.
The national champion UConn women’s basketball team spent a fun-filled afternoon with
patients in our Center for Cancer and Blood Disorders, prior to winning their 10th NCAA
championship. Pictured above, player Breanna Stewart sits with one of her biggest fans,
18 year-old Taylor Fascione of Berlin.
Dressed as The Hulk, 5-year-old Josiah Mulero of Hartford joins his favorite crime fighters for a
photo on National Superhero Day at Connecticut Children’s. The hospital wide event featured
costumed window washers and plenty of themed events. Among the activities were life-sized
models provided by LEGO®, a Dave & Busters obstacle course, Monaco Ford’s Batmobile and
cape decorating with Hole in the Wall Gang camp.
New England Patriots cheerleaders, Erica and Alyssa visit with 20-year-old Hunter Spiegel
of Newtown during a recent visit to the Medical Center. Hunter is a huge Pats fan and was
excited to talk about the team’s recent Superbowl win!
During a very special visit to the Medical Center, Hartford Police Detective Dan Blumes,
Police Chief James Rovella, and Detective Zack Sherri met some of the toughest kids around,
like 10-year-old Davon Brown of Waterbury.