Play ball: Back on the field after catcher’s knee

catchers kneeBrian Burke, a rising senior at Curry College, has been playing baseball for as long as he can remember. He loves his sport and hopes to have a shot at the pros after graduation.

It’s a far cry from where he thought he would be four years ago when he had surgery for osteochondritis dissecans (OCD) in his right knee. With OCD, blood supply to the knee is restricted, damaging the bone and cartilage, and sometimes causing a piece of bone and cartilage to separate. The condition can increase an athlete’s risk for early arthritis.

“When I first heard that I needed surgery, I though my career was over,” recalls Brian.

It’s important to trust the rehabilitation process, and do your exercises every day. I felt 1,000 times better than before surgery.

His orthopedic surgeon Dr. Mininder Kocher, associate director of the Boston Children’s Hospital Sports Medicine Division, reassured Brian that he would be able to return to his beloved sport … as long as he committed to rehabilitation.

“What Brian had is catcher’s knee, a condition that hasn’t been described before,” says Kocher.

What is catcher’s knee?

Athletes, especially growing athletes who specialize in one position at a young age, are at risk for overuse conditions, explains Kocher.

It’s fairly common for kids to become catching specialists by age 10. They’re catching all of the time, which means they’re sitting in a hyperflexed position and then standing up rapidly to throw. “Catchers are doing this through every game and practice,” says Kocher.

With OCD, the bone and articular cartilage that protects the end of the bone separate; it hampers the normal, fluid functioning of the knee and can cause pain and swelling. “We’re seeing the condition in catchers. But it manifests differently than typical OCD. It tends to be more extensive and advanced, and it involves the back of the knee,” says Kocher.

Catcher’s knee: Brian’s experience

Brian started catching at age 10, and by his freshman year of high school, he had developed intermittent knee pain. “It would start when I was stretching, but then it would go away when the game started. I realize now that was adrenaline,” he says.

Two years later, the pain had become constant. That’s when he was referred to Kocher.

Kocher recommended surgery to repair the damage to Brian’s knee.

“Rehabilitation after surgery is very important. The bone and cartilage need to heal, and athletes need to focus on flexibility, strength and proprioception, ” says Kocher.

Brian complied with Kocher’s post-operative plan, sticking to a strict rehabilitation plan that included band work and pool walking to build his strength.

“It’s important to trust the rehabilitation process, and do your exercises every day,” says Brian. “I felt 1,000 times better than before surgery.”

Brian was eager to return to the field. In addition to committing to rehab, he practiced catching during the first few months after surgery, sitting on a chair or bucket instead of squatting. It protected his knee and helped him maintain his ability to frame the ball.

He eased his way back to baseball, returning first as a designated hitter for his high school team and then to catching for his AAU team. By his senior year, Brian was behind the plate again.

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His next stop was Curry College, where he caught for the Curry Colonels during his freshman year.

From catching to pitching

But his OCD flared up, and Brian needed another surgery. Dr. Yi-Meng Yen, orthopedic surgeon in the Boston Children’s Orthopedic Center, completed the second surgery.

Though Brian loved catching, his love for baseball was greater, and after some difficult discussions with his surgeons and parents, he decided it would be better if he transitioned into another position that put less stress on his knees. He switched from behind the plate to the pitching mound.

“It was a smart decision and probably best for the long-term health of his knee because even though his cartilage had healed it remained susceptible to injury,” says Kocher.

“It wasn’t a hard transition. I had to change from a short-arm catching throw to a long-arm pitching throw,” explains Brian. The new position clicked. Brian had a 4-2 record with a 2.6 ERA his first year.

As Brian works to better his stats, Kocher is digging into data as well.

He and his colleagues have published a study that describes the condition and are working to build awareness of catcher’s knee and develop injury-prevention strategies. Possibilities include:

  • Catch count: Young catchers would be limited on the number of innings or catches, which could reduce pressure on the knee.
  • Knee savers: A web-shaped pad would rest behind the player’s calf to reduce pressure on the knee.
  • Injury-prevention conditioning to maintain flexibility and balance the quadriceps and hamstring muscles may help young catchers.

Kocher adds, “I would encourage parents to avoid early specialization, postponing specialization until the teen years. Younger athletes can play part of the game catching and part in another position.”

Meanwhile, Brian is looking forward to his senior year at Curry College and a slew of possibilities after graduation — ranging from minor league ball to sports marketing.

Learn more about Boston Children’s Sports Medicine. Get our baseball injury-prevention guide.