First-of-its-kind knee surgery gets Ashley in the swing

meniscus transplantSixteen-year-old Ashley Meyer never planned to golf. At age 5, she had a different plan. She wanted to cheer — and to be the best cheerleader.

Ashley never planned to be a Red Sox fan either. But during baseball season, the Philadelphia native shuns Phillies wear, donning Red Sox garb instead. And when basketball season rolls around, she’s often sporting Celtics’ green rather than 76ers’ blue.

We knew right away. Ashley turned to me and said, ‘Mom, he’s the one who will fix me.’

“We call her the Philly traitor,” jokes Ashley’s mom Loreen, a nurse at St. Christopher’s Hospital for Children in Philadelphia.

Nicknames aside, Loreen and her husband Robert are fine with their daughter’s affinity for Boston.

After all, it’s the city where Ashley regained her mobility.

Ashley’s health challenges started when she was 5. Her knee would click and lock.

Although Ashley always seemed to be smiling, the pain often kept her from running or playing, says Loreen.

Loreen took Ashley to her pediatrician and then a pediatric orthopedic surgeon. An MRI showed a discoid meniscus. The condition, characterized by an abnormally shaped meniscus, can cause knee pain or knee popping. Typically, children with these symptoms can be treated via arthroscopic surgery.

Ashley had her first surgery to reshape and repair her meniscus at Children’s Hospital of Philadelphia.

“She did OK and stuck with her physical therapy, but she plateaued to a point that left her with ongoing pain and difficulty walking,” says Loreen.

Over the next two years, Ashley had two more knee surgeries at St. Christopher’s Hospital for Children to repair her meniscus.

Each time, the result was the same. She’d get better, but the pain would persist, and walking grew increasingly challenging. She needed crutches, a walker and then a wheelchair.

The search for a second opinion

“We became those parents,” admits Loreen. The Meyers searched up and down the East coast for a second opinion and pediatric orthopedic surgeon who could help Ashley. No one seemed to be able to solve the puzzle and remedy Ashley’s knee pain.

When Ashley was 9, the family’s search ended. Loreen, Robert and Ashley traveled to Boston Children’s Hospital for a consult with Dr. Mininder Kocher, an orthopedic surgeon with the Boston Children’s Orthopedic Center and associate director of the Sports Medicine Division.

meniscus transplant
Ashley with Dr. Kocher before her meniscus transplant

By that time, Ashley’s knee was completely locked. She couldn’t walk. The pain was intense. But this visit was different.

“We knew right away. Ashley turned to me and said, ‘Mom, he’s the one who will fix me.’ Robert, Ashley and I were instantly impressed with his demeanor, style, wealth of knowledge and compassion.”

The answer to Ashley’s knee pain

“Ashley was facing an incredible dilemma. The meniscus acts as the knee’s shock absorber. She had no meniscus. She was young and in pain and developing early arthritis,” explains Kocher.

What are the alternatives to meniscus transplant?
One alternative to meniscus transplant was delaying the surgery until Ashley stopped growing at age 15 or 16. (Many pediatric knee surgeries risk damaging a child’s growth plate  — the area of growing tissue at the end of long bones responsible for bone growth). The challenge with this option was Ashley would suffer through several more years of knee pain and worsening arthritis, which would likely make her ineligible for the meniscus transplant.
Another option was a knee replacement when Ashley was in her early 20s. “Again, it’s not a great option because knee replacements wear out and have to be replaced. It’s a good option for elderly people but not for young adults,” says Kocher.

For the first time, the Meyers had options. Kocher explained the pros and cons of each treatment plan.

It was 2009. At the time, orthopedic surgeons had performed meniscus transplants in adults for about 10 years.

Kocher suggested meniscus transplant surgery, which was experimental in a child, and outlined the risks. As with any transplant, there was the risk of rejection. The tissue would be fragile; it could tear easily. The donor meniscus might not grow with Ashley.

The family carefully weighed the decision.

“We knew we could trust Dr. Kocher,” says Loreen. The Meyers decided to proceed with surgery: Ashley would become the first child to undergo a meniscus transplant.

Though it seems like it might have been a difficult decision, it wasn’t, says Loreen. “Ashley was in such a bad situation — her ability to walk was really hampered.”

The innovative procedure worked. Ashley’s body didn’t reject the tissue. It didn’t tear. The new meniscus grew with her leg.

Ashley committed to rehabilitation and physical therapy and slowly eased her way into mobility, starting with swimming and walking.

meniscus transplant“Ashley is a true success. The transplant reduced her pain and delayed progression of arthritis. She’s also been able to do some sports and activities, which is a bonus,” says Kocher.

Ashley has needed ongoing follow-up care and minor knee surgeries, so the family travels to Boston regularly.

“Dr. Kocher has always understood the challenges of travelling from Philadelphia to Boston and has worked with us to make it easier on our family,” says Loreen.

That means partnering with Ashley’s local orthopedic surgeon, so that the family doesn’t need to travel for the aches and pains that can flare during growth spurts.

Ashley can have an MRI locally and the surgeons review it together, developing a plan for care that lets the family avoids extra trips from Philadelphia to Boston and Ashley focus on being a teen.

Surgical innovation: Six years later

And that’s exactly what she’s done. She’s made new plans. She joined her high school golf team and is beginning to look at colleges. And her parents are thrilled with the plan.

“After everything Ashley has been through, it’s a wonderful feeling. I feel very good about the decision we made for her. If we hadn’t gone ahead with the surgery, I’m not sure what her life would be like.”

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