Back on the Court

Teen undergoes orthopedic surgery to repair severe cartilage damage and bone decay in elbow

Carter Gresham already had an orthopedics appointment scheduled at CHKD when his elbow gave out in the middle of tryouts for Coastal Virginia Volleyball Club. The Western Branch High School junior felt a sharp pop while serving the ball and was overcome with excruciating pain.

In that moment, Carter realized he could no longer go on playing volleyball. For the past two years, the Chesapeake teen had pushed through constant pain in his elbow so he wouldn’t have to give up the game he loved so much.

At Carter’s first appointment with Dr. Stephanie Pearce, a sports medicine and orthopedic surgeon at CHKD, he couldn’t straighten his left arm at all. It was permanently bent as if he was trying to flex his bicep. Imaging tests revealed why: His capitellum – the end of the upper arm bone that creates the elbow joint – had broken into two pieces.

He learned the damage was caused by osteochondritis dissecans (OCD), a condition that occurs most often in children and adolescents, who may experience symptoms for years before seeking treatment. “It is less of an injury and more a disease process,” Dr. Pearce says.

With OCD, bone and cartilage can break loose from a joint, causing pain and limiting motion – and in severe cases, the bone can die from lack of blood flow. Once the bone becomes unstable, only surgery can help repair the joint and improve its function.

Although the idea of going under anesthesia scared him, Carter agreed to the surgery.

Carter spent months working with sports medicine physical therapist Tim James so he could regain enough strength and mobility to play volleyball his senior year of high school.

Like many high-level athletes, Carter, a quiet teen, got much more out of volleyball than just being a competitive player. He enjoyed the confidence that came from his position as the team’s setter, controlling the pace of the game and making quick decisions on the court.

If he wanted to pursue his dreams to play volleyball in college, Carter knew his best shot was to have the surgery and work with sports medicine physical therapists to regain his strength and mobility.

Operating on the elbow can be tricky due to the small treatment area, says Dr. Pearce, who specializes in complex knee, elbow, shoulder, and hip conditions. During her fellowship at the renowned Steadman Clinic in Vail, Colorado, Dr. Pearce focused on cartilage preservation and advanced arthroscopy, honing the skills necessary to help athletes like Carter.

To remove the damaged cartilage and repair Carter’s elbow, Dr. Pearce used arthroscopy, a minimally invasive technique that involves inserting a tiny video camera and other tools into the joint through small incisions. During the procedure, she discovered Carter’s OCD was so advanced that a portion of the bone was gone, creating what looked like a pothole. “Dr. Pearce told me it was the second-worst case she had seen in her life,” Carter says.

After drilling holes in the damaged area to encourage blood flow, Dr. Pearce filled the space with donor cartilage that works like scaffolding and allows cartilage to regrow into the area. Due to the size of the defect, Dr. Pearce planned for a second, larger surgery after the arthroscopy procedure if Carter’s symptoms continued through his postoperative recovery.

Carter went home that same night. Only time would tell if he would need any further procedures.

Three days after surgery, Carter had his first of many visits to CHKD’s Sports Medicine Physical Therapy Center at Harbour View in Suffolk, where he worked with physical therapists specially trained to help young athletes recover and get back in the game.

Each time Carter would visit Dr. Pearce during his recovery, he would ask about playing volleyball again. It wasn’t until his brace came off that he finally heard the good news: he could go back to playing in a couple of months. And best of all, he would be back in time to participate in his senior high school season.

Carter spent months working with sports medicine physical therapist Tim James so he could regain enough strength and mobility to play volleyball his senior year of high school.

“I think I cried when I started playing volleyball again. For the first time, it didn’t hurt.” Carter Gresham

Carter couldn’t believe how great his arm looked when the brace came off. “I had the biggest smile on my face,” he says. “It was perfectly straight.”

Once he was back on the cour t, Carter had to relearn everything. The biggest shock, however, was the absence of pain. “I think I cried when I started playing volleyball again,” Carter says. “For the first time, it didn’t hurt.”

So far, Carter, now 18, has had no further issues with his elbow, which bears a small, unnoticeable scar. Repeated MRIs have shown that his elbow is healing, recreating new cartilage and bone, and does not need further surgery at this time. “It’s looking like a capitellum again, which is amazing,” Dr. Pearce says.

Carter’s father, who also suffered from OCD while growing up, says he is grateful for the care his son received at CHKD.

“Dr. Pearce is such a compassionate doctor,” says Grant Gresham. “She cared about our well-being and wanted to help Carter recover fully and not just get by. She has the knowledge and skill set to be a benefit for people who have OCD. It’s so rare.”

Carter’s return to volleyball was so successful, he has achieved his dream to continue his sport at the collegiate level, recently committing to play next year at Marymount University in Arlington, Virginia. He plans to study nursing, something he has always wanted to do.

“I’m grateful for the new perspective that I have from being injured,” Carter says.

CHKD Sports Medicine provides a comprehensive treatment approach for growing athletes and has helped thousands of kids like Carter return to sports after injury.

At CHKD, our orthopedic surgeons use state-of-the-art surgical techniques based on the latest research in sports medicine and work closely with our sports medicine physicians, certified athletic trainers, and sports medicine physical therapists from the time a child is injured, through surgery, and throughout their recovery.

CHKD’s Sports Medicine program is led by Dr. Marc Cardelia, orthopedic surgeon and surgical director of the program, and Dr. Joel Brenner, a sports medicine physician and medical director of the program.