Zach’s Back in the Game

By Greg Raver-Lampman

By the fourth hour, Berkeley Brandt and his wife Sara feared the worst.

When their 11-year-old son Zachary went into surgery at CHKD to repair a knee he shattered in gym class, CHKD pediatric orthopedic surgeon Ole Raustol estimated that the surgery would take about two hours. Although nurses updated them every hour, “by the third hour, we were getting nervous,” Sara said. By the fourth hour, the Brandts were the only people in CHKD’s surgery waiting room.

Zach Brandt
Surgery to his left knee and post-surgical therapy combine to return soccer player to the field.

“When Dr. Raustol came out, you could see the strained look on his face,” Berkeley Brandt recalls. The surgeon showed the worried parents pictures taken with a tiny arthroscopic camera of the shattered bones in Zachary’s knee joint.

“It looked like the damage came from a gunshot wound,” Berkeley said. After the long surgery to piece the boy’s knee back together, Dr. Raustol assured them Zachary would be able to walk again, but intensive physical therapy would be needed to restore his ability to run.

“It broke my heart to hear that, because Zach was so into athletics and sports,” Berkeley said.

In cases like Zachary’s, the best outcome requires a pediatric orthopedic surgeon such as Dr. Raustol, highly attuned to the unique structures and growth patterns of young bones. But surgery is just the beginning. Choosing the best rehab therapist can make an enormous difference to a child’s future.

Dr. Raustol referred the Brandts to CHKD physical therapist Tim Marinelli, who has a PhD in physical therapy from Old Dominion University. Because the Brandts live in Yorktown, Marinelli would hold the twice-weekly sessions at CHKD’s Health and Surgery Center at Oyster Point in Newport News.

“Dr. Raustol made it clear it would be a long, hard road,” Zachary’s father recalls.

That it was.

Zachary’s injury occurred in September 2008.

A sports nut who played goalie on travel soccer teams, Zachary was playing a goal-kicking game at school when he knocked knees with another player.

“It wasn’t very hard,” Zachary recalls. But the knees hit at an angle that caused Zachary’s left knee to essentially shatter. In an older child, the ligament inside the knee might have torn, but Zach’s ligament was stronger than his still growing bone. The ligament yanked chunks of bone off on both ends.

Zach Brandt

“This is as close to a shatter as you can get in a pediatric population,” Dr. Raustol said. Only after he inserted an arthroscope during surgery could the surgeon see the full extent of the damage, including a shredded meniscus – the padding of cartilage that keeps the knee bones from grinding against each other.

During the long surgery, Dr. Raustol repaired the cartilage and then assembled the bone fragments like pieces of a puzzle. Because Zach was still growing, the surgeon couldn’t use metal screws that might damage the growth plate. He had to suture all the pieces into place.

“I would say it’s one of the more challenging cases I’ve ever done of that type,” Dr. Raustol said.

Only extensive follow-up physical therapy could keep Zachary’s knee from seizing up. “I told the parents that putting it together would seem like the easy part,” Dr. Raustol said. “The hard part is getting the motion back.”

But Zachary couldn’t begin therapy for a month because he was in a full-leg cast. By the time he started, his muscles had atrophied. He couldn’t straighten his leg all the way.

Having the therapy sessions at Oyster Point was a godsend for the Brandts, who live just 15 minutes from the center. “It would have been so hard on us to travel to Norfolk twice a week,” Sara said.

Marinelli said few patients know how difficult, painful and gradual therapy can be. “At Zach’s age, a lot of kids will give up,” he said. “Therapy takes a lot of willpower and courage.”

It can be tough on the parents as well. “I’m a tough guy,” said Zach’s dad, a former Navy pilot turned teacher, “but watching him work so hard was taking a toll on me mentally.”

The boy’s determination impressed both Dr. Raustol and Marinelli. Zachary would continue the therapy when he was at home. “If he’s not doing what he needs to do every day of the week, he’s not going to make any progress,” Marinelli told the family. “I stretch him just 40 minutes two times a week. That’s not enough.”

Zachary was determined to get better. “If I stopped, then I wouldn’t be able to run and play soccer,” he said.

Dr. Raustol and Marinelli consulted with each other routinely, collaboration that was invaluable. “When we would go for an appointment with Dr. Raustol, Tim would get an immediate update,” Sara said. When Marinelli decided Zachary had reached a limit on mobility, Dr. Raustol performed a follow-up surgery to eliminate scar tissue.

As the therapy progressed, Marinelli said, Zachary realized that physical therapy could be fun. They started running and jumping drills, working to strengthen Zachary’s leg. By the time he left therapy this past April, Zachary was fully mobile and pain free.

Today, he’s back in the game, with a goal of being selected for a travel soccer team, the ultimate level of participation for the best players.

“I’m trying to get back to where I was,” Zachary said. “I just need to keep working on stamina.”

While both Sara and Berkeley Brandt offer high praise for both Dr. Raustol and Tim Marinelli, they are equally grateful for the convenience of the sports medicine gym at CHKD’s Oyster Point Health and Surgery Center. They were glad they had chosen the pediatric specialists of CHKD because of the way Dr. Raustol and Marinelli worked as a team, constantly sharing information to make sure Zachary received the best possible care at every stage of his recovery.

“It’s such a blessing to have this facility here for families like us,” Sara said. “For our son, we would have gone anywhere, but it was just down the road.”

Dr. Raustol practices with CHKD surgical group’s orthopedics and sports medicine practice.

This story was featured in the third 2009 issue of KidStuff, a publication of Children's Hospital of The King's Daughters. Click to read more patients' stories.