Sports Medicine

Patient Stories | Leighton and Osteochondritis Dissecans

Second Opinion Keeps Leighton’s Gymnastics Dreams Alive Following Osteochondritis Dissecans Diagnosis

Leighton had always been a natural gymnast. As soon as she could walk, she was constantly on the go—jumping, bouncing or climbing. When Leighton was 2, her mom, Shawn, enrolled the two of them in mommy-and-me tumbling classes. 

“Each week, she’d set out her leotard the night before,” Shawn said. “She couldn’t wait to go to class.”

Once Leighton was 5, Shawn switched her to a bigger gym with a gymnastics team. The gym hosted what they called “fun meets” to give the kids a feel for competing. Leighton loved it and soon started competing in real meets. As the years went by, she racked up first-place finish after first-place finish, and several state championship wins.

“She saw a lot of success, and she really loved it,” Shawn said. 

Then one morning in September 2021, Leighton woke up and couldn’t fully straighten her right elbow. “I figured I’d just slept on it wrong,” she said, “but then I had some pain when I did handstands later that day.”

Shawn took Leighton to a sports medicine doctor near their home in Michigan. The doctor told them that Leighton’s pain was likely nothing to worry about—probably something relatively benign like tendonitis—but she wanted to do an X-ray to rule out a more serious condition called osteochondritis dissecans (OCD). 

Osteochondritis dissecans is a joint disorder that occurs when the bone underneath the cartilage disappears, causing the cartilage and bone to break loose, which leads to pain and disrupts joint motion. The condition is rare, with only about 5,000 new cases diagnosed each year in the United States, but it’s most common in children and adolescents between the ages of 8 and 16 who are very active in sports.

“The doctor said she’d take an X-ray of the right elbow first, then do an X-ray of Leighton’s left elbow for comparison,” Shawn said. “She came into the room afterward and said, ‘Well, I have some not-so-great news. Leighton actually has OCD in both elbows.’”

The sports medicine doctor referred Leighton to a local orthopaedic specialist, who told Leighton she’d have to quit gymnastics and “didn’t really give us any options,” Shawn said, noting that she wasn’t ready to accept that outcome as the only one available to her daughter. “As her mom, I just wanted the best care possible for her. Whether that meant she could do conservative treatment or surgery, or even if it did mean she’d have to quit gymnastics, I wanted to find the best possible place and the best possible physician to care for Leighton, so she could be as healthy as possible in the future.”

Shawn, who works in healthcare but isn’t a clinician, started researching medical journals and joined an osteochondritis dissecans support group on social media. “I kept seeing this ‘Dr. Wall’ referenced everywhere,” she said. “His name was all over the social media group and all over the medical journals. I quickly learned he’s the foremost expert on OCD.”

Shawn decided to make the four-hour drive from their home in Michigan so Leighton could get a second opinion from Eric Wall, MD, director of Orthopaedic Sports Medicine at Cincinnati Children’s.

Treatment Options, Surgery and Return to the Gym

Shawn soon realized everything she’d read about Dr. Wall was true. While most orthopaedic surgeons see one new osteochondritis dissecans case every five years, he sees up to 60 new cases each year—including patients from all over the country. In fact, to keep patients and their families from having to travel so much to and from Cincinnati Children’s, Dr. Wall maintains medical licenses in seven states so he can follow patients via telehealth.

“I’ve never advertised,” he said. “It’s more that OCD has been a special interest of mine for 30 years, and patients have found me.”

Despite his expertise, Dr. Wall “never talked down to us,” Shawn said. “He gave us options, made us feel welcome and, most importantly, gave Leighton hope that she could return to her sport.”

Gertrude Whitaker, MSN, RN, a nurse practitioner in the Division of Orthopaedic Surgery, also was “a true blessing,” Shawn said. “Gertrude holds your hand through everything and is incredibly responsive to any questions you have, answering them over the phone or over the portal,” she added.

“My primary role is supporting the families and acting as a liaison for Dr. Wall,” Whitaker said. “I always try to meet these patients and families where they are and help them progress back to activities. It’s a frustrating condition. I try to reassure them that we’re getting them to a point where they can move forward, and our goal is the same as theirs: to get them back to their sport.”

After discussing Leighton’s options, Shawn said they chose to go with surgery because Dr. Wall made them feel confident it would work and she could get back to gymnastics.

Osteochondritis dissecans is traditionally “very resistant to healing,” Dr. Wall said. However, the success rate of osteochondritis dissecans surgery has climbed significantly in recent years, especially for elbows. “We’ve improved the success rate quite substantially in the past five years,” he said. “It’s now close to 90% to 95% or better, compared with what the success rate used to be, which was 50%.”

The reason for the improvement is an evolving treatment approach.  

“We used to do less-effective surgery first because it was less invasive,” Dr. Wall said. “Then we realized that kids kept coming back because there was a high failure rate involved with minor surgery. That’s why we’ve now shifted to doing a little bit more complex surgery that’s more effective at getting high-level athletes back to their sport.”

Because Leighton’s osteochondritis dissecans was especially advanced in her right elbow, she ended up needing three surgeries—one on her left elbow and two on her right—to heal the cartilage and bones in her joints. In total, she lost about a year and a half of gymnastics while recovering from the surgeries.

While Dr. Wall's surgical expertise was critically important to Leighton's return to sport, Shawn also wanted to recognize the many people and different specialties who aided Leighton in her journey. 

"Having support for Leighton through a physical therapist familiar with OCD— as well as supportive and flexible coaches and teammates, family and friends supporting her dreams—is so important to her returning as a well-rounded athlete," Shawn said. 

Today, Leighton is back in the gym, without pain and even stronger than before. And she’s looking forward to a bright future. 

“I’d like to be a gymnast in college and would love to become a sports medicine doctor,” Leighton, now 13, said.

Because she was treated for her osteochondritis dissecans, those dreams are well within reach, Dr. Wall said.

“This condition involves the cartilage surface in the joint, so it can ultimately—if it goes untreated or is undertreated—destroy the joint surface, which leads to arthritis,” he said. “So it’s critical to diagnose and treat correctly. In fact, I call it one of the most important conditions people have never heard of.”

(Published September 2024)