When Dr. Anthony Silverio, orthopedic surgeon, first met Nina Kumer at Akron Children’s Hospital’s Beeghly campus in 2018 he was struck by the severity of a painful knee condition plaguing the 9-year-old.
“Nina’s condition is something we typically see in teens and adults,” said Dr. Silverio. “It’s uncommon to see someone so young with kneecaps that painfully dislocate multiple times a day.”
While Nina’s early-onset may have been a rarity for Dr. Silverio, her dad, Craig, held an important clue. Caused by a combination of congenital deformity and genetic disposition, Craig has had a total of 9 knee surgeries in his life. In fact, the former college football player no longer has a kneecap in his right leg.
“As someone who used to regularly dislocate my kneecap, I could empathize with how painful it was,” said Craig. “And Nina’s was particularly uncomfortable to look at because it was so disfigured.”
Craig had his first surgery when he was a freshman in high school, but Nina’s case presented a different challenge.
“Her growth plates weren’t closed, so we had a unique hurdle to navigate to get Nina to a higher level of functioning while not disrupting her growth,” said Dr. Silverio.
An avid sports fan, Nina enjoyed participating in basketball, golf and taekwando (a self-defense discipline) on her good days. As her dislocations started happening multiple times a day, sports became too painful to participate in. Although the family tried physical therapy, it didn’t do much to improve her condition.
Nina says the dislocations often lasted just a few seconds as her knee tracked in and out of alignment, but the pain lingered.
“Prior to surgery Nina relied on ice, Tylenol and Aleve as well as several different kinds of braces and athletic tapes,” said Pam, Nina’s mom. “The dislocations would happen 2 to 3 times a day and she would just break down and cry from the pain.”
When it was decided that surgery would be Nina’s best option, Dr. Silverio took one of the tendons in Nina’s right knee and moved it into a new position in the same knee to stabilize it. Since the left knee wasn’t as severe, Dr. Silverio opted not to operate on it with the hope it would strengthen on its own.
Pam likens the surgery to a rope with too much slack.
“By shortening the tendon and attaching it to the muscle, it didn’t have the extra slack that allowed it to slide off to the side,” she said.
Nina says the first week following surgery wasn’t pleasant, but it turned out to be worth it in the long run. In addition to binge watching the Fuller House television series on Netflix, she spent time visiting with friends.
“I couldn’t bear weight the first week, so I was on painkillers and used an ice machine that wrapped around my leg to help with swelling,” she said. “The following week I graduated to a walker (she wore a brace for 6 months) and soon began intensive physical therapy 3 times a week.”
An honor student in the 5th grade at Lowellville elementary school, Nina is a quick study.
“She knew what she had to do to get better and she followed everything to a ‘T’,” said Pam. “The physical therapists set an early goal of getting her knee flexion to 110 degrees and Nina accomplished that goal 1 month ahead of schedule.”
Nina joked that a motivating factor to attending physical therapy was getting away from her big brother, Nicholas, for a little while.
“I also really liked my therapists, they made it fun,” she said.
Now a physical therapy graduate, Nina has returned to her position as point guard on her basketball team. While she doesn’t do specific therapy exercises anymore, remaining active helps her knees stay strong.
Recently Nina had her 2-year post-operative visit and Dr. Silverio was happy with what he saw. While Nina has no physician-imposed limitations on activities, Pam says she is cautious.
“She gave up softball initially because she didn’t want to risk messing up her knee by sliding into bases. Now that her knee is better she has returned to the sport,” she said. “However, she’s still careful when riding her bike down a hill.”
Both Pam and Craig say they were impressed with Dr. Silverio and the care Nina received at Akron Children’s. While they hope this will be the end of Nina’s surgeries, they know there is a chance she may need more down the road.
“Dr. Silverio included Nina in all conversations related to her care,” said Craig. “He prepared her for what would happen in surgery and beyond.”
“He didn’t make us any promises” added Pam. “He made it clear she wasn’t going to see results after leaving the operating room, but that she was going to have to put in the work. We are very grateful to him.”