Torn ACL and Meniscus: Berlin’s Story

Meet Berlin

At 14 years old, Berlin Butler-Swanger has played soccer since she was 7 years old, half her life.

“I play forward for the Kansas City Athletics 2006 Elite Club National League (ECNL) team,” Berlin said. “They’re an amazing club. My favorite part of the game is scoring.”

But Berlin also isn’t afraid to step up and defend her team, especially when she feels like they’re getting shoved around.

That’s exactly what happened when they were in Detroit May 12, 2019, playing another ECNL team, the Michigan Hawks.

“I got mad because there was this one girl on the opposing team who was pushing my team around, but the ref wasn’t calling fouls,” Berlin said.

“It was the last six seconds of the game and I decided I was going to take the ball away from her, so I went in to shoulder her,” Berlin described. Unfortunately, when she made that move, Berlin twisted her right leg, heard a “pop,” then fell to the ground in pain.

“The pain was pretty bad and I was crying,” Berlin admitted. “But I was crying because I was so disappointed. I knew I had torn my ACL (anterior cruciate ligament).”

The cruciate ligaments control the back and forth motion of the knee. The ACL also provides rotational stability for the other structures in the joint.

A long road home

With help from the opposing team’s athletic trainer, Berlin’s dad iced her knee down, then they made the long drive back to Kansas City from Detroit, an 11 ½ hour trip. The next day, Berlin got an appointment to see Brian Harvey, DO, pediatric sports medicine physician at Children’s Mercy Sports Medicine Village West.

“We couldn’t believe how quickly we got in to see Dr. Harvey,” said Berlin’s mother, Miranda Butler-Swanger.

Dr. Harvey ordered an MRI that confirmed Berlin’s suspicions, then he referred her to Kevin Latz, MD, a pediatric orthopedic surgeon with Children’s Mercy Kansas City, and Chief, Section of Sports Medicine.

“In addition to the ACL tear, Dr. Latz thought Berlin might have torn her meniscus, but he couldn’t tell how bad the damage was until surgery,” Miranda said. The meniscus is one of two wedge-shaped pieces of cartilage that act as "shock absorbers" between the thighbone and shinbone.

“When we met with Dr. Latz, he wanted to know what Berlin’s goals were and what our goals as a family were for her,” Miranda said. “He took the time to listen to us and thoroughly explained his plan for surgery.”

But before Dr. Latz would reconstruct Berlin’s ACL, he recommended four weeks of physical therapy with Nicole Hogan, DPT, Sports Medicine physical therapist at Village West. The goal was to strengthen Berlin’s quads and hamstrings to ensure the best possible outcomes post-surgery.

Equipped with crutches and wearing a knee brace, Berlin began working twice a week with Nicole, getting ready for her June 26 surgery.

“It was tough at first because I couldn’t bear any weight on my knee,” Berlin said. But by the time her surgery day came around, she was feeling stronger and passed her Biodex testing.

Biodex is a multi-joint isokinetic machine that provides physicians and their patients valuable information about strength deficits and muscle imbalances that may predispose a particular joint to further injury before surgery and after rehabilitation.

With every hurdle cleared, Dr. Latz reconstructed Berlin’s ACL during an outpatient procedure at the Children’s Mercy Adele Hall Campus and he also repaired her lateral meniscus.

“Because we had to repair Berlin’s lateral meniscus tear, we limited her weight bearing and range of motion, making the first six weeks of her rehab a little slower than usual,” Dr. Latz explained. “This also means her prognosis is a little more uncertain because meniscus tears don’t always heal, despite our best efforts.”

Due to her age, Dr. Latz also had to take Berlin’s growth plates into consideration during the operation. “We did alter Berlin’s surgery slightly to try to avoid damage to the growth plates in her femur and tibia,” he said. “We will need to follow her very closely until she reaches skeletal maturity over the next year or two.”

Back to physical therapy

Several days after surgery, Berlin returned to physical therapy at Children’s Mercy Village West, ready to get down to the business of recovery.

“Berlin was such a hard worker and had a very positive attitude and demeanor,” Nicole said. “I often had to pull back on the reins as she was doing her therapy. She motivated herself most of the time.”

Early on, Nicole focused on helping Berlin build a strong foundation, incorporating the pool and aquatic therapy into her rehab.

“Working in the pool really helped Berlin to feel like she was making make great progress during the early stages of her recovery. She didn’t have all her body weight on her knee because of the buoyancy of the water and so she was able to get back to walking and other dynamic movements, like jumping, earlier than what she was able to do on land,” Nicole said.

And when Nicole put her on the anti-gravity treadmill at Village West, Berlin was “over the moon!”

This machine uses NASA-developed technology to unweight patients, which reduces impact on the joints while walking or running during rehab.

“I think Berlin got a little teary-eyed when Nicole put her on the anti-gravity machine at 40%, and she was actually jogging on her own two feet,” Miranda said.

“I loved that machine. It was so much fun!” Berlin added.

“It’s like you’re walking on the moon.”

Over several months, Berlin’s therapy progressed to a program focused on strength training, with an emphasis on quad and hamstring exercises, and balance/proprioceptive work for increased stability and control. She even utilized the Versaclimber at Village West.

“We advanced to more unpredictable movements, like what she would face on the soccer field,” Nicole added. “Those are the movements where Berlin needed to further solidify confidence in her knee. We wanted to continue to strengthen her muscle memory to get to the point where she could just react, and not hesitate when performing contact activities on the field because she’s worried about reinjuring herself.”

Like sisters

During the countless hours Nicole and Berlin spent at Village West working on Berlin’s recovery, the two connected like sisters.

“From the beginning, our personalities meshed really well,” Nicole said of her patient. “Berlin became like family to me. I enjoyed talking with her, not just about physical therapy and school, but about life in general. That’s what makes therapy at Children’s Mercy so special—the personal relationships we’re able to create with each patient and their own unique experiences.”

“I felt like Nicole is a big sister,” Berlin added. “ I got to know her really well. She was very patient with me, but when she needed to be tough, she was. She knew when to push me.”

Cleared to play

Throughout Berlin’s recovery, she was fortunate to be with a soccer club that held her spot open. “Berlin’s coach was really great about everything,” Miranda said. “She went to practices and supported the team at home games. They encouraged her to take her time to get healthy.”

Miranda said even though they made the drive from their Olathe home to Village West for months, it was well worth it.

“Everything went very smoothly, no bumps or hiccups,” Miranda said. “Dr. Latz did a wonderful job with her surgery, and he and Nicole worked together to help Berlin recover. The care has been very personal.

“Plus, it was fun for her to get to work out in a place that was created just for this purpose. Everything she did pointed back to achieving strength, balance and control. It felt like she was making progress all along the way.”

“At first, I had some self-doubt. I was so young to have surgery, but there was never any question of whether I would do it or not. I would never quit soccer, and Dr. Latz and Nicole understood that,” Berlin said. “Now I feel good. I don’t feel like my knee is ‘broken’ anymore.”

Nicole believes Berlin has become stronger and more confident throughout the recovery process, too. “She’s in a wonderful place right now,” Nicole said. “I admire Berlin’s tenacity and how she pushed herself.

“I’m the guide who provided the tools, but Berlin is the one who really used them, and because of that, she’s going to thrive and flourish,” Nicole said. “I thoroughly enjoyed my time with her and I’m so glad we crossed paths. Hopefully, this experience has helped her grow emotionally and physically. I think she will come back a stronger, better athlete. She’s done an amazing job!”

And she has! After Berlin was cleared to return to sport in March 2020, she had the opportunity to play in four games before the COVID-19 pandemic shut the league down. Throughout the stay-at-home orders, she continued to participate in twice-a-week Zoom trainings with her team. They finished their season online, then she tried out and was selected to rejoin the top 2006 girls ECNL team.

“This has been a huge learning experience for me,” Berlin said. “I’ve learned a lot of patience, definitely perseverance. Right after surgery, I wasn’t sure where I would be in six months, but there was never a moment when I wanted to give up. When Nicole let me start doing soccer drills, running and shooting, I felt really strong.”

“Berlin will get to play again,” Miranda said. “That was her goal all along. We are extremely blessed and thankful. And though she will be wearing her leg brace until March 2021, she feels good and is running now to prepare for the fall 2020 season.”

“I’ve grown throughout therapy,” Berlin said. “I don’t want to be the same player I was when this started. I want to be better. Thanks to Children’s Mercy, I think I will be.”