It wouldn’t take much. A slight misstep or a weird angle on the pavement, and Nicholas DiBella would fall.
His knees, which had given him trouble since birth, would often give out without warning, and he’d tumble to the ground. Even when he was staying on his feet, there was pain. His parents needed an adult-sized stroller to bring him anywhere — even a short walk through the park was too much for him to handle.
And then there were the aesthetics. His kneecaps had grown out towards the side of both of his legs, and would often shift suddenly when he walked. During the summer, his parents usually dressed him in long shorts, to spare him the gaze of onlookers.
“It was really quite jarring to look at,” said Evelyn DiBella, Nick’s mom. “His kneecap would push out to the side, and he’d have to straighten his leg out, and then it would pop back into place.”
Patients with Down Syndrome often struggle with instability in their joints. For Nick, the problem got steadily worse as he aged, and soon, his parents were looking for help. Their search led them to Golisano Children’s Hospital.
‘One side at a time’
Natasha O’Malley, M.D., first met Nick in 2016. Nick had been seeing UR Medicine providers for two years, but when it became obvious that surgery was going to be necessary, O’Malley — who is experienced in treating these conditions — was called in.
O’Malley’s team set out to plan Nick’s surgery, with the goal of putting all the important parts of his knees — the tibia, femur, tendon, and ligament — back into alignment, as years of the abnormal growth had pushed them all out of whack. He’d also developed “knock knees,” meaning his knees bent inward when he stood.
O’Malley decided to treat his right knee first, rather than doing both procedures at once.
“We took things one side at a time, because when you’re rehabbing a knee, you really have to depend on your other leg for support,” said Emily Hermann, N.P., who treated Nick alongside O’Malley.
His first surgery took place in 2016. O’Malley made cuts to his femur and tibia so they could be realigned properly, re-positioned his tendon, and performed a ligament reconstruction. His healing wasn’t perfect, though, so he returned the following year for an additional procedure — a new plate and bone graft to improve the healing process.
Throughout the process, Nick endured a grueling rehab, first with home visits from a physical therapist, and then additional appointments in an outpatient office.
“I often tell families that I do one day of work, but they do a lot more,” said O’Malley. “But Nick and his family were both very determined. They were committing to getting him better.”
The next time Nick saw O’Malley, he pointed straight at his left knee. The implication was obvious.
“He’s pretty much nonverbal, but you can understand him through his looks,” said Evelyn DiBella. “He wanted that other knee done.”
Crossing the stage
The realignment surgery for his left knee took place in January, and since then, Nick has surprised everyone with the speed of his recovery.
Today, he’s as comfortable as ever, and his steadily-increasing confidence in his ability to walk has led to a happier outlook and a brighter personality.
“I have a picture of him playing challenger baseball, and he had the biggest grin on his face I’d ever seen. It was like I didn’t even know him,” said Evelyn DiBella.
One of his biggest accomplishments came in June, when he graduated from Hornell High School. With family and friends looking on, Nick cracked another big smile as he walked across the stage to collect his diploma.
“It’s like nothing ever happened to him,” said Evelyn DiBella. “It’s amazing — he’s walking up and down stairs, and he’s happier and more social. I really can’t say enough about what Dr. O’Malley has done for him.”