As Diana Ladio steps onto the stage to begin her violin performance, she’s finally no longer worrying about her agonizing knee pain.

Ladio is a professional violinist who has been touring since she was 18 years old, as well as an educator, teaching music workshops for underprivileged children. 

She’s on an average of two flights a week, must be ready to jump around on stage and constantly interact with the children she teaches.

With consistent pain in her knee due to progressive cartilage wear, Ladio was struggling to stay active without intense pain.

Her fears of consistent knee pain were relieved after a live donor cartilage tissue transplant just before Christmas day of 2020. 

Constant knee pain

After running five marathons, Ladio started to notice intense pain in her knee that was getting progressively worse.

When the pain became unbearable, an MRI revealed she had an osteochondral (cartilage) defect.

“A piece of cartilage in my knee wasn’t where it should be, it was like a hole had formed in the cartilage,” said Ladio.

“There is no sure way to know how it formed, but the best guess is that it was from trauma to the knee as a child that was only made worse by running as an adult.”

Soon after the scan, Ladio had an initial procedure to resolve the issue by placing artificial cartilage in the knee and got back to running once she was healed.

“I wasn’t ready to give up running even though my body was telling me it was time to stop,” said Ladio.

About a year later, Ladio ran a 10K in the snow and had a slight slip that she was able to recover from without falling. However, something in her knee didn’t feel right after the slip and she went back for another scan. 

The scan revealed that the artificial cartilage in her knee had not healed and she would need a second surgery to replace the cartilage, but this time, with live donor cartilage.

Creating time for surgery

With Ladio’s busy touring and teaching schedule, finding down time to recover from surgery was going to be a challenge.

However, when the pandemic began in 2020, her travel plans came to a halt leaving time to have surgery and recover.

Ladio worked with John Grant, M.D., Ph.D., an orthopaedic surgeon at MedSport, part of University of Michigan Health, to get her name on the JRF Ortho orthopaedic tissue donor list for live donor cartilage, and begin planning out her surgery.

“The donor tissue comes from someone who is less than 30 to 35 years of age and has recently passed but has healthy knee joints,” said Grant.

“In the body, cartilage cells don't have much of a blood supply, so they can be kept alive for about four weeks in a fridge with nutrient fluid to support the cells. It takes about two weeks from the time that gifted tissues are taken from the donor body to test the tissue and then you have about two weeks to coordinate with the patient, the surgeon, and the operating room to find a time to do the surgery and transplant the donor cartilage tissue into the patient.”

In December 2020, Ladio and Grant received the news that there was donor cartilage ready for Ladio and plans for surgery went into action.

For the procedure, Grant performed a structural treatment of Ladio’s knee to replace the cartilage. The procedure consisted of an osteochondral allograft transplant of the live donor cartilage into the back of Ladio’s kneecap as well as the cartilage at the end of the thigh bone.

“The knee of the patient is opened, and you measure the shape and area of cartilage damage,” explained Grant.

“Once the area is measured, a socket is made in the patient’s bone in the damaged area and then a similar size and shape dowel of cartilage and bone is then removed from the donor tissue. The new donor cartilage is then placed into the previously made socket in the patient’s knee. Once the surgery is done, the donor bone under the cartilage surface then heals to the bone in the patient’s knee to anchor the new healthy cartilage surface.”

Ladio planned to spend a few weeks with her parents in Michigan before returning to her home in Nashville after her surgery. She ended up staying for three months.

“The recovery process was more intense than I anticipated,” Ladio said.

“I spent a lot of time with my physical therapy team just learning how to walk again before completing daily tasks.”

While recovering at home in Michigan, Ladio worked with her physical therapist, Jill Stockford at Medsport. 

The pair started working together after Ladio’s first incident in 2017.

Stockard and Ladio were able to bond over their love of running and Stockford understood why Ladio was eager to return to the sport. 

Working with Grant, Stockford created a physical therapy routine that started by focusing on reducing swelling in Ladio’s leg and gradually moving to adding weight to her leg.

Returning to the stage

After her three months stay in Michigan, Ladio was ready to not only return home but also return to touring.

As she began returning to touring, Ladio made sure to find a gym on each stop of the tour to work through the physical therapy exercises she had worked on with Stockford.

When Ladio was in the Ann Arbor area, she would always return to Stockford to check her physical therapy progress and make any needed adjustments to her exercises.

Stockford and Ladio created a bond through Ladio’s time in physical therapy and were both overcome with joy seeing her improvements.

“Her first day on the Alter-G, a specialized treadmill that supports your body with air so there is less shock with running, was October 2021,” said Stockford. 

“That was a very special day for both of us with lots of tears shed. It took tremendous strength, fortitude, and patience for Diana to work herself back to running.

She was incredibly dedicated with doing her exercises every day, even with a very busy traveling schedule, both nationally and internationally.”

As she began to tour with her band once again and move about the classroom teaching children how to play violin, she was thinking less about the pain in her knee.

“I live such an active lifestyle and having the ability to move around throughout the day with little knee pain was a game changer,” she said.

In addition to her work on the stage, Ladio also recently got in contact with JRF Ortho through Grant and was sponsored to ride on their float with OneLegacy at the Rose Bowl parade in Pasadena, California in December 2023.

“I was able to talk to not only those who received organ donations, but those who had family members that donated,” said Ladio.

“It really put into perspective the impact of organ donations on both sides. It was an impactful experience that I will never forget. With my experience of receiving donor tissue and seeing the impact that organ donation has made on others, I strongly encourage those who can donate to do so, the emotional and human impacts can hardly be measured.”

In addition to participating in the parade, University of Michigan alum Ladio was able to attend the Rose Bowl game with her mom and see the team get the win that took them to the championships. 

She could only describe this as serendipitous.

“The choice to have surgery on my knee was a difficult one and it was not an easy recovery, but the life and energy it has given me has been worth it,” said Ladio.

“I am incredibly grateful for organ and tissue donation for making this procedure possible for me and encourage others to stop and listen to their body.”

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