ACL Reconstruction

1. What is the ACL?
The anterior cruciate ligament connects the thigh bone (femur) to the shin bone (tibia) and is one of the four main stabilizers of the knee joint.

2. How is the ACL injured?
The ACL can be sprained (partially stretched or completely torn) by non-contact injuries (such as landing from a jump or pivoting) or by contact injuries (such as a blow to the outside aspect of the knee.

3. How are ACL tears diagnosed?
Usually ACL tears are diagnosed with specific physical exam maneuvers. However, it is sometimes difficult to get accurate examinations in the setting of an acute injury. X-rays show f there are any associated bony injuries. MRIs are used to confirm a torn ACL as well as determine if there are any other associated injuries such as a meniscus tear or cartilage injury.

4. How are ACL tears treated?
If the ACL is completely torn, surgical reconstruction is usually recommended. Some people can be very active without their ACL, but the majority of people will not feel stable with high-level athletic activities and will either give them up or place their knee at risk for further injury by competing with an unstable knee.

5. How is the ACL reconstructed?
We perform arthroscopically assisted ACL reconstructions. This involves recreating the ACL by placing a graft to act like the old ACL.

6. What type of grafts are there?
We offer several graft options. Autograft is your own tissue such as your a portion of your patella tendon or hamstring tendons. Allograft is tissue donated from a cadaver.

Rotator Cuff Repair

1. What is the Rotator Cuff?
The rotator cuff is made up of four muscles that provide stability and motion to the shoulder joint.

2. What is a rotator cuff tear?
From attrition (wear and tear) or trauma, the rotator cuff tendons can tear. If they tear, you can still have fairly normal function, but you may have pain with using your shoulder or sleeping at night.

3. How is a rotator cuff tear diagnosed?
The diagnosis of a rotator cuff tear is based on examination, x-rays, and if recommended an MRI.

4. What is the treatment of Rotator cuff tears?
Depending on the type of tear and your activity, some rotator cuff tears may be treated with medication, therapy, injections, or surgery.

Instability or Labral Repair

1. What is the labrum?
The labrum is a band of connective tissue that creates stability in the shoulder joint by preventing the ball from moving too far in the front or back of the socket.

2. How do you treat labral tears?
Some labral tears occur as natural aging process, while others are the result of trauma (a shoulder dislocation). Traumatic labral tears are usually treated with surgery while degenerative(age-related) tears are treated without surgery.

3. What is Shoulder Instability?
Shoulder instability is when the ball is loose in the socket of the shoulder. This may be acute or chronic (multiple occasions).

4. What is the treatment of shoulder instability?
In most cases, shoulder instability can be treated with exercises. In some cases, surgery is indicated to provide stability by tightening ligaments or providing bony support to the shoulder joint.

Meniscus Tear

1. What is the meniscus?
The meniscus is a type of cartilage that acts as a cushion on the inside (medial) and outside (lateral) part of the knee.

2. What does a meniscus do?
The meniscus acts as a cushion between the thigh and shin bones and it adds stability to the knee joint.

3. How does a meniscus tear?
Meniscus tears may be the result of trauma or degeneration (a natural breakdown of the tissue with age).

4. How do you diagnose meniscus tears?
The patient’s complaints and physical exam usually are the most important data. X-rays are often obtained to evaluate for arthritis. MRIs are used to confirm this suspected diagnosis.

5. How are meniscus tears treated?
Depending on the type of tear and the symptoms the tear is causing, tears may be treated differently. Non-operative management includes rest, anti-inflammatory medication, therapy, or injections. Operative management includes arthroscopic surgery to cut away the torn tissue or repair it.

Cartilage Repair

1. What is articular cartilage?
Articular cartilage is the cushion tissue on the end of the bones of the large joints in our body.

2. How does articular cartilage get injured?
Injuries to articular cartilage may result from trauma or from degeneration (arthritis).

3. How are these injuries diagnosed?
Pain is a common complaint. Sometimes mechanical symptoms (clicking, locking, popping) are also present. X-rays may be helpful in cases of severe cartilage loss (arthritis). MRIs are helpful to assess the integrity of cartilage.

4. How are these injuries treated?
Isolated defects may be treated with a variety of techniques to restore a smooth cap to the crater such as microfracture, osteochondral autograft/allograft transplants (OATS) or autologous chondrocyte transplantation (ACI). Diffuse degeneration of cartilage, or arthritis, is usually treated with resurfacing or replacement procedures.

Bursitis

1. What is a Bursa?
We have bursae all over our bodies. They are small fluid-filled sac-like structures that allow tendons to glide over bony prominences or under our skin. Normally, bursae are not filled with much fluid and are like a plastic grocery bag collapsed on itself. These low friction surfaces allow tendons to move without getting irritated.

2. Where are bursae located?
All over or body, but mostly around joints. The most commonly injured bursa are located in the shoulder, elbow, hip, knee and achilles.

3. What is bursitis?
Bursitis is inflammation of a bursa sac. This can be a result of trauma, overuse, infection, or systemic processes like gout, lupus, or rheumatoid arthritis.

4. How is bursitis treated?
This depends on the cause of the bursitis. Traumatic or overuse bursitis often responds with rest, antiinflammatory medication, injections, and rehab exercises. Infections require antibiotic medication and sometimes surgery.

Patella Malalignment/ Instability

What is Patella malalignment?
Patella malalignment is the result of abnormal orientation of the bones of the hip, knee, or foot. It results from the development of the bones from birth and can result in instability or cartilage irritation (chondromalacia) and breakdown (arthritis).

2. What is patella instability?
Patella instability is when the kneecap repeatedly dislocates or subluxes (partially dislocates) from its normal relationship in the knee.

3. How is patella malalignment/instability diagnosed?
The symptoms and history reported by the patient are key. Physical examination usually will show some structural or postural abnormalities in the hip, knee, or foot that are usually the cause of the problem.

4. How is this problem treated?
Nonoperative options include: knee braces, arch supports for the feet, core strengthening, and hamstring flexibility. Surgical options may involve soft tissue repairs or reconstructions, or in some cases, realignment of some of the bones of the knee.

Osteochondral Lesions

1. What are osteochondral lesions of the ankle?
These are bone and cartilage injuries to a bone in the ankle called the talus.

2. How do they occur?
They may be the result of a single trauma such as a bad ankle sprain, or multiple repetitive trauma like recurrent ankle sprains. In some adolescents, these injuries can occur spontaneously.

3. How are they diagnosed?
They may cause pain or swelling in the ankle. They are usually painful to touch. X-rays will often show them. MRIs are usually ordered to assess the extent of the injury as well as the quality of the cartilage.

4. How are they treated?
Treatment is very individualized based on the type of lesion and the patient. Non-operative management includes immobilization, activity modification, and protected weight bearing. Surgical management may include arthroscopic or open procedures to restore the integrity of the articular surface of the talus.

Ankle Impingement

1. What is ankle impingement?
Ankle impingement occurs when two of the ankle bones (the talus and the tibia) repetitively abut one another. This may lead to pain because of bone spurs that form or because the ankle joint lining gets irritated (synovitis).

2. How is it diagnosed?
Physical exam may reproduce symptoms with specific maneuvers. X-rays may show bone spurs. An MRI will usually show synovitis (inflammed joint lining).

3. How is it treated?
Rest, anti-inflammatories, therapeutic exercises, and sometimes a steroid injection may successfully treat it. Arthroscopic surgery is also successful in treating this problem.