As a board-certified orthopedic surgeon and specialist in knee and shoulder surgery at the Hospital for Special Surgery (HSS) in New York City, people often reach out to me with questions about knee and shoulder surgery, recovery, and research. I provide compassionate, knowledgeable care informed by my ongoing research and offer both surgical and non-surgical treatments for knee injuries. I’ve put together this list of frequently asked questions to help you find the answers you need.
Yes—virtual consults are available for those with recent MRIs or X-rays. Please call my office at 212-606-1725 to schedule, upload your imaging, and discuss your options for knee and shoulder injuries. Set up your appointment or remote consultation.
Since I already have residents and fellows observing at the Hospital for Special Surgery (HSS), I typically cannot accommodate additional observers.
Definitions:
Cartiheal is approved for degenerative cartilage lesions, especially with bone involvement, and often for patients over 35.
MACI repairs one or more cartilage defects and requires two surgeries.
OCA suits single focal lesions >2 cm², heals faster than MACI, and uses donor tissue.
Both have an average full recovery of about six months.
Cartiheal is still new, and while recovery times are similar, osteochondral allografts have a success rate of around 85%.
No; current evidence does not support extra payment for these custom implants as no superior outcome data exists.
Osteoarthritis is a degenerative joint disease where cartilage gradually wears away, leading to pain and stiffness. And yes, the MISHA knee system is an implantable shock absorber now available for certain patients with early medial knee osteoarthritis.
Anterior Cruciate Ligament (ACL) is the main ligament that helps stabilize the knee. Pain and swelling after a retear vary and depend on the injury mechanism. Persistent swelling warrants an MRI to assess for secondary ligament or cartilage injury, as these can cause instability while pivoting.
Tibial plateau avulsion is when a piece of bone at the top of the shinbone is pulled off by a ligament or tendon, sometimes caused by trauma or sports injury. Patellar instability means the kneecap is prone to shifting out of place, leading to pain and sometimes dislocation.
A pediatric orthopedic surgeon with experience in sports injuries or patellar instability—especially one with a clear understanding of growth plate considerations—would be best. (Growth plates are areas of developing tissue at the ends of long bones in children and adolescents; injury here can affect growth.)
An osteotomy is surgical cutting and realignment of bone to improve joint function, and a TTO is a surgery where the bony bump below the kneecap is moved to correct knee alignment and improve stability. Early recovery is challenging; use cold therapy often, fully straighten your knee, achieve 90 degrees flexion while sitting, and perform quad sets to maintain quadriceps strength. (Quad sets are exercises where you tighten the thigh muscle with the leg straight to maintain strength during recovery.) Here’s more information on TTO rehab.
Yes, patients are usually sent to physical therapy for at least six months to ensure optimal mobility and strength. Make sure you find a licensed physical therapist with experience helping patients recover from these types of surgeries.
The screw should be removed six months or later, once bone healing is confirmed.
If pain persists, a high-quality MRI can help evaluate remaining cartilage. Persistent defects may be treatable with cartilage transplant procedures.
Patella alta means the kneecap sits higher than normal in the knee joint, which can cause instability. As far as when surgery is possible, you don’t necessarily need to wait until you’re fully grown. Bone age (assessed via hand X-rays) guides timing of surgery. In select cases, patellar tendon shortening is possible during growth. This post provides additional information about patella alta treatment.
Post-MPFL reconstruction, weight-bearing and knee flexion while sitting typically resume immediately. If strong pre-op, most can return to nearly full activity in about four months.
Outerbridge is a cartilage grading system; grade IV means severe cartilage loss exposing bone.
While not curable, new options exist for treating patellofemoral osteoarthritis. Patients under 40 may benefit from cartilage transplant and osteotomy; partial knee replacement is viable in some cases. (A partial knee replacement is a surgical procedure replacing only the damaged compartment of the knee, not the whole joint.
Genu recurvatum is a condition where the knee hyperextends, bending backward beyond normal limits. And no, bracing is not effective long-term for genu recurvatum.
Operative treatment is not typical. Working with a physical therapist to avoid knee locking and improve neuromuscular control can help with prevention.
This is known as a patellar tendon avulsion, which almost always requires surgical repair. This injury happens when the tendon connecting the kneecap to the shinbone pulls off a piece of bone.
For additional or specific questions about knee or shoulder surgery, recovery, or recent orthopedic research, contact me directly, and I’ll do my best to respond and update this page as new insights and treatments become available.
About this resource: Answers reflect the latest research and my surgical experience at HSS, and are updated regularly as new data and techniques emerge. For more patient education and resources, see my patient information and check out my blog posts.