People often write to me with questions about knee and shoulder surgery, recovery, and research. I’ve put together this list of frequently asked questions to help you find the answers you need.
Cartiheal is approved in patients with degenerative cartilage lesions; I think it is a good option in those with bone edema or a bone/cartilage lesion, especially in those over 35. Matrix-associated autologous chondrocyte implantation (MACI) is indicated for repair of single or multiple cartilage defects and requires two operations.
Osteochondral allograft transplantation (OCA) is for a single focal lesion that is greater than two square cm. It heals more quickly than MACI and requires donor tissue. There is a lot of overlap in their indications.
Cartiheal is still fairly new, so I can’t say which is better. An osteochondral allograft can be around the same recovery time, with success rates of about 85%.
No, these are generally not worth it as there is no data to support it.
Since I already have residents and fellows observing at the Hospital for Special Surgery (HSS), I typically cannot accommodate additional observers.
Yes, the MISHA knee system is available. It is an implantable shock absorber (ISA) that is a good option for patients with early medial knee osteoarthritis.
Pain and swelling of an ACL/knee ligament retear is variable and dependent on the mechanism of injury. You should have an MRI done if there is any swelling.
You should see a pediatric orthopedic surgeon experienced in sports or a sports surgeon experienced with patellar instability in your area as they have relevant experience with the growth plate.
Every surgeon rehabs their osteotomies differently. I recommend using a lot of cold therapy and making sure to fully straighten your knee and bend to 90 degrees when sitting. Quad sets also help keep your quad from atrophying too much.
Yes, typically I send patients who had TTO surgery to physical therapy for at least 6 months.
No, unfortunately bracing doesn’t really work for constant hyperextension (genu recurvatum).
We don’t treat genu recurvatum operatively, but a good physical therapist can help you train your legs to try to avoid locking them out fully in recurvatum.
That isn’t completely true. We check bone age with hand X-rays and then determine when surgery is possible for patella alta. I also have published a surgical technique for shortening the patellar tendon. This can be done while still growing.
After MPFL surgery, you can weight bear immediately and bend your knee when sitting. Usually you can get back to nearly full activity in four months if you are strong going into the surgery.
Depending on your age, you may be a candidate for a cartilage transplant and osteotomy or a patellofemoral replacement. If you are less than 40 years old, then a cartilage transplant might work for you.
The screw should be removed six months or later after a TTO.
That is a patellar tendon avulsion. While I would need to see imaging to provide a diagnosis or treatment recommendation, this pretty much always requires surgery.
If you still have pain, it may be worth getting a high quality MRI and assessing your cartilage as damage to it can lead to pain and inability to run. In many cases this can be treated with a cartilage transplant.
Have more questions about your knee surgery, shoulder surgery, or recovery? Please reach out and I will do my best to respond and update these frequently asked questions.