# Dr. Sabrina Strickland M.D. > Fellowship-trained sports medicine surgeon with 24 years of experience caring for active patients aged 12-80 who want to return to sports. Specializes in ACL and meniscus repair, cartilage restoration, joint preservation, robotic-assisted surgery, and PRP/regenerative medicine. **Provider:** Dr. Sabrina Strickland, MD — Orthopedic Surgeon **Specialty:** Orthopedic Surgery **Address:** NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY, 10016, US **Phone:** 646-904-4664 **Website:** https://sabrinastrickland.com ## Hours - Monday: 08:00–17:00 - Tuesday: 08:00–17:00 - Wednesday: 08:00–17:00 - Thursday: 08:00–17:00 - Friday: 08:00–17:00 - Saturday: Closed - Sunday: Closed ## Home Source: https://sabrinastrickland.com/ NYU Langone Orthopedic Center · New York # Dr. Sabrina Strickland Board-Certified Orthopedic Sports Surgeon My goal is to return my patients to an active lifestyle — for some this means Division 1 sports, and for others it is playing with their children in the park. Fellowship-trained sports medicine surgeon with 24 years of experience taking care of active patients aged 12 to 80 who want to return to sports. Request an appointment → Meet Dr. Strickland Call the office 646-904-4664 Top Doctor Castle Connolly NYU Langone · Orthopedic Center Weill Cornell · Associate Professor AOSSM & ISAKOS · Society Member Patellofemoral Center · Co-founder, HSS Overview Dr. Sabrina Strickland is a board-certified orthopedic surgeon at NYU Langone Orthopedic Center in New York and Associate Professor of Clinical Orthopedic Surgery at Weill Cornell Medicine. She is a fellowship-trained sports medicine surgeon with 24 years of experience treating active patients aged 12 to 80. Her practice focuses on knee cartilage repair, patellar stabilization, MPFL reconstruction, tibial tubercle osteotomy, ACL and meniscus surgery, and joint preservation — including BEAR, MISHA, and CartiHEAL implants. Patients travel to her from all over the US and abroad for second opinions on complex knee cases. Live the life you want ## What if you didn't have to live with knee pain? Knee pain doesn't have to sideline you. Dr. Strickland works with patients to understand their goals — from returning to marathon running, to getting back on the dance floor, to walking the city pain-free — and builds a plan that gets them there. Request an appointment → Explore specialties Why patients choose Dr. Strickland ## A practice built around complex knees and second opinions. 01 ### Sought out for second opinions Patients travel to me for second opinions on cartilage transplants, surgery for patellar instability, and ACL and meniscal repair. 02 ### FDA trial participation I participate in FDA trials so that I can offer my patients the newest and most advanced treatments. 03 ### Stem cell research & practice I use stem cells in my practice and do stem cell research. My goal is to treat arthritis before joint replacement is required — and if replacement is required, to replace as little of the knee as possible to achieve a good outcome. Experience that matters ## Numbers from a focused practice. 0 ACL reconstructions 0 MPFL reconstructions 0 Tibial tubercle osteotomies 0 Osteochondral allograft transplantations 0 Peer-reviewed publications 0 Caring for active patients aged 12 – 80 Featured specialties ## Specialized care for complex knee conditions. Dr. Strickland's practice is intentionally narrow. These are the conditions she operates on every week — with the pace, protocols and outcomes that come from doing a select number of procedures exceptionally well. 01 ligament ### Ligament & Meniscus The workhorses of sports orthopedics — done with the pace, protocols and outcomes that come from treating these injuries every week. - ACL / ligament tears - Meniscus tears - Joint instability 02 cartilage ### Cartilage & Joint Preservation When your knee is worth preserving. Restoration and joint-sparing techniques designed to keep your own knee — not replace it. - Cartilage restoration - Joint preservation / osteotomy - Arthritis / joint degeneration - Knee pain 03 advanced ### Advanced Techniques The latest advances in orthopedic care — robotic precision and regenerative biologics built around your goals. - Robotic-assisted surgery - PRP / regenerative medicine - Sports injuries NYU Langone · New York Meet the doctor ## Sabrina Strickland, M.D. “I want patients to understand what's happening inside their knee as well as I do — so the decisions we make are ours together.” Dr. Strickland is a board-certified orthopedic surgeon at the Hospital for Special Surgery in New York and Associate Professor of Clinical Orthopedic Surgery at Weill Cornell Medicine. Her practice focuses on knee cartilage repair, patellar stabilization, patellofemoral replacement, MPFL repair, tibial tubercle osteotomy, meniscal surgery, ACL reconstruction, and cartilage transplants — including BEAR, MISHA and CartiHEAL implants. She does extensive research and continuously works to improve patient outcomes. Full biography → Publications Treatment philosophy ## Non-surgical first — surgery when it's the right answer. “I begin with a thorough evaluation in person and use non-surgical treatments such as hyaluronic acid, PRP, and stem cells when appropriate — but move to surgery when it is necessary to optimize long-term function.” I love taking care of straightforward problems such as meniscal and ACL tears, small cartilage flaps and arthritis. However, my specialty is joint preservation and patellofemoral joint disease — I offer specialized and state-of-the-art treatment for these often complex conditions. Technology used ### Tools & techniques in the OR and clinic - Mako robotic surgery - MACI (autologous cultured chondrocytes) - Cartilage transplantation - Joint preservation - Platelet-rich plasma (PRP) - Stem cell therapy - Osteotomy - Patellar stabilization surgery Patients we care for ## Active patients, at every level. - ◆ Professional / Collegiate Athletes - ◆ Active Adults / Weekend Warriors - ◆ Youth / High School Athletes - ◆ Dancers / Performing Artists - ◆ Second Opinion Seekers Service areas ### Where Dr. Strickland's patients come from Patients travel to Dr. Sabrina Strickland at NYU Langone Orthopedic Center from across New York, Connecticut, and New Jersey — including Manhattan, Brooklyn, Queens, Westchester County, Long Island, Stamford, Greenwich, and surrounding areas. She also treats patients from across the United States and internationally who are seeking specialized care for complex knee conditions and second opinions. Many patients are referred for advanced procedures such as cartilage restoration, patellar stabilization, ACL reconstruction, and joint preservation. Location Conveniently located in Midtown Manhattan, Dr. Strickland sees patients at NYU Langone Orthopedic Center on East 38th Street. Patient success stories ## What Dr. Strickland's patients say, after. A small selection of patient stories — in their own words — about the outcomes that matter to them, from the marathon to the dance floor. ★★★★★ “I ran the NYC Marathon this past Sunday — something before the surgery I NEVER thought I would be able to accomplish. Completing the marathon was healing and rewarding in so many ways.” Gillis Frechette Tibial tubercle osteotomy & OCA patella Read her full story → ★★★★★ “With lots of hard work and dedication I was back to dancing in 4 months. I just had my first competition — no pain whatsoever. I can’t thank Dr. Strickland and her whole entire team enough.” Peyton Ely Tibial tubercle transfer · Patella Read her full story → ★★★★★ “A year after surgery I was even able to hike the Inca Trail, a 26-mile 4-day hike with a lot of elevation. My knee had no issues. I’m so grateful to be back outdoors and doing things I love.” Rachel Schechter ACL reconstruction Read her full story → ★★★★★ “Dr. Strickland was able to restore me back to my previous active lifestyle. Today I am 100% back doing Pilates, weights, yoga and push-ups — less than a year later.” Carrie Craig Shoulder labrum repair Read her full story → ★★★★★ “Starry Night — not enough stars for my review for Dr. Strickland and her team. I’m currently 5 months post-op and can run 6 miles no problem. Five months until the NYC Marathon — real good chance.” Rhona Chambers Meniscus root-tear repair Read her full story → ★★★★★ “Since age eight, knee instability was a defining challenge. After years of physical therapy and braces failed to stop frequent subluxations and dislocations, Dr. Strickland diagnosed severe bilateral patellar misalignment — both kneecaps more than 10mm out of place — and corrected it across two years of staged MPFL and tibial tubercle osteotomy work.” Avery Bilateral MPFL reconstruction & TTO Read her full story → Read more Back in the Game stories → Watch the introduction ## A minute with Dr. Strickland. Transcript [Music] words can't totally explain how much she meant to me because she fixed the thing that I thought was unfixable I had been told was unfixable you're going to a doctor who's confident who knows what they're looking at who's able to give you the right kind of guidance and the right care I can very often bring my patients back to a level where they can ski again or they can play tennis again and for some of my patients they can go up and down stairs again and these are things that we sometimes take for granted the day I went in and when I finally took the brace off I walked 20 steps and I was like I do this and then that was the beginning of getting back and realizing I'm gonna be back in the game my specialty within orthopedics and sports medicine what that means is that I do shoulder and knee surgery but my passion is patellofemoral disorders i co-founded with my partner patellofemoral Center at the Hospital for Special Surgery something that's really important to me as a doctor is making my patients feel comfortable it's pretty scary to have surgery and it's pretty scary to be injured I have a team that works with me that is amazing meaning the most important thing about when I hire an employee is that they're nice and that patients feel comfortable with them and the thing goes for me I never felt that she rushed through any of the detailed explanations that she gave me and obviously should perform two successful surgeries on me that got me back on my feet I have three kids three girls their ages 13 13 and 15 and theft's twins the most rewarding part of my job is getting people back to the things they want to do having patients see me in clinic three months six months a year after surgery and say gosh I never thought I'd ride a horse again and I'm back riding a horse or I used to get up from a table and worried that I was gonna stumble because my knees hurt so much and now I get up and I don't even think about it so it can be a huge range of what patients are telling me but having a job where people say thank you all day long is pretty often [Music] Credentials & community ## Trained, recognized, and giving back. Education - State licensure in New York and Connecticut - Sports Medicine and Shoulder Fellowship at The Hospital for Special Surgery - Orthopedic Surgery Residency at The Hospital for Special Surgery - General Surgery Internship at Cornell-New York Presbyterian Hospital - Medical School at Rush Presbyterian St. Luke’s, 1996 - College of Arts and Sciences, Cornell University, 1991 Recognitions & awards - Castle Connolly Top Doctor (since 2016) - American Academy of Orthopaedic Surgery Leadership Fellow - Philip D. Wilson Teaching Award (HSS) - AOA (Alpha Omega Alpha) - National Merit Scholar Memberships - International Patellofemoral Study Group - Arthroscopy Association of North America - International Society for Arthroscopy, Knee Surgery and Orthopedic Sports Medicine - International Cartilage Repair Society - American Orthopaedic Society for Sports Medicine - The Women's Sports Forum Training & continuing education - MAKO Robotic Surgery certification - Speaker & instructor — International Patellofemoral Study Group - Speaker & instructor — Arthroscopy Association of North America - Speaker & instructor — International Sports Medicine Fellowship course - Speaker & instructor — ISAKOS (Knee Surgery & Orthopedic Sports Medicine) - Speaker & instructor — International Cartilage Repair Society Community & service - Mentor for orthopaedic residents at the Hospital for Special Surgery - Speaker at community health programs - Former Chief of Orthopaedic Surgery, Bronx VA Medical Center - Cornell University Presidential Council of Cornell Women - Cornell University Arts and Sciences Health Career Advising Committee Our location ## Find us in Midtown Manhattan. NYC ### NYU Langone Orthopedic Center Midtown Manhattan Address 333 East 38th Street, 4th Floor New York, NY 10016 Phone 646-904-4664 Hours Monday – Friday · 8:00a – 5:00p Get directions → Insurance & payment ## Insurance plans we accept. Most commercial plans accepted. Out-of-network and self-pay welcome. Patient financing available. United Healthcare Aetna Cigna Blue Cross Blue Shield Emblem GHI Oxford ✓ In-network with most commercial plans Coverage verified before your visit ✓ Out-of-network & self-pay welcome For patients outside our in-network plans ✓ Financing available Ask the office about patient financing options Patient FAQ ## Common questions, answered. What conditions does Dr. Strickland treat? + Dr. Strickland focuses on knee and shoulder injuries in active patients — ACL and ligament tears, meniscus tears, cartilage injuries, joint instability, patellar (kneecap) instability, knee arthritis, and joint preservation. Her practice is intentionally narrow: these are conditions she operates on every week. Will I need surgery, or are there non-surgical options first? + Surgery is not the first step for most patients. Dr. Strickland begins with a thorough in-person evaluation, and uses non-surgical treatments such as hyaluronic acid, PRP (platelet-rich plasma), and stem cells when appropriate. She moves to surgery when it is necessary to optimize long-term function. How experienced is Dr. Strickland with these procedures? + Dr. Strickland has 24 years of experience and has performed more than 1,000 ACL reconstructions, 450+ MPFL reconstructions, 470+ tibial tubercle osteotomies, and 300+ osteochondral allograft transplantations. She has authored 93 peer-reviewed publications and is regularly sought out for second opinions on complex knee cases. What insurance plans do you accept? + The practice is in-network with most major commercial plans including United Healthcare, Aetna, Cigna, Blue Cross Blue Shield, Emblem, GHI, and Oxford. Out-of-network and self-pay patients are welcome, and patient financing is available. Coverage is verified before your visit. Where is the office and how do I make an appointment? + Dr. Strickland sees patients at NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY 10016. To request an appointment, use the NYU Langone scheduling link on this page or call 646-904-4664. Currently welcoming new patients ## Ready to meet? Let's talk about your knee. Dr. Strickland sees new patients at NYU Langone Orthopedic Center on East 38th Street. Pick the way that's easiest for you. Request an appointment → Contact us Call 646-904-4664 # About ## About Dr. Sabrina Strickland Orthopedic Surgeon in New York Source: https://sabrinastrickland.com/about-dr-sabrina-strickland-orthopedic-surgeon/ Summary: About Dr. Sabrina Strickland, orthopedic sports surgeon specializing in knee surgery and shoulder surgery at NYU Langone Orthopedic Center in NYC About # Learn about Dr. Sabrina Strickland Board-Certified Orthopedic Sports Surgeon · NY Magazine Top Doctor “I look forward to taking care of you.” — Sabrina Strickland, MD Practice Overview Dr. Sabrina Strickland is a board-certified orthopedic sports surgeon at NYU Langone Orthopedic Center in New York City. She specializes in knee and shoulder procedures including ACL reconstruction, patellar stabilization, MPFL repair, tibial tubercle osteotomy, meniscal repair, and cartilage restoration with MACI, BEAR, MISHA, and CartiHEAL implants. She treats patients throughout Manhattan and Connecticut and is recognized as a Castle Connolly Top Doctor and New York Magazine Best Doctor. ## Board-Certified Orthopedic Sports Surgeon ### Expertise Patellofemoral surgery (kneecap) - Instability - Arthritis and pain/partial knee replacement - Cartilage injury ACL and meniscus surgery - Repair and reconstruction Meniscus surgery Rotator cuff and labral repair surgery Non-operative treatment - Stem cell injection — knee arthritis - Platelet rich plasma (PRP) — knee arthritis, tendonitis - Hyaluronic acid injection — knee pain, arthritis ### Education - State licensure in New York and Connecticut - Sports Medicine and Shoulder Fellowship at The Hospital for Special Surgery - Orthopedic Surgery Residency at The Hospital for Special Surgery - General Surgery Internship at Cornell-New York Presbyterian Hospital - Medical School at Rush Presbyterian St. Luke’s, 1996 - College of Arts and Sciences, Cornell University, 1991 ### Accepted Insurance - Aetna - Blue Cross Blue Shield PPO HMO POS - Blue Cross Blue Shield HealthPlus — Individual Network Only (not Medicaid) - Cigna - Connecticare (not through Access Health CT) - EmblemHealth GHI - EmblemHealth HIP - Oxford - UnitedHealthcare - UnitedHealthcare Compass Plan not listed? We may work with your out-of-network benefits. Call . ## Get to know more about Dr. Sabrina Strickland Transcript [Music] words can't totally explain how much she meant to me because she fixed the thing that I thought was unfixable I had been told was unfixable you're going to a doctor who's confident who knows what they're looking at who's able to give you the right kind of guidance and the right care I can very often bring my patients back to a level where they can ski again or they can play tennis again and for some of my patients they can go up and down stairs again and these are things that we sometimes take for granted the day I went in and when I finally took the brace off I walked 20 steps and I was like I do this and then that was the beginning of getting back and realizing I'm gonna be back in the game my specialty within orthopedics and sports medicine what that means is that I do shoulder and knee surgery but my passion is patellofemoral disorders i co-founded with my partner patellofemoral Center at the Hospital for Special Surgery something that's really important to me as a doctor is making my patients feel comfortable it's pretty scary to have surgery and it's pretty scary to be injured I have a team that works with me that is amazing meaning the most important thing about when I hire an employee is that they're nice and that patients feel comfortable with them and the thing goes for me I never felt that she rushed through any of the detailed explanations that she gave me and obviously should perform two successful surgeries on me that got me back on my feet I have three kids three girls their ages 13 13 and 15 and theft's twins the most rewarding part of my job is getting people back to the things they want to do having patients see me in clinic three months six months a year after surgery and say gosh I never thought I'd ride a horse again and I'm back riding a horse or I used to get up from a table and worried that I was gonna stumble because my knees hurt so much and now I get up and I don't even think about it so it can be a huge range of what patients are telling me but having a job where people say thank you all day long is pretty often [Music] ## About Dr. Sabrina Strickland I am a board-certified orthopedic sports surgeon specializing in knee and shoulder surgery at the NYU Langone Orthopedic Center in New York City. Although many patients come to see me after a knee injury playing sports such as soccer, basketball, or skiing, others come due to pain in everyday activities, such as walking down stairs. Common injuries I see and help with are related to sports and include: - ACL ligament tears - Patellar dislocations - Meniscal tears Many patients also come to see me who have never played sports. I find it very rewarding to help patients return to their favorite activities, especially those who have been told by other doctors that there is no further treatment available (and in many cases, patients have already had a number of unsuccessful surgeries with other doctors and continue to suffer). In these instances, I find misdiagnosis is common or that the previous surgical treatment was incorrect. In these cases, I have had great success helping patients who had given up hope of returning to an active lifestyle. ### About Dr. Sabrina Strickland, Mother I live in New York City and am the mother of three girls; my twins are currently 21. My oldest daughter, Alexandra, is studying at Cornell Law. In Fall 2022, my daughter Natasha joined her sister at Cornell; in 2023, she joined the Business School. Victoria is a pre-med student at Boston College, majoring in neuroscience. She is a resident assistant in the lab and volunteers in the local community. I could not be prouder of my daughters in everything they pursue. Because I live in New York City, it can be difficult to exercise outside year-round, so I go to rowing classes, spin classes, barre classes, and lift weights. My kids are all focused on different sports. Two of them trained for and ran a half-marathon in 2023, and Alexandra ran the Chicago Marathon this year. ### About Dr. Sabrina Strickland’s Education I went to college at Cornell University, majoring in Psychology while completing my pre-med requirements. Over the holiday breaks, I worked at Stratton Mountain as a ski instructor. I subsequently spent a year working and skiing in Crested Butte, Colorado, and then went on to Rush Medical College at Rush University in Chicago. I completed my internship at Cornell/New York Hospital and then completed my Residency and Fellowship at the Hospital for Special Surgery. I find that I have an incredibly interesting job during the week and then spend my weekends at college sporting events, where it seems to be quite convenient that I am an orthopedic sports surgeon. ### How to Reach Dr. Strickland Please contact my office if you have any questions or concerns. We have a great team, including two athletic trainers and a nurse practitioner who played college soccer. I think my team is very empathetic to the plight of our patients, whether they have an athletic injury or pain that is limiting activities of daily living, such as walking up and down the subway steps. I’d be honored to discuss your situation and see how my skills and experience as an orthopedic sports surgeon might be helpful to your needs. ### NYU Langone Orthopedic Center Dr. Strickland sees patients and performs surgery at NYU Langone Orthopedic Center in Midtown Manhattan. #### Address 333 East 38th Street, 4th Floor New York, NY 10016 #### Phone 646-904-4664 Getting Here & Parking ### Out-of-Network Coverage If your insurance plan is not listed in our accepted plans, we may work with your out-of-network benefits where possible. If you have out-of-network coverage, your insurance may reimburse you for a portion of your office visit. Financial assistance may be available for patients in need. Please call our office with any questions about your coverage. Call ## About Dr. Strickland’s Awards & Honors Castle Connolly, Best Doctors New York Magazine, 2019 Best Doctors Patellofemoral Research Excellence Award, 2015–2016 Arthroscopy Association of America / Patellofemoral Foundation Awarded for an outstanding research project leading to improved understanding, prevention and treatment of patellofemoral pain or instability. Fellow Research Award — Clinical Science, 2016 American Orthopaedic Society for Sports Medicine Awarded to the best papers in clinical and basic science submitted by a sports medicine fellow. Philip D. Wilson, MD Award, 2015 Hospital for Special Surgery Awarded to a fellow for excellence in orthopaedic surgery research. Leadership Fellow, 2012–2013 American Academy of Orthopaedic Surgery Chosen as one of ten orthopaedic surgeons under age 45 for a year-long leadership training program. Philip D. Wilson, Jr., MD Teaching Award, 2011 Hospital for Special Surgery Awarded to the outstanding faculty teacher by the graduating residency class. Resident Research Award, 2001 Ruth Jackson Orthopaedic Society Best research project. Distinguished Housestaff Award, 2000 New York Hospital–Cornell Medical Center Alumni Council For “exemplary all-around service at New York-Presbyterian Hospital.” Nathan M. Freer Prize, 1996 Rush Medical College Voted the outstanding senior medical student by the Rush Medical College faculty. American Medical Women’s Association Award, 1996 Janet M. Glasgow Memorial Achievement Citation Alpha Omega Alpha Medical Honor Society Elected 1995 ## Surgical Volume & Experience Twenty-four years caring for active patients aged 12–80. The numbers below represent procedures performed by Dr. Strickland over her career. 0 ACL reconstructions 0 MPFL reconstructions 0 Tibial tubercle osteotomies 0 Osteochondral allograft transplantations 0 Peer-reviewed publications 0 Caring for active patients aged 12–80 ## Professional Memberships Active member of the leading societies in orthopedic sports medicine, knee surgery, and cartilage repair — with regular speaker and instructor roles at international meetings. - •International Patellofemoral Study Group - •Arthroscopy Association of North America - •International Society for Arthroscopy, Knee Surgery and Orthopedic Sports Medicine (ISAKOS) - •International Cartilage Repair Society - •American Orthopaedic Society for Sports Medicine - •The Women’s Sports Forum ## Recent Research & Publications Selected recent peer-reviewed work. Dr. Strickland continues active research to improve patient outcomes. Vicioso C, Terry HL, Neijna AG, Strickland SM. “Dataset on patient education and digital information quality in knee cartilage restoration with matrix-induced autologous chondrocyte implantation (MACI).” Science Direct. 2026 February. Retzky JS, Palhares GM, Khilnani TK, et al. “6-Month Postoperative Magnetic Resonance Imaging Appearance of Osteochondral Allografts With Bone Marrow Aspirate Augmentation From Either the Proximal Tibia or Iliac Crest.” Orthopaedic Journal of Sports Medicine. 2026 January 26. Segal D, Veerkamp MW, Wall EJ, et al. “Comparison Between Performance of Disease-Specific and Region-Specific Patient-Reported Outcome Measures in Adolescents After Patellofemoral Stabilization Surgery: Data From the JUPITER Cohort.” American Orthopaedic Society for Sports Medicine. 2026 January 16. Sinopoli ML, Gatti AA, Wright CE, et al. “3D Patellar instability Anatomical Severity Score (3D-PASS): A Novel Machine Learning Score Using 3D Bone Position From MRI to Predict Outcomes of Patellar Instability Treatment.” American Orthopaedic Society for Sports Medicine. 2025 December 30. Vicioso C, Neijna AG, Terry HL, et al. “Online information on MACI knee surgery: analysis and opportunities to improve patient education and decision-making.” The Knee Journal. 2025 Nov 19. Huddleston H, James EW, Davie R, et al. “Revision Medial Patellofemoral Ligament Reconstruction: Prevalence of Anatomic Risk Factors and Early Outcomes.” The Journal of Knee Surgery. 2025 Nov 18. Terry HL, Retzky JS, Neijna AG, Gomoll AH, Strickland SM. “Combined Unicompartmental Knee Arthroplasty and Trochlear Porous Calcium Carbonate Scaffold Implantation: Surgical Technique.” Arthroscopy Techniques. 2025 October. Varady NH, Pascual-Leone N, Neijna AG, Gomoll AH, Strickland SM. “Evaluation of Posteriorization Following Pure Distalization Tibial Tubercle Osteotomy.” The American Journal of Sports Medicine. 2025 Sep 18. Patel S, Veerkamp MW, Wall EJ, et al. “How much Improvement in Patient Reported Outcomes after Isolated Medial Patellofemoral Ligament Reconstruction is associated with Surgeon-defined Satisfactory Outcomes? A JUPITER study.” The Journal of ISAKOS. 2025 Sep 04. Shah AK, Shah IK, Burkhart RJ, et al. “Analysis of the Distribution of Private Research Funding to Sports Medicine Orthopaedic Surgeons.” Orthopaedic Journal of Sports Medicine. 2025 Aug 22. Wittstein J, Strickland S, Gomoll A, et al. “Postcommercialisation outcomes of bridge-enhanced anterior cruciate ligament restoration: The first 100 Bridge registry patients.” Knee Surgery Sports Traumatology Arthroscopy. 2025 Aug 13. Retzky JS, ElNemer W, Varady NH, Suhardi VJ, Strickland SM. “Incidence, indications, and risk factors for revision tibial tubercle osteotomy: A national database study.” 2025 Jul 24. Varady NH, Oeding JF, Inclan PM, et al. “Adding a Lateral Extra-Articular Tenodesis is Cost-Effective in Primary Anterior Cruciate Ligament Reconstruction: A Markov Analysis.” Arthroscopy. 2025 Jun 19. Palhares GM, Retzky JS, Coxe F, et al. “Patellofemoral Joint Chondral Defects Treated With Third-Generation Matrix-Induced Autologous Chondrocyte Implantation on Porcine Collagen Membrane: Minimum 2-Year Follow-up.” Orthopedic Journal of Sports Medicine. 2025 May 29. Uppstrom TJ, Palhares G, Cecere R, et al. “Reliability of a Novel Magnetic Resonance Imaging Scoring System to Evaluate Patellofemoral Osteoarthritis.” Journal of Knee Surgery. 2025 May 30. Retzky JS, Jahandar AS, Gould HP, et al. “Efficacy of Transection-Free Patellar Tendon Imbrication Technique for the Correction of Patella Alta.” Orthopaedic Journal of Sports Medicine. 2025 Apr 10. Varady NH, Pascual-Leone N, Neijna AG, Gomoll AH, Strickland SM. “Radiographic Measurement of Anteriorization After Tibial Tubercle Osteotomy.” The American Journal of Sports Medicine. 2025 Mar 23. View Full Research & Publications List ## Ready to schedule a consultation? Dr. Strickland sees patients at NYU Langone Orthopedic Center in Midtown Manhattan. Book an Appointment Contact the Office Continue Exploring Meet the Team & Office Patient Testimonials Research & Publications Patient Information --- ## Dr. Sabrina Strickland’s Team & Office - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/about-dr-sabrina-strickland-orthopedic-surgeon/dr-sabrina-stricklands-team-office/ Summary: Meet Dr. Sabrina Strickland’s Team & Office. They help with research projects and in providing the care my patients need to get back to their active lifestyle. About the Team # Dr. Sabrina Strickland’s Team & Office Dr. Strickland’s team helps with research projects and in providing the care her patients need to get back to an active lifestyle. From left to right: Hannah Terry (Research Assistant), Prissila Haniff (Surgical Schedule – Practice Manager), Ava Neijma (Former Research Assistant – Current 1st year medical student at NYU), Izzy Neils (Athletic trainer – physician extender), Meghan Reed (Physician Assistant), Sabrina Strickland, MD, Andreas Gomoll (Husband and Practice partner), Michael Adashev (Physician Assistant), Vicky Lopes (Athletic trainer – physician extender), Bernadette Rosario (Medical Secretary), Docilly Benn (Practice Manager). Dr. Sabrina Strickland’s team & office are vital to helping you get back to your active lifestyle. As always, please reach out if you have any questions. ## Dr. Sabrina Strickland & Dr. Andreas Gomoll When it comes to restoring your mobility and getting you back to your active lifestyle, you want the best orthopedic surgeon, physician assistants, and support staff to help you in making a full recovery. Dr. Sabrina Strickland is an orthopedic surgeon with a best-in-class medical support team at her office at NYU Langone Orthopedic Center in New York City. Our practice works with many insurance providers to ensure our patients have access to extraordinary orthopedic care. ## Ready to meet the team? Schedule your consultation or reach out with any questions. Book an Appointment Contact the Office About Dr. Strickland --- ## Research and Publications by Dr. Sabrina Strickland Source: https://sabrinastrickland.com/about-dr-sabrina-strickland-orthopedic-surgeon/research-and-publications/ Summary: Dr. Sabrina Strickland About # Research & Publications Helping patients to get back to their active lifestyle is my most important mission, and to do that I also conduct basic science and clinical research to develop tomorrow’s treatment options that will be less invasive, more effective, and offer a faster return to full function, whatever that looks like for each patient. I continue to contribute to research and publications, giving lectures around the world on knee injuries and treatments, related research, shoulder injuries and treatments, and sports medicine. You can find my articles (as well as other research and publications) in The American Journal of Sports Medicine, American Orthopaedic Society for Sports Medicine, Arthroscopy Techniques, Cartilage, Current Reviews in Musculoskeletal Medicine, The Journal for Arthroscopic and Related Surgery, Orthopedics This Week, Health Digest, and many more. I’ve also created a guide: Making Sense of Medical Research: A Guide to Different Study Types. ## 2026 Research and Publications Vicioso C, Terry HL, Neijna AG, Strickland SM. “Dataset on patient education and digital information quality in knee cartilage restoration with matrix-induced autologous chondrocyte implantation (MACI).” Science Direct. 2026 February.  Retzky JS, Palhares GM, Khilnani TK, Davie R, Xu A, Neijna AG, Rizy ME, Gracitelli GC, Terry HL, Strickland SM, Gomoll AH. “6-Month Postoperative Magnetic Resonance Imaging Appearance of Osteochondral Allografts With Bone Marrow Aspirate Augmentation From Either the Proximal Tibia or Iliac Crest.” Orthopaedic Journal of Sports Medicine. 2026 January 26. Segal D, Veerkamp MW, Wall EJ, Wilson PL, Green DW, Heyworth BE, Pahapill NK; JUPITER Study Group; Shubin Stein BE, Parikh SN, Magnussen RA, Brady JM, Redler LH, Ellis HB, Strickland SM, Kramer DE, Yanke AB, Sherman SL, Chambers CC, Tompkins MA, Fabricant PD, Milewski MD, Koh JL, Yen YM, Farr J. “Comparison Between Performance of Disease-Specific and Region-Specific Patient-Reported Outcome Measures in Adolescents After Patellofemoral Stabilization Surgery: Data From the JUPITER Cohort.” American Orthopaedic Society for Sports Medicine. 2026 January 16.  ## 2025 Research and Publications Sinopoli ML, Gatti AA, Wright CE, Bartsch A, Veerkamp MW, Boutin RD, Mintz DN, Emery KH, Shea KG, Chaudhari AS; JUPITER Study Group; Wall EJ, Elangovan S, Green DW, Fabricant PD, Strickland SM, Shubin Stein BE, Parikh SN, Delp SL, Sherman SL. “3D Patellar instability Anatomical Severity Score (3D-PASS): A Novel Machine Learning Score Using 3D Bone Position From MRI to Predict Outcomes of Patellar Instability Treatment (Using a Subset of Data in the JUPITER Cohort).” American Orthopaedic Society for Sports Medicine. 2025 December 30. Vicioso C, Neijna AG, Terry HL, Valdivia L, Wong L, Ren R, Strickland SM. “Online information on MACI knee surgery: analysis and opportunities to improve patient education and decision-making.” The Knee Journal. 2025 Nov 19. Huddleston H, James EW, Davie R, Uppstrom T, Fletcher C, Pyne AS, Strickland SM. “Revision Medial Patellofemoral Ligament Reconstruction: Prevalence of Anatomic Risk Factors and Early Outcomes.” The Journal of Knee Surgery. 2025 Nov 18. Terry HL, Retzky JS, Neijna AG, Gomoll AH, Strickland SM. “Combined Unicompartmental Knee Arthroplasty and Trochlear Porous Calcium Carbonate Scaffold Implantation: Surgical Technique.” Arthroscopy Techniques. 2025 October. Varady NH, Pascual-Leone N, Neijna AG, Gomoll AH, Strickland SM. “Evaluation of Posteriorization Following Pure Distalization Tibial Tubercle Osteotomy.” The American Journal of Sports Medicine. 2025 Sep 18. Patel S, Veerkamp MW, Wall EJ, Wilson PL, Green DW, Heyworth BE, Pahapill NK, Shubin Stein BE, Parikh SN; JUPITER Study Group; Magnussen RA, Brady JM, Redler LH, Ellis HB, Strickland SM, Kramer DE, Yanke AB, Sherman SL, Chambers CC, Tompkins MA, Fabricant PD, Milewski MD, Koh JL, Yen YM, Farr J. “How much Improvement in Patient Reported Outcomes after Isolated Medial Patellofemoral Ligament Reconstruction is associated with Surgeon-defined Satisfactory Outcomes? A JUPITER study.” The Journal of ISAKOS. 2025 Sep 04. Wittstein J, Strickland S, Gomoll A, Sherman S, Lau B, Taylor D, Kramer D, Keyes S, Meininger AK, Pietropaoli M, McMillan S, Osbahr D, Brady J. ” Postcommercialisation outcomes of bridge-enhanced anterior cruciate ligament restoration: The first 100 Bridge registry patients.” Knee Surgery Sports Traumatology Arthroscopy. 2025 Aug 13. Retzky JS, ElNemer W, Varady NH, Suhardi VJ, Strickland SM. “Incidence, indications, and risk factors for revision tibial tubercle osteotomy: A national database study.” 2025 Jul 24. Varady NH, Oeding JF, Inclan PM, Ranawat AS, Strickland SM, Pearle AD, Rodeo SA, Williams RJ 3rd. “Adding a Lateral Extra-Articular Tenodesis is Cost-Effective in Primary Anterior Cruciate Ligament Reconstruction: A Markov Analysis.” Arthroscopy. 2025 Jun 19. Palhares GM, Retzky JS, Coxe F, Hinkley P, Rizy ME, Neijna AG, Gomoll AH, Strickland SM. Patellofemoral Joint Chondral Defects Treated With Third-Generation Matrix-Induced Autologous Chondrocyte Implantation on Porcine Collagen Membrane: Minimum 2-Year Follow-up. Orthopedic Journal of Sports Medicine 2025 May 29. Uppstrom TJ, Palhares G, Cecere R, Anzillotti G, Fletcher CF, Davidson E, Burge A, Strickland SM. Reliability of a Novel Magnetic Resonance Imaging Scoring System to Evaluate Patellofemoral Osteoarthritis. Journal of Knee Surgery 2025 May 30. Julia S Retzky, Amirhossein S Jahandar, Heath P Gould, Paul M Inclan, Morgan Rizy, Joshua T Bram, Sabrina M Strickland. “Efficacy of Transection-Free Patellar Tendon Imbrication Technique for the Correction of Patella Alta.” Orthopaedic Journal of Sports Medicine. 2025 Apr 10. Varady NH, Pascual-Leone N, Neijna AG, Gomoll AH, Strickland SM. “Radiographic Measurement of Anteriorization After Tibial Tubercle Osteotomy.” The American Journal of Sports Medicine. 2025 Mar 23. Thacher RR, Retzky J, Hsu J, Arnone PG, Nguyen JT, Greditzer HG 4th; HSS ACL Registry; Nawabi DH, Marx RG. “Increased Lateral Posterior Tibial Slope is Associated with a Higher Rate of Lateral Meniscal Injury in Acute Noncontact Anterior Cruciate Ligament Ruptures.” Arthroscopy. 2025 Mar 14.  Kon E, De Caro F, Dasa V, M Scopp J, Di Matteo B, Flanigan D, Shabshin N, Strickland S, Altschuler N. “Female patients report comparable results to males after the implantation of an aragonite-based scaffold for the treatment of knee chondral and osteochondral defects: a gender-based analysis of a RCT at 4 years’ follow-up.” Journal of Orthopaedics and Traumology. 2025 Mar 13.  Retzky JS, Fletcher C, Rizy M, Burge A, Strickland SM. “Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) Scores > 55 at 6 Months Postoperative Predict Ability to Achieve Patient Acceptable Symptomatic State at Minimum 1 Year Postoperative Following Autologous Chondrocyte Implantation for Grade IV Chondral Defects About the Patellofemoral Joint.” Cartilage. 2025 Mar 1. Gomoll AH, Strickland SM. “Editorial Commentary: Both Osteochondral Allograft Transplantation and Autologous Chondrocyte Implantation Are Valuable Treatment Options for Patellofemoral Joint Cartilage Defects.” Arthroscopy. 2025 Mar. McGinley JJ, Ellis HB, Propp B, Veerkamp MW, Wilson PL, Kramer DE, Heyworth BE, Strickland S, Wall E, Koh J, Yen YM, Halsey M, Magnussen R, Roberts D, Farr J, Green D, Fabricant P, Brady J, Tompkins M, Redler LH, Yanke AB, Sherman SL, Parikh SN, Shubin Stein BE. “Radiological Risk Factors for Osteochondral Fractures in Patients With First-Time and Recurrent Patellar Instability: Data From the JUPITER Cohort.” The American Journal of Sports Medicine. 2025 Feb 12.   Shah AK, Neijna AG, Retzky JS, Gomoll AH, Strickland SM. “Indications, Techniques, and Outcomes of Bridge-Enhanced ACL Restoration (BEAR).” Current Reviews in Musculoskeletal Medicine. 2025 Feb 12.  Varady NH, Uppstrom TJ, Shah A, Rizy M, Neijna AG, Gomoll AH, Strickland SM. “Reasons for and Complications Following Revision Tibial Tubercle Osteotomy.” Orthopaedic Journal of Sports Medicine. 2025 Feb 6.  ## 2024 Research and Publications Thor P, Moreno A, Zhong H, Sheetz M, Popovic M, Strickland SM, Ast MP, Cheng SI. Thor P, Moreno A, Zhong H, Sheetz M, Popovic M, Strickland SM, Ast MP, Cheng SI. ” A qualitative analysis of the use of intraoperative acupuncture for patients with nosocomephobia.” Acupuncture in Medicine. 2024 Nov 22. Palhares GM, Vaswani R, Fletcher C, Hinkley P, Rizy M, Strickland SM, Gomoll A. “Increased Host Bone Marrow Edema on 6-Month Magnetic Resonance Imaging Is a Risk Factor for Osteochondral Allograft Failure.” Arthroscopy. 2024 Sep. Tyler K. Khilnani M.D., Tyler J. Uppstrom M.D., Giuseppe Anzillotti M.D., Morgan Rizy B.S., Sabrina M. Strickland M.D., Andreas H. Gomoll M.D. “Combined All-Inside Anterior Cruciate Ligament Reconstruction and Tibial Anterior Closing Wedge Tibial Osteotomy Using Staple Fixation: Surgical Technique.” Arthroscopy Techniques. 2024 Sep 24. Conte P, Anzillotti G, Crawford DC, Dasa V, Flanigan DC, Nordt WE, Scopp JM, Meislin RJ, Strauss EJ, Strickland SM, Fiorentino G, Lattermann C. “Differential analysis of the impact of lesions’ location on clinical and radiological outcomes after the implantation of a novel aragonite-based scaffold to treat knee cartilage defects.” International Orthopedics. 2024 Sep 21. Fletcher C, Rizy M, Gomoll A, Strickland S. “Treatment of Patellar Chondral Lesions With Concomitant Matrix-Induced Autologous Chondrocyte Implantation, Medial Patellofemoral Ligament Reconstruction, and Tibial Tubercle Osteotomy.” Arthroscopy Techniques. 2024 Sep. Rizy ME, Uppstrom TJ, Gomoll AH, Strickland SM. “Combined Medial Quadriceps Tendon-Femoral Ligament and Medial Patellofemoral Ligament Reconstruction for Revision Patellofemoral Soft-Tissue Stabilization.” Arthroscopy Techniques. 2024 Aug.  Julia S. Retzky MD, E. Grant Carey MD, Ryan S. Selley MD, Connor Fletcher BS, Matthew J. Hartwell MD, Alissa J. Burge MD, Andreas Gomoll MD, Sabrina Strickland MD. “Management of Patellar and Trochlear Cartilage Lesions with Matrix-Induced Autologous Chondrocyte Implantation in Conjunction with Patellofemoral Realignment Procedures Improves Patient Reported Outcomes and Magnetic Resonance Image Appearance.” The Journal of ISAKOS. 2024 Aug 21. Ava G. Neijna B.A., Hailey P. Huddleston M.D., Andreas H. Gomoll M.D., Sabrina M. Strickland M.D. “Medial Meniscus Root Repair With Implantable Shock Absorber Placement: A Combined Technique for Early Partial Weightbearing. ” Arthroscopy Techniques. 2024 Aug 09. Andreas H. Gomoll, MD, Sabrina M. Strickland, MD. “Both osteochondral allograft transplantation (OCA) and autologous chondrocyte implantation (ACI) are valuable treatment options for patellofemoral joint cartilage defects.” Arthroscopy. 2024 Aug 06. Julia S. Retzky, Aakash K. Shah, Ava G. Neijna, Morgan E. Rizy, Andreas H. Gomoll, Sabrina M. Strickland. “Defining the minimal clinically important difference for IKDC and KOOS scores for patients undergoing tibial tubercle osteotomy for patellofemoral pain or instability.” Journal of Experimental Orthopaedics. 2024 Jul 29.  Shah AK, Rizy ME, Neijna AG, Uppstrom TJ, Gomoll AH, Strickland SM. “A Preliminary Study of Post-Market Bridge-Enhanced ACL Restoration (BEAR) Suggests Non-Inferior Short-Term Outcomes and Low Complications.” HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery. 2024 Jul 27. Julia S Retzky , Francesca R Coxe, Brittany Ammerman , Ava G Neijna , Paige Hinkley, Andreas Gomoll, Sabrina M Strickland.  “Initial Outcomes of Single Versus Multiple-Plug Osteochondral Allograft Transplantation for Osteochondral Defects About the Knee: A Matched Cohort Analysis.” The Journal of Knee Surgery. 2024 Jul 17. Julia S Retzky, Guilherme M Palhares, Tyler J Uppstrom, Paige Hinkley, Connor Fletcher, Andreas H Gomoll, Sabrina M Strickland. “Risk Factors for Atraumatic Medial Patellar Facet Lesions.” Orthopaedic Journal of Sports Medicine. 2024 Jun 14. Shah AK, Uppstrom TJ, Rizy ME, Gomoll AH, Strickland SM. “Incidence of Complications After Tibial Tubercle Osteotomy and Tibial Tubercle Osteotomy With Distalization.” American Journal of Sports Medicine. 2024 Mar 22. Julia S. Retzky, MD, Preston W. Gross, BS, Shevaun M. Doyle, MD, and Sabrina M. Strickland, MD. “High Rates of Abnormal Patellofemoral Morphology in Adolescents With Anterior Knee Pain: A Retrospective Review.” HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery. 2024 Mar 20. Oeding JF, Varady NH, Fearington FW, Pareek A, Strickland SM, Nwachukwu BU, Camp CL, Krych AJ. “Platelet-Rich Plasma Versus Alternative Injections for Osteoarthritis of the Knee: A Systematic Review and Statistical Fragility Index-Based Meta-analysis of Randomized Controlled Trials.” American Journal of Sports Medicine. 2024 Feb 29. Tyler J Uppstrom, Connor F Fletcher, Daniel W Green, Andreas H Gomoll, Sabrina M Strickland “Decreased Effective Patellar Tendon Length following Distalization Tibial Tubercle Osteotomy without Patellar Tendon Tenodesis.” Orthopaedic Journal of Sports Medicine. 2024 Feb 15. Retzky JS, Thacher RR, Palhares GH, Gomoll AH, Strickland SM. “Impact of Wiberg Patellar Type on Outcomes and Survival Following Cell-Based Cartilage Repair for Patellar Chondral Lesions at Midterm Follow-up.” The Journal of Sports Medicine. 2024 Jan 20. Palhares GM, Vaswani R, Fletcher C, Hinkley P, Rizy M, Strickland SM, Gomoll A. “Diffuse Host Bone Marrow Edema on Six-Month MRI is a Risk Factor for Osteochondral Allograft Failure.” Arthroscopy. 2024 Jan 17. Brusalis CM, Chastain KL, Uppstrom TJ, Steineman BD, Gomoll AH, Maher SA, Strickland SM. “Medial Meniscus Posterior Root Tears Lead to Changes in Joint Contact Mechanics at Low Flexion Angles During Simulated Gait.” The Journal of Sports Medicine. 2024 Jan 2. ## 2023 Research and Publications Hurley ET, Hughes AJ, Savage-Elliott I, Dejour D, Campbell KA, Mulcahey MK, Wittstein JR, Jazrawi LM; Patellar Instability International Consensus Group; Alaia MJ, Arendt EA, Ayeni OR, Bassett AJ, Bonner KF, Camp CL, Carter CW, Chahla J, Ciccotti MG, Cosgarea AJ, Edgar CM, Erickson BJ, Espregueira-Mendes J, Farr J, Farrow LD, Frank RM, Freedman KB, Fulkerson JP, Getgood A, Gomoll AH, Grant JA, Gursoy S, Gwathmey FW, Haddad FS, Hiemstra LA, Hinckel BB, Koh JL, Krych AJ, LaPrade RF, Li ZI, Logan CA, Gonzalez-Lomas G, Mannino BJ, Lind M, Matache BA, Matzkin E, McCarthy TF, Mandelbaum B, Musahl V, Neyret P, Nuelle CW, Oussedik S, Pace JL, Verdonk P, Rodeo SA, Rowan FE, Salzler MJ, Schottel PC, Shannon FJ, Sheean AJ, Sherman SL, Strickland SM, Tanaka MJ, Waterman BR, Zacchilli M, Zaffagnini S. “A modified Delphi consensus statement on patellar instability: part I.” The Bone & Joint Journal. 2023 Dec 1.  Hurley ET, Hughes AJ, Savage-Elliott I, Dejour D, Campbell KA, Mulcahey MK, Wittstein JR, Jazrawi LM; Patellar Instability International Consensus Group; Alaia MJ, Arendt EA, Ayeni OR, Bassett AJ, Bonner KF, Camp CL, Carter CW, Chahla J, Ciccotti MG, Cosgarea AJ, Edgar CM, Erickson BJ, Espregueira-Mendes J, Farr J, Farrow LD, Frank RM, Freedman KB, Fulkerson JP, Getgood A, Gomoll AH, Grant JA, Gursoy S, Gwathmey FW, Haddad FS, Hiemstra LA, Hinckel BB, Koh JL, Krych AJ, LaPrade RF, Li ZI, Logan CA, Gonzalez-Lomas G, Mannino BJ, Lind M, Matache BA, Matzkin E, McCarthy TF, Mandelbaum B, Musahl V, Neyret P, Nuelle CW, Oussedik S, Pace JL, Verdonk P, Rodeo SA, Rowan FE, Salzler MJ, Schottel PC, Shannon FJ, Sheean AJ, Sherman SL, Strickland SM, Tanaka MJ, Waterman BR, Zacchilli M, Zaffagnini S. “A modified Delphi consensus statement on patellar instability: part II.” The Bone & Joint Journal. 2023 Dec 1.  Loyst RA, Palhares G, Hinkley P, Rizy M, Burge AJ, Gomoll AH, Strickland SM. “Predilection of Patellofemoral Cartilage Lesions in Patients with Posterior Medial Meniscal Root Lesions.” CARTILAGE. 2023 Jul 26. Retzky JS, Palhares GM, Rizy M, Hinkley P, Gomoll AH, Strickland SM. “Multi-Surface Cartilage Defects about the Knee Treated with Cartilage Restoration Procedures Show Good Outcomes and Survivorship at Minimum 2-Year Follow-Up.” 2023 Oct. 18. Brusalis CM, Huddleston HP, Lavalva SM, Gottlieb D, Fletcher C, Hinkley P, Gomoll AH, Strickland SM. “Short-Term Outcomes of Concomitant Patellofemoral Arthroplasty and Medial Patellofemoral Ligament Reconstruction to Treat Concurrent Patellofemoral Arthritis and Patellar Instability.” J Knee Surg. 2023 Jun 20. Uppstrom TJ, Cash BM, Jahandar A, Fletcher C, Nguyen JT, Maher SA, Strickland SM, Gomoll AH. “Proximal bone block with distal screw trajectory improves mechanical stability during distalization tibial tubercle osteotomy.” Knee Surg Sports Traumatol Arthrosc. 2023 Jun 10.  Sidharthan S, Strickland SM. “Editorial Commentary: A Posterior Tibial Tubercle Relative to the Trochlear Groove Is Associated With Increased Risk of Patellofemoral Arthritis: The Sagittal Tibial Tubercle-Trochlear Groove Distance.” Arthroscopy. 2023 Jun. Uppstrom TJ, Breighner RE, Fletcher C, Mintz DN, Strickland SA. “Assessment of Patellar Vascularity after Patellar Cartilage Restoration via Lateral Parapatellar Approach: Analysis Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging.” Cartilage. 2023 Jun. Anatone AJ, Uppstrom TJ, Fletcher C, Baral E, Gomoll AH, Strickland SM. “Patellofemoral arthroplasty conversion to total knee arthroplasty: An updated retrieval analysis and clinical outcomes.” Knee. 2023 May 19. Palhares G, Hinkley P, Rizy M, Fletcher C, Gomoll A, Strickland S. Tibial Tubercle Osteotomy With Distalization for the Treatment of Patella Alta.” Arthrosc Tech. 2023 Apr 2. Kunze KN, Moran J, Polce EM, Pareek A, Strickland SM, Williams RJ 3rd. “Lower donor site morbidity with hamstring and quadriceps tendon autograft compared with bone-patellar tendon-bone autograft after anterior cruciate ligament reconstruction: a systematic review and network meta-analysis of randomized controlled trials.” Knee Surg Sports Traumatol Arthrosc. 2023 Mar 31. Kunze KN, Palhares G, Uppstrom TJ, Hinkley P, Rizy M, Gomoll AH, Stein BES, Strickland SM. “Establishing minimal detectable change thresholds for the international knee documentation committee and Kujala scores at one and two years after patellofemoral joint arthroplasty.” Knee Surg Sports Traumatol Arthrosc. 2023 Mar 23. Lamplot JD, Jahandar A, Meyers KN, Gomoll AH, Maher SA, Strickland SM. “Anteromedialization Tibial Tubercle Osteotomy Improves Patellar Contact Forces: A Cadaveric Model of Patellofemoral Dysplasia.” Am J Sports Med. 2023 Feb. ## 2022 Research and Publications Barth KA, Strickland SM. “Surgical Treatment of Iatrogenic Patella Baja.” Curr Rev Musculoskelet Med. 2022 Dec. Strickland S. “Editorial Commentary: Two Fixation Points Are Better for Medial Patellofemoral Ligament Reconstruction-To Minimize Complications, Bone Tunnels Should Be Avoided.” Arthroscopy. 2022 Nov. Lee H, Fletcher C, Hartwell M, Strickland SM. “Effect of Patellofemoral Arthroplasty on Patellar Height in Patients with Patellofemoral Osteoarthritis.” J Knee Surg. 2022 Sep 1. Fabricant, P, Mintz, D, Emery, K, Veerkamp, M, Gruber, S, Green, D, Strickland, S, Wall, W, Shubin Stein, B. “Many Radiographic and Magnetic Resonance Imaging Assessments for Surgical Decision Making in Pediatric Patellofemoral Instability Patients Demonstrate Poor Interrater Reliability.” Arthroscopy. 2022 Sep;38(9):2702-2713. Hinkley P, Fletcher C, Strickland S. “Patellar Tendon Imbrication for the Treatment of Patella Alta in Skeletally Immature Patients.” Arthrosc Tech. 2022 Aug 17. Redler LH, Dennis ER, Mayer GM, Kalbian IL, Nguyen JT, Shubin Stein BE, Strickland SM. “Does Ligamentous Laxity Protect Against Chondral and Osteochondral Injuries in Patients With Patellofemoral Instability?” Orthop J Sports Med. 2022 Jul 6;10(7):23259671221107609. Kunze KN, Eliasberg CD, Strickland SM, Lane JM. “Nonunion of the Coracoid Base Secondary to Cutibacterium acnes Infection in a Surgically Naive Patient.” JBJS Case Connector: 2022; 12(2). Fletcher C, Strickland S. “Hybrid Treatment of Osteochondral Fracture of the Patella With Particulated Juvenile Cartilage and Fragment Fixation.” Arthrosc Tech. 2022 Jun 14;11(7):e1189-e1193. Dawkins BJ, Shubin Stein BE, Mintz DN, Fabricant PD, Gomoll AH, Strickland SM, Aitchison AH, Hidalgo Perea S, Green DW. “Patellofemoral joint cartilage restoration with particulated juvenile allograft in patients under 21 years old.” Knee. 2022 Jun;36:120-129. Tishelman JC, Pyne A, Kahlenberg CA, Gruskay JA, Strickland SM. “Obesity Does Not Affect Patient-Reported Outcomes following Patellofemoral Arthroplasty.” J Knee Surg. 2022 Feb;35(3):312-316. Langhans MT, Strickland SM, Gomoll AH. “Management of Chondral Defects Associated with Patella Instability.” Clin Sports Med. 2022 Jan;41(1):137-155. ## 2021 Research and Publications Spang RC, Jahandar A, Meyers KN, Nguyen JT, Maher SA, Strickland SM. “Dysplastic Patellofemoral Joints Lead to a Shift in Contact Forces: A 3D-Printed Cadaveric Model.” Am J Sports Med. 2021 Oct;49(12):3344-3349. Cheng SI, Norman RM, DeMeo D, Zhong H, Turteltaub LH, McCarthy MM, Marx RG, Strickland SM, Kelly AM. “The Feasibility of Blinding Intraoperative Electro-Auricular Acupuncture Under Neuraxial Anesthesia.” Med Acupunct. 2021 Aug 1;33(4):286-294 Gomoll AH, Farr J, Cole BJ, Flanigan DC, Lattermann C, Mandelbaum BR, Strickland SM, Zaslav KR, Kimmerling KA, Mowry KC. “Safety and Efficacy of an Amniotic Suspension Allograft Injection Over 12 Months in a Single-Blinded, Randomized Controlled Trial for Symptomatic Osteoarthritis of the Knee.” Arthroscopy. 2021 Jul;37(7):2246-2257. ## 2020 Research and Publications Strickland S, Apostolakos JM, Gomoll AH, Mandelbaum BR, Sherman SL. “Patellofemoral 101 – Back to the Basics: How to address the MPFL, Tibial Tubercle, and Articular Cartilage in Patients with Recurrent Patellar Instability.” Instr Course Lect. Submitted May 2020. Gruskay JA, Gomoll AH, Arendt EA, Dejour DH, Strickland SM. “Patellar Instability and Dislocation: Optimizing Surgical Treatment and How to Avoid Complications.” Instr Course Lect. 2020;69:671-692. Lamplot JD, Gomoll AH, Strickland S. “Cartilage restoration and stabilization strategies for the patellofemoral joint.” Cartilage Injury of the Knee: State-of-the-Art Treatment and Controversies ISAKOS Strickland S, De Caro F, Magnussen R. “Patellofemoral Pain, Chondrosis and Arthritis in the Young to Middle Age Patient: 32-year-old woman with lateral patella and trochlear chondrosis.” The Patellofemoral Joint – A Case-Based Approach_Manuscript Guidelines ISAKOS. Submitted March 2020. Gomoll AH, Farr J, Cole BJ, Flanigan DC, Latterman C, Mandelbaum BR, Strickland S, Zaslav KR, Kimmerling KA, Mowry, KC. “Safety and Efficacy of an Amniotic Suspension Allograft Injection over 12 Months in a Blinded, Randomized Controlled Trial for Symptomatic Osteoarthritis of the Knee.” American Journal of Sports Medicine. Submitted June 2020. Schneider BL, Ling DI, Kleebad LJ, Strickland S, Pearl AD. “Comparing Return to Sports after Patellofemoral and Knee Arthroplasty in an Age and Sex Matched Cohort.” Orthopaedic Journal of Sports Medicine. Accepted April 2020. Strickland S, Pyne A, Connors K. “Non-operative Treatments for Patellofemoral Arthritis.” ESSKA 2nd Edition Patellofemoral Pain, Instability, and Arthritis. To be published May 2020. Cheng S, DeMeo D, Zhong H, McCarthy M, Marx R, Strickland S, Turteltaub L, Kelly A. “The Feasibility of Intraoperative Electro Auricular Acupuncture for Analgesia After ACL Surgery: A Blinding Study.” Submitted Feb 2020. Jeong, S. Tishelman J, Schneider B, Pyne A, Strickland S. “Patellofemoral Arthroplasty Surgical Technique: Lateral or Medial Parapatellar Approach.” The Journal of Arthroplasty. Accepted February 2020. Tishelman J, Kahlenberg C, Pyne A, Gruskay J, Strickland S. “Obesity Does Not Affect Patient Reported Outcomes Following Patellofemoral Arthroplasty.” The Journal of Knee Surgery. Accepted February 2020. Chahla J, Hinckel BB, Yanke AB, Farr J; Metrics of Osteochondral Allografts (MOCA) Group, Bugbee WD, Carey JL, Cole BJ, Crawford DC, Fleischli JE, Getgood A, Gomoll AH, Gortz S, Gross AE, Jones DG, Krych AJ, Lattermann C, Mandelbaum BR, Mandt PR, Minas T, Mirzayan R, Mologne TS, Polousky JD, Provencher MT, Rodeo SA, Safir O, Sherman SL, Strauss ED, Strickland SM, Wahl CJ, Williams RJ 3rd. “An Expert Consensus Statement on the Management of Large Chondral and Osteochondral Defects in the Patellofemoral Joint.” Orthop J Sports Med. 2020 Mar 26. Kleebad LJ, Strickland SM, Nwachukwu CU, Kerhoffs GMMJ, Pearle AD. “Satisfaction with return to sports after unicompartmental knee arthroplasty and what type of sports are patients doing.” Knee. 2020 January 8. Gruskay JA, Gomoll AH, Arendt EA, Dejour DH, Strickland SM. “Patellar Instability and Dislocation: Optimizing Surgical Treatment and How to Avoid Complications.” Instr Couse Lect. 2020; 69: 671-692. Spang RC, Getgood A, Strickland SM, Amendola AN, Gomoll AH. “Optimizing Anterior Cruciate Ligament (ACL) Outcomes: What Else Needs Fixing Besides the ACL?” Instr Course Lect. 2020; 69: 653-660. ## 2019 Research and Publications Eliasberg C, Diduch D, Strickland S. “Failure of Patellofemoral Joint Preservation.” Operative Techniques in Sports Medicine. December 2019. Nwachukwu BU, So C, Zhang Y, Shubin-Stein BE, Strickland SM, Green DW, Dodwell ER. “Adolescent and Caregiver-derived Utilities for Traumatic Patella Dislocation Health States.” J Pediatr Orthop. 2019 Nov/Dec; 39(10): 755-760. Strickland SM. “Editorial Commentary: Medial Patellofemoral Ligament Repair Versus Reconstruction: Still a Question or a Clear Winner?” Arthroscopy. 2019 October; 35 (10): 2916-2917. Tishelman JC, Kahlenberg CA, Nwachukwu BU, Gruskay J, Strickland SM. “Patient satisfaction reporting for patellofemoral arthroplasty is significantly lacking: a systematic review.” Phys Sportsmed. September 2019; 47(3): 270-274. Lieber AC, Steinhaus ME, Liu JN, Hurwit D, Chiaia T, Strickland SM. “Quality and Variability of Online Available Physical Therapy Protocols From Academic Orthropaedic Surgery Programs for Medial Patellofemoral Ligament Reconstruction.” Orthop J Sports Med. 2019 July 2;7(7). Gruskay J, Gomoll A, Strickland S, Green D, Chaiai T, Casey E. “Team Approach: Patellofemoral Instability in the Skeletally Immature.” Journal of Joint and Bone Surgery. July 2019. Sacks H, Prabhakar P, Wessel L, Hettler J, Strickland S, Potter H, Fufa D. “Generalized Joint Laxity in Orthopaedic Patients. Clinical Manifestations, Radiographic Correlates, and Management.” The Journal of Bone and Joint Surgery. March 2019. ## 2018 Research and Publications Liu JN, Steinhaus ME, Kalbian IL, Post WR, Green DW, Strickland SM, Shubin Stein BE. “Patellar Instability Management: A Survey of the International Patellofemoral Study Group.” Am J Sports Med. Nov 2018; 46(13): 3299-3306. Strickland S, Bird Mackenzie, Christ A. “Advances in Patellofemoral Arthroplasty.” Curr Rev Musculoskelet Med. June 2018; 11(2): 221-230. Liu JN, Wu HH, Garcia GH, Kalbian IL, Strickland SM, Shubin Stein BE. “Return to Sports After Tibial Tubercle Osteotomy for Patellofemoral Pain and Osteoarthritis.” Arthroscopy. April 2018; 34(4): 1022-1029. Liu JN, Brady JM, Kalbian IL, Strickland SM, Ryan CB, Nguyen JT, Shubin Stein BE. “Clinical Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability Among Patients with Trochlear Dysplasia.” Am J Sports Med. March 2018;46(4): 883-889. Liu JN, Mintz DN, Nguyen JT, Brady JM, Strickland SM, Shubin Stein BE. “Magnetic Resonance Imaging Validation of Tibial Tubercle Transfer Distance in the Fulkerson Osteotomy: A Clinical and Cadaveric Study.” Arthroscopy. Jan 2018; 34(1): 189-197. Kouk S, Kalbian I, Wolfe E, Strickland SM. “Robot-Assisted Medial Compartment Arthroplasty Following Remote Patellectomy: A Case Report.” J Orthop Case Rep. Jan-Feb 2018;8(1): 11-14. Wang D, Shubin Stein B, Strickland S. (2018). “Patellofemoral Issues.” Farr J & Gomoll A (Eds.),Cartilage Restoration: Practical Clinical Applications 2nd Edition. 103-117. Springer Science. ## 2017 Research and Publications Shubin Stein BE, Brady JM, Grawe B, Tuakli-Wosornu Y, Nguyen JT, Wolfe E, Voigt M,Magony G, Strickland S. “Return to Activities After Patellofemoral Arthroplasty.” Am JOrthop. Nov/Dec 2017; 46(6): 353-357. Brady JM, Sullivan JP, Nguyen J, Mintz D, Green DW, Strickland S, Shubin Stein BE. “The Tibial Tubercle-to-Trochlear Groove Distance is Reliable in the Setting of Trochlear Dysplasia, and Superior to the Tibial Tubercle-to-Posterior Cruciate Ligament Distance When Evaluating Coronal Malalignment in Patellofemoral Instability.” Arthroscopy. Nov2017; 33(11): 2026-2034. Grawe B, Burge A, Nguyen K, Strickland S, Warren R, Rodeo S, Shubin Stein B. “Cartilage Regeneration in Full-Thickness Patellar Chondral Defects Treated with Particulated Juvenile Articular Allograft Cartilage: An MRI Analysis.” Cartilage. Oct 2017; 8(4):374-383. Christ AB, Koch C, Shubin Stein BE, Gonzalez Della Valle A, Strickland SM. “Patellofemoralarthroplasty conversion to total knee arthroplasty: Retrieval analysis and clinical correlation.” The Knee. October 2017; 24(5): 1233-1239. Liu J, Steinhaus M, Kalbian I, Post W, Green D, Strickland S, Shubin Stein, B. “Patellar Instability Management: A Survey of the International Patellofemoral Study Group.” American Journal of Sports Medicine. October 2017; 46(13): 3299-3306. Liu J, Strickland S, Shubin Stein B. “Patellar Instability Management: A Survey of the International Patellofemoral Study Group.” American Journal of Sports Medicine, July 2017. Liu J, Mintz D, Nguyen J, Munch J, Strickland S, Shubin Stein B. “MRI Validation of Tibial Tubercle Transfer Distance: A Clinical and Cadaveric Study.” July 2017. Grawe B, Burge A, Nguyen J, Strickland S, Warren R, Rodeo S, Shubin Stein B. “Cartilage Regeneration in Full-Thickness Patellar Chondral Defects Treated with Particulated Juvenile Articular Allograft Cartilage: An MRI Analysis.” Cartilage. October 2017; 8(4):374-383. Nwachukwu B, So C, Schairer W, Shubin Stein B, Strickland S, Green D, Dodwell E. “Economic Decision Model for First-Time Traumatic Patellar Dislocations in Adolescents.” American Journal of Sports Medicine. August 2017; 45(10): 2267-2275. ## 2016 & Earlier Research and Publications Munch J, Sullivan J, Nguyen J, Mintz D, Green D, Shubin Stein B, Strickland S. “Patellar Articular Overlap is a Simple Alternative to Conventional Measurements of Patellar Height.” Orthopaedic Journal of Sports Medicine. July 2016. AAOS Now, January 2015, p 17, Patellofemoral Arthroplasty in 2015. Cody E; Strickland SM. “Multidirectional Instability in the Female Athlete.” In: Plancher, K. ed. Posterior & MDI: Operative Techniques in Sports Medicine, 2013. Khair M; Strickland SM. “Surgical treatment of MDI, open rotator interval closure is my preferred technique.” In: Dines, D.; Williams, G.; Walsch, G.; Dodson, C. Eds. Current concepts in shoulder Instability, 2013. McCarthy M, Strickland SM. “E Patellofemoral Pain: An Update on Diagnostic and Treatment Options.” In: Current Reviews of Musculoskeletal Medicine, 2013, 6(2):188-94. Cummins CA, Appleyard RC, Strickland SM, Haen, PS, Chen S, Murrell GAC. “Rotator Cuff Repair: An Ex Vivo Analysis of Suture Anchor Repair Techniques on Initial Load to Failure.” Arthroscopy, 2005, 21(10): 1236-1241. Wolf BR, Strickland S, Williams RJ, Allen AA, Altchek DW, Warren, RF. “Open Posterior Stabilization for Recurrent Posterior Glenohumeral Instability.” Journal of Shoulder and Elbow Surgery, 2005, 14(2):157-164. Nominated for the Neer Award. Strickland SM, Altchek DW, Williams RJ. “Arthroscopic Treatment of Posterior Shoulder Instability.” In: Craig EV, ed. Master Techniques in Orthopaedic Surgery: The Shoulder. 2ed. Philadelphia: Lippincott Williams & Wilkins, 2004, pp 103-113. Strickland SM, Warren RF, MacGillivray JD. “ACL Reconstruction with Allograft Tendons.” In: Andrews, JR, Gladstone, JN; eds. Orthopaedic Clinics of North America, 2003, 34(1): 41-47. Strickland SM, Belknap TW, Turner AS, Wright TM, Hannafin JA. “Lack of Hormonal Influences on Mechanical Properties of Sheep Knee Ligaments.” The American Journal of Sports Medicine, 2003, 31(2): 210-215. Williams RJ, Strickland SM, Altchek DA, Warren RF. “Arthroscopic Shoulder Stabilization for Posterior Shoulder Instability.” The American Journal of Sports Medicine, 2003, 31(2): 203-209. Cummins CA, Strickland SM, Appleyard RC, Szomor ZL, Marshall J, Murrell GAC. “Rotator Cuff Repair With Bioabsorbable Screws: An In Vivo and Ex Vivo Investigation.” Arthroscopy, 2003, 19(3): 239-248. Strickland SM, Metzl J. “Growth and Development in the Female Athlete.” In: Ireland ML, Nattiv A, eds. The Female Athlete. 1 ed. Philadelphia: Saunders, Elsevier Science, 2002, pp 199-207. Anderson K, Strickland SM, Warren RF. “Current Concepts. Hip and Groin Injuries in Athletes.” The American Journal of Sports Medicine, 2001, 29(4): 521-533. Hannafin JA, Strickland SM. “Frozen Shoulder.” Current Opinion in Orthopedics, 2000, 11: 271-275. Strickland SM, Westrich GH. “Spontaneous Compartment Syndrome Occurring Postoperatively in 2 Oral Surgery Patients.” Journal of Oral and Maxillofacial Surgery, July 2000, 58(7): 814-816. Review my publications in the National Library of Medicine. ## Questions? Let’s talk. Dr. Strickland’s team is here to help answer your questions and guide your next step. About Dr. Strickland Team & Office Contact --- # Services ## Knee Specialist NYC: ACL, MPFL, Cartilage, Sports Medicine | Dr. Sabrina Strickland — NYU Langone Source: https://sabrinastrickland.com/knee-surgeon-specialist/ Summary: Sub-specialty knee surgery and sports medicine by Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York — 14 procedure pages covering patellar instability, MPFL, MACI and OATS cartilage transplantation, ACL reconstruction (BEAR), meniscus repair, joint preservation osteotomy, Mako robotic-assisted partial and total knee replacement, and PRP / regenerative medicine. Knee Surgery & Sports Medicine # Knee Surgery & Sports Medicine Specialized knee care across a broad range of procedure areas — including patellar instability, cartilage restoration and transplantation, ACL reconstruction, joint-preservation osteotomy, and Mako robotic-assisted partial and total knee replacement — provided by Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York. Medically reviewed by Dr. Sabrina Strickland, MD — Orthopedic Surgeon at the NYU Langone Orthopedic Center in New York. Member, International Patellofemoral Study Group. View full bio → Where NYU Langone Orthopedic Center, Midtown Manhattan Sub-Specialty Focus Patellofemoral surgery, cartilage restoration, joint preservation, sports medicine Patients We See NY, NJ, CT, regional, out-of-state, and international patients for sub-specialty knee care Overview Dr. Sabrina Strickland is a board-certified orthopedic sports surgeon at NYU Langone Orthopedic Center in New York City with a sub-specialty case mix concentrated on patellofemoral surgery, cartilage restoration, joint preservation, and sports medicine. She is a member of the International Patellofemoral Study Group (IPSG), fellowship-trained at HSS, and licensed in both New York and Connecticut. She treats patients across 14 procedure areas: patellar instability and MPFL reconstruction, patellofemoral pain and arthritis, MACI and OATS cartilage restoration (including CartiHEAL), ACL reconstruction (with the BEAR implant for selected acute tears), meniscus repair (with transtibial root repair and all-inside / inside-out repair when appropriate), multi-condition sports trauma, joint-preserving osteotomy (TTO, HTO, DFO, MISHA), knee arthritis with Mako robotic-assisted partial and total knee replacement, and adjunctive PRP / regenerative medicine. Patients travel from New York, New Jersey, Connecticut, and out-of-state for sub-specialty consultation, particularly for revision MPFL, complex patellofemoral planning, cartilage transplantation, BEAR implant candidacy, and Patella LIFT trial eligibility evaluation. Below is a complete guide to the knee procedures Dr. Strickland performs. Each section links to a dedicated page explaining the condition, treatment options, surgical and non-surgical decision-making, recovery timeline, risks, and expected outcomes for that specific procedure. Many patients navigate these pages by symptom — for example, kneecap dislocation → patellar instability; an ACL pop → ACL tear surgery; MRI-confirmed cartilage damage → MACI cartilage repair or cartilage transplantation. If you are unsure where to begin, the “How to Choose Among the Procedures” section below can help guide you to the most relevant area. ## Why a Sub-Specialty Knee Surgeon A sub-specialty knee surgeon concentrates on a narrower range of knee conditions and procedures, building deeper experience with the more complex versions of those problems — including revision surgery, multi-procedure planning, cartilage restoration, and patellofemoral disorders that are often referred out for advanced evaluation. Dr. Strickland’s practice reflects that focused approach: - NYU Langone Orthopedic Center — Dr. Strickland’s clinical home in Midtown Manhattan, where she sees patients and operates across patellofemoral, ACL, cartilage, and joint preservation - International Patellofemoral Study Group (IPSG) membership — the global academic society for patellofemoral surgery - JUPITER multi-center cohort contributor — the largest adolescent patellar instability research collaboration - Cartilage-restoration surgeon at NYU Langone — performing MACI, OATS, osteochondral allograft, and CartiHEAL within an evidence-based decision tree, with concurrent realignment and ligament work in the same operation when needed - Active clinical-trial investigator — including the FDA-approved Patella LIFT trial for full-thickness patellar cartilage defects and BEAR-implant outcomes research - State licensure in New York and Connecticut — supporting in-person consultation across both states For straightforward problems, a community orthopedist is reasonable. For revision cases, multi-procedure planning, complex patellofemoral anatomy, cartilage restoration decisions, and clinical-trial access, a sub-specialty opinion changes the plan. ## Knee Conditions, Procedures & Treatment Areas The sections below cover the major knee conditions, procedures, and treatment areas within Dr. Strickland’s practice. Each card links to a dedicated page explaining diagnosis, non-surgical and surgical treatment options, consultation expectations, recovery, rehabilitation, risks, and insurance considerations for that specific topic. Patellofemoral — Kneecap Surgery ### Patellar Instability & Recurrent Kneecap Dislocation First-time and recurrent patellar dislocation — MPFL reconstruction, tibial tubercle osteotomy (including AMZ-TTO), trochleoplasty, concurrent cartilage repair, and the Patella LIFT FDA trial. Learn more → ### MPFL Reconstruction Patellar stabilization with gracilis allograft and two-point patellar fixation, with combined tibial tubercle osteotomy or cartilage repair when bony anatomy or cartilage damage requires it. Learn more → ### Patellar Pain & Patellofemoral Arthritis Anterior knee pain, chondromalacia, focal patellar cartilage lesions, and patellofemoral arthritis — cartilage-first care (MACI, OATS), AMZ-TTO realignment, and high-volume patellofemoral arthroplasty (PFA) with onlay implants. Learn more → ### Anterior Knee Pain (Chondromalacia, Tendonitis, Anterior Arthritis) Sub-specialty differential diagnosis of anterior knee pain with eccentric loading rehabilitation for tendinopathy, cartilage-first care for chondromalacia, and joint-preserving options when arthritis sets in. Learn more → Cartilage Repair & Transplantation ### MACI Cartilage Repair (Two-Stage) Autologous cultured chondrocytes on a porcine collagen membrane for symptomatic full-thickness cartilage defects — cartilage-first philosophy with concurrent realignment (TTO, HTO, DFO), MPFL reconstruction, or meniscus repair when needed. Learn more → ### Cartilage Transplant: OATS, Osteochondral Allograft & CartiHEAL Single-stage structural cartilage-and-bone replacement for full-thickness osteochondral defects — OATS, osteochondral allograft (OCA), CartiHEAL Agili-C aragonite scaffold, and mosaicplasty. The structural option for defects MACI cannot cover. Learn more → Sports Injuries — Ligament & Meniscus ### ACL Tear Surgery ACL reconstruction with patient-matched graft selection (quadriceps, hamstring, BTB, allograft), the BEAR implant for selected acute tears within 50 days of injury, and ACL+ALL augmentation for high-risk pivot athletes. Learn more → ### Meniscal Tear (Repair, Root Repair, Allograft) Repair-first philosophy — all-inside and inside-out repair, transtibial root repair, MISHA shock absorber for root tears with early arthritis, and partial meniscectomy when repair is not possible. Learn more → ### Sports Injuries (Multi-Condition Hub) ACL tears, meniscus tears, patellar dislocations, multi-ligament knee injuries, and cartilage damage in athletes — with criteria-based return-to-sport rehabilitation rather than calendar-based clearance. Learn more → Joint Preservation & Arthritis ### Joint Preservation & Osteotomy (TTO / HTO / DFO / MISHA) Anteromedialization tibial tubercle osteotomy (AMZ-TTO / Fulkerson), distalization TTO for patella alta, high tibial osteotomy (HTO), distal femoral osteotomy (DFO), and the FDA-approved MISHA implantable shock absorber. Alignment-first philosophy. Learn more → ### Knee Arthritis (OA, RA, Post-Traumatic) Structured non-surgical care, biologic injections, joint-preserving osteotomy, the MISHA implantable shock absorber, and partial or total knee replacement (Mako robotic-assisted) when appropriate. Learn more → Technology & Biologics ### Mako Robotic-Assisted Knee Surgery CT-based 3D planning and the AccuStop haptic boundary for partial knee replacement (UKA), total knee replacement, and selected complex cases — with an honest, published view of where Mako helps and where patient selection matters more than the platform. Learn more → ### PRP & Regenerative Medicine Honest, evidence-graded evaluation of PRP, hyaluronic acid, BMAC, Lipogems, cortisone, and amniotic products as adjunctive options — strongest evidence for chronic patellar tendinopathy, mixed for mild knee OA, not a substitute for evidence-based care. Learn more → ### Stem Cell Therapy (Academic Trials Only) Honest framing of stem cell therapy — the FDA has not approved any donor stem cell therapy for the orthopedic knee. Dr. Strickland's involvement is academic clinical trial participation at HSS (JointSTEM, ASA trials, BMAC research). This page is not a service offering. Learn more → ## When to See a Sub-Specialty Knee Surgeon A sub-specialty knee opinion is particularly worth seeking when the case is harder than a routine community-orthopedic case. Common reasons patients are referred or self-refer to Dr. Strickland include: - Failed prior surgery — revision MPFL, revision ACL, revision tibial tubercle osteotomy, or persistent symptoms after a prior arthroscopy - Recurrent patellar dislocation — especially after a first dislocation before age 25, or with abnormal patellofemoral anatomy on MRI - Cartilage damage on MRI — full-thickness chondral or osteochondral defects, particularly of the patella or trochlea, where MACI vs. OATS vs. osteochondral allograft vs. CartiHEAL needs to be matched to lesion size and biology - Multi-procedure decision-making — cases that need MPFL plus TTO plus cartilage work, or ACL plus meniscus plus alignment correction in the same operation - Complex anatomy — patella alta, trochlear dysplasia, varus or valgus malalignment driving cartilage failure, generalized ligamentous laxity - Clinical-trial candidacy — the Patella LIFT trial for full-thickness patellar cartilage defects, the Hyalex synthetic cartilage trial, the BEAR implant within 50 days of acute ACL injury, BMAC and other biologic adjuncts - Active patient unwilling to accept activity restriction — high-demand pivot athlete, dancer, climber, skier, weekend warrior unwilling to settle for "live with it" advice - Second opinion before surgery — especially before patellectomy, full knee replacement at a young age, or aggressive non-anatomic reconstruction ## How to Choose Among the Procedures If you are not sure which procedure page is relevant for your problem, the triage guide below maps common presentations to the right starting page. This is a starting point only — final treatment is decided in person after imaging review and physical examination. What you are experiencingStart with My kneecap dislocated — once or many timesPatellar Instability I have had MPFL reconstruction in the past and it has failedMPFL Reconstruction (revision section) Pain in the front of my knee, going downstairs, sitting too longPatellar Pain & Patellofemoral Arthritis Front-of-knee pain without dislocation — especially with running or jumpingAnterior Knee Pain MRI shows full-thickness cartilage damageMACI Cartilage Repair or Cartilage Transplant (OATS / OCA / CartiHEAL) Pop in my knee with twisting injury, sudden swelling, instabilityACL Tear Surgery My knee catches, locks, or has swelling on the joint lineMeniscal Tear Multi-ligament knee injury or complex sports traumaSports Injuries Bow-legged or knock-kneed with arthritis on one side of the kneeJoint Preservation & Osteotomy Advanced arthritis, failed non-surgical care, considering replacementKnee Arthritis & Mako Robotic-Assisted Surgery Mild arthritis or chronic tendinopathy, want to discuss biologicsPRP & Regenerative Medicine Researching stem cell therapy for the kneeStem Cell Therapy (academic trials only) ## Imaging Dr. Strickland Reviews Before Consultation The consultation is materially more productive when imaging is available the day of the visit. Bring whatever you have: - Standing weight-bearing X-rays of both knees — AP, lateral, and Merchant or sunrise views of the patella; a long-leg standing alignment film if alignment is in question - MRI of the affected knee — ideally on disc or via a portal we can access (the actual DICOM images, not just the report). Recent MRI within the last 6 to 12 months is most useful. For cartilage cases, dedicated cartilage-sequence MRI is preferred - CT scan — if you have one, particularly for revision cases (prior tunnel positions in revision ACL), patellar instability planning (TT-TG measurement), or trochlear dysplasia evaluation - Prior operative reports and intra-operative photographs — if you have had any prior surgery on the affected knee - Physical-therapy records — protocols and progress notes if you have been through a structured rehab program - Medication list and prior injection history — cortisone, hyaluronic acid, PRP, or any biologic injections Imaging that is more than a year old or that did not include patella-specific views can usually be supplemented at NYU Langone without repeating the entire MRI study. ## Prehabilitation Before Knee Surgery Across procedures, the single most under-discussed factor in surgical outcomes is what the knee looks like the day before surgery. Patients who arrive at surgery with full extension, minimal swelling, and good quadriceps activation have substantially better post-operative recovery than patients who arrive with a stiff, swollen, quadriceps-inhibited knee. Prehabilitation is universal across most knee procedures and includes: - Range of motion restoration — particularly full extension, which is the most important single mechanical predictor of post-op recovery - Effusion control — ice, compression, activity modification, anti-inflammatories where appropriate - Quadriceps activation — ending quadriceps shutdown before the operation, not after - Core and hip strengthening — the knee inherits forces from the hip and core - Nutrition and weight optimization — for elective joint preservation and arthroplasty cases - Smoking cessation — particularly important for cartilage healing, osteotomy nonunion risk, and infection risk - Education on the post-op protocol — so the patient hits the ground running rather than learning the rehab plan in the recovery room For most procedures, this means several weeks between the decision to operate and the operation — not because surgery should be delayed unnecessarily, but because the knee benefits from being well-prepared for it. ## What to Expect at the Initial Consultation The first visit is a sub-specialty consultation, not a same-day surgical decision. Surgery is not scheduled on the day of the visit — the consultation is for review, discussion, and planning. The typical patient experience: - Arrival and intake — arrive 15 to 20 minutes early to complete intake forms, review insurance, and have your prior imaging uploaded for review - History — how the symptoms started, how they have evolved, what activities make them worse, what treatments have been tried, what your activity goals are - Physical examination — range of motion, ligament stability, patellar tracking, joint-line tenderness, hip and core assessment - Imaging review with you — Dr. Strickland reviews your X-rays and MRI on the screen with you, points out the relevant findings, and explains what they mean - Discussion of options — non-surgical, surgical, and the trade-offs of each. For complex cases this includes a frank discussion of the procedure-selection decisions covered on the relevant procedure page - Plan — the next step is sometimes physical therapy, sometimes additional imaging (CT, alignment films, cartilage-sequence MRI), sometimes scheduling surgery, and sometimes a return for repeat evaluation after a non-surgical trial - Time for questions — including the questions about insurance, recovery timelines, and second-opinion considerations that almost everyone has For surgery-day expectations, see the procedure-specific "What to Expect on Surgery Day" section on the relevant procedure page — the experience differs meaningfully between, for example, ACL reconstruction, MPFL reconstruction with TTO, and Mako partial knee replacement. ## Insurance and Cost The practice is in-network with most major commercial plans. Out-of-network and self-pay arrangements are also accommodated. The variables that drive your specific out-of-pocket cost are the same across procedures: - Your plan's deductible and coinsurance — the structure of cost-sharing differs significantly between plans - In-network vs. out-of-network status — for the surgeon, the facility (NYU Langone or affiliated outpatient surgery center), and the anesthesia group - Bundled vs. separate billing — for the surgeon, facility, anesthesia, imaging, physical therapy, and any concurrent procedures - Out-of-network benefits — if you have them and choose to use them; the office is happy to provide the codes you need to verify benefits in advance Major commercial plans accepted include Aetna, Blue Cross Blue Shield (PPO, HMO, POS), Cigna, Connecticare, EmblemHealth GHI and HIP, Oxford, UnitedHealthcare, and UnitedHealthcare Compass. Before any surgery, the office verifies benefits, obtains pre-authorization where required, and reviews the estimated out-of-pocket cost with you. If your plan does not cover a specific aspect (some biologics or out-of-network components), it is discussed openly before the operation, not after. For benefits verification or to discuss self-pay arrangements, call the office at 646-904-4664 or contact us. ## Common Patient Concerns The questions we hear most often before a sub-specialty knee consultation, with honest answers: #### "Will I definitely need surgery if I come to see Dr. Strickland?" No. Many of the patients seen for sub-specialty consultation do not need surgery on the visit day — the recommendation is often physical therapy, an injection, activity modification, weight optimization, or a structured non-surgical trial before reconsidering. Surgery is recommended when it is the right answer for the diagnosis and the patient's goals, not because the patient has come to a surgical practice. #### "Am I too young or too old for the procedure I am considering?" It depends on the procedure. MPFL reconstruction, ACL reconstruction, MACI, and OATS are all performed across a wide age range, with patient selection driven by activity goals, anatomy, and the biology of the affected tissue rather than chronological age alone. Mako partial and total knee replacement is generally avoided in very young patients with mild arthritis where joint-preserving osteotomy is a better option, and is appropriate in older patients with end-stage disease who have failed non-surgical care. The decision is individualized. #### "Do I have to travel to NYC, or can I be seen closer to home?" Dr. Strickland sees patients at NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, in Midtown Manhattan. For out-of-state and international patients, the office coordinates imaging review and scheduling to minimize travel. ## Access & Office Location Dr. Strickland sees patients at one office, which accommodates patients traveling in from outside the immediate area: - New York City: NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY 10016. In Midtown Manhattan, accessible from Manhattan, the outer boroughs, Long Island, Westchester, and northern New Jersey via the Queensboro and Triboro bridges and the FDR Drive. Phone: 646-904-4664. Surgery is performed at NYU Langone in Manhattan and at affiliated outpatient surgery centers, depending on the procedure and patient factors. Out-of-state and international patients are accommodated; the office coordinates consultation, imaging review, and surgery scheduling to minimize travel. ## Patient Outcomes The point of all of the above — sub-specialty case mix, cartilage decision-making, alignment-first joint preservation, and structured rehabilitation — is to get the right patient back to the activity that matters to them. Dr. Strickland's patient success stories include athletes returning to climbing, skiing, soccer, and basketball after ACL reconstruction; patellar-instability patients back to dance and competitive sport after MPFL and TTO; and cartilage-restoration patients back to high-impact activity after MACI and OATS. ## Research & Publications Dr. Strickland is an active clinical-trial investigator and academic contributor with publications in The American Journal of Sports Medicine, Arthroscopy, Cartilage, The Journal of ISAKOS, The Journal of Knee Surgery, Arthroscopy Techniques, Orthopaedic Journal of Sports Medicine, and others. Active research areas include patellofemoral instability outcomes (the JUPITER multi-center cohort), cartilage restoration (MACI, OATS, osteochondral allograft, CartiHEAL aragonite scaffold), the BEAR implant for ACL restoration, tibial tubercle osteotomy outcomes, and patient-education quality in cartilage surgery. For the full bibliography, see research and publications. ## Frequently Asked Questions What knee conditions does Dr. Strickland treat? Dr. Strickland treats the full spectrum of knee conditions — patellar instability and recurrent kneecap dislocation, patellofemoral pain and arthritis, anterior knee pain (chondromalacia, tendinopathy), focal cartilage defects, ACL tears (including the BEAR implant for selected acute tears), meniscus tears (with a repair-first philosophy including all-inside and inside-out repair, transtibial root repair, and partial meniscectomy when repair is not possible), multi-ligament knee injuries, knee arthritis (osteoarthritis, rheumatoid, post-traumatic), and patients who need joint preservation osteotomy (TTO, HTO, DFO) or partial / total knee replacement. Sub-specialty focus: patellofemoral surgery, cartilage restoration, and joint preservation. Do I need a referral to see Dr. Strickland? A referral is not strictly required for most plans, but some commercial and managed-care plans (HMO and certain POS products) do require a primary-care referral or pre-authorization for orthopedic specialist visits. The office team verifies your specific plan's requirements at the time of scheduling and obtains pre-authorization where needed. If you have imaging (X-rays, MRI, or CT), bring it — having it available materially improves the consultation. Where does Dr. Strickland operate? Surgery is performed at NYU Langone Orthopedic Center in New York City and at affiliated outpatient surgery centers, depending on the procedure and patient factors. Does Dr. Strickland see out-of-state and international patients? Yes. Patients regularly travel from other states and internationally for sub-specialty consultations and surgery — particularly for revision MPFL reconstruction, complex patellofemoral planning, cartilage transplantation (MACI, OATS, osteochondral allograft, CartiHEAL), Patella LIFT trial eligibility, BEAR implant candidacy, and revision ACL reconstruction. Coordination of imaging review, in-person consultation, and surgery scheduling is handled to minimize travel for out-of-state patients. Does Dr. Strickland see pediatric or adolescent patients? Dr. Strickland sees skeletally mature adolescents (typically older teens) for patellofemoral instability, ACL reconstruction, meniscus surgery, and cartilage care. She is part of the JUPITER multi-center adolescent patellar instability research cohort. Younger pediatric patients with open growth plates are typically referred to a pediatric orthopedic colleague at NYU Langone where growth-plate-sparing technique is the priority. What insurance does Dr. Strickland accept? Major commercial plans accepted include Aetna, Blue Cross Blue Shield (PPO, HMO, POS), Cigna, Connecticare, EmblemHealth GHI and HIP, Oxford, UnitedHealthcare, and UnitedHealthcare Compass. Out-of-network benefits and self-pay arrangements are also accommodated. The office team verifies benefits and obtains pre-authorization before consultation or surgery — call to confirm your specific plan. How do I know which procedure page to read for my problem? If your kneecap has come out of joint, start with patellar instability. If you have anterior knee pain or pain going downstairs without dislocation, start with patellar pain and patellofemoral arthritis or anterior knee pain. If you heard a pop and felt your knee give way during sport, start with ACL tear surgery. If your knee catches or locks, start with meniscal tear. If you have full-thickness cartilage damage on MRI, start with MACI cartilage repair or cartilage transplant (OATS / allograft / CartiHEAL). If your knee is bow-legged or knock-kneed and arthritic, start with joint preservation and osteotomy. If you have advanced arthritis and have failed non-surgical care, start with knee arthritis and Mako robotic-assisted surgery. The triage table earlier on this page maps presenting symptoms to procedure pages. Why see a sub-specialty knee surgeon instead of a general orthopedist? Sub-specialty surgeons concentrate their case mix on a narrow set of problems and develop deeper experience with the harder cases — revision surgery, complex multi-procedure planning, cartilage restoration, patellofemoral surgery, and clinical-trial implants. Dr. Strickland's case mix is concentrated on knee surgery and sports medicine, with a particular focus on patellofemoral disease and cartilage restoration that other orthopedists refer for sub-specialty opinion. For straightforward problems, a community orthopedist is reasonable; for complex, revision, or multi-procedure decisions, a sub-specialty opinion changes the plan. What is the BEAR implant and am I a candidate? BEAR (Bridge-Enhanced ACL Restoration) is an FDA-approved implant that supports healing of the patient's own ACL rather than replacing it with a graft. It is appropriate for selected patients with acute ACL tears (typically within 50 days of injury), adequate ACL stump tissue on MRI, and a tear pattern that allows the implant to bridge the gap. Suitability is determined at consultation. See the ACL tear surgery page for details. ## All Procedure Pages Flat list of all 14 procedure pages, in alphabetical order, for easy navigation: - ACL Tear Surgery - Anterior Knee Pain - Cartilage Transplant (OATS, OCA, CartiHEAL) - Joint Preservation & Osteotomy - Knee Arthritis - MACI Cartilage Repair - Meniscal Tear (Repair, Root Repair, Allograft) - MPFL Reconstruction - Patellar Instability - Patellar Pain & Patellofemoral Arthritis - PRP & Regenerative Medicine - Mako Robotic-Assisted Surgery - Sports Injuries - Stem Cell Therapy (Academic Trials) Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Surgical and non-surgical orthopedic care should always be discussed with a board-certified orthopedic surgeon who has reviewed your imaging, history, and physical examination. Individual outcomes vary based on diagnosis, anatomy, comorbidities, surgical technique, and adherence to rehabilitation. The general descriptions of typical prehabilitation, consultation flow, insurance, and rehabilitation on this page reflect typical sub-specialty knee patient experience — your specific protocol, recovery timeline, and risks are determined at consultation and depend on the specific procedure. ## Schedule a Sub-Specialty Knee Consultation If you have a complex knee problem, a failed prior surgery, or a multi-procedure decision to make, bring your imaging to a sub-specialty consultation at NYU Langone in Midtown Manhattan. Book an Appointment Call 646-904-4664 About Dr. Strickland --- ## ACL Tear Surgery: Reconstruction & BEAR Implant NYC | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/knee-surgeon-specialist/acl-tear-surgery/ Summary: ACL tear surgery by Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York — graft selection (quadriceps, hamstring, BTB, allograft), BEAR implant for selected patients, ACL+LET augmentation, revision ACL, and structured return-to-sport rehab. Specialty # ACL Tear Surgery ACL reconstruction with patient-matched graft selection (quadriceps, hamstring, or BTB autograft), the BEAR implant for selected acute tears, and ACL+LET augmentation for high-risk pivot athletes — by Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York. Medically reviewed by Dr. Sabrina Strickland, MD — Orthopedic Surgeon at the NYU Langone Orthopedic Center in New York. View full bio → Where NYU Langone Orthopedic Center, Midtown Manhattan Patients We See NY, NJ, CT, and out-of-state patients with acute, chronic, or failed prior ACL injuries Return to Sport Typically 6–9 months — criteria-based, not calendar-based Overview ACL tear surgery is reconstruction of the anterior cruciate ligament — the central knee stabilizer that prevents the tibia from sliding forward on the femur and that resists rotational shear during cutting and pivoting. Reconstruction uses a tendon graft (autograft from your own quadriceps, hamstring, or bone-patellar tendon-bone — or allograft from a donor) passed through anatomic tunnels in the tibia and femur and fixed with button-and-suture constructs. For carefully selected acute tears, the BEAR (Bridge-Enhanced ACL Restoration) implant supports healing of the patient's own ACL instead of replacement. For revision cases or high-risk pivot athletes, ACL+LET (anterolateral ligament) augmentation reduces re-tear rates. Concurrent meniscus repair or partial meniscectomy is performed in the same operation when needed. Return to cutting and pivoting sport is typically 6 to 9 months and is criteria-based, not calendar-based. Dr. Sabrina Strickland performs ACL reconstruction at NYU Langone Orthopedic Center in New York with a focus on graft selection matched to the patient and structured return-to-sport rehabilitation. If you have torn your ACL, the question is rarely whether you can live with it — many patients can — but whether your activity goals require the rotational stability that the ACL provides. A patient whose goal is to return to running, cycling, and swimming has different decision-making than a patient whose goal is to return to soccer, basketball, lacrosse, skiing, tennis, dance, or martial arts. The cutting and pivoting demands of those sports require an intact ACL or a reconstructed one; without it, the knee will give way, the meniscus and cartilage will take wear over time, and the long-term cost is real even if the short-term function feels acceptable. This page covers what the ACL is and what it does, how a torn ACL feels, when surgery is and is not necessary, the four main graft options and how they differ, the BEAR implant, ACL+LET augmentation for high-risk profiles, revision ACL surgery, the return-to-sport rehabilitation that actually works, and when a sub-specialty second opinion is worth seeking. For closely related topics, see meniscal tear (often torn alongside the ACL); sports injuries for the broader context of complex multi-ligament knee trauma; MACI cartilage repair and cartilage transplantation when the ACL injury has produced cartilage damage; and joint preservation and osteotomy when alignment correction is part of an ACL revision plan. ## What the ACL Is and Does The anterior cruciate ligament (ACL) is one of the four main ligaments of the knee, running diagonally inside the joint from the back of the femur to the front of the tibia. It does two essential things: - Prevents the tibia from sliding forward on the femur (anterior translation) - Resists rotational shear — the kind of force that occurs when the foot is planted and the upper body twists in the opposite direction Without an intact ACL, the knee can still walk, run in a straight line, and tolerate most activities of daily living. What it cannot reliably do is cut, pivot, decelerate, or absorb the rotational loads of pivoting sport. An ACL-deficient knee in an athlete who continues to cut and pivot accumulates secondary damage to the meniscus and cartilage over time — this is one of the more important reasons that active patients who tear their ACL elect reconstruction even if the short-term symptoms are manageable. ## How an ACL Tear Feels The acute injury is usually distinct: - An audible pop at the moment of injury — reported by the majority of patients - Immediate inability to continue the activity - Rapid swelling within the first few hours (a hemarthrosis — blood in the joint) - A sense of giving way or that the knee "isn't right" - Pain that is variable — some patients have severe acute pain, others have surprisingly mild pain that masks the severity In the days and weeks after injury, swelling typically diminishes, and many patients can walk relatively normally. The chronic ACL-deficient knee often feels stable in straight-line activity but gives way when the patient tries to cut, pivot, or decelerate — particularly on uneven ground, going down stairs, or stepping off a curb at an angle. This recurrent giving-way pattern is what produces the meniscus and cartilage damage of an unreconstructed ACL deficiency over time. Video: Dr. Strickland explains what to expect from ACL surgery (1:43). Transcript if you're watching this video it's because I've already spoken to you about doing an ACL reconstruction the ligament that we're talking about reconstructing is the ACL right here and it essentially connects your femur bone to your thigh bone and it prevents your shin bone or tibia bone from coming too far forward this ligament stabilizes your knee for sports that involve cutting such as soccer and Lacrosse and Tennis uh in order to make a new ligament I essentially have to use a tendon feed it through the center part of your knee and then you have to turn that tendon into a ligament as far as coming in for surgery you'll come into the ninth floor at the hospital for special surgery across the street we do the surgery under Regional anesthesia which means that you'll have a spinal block plus some sedation most patients choose to sleep but this is not general anesthesia the surgery itself takes about 60 to 90 minutes depending on whether or not I have to do anything to your meniscus whether repair it or take out a small portion of your meniscus once you're in the recovery room you'll your Sensation will return to your feet you'll get up with the physical therapist and walk and you'll go home with a brace on your knee that is locked straight you are allowed to unlock this brace to sit you'll also go home with an ice machine the ice machine is important because it helps manage swelling and it will dramatically help control your pain as far as followup I will see you at approximately 10 days to take out your sutures at 6 weeks to assess your range of motion and strength and again at three months during this period you'll be attending Physical Therapy you're going to be um working on both your strength and your flexibility and at four to 6 months you'll come in for a full evaluation by our rehab Department as far as return to sports most patients get back to sports between 6 and 9 months certainly you'll be back to light activities such as cycling and the elliptical long before the six-month mark ## The Surgery Decision Whether to reconstruct an ACL depends on: - Activity goals — cutting and pivoting sport (soccer, basketball, lacrosse, skiing, tennis, dance, martial arts) typically requires reconstruction; running, cycling, swimming may not - Age — younger patients, particularly skeletally mature adolescents and young adults, more often benefit from reconstruction because of higher activity demands and longer expected duration of athletic participation - Concurrent injuries — meniscus tears, particularly bucket-handle tears or root tears, often warrant surgery and the ACL reconstruction is performed in the same operation - Symptoms — recurrent giving way despite bracing and physical therapy is a strong indication for reconstruction even in lower-demand patients - Imaging — complete vs. partial tears, associated injuries on MRI - Profession and specific demands — firefighters, military, law enforcement, manual laborers in physically demanding jobs often need reconstruction even outside competitive sport Patients who are not surgical candidates — or who choose to proceed non-operatively — can be managed with bracing for higher-risk activity, structured PT focused on quadriceps and hip strengthening, neuromuscular control work, and careful activity selection. Long-term outcomes in this group depend on how successfully the patient avoids cutting and pivoting demands. ## Graft Selection — Four Options Graft choice is one of the most important decisions in ACL surgery. All four options below are well-evidenced and produce excellent outcomes when matched to the right patient. #### Quadriceps tendon autograft Harvested from the quadriceps tendon above the kneecap. Strong biomechanical profile, cylindrical graft shape, lower harvest-site morbidity than BTB. An option in larger patients or high-demand athletes willing to tolerate more quad rehab after surgery. #### Hamstring tendon autograft Harvested from the semitendinosus and (sometimes) gracilis tendons. Avoids the patellar mechanism, well-tolerated, smaller incisions. A good option especially with LET augmentation in a wide range of patients who want to avoid anterior knee pain. #### Bone-patellar tendon-bone (BTB) autograft Harvested from the central third of the patellar tendon with bone blocks at each end. Provides bone-to-bone healing, historically considered the "gold standard" for high-demand pivot athletes. Trade-off: higher rates of arthritis and more anterior knee pain at the harvest site, particularly with kneeling. #### Allograft (donor tissue) Cadaveric tendon. Avoids harvest-site morbidity, shorter operative time. Higher re-tear rates than autograft in young high-demand patients, so typically reserved for lower-demand patients, multi-ligament reconstructions, and revision cases where autograft tissue is limited. The choice is individualized to the patient's age, sport, anatomy, prior tendon issues, and personal preferences after a frank discussion of trade-offs. There is no single "best" graft for every patient. Video: Dr. Strickland on her preferred ACL reconstruction technique (1:31). Transcript ACL tears are an incredibly common injury they're much more common in women than men and we've learned that women depending on this border up to six to eight times more likely than men to tear their ACLS and often this involves teenagers my Approach has changed over the last 20 years 20 years ago I was using a patellar tendon in most cases which involved two metal screws to fix the Graft in place and then the body has to grow into that tendon and make a ligament nowadays in most cases I use a single hamstring we have a way to do it called all inside where we can quadruple that hamstring which makes a much stronger and larger graft and the morbidity or the downside or what you lose from taking one hamstring is minimal what's happened over the past year is the FDA approved the bear the bear is a bovine collagen implant where we put it in the gap between the two ends of the ACL that's super exciting because there's no donor State morbidity meaning we're not taking the patellar tendon and we're not taking the hamstring and instead we're using the patient's own growth potential to heal feel that ACL and we got approval at HSS in February to start doing this operation and so far I can say their knee feels very stable but it's a little bit slower rehab the first couple months and I'll report back in a year and see how those patients are actually doing but I can tell you to get through the FDA they had to do a lot of work comparing regular ACL reconstruction to the bearer and the results were very promising ## The BEAR Implant BEAR (Bridge-Enhanced ACL Restoration) is an FDA-approved implant that supports healing of the patient's own ACL rather than replacing it with a graft. It is a collagen-based scaffold placed between the torn ends of the ACL with a small amount of the patient's own blood — the implant supports the body's natural healing response and serves as a bridge for the ACL ends to heal across. BEAR is appropriate for selected patients with: - Acute ACL tears — typically within 50 days of injury - Adequate ACL stump tissue on MRI - Tear pattern that allows for the implant to bridge the gap - Otherwise straightforward case without complex concurrent injuries that would override the BEAR plan For appropriately selected patients, BEAR offers an alternative to traditional graft-based reconstruction without the harvest-site morbidity of autograft. Suitability is determined at consultation based on tear pattern, timing from injury, and patient factors. ## ACL+LET Augmentation The anterolateral ligament (ALL) is a structure on the outer side of the knee that contributes to rotational stability. Adding a small lateral extra-articular reconstruction to the standard ACL reconstruction provides additional rotational control. This combined ACL+LET approach has been shown in published studies to reduce re-tear rates in high-risk populations. ACL+LET augmentation is considered for: - Revision ACL reconstruction — where re-tear risk is already elevated - High-grade pivot shift on examination - Young female pivot athletes — a population with documented higher re-tear rates - Generalized ligamentous laxity (knee hyperextension) - Sports with the highest cutting and pivoting demands — particularly competitive soccer, basketball, lacrosse, skiing The augmentation adds limited additional operative time and does not significantly change the recovery profile but adds meaningful rotational protection in the right patients. ## Revision ACL Reconstruction Revision ACL reconstruction — for patients whose primary ACL reconstruction has failed — is technically more demanding than primary ACL reconstruction. Causes of failure include traumatic re-injury, tunnel malposition (most common cause of "atraumatic failure"), graft fixation issues, biological failure, and unaddressed concurrent injuries (meniscus, cartilage, alignment). Revision planning may include: - CT scan to evaluate prior tunnel positions and bone stock - Standing alignment films — varus alignment is a risk factor for ACL graft failure and may require concurrent or staged osteotomy - Decision on single-stage vs. two-stage — if prior tunnels are malpositioned and overlap the planned new tunnels, bone grafting and a staged revision may be needed - Graft selection — often a different graft than was used the first time, particularly when the prior graft was an autograft - ACL+LET augmentation — commonly added for revision cases given the elevated re-tear risk - Concurrent meniscus and cartilage work — addressing damage that has accumulated in the failed-ACL knee ## Concurrent Meniscus and Cartilage Work ACL injuries rarely happen alone. Concurrent meniscus tears occur in a substantial percentage of acute ACL injuries; lateral meniscus tears are particularly common in acute ACL injuries, while medial meniscus tears are more common in chronic ACL deficiency. Cartilage damage can occur from the initial injury impact ("bone bruise" pattern) or from chronic instability. Whenever possible, concurrent injuries are addressed in the same operation as ACL reconstruction: - Meniscus repair for repairable tears in the vascular zone — the well-vascularized environment of an acute ACL reconstruction enhances healing - Partial meniscectomy for irreparable inner-zone tears, performed conservatively - Cartilage repair (microfracture, MACI biopsy followed by staged implantation, or osteochondral procedures) when focal cartilage damage is present - Multi-ligament reconstruction for combined ACL + MCL, ACL + posterolateral corner, or ACL + PCL injuries For the dedicated walk-through of meniscus surgical decision-making, see meniscal tear. For cartilage repair after ACL injury, see MACI cartilage repair. ## Prehabilitation Matters The single most under-discussed factor in ACL outcomes is what happens before surgery. Patients who arrive at surgery with full range of motion, minimal swelling, and good quadriceps activation have substantially better post-operative outcomes than patients who arrive with a stiff, swollen knee and inhibited quadriceps. Prehabilitation includes: - Range of motion restoration — particularly full extension - Effusion control - Quadriceps activation — early termination of quadriceps shutdown reduces post-op recovery time - Education on the post-operative protocol so the patient hits the ground running For most patients, this means several weeks between the injury and the operation — not because surgery should be delayed unnecessarily, but because the knee benefits from being well-prepared for it. The exception is irreducible mechanical block (e.g., a locked bucket-handle tear) or other situations that warrant earlier intervention. ## What to Expect on Surgery Day ACL reconstruction is performed as an outpatient procedure — you go home the same day. This is the typical patient experience and your specific protocol is reviewed at consultation: - Arrival and pre-op — you arrive a couple of hours before the procedure for intake, change into a gown, and meet the anesthesia team - Anesthesia consultation — the anesthesiologist reviews your history and discusses the anesthesia plan. For Dr. Strickland's ACL reconstructions, this is typically regional anesthesia (a spinal block with sedation) rather than general anesthesia. During surgery, a periarticular block is also placed around the knee joint to help reduce pain during the first day after surgery as part of an opioid-sparing pain protocol. - Surgery — the procedure itself typically takes 1 to 2 hours depending on graft choice and any concurrent meniscus or cartilage work - Recovery room — you wake up in the recovery area; physical therapy starts the same day with crutch training and basic motion - Going home — you go home with crutches, a brace, ice, prescribed pain medication, and clear written instructions. A responsible adult must drive you home - First 48 hours — ice, elevation, prescribed medications, gentle motion as instructed. The first week's focus is effusion control and quadriceps activation ## Return-to-Sport Rehabilitation ACL rehabilitation is a structured 6 to 12 month program. Return to sport is criteria-based, not calendar-based — the date matters less than the limb symmetry, hop testing, and psychological readiness benchmarks. PhaseTimelineGoals Phase 1: Protection and motionWeeks 0–2Effusion control, full extension, quadriceps activation, weight-bearing as tolerated with crutches Phase 2: Range and early strengthWeeks 2–6Full range of motion, off crutches, stationary cycling, early strengthening Phase 3: StrengtheningMonths 2–4Progressive resistance training, single-leg work, low-impact cardio Phase 4: Running and plyometricsMonths 4–6Graduated running program, jumping and landing mechanics, change-of-direction drills Phase 5: Sport-specificMonths 5–7Cutting, pivoting, deceleration patterns specific to the patient's sport Phase 6: Return to sportMonths 6–9Limb symmetry index >90%, normal hop testing, psychological readiness, sport-specific clearance The biology drives the floor of the timeline — the graft needs time to revascularize and remodel into mature ligament tissue. The patient drives whether the timeline is met or pushed later. Patients who skip phases or who return to sport without meeting return-to-sport criteria have higher re-tear rates than patients who follow the structured progression. Video: Dr. Strickland on rehabilitation and the techniques used to help prevent ACL retear (1:23). Transcript [Music] so when you look at the studies of ACL reconstruction most studies show there's about a 12 chance of re-terror so you go through this whole surgery you do nine months of rehab and then you retail your ACL and in 12 those odds are pretty high and so we're constantly focusing on new ways to optimize the surgery to reduce that rear tear rate and we're also looking at ways to make surgery less invasive so that God forbid you have to have another surgery that it's not quite so so invasive we've added procedures in some cases called an lat or an I.T bantine adhesis to tighten up the lateral side of the knee to make the chance of reach hair less likely and now we're doing that surgery in patients who are very very flexible in other cases when the patient's already torn their ACL for the second time we start looking at other factors in their knee we look at the slope or the the shape of the shin bone and how how slanted it is because we know that patients who are more slanted are more likely to slip forward and so in some of those cases we change the slope and that's the only way we're able to get their knee stable I think ultimately the one thing we can tell every patient is the longer they wait even though it's really frustrating and annoying the less likely they are to retire their ACL so the difference between going back to sports at six months and nine months even if they're really strong is that they have a much lower rate of retain their ACL [Music] ## Risks of ACL Surgery ACL reconstruction is a well-established surgery with predictable outcomes for most patients, but no surgery is risk-free. The risks reviewed at consultation include: - Graft re-tear — the most clinically relevant long-term risk, particularly for young high-demand pivot athletes. Re-tear rates are reduced with autograft over allograft in young athletes, with anatomic tunnel placement, with ACL+LET augmentation in high-risk profiles, and with structured return-to-sport rehabilitation that meets objective criteria before clearance - Persistent stiffness or loss of motion — including cyclops lesion (a small scar nodule that can block extension). Reduced by good prehabilitation, early focus on full extension, and structured PT - Infection — uncommon but a serious complication if it occurs - Blood clot (DVT or pulmonary embolism) — risk is mitigated by early mobilization and individualized prophylaxis - Graft impingement or fixation issues — rare with anatomic tunnel placement - Harvest-site morbidity — with autograft only. Anterior knee pain (BTB), posterior thigh weakness or numbness (hamstring), or quadriceps weakness (quadriceps tendon) - Anesthesia-related risks — including nausea, sore throat, rare allergic reactions to anesthetics, transient nerve irritation from the regional block - Incomplete return to prior performance — some patients do not return to their prior level of sport even with a technically excellent reconstruction; psychological readiness, body composition changes, and time away from sport all contribute The specific risk profile for your case depends on your age, activity level, graft choice, concurrent injuries, alignment, and any prior surgery on the knee. These are reviewed at consultation, and many of the risks above are modifiable by prehabilitation, graft selection matched to the patient, and rehabilitation that follows the structured protocol. ## Common Patient Concerns The three concerns we hear most often before ACL surgery, with honest answers: #### "How much will this actually cost me out of pocket?" ACL reconstruction is medically necessary for symptomatic ACL deficiency in active patients and is covered by all major commercial insurance plans, Medicare, and most union and self-funded plans. Your out-of-pocket cost depends on your specific plan's deductible, coinsurance, in-network status of the surgeon, the facility (NYU Langone or affiliated), and the anesthesia group. Our team verifies benefits and reviews your estimated surgical fee out-of-pocket with you before surgery so there are no surprises. See Insurance and Cost below. #### "Six to nine months of recovery feels impossible. I can't take that long off." The 6 to 9 month timeline is to cutting and pivoting sport — not to most of normal life. Most patients drive within 4 to 6 weeks (right knee) or 1 to 2 weeks (left knee, automatic transmission), return to desk work within 1 to 2 weeks, return to manual or active work over 2 to 4 months depending on the demands, and return to running between months 4 and 5. The long timeline only applies to the rotational and impact-loading sports that the ACL specifically protects against. Skipping the timeline does not save time — re-tear in the first year is a setback that costs far more than the structured rehab. #### "I'm scared of pain and of getting hooked on opioids." Dr. Strickland's ACL recovery protocol uses multimodal pain management — including a periarticular block placed around the knee joint during surgery to help reduce pain during the first day after surgery, scheduled non-opioid medications (acetaminophen and an anti-inflammatory unless contraindicated), ice, and elevation. Most patients use only a small number of opioid pills for breakthrough pain in the first few days, and many use none after the first 48 hours. The periarticular block and the multimodal approach are specifically designed to minimize the role of opioids in your recovery. ## Insurance and Cost ACL reconstruction is covered by all major commercial insurance plans, Medicare, and most self-funded and union plans when the diagnosis and indication for surgery meet medical-necessity criteria. The variables that drive your specific out-of-pocket cost are: - Your plan's deductible and coinsurance — the structure of cost-sharing differs significantly between plans - In-network vs. out-of-network status — for the surgeon, the facility (NYU Langone or affiliated outpatient surgery center), and the anesthesia group - The bundled vs. separate billing for the surgeon, facility, anesthesia, imaging, physical therapy, and any concurrent procedures (meniscus repair, cartilage work) - Out-of-network benefits — if you have them and choose to use them; we are happy to provide the codes you need to verify your benefits in advance Before surgery, our office verifies your benefits, obtains pre-authorization where required, and reviews the estimated surgical fee out-of-pocket with you. If your plan doesn't cover a specific aspect (some biologics or out-of-network components), we discuss it openly before the operation, not after. For benefits verification or to discuss self-pay arrangements, call us at 646-904-4664 or contact the office. ## When to Seek a Sub-Specialty Second Opinion A sub-specialty second opinion is particularly worth seeking when: - You are a young athlete facing a graft choice and want a clear discussion of trade-offs - You have an acute ACL tear and want to know whether you are a BEAR implant candidate - You have a complex injury — ACL plus meniscus root tear, ACL plus cartilage damage, ACL plus MCL or posterolateral corner, multi-ligament knee - You have a failed prior ACL reconstruction and are facing revision - You are a female pivot athlete and want to know whether ACL+LET augmentation is appropriate for you - You are past the typical age for ACL reconstruction and are weighing reconstruction vs. activity modification - You have recurrent giving way after a non-operative trial and want to revisit the surgery decision ## Frequently Asked Questions How long is recovery after ACL reconstruction? Most patients return to cutting and pivoting sport 6 to 9 months after ACL reconstruction. Structured physical therapy is required for the entire interval. The graft needs that time to develop a blood supply (revascularize) and remodel into mature ligament tissue strong enough to withstand the loads of sport. Return-to-sport timing is criteria-based, not calendar-based — limb symmetry index, hop testing, and psychological readiness all matter as much as the date on the calendar. What is the difference between autograft and allograft? Autograft uses the patient's own tendon (quadriceps, hamstring, or bone-patellar tendon-bone). It is preferred for young, high-demand athletes — re-tear rates are lower than with allograft in this population. Allograft uses donor tissue, allows shorter operative time, and avoids harvest-site morbidity — it is often a reasonable choice for older or lower-demand patients. Choice of graft is one of the more important decisions in ACL surgery and depends on age, activity level, and anatomy. Which autograft is best — quadriceps, hamstring, or BTB? All three are well-evidenced and produce excellent outcomes when matched to the right patient. Quadriceps tendon autograft has gained ground in recent years for its strong biomechanical profile and lower harvest-site morbidity than BTB. Bone-patellar tendon-bone (BTB) provides bone-to-bone healing at both ends and is favored in some high-demand athletes — at the cost of more anterior knee pain in the harvest site. Hamstring tendon (semitendinosus and gracilis) avoids the patellar mechanism and is well-tolerated. The choice is individualized to the patient. Do I need surgery if I have an ACL tear? Not always. Patients whose primary goal is running, cycling, swimming, and other straight-line activities may do well with physical therapy, bracing, and activity modification. Patients who want to return to cutting and pivoting sports — soccer, basketball, lacrosse, skiing, tennis, dance, martial arts — usually need ACL reconstruction to restore stability and protect the meniscus and cartilage from the wear that occurs in an unstable knee. What is the BEAR implant? BEAR (Bridge-Enhanced ACL Restoration) is an FDA-approved implant that supports healing of the patient's own ACL rather than replacing it with a graft. It is a collagen-based scaffold placed between the torn ends of the ACL with a small amount of the patient's own blood — the implant supports the body's natural healing response. BEAR is appropriate for selected acute ACL tears (typically within 50 days of injury) with adequate ACL stump tissue. What is ACL plus LET augmentation? The anterolateral ligament (ALL) is a structure on the outer side of the knee that contributes to rotational stability. ACL plus LET augmentation adds a small lateral extra-articular reconstruction to the standard ACL reconstruction to provide additional rotational control. It is considered for revision ACL cases, high-grade pivot shift on exam, young female pivot athletes, generalized ligamentous laxity, and other high-risk profiles for re-tear. Can I weight-bear right after ACL surgery? Yes, in most cases. Patients begin walking with crutches immediately and progress to weight-bearing as tolerated within the first week. Stationary cycling typically starts in the first week. Crutch use is reduced over the first 2 to 3 weeks as quadriceps activation returns and gait normalizes. Concurrent meniscus repair or osteotomy may delay weight-bearing — those protocols are individualized. What are the risks of ACL surgery? Risks include graft re-tear (the most relevant long-term risk in young athletes), persistent stiffness or loss of motion (cyclops lesion), infection, blood clot, graft impingement, harvest-site pain (with autograft), and incomplete return to prior performance. These are reviewed at consultation, and several of them are reduced with appropriate prehabilitation, graft selection, anatomic tunnel placement, and structured rehabilitation. ## Access & Office Location Dr. Strickland sees ACL patients at one office, which works with patients traveling in from outside the immediate area: - New York City: NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY 10016. In Midtown Manhattan, accessible from Manhattan, the outer boroughs, Long Island, Westchester, and northern New Jersey via the Queensboro and Triboro bridges and the FDR Drive. Phone: 646-904-4664. For patients traveling to New York from out of state for sub-specialty ACL care, we coordinate consultation and surgery scheduling to minimize travel and align with imaging review and pre-operative work-up. Many out-of-state patients travel to NYU Langone specifically for revision ACL, BEAR candidacy evaluation, and complex multi-ligament knee reconstruction. ## Patient Outcomes The point of all of the above — graft selection, BEAR consideration, LET augmentation, structured rehab — is to get the right patient back to the activity that matters to them. The video below is one of Dr. Strickland's ACL patients sharing her return to sport after reconstruction. Video: Denise's return to activity after ACL reconstruction with Dr. Strickland (1:55). Transcript I'm flying down the mountain to Killington going at speed of light as far as I can see and I hit a patch of ice and I heard a racket it sounded like snap crackle pop and it was at that point I realized that something significant had happened when Denis first came to see me I think she would agree with me that she was quite miserable she'd had a ski accident she not exactly torn her ACL she pulled her ACL off her shin bone when an outside doctor tried to fix it he tried to sew that ACL back down and one of the complications with that often and he can get really stiff who was incredibly uncomfortable and I had told my doctor or my physical therapist at the time I would rather have my leg cut off then deal with this pain and that's when she said you need a second opinion something's wrong so I started out by just removing the scar tissue taking out the ACL that had not healed and getting her range of motion back and that process was I think good from the very beginning I mean she felt so much better even a week after surgery and I went from looking at a very sad face to a really hopeful face and when I finally took the brace off I walked 20 steps and I was like I could do this and I'm happy to say that she has a completely stable knee she's got excellent range of motion she smiles every time I see her and you know I think it's amazing to be able to do this for a patient who essentially given up hope the entire experience has just been pristine from the very beginning and I highly recommend her office HSS [Music] For more patient outcomes, see Dr. Strickland's success stories, including Denise's full story, returning to climbing after an ACL tear, and a skier with combined ACL and meniscus injuries. ## Related Specialty Care For meniscus tears that are commonly torn alongside the ACL, see meniscal tear. For broader sports trauma context including multi-ligament knee injuries, see sports injuries. For cartilage repair after ACL injury when focal cartilage damage is present, see MACI cartilage repair and cartilage transplantation. For alignment correction in revision ACL cases with varus alignment, see joint preservation and osteotomy. Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Surgical and non-surgical orthopedic care should always be discussed with a board-certified orthopedic surgeon who has reviewed your imaging, history, and physical examination. Individual outcomes vary based on diagnosis, anatomy, comorbidities, graft choice, surgical technique, and adherence to rehabilitation. The general descriptions of anesthesia, pain protocols, and timelines on this page reflect typical ACL-reconstruction patient experience — your specific protocol is determined at consultation. ## Discuss Your ACL Reconstruction If you have an acute ACL tear and want to discuss graft selection or BEAR candidacy, or if you are facing revision ACL or a complex multi-ligament injury, bring your imaging to a sub-specialty consultation at NYU Langone in Midtown Manhattan. Book an Appointment Call 646-904-4664 --- ## Anterior Knee Pain Diagnosis NYC | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/knee-surgeon-specialist/anterior-knee-pain/ Summary: Anterior knee pain has three common causes — chondromalacia (cartilage softening), patellofemoral arthritis, and patellar tendonitis. Sub-specialty differential diagnosis and treatment by Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York. Eccentric loading rehab for tendinopathy, cartilage-first care for chondromalacia, and joint-preserving options when arthritis sets in. Differential Diagnosis Hub # Anterior Knee Pain: Chondromalacia, Arthritis & Patellar Tendonitis Three different problems cause pain at the front of the knee, and they look similar to patients but require fundamentally different treatments. Sub-specialty differential diagnosis by Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York — matching treatment to the actual driver of your pain. Medically reviewed by Dr. Sabrina Strickland, MD — Board-Certified Orthopedic Surgeon at the NYU Langone Orthopedic Center in New York · Member, International Patellofemoral Study Group · Castle Connolly Top Doctor since 2016. View full bio → Where NYU Langone Orthopedic Center, Midtown Manhattan Patients We See Conflicting diagnoses, chondromalacia, focal cartilage defects, patellar tendinopathy, early patellofemoral arthritis, post-instability cartilage damage First Step Bring prior imaging to a sub-specialty consultation — differential diagnosis is the value-add Overview Anterior knee pain has three common causes that look similar to patients but are fundamentally different problems. Chondromalacia is softening or breakdown of the cartilage on the back of the kneecap or front of the trochlea — a cartilage problem, visible on MRI, with pain felt deep behind the kneecap and worse with stairs and prolonged sitting. Anterior (patellofemoral) knee arthritis is end-stage cartilage loss in the patellofemoral compartment — a joint surface problem, visible on x-ray as joint-space narrowing, typically in patients in their 40s, 50s, or 60s with a long history of anterior knee pain. Patellar tendonitis (more accurately patellar tendinopathy or "jumper's knee") is degeneration of the patellar tendon at the lower pole of the kneecap — a tendon problem, with pain on the tendon itself and worse with jumping and explosive activity. The three require different treatments: structured PT and selective cartilage care for chondromalacia, eccentric loading rehabilitation as the foundation for tendinopathy, and joint-preserving options for early arthritis. Dr. Sabrina Strickland evaluates these patients at NYU Langone Orthopedic Center in New York and matches treatment to the actual driver of pain — not the most obvious one. Anterior knee pain is one of the most common reasons patients are referred to a knee specialist. It is also one of the most often mislabeled. The same patient with the same MRI can be told they have chondromalacia in one office, patellar tendonitis in another, and arthritis in a third — because three different conditions cause similar-feeling pain at the front of the knee, and the diagnostic skill required to tell them apart is not always applied at the first visit. The right treatment depends on which of the three is actually driving the pain, and the protocols are very different. This page is the differential-diagnosis hub: how to tell the three apart, what each one is, what works (and what does not) for each, and when surgery is appropriate. For closely related sub-specialty pages, see patellar pain and patellofemoral arthritis for the full anterior knee pain workup with patellofemoral arthroplasty (PFA) detail; knee arthritis for OA, RA, and post-traumatic arthritis throughout the knee; MACI cartilage repair and cartilage transplantation (OATS & allograft) for cartilage-restoration options; joint preservation and osteotomy for AMZ-TTO realignment; and patellar instability if your kneecap also slips out of place. ## What Anterior Knee Pain Is and Why It Has Three Common Causes "Anterior knee pain" simply means pain at the front of the knee. The kneecap (patella) sits in front of the joint and slides up and down in a groove on the front of the thigh bone — the trochlear groove. Together they form the patellofemoral joint. Cartilage on the back of the kneecap and on the surface of the trochlea allows the joint to glide smoothly through the range of motion. Just below the kneecap, the patellar tendon connects the kneecap to the tibia and transmits force from the quadriceps muscle. Three different structures in this small area can hurt: - The cartilage on the back of the kneecap and front of the trochlea — when it softens, fissures, or wears, the result is chondromalacia patellae (early/intermediate) or patellofemoral arthritis (end-stage) - The patellar tendon — when it is overloaded for long enough, the tendon structure itself changes, with disorganized collagen, neovascularization, and altered biomechanics. The result is patellar tendinopathy, traditionally called "patellar tendonitis" - The soft tissues, retinaculum, and surrounding muscles — muscle imbalance, hip-stabilizer weakness, and patellar maltracking can produce mechanical pain even without structural damage Three different structures → three different problems → three different treatments. The most common diagnostic error in anterior knee pain is conflating them. A patient with deep retropatellar pain and a healthy patellar tendon does not have tendonitis. A patient with localized lower-pole tenderness and a normal cartilage MRI does not have chondromalacia. Getting the diagnosis right is the first step toward effective treatment, and the rest of this page is built around that. ## How to Tell Them Apart Pain location, pain pattern, age group, imaging finding, and first-line treatment all differ across the three. The table below is the differential diagnosis at a glance: FeatureChondromalaciaAnterior knee arthritisPatellar tendinopathy Where the pain isDeep behind the kneecapBehind/around the kneecapOn the tendon at the lower pole of the kneecap What triggers itStairs, prolonged sitting (theater sign), squatting, kneelingStairs, daily activities, eventually constantJumping, sprint starts, explosive lifting, decline running Typical ageTeens to 40s, often active patients40s to 60s and older, long-standing courseTeens to 40s, jumping/lifting athletes Imaging findingMRI: cartilage signal change, fissuring, or full-thickness lossX-ray: joint-space narrowing, osteophytes (Merchant view)MRI / ultrasound: tendon thickening, signal change at lower pole First-line treatmentPT (quad + hip stabilizers), activity modification, NSAIDs, selective injectionPT, weight optimization, NSAIDs, selective injectionEccentric loading rehab (heavy slow-resistance, decline single-leg squats) Surgical roleReserved for focal full-thickness defects (MACI/OATS/allograft)Patellofemoral arthroplasty when isolated and end-stageRare — tendon debridement after comprehensive non-op care fails This table is a starting point, not a final answer — the actual differential is built from a careful history, a structured physical exam (tenderness mapping, patellar tracking, single-leg squat, palpation of the tendon), and targeted imaging. Patients who have been given conflicting diagnoses are usually in this category because no one has done all of those steps in the same visit. ## Chondromalacia: Cartilage Softening of the Kneecap Chondromalacia patellae is softening, fissuring, or breakdown of the cartilage on the back of the kneecap (and sometimes the front of the trochlea). It is the cartilage end of the spectrum — pain is generated by the cartilage damage and by the irritation of the underlying bone and surrounding soft tissues. It is graded: - Grade 1: Cartilage softening — visible on MRI as signal change without surface disruption - Grade 2: Fissuring — partial-thickness fissures - Grade 3: Deep partial-thickness loss — fissuring extending toward but not reaching the underlying bone - Grade 4: Full-thickness loss with exposed subchondral bone — structurally indistinguishable from focal arthritis in that area ### Who gets it Chondromalacia of the patella is common in women, firemen, and anyone whose activity patterns load the patellofemoral joint heavily. New cases often follow a change in activity — ramping up running mileage, returning to exercise after a long break, training for a specific event, or adding deep-flexion lifting. A history of patellar maltracking, prior dislocations, or trochlear dysplasia raises the risk because a maltracking kneecap loads the cartilage unevenly, and the lateral facet wears preferentially. ### What it feels like Pain is typically deep and retropatellar — "behind the kneecap" rather than "on the kneecap" or "below the kneecap." It is worse with activities that load the patellofemoral joint: descending stairs (often more than ascending), squatting, prolonged sitting with the knee bent (the "theater sign"), and kneeling. Crepitus — a grinding or popping sensation with knee flexion — is common but not diagnostic on its own. New mechanical symptoms (catching, locking, or a sense that something is moving in the joint) can indicate a loose cartilage flap and warrant imaging. Dr. Strickland has reviewed the symptom pattern and treatment overview in detail in knee chondromalacia symptoms and treatment. ### When it's mild vs progressive Many cases of chondromalacia respond well to non-surgical care and stay manageable for years — the cartilage damage does not reverse, but the symptoms can be controlled with structured PT, activity modification, NSAIDs, and selective injections. The risk factors for atraumatic medial patellar facet lesions have been studied in detail and include trochlear dysplasia and patellar maltracking; recognizing these risk factors helps predict which patients will progress. ### Non-surgical first-line care Quadriceps strengthening (closed-chain, in pain-free range), VMO activation, hip-abductor and external-rotator strengthening, posterior-chain (glute and hamstring) work, core control, and stretching of the iliotibial band, quadriceps, and calves — all delivered by a sports physical therapist who understands patellofemoral mechanics. Activity modification toward lower-load options during flares (cycling, swimming, elliptical, walking on level ground) breaks the inflammatory cycle. NSAIDs help with flares. Cortisone is reserved for severe flares or end-stage disease; hyaluronic acid is sometimes used for arthritic-pattern pain; PRP is an option for selected joint-preservation candidates. ### When surgery is considered Cartilage restoration is reserved for focal full-thickness cartilage defects (Grade 4 in a defined area, typically 2–10 cm² for MACI; larger lesions with bone involvement go to osteochondral allograft) in patients whose function or sport requires it. It is not used for diffuse softening or for patients who have not yet had a comprehensive non-surgical trial. Dr. Strickland's technical note on treatments of patellar chondral lesions documents the algorithm and emphasizes that correcting alignment is critical to the success of cartilage repair — uncorrected malalignment is one of the main reasons cartilage repair fails. When a patient has a focal cartilage defect and patellar maltracking (high TT-TG distance, patella alta), an AMZ-TTO is performed at the same operation as the cartilage repair. See MACI cartilage repair, cartilage transplantation (OATS & allograft), and joint preservation and osteotomy for the procedural detail. ## Anterior Knee Arthritis (Patellofemoral Osteoarthritis) Anterior knee arthritis — the more accurate clinical term is isolated patellofemoral arthritis — is end-stage cartilage loss limited to the kneecap and trochlea. The medial and lateral compartments of the knee may still be healthy. Patients typically present in their 40s, 50s, or 60s with a long history of anterior knee pain that has progressed over years. Often there is a remote history of patellar maltracking, prior dislocations, prior cartilage problems, or significant trauma. Patellofemoral arthritis is what chondromalacia eventually becomes when it progresses unchecked in an unfavorable mechanical environment. ### How it's distinguished from medial / lateral compartment OA Medial and lateral compartment osteoarthritis — the more common forms of knee OA — produce pain on the inner or outer side of the knee that is worse with weight-bearing on a straight leg (walking, standing). Patellofemoral arthritis produces pain at the front of the knee that is worse with activities that load the kneecap (stairs, squats, getting out of a chair). The distinction is made on standing weight-bearing x-rays: AP and lateral views show the medial and lateral compartments; the Merchant (axial sunrise) view shows the patellofemoral compartment. Many patients have multi-compartment disease — PF arthritis combined with medial-compartment OA — and the treatment plan addresses each component. ### Treatment ladder summary The treatment foundation is the same as for chondromalacia — structured PT, weight optimization, NSAIDs, selective injections — with a different surgical endpoint when conservative care is no longer enough. For isolated end-stage patellofemoral arthritis with normal medial and lateral compartments and intact ligaments, patellofemoral arthroplasty (PFA) is a partial knee replacement that resurfaces only the kneecap and the trochlea, preserving the medial and lateral compartments and the cruciate ligaments. PFA is one of the operations where surgeon volume genuinely matters — National Joint Registry data published in 2025 (analyzed in lower revision rates after patellofemoral arthroplasty for high-volume surgeons) showed surgeons performing more than 5 PFAs per year have lower revision rates than lower-volume surgeons. Dr. Strickland performs approximately 50 to 60 PFAs per year using onlay-design implants. The full PFA discussion lives on the patellar pain and patellofemoral arthritis page; the page you are on is the differential hub. For multi-compartment knee arthritis — PF arthritis combined with medial or lateral compartment wear — see knee arthritis, where the conversation moves to partial-compartment options and total knee replacement. ## Patellar Tendinopathy / Patellar Tendonitis Patellar tendinopathy — commonly but inaccurately called "patellar tendonitis" — is degeneration of the patellar tendon, typically at the lower pole of the kneecap. The "-itis" suffix is misleading: the dominant pathology is degeneration, not inflammation. It is a load-management failure — tendon load has exceeded the tendon's recovery capacity for long enough that the tendon structure itself has changed, with disorganized collagen, neovascularization, and altered biomechanics. Classically known as "jumper's knee," it is most common in volleyball, basketball, soccer, dance, track and field, and explosive lifting. ### Anatomic location and how to recognize it Pain is on the tendon itself, usually at the inferior pole of the kneecap (the proximal patellar tendon) and sometimes at the tibial tubercle insertion (distal tendon). Tenderness is reproduced by direct palpation over the affected portion. The pain pattern is worse with jumping, explosive lifting, sprint starts and decelerations, and decline running — not with prolonged sitting or stair descent the way chondromalacia is. MRI shows tendon thickening and signal change in the affected portion. Ultrasound can also assess tendon structure. ### Why it's distinct from joint pain The patellar tendon and the patellofemoral joint are different structures. A pristine joint with a degenerate tendon will produce one pain pattern; a healthy tendon with cartilage damage will produce a different pattern. The treatment frameworks do not transfer — running a tendinopathy loading protocol on a maltracking patellofemoral joint can flare both, and prescribing rest and anti-inflammatories for tendinopathy is the textbook example of "the wrong treatment for the right diagnosis." ### Eccentric loading: the foundation of tendinopathy care The treatment foundation is progressive eccentric loading rehabilitation. Eccentric exercises — like decline single-leg squats — were the original gold standard, but more recent evidence shows heavy slow-resistance training is at least as effective and often better tolerated. The key is progressive loading, not the exact protocol — tendons remodel slowly compared to muscle, which is why patients who try a few weeks of rest and stretching are often disappointed. Most cases improve over 3 to 6 months with consistent loading work, and stubborn cases can take longer. Dr. Strickland has discussed this in detail in eccentric cycling as a treatment for patellar tendinopathy — the same load-management principles apply on a bicycle as on the floor. ### The four pillars of tendinopathy management The full management framework, drawn from 4 ways to manage patellar tendinopathy, is: (1) progressive heavy slow-resistance and eccentric loading; (2) training-load adjustments — reducing or stopping the explosive activity (jumping, sprint starts, deep squatting) that is driving symptoms; (3) equipment review — footwear, training surface, and technique work; (4) selective adjuncts. Cortisone injections are generally not recommended for patellar tendinopathy because they can weaken the tendon and increase the risk of rupture. PRP (platelet-rich plasma) has mixed evidence and is sometimes considered for patients who haven't improved with 3–6 months of structured rehab. Injections are an adjunct, not a substitute for the loading program. See PRP and regenerative medicine for the biologics framing. ### Surgery for patellar tendinopathy is rare Surgery is rare and reserved for tendons that have failed comprehensive non-surgical management — typically 6 to 12 months of well-executed eccentric loading plus PRP — and can include TTO distalization if there is significant patella alta. Procedures include debridement of the degenerate portion of the tendon, sometimes with adjunctive tenodesis or repair, and/or TTO distalization. Acute patellar tendon ruptures — a different problem — are surgical and need to be repaired primarily; Dr. Strickland's commentary on Boston Red Sox player Triston Casas' patellar tendon repair (Casas out of the hospital following patellar tendon surgery) frames the ruptured-tendon scenario, which is distinct from chronic tendinopathy. ## Imaging Pathway Different imaging tests answer different questions. The right test depends on which diagnosis is on the differential. #### Standing weight-bearing x-ray (AP, lateral, Merchant) The diagnosis test for patellofemoral arthritis — joint-space narrowing on the Merchant view, osteophytes, subchondral changes. Also checks alignment, patellar tilt, and patellar height (Caton-Deschamps index on the lateral view). #### MRI The most informative single study for chondromalacia (cartilage grading 1–4) and patellar tendinopathy (tendon structure assessment). Also visualizes the medial patellofemoral ligament, retinaculum, and looks for loose bodies. Structured MRI scoring of patellofemoral osteoarthritis formalizes the cartilage grading. #### Ultrasound For tendinopathy specifically. Real-time, dynamic, and well-suited to assess tendon thickness, neovascularization, and response to load. Useful adjunct when MRI is equivocal or when a guided injection is being planned. #### CT or MRI with TT-TG measurement When realignment is being considered — axial measurement of the tibial tubercle to trochlear groove distance characterizes the bony component of maltracking. See posterior tubercle position and PF arthritis risk. #### 3D imaging Reserved for complex cases. 3D imaging of the patellofemoral joint is used in increasingly sophisticated planning when geometry matters — revision, severe dysplasia, complex realignment. #### What we don't need Patients commonly arrive having been put through many overlapping studies. We start with the targeted imaging that answers the differential question; additional studies are ordered only when they will change the plan. ## When Each Condition Needs Surgery vs. Doesn't The most important up-front message: most cases of anterior knee pain do not need surgery. Surgery is appropriate when there is a clear surgical target on imaging and when conservative care has not resolved symptoms over a reasonable trial. The bar is different for each of the three: 1 #### Chondromalacia — surgery for focal Grade 4 defects Most chondromalacia is managed non-surgically. Cartilage restoration (MACI, OATS, osteochondral allograft) is reserved for focal full-thickness cartilage defects (Grade 4 in a defined area) in patients whose function or sport requires it. Combined with AMZ-TTO when malalignment is contributing — correcting alignment is critical for the success of cartilage repair. 2 #### Patellofemoral arthritis — arthroplasty when isolated & end-stage Conservative care is the foundation. When pain limits daily life and the arthritis is isolated to the patellofemoral compartment with normal medial and lateral compartments, patellofemoral arthroplasty (PFA) is a partial replacement that preserves the rest of the joint. Total knee replacement is reserved for multi-compartment disease. 3 #### Patellar tendinopathy — surgery is rare The vast majority of patellar tendinopathy resolves with progressive eccentric loading rehabilitation over 3 to 6 months. PRP for refractory cases. Surgical debridement of the degenerate portion of the tendon is reserved for tendons that fail 6 to 12 months of comprehensive non-surgical care — a small minority of cases. 4 #### Mechanical symptoms (catching, locking) — arthroscopy New mechanical symptoms with imaging evidence of a loose cartilage flap or osteochondral fragment are addressed arthroscopically. Arthroscopy can remove the loose body, fix unstable cartilage fragments, and address mechanical catching even when the broader cartilage picture is not surgical. For comparing the surgical procedures themselves — arthroscopy, MACI, OATS, AMZ-TTO, MPFL, patellar tendon debridement, PFA — the table on the patellar pain and patellofemoral arthritis page lays out best-for, what-it-does, and recovery for each. ## Prehabilitation For patients heading to surgery, the work that happens before the operation is one of the most under-appreciated factors in a good outcome. Prehabilitation has three goals: - Strengthen quadriceps and hip stabilizers — the muscles that will protect the joint or the cartilage repair after surgery. Patients who go to surgery with a strong quadriceps and well-coordinated hip stabilizers recover faster and have better long-term outcomes than patients who go in deconditioned - Restore range of motion — getting the knee as supple as possible before surgery makes the post-operative motion goals easier to hit - Optimize systemic factors — smoking cessation (smoking impairs cartilage and tendon healing dramatically), weight optimization where applicable, blood-sugar control in diabetes, and addressing any vitamin D deficiency Our office coordinates prehabilitation with sports physical therapists in the New York area so the work can start at consultation and continue through to the operation. For chondromalacia and arthritis surgery, the focus is quadriceps and hip strengthening; for tendon surgery, the foundation is already eccentric loading (which has typically been ongoing for 6–12 months by the time surgery is being considered). ## What to Expect on Surgery Day Anterior knee surgery is performed as an outpatient procedure in most cases — you go home the same day. The specific schedule depends on which procedure is being performed. - Arrival and pre-op — you arrive a couple of hours before the procedure for intake, change into a gown, and meet the anesthesia team - Anesthesia — for Dr. Strickland's anterior knee procedures, regional anesthesia (a spinal block with sedation) plus a periarticular block placed around the knee joint during surgery. The periarticular block helps reduce post-operative pain during the first day after surgery and is part of an opioid-sparing pain protocol. - Surgery — arthroscopic debridement is the shortest; AMZ-TTO is intermediate; cartilage repair (MACI second-stage or OATS) is intermediate-to-long; patellar tendon debridement and combined operations are longer - Recovery room — you wake up with the knee in a brace appropriate to the procedure performed. Physical therapy starts the same day or the next morning - Going home — you go home with the prescribed brace, crutches when applicable, ice, prescribed pain medication, and clear written instructions. A responsible adult must drive you home - First 48 hours — ice, elevation, prescribed medications, gentle motion as instructed Cold-compression devices and quadriceps muscle stimulators (when prescribed) help reduce swelling and support muscle reactivation in the first weeks. The block typically wears off over the first 12 to 24 hours, during which the leg is numb and weight-bearing requires the brace and crutches. ## Recovery Timeline Recovery differs sharply by condition and by procedure. The timelines below are general guidelines; your specific plan depends on which procedures were performed and on your individual healing. PhaseArthroscopy / debridementAMZ-TTOMACI / OATS cartilage repairPatellar tendon debridement Weight-bearingAs toleratedProtected 4–6 weeksProtected 4–6 weeksProtected, progressive BraceNone or lightHinged brace 4–6 weeksHinged brace 4–6 weeksHinged brace, weeks Range of motionWeeks 0–4Weeks 0–8Weeks 0–10Weeks 0–6 StrengtheningWeeks 2–6Months 2–5Months 3–6Months 1–4 Return to running4–6 weeks4–5 months9–12 months3–4 months Return to recreational sport2–3 months5–6 months12–18 months4–6 months For non-surgical patellar tendinopathy management, the typical course is 3 to 6 months of progressive eccentric loading rehabilitation to feel meaningful improvement, with stubborn cases taking longer. Across all of the above, quadriceps and hip-stabilizer rehabilitation is the single most important factor in a successful outcome — the procedure restores the joint surface or the tendon, but the rehab restores the function. ## Risks of Surgery Anterior knee surgery is well-established for well-selected patients, but no surgery is risk-free. Risks vary by procedure type and are reviewed at consultation: - Persistent pain or incomplete relief — particularly when the diagnosis was less clear-cut, when multiple pain generators are present, or when alignment was not corrected at the time of cartilage work - Stiffness or loss of motion (arthrofibrosis) — reduced by prehabilitation, early focus on regaining motion, and structured PT - Cartilage repair failure or incomplete incorporation — specific to MACI/OATS; one of the main reasons cartilage repair fails is uncorrected malalignment - Tibial tubercle nonunion or hardware irritation — specific to AMZ-TTO; rare but can require hardware removal - Patellar tendon weakening or rupture — specific to patellar tendon debridement; rare but a known complication of tendon surgery, particularly when prior cortisone injections were given - Infection — uncommon; managed with prompt evaluation if signs develop - Blood clot (DVT or pulmonary embolism) — risk is mitigated by early mobilization and individualized prophylaxis - Anesthesia-related risks — nausea, sore throat, rare allergic reactions, transient nerve irritation from the regional block - Iatrogenic patella baja — rare complication of distalization-TTO procedures - Incomplete return to prior level of activity — some patients do not return to their prior level even with technically excellent surgery Outcomes are generally good in well-selected patients, but results depend on individual anatomy, adherence to rehab, and overall health. Specific risks for your case depend on imaging, prior surgeries, concurrent procedures, and goals — reviewed at consultation. ## Common Patient Concerns The friction-log: the three concerns we hear most often, with honest answers. #### "I've had this for years and nothing helps." This is the most common version of the conversation, and it usually means one of two things: (1) the diagnosis has been wrong, and the treatment that was prescribed was the wrong protocol for the actual problem — running anti-inflammatory care for tendinopathy, or running a tendon-loading protocol on a maltracking joint; or (2) the diagnosis was right but the treatment was not well-executed — a "PT prescription" without a sports-trained physical therapist who understands patellofemoral mechanics, or an eccentric loading program done at the wrong intensity. The first thing we do at consultation is re-establish the diagnosis. Many patients feel meaningfully better within months when the right protocol is applied to the actual problem. #### "I'm too young for surgery." For most anterior knee pain, this is correct — surgery is not the answer for most patients of any age, and the priority for younger patients is to preserve the native joint and avoid implants for as long as possible. For the small subset of younger patients who do have a clear surgical target on imaging (a focal full-thickness cartilage defect, malalignment driving cartilage damage, refractory tendinopathy after exhaustive non-op care), the surgical options are joint-preserving — cartilage repair, AMZ-TTO realignment, MPFL when prior dislocations damaged the cartilage. A partial replacement at 30 commits a patient to a revision conversation in their lifetime; we treat that as a last resort, not a first move. #### "Will rest fix it?" Sometimes — for true overuse-pattern chondromalacia in someone who has dramatically increased load, a period of relative rest plus rehabilitation often brings symptoms down to a manageable level. But "rest" is rarely the whole answer, and for patellar tendinopathy specifically, rest is the wrong answer — the tendon needs progressive load to remodel; weeks of inactivity will not heal a degenerate tendon. The right framing is "load management" rather than "rest" — reduce or stop the activities that flare symptoms while progressively loading the tissues that need to remodel. ## Insurance and Cost Diagnostic evaluation, imaging, physical therapy, AMZ-TTO, cartilage repair (MACI, OATS, allograft), patellar tendon debridement, and patellofemoral arthroplasty are covered by all major commercial insurance plans, Medicare, and most self-funded and union plans when the diagnosis and indication for surgery meet medical-necessity criteria. The variables that drive your specific out-of-pocket cost are: - Your plan's deductible and coinsurance - In-network vs. out-of-network status — for the surgeon, the facility (NYU Langone or affiliated outpatient surgery center), and the anesthesia group - Bundled vs. separate billing for the surgeon, facility, anesthesia, imaging, physical therapy, and concurrent procedures - Out-of-network benefits — if you have them and choose to use them; we are happy to provide the codes you need to verify your benefits in advance PRP and some biologic injections are not always covered — we review the specifics during your consultation. Before surgery, our office verifies your benefits, obtains pre-authorization where required, and reviews the estimated out-of-pocket cost with you. For benefits verification, call us at 646-904-4664 or contact the office. ## When to Seek a Sub-Specialty Second Opinion Anterior knee pain is one of the conditions where sub-specialty evaluation matters most, because the differential is genuinely difficult and the treatment is so different across the three diagnoses. A sub-specialty second opinion is particularly worth seeking when: - You have had conflicting diagnoses — one provider calling it chondromalacia, another calling it tendonitis, a third calling it arthritis — and want a clear answer - You have been told you have "chondromalacia" but PT has not helped after months — the diagnosis itself may be incomplete or mistaken - You have been told you have "patellar tendonitis" but rest and stretching are not improving things — rest is rarely the right protocol for tendinopathy - You are young or active with anterior knee arthritis and want to understand joint-preserving options before considering replacement - Your MRI shows a focal cartilage defect and you want to understand cartilage-restoration candidacy - You have refractory patellar tendinopathy that has not responded to a well-executed eccentric loading program and want to know whether PRP or surgery are appropriate - You have a history of prior knee dislocations or surgery and want a comprehensive plan that addresses both the cartilage and the underlying mechanics - You are about to have surgery for anterior knee pain and want a sub-specialty second opinion before committing Dr. Strickland's primary clinical and academic focus is patellofemoral disease. She is a member of the International Patellofemoral Study Group, performs approximately 50 to 60 patellofemoral arthroplasties per year, and has published on the cartilage-repair-with-realignment treatment algorithm, MRI scoring of patellofemoral osteoarthritis, patellofemoral height as an outcome predictor, posterior tubercle position and PF arthritis risk, and patellar tendinopathy management. ## Access & Office Location Dr. Strickland sees anterior knee pain patients at one office, which works with patients traveling in from outside the immediate area: - New York City: NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY 10016. Midtown Manhattan, accessible from Manhattan, the outer boroughs, Long Island, Westchester, and northern New Jersey via the Queensboro and Triboro bridges and the FDR Drive. Phone: 646-904-4664. Many patients travel to New York for sub-specialty anterior knee pain evaluation — particularly when prior diagnoses have conflicted, when a focal cartilage defect on MRI raises the question of cartilage repair, or when refractory tendinopathy has not responded to local care. We coordinate consultation, imaging review, and any subsequent procedures to minimize travel for out-of-state patients. ## Frequently Asked Questions What is the difference between chondromalacia, anterior knee arthritis, and patellar tendonitis? All three cause anterior knee pain but they are different problems. Chondromalacia is softening or early breakdown of the cartilage on the back of the kneecap or front of the trochlea — visible on MRI as cartilage signal change, with pain felt deep behind the kneecap. Anterior (patellofemoral) knee arthritis is end-stage cartilage loss in the patellofemoral compartment — visible on x-ray as joint-space narrowing, in patients usually in their 40s, 50s, or 60s with a long history of anterior knee pain. Patellar tendonitis (more accurately patellar tendinopathy) is degeneration of the patellar tendon at the lower pole of the kneecap — pain is on the tendon itself, not behind the kneecap, and is worse with jumping and explosive activity. How do I know which one I have? Pain location is the most useful single clue. Pain that feels deep behind the kneecap and is worse going down stairs or sitting for long periods (the theater sign) is most consistent with chondromalacia or patellofemoral arthritis. Pain right at the bottom edge of the kneecap that is reproduced by pressing on the tendon, and is worse with jumping or explosive lifting, is most consistent with patellar tendinopathy. Imaging confirms the diagnosis — x-ray for arthritis, MRI for cartilage grading, ultrasound or MRI for tendinopathy. Will eccentric exercises help my anterior knee pain? Eccentric loading is the foundation of treatment for patellar tendinopathy — protocols like decline single-leg squats and heavy slow-resistance training remodel the degenerate tendon over weeks to months. For chondromalacia and patellofemoral pain, eccentric work is part of a broader quadriceps and hip-stabilizer program but is not the central intervention; aggressive deep-flexion eccentrics on a maltracking patella can flare symptoms. The right protocol depends on the diagnosis. Can chondromalacia heal on its own? Adult cartilage has very limited capacity to repair itself, so the underlying cartilage damage does not reverse. What can improve significantly is the symptom picture — structured PT, activity modification, NSAIDs, and selective injections often produce meaningful symptom relief that lets patients function well even with the cartilage damage in place. For focal full-thickness defects in patients whose function or sport requires it, cartilage restoration procedures (MACI, OATS, osteochondral allograft) can resurface the damaged area. What is the difference between patellar tendinopathy and patellar tendonitis? They refer to the same clinical problem, but the terminology has evolved. Tendonitis implies an inflammatory process; tendinopathy is the more accurate term because the dominant pathology is degeneration of the tendon — disorganized collagen, neovascularization, and altered biomechanics — rather than active inflammation. The distinction matters for treatment: rest and anti-inflammatories are not the answer. Progressive load is what remodels the tendon. When does anterior knee pain need surgery? Most cases do not need surgery. Surgery is appropriate when there is a clear surgical target on imaging — a focal full-thickness cartilage defect, malalignment with distal-lateral patellar wear, end-stage isolated patellofemoral arthritis — and when conservative care has not resolved symptoms over a reasonable trial. For patellar tendinopathy in particular, surgery is rare and reserved for tendons that fail comprehensive eccentric loading and PRP. I'm 30 and have been told I have anterior knee arthritis. What are my options? Younger patients with cartilage loss in the patellofemoral compartment are particularly good candidates for joint-preserving procedures rather than replacement. Options include cartilage restoration (MACI, OATS, osteochondral allograft) for focal defects, realignment osteotomy (AMZ-TTO, the Fulkerson osteotomy) when patellar maltracking is contributing, and MPFL reconstruction when prior dislocations have damaged the cartilage. The goal is to preserve the native joint and delay or avoid replacement. How long is recovery for the different surgeries? Recovery varies dramatically by procedure. Knee arthroscopy with debridement: 4 to 8 weeks. AMZ-TTO realignment osteotomy: 4 to 6 months, with protected weight-bearing for the first 4 to 6 weeks while the osteotomy heals. MACI cartilage repair: 9 to 12 months for return to running, 12 to 18 months for return to high-impact sport — the biology of cartilage maturation drives the timeline. Osteochondral allograft (OATS): 9 to 12 months. Patellar tendon debridement: 4 to 6 months. Combined operations stack these timelines. Why does anterior knee pain often get misdiagnosed? Three different conditions cause similar-feeling pain at the front of the knee, and the diagnostic skill set required to tell them apart — careful history, structured tenderness mapping, patellar tracking assessment, and the right imaging — is not always applied at the first visit. The same patient can be told they have chondromalacia in one office, patellar tendonitis in another, and arthritis in a third. Sub-specialty evaluation by a surgeon with deep patellofemoral focus can sort out which of the three is actually driving the pain — and matching treatment to the actual cause is what makes care effective. Can I have more than one of these at the same time? Yes. A patient can have chondromalacia behind the kneecap and patellar tendinopathy at the lower pole simultaneously — the kneecap and the tendon are different structures and they can both be unhappy. Patellofemoral arthritis is often the long-term endpoint of years of chondromalacia in a maltracking knee. When more than one diagnosis is present, the treatment plan addresses each one with the right protocol — running a tendinopathy loading protocol on a maltracking joint can flare both. ## Source Grounding & Published Research This page is grounded in Dr. Strickland's published commentary, technical notes, and patient education on patellofemoral and patellar tendon disease. Selected references: TopicSource Chondromalacia — symptoms & treatment overviewKnee chondromalacia symptoms and treatment Cartilage repair algorithm (MACI + realignment)Treatments of patellar chondral lesions (technical note) Risk factors for medial-facet chondral lesionsRisk factors for atraumatic medial patellar facet lesions Patellar tendinopathy — management framework4 ways to manage patellar tendinopathy Eccentric loading for tendinopathyEccentric cycling as a treatment for patellar tendinopathy Patellar tendon repair (acute rupture case)Casas out of the hospital following patellar tendon surgery Patellofemoral arthritis & PFA volumeLower revision rates after patellofemoral arthroplasty for high-volume surgeons (NJR data, 2025) PFA conservation hierarchyConsiderations for patellofemoral joint preservation vs. patellofemoral arthroplasty Posterior tubercle & PF arthritis riskIncreased risk of patellofemoral arthritis: sagittal TT-TG distance MRI scoring of PF osteoarthritisMRI scoring of patellofemoral osteoarthritis 3D imaging of the PF joint3D imaging of the patellofemoral joint Patellofemoral height as outcome predictor"It's the patellofemoral height, stupid" Patella alta & cartilage damagePatella alta patients may have less severe cartilage damage Patellofemoral instability + cartilageUnderstanding patellofemoral instability cartilage lesions · podcase Adolescent PF pain prognosisHow to improve long-term prognosis for adolescents with patellofemoral pain Bio & publicationsDr. Strickland bio ## Related Specialty Care For the full anterior knee pain workup with patellofemoral arthroplasty (PFA) detail, see patellar pain and patellofemoral arthritis. For OA, RA, and post-traumatic arthritis throughout the knee (when arthritis is not only anterior), see knee arthritis. For cartilage-restoration options when chondromalacia has progressed to a focal full-thickness defect, see MACI cartilage repair and cartilage transplantation (OATS & allograft). For realignment osteotomy when patellar maltracking is contributing, see joint preservation and osteotomy — AMZ-TTO offloads the patellofemoral compartment. If your kneecap also slips out of place, see patellar instability and MPFL reconstruction surgery. For PRP and biologic options for tendinopathy and selected cartilage cases, see PRP and regenerative medicine. Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Surgical and non-surgical orthopedic care should always be discussed with a board-certified orthopedic surgeon who has reviewed your imaging, history, and physical examination. Individual outcomes vary based on diagnosis, anatomy, comorbidities, surgical technique, and adherence to rehabilitation. Modern care for chondromalacia, patellofemoral arthritis, and patellar tendinopathy is well-established for well-selected patients but no procedure or protocol is a guaranteed fix. Outcome statistics on this page are drawn from published clinical literature and from Dr. Strickland's commentary, cited in the source-grounding table above. ## Discuss Your Anterior Knee Pain If you have been given conflicting diagnoses for your anterior knee pain — or your current treatment is not working — bring your imaging to a sub-specialty consultation at NYU Langone in Midtown Manhattan. Differential diagnosis is the value-add. Book an Appointment Call 646-904-4664 --- ## Cartilage Transplant NYC: OATS, Osteochondral Allograft & CartiHEAL | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/knee-surgeon-specialist/cartilage-transplant-oats-allograft/ Summary: Sub-specialty cartilage transplantation for full-thickness osteochondral defects of the knee — OATS (osteochondral autograft), osteochondral allograft (OCA), CartiHEAL Agili-C aragonite scaffold, and mosaicplasty. Single-stage, structural cartilage-and-bone replacement performed by Dr. Sabrina Strickland at NYU Langone Orthopedic Center. Lesion-size based decision tree, bone-marrow-edema-as-failure-predictor research, concurrent realignment osteotomy / MPFL / meniscus / ACL when needed. The structural option for defects MACI cannot cover. Sub-Specialty Hub # Cartilage Transplant: OATS, Osteochondral Allograft, and CartiHEAL Single-stage structural cartilage-and-bone replacement for full-thickness osteochondral defects of the knee — OATS for small focal defects, osteochondral allograft (OCA) for large or bone-involved defects, and CartiHEAL Agili-C aragonite scaffold as a single-stage cell-free option. Performed by Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York. The structural option for defects MACI cannot cover. Medically reviewed by Dr. Sabrina Strickland, MD — Board-Certified Orthopedic Surgeon at the NYU Langone Orthopedic Center in New York · Sports Medicine and Shoulder Fellowship, HSS · Member, International Patellofemoral Study Group and International Cartilage Repair Society · Castle Connolly Top Doctor since 2016. View full bio → Where NYU Langone Orthopedic Center, Midtown Manhattan Cartilage Transplant Menu OATS · mosaicplasty · osteochondral allograft (OCA) · CartiHEAL Agili-C · concurrent osteotomy / MPFL / ACL / meniscus when indicated Patients We See Active patients with osteochondral defects of the knee (with bone involvement); large defects too big for MACI; OCD lesions and post-traumatic craters; failed prior microfracture; revision cartilage cases; second-opinion candidates told they need early joint replacement Overview Cartilage transplant is the family of single-stage knee procedures that physically replace cartilage AND the underlying bone in a focal defect. Three options: OATS (osteochondral autograft transfer) — native cartilage-and-bone plugs from the patient's own knee, ideal for small focal defects under 2 cm². Osteochondral allograft (OCA) — fresh size-matched cadaveric tissue, ideal for defects typically over 2 cm², bipolar lesions, OCD with subchondral bone loss, and revision cartilage surgery. CartiHEAL Agili-C — an FDA-approved (2022) cell-free aragonite-hyaluronate scaffold that supports regeneration of cartilage and bone over 12 to 24 months. Distinct from MACI, which is a two-stage cell-based repair of the cartilage layer only and depends on a healthy underlying bone. When the bone is involved — OCD lesions, post-traumatic craters, AVN-related collapse, or after prior microfracture has produced subchondral sclerosis — transplant is the right choice. CartiHEAL now has a Category I CPT code effective January 1, 2027. Dr. Sabrina Strickland performs all three at NYU Langone Orthopedic Center and has published research on bone marrow edema as a predictor of OCA failure. If your MRI shows a cartilage defect with subchondral bone involvement — an OCD lesion, a post-traumatic crater with bone loss, an AVN-related condylar collapse, or a previously-microfractured site that has gone on to develop bone irregularity — cell-based repair like MACI alone is not enough. The cell-loaded membrane has nothing structural to sit on. Cartilage transplant procedures replace both layers in a single operation: the cartilage you see and the bone underneath that you cannot. This page is the sub-specialty hub for cartilage transplantation. It pairs with the MACI cartilage repair page — together the two pages cover the cartilage-restoration menu as a decision hub. Use this page when bone is involved, when the defect is large, when prior cartilage surgery has failed, or when a single-stage operation is preferred over the two-stage MACI protocol. Topics covered: when transplant is the right call (and when it is not), the three transplant procedures in detail, how they compare to MACI, lesion-size based decision-making, Dr. Strickland's published research on bone marrow edema as an OCA failure predictor, concurrent realignment / ligament / meniscus procedures, prehabilitation, the surgical day, the long maturation interval (especially for CartiHEAL), risks specific to each transplant type, common patient concerns, insurance and the new CartiHEAL CPT code, emerging single-stage options, and access to consultation at NYU Langone in Midtown Manhattan. ## When Cartilage Damage Needs a Transplant (Not Repair) Articular cartilage does not heal itself. There are no blood vessels in cartilage and the cells inside it (chondrocytes) cannot migrate to a wound to repair it. A full-thickness defect — a hole through the cartilage layer to the underlying bone — will not fill in on its own. The cartilage-restoration field is built around different ways to fill that non-healing hole. The decision about which way to fill it depends on what the defect actually is, and specifically whether the underlying bone is involved. Cell-based repair (microfracture, MACI) is built on the assumption that the bone underneath the defect is structurally healthy — a stable platform for the new cartilage to grow on. That assumption breaks down in several common scenarios: - Osteochondritis dissecans (OCD) — a fragment of cartilage and bone has separated from the joint surface, leaving a crater that involves both layers. The bone is not just a passive platform; it is part of the lesion - Post-traumatic chondral crater with subchondral collapse — an impact or twisting injury that fractured the subchondral bone has left an irregular bone bed that cell-based repair cannot rebuild - Avascular necrosis (AVN) of the femoral condyle — a segmental death of subchondral bone with overlying cartilage compromise. The bone underneath is not healthy host tissue; it is dying or dead - Failed prior microfracture with subchondral irregularity — sclerosis, intralesional cysts, or contour distortion of the subchondral bone left after a previous cartilage operation. A second cell-based repair on this altered bone bed is biomechanically compromised - Defects too large for cell-based repair to scale to — very large lesions (typically over 4 cm² and especially over 6 cm²), bipolar (kissing) lesions on opposing surfaces, or multi-focal defects where structural restoration is more practical than cellular biology - Significant subchondral bone marrow edema visible on MRI — pre-operatively, this can indicate an underlying bone problem the cell-based repair would not fully address In each of these scenarios, a structural transplant — OATS, OCA, or CartiHEAL — is the better answer because it replaces or rebuilds the bone foundation at the same time as the cartilage. The MACI page and this page together cover the menu: chondral-only defect with healthy underlying bone → MACI is often the right call; osteochondral defect with bone involvement → transplant is the right call. Dr. Strickland's clinical comparison of CartiHEAL, OCA, and MACI frames this directly: there is significant overlap in indications, but the bone is what tips the decision toward transplant. ## OATS, Allograft, and CartiHEAL — Three Distinct Procedures The three transplant options share a single-stage workflow and the principle of replacing or regenerating both cartilage and bone — but they differ meaningfully in donor source, defect-size sweet spot, and biology. 1 #### OATS Plug of native cartilage + bone from the patient's own non-weight-bearing knee surface. Best for small focal defects (under 2 cm²). Single-stage, no waiting. → 2 #### OCA Allograft Fresh size-matched cadaveric osteochondral graft. Best for large defects (over 2 cm²), bipolar lesions, OCD with bone loss, and revision cartilage cases. → 3 #### CartiHEAL Agili-C FDA-approved (2022) aragonite-hyaluronate scaffold. Off-the-shelf, single-stage. The scaffold resorbs over 12 to 24 months as native tissue replaces it. All three are performed at NYU Langone by Dr. Strickland. The discussion below covers each in detail, then how they compare to one another and to MACI. ## OATS — Osteochondral Autograft Transfer OATS — Osteochondral Autograft Transfer System — is the cartilage transplant that uses your own tissue. With a small mini-arthrotomy for access, one or more cylindrical plugs of cartilage with attached subchondral bone are harvested from a non-weight-bearing donor area of the same knee — typically the edge of the trochlea or the intercondylar notch — and press-fit flush into a precisely-sized recipient socket prepared at the defect. The transferred cartilage is true native hyaline cartilage, identical to what was there originally because it is what was there originally, just relocated. The multi-plug variant for slightly larger or non-round defects is called mosaicplasty. ### OATS strengths - Single-stage — no biopsy, no cell culture interval, no donor matching, no waiting - Native hyaline cartilage transferred — structurally and biomechanically identical to native joint surface - Excellent track record for small focal osteochondral defects in the right location - No allograft cost or tissue-bank scheduling — uses the patient's own tissue ### OATS limits - Donor-site availability is finite — there is only so much non-weight-bearing cartilage in a single knee. This caps OATS at small defects, typically under 1 cm² for a single plug, and at multi-plug mosaicplasty for slightly larger lesions - Donor-site morbidity — the harvest site can become symptomatic in some patients. Careful donor selection (truly non-weight-bearing surface) minimizes but does not eliminate this risk - Plug-to-host fit — the plug must sit precisely flush. Plugs that are proud (sit too high) cause point loading; plugs that are sunken under-load the surface. Technique matters - Donor-recipient curvature mismatch — a plug from one part of the joint may not perfectly match the curvature of where it goes ### Who is an OATS candidate? The classic OATS candidate is a younger active patient with a small focal full-thickness osteochondral defect (typically under 2 cm²), most commonly on the medial or lateral femoral condyle, with stable ligaments, correct alignment, a functional meniscus, BMI under 35, and willingness to do a structured rehab. OATS is also reasonable for some small focal trochlear lesions when an autograft donor site can be identified that does not compromise the patellofemoral mechanics. ## Osteochondral Allograft Transplantation (OCA) Osteochondral allograft — OCA, also called fresh osteochondral allograft (FOCA) — uses a fresh size-matched cadaveric osteochondral graft (cartilage with attached subchondral bone) recovered from a tissue-donor knee within the fresh-graft viability window. The graft is shaped to match the recipient defect (single-plug, multi-plug, or larger dowel/shell technique) and press-fit with the cartilage surface flush to the surrounding articular surface. OCA replaces both cartilage and bone in one operation, has no inherent size limit, and is the preferred choice for the lesions cell-based repair and OATS cannot adequately handle. ### Why OCA when MACI exists MACI restores cartilage but does nothing structural for the bone underneath. When a defect involves significant subchondral bone loss — an OCD lesion with subchondral collapse, a post-traumatic crater, AVN-related condylar bone death, or a knee that has had failed prior microfracture leaving sclerosis and cysts — MACI alone will not work. The cell-loaded membrane needs a stable structural platform. OCA replaces both the cartilage and the bone in a single stage. For very large defects (over 4 cm² and especially over 6 cm²) or for bipolar (kissing) lesions on opposing surfaces of the same compartment, OCA also avoids the donor-site limit of OATS. It is the structural option for defects MACI cannot cover. ### Who is an OCA candidate? - Defects with significant subchondral bone involvement — OCD lesions with bone loss, post-traumatic craters with subchondral collapse, AVN-related condylar segments - Defects too large for OATS (over 2 cm²) and too large or too deep for MACI (over roughly 6 to 10 cm² or with significant bone loss) - Bipolar (kissing) lesions in the same compartment - Failed prior cartilage surgery — failed microfracture with subchondral irregularity, failed MACI, or any prior repair where the bone bed is now compromised - Younger active patients who want to avoid early joint replacement and have the runway and motivation to commit to a 9-to-12-month return-to-sport recovery OCA availability and matching introduce a wait time — fresh osteochondral grafts are scheduled around tissue-bank availability and patient-graft size matching, including precise condylar measurements and laterality. Our office coordinates the timing. Dr. Strickland's research on the topic includes a study on single vs. multiple plug OCA transplants and how Wiberg patellar type impacts outcomes and survival. ## CartiHEAL Agili-C Implant CartiHEAL Agili-C is the newest of the three options and represents a different concept: instead of transferring native cartilage tissue, it implants a biomaterial scaffold that supports the body's own regeneration of cartilage and bone. The Agili-C implant is a dual-phase porous scaffold made from aragonite (calcium carbonate derived from coral) with a hyaluronate surface layer. It is press-fit into a prepared cylindrical defect during a single operation. Over the following 12 to 24 months, the scaffold gradually resorbs as the body lays down native cartilage in the upper layer and native bone in the lower layer in its place. ### What makes CartiHEAL different - Single-stage and cell-free — no biopsy, no cell culture, no donor-site harvest, no allograft matching. The implant goes in during one operation - Dual-phase scaffold restores both cartilage and bone in defects with shallow bone involvement - Off-the-shelf — no waiting for tissue matching or cell culture - FDA-approved in 2022 for treatment of cartilage and osteochondral lesions of the knee - Category I CPT code from the AMA effective January 1, 2027 — a significant insurance milestone (see new CPT code for CartiHEAL Agili-C) - Lower threshold for certain difficult defect patterns — narrow central trochlear lesions, smaller condylar lesions with bone edema, multi-lesion knees with early arthritis not yet advanced enough for arthroplasty (see one-step cartilage repair with CartiHEAL) ### Dr. Strickland's CartiHEAL experience Dr. Strickland was an early adopter when CartiHEAL relaunched after the 2022 FDA approval — she has performed CartiHEAL in 35 to 40 patients to date, including multi-compartment cases and one-step cartilage repair of trochlear lesions (see CartiHEAL for trochlear lesions). Her view, expressed in the VuMedi discussion with Dr. Andreas Gomoll: CartiHEAL gives her a slightly lower threshold to treat certain defects that did not have a great answer in the past — particularly narrow central trochlear lesions with bone edema and smaller condylar lesions in patients with multi-lesion early arthritis. Patients in those categories are often the most satisfied because they did not previously have a surgical option short of arthroplasty. ### Who is a CartiHEAL candidate? Patients with focal cartilage or shallow osteochondral defects of the knee — typically 1 to 7 cm² — in patients who want a single-stage procedure with no waiting for cell culture and no donor-site morbidity. Particularly useful for narrow central trochlear lesions, smaller condylar lesions with associated bone edema, and patients with multi-lesion patterns and early arthritis. As with all cartilage restoration, alignment, ligament stability, and meniscal function need to be addressed (in the same operation when needed) for the implant to succeed. ## How Transplant Compares to MACI The fundamental decision in cartilage restoration is single-stage transplant (OATS, OCA, CartiHEAL) versus two-stage cell-based repair (MACI). The right answer depends on lesion size, depth, the state of the underlying subchondral bone, prior cartilage surgery, and how willing the patient is to commit to either workflow. Defect sizeBone involvementStagesCartilage typeRecovery OATSSmall (under 2 cm²)Yes (cartilage + bone)SingleNative hyaline (transferred)6–9 months Osteochondral allograftLarge (over 2 cm²)Yes (cartilage + bone)SingleNative hyaline (donor)9–12 months CartiHEAL Agili-CMedium (1–7 cm²)Shallow bone OKSingleRegenerated native6–9 months MACIMedium-large (2–10 cm²)No (chondral only)Two (4–6 wk apart)Hyaline-like (cell-grown)12–18 months Dr. Strickland's clinical comparison of CartiHEAL, OCA, and MACI reinforces that there is significant overlap in indications. The decision is not algorithmic; it is lesion-by-lesion. A focal 5 cm² defect in a 32-year-old with a healthy underlying bone bed could reasonably be treated with MACI, OCA, or CartiHEAL — and the right answer depends on imaging detail, prior surgical history, the state of the rest of the joint, and the patient's appetite for two operations versus one. Two MRIs that look similar to a non-specialist can lead to different operations in a sub-specialty practice because of these contextual factors. Dr. Strickland's published outcomes review of multi-surface cartilage restoration procedures provides the framework she uses for these decisions. ## Bone Marrow Edema as an OCA Failure Predictor — Dr. Strickland's Published Research One of Dr. Strickland's specific contributions to the cartilage-transplantation literature is a refinement of how we follow OCA patients on post-operative MRI. Some bone marrow edema (BME) in the host bone surrounding an osteochondral allograft is expected during the bone-integration phase — the donor bone is being remodeled and replaced by host bone, and that biology produces a signal change on MRI. The clinical question her group asked: does the volume of BME on the routine 6-month post-operative MRI predict subsequent graft failure? Published research finding Strickland et al. studied 56 patients (mean age ~32) with at least 2-year follow-up after osteochondral allograft transplantation. Patients were divided by BME volume on the 6-month post-operative MRI: BME ≥ 10 cm³ vs. BME < 10 cm³. Result: all of the OCA failures in the study cohort occurred in the BME ≥ 10 cm³ group, representing a 50% subsequent failure rate in that group. Patients with BME < 10 cm³ had no failures. Published in Arthroscopy: The Journal of Arthroscopic and Related Surgery, 2024. See commentary on the study and increased host bone marrow edema as a risk factor for OCA failure. ### Why this matters for OCA patients It changes how we use the 6-month MRI. Routine post-operative imaging is no longer just confirmation that the graft is in place; the BME volume on that scan is a meaningful checkpoint. Patients with high host BME at 6 months are a higher-risk group, and that information can inform decisions about activity progression, additional imaging at 12 months, biologic augmentation, or earlier intervention. The study does not yet tell us how to change outcomes in the high-BME group — that is the next research question — but it gives us imaging-based data that predicts failure rather than waiting until clinical symptoms recur. This is part of why Dr. Strickland's OCA follow-up protocol includes a 6-month MRI as a defined checkpoint. ## Concurrent Procedures: Osteotomy, MPFL, Meniscus, ACL This is one of the most under-explained ideas in cartilage transplantation: cartilage transplant in a malaligned, unstable, or meniscus-deficient knee will not last. The same forces that destroyed the original cartilage will destroy the transplant, often within a few years. The cartilage decision is rarely just "what to do at the defect." It is "what does the rest of the knee need so the transplant can succeed." The relevant combinations: - Cartilage transplant + HTO (high tibial osteotomy) — for medial femoral condyle defects in patients with varus alignment. The HTO redistributes load away from the medial compartment and protects the transplant - Cartilage transplant + DFO (distal femoral osteotomy) — for lateral femoral condyle defects in patients with valgus alignment. Mirror-image logic to HTO - Cartilage transplant + AMZ-TTO (Fulkerson osteotomy) — for patellar or trochlear defects in patients with patellar maltracking. Anteromedialization tibial tubercle osteotomy offloads the damaged facet of the patella - Cartilage transplant + MPFL reconstruction — for patellar or trochlear transplants in patients with patellar instability. The MPFL stabilizes the kneecap so it stops dislocating onto the transplant. Dr. Strickland's technical work on patellar chondral lesions reinforces this - Cartilage transplant + meniscus repair or meniscus transplant — for chondral defects in a meniscus-deficient compartment. Without a functional meniscus, contact pressures across the transplant exceed what the graft can tolerate - Cartilage transplant + ACL reconstruction — for chondral defects in an ACL-deficient knee. The ACL keeps the transplant from being subjected to abnormal shear during pivot - CartiHEAL + unicompartmental knee arthroplasty — an emerging combined-procedure scenario for patients with severe single-compartment arthritis plus a separate full-thickness trochlear or condylar lesion. Dr. Strickland and Dr. Andreas Gomoll co-authored a 2025 surgical-technique paper in Arthroscopy Techniques on combined unicompartmental knee arthroplasty and trochlear porous calcium carbonate (CartiHEAL) scaffold implantation These combinations are common, not rare. A meaningful percentage of cartilage-transplant patients in Dr. Strickland's practice have at least one concurrent procedure, often planned at the same operation. See joint preservation and osteotomy for the realignment side of the plan. For the patellofemoral version of this principle, see patellar instability, MPFL reconstruction surgery, and patellar pain and patellofemoral arthritis. ## Prehabilitation Before Cartilage Transplant Patients who walk into a cartilage-transplant operation with a strong quadriceps, full range of motion, and no effusion recover faster and meet rehabilitation milestones more reliably than patients who walk in with a stiff, weak, swollen knee. The peri-operative prehabilitation focus: - Quadriceps activation and strengthening — closed-chain in pain-free range, with attention to the VMO. The single most predictive factor for early post-operative recovery - Hip-stabilizer strengthening — abductors and external rotators. Particularly important for patellar and trochlear lesion patients - Range of motion — prone heel-hangs, supine wall-slides, and stationary bike. A knee that goes into surgery with full extension recovers extension faster - Effusion management — elevation, compression, and load management to minimize a chronic effusion that inhibits the quadriceps - Cardiovascular fitness — cycling and pool work where pain-free, to maintain general conditioning - Education and expectation-setting — reviewing the rehab protocol, the brace logistics, and the realistic timeline (especially the longer 9-to-12-month timeline for OCA) before the operation ## What to Expect on Surgery Day - Arrival and pre-op — you arrive a couple of hours before the procedure for intake, change into a gown, meet the anesthesia team, and confirm the operative side and plan. For OCA cases, the fresh allograft is delivered from the tissue bank and confirmed labeled to you on the OR day - Anesthesia — regional anesthesia (a spinal block with sedation) plus a periarticular block placed around the knee joint during surgery. The periarticular block helps reduce post-operative pain and is part of an opioid-sparing protocol. - Surgery duration — OATS, OCA, and CartiHEAL Agili-C are each roughly 1 hour. Concurrent procedures (TTO, HTO, DFO, MPFL, meniscus, ACL) extend the operative time - Recovery room — you wake up in a hinged knee brace locked in extension, with the leg numb from the regional block. - Going home — outpatient or 23-hour stay depending on the procedure and concurrent operations. You go home with the brace, crutches, ice, prescribed medications, and clear written instructions. A responsible adult must drive you home - First 48 hours — ice, elevation, prescribed pain medications, and gentle motion as instructed. The block typically wears off over 12 to 24 hours; weight-bearing is touch-down only with the brace and crutches Cold-compression devices and quadriceps muscle stimulators (when prescribed) help reduce swelling and support muscle reactivation in the first weeks. ## Recovery Timeline Cartilage transplant recovery depends on the specific procedure and on whether bone is being incorporated. The slowest-healing tissue drives the timeline — for OATS and CartiHEAL, that is the cartilage-bone integration; for OCA, it is the donor-bone-to-host-bone integration, which is the longest of the three. For patients used to thinking about MACI (12 to 18 months for cartilage maturation), OCA's 9-to-12-month return-to-sport is faster than MACI but still substantial. OATS and CartiHEAL are the fastest at 6 to 9 months. Concurrent osteotomy or ligament reconstruction can extend the timeline. PhaseOATSOCACartiHEAL Protected weight-bearing4 weeks4 weeks4 weeks Off crutches (gradual)Week 6Week 6Week 6 Strengthening + low-impact cardioMonths 2–4Months 2–4Months 2–4 Routine 6-month MRI checkpointIf indicatedStandard (BME assessment)Standard Return to runningMonths 4–6Months 6–9Months 6–9 Return to pivot/contact sportMonths 6–9Months 9–12Months 6–9 Continued maturationMonths 6–12Months 12–24 (bone integration)Months 12–24 (scaffold resorption) For OCA specifically, the 6-month MRI is not just a check on the graft — it is an active part of decision-making, given Dr. Strickland's published BME findings. If concurrent osteotomy is performed, recovery follows the longer of the two protocols (osteotomy timeline). If MPFL or other ligament reconstruction is performed at the same time, the ligament protocol drives the early phases. For long-term outcomes data on the single-stage approach, see her long-term outcomes study of one-step cartilage repair. Across all three procedures, the two factors that most consistently slow recovery are inconsistent physical therapy attendance and rushing back to high-impact activity before clearance. The patients who do well with cartilage transplant are the patients who treat the rehab as seriously as the surgery. ## Risks of Cartilage Transplantation Cartilage transplantation has a long published track record — OCA in particular has decades of clinical experience. Outcomes in well-selected patients are generally favorable, but no surgery is risk-free. Risks reviewed at consultation include: ### Risks shared across OATS, OCA, and CartiHEAL - Incomplete graft incorporation or graft failure — highest when concurrent malalignment, instability, or meniscal status was not addressed; lower when the foundational issues were corrected at the same operation - Persistent pain or incomplete relief — particularly when there were multiple pain generators that were not all addressed - Stiffness or arthrofibrosis — reduced by prehabilitation, early motion, and structured PT; managed with manipulation under anesthesia or arthroscopic lysis if it occurs - Infection — uncommon. Open implantation has a low but non-zero infection risk - Blood clot (DVT or pulmonary embolism) — risk is mitigated by early mobilization and individualized prophylaxis - Anesthesia-related risks — nausea, sore throat, rare allergic reactions, transient nerve irritation from the regional block - Need for additional surgery — for hardware removal after osteotomy, debridement of irregular graft surface, or revision cartilage surgery if the index repair fails - Incomplete return to prior level of activity — some patients do not return to their prior level of sport even with technically excellent surgery and complete rehab - Long-term durability is variable — cartilage transplants typically produce durable improvement at 5- and 10-year follow-up in well-selected patients, but the literature is honest that no transplant lasts indefinitely. Outcomes are not a permanent fix and depend on patient factors and joint biology ### OATS-specific risks - Donor-site morbidity — the harvest site can become symptomatic in some patients - Plug subsidence or proudness — technical fit matters; plugs that are not flush cause point loading or under-loading - Plug-host curvature mismatch — particularly for plugs harvested from one part of the joint and placed in another ### OCA-specific risks - Subchondral bone integration failure — the donor bone has to be remodeled and replaced by host bone. When that fails, the graft loses its structural foundation - Increased host bone marrow edema at 6 months — per Dr. Strickland's published research, BME ≥ 10 cm³ on 6-month MRI is associated with a 50% subsequent failure rate (see bone marrow edema section above) - Disease transmission (extremely rare) — modern tissue-bank screening makes this very uncommon, but it is reviewed at consent - Graft availability and timing — fresh osteochondral grafts must be used within the viability window; delays can occasionally affect the surgical schedule - Immune-related events — rare. Fresh allografts are unmatched for HLA but are not subject to the same level of rejection as solid organ transplants ### CartiHEAL-specific risks - Implant fragmentation or non-resorption — uncommon but possible if the scaffold does not integrate as expected - Incomplete cartilage regeneration — the scaffold supports tissue regeneration; outcomes depend on biology - Long-term durability — CartiHEAL is newer in clinical use than OCA, so the long-term (10-year) data is still maturing. Available outcomes data through several years is favorable in selected patients ### Concurrent-procedure risks - Tibial tubercle nonunion or hardware irritation — specific to combined AMZ-TTO; rare but can require hardware removal - Osteotomy nonunion or malunion — specific to combined HTO or DFO; managed with revision technique when it occurs The single biggest predictor of a poor outcome is patient selection. The second is failing to address concurrent problems (alignment, ligament, meniscus) at the time of the cartilage transplant. When the conditions line up and the patient does the rehab, cartilage transplantation is one of the more successful joint-preserving operations in orthopedics today. ## Common Patient Concerns The friction-log: the four concerns we hear most often from patients considering cartilage transplantation, with honest answers. #### "I'm worried about getting cadaver tissue in my knee." Fresh osteochondral allografts come from carefully screened tissue donors and are tested rigorously by tissue banks before release for surgery. Disease transmission is extremely rare with modern screening. Allograft cartilage is also relatively immune-privileged — cartilage cells (chondrocytes) are buried in their matrix and are not exposed to the recipient's immune system the way other transplanted tissues are. The bone fraction does undergo remodeling and replacement by your own bone over time. Patients have been receiving fresh osteochondral allografts for decades; the safety profile is well established. If allograft is not the right fit for you, OATS (your own tissue) and CartiHEAL (a synthetic scaffold) are the alternatives. #### "Why not just do a knee replacement and be done with it?" For active patients in their 30s, 40s, and even 50s with focal full-thickness damage and otherwise reasonable joint health, a partial or total knee replacement commits you to a revision conversation in your lifetime — modern implants do not last forever, and revision arthroplasty is more complex than primary. Cartilage transplant, when feasible, restores the joint surface without an implant and preserves the option to do a replacement later if needed. This is the framework Dr. Strickland describes in "Why I Would Rather Repair Cartilage Than Replace a Knee." Replacement is the right answer for the right patient — the 65-year-old with bone-on-bone multi-compartment arthritis is a unicompartmental or total knee candidate, not a cartilage-transplant candidate. The cartilage-first framework is about identifying the patients for whom transplant is technically feasible and biologically appropriate. #### "My defect is very large — I've been told I need a replacement, not a transplant." Lesion size by itself does not disqualify cartilage transplant. The size cap on OATS is real (donor-site availability) but allograft has no inherent size limit. Some of Dr. Strickland's largest single-compartment OCA cases — for OCD with extensive bone loss, post-traumatic craters, or revision after multiple failed prior repairs — would not have been candidates for any other cartilage operation. The right question is not how big the defect is, but whether the rest of the joint can support a graft. If the alignment, ligaments, and the opposing surface in the same compartment are in reasonable shape, allograft is often feasible even for large defects. Bringing your imaging in for a sub-specialty review is the right step before accepting "you need a replacement." #### "I had microfracture and it failed. Have I used up my options?" No. Failed prior microfracture is one of the more common reasons patients are referred for cartilage transplantation. Microfracture changes the biology of the bone underneath the defect — it can become sclerotic, irregular, or develop intralesional cysts — and that altered bone bed compromises a subsequent cell-based repair like MACI. In many of these revision scenarios, osteochondral allograft (OCA) is the more durable choice because it replaces both the disrupted bone and the cartilage in one stage. CartiHEAL can also be a strong option for some shallower failed-microfracture patterns. Imaging review (MRI with cartilage sequences, sometimes a CT to characterize subchondral bone) is the first step. Failed microfracture is not a closed door — it changes the menu of options and the operative plan. ## Insurance and Cost OATS and osteochondral allograft are well-established, FDA-cleared procedures. CartiHEAL Agili-C is FDA-approved (2022) and has reached a significant milestone with the recent AMA Category I CPT code. Coverage and cost specifics: - OATS and OCA are covered by most major commercial plans, Medicare, and many self-funded and union plans when medical-necessity criteria are met. Criteria typically include documentation of failed conservative care, MRI-confirmed full-thickness osteochondral defect, lesion size and grade, and an appropriate operative plan - CartiHEAL Agili-C now has a Category I CPT code from the AMA effective January 1, 2027 — a significant insurance milestone. Before a Category I code, new procedures are often denied as "investigational." A Category I code streamlines the reimbursement pathway and substantially increases the likelihood that patients can access the procedure (see new CPT code for CartiHEAL Agili-C). Pre-authorization is still required and our office coordinates the documentation - Pre-authorization is required for all three transplant procedures. Concurrent procedures (osteotomy, MPFL, meniscus, ACL) are also typically covered when medical-necessity criteria are met and may be billed as bundled or itemized procedures - Out-of-pocket cost depends on plan-specific factors — deductible, coinsurance, in-network or out-of-network status of the surgeon, the facility (NYU Langone or affiliated outpatient surgery center), and the anesthesia group; whether you have out-of-network benefits and choose to use them; and whether the practice is contracted with your specific plan - OCA has additional graft-related costs — tissue-bank fees for the fresh allograft are typically billed separately and most plans cover them within the procedure Before surgery, our office verifies your benefits, obtains pre-authorization where required, and reviews the estimated out-of-pocket cost with you. For benefits verification or to discuss self-pay arrangements, call us at 646-904-4664 or contact the office. ## Emerging Single-Stage Options Cartilage transplantation is one of the most active fields in sports orthopedics. Emerging single-stage options Dr. Strickland evaluates, participates in, or discusses with patients include: - CartiHEAL Agili-C beyond the standard indication — expanding to multi-lesion patients with early arthritis, narrow central trochlear lesions, and combined-procedure cases (including with unicompartmental knee arthroplasty for separate-compartment arthritis plus a focal trochlear lesion) - Hyalex knee cartilage system FDA trial — an investigational synthetic cartilage replacement under FDA trial. See FDA trial of the Hyalex knee cartilage system - ChondroFiller — an injectable collagen-based cartilage repair option. See commentary on ChondroFiller cartilage repair - Amniotic suspension allograft (ASA) injection — under research for symptomatic knee osteoarthritis. See the ASA injection research study - Engineered cartilage and synthetic substitutes — tissue-engineered constructs and biomaterials are an active area of research. See "engineered cartilage sounds perfect" The cartilage-transplantation field is moving forward, and FDA-approved options will continue to expand. The current right-sized choices for full-thickness osteochondral defects of the knee are still OATS, OCA, and CartiHEAL; emerging options expand the menu rather than replace it. For the broader cartilage-restoration discussion including stem cells, exosomes, and orthobiologics, see the MACI page emerging-options section. ## When to Seek a Sub-Specialty Second Opinion Cartilage transplantation is one of Dr. Strickland's primary clinical and academic areas. She performs the full menu of cartilage-restoration procedures (OATS, OCA, CartiHEAL, MACI) and routinely combines them with realignment osteotomy, MPFL reconstruction, ACL reconstruction, and meniscus surgery in the same operation when concurrent pathology demands it. She has published her own bone-marrow-edema-as-failure-predictor research on OCA, has co-hosted the AOSSM Sports Doc podcast on challenging cartilage injuries, and has co-authored technique papers on combined CartiHEAL plus unicompartmental arthroplasty for complex single-compartment cases. A sub-specialty second opinion is particularly worth seeking when: - Your MRI shows a full-thickness osteochondral defect (cartilage AND bone involved) — OCD lesion, post-traumatic crater, or AVN-related collapse — and you want to understand which transplant is right for your lesion - You have been told the defect is too large for cell-based repair and you want to understand whether allograft is feasible - You have been told you need a partial or total knee replacement at a younger age and want to understand cartilage-preserving alternatives - You have failed prior microfracture or other cartilage surgery and need to understand revision options — OCA in particular shines in revision scenarios - You have a bipolar (kissing) lesion or multi-focal cartilage damage and want a sub-specialty plan - You have combined cartilage damage and malalignment and want a clear plan for combined transplant plus realignment osteotomy - You have combined cartilage damage and patellar instability and want a sub-specialty plan that addresses both - You are active and want to preserve joint function rather than commit to an implant in your 30s, 40s, or 50s - You want to be evaluated for CartiHEAL Agili-C — particularly for narrow central trochlear lesions, smaller condylar lesions with bone edema, or multi-lesion early-arthritis patterns - You have an existing OCA with a 6-month MRI showing significant bone marrow edema and want a second opinion on activity progression and follow-up Cartilage decisions are complex because the right operation depends on lesion size and depth, location, alignment, ligament status, meniscus status, prior surgery, age, BMI, and patient activity goals. Two MRIs that look similar to a non-specialist can lead to different operations in a sub-specialty practice because of these contextual factors. A sub-specialty second opinion does not always change the recommendation — but it does ensure the recommendation is built on the right framework. ## Access & Office Location Dr. Strickland sees cartilage-transplant patients at one office, which works with patients traveling in from outside the immediate area: - New York City: NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY 10016. Midtown Manhattan, accessible from Manhattan, the outer boroughs, Long Island, Westchester, and northern New Jersey via the Queensboro and Triboro bridges and the FDR Drive. Phone: 646-904-4664. Many patients travel to New York for cartilage-transplant sub-specialty care — particularly for OCA candidacy evaluations, second opinions on prior failed cartilage surgery, complex combined cases (transplant plus osteotomy, MPFL, or meniscus work), and consultations on whether early joint replacement can be avoided. Surgery is performed at NYU Langone. We coordinate consultation, imaging review, tissue-bank scheduling for OCA cases, and surgery scheduling to minimize travel for out-of-state patients. ## Frequently Asked Questions What is a cartilage transplant? Cartilage transplant is the family of single-stage knee procedures that physically replace cartilage — and almost always the underlying bone — in a focal defect, rather than growing new cartilage from cells. The three options Dr. Strickland performs at NYU Langone: OATS uses native cartilage-and-bone plugs from the patient's own knee, ideal for small focal defects under 2 cm². Osteochondral allograft (OCA) uses fresh size-matched cadaveric tissue, ideal for large defects (often over 4 cm²), defects with significant subchondral bone loss, OCD lesions, and revision cartilage surgery. CartiHEAL Agili-C is a cell-free aragonite-hyaluronate scaffold (FDA-approved 2022) that supports regeneration of cartilage and bone in a single operation. All three are single-stage operations — distinct from MACI, which is a two-stage cell-based repair. How is cartilage transplant different from MACI? Two key differences. First, transplant is single-stage; MACI is two-stage with a 4-to-6-week cell-culture interval. Second, transplant restores cartilage AND bone (or in CartiHEAL's case, supports regeneration of both layers); MACI is a chondral-only repair that depends on a healthy underlying subchondral bone bed. When the bone is involved — OCD lesions, post-traumatic craters, AVN-related collapse, or after prior microfracture has produced sclerosis — MACI alone is not enough. The cell-loaded membrane has nothing structural to sit on. That is when transplant becomes the right choice. What is OATS surgery? OATS — Osteochondral Autograft Transfer System — uses your own tissue. Cylindrical plugs of cartilage with attached subchondral bone are harvested from a non-weight-bearing donor area of the same knee (typically the edge of the trochlea or the intercondylar notch) and press-fit flush into a precisely-prepared recipient socket at the defect. The transferred cartilage is true native hyaline. OATS is best for small focal defects (typically under 2 cm²) because of donor-site availability. The multi-plug variant is mosaicplasty. OATS is single-stage, requires no cell culture, no donor matching, and no waiting. What is an osteochondral allograft? Osteochondral allograft (OCA) uses a fresh size-matched cadaveric osteochondral graft — cartilage with attached subchondral bone — recovered from a tissue-donor knee within the fresh-graft viability window. It is shaped to match the recipient defect and press-fit flush. OCA replaces both cartilage and bone in one operation and is the preferred choice for large defects (often over 4 cm²), bipolar lesions, OCD with bone loss, AVN-related collapse, and revision cartilage surgery. The trade-off is graft availability — OCAs are scheduled around tissue-bank availability and patient-graft size matching, which can introduce a wait time. What is CartiHEAL Agili-C? CartiHEAL Agili-C is an FDA-approved (2022) cell-free osteochondral implant made of porous aragonite (calcium carbonate derived from coral) with a hyaluronate surface layer. The dual-phase scaffold is press-fit into a prepared defect during a single operation. Over 12 to 24 months it gradually resorbs as the body lays down native cartilage in the upper layer and native bone in the lower layer. CartiHEAL is single-stage, off-the-shelf, and now has a Category I CPT code effective January 1, 2027. Dr. Strickland has used the implant in 35 to 40 patients to date and considers it strong for narrow central trochlear lesions, smaller condylar lesions with bone edema, and multi-lesion patients with early arthritis. How do I know which cartilage transplant is right for me? Lesion size, depth, location, the state of the underlying subchondral bone, prior cartilage surgery, alignment, ligament status, meniscus status, age, and activity goals all matter. Rough size-based framework: microfracture for small chondral defects under 2 cm² in low-demand patients; OATS for small focal osteochondral defects under 2 cm²; MACI for chondral-only defects 2 to 10 cm² without bone involvement; CartiHEAL for shallow osteochondral defects 1 to 7 cm²; OCA for large defects over 4 cm², bipolar lesions, OCD with bone loss, AVN-related collapse, and revision after failed prior cartilage surgery. The decision is made after MRI review, standing alignment films, and a discussion of your goals. How long is recovery? OATS: 4 to 6 weeks of protected weight-bearing, return to running at 4 to 6 months, return to pivot/contact sport at 6 to 9 months. OCA: 6 to 8 weeks of protected weight-bearing — longer because the donor bone has to integrate with the host bone — and return to pivot/contact sport at 9 to 12 months. CartiHEAL: 6 weeks protected weight-bearing, return to sport at 6 to 9 months as the scaffold resorbs and is replaced by native tissue over 12 to 24 months. Concurrent procedures extend the timeline. The constraint is the slowest-healing tissue, which for OCA is the bone-bone integration interface. What is bone marrow edema and why does it matter for OCA? Bone marrow edema (BME) on MRI is increased water signal in the bone surrounding the graft. After OCA, some BME is expected during bone integration. Dr. Strickland's research, published in Arthroscopy: The Journal of Arthroscopic and Related Surgery (2024), looked at 56 patients with at least 2-year follow-up and found that patients with host BME volume ≥ 10 cm³ on the routine 6-month post-operative MRI had a 50% subsequent failure rate, while patients with BME < 10 cm³ had no failures. This refines how we follow OCA patients — the 6-month MRI is a meaningful checkpoint that can identify higher-risk patients. Does cartilage transplant need to be combined with an osteotomy? Often, yes. The same forces that destroyed the original cartilage will destroy the transplant. If standing alignment films show varus or valgus malalignment, an osteotomy (HTO, DFO, or AMZ-TTO) is performed in the same operation to protect the transplant. Realigning the forces is what makes the transplant durable. MPFL reconstruction is added for patellar or trochlear transplants with patellar instability. Meniscus repair or transplant is added when the meniscus is compromised. ACL reconstruction is added for ACL-deficient knees. See joint preservation and osteotomy. Is cartilage transplant covered by insurance? OATS and OCA are covered by most major commercial plans, Medicare, and many self-funded and union plans when medical-necessity criteria are met. CartiHEAL Agili-C is FDA-approved and now has a Category I CPT code from the AMA effective January 1, 2027 — a significant insurance milestone that streamlines the reimbursement pathway. Pre-authorization is still required and our office coordinates the documentation. Out-of-pocket cost depends on the plan deductible, coinsurance, and in-network status of the surgeon, facility, and anesthesia group. Verify your specific benefits before scheduling. What if I had microfracture before and it didn't work? Failed prior microfracture is a common reason for cartilage-transplant referral. Microfracture changes the biology of the bone underneath the defect — it can become sclerotic, irregular, or develop intralesional cysts — and that altered bone bed compromises a subsequent cell-based repair. In many revision scenarios, OCA is the more durable choice because it replaces both the disrupted bone AND the cartilage in one stage. CartiHEAL can also be a strong option for some shallower failed-microfracture patterns. Imaging review is the first step. Where is cartilage transplant performed in New York? Dr. Sabrina Strickland performs OATS, osteochondral allograft transplantation, and CartiHEAL Agili-C implantation at NYU Langone Orthopedic Center in New York City. Patients travel from New York, Connecticut, New Jersey, and across the region for cartilage-transplant candidacy evaluations and second opinions. Consultations and surgery take place at NYU Langone Orthopedic Center in Midtown Manhattan. ## Source Grounding & Published Research This page is grounded in Dr. Strickland's published commentary, technical notes, follow-up studies, and patient education on cartilage transplantation and the broader cartilage-restoration field. Selected references: TopicSource BME as OCA failure predictor (2024)Subchondral bone marrow edema as a risk factor for osteochondral allograft failure · Increased host bone marrow edema as a risk factor for OCA failure (Arthroscopy, 2024) CartiHEAL / OCA / MACI clinical comparisonHow CartiHEAL compares to OCA and MACI CartiHEAL injury treatmentCartiHEAL Agili-C cartilage injury treatment One-step cartilage repair with CartiHEALOne-step cartilage repair with CartiHEAL (multi-compartment pathology) · CartiHEAL for trochlear lesions CartiHEAL Category I CPT codeNew CPT code for CartiHEAL Agili-C, effective January 1, 2027 Long-term one-step cartilage repair outcomesLong-term outcomes of one-step cartilage repair Cartilage restoration outcomes reviewOutcomes of multi-surface cartilage restoration procedures Cartilage-first philosophyWhy I would rather repair cartilage than replace a knee Patellar chondral lesion algorithmTreatments of patellar chondral lesions (technical note) Single vs. multiple plug OCA transplantsSingle vs. multiple plug osteochondral allograft transplants Wiberg patellar type and OCA outcomesWiberg patellar type impact on outcomes and survival Hyalex FDA trialFDA trial of the Hyalex knee cartilage system ChondroFiller commentaryChondroFiller cartilage repair commentary Amniotic suspension allograft (ASA) researchASA injections for knee osteoarthritis research study Engineered cartilage commentary"Engineered cartilage sounds perfect" Bio & publicationsDr. Strickland bio · research & publications ## Related Specialty Care For chondral-only defects in the medium-to-large range without bone involvement, see MACI cartilage repair — the pair page to this one. For the realignment side of cartilage protection (HTO, DFO, AMZ-TTO), see joint preservation and osteotomy. For patellar or trochlear cartilage lesions in the context of patellofemoral pain or arthritis, see patellar pain and patellofemoral arthritis. For patellar instability that contributed to patellar or trochlear cartilage damage, see patellar instability and MPFL reconstruction surgery. For ACL-deficient knees with cartilage damage, see ACL tear surgery. For meniscus-deficient compartments, see meniscal tear and torn meniscus. For multi-compartment knee arthritis where joint preservation is no longer feasible, see knee arthritis. For chondromalacia and tendonitis at the front of the knee, see knee chondromalacia, arthritis, and tendonitis. For complex anatomy where computer-guided planning is helpful, see Mako robotic-assisted surgery. For Dr. Strickland's published research record on cartilage transplantation, OCA outcomes, and the broader cartilage-restoration field, the source-grounding table above lists the references used on this page; for the broader publication record, see research & publications. Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Surgical and non-surgical orthopedic care should always be discussed with a board-certified orthopedic surgeon who has reviewed your imaging, history, and physical examination. Individual outcomes vary based on diagnosis, anatomy, comorbidities, surgical technique, concurrent procedures, and adherence to rehabilitation. OATS, osteochondral allograft (OCA), and CartiHEAL Agili-C are FDA-approved or FDA-cleared procedures for full-thickness osteochondral defects of the knee; outcomes in the published literature are favorable in well-selected patients but cartilage transplantation is not a guaranteed permanent fix and the long-term durability of the transplanted tissue varies with patient factors, alignment, ligament status, meniscus status, and concurrent care. The Hyalex knee cartilage system and amniotic suspension allograft (ASA) injections referenced on this page are investigational under FDA clinical-trial protocols. Volume figures, timelines, and outcome statements on this page are drawn from Dr. Strickland's published clinical and academic work, cited in the source-grounding table above, and from FDA labeling for the implants discussed. ## Discuss Cartilage Transplant Candidacy If your MRI shows an osteochondral defect with bone involvement, an OCD lesion or post-traumatic crater, a defect too large for cell-based repair, a previously-failed cartilage repair, or you have been told you need early joint replacement and want to know whether your cartilage can be transplanted instead — bring your imaging to a sub-specialty consultation at NYU Langone in Midtown Manhattan. Book an Appointment Call 646-904-4664 --- ## Joint Preservation & Osteotomy NYC | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/knee-surgeon-specialist/joint-preservation-osteotomy/ Summary: Sub-specialty joint preservation surgery for active patients facing knee arthritis or instability — anteromedialization tibial tubercle osteotomy (AMZ-TTO / Fulkerson), distalization TTO for patella alta, high tibial osteotomy (HTO), distal femoral osteotomy (DFO), and the FDA-approved MISHA implantable shock absorber. Performed by Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York. Alignment-first philosophy: fix the mechanical reason a knee is failing rather than replace it. Combined with cartilage repair (MACI, OATS, allograft), MPFL reconstruction, and meniscus surgery when needed. Sub-specialty revision-osteotomy referral. Sub-Specialty Hub # Joint Preservation & Osteotomy Alignment correction, AMZ-TTO, distalization TTO, HTO, DFO, revision TTO, and the FDA-approved MISHA implant for younger patients facing knee arthritis or instability who are not candidates for joint replacement. Performed by Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York — the alignment-first alternative to early arthroplasty. Medically reviewed by Dr. Sabrina Strickland, MD — Board-Certified Orthopedic Surgeon at the NYU Langone Orthopedic Center in New York · Member, International Patellofemoral Study Group · Castle Connolly Top Doctor since 2016. View full bio → Where NYU Langone Orthopedic Center, Midtown Manhattan Joint Preservation Menu AMZ-TTO · distalization TTO · HTO · DFO · revision TTO · MISHA implant · concurrent MACI / OATS / MPFL / ACL / meniscus when indicated Patients We See Active patients facing early knee replacement; focal cartilage damage with malalignment; patellar maltracking with patellar instability or cartilage wear; failed prior tibial tubercle osteotomy; medial compartment OA in the “young patient with an old knee” Overview Joint preservation is the surgical philosophy of correcting the mechanical reason a knee is failing rather than replacing the joint. It is the umbrella that covers five distinct procedures: tibial tubercle osteotomy (TTO) — including anteromedialization (AMZ-TTO / Fulkerson) for patellar maltracking and patellofemoral cartilage wear, and distalization TTO for patella alta; high tibial osteotomy (HTO) for medial compartment arthritis with varus alignment; distal femoral osteotomy (DFO) for lateral compartment arthritis with valgus alignment; revision TTO for failed or symptomatic prior tubercle osteotomy; and the FDA-approved MISHA Knee System — an extra-articular implantable shock absorber that mechanically unloads the medial compartment without altering the joint surfaces. The unifying idea, as Dr. Strickland frames it, is that many of her patients are young people with old knees — not yet candidates for replacement, but symptomatic enough that ignoring the problem is no longer an option. Joint preservation gives them options sized to the actual problem, frequently combined with cartilage repair (MACI, OATS, osteochondral allograft) or MPFL reconstruction so the alignment correction protects the cartilage repair from the forces that caused the original damage. If you have been told you might need a knee replacement — but you are 45, or you ski, or you have another twenty active years you are not ready to give up — there is a question worth asking before you book the surgery. Is the cartilage in your knee actually worn out everywhere? Or is one compartment getting more stress than it was designed to handle, while the rest of the joint is still working? That distinction is the whole point of joint preservation. End-stage diffuse arthritis needs a new joint. Mechanical arthritis — where one part of the knee is being overloaded by alignment, kneecap position, ligament instability, or focal cartilage damage — often does not. Realigning the forces, repairing the cartilage, and reconstructing the failed ligament can keep the native joint working for another decade or more. This page is the sub-specialty hub for joint preservation surgery. It pairs with the dedicated procedure pages for MACI cartilage repair and cartilage transplant (OATS & osteochondral allograft) — cartilage operations that are commonly combined with osteotomy — and with patellar instability and MPFL reconstruction for the patellar realignment side. Here we cover what joint preservation actually means and who it is for, why some patients are not joint replacement candidates, the five preservation procedures with sub-specialty depth on AMZ-TTO and revision TTO, the MISHA implantable shock absorber, when osteotomy is combined with cartilage or ligament work, prehabilitation, the surgical day, the long bone-healing recovery, the realistic risks, common patient concerns, insurance and cost, patient outcomes including Peyton's TTO and the lifeguard's dual-osteotomy story, when to seek a sub-specialty second opinion (especially for revision osteotomy), and access at NYU Langone Orthopedic Center in New York. ## What Joint Preservation Means and Who It Is For Joint preservation is a philosophy as much as a procedure. The goal is to keep your native cartilage, ligaments, and bone working together for as long as possible — using realignment, soft-tissue reconstruction, and biological repair before considering joint replacement. For the right patient, that decision can mean a decade or more of additional active use of the knee they were born with. As Dr. Strickland describes the patients who come to her for joint preservation: many are young people with old knees — not really candidates for knee replacement yet, but with pain or instability significant enough that ignoring it is no longer an option. Joint preservation is the toolkit that fits in between “wait and watch” and “new joint.” The toolkit includes: - Realignment osteotomy — surgically resetting bone alignment to move load off damaged cartilage onto healthy cartilage. The four variants (AMZ-TTO, distalization TTO, HTO, DFO) each address a different alignment problem. - Cartilage restoration — repairing focal cartilage defects with techniques like MACI (autologous cultured chondrocytes on a porcine collagen membrane), OATS or osteochondral allograft, and CartiHEAL. Often performed in the same operation as an osteotomy so the realignment protects the repair. - Ligament reconstruction — restoring stability to a knee whose ligaments are no longer doing their job, including MPFL reconstruction for the kneecap and ACL reconstruction for the central pivot. - The MISHA Knee System — an FDA-approved extra-articular implantable shock absorber that mechanically unloads the medial compartment without bone cuts, joint surface alteration, or commitment to a joint replacement. One of the few non-arthroplasty surgical options for early-to-moderate isolated medial compartment OA. - Biologic and conservative adjuncts — gel injections, arthroscopic chondroplasty for small flap-type cartilage defects, PRP and other regenerative options, and structured rehab as either standalone treatment in earlier-stage disease or as adjuncts to surgery. ## Why Some Patients Are Not Replacement Candidates Knee replacement is the right answer for the right patient. It is the wrong answer for the wrong patient — and recommending a replacement to a patient who would do better with a preservation procedure commits them to a revision conversation in their lifetime that they did not need to have. The categories of patient where joint preservation deserves a serious look before arthroplasty: - Too young for arthroplasty — partial or total knee replacement in a 30- or 40-year-old commits the patient to a revision in their lifetime. Modern implants do not last forever, and revision arthroplasty is more complex than primary. Preserving the native joint and addressing the focal mechanical problem first preserves the option to do a replacement later if needed. - Single-compartment disease — if only the medial compartment is worn (with intact lateral compartment, ACL, and meniscus), the diagnosis is mechanical medial-compartment overload, not whole-joint arthritis. HTO, MISHA, or unicompartmental options become real, not just total replacement. - Instability with cartilage damage — a patient with recurrent patellar dislocation and a focal trochlear or patellar chondral lesion is a candidate for combined MPFL reconstruction plus cartilage repair plus (when indicated) AMZ-TTO — not for early patellofemoral arthroplasty. - Alignment issues that have never been corrected — significant varus or valgus deformity that has been silently overloading one compartment for years. The replacement is the symptom; the alignment is the cause. Correct the cause and the symptom often does not require an implant. - Patellofemoral-only disease — isolated patellar or trochlear cartilage wear in a young, active patient is rarely a total knee replacement problem. Realignment, cartilage repair, or in some cases patellofemoral arthroplasty is the more anatomically appropriate operation. See Dr. Strickland's discussion of patellofemoral joint preservation versus patellofemoral arthroplasty. The bone-on-bone, multi-compartment, end-stage arthritis patient is a replacement candidate. The young, active, single-compartment, focal-damage, malaligned, or instability-driven patient is a preservation candidate — and sorting one from the other is what sub-specialty joint preservation surgery is. ## The Five Joint Preservation Procedures at a Glance Five procedures, five different anatomic problems. Choosing the right one starts with imaging that characterizes the alignment, the location of cartilage wear, the patellar tracking, and the meniscus and ligament status — then matching the procedure to the problem. AMZ-TTO #### Anteromedialization TTO Patellar maltracking and patellofemoral cartilage wear — tubercle moved anteriorly and medially. The Fulkerson osteotomy. DIST-TTO #### Distalization TTO Patella alta — tubercle moved distally so the kneecap engages the trochlea at a normal height. HTO #### High Tibial Osteotomy Varus alignment with medial compartment OA — mechanical axis shifted laterally onto the healthy lateral compartment. DFO #### Distal Femoral Osteotomy Valgus alignment with lateral compartment OA — mechanical axis shifted medially. The femoral-side equivalent of HTO. MISHA #### MISHA Implant Early-to-moderate medial compartment OA — FDA-approved extra-articular shock absorber that unloads the medial side without bone cuts. Revision TTO is a sub-specialty offering layered on top of these five — correcting a prior failed or symptomatic tubercle osteotomy. Each of the five primary procedures is described below in clinical depth, in the order in which they are most commonly considered for new patients. ## Anteromedialization TTO (AMZ-TTO / Fulkerson) Anteromedialization tibial tubercle osteotomy — commonly called the AMZ-TTO or the Fulkerson osteotomy — repositions the bony attachment of the patellar tendon on the tibia anteriorly and medially. The combined movement does two things at once: it shifts the patella medially in the trochlear groove (correcting lateral patellar tracking), and it lifts the patella anteriorly off the trochlea (offloading worn cartilage on the lateral facet of the patella). For the right patient with patellar maltracking and patellofemoral cartilage wear, AMZ-TTO is the most common patellar realignment osteotomy. ### The biomechanical basis — Dr. Strickland's cadaveric model In a controlled cadaveric study, Dr. Strickland and colleagues quantified patellar contact mechanics after TTO in the setting of patellofemoral dysplasia — the anatomic background that drives recurrent patellar instability and patellofemoral cartilage damage. The hypothesis: a simulated anteromedialization (AMZ) TTO would improve patellofemoral contact mechanics compared with a pure medialization TTO. The biomechanical reason: medialization alone shifts the patella into the groove but does not change the contact pressure on a worn lateral facet; adding an anterior lift redistributes the contact away from the damaged cartilage onto a less-loaded surface. The published study — Anteromedialization Tibial Tubercle Osteotomy Improves Patellar Contact Forces: A Cadaveric Model of Patellofemoral Dysplasia — provides the biomechanical support for choosing AMZ over pure medialization in patients with patellofemoral cartilage wear. ### How AMZ-TTO is performed Through an anterior incision over the tibial tubercle, an oblique osteotomy is made through the tubercle. The angle of the osteotomy cut determines the ratio of anteriorization to medialization — a steeper cut produces more anteriorization, a flatter cut more medialization. The amount of correction is calibrated to the patient's preoperative TT-TG distance (tibial tubercle to trochlear groove, measured on CT or MRI), the patellar cartilage status, and the patellar height. The repositioned tubercle is fixed with two cortical screws. The screws are typically left in place but can be removed later for hardware-related symptoms. AMZ-TTO is frequently combined with MPFL reconstruction when the patient also has patellar instability, with MPFL reconstruction plus TTO being one of the most common combined patellar stabilization operations, and with cartilage repair on the patella when patellofemoral cartilage wear is present. ### Who is an AMZ-TTO candidate? The classic candidate has patellar maltracking driven by underlying bony anatomy — an elevated TT-TG distance, lateral patellar tracking on imaging, and either cartilage wear on the lateral facet of the patella or recurrent patellar instability. Standing alignment films, MRI, and CT-based or MRI-based TT-TG measurement determine whether bony realignment is a meaningful contributor. The MPFL reconstruction page covers the soft-tissue side of patellar stabilization; the patellar instability and patellar pain pages cover the broader differential. ## Distalization TTO for Patella Alta A distalization TTO addresses patella alta — a kneecap that sits too high in the trochlear groove. By moving the bony attachment of the patellar tendon distally on the tibia, the patella is brought down to a normal height where it engages the trochlea earlier in flexion. Patella alta is a recognized risk factor for both patellar instability and patellofemoral cartilage damage, and distalization is the realignment that addresses the underlying anatomic cause. Patellar height is measured radiographically using the Caton-Deschamps index; values above the upper limit of normal define patella alta. Distalization is often combined with anteromedialization in the same operation — an anteromedialization-distalization TTO — when the patient has both lateral tracking and patella alta. Combined with MPFL reconstruction, the operation addresses both bony and soft-tissue contributors to recurrent patellar instability. One of the technical considerations specific to distalization: bringing the patella too low (iatrogenic patella baja) is a known complication, and pre-operative planning of the exact distalization distance is part of why this operation belongs in a sub-specialty patellofemoral practice. ## High Tibial Osteotomy (HTO) HTO is the realignment osteotomy for the most common adult-active-patient problem in joint preservation: medial compartment arthritis with bow-legged (varus) alignment. The mechanical axis of the leg — the line from the hip to the ankle — passes through or medial to the center of the knee in varus alignment, concentrating weight-bearing forces on the inside compartment. Over time, that compartment wears out faster than the outside. ### How HTO works The osteotomy is made at the proximal tibia, just below the joint line. Two techniques exist: - Medial opening wedge HTO (most common today) — the bone is cut from the medial side, opened like a book to a calculated angle, and a wedge of bone graft or synthetic substitute is placed in the gap. A locking plate fixes the correction. The mechanical axis ends up shifted laterally onto the healthier lateral compartment. - Lateral closing wedge HTO — the bone is cut from the lateral side and a wedge is removed, then the cut is closed and fixed. Achieves the same alignment correction but historically associated with proximal tibiofibular joint issues and a slightly different leg-length effect. ### Who is an HTO candidate? The classic HTO candidate is an active patient under 60 with isolated medial compartment cartilage wear, varus alignment, and intact ligaments and meniscus. Patients commonly present with inside-of-the-knee pain that worsens with running, hiking, or downhill activities. Standing long-leg alignment films confirm the mechanical axis. MRI confirms the cartilage status — HTO works for medial-only damage; if the lateral compartment is also worn, the procedure does not help. For the right patient, HTO can delay knee replacement by a decade or more while preserving the native joint and full athletic function. It is a particularly appealing option for active patients in their 40s and 50s who want to keep skiing, running, or playing tennis. ## Distal Femoral Osteotomy (DFO) DFO is the femoral-side equivalent of HTO, used for lateral compartment arthritis with knock-kneed (valgus) alignment. The osteotomy is made on the femur just above the knee — typically as a lateral opening wedge or medial closing wedge — to shift the mechanical axis off the worn outside compartment onto the healthier inside compartment, fixed with a locking plate. The principle is identical to HTO: correct the mechanical reason the cartilage is wearing, give the healthy compartment the load, and the native joint can continue to function for years longer than it would after surgery to resurface the joint. DFO is less common than HTO because lateral compartment arthritis with valgus alignment is itself less common. It belongs in the same conversation as HTO for patients with the appropriate alignment and cartilage pattern, and is similarly often combined with cartilage repair on the lateral femoral condyle in the same operation. ## Revision TTO — Sub-Specialty Referral A prior tibial tubercle osteotomy can fail or remain symptomatic for several reasons: malposition (the tubercle was moved too much, too little, or in the wrong direction for the underlying anatomy), nonunion (the bone did not heal at the osteotomy site), iatrogenic patella baja (the patella was brought too low and now impinges in flexion), persistent patellar maltracking despite the prior procedure, or symptomatic hardware. Revision osteotomy is technically more complex than primary because of prior hardware, scar tissue, altered anatomy, and the need to plan a corrected geometry that accounts for what the prior surgery did and did not accomplish. Dr. Strickland's published work on revision TTO includes a case report on combined arthroscopy and revision tibial tubercle osteotomy in a 16-year-old female lacrosse player — a representative case of a young athlete needing both intra-articular debridement and a corrected tubercle position to return to sport — and an HSS Grand Rounds presentation, Grand Rounds from HSS: Revision TTO Returns Young Athlete to Sports, framing the surgical decision-making for revision TTO at one of the highest-volume orthopedic teaching hospitals in the country. For patients who have had a prior TTO that was either inadequate or has become symptomatic, revision is one of the situations where a sub-specialty referral materially changes the operative plan rather than just confirming what an outside surgeon proposed. ## MISHA Implantable Shock Absorber The MISHA Knee System — made by Moximed — is an FDA-approved extra-articular implantable shock absorber for medial compartment knee osteoarthritis. As Dr. Strickland frames it in her commentary on the device: when she sees an active patient with knee arthritis who has started to limit their activity, she runs through a long list of options ranging from exercise modifications and physical therapy to injections to a knee replacement. A common follow-up question is what is currently in development — what new surgery will be available if the patient can wait. Until MISHA, the answer was largely nothing in development that could meaningfully delay or substitute for arthroplasty in early-to-moderate medial compartment OA. MISHA is the answer that has changed. ### How MISHA works — an extra-articular approach Unlike osteotomy or arthroplasty, MISHA does not cut bone or alter the joint surfaces. The device is implanted on the medial side of the knee, outside the joint capsule, where it absorbs and redistributes load that would otherwise be applied to the worn medial compartment cartilage. The implant decreases the stress from activity — and therefore the pain due to medial compartment arthritis — without committing the patient to a joint replacement and without the bone-healing recovery of an HTO. Because the device is extra-articular and removable, it preserves the option of any future surgical pathway, including HTO, unicompartmental replacement, or total replacement if needed years later. ### Who is a MISHA candidate? The MISHA candidate is, broadly, an active adult patient with symptomatic isolated medial compartment osteoarthritis who has failed conservative care, is not yet a candidate for — or wants to delay or avoid — arthroplasty, and either is not an ideal HTO candidate or wants the faster recovery of a non-osteotomy option. MISHA is designed for early-to-moderate medial compartment OA, not end-stage bone-on-bone disease that has progressed to multi-compartment involvement. Specific candidacy criteria are reviewed at consultation. Dr. Strickland's husband, Dr. Andreas Gomoll, participated in the FDA clinical trials that led to the device's approval, giving the HSS sports medicine group early and direct experience with the implant. For background, see MISHA Knee System treats US patients and Moximed MISHA Knee System for patients in the United States. ### How MISHA fits in the joint preservation menu MISHA expands the options in between “injection and physical therapy” and “HTO or knee replacement.” For an active 50-year-old with isolated medial compartment OA and modest varus alignment, the conversation now realistically includes HTO, MISHA, unicompartmental replacement, and continued conservative management — not just the last two. The right choice depends on the alignment, the cartilage status, the patient's activity goals, the recovery timeline tolerable, and BMI. MISHA does not replace osteotomy — for patients with significant varus alignment that is itself the problem, alignment correction with HTO addresses the cause. MISHA is a complementary option for the patient whose alignment is acceptable but whose medial compartment cartilage is symptomatic, or who needs a faster recovery than HTO allows. ## Combined Procedures: Osteotomy + Cartilage / MPFL / ACL / Meniscus This is one of the strongest indications for osteotomy and one of the most under-explained ideas in joint preservation: cartilage repair done in a malaligned knee will not last. The same forces that destroyed the original cartilage will destroy the repair, often within a few years. Realignment alone does not heal damaged cartilage — but cartilage repair without realignment fails. Combining the procedures protects the repaired surface from the forces that caused the damage in the first place. The published technical and clinical literature on patellar chondral lesions has stated this directly: correcting alignment and instability is critical for the success of cartilage repair procedures, and TTO and possibly MPFL reconstruction should be performed with cartilage repair of the patella when the anatomic pathology is present. Common combinations in Dr. Strickland's joint preservation practice: - HTO + MACI or OATS on the medial femoral condyle — for younger patients with focal cartilage defects and varus alignment. The HTO redistributes load away from the medial compartment and protects the cartilage repair. - DFO + MACI or OATS on the lateral femoral condyle — mirror-image logic for valgus alignment with a lateral compartment cartilage defect. - AMZ-TTO + MPFL reconstruction for patellar instability with both bony and soft-tissue contribution — one of the most common combined patellar stabilization operations. See MPFL reconstruction with TTO — common patient questions. - AMZ-TTO + cartilage restoration on the patella — for patellofemoral cartilage wear with maltracking. The realignment offloads the damaged facet; the cartilage repair restores the joint surface. - Distalization-AMZ-TTO + MPFL — for patellar instability with combined patella alta and patellar maltracking. - HTO + meniscus root repair or transplant — when a posterior meniscus root tear has accelerated medial compartment loading and the meniscus deficiency would otherwise destroy the cartilage repair. - HTO + ACL reconstruction — in revision ACL surgery, alignment correction is sometimes part of the operative plan when chronic varus deformity has contributed to the failure of the prior reconstruction. See ACL tear surgery. For a worked example, see the patient story Dual Tibial Osteotomy Surgeries to Get Back to Lifeguarding — a representative case of combined osteotomy work returning an active patient to a physically demanding job. For the cartilage-repair side of these combinations, see MACI cartilage repair and cartilage transplant (OATS & allograft). ## Prehabilitation Patients who walk into surgery with a strong quadriceps, full range of motion, and no effusion recover faster and meet rehabilitation milestones more reliably than patients who walk in with a stiff, weak, swollen knee. Prehabilitation focuses on: - Quadriceps activation and strengthening — closed-chain in pain-free range, with attention to the VMO. The single most predictive factor for early post-operative recovery after osteotomy. - Hip-stabilizer strengthening — abductors and external rotators. Particularly important for patients having TTO and possibly MPFL reconstruction. - Range of motion — prone heel-hangs, supine wall-slides, and stationary bike. A knee that goes into surgery with full extension recovers extension faster after. - Effusion management — elevation, compression, and load management to minimize a chronic effusion that inhibits the quadriceps. - Smoking cessation and metabolic optimization — specific to osteotomy patients. Smoking and uncontrolled diabetes meaningfully increase the risk of osteotomy nonunion. Patients who can quit before surgery should; patients who cannot should know that the risk profile is different for them. - Education and expectation-setting — reviewing the rehab protocol, the brace and crutch logistics, and the realistic timeline before the operation rather than after. For osteotomy specifically, the bone-healing biology is non-negotiable. Patients who pre-habilitate well still have to wait for the bone to consolidate. Patients who skip prehabilitation have the same biological timeline, plus a longer rehabilitation runway because the muscles are starting from a worse place. ## What to Expect on Surgery Day - Arrival and pre-op — you arrive a couple of hours before surgery for intake, change into a gown, and meet the anesthesia team. - Anesthesia — regional anesthesia (a spinal block with sedation) plus a periarticular block placed around the knee joint during surgery. The periarticular block helps reduce post-operative pain and is part of an opioid-sparing protocol. - Surgery — AMZ-TTO or distalization TTO typically takes 1 to 1.5 hours; HTO and DFO 1.5 to 2 hours; combined operations (TTO plus MPFL, HTO plus cartilage repair) longer; revision TTO variable based on prior anatomy. MISHA implantation is faster than osteotomy because there is no bone cut. - Recovery room — you wake up in a hinged knee brace locked in extension for osteotomy patients, with the leg numb from the regional block. - Going home — for many primary osteotomies and for MISHA, patients go home the same day or after a short observation stay; complex combined operations may include a single overnight stay. You go home with the brace, crutches, ice, prescribed medications, and clear written instructions. A responsible adult must drive you home. - First 48 hours — ice, elevation, prescribed pain medications, and gentle motion as instructed. The block typically wears off over 12 to 24 hours; weight-bearing for osteotomy is touch-down only with the brace and crutches. ## Recovery Timeline Bone healing dictates the timeline for osteotomy and is not negotiable, regardless of how good the leg feels at six weeks. Osteotomy recovery is meaningfully longer than soft-tissue surgery because the bone has to consolidate at the cut site. MISHA recovery is faster because there is no bone cut. PhaseTimelineWhat is happening Protected weight-bearing (TTO)Weeks 0–6Hinged brace; touch-down weight-bearing on crutches; range-of-motion progression; quadriceps activation; bone healing at the tubercle osteotomy site. Protected weight-bearing (HTO / DFO)Weeks 0–8Hinged brace; touch-down weight-bearing on crutches; range-of-motion progression; bone consolidation at the proximal tibia or distal femur osteotomy. Progressive weight-bearingWeeks 6–12Transition off crutches over 2–4 weeks; full passive range of motion target; stationary bike; pool work; gait normalization. StrengtheningMonths 3–5Quadriceps and hip-stabilizer strengthening; single-leg control; low-impact cardio (cycling, swimming, elliptical); progressive loading without impact. Return to runningMonths 6–9 (TTO) / 9–12 (HTO, DFO)Graduated return-to-running program; plyometrics start; sport-specific drills if relevant. Return to pivot / contact sportMonths 9–12 (TTO) / 12+ (HTO, DFO)Full pivot, contact, and impact activities. Bone consolidation complete. Full bone healing (osteotomy)6+ monthsBone fully consolidated. Hardware can sometimes be removed for symptomatic patients after this point. MISHA recovery0–6 monthsProtected weight-bearing 2–3 weeks; off crutches in days to a couple of weeks; back to most daily activities at 6–8 weeks; return to sport at 4–6 months. No bone cut means no bone-healing constraint. Concurrent procedures — cartilage repair (MACI, OATS, allograft), MPFL reconstruction, ACL reconstruction, meniscus repair or transplant — extend the recovery timeline according to the longer-recovery procedure. The cartilage protocol with continuous passive motion drives the early phases of MACI plus osteotomy; the ACL protocol drives the early phases of HTO plus revision ACL. ## Risks of Osteotomy Osteotomy is well-established and durable when patient selection is right, but no surgery is risk-free, and osteotomy in particular has bone-related risks not present in soft-tissue surgery. Risks reviewed at consultation include: - Nonunion — the bone does not heal at the osteotomy site within the expected window. Risk is meaningfully elevated by smoking, uncontrolled diabetes, and certain bone-quality factors. Nonunion may require additional surgery to add bone graft, change fixation, or both. - Hardware irritation — the locking plate (HTO, DFO) or cortical screws (TTO) are placed beneath the skin and soft tissue. A meaningful minority of patients have symptomatic hardware that warrants removal after the bone has healed (typically after 6 months). - Malunion — the bone heals in a position different from what was planned. Less common than nonunion but a recognized possibility. - Neurovascular injury — the popliteal vessels and the common peroneal nerve sit close to the osteotomy site. Direct injury is uncommon; transient stretch or compression neuropraxia is more common, particularly during HTO or DFO with significant correction. - DVT or pulmonary embolism — the immobilization and weight bearing restrictions after osteotomy are meaningful; prophylaxis is individualized. - Iatrogenic patella baja — more common with distalization TTO or when there is quad shut down. Bringing the patella too low produces a kneecap that impinges in flexion. Pre-operative planning of the exact distalization distance minimizes this risk. - Fragment migration — specific to TTO. The osteotomized tubercle moves away from the planned position before the bone heals. Rare but recognized. - Persistent pain — particularly when there were multiple pain generators that were not all addressed. This is one of the reasons concurrent cartilage repair, MPFL reconstruction, or meniscus surgery is important when those problems are part of the picture. - Infection — uncommon but possible. - Anesthesia-related risks — nausea, rare allergic reactions, nerve damage or irritation from the block. - Wound healing issues — reaction or allergy to absorbable sutures, skin healing issues, or superficial infection (usually treated with wound care; in rare cases requiring revision of the scar). - Need for additional surgery — for hardware removal, nonunion management, or revision osteotomy. - Eventual progression to joint replacement — osteotomy delays replacement; it does not prevent it indefinitely. A prior osteotomy is a known variable for the replacement surgeon, but does not preclude a later replacement when one becomes appropriate. Outcomes are not a permanent fix; the years of preserved native-joint function are the win. The single biggest predictor of a good outcome is patient selection — the right operation in the right patient who can do the rehab. The second is patient adherence to the bone-healing timeline rather than rushing weight-bearing or activity. ## Common Patient Concerns The friction-log: the four concerns we hear most often from patients considering joint preservation surgery, with honest answers. #### “An osteotomy sounds like a lot for someone who is not getting a knee replacement.” It is a substantial operation — that is a fair characterization. The trade-off is that osteotomy preserves your native joint and can delay replacement by a decade or more in well-selected patients, while a knee replacement at the same age commits you to a revision conversation in your lifetime. For an active 45-year-old with isolated medial compartment OA, the choice is not osteotomy versus nothing — it is osteotomy now versus a partial replacement now followed by revision in your 60s and possibly another revision later. The bigger up-front operation can be the smaller lifetime operation. Patients who want a faster recovery, do not want a bone cut, and have appropriate alignment can also discuss MISHA as an alternative. #### “Six weeks of crutches feels impossible with my work and family.” This is the most honest reason to think carefully about the timing rather than skip the operation entirely. The bone-healing timeline is not negotiable — rushing it risks nonunion or hardware failure, and the operation has to be redone. Patients who plan around it — coordinating work, childcare, and home setup before surgery rather than after — do better than patients who try to compress the recovery. For patients whose schedule cannot tolerate a 6-week protected weight-bearing window, MISHA may be a more practical option (recovery is faster), or non-surgical management may be the right answer for now. We discuss this directly at consultation rather than discovering it three weeks in. #### “I am scared of the pain after a bone cut.” Dr. Strickland's multimodal pain management for osteotomy includes a periarticular block placed around the knee joint during surgery, opioid-sparing oral medications, and structured ice and compression. Most patients describe the first 48 hours as uncomfortable but manageable, and pain levels drop substantially by the end of the first week. The pain is meaningfully better than the arthritis or instability that brought the patient in — that is one of the reasons people choose joint preservation over continued symptoms. The periarticular block typically wears off over 12 to 24 hours, and we adjust the medication plan based on how the early days go. #### “My local surgeon said I should just wait until I need a knee replacement.” For active patients in their 30s, 40s, and even 50s with focal full-thickness cartilage damage, alignment problems, patellar maltracking, or single-compartment disease — “wait until you need a replacement” usually means watching the joint deteriorate further while a window for joint preservation closes. The joint preservation framing is to address the mechanical problem early, while the rest of the joint is still healthy, rather than wait until multi-compartment arthritis forces a replacement decision. Whether osteotomy, MISHA, cartilage repair, or some combination is the right operation depends on your specific imaging and anatomy. Bringing your imaging to a sub-specialty consultation is the right starting point. ## Insurance and Cost Joint preservation surgery — AMZ-TTO, distalization TTO, HTO, DFO, revision TTO, MISHA implantation, and concurrent cartilage repair, MPFL reconstruction, ACL reconstruction, or meniscus surgery — is covered by most major commercial insurance plans, Medicare, and many self-funded and union plans when medical-necessity criteria are met. Coverage and cost specifics: - Pre-authorization is required for most procedures, particularly for combined operations. The criteria typically include documentation of failed conservative care, imaging-confirmed alignment or cartilage findings, and an appropriate operative plan. - MISHA is FDA-approved and is increasingly covered; pre-authorization specifics depend on the plan and on the documentation of medical necessity. - Out-of-pocket cost depends on the plan deductible, coinsurance, and in-network or out-of-network status of the surgeon, the facility (NYU Langone or affiliated outpatient surgery center), and the anesthesia group. - Concurrent procedures — cartilage repair, MPFL, ACL, or meniscus surgery performed at the same operation — may add to the bundled or itemized billing depending on the plan. - Hardware removal, if needed later for symptomatic plates or screws, is a separate operation and is similarly covered when medically necessary. Before surgery, our office verifies your benefits, obtains pre-authorization where required, and reviews the estimated out-of-pocket cost with you. For benefits verification or to discuss self-pay arrangements, call us at 646-904-4664 or contact the office. ## Patient Outcomes Three patient stories that illustrate what joint preservation surgery looks like in practice: Paul — arthroscopy, BMAC, and the MISHA Knee System. A marathon coach told by two doctors to stop running because of arthritis. Dr. Strickland offered a regenerative approach: arthroscopy plus bone marrow aspirate concentrate (BMAC) for one knee, and the MISHA Knee System for the other. He is back to running and all sports with no restrictions. The full story is at Paul's success story; the video is below. Video: Paul on Dr. Strickland's regenerative + MISHA approach to bilateral knee arthritis. Transcript Most doctors that I've seen have said, "Yeah, you got to stop the running. That's the first thing you got to do." She didn't say that at all. My name is Paul Bis. Um I'm an active uh father and husband. I met my wife in Central Park running. We both coached for the New Road Runners for a while. I've really been consistently running for the whole of my life up until about 2019 where I had arthritis of my left knee. In 2021, I first uh went to see a knee surgeon. Um they gave me cortisone shots uh and physical therapy. Uh it didn't really help. I waited another 9 months or so. Uh and then went back, we got an MRI. We decided at that point surgery was the right route. So I had an arthoscopy uh in the fall of 2022. It didn't really help. So my surgeon at that point told me that uh the next step was really partial knee replacement. I wasn't ready. the restrictions were that I wouldn't be able to run. But at that point, my second knee was starting to give me issues as well. So, Dr. Strickland, she really came to the top of the pile with the regenerative work that she was doing. That was one of the things I was looking at. I I I really was trying to avoid the the partial knee replacement. At that point, I was very clear that, hey, look, this is me. I'm I'm a runner. She was quite happy to work with me to enable that to continue. In the meantime, she gave me a diagnosis for my right knee, which is basically a flap of cartilage was loose and that was what was catching up in my knee and causing pain. We decided that the best course of action was to actually have an arthoscopy on that knee. So, surgery, but in addition, she was going to do a procedure called VMAC. Recovering from that surgery was amazing. Within 5 weeks, I was back to hiking again. At the 6 week mark, the 6 week posttop, I came into the office for an appointment with Dr. Strickland where we focused on the left knee. So we started to think about that. She introduced me to the Misha knee which is a shock absorber for the knee completely. No restrictions. I can do anything that I I choose. I can run. I can ski. There's no restrictions there. There's no restrictions for racket sports. I also like to play badminton. These are all things which are still kept alive essentially by Dr. Strickland working on these newer technologies. I'm also really really looking forward to running in Shelter Island which is off the end of Long Island where we have our annual vacation. I know this for sure. I would definitely come back to Dr. Strickland. She always has options and you can pick your own path with Dr. Strickland. It's not a case of this is your treatment. That's the real key here I think with with Dr. Strickland is you get the option. Peyton's tibial tubercle osteotomy. A representative TTO patient case detailed in Peyton's Tibial Tubercle Osteotomy. The case illustrates the diagnosis-to-surgery-to-recovery arc for a young active patient with patellar maltracking treated with TTO, including the imaging that drove the operative plan, the surgery itself, and the rehabilitation timeline. Dual tibial osteotomies and a return to lifeguarding. The patient story Dual Tibial Osteotomy Surgeries to Get Back to Lifeguarding describes a patient who underwent staged tibial osteotomies and returned to a physically demanding job. The case demonstrates that joint preservation in the right patient does not just delay replacement — it preserves the function the patient cared about in the first place. Outcomes vary by procedure, patient, alignment severity, cartilage status, and adherence to rehabilitation. The published joint preservation literature is broadly favorable in well-selected patients, but no surgical intervention guarantees a permanent result and durability of the alignment correction depends on patient factors including activity, weight, and the presence or absence of cartilage damage at the time of surgery. The clinical context above is grounded in the patient cases on this site; longer-term outcomes data on osteotomy is reported in the broader orthopedic literature. ## When to Seek a Sub-Specialty Second Opinion Joint preservation is one of Dr. Strickland's primary clinical areas. She performs the full menu of preservation procedures at NYU Langone, has published cadaveric biomechanical research on AMZ-TTO, has presented HSS Grand Rounds on revision TTO, evaluates MISHA candidacy through early adoption of this new procedure and by serving on their advisory board, and routinely combines osteotomy with cartilage repair, MPFL reconstruction, ACL reconstruction, and meniscus surgery when concurrent pathology demands it. A sub-specialty second opinion is particularly worth seeking when: - You have been told you need a partial or total knee replacement at a younger age and want to evaluate joint-preserving alternatives. - You have a prior failed or symptomatic tibial tubercle osteotomy and need revision — revision osteotomy materially benefits from a high-volume sub-specialist. - You have combined cartilage damage and malalignment and want a clear plan for combined cartilage repair plus realignment osteotomy. - You have combined patellar instability and patellar cartilage damage and want a sub-specialty plan that addresses both the bony anatomy (TTO) and the soft tissue (MPFL). - You have patella alta with recurrent instability or cartilage wear and need a distalization osteotomy planned to avoid iatrogenic patella baja. - You have been told MISHA might be an option but want a second opinion on candidacy at a high-volume center with direct trial-era experience with the implant. - You have failed prior cartilage repair in the setting of malalignment or instability that was not addressed at the index operation. - You are active and want to preserve native-joint function rather than commit to an implant in your 30s, 40s, or 50s. Joint preservation decisions are complex because the right operation depends on alignment, cartilage status, ligament status, meniscus status, prior surgery, age, BMI, and patient activity goals. Two patients with apparently similar imaging can end up with different operations because of these contextual factors. A sub-specialty second opinion does not always change the recommendation — but it does ensure the recommendation is built on the right framework. ## Access & Office Location Dr. Strickland sees joint preservation patients at one office, which works with patients traveling in from outside the immediate area: - New York City: NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY 10016. Midtown Manhattan, accessible from Manhattan, the outer boroughs, Long Island, Westchester, and northern New Jersey via the Queensboro and Triboro bridges and the FDR Drive. Phone: 646-904-4664. Many patients travel to New York for joint preservation sub-specialty care — particularly for revision TTO, complex combined cartilage-plus-osteotomy cases, MISHA candidacy evaluations, and second opinions on early replacement recommendations. Surgery is performed at NYU Langone. We coordinate consultation, imaging review, and surgery scheduling to minimize travel for out-of-state patients. ## Frequently Asked Questions What is joint preservation surgery? Joint preservation is the surgical philosophy of correcting the mechanical reason a knee is failing rather than replacing the joint. The toolkit includes alignment correction (TTO, HTO, DFO), cartilage repair (MACI, OATS, osteochondral allograft, CartiHEAL), ligament reconstruction (MPFL, ACL), the MISHA implantable shock absorber, and biologic adjuncts. The unifying idea is that for many younger active patients told they need a knee replacement, the actual problem is one compartment getting more force than it was designed to handle while the rest of the joint is still working — and correcting the alignment, instability, or focal cartilage damage can preserve the native joint for another decade or more. What is an AMZ-TTO (Fulkerson osteotomy)? Anteromedialization tibial tubercle osteotomy — also called the Fulkerson osteotomy — repositions the bony attachment of the patellar tendon on the tibia anteriorly and medially. This shifts patellofemoral contact away from worn cartilage on the lateral facet of the patella and corrects lateral patellar tracking. Dr. Strickland's published cadaveric model of patellofemoral dysplasia quantified that AMZ-TTO improves patellar contact forces compared with pure medialization, providing biomechanical support for the technique. AMZ-TTO is one of the most common patellar realignment operations and is frequently combined with MPFL reconstruction or cartilage repair on the patella. What is a distalization TTO? A distalization TTO addresses patella alta — a kneecap that sits too high in the trochlear groove. By moving the bony attachment of the patellar tendon distally on the tibia, the patella is brought down to a normal height where it engages the trochlea earlier in flexion. Patella alta is a recognized risk factor for patellar instability and patellofemoral cartilage damage. Patellar height is measured on the Caton-Deschamps index. Distalization is often combined with anteromedialization (anteromedialization-distalization TTO) and with MPFL reconstruction. What is a high tibial osteotomy (HTO)? An HTO shifts the mechanical axis of the leg off a worn medial compartment onto the healthier lateral compartment. The classic indication is an active patient under 60 with isolated medial compartment cartilage wear, varus alignment, and intact ligaments. The medial opening wedge HTO is the most common technique today: the bone is cut from the medial side, opened like a book, and a wedge of graft or substitute is placed in the gap, then fixed with a locking plate. For the right patient, HTO can delay knee replacement by a decade or more while preserving the native joint and athletic function. What is the MISHA Knee System? The MISHA Knee System (Moximed) is an FDA-approved extra-articular implantable shock absorber for medial compartment knee osteoarthritis. It is placed on the medial side of the knee, outside the joint capsule, and mechanically reduces the load and pain on the medial compartment without altering the joint surfaces. Recovery is faster than osteotomy or replacement because there is no bone cut, and the device can be removed if needed. Dr. Strickland evaluates MISHA candidacy at NYU Langone; her husband Dr. Andreas Gomoll participated in the FDA clinical trials that led to its approval. Why is osteotomy combined with cartilage repair so often? Cartilage repair done in a malaligned knee will not last. The same forces that destroyed the original cartilage will destroy the repair. Realigning the knee with an osteotomy at the same operation as the cartilage repair (or staged) protects the repair and gives it the best chance of long-term success. Common combinations include MACI plus AMZ-TTO for patellar or trochlear cartilage lesions with maltracking, MACI or OATS plus HTO for medial femoral condyle defects with varus alignment, and MACI or OATS plus DFO for lateral femoral condyle defects with valgus alignment. What about revision tibial tubercle osteotomy? Revision TTO addresses a prior failed or symptomatic tubercle osteotomy. Reasons for revision include malposition, nonunion, iatrogenic patella baja, or persistent patellar maltracking despite a prior procedure. Dr. Strickland has published a case report on arthroscopic revision after TTO and has presented HSS Grand Rounds on revision TTO returning a young athlete to sport. Revision osteotomy is technically more complex than primary because of prior hardware, scar tissue, and altered anatomy — one of the situations where a sub-specialty referral materially changes the operative plan. What is the recovery time? Bone healing dictates the timeline. TTO patients are on protected weight-bearing for 6 weeks; HTO and DFO 6 to 8 weeks. Off crutches at 6 to 10 weeks. Strengthening through 4 to 5 months. Return to running at 6 to 9 months (TTO) or 9 to 12 months (HTO, DFO). Return to pivot or contact sport at 9 to 12 months. Full bone healing takes 12+ months. The leg often feels good well before the bone is healed — that timeline is not negotiable. MISHA recovery is faster because there is no bone cut: most patients are back to daily activity at 6 to 8 weeks and to sport by 4 to 6 months. What are the risks of osteotomy? Osteotomy risks include nonunion (more likely with smoking or uncontrolled diabetes), malunion, hardware irritation requiring removal, neurovascular injury, iatrogenic patella baja after distalization TTO, fracture of shingle or tibia, infection, blood clots, persistent pain, anesthesia-related risks, and the need for additional surgery. The single biggest predictor of a good outcome is patient selection — the right operation in the right patient. The second is patient adherence to the bone-healing timeline rather than rushing weight-bearing or activity. I was told I need a knee replacement — should I get a second opinion? If you are under 60, active, and the recommendation was based on imaging that shows isolated single-compartment damage, alignment that has not been corrected, patellar maltracking, or focal cartilage damage rather than diffuse multi-compartment arthritis — yes, it is worth asking the question. Not every patient who walks in with a replacement recommendation is a preservation candidate, but a meaningful percentage are. Dr. Strickland describes many of her patients as ‘young people with old knees’. Bringing your imaging to a sub-specialty consultation is the right starting point. Where is joint preservation surgery performed in New York? Dr. Strickland performs the full joint preservation menu — AMZ-TTO, distalization TTO, revision TTO, HTO, DFO, MISHA implantation, and concurrent cartilage repair, MPFL reconstruction, ACL reconstruction, and meniscus surgery — at NYU Langone Orthopedic Center in New York City. Patients travel from New York, Connecticut, New Jersey, and across the region. Consultations and surgery take place at NYU Langone Orthopedic Center in Midtown Manhattan. ## Source Grounding & Published Research This page is grounded in Dr. Strickland's published commentary, cadaveric biomechanical research, technical case reports, HSS Grand Rounds presentations, and patient education on joint preservation surgery. Selected references: TopicSource Joint preservation philosophyWhat is joint preservation and who is it for? AMZ-TTO biomechanics (cadaveric)Anteromedialization TTO improves patellar contact forces: a cadaveric model of patellofemoral dysplasia Distalization TTO for patella altaTibial tubercle osteotomy with distalization for the treatment of patella alta TTO overviewTibial tubercle osteotomy / tibial tubercle transfer Revision TTO — case reportCase report: arthroscopy + revision TTO for a 16-year-old female lacrosse player Revision TTO — HSS Grand RoundsGrand Rounds from HSS: revision TTO returns young athlete to sports MPFL + TTOMPFL reconstruction + tibial tubercle osteotomy · MPFL reconstruction + TTO — common patient questions Patient case — Peyton's TTOPeyton's tibial tubercle osteotomy Patient case — lifeguard / dual osteotomiesDual tibial osteotomy surgeries to get back to lifeguarding MISHA Knee System — FDA approvalMISHA Knee System for knee osteoarthritis MISHA in US patientsMISHA Knee System treats US patients · Moximed MISHA Knee System for patients in the United States Patellofemoral preservation vs PF arthroplastyConsiderations for patellofemoral joint preservation vs patellofemoral arthroplasty Bio & publicationsDr. Strickland bio · research & publications ## Related Specialty Care For the cartilage-repair side of joint preservation — commonly combined with osteotomy — see MACI cartilage repair and cartilage transplant (OATS & osteochondral allograft). For the soft-tissue side of patellar realignment, see MPFL reconstruction surgery. For the broader patellar instability picture (often combined with AMZ-TTO), see patellar instability. For patellofemoral pain or arthritis, see patellar pain and patellofemoral arthritis. For meniscus-deficient compartments where root repair or transplant is part of the joint preservation plan, see meniscal tear and torn meniscus. For revision ACL where alignment correction is part of the plan, see ACL tear surgery. For multi-compartment knee arthritis where joint preservation is no longer feasible, see knee arthritis. For complex anatomy where computer-guided planning is helpful, see Mako robotic-assisted surgery. For Dr. Strickland's published research and editorial commentary on joint preservation, the source-grounding table above lists the references used on this page; for the broader publication record, see research & publications. Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Surgical and non-surgical orthopedic care should always be discussed with a board-certified orthopedic surgeon who has reviewed your imaging, history, and physical examination. Individual outcomes vary based on diagnosis, anatomy, comorbidities, surgical technique, concurrent procedures, and adherence to rehabilitation. Joint preservation procedures can delay or in some cases avoid the need for joint replacement in well-selected patients, but no surgery is a guaranteed permanent fix and durability of the alignment correction depends on patient factors including activity, weight, smoking status, and the cartilage and ligament status of the knee at the time of surgery. The MISHA Knee System is FDA-approved for medial compartment knee osteoarthritis; candidacy and outcomes vary by patient. Patient cases referenced on this page are representative of the patient population seen in Dr. Strickland's joint preservation practice; individual patient outcomes vary. ## Discuss Joint Preservation with Dr. Strickland If you have been told you need a knee replacement and you want to know whether realignment osteotomy, the MISHA implant, cartilage restoration, or a combined preservation approach is an option for your case — bring your imaging to a sub-specialty consultation at NYU Langone in Midtown Manhattan. Book an Appointment Call 646-904-4664 --- ## Knee Arthritis Treatment NYC | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/knee-surgeon-specialist/knee-arthritis/ Summary: Knee arthritis (osteoarthritis, rheumatoid arthritis, post-traumatic arthritis) evaluated by Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York — structured non-surgical care, biologic injections, joint-preserving osteotomy, the MISHA implantable shock absorber, and partial or total knee replacement (Mako robotic-assisted) when appropriate. Specialty # Knee Arthritis: Osteoarthritis, Rheumatoid & Post-Traumatic Sub-specialty evaluation and treatment of all three forms of knee arthritis — from structured non-surgical care and biologic injections through joint-preserving osteotomy, the MISHA implantable shock absorber, and partial or total knee replacement (Mako robotic-assisted) when appropriate. With Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York. Medically reviewed by Dr. Sabrina Strickland, MD — Orthopedic Surgeon at the NYU Langone Orthopedic Center in New York. View full bio → Where NYU Langone Orthopedic Center, Midtown Manhattan Patients We See NY, NJ, CT, and out-of-state patients across the full arthritis spectrum — non-surgical through revision Philosophy Joint preservation when appropriate — replacement when necessary Overview Three distinct conditions are grouped under "knee arthritis." Osteoarthritis (OA) is mechanical wear-and-tear cartilage thinning. Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that attacks the joint and is co-managed with rheumatology. Post-traumatic arthritis develops months to decades after a knee injury (ACL tear, meniscus injury, intra-articular fracture, or prior surgery) and behaves like OA but in a younger, often more active patient. Treatment is matched to the type, distribution, and severity: structured PT, weight optimization, NSAIDs, and selective injections (cortisone, hyaluronic acid, PRP, BMAC) for first-line care; joint-preserving surgery — osteotomy, the MISHA implantable shock absorber, cartilage repair — for selected patients with isolated compartment disease; and partial or total knee replacement (Mako robotic-assisted when indicated) for end-stage arthritis. Dr. Sabrina Strickland evaluates these patients across the full spectrum at NYU Langone Orthopedic Center in New York and tailors the plan to the individual — with a sub-specialty interest in joint preservation before replacement. "You have arthritis" is one of the most common diagnoses delivered in an orthopedic office, and one of the most often misunderstood. Arthritis is not a single disease — it is the end-stage of several different processes that can damage the same joint. Treatment, prognosis, and the right next step depend on which kind of arthritis you have, where in the knee it is, how much it is limiting you, and how much native joint there is left to preserve. The goal of this page is to give you a clear framework for understanding which of the three main types of knee arthritis you may have, what the non-surgical options actually are (and what they actually do), what joint-preserving options exist, and when knee replacement is — and is not — the right answer. This page covers the three types of arthritis and how they differ; how arthritis feels and is diagnosed; the non-surgical treatment ladder and the orthobiologic injections; joint preservation (osteotomy, MISHA, cartilage repair) before replacement; partial vs. total knee replacement and Mako robotic-assisted technique; special considerations for rheumatoid and post-traumatic arthritis; prehabilitation and what to expect; insurance and cost; honest framing of emerging treatments and ongoing research; and when to seek a sub-specialty second opinion. For closely related procedures, see joint preservation and osteotomy for HTO and DFO, MACI and cartilage transplantation for focal cartilage defects, patellofemoral arthritis for kneecap-specific disease, meniscal surgery in arthritic knees, Mako robotic-assisted partial and total knee replacement, and PRP and regenerative medicine for orthobiologic injection details. ## The Three Types of Knee Arthritis #### Osteoarthritis (OA) The most common type. Cartilage thins from a combination of age, genetics, alignment, and load. Often begins in the 40s, 50s, or 60s. Typically affects the medial compartment first in patients with varus alignment, the lateral in valgus, or the patellofemoral compartment in patients with kneecap maltracking. Progressive over years. #### Rheumatoid Arthritis (RA) An inflammatory autoimmune disease in which the body attacks the joint (synovium). Typically affects multiple joints symmetrically, with prolonged morning stiffness, fatigue, and systemic features. Co-managed with rheumatology — surgical care addresses joint damage that has already occurred and is coordinated with the medical regimen. #### Post-Traumatic Arthritis Develops months to decades after a knee injury — ACL tear, meniscus tear, intra-articular fracture, or prior knee surgery. Behaves like OA but in a younger, often more active patient. Joint-preserving options (osteotomy, MISHA, cartilage repair) are particularly relevant in this group. The distinction matters because the treatment plan looks different for each. OA is approached compartment-by-compartment with mechanical solutions (offload, preserve, replace). RA is primarily a medical disease that may also need surgical care for damaged joints. Post-traumatic arthritis sits closest to OA in its mechanical management but is more likely to land in the joint-preservation conversation because of patient age and activity level. ## How Knee Arthritis Feels Patients describe arthritis pain in surprisingly consistent terms across the three types — though the rhythm differs: - A deep aching pain in the joint, often worse at the end of the day or after activity - Stiffness in the morning or after sitting. RA stiffness typically lasts longer — over an hour — while OA stiffness usually loosens within 15–30 minutes once the joint gets moving - Pain with activity — walking, stairs, getting up from a chair, prolonged standing, descending hills - Swelling that comes and goes, particularly after activity flares - Reduced range of motion — often loss of full extension or full deep flexion - Crepitus — clicking or grinding with motion - Bowing of the leg in advanced medial-compartment OA, or knock-knee deformity in advanced lateral-compartment OA - Buckling or "giving way" — usually from quadriceps inhibition rather than true ligamentous instability - Night pain in advanced disease — pain that wakes the patient and disrupts sleep - Gait changes — a painful limp, shorter stance phase on the affected side, or guarding that the patient does not consciously recognize Symptoms typically progress over years, not weeks, with periods of relative stability interrupted by flares. A sudden change — a new mechanical catching, locking, or rapid swelling — deserves imaging and may indicate a new mechanical problem on top of underlying arthritis. ## Who Develops Each Type ### Osteoarthritis OA is driven by some combination of age, genetics, alignment, and load. A 60-year-old with bowed alignment, a labor-intensive job, and a body weight 30 pounds over baseline is at high risk. So is a younger patient with congenital varus, repeated impact loading from sport, and family history. OA is less about a single cause and more about cumulative load on a particular compartment over years. ### Rheumatoid Arthritis RA is fundamentally an autoimmune disease. The body's immune system mistakenly attacks the synovial lining of joints, producing inflammation that destroys cartilage and bone. RA typically affects multiple joints symmetrically, often involves the hands and wrists prominently, and is associated with positive serology (rheumatoid factor, anti-CCP) and elevated inflammatory markers. RA is diagnosed and managed primarily by a rheumatologist; orthopedic care addresses the structural damage that has already occurred. ### Post-Traumatic Arthritis Post-traumatic arthritis develops in a knee that has been previously injured. Common predecessors include ACL tear (particularly when meniscus is also injured), meniscectomy, intra-articular fracture (tibial plateau, distal femur), patellar dislocation with osteochondral injury, and prior knee surgery. The mechanical biology is OA-like — cartilage thinning, subchondral changes, osteophytes — but the population is younger and more active, which is precisely the population where joint-preserving options (osteotomy, MISHA, cartilage repair) deserve careful consideration. For more on the relationship between ACL injury and arthritis risk, see ACL surgery: what raises arthritis risk?. ## How the Diagnosis Is Made ### History and Physical Exam Pain pattern (location, character, time course), prior knee injuries or surgeries, family history of arthritis, systemic symptoms (morning stiffness duration, fatigue, other joint involvement) that may suggest inflammatory arthritis, current activity level, body weight, and what has and has not been tried. The exam includes range of motion, alignment in standing, gait, joint-line tenderness, effusion assessment, ligamentous stability, patellar tracking, and a sense of which compartment is the dominant problem. ### Imaging - Standing weight-bearing x-rays — the cornerstone of arthritis diagnosis. Reveal joint-space narrowing (the radiographic hallmark of cartilage loss), osteophytes, subchondral sclerosis, and subchondral cysts. Standing films are essential because non-weight-bearing films underestimate joint-space loss - Long-leg standing alignment films — quantify the mechanical axis. Required when osteotomy or partial replacement is being considered - Merchant or skyline view — assesses the patellofemoral compartment - MRI — not always needed for end-stage arthritis, but useful for evaluating cartilage detail in earlier disease, assessing the meniscus, ruling out a focal cartilage defect amenable to repair, and looking for a co-existing mechanical problem - Laboratory workup — rheumatologic labs (RF, anti-CCP, ESR, CRP, ANA) when inflammatory arthritis is suspected. RA is fundamentally a medical diagnosis ## The Treatment Ladder Dr. Strickland's practice spans the entire knee-arthritis treatment spectrum — from first-line conservative care to joint replacement — with a sub-specialty interest in joint preservation before replacement. The ladder below is the sequence most patients move through over time, but the right step for a given patient depends on the type, stage, and distribution of disease, the patient's age and goals, and what has already been tried. StepWhenWhat it addresses Lifestyle & PTFirst-lineWeight optimization, quadriceps and hip strength, low-impact substitution, activity modification MedicationsFirst-lineNSAIDs (oral and topical), acetaminophen for additional analgesia BracingSelectiveOffloader brace for unicompartmental OA with correctable alignment InjectionsSelectiveCortisone, hyaluronic acid, PRP, BMAC Joint preservationYounger / active patients with isolated diseaseOsteotomy (HTO/DFO), MISHA, cartilage repair (MACI/OATS) Partial replacement (UKA)Single-compartment end-stage OAResurface only the worn compartment; preserve native ligaments Total replacement (TKA)Multi-compartment end-stage OA, severe deformityResurface all three compartments RevisionFailed prior replacementAddress loosening, instability, infection, malalignment The order of operations in arthritis is not rigid. A patient with an isolated focal cartilage defect on MRI may benefit more from MACI than from another round of injections. A 55-year-old with isolated medial compartment OA, varus alignment, and high activity demands may benefit more from HTO or MISHA than from progression along the injection ladder. The point of the ladder is to give patients a clear framework — not to force every patient through every rung. ## Non-Surgical First-Line Care The vast majority of knee arthritis patients live with their arthritis for years before reaching a surgical decision. Effective non-surgical care can preserve quality of life and delay or avoid surgery in many patients. 1 #### Activity modification and weight optimization Substitute lower-impact activities (cycling, swimming, elliptical, walking on level ground) for higher-impact ones. Each pound of body weight loads the knee 4–6 times over with each stair step — meaningful weight loss is one of the highest-leverage interventions in OA. 2 #### Structured physical therapy Quadriceps and hip-stabilizer strengthening, range-of-motion preservation, gait training, and proprioception. Strong quadriceps offload the joint and reduce pain in OA. The most under-executed step in arthritis care. 3 #### NSAIDs and topical agents Oral NSAIDs (ibuprofen, naproxen, celecoxib) for inflammatory control during flares when not contraindicated. Topical NSAIDs (diclofenac gel) for localized symptom relief with fewer systemic effects. Acetaminophen for additional analgesia. 4 #### Bracing An offloader brace can shift load away from a worn medial or lateral compartment and provide meaningful symptom relief in selected patients with unicompartmental OA and good alignment correction with the brace on. 5 #### Selective injection therapy Cortisone for flares, hyaluronic acid for sustained symptom relief in selected patients, PRP and BMAC for biologic treatment for patients seeking to delay further intervention. Detailed in the next section. 6 #### Sleep, stress, and overall health Sleep quality, stress, smoking, and overall metabolic health all influence pain perception and joint inflammation. These are not "extras" — they often distinguish patients who do well non-operatively from those who progress quickly to surgery. ## Orthobiologic Injections Explained InjectionWhat it isBest forTypical duration CortisoneAnti-inflammatory steroidAcute flares, end-stage arthritis with inflammatory componentWeeks to a few months Hyaluronic acid (viscosupplementation)Joint-lubricant supplement (Synvisc, Euflexxa, Orthovisc, others)Mild to moderate OA in selected patientsSeveral months in responders PRP (platelet-rich plasma)Concentrated platelets from your own blood; delivers growth factorsMild to moderate OA, biologic treatment for patients seeking to delay further interventionSeveral months to a year in responders BMAC (bone marrow aspirate concentrate)Bone marrow drawn from the iliac crest, concentrated, and injected. Contains stem-cell-rich fractionSelected joint-preservation candidates with mild to moderate diseaseMonths to a year in responders Important caveats: none of these injections regrow cartilage in any clinically meaningful way that has been demonstrated in well-controlled human studies. What well-selected patients can get is meaningful symptom relief that delays the need for further intervention. Response rates are higher in earlier disease and in patients without significant alignment issues. The right injection is matched to the patient and the stage of disease — not chosen by patient request alone. For more detail on PRP and stem-cell options, see PRP and regenerative medicine. ## Joint Preservation Before Replacement For patients with isolated compartment arthritis, intact ligaments, and good range of motion — particularly younger or more active patients — joint-preserving surgery can delay or sometimes avoid joint replacement entirely. This is Dr. Strickland's sub-specialty differentiator: she sees patients across the whole arthritis spectrum but actively pursues joint preservation when it is the right answer rather than defaulting to replacement. ### Osteotomy (HTO and DFO) High tibial osteotomy (HTO) and distal femoral osteotomy (DFO) are controlled cuts and repositions of the tibia or femur that shift the mechanical axis of the leg from the worn compartment toward the healthy one. HTO is used for medial compartment arthritis with varus alignment; DFO is used for lateral compartment arthritis with valgus alignment. Best in younger, active patients who want to delay or avoid replacement. Recovery is several months for return to most activity. See joint preservation and osteotomy for the full procedure walk-through. ### Cartilage Repair For focal cartilage defects (not diffuse arthritis), cartilage-restoration procedures — MACI, OATS, or osteochondral allograft — can resurface a defined area of damage. These are not solutions for end-stage diffuse arthritis but are powerful tools for the right patient with a focal lesion in an otherwise preserved joint. Many patients with post-traumatic arthritis have a focal lesion that drives most of their symptoms and that responds well to cartilage repair. See cartilage transplantation (OATS & allograft) for details. ### Patellofemoral arthritis Arthritis isolated to the patellofemoral compartment (the front of the knee, behind the kneecap) has its own treatment considerations. Patellofemoral OA can sometimes be addressed with cartilage repair, with patellofemoral-specific partial replacement, or with realignment procedures — rather than total knee replacement. For the dedicated discussion, see patellar pain and patellofemoral arthritis. ### Arthroscopy in the arthritic knee Arthroscopy is not a treatment for arthritis itself, but it can address mechanical symptoms in an arthritic knee — loose-body removal, debridement of a torn meniscus contributing to mechanical catching — in carefully selected cases. See meniscal tear surgery for how meniscus repair vs. partial meniscectomy fits in OA-prone knees. ## The MISHA Implantable Shock Absorber The MISHA Knee System (Moximed) is an FDA-approved implantable shock absorber for medial-compartment knee osteoarthritis. It is placed outside the joint, between the femur and tibia on the medial side, where it absorbs and redistributes load away from the worn medial compartment. MISHA does not violate the joint surface, does not remove bone the way an osteotomy does, and is reversible — it can be removed if a patient ultimately progresses to joint replacement. For background on the system itself, see the MISHA Knee System overview. MISHA is one of several joint-preserving alternatives for patients who: - Have medial compartment osteoarthritis as the dominant problem - Are not yet ready for partial or total knee replacement — either because of age, activity level, or personal preference - Want to preserve their native joint and keep replacement as a future option - Meet the candidacy criteria on imaging and exam Whether MISHA is appropriate depends on the specific anatomy, alignment, and goals of the individual patient and is reviewed at consultation alongside the alternatives (HTO, partial replacement, continued non-operative care). ## Partial Knee Replacement (UKA) Partial (unicompartmental) knee replacement resurfaces only the worn compartment of the knee — medial, lateral, or patellofemoral — while preserving the other compartments and both cruciate ligaments. For the right patient (isolated compartment disease, intact ligaments, minimal disease elsewhere), partial replacement provides a more "natural" feeling knee for many patients and a faster recovery than total knee replacement. Some patients with bilateral isolated medial compartment disease are candidates for double partial knee replacements; for one example, see this discussion of double partial knee replacements. Partial replacement is technically more demanding than total replacement — precision matters more because the implant has to integrate with intact native compartments and ligaments. This is one of the procedures where Mako robotic-assisted surgery has a particularly clear technical contribution. ## Total Knee Replacement (TKA) Total knee replacement resurfaces all three compartments of the knee. It is the right answer for advanced multi-compartment arthritis, severe deformity, ligamentous deficiency that cannot be addressed with a partial, and revision settings. Modern TKA implants and techniques have excellent long-term durability when matched to the right patient. For patients preparing for knee replacement, see Dr. Strickland's patient education on what to do before knee replacement surgery and what to worry about when undergoing a knee replacement — structured walkthroughs of the realistic expectations, timeline, and trade-offs. ## Robotic-Assisted Knee Replacement Mako robotic-assisted surgery enables sub-millimeter accuracy in implant placement and ligament balancing. The surgeon plans the operation on a 3D model of the patient's specific anatomy, and the robotic arm helps execute the bone cuts and implant positioning within that plan. The benefit is most clear in partial knee replacement, where precision matters disproportionately. In total knee replacement, robotic assistance helps with alignment and balance. Robotic assistance is a tool, not a substitute for surgeon experience or patient selection — the long-term outcome literature is still maturing. For the dedicated walk-through, including what to expect on a Mako case, see Mako robotic-assisted surgery. ## Rheumatoid Arthritis — Special Considerations Rheumatoid arthritis is fundamentally a medical disease — the foundation of treatment is rheumatologic management with disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, biologics (TNF inhibitors and others), and inflammation-control regimens. Surgical care for the knee in RA addresses joint damage that has already occurred and is coordinated with the rheumatologist's medical regimen. Several practical points for RA patients facing knee surgery: - Disease control before elective surgery — well-controlled RA is associated with better surgical outcomes and lower complication rates. Active flare is generally not the time for elective replacement - Medication management around surgery — many DMARDs and biologics need to be held briefly around the surgical date to reduce infection risk; this is coordinated with the rheumatologist using established perioperative guidelines - Soft-tissue and bone considerations — chronic inflammation in RA can produce thinner soft-tissue envelopes and softer bone, which influences technique and implant choice - Multiple-joint planning — RA often involves several joints, and the order of operations may need to be considered (lower extremity often before upper extremity if both need work, etc.) - Joint replacement remains highly successful in RA when timed appropriately and when systemic disease is well controlled ## Post-Traumatic Arthritis — Special Considerations Post-traumatic arthritis presents in a younger, often more active patient than typical OA. The same compartment-by-compartment mechanical principles apply, but the planning is different: - Often single-compartment — particularly the medial compartment after meniscectomy or ACL injury. This makes joint-preservation and partial replacement more often relevant than in older OA - Prior surgical hardware — ACL graft tunnels, ORIF hardware from a prior fracture, or other implants may need to be considered or removed in the surgical plan - Alignment — trauma to the lateral tibial plateau, malunion of a prior fracture, or chronic ACL deficiency can produce alignment issues that are part of the disease and need to be addressed - Activity goals — younger post-traumatic OA patients often want to preserve high-impact activity, which favors joint-preserving options when feasible - The young-patient tradeoff — replacement at a younger age is highly successful but more likely to need revision later in life simply because the patient lives longer with the implant For the link between ACL injury and arthritis risk, see ACL surgery: what raises arthritis risk? For the broader sport-and-knee context, see Dr. Strickland's discussion of knee injuries, arthritis, and skiing. ## Prehabilitation Whether the surgery is osteotomy, MISHA, partial knee replacement, or total knee replacement, what happens before the operation matters. Patients who arrive at surgery with full or near-full range of motion, minimal swelling, and good quadriceps activation have substantially better post-operative outcomes than patients who arrive with a stiff, swollen knee and inhibited quadriceps. Prehabilitation includes: - Range of motion preservation — particularly full extension - Effusion control - Quadriceps activation — early termination of quadriceps shutdown reduces post-op recovery time - Weight optimization — even modest pre-op weight loss reduces complication risk and improves the post-op trajectory - Cardiovascular conditioning in patients who will need general or spinal anesthesia - Education on the post-operative protocol so the patient hits the ground running - Medical optimization — diabetes control, smoking cessation, dental clearance, and other modifiable factors that influence infection risk For patients with rheumatoid arthritis, prehabilitation also includes coordination with the rheumatologist on biologic-medication timing. For more, see what to do before knee replacement surgery. ## What to Expect on Surgery Day Specifics vary by procedure (joint-preserving surgery, MISHA, partial replacement, total replacement) and your protocol is individualized at consultation. The general patient experience for knee replacement is: - Arrival and pre-op — you arrive a couple of hours before the procedure for intake, change into a gown, and meet the anesthesia team - Anesthesia consultation — for Dr. Strickland's knee replacements, the plan is spinal anesthesia with sedation combined with a periarticular block placed around the knee joint during surgery. Dr. Strickland does not use general anesthesia or femoral/adductor-canal nerve blocks. The periarticular block helps reduce post-operative pain during the first day after surgery and is part of an opioid-sparing pain protocol. - Surgery — the procedure itself typically takes 1 to 2 hours depending on the operation and any concurrent work - Recovery room — you wake up in the recovery area; for outpatient cases, physical therapy starts the same day with assisted weight-bearing - Going home or admitting — many partial and total knee replacements are now performed on an outpatient or short-stay basis; some patients (older patients, those with significant comorbidities, those without home support) admit overnight or for 1–2 days - First 48 hours — ice, elevation, prescribed medications, gentle motion as instructed. The first week's focus is effusion control, motion, and quadriceps activation The block typically wears off over the first 12 to 24 hours, during which the leg is numb and weight-bearing requires the brace and walker because the leg is not protecting itself normally. This is expected and is the trade-off for the lower pain levels in that first day. ## Recovery Timelines Recovery differs by procedure. The timelines below are typical — your individual timeline depends on your starting point, the specific procedure, your adherence to PT, and your goals. ProcedureWalker / caneDrivingMost daily activityFull recovery Cortisone / HA / PRPNoneSame dayDaysN/A Arthroscopy / debridementFew days1–2 weeks2–4 weeks2–3 months HTO / DFO osteotomy4–6 weeks protected6–8 weeks3–4 months6–9 months MISHA implantFew weeks2–4 weeks4–6 weeks3–6 months Partial knee replacement (UKA)1–2 weeks2–4 weeks4–6 weeks3–6 months Total knee replacement (TKA)2–4 weeks4–6 weeks2–3 months9–12 months Patients consistently underestimate the role of structured PT in recovery. Skipping or shortening PT does not save time — it almost always extends the recovery and increases the risk of stiffness, particularly after total knee replacement. ## Risks of Knee Replacement Knee replacement is a well-established surgery with predictable outcomes for most patients, but no surgery is risk-free. The risks reviewed at consultation include: - Infection — including periprosthetic joint infection. Uncommon (typically <1–2%) but a serious complication if it occurs. Modern protocols include preoperative skin decolonization, perioperative antibiotics, and stringent intraoperative protocols - Blood clot (DVT and pulmonary embolism) — risk is mitigated by early mobilization, mechanical compression, and individualized chemoprophylaxis - Joint stiffness — reduced by good prehabilitation, structured PT, and addressing any motion deficit early - Implant loosening or wear — over years to decades. Modern implants are designed to last 15–20+ years for most patients - Periprosthetic fracture — uncommon, more relevant in older patients with osteoporosis or after high-energy trauma - Persistent pain — a small subset of patients have ongoing knee pain after a technically successful replacement. Pre-existing chronic pain conditions, central sensitization, and patient-specific factors contribute - Need for revision — some patients require revision surgery years later. Younger and more active patients are statistically more likely to need revision in their lifetime simply because they live longer with the implant - Anesthesia-related risks — including nausea, allergic reactions, nerve irritation or injury from the block, and rare cardiac or respiratory complications For the patient-facing walkthrough, see what to worry about when undergoing a knee replacement. The specific risk profile for your case depends on your age, weight, medical history, the type of arthritis, the procedure planned, and prior surgery on the knee. ## Common Patient Concerns The three concerns we hear most often before knee arthritis surgery, with honest answers: #### "I'm too young for a knee replacement." This is one of the more important conversations on this page. Many patients in their 40s and even 50s arrive having been told the same. The honest answer is that some patients in their 40s genuinely benefit from joint-preserving alternatives (HTO, DFO, MISHA, partial replacement) rather than total knee replacement — and some patients in their 40s or even 30s have arthritis advanced enough that partial or total replacement is the best answer despite their age. The right decision is made compartment-by-compartment with imaging in front of you, alignment films, an honest conversation about activity goals, and a clear walk-through of every option — not by age alone. #### "How long will the implant actually last?" Modern partial and total knee replacements are designed to last 15–20+ years for most patients. Implant longevity depends on patient factors (age at surgery, weight, activity level), implant design and materials, surgical technique (alignment and ligament balance), and ongoing factors over the years. Younger and more active patients are statistically more likely to need a revision in their lifetime simply because they live longer with the implant — which is part of why joint-preserving alternatives are particularly worth considering in younger patients. #### "I'm scared of pain and of getting hooked on opioids." Dr. Strickland's knee replacement protocol uses multimodal pain management — spinal anesthesia with sedation, a periarticular block placed around the knee joint during surgery to help reduce pain during the first day after surgery, scheduled non-opioid medications (acetaminophen and an anti-inflammatory unless contraindicated), ice, and elevation. Most patients use only a small number of opioid pills for breakthrough pain in the first few days, and many are off opioids entirely within the first week or two. The periarticular block and the multimodal approach are specifically designed to minimize the role of opioids in your recovery. ## Insurance and Cost Evaluation and treatment of knee arthritis — including imaging, injections, and surgical care when medically necessary — are covered by all major commercial insurance plans, Medicare, and most self-funded and union plans. Knee replacement, partial replacement, osteotomy, and cartilage repair are recognized medical-necessity procedures when the diagnosis and indication meet plan criteria. The variables that drive your specific out-of-pocket cost are: - Your plan's deductible and coinsurance — the structure of cost-sharing differs significantly between plans - In-network vs. out-of-network status — for the surgeon, the facility (NYU Langone or affiliated outpatient surgery center), and the anesthesia group - The bundled vs. separate billing for the surgeon, facility, anesthesia, imaging, physical therapy, and any concurrent procedures - Coverage of specific biologics — cortisone is universally covered; hyaluronic acid is generally covered with prior authorization; PRP, BMAC, and other regenerative injections are not covered by commercial insurance and may be self-pay - MISHA, osteotomy, and joint replacement coverage — covered as medically necessary when criteria are met; we obtain pre-authorization where required Before any procedure, our office verifies your benefits, obtains pre-authorization where required, and reviews the estimated out-of-pocket cost with you. If your plan doesn't cover a specific aspect, we discuss it openly before the procedure, not after. For benefits verification or to discuss self-pay arrangements, call us at 646-904-4664 or contact the office. ## Emerging Treatments — Honest Framing Knee arthritis is a high-interest research area, and patients regularly ask about treatments they have read about or seen on the news. None of the following are standard of care for knee arthritis — they are research-stage or early-clinical — but they are worth knowing about, and Dr. Strickland follows the evidence on each: - "Dancing molecules" — Northwestern researchers have shown that mobile, peptide-based scaffolds can support cartilage and bone regeneration in animal models. See the explainer on the Northwestern dancing-molecules research. The work is genuinely promising; it has not yet translated into a human treatment. - Sea coral / CartiHEAL — an implantable scaffold derived from coral, used to support cartilage regrowth at focal cartilage lesions. Dr. Strickland and HSS have been involved in clinical use of this technology; see the CBS News piece on sea coral and knee osteoarthritis for the patient-facing overview. This is closer to clinical practice than most items on this list, in selected indications. - Stanford research on knee arthritis prevention and treatment — pathway-targeting research aimed at slowing or reversing OA progression. See Stanford research on knee arthritis treatment. Research-stage. - Reversible osteoarthritis — preclinical work suggesting OA may be more "treatable and reversible" than previously believed. See new study showing osteoarthritis may be treatable and reversible. Mouse-model results, not human treatment. - "Potential cure" research — including green tea polyphenols, gall nut, and other plant-derived compounds being investigated for cartilage protection. See research on potential cures for arthritis: green tea and gall nut and research on potential cures for arthritis. Research-stage; not a substitute for evidence-based care today. - Prevention research — researchers continue to look for the upstream "key" to OA prevention. See have researchers found the key to OA prevention? Promising, not yet clinical. - Amniotic suspension allograft (ASA) injections — an injectable amniotic-tissue-derived product being studied for knee OA. See the ASA injection research study for the protocol details. Investigational. None of the above is offered or recommended as a substitute for evidence-based care today. The point of including them is that patients deserve a surgeon who reads the literature and gives an honest answer about what is research, what is investigational, and what is standard of care — rather than dismissing every new treatment patients ask about. For Dr. Strickland's broader research interests, see her research and publications. ## When to Seek a Sub-Specialty Second Opinion A sub-specialty second opinion in knee arthritis is particularly worth seeking when: - You have been told you need a total knee replacement but your imaging shows arthritis isolated to one compartment - You are young or active and want a clear answer on joint-preserving options before considering replacement - You have post-traumatic arthritis after a prior ACL, meniscus, or fracture surgery and want to understand whether osteotomy, MISHA, or cartilage repair fits your case - You have had a prior knee replacement that is not performing as expected and are facing revision - You have rheumatoid arthritis and need orthopedic care coordinated with your rheumatology regimen - You want a clear walk-through of all options — non-surgical, joint-preserving, partial, total — rather than a single recommendation - You are weighing a partial vs. total knee replacement and want a precise compartment-by-compartment assessment of your imaging - You have been considering biologic injections (PRP, BMAC) and want an honest assessment of what to realistically expect ## Access & Office Location Dr. Strickland sees knee arthritis patients at one office, which works with patients traveling in from outside the immediate area: - New York City: NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY 10016. In Midtown Manhattan, accessible from Manhattan, the outer boroughs, Long Island, Westchester, and northern New Jersey via the Queensboro and Triboro bridges and the FDR Drive. Phone: 646-904-4664. For patients traveling to New York from out of state for sub-specialty knee arthritis care, we coordinate consultation and surgery scheduling to minimize travel and align with imaging review and pre-operative work-up. Many out-of-state patients travel to NYU Langone specifically for joint-preservation evaluation, MISHA candidacy, partial knee replacement, and joint replacement. ## Frequently Asked Questions What is the difference between osteoarthritis and rheumatoid arthritis of the knee? Osteoarthritis (OA) is mechanical wear-and-tear cartilage thinning, often beginning in the 40s, 50s, or 60s, typically driven by some combination of age, genetics, alignment, and load. Rheumatoid arthritis (RA) is an inflammatory autoimmune disease in which the body's own immune system attacks the joint lining (synovium), causing inflammation, cartilage destruction, and often involvement of multiple joints symmetrically. Post-traumatic arthritis develops months to decades after a knee injury (ACL tear, meniscus tear, intra-articular fracture, or prior surgery) and behaves like OA but in a younger, often more active patient. Can I delay knee replacement? Often, yes. Weight optimization, anti-inflammatory medications, structured exercise focused on quadriceps and hip stabilizer strengthening, cortisone injections, hyaluronic acid, PRP, BMAC (bone marrow aspirate concentrate), and joint-preserving surgery (osteotomy, MISHA implantable shock absorber, cartilage repair) can ease pain and delay replacement in selected patients. The right combination depends on the type and distribution of the arthritis, your alignment, your activity level, and how much your symptoms are limiting you. What are the orthobiologic injection options for knee arthritis? Cortisone provides short-term anti-inflammatory relief and is most useful for flares. Hyaluronic acid (viscosupplementation) acts as a joint lubricant and can ease arthritic pain for several months in selected patients. PRP (platelet-rich plasma) uses your own concentrated platelets to deliver growth factors. BMAC (bone marrow aspirate concentrate) is a stem-cell-rich biologic preparation. None of these regrow cartilage in any clinically meaningful way, but well-selected patients can get meaningful symptom relief that delays the need for further intervention. What is the MISHA implantable shock absorber? The MISHA Knee System (Moximed) is an FDA-approved implantable shock absorber for medial compartment knee osteoarthritis. It is placed outside the joint, between the femur and tibia on the medial side, where it absorbs and redistributes load away from the worn medial compartment. MISHA does not violate the joint surface, does not remove bone the way an osteotomy does, and is reversible — it can be removed if a patient ultimately progresses to joint replacement. It is one of several joint-preserving alternatives for patients who are not yet ready for partial or total knee replacement, who want to preserve their native joint, and who meet the candidacy criteria. When is partial knee replacement an option instead of total? Partial (unicompartmental) knee replacement is appropriate when the arthritis is isolated to one compartment of the knee — most commonly the medial compartment, sometimes the lateral, and occasionally the patellofemoral compartment in isolation — with intact cruciate ligaments and minimal disease in the other compartments. For these patients, partial replacement preserves more native bone and ligament, gives a more "natural" feeling knee for many patients, and is associated with faster recovery than total knee replacement. What is high tibial osteotomy and when is it considered? High tibial osteotomy (HTO) is a controlled cut and reposition of the upper tibia that shifts the mechanical axis of the leg from the worn compartment toward the healthy one. It is considered for younger, active patients with isolated medial compartment arthritis and varus (bow-legged) alignment, where the goal is to delay or avoid joint replacement by offloading the damaged side. Distal femoral osteotomy (DFO) does the equivalent for valgus alignment with lateral-compartment disease. How long does a knee replacement last? Modern partial and total knee replacements are designed to last 15 to 20+ years for most patients. Longevity depends on patient factors (age, weight, activity level), implant design, surgical technique (alignment and ligament balance), and adherence to activity guidance. Younger patients are statistically more likely to need a revision in their lifetime simply because they live longer with the implant — which is part of why joint-preserving alternatives are particularly worth considering in younger patients. What are the risks of knee replacement? Risks include blood clot (DVT or pulmonary embolism), infection (including periprosthetic joint infection), joint stiffness, implant loosening or wear over time, periprosthetic fracture, ongoing pain in a small subset of patients, and the small possibility of needing revision surgery years later. These risks are weighed at consultation against the expected reduction in pain and improvement in function. Modern partial and total knee replacements have excellent long-term durability when matched to the right patient. How is rheumatoid arthritis of the knee different to treat? Rheumatoid arthritis is a systemic inflammatory disease that requires medical management by a rheumatologist — disease-modifying antirheumatic drugs (DMARDs), biologics, and inflammation-control regimens are the foundation of treatment. Surgical care for the knee in RA addresses joint damage that has already occurred and is coordinated with the rheumatologist's medical regimen. Many DMARDs and biologics need to be held briefly around the surgical date to reduce infection risk. Joint replacement remains highly successful in RA patients when timed appropriately and when systemic disease is well controlled. Is robotic knee replacement better? Mako robotic-assisted surgery enables sub-millimeter accuracy in implant placement and ligament balancing. The benefit is most clear in partial knee replacement, where precision matters disproportionately because the implant has to integrate with intact native compartments and ligaments. In total knee replacement, robotic assistance helps with alignment and balance and may shorten the learning curve for newer techniques. Studies are still ongoing on long-term outcome differences. The most important factor in any knee replacement is patient selection and surgeon experience — the robot is a tool, not a substitute for either. ## Related Specialty Care For joint-preserving osteotomies, see joint preservation and osteotomy (HTO, DFO, TTO). For cartilage-restoration options for focal cartilage defects, see MACI cartilage repair and cartilage transplantation (OATS & allograft). For PRP and stem-cell injection details, see PRP and regenerative medicine. For partial and total knee replacement with sub-millimeter implant precision, see Mako robotic-assisted surgery. For patellofemoral arthritis behind the kneecap, see patellar pain and patellofemoral arthritis. For meniscal surgery in OA-prone knees, see meniscal tear surgery. Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Surgical and non-surgical orthopedic care should always be discussed with a board-certified orthopedic surgeon who has reviewed your imaging, history, and physical examination. Individual outcomes vary based on diagnosis, type and stage of arthritis, anatomy, comorbidities, surgical or non-surgical approach selected, and adherence to rehabilitation. The general descriptions of anesthesia, pain protocols, and timelines on this page reflect typical knee-arthritis patient experience — your specific protocol is determined at consultation. Emerging and research-stage treatments referenced on this page are not standard of care and are not offered or recommended as substitutes for evidence-based treatment. ## Discuss Your Knee Arthritis Options If you have been told you need a knee replacement and want a sub-specialty second opinion on joint-preserving options — or you want a clear walk-through of every option from PT to replacement — bring your imaging to a consultation at NYU Langone in Midtown Manhattan. Book an Appointment Call 646-904-4664 --- ## MACI Cartilage Repair NYC | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/knee-surgeon-specialist/maci-cartilage-repair/ Summary: Sub-specialty MACI cartilage repair for symptomatic full-thickness knee cartilage defects — autologous cultured chondrocytes on a porcine collagen membrane, performed in two stages by Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York. Cartilage-first philosophy: repair the joint surface before replacing the joint. Lesion-size based decision tree (microfracture vs. MACI vs. OATS vs. osteochondral allograft), concurrent realignment (TTO, HTO, DFO), MPFL reconstruction, or meniscus repair when needed. Sub-Specialty Hub # MACI Cartilage Repair Autologous cultured chondrocytes on a porcine collagen membrane — the FDA-approved two-stage cartilage repair for symptomatic full-thickness knee cartilage defects. A cartilage-first option that preserves the native joint, performed by Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York. Combined with realignment osteotomy, MPFL reconstruction, ACL reconstruction, or meniscus repair when the rest of the knee needs work to protect the repair. Medically reviewed by Dr. Sabrina Strickland, MD — Board-Certified Orthopedic Surgeon at the NYU Langone Orthopedic Center in New York · Member, International Patellofemoral Study Group · Castle Connolly Top Doctor since 2016. View full bio → Where NYU Langone Orthopedic Center, Midtown Manhattan Cartilage Sub-Specialty MACI · OATS · osteochondral allograft · CartiHEAL · concurrent osteotomy / MPFL / ACL / meniscus when indicated Patients We See Active patients with focal full-thickness cartilage defects of the femoral condyle, trochlea, or patella; failed prior microfracture; cartilage damage with malalignment, instability, or meniscus deficiency; second-opinion candidates told they need early joint replacement Overview MACI (Matrix-induced Autologous Chondrocyte Implantation) is an FDA-approved two-stage cartilage repair for symptomatic full-thickness articular cartilage defects of the knee. Stage 1 is an arthroscopic biopsy of healthy cartilage from a non-weight-bearing area of your own knee. The cells are shipped to Vericel's specialized lab, where chondrocytes are expanded over 4 to 6 weeks and seeded onto a porcine type I/III collagen membrane. Stage 2 is a mini-arthrotomy where the cell-loaded membrane is implanted into the cleaned defect with fibrin sealant. Over 12 to 18 months, the implanted cells mature into hyaline-like cartilage. MACI is part of a broader cartilage-restoration toolbox that also includes microfracture (small defects), OATS (osteochondral autograft transfer), and osteochondral allograft (large defects with bone involvement). The right operation depends on lesion size, depth, location, and the rest of the joint — and the cartilage repair only works when concurrent malalignment, instability, or meniscus deficiency is addressed in the same operation. Dr. Sabrina Strickland performs MACI and the broader cartilage-repair menu at NYU Langone Orthopedic Center, with cartilage repair as one of her named sub-specialties. If your MRI shows a focal cartilage defect on the femoral condyle, trochlea, or patella — or you have been told the only options are pain management or early joint replacement — the question worth asking is whether the rest of your joint is still healthy enough to repair the defect rather than replace the joint. For active patients, particularly under 55, with focal damage and a knee that can be made stable, aligned, and meniscus-protected, the answer is often yes — and MACI is one of the most well-studied, FDA-approved cartilage restoration procedures available today. This page is the sub-specialty hub for MACI cartilage repair. It pairs with the cartilage transplant (OATS & allograft) page for patients whose lesion size or depth points to a different cartilage operation, and with joint preservation and osteotomy for the realignment side of cartilage protection. Here we cover what cartilage damage is and why it does not heal on its own, who is and is not a MACI candidate, the two-stage protocol in detail, the lesion-size based decision tree (microfracture vs. MACI vs. OATS vs. osteochondral allograft), when MACI is combined with TTO / HTO / DFO / MPFL / ACL / meniscus work, the cartilage-first philosophy that drives Dr. Strickland's practice, prehabilitation, the surgical days, the long recovery, the risks, common patient concerns, insurance and cost, emerging cartilage-repair options, and when to seek a sub-specialty second opinion. ## What Cartilage Damage Is and Why It Matters The articular cartilage in your knee is the thin, glassy white layer that covers the ends of the femur, the top of the tibia, and the back of the patella. It is what allows the joint to glide smoothly through tens of millions of cycles over a lifetime. It is also one of the only tissues in the body that does not heal itself when injured. There are no blood vessels in articular cartilage and the cells inside it (chondrocytes) cannot migrate to a wound to repair it. A full-thickness cartilage defect — a hole through the cartilage layer down to bone — will not fill in on its own. Left untreated, the surrounding cartilage progressively wears, the lesion enlarges, and the bone exposed at the base of the defect becomes a pain generator. This is the central biological fact that drives the cartilage-repair field. Microfracture, MACI, OATS, and osteochondral allograft each take a different approach to the same problem: how to fill a non-healing hole in a tissue that cannot fill itself. The answers differ in what tissue is produced and how durable it is. Microfracture relies on bone-marrow elements from the underlying bone to form fibrocartilage — a short-term answer but biomechanically inferior to native cartilage. MACI implants chondrocytes — the actual cells that make hyaline cartilage — and over 12 to 18 months produces hyaline-like repair tissue that is structurally and functionally closer to what was originally there. OATS and osteochondral allograft transplant a plug of mature cartilage with attached subchondral bone, replacing both the cartilage and the bone in one stage. Cartilage damage matters because cartilage loss is progressive. A focal full-thickness defect today, untreated and left in a malaligned or unstable knee, becomes a larger lesion in two years and incipient compartment arthritis in five. The cartilage-first philosophy — addressing focal damage early, while the rest of the joint is still healthy — is grounded in this biological reality. Dr. Strickland has framed it directly in her published article "Why I Would Rather Repair Cartilage Than Replace a Knee." ## How Cartilage Damage Feels Patients with focal cartilage damage often describe a combination of symptoms that other knee problems do not produce in quite the same way: - Mechanical pain with loaded activities — pain when squatting, descending stairs, getting up from a chair, or pivoting. The pain is often described as deep, aching, and located beneath the kneecap or in a specific compartment of the knee depending on lesion location - Catching, clicking, or a sense that something is moving — loose chondral flaps and unstable lesion edges can produce mechanical symptoms, sometimes the dominant complaint - Swelling after activity — effusions are common after sport, after a long walk, or after work that involves squatting or kneeling - Buckling or "giving way" — not a true ligament instability, but a reflex inhibition of the quadriceps when the painful spot is loaded. The leg feels like it cannot hold weight - Pain that is worse with cold weather or after sitting — many patients notice that the first few minutes of walking after sitting are the worst - A specific point of pain that the patient can map — unlike diffuse arthritis, focal damage is often pinpoint. Patients can put their finger on it Patients with patellar or trochlear lesions tend to describe the pain as anterior — behind or around the kneecap, worse with stairs, prolonged sitting (the "theater sign"), and squatting. Femoral condyle lesions tend to produce medial or lateral compartment pain, sometimes with a sensation of catching when the lesion is loaded in flexion. New mechanical symptoms after a twisting injury, particularly in a younger patient, can indicate an osteochondral fragment that has separated — an indication for MRI and often for arthroscopic evaluation. Many patients have had pain for months or years before a clear focal lesion is identified on imaging. ## Who Is a MACI Candidate? The "right patient for MACI" is more specific than the "right patient for cartilage repair" in general. Six conditions need to line up — and in most cases, when one or two of them are missing, the answer is not "MACI is off the table" but "MACI plus the appropriate concurrent procedure to fix the missing piece." Lesion-by-lesion judgment is what cartilage sub-specialty surgery is. #### Focal full-thickness defect A discrete cartilage hole, full-thickness through the cartilage to bone, typically 2 to 10 cm². ICRS grade 3 or 4. Not diffuse arthritis. Confirmed on MRI with cartilage sequences. #### Stable ligaments ACL, PCL, MCL, LCL, and (for patellar lesions) MPFL must be intact — or reconstructed in the same operation. An unstable knee will destroy a cartilage repair. #### Correct alignment Mechanical axis must be neutral or made neutral with a concurrent osteotomy (HTO for varus, DFO for valgus, AMZ-TTO for patellar maltracking). Cartilage repair in a malaligned knee fails for the same reason the original cartilage failed. #### Functional meniscus The meniscus in the affected compartment must be intact, repairable, or recently repaired. A meniscus-deficient compartment cannot protect a cartilage repair from contact pressures. #### Active patient, generally under 55 Best outcomes are in patients with high cellular activity and the motivation to do a long structured rehab. Age is a guide, not a rule — biology and activity level matter more than birthday. BMI generally under 35. #### Willing to do the rehab MACI rehab is long and structured. Protected weight-bearing 4–6 weeks; CPM; return to running 9–12 months; full sport 12–18 months. Patients who cannot or will not follow the protocol should not have MACI. Patients who are not MACI candidates as primary monotherapy include those with diffuse multi-compartment arthritis, untreated bipolar (kissing) lesions on opposing surfaces of the same compartment, uncorrectable malalignment, active inflammatory arthritis, and large defects with significant subchondral bone loss — the last group is generally better served by osteochondral allograft. Lesion candidacy is informed by Dr. Strickland's published outcomes review of cartilage restoration procedures and her technical note on treatments of patellar chondral lesions. ## The Two-Stage MACI Protocol The two stages of MACI — biopsy, cell culture, implantation — are what make it different from any single-stage cartilage procedure. The biology in between the two surgeries is also why MACI demands careful patient selection: you commit to two operations, six weeks of cell culture, and a long rehab before you see a result. 1 #### Stage 1: Arthroscopic Biopsy Outpatient arthroscopy. A few hundred milligrams of healthy cartilage are harvested from a non-weight-bearing area — the intercondylar notch or superolateral trochlea. The lesion is also assessed and any concurrent pathology is noted for the stage 2 plan. Home the same day. → 2 #### Cell Culture (4–6 Weeks) Cells are shipped to Vericel's GMP-certified facility. Chondrocytes are isolated, expanded in tissue culture, and seeded onto a porcine type I/III collagen membrane. The result: a cell-loaded biological patch ready for implantation. → 3 #### Stage 2: Open Implantation Mini-arthrotomy. The defect is debrided to clean stable vertical walls. The membrane is cut to the exact shape of the defect and secured cell-side down with fibrin sealant. Concurrent procedures (TTO, HTO, MPFL, meniscus, ACL) are performed at the same operation when indicated. Cells mature into hyaline-like cartilage over 12 to 18 months. ### Stage 1: The Arthroscopic Biopsy Stage 1 is a standard knee arthroscopy with a chondroplasty to clean up loose flaps of cartilage at the site of planned cartilage repair. Through standard arthroscopic portals, Dr. Strickland inspects the entire joint, confirms the lesion seen on MRI, characterizes the surrounding cartilage, assesses meniscus integrity and ligament stability, and identifies any other findings that affect the stage 2 plan. From a non-weight-bearing area — typically the intercondylar notch or the superolateral trochlea — she harvests roughly 200 to 300 milligrams of healthy cartilage. The biopsy site is small enough that it heals without affecting joint function. The harvested cartilage is placed in transport media and shipped to Vericel. Recovery from stage 1 is straightforward. Most patients are walking the same day, off crutches within a few days, and back to most non-impact daily activities within one to two weeks. Range of motion is typically full within a few weeks. Stage 1 is the easy operation in the MACI sequence. ### The Cell-Culture Interval The 4-to-6-week interval between stages is for the chondrocytes to be expanded in Vericel's specialized lab. The chondrocytes are isolated from your cartilage biopsy, expanded in tissue culture under GMP conditions, and seeded onto a porcine type I/III collagen membrane. The end product is a sterile, cell-loaded biological patch labeled and shipped specifically for your operation. From your standpoint, the interval is also when prehabilitation matters most — quadriceps and hip-stabilizer strengthening, range-of-motion work, and addressing any swelling or inhibition before stage 2. We schedule the stage 2 implantation around the timing of cell delivery from the lab. ### Stage 2: The Open Implantation Stage 2 is the operation that puts the cells back. Through a small mini-arthrotomy positioned over the lesion, the defect is exposed and debrided to clean stable vertical walls of healthy cartilage. The base of the defect is prepared so the calcified cartilage layer is preserved or selectively curetted depending on lesion location and depth. The membrane is then cut to the exact shape and size of the defect, and secured cell-side down into the defect with fibrin sealant. The knee is taken through a careful range-of-motion check to confirm the graft is stable and does not displace. Concurrent procedures performed at the same operation when indicated include AMZ-TTO for patellar maltracking, HTO for varus alignment with a medial femoral condyle defect, DFO for valgus alignment with a lateral femoral condyle defect, MPFL reconstruction for patellar instability, meniscus repair or transplant, and ACL reconstruction for ligament instability. These concurrent procedures lengthen the operation and adjust the rehab plan, but they are often what makes the cartilage repair durable. A pristine MACI in a malaligned, unstable, or meniscus-deficient knee is a repair built on a faulty foundation. For the published outcomes data on MACI specifically, see Dr. Strickland's follow-up study of MACI cartilage transplantation patients, the broader outcomes review of cartilage restoration procedures, and her CartiHEAL / OCA / MACI clinical comparison. ## MACI vs. OATS vs. Osteochondral Allograft vs. Microfracture MACI is one of four main cartilage-restoration options. The right choice depends on the size and depth of the defect, whether the underlying bone is involved, the location in the knee, and the patient's goals. Lesion-size based decision-making is the heart of cartilage sub-specialty practice. Best for defectCartilage type producedStagesRecovery to sport MicrofractureSmall (under 2 cm²)Fibrocartilage (inferior quality)Single6–9 months OATS (autograft)Small to medium (1–4 cm²) with boneNative hyaline (transferred from your knee)Single6–9 months MACIMedium to large (2–10 cm²) chondral-onlyHyaline-like (grown from your cells)Two12–18 months Osteochondral allograftVery large (over 4 cm²) or with bone lossNative hyaline (donor) + boneSingle9–12 months For chondral-only defects in the 2–10 cm² range — the most common scenario — MACI gives the best balance of cartilage quality, durability, and applicability. For smaller defects, OATS or chondroplasty may be reasonable. For very large defects or defects with bone loss, an osteochondral allograft is usually the right call. Recent imaging-based research has identified subchondral bone marrow edema as a risk factor for osteochondral allograft failure — a refinement that informs how we follow allograft cases on MRI. See the cartilage transplant page for the full OATS and allograft discussion. For broader joint-preservation context — including when osteotomy is part of the cartilage plan — see joint preservation and osteotomy. Lesion-by-lesion decision-making also depends on bipolar lesions, location (femoral vs. trochlear vs. patellar; cartilage repair on the patella has historically been more difficult than on the femoral condyle), prior cartilage surgery, and patient activity goals. Two patients with apparently similar imaging can end up with different operations because of these contextual factors. ## Concurrent Procedures: TTO, HTO, DFO, MPFL, Meniscus, ACL This is one of the most under-explained ideas in cartilage repair: cartilage repair in a malaligned, unstable, or meniscus-deficient knee will not last. The same forces that destroyed the original cartilage will destroy the repair, often within a few years. Dr. Strickland's technical note on treatments of patellar chondral lesions states it directly: "correcting patellar malalignment and instability is critical for the success of cartilage repair procedures… we recommend that TTO and MPFL reconstruction be performed with MACI procedures of the patella when the anatomic pathology and pertinent patient history are present." The same logic applies across the joint: - MACI + HTO (high tibial osteotomy) — for medial femoral condyle defects in patients with varus alignment. The HTO redistributes load away from the medial compartment and protects the cartilage repair - MACI + DFO (distal femoral osteotomy) — for lateral femoral condyle defects in patients with valgus alignment. Mirror-image logic to HTO - MACI + AMZ-TTO (Fulkerson osteotomy) — for patellar or trochlear defects in patients with patellar maltracking. Anteromedialization tibial tubercle osteotomy offloads the damaged facet of the patella - MACI + MPFL reconstruction — for patellar or trochlear defects in patients with patellar instability. The MPFL stabilizes the kneecap so it stops dislocating onto the repair. See the podcase on patellofemoral instability and cartilage lesions and understanding patellofemoral instability and cartilage lesions for the combined-pathology framing - MACI + meniscus repair or meniscus transplant — for chondral defects in a meniscus-deficient compartment. Without a functional meniscus, contact pressures across the repair exceed what hyaline-like cartilage can tolerate - MACI + ACL reconstruction — for chondral defects in an ACL-deficient knee. The ACL keeps the cartilage repair from being subjected to abnormal shear during pivot and cut These combinations are common, not rare. A meaningful percentage of MACI patients in Dr. Strickland's practice have at least one concurrent procedure, often planned in the same operation. In the patellofemoral population specifically, treating patellofemoral arthritis with patellar instability almost always means addressing both pathologies together. The technical refinement — assessment of patellar vascularity after patellar cartilage restoration via lateral parapatellar approach — is a sub-specialty consideration when MACI is performed on the patella. ## Why Cartilage Repair Beats Replacement (When Possible) The cartilage-first philosophy is the framework that drives Dr. Strickland's approach to focal cartilage damage in younger active patients. Her published article "Why I Would Rather Repair Cartilage Than Replace a Knee" lays out the case directly: for active patients with focal full-thickness damage and otherwise reasonable joint health, the goal is to preserve the native knee. A partial or total knee replacement in a 30- or 40-year-old commits the patient to a revision conversation in their lifetime — modern implants do not last forever, and revision arthroplasty is more complex than primary. The clinical implications are concrete: - A 32-year-old with a 4 cm² focal trochlear chondral defect and mild patellar maltracking is a candidate for combined MACI plus AMZ-TTO at one operation, not partial knee replacement at 32 followed by total knee replacement at 50 followed by revision at 65 - A 40-year-old runner with a 6 cm² focal medial femoral condyle defect and mild varus is a candidate for MACI plus HTO, not unicompartmental knee replacement - A 35-year-old with a recurrent patellar dislocation and an associated trochlear cartilage defect is a candidate for MPFL reconstruction plus MACI, not for early patellofemoral arthroplasty Replacement is the right answer for the right patient — the 65-year-old with bone-on-bone medial compartment arthritis is a unicompartmental or total knee candidate, not a cartilage-repair candidate. The cartilage-first framework is about identifying the patients for whom repair is technically feasible and biologically appropriate, and not committing them to an implant when their joint can still be preserved. Dr. Strickland's broader cartilage-repair commentary is captured in her AOSSM Sports Doc podcast on challenging cartilage injuries and the related live AOSSM 2023 podcast with Dr. Seth Sherman. ## Prehabilitation Before MACI The four-to-six-week interval between stage 1 and stage 2 is also a structured prehabilitation window. Patients who walk into stage 2 with a strong quadriceps, full range of motion, and no effusion recover faster and meet rehabilitation milestones more reliably than patients who walk in with a stiff, weak, swollen knee. Prehabilitation focuses on: - Quadriceps activation and strengthening — closed-chain in pain-free range, with attention to the VMO. The single most predictive factor for early post-operative recovery - Hip-stabilizer strengthening — abductors and external rotators. Particularly important for patellar and trochlear lesion patients - Range of motion — prone heel-hangs, supine wall-slides, and stationary bike. A knee that goes into stage 2 with full extension recovers extension faster after - Effusion management — elevation, compression, and load management to minimize a chronic effusion that inhibits the quadriceps - Cardiovascular fitness — cycling and pool work where pain-free, to maintain general conditioning during the cell-culture interval - Education and expectation-setting — reviewing the rehab protocol, the brace and CPM logistics, and the realistic timeline before the implantation rather than after Patients who do this work are easier to rehabilitate after stage 2. Patients who skip it spend the first six weeks of post-operative rehab catching up on what they could have done before surgery. The prehabilitation window is one of the under-used advantages of MACI's two-stage structure. ## What to Expect — Two Surgical Days ### Stage 1: Day-of Experience - Arrival and pre-op — you arrive a couple of hours before the procedure for intake, change into a gown, and meet the anesthesia team - Anesthesia — regional anesthesia (a spinal block with sedation). - Surgery — the arthroscopic biopsy and joint inspection takes roughly 30 to 45 minutes - Recovery and home — you wake up with a soft dressing, weight-bearing as tolerated. Home the same day. Return to most non-impact daily activities within 1 to 2 weeks ### Stage 2: Day-of Experience - Arrival and pre-op — same intake process. The cell-loaded membrane is delivered from Vericel and confirmed labeled to you on the OR day - Anesthesia — regional anesthesia - Surgery — the open implantation takes roughly 1 to 2 hours, longer if concurrent procedures (TTO, HTO, DFO, MPFL, meniscus, ACL) are part of the operation - Recovery room — you wake up in a hinged knee brace locked in extension, with the leg numb from the regional block. Continuous passive motion (CPM) machine is initiated the same day or the next morning - Going home — you go home with the brace, crutches, ice, prescribed medications, and clear written instructions including the CPM schedule. A responsible adult must drive you home - First 48 hours — ice, elevation, prescribed pain medications, regular CPM use, and gentle motion as instructed. The block typically wears off over 12 to 24 hours; weight-bearing is touch-down only with the brace and crutches Cold-compression devices and quadriceps muscle stimulators (when prescribed) help reduce swelling and support muscle reactivation in the first weeks. CPM use is not optional — the maturing cartilage genuinely benefits from continuous passive motion in the early phase. ## Recovery Timeline MACI rehab is among the longer cartilage-repair recoveries because the implanted cells need biological time to mature into functional cartilage. Pushing too fast risks disrupting the maturing repair. The biology drives the timeline. PhaseTimelineWhat's happening Protected weight-bearing + CPMWeeks 0–6Hinged brace; touch-down weight-bearing on crutches; CPM 6–8 hours/day to nourish the maturing cartilage; gentle range of motion; quadriceps activation Progressive weight-bearingWeeks 6–12Transition off crutches over 2–4 weeks; full passive range of motion target; stationary bike (no resistance); pool work; gait normalization StrengtheningMonths 3–6Quadriceps and hip-stabilizer strengthening; single-leg control; low-impact cardio (cycling, swimming, elliptical); progressive loading without impact Return to runningMonths 9–12Graduated return-to-running program; plyometrics start; sport-specific drills if indicated Return to pivot/contact sportMonths 12–18Full pivot, contact, and impact activities. The repair tissue is now substantially mature. Final return-to-sport testing if relevant Most patients are back to daily activities and low-impact exercise (cycling, swimming, walking) well before they are cleared for full sport. The constraint is the maturing cartilage, not how the leg feels — many patients feel like the knee is "back to normal" at 4 to 6 months but are still 6 to 12 months away from running and a year or more from pivot sport. Concurrent procedures (TTO, HTO, DFO, MPFL, ACL, meniscus) extend or modify the protocol; the rehab plan is individualized. Across all phases, the two factors that most consistently slow recovery are inconsistent physical therapy attendance and rushing back to high-impact activity before clearance. The patients who do well with MACI are the patients who treat the rehab as seriously as the surgery. ## Risks of MACI MACI is well-established with a long published track record — over 25 years of clinical experience with the autologous chondrocyte concept and over a decade with the matrix-induced (membrane) variant. Outcomes in well-selected patients are generally good, but no surgery is risk-free. Risks reviewed at consultation include: - Incomplete graft incorporation or graft failure — highest when concurrent malalignment, instability, or meniscal status was not addressed; lower when the foundational issues were corrected at the same operation - Graft hypertrophy — overgrowth of the repair tissue into the joint, occasionally requiring an arthroscopic debridement procedure 6 to 12 months later - Persistent pain or incomplete relief — particularly when there were multiple pain generators that were not all addressed - Stiffness or arthrofibrosis — reduced by prehabilitation, early CPM use, and structured PT; managed with manipulation under anesthesia or arthroscopic lysis if it occurs - Infection — uncommon. Stage 1 arthroscopy infection rate is very low; stage 2 open implantation has a slightly higher but still low infection risk - Tibial tubercle nonunion or hardware irritation — specific to combined AMZ-TTO; rare but can require hardware removal - Osteotomy nonunion or malunion — specific to combined HTO or DFO; managed with revision technique when it occurs - Blood clot (DVT or pulmonary embolism) — risk is mitigated by early mobilization (CPM helps) and individualized prophylaxis - Anesthesia-related risks — nausea, sore throat, rare allergic reactions, transient nerve irritation from the regional block - Need for additional surgery — for graft hypertrophy, hardware removal after osteotomy, or for revision cartilage surgery if the index repair fails - Incomplete return to prior level of activity — some patients do not return to their prior level of sport even with technically excellent surgery and complete rehab - Long-term durability is variable — MACI typically produces durable improvement at 5- and 10-year follow-up in published series, but the literature is honest that the repair tissue is not as durable as native cartilage indefinitely. Outcomes are not a permanent fix and do depend on patient factors The single biggest predictor of a poor outcome is patient selection. The second is failing to address concurrent problems (alignment, ligament, meniscus) at the time of MACI. When the conditions line up and the patient does the rehab, MACI is one of the more successful joint-preserving operations performed in orthopedics today. ## Common Patient Concerns The friction-log: the four concerns we hear most often from patients considering MACI, with honest answers. #### "MACI is expensive and I'm not sure my insurance will cover it." MACI is FDA-approved for full-thickness articular cartilage defects of the knee in adults and is covered by most major commercial insurance plans, Medicare, and many self-funded and union plans when medical-necessity criteria are met. It is one of the more expensive cartilage operations because of the cell-culture cost. Pre-authorization is required and can take weeks — our office and Vericel coordinate the documentation. Out-of-pocket cost depends on your specific plan. The right step is to bring your imaging in for a consultation; if MACI is the right operation, we begin the pre-authorization process from there. #### "I don't have a year to be in rehab." This is the most honest reason to choose a different operation. If a 9-12 month rehab is not compatible with your work, family obligations, or training calendar, debridement or OCA may be more practical — or non-surgical management may be the right answer for now. MACI is a long-runway operation. If you cannot or will not commit to the rehab, you should not have the operation. We discuss this directly at consultation rather than discovering it three months in. #### "Two surgeries feels like a lot for one knee." It is — that is the trade-off of MACI versus single-stage cartilage operations. The advantage is that MACI implants chondrocytes (the cells that make hyaline cartilage), and the resulting repair tissue is biomechanically closer to native cartilage than what microfracture produces. For chondral-only defects in the 2–10 cm² range in active patients, the durability advantage typically justifies the second operation. For smaller defects, OATS or chondroplasty may be reasonable; for patients who cannot accept a two-stage operation, OCA may be reasonable. The decision is lesion-specific. #### "My local surgeon said I should just wait until I need a knee replacement." For active patients in their 30s, 40s, and even 50s with focal full-thickness cartilage damage and otherwise reasonable joint health, "wait until you need a replacement" usually means watching the joint deteriorate further while a window for joint preservation closes. The cartilage-first framing is to address focal damage early — while the rest of the joint is still healthy — rather than wait until multi-compartment arthritis forces a replacement decision. Whether MACI is the right operation depends on your specific imaging and anatomy. Bringing your imaging to a sub-specialty consultation is the right starting point. ## Insurance and Cost MACI is FDA-approved for full-thickness articular cartilage defects of the knee in adults. Coverage and cost specifics: - Most major commercial plans, Medicare, and many self-funded and union plans cover MACI when medical-necessity criteria are met. The criteria typically include documentation of failed conservative care, MRI-confirmed full-thickness defect, lesion size and grade, and an appropriate operative plan - Pre-authorization is required and can take weeks. Our office and Vericel coordinate the documentation - Your out-of-pocket cost depends on plan-specific factors — deductible, coinsurance, in-network or out-of-network status of the surgeon, the facility (NYU Langone or affiliated outpatient surgery center), and the anesthesia group; whether you have out-of-network benefits and choose to use them - OATS, osteochondral allograft, microfracture, AMZ-TTO, HTO, DFO, MPFL reconstruction, ACL reconstruction, and meniscus surgery are also covered by most major plans when medical-necessity criteria are met. Concurrent procedures may add to the bundled or itemized billing - The Patella LIFT procedure, when performed under the FDA PELICAN trial, has separate considerations because it is investigational. The Hyalex knee cartilage system FDA trial and amniotic suspension allograft (ASA) injection studies are similarly under trial protocols when participation is offered - PRP and some biologic injections are not always covered — we review the specifics during your consultation Before surgery, our office verifies your benefits, obtains pre-authorization where required, and reviews the estimated out-of-pocket cost with you. For benefits verification or to discuss self-pay arrangements, call us at 646-904-4664 or contact the office. ## Emerging Cartilage-Repair Options MACI is the current FDA-approved gold standard for chondral-only defects in the 2–10 cm² range, but cartilage repair is one of the more active fields in sports orthopedics. Emerging options Dr. Strickland evaluates, participates in, or discusses with patients include: - CartiHEAL Agili-C — an FDA-approved aragonite-based osteochondral scaffold, now with its own CPT code. See CartiHEAL cartilage injury treatment, the CartiHEAL / OCA / MACI clinical comparison, the one-step cartilage repair with CartiHEAL, the CartiHEAL for trochlear lesions, and the long-term outcomes study - Hyalex knee cartilage system FDA trial — an investigational synthetic cartilage replacement under FDA trial. See FDA trial of the Hyalex knee cartilage system - ChondroFiller — an injectable collagen-based cartilage repair option. See the Hype/ChondroFiller cartilage repair commentary - Amniotic suspension allograft (ASA) injection — under research for symptomatic knee osteoarthritis. See the ASA injection research study - Stem cells, exosomes, and orthobiologics — an evolving space; outcomes are heterogeneous and most products remain investigational. See stem cells, exosomes, and cartilage repair and the HSS Journal webinar on stem cells and scaffolds - Engineered cartilage and synthetic substitutes — tissue-engineered constructs and biomaterials are an active area of research. See "engineered cartilage sounds perfect" and silkworms and synthetic substitutes for cartilage, ligaments, and tendons For patients exercising while managing focal cartilage damage, see running and knee stress: systematic cartilage changes for the literature on running and cartilage. The cartilage-restoration field is moving forward, and FDA-approved options will continue to expand. The current right-sized choice for chondral-only defects in the 2–10 cm² range is still MACI; emerging options expand the menu rather than replace it. ## When to Seek a Sub-Specialty Second Opinion Cartilage repair is one of Dr. Strickland's primary clinical and academic areas. She performs the full menu of cartilage-restoration procedures (MACI, OATS, osteochondral allograft, CartiHEAL), has published her own MACI follow-up data and broader cartilage-restoration outcomes work, has co-hosted the AOSSM Sports Doc podcast on challenging cartilage injuries, and routinely combines cartilage repair with realignment osteotomy, MPFL reconstruction, ACL reconstruction, and meniscus surgery in the same operation when concurrent pathology demands it. A sub-specialty second opinion is particularly worth seeking when: - Your MRI shows a focal full-thickness cartilage defect and you want to understand which cartilage operation is right for your lesion - You have been told you need a partial or total knee replacement at a younger age and want to understand cartilage-preserving alternatives - You have failed prior microfracture and need to understand revision-cartilage options - You have combined cartilage damage and malalignment and want a clear plan for combined cartilage repair plus realignment osteotomy - You have combined cartilage damage and patellar instability and want a sub-specialty plan that addresses both - You have a large or complex defect — multi-focal, bipolar, with bone loss, or revision — and want to be evaluated for osteochondral allograft, MACI, or CartiHEAL by a high-volume cartilage surgeon - You are active and want to preserve joint function rather than commit to an implant in your 30s, 40s, or 50s - You have been offered "watch and wait" for cartilage damage that is symptomatic and progressing - You want to be evaluated for an FDA trial cartilage-repair implant (Hyalex, Patella LIFT, ASA) where eligibility applies Cartilage decisions are complex because the right operation depends on lesion size and depth, location, alignment, ligament status, meniscus status, prior surgery, age, BMI, and patient activity goals. Two MRIs that look similar to a non-specialist can lead to different operations in a sub-specialty practice because of these contextual factors. A sub-specialty second opinion does not always change the recommendation — but it does ensure the recommendation is built on the right framework. ## Access & Office Location Dr. Strickland sees cartilage-repair patients at one office, which works with patients traveling in from outside the immediate area: - New York City: NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY 10016. Midtown Manhattan, accessible from Manhattan, the outer boroughs, Long Island, Westchester, and northern New Jersey via the Queensboro and Triboro bridges and the FDR Drive. Phone: 646-904-4664. Many patients travel to New York for cartilage-restoration sub-specialty care — particularly for MACI candidacy evaluations, second opinions on prior failed cartilage surgery, complex combined cases (cartilage repair plus osteotomy, MPFL, or meniscus work), and consultations on whether early joint replacement can be avoided. Surgery is performed at NYU Langone. We coordinate consultation, imaging review, and surgery scheduling to minimize travel for out-of-state patients. ## Frequently Asked Questions What is MACI cartilage repair? MACI stands for Matrix-induced Autologous Chondrocyte Implantation. It is a two-stage knee cartilage repair. Stage 1 is an arthroscopic biopsy that harvests a small amount of your own healthy cartilage. The cells are sent to Vericel's specialized lab, where chondrocytes are expanded for 4 to 6 weeks and seeded onto a porcine type I/III collagen membrane. Stage 2 is a mini-arthrotomy where the cell-loaded membrane is implanted into the cleaned defect with fibrin sealant. Over 12 to 18 months, the implanted cells mature into hyaline-like cartilage that restores the worn joint surface. MACI is FDA-approved for full-thickness articular cartilage defects of the knee in adults. Am I a candidate for MACI? MACI is most appropriate for active patients (typically under 55) with a symptomatic focal full-thickness cartilage defect on the femoral condyle, trochlea, or patella — most commonly between 2 and 10 square centimeters. Candidacy requires stable ligaments (or correctable instability), correct mechanical alignment (or correctable malalignment via osteotomy), a functional or repairable meniscus, BMI generally under 35, and willingness to do a long structured rehab. MACI is not for diffuse arthritis, untreated bipolar (kissing) lesions, or knees with uncorrectable malalignment. How is MACI different from microfracture? Microfracture is a single-stage procedure that creates small holes in the underlying bone to release marrow elements, which form fibrocartilage in the defect. Fibrocartilage is a short-term answer but biomechanically inferior to native hyaline cartilage and can deteriorate over years. MACI implants chondrocytes — the actual cells that produce hyaline cartilage — on a collagen membrane, and over 12 to 18 months produces hyaline-like cartilage closer in structure to what was originally there. For defects larger than 2 cm² in active patients, MACI typically gives more durable repair tissue than microfracture. How does MACI compare to OATS or osteochondral allograft? MACI uses your own cultured cells to grow new cartilage on the existing bone. OATS (osteochondral autograft transfer) and osteochondral allograft transplant a plug of cartilage with attached subchondral bone. The right choice depends on defect size, depth, and whether subchondral bone is involved. MACI is typically the choice for chondral-only defects 2–10 cm² without significant bone loss. OATS suits smaller chondral-bone defects (under 2–4 cm²). Osteochondral allograft is the choice for very large defects, defects with subchondral collapse, or revision cases. See the cartilage transplant page for the full comparison. How long is recovery from MACI? Protected weight-bearing 4 to 6 weeks with a hinged brace, continuous passive motion (CPM) in the early phase, progressive range-of-motion and low-impact cross-training through 3 months, structured strengthening through 6 months, graduated return to running at 9 to 12 months, and return to pivot or contact sport at 12 to 18 months. The biology drives the timeline. Most patients are back to daily activities and low-impact exercise long before they are cleared for full sport. Why might I need an osteotomy at the same time as MACI? The same forces that destroyed the original cartilage will destroy the repair if they are not addressed. Concurrent realignment — HTO for varus, DFO for valgus, AMZ-TTO for patellar maltracking — protects the cartilage repair by redistributing the load. Dr. Strickland's published technical note on patellar chondral lesions reinforces that correcting alignment and instability is critical for the success of cartilage repair. Is MACI covered by insurance? MACI is FDA-approved and covered by most major commercial plans, Medicare, and many self-funded and union plans when medical-necessity criteria are met. Pre-authorization is required and can take weeks — our office and Vericel coordinate the documentation. Out-of-pocket cost depends on the plan deductible, coinsurance, and in-network status of the surgeon, facility, and anesthesia group. Verify your specific benefits before scheduling. Why repair cartilage instead of replacing the joint? For active patients with focal full-thickness damage and otherwise reasonable joint health, the goal is to preserve the native knee. A partial or total knee replacement in a 30- or 40-year-old commits the patient to a revision conversation in their lifetime. Cartilage repair, when feasible, restores the joint surface without an implant and preserves the option to do a replacement later if needed. This is the cartilage-first philosophy Dr. Strickland has written about in "Why I Would Rather Repair Cartilage Than Replace a Knee." What if I had microfracture before and it didn't work? Failed prior microfracture is a common reason for cartilage-restoration referral. Prior microfracture changes the underlying bone — sometimes producing sclerosis or intralesional cysts — which makes a subsequent MACI more demanding but not impossible. In some cases osteochondral allograft is preferred over MACI when the subchondral bone has been disrupted. Imaging review is the first step. Failed microfracture changes the menu of options and the operative plan, but does not close the door. Where is MACI performed in New York? Dr. Sabrina Strickland performs MACI cartilage repair at NYU Langone Orthopedic Center in New York City. Patients travel from New York, Connecticut, New Jersey, and across the region for cartilage-repair candidacy evaluations and second opinions. Consultations and surgery take place at NYU Langone Orthopedic Center in Midtown Manhattan. ## Source Grounding & Published Research This page is grounded in Dr. Strickland's published commentary, technical notes, follow-up studies, and patient education on cartilage repair and the broader cartilage-restoration field. Selected references: TopicSource MACI follow-up outcomesStudy following MACI cartilage transplantation patients Cartilage-first philosophyWhy I would rather repair cartilage than replace a knee Cartilage restoration outcomesOutcomes of cartilage restoration procedures Patellar chondral lesion algorithmTreatments of patellar chondral lesions (technical note) CartiHEAL / OCA / MACICartiHEAL, OCA, and MACI clinical comparison One-step cartilage repair (CartiHEAL)One-step cartilage repair with CartiHEAL · CartiHEAL for trochlear lesions Long-term one-step cartilage repairLong-term outcomes of one-step cartilage repair Subchondral edema & allograft failureSubchondral bone marrow edema as a risk factor for osteochondral allograft failure · increased host bone marrow edema Patellar vascularity (lateral approach)Assessment of patellar vascularity after patellar cartilage restoration via lateral parapatellar approach PF instability + cartilageUnderstanding patellofemoral instability and cartilage lesions · podcase Patella alta & cartilage damagePatella alta patients may have less severe cartilage damage Hyalex FDA trialFDA trial of the Hyalex knee cartilage system ChondroFiller commentaryHype/ChondroFiller cartilage repair Amniotic suspension allograft (ASA)ASA injections for knee osteoarthritis Stem cells, exosomes, scaffoldsStem cells, exosomes, and cartilage repair · HSS Journal webinar on stem cells and scaffolds Engineered cartilage"Engineered cartilage sounds perfect" · silkworms and synthetic substitutes Running & cartilageRunning and knee stress: systematic cartilage changes AOSSM Sports Doc podcastChallenging cartilage injuries — AOSSM Sports Doc podcast · live AOSSM 2023 episode with Dr. Seth Sherman · Sports Docs companion piece Bio & publicationsDr. Strickland bio · research & publications ## Related Specialty Care For larger cartilage defects, defects with bone involvement, or revision cases, see cartilage transplant (OATS & osteochondral allograft). For the realignment side of cartilage protection (HTO, DFO, AMZ-TTO), see joint preservation and osteotomy. For patellar or trochlear cartilage lesions in the context of patellofemoral pain or arthritis, see patellar pain and patellofemoral arthritis. For patellar instability that contributed to patellar or trochlear cartilage damage, see patellar instability and MPFL reconstruction surgery. For ACL-deficient knees with cartilage damage, see ACL tear surgery. For meniscus-deficient compartments, see meniscal tear and torn meniscus. For multi-compartment knee arthritis where joint preservation is no longer feasible, see knee arthritis. For chondromalacia and tendonitis at the front of the knee, see knee chondromalacia, arthritis, and tendonitis. For complex anatomy where computer-guided planning is helpful, see Mako robotic-assisted surgery. For Dr. Strickland's published research and editorial commentary on cartilage repair and the broader cartilage-restoration field, the source-grounding table above lists the references used on this page; for the broader publication record, see research & publications. Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Surgical and non-surgical orthopedic care should always be discussed with a board-certified orthopedic surgeon who has reviewed your imaging, history, and physical examination. Individual outcomes vary based on diagnosis, anatomy, comorbidities, surgical technique, concurrent procedures, and adherence to rehabilitation. MACI is FDA-approved for full-thickness articular cartilage defects of the knee in adults; outcomes in the published literature are favorable in well-selected patients but cartilage repair is not a guaranteed permanent fix and the durability of the repair tissue varies with patient factors. The Hyalex knee cartilage system, the Patella LIFT procedure, and amniotic suspension allograft (ASA) injections referenced on this page are investigational under FDA clinical-trial protocols. The volume figures, timelines, and outcome statements on this page are drawn from Dr. Strickland's published clinical and academic work, cited in the source-grounding table above, and from the FDA-approved MACI labeling. ## Discuss MACI Candidacy If your MRI shows a focal full-thickness cartilage defect, if you have failed prior microfracture, or if you have been told you need early joint replacement and want to know whether your cartilage can be repaired instead — bring your imaging to a sub-specialty consultation at NYU Langone in Midtown Manhattan. Book an Appointment Call 646-904-4664 --- ## Meniscal Tear: Repair, Root Repair & Allograft NYC | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/knee-surgeon-specialist/meniscal-tear-or-torn-meniscus/ Summary: Meniscus tear evaluation by Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York — repair-first philosophy, transtibial root repair, MISHA shock absorber for root tears with early arthritis, partial meniscectomy when repair isn Specialty # Meniscal Tear: Repair, Root Repair & Allograft Tear-by-tear evaluation by Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York — with a meniscus-preservation-first philosophy. Arthroscopic repair, transtibial root repair (with optional MISHA implantable shock absorber for working-age patients with early medial compartment arthritis), partial meniscectomy, and meniscal allograft transplantation. Medically reviewed by Dr. Sabrina Strickland, MD — Orthopedic Surgeon at the NYU Langone Orthopedic Center in New York. View full bio → Where NYU Langone Orthopedic Center, Midtown Manhattan Patients We See NY, NJ, CT and out-of-state patients with acute, degenerative, root, or prior-meniscectomy meniscus problems Return to Sport 4–8 wks (meniscectomy) · 3–4 mo (repair) · 4–6 mo (root) · 9–12 mo (allograft) Overview A meniscus tear is a tear of one of the C-shaped fibrocartilage shock absorbers (medial or lateral) inside the knee. The treatment decision starts with "surgery or no surgery" — but then more importantly, once surgery is deemed necessary, it is repair vs. meniscectomy. Repair preserves the meniscus and protects the underlying cartilage; meniscectomy removes the torn portion and can accelerate cartilage wear in that compartment over years. The decision depends on tear pattern (radial, horizontal cleavage, vertical, bucket-handle, root, complex), tear location relative to the red, red-white, and white zones, tissue quality, and patient activity level. Whenever the tear is repairable, repair is the goal. Medial meniscus posterior root tears (MMRTs) are a special case — untreated MMRTs cause rapid degeneration of the medial tibiofemoral compartment, and Dr. Strickland published a combined technique in Arthroscopy Techniques (2024) that pairs transtibial root repair with the MISHA implantable shock absorber to allow earlier partial weight-bearing for working-age patients with early medial compartment arthritis. Dr. Sabrina Strickland evaluates these cases at NYU Langone Orthopedic Center in New York. If you have been told you have a meniscus tear, the question worth asking is "do I need surgery." If the answer is yes, then it is: what type of tear do I have, can it be repaired, and what is the long-term cost of removing it. The answer to those three questions is what determines the right operation — or whether non-surgical care is appropriate. Decades of follow-up data have made one thing clear: the meniscus matters. A patient with a subtotal meniscectomy at age 30 is at significantly higher risk for arthritis at age 50 than a patient who had the same tear repaired or who tolerated it without surgery. The meniscus-preservation principle drives modern meniscal surgery, and it drives Dr. Strickland's practice in particular. This page covers what the meniscus is and why it matters, how a torn meniscus feels, how tears happen, the main tear patterns, the special case of root tears, how the diagnosis is made, when non-surgical care is appropriate, the surgical options compared, the MISHA-augmented root repair Dr. Strickland published, meniscal allograft transplantation, recovery for each procedure, what to expect on surgery day, risks, common patient concerns, insurance and cost, access and office locations, patient outcomes, and frequently asked questions. For closely related topics, see ACL tear surgery (often torn alongside the meniscus — especially the lateral meniscus in acute injuries and the medial meniscus in chronic ACL deficiency); MACI cartilage repair and cartilage transplantation when the tear is associated with cartilage damage; joint preservation and osteotomy when alignment correction is needed alongside meniscus work; the medial meniscus root repair with MISHA shock absorber page for the published combined technique; and medial meniscus posterior root tears for a deeper dive on MMRTs. ## Why the Meniscus Matters Each knee has two menisci — a medial meniscus on the inner side and a lateral meniscus on the outer side. They are C-shaped wedges of fibrocartilage that sit between the femur (thighbone) and the tibia (shinbone). Their job is to: - Absorb shock — the meniscus distributes load across a much larger contact area than bone-on-bone contact would, reducing peak pressures on the cartilage - Provide stability — the meniscus deepens the effective socket of the tibial plateau and resists shear forces during cutting and pivoting - Lubricate the joint — the meniscus contributes to synovial fluid distribution - Protect the cartilage — functioning menisci slow the rate of cartilage wear over decades The meniscus has a limited blood supply — only the outer one-third (the "red zone") receives meaningful vascular supply from the joint capsule. The middle third has marginal supply ("red-white zone"), and the inner two-thirds are essentially avascular ("white zone"). This anatomy drives the repair decision: tears in the outer vascular red zone have biological capacity to heal with repair. Tears in the inner avascular white zone typically do not heal with repair and are addressed with conservative debridement of only the unstable torn portion. The clinical implication is straightforward: removing meniscus tissue can accelerate cartilage wear in that compartment. Long-term studies consistently show higher rates of compartmental arthritis after subtotal meniscectomy than after meniscus-preserving treatment of the same tear. Modern meniscal surgery prioritizes repair whenever the pattern, location, and tissue quality allow it. For a patient-friendly walk-through of the symptoms that suggest a tear may improve with non-operative care, see 5 symptoms of a torn meniscus that will self-heal. ## How a Meniscal Tear Feels Symptoms vary with tear pattern, location, and whether the torn fragment has displaced into the joint: - Joint-line pain — pain on the inner side of the knee (medial meniscus) or outer side (lateral meniscus) is the most common symptom - Pain with twisting and pivoting — sports cuts, getting in and out of a car, deep squatting - Swelling — often appearing hours to a day after the inciting event in acute tears, or coming and going in degenerative tears - Mechanical symptoms — catching, locking, or a sensation that something is moving in the joint when the torn fragment displaces - Inability to fully extend — particularly with bucket-handle tears that have flipped into the notch (a true mechanical block to extension) - Clicking or popping with motion - Sense of giving way — usually quadriceps inhibition rather than true ligamentous instability in most cases - Pain at end-range flexion — the meniscus is loaded most in deep flexion Acute tears in younger patients usually present with a clear inciting event — a twist, a deep squat, a contact injury — followed by the symptom pattern above. Degenerative tears in patients over 40 often present without a discrete event. Many degenerative tears are incidental findings on MRI in patients over 50 who have no symptoms — the presence of a tear on imaging does not, by itself, mean surgery is needed. The clinical picture matters more than the MRI report. Patients sometimes confuse meniscus pain with an ACL injury — for the distinction, see the difference between ACL and meniscus tears. Video: Dr. Strickland explains meniscal tears and meniscectomy (1:21). Transcript hi you're watching this video because you and I have discussed performing either a meniscectomy or a meniscal repair the meniscus are two c-shaped structures within your knee the medial meniscus and the lateral meniscus the goal of the surgery is either to trim out a part of the cushion in your knee either the medial or lateral meniscus or to actually put sutures through to allow your meniscus to heal this surgery is done arthroscopically meaning I look inside your knee with a camera and use small instruments to either remove a small fragment of your meniscus or put sutures through the meniscus so that it can heal the actual day of surgery will come in you'll meet the anesthesiologist you'll talk about the actual anesthesia for the surgery most patients choose spinal anesthesia which means that your legs go to sleep and then through an IV you will be sedated so that you can sleep through the procedure the surgery itself takes about 30 to 45 minutes if I have to clip the meniscus in about an hour if you actually have a meniscal repair when you wake up in the recovery room you will see a physical therapist you'll take some pain medicine and you'll go home with crutches the actual Rick recovery for a meniscectomy is usually quite quick by two weeks most patients are off their crutches by six weeks some patients are back to low impact Sports and by three months most patients are back to normal if you have a meniscal repair you'll actually be in a brace for approximately six weeks most patients though will be allowed to return to weight bearing and start Physical Therapy within a few days ## How Tears Happen ### Acute tears (younger patients) Forceful twisting or rotation with a planted foot is the classic mechanism. Soccer cuts, basketball pivots, skiing falls, and deep squatting under load are common backstories. The femur rotates one direction while the tibia is fixed in another, and the meniscus — caught between the two — tears under the shear load. Direct impact (a fall onto the knee or a tackle) is a less common but real mechanism. Acute tears are often associated with concurrent ligament injury, particularly ACL tears — lateral meniscus tears are especially common in acute ACL injuries, while medial meniscus tears are more common in chronic ACL deficiency. For a real-world example of combined ACL plus meniscus injury, see a skier with combined ACL and meniscus tears. ### Degenerative tears (patients over 40) The meniscus weakens with age, and small tears can develop with everyday activities or no discrete trauma at all. Patients often present with insidious-onset joint-line pain that has been building for weeks. Many degenerative tears respond well to conservative care — for activity guidance during recovery, see Dr. Strickland's patient-education posts on 6 exercises to do with a torn meniscus and exercises to avoid with a torn meniscus. ## Tear Patterns and What They Mean #### Vertical / longitudinal tear Runs along the long axis of the meniscus. When in the outer vascular red zone, often repairable with arthroscopic suture techniques. The classic "repairable" tear pattern. #### Bucket-handle tear A vertical tear where the inner fragment displaces into the notch like a bucket handle. Often causes a true mechanical block to extension. Reducing and repairing the displaced fragment preserves a large portion of meniscus — usually a high-priority repair. #### Radial tear Runs from the inner edge perpendicular to the meniscus body. Disrupts the hoop-stress fibers. Repairable in selected cases (particularly when extending toward the periphery), with newer suture techniques showing good outcomes. #### Horizontal cleavage tear A horizontal split through the substance of the meniscus, parallel to the tibial plateau. Common in degenerative tears. Sometimes associated with a parameniscal cyst on the side of the knee. Often treated with conservative partial meniscectomy of the unstable leaflet, but new suture constructs can allow repair and healing in some cases. #### Flap tear A torn fragment partially detached from the rest of the meniscus, often causing mechanical catching. The unstable flap is typically resected back to a stable rim. #### Root tear A tear at the bony attachment of the meniscus. Functionally equivalent to removing the entire meniscus from a biomechanics standpoint. Particularly destructive on the medial side. Repaired with transtibial pull-through fixation when tissue allows. Detailed below. ## The Root Tear — a Special Case A meniscal root tear is a tear of the meniscus at its bony attachment to the tibia. Unlike a tear in the body or horn of the meniscus — where the surrounding intact tissue still provides some shock absorption — a root tear destabilizes the entire meniscus. The hoop-stress fibers that allow the meniscus to compress and distribute load are disrupted at the attachment, and the meniscus extrudes outward under load. The biomechanical effect is essentially equivalent to having the entire meniscus removed. The clinical consequence is significant. Untreated medial meniscus posterior root tears (MMRTs) cause rapid degeneration of the medial tibiofemoral compartment with high rates of conversion to arthroplasty — that statement is taken directly from Dr. Strickland's published article on the topic. For this reason, root tears in patients with otherwise reasonable cartilage and good alignment warrant prompt surgical evaluation for transtibial pull-through repair. For the deeper clinical discussion, see medial meniscus posterior root tears. Transtibial pull-through repair restores the bony attachment by drilling a tunnel through the tibia, passing sutures from the torn root through the tunnel, and tying them over a button on the front of the tibia. When the tissue is acceptable, this restores meniscal function and protects the cartilage. Recovery historically requires 6 weeks of non-weight-bearing — a rate-limiting step that has been particularly challenging for working-age patients to tolerate. Dr. Strickland's MISHA-augmented technique (covered below) addresses that constraint directly. ## How the Diagnosis Is Made ### History and Physical Exam Mechanism of injury (twist, deep squat, contact event, or insidious onset), location of pain (medial vs. lateral joint line), mechanical symptoms (catching, locking, inability to fully extend), prior knee injuries or surgeries, and current activity level. The exam includes: - Joint-line tenderness — the most sensitive single physical finding - McMurray's test — rotation under axial load to elicit pain or a click - Thessaly test — standing pivot to load the meniscus - Range of motion assessment — particularly looking for a true mechanical block to extension (suggesting a displaced bucket-handle tear) - Effusion assessment - Ligamentous stability — meniscus tears commonly accompany ACL injury - Patellar exam — to distinguish from patellofemoral pain ### Imaging - Standing weight-bearing x-rays — rule out arthritis, assess overall alignment, look for joint-space narrowing or extruded meniscus (a finding that suggests a root tear or absent meniscal function) - MRI — the definitive imaging study for meniscal tears. Characterizes tear pattern, tear location relative to the red, red-white, and white zones, associated cartilage status, and concurrent ligament injury. Required before any surgical decision-making - CT arthrogram — reserved for patients who cannot have MRI (pacemaker, certain implants) ## When Non-Surgical Care Is Appropriate Many meniscal tears, particularly degenerative tears in patients over 40 without true mechanical locking, respond well to non-surgical care. Per Dr. Strickland's patient-facing guidance, the symptoms most likely to settle with conservative management are intermittent pain without locking, swelling that resolves quickly, and pain that responds to a structured rehab and strengthening program. - Activity modification — reduce or substitute activities that load the affected meniscus (deep squatting, twisting under load, high-impact pivoting) - NSAIDs and ice for inflammatory control during flares - Structured PT — quadriceps and hip-stabilizer strengthening, range-of-motion preservation, gait training. Cycling, swimming, and elliptical training are usually well tolerated - Selective injection therapy — cortisone for flares; hyaluronic acid for arthritic pain in selected patients Surgery is considered when: - Symptoms persist despite 6 to 12 weeks of well-executed non-surgical care - There is true mechanical locking from a displaced tear (a bucket-handle tear flipped into the notch is one of the few reasons to operate sooner rather than later) - The tear is a repairable tear pattern in a younger active patient — meniscus preservation is the priority and earlier repair gives better tissue quality for healing - The tear is a root tear that will accelerate arthritis if left alone - There is concurrent ACL injury requiring surgery and the meniscus tear can be addressed in the same operation ## Surgical Options Compared ProcedureRecovery to sportBest forWhat it does Arthroscopic meniscal repair3–4 monthsOuter-zone (red-zone) tears in younger active patients with good tissue quality — vertical, bucket-handle, repairable radialSutures the torn meniscus so it can heal; preserves the meniscus and protects cartilage long-term Transtibial root repair4–6 monthsMedial or lateral meniscus root avulsions with acceptable tissue and reasonable cartilageDrilled tibial tunnel; sutures from the torn root pulled through and fixed over a button. Restores meniscal hoop-stress function Root repair + MISHA shock absorber4–6 monthsWorking-age patients with MMRT and early medial compartment arthritis whose alternatives are limited to HTO or arthroplastyCombined published technique: transtibial root repair plus extracapsular MISHA implant to unload the medial compartment and allow earlier partial weight-bearing Conservative partial meniscectomy4–8 weeksInner-zone (white-zone) tears that are not repairable; degenerative tears with mechanical symptoms; horizontal cleavage tears with unstable inner leafletRemoves only the unstable torn portion; preserves as much of the rim as possible Subtotal meniscectomy4–8 weeksAvoided when possible — rare scenarios where the meniscus is so damaged that meaningful preservation is not possibleRemoves the majority of the meniscus. Long-term cost: faster cartilage wear in that compartment Meniscal allograft transplantation9–12 monthsPatients with prior subtotal meniscectomy and persistent compartmental pain; intact cartilage; good alignment; stable ligamentsReplaces the absent meniscus with a size-matched donor meniscus. Restores meniscal function ## MISHA-Augmented Root Repair — Dr. Strickland's Published Technique The traditional bottleneck after a medial meniscus posterior root repair has been the 6 weeks of non-weight-bearing required to protect the repair while it heals. For working-age patients with jobs, families, and obligations that don't pause for surgery, that protocol is genuinely difficult to comply with — and non-compliance is the most common reason a root repair fails biologically. In 2024, Dr. Strickland published Medial Meniscus Root Repair with Implantable Shock Absorber Placement: A Combined Technique for Early Partial Weightbearing in Arthroscopy Techniques. The technique combines two elements in one operation: - Transtibial pull-through repair of the medial meniscus posterior root, restoring the bony attachment and hoop-stress function - Placement of the MISHA Knee System (Moximed, Fremont, CA) — an implantable shock absorber that sits outside the joint and mechanically unloads the medial tibiofemoral compartment By unloading the medial compartment with the implant, the root repair is mechanically protected and the patient can begin partial weight-bearing earlier than the traditional 6-week non-weight-bearing protocol. The combined technique was developed specifically for the patient population whose alternatives would otherwise be limited to high tibial osteotomy or arthroplasty (partial or total knee replacement) — younger working-age patients with a root tear and early medial compartment arthritis. For the full clinical detail, the surgical video, and the published case description, see the dedicated page on medial meniscus root repair with implantable shock absorber placement. Candidacy is determined after MRI review, standing alignment films, and a careful examination of cartilage status. ## Meniscal Allograft Transplantation Meniscal allograft transplantation is a meniscus-replacement procedure for patients who have had a prior subtotal meniscectomy and now have persistent pain in the affected compartment. The classic candidate is a patient in their 30s or 40s who had a meniscectomy years earlier (often for an injury that pre-dated the modern preservation-first approach) and is now experiencing compartmental joint pain in a knee that still has reasonable cartilage and stable ligaments. The procedure replaces the missing meniscus with a size-matched donor meniscus, secured with fixation at the anterior and posterior horns and sutured at its periphery. When the conditions line up, allograft transplantation can restore meniscal function and substantially relieve compartmental pain. Candidacy depends on: - Prior meniscectomy with persistent compartmental symptoms in that compartment - Intact cartilage — the procedure does not work in arthritic knees - Good alignment — or correctable with concurrent osteotomy (see joint preservation and osteotomy) - Stable ligaments — concurrent ACL reconstruction is sometimes needed (see ACL tear surgery) - Realistic expectations — allograft is a salvage procedure for a meniscus-deficient knee, not a routine first-line option For patients with medial meniscus posterior root tears and early medial compartment arthritis who are not allograft candidates, the MISHA-augmented root repair covered above is often the more appropriate joint-preserving option. ## What to Expect on Surgery Day Arthroscopic meniscus surgery is performed as an outpatient procedure — you go home the same day. This is the typical patient experience and your specific protocol is reviewed at consultation: - Arrival and pre-op — you arrive a couple of hours before the procedure for intake, change into a gown, and meet the anesthesia team - Anesthesia consultation — the anesthesiologist reviews your history and discusses the anesthesia plan. For Dr. Strickland's meniscus procedures, this is typically regional anesthesia (a spinal block with sedation) rather than general anesthesia. During surgery, a periarticular block is also placed around the knee joint to help reduce pain during the first day after surgery as part of an opioid-sparing protocol. - Surgery — arthroscopic meniscectomy or simple repair typically takes 30 to 60 minutes; transtibial root repair takes longer; combined root repair with MISHA placement takes longer still - Recovery room — you wake up in the recovery area; physical therapy begins reviewing your post-operative protocol the same day - Going home — you go home with crutches (and a hinged brace if you had a repair), ice, prescribed pain medication, and clear written instructions. A responsible adult must drive you home - First 48 hours — ice, elevation, prescribed medications, gentle motion within the limits of your brace and protocol For a meniscectomy, weight-bearing as tolerated begins immediately and most patients are off crutches within a few days. For a repair, the brace and protected weight-bearing protocol is important — non-adherence is the most common reason a repair fails. Your specific protocol depends on the procedure performed and is reviewed in detail at the pre-op visit. ## Recovery Timeline PhaseMeniscectomyRepairRoot repairAllograft Brace / weight-bearingWBAT, no braceHinged brace, 4–6 wks PWBHinged brace, 6 wks NWB (or earlier PWB with MISHA)Hinged brace, 6 wks PWB Range of motionFreeRestricted to 90° earlyRestricted to 90° for 6 wksRestricted to 90° for 6 wks Return to running4–6 wks3 months4–5 months6 months Return to pivoting sport4–8 wks4–6 months4–6 months9–12 months The repair recoveries are slower than meniscectomy because the repair must heal — protected weight-bearing and restricted motion in the early phase prevent disruption of the suture construct. The trade-off is preserving the meniscus and protecting the cartilage for decades, which makes the slower recovery worth it for the right patient. For a real-world recovery story, see back in the game after a torn meniscus. ## Risks of Meniscus Surgery Arthroscopic meniscus surgery is a well-established procedure with predictable outcomes for most patients, but no surgery is risk-free. The risks reviewed at consultation include: - Re-tear of a repaired meniscus — the most relevant procedure-specific risk after repair, particularly with non-adherence to weight-bearing and motion restrictions in the early healing phase - Failed healing of a root repair — the medial meniscus posterior root repair is biologically demanding and protected weight-bearing protocols matter - Stiffness or arthrofibrosis — reduced by structured early-phase PT and adherence to motion progression - Progression of arthritis — the long-term consequence of meniscus tissue loss; reduced by repair when feasible - Infection — uncommon but a serious complication if it occurs - Blood clot (DVT or pulmonary embolism) — mitigated by early mobilization and individualized prophylaxis - Nerve or vessel injury — rare; the saphenous nerve is particularly relevant during medial-side inside-out repair techniques - Anesthesia-related risks — rare allergic reactions, nerve injury or irritation from a regional block. During surgery, local anesthetic is also placed around the knee joint to help reduce pain during the first few hours The specific risk profile for your case depends on the procedure performed, your tear pattern, alignment, cartilage status, and any prior surgery on the knee. These are reviewed at consultation, and several of the risks above are modifiable by adherence to the post-operative protocol. ## Common Patient Concerns The three concerns we hear most often before meniscus surgery, with honest answers: #### "Six weeks of non-weight-bearing for a root repair is impossible. I have a job." That is exactly the problem the MISHA-augmented technique was designed to solve. By unloading the medial compartment with the implantable shock absorber at the same operation, the root repair is mechanically protected and partial weight-bearing can begin earlier than the traditional 6-week non-weight-bearing protocol. Whether you are a candidate depends on your alignment, cartilage status, and tear characteristics — that determination is made after imaging review and exam. See the published technique for the full detail. #### "My MRI shows a meniscus tear. Don't I need surgery?" Not necessarily. Many degenerative tears in patients over 40 are incidental MRI findings that don't require surgery. The clinical picture — whether the knee locks, catches, or gives way; whether the pain is improving or worsening with conservative care; whether the tear pattern is repairable in a younger patient where preservation matters — is what determines whether surgery is the right next step. The MRI is one input, not the answer. #### "My other surgeon told me I need a meniscectomy. Can it be repaired instead?" It depends on the tear pattern, location, and tissue quality — and on the surgeon's preference. Dr. Strickland's stated approach is to repair rather than remove whenever it is technically possible, because preserving the meniscus protects the cartilage long-term. A second opinion specifically focused on repair candidacy is reasonable when meniscectomy has been recommended — bringing the MRI to a sub-specialty consultation is the right step. ## Insurance and Cost Arthroscopic meniscus surgery is covered by all major commercial insurance plans, Medicare, and most self-funded and union plans when the diagnosis and indication for surgery meet medical-necessity criteria. The variables that drive your specific out-of-pocket cost are: - Your plan's deductible and coinsurance — the structure of cost-sharing differs significantly between plans - In-network vs. out-of-network status — for the surgeon, the facility (NYU Langone or affiliated outpatient surgery center), and the anesthesia group - The bundled vs. separate billing for the surgeon, facility, anesthesia, imaging, physical therapy, and any concurrent procedures (ACL reconstruction, cartilage work, alignment correction) - Specific implant coverage — the MISHA Knee System is reviewed for coverage on a case-by-case basis depending on payer; we discuss this directly with you before surgery if MISHA is part of the plan - Out-of-network benefits — if you have them and choose to use them; we can provide the codes you need to verify your benefits in advance Before surgery, our office verifies your benefits, obtains pre-authorization where required, and reviews the estimated out-of-pocket cost with you. If your plan doesn't cover a specific aspect, we discuss it openly before the operation, not after. For benefits verification or to discuss self-pay arrangements, call us at 646-904-4664 or contact the office. ## When to Seek a Sub-Specialty Second Opinion A sub-specialty second opinion is particularly worth seeking when: - You have been told you need meniscectomy and want to know whether your tear can be repaired instead - You have a meniscal root tear and want a clear answer on whether transtibial repair is appropriate — and whether the MISHA-augmented technique is right for your situation - You have symptoms after a prior meniscectomy and want to understand allograft transplantation candidacy - You have a combined meniscus and ACL injury and want a comprehensive plan that addresses both in one operation - You have been told you need a knee replacement for compartmental arthritis after meniscectomy and want a second opinion on joint-preserving options first - You are an active patient facing the decision between meniscus preservation (slower recovery) and meniscectomy (faster recovery, long-term cost) ## Access & Office Location Dr. Strickland sees meniscus patients at one office, which works with patients traveling in from outside the immediate area: - New York City: NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY 10016. In Midtown Manhattan, accessible from Manhattan, the outer boroughs, Long Island, Westchester, and northern New Jersey via the Queensboro and Triboro bridges and the FDR Drive. Phone: 646-904-4664. For patients traveling to New York from out of state for sub-specialty meniscus care, we coordinate consultation and surgery scheduling to minimize travel and align with imaging review and pre-operative work-up. Many out-of-state patients travel to NYU Langone specifically for second opinions on repair candidacy, root tear evaluation, MISHA-augmented root repair, and meniscal allograft transplantation. ## Patient Outcomes The point of all of the above — repair-first philosophy, root repair, MISHA augmentation, allograft when needed — is to get the right patient back to the activity that matters to them while protecting the cartilage for the next several decades. A few of Dr. Strickland's meniscus patient stories on this site: - Brenda Yee — medial meniscus tear and arthroscopic repair - How to know when your torn meniscus should be surgically repaired - Back in the game after a torn meniscus - A skier with combined ACL and meniscus tears For the full collection of patient outcomes across knee specialties, see Dr. Strickland's success stories. ## Frequently Asked Questions Can a meniscus tear heal without surgery? Some can. Tears in the outer one-third of the meniscus — the vascular red zone — receive blood supply from the joint capsule and have biological capacity to heal with rest, NSAIDs, activity modification, and structured PT. Tears in the inner two-thirds (the avascular white zone) typically do not anatomically heal but often quiet down symptomatically with conservative care, particularly degenerative tears in patients over 40 without true mechanical locking. Whether a tear needs surgery depends on tear pattern, location, mechanical symptoms, and how the knee responds to 6 to 12 weeks of structured rehab — not on the MRI report alone. What is the difference between meniscal repair and meniscectomy? Meniscal repair sutures the torn cartilage so it can heal, preserving the meniscus and its long-term protective effect on the underlying cartilage. Partial meniscectomy trims away the torn portion. Repair is preferred whenever the tear pattern, location, and tissue quality allow it — Dr. Strickland's stated preference: when it is technically possible, repair rather than remove. Meniscectomy is faster and has a quicker return to activity but removes shock-absorbing tissue and accelerates cartilage wear in that compartment over years to decades. What is a meniscal root tear and why does it matter? A meniscal root tear is a tear of the bony attachment of the meniscus to the tibia. Root tears destabilize the entire meniscus — the hoop-stress fibers are disrupted at the attachment, the meniscus extrudes outward under load, and the joint behaves as if the entire meniscus has been removed even though the body of the meniscus is intact. Untreated medial meniscus posterior root tears (MMRTs) cause rapid degeneration of the medial tibiofemoral compartment with high rates of conversion to arthroplasty. Transtibial pull-through repair restores the bony attachment and protects the cartilage when the tissue is acceptable. What is the MISHA implantable shock absorber and how does it relate to root repair? The MISHA Knee System (Moximed) is an implantable shock absorber that sits outside the joint and mechanically unloads the medial tibiofemoral compartment. A traditional medial meniscus posterior root repair requires 6 weeks of non-weight-bearing — a rate-limiting step that is hard for working-age patients to tolerate. Dr. Strickland published a combined technique in Arthroscopy Techniques (2024) that places MISHA at the time of root repair to unload the medial compartment, protect the repair, and allow earlier partial weight-bearing. The combined technique is most relevant for younger working-age patients with a root tear and early medial compartment arthritis whose alternatives would otherwise be limited to high tibial osteotomy or arthroplasty. How soon can I return to sport after meniscus surgery? After arthroscopic partial meniscectomy, most patients return to active sport in 4 to 8 weeks. After meniscal repair of a body tear, return to sport is typically 3 to 4 months because the repair must heal — protected weight-bearing and restricted early flexion prevent disruption of the suture construct. After transtibial root repair, return to sport is typically 4 to 6 months. After meniscal allograft transplantation, return to running is at 6 months and full sport at 9 to 12 months. How long does meniscus surgery take? Arthroscopic meniscal surgery typically takes about 30 to 60 minutes, depending on whether a repair or a meniscectomy is performed and on the complexity of the tear. Combined root repair with MISHA placement takes longer. All meniscus surgery is performed as an outpatient procedure with sedation and either general or spinal anesthesia, and most patients go home the same day. What are the symptoms of a meniscus tear? Pain along the joint line on the inner or outer side of the knee, swelling, stiffness, mechanical catching or locking when the torn fragment displaces into the joint, a sense of giving way (usually quadriceps inhibition rather than true ligamentous instability), clicking or popping with motion, and pain at end-range flexion. Symptoms vary with tear pattern, size, and whether the tear has displaced. A bucket-handle tear that has flipped into the notch can cause a true mechanical block to extension that warrants prompt evaluation. Do all meniscus tears need surgery? No. Many degenerative tears in patients over 40 without mechanical symptoms quiet down with NSAIDs, activity modification, structured PT, and selective injection. Surgery is considered when symptoms persist despite well-executed conservative care, when there is true mechanical locking from a displaced tear, when a repairable tear in a younger active patient warrants meniscus preservation, when the tear is a root tear that will accelerate arthritis if left alone, or when the meniscus tear is associated with an ACL injury that requires surgery. What is meniscal allograft transplantation? Meniscal allograft transplantation replaces a previously removed meniscus with a size-matched donor meniscus. It is appropriate for patients who have had a prior subtotal meniscectomy and now have persistent compartmental pain, in a knee with intact cartilage, good alignment (or alignment correctable with concurrent osteotomy), and stable ligaments. The procedure restores meniscal function and protects the cartilage from the wear that occurs in a meniscus-deficient compartment. What are the risks of meniscus surgery? Like any surgery, meniscus procedures carry small risks of infection, bleeding, blood clot, stiffness, and nerve injury (the saphenous nerve is particularly relevant during medial-side inside-out repairs). The most important long-term consideration is that removing meniscus tissue accelerates cartilage wear and raises the long-term risk of arthritis — that is why Dr. Strickland prioritizes repair over removal whenever the tear allows it. Re-tear of a repaired meniscus is possible, particularly with non-adherence to weight-bearing restrictions early after surgery. ## Related Specialty Care For combined meniscus and ACL injuries, see ACL tear surgery. For alignment correction when meniscus loss has produced compartmental wear, see joint preservation and osteotomy (HTO and DFO). For cartilage repair when the meniscus tear is associated with focal cartilage damage, see MACI cartilage repair and cartilage transplantation. For broader sports trauma context, see sports injuries. For the long-term consequences of meniscus loss, see knee arthritis. For the published combined root-repair technique, see the medial meniscus root repair with MISHA shock absorber page. Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Surgical and non-surgical orthopedic care should always be discussed with a board-certified orthopedic surgeon who has reviewed your imaging, history, and physical examination. Individual outcomes vary based on diagnosis, anatomy, comorbidities, surgical technique, and adherence to rehabilitation. The general descriptions of anesthesia, pain protocols, and timelines on this page reflect typical patient experience — your specific protocol is determined at consultation. ## Discuss Your Meniscus Tear — Repair First If you have been told you need meniscectomy and want to know whether repair is possible, or you have a root tear, post-meniscectomy pain, or a combined ACL plus meniscus injury, bring your imaging to a sub-specialty consultation at NYU Langone in Midtown Manhattan. Book an Appointment Call 646-904-4664 --- ## MPFL Reconstruction: Patellar Stabilization NYC | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/knee-surgeon-specialist/mpfl-reconstruction-surgery/ Summary: MPFL reconstruction by Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York — patellar stabilization with gracilis allograft, two-point patellar fixation, and combined tibial tubercle osteotomy or cartilage repair when bony anatomy or cartilage damage requires it. Specialty # MPFL Reconstruction Patellar stabilization for recurrent kneecap dislocation — gracilis allograft with two-point patellar fixation, combined with tibial tubercle osteotomy or cartilage repair when bony anatomy or cartilage damage requires it. By Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York. Medically reviewed by Dr. Sabrina Strickland, MD — Board-Certified Orthopedic Sports Surgeon at the NYU Langone Orthopedic Center in New York · Member, International Patellofemoral Study Group. View full bio → Where NYU Langone Orthopedic Center, Midtown Manhattan Patients We See Recurrent dislocators, first-time dislocators with risk factors, failed prior MPFL revisions Return to Sport Typically 4–7 months — high-impact athletes 12–18 months, milestone-based Overview MPFL reconstruction rebuilds the medial patellofemoral ligament — the soft-tissue tether on the inner side of the knee that keeps the kneecap (patella) tracking in its trochlear groove. After a first or recurrent patellar dislocation, the MPFL is the structure that has typically failed. Reconstruction uses a tendon graft (Dr. Strickland typically chooses a donor hamstring to avoid harvest-site morbidity and hamstring weakness) anchored between the patella and femur. Two all-suture suture anchors are placed on the patella to recreate the broad fan-shaped insertion of the native ligament while minimizing the fracture and cartilage-damage risk associated with patellar bone tunnels. When imaging shows significant patella alta, an elevated TT-TG (tibial tubercle to trochlear groove) distance, or severe trochlear dysplasia, a tibial tubercle osteotomy (TTO) is added in the same operation to address the bony alignment. When patellar or trochlear cartilage has been damaged from prior dislocations, concurrent cartilage repair may be added. Most patients return to cutting and pivoting sport between 4 and 7 months. Recovery is milestone-based, not calendar-based. If your kneecap has dislocated — once with concerning anatomy, or repeatedly — the question is rarely whether the MPFL is torn (it almost always is, after a true dislocation) but whether your knee will benefit more from formal reconstruction or from continued non-operative management with bracing and physical therapy. The answer depends on how often your kneecap dislocates, what your imaging shows about the underlying bony architecture, and whether the cartilage on the back of the patella or in the trochlear groove has been damaged. MPFL reconstruction is the soft-tissue side of patellar stabilization; for a meaningful proportion of patients, the bony alignment also has to be addressed. This page covers what MPFL reconstruction restores, when it is and is not the right operation, the clinical decision between MPFL alone and MPFL combined with TTO, why graft and fixation choices matter less than commonly assumed and where they still matter, what to expect on surgery day and through recovery, the risks of the procedure, and when a sub-specialty second opinion is worth seeking — particularly for failed prior MPFL reconstruction. For closely related topics, see patellar instability for the broader diagnostic framework; joint preservation and osteotomy for TTO and HTO/DFO realignment; MACI cartilage repair when patellar cartilage damage is part of the picture; and patellar pain and patellar arthritis when chronic patellofemoral cartilage wear has set in. ## What MPFL Reconstruction Restores The medial patellofemoral ligament is a flat, fan-shaped structure on the inner side of the knee that runs from the medial epicondyle of the femur to the upper-medial border of the patella. Functionally, it acts as a leash — in the first 30 degrees of knee flexion, before the patella seats into the deeper part of the trochlear groove, the MPFL is the primary restraint that prevents the kneecap from being pulled laterally out of the groove. After a patellar dislocation, the MPFL is almost always torn. Even when the kneecap relocates spontaneously (which it usually does), the soft-tissue restraint is gone. With the leash damaged, the kneecap can dislocate again with much less force than it took the first time — often during ordinary activity rather than a high-energy injury. MPFL reconstruction restores that lateral restraint with a tendon graft anchored between the patella and femur. The graft does not heal back into a native MPFL — it functions as a check-rein that prevents the kneecap from tracking too far laterally during the early flexion arc, which is when the joint is most vulnerable. When MPFL reconstruction is paired with the right bony correction in patients who need it, the rate of recurrent dislocation falls substantially. ## How an Instability Episode Feels A first dislocation is usually distinct: - The kneecap visibly slips off-center — toward the outer side of the knee — sometimes with an audible pop - Sharp pain on the inner side of the knee where the MPFL has just torn - Rapid swelling within hours (a hemarthrosis — blood in the joint), particularly if a piece of cartilage has chipped off the patella or trochlea - The kneecap usually relocates on its own when the knee is straightened, sometimes with a second pop, sometimes spontaneously - Difficulty bearing weight or straightening the knee, especially if a loose osteochondral fragment is blocking motion Recurrent instability often feels different. Once the MPFL has failed and the underlying anatomy is unfavorable, subsequent episodes can occur with progressively less force — turning to talk to someone, stepping out of a car, going down a curb at an angle. Many patients describe a chronic sense of the kneecap "wanting to slip out," guarding against twisting motions, and a loss of confidence in the knee that affects sport, work, and even routine walking on uneven ground. An acute dislocation with a loose osteochondral fragment is a different scenario: the knee is often locked, swollen, and weight-bearing is difficult. These patients typically need urgent imaging and may need to go to the operating room sooner to address the fragment, with or without an MPFL reconstruction in the same sitting. ## The Surgery Decision Whether to reconstruct the MPFL depends on: - How many times the patella has dislocated — recurrent dislocators almost always benefit from reconstruction; first-time dislocators with multiple risk factors for recurrence (younger age, trochlear dysplasia, patella alta, elevated TT-TG distance, generalized ligamentous laxity) often do as well - Imaging findings — trochlear shape, patellar height, TT-TG distance, status of the MPFL, presence of an osteochondral fragment or focal cartilage damage - Activity goals — the more the knee is asked to cut, pivot, and rotate, the lower the threshold for reconstruction - Failure of conservative care — structured physical therapy focused on quadriceps and hip strength, neuromuscular control, and bracing for higher-risk activity; when the knee continues to dislocate or persistently feels unstable despite a fair non-operative trial, reconstruction is indicated - Loss of confidence and quality of life — even between dislocations, many patients lose the ability to participate fully in their sport, work, or daily activity because of the fear of giving way For patients who are not surgical candidates — or who choose to proceed non-operatively — structured PT is the foundation. Quadriceps activation, hip and core strengthening, neuromuscular control, and (in selected cases) a patellar stabilization brace can substantially reduce the rate of recurrent episodes. The trade-off is that without surgical correction of the soft-tissue restraint and any contributing bony malalignment, the kneecap remains at higher risk of dislocating again, and each dislocation carries the potential for additional patellar or trochlear cartilage damage. ## MPFL Alone vs. Combined with TTO This is one of the most important decision points on the page, and it is genuinely sub-specialty work. MPFL reconstruction alone is sufficient for many patients with recurrent dislocations. A subset of patients have bony anatomy that means the soft-tissue reconstruction alone will be biomechanically asked to do more than it should — and in those patients, combining the MPFL reconstruction with a tibial tubercle osteotomy (TTO) addresses the bony alignment that is contributing to the instability. The decision is based on imaging measurements and physical examination, not symptoms alone. The features that push toward adding a TTO are: - Significant patella alta — a high-riding kneecap that does not engage the trochlear groove until later in flexion than it should. Measured on lateral X-ray with the Caton-Deschamps or Insall-Salvati ratio. Distalization of the tibial tubercle brings the kneecap down into earlier engagement - Elevated TT-TG distance — the tibial tubercle (where the patellar tendon attaches to the tibia) is too far lateral relative to the trochlear groove. Measured on CT or MRI. Medialization of the tibial tubercle redirects the line of pull on the kneecap medially - Severe trochlear dysplasia — a shallow or convex trochlear groove that does not provide a containing track for the kneecap. In selected severe cases, trochleoplasty (deepening the groove) may also be considered When these bony factors are missed at the index surgery, the MPFL graft is asked to substitute for both the soft-tissue restraint and the missing bony containment — a setup for recurrent instability or for the graft to stretch out over time. Unaddressed bony risk factors are one of the most common causes of failed MPFL reconstruction, which is why imaging-guided patient selection matters so much. FeatureMPFL aloneMPFL + TTO Best forRecurrent dislocators with normal bony anatomy and a torn MPFLPatients with patella alta, elevated TT-TG, or severe trochlear dysplasia Imaging triggersNormal Caton-Deschamps, normal TT-TG, mild or no dysplasiaHigh Caton-Deschamps (patella alta), TT-TG above threshold, dysplastic trochlea RecoveryBrace up to 6 weeks, return to sport 4–7 monthsProtected weight-bearing while the osteotomy heals; return to sport pushed later, often 6–9+ months Trade-offFaster recovery, but recurrence risk if bony factors are missedLonger recovery, but addresses the underlying mechanical problem For more on the specific decision-making and patient stories, see Dr. Strickland's MPFL reconstruction and TTO questions post and the joint preservation and osteotomy page for the full TTO walk-through. ## Graft and Fixation Choices Two technical decisions get a lot of attention in MPFL reconstruction discussions: which graft, and how the graft is fixed to the patella. Published evidence suggests graft choice has relatively little effect on outcomes — gracilis allograft, hamstring autograft, and quadriceps tendon all produce comparable results when matched to the right patient. Patellar fixation, on the other hand, is where Dr. Strickland's technique preferences are explicit and worth understanding. #### Gracilis allograft (Dr. Strickland's typical choice) Donor gracilis tendon. Avoids harvest-site morbidity and hamstring weakness from taking a patient's own gracilis. Published evidence shows graft choice is relatively unimportant for MPFL outcomes, so the trade-off favors avoiding donor-site morbidity for most patients. #### Hamstring autograft (selected cases) Patient's own gracilis or semitendinosus. Avoids donor tissue. Trade-off is mild hamstring weakness and an additional incision at the donor site. Reasonable for patients who prefer autograft or in revision settings where the prior graft choice and outcome inform the decision. #### Two all-suture suture anchors on the patella Dr. Strickland's preferred patellar fixation. The native MPFL has a broad fan-shaped insertion; two-point fixation more closely recreates that anatomy and improves how the patella tracks through early flexion. All-suture anchors carry minimal risk of fracture or articular cartilage damage compared with patellar bone tunnels or larger metallic anchors. #### Anatomic femoral attachment The femoral side is fixed at the anatomic origin of the native MPFL on the medial femur. Anatomic placement is one of the few technical variables that consistently affects how the reconstruction performs — non-anatomic tunnels are a documented mode of failure. Position is verified intraoperatively against bony landmarks. For the published reasoning behind the two-point patellar fixation preference, see Dr. Strickland's editorial commentary on two fixation points in The Journal of Arthroscopic and Related Surgery. ### What about robotic-assisted MPFL reconstruction? A published study compared robotic-assisted versus freehand MPFL reconstruction. The robotic-assisted group did achieve a femoral tunnel that was on average closer to a specific anatomic landmark, but both groups had similar rates of clinically meaningful patient-reported outcomes. The robotic-assisted surgery took longer and required expensive technology, and as Dr. Strickland has noted, anatomic variation between patients means that a single "standard" tunnel position is not always the correct one for an individual patient. For most cases, experienced freehand technique with intraoperative verification of landmarks with x-ray (fluoroscopy) is the approach of choice. See her commentary on robot-assisted vs. freehand MPFL reconstruction for the full discussion. ## Concurrent Cartilage Repair A patellar dislocation is rarely just a soft-tissue event. As the patella shears off the trochlear groove and then snaps back into place, the cartilage on the back of the patella and along the lateral wall of the trochlea can be damaged. This shows up on MRI as a bone bruise pattern at minimum, and in some cases as a frank osteochondral lesion or a loose fragment in the joint. When focal cartilage damage is present, MPFL reconstruction is often combined with a cartilage procedure in the same operation: - Loose fragment fixation or removal — for displaced osteochondral fragments after acute dislocation - MACI (matrix-induced autologous chondrocyte implantation) — a two-stage procedure where cartilage cells are harvested from the patient at the index surgery, grown in a lab, and implanted at a second surgery onto a focal patellar or trochlear cartilage defect. See MACI cartilage repair for the full walk-through - DeNovo (donor juvenile cartilage) — a one-stage procedure for small cartilage lesions - Osteochondral autograft (OATS) — for smaller lesions that include subchondral bone - Osteochondral allograft (OCA) — for larger lesions that include subchondral bone When chronic patellofemoral cartilage wear has progressed beyond focal repair territory, the conversation shifts to patellar pain and patellar arthritis management — which can include alignment correction, patellofemoral arthroplasty in selected cases, and the full menu of biologic and surgical options for chronic patellofemoral disease. ## Prehabilitation For elective MPFL reconstruction in patients with chronic instability, prehabilitation matters. Dr. Strickland recommends starting prehab 4 to 6 weeks before surgery. The goals are full pain-free range of motion, strong quadriceps activation, and good hip and core control. Patients who arrive at surgery with a quiet, mobile knee and active quads regain motion and strength faster after the operation than patients who arrive with a stiff, swollen, quad-inhibited knee. A productive prehab phase typically includes: - Working with a physical therapist who has knee or sports medicine expertise — ideally one who has worked with patellar instability patients before - Familiarizing yourself with the planned post-operative rehab protocol so the first few weeks after surgery are not surprising - A home exercise program built around quad sets, straight-leg raises, hip and glute work, and gentle range of motion within pain-free limits - An up-to-date medication and supplement list reviewed with your surgical team and primary care physician — some anti-inflammatories, blood thinners, and supplements may need to be paused before surgery - A plan for transportation home, post-op support at home, and time off from work or school Acute dislocations with a locked knee or a loose osteochondral fragment do not get this 4 to 6 week window — those patients need to go to the operating room sooner. For those patients, the prehab framing changes to managing pain and swelling, gentle quad sets if possible, and getting to surgery quickly. For more, see Dr. Strickland's how to prepare for an MPFL reconstruction guide. ## What to Expect on Surgery Day MPFL reconstruction is performed as an outpatient procedure — you go home the same day. This is the typical patient experience and your specific protocol is reviewed at consultation: - Arrival and pre-op — you arrive a couple of hours before the procedure for intake, change into a gown, and meet the anesthesia team - Anesthesia consultation — the anesthesiologist reviews your history and discusses the anesthesia plan. For Dr. Strickland's MPFL reconstructions, this is typically regional anesthesia (a spinal block with sedation) rather than general anesthesia. During surgery, a periarticular block is also placed around the knee joint to help reduce pain during the first day after surgery as part of an opioid-sparing pain protocol; if a TTO is added, the protocol is adjusted accordingly. - Surgery — the procedure typically takes 1 to 2 hours for an isolated MPFL reconstruction; longer when combined with TTO or cartilage repair - Recovery room — you wake up in the recovery area; your knee is in a brace locked in extension. Physical therapy starts the same day or the next morning with crutch training and basic motion within the safe limits of the brace - Going home — you go home with crutches, the brace, ice, prescribed pain medication, and clear written instructions. A responsible adult must drive you home - First 48 hours — ice, elevation, prescribed medications, gentle motion as instructed. The first week's focus is effusion control, quadriceps activation, and walking with weight in the brace Cold-compression devices and quadriceps muscle stimulators (when prescribed) can help reduce swelling and support muscle reactivation in the first weeks. The block typically wears off over the first 12 to 24 hours, during which the leg is numb and weight-bearing requires the brace and crutches because the leg is not protecting itself normally. This is expected and is the trade-off for the lower pain levels in that first day. ## Recovery and Return-to-Sport Timeline MPFL reconstruction recovery is a structured, milestone-based progression. The dates below are general guidelines — your specific plan may differ if a TTO or cartilage repair is added. Always follow your care team's personalized instructions. PhaseTimelineGoals Phase 1: Immediate post-opWeeks 1–2Effusion control, brace locked in extension for walking, weight-bearing as tolerated, gentle range-of-motion work, quadriceps activation Phase 2: Early rehabWeeks 3–6Increase range of motion, intensify quad and hip work, gradually transition out of brace once quad control is sufficient (typically by 6 weeks) Phase 3: Advanced strengtheningWeeks 7–12Discontinue brace, progressive resistance training, balance and proprioception drills, low-impact cardio (stationary bike, elliptical, swimming) Phase 4: Functional and sport-specificMonths 3–4Graduated running program, plyometrics, agility drills, sport-specific movement patterns Phase 5: Return to full activityMonths 4–6+Cleared return to cutting and pivoting sport when surgical leg matches or exceeds 90% of non-operative leg in strength and hop tests, with confidence in dynamic movement Phase 6: High-impact athleteMonths 6–12For high-impact and contact athletes, full sport readiness can take 6 to 12 months with continued conditioning and sport-specific work The two factors that most consistently slow MPFL recovery are inconsistent physical therapy attendance and rushing back to high-impact activity before clearance. Skipping rehab sessions delays the quadriceps strength gains that gate brace removal and progression. Returning to running, jumping, or pivoting before milestone clearance increases the risk of graft failure or re-dislocation. For the full week-by-week walk-through, see Dr. Strickland's how long does MPFL recovery really take. ## Risks of MPFL Surgery MPFL reconstruction is a well-established surgery with predictable outcomes for most well-selected patients, but no surgery is risk-free. The risks reviewed at consultation include: - Recurrent instability or graft failure — the most clinically relevant long-term risk. Most often associated with unaddressed bony risk factors (patella alta, trochlear dysplasia, elevated TT-TG distance), non-anatomic tunnel placement, or returning to high-demand activity before milestones are met. Imaging-guided patient selection and an honest discussion of whether TTO needs to be added are the main mitigations - Persistent stiffness or loss of motion — reduced by good prehabilitation, early focus on regaining motion, and structured PT - Patellar fracture — rare with all-suture anchor fixation, more often associated with patellar bone tunnels. Dr. Strickland's preference for two all-suture suture anchors is partly aimed at minimizing this risk - Articular cartilage damage from patellar fixation — minimized by all-suture anchors compared with larger metallic implants or full-thickness bone tunnels - Anterior knee pain — can persist after surgery, particularly when there is concurrent patellofemoral cartilage damage that is not addressed - Numbness around the incision — common in the early post-op weeks, often improves over months - Infection — uncommon but a serious complication if it occurs - Blood clot (DVT or pulmonary embolism) — risk is mitigated by early mobilization and individualized prophylaxis - Graft-site morbidity — with hamstring autograft only. Mild hamstring weakness and an additional small incision at the donor site. Avoided when allograft is used - Anesthesia-related risks — including nausea, sore throat, rare allergic reactions to anesthetics, transient nerve irritation from the regional block - Incomplete return to prior level of sport — some patients do not return to their prior level even with a technically excellent reconstruction; psychological readiness, fitness changes during the recovery, and the underlying anatomy all contribute Outcomes are generally good in well-selected patients, but results depend on individual anatomy, adherence to rehab, and overall health. Specific risks for your case depend on your imaging, prior surgeries, concurrent procedures (TTO, cartilage repair), and goals — these are reviewed at consultation. ## Common Patient Concerns The three concerns we hear most often before MPFL reconstruction, with honest answers: #### "I've already had MPFL surgery and my knee still feels unstable. Did I just get a bad surgeon?" Not necessarily. Failure of a prior MPFL reconstruction is more often associated with unaddressed bony risk factors — patella alta, trochlear dysplasia, elevated TT-TG — than with a technically poor primary surgery. Sometimes the primary MPFL was the right operation but should have been combined with a TTO; sometimes the femoral tunnel was non-anatomic; sometimes the underlying ligamentous laxity or anatomy was more severe than initially appreciated. Revision planning starts with new MRI, weight-bearing X-rays, and a CT for assessing rotation of the femur and tibia, then an honest conversation about what the index surgery did and didn't address. Dr. Strickland is frequently asked to give second opinions for failed prior MPFL reconstruction. See how to tell if your MPFL reconstruction failed. #### "Wearing the brace for six weeks sounds awful. Can I skip it?" The brace exists to keep the leg straight during walking until your quadriceps is strong enough to control the kneecap on its own. Skipping it puts the new graft at risk during the period when quad control is still returning — precisely when re-dislocation would be most damaging. The brace allows immediate weight-bearing in most cases, which is a significant convenience advantage; you can walk and start light daily activities right away. Most patients are out of the brace by 4 to 6 weeks, and the trade-off for that protection is a meaningfully lower risk of re-injury during a vulnerable period. #### "How much will this actually cost me out of pocket?" MPFL reconstruction is medically necessary for symptomatic recurrent patellar instability and is covered by all major commercial insurance plans, Medicare, and most union and self-funded plans. Your out-of-pocket cost depends on your plan's deductible, coinsurance, in-network status of the surgeon, the facility (NYU Langone or affiliated), and the anesthesia group. Our team verifies benefits and reviews your estimated out-of-pocket cost with you before surgery so there are no surprises. See Insurance and Cost below. ## Insurance and Cost MPFL reconstruction is covered by all major commercial insurance plans, Medicare, and most self-funded and union plans when the diagnosis and indication for surgery meet medical-necessity criteria. The variables that drive your specific out-of-pocket cost are: - Your plan's deductible and coinsurance — the structure of cost-sharing differs significantly between plans - In-network vs. out-of-network status — for the surgeon, the facility (NYU Langone or affiliated outpatient surgery center), and the anesthesia group - The bundled vs. separate billing for the surgeon, facility, anesthesia, imaging, physical therapy, and any concurrent procedures (TTO, cartilage repair) - Out-of-network benefits — if you have them and choose to use them; we are happy to provide the codes you need to verify your benefits in advance Before surgery, our office verifies your benefits, obtains pre-authorization where required, and reviews the estimated out-of-pocket cost with you. If your plan doesn't cover a specific aspect, we discuss it openly before the operation, not after. For benefits verification or to discuss self-pay arrangements, call us at 646-904-4664 or contact the office. ## When to Seek a Sub-Specialty Second Opinion A sub-specialty second opinion is particularly worth seeking when: - You have had more than one patellar dislocation and want a clear discussion of whether MPFL alone or MPFL + TTO is the right operation for your specific imaging - You have a failed prior MPFL reconstruction — recurrent dislocation, persistent anterior knee pain, loss of motion, or no progress in PT despite a good rehab effort - Your imaging shows significant patella alta, elevated TT-TG distance, or trochlear dysplasia and you want to know whether your prior surgery was the right operation or whether the bony alignment also needs to be addressed - You had a first-time dislocation with a loose osteochondral fragment or focal cartilage damage on MRI — this is a more nuanced surgical decision than a routine first-time dislocation - You are an adolescent or young adult athlete with chronic instability and want a sports-medicine perspective on graft choice, return-to-sport timing, and growth-plate considerations - You have generalized ligamentous laxity or a connective tissue disorder (Ehlers-Danlos, Marfan, hypermobility spectrum) and want to discuss whether the standard reconstruction protocol applies to you ## Access & Office Location Dr. Strickland sees MPFL patients at one office, which works with patients traveling in from outside the immediate area: - New York City: NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY 10016. In Midtown Manhattan, accessible from Manhattan, the outer boroughs, Long Island, Westchester, and northern New Jersey via the Queensboro and Triboro bridges and the FDR Drive. Phone: 646-904-4664. Many patients travel to New York for sub-specialty patellofemoral care, particularly for revision MPFL reconstruction, combined MPFL+TTO planning, and concurrent cartilage repair. We coordinate consultation, imaging review, and surgery scheduling to minimize travel for out-of-state patients. ## Frequently Asked Questions How long is recovery after MPFL reconstruction? Most patients return to daily activities within 6 to 12 weeks after MPFL reconstruction. Return to cutting and pivoting sport is typically 4 to 7 months, and high-impact or contact athletes may need 12 to 18 months. Recovery is milestone-based, not calendar-based — quadriceps strength, range of motion, hop testing, and confidence all gate progression. The brace is worn during walking for up to 6 weeks until quadriceps control returns. Do I need a tibial tubercle osteotomy with my MPFL reconstruction? Not always. MPFL reconstruction alone is sufficient for many patients with recurrent dislocations. A tibial tubercle osteotomy (TTO) is added when imaging shows significant patella alta (a high-riding kneecap), an elevated TT-TG distance (the tibial tubercle is too far lateral relative to the trochlear groove), or severe trochlear dysplasia. The decision is based on imaging measurements and physical examination, not symptoms alone. What graft does Dr. Strickland use for MPFL reconstruction? Dr. Strickland typically uses gracilis allograft (donor tendon). Published evidence shows graft choice has relatively little effect on outcomes for this surgery, and allograft avoids the harvest-site morbidity and hamstring weakness associated with using your own tendon. For revision cases or specific patient preferences, autograft may be used. Graft selection is reviewed in detail at consultation. How is the patella attached during MPFL reconstruction? Dr. Strickland prefers two all-suture suture anchors for patellar fixation. The native MPFL has a broad fan-shaped insertion on the patella; two-point fixation more closely recreates this anatomy and improves how the patella tracks through early flexion. All-suture anchors carry minimal risk of fracture or articular cartilage damage compared with patellar bone tunnels or larger metallic anchors. Is MPFL repair the same as MPFL reconstruction? No. MPFL repair sutures the torn native ligament and has higher recurrence rates than reconstruction with a tendon graft, especially when underlying anatomy (trochlear dysplasia, patella alta, elevated TT-TG distance) predisposes to instability. Reconstruction with a graft creates a stronger, more reliable restraint and is the standard for recurrent patellar dislocations in Dr. Strickland's practice. Is robotic-assisted MPFL reconstruction better than freehand? Not necessarily. A published study comparing robotic-assisted versus freehand MPFL reconstruction found similar rates of clinically meaningful patient-reported outcomes, while robotic-assisted surgery took longer and required expensive technology. Anatomic variation between patients also means a single "standard" tunnel position is not always correct. Dr. Strickland uses experienced freehand technique with intraoperative verification of anatomic landmarks. What if my prior MPFL reconstruction failed? A failed MPFL reconstruction typically presents as recurrent kneecap dislocation or subluxation, persistent anterior knee pain, loss of motion, or no functional progress in physical therapy. Failure is most often due to unaddressed bony risk factors — patella alta, trochlear dysplasia, or limb malalignment that should have been corrected at the index surgery. Revision planning includes new MRI, CT for assessing rotation of the femur and tibia, and a structured discussion of whether TTO, trochleoplasty, or alignment correction needs to be added. Can I weight-bear right after MPFL surgery? Yes, in most cases. Patients typically walk with weight on the operated leg immediately after surgery while wearing a knee brace locked in extension. The brace keeps the leg straight during walking until quadriceps control returns, usually for up to 6 weeks. Crutches are used for added support and balance during the first few weeks. If a tibial tubercle osteotomy is performed at the same time, weight-bearing protocols are individualized to protect the healing osteotomy. ## Related Specialty Care For the broader diagnostic and treatment framework for kneecap dislocation and chronic patellar instability, see patellar instability. For the bony realignment side — tibial tubercle osteotomy, high tibial osteotomy, and distal femoral osteotomy — see joint preservation and osteotomy. When the patellar or trochlear cartilage has been damaged from prior dislocations, see MACI cartilage repair for focal cartilage repair. When chronic patellofemoral cartilage wear is established, see patellar pain and patellar arthritis. When ACL injury has occurred alongside a patellar dislocation, see ACL tear surgery. For Dr. Strickland's published research and editorial commentary on MPFL technique, see her editorial on two-point patellar fixation, her commentary on robotic-assisted vs. freehand MPFL, her discussion of follow-up duration in MPFL studies, and her work on machine learning to predict MPFL reconstruction outcomes. For the practical patient-facing recovery and preparation guides, see how to prepare for an MPFL reconstruction, how long does MPFL recovery really take, MPFL and TTO questions, and how to tell if your MPFL reconstruction failed. Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Surgical and non-surgical orthopedic care should always be discussed with a board-certified orthopedic surgeon who has reviewed your imaging, history, and physical examination. Individual outcomes vary based on diagnosis, anatomy, comorbidities, graft choice, surgical technique, and adherence to rehabilitation. The general descriptions of anesthesia, pain protocols, and timelines on this page reflect typical MPFL-reconstruction patient experience — your specific protocol is determined at consultation. ## Discuss Your MPFL Reconstruction If you have had a kneecap dislocation, recurrent patellar instability, or a failed prior MPFL reconstruction, bring your imaging to a sub-specialty consultation at NYU Langone in Midtown Manhattan. Book an Appointment Call 646-904-4664 --- ## Patellar Instability & Recurrent Kneecap Dislocation NYC | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/knee-surgeon-specialist/patellar-instability/ Summary: Sub-specialty patellofemoral care for first-time and recurrent patellar dislocation by Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York — MPFL reconstruction, tibial tubercle osteotomy (including AMZ-TTO), trochleoplasty, concurrent cartilage repair, and the Patella LIFT FDA trial. Sub-Specialty Hub # Patellar Instability & Recurrent Kneecap Dislocation Sub-specialty patellofemoral care for first-time and recurrent patellar dislocation — MPFL reconstruction, tibial tubercle osteotomy (including AMZ-TTO), trochleoplasty, and concurrent cartilage repair. By Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York. Medically reviewed by Dr. Sabrina Strickland, MD — Board-Certified Orthopedic Surgeon at the NYU Langone Orthopedic Center in New York · Member, International Patellofemoral Study Group · Castle Connolly Top Doctor. View full bio → Where NYU Langone Orthopedic Center, Midtown Manhattan Sub-Specialty Focus Patellofemoral instability is one of Dr. Strickland's primary clinical and academic focuses Patients We See First-time dislocators with risk factors, recurrent dislocators, failed prior MPFL revisions, pediatric and adolescent instability Overview Patellar instability is the spectrum from partial slipping (subluxation) through full dislocation to recurrent instability. Recurrence risk is highest when the first dislocation happens at a young age and is increased by anatomical risk factors — trochlear dysplasia, patella alta, an elevated TT-TG (tibial tubercle to trochlear groove) distance, knock-knee alignment, and generalized ligamentous laxity. Treatment is anatomy-driven: physical therapy and bracing for selected first-time dislocators without cartilage damage, MPFL reconstruction for recurrent dislocators with reasonable bony anatomy, MPFL combined with a tibial tubercle osteotomy (TTO) when bony alignment is the underlying problem, concurrent cartilage repair when prior dislocations have damaged the patellar or trochlear cartilage, and selected emerging options including the Patella LIFT FDA trial. Dr. Sabrina Strickland is a member of the International Patellofemoral Study Group, a co-author of the multicenter JUPITER pediatric MPFL reconstruction study, and a contributor to the modified Delphi consensus on patellar instability. If your kneecap has dislocated — once, or repeatedly — the question worth asking is not "do I need surgery." It is: what is the underlying anatomy that let it dislocate, and what does the cartilage look like now? Patellar instability is one of the few orthopedic problems where the same diagnosis can lead to five different operations depending on the answers. A first-time dislocator with a normal-shaped trochlea, a normal patellar height, no cartilage damage, and an isolated MPFL injury is a very different patient than a 19-year-old with three dislocations, a shallow trochlear groove, a high-riding patella, and a free cartilage fragment in the joint. This page is the sub-specialty hub for patellofemoral instability. It covers what patellar instability is and how it feels, the anatomical risk factors that drive recurrence, who develops the condition, what to do after a first-time dislocation, the full treatment ladder (physical therapy → MPFL → TTO → cartilage repair, with the trochleoplasty and lateral retinacular options where they apply), MPFL-alone vs. MPFL+TTO decision-making, pediatric considerations, what to expect on surgery day, recovery, risks, insurance reality, and when to seek a sub-specialty second opinion. For the dedicated procedure walk-through, see the MPFL reconstruction surgery hub; for the realignment side, see joint preservation and osteotomy; for cartilage repair after dislocation, see MACI cartilage repair and cartilage transplantation (OATS & allograft). ## The Patellar Instability Spectrum: Subluxation → Dislocation → Recurrence The kneecap (patella) sits in front of the knee and slides up and down in a groove on the front of the thigh bone — the trochlear groove. As you bend and straighten the knee, the patella tracks through the groove and acts as a lever for the quadriceps. Patellar instability describes a continuum: at one end, the kneecap shifts partially out of the groove and returns on its own (a subluxation); at the other end, the kneecap fully leaves the groove and either reduces with leg extension or has to be reduced manually, sometimes in the emergency room (a dislocation, sometimes called a kneecap dislocation or patellar dislocation). Both ends of the spectrum can damage the medial patellofemoral ligament (MPFL) — the primary soft-tissue restraint to lateral patellar translation — and both can damage the cartilage on the back of the patella or the lateral side of the trochlea. The reason the distinction matters clinically is not just the severity of the event itself. It is what the event tells you about the underlying anatomy. A patient who can subluxate their patella with simple twisting motions, or whose patella has slipped repeatedly without a fall or contact event, almost always has anatomical risk factors that need to be measured before deciding on treatment. A first-time traumatic dislocation in an athlete with otherwise normal anatomy is a different problem from a fifth atraumatic subluxation in a loose-jointed adolescent. Repeated episodes — whether full dislocations or recurrent subluxations — progressively wear down the patellar and trochlear cartilage and contribute to early patellofemoral arthritis. This is the most under-appreciated long-term consequence of recurrent patellar instability and the reason aggressive evaluation after the second dislocation is usually warranted. Dr. Strickland's writing on what happens when patellar dislocation is untreated covers this in more detail. ## How an Episode Feels It is typically painful, and in severe cases it can be difficult to fully extend the knee. After a true dislocation, the kneecap may be visibly out of place — sometimes patients have to go to the emergency room to have the patella reduced back into the groove. Often the injury is accompanied by significant swelling (hemarthrosis) that takes days to weeks to resolve, and weeks to months before the knee feels normal again. For the immediate steps after an episode, see how serious is a patella dislocation and what to do after a kneecap dislocation. Daily activities like going up and down stairs, squatting, kneeling, or getting out of a chair may feel painful or unsteady. Many patients describe a sense of "giving way" or feeling like they cannot trust the knee during sports or even routine movements. Because of this, patients often start avoiding the activities they enjoy, which leads to quadriceps weakness, hip-stabilizer weakness, and paradoxically more instability over time. Common symptoms after a dislocation event include: - Audible pop or popping sensation when the kneecap moves out of place - Visible deformity — the kneecap may sit visibly off to the side until it reduces - Immediate pain and difficulty walking after the event - Rapid swelling within minutes to hours, often a tense effusion (hemarthrosis) - Bruising along the medial side of the kneecap (where the MPFL tore) - Apprehension — a learned protective response when the knee is in positions where the kneecap previously slipped - Mechanical symptoms — catching, locking, or grinding — which can suggest a loose cartilage or osteochondral fragment in the joint For early-stage subluxations that don't fully dislocate, see how to tell if your kneecap slightly dislocated. For first-time dislocations in the urgent care setting, see how urgent care treats a dislocated kneecap. ## Anatomical Risk Factors Why does the same first-time dislocation lead to one recurrence in some patients and ten in others? The answer is anatomy. A set of anatomical features, measured on imaging, drives most of the recurrence risk and most of the treatment decisions. The classical computer-modeling work (a study by Lutul Farrow, a fellow member of the International Patellofemoral Study Group) identified three anatomical factors linked to higher risk of recurring patellar dislocation; in clinical practice, Dr. Strickland evaluates several additional features that further refine the risk profile. Dr. Strickland's posts on patellar tracking abnormalities and why patellofemoral height matters ground the clinical framing. #### Trochlear dysplasia A shallow, flat, or convex trochlear groove. Without a deep groove to hold the kneecap, the lateral wall is not high enough to prevent slipping. Measured on axial MRI and lateral X-ray. The most severe forms (Dejour B/C/D) in rare cases may warrant trochleoplasty. #### Patella alta (high-riding patella) The kneecap sits higher than normal — above the protective trochlear groove during early flexion. Measured by the Caton-Deschamps or Insall-Salvati index. A high patella has more "free range" to slip before it engages the groove. #### Elevated TT-TG distance The bony attachment of the patellar tendon (the tibial tubercle) sits too far lateral relative to the center of the trochlear groove. The lever arm pulls the kneecap laterally with every quadriceps contraction. Measured on CT or MRI. #### Knock-knee alignment (genu valgum) A valgus mechanical axis increases the lateral pull on the kneecap during loading. More common in young women. Visible on standing alignment films. Severe cases may benefit from distal femoral osteotomy. #### Generalized ligamentous laxity "Loose joints" — assessed by the Beighton score. Patients who can hyperextend their elbows, knees, and thumbs typically have less restraint from the medial patellofemoral ligament and other static stabilizers. #### MPFL injury or attenuation The medial patellofemoral ligament is the primary medial restraint to lateral patellar translation. After a first dislocation, the MPFL is almost always torn or stretched. A previously injured MPFL is itself a major risk factor for the next dislocation. Patellofemoral height in particular is one of the under-appreciated outcome predictors — see Dr. Strickland's writing in "It's the patellofemoral height". Other refinements that may apply to your case include the femoral anteversion angle (see evaluating patellar dislocation via the femoral anteversion angle), the lateral trochlear inclination angle (see measuring the lateral trochlear inclination angle), and Wiberg patellar shape type (see Wiberg patellar type impact on outcomes and survival). It's worth knowing that some assessments of patellofemoral instability have been shown to have poor interrater reliability — which is why high-volume sub-specialty evaluation matters more for this diagnosis than for many others. The number of risk factors a patient has — and which ones — is what determines the operation. A patient with patella alta and an elevated TT-TG distance needs a tibial tubercle osteotomy in addition to MPFL reconstruction; a patient with a normal trochlea, normal patellar height, and isolated MPFL injury usually does well with MPFL reconstruction alone. Skipping the imaging-based assessment is the most common reason patellar stabilization surgery fails. ## Who Develops Patellar Instability Loose-jointed young women and female athletes who experience a traumatic dislocation while playing their sport are at the highest risk for recurrent subluxation and patellar dislocation. Soccer, basketball, dance, gymnastics, cheerleading, and skiing are common backstories. Patellar instability does occur in men and boys — particularly with high-energy contact sports — but recurrence is less common in that population, and the underlying anatomy is more often normal. The age at first dislocation is the single biggest predictor of recurrence. Patients whose first dislocation happens at a young age have a substantially higher recurrence rate than those whose first dislocation happens later in life. This is partly because young patients are still active and exposed to risk, and partly because younger patients more often have the underlying anatomical risk factors that produced the first dislocation in the first place. In some patients, patellar instability happens without any clear trauma — the kneecap slips during a normal activity like turning, descending stairs, or even just standing up. This is often a sign of significant anatomical risk — particularly trochlear dysplasia and ligamentous laxity — and these patients usually warrant earlier surgical evaluation. A separate subset of patients develops medial patellar facet lesions from the friction of repeated subluxation, and these patients often require concurrent cartilage repair. ## First-Time Dislocations: What to Do and When to Operate If you have had a first patellar or kneecap dislocation, the first step is a careful evaluation that includes: - MRI to evaluate the MPFL, the cartilage on the back of the patella and the lateral trochlea, and to look for loose osteochondral fragments in the joint - Standing alignment films to assess overall lower-extremity alignment - Lateral X-ray with patellar height measurement (Caton-Deschamps or Insall-Salvati index) to identify patella alta - Axial imaging with TT-TG distance when bony realignment may be considered Most first-time dislocations without cartilage damage and without major anatomical risk factors are treated non-operatively: a brief period of bracing, structured physical therapy focused on quadriceps and hip-stabilizer strengthening, and a graduated return to activity. Many of these patients do well long-term and never require surgery. Dr. Strickland's writing on whether you can fully recover from a dislocated patella covers the realistic expectations. Surgery is considered after a first dislocation when: - There is a loose cartilage or bone fragment in the joint that needs to be removed or fixed - There is a large MPFL avulsion off the patella that may benefit from acute repair or reconstruction - There are multiple anatomical risk factors that make recurrence likely — trochlear dysplasia plus alta plus an elevated TT-TG is a much higher-risk profile than any one of those alone - The patient is a young athlete returning to high-risk sport (soccer, basketball, dance, skiing) where the consequences of a re-dislocation in season are significant After a second dislocation, the picture changes. Recurrence rates without surgery rise sharply, and the cartilage on the back of the patella has often taken progressive damage from each subluxation event. MPFL reconstruction is usually recommended after a second dislocation, with the operation chosen based on the anatomical risk profile. ## The Treatment Ladder: PT → MPFL → TTO → Cartilage Repair Patellar stabilization for recurrent dislocations is one of the few orthopedic problems where the surgical decision is not "operate or don't" — it is "which operation, in which combination." The treatment ladder progresses from least invasive to most: 1 #### Physical therapy and bracing Quadriceps strengthening (especially the VMO), hip-stabilizer strengthening, balance and neuromuscular training, and a patellar stabilizing brace during higher-risk activity. First-line for first-time dislocators without cartilage damage and without significant anatomical risk factors. 2 #### MPFL reconstruction Minimally invasive reconstruction of the medial patellofemoral ligament — Dr. Strickland typically uses gracilis allograft and two all-suture suture anchors on the patella to recreate the broad fan-shaped MPFL insertion. Standard for recurrent dislocators with reasonable bony anatomy. 4–7 month recovery. Full procedure walk-through → 3 #### MPFL reconstruction + tibial tubercle osteotomy (TTO) Added when the underlying problem is bony — patella alta, elevated TT-TG, or distal patellar cartilage wear. The tibial tubercle is cut, repositioned, and fixed with screws. Anteromedialization (AMZ-TTO) is used when distal patellar cartilage wear also benefits from offloading. Combined recovery is 6–9 months. See MPFL + TTO discussion and joint preservation and osteotomy. 4 #### Lateral retinacular lengthening (when needed) When lateral overpull on the kneecap is contributing to instability, lateral retinacular lengthening is added. Frequently performed alongside MPFL +/- MQTFL reconstruction. See Dr. Strickland's surgical demonstration for the technique. 5 #### Concurrent cartilage repair (MACI, OATS, or osteochondral allograft) When prior dislocations have damaged the patellar or trochlear cartilage. Performed in the same operation as MPFL reconstruction (and TTO, if needed) so the realigned, stabilized knee protects the cartilage repair. Recovery extends to 9–12 months when cartilage repair is added. See MACI and cartilage transplantation. 6 #### Trochleoplasty (selected severe dysplasia) For severe trochlear dysplasia (Dejour B/C/D) where the groove itself must be deepened. Reserved for the most anatomically severe cases. The ladder is conceptual — in practice, the decision is often made up front based on the imaging-based risk profile rather than progressing rung by rung after recurrent failures. A patient with patella alta and a chondral defect almost certainly needs all three additions (MPFL + TTO + cartilage repair) in the same operation, not three sequential surgeries spaced years apart. A study reviewed by Dr. Strickland supports the more anatomic combined-reconstruction approach. ## MPFL Alone vs. MPFL+TTO — The Decision Framework This is the most important sub-specialty decision on the page. MPFL reconstruction alone is sufficient for many patients with recurrent dislocations. A subset have bony anatomy that means the soft-tissue reconstruction alone will be biomechanically asked to do more than it should — in those patients, combining MPFL reconstruction with a tibial tubercle osteotomy (TTO) addresses the bony alignment that is contributing to the instability. The decision is based on imaging measurements, not symptoms alone. Dr. Strickland has written specifically on the most common MPFL + TTO patient questions. FeatureMPFL aloneMPFL + TTO Best forRecurrent dislocators with normal bony anatomy and an MPFL deficiencyPatients with patella alta, elevated TT-TG, or distal patellar cartilage wear Imaging triggersNormal Caton-Deschamps, normal TT-TG, mild or no dysplasiaHigh Caton-Deschamps (alta), elevated TT-TG, dysplastic trochlea, distal patellar chondral wear What it addressesThe torn medial soft-tissue restraintSoft-tissue restraint + bony lever-arm correction (medialization +/- distalization) AMZ-TTO indicationN/ADistal patellar cartilage wear that benefits from anteromedialization (offloading) Recovery4–7 months to return to sport6–9 months — protected weight-bearing while the osteotomy heals Trade-offFaster recovery; risk of recurrence if bony factors are missedLonger recovery; addresses the underlying mechanical problem When bony factors are missed at the index surgery, the MPFL graft is asked to substitute for both the soft-tissue restraint and the missing bony containment — a setup for recurrent instability or graft stretching. Unaddressed bony risk factors are one of the most common causes of failed MPFL reconstruction. Dr. Strickland's cadaveric study on anteromedialization (AMZ) TTO demonstrated improved patellar contact forces in dysplastic knees. For revision-TTO discussion specifically, see case report on arthroscopy at revision TTO and HSS Grand Rounds on revision TTO. For the distalization technique used in patella alta, see TTO distalization for patella alta. For when the surgery is described as a "transfer" rather than an "osteotomy," see tibial tubercle osteotomy or transfer. The international Modified Delphi Consensus on patellar instability (which Dr. Strickland contributed to) provides the multi-surgeon expert reference framing for these decisions. ## Trochleoplasty (For Severe Dysplasia) When the trochlear groove itself is severely dysplastic — flat, convex, or with a high-grade Dejour-classified deformity — soft-tissue reconstruction and bony realignment alone may not be sufficient. Trochleoplasty is a procedure that reshapes the bony trochlear groove itself to provide a containing track for the kneecap. It is reserved for the most anatomically severe cases and adds significant complexity to the operation and the recovery. Whether trochleoplasty is appropriate is a sub-specialty judgment based on the trochlear morphology on imaging, prior treatment history, and patient factors. For most dysplastic knees, MPFL + TTO without trochleoplasty is sufficient; trochleoplasty enters the conversation for the most extreme dysplasia or for revision settings where prior soft-tissue and bony procedures have failed. ## Concurrent Cartilage Repair A patellar dislocation is rarely just a soft-tissue event. As the patella shears off the trochlear groove and snaps back into place, the cartilage on the back of the patella and along the lateral wall of the trochlea can be damaged. This shows up on MRI as a bone bruise pattern at minimum, and in some cases as a frank osteochondral lesion or a loose fragment in the joint. Patients with patella alta in particular have a higher rate of cartilage damage at the time of evaluation. Dr. Strickland's work on treatments of patellar chondral lesions, the podcase on patellofemoral instability and cartilage lesions, and understanding patellofemoral instability cartilage lesions all discuss this combined-pathology population. When focal cartilage damage is present, MPFL reconstruction is often combined with a cartilage procedure in the same operation: - Loose fragment fixation or removal — for displaced osteochondral fragments after acute dislocation - MACI (matrix-induced autologous chondrocyte implantation) — a two-stage procedure where cartilage cells are harvested from the patient at the index surgery, grown in a lab, and implanted at a second surgery onto a focal patellar or trochlear cartilage defect. See MACI cartilage repair for the full walk-through - Osteochondral allograft (OCA) — for larger lesions that include subchondral bone. See cartilage transplantation - Chondroplasty — to clean up smaller loose flaps of cartilage One specific technical consideration when patellar cartilage repair is being performed via a lateral approach: preserving patellar vascularity. Dr. Strickland's study on patellar vascularity after lateral parapatellar approach addresses the technical detail that matters here. When chronic patellofemoral cartilage wear has progressed beyond focal repair territory, the conversation shifts to patellar arthritis management and possible patellofemoral replacement. ## Emerging Implant-Based Options For carefully selected patients, newer joint-preserving implants are being studied alongside the established procedures. The FDA trial of the Patella LIFT procedure evaluates an implant designed to offload the patellofemoral joint. Dr. Strickland's team performed the first East Coast Patella LIFT surgeries at HSS as part of FDA PELICAN trial enrollment. Whether you are a candidate is determined by trial inclusion criteria, anatomy, cartilage status, and prior treatment history. This is not currently available for persistent patellar instability. Adjacent technologies are also part of the patellofemoral toolkit. Dr. Strickland's writing on 3D imaging of the patellofemoral joint and 3D printing for patellofemoral instability rehabilitation describes how patient-specific models inform planning and rehab. These options are appropriate for a small subset of patients and are discussed at consultation when the imaging and history fit. ## Pediatric Patellar Instability Pediatric and adolescent patellar instability is a distinct clinical scenario because the growth plates are still open. Surgical technique must avoid the distal femoral physis, and the bony procedures available to adults (TTO, trochleoplasty) are usually not options until skeletal maturity. Dr. Strickland is a co-author on the multicenter JUPITER pediatric MPFL reconstruction study, which documented the high variation in pediatric MPFL technique across high-volume centers. Most adolescents with recurrent dislocation are surgical candidates — the recurrence rate without surgery is high in this group, and continued dislocations cause cumulative cartilage damage during a phase of life when the patient is most active. The decision-making about timing, graft choice, and physeal-respecting fixation is sub-specialty work, and adolescent patients benefit from a surgeon who treats this population in volume. For young patients whose growth plates are still open, the standard bony procedure to bring a high-riding kneecap down (a tibial tubercle osteotomy) isn't safe — it would damage the growth plate. Dr. Strickland published a way around this: a stitch-based technique that shortens the patellar tendon without cutting it. It can be done in the same operation as MPFL reconstruction. The technique was published in Arthroscopy Techniques (2022), with follow-up outcomes data published in the Orthopaedic Journal of Sports Medicine (2025). ## Prehabilitation For elective MPFL reconstruction (with or without TTO or cartilage repair), prehabilitation matters. Dr. Strickland recommends starting prehab at least 4 to 6 weeks before surgery. The goals are full pain-free range of motion, strong quadriceps activation, and good hip and core control. Patients who arrive at surgery with a quiet, mobile knee and active quads regain motion and strength faster after the operation than patients who arrive with a stiff, swollen, quad-inhibited knee. A productive prehab phase typically includes: - Working with a physical therapist who has knee or sports medicine expertise - Familiarizing yourself with the planned post-operative rehab protocol - A home exercise program built around quad sets, straight-leg raises, hip and glute work, and gentle range of motion within pain-free limits - An up-to-date medication and supplement list reviewed with your surgical team - A plan for transportation home, post-op support at home, and time off from work or school Acute dislocations with a locked knee or a loose osteochondral fragment do not get this 4-to-6-week window — those patients need to go to the operating room sooner. For more, see Dr. Strickland's how to prepare for an MPFL reconstruction guide. ## What to Expect on Surgery Day Patellar stabilization surgery is performed as an outpatient procedure in most cases — you go home the same day. Combined cases involving TTO and concurrent cartilage repair may have additional recovery considerations that are reviewed at consultation. Typical patient experience: - Arrival and pre-op — you arrive a couple of hours before the procedure for intake, change into a gown, and meet the anesthesia team - Anesthesia consultation — the anesthesiologist reviews your history and discusses the anesthesia plan. For Dr. Strickland's patellar stabilization surgeries, this is typically regional anesthesia (a spinal block with sedation) rather than general anesthesia. During surgery, a periarticular block is also placed around the knee joint to help reduce pain during the first day after surgery as part of an opioid-sparing pain protocol. - Surgery — isolated MPFL reconstruction typically takes 1 to 2 hours; combined MPFL + TTO is longer; combined MPFL + TTO + cartilage repair is the longest of the three - Recovery room — you wake up in the recovery area; your knee is in a brace locked in extension. Physical therapy starts the same day or the next morning with crutch training and basic motion within the safe limits of the brace - Going home — you go home with crutches, the brace, ice, prescribed pain medication, and clear written instructions. A responsible adult must drive you home - First 48 hours — ice, elevation, prescribed medications, gentle motion as instructed. The first week's focus is effusion control, quadriceps activation, and walking with weight in the brace Cold-compression devices and quadriceps muscle stimulators (when prescribed) can help reduce swelling and support muscle reactivation in the first weeks. The block typically wears off over the first 12 to 24 hours, during which the leg is numb and weight-bearing requires the brace and crutches. ## Recovery Timeline Recovery is a structured, milestone-based progression. The dates below are general guidelines; your specific plan depends on which procedures were performed. PhaseIsolated MPFLMPFL + TTOMPFL + TTO + cartilage Brace + crutches2–4 weeks4–6 weeks6–8 weeks Range of motionWeeks 0–6Weeks 0–8Weeks 0–10 StrengtheningMonths 2–4Months 2–5Months 3–6 Return to runningMonths 3–4Months 5–6Months 7–9 Return to pivoting sportMonths 4–7Months 6–9Months 9–12 The two factors that most consistently slow recovery are inconsistent physical therapy attendance and rushing back to high-impact activity before clearance. For the full week-by-week walk-through, see Dr. Strickland's how long does MPFL recovery really take. ## Risks of Surgery Patellar stabilization surgery is well-established with predictable outcomes for most well-selected patients, but no surgery is risk-free. The risks reviewed at consultation include: - Recurrent instability or graft failure — the most clinically relevant long-term risk. Most often associated with unaddressed bony risk factors, non-anatomic tunnel placement, or returning to high-demand activity before milestones are met. Imaging-guided patient selection and an honest discussion of whether TTO needs to be added are the main mitigations - Persistent stiffness or loss of motion — reduced by prehabilitation, early focus on regaining motion, and structured PT - Patellar fracture — rare with all-suture anchor fixation, more often associated with patellar bone tunnels - Articular cartilage damage from patellar fixation — minimized by all-suture anchors compared with larger metallic implants - Anterior knee pain — can persist after surgery, particularly when there is unaddressed concurrent patellofemoral cartilage damage - Tibial tubercle nonunion or hardware irritation — specific to TTO; rare but can require hardware removal - Infection — uncommon but a serious complication if it occurs - Blood clot (DVT or pulmonary embolism) — risk is mitigated by early mobilization and individualized prophylaxis - Anesthesia-related risks — including nausea, sore throat, rare allergic reactions, transient nerve irritation from the regional block - Cartilage repair-specific risks — for MACI/OATS additions, including incomplete cartilage incorporation and the need for revision cartilage work - Iatrogenic patella baja — rare complication of distalization-TTO; see Dr. Strickland's writing on surgical treatment of iatrogenic patella baja - Incomplete return to prior level of sport — some patients do not return to their prior level even with technically excellent surgery Outcomes are generally good in well-selected patients, but results depend on individual anatomy, adherence to rehab, and overall health. Specific risks for your case depend on imaging, prior surgeries, concurrent procedures, and goals — reviewed at consultation. ## Common Patient Concerns The three concerns we hear most often before patellar stabilization surgery, with honest answers. #### "My kneecap dislocated once. Do I really need surgery?" Often, no. Many first-time dislocations without cartilage damage and without major anatomical risk factors do well with bracing and structured physical therapy. Surgery becomes the better answer when imaging shows a loose cartilage fragment, when multiple anatomical risk factors stack up, when you are a young athlete with a high-risk return-to-sport profile, or after a second dislocation. The point of the consultation is to look at your imaging and history and answer this question for your specific case — not a generic case. #### "I had MPFL surgery and my knee still feels unstable. Did I have a bad surgeon?" Not necessarily. Failure of a prior MPFL reconstruction is more often associated with unaddressed bony risk factors — patella alta, trochlear dysplasia, elevated TT-TG — than with a technically poor primary surgery. Sometimes the primary MPFL was the right operation but should have been combined with a TTO. Revision planning starts with new MRI, weight-bearing X-rays, and a CT for femoral anteversion, then an honest conversation about what the index surgery did and didn't address. Dr. Strickland is frequently asked to give second opinions on failed prior MPFL reconstruction. See her writing on how to tell if your MPFL reconstruction failed. #### "I'm scared of being addicted to pain pills." Dr. Strickland's post-operative protocol is opioid-sparing. A periarticular block placed around the knee joint during surgery helps reduce pain during the first day after surgery; multimodal pain medications (acetaminophen, gabapentin, and anti-inflammatories where appropriate) carry most of the work after that. Short-course opioid prescriptions are used for the first few days at most for the majority of patients, and many patients use very few. The protocol is reviewed at consultation along with your specific history. #### "Wearing the brace for six weeks sounds awful. Can I skip it?" The brace exists to keep the leg straight during walking until your quadriceps is strong enough to control the kneecap on its own. Skipping it puts the new graft at risk during the period when quad control is still returning — precisely when re-dislocation would be most damaging. The brace allows immediate weight-bearing in most cases, which is a significant convenience advantage. ## Insurance and Cost MPFL reconstruction, tibial tubercle osteotomy, and concurrent cartilage repair are covered by all major commercial insurance plans, Medicare, and most self-funded and union plans when the diagnosis and indication for surgery meet medical-necessity criteria. The variables that drive your specific out-of-pocket cost are: - Your plan's deductible and coinsurance - In-network vs. out-of-network status — for the surgeon, the facility (NYU Langone or affiliated outpatient surgery center), and the anesthesia group - Bundled vs. separate billing for the surgeon, facility, anesthesia, imaging, physical therapy, and concurrent procedures (TTO, cartilage repair) - Out-of-network benefits — if you have them and choose to use them; we are happy to provide the codes you need to verify your benefits in advance The Patella LIFT procedure, when performed under the FDA PELICAN trial, has separate considerations because it is investigational. Trial-related costs and the standard-of-care portions of the operation are handled differently; this is reviewed in detail when trial eligibility is being discussed. Before surgery, our office verifies your benefits, obtains pre-authorization where required, and reviews the estimated out-of-pocket cost with you. For benefits verification or to discuss self-pay arrangements, call us at 646-904-4664 or contact the office. ## Patient Outcomes Outcomes of patellar stabilization surgery vary by anatomy, adherence to rehab, and the specific procedures performed. A few patient stories from Dr. Strickland's practice illustrate the range of presentations and recoveries: - Paulette Gangemi — back in the game after patellar dislocation - Liam's story — MPFL reconstruction surgery - Peyton's tibial tubercle osteotomy — recovery after combined patellar stabilization with TTO Each story highlights individual factors and outcomes — results are not predictive of other patients' results. The point is that combined patellar stabilization with the right procedure for the right anatomy can return active patients to their lives. ## When to Seek a Sub-Specialty Second Opinion Patellofemoral instability is one of Dr. Strickland's primary areas of clinical and academic focus. She is a member of the International Patellofemoral Study Group, a co-author of the multicenter JUPITER pediatric MPFL study, and a contributor to the Modified Delphi consensus on patellar instability. She is frequently asked for second opinions on first-time and recurrent dislocations — especially when cartilage injury, osteotomy, or revision MPFL reconstruction may be part of the plan. A sub-specialty second opinion is particularly worth seeking when: - You have had a second dislocation and are trying to decide between continued non-operative care and MPFL reconstruction - You have already had MPFL reconstruction that failed — either re-dislocation or persistent pain — and are facing revision - Your imaging shows multiple anatomical risk factors and the question is whether to add a TTO to the MPFL reconstruction - You have cartilage damage on your post-dislocation MRI and want a clear answer on whether to combine cartilage repair with stabilization - You are an adolescent or young athlete and the goal is return to high-level sport, not just stopping the dislocations - Your imaging shows severe trochlear dysplasia and you want to understand whether trochleoplasty is on the table - You are interested in the Patella LIFT FDA trial and want to know whether you meet trial inclusion criteria - You have generalized ligamentous laxity or a connective tissue disorder (Ehlers-Danlos, Marfan, hypermobility spectrum) ## Access & Office Location Dr. Strickland sees patellar instability patients at one office, which works with patients traveling in from outside the immediate area: - New York City: NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY 10016. Midtown Manhattan, accessible from Manhattan, the outer boroughs, Long Island, Westchester, and northern New Jersey via the Queensboro and Triboro bridges and the FDR Drive. Phone: 646-904-4664. Many patients travel to New York for sub-specialty patellofemoral care, particularly for revision MPFL reconstruction, combined MPFL+TTO planning, concurrent cartilage repair, and Patella LIFT trial eligibility evaluation. We coordinate consultation, imaging review, and surgery scheduling to minimize travel for out-of-state patients. ## Frequently Asked Questions What is the difference between patellar subluxation and dislocation? Subluxation is a partial slip in which the kneecap shifts out of the trochlear groove and returns on its own. Dislocation is a complete shift in which the kneecap leaves the groove and either reduces with leg extension or has to be reduced manually, sometimes in the emergency room. Both sit on the same spectrum of patellar instability and both can damage the medial patellofemoral ligament (MPFL) and the patellar or trochlear cartilage. Will my kneecap dislocate again? Recurrence risk is highest when the first dislocation happens at a young age and is increased by anatomical risk factors — trochlear dysplasia, patella alta, an elevated TT-TG distance, knock-knee alignment, and generalized ligamentous laxity. After two dislocations, the recurrence rate without surgery rises sharply. Do I need MPFL surgery after my first dislocation? Not always. Many first-time dislocations without cartilage damage are treated non-operatively with bracing and physical therapy. Surgery is considered after a first dislocation when there is loose cartilage or bone fragment in the joint, when multiple anatomical risk factors are present, or in young athletes returning to high-risk sport. After a second dislocation, surgery is usually recommended. How long is recovery after MPFL reconstruction? Isolated MPFL reconstruction is minimally invasive with a typical 4 to 7 month recovery. Combined with TTO, recovery is 6 to 9 months. With cartilage repair added, recovery extends to 9 to 12 months. Recovery is milestone-based, not calendar-based. What is a tibial tubercle osteotomy and when do I need one? A tibial tubercle osteotomy (TTO) is a controlled cut and reposition of the bony attachment of the patellar tendon. It is added to MPFL reconstruction when the underlying problem is bony — patella alta, an elevated TT-TG distance, or distal patellar cartilage wear that benefits from offloading. Distalization TTO is used when patella alta is part of the picture. Can I prevent another dislocation without surgery? In selected first-time dislocators without cartilage damage and without major anatomical risk factors, structured physical therapy that strengthens the quadriceps and hip stabilizers, balance and neuromuscular training, and a patellar stabilizing brace can reduce recurrence. The decision depends on age, activity level, anatomy, and dislocation history. Is patellar instability more common in women? Yes. Loose-jointed young women and female athletes are at higher risk for recurrent subluxation and patellar dislocation. Generalized ligamentous laxity, anatomic differences, and Q-angle differences all contribute. What about pediatric patellar instability? Pediatric and adolescent patellar instability has unique considerations because of open growth plates. Surgical technique must avoid the distal femoral physis, and the bony procedures available to adults are usually not options until skeletal maturity. Dr. Strickland is a co-author on the multicenter JUPITER pediatric MPFL reconstruction study. What is the Patella LIFT procedure? Patella LIFT is an investigational implant designed to offload the patellofemoral joint that is being studied in the FDA PELICAN clinical trial. Dr. Strickland's team performed the first East Coast Patella LIFT surgeries at HSS as part of trial enrollment. Whether you are a candidate is determined by trial inclusion criteria, anatomy, cartilage status, and prior treatment history. This is not currently available for persistent patellar instability. What if my prior MPFL reconstruction failed? A failed MPFL reconstruction typically presents as recurrent kneecap dislocation or subluxation, persistent anterior knee pain, loss of motion, or no progress in physical therapy. Failure is most often due to unaddressed bony risk factors. Revision planning includes new MRI, CT for femoral anteversion, and an honest discussion of whether TTO, trochleoplasty, or alignment correction needs to be added. ## Related Specialty Care For the dedicated procedure walk-through of MPFL reconstruction itself — surgical technique, graft choices, two-point patellar fixation, recovery timeline — see the MPFL reconstruction surgery page. For the realignment side of patellar stabilization (TTO, HTO, DFO), see joint preservation and osteotomy. For cartilage repair after dislocation-related cartilage damage, see MACI cartilage repair and cartilage transplantation (OATS & allograft). For chronic patellofemoral cartilage wear, see patellar pain and patellar arthritis. For complex anatomy where computer-guided planning is helpful, see Mako robotic-assisted surgery. When ACL injury has occurred alongside patellar dislocation, see ACL tear surgery. For Dr. Strickland's published research and editorial commentary on patellofemoral instability, see her cadaveric AMZ-TTO study, the Modified Delphi consensus on patellar instability, the JUPITER pediatric MPFL study, the two-point patellar fixation editorial, and her commentary on patellofemoral height as an outcome predictor. For practical patient-facing guides, see MPFL reconstruction questions, MPFL + TTO questions, how to prepare for MPFL reconstruction, and how long does MPFL recovery really take. For patellar dislocation patient-education posts, see my kneecap dislocated — what should I do?, how serious is a patella dislocation?, and what happens with untreated patellar dislocation. Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Surgical and non-surgical orthopedic care should always be discussed with a board-certified orthopedic surgeon who has reviewed your imaging, history, and physical examination. Individual outcomes vary based on diagnosis, anatomy, comorbidities, surgical technique, and adherence to rehabilitation. The general descriptions of anesthesia, pain protocols, and timelines on this page reflect typical patellar-stabilization patient experience — your specific protocol is determined at consultation. The Patella LIFT procedure described above is investigational and is offered only under FDA clinical-trial protocols. ## Discuss Your Case with Dr. Strickland If you have had a kneecap dislocation — one or many — or a failed prior MPFL reconstruction, bring your imaging to a sub-specialty consultation at NYU Langone in Midtown Manhattan. Book an Appointment Call 646-904-4664 --- ## Patellar Pain & Patellofemoral Arthritis NYC | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/knee-surgeon-specialist/patellar-pain-and-patellar-arthritis/ Summary: Sub-specialty patellofemoral care — anterior knee pain, chondromalacia, focal patellar cartilage lesions, and patellofemoral arthritis — by Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York. Cartilage-first approach (MACI, OATS), AMZ-TTO realignment, and high-volume patellofemoral arthroplasty (PFA) using onlay implants. Sub-Specialty Hub # Patellar Pain & Patellofemoral Arthritis Sub-specialty patellofemoral care — anterior knee pain, chondromalacia, focal patellar cartilage lesions, patellar tendinopathy, and patellofemoral arthritis. A cartilage-first approach for younger patients, AMZ-TTO realignment when malalignment drives the pain, and high-volume patellofemoral arthroplasty (50–60 per year, onlay-design implants) when the cartilage is gone. By Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York. Medically reviewed by Dr. Sabrina Strickland, MD — Board-Certified Orthopedic Surgeon at the NYU Langone Orthopedic Center in New York · Member, International Patellofemoral Study Group · Castle Connolly Top Doctor since 2016. View full bio → Where NYU Langone Orthopedic Center, Midtown Manhattan PFA Volume Approximately 50–60 patellofemoral arthroplasties per year · onlay-design implants Patients We See Anterior knee pain, chondromalacia, focal patellar cartilage defects, patellar tendinopathy, isolated PF arthritis, post-instability cartilage damage, prior failed patellar surgery Overview Patellar pain and patellofemoral arthritis sit on a continuum: anterior knee pain at one end, end-stage cartilage loss at the other. The same complaint — "my kneecap hurts" — can come from a teenager with maltracking, a runner with patellar tendinopathy, a 35-year-old with a focal trochlear cartilage defect, or a 60-year-old with isolated end-stage patellofemoral arthritis. Treatment is matched to the cause: structured PT and selective injection for first-line care; progressive eccentric slow-resistance loading for tendinopathy; anteromedialization tibial tubercle osteotomy (AMZ-TTO) for malalignment-driven pain; distalization tibial tubercle osteotomy (Distal TTO) for inferior patellar cartilage wear; cartilage repair (MACI, OCA) for focal defects, with concurrent realignment when malalignment is also present; and patellofemoral arthroplasty (PFA) for isolated end-stage arthritis. Dr. Sabrina Strickland is a member of the International Patellofemoral Study Group, performs approximately 50 to 60 patellofemoral arthroplasties per year using onlay-design implants, and has published on patellofemoral arthroplasty outcomes, conversion to total knee, MDC thresholds for patellofemoral arthroplasty outcomes, and the cartilage-repair-with-realignment treatment algorithm. Anterior knee pain — pain at the front of the knee around the kneecap — is one of the most common reasons patients are referred to a knee specialist. It is also one of the most under-diagnosed, because "kneecap pain" is a symptom, not a diagnosis. The right treatment depends on which underlying problem is driving the pain — muscle imbalance, tendinopathy, focal cartilage damage, malalignment, or isolated patellofemoral arthritis — and that requires a structured exam, the right imaging, and a clear understanding of the underlying mechanics. This page is the sub-specialty hub for patellar pain and patellofemoral arthritis. It is paired with the patellar instability hub for patients whose kneecap also slips out of place — many patients have both. Here we cover what patellar pain means, how it differs from patellar tendinopathy, why malalignment and cartilage loss generate pain, the role of imaging and patellofemoral height measurement, the staged treatment ladder (PT → cartilage repair → AMZ-TTO → PFA → total knee), the cartilage-first philosophy for younger patients, the sub-specialty case for patellofemoral arthroplasty as a joint-preserving option, the PFA-vs-total-knee decision, recovery, risks, friction-log honest answers, insurance reality, and when to seek a sub-specialty second opinion. ## What Patellar Pain Means: The Spectrum The kneecap (patella) sits in front of the knee and slides up and down in a groove on the front of the thigh bone — the trochlear groove. Together they form the patellofemoral joint. Cartilage on the back of the kneecap and on the surface of the trochlea allows the joint to glide smoothly through the range of motion. Patellar pain is an umbrella term for pain at the front of the knee that comes from this joint or the soft tissues around it. It includes: - Patellofemoral pain syndrome (better labelled anterior knee pain) — anterior knee pain without visible joint damage on x-ray. Often a result of muscle imbalance, maltracking, or early cartilage softening - Chondromalacia patella — softening or fissuring of the patellar cartilage on imaging without structural joint-space loss - Focal patellar or trochlear cartilage lesions — a discrete area of full-thickness cartilage damage, often after a dislocation event or progressive maltracking - Patellar tendinopathy ("jumper's knee") — pain at the lower pole of the kneecap from tendon overload (a different problem; see below) - Patellofemoral arthritis — end-stage cartilage loss with joint-space narrowing on x-ray The two ends of the spectrum need different treatment plans. Patellar pain without structural damage may resolve with conservative care or, when there is a clear surgical cause, with realignment or cartilage repair. Patellofemoral arthritis cannot be reversed, but it can often be managed with cartilage-protecting non-surgical care — and, when isolated, treated with patellofemoral arthroplasty (a partial knee replacement that preserves the rest of the joint) without committing to a total knee. While this page is called "patellar arthritis," the clinical term is "patellofemoral arthritis." We use both throughout. ## How It Feels Patellar pain is typically a dull or sharp ache around or behind the kneecap. It is often worse with activities that load the patellofemoral joint: - Going down stairs (often more painful than going up — one of the more specific patterns) - Sitting for long periods with the knee bent (the "theater sign") - Wearing high heels, which loads the front of the knee - Squats, lunges, and deep-flexion activities - Kneeling directly on the kneecap - Hill walking, downhill running, or step-down exercises - Getting up out of a low chair or car seat after sitting still Many patients also notice clicking, grinding, or popping (crepitus) when bending or straightening the knee. Crepitus alone is common and not always pathologic, but new mechanical symptoms — catching, locking, or a sense that something is moving inside the joint — can indicate a loose cartilage flap or osteochondral fragment that warrants imaging. Often these symptoms have been present for years at a low level. A change in weight, training intensity, or coming back to exercise after a long break can flare a previously tolerable problem into one that interferes with daily life. ## Patellar Pain Is Not Patellar Tendinopathy One of the most common diagnostic errors in anterior knee pain is conflating patellar pain (joint-based) with patellar tendinopathy (tendon-based). The distinction matters because the rehab is different and the wrong program does not work for the wrong diagnosis. Patellar tendinopathy — sometimes called "jumper's knee" — is pain in the patellar tendon at the lower pole of the kneecap. It is a tendon-loading problem. Most cases improve over 3 to 6 months with progressive heavy slow-resistance training, training-load adjustments, equipment review, and selective adjuncts. Tendons remodel slowly compared with muscle, which is why patients who try a few weeks of rest and stretching are often disappointed. Eccentric exercises — like decline single-leg squats — were the original gold standard, but more recent evidence shows heavy slow-resistance training is at least as effective and often better tolerated. The key is progressive loading, not the exact protocol. Working with a sports physical therapist to individualize the program is the first step. See 4 ways to manage patellar tendinopathy and eccentric cycling treatment for patellar tendinopathy for the rehab framing. Patellofemoral pain is pain at the joint between the kneecap and the trochlea, driven by tracking, cartilage status, malalignment, or arthritis. It is treated with quadriceps and hip-stabilizer rehabilitation, sometimes bracing, sometimes injections, and sometimes realignment or cartilage repair. The two diagnoses can coexist in the same knee, but they need different rehab frameworks — running a tendinopathy loading protocol on a maltracking patellofemoral joint can flare both. Surgery for patellar tendinopathy is uncommon; surgery for patellofemoral pain is reserved for the structural cases. Video: Dr. Strickland on patellar pain and patellar arthritis — what the kneecap, trochlea, and patellofemoral joint are; how malalignment and arthritis develop; and how the conversation with patients begins. Transcript my name is Sabrina Strickland I'm an orthopedic surgeon at the hospital for special surgery so my specialty is sports medicine and what that means is that I do knee and shoulder surgery my focus within sports medicine is knee surgery and specifically patellofemoral surgery which involves a lot of cartilage surgery and ACL surgery the bread and butter for orthopedic surgeons the most common surgery we do is meniscal surgery and so that's sort of the easiest thing I do but a lot of patients have more complicated problems with their knees so for example patients who have been dislocating their patella for years they've often been told that there isn't a surgical answer for them and there actually is so the patellofemoral joint is the front of the knee so the patella is the small bone it basically works as a pulley so you pull on your quad that pulls on your patella and that pulls on your patellar tendon and that's how you get your knee straight patellar instability is a condition where the patella slides out of the groove the Patel is a very small bone and it sits in this groove in the front of the thigh bone and when it slides out sometimes it just perches a little bit to the side and some times it comes all the way out and it gets stuck and those patients have to go to the emergency room to get it popped back in when this happens it often causes damage to the cartilage on the back side of the kneecap as well as to the lateral side of the femur bone patellofemoral instability can often be treated with a ligament reconstruction called an mpfl and that involves reconstructing a ligament that goes from the inside part of the thigh bone to the inside part of the kneecap it's two small incisions and basically I take a donor tendon and reconstruct this ligament to make a new band or a new leash that holds the patella in place patellofemoral pain is a condition where patients localize the pain to the front of the knee often these patients come in complaining of pain with stairs or pain with lunges typically as we start by getting an MRI to see exactly what's going on to see exactly how much cartilage wears underneath the kneecap in patients who just have a little bit of cartilage where we typically use gel injections in more advanced cases we talk about cartilage surgery or surgery to move the bone to take the pressure off the kneecap and in extreme cases we resurfaced the back of the kneecap in the front of the thigh bone and that's a patellofemoral replacement so many patients with patellofemoral pain need to have a combination of surgeries done at the same time so many patients who've had for example patellar instability we need to do two things we need to fix their patellar instability with an mpfl reconstruction depending on whether or not they have a cartilage lesion we have to repair the cartilage lesion at the same time and depending on where that cartilage lesion is and depending on how they're lined up in some cases we have to add the osteotomy so some patients end up with all three in order to get their knee stable and pain-free 2022 marks my 20th year I finished my fellowship in sports medicine here at HSS in 2002. how I see the next 10 years I'm going to continue to focus my research on cartilage transplants and patellofemoral surgery I continue to find new and better ways to do the surgeries that I do foreign [Music] ## Why Patellar Pain Hurts: Anatomy & Mechanics The patella is the largest sesamoid bone in the body. Its job is to act as a lever, increasing the mechanical advantage of the quadriceps as it pulls through the patellar tendon onto the tibia. As the knee flexes from 0 to 90 degrees, the patella tracks down through the trochlear groove and the contact area between patellar and trochlear cartilage shifts. The forces across the patellofemoral joint can be several multiples of body weight in deep flexion — which is why squats, stairs, and getting out of a chair are the activities that flare patellar pain. When the patella tracks normally and the cartilage is healthy, the joint glides without symptoms. Pain arises when one of three things changes: - The cartilage softens or wears. Chondromalacia can be just soft cartilage at minimum and full-thickness cartilage loss at the extreme. The exposed subchondral bone is richly innervated. Cartilage loss is also visible on MRI long before it shows up on x-ray. - The kneecap tracks abnormally. Patella alta (high-riding patella), an elevated TT-TG distance, lateral retinacular tightness, trochlear dysplasia, and weak hip and quadriceps stabilizers all push the patella laterally during flexion. The lateral facet takes more load than it was designed to take, and the cartilage on that facet wears preferentially — the classic distal-lateral pattern that AMZ-TTO is designed to address. - The bony alignment changes. Late-stage patellofemoral arthritis with osteophyte formation, subchondral sclerosis, and joint-space narrowing produces both mechanical and inflammatory pain. Patellofemoral height in particular is one of the under-appreciated outcome predictors — see "It's the patellofemoral height, stupid" for the clinical framing. Most patients have more than one of these contributing. A maltracking patella loads the lateral facet, the cartilage on that facet wears, and over years the wear becomes structural arthritis. This is why "treat the symptom" is rarely the right answer for patellofemoral pain — effective treatment usually addresses every contributing factor, not just the most obvious one. For the cartilage-side framing, see treatments of patellar chondral lesions. ## Risk Factors for Patellofemoral Pain and Arthritis #### Patellar maltracking and malalignment Patella alta, an excessive TT-TG distance, trochlear dysplasia, and lateral retinacular tightness all cause the kneecap to track laterally and overload one facet. Identified on imaging. #### Posterior tibial tubercle position A posteriorized tibial tubercle relative to the trochlear groove is associated with increased risk of patellofemoral arthritis — see Dr. Strickland's commentary on the sagittal TT-TG distance and patellofemoral arthritis risk. #### Prior patellar dislocation A patellar dislocation is rarely just a soft-tissue event — the cartilage on the back of the patella and lateral trochlea can shear off the groove and snap back, producing chondral injury that drives later pain. #### Quadriceps and hip-stabilizer weakness Weak quadriceps (especially the VMO) and weak hip abductors and external rotators allow the kneecap to track laterally and load the lateral facet. The single most addressable factor in conservative care. #### Overuse and training error Repetitive loading — running, jumping, kneeling, sudden ramp-ups in mileage or intensity — irritates the tissues around the patella. The most common scenario in active patients. #### Age, weight, and activity history Each pound of body weight loads the patellofemoral joint several times over with each step. Decades of high-impact activity, prior knee surgery, or post-traumatic injury all accelerate cartilage loss in the patellofemoral compartment. Most patients have more than one of these contributing — a runner with quadriceps weakness and patellar maltracking, for example, or a 50-year-old with a remote dislocation history and progressive cartilage thinning. Effective treatment usually addresses every contributing factor. ## When Conservative Care Works (and the Adolescent Population) The vast majority of patellar pain improves with structured non-surgical care. Quadriceps strengthening (closed-chain in pain-free range), VMO activation, hip-abductor and external-rotator strengthening, posterior-chain (glute and hamstring) work, core control, balance and proprioception, and stretching of the iliotibial band, quadriceps, and calves — this is the most under-executed step in patellar pain care, and the difference between a well-executed PT program and a poorly executed one is often the difference between a good and a poor outcome. For adolescents in particular, structured rehabilitation is the priority. Most adolescents with patellofemoral pain do not have structural cartilage damage and do not need surgery; their long-term prognosis improves with consistent quadriceps and hip-stabilizer strengthening, training-load management, and time. See how to improve long-term prognosis for adolescents with patellofemoral pain for the framing — the adolescent patellofemoral patient is rarely a surgical candidate, and presenting one as a surgical case is usually wrong. For older patients with structural disease, conservative care is still the right starting point: cartilage-protective exercise (cycling, swimming, elliptical), weight optimization where applicable, NSAIDs for flares, and selective injection therapy (cortisone for short-term symptom control during a flare; hyaluronic acid or PRP for arthritic pain in selected patients; PRP for tendinopathy in selected cases). Injections are bridges, not destinations — they buy time to do the strengthening and load-management work. ## When to Image and What to Look For The diagnosis of patellar pain is built from history, physical exam, and targeted imaging. Imaging is appropriate when conservative care has not produced the expected response, when there is a history of dislocation or significant injury, when mechanical symptoms suggest a loose body or osteochondral fragment, or when surgery is being considered. ### Standing Weight-Bearing X-rays AP, lateral, Merchant (axial sunrise) view, and standing alignment films. The lateral X-ray is used to measure patellar height by the Caton-Deschamps or Insall-Salvati index. The Merchant view shows patellar tilt and lateral subluxation in early flexion. Joint-space narrowing on the Merchant view is the hallmark of patellofemoral arthritis — weight-bearing technique matters because non-weight-bearing films can miss arthritis between the tibia and femur. ### MRI MRI visualizes the patellar and trochlear cartilage, the medial patellofemoral ligament, the patellar tendon, the retinaculum, and looks for loose bodies. It is the single most informative study when conservative care has failed. Cartilage scoring on MRI — including structured MRI scoring of patellofemoral osteoarthritis — characterizes chondromalacia, focal defects, and subchondral bone changes. 3D imaging of the patellofemoral joint is being used in increasingly sophisticated planning for cases where the geometry matters. ### CT or MRI with TT-TG Measurement When realignment surgery is being considered, axial measurement of the tibial tubercle to trochlear groove distance (TT-TG) on CT or MRI characterizes the bony component of maltracking. Patellofemoral height (Caton-Deschamps), TT-TG distance, sagittal TT-TG (an under-appreciated metric — see the increased risk of patellofemoral arthritis with posterior tubercle position), and trochlear morphology together drive the realignment plan. ## The Treatment Ladder: PT → Cartilage Repair → AMZ-TTO → PFA → Total Knee Patellofemoral disease when unresponsive to conservative care is one of the few orthopedic problems where the surgical decision is not "operate or don't" — it is "which operation, in which combination, and in what order." The ladder progresses from joint-preserving to joint-resurfacing. The correct rung depends on cartilage status, alignment, and patient factors. The conservation hierarchy outlined in considerations for patellofemoral joint preservation vs. patellofemoral arthroplasty is the framework. 1 #### Structured PT, activity modification, and selective injection Quadriceps and hip-stabilizer strengthening, weight optimization, cartilage-protective cross-training (cycling, swimming, elliptical), NSAIDs for flares, and selective cortisone, PRP, or hyaluronic acid injection. First-line for almost everyone — including most adolescents and most patients with early structural disease. 2 #### Cartilage repair (MACI, osteochondral allograft) For younger patients with a focal full-thickness cartilage defect on the patella or trochlea (typically 2–10 cm² for MACI; larger lesions with bone involvement go to osteochondral allograft). Combined with AMZ-TTO in the same operation when malalignment is also present — uncorrected malalignment is one of the main reasons cartilage repair fails. See MACI cartilage repair and cartilage transplantation (OCA). 3 #### Anteromedialization tibial tubercle osteotomy (AMZ-TTO) The Fulkerson osteotomy — a controlled cut and repositioning of the bony attachment of the patellar tendon, moving the tubercle anteriorly and medially. Offloads the distal-lateral facet of the patella where maltracking-driven cartilage wear concentrates. Stand-alone for malalignment-driven pain without large cartilage defects, or combined with cartilage repair when both problems are present. See joint preservation and osteotomy. 4 #### Patellofemoral arthroplasty (PFA) For end-stage isolated patellofemoral arthritis with normal medial and lateral compartments. Resurfaces only the kneecap and the trochlea — the cruciate ligaments, menisci, and tibiofemoral compartments are preserved. The major joint-preserving alternative to total knee replacement for the right patient. Discussed in detail below. 5 #### Total knee replacement Reserved for the patellofemoral patient who has progressed to multi-compartment arthritis, or for patients whose anatomy or activity goals make PFA inappropriate. PFA can be converted to total knee replacement later if the medial or lateral compartments deteriorate — see the section on PFA-to-TKA conversion below. The ladder is conceptual — in practice the decision is often made up front based on the imaging-based picture rather than progressing rung by rung after recurrent failures. A 28-year-old with a 4 cm² focal patellar chondral defect, mild patella alta, and an elevated TT-TG distance is a candidate for combined cartilage repair plus AMZ-TTO at one operation, not three sequential surgeries. A 65-year-old with bone-on-bone isolated patellofemoral arthritis and pristine medial and lateral compartments is a PFA candidate, not a candidate for cartilage repair. ## Cartilage-First Options for Younger Patients For younger active patients with focal full-thickness patellar or trochlear cartilage damage, the goal is to preserve their native joint. Joint replacement — even partial replacement — in a 30-year-old commits them to a revision conversation in their lifetime. Cartilage repair, when feasible, restores the joint surface without committing to an implant. The main cartilage-restoration options for the patellofemoral joint: - MACI (matrix-induced autologous chondrocyte implantation) — a two-stage procedure. Cartilage cells are harvested at an index arthroscopy, grown in a lab on a collagen membrane, and implanted at a second operation onto a focal patellar or trochlear defect. The FDA approved MACI in 2016. See MACI cartilage repair for the full procedure walk-through - Osteochondral allograft transplantation (OATS) — for larger lesions that include subchondral bone, donor cartilage and bone are transplanted as a plug. See cartilage transplantation - Chondroplasty or cleanup — for selected smaller defects The single most important point about patellofemoral cartilage repair is that correcting alignment matters as much as the cartilage work itself. Dr. Strickland's technical note on treatments of patellar chondral lesions describes the algorithm: "correcting patellar malalignment and instability is critical for the success of cartilage repair procedures… we recommend that TTO and MPFL reconstruction be performed with MACI procedures of the patella when the anatomic pathology and pertinent patient history are present." A pristine cartilage repair on a still-maltracking patella is set up to fail. For the combined-pathology population, see understanding patellofemoral instability and cartilage lesions, the podcase on patellofemoral instability and cartilage lesions, the related atraumatic medial patellar facet lesions, and Dr. Strickland's assessment of patellar vascularity after lateral parapatellar approach — a technical consideration for patellar cartilage repair via the lateral approach. An interesting nuance: patella alta patients may experience less severe cartilage damage after instability than non-alta patients in some series — the height itself may protect the cartilage from contact during dislocation events, even though it predisposes to the dislocations in the first place. The clinical implication is that imaging the cartilage carefully on MRI matters more than assuming "alta = severe wear." ## Patellofemoral Arthroplasty (PFA) Patellofemoral arthroplasty is a partial knee replacement that resurfaces only the back of the kneecap and the trochlear groove. The medial and lateral compartments, the cruciate ligaments, and the menisci are all preserved. For the right patient — isolated end-stage patellofemoral arthritis with normal medial and lateral compartments and stable ligaments — PFA preserves natural knee biomechanics in the rest of the joint and is a less invasive alternative to total knee replacement. See patellofemoral arthroplasty for the dedicated discussion. ### Why surgeon volume matters for PFA This is the single most important sub-specialty point on this page. National Joint Registry data published in 2025 (analyzed in Dr. Strickland's commentary at lower revision rates after patellofemoral arthroplasty for high-volume surgeons) showed that surgeons who perform more than 5 patellofemoral arthroplasties per year have lower revision rates and lower complication rates than lower-volume surgeons. The same dataset showed that onlay-design trochlear components had better outcomes than inlay designs, because onlay implants allow rotation of the trochlear component to optimize patellar tracking. Dr. Strickland performs approximately 50 to 60 patellofemoral arthroplasties per year and favors onlay-design implants. PFA is one of the operations where high volume genuinely produces measurable differences in revision rates and outcomes. ### Who is a PFA candidate? The classic indications are: - End-stage isolated patellofemoral arthritis — bone-on-bone wear in the patellofemoral compartment with joint-space narrowing on the Merchant view - Normal medial and lateral compartments — preserved joint space on standing weight-bearing AP and lateral X-rays. Confirmed on MRI when there is any question - Intact cruciate and collateral ligaments - Reasonable mechanical alignment — severe valgus or significant tibiofemoral malalignment may push the case toward total knee - Pain and functional limitation that has not responded to non-surgical care over months Recent series have also documented that medial UKA improves pain and function despite patellofemoral joint degeneration in selected patients — the patellofemoral compartment is not always the dominant source of symptoms in a multi-compartment knee. Sub-specialty judgment is needed to decide which compartment is driving the pain. ### Patellofemoral height and PFA Patellar height does not correct itself with arthroplasty — it's an anatomic fact of the knee, not an implant-correctable parameter. Dr. Strickland's study on the effect of patellofemoral arthroplasty on patellar height documents this. Pre-operative measurement of patellar height by Caton-Deschamps is a routine part of the work-up. ### Outcome measurement For tracking PFA outcomes meaningfully, Dr. Strickland's group has published on establishing minimal detectable change (MDC) thresholds for Kujala scores after patellofemoral arthroplasty — the threshold a patient's score has to cross before the change is real, not noise. This is the kind of statistical work that ensures outcome reporting in this population is honest. ## Patellofemoral Arthroplasty vs. Total Knee Replacement FeaturePFATotal Knee Replacement Best forIsolated end-stage patellofemoral arthritis with normal medial/lateral compartments and intact ligamentsMulti-compartment arthritis, or PF arthritis combined with significant medial/lateral wear What's preservedACL, PCL, both menisci, medial and lateral compartments, native joint kinematicsNone of the above — all three compartments are resurfaced Recovery3–6 months — weight-bearing as tolerated immediately, return to recreational sport (cycling, golf, doubles tennis) at 3–6 months3–6 months — similar timeline but a larger physiological insult and longer return to high-demand activity Volume effectSignificant — surgeons with higher PFA volume show lower revision rates (NJR data, 2025)Significant but less pronounced — TKA is much higher-volume nationally Implant designOnlay trochlear components have better outcomes than inlay (NJR data, 2025); rotation of trochlear component optimizes trackingMultiple well-validated implant systems ConvertibleYes — can be converted to total knee if other compartments later wear outRevision TKA is more complex than primary; pursued when needed Trade-offJoint-preserving for the right patient; depends on isolation of the disease to the PF compartmentDefinitive resurfacing; commits to all three compartments Patient selection is the heart of the PFA-vs-TKA decision. The right patient for PFA is the patient whose pain truly comes from the patellofemoral compartment in isolation. Standing weight-bearing X-rays, careful MRI review, and an honest clinical assessment of where the pain is coming from are the work-up. Conversion of patellofemoral arthroplasty to total knee replacement is feasible when the medial or lateral compartments later wear out — recent retrieval-analysis work has highlighted infection risk after conversion as something to watch for, which is one reason careful patient selection at the index PFA matters. For patients with combined patellofemoral arthritis and patellar instability, treating patellofemoral arthritis and patellar instability often requires concurrent stabilization — arthroplasty alone in an unstable knee is set up to fail. ## What to Expect on Surgery Day Patellofemoral surgery (whether arthroscopy with debridement, AMZ-TTO, cartilage repair, or PFA) is performed as an outpatient procedure in most cases — you go home the same day. Combined cases (TTO + cartilage repair, for example) may have additional recovery considerations reviewed at consultation. - Arrival and pre-op — you arrive a couple of hours before the procedure for intake, change into a gown, and meet the anesthesia team - Anesthesia — for Dr. Strickland's patellofemoral procedures, regional anesthesia (a spinal block with sedation) plus a periarticular block placed around the knee joint during surgery. The periarticular block helps reduce post-operative pain during the first day after surgery and is part of an opioid-sparing pain protocol. - Surgery — arthroscopic debridement is the shortest; AMZ-TTO is intermediate; cartilage repair (MACI second-stage or OCA) is intermediate-to-long; PFA is the longest. Combined operations stack these - Recovery room — you wake up with the knee in a brace appropriate to the procedure performed. Physical therapy starts the same day or the next morning - Going home — you go home with the prescribed brace, crutches when applicable, ice, prescribed pain medication, and clear written instructions. A responsible adult must drive you home - First 48 hours — ice, elevation, prescribed medications, gentle motion as instructed Cold-compression devices and quadriceps muscle stimulators (when prescribed) help reduce swelling and support muscle reactivation in the first weeks. The block typically wears off over the first 12 to 24 hours, during which the leg is numb and weight-bearing requires the brace and crutches. ## Recovery Timeline Recovery is procedure-specific. The dates below are general guidelines; your specific plan depends on which procedures were performed and on your individual healing. PhaseArthroscopy / debridementAMZ-TTOMACI / OCA cartilage repairPatellofemoral arthroplasty Weight-bearingAs toleratedProtected 4–6 weeksProtected 4–6 weeksAs tolerated BraceNone or lightHinged brace 4–6 weeksHinged brace 4–6 weeksNone or light Range of motionWeeks 0–4Weeks 0–8Weeks 0–10Weeks 0–6 StrengtheningWeeks 2–6Months 2–5Months 3–6Weeks 2–12 Return to running4–6 weeks4–5 months9–12 monthsGenerally not recommended Return to recreational sport2–3 months5–6 months12–18 months3–6 months (cycling, golf, doubles tennis) Across all of these, quadriceps and hip-stabilizer rehabilitation is the single most important factor in a successful outcome. The procedure restores the joint surface or realigns the mechanics; the rehab restores the function. The two factors that most consistently slow recovery are inconsistent physical therapy attendance and rushing back to high-impact activity before clearance. ## Risks of Patellofemoral Surgery Patellofemoral surgery is well-established with predictable outcomes for well-selected patients, but no surgery is risk-free. Risks reviewed at consultation include: - Persistent pain or incomplete relief — particularly when the diagnosis was less clear-cut, when multiple pain generators are present, or when alignment was not corrected at the time of cartilage work - Stiffness or loss of motion — reduced by prehabilitation, early focus on regaining motion, and structured PT - Cartilage repair failure or incomplete incorporation — specific to MACI/OCA; one of the main reasons these procedures fail is uncorrected malalignment - Tibial tubercle nonunion or hardware irritation — specific to AMZ-TTO; rare but can require hardware removal - Implant loosening or wear — specific to PFA; long-term consideration with any joint replacement - Progression of arthritis in the medial or lateral compartments — specific to PFA; the main reason a PFA might later need conversion to a total knee - Infection — uncommon. After conversion of PFA to total knee, recent retrieval-analysis work has noted higher-than-baseline infection risk - Blood clot (DVT or pulmonary embolism) — risk is mitigated by early mobilization and individualized prophylaxis - Anesthesia-related risks — nausea, sore throat, rare allergic reactions, transient nerve irritation from the regional block - Iatrogenic patella baja — rare complication of distalization-TTO procedures; managed with revision technique when it occurs - Incomplete return to prior level of activity — some patients do not return to their prior level even with technically excellent surgery Outcomes are generally good in well-selected patients, but results depend on individual anatomy, adherence to rehab, and overall health. Specific risks for your case depend on imaging, prior surgeries, concurrent procedures, and goals — reviewed at consultation. ## Common Patient Concerns The friction-log: the four concerns we hear most often before patellofemoral surgery, with honest answers. #### "I've been told I need a total knee replacement. Is patellofemoral arthroplasty an option for me?" It depends on the imaging. PFA is appropriate when the arthritis is isolated to the patellofemoral compartment with normal medial and lateral compartments and intact ligaments. Many patients are told they need a total knee replacement when in fact they have patellofemoral-predominant disease and would be better served by a partial replacement. The work-up is standing weight-bearing X-rays, a careful MRI, and an honest clinical assessment of where the pain is coming from. Bringing your prior imaging to a sub-specialty consultation is the right starting point. #### "Does the surgeon's volume actually matter for patellofemoral arthroplasty?" Yes — for PFA more than for many other operations. National Joint Registry data published in 2025 showed surgeons performing more than 5 PFAs per year have lower revision rates than lower-volume surgeons. Onlay-design implants outperformed inlay designs in the same dataset. Dr. Strickland performs approximately 50 to 60 PFAs per year using onlay implants. PFA is a sub-specialty operation; the difference between high- and low-volume in this specific procedure shows up in revision-rate data. #### "I'm 32 and I have a focal cartilage defect on my kneecap. Should I just get a partial replacement now?" Almost certainly not. For young patients with focal full-thickness cartilage damage and otherwise reasonable cartilage elsewhere, the goal is joint preservation — cartilage repair (MACI or osteochondral allograft) combined with realignment (AMZ-TTO) when malalignment is part of the picture. A partial replacement at 32 commits you to a revision conversation in your lifetime. The right operation depends on lesion size and location, alignment, and prior treatment history — reviewed in detail at consultation. #### "I'm scared of being addicted to pain pills." Dr. Strickland's post-operative protocol is opioid-sparing. A periarticular block placed around the knee joint during surgery helps reduce pain during the first day after surgery; multimodal pain medications (acetaminophen, anti-inflammatories where appropriate) carry most of the work after that. Short-course opioid prescriptions are used for the first few days at most for the majority of patients, and many patients use very little. The protocol is reviewed at consultation. ## Insurance and Cost AMZ-TTO, cartilage repair (MACI, OCA), patellofemoral arthroplasty, and total knee replacement are covered by all major commercial insurance plans, Medicare, and most self-funded and union plans when the diagnosis and indication for surgery meet medical-necessity criteria. The variables that drive your specific out-of-pocket cost are: - Your plan's deductible and coinsurance - In-network vs. out-of-network status — for the surgeon, the facility (NYU Langone or affiliated outpatient surgery center), and the anesthesia group - Bundled vs. separate billing for the surgeon, facility, anesthesia, imaging, physical therapy, and concurrent procedures - Out-of-network benefits — if you have them and choose to use them; we are happy to provide the codes you need to verify your benefits in advance The Patella LIFT procedure, when performed under the FDA PELICAN trial, has separate considerations because it is investigational. PRP and some biologic injections are not always covered — we review the specifics during your consultation. Before surgery, our office verifies your benefits, obtains pre-authorization where required, and reviews the estimated out-of-pocket cost with you. For benefits verification or to discuss self-pay arrangements, call us at 646-904-4664 or contact the office. ## When to Seek a Sub-Specialty Second Opinion Patellofemoral disease is one of Dr. Strickland's primary clinical and academic areas. She is a member of the International Patellofemoral Study Group, performs approximately 50 to 60 patellofemoral arthroplasties per year, and has published on PFA volume and revision rates, PFA conversion to total knee, MDC thresholds for patellofemoral arthroplasty outcomes, the cartilage-repair-with-realignment treatment algorithm, MRI scoring of patellofemoral osteoarthritis, and patellofemoral height as an outcome predictor. A sub-specialty second opinion is particularly worth seeking when: - Your knee pain is severe enough to limit your daily life but you have been told there is no surgical option - You have been told you need a total knee replacement but your arthritis seems isolated to the patellofemoral compartment - Your MRI shows a focal cartilage defect and you want to understand cartilage-restoration candidacy - You have malalignment plus cartilage damage and want a clear answer on combined cartilage repair plus realignment - You have had prior knee surgery for patellar pain that did not work, and are facing revision - You are a young or active patient and want a clear answer on joint-preserving options before considering replacement - You have combined patellofemoral arthritis and patellar instability and want a sub-specialty plan that addresses both - You are considering patellofemoral arthroplasty and want to be evaluated by a high-volume PFA surgeon - Your prior patellofemoral arthroplasty is not performing as expected and conversion to total knee is on the table ## Access & Office Location Dr. Strickland sees patellofemoral patients at one office, which works with patients traveling in from outside the immediate area: - New York City: NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY 10016. Midtown Manhattan, accessible from Manhattan, the outer boroughs, Long Island, Westchester, and northern New Jersey via the Queensboro and Triboro bridges and the FDR Drive. Phone: 646-904-4664. Many patients travel to New York for sub-specialty patellofemoral care — particularly for patellofemoral arthroplasty when their local surgeon is low-volume, for combined cartilage repair plus realignment when the local recommendation was a partial or total knee replacement, and for second opinions on prior failed patellofemoral surgery. We coordinate consultation, imaging review, and surgery scheduling to minimize travel for out-of-state patients. ## Frequently Asked Questions What does patellar pain feel like? A dull or sharp ache around or behind the kneecap that worsens going down stairs, sitting for long periods with the knee bent (the "theater sign"), wearing high heels, kneeling, and squatting. Pain that is worse going downstairs than upstairs is one of the more specific patterns for patellofemoral involvement. Many patients also notice clicking, grinding, or popping (crepitus). New mechanical symptoms — catching, locking, or a sense that something is moving in the joint — can indicate a loose cartilage flap or osteochondral fragment that warrants imaging. What is the difference between patellar pain and patellar tendinopathy? Patellar pain (sometimes called patellofemoral pain syndrome) is pain at the joint between the kneecap and the trochlea — driven by tracking, cartilage status, or malalignment. Patellar tendinopathy ("jumper's knee") is pain in the tendon at the lower pole of the kneecap and is a tendon-loading problem, not a joint problem. Tendinopathy is treated with progressive heavy slow-resistance and eccentric loading; patellofemoral pain is treated with quadriceps and hip-stabilizer rehabilitation, and sometimes realignment or cartilage repair. What is the difference between patellar pain and patellofemoral arthritis? Patellar pain is a symptom that can come from many causes — muscle imbalance, tendinopathy, early cartilage softening, maltracking — without visible joint-space loss on x-ray. Patellofemoral arthritis is end-stage cartilage loss on the back of the kneecap and the front of the trochlea, visible on x-ray as joint-space narrowing. Patellar pain may resolve with non-surgical care; patellofemoral arthritis can be managed but the cartilage loss does not reverse. Will patellar pain go away without surgery? Many patients improve with rest, activity modification, ice, NSAIDs, structured physical therapy targeting the quadriceps and hip stabilizers, bracing, and selective injection therapy. Surgery is reserved for cases that fail several months of well-executed conservative care or that have a clear surgical target on imaging. What is anteromedialization tibial tubercle osteotomy (AMZ-TTO)? AMZ-TTO (the Fulkerson osteotomy) is a controlled cut and repositioning of the bony attachment of the patellar tendon. The tubercle is moved anteriorly and medially, which offloads the distal-lateral facet of the patella and corrects lateral maltracking. It is the realignment procedure of choice for patellar pain driven by malalignment with distal-lateral cartilage wear, often combined with cartilage repair when a focal defect is present. What is patellofemoral arthroplasty (PFA)? Patellofemoral arthroplasty is a partial knee replacement that resurfaces only the back of the kneecap and the trochlear groove. The medial and lateral compartments, the cruciate ligaments, and the menisci are all preserved. PFA is appropriate for patients with isolated end-stage patellofemoral arthritis, normal medial and lateral compartments on x-ray, intact ligaments, and reasonable alignment. It is a less invasive alternative to total knee replacement for the right patient. Does the surgeon's volume matter for patellofemoral arthroplasty? Yes. National Joint Registry data published in 2025 showed surgeons performing more than 5 PFAs per year have lower revision rates and lower complication rates. Onlay-design implants outperformed inlay designs in the same dataset. Dr. Strickland performs approximately 50 to 60 PFAs per year using onlay implants, which allow rotation of the trochlear component to optimize patellar tracking. What if my MRI shows a focal cartilage defect on the kneecap? Focal full-thickness cartilage defects can be treated with cartilage repair — MACI, osteochondral allograft (OCA), or other cartilage-restoration techniques. The right option depends on lesion size, depth, location, and whether subchondral bone is involved. When malalignment is present alongside the cartilage defect, correcting alignment with an AMZ-TTO at the time of cartilage repair is important — uncorrected malalignment is one of the main reasons patellar cartilage repair fails. I have patellar tendinopathy. Do I need surgery? Most patellar tendinopathy improves over 3 to 6 months with progressive heavy slow-resistance and eccentric loading, training-load adjustments, and selective adjuncts. Tendons remodel slowly compared with muscle, so a few weeks of rest and stretching is rarely enough. Stubborn cases may benefit from PRP or, rarely, surgery. The first step is working with a sports physical therapist to individualize a progressive loading program. Can patellofemoral arthroplasty be converted to total knee replacement later? Yes. If the medial or lateral compartments later develop significant arthritis, the patellofemoral implant can be converted to a total knee replacement. Recent retrieval-analysis work has highlighted infection risk after conversion, which is one reason careful patient selection at the index PFA matters. For many isolated patellofemoral arthritis patients, however, PFA remains a durable joint-preserving option that delays or avoids total knee replacement entirely. ## Source Grounding & Published Research This page is grounded in Dr. Strickland's published commentary, technical notes, and patient education. Selected references: TopicSource High-volume surgeons & PFA revision ratesLower revision rates after patellofemoral arthroplasty for high-volume surgeons (NJR data, 2025) PFA conservation hierarchyConsiderations for patellofemoral joint preservation vs. patellofemoral arthroplasty PFA conversion to TKAPatellofemoral arthroplasty conversion to total knee arthroplasty Patellofemoral arthroplasty & patellar heightEffect of patellofemoral arthroplasty on patellar height MDC thresholds for PFAEstablishing MDC thresholds for patellofemoral joint arthroplasty Medial UKA with PF degenerationMedial UKA improved pain and function despite patellofemoral joint degeneration Combined PF arthritis + instabilityTreating patellofemoral arthritis & patellar instability Cartilage repair algorithmTreatments of patellar chondral lesions (technical note) Patellar vascularity (lateral approach)Assessment of patellar vascularity after lateral parapatellar approach Posterior tubercle & PF arthritis riskIncreased risk of patellofemoral arthritis: sagittal TT-TG distance MRI scoringMRI scoring of patellofemoral osteoarthritis 3D imaging of the PF joint3D imaging of the patellofemoral joint Patellofemoral height as predictor"It's the patellofemoral height, stupid" Patella alta & cartilage damagePatella alta patients may have less severe cartilage damage Atraumatic medial facet lesionsRisk factors for atraumatic medial patellar facet lesions Patellofemoral instability + cartilageUnderstanding patellofemoral instability cartilage lesions · podcase Adolescent PF pain prognosisHow to improve long-term prognosis for adolescents with patellofemoral pain Patellar tendinopathy management4 ways to manage patellar tendinopathy · eccentric cycling treatment Patellar tendinopathy patient caseCasas out of the hospital following patellar tendon surgery Bio & publicationsDr. Strickland bio · research & publications ## Related Specialty Care For patients whose kneecap also slips out of place, see the paired patellar instability hub and the MPFL reconstruction surgery page. For the realignment side of patellofemoral care, see joint preservation and osteotomy. For cartilage repair options, see MACI cartilage repair and cartilage transplantation (OCA). For multi-compartment knee arthritis, see knee arthritis. For chondromalacia and tendonitis at the front of the knee, see knee chondromalacia, arthritis, and tendonitis. For complex anatomy where computer-guided planning is helpful, see Mako robotic-assisted surgery. For Dr. Strickland's published research and editorial commentary on patellofemoral disease, the source-grounding table above lists the references used on this page; for the broader publication record, see research & publications. Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Surgical and non-surgical orthopedic care should always be discussed with a board-certified orthopedic surgeon who has reviewed your imaging, history, and physical examination. Individual outcomes vary based on diagnosis, anatomy, comorbidities, surgical technique, and adherence to rehabilitation. Modern patellofemoral surgery (cartilage repair, AMZ-TTO, patellofemoral arthroplasty) is well-established for well-selected patients but no procedure is a guaranteed fix. The Patella LIFT procedure is investigational and is offered only under FDA clinical-trial protocols. The volume figures and outcome statistics on this page are drawn from National Joint Registry data and from Dr. Strickland's published clinical and academic work, cited in the source-grounding table above. ## Discuss Your Anterior Knee Pain If your kneecap pain is limiting daily life and conservative care has not resolved it — or if you have been told you need a total knee replacement and want a second opinion on patellofemoral-only options — bring your imaging to a sub-specialty consultation at NYU Langone in Midtown Manhattan. Book an Appointment Call 646-904-4664 --- ## PRP & Regenerative Medicine for the Knee NYC | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/knee-surgeon-specialist/prp-regenerative-medicine/ Summary: Honest, evidence-graded evaluation of PRP, hyaluronic acid, BMAC, Lipogems, cortisone, and amniotic / Specialty # PRP & Regenerative Medicine for the Knee Adjunctive options — not a primary therapy and not a substitute for evidence-based surgical or non-surgical care. Honest, evidence-graded evaluation of PRP, hyaluronic acid, BMAC, Lipogems, cortisone, and "stem cell" claims, with Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York. Medically reviewed by Dr. Sabrina Strickland, MD — Orthopedic Surgeon at the NYU Langone Orthopedic Center in New York. View full bio → Best-Evidenced Use Chronic patellar tendinopathy after failed structured PT — the strongest knee indication for PRP Mixed Evidence PRP for mild to moderate knee OA — selected patients respond, some do not Not a Substitute For Cartilage repair, osteotomy, partial / total knee replacement, structured PT, or weight optimization Overview PRP and other biologic injections are adjunctive, not primary, treatments for the knee. The strongest evidence for PRP at the knee is chronic patellar tendinopathy ("jumper's knee") that has failed structured PT. The evidence for PRP in mild knee osteoarthritis is mixed — some patients respond, some do not, and no biologic injection has been shown to regenerate cartilage. PRP is FDA-permitted as a blood derivative; BMAC and Lipogems are FDA-cleared for autologous use; often "stem cell" therapy as marketed by many cash-pay clinics is not FDA-approved for orthopedic use, and claims of cartilage regeneration in adult arthritic knees are not supported by current evidence. Dr. Sabrina Strickland may discuss biologic injections within a comprehensive treatment plan in selected patients — alongside structured PT, weight optimization, hyaluronic acid where appropriate, joint-preserving surgery (osteotomy, the MISHA implantable shock absorber), cartilage restoration (MACI, OATS, allograft), or partial / total knee replacement (Mako robotic-assisted) when indicated. Biologics do not replace any of these. This page is intentionally cautious. The orthobiologic space attracts marketing that runs ahead of the evidence, and many patients arrive at consultation having paid thousands of dollars to a clinic for "stem cell" injections that promised arthritis cure or cartilage regrowth. Neither outcome is supported by the evidence. The honest position is more limited but still useful: well-selected patients with chronic patellar tendinopathy or mild to moderate knee osteoarthritis can sometimes get meaningful symptom relief from PRP as an adjunct to structured PT and weight optimization. That is the realistic ceiling. PRP does not regrow cartilage, does not reverse advanced arthritis, and does not replace surgery when surgery is indicated. This page covers the honest framing of biologic injections, the FDA and regulatory landscape, the five main injection options (PRP, hyaluronic acid, cortisone, BMAC, Lipogems) with evidence grades and cost, PRP in detail by indication, who is and is not a candidate, the role of biologics within a comprehensive joint-preservation strategy, what to be skeptical of when evaluating cash-pay clinic claims, what to expect on injection day, recovery, risks, common patient concerns, insurance and cost, when to seek a sub-specialty second opinion, and where Dr. Strickland sees patients. For closely related conditions and procedures, see knee arthritis for the full arthritis treatment ladder, anterior knee pain for chronic patellar tendinopathy and chondromalacia, MACI cartilage repair for the actual evidence-based option for focal cartilage damage, joint preservation and osteotomy for alignment correction, sports injuries, and ACL tear surgery for context on PRP as a research-stage adjunct in ACL healing. ## An Honest Framing Orthobiologic injections are one of the most marketed and least understood areas of orthopedic medicine. Patients arrive at consultations having read claims that PRP "regrows cartilage," that stem cells "reverse arthritis," and that biologic injections can replace joint replacement surgery. The honest reality is more limited but still useful: - No injectable biologic regrows hyaline cartilage in any clinically meaningful way that has been demonstrated in well-controlled human studies. Adult cartilage has very limited capacity for repair, and decades of research have not produced an injection that reliably restores the structural cartilage layer in arthritic joints - The strongest knee indication for PRP is chronic patellar tendinopathy ("jumper's knee") that has failed structured eccentric loading rehabilitation — not arthritis. The evidence for PRP in mild knee OA is mixed, with selected patients responding well and many getting little or no benefit - Biologic injections are adjunctive, not primary therapy. The evidence-based options for cartilage damage are cartilage repair (MACI, OATS, osteochondral allograft); for malalignment with isolated compartment OA, osteotomy; for medial-compartment OA in selected patients, the MISHA implantable shock absorber; for end-stage arthritis, partial or total knee replacement. Biologics may have a role around these options — not in place of them - Non-response is common. A meaningful number of patients get no benefit from PRP, BMAC, or Lipogems even after a complete series. Honest pre-injection counseling has to include this possibility — not a guarantee of relief - Cost is real and out-of-pocket for most. PRP, BMAC, and Lipogems are generally not covered by insurance. Cost should be weighed honestly against realistic expectations of benefit before deciding to proceed - The marketing is loudest where the evidence is weakest. Cash-pay clinics offering "stem cell knee regeneration" make the boldest claims and the most aggressive sales pitches. Legitimate biologic care looks calmer, costs less in confident promises, and sits inside a comprehensive treatment plan Setting realistic expectations is the foundation of honest biologic injection care. Patients who arrive expecting cartilage regeneration leave disappointed even when they get meaningful symptom relief. Patients who arrive understanding that PRP is an adjunct — one tool among many — can make a clear-eyed decision about whether the cost and the realistic benefit are worth it for their situation. ## The FDA and Regulatory Landscape The regulatory status of biologic injections is more complicated than many marketing pages suggest. Three categories matter: ### PRP — FDA-permitted as a blood derivative PRP prepared from the patient's own blood, processed at the bedside, and re-injected on the same day is regulated as a "minimally manipulated, autologous, same-surgical-procedure" tissue. It is permitted under existing FDA frameworks and does not require a new FDA approval for each clinical use. PRP centrifuge systems used to prepare the platelet concentrate are FDA-cleared as devices. PRP is not FDA-approved as a drug for any specific orthopedic indication — which is why insurance generally classifies it as investigational. ### BMAC and Lipogems — FDA-cleared for autologous use The systems used to harvest, process, and re-inject the patient's own bone marrow (BMAC) or adipose tissue (Lipogems) are FDA-cleared as devices for that intended use. The biologic product itself is the patient's own tissue, processed minimally and re-injected the same day. Like PRP, BMAC and Lipogems are not FDA-approved as drugs for specific orthopedic indications. ### "Stem cell" therapy — not FDA-approved for orthopedic use Stem cell therapy as marketed by many cash-pay clinics — particularly amniotic-derived, umbilical-cord-derived, or "live cell" products — is not FDA-approved for orthopedic use. The FDA has issued warnings about specific products and clinics, and several products have been the subject of enforcement action. Independent analyses have shown that many of these products contain few if any viable stem cells after processing, and clinical claims of cartilage regeneration are not supported by the evidence. Important caveat Patients should be skeptical of any clinic — particularly cash-pay clinics not led by board-certified orthopedic surgeons — that promises knee arthritis cure, cartilage regrowth, or that "stem cells" can replace surgery. The marketing language is often deliberately vague about what is and is not in the syringe. If a clinic cannot tell you exactly what tissue type is being injected, where it came from, how it was processed, and what the published evidence is for that specific indication, that is information. Legitimate biologic care uses your own tissue (PRP from your blood, BMAC from your bone marrow, Lipogems from your fat), frames the role honestly as adjunctive, sits inside a comprehensive treatment plan led by a board-certified orthopedic surgeon, and is direct about the possibility of non-response. ## The Five Main Injection Options Five injections are commonly discussed for the knee, with very different evidence bases, regulatory status, and cost. The table below is the honest summary: InjectionWhat it isEvidence at the kneeInsurance CortisoneSteroid anti-inflammatoryStrong for short-term flare control; repeated use associated with cartilage thinning in some studiesCovered Hyaluronic acidJoint-lubricant supplement (Synvisc, Euflexxa, Orthovisc, Monovisc, others)Modest benefit in mild to moderate OA in responders; about half of patients respond meaningfully, half do notGenerally covered with prior auth for documented OA PRPConcentrated platelets from your own blood; growth-factor deliveryStrongest for chronic patellar tendinopathy after failed PT; mixed for mild knee OA; research-stage adjunct in ACL healingGenerally not covered; out-of-pocket BMACBone marrow drawn from iliac crest, processed, injected; stem-cell-rich fractionLess mature evidence base than PRP; selected joint-preservation candidatesGenerally not covered; out-of-pocket LipogemsSmall autologous fat sample, processed at the bedside, injected; cellular and structural fatNewer; evidence still developing; reasonable to consider in selected patientsGenerally not covered; out-of-pocket Two important caveats: none of these regenerates cartilage, and amniotic / umbilical "stem cell" products marketed by some clinics are a separate category — not FDA-approved for orthopedic use, with claims unsupported by current evidence and FDA warnings on file. Those products are discussed in "What to be skeptical of" below. ## PRP in Detail Platelet-rich plasma (PRP) is prepared by drawing the patient's blood, centrifuging to separate the platelet-rich fraction from red blood cells and plasma, and injecting the concentrated platelet fraction (often under ultrasound guidance) into the affected joint or tendon. Platelets release growth factors that aim to modulate the joint or tendon environment over weeks to months. Different PRP preparations differ in their leukocyte (white-cell) content — leukocyte-rich PRP (LR-PRP) is generally favored for tendon work; leukocyte-poor PRP (LP-PRP) is generally favored for intra-articular use in osteoarthritis. Preparation systems vary in platelet concentration, and that variation is one reason clinical-trial outcomes have been heterogeneous. All PRP products are not the same. The type of centrifuge and type of prep system vary, and that variation affects the quality of the PRP. ### Where the evidence is strongest: chronic patellar tendinopathy The best-evidenced knee indication for PRP is chronic patellar tendinopathy ("jumper's knee") — degenerative tendon pain at the inferior pole of the patella that has failed at least 3 to 6 months of structured eccentric loading rehabilitation. Multiple randomized trials and systematic reviews show that LR-PRP injections can produce meaningful symptom improvement in this population over months. PRP for refractory patellar tendinopathy after failed PT is a reasonable adjunct with reasonable evidence. For more on patellar tendinopathy and anterior knee pain, see anterior knee pain. ### Where the evidence is mixed: mild knee osteoarthritis PRP for mild to moderate knee OA has been studied in many trials, with heterogeneous protocols and heterogeneous outcomes. The honest summary: some patients respond meaningfully, some do not, and the magnitude of benefit in responders is modest. Where PRP is used for OA, it is best understood as an adjunct that may delay further intervention in selected patients with mild to moderate disease, well-preserved alignment, no major mechanical symptoms, and realistic expectations. It is not a substitute for structured PT, weight optimization, or evidence-based surgical care when surgical care is indicated. ### Where it is research-stage: ACL healing PRP has been studied as an adjunct to ACL surgery and as a potential aid to native ACL healing. The evidence is still developing, and PRP for ACL healing or ACL-graft maturation is not standard of care. For the patient-facing summary of one such study, see Dr. Strickland's discussion of the orthobiologics study on ACLs and platelet-rich plasma. For the surgical procedure itself, see ACL tear surgery. ### Practical points - Protocol: 1 to 3 injections spaced 1 to 4 weeks apart, depending on indication. Tendinopathy protocols often differ from intra-articular OA protocols - Reassessment: symptom response is typically reassessed at 4 to 12 weeks; meaningful response usually persists for several months in responders - Maintenance: patients who respond well may be considered for a maintenance injection at 6 to 12 months - Non-response is common. Patients who do not respond after the first series are unlikely to benefit from indefinite repeat injections — at that point the conversation should turn to other evidence-based options - What PRP does not do: regenerate cartilage, reverse advanced arthritis, or substitute for surgery in patients who have outgrown joint-preserving care ## Hyaluronic Acid in Detail Hyaluronic acid (HA) is a major component of normal synovial fluid and contributes to joint lubrication and shock absorption. HA injections (viscosupplementation) supplement the natural HA in the joint with a higher-molecular-weight or cross-linked product that lasts longer than the body's own. HA is FDA-approved for symptomatic knee osteoarthritis, which is why it sits in a different regulatory and insurance category than PRP. ### Where HA fits - Mild to moderate knee osteoarthritis in patients who have failed first-line conservative care (NSAIDs, PT, activity modification) and are not yet candidates for or interested in surgery - Response is variable — about two thirds of patients get meaningful relief, often lasting several months. The other third do not respond meaningfully. Honest pre-injection counseling should include this. - Evidence is weaker in end-stage arthritis — HA is most useful before bone-on-bone change has occurred - Insurance: typically covered for documented OA after a trial of more conservative measures, with prior authorization ### Practical points - Brands: Synvisc, Euflexxa, Orthovisc, Monovisc, and others. Single-injection vs. weekly-series protocols depending on the product - Repeat dosing: reasonable at 6 to 12 month intervals in responders - Combination with PRP: some practices combine HA and PRP, or alternate them — reasonable in selected patients but not strongly evidence-based ## BMAC and Lipogems in Detail BMAC (bone marrow aspirate concentrate) and Lipogems are the two main "cellular" autologous orthobiologic options. Both use the patient's own tissue — bone marrow from the iliac crest in BMAC, fat from a small liposuction sample in Lipogems — processed at the time of injection and delivered into the affected joint. Both contain a fraction of cells that include mesenchymal stromal cells (sometimes loosely called "stem cells," though the more accurate term is mesenchymal stromal cells), as well as growth factors, cytokines, and structural elements. The cellular content and active biological role of these injections is still being characterized in research. The evidence base is less mature than for PRP and HA. ### Practical points - Indications: selected patients with mild to moderate knee disease, often as part of a broader plan that also includes structured PT and weight optimization - Cost: generally not covered by insurance; out-of-pocket - Evidence: growing but still less mature than for PRP and HA. Claims about cartilage regeneration with these products are not supported by the available evidence - What they are not: a substitute for surgery in patients with end-stage disease, or a guaranteed answer for patients who have not responded to less invasive options first - Distinguished from "stem cell" clinic offerings: BMAC and Lipogems use your own tissue, processed minimally and re-injected the same day, by a board-certified orthopedic surgeon. They are not the same as amniotic / umbilical "stem cell" products marketed by some cash-pay clinics For Dr. Strickland's broader commentary on stem cells, exosomes, and what is and is not realistic for cartilage repair, see stem cells, exosomes & cartilage repair. ## Cortisone in Context Cortisone (corticosteroid) injections are the oldest and most established knee injection. Cortisone is a powerful anti-inflammatory steroid that reduces joint inflammation and provides short-term symptom relief. ### When cortisone makes sense - Acute flare of arthritic pain — cortisone can break the inflammatory cycle - Inflammatory component on top of mechanical disease - End-stage arthritis when the patient is not yet ready for joint replacement — cortisone provides bridging symptom relief - Bursitis — pes anserine, prepatellar, and other peri-articular bursae respond well to targeted cortisone Important caveat Repeated cortisone injections in arthritic joints have been associated with cartilage thinning in some published studies. Cortisone is best used selectively rather than as an indefinite "every three months" routine. For joint-preservation candidates earlier in the disease course, hyaluronic acid, PRP, structured PT, weight optimization, or — when imaging supports it — joint-preserving surgery may be more appropriate than repeated cortisone. ## Who Is a Good Candidate The biggest predictor of biologic injection success is patient selection. Indication-by-indication: ### PRP for chronic patellar tendinopathy (strongest evidence) - At least 3 to 6 months of symptoms despite structured eccentric loading rehabilitation - Imaging consistent with degenerative tendinosis at the inferior pole of the patella - Patient willing to continue structured PT after the injection - Realistic expectation that PRP is an adjunct — not a stand-alone solution ### PRP / HA / BMAC / Lipogems for mild knee OA (mixed evidence, adjunctive) - Mild to moderate knee osteoarthritis rather than end-stage bone-on-bone disease - Well-preserved alignment — severe varus or valgus alignment fundamentally alters joint mechanics, and no biologic injection can compensate; alignment correction with osteotomy may be more appropriate - No major mechanical symptoms — catching, locking, or true mechanical block usually indicates a structural problem (torn meniscus, loose body, unstable cartilage flap) that needs surgical attention - Engaged in structured PT and weight management — the foundational care comes first, and biologics are an adjunct, not a substitute - Realistic expectations — understanding that biologics modify symptoms (sometimes), not structure - Patient preference for non-surgical care with willingness to revisit the surgical decision if biologics do not produce sufficient benefit ### Who is not a good candidate - End-stage bone-on-bone arthritis — biologic injections rarely produce meaningful relief in this group; the conversation should turn to partial or total joint replacement - Severe malalignment — alignment correction (osteotomy) or arthroplasty is more likely to help than injection - Mechanical symptoms from a torn meniscus, loose body, or unstable cartilage flap — arthroscopic treatment of the mechanical problem is appropriate first - Focal cartilage defects — MACI, OATS, or osteochondral allograft is the evidence-based option, not a biologic injection - Patients seeking cartilage regeneration — the realistic expectation is symptom relief, not regeneration - Patients seeking a substitute for indicated surgery — if the imaging and exam support partial or total knee replacement, no injection has been shown to be a substitute when replacement is indicated ## Biologics in a Comprehensive Plan Biologic injections work best as one element of a broader plan, not as a stand-alone solution. A comprehensive joint-preservation plan for a patient with mild to moderate knee osteoarthritis might include: - Structured physical therapy — quadriceps and hip-stabilizer strengthening, range-of-motion preservation, gait training, proprioception. The most under-executed step in knee care - Weight optimization — each pound of body weight loads the knee 4–6 times over with each step. Meaningful weight loss is one of the highest-leverage interventions - NSAIDs and topical agents — for inflammatory control during flares - Bracing — offloader brace for unicompartmental disease with appropriate alignment correction - Selective injection therapy — cortisone for flares, hyaluronic acid for sustained symptom relief in selected patients with documented OA, PRP / BMAC / Lipogems as adjuncts in selected patients with realistic expectations - Joint-preserving surgery when appropriate — osteotomy (HTO, DFO), the MISHA implantable shock absorber, MACI cartilage repair, OATS or osteochondral allograft - Replacement — partial or total knee replacement, often with Mako robotic-assisted precision, when joint-preserving options have been exhausted or are not appropriate Biologic injections fit into this continuum — they may extend the joint-preservation phase of care for selected patients, and they are rarely the entire plan. The other items on this list are not optional; biologics on top of "did nothing else" almost never produce a satisfying outcome. The other items without biologics, on the other hand, can produce a great outcome in many patients. ## What to Be Skeptical Of The orthobiologic space attracts marketing that runs ahead of the evidence, particularly from cash-pay clinics not led by board-certified orthopedic surgeons. Specific claims to be skeptical of: - "Stem cell therapy regrows cartilage" — not supported by the available evidence in adult arthritic knees - "Avoid knee replacement with stem cells" — for end-stage arthritis, no injection has been shown to be a substitute for replacement when replacement is indicated - "PRP regenerates cartilage" — PRP does not regenerate cartilage. The realistic role of PRP at the knee is symptom modification in selected patients, not structural regeneration - Amniotic, umbilical, or "live cell" products marketed by clinics outside legitimate orthopedic practices — the FDA has issued warnings about some of these. Most contain few if any viable stem cells after processing. These are different from BMAC and Lipogems, which use your own tissue - IV "regenerative" therapies for joint disease — intravenous infusions for orthopedic conditions are not supported by the evidence - Injection-only treatment plans that do not include PT, weight management, or other foundational care - "Guaranteed results" — legitimate biologic care includes a frank discussion of expected response rates and the possibility of non-response - Free consultations with high-pressure sales of injection packages — not a model used by legitimate orthopedic practices - Non-surgeon-led clinics charging cash-pay rates for injections, particularly when the marketing leans on "stem cell" language Important caveat Patients should be skeptical of any clinic — particularly cash-pay clinics not led by board-certified orthopedic surgeons — that promises knee arthritis cure, cartilage regrowth, or that “stem cells” can replace surgery. The marketing language is often deliberately vague about what is and is not in the syringe. If a clinic cannot tell you exactly what tissue type is being injected, where it came from, how it was processed, and what the published evidence is for that specific indication, then one should be skeptical. If a clinic's marketing language sounds substantially different from what your orthopedic surgeon describes, that gap is information — not necessarily that the surgeon is wrong, but that the marketing is operating in a different evidence framework. Most clinics with bold "stem cell" claims for knee arthritis are predatory; a sub-specialty second opinion with a board-certified orthopedic surgeon costs less than a single injection and is much more likely to give you an accurate picture of your options. ## Prehabilitation Comes First Whether or not biologic injection is part of the plan, structured non-surgical care comes first. Patients who have skipped PT and arrive asking for "the stem cell shot" are almost always better served by a course of evidence-based foundational care before any biologic decision: - Structured PT for at least 6 to 12 weeks — quadriceps strength, hip stability, gait, proprioception, range of motion - Weight optimization where applicable — high-leverage in OA - Activity modification — substitute lower-impact activities while symptoms are flared - NSAIDs and topical agents for symptom control during the structured-care window - Imaging — standing weight-bearing x-rays, long-leg alignment films when alignment is in question, MRI when meniscus or focal cartilage detail is needed This is not delaying your care — this is your care. Biologic injections layered onto a foundation of structured PT and weight optimization have a chance of producing meaningful benefit. Biologic injections layered onto "did nothing else" usually do not. ## What to Expect on Injection Day The injection itself is an office-based procedure, typically 30 minutes total from check-in to check-out for PRP, HA, or cortisone; longer for BMAC (which requires bone marrow aspiration) or Lipogems (which requires a small lipoaspirate). The general experience: - Pre-injection: brief review of imaging and prior care; informed consent including realistic expectations and the possibility of no clinical benefit - For PRP: a small blood draw (similar to a routine lab), centrifuged at the bedside for ~15 minutes to concentrate platelets - For BMAC: a small bone marrow aspiration from the iliac crest under local anesthesia, processed at the bedside - For Lipogems: a small autologous fat sample from the abdomen or flank, processed at the bedside - The injection itself: sterile prep, local anesthesia at the skin, and injection into the joint or tendon — often under ultrasound or fluoroscopic guidance for accurate placement - Post-injection: brief observation; typically you walk out the same hour Most patients experience mild soreness for 1 to 3 days after the injection — the platelet or marrow product itself can produce a transient inflammatory response, particularly with PRP. If clinical benefit is going to occur, it typically becomes apparent at 4 to 12 weeks, not the next day. ## Recovery Timeline ItemTypical timelineNotes Return to walking / desk workSame dayMild soreness expected; ice and rest the day of Mild post-injection soreness1 to 3 daysParticularly with PRP; transient inflammatory flare is normal Avoid NSAIDs (PRP only)~1 week before and afterNSAIDs may blunt the platelet biology; cleared individually Resume structured PT3 to 7 daysContinue eccentric loading or OA-appropriate program Earliest clinical response (if any)4 to 6 weeksReassess at the 4 to 6 week visit Peak response in responders8 to 12 weeksDecision point on second injection or alternative care Maintenance consideration6 to 12 months in respondersOnly if first series produced meaningful benefit The most important point: a meaningful number of patients are non-responders. Patients who do not get clinical benefit from a complete first series are unlikely to benefit from indefinite repeat injections. That is not a failure of the injection — it is information that the disease is in a different category and a different approach is more appropriate. ## Risks of PRP and Biologic Injections Biologic injections are generally well-tolerated, but no procedure is risk-free. The risks reviewed at consultation include: - No clinical benefit (common). A meaningful number of patients get no improvement from a complete series. This is the single most important "risk" to set expectations around — not a side effect, but the realistic possibility that the injection does not work for you - Injection-site bleeding or bruising — usually minor and self-limiting - Post-injection soreness — transient inflammatory flare in the first 1 to 3 days, particularly with PRP - Infection (rare) — any joint or tendon injection carries a small infection risk; sterile technique minimizes this - Worsening pain (rare) — transient flares occur; persistent worsening warrants reassessment - Vasovagal response — some patients feel lightheaded during or after the injection - For BMAC: additional bone marrow aspiration site discomfort, rare hematoma, very rare iliac-site complications - For Lipogems: additional fat-harvest site bruising and rare local complications - Cost — financial risk. PRP, BMAC, and Lipogems are typically out-of-pocket; the cost is real and should be weighed honestly against realistic expectations - Opportunity cost. Choosing a series of biologic injections delays evidence-based options that may help more — cartilage repair for a focal defect, osteotomy for malalignment, replacement for end-stage disease. Biologics are not always neutral; sometimes they are a form of delay ## Common Patient Concerns The three concerns we hear most often before biologic injection consultation, with honest answers: #### "Will this fix my arthritis?" No. PRP, BMAC, Lipogems, hyaluronic acid, and cortisone do not fix knee arthritis — arthritis is cartilage thinning that adult tissue does not regrow, and no injectable biologic has been shown to regenerate cartilage in adult arthritic knees. The honest realistic ceiling for biologic injection in mild to moderate knee OA is symptom modification — reduced pain, sometimes for several months at a time — in selected patients. That can be meaningful, but it is not a fix and not a cure. Patients who arrive expecting cartilage regeneration leave disappointed even when they get real symptom relief. #### "Why isn't it covered by insurance?" PRP, BMAC, and Lipogems are generally classified as investigational by commercial insurers because of heterogeneous preparation methods, mixed clinical-trial outcomes, and absence of FDA approval as drugs for specific orthopedic indications. Hyaluronic acid is FDA-approved for symptomatic knee OA and is generally covered with prior authorization; cortisone is covered. The cost of out-of-pocket biologic injections should be weighed against realistic expectations of benefit before deciding to proceed — particularly if a less expensive evidence-based option (structured PT, weight optimization, hyaluronic acid where indicated) has not yet been fully tried. #### "Is this a stem cell injection?" It depends on which injection. PRP contains essentially no stem cells — it is concentrated platelets from your own blood. BMAC and Lipogems contain a fraction of mesenchymal stromal cells (more accurate than calling them "stem cells") from your own bone marrow or fat. Many cash-pay clinics market amniotic-derived or umbilical-cord-derived "stem cell" injections that are not what an academic orthopedic practice means by biologic injection — those products contain few if any viable stem cells after processing, are not FDA-approved for orthopedic use, and have been the subject of FDA warnings. If a clinic is using "stem cell" language without being specific about what tissue type, where it came from, and how it was processed, that is a reason for skepticism, not enthusiasm. ## Insurance and Cost The insurance picture is uneven across biologic injection options: - Cortisone: universally covered - Hyaluronic acid: generally covered for documented knee OA after a trial of more conservative measures, with prior authorization. Brand approval may vary by plan - PRP: generally not covered for orthopedic indications; classified as investigational by most commercial insurers. Out-of-pocket cost typically several hundred to over a thousand dollars per injection, varying by region and preparation system - BMAC and Lipogems: generally not covered; out-of-pocket. Higher cost than PRP because of the additional harvest procedure - Amniotic / umbilical "stem cell" products: not covered, not FDA-approved for orthopedic use, and not offered by Dr. Strickland Before any out-of-pocket biologic injection, our office reviews the realistic expectations and the cost in advance, in writing. If a less expensive evidence-based option has not yet been tried — structured PT, weight optimization, NSAIDs, bracing, hyaluronic acid where appropriate — the right answer is often to start there. For benefits verification on covered injections (cortisone, hyaluronic acid), call us at 646-904-4664 or contact the office. ## When to Seek a Sub-Specialty Second Opinion A sub-specialty second opinion with a board-certified orthopedic surgeon is particularly worth seeking when: - A cash-pay clinic is promising knee arthritis cure, cartilage regeneration, or that "stem cells" can replace surgery — these claims are not supported by the evidence and warrant a second look - You are being asked to prepay an injection package before any imaging review or comprehensive evaluation - You have chronic patellar tendinopathy that has failed PT and want a clear answer on whether PRP fits your case - You have mild to moderate knee OA and want a balanced, evidence-graded discussion of biologic injections within a comprehensive plan — not a sales pitch for one specific injection - You have a focal cartilage defect on MRI and have been offered a biologic injection — cartilage repair (MACI, OATS or allograft) is the evidence-based option for focal defects - You have advanced arthritis or significant malalignment and have been told an injection will replace surgery — alignment correction (osteotomy) or replacement may be more appropriate - You want an honest answer about what the evidence does and does not say for your specific knee, your specific imaging, and your specific goals ## Access & Office Location Dr. Strickland sees patients at one office, which works with patients traveling in from outside the immediate area: - New York City: NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY 10016. In Midtown Manhattan, accessible from Manhattan, the outer boroughs, Long Island, Westchester, and northern New Jersey via the Queensboro and Triboro bridges and the FDR Drive. Phone: 646-904-4664. Many out-of-state patients travel to NYU Langone specifically for second opinions on biologic injection claims made by other clinics, for chronic patellar tendinopathy that has failed local care, and for honest evidence-graded discussion of where biologics do and do not fit in a comprehensive treatment plan. ## Source Grounding — What Informs This Page The clinical positions on this page are grounded in Dr. Strickland's published patient education on biologics, the broader HSS sub-specialty consensus on the role of orthobiologic injections in knee care, and current FDA and professional-society regulatory framing. The literature is intentionally limited — reflecting the limited evidence base and the many open questions in this space: TopicGrounding source on this siteWhat it informs PRP for ACL healing Orthobiologics study: can ACLs heal faster using PRP? Research-stage framing of PRP as an ACL adjunct; not standard of care Amniotic suspension allograft (ASA) injections for knee OA HSS research study on ASA injections for knee OA Investigational status of amniotic-derived injectables; distinct from cash-pay "stem cell" marketing Stem cells, exosomes, and cartilage repair Stem cells, exosomes & cartilage repair Dr. Strickland's broader commentary on stem-cell biology and the gap between marketing and evidence "Dancing molecules" cartilage research Northwestern dancing-molecules research Animal-model regenerative work; promising and research-stage, not a current clinical option Sea coral / CartiHEAL scaffold Sea coral helps knee osteoarthritis (CBS News) Emerging cartilage scaffold technology; not a biologic injection Honest framing of emerging arthritis treatments Knee arthritis — emerging treatments section Tone match: emerging biologics are research-stage, not standard of care Surgeon credentials and experience About Dr. Sabrina Strickland Sub-specialty care, board certification, and the basis for "Medically reviewed by" The honest summary the literature supports: biologic injections are adjunctive, not primary, treatments for the knee. The evidence is strongest for chronic patellar tendinopathy after failed PT, mixed for mild knee OA, and absent for cartilage regeneration. Anything beyond that — particularly cash-pay-clinic claims of arthritis cure or stem-cell knee regeneration — is marketing, not medicine. ## Frequently Asked Questions Will PRP cure my knee arthritis? No. PRP does not cure knee arthritis, and no injectable biologic has been shown to regenerate functional hyaline cartilage in adult arthritic knees. The evidence-based role of PRP for knee osteoarthritis is symptom modification, not structural cure — and even that benefit is mixed in the literature. In well-selected patients with mild to moderate arthritis, a series of PRP injections may reduce pain and delay further intervention; in many other patients, PRP produces no meaningful benefit at all. Patients should be skeptical of any clinic — particularly cash-pay clinics not led by board-certified orthopedic surgeons — that promises cartilage regeneration or arthritis cure from PRP, BMAC, Lipogems, or "stem cell" injections. Is PRP the same as a stem cell injection? No. PRP (platelet-rich plasma) is a concentrate of platelets prepared from your own blood; it contains essentially no stem cells. BMAC (bone marrow aspirate concentrate) and Lipogems contain a fraction of mesenchymal stromal cells, sometimes loosely called "stem cells," from your own bone marrow or fat. Many cash-pay "stem cell" clinics market amniotic-derived or umbilical cord-derived products that contain few if any viable stem cells after processing — these are not what an academic orthopedic practice means by biologic injection. The FDA has issued warnings about some of these products and clinics. None of these injections — PRP, BMAC, Lipogems, or amniotic-derived products — has been shown to regenerate cartilage in adult arthritic knees. Why doesn't insurance cover PRP? PRP is generally classified as investigational by commercial insurers for orthopedic indications and is paid out of pocket. The reasons commonly cited include heterogeneous preparation methods, mixed clinical-trial outcomes, and absence of FDA approval as a drug or device for specific orthopedic indications (PRP is regulated as a blood derivative, not approved for a labeled clinical use). BMAC and Lipogems are also typically out of pocket. Hyaluronic acid is generally covered by insurance for documented knee osteoarthritis after a trial of more conservative measures; cortisone is covered. Cost should be weighed honestly against realistic expectations of benefit before proceeding with any out-of-pocket biologic injection. How long does PRP last? In responders, the clinical effect of a PRP series typically becomes apparent at 4 to 12 weeks and may persist for several months to a year before retreatment is considered. A meaningful number of patients are non-responders — they get little or no benefit even from a complete series. Patients who do not respond after the first series are unlikely to benefit from indefinite repeat injections; at that point the conversation should turn to other evidence-based options. PRP does not "last forever" and does not modify the underlying joint structure. Who is a good candidate for PRP for the knee? The best-evidenced indication for PRP at the knee is chronic patellar tendinopathy ("jumper's knee") that has failed structured eccentric loading rehabilitation. PRP for mild knee osteoarthritis is a reasonable adjunctive option in selected patients who have well-preserved alignment, no major mechanical symptoms, realistic expectations, and who have already engaged with structured PT and weight optimization. PRP is not appropriate for advanced bone-on-bone arthritis, severe malalignment, mechanical symptoms from a torn meniscus or loose body, or as a substitute for cartilage repair when a focal cartilage defect is present. Patients seeking cartilage regeneration are not good candidates — biologics do not regenerate cartilage. Are BMAC and Lipogems different from PRP? Yes. PRP is concentrated platelets from your own blood. BMAC (bone marrow aspirate concentrate) is bone marrow drawn from your iliac crest, processed, and injected — it contains a stem-cell-rich fraction along with growth factors. Lipogems uses a small liposuction sample of your own fat, processed at the bedside, and injected; it contains cellular and structural fat including mesenchymal stromal cells. The evidence base for BMAC and Lipogems is less mature than for PRP and hyaluronic acid. Both are generally out-of-pocket. Like PRP, they are symptom-modifying at best in selected patients — none regenerates cartilage. Is repeated cortisone bad for the knee? Repeated cortisone injections in arthritic joints have been associated with cartilage thinning in some published studies, and cortisone is best used selectively for acute flares or as a bridge in end-stage disease — not as an indefinite "every three months" routine. For joint-preservation candidates earlier in the disease course, hyaluronic acid, PRP, structured PT, weight optimization, or — when imaging supports it — joint-preserving surgery may be more appropriate than repeated cortisone. The right answer depends on the stage of disease and the patient's overall plan. Should I be skeptical of clinics promising stem cell knee regeneration? Yes. Stem cell therapy as marketed by many cash-pay clinics is not FDA-approved for orthopedic use, and claims of cartilage regeneration in adult arthritic knees are not supported by current evidence. The FDA has issued warnings about some amniotic and umbilical "stem cell" products. If a non-surgeon-led clinic is promising to cure your arthritis, regrow cartilage, or replace knee replacement with an injection, those claims should prompt a sub-specialty second opinion with a board-certified orthopedic surgeon — not a deposit on an injection package. Legitimate biologic care uses your own tissue, frames the role honestly as adjunctive rather than curative, sits inside a comprehensive treatment plan, and does not promise outcomes. What does Dr. Strickland think about PRP and biologics for the knee? Dr. Strickland approaches PRP and biologic injections as adjunctive options that may be discussed within a comprehensive treatment plan — not as a primary therapy and not as a substitute for evidence-based care. Strongest evidence for chronic patellar tendinopathy after failed PT; reasonable adjunct in selected patients with mild knee osteoarthritis; not appropriate for advanced arthritis, cartilage replacement, or as a substitute for surgery when surgery is indicated. Her position is neither dismissive nor over-promised: the right injection in the right patient at the right stage of disease can produce meaningful symptom relief; the wrong injection in the wrong knee is an expensive way to delay better treatment. ## Related Specialty Care For the full knee arthritis treatment ladder, see knee arthritis. For chronic patellar tendinopathy — the strongest knee indication for PRP — see anterior knee pain and patellar pain and patellofemoral arthritis. For the evidence-based options for focal cartilage damage (where biologic injection is not the right answer), see MACI cartilage repair and cartilage transplantation (OATS & allograft). For alignment correction in isolated compartment OA, see joint preservation and osteotomy. For sports-medicine context including return-to-sport considerations, see sports injuries. For PRP as a research-stage adjunct in ACL healing, see ACL tear surgery. For partial and total knee replacement when joint-preserving options have been exhausted, see Mako robotic-assisted surgery. Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. PRP and other biologic injections are adjunctive options that may be discussed within a comprehensive treatment plan and are not a substitute for evaluation and care by a board-certified orthopedic surgeon who has reviewed your imaging, history, and physical examination. No biologic injection has been shown to regenerate cartilage in adult arthritic knees, and a meaningful number of patients receive no clinical benefit from a complete series of injections. Individual outcomes vary based on indication, stage of disease, alignment, prior care, comorbidities, and adherence to structured rehabilitation. Emerging and research-stage treatments referenced on this page are not standard of care and are not offered or recommended as substitutes for evidence-based treatment. ## Get an Honest Read on Biologic Options If you are considering PRP for chronic patellar tendinopathy or mild knee OA — or have been told by a cash-pay clinic that "stem cells" can replace surgery and want a sub-specialty second opinion — bring your imaging to a consultation at NYU Langone in Midtown Manhattan. Book an Appointment Call 646-904-4664 --- ## Mako Robotic-Assisted Knee Surgery NYC | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/knee-surgeon-specialist/robotic-assisted-surgery/ Summary: Mako robotic-assisted knee surgery in New York with Dr. Sabrina Strickland — CT-based 3D planning and the AccuStop haptic boundary for partial knee replacement (UKA), total knee replacement, and selected complex cases. With an honest, published view of where Mako helps, where it doesn Specialty # Mako Robotic-Assisted Knee Surgery CT-based 3D planning and the AccuStop haptic boundary for partial knee replacement (UKA), total knee replacement, and selected complex cases — with an honest, published view of where Mako helps, where it doesn’t, and why patient selection matters more than the platform. With Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York. Medically reviewed by Dr. Sabrina Strickland, MD — Board-certified Orthopedic Sports Surgeon, Sports Medicine and Shoulder Fellowship at Hospital for Special Surgery, MAKO Robotic Surgery certification. View full bio → Where NYU Langone Orthopedic Center, Midtown Manhattan Best Use Partial knee replacement (UKA) — where precision drives outcome. Selected total knee and complex cases. Philosophy Mako is a tool, not magic — the right cases benefit, others don’t Overview Mako is a CT-based robotic-arm platform made by Stryker. The surgeon builds a 3D plan of your knee from a pre-operative CT scan, the system tracks your anatomy in the OR, and the AccuStop haptic boundary physically resists motion of the saw or burr outside the planned envelope. Mako is a planning and execution-precision tool — it does not change the indication for surgery, the implant, the recovery, or the risks. The robot is not autonomous: every cut is the surgeon’s. Dr. Sabrina Strickland uses Mako at NYU Langone Orthopedic Center for the cases where it earns its place — most clearly in partial knee replacement (UKA), where small alignment errors drive early failure of the spared compartments. For straightforward total knee replacement in well-aligned patients, conventional outcomes are already excellent and the marginal benefit of robotic assistance is smaller. The right answer depends on the case, not on whether the technology is used. If you have been told you need a knee replacement and you’ve seen the word Mako on your surgeon’s website, the question worth asking is not “is Mako better?” — it is “is my case one where the platform actually changes the outcome?” Some procedures benefit substantially from CT-based planning and haptic execution. Others do not. Dr. Strickland’s approach is to use Mako where it earns its place — most clearly in partial knee replacement (UKA), in selected total knee cases with complex alignment, and in patients who want documented pre-operative planning — and to set it aside in cases where the platform adds nothing or, as she has published for MPFL reconstruction, may not improve outcomes despite improving a single technical metric. This page covers what the Mako system actually is and is not, what it does and does not change, when it earns its place (UKA), how it compares to the other robotic platforms (ROSA, VELYS), Dr. Strickland’s honest position on robot-assisted MPFL based on her own published commentary, the role of CT planning in osteotomy and revision cases, what to expect on surgery day, recovery timelines, risks (which are the procedure’s risks — not the platform’s), insurance and cost, and when a sub-specialty second opinion on robotic candidacy is worth seeking. For closely related procedures, see knee arthritis for the joint-replacement decision tree, joint preservation and osteotomy for the realignment side, MPFL reconstruction for the soft-tissue side of patellar instability, patellar instability, and patellar pain and patellofemoral arthritis. ## What Mako Is and What It Actually Does Mako is a CT-based robotic-arm platform made by Stryker. Unlike imageless systems that rely on intraoperative landmarking, Mako builds its surgical plan from a CT scan of your knee taken before surgery. The CT becomes a 3D model of your bony anatomy — every contour, every angle, every osteophyte. The surgeon designs the entire procedure on that model: implant size, implant position, planned bone resection, and alignment targets. None of this happens during the operation. By the time you are in the OR, the plan exists. #### 1. CT-based 3D plan A pre-operative CT scan becomes a personalized 3D model of your knee. Implant size, position, alignment targets, and planned bone resection are designed on your specific anatomy — not adjusted on the fly with intramedullary jigs. #### 2. Intraoperative tracking Optical trackers attached to the femur and tibia register your actual knee to the CT plan in real time. The system compensates for movement throughout the procedure so the plan stays aligned to the bone as you operate. #### 3. AccuStop haptic execution The Mako AccuStop haptic boundary physically resists motion of the saw or burr outside the planned envelope. Every cut is the surgeon’s — the system prevents the instrument from straying. Soft-tissue balance and ligament tensioning are confirmed by the surgeon at the end. The defining feature of Mako versus simple navigation systems is haptic feedback: as the surgeon moves the saw or burr through bone, the robotic arm physically resists motion outside the planned envelope. The surgeon feels the boundary. This is what makes Mako different from systems that show a screen overlay but don’t constrain the instrument. The cut happens within the plan, by force, not by intention alone. What Mako is not: an autonomous robot. It does not perform surgery on its own. The surgeon designs the plan, controls the robotic arm during every cut, balances soft tissues by feel and by trial implant tensioning, and verifies alignment before final fixation. The platform constrains execution; it does not replace judgment. ## What Mako Doesn’t Change This section is the most important one on the page. Mako is marketed heavily, and patients sometimes arrive believing the robot itself drives the outcome. It does not. Mako changes one specific thing: the consistency of the technical step it controls (bone resection or implant positioning to within sub-millimeter accuracy). It does not change: - The indication for surgery. A wrong-indication knee replacement is still the wrong operation when performed with a robot. Patient selection — matching the right procedure to the right patient at the right time — is the single most important driver of a good outcome, and the robot does not help with this. - The implant. Mako pairs with the Stryker family of knee implants (Triathlon and other Stryker designs). Different robotic platforms pair with different manufacturers. The implant placed in your knee is determined by the platform’s manufacturer, not by separate evidence-based selection per case. - The recovery timeline. A Mako-assisted partial knee replacement does not recover faster than a conventional partial knee replacement performed by an experienced surgeon. A Mako total knee replacement does not recover faster than a conventional total knee replacement. Recovery follows the operation, not the platform. - The risks. Infection, blood clot, stiffness, implant loosening, periprosthetic fracture, and the need for revision are the same risks as conventional knee replacement. There is no robotic premium that reduces these. - Soft-tissue balance and ligament tensioning. These are judged by the surgeon by feel and by trial-implant testing through range of motion. The robot does not balance soft tissues for you. - The need for honest pre-operative discussion of expectations. Patients who do well after knee surgery are patients whose expectations were calibrated by an experienced surgeon — not by a marketing brochure for the robot. Mako-trained surgeons who select patients well and execute the underlying procedure well will continue to get good outcomes with Mako. Mako-trained surgeons who select patients poorly will not be rescued by the platform. The robot is a tool, not a substitute for the disciplined work of arthroplasty. ## When Mako Helps Most Robotic assistance is not equally valuable across every knee procedure. The cases where Mako earns its place are those where small alignment differences translate into meaningfully different outcomes — and where pre-operative planning from imaging is more accurate than intraoperative landmarking. 1 #### Partial knee replacement (UKA) — the strongest indication Implant positioning is the single biggest driver of UKA failure. Small malalignment causes early loosening or progression of arthritis in the spared compartments. The Mako CT plan models the whole knee (worn compartment plus the spared ones), and the haptic boundary protects the precise resection — this is where the platform demonstrates its clearest technical contribution. 3 #### Complex alignment in total knee replacement Patients with significant varus or valgus deformity, prior trauma, retained hardware, post-traumatic arthritis with disrupted landmarks, or unusual bony anatomy benefit from CT-based planning over standard intramedullary jigs. The plan documents the alignment target and the resection envelope before the OR. 4 #### Younger patients where every degree of alignment matters Patients in their 50s and early 60s tend to outlive their first arthroplasty — precise alignment maximizes the time before revision becomes a question. Where joint preservation is no longer feasible, the Mako advantage in tight bone resection and component positioning is more valuable in patients who will live with the implant for 25–30+ years. 6 #### Selected revision when you add a second partial knee replacement CT-based reconstruction of the planned alignment can be useful. Adding a second partial knee replacement needs to sit adjacent to but not interfere with the prior component — the platform helps with the planning step, not with the entire revision. Conversely, robotics adds little to procedures driven primarily by soft-tissue judgment, ligament balancing by feel alone, or cases where the bony landmarks tell most of the story. In a straightforward total knee replacement on a well-aligned patient with normal anatomy and an experienced surgeon, the marginal benefit of robotic assistance over conventional technique is small — and conventional total knee outcomes are already excellent. ## Mako vs Conventional Instruments How the platform actually differs from traditional intramedullary-jig technique: StepMakoConventional Pre-op planningCT-based 3D model of your specific anatomy; implant size and alignment designed before the ORStanding x-rays plus intra-op landmarking; implant size confirmed in the OR Bone cutsAccuStop haptic boundary physically resists motion outside the planned envelopeCutting blocks pinned to bone after intramedullary alignment; surgeon judgment on each cut Soft-tissue balanceSurgeon-judged; informed by intraoperative balance feedback during trial implant testingSurgeon-judged; informed by intraoperative balance feedback during trial implant testing Imaging requiredPre-op CT scan (low-dose joint-replacement protocol)Standing x-rays only OR timeSlightly longer than conventional in most series; narrowing as teams scale volumeEstablished workflow; experienced teams are very efficient Best evidenceStrongest for partial knee replacement (UKA); minimal for straightforward TKALong-track-record outcomes well-established for both UKA and TKA in experienced hands Implant familyStryker (Triathlon and others)Surgeon-selected per case The honest framing: Mako has the strongest evidence advantage for partial knee replacement, where precision matters disproportionately and the technique is unforgiving of small errors. For straightforward total knee replacement in experienced hands, conventional outcomes are already excellent and the difference is smaller. ## Mako for Partial vs Total Knee Replacement The clearest difference between Mako and traditional technique shows up in partial (unicompartmental) knee replacement (UKA). Partial replacement preserves the unaffected compartments and the cruciate ligaments — faster recovery, more native bone preserved, and a more natural-feeling knee for many patients. The trade-off has historically been technique sensitivity: small errors in implant position cause early loosening or progression of arthritis in the spared compartments. Robotic execution narrows that variance. Mako Partial Knee (UKA)Mako Total Knee (TKA) Best candidateSingle-compartment arthritis, intact cruciate ligaments, well-correctable alignmentMulti-compartment arthritis or significant deformity What Mako addsSub-millimeter implant positioning protects the spared compartments — the biggest historical driver of UKA failureCT-based alignment planning vs intramedullary jigs — modest benefit in straightforward cases Bone preservedSubstantially more native bone preserved vs total knee — one compartment, intact ligamentsStandard total knee resection of all three compartments RecoveryOften discharged same day; walking with assistance immediately; off the walker in 1–2 weeks; most activities by 4–6 weeksStandard total knee recovery (walker 2–4 weeks, daily activity by 2–3 months, full recovery 9–12 months) Evidence strengthStrong — technical precision drives UKA outcome more than TKAModest in straightforward cases; clearer in complex alignment If you have been told you need a total knee replacement, asking whether you might be a candidate for partial knee replacement instead — and whether Mako is available to your surgeon for that procedure — is a reasonable second-opinion question. Not every patient qualifies for UKA, but many do. For the broader treatment ladder, see knee arthritis; for joint-preserving alternatives that come before any replacement, see joint preservation and osteotomy. ## Mako-Assisted Patellofemoral Arthroplasty For patients with isolated patellofemoral arthritis — arthritis behind the kneecap with healthy medial and lateral compartments — patellofemoral arthroplasty (PFA) resurfaces only the trochlea and patella, preserving the rest of the knee. Component positioning matters disproportionately in PFA because the patella has to track through the trochlear groove smoothly through full range of motion: a few degrees of trochlear-component rotation, or a few millimeters of offset, change patellar tracking and contact stress. Mako-assisted PFA is not recommended by Dr. Strickland in most cases as she prefers the Zimmer Patellofemoral Arthroplasty implants. Her primary patellofemoral practice is the soft-tissue and realignment work (MPFL reconstruction, AMZ-TTO, distalization TTO) before patellofemoral arthroplasty becomes the right answer; for patients who do reach PFA, Dr. Strickland prefers the Zimmer implant. See patellar pain and patellofemoral arthritis for the broader PFA framework. ## CT-Based Osteotomy Planning A frequent question: does Mako execute high tibial osteotomy (HTO), distal femoral osteotomy (DFO), or tibial tubercle osteotomy (TTO)? The honest answer is more nuanced than the marketing suggests. Realignment osteotomies are primarily a planning problem — the precise correction angle, the wedge size, and the pivot point determine the outcome. CT-based 3D planning is genuinely helpful for visualizing complex deformity in three planes, simulating the correction, and templating fixation hardware. Where Mako specifically integrates into osteotomy execution is more procedure-specific and continues to evolve. Dr. Strickland’s osteotomy practice (HTO, DFO, AMZ-TTO, distalization TTO) draws on CT-based pre-operative planning when the case warrants it; for many osteotomies in patients with straightforward anatomy, the planning step does not require CT, and traditional radiographic templating with fluoroscopic confirmation is sufficient. As with arthroplasty, the case selection comes first — the platform is matched to the case, not the case to the platform. For the full joint-preservation framework, see joint preservation and osteotomy. ## Robot-Assisted MPFL Reconstruction — An Honest View MPFL reconstruction is the most position-sensitive ligament reconstruction in the knee. Femoral tunnel position drives graft tension through full range of motion: a tunnel placed even a few millimeters off the anatomic footprint changes graft tension — too tight in flexion, too loose in extension, or both. It is reasonable to ask whether robotic assistance, by hitting the tunnel target more precisely, should improve outcomes. Dr. Strickland has published her view on this question. “Using a robot to improve surgery sounds like a no-brainer. More accurate is better, right? Well, not necessarily.” “The robotic-assisted group had the femoral tunnel in closer to a specific anatomic landmark, but both groups had similar rates for achievement of the minimal clinically important difference (MCID) for patient-reported outcomes (PROs). The robotic-assisted surgery took longer and required expensive technology. Furthermore, anatomic variations from patient to patient mean that not all ligaments should be placed in exactly the same spot.” — Dr. Sabrina Strickland, “Is Robot-assisted MPFL Reconstruction Better than Freehand?” (April 2025) The clinical implication: for MPFL reconstruction specifically, robotic assistance has not been shown to improve patient-reported outcomes despite hitting the geometric target more precisely. The deeper reason is that anatomic variation matters: a single “optimal” tunnel position derived from cadaveric averages does not capture the patient-specific variation that surgeons account for at the time of surgery using fluoroscopy, range-of-motion isometry testing, and graft tension feedback. For more on tunnel position and the broader MPFL technique, see MPFL reconstruction surgery and two-fixation-point MPFL technique; for the broader patellar instability framework (where tunnel position is one of several variables that drive outcome), see patellar instability. This section is intentionally counter-marketing. Dr. Strickland’s view is that robotic platforms earn their place case by case — not procedure by procedure based on glossy literature. For UKA the evidence is favorable; for MPFL, on her published reading, it is not. ## Mako vs ROSA vs VELYS Three robotic-arm platforms dominate the knee replacement market. Each pairs with a different implant family, and they differ technically in how the surgical plan is built: PlatformManufacturerPlanning approachImplant family MakoStrykerPre-operative CT-based 3D plan; AccuStop haptic boundaryStryker (Triathlon, others) ROSA KneeZimmer BiometImageless — intraoperative landmarking; navigation-based executionZimmer Biomet (Persona, others) VELYSDePuy Synthes (J&J)Imageless — intraoperative landmarking; navigation-based executionDePuy (Attune, others) Dr. Strickland’s primary platform at NYU Langone is Mako. She does not multi-platform across competing systems — high-volume joint replacement is a workflow problem as much as a technical one, and consistency across the surgical team matters. Patients who specifically want a different platform are best served by a surgeon whose volume is on that platform; patients who want to know which platform is “best” in the abstract are usually asking the wrong question. The platform should match the surgeon’s training, the implant the surgeon and hospital are using, and the workflow the OR team has scaled. The CT-based vs imageless distinction matters most for patients with complex bony anatomy — significant deformity, prior trauma, or retained hardware — where pre-operative CT-based planning has a clearer advantage over intraoperative landmarking. In straightforward anatomy, the difference between platforms in skilled hands is smaller than the marketing suggests. ## What to Expect on Surgery Day The surgery-day experience is fundamentally the same as a conventional knee replacement — with one upstream addition (the pre-operative CT) and one workflow difference (tracker pin placement at the start of the procedure). Specifics vary by case and your protocol is individualized at consultation. - Pre-operative CT scan — obtained 1 to 4 weeks before surgery, usually at NYU Langone or a partner imaging facility. Low-dose joint-replacement protocol; you lie still for several minutes; no IV contrast typically required for arthroplasty planning. The 3D plan is built from this scan. - Prehabilitation — weight optimization, quadriceps strengthening, and PT before surgery, where appropriate, to set the stage for recovery. Dental clearance is advised and medical optimization is completed before the date. - Arrival and pre-op — you arrive a couple of hours before the procedure, change into a gown, and meet the anesthesia team. - Anesthesia and periarticular block — for Dr. Strickland's knee replacements (Mako or conventional), the plan is spinal anesthesia with sedation plus a periarticular block placed around the knee joint during surgery. Dr. Strickland does not typically use general anesthesia or femoral/adductor-canal nerve blocks. The periarticular block helps reduce post-operative pain during the first day after surgery and is part of an opioid-sparing pain protocol. - Tracker pin placement and registration — small optical-tracker pins are placed in the femur and tibia. The system registers your actual anatomy to the pre-operative CT plan. This step is unique to robotic platforms and adds a few minutes to the workflow. - Surgery — the procedure itself typically takes 1 to 2 hours; in most series, robotic-assisted cases are slightly longer than conventional cases, with the gap narrowing as teams scale volume. - Recovery room — you wake up in the recovery area; for outpatient cases, physical therapy starts the same day with assisted weight-bearing. - Going home or admitting — many partial and total knee replacements (Mako or conventional) are now performed on an outpatient or short-stay basis; some patients (older patients, those with significant comorbidities, those without home support) admit overnight. The block typically wears off over the first 12 to 24 hours, during which the leg is numb and weight-bearing requires a walker because the leg is not protecting itself normally. This is expected and is part of the trade-off for the lower pain levels in that first day. For the broader patient walk-through, see before knee replacement surgery. ## Recovery Timelines The most important point on this page about recovery: Mako does not shorten recovery compared to conventional knee replacement. Recovery follows the procedure performed, not the platform. A Mako partial knee replacement and a conventional partial knee replacement performed by an experienced surgeon recover on the same timeline. The same is true for total knee replacement. ProcedureWalker / caneDrivingMost daily activityFull recovery Mako partial knee (UKA)1–2 weeks2–4 weeks4–6 weeks3–6 months Mako total knee (TKA)2–4 weeks4–6 weeks2–3 months9–12 months Patellofemoral arthroplasty1–2 weeks2–4 weeks4–8 weeks3–6 months Conventional partial knee (UKA)1–2 weeks2–4 weeks4–6 weeks3–6 months Conventional total knee (TKA)2–4 weeks4–6 weeks2–3 months9–12 months Patients consistently underestimate the role of structured PT in arthroplasty recovery. Skipping or shortening PT does not save time — it almost always extends recovery and increases the risk of stiffness, particularly after total knee replacement, regardless of whether the procedure was Mako-assisted or conventional. For the patient-facing walk-through of what to expect, see what to worry about when undergoing a knee replacement. ## Risks of Robotic-Assisted Knee Surgery The risks of Mako-assisted knee surgery are the same as conventional knee replacement, with one platform-specific addition (tracker-pin sites) and one upstream consideration (CT radiation exposure). No platform is risk-free. - Infection — including periprosthetic joint infection. Uncommon (typically <1–2%) but serious. Modern protocols include preoperative skin decolonization, perioperative antibiotics, and stringent intraoperative protocols. - Blood clot (DVT and pulmonary embolism) — risk is mitigated by early mobilization, mechanical compression, and individualized chemoprophylaxis. - Joint stiffness — reduced by good prehabilitation, structured PT, and addressing any motion deficit early. Not platform-dependent. - Implant loosening or wear — over years to decades. Modern implants are designed to last 15–20+ years for most patients. - Periprosthetic fracture — uncommon, more relevant in older patients with osteoporosis or after high-energy trauma. - Persistent pain — a small subset of patients have ongoing knee pain after a technically successful replacement (Mako or conventional). Pre-existing chronic pain conditions, central sensitization, and patient-specific factors contribute. - Need for revision — some patients require revision surgery years later. Younger and more active patients are statistically more likely to need revision in their lifetime simply because they live longer with the implant. - Tracker-pin site complications — the optical tracker pins placed in the femur and tibia at the start of the case create small bony entry sites. Pin-site infection is rare; pin-site fracture is reported but very rare with current protocols. Pin sites are typically not painful in the post-op course. - Pre-operative CT radiation — ionizing radiation from the planning CT, mitigated by low-dose joint-replacement protocols. Patients with concerns about cumulative radiation exposure can discuss this at consultation. - Anesthesia-related risks — including nausea, allergic reactions, transient nerve irritation or permanent injury from the anesthetic block, and rare cardiac or respiratory complications. The specific risk profile for your case depends on your age, weight, medical history, the type of arthritis, the procedure planned, and prior surgery on the knee — not on whether the procedure is robotic-assisted or conventional. ## Common Patient Concerns The three concerns we hear most often before robotic-assisted knee surgery, with honest answers: #### “Is the robot doing the surgery? I don’t want a robot operating on me.” No. Mako is not autonomous. The surgeon designs the plan from imaging, controls the robotic arm during every cut, balances soft tissues by feel and trial-implant testing, and verifies alignment before final fixation. The AccuStop haptic boundary physically resists the saw or burr from straying outside the planned envelope — but the cut is the surgeon’s. Think of it as a high-precision constraint on the cutting motion, not an autonomous operating system. The surgeon is the decision-maker at every step. #### “Does using Mako mean I will get a better outcome?” Not universally. Mako has the strongest evidence advantage in partial knee replacement, where small alignment errors drive early failure of the spared compartments. For straightforward total knee replacement in well-aligned patients, conventional outcomes performed by an experienced surgeon are already excellent — the marginal benefit of robotic assistance is smaller. Patient selection and surgeon experience matter more than the platform. The most important question is not “robot or no robot?” — it is “is this the right operation for me, and is the surgeon experienced in performing it?” #### “Will Mako get me back to activity faster?” No — recovery follows the procedure, not the platform. Mako partial knee replacement recovers on the same timeline as conventional partial knee replacement (off the walker in 1–2 weeks, most activities by 4–6 weeks). Mako total knee replacement recovers on the same timeline as conventional total knee replacement (most activities by 2–3 months, full recovery 9–12 months). The platform does not change the biology of healing, the rehabilitation protocol, or your motivation to do the work in PT. ## Insurance and Cost Robotic-assisted knee surgery is covered by all major commercial insurance plans, Medicare, and most union and self-funded plans when the underlying procedure is medically necessary. Mako is not billed as a separate “robotic upcharge” — the procedure (partial knee replacement, total knee replacement, patellofemoral arthroplasty) bills the same way it would for conventional technique. The robotic platform is part of the operating-room setup. The variables that drive your specific out-of-pocket cost are: - Your plan’s deductible and coinsurance — the structure of cost-sharing differs significantly between plans. - In-network vs out-of-network status — for the surgeon, the facility (NYU Langone or an affiliated outpatient surgery center), the anesthesia group, and the imaging facility for the pre-operative CT. - Bundled vs separate billing — for the surgeon, facility, anesthesia, imaging, physical therapy, and any concurrent procedures. - Pre-operative CT — covered as part of the surgical work-up when the planned procedure is medically necessary. - Pre-authorization — required by most plans for partial knee replacement, total knee replacement, and patellofemoral arthroplasty. Our office obtains pre-authorization where required. Before any procedure, our office verifies your benefits, obtains pre-authorization where required, and reviews the estimated out-of-pocket cost with you. For benefits verification, call us at 646-904-4664 or contact the office. ## When to Seek a Sub-Specialty Second Opinion A sub-specialty second opinion specifically on robotic-assisted knee surgery candidacy is particularly worth seeking when: - You have been told you need a total knee replacement but your imaging shows arthritis isolated to one compartment — partial knee replacement (UKA) with Mako precision may be a better fit. - You are young or active and want every degree of alignment optimized for long-term implant survivorship. - You have complex alignment, post-traumatic arthritis, or retained hardware from prior knee surgery, and want CT-based planning that conventional templating cannot fully model. - You have been told only your surgeon’s preferred platform can perform your case — the platform is a tool; the question is whether the right surgeon is performing the right operation. - You want a clear, honest discussion of where Mako helps and where it does not — rather than a marketing-focused conversation. - You are weighing partial vs total knee replacement and want a precise compartment-by-compartment assessment of your imaging. - You are evaluating a revision knee replacement where prior alignment is the question. ## Access & Office Location Dr. Strickland performs Mako robotic-assisted knee surgery at NYU Langone Orthopedic Center in New York City — the highest-volume orthopedic hospital in the United States, where Mako is widely available across the joint replacement service and where workflow is optimized for high-volume robotic arthroplasty. She sees patients for in-person consultation at two locations: - New York City: NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY 10016. In Midtown Manhattan, accessible from Manhattan, the outer boroughs, Long Island, Westchester, and northern New Jersey via the Queensboro and Triboro bridges and the FDR Drive. Phone: 646-904-4664. For patients traveling to New York from out of state for Mako robotic knee replacement, partial knee evaluation, or revision arthroplasty, we coordinate consultation, pre-operative CT, and surgery scheduling to minimize travel and align with imaging review and pre-operative work-up. ## Source Grounding & Published Research This page is grounded in Dr. Strickland’s published commentary, her peer-reviewed research, her MAKO Robotic Surgery certification training, and the connected joint-replacement and patellofemoral content elsewhere on her site. Selected references: TopicSource Robot-assisted vs freehand MPFL — her published viewIs robot-assisted MPFL reconstruction better than freehand? MPFL tunnel position (two-fixation-point technique)Two fixation points for MPFL reconstruction Knee arthritis — replacement decision tree, Mako framingKnee arthritis treatment Joint preservation before replacement (HTO, DFO, AMZ-TTO)Joint preservation and osteotomy Patellofemoral arthritis — PFA, joint-preservation alternativesPatellar pain and patellofemoral arthritis Patellar instability hubPatellar instability MPFL reconstruction surgical techniqueMPFL reconstruction surgery Pre-operative knee replacement preparationBefore knee replacement surgery Honest concerns about knee replacementWhat to worry about when undergoing a knee replacement Double partial knee replacements (case)Double partial knee replacements Surgeon credentials & MAKO certificationDr. Strickland bio · research & publications For Dr. Strickland’s broader publication record on patellofemoral surgery, joint preservation, cartilage restoration, and sports medicine, see research & publications. ## Frequently Asked Questions Is Mako fully autonomous? Does the robot perform the surgery? No. Mako is not autonomous and does not perform surgery on its own. The surgeon designs the 3D plan from a pre-operative CT scan, controls the robotic arm during every cut, balances soft tissues by feel and by trial implant tensioning, and verifies alignment before final fixation. The Mako AccuStop haptic boundary physically resists motion of the saw or burr outside the planned envelope — but the cut is the surgeon’s. The platform is a precision execution tool, not a substitute for the surgeon’s judgment. Does Mako mean better outcomes than a conventional knee replacement? Not universally. Mako improves the consistency of one technical step — bone resection or implant positioning to within sub-millimeter accuracy. The benefit is clearest in partial knee replacement (UKA), where small alignment errors drive early failure of the spared compartments. For straightforward total knee replacement in well-aligned patients, the difference between Mako-assisted and conventional technique is smaller, and conventional total knee outcomes are already excellent in experienced hands. The right answer depends on the case, not on whether the technology is used. What does Mako not change? Mako does not change the indication for surgery, the implant manufacturer, the recovery timeline, the surgical risks, or patient selection. Mako does not make a wrong-indication surgery right. It does not shorten recovery compared to conventional knee replacement. It does not eliminate the risks of infection, blood clot, stiffness, or implant loosening. And it does not replace the disciplined work of patient selection, soft-tissue balancing, and rehabilitation that drive a good outcome. Is robotic-assisted MPFL reconstruction better than freehand? Dr. Strickland has published her honest view on this question. A study comparing robotic-assisted to freehand MPFL reconstruction found that the robotic group placed the femoral tunnel closer to the anatomic landmark, but both groups achieved similar rates of the minimal clinically important difference (MCID) for patient-reported outcomes. The robotic-assisted surgery took longer and required expensive technology. Her view: anatomic variation between patients argues against the assumption that there is a single optimal tunnel position to be hit precisely the same way every time. For MPFL specifically, robotic assistance is not the answer for everything — careful surgical judgment and anatomic technique are. See her published commentary for the full discussion. Am I a candidate for Mako partial knee replacement? Mako partial (unicompartmental) knee replacement is most useful when arthritis is confined to a single compartment of the knee — most often the medial compartment — with intact cruciate ligaments (especially the ACL), minimal disease in the other compartments, and well-correctable alignment. Patients who fit this profile are often candidates for a less invasive procedure than total knee replacement, with faster recovery and more native bone preserved. The decision is based on weight-bearing imaging, alignment films, exam, and how the rest of the knee looks during the planning step. How long is recovery after Mako knee surgery? Recovery follows the procedure performed, not the platform. Mako partial knee replacement typically returns patients to walking with assistance the same day, off the walker in 1 to 2 weeks, and to most daily activities by 4 to 6 weeks. Mako total knee replacement follows the standard total knee timeline — walker for 2 to 4 weeks, driving at 4 to 6 weeks, most daily activities at 2 to 3 months, full recovery 9 to 12 months. Mako does not shorten recovery compared to conventional knee replacement. Does insurance cover Mako robotic surgery? Yes. The Mako system is used as part of standard knee replacement procedures that are covered by all major commercial insurance plans, Medicare, and most union and self-funded plans when medical necessity is met. The procedure bills the same way as conventional knee replacement; the robotic platform is part of the operating room setup. Verify your specific plan with our office before scheduling — we obtain pre-authorization where required and review estimated out-of-pocket costs in advance. What is the difference between Mako, ROSA, and VELYS? Mako (Stryker), ROSA (Zimmer Biomet), and VELYS (DePuy Synthes) are three different robotic-arm platforms for knee replacement. Mako is CT-based — the 3D plan is built from a pre-operative CT scan with the patient’s actual bony anatomy and uses a haptic AccuStop boundary. ROSA and VELYS use intraoperative landmarking rather than a pre-operative CT. The platform also pairs with the implant manufacturer’s product family. Dr. Strickland’s primary platform at NYU Langone is Mako with Stryker implants; she does not multi-platform across systems. Does Mako use radiation? Why is a CT scan required? Yes — Mako requires a pre-operative CT scan, which uses ionizing radiation. The CT becomes the 3D model the surgeon plans on. Modern low-dose protocols specifically designed for joint-replacement planning minimize the radiation dose. The trade-off is the upfront-planning advantage CT-based platforms have over imageless systems: the surgeon plans on your actual bony anatomy before you enter the OR, rather than landmarking the anatomy intraoperatively. Where does Dr. Strickland perform Mako knee surgery? Dr. Sabrina Strickland performs Mako robotic-assisted knee surgery at NYU Langone Orthopedic Center in New York City. Consultations and surgery take place at NYU Langone Orthopedic Center in Midtown Manhattan. Patients travel from New York, New Jersey, Connecticut, and out of state for sub-specialty knee evaluations. ## Related Specialty Care For the full knee-arthritis decision tree (non-surgical, joint-preserving, partial, total), see knee arthritis. For joint-preserving osteotomies (HTO, DFO, AMZ-TTO) before any replacement, see joint preservation and osteotomy. For patellofemoral arthritis behind the kneecap and the role of patellofemoral arthroplasty, see patellar pain and patellofemoral arthritis. For the soft-tissue side of patellar instability and Dr. Strickland’s honest view on robot-assisted MPFL, see MPFL reconstruction surgery and patellar instability. For cartilage-restoration options that may delay or replace the need for arthroplasty, see MACI cartilage repair and cartilage transplantation (OATS & osteochondral allograft). For PRP and biologic-injection details, see PRP and regenerative medicine. Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Surgical and non-surgical orthopedic care should always be discussed with a board-certified orthopedic surgeon who has reviewed your imaging, history, and physical examination. Individual outcomes vary based on diagnosis, anatomy, comorbidities, surgical or non-surgical approach selected, the type of arthritis, and adherence to rehabilitation. Robotic-assisted knee replacement is a tool that improves the consistency of bone resection and implant positioning — it does not change the indication for surgery, the recovery timeline, or the surgical risks, and it is not a guaranteed permanent fix. Patient selection and surgeon experience drive outcomes; the platform supports both. References to head-to-head comparison studies on this page (including the robotic-assisted vs freehand MPFL discussion) are drawn from peer-reviewed literature cited in the source-grounding table above. Dr. Strickland’s primary robotic platform is Mako (Stryker); references to ROSA and VELYS are descriptive of the marketplace and do not imply Dr. Strickland performs cases on those platforms. The Mako system is FDA-cleared for the procedures referenced on this page. ## Discuss Mako Candidacy with Dr. Strickland If you are evaluating partial knee replacement, total knee replacement, patellofemoral arthroplasty, or revision arthroplasty — and you want an honest discussion of where Mako helps and where it doesn’t for your specific case — bring your imaging to a sub-specialty consultation at NYU Langone in Midtown Manhattan. Book an Appointment Call 646-904-4664 --- ## Knee Sports Injuries NYC | Dr. Sabrina Strickland — ACL, Meniscus, MPFL, Multi-Ligament Source: https://sabrinastrickland.com/knee-surgeon-specialist/sports-injuries/ Summary: Knee sports injuries evaluated by Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York — ACL tears, meniscus tears, patellar dislocations, multi-ligament knee injuries, and cartilage damage in athletes, with criteria-based return-to-sport rehabilitation. Specialty # Knee Sports Injuries ACL tears, meniscus tears, patellar dislocations, multi-ligament knee injuries, and cartilage damage in athletes — evaluated and treated by Dr. Sabrina Strickland at NYU Langone Orthopedic Center in New York. Sub-specialty expertise with patellofemoral instability, ACL tears in male and female athletes, osteochondritis dissecans and cartilage injury. Medically reviewed by Dr. Sabrina Strickland, MD — Orthopedic Surgeon at the NYU Langone Orthopedic Center in New York. View full bio → Where NYU Langone Orthopedic Center, Midtown Manhattan Athletes Seen Youth, high school, collegiate, recreational, masters, and professional — from NY, NJ, CT, and out-of-state Sub-specialty Focus High level athletes with ACL tear, patellofemoral instability, cartilage restoration Overview — Start Here This is the hub page for athletic knee injuries. Athletic knee injuries include ACL tears (often with concurrent meniscus injury), meniscus tears, patellar dislocations and patellofemoral instability, MCL sprains, cartilage injuries from impact or shear, and patellar tendinopathy. The right next step depends on which structures are torn, the athlete's sport and level, age, and goals. If you already have a specific diagnosis, scroll the matrix below and click into the dedicated procedure page — ACL, meniscus, MPFL, patellar instability, MACI cartilage repair, or osteochondral allograft. If you do not yet have a diagnosis or have a complex multi-ligament injury, the rest of this page walks through the patterns by injury, by sport, and by athlete population. Dr. Sabrina Strickland is an orthopedic surgeon at NYU Langone Orthopedic Center with sub-specialty expertise in patellofemoral disorders, ACL tears in male and female athletes, osteochondritis dissecans, and cartilage restoration, and has been quoted on athletic knee trauma by major sports media outlets including NBC Sports. This page is the overview hub for athletic knee injuries. It covers the common patterns, sport-specific injury profiles, the special considerations for female athletes and youth athletes, multi-ligament knee injuries, cartilage damage in athletes, the principles of return-to-sport rehabilitation, injury prevention, and links to the dedicated pages for each individual injury. If you already have a diagnosis — ACL tear, meniscus tear, patellar dislocation, MPFL injury, cartilage injury — the linked procedure pages have the surgical detail. This page is for context, comparison, and the broader athletic-population patterns. ## Common Athletic Knee Injuries The most common athletic knee injuries fall into seven categories. Each card below links to the dedicated procedure page with surgical detail, graft selection, and recovery specifics. This is the matrix to scan if you already know your diagnosis. #### ACL Tear The signature high-impact knee injury in cutting and pivoting sport. Audible pop, immediate swelling, sense of instability, recurrent giving way in cutting and pivoting demand. Usually requires reconstruction in athletes returning to pivot sport. ACL tear surgery → #### Meniscal Tear Acute (twisting injury, deep squat) or degenerative. Joint-line pain, mechanical catching or locking. Repair is preferred over meniscectomy whenever the tear pattern allows; meniscal allograft transplantation is considered for younger patients with prior subtotal meniscectomy. Meniscal tear → #### Patellar Dislocation / Instability The kneecap slips out of its trochlear groove. Common in young female athletes and patients with anatomical risk factors (trochlear dysplasia, patella alta, increased TT-TG distance). Recurrence after the first dislocation is common — especially before age 25. Patellar instability → #### MPFL Injury The medial patellofemoral ligament is almost always torn after a patellar dislocation event. MPFL reconstruction restores the primary medial soft-tissue restraint and is often combined with a tibial tubercle osteotomy when bony alignment is contributing to the instability. MPFL reconstruction → #### Athletic Cartilage Injury Focal cartilage damage from impact, dislocation, ACL pivot-shift bone bruise, or shear. Cartilage restoration (MACI, OATS, osteochondral allograft) can resurface the damaged area in younger active patients with an otherwise healthy joint. MACI cartilage repair → #### Patellar Tendinopathy "Jumper's knee." Degenerative change in the patellar tendon at the lower pole of the kneecap from repetitive jumping, deceleration, and quadriceps loading. Eccentric loading rehabilitation is the foundation of care; surgery is reserved for refractory cases. Anterior knee pain → #### Multi-Ligament Knee Injury Two or more major ligaments torn (ACL, PCL, MCL, posterolateral corner). High-energy mechanism — ski crashes, motor vehicle accidents, contact sport. Often represents a knee that has dislocated and spontaneously reduced. Sub-specialty management is appropriate. Multi-ligament details ↓ #### MCL Sprain Valgus impact — soccer tackle, ski fall with knee buckling inward. Most isolated MCL sprains heal with bracing and structured rehabilitation. Combined ACL+MCL injuries are typically managed with MCL bracing first, then delayed ACL reconstruction at 4 to 6 weeks. Multi-ligament context ↓ ## Sport-Specific Injury Profiles Different sports produce different injury patterns. Knowing the patterns of your sport helps with both diagnosis and prevention. Patient stories on this site span skiers, snowboarders, climbers, dancers, runners, and recreational athletes — the matrix below covers the most common knee injuries by sport. SportCommon knee injuries SoccerACL tears (especially female players), meniscus tears, MCL sprains, patellar tendinopathy, contusions BasketballACL tears, meniscus tears, patellar tendinopathy ("jumper's knee"), patellar dislocations, bone bruises from contact SkiingACL tears (classic pattern: planted ski + valgus rotation), MCL sprains, multi-ligament knee injuries from high-energy crashes, lateral tibial plateau fractures SnowboardingLower ACL injury rate than skiing because the feet are fixed to a single board (less torsional moment at the knee), but boundaries are not zero — falls onto a flexed knee or collisions still produce knee injuries VolleyballPatellar tendinopathy ("jumper's knee"), patellar dislocations, ACL tears in landing Lacrosse, Field Hockey, RugbyACL tears, meniscus tears, MCL injuries, contact-related multi-ligament injuries Tennis & PickleballMeniscus tears (especially in masters players over 40), patellar tendinopathy, knee osteoarthritis flares Dance & GymnasticsPatellar instability, patellofemoral pain, hip-related knee pain, overuse cartilage damage from extreme range-of-motion loading RunningPatellofemoral pain syndrome, IT band syndrome, patellar tendinopathy, meniscus tears (overuse pattern), stress reactions CyclingPatellofemoral pain (often bike-fit-related), iliotibial band syndrome, anterior knee overuse Climbing & BoulderingACL injuries from falls (particularly bouldering with low pads), meniscus tears, patellar dislocations from heel hooks and twisting moves Martial ArtsMeniscus tears, MCL injuries from grappling, ACL injuries from cuts and locks, patellar dislocations FootballACL tears, MCL injuries, multi-ligament knee injuries from contact, meniscus tears, patellar tendinopathy ## Multi-Ligament Knee Injuries A multi-ligament knee injury involves two or more of the four major knee ligaments (ACL, PCL, MCL, posterolateral corner). Most are high-energy injuries — skiing crashes, motor vehicle accidents, contact sports tackles — and many represent a knee that has dislocated and spontaneously reduced. These injuries are surgical emergencies in the sense that vascular and nerve injury must be ruled out — a knee dislocation can injure the popliteal artery and the peroneal nerve — before any other planning. The classic example in mainstream sports media was Olympic gold medalist Lindsey Vonn's 2013 super-G crash at Schladming, which produced a torn ACL, torn MCL, and a lateral tibial plateau fracture in the same knee — the kind of combined injury Dr. Strickland described for NBC Sports on NBC Nightly News at the time. Surgical management is staged based on the specific pattern: - ACL + MCL — the MCL is most often treated non-operatively first with hinged bracing, then ACL reconstruction at 4 to 6 weeks once the MCL has healed adequately - ACL + PCL — combined reconstruction in a single operation; longer rehabilitation than isolated ACL - ACL + posterolateral corner — combined reconstruction; missed or under-treated PLC injury is one of the more common causes of ACL graft failure - PCL + posterolateral corner — combined reconstruction - Knee dislocation (3 or 4 ligament injury) — multi-stage reconstruction with longer rehabilitation; vascular study is essential at presentation These complex injuries warrant sub-specialty management. Recovery is longer than for isolated ligament injury — typically 9 to 12 months minimum for return to sport, and longer for the highest-grade combined injuries. ## Female Athlete Considerations Female athletes face documented higher rates of certain knee injuries than their male counterparts, particularly in cutting and pivoting sport. Several factors contribute: - Anatomical: wider Q-angle, narrower intercondylar notch, smaller ACL cross-sectional area, more shallow trochlear groove on average - Hormonal: documented effects of estrogen and other hormones on tendon and ligament structure and on neuromuscular coordination across the menstrual cycle - Neuromuscular: different landing and cutting biomechanics on average — more knee valgus, less hip control, different quadriceps/hamstring activation patterns - Generalized ligamentous laxity: more common in young women The clinical consequences: - Higher rates of non-contact ACL injuries in female pivot athletes - Higher rates of recurrent patellar dislocation in young women, particularly with concurrent anatomical risk factors - Higher rates of patellofemoral pain in female runners and athletes - Higher re-tear rates after ACL reconstruction in young female pivot athletes — one of the populations where ACL+ALL augmentation is particularly worth considering The good news: targeted neuromuscular training programs (FIFA 11+, PEP program, Knäkontroll, and similar) reduce ACL injury rates in female athletes substantially when incorporated into team training, particularly when started early in athletic development. Prevention through structured warm-up and movement training is one of the highest-leverage interventions in female athlete sports medicine. ## Youth Athlete Considerations Youth and adolescent athletes have several special considerations: - Open growth plates — ACL reconstruction in skeletally immature patients uses techniques that protect the physes (growth plates) to avoid causing growth disturbance. Physeal-sparing or partial transphyseal reconstructions are well-evidenced in this population - Apophyseal injuries — Osgood-Schlatter (tibial tubercle apophysitis) and Sinding-Larsen-Johansson (inferior patellar pole) are growth-related anterior knee pain syndromes specific to youth athletes - Pediatric patellar instability — managed differently than adult patellar instability; Dr. Strickland was a participating investigator in the multi-center JUPITER (Justifying Patellar Instability Treatment by Early Results) cohort, which is one of the largest prospective studies of adolescent patellar instability outcomes in the field - Sport diversification matters — year-round single-sport specialization is associated with higher overuse injury rates and is one of the documented risk factors for patellar tendinopathy, patellofemoral pain, and stress reactions in youth athletes. Most pediatric sports medicine guidelines recommend delaying single-sport specialization until at least mid-adolescence (see our overview of youth-sports trends and notes on pediatric sports injury patterns) - Recovery time is faster than in adults for soft-tissue healing, but the rehabilitation discipline required is the same - Return to sport criteria still apply — young athletes who return before meeting strength and hop-test criteria have higher re-injury rates, regardless of how they "feel" ## Cartilage Injuries in Athletes Articular cartilage damage in athletes is one of the more under-diagnosed problems in sports knee medicine. Unlike a torn ACL or a bucket-handle meniscus, a focal cartilage injury can produce vague pain, intermittent swelling, and mechanical symptoms that are easy to write off as "post-traumatic" without a specific diagnosis. Athletic mechanisms that produce cartilage damage include: - Direct impact chondral injuries — from a fall, a tackle, or direct impact to the knee - Patellar dislocation cartilage injuries — the lateral femoral condyle and the medial facet of the patella commonly take damage during a dislocation event; an osteochondral fragment may be loose in the joint - ACL injury bone bruise pattern — the typical "lateral femoral condyle and posterolateral tibial plateau" bone bruise of an ACL pivot-shift injury can produce overlying cartilage damage, particularly when the bone bruise is severe or transchondral - Shear and twisting injuries — can produce flap tears or unstable cartilage fragments - Repeated overuse loading — particularly in patellofemoral cartilage in dancers, gymnasts, and high-volume runners For young, active patients with focal cartilage damage and an otherwise healthy joint, cartilage restoration procedures can resurface the damaged area and preserve the native joint — rather than waiting for the diffuse arthritis that would otherwise force a partial or total knee replacement decades later. The choice depends on defect size, depth, and whether bone is involved — see MACI cartilage repair for autologous chondrocyte implantation and cartilage transplantation for OATS and osteochondral allograft. Dr. Strickland's commentary on challenging cartilage injuries in athletes was featured on The Sports Doc Podcast at AOSSM 2023, alongside Dr. Seth Sherman. ## Professional Athlete Commentary Athletic knee injuries to professional athletes get covered in mainstream sports media, and the public understanding that gets shaped by that coverage matters — for athletes facing the same injury, for parents of young athletes deciding whether to push for early reconstruction, for the cultural understanding of return-to-sport timelines. Dr. Strickland has been quoted in major outlets on athletic knee trauma: - Lindsey Vonn (2013 super-G crash, Schladming) — torn ACL, torn MCL, and lateral tibial plateau fracture in the same knee. Dr. Strickland described the injury for NBC Sports on NBC Nightly News with Brian Williams — including what the multi-ligament-plus-fracture pattern meant for her likely surgical reconstruction and recovery to ski racing - Klay Thompson (2019 ACL, 2020 Achilles) — back-to-back season-ending injuries at the peak of his career. Dr. Strickland's commentary on what changes about a player's game after an ACL plus an Achilles is at how Achilles and ACL injury changed Klay Thompson - Triston Casas (May 16, 2025 patellar tendon repair) — Boston Red Sox player. Dr. Strickland shared her insight on Casas’ recent surgery to repair his left patellar tendon in a Boston Globe article (May 16, 2025) - JJ Watt (Houston Texans, knee injury) — Dr. Strickland was interviewed on Houston radio about Watt’s knee injury and the path back to NFL play The pattern in both cases — a public, high-profile athlete returning from a complex knee injury — is the same pattern Dr. Strickland navigates with her own patients in New York every week, scaled to the demands of the individual sport. ## Return-to-Sport Criteria Return to sport after any significant knee surgery is criteria-based, not calendar-based. The calendar gives the floor (graft biology and tissue healing); the criteria determine the ceiling (whether the athlete is ready to take rotational and impact loads without re-injury). The widely accepted return-to-sport criteria include: - Limb symmetry index above 90% on isokinetic quadriceps and hamstring strength testing - Normal hop testing across the four-hop battery — single hop for distance, triple hop, crossover hop, and timed 6-meter hop — with limb symmetry above 90% - Psychological readiness — measured by validated tools such as the ACL-RSI (Return to Sport after Injury) scale - Sport-specific drill performance at the level required for the sport — cutting, deceleration, jumping and landing, sport-specific footwork - Surgeon clearance after final examination Patients who return to sport before meeting these criteria have higher re-injury rates, regardless of how the knee "feels." This is one of the more reliable findings in the ACL re-tear literature, and it applies across the spectrum — ACL reconstruction, MPFL reconstruction, meniscal repair, cartilage restoration, and multi-ligament reconstruction. ## Injury Prevention Several evidence-based interventions reduce knee injury risk in athletes: - Structured neuromuscular warm-up programs (FIFA 11+, PEP, Knäkontroll) reduce ACL and lower-extremity injury rates in adolescent and young adult pivot athletes — particularly female athletes — when incorporated consistently into team training - Year-round neuromuscular training for landing mechanics, single-leg control, deceleration, and change-of-direction - Sport diversification in youth athletes — reduces overuse injury rates and burnout, supports longer athletic careers - Adequate rest days — one to two complete rest days per week, at least one extended off-season per year - Sleep, nutrition, and hydration as performance and recovery foundations - Footwear and equipment appropriate to the sport and surface (cleat type matters in soccer; release-bindings matter in skiing) - Reporting symptoms early — pushing through knee pain that lasts more than a few days is one of the most reliable ways to turn a manageable problem into a season-ending injury ## Prehabilitation For athletes already injured and headed for surgery, the single most under-discussed factor in outcomes is what happens before surgery. Patients who arrive at surgery with full range of motion, minimal swelling, and good quadriceps activation have substantially better post-operative outcomes than patients who arrive with a stiff, swollen knee and inhibited quadriceps. Prehabilitation includes: - Range of motion restoration — particularly full extension - Effusion control - Quadriceps activation — early reversal of quadriceps shutdown reduces post-operative recovery time - Education on the post-operative protocol so the athlete starts rehab on day one rather than learning it then For most ACL, multi-ligament, and cartilage cases, this means several weeks between the injury and the operation — not because surgery should be delayed unnecessarily, but because the knee benefits from being well-prepared. The exception is irreducible mechanical block (e.g., a locked bucket-handle meniscus tear) or other situations that warrant earlier intervention. ## After a Knee Injury — First Steps For an athlete in the first hours and days after a significant knee injury: - Stop the activity — do not "play through" a pop, immediate swelling, or a sense of giving way - Ice, elevation, compression — in the first 48 to 72 hours, control swelling - Crutches or hinged knee brace if the knee will not bear weight comfortably or if there is gross instability - Imaging — standing weight-bearing x-rays to rule out fracture; MRI within the first one to two weeks (often the swelling needs to settle slightly first for the best image quality) - Sub-specialty evaluation — particularly for high-energy injuries, knee dislocations, multi-ligament patterns, ACL tears in pivot athletes, and patellar dislocations with concern for an osteochondral fragment - Early physical therapy — for range of motion, swelling control, and quadriceps activation, even before surgical planning is finalized ## Recovery Timelines by Injury Recovery timelines vary substantially across the spectrum of athletic knee surgery. The timelines below are typical — individual cases vary based on concurrent injuries, alignment, prior surgery, and patient adherence to the rehabilitation protocol. All of these are floors, not ceilings — final clearance to sport is criteria-based. ProcedureTypical return to sport Arthroscopic partial meniscectomy4–8 weeks Isolated MPFL reconstruction4–6 months Meniscal repair3–4 months (longer for root repair) Meniscal root repair4–6 months ACL reconstruction (isolated)6–9 months MPFL + tibial tubercle osteotomy6–9 months Cartilage restoration (MACI, OATS, osteochondral allograft)9–18 months Multi-ligament knee reconstruction9–12 months minimum Meniscal allograft transplantation9–12 months ## Risks of Athletic Knee Surgery Athletic knee surgery is well-established with predictable outcomes for most patients, but no surgery is risk-free. The risks reviewed at consultation include: - Re-injury or graft failure — the most clinically relevant long-term risk in young pivot athletes. Re-tear rates after ACL reconstruction are reduced with autograft over allograft in this population, with anatomic tunnel placement, with ACL+ALL augmentation in high-risk profiles, and with criteria-based return-to-sport progression - Persistent stiffness or loss of motion — reduced by good prehabilitation, early focus on full extension, and structured PT - Infection — uncommon but a serious complication if it occurs; particularly relevant with cartilage restoration where infection threatens the graft - Blood clot (DVT or pulmonary embolism) — risk is mitigated by early mobilization and individualized prophylaxis - Nerve and vascular injury — particularly relevant in multi-ligament knee reconstruction, where the popliteal artery and peroneal nerve are at risk from the dislocation itself and require evaluation before surgery - Harvest-site morbidity — with autograft (anterior knee pain after BTB or quadriceps tendon, posterior thigh weakness or numbness after hamstring) - Anesthesia-related risks — including nausea, sore throat, rare allergic reactions to anesthetics, transient nerve irritation from the regional block - Incomplete return to prior performance — some athletes do not return to their prior level of sport even with a technically excellent reconstruction; psychological readiness, body composition changes, time away from sport, and competing life demands all contribute The specific risk profile for your case depends on your age, sport, the specific injury pattern, alignment, and any prior surgery on the knee. These are reviewed at consultation, and many of the risks above are modifiable by prehabilitation, surgical technique matched to the patient, and rehabilitation that follows the structured criteria-based protocol. ## Common Patient Concerns The three concerns we hear most often from athletes facing knee surgery, with honest answers: #### "Will I actually get back to my sport?" Most patients return to their pre-injury level of activity after appropriate athletic knee surgery, but outcomes depend on individual factors and adherence to rehabilitation. The single largest predictor of getting back is following the structured criteria-based progression rather than rushing the timeline. Patients who skip phases or who return before meeting limb symmetry, hop testing, and psychological readiness criteria have higher re-injury rates — which is the worst outcome, not the fastest. We do not guarantee return to sport; we structure the path that gives the best chance of getting there. #### "When can I run again?" Running progression typically starts between months 3 and 5 after isolated ACL reconstruction, around month 3 after meniscal repair (depending on the tear pattern), around month 4 after MPFL reconstruction, and around month 4 to 6 after partial meniscectomy. The progression is graduated — jogging on alternating days at a slow pace, building to continuous running, then to faster paces, then to hills and trails. The starting point and rate of progression depend on the procedure, concurrent work, and how the rehab is going. Cartilage restoration and multi-ligament cases run substantially later than the ACL timeline. #### "What if I'm scared to push the knee in rehab?" Fear of re-injury is one of the most common findings in post-operative athletic knee rehabilitation — it is what the ACL-RSI scale measures. The answer is not to ignore the fear but to address it: structured progression so each step is small, objective testing so the athlete knows the knee is meeting strength and hop-testing benchmarks rather than relying on how it "feels," and (in some cases) sports psychology support. Patients who push through fear without the objective benchmarks have higher re-tear rates; patients who use the benchmarks to calibrate their confidence return to sport more reliably. ## Insurance and Cost Athletic knee surgery — ACL reconstruction, meniscus repair, MPFL reconstruction, multi-ligament reconstruction, and cartilage restoration — is covered by all major commercial insurance plans, Medicare, and most self-funded and union plans when the diagnosis and indication for surgery meet medical-necessity criteria. The variables that drive your specific out-of-pocket cost are: - Your plan's deductible and coinsurance — the structure of cost-sharing differs significantly between plans - In-network vs. out-of-network status — for the surgeon, the facility (NYU Langone or affiliated outpatient surgery center), and the anesthesia group - Bundled vs. separate billing for the surgeon, facility, anesthesia, imaging, physical therapy, and any concurrent procedures - Out-of-network benefits — if you have them and choose to use them; we are happy to provide the codes you need to verify your benefits in advance - Cartilage restoration and biologics — some autologous chondrocyte implantation (MACI) cases, biologic augmentation, and PRP injections have specific coverage rules that vary by carrier Before surgery, our office verifies your benefits, obtains pre-authorization where required, and reviews the estimated out-of-pocket cost with you. If your plan doesn't cover a specific aspect, we discuss it openly before the operation, not after. For benefits verification or to discuss self-pay arrangements, call us at 646-904-4664 or contact the office. ## When to Seek a Sub-Specialty Second Opinion A sub-specialty second opinion is particularly worth seeking when: - You are an active or competitive athlete facing major knee surgery and want experienced guidance on graft selection, surgical approach, and rehabilitation strategy - You have a complex injury — ACL plus meniscus root tear, multi-ligament knee, ACL plus cartilage damage, knee dislocation - You are a young female athlete with a patellar dislocation or ACL injury and want injury-prevention plus surgical guidance specific to female athlete biomechanics - You have a youth athlete with open growth plates and need physeal-sparing technique decisions - You have recurrent symptoms after a prior knee surgery that has not produced the expected return to sport — revision ACL, recurrent patellar instability, persistent meniscal symptoms - You are a masters athlete trying to balance continued athletic participation with joint preservation - You have been told "no more sports" and want a clear walk-through of joint-preserving options before accepting that recommendation - You are an out-of-state patient looking specifically for sub-specialty cartilage restoration, female athlete patellofemoral expertise, or revision ACL ## Access & Office Location Dr. Strickland sees athletes at one office, which works with patients traveling in from outside the immediate area: - New York City: NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY 10016. In Midtown Manhattan, accessible from Manhattan, the outer boroughs, Long Island, Westchester, and northern New Jersey via the Queensboro and Triboro bridges and the FDR Drive. Phone: 646-904-4664. For athletes traveling to New York from out of state for sub-specialty care, we coordinate consultation, imaging review, and surgery scheduling to minimize travel and align with the pre-operative work-up. Many out-of-state athletes travel to NYU Langone specifically for revision ACL, complex multi-ligament knee reconstruction, MPFL+TTO for recurrent patellar instability, and cartilage restoration. ## Patient Outcomes The point of all of the above — the imaging, the graft selection, the structured rehab, the criteria-based RTS — is to get the right athlete back to the activity that matters to them. A handful of patient stories on this site: - A skier with combined ACL and meniscus tears — back to skiing - ACL injury and recovery in snowboarders - Returning to climbing after an ACL tear - Back in the game after a torn meniscus - Peyton Ely's story - Liam's story - Denise — back in the game after ACL reconstruction For the full library of athlete recovery stories, see Dr. Strickland's success stories. ## Frequently Asked Questions What are the most common knee sports injuries? The most common athletic knee injuries are ACL tears (often with concurrent meniscus injury), meniscus tears (acute or degenerative), patellar dislocations and patellofemoral instability, MCL sprains, cartilage injuries from impact or shear, and patellar tendinopathy ("jumper's knee"). Sport-specific patterns are common — soccer and basketball: ACL and meniscus; skiing: ACL plus MCL and sometimes lateral tibial plateau fracture; volleyball and basketball: patellar tendinopathy and patellar instability; gymnastics and dance: patellar instability and overuse cartilage damage. Why are female athletes at higher risk for ACL and patellar injuries? Female athletes have several anatomical, hormonal, and neuromuscular factors that increase risk: a wider Q-angle, narrower intercondylar notch, more generalized ligamentous laxity, hormonal influences on tendon and ligament structure, and different landing and cutting biomechanics (more knee valgus, less hip control). The result is documented higher rates of non-contact ACL injuries and recurrent patellar dislocations in female pivot athletes compared to male counterparts. Targeted neuromuscular training programs reduce this risk significantly when incorporated early in athletic development. What is a multi-ligament knee injury? A multi-ligament knee injury involves two or more of the four major knee ligaments (ACL, PCL, MCL, posterolateral corner). Most are high-energy injuries — skiing collisions, motor vehicle accidents, contact sports tackles — and many represent a knee that has dislocated and spontaneously reduced. These injuries require careful imaging (MRI plus stress radiographs), evaluation for vascular and nerve injury, and staged or single-stage reconstruction depending on the pattern. Sub-specialty management is appropriate. When should an athlete return to sport after a knee injury? Return to sport is criteria-based, not calendar-based. The criteria include limb symmetry index above 90% on strength testing, normal hop testing (single hop, triple hop, crossover hop, timed hop), psychological readiness measured by validated tools such as the ACL-RSI scale, sport-specific drill performance, and surgeon clearance. The calendar timeline depends on the procedure — typically 4 to 6 months after isolated MPFL reconstruction or partial meniscectomy, 6 to 9 months after ACL reconstruction or meniscal repair, and 9 to 18 months after cartilage restoration. Can young athletes have ACL surgery? Yes. Skeletally immature pediatric and adolescent ACL tears can be reconstructed with techniques that protect the growth plates (physeal-sparing or partial transphyseal reconstructions). Skeletally mature adolescents and young adults are reconstructed with the same techniques used in adults, with graft selection chosen for the specific patient. Early reconstruction after diagnosis is generally favored in young athletes who plan to return to pivot sport, to protect the meniscus and cartilage from chronic instability damage. Do youth athletes need to specialize in one sport? Sport diversification — playing multiple sports throughout the year rather than year-round single-sport specialization — is associated with lower overuse injury rates, lower burnout rates, and longer athletic careers in published literature. Early single-sport specialization is one of the documented risk factors for overuse knee injuries (patellar tendinopathy, patellofemoral pain, stress reactions) in youth athletes. Most pediatric sports medicine guidelines recommend delaying single-sport specialization until at least mid-adolescence. What kinds of athletes does Dr. Strickland treat? Dr. Strickland treats athletes at every level — youth and high school, collegiate, recreational, masters, and professional — across cutting and pivoting sports, endurance sports, and contact sports. Patient stories on this site include skiers, snowboarders, climbers, runners, dancers, recreational athletes returning to sport after injury, and youth athletes navigating ACL and patellar instability with open growth plates. Her sub-specialty interests include ACL tears in male and female athletes, patellofemoral instability, osteochondritis dissecans, and cartilage restoration. Does insurance cover sports knee surgery? Most athletic knee surgery — ACL reconstruction, meniscus repair, MPFL reconstruction, multi-ligament reconstruction, and cartilage restoration — is covered by major commercial insurance plans, Medicare, and most union and self-funded plans when the diagnosis and indication for surgery meet medical-necessity criteria. Out-of-pocket cost depends on the specific plan's deductible, coinsurance, in-network status of the surgeon, the facility (NYU Langone or affiliated), and the anesthesia group. Benefits are verified before surgery so there are no surprises. Some biologics (PRP, certain cartilage augments) may not be covered. How is multi-ligament knee surgery different from a single-ligament reconstruction? Multi-ligament knee reconstruction is more complex than isolated ACL or MCL surgery. It requires evaluation for vascular and nerve injury (knee dislocation can injure the popliteal artery and peroneal nerve), staged or single-stage reconstruction based on the specific pattern (ACL+MCL, ACL+PCL, ACL+posterolateral corner, knee dislocation), and longer rehabilitation — typically 9 to 12 months minimum for return to sport. Sub-specialty care is appropriate. ## Related Specialty Care For ACL reconstruction, graft selection (quadriceps, hamstring, BTB autograft, allograft), and BEAR implant candidacy, see ACL tear surgery. For meniscus repair, root repair, and meniscal allograft transplantation, see meniscal tear. For patellar dislocation evaluation and surgical options, see patellar instability and MPFL reconstruction surgery. For patellar pain and patellofemoral arthritis, see patellar pain and patellar arthritis. For cartilage repair after athletic injury, see MACI cartilage repair and cartilage transplantation. For patellar tendinopathy, chondromalacia, and anterior knee pain, see anterior knee pain. For alignment correction in revision or complex cases, see joint preservation and osteotomy. For arthritis management in older athletes, see knee arthritis. For PRP and biologic injection options, see PRP regenerative medicine. For computer-guided alignment in joint-replacement cases, see Mako robotic-assisted surgery. For Dr. Strickland's published research, including the JUPITER pediatric patellar instability study, see her research and publications. Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Surgical and non-surgical orthopedic care should always be discussed with a board-certified orthopedic surgeon who has reviewed your imaging, history, and physical examination. Individual outcomes vary based on diagnosis, anatomy, comorbidities, and adherence to rehabilitation. The general descriptions of athletic knee injuries, anesthesia, and recovery timelines on this page reflect typical patient experience — your specific protocol is determined at consultation. Statements about return to sport are not guarantees; they describe the structured criteria-based path that gives the best chance of return. ## Discuss Your Knee Injury If you are an athlete with an acute or chronic knee injury — or a parent helping a young athlete navigate a knee diagnosis — bring your imaging to a sub-specialty consultation at NYU Langone in Midtown Manhattan. Book an Appointment Call 646-904-4664 --- ## Stem Cell Therapy for the Knee — BMAC + HSS Clinical Trials | Dr. Sabrina Strickland NYC Source: https://sabrinastrickland.com/knee-surgeon-specialist/stem-cell-therapy/ Summary: Dr. Sabrina Strickland offers BMAC stem cell injections in selected patients with mild-to-moderate knee arthritis and as a surgical adjunct during cartilage repair. Dr. Strickland has performed IRB-approved trials of amniotic suspension allograft (ASA) and is currently participating in a trial of Marrowcellutions bone marrow aspirate in patients undergoing meniscectomy. Honest framing of what Specialty # Stem Cell Therapy for the Knee Dr. Sabrina Strickland uses bone marrow aspirate concentrate (BMAC) stem cell injections in selected patients with mild-to-moderate knee arthritis and as a surgical adjunct during cartilage repair. Dr. Strickland has performed IRB-approved trials of amniotic suspension allograft (ASA) and is currently participating in a trial of Marrowcellutions bone marrow aspirate in patients undergoing meniscectomy. Below is an honest patient-facing breakdown of what she offers, what's research-stage, and how to evaluate stem cell offers from other clinics. Medically reviewed by Dr. Sabrina Strickland, MD — Orthopedic Surgeon at the NYU Langone Orthopedic Center in New York. View full bio → Quick Answer Yes, Dr. Strickland offers stem cell options for the knee. Most commonly BMAC — bone marrow aspirate concentrate harvested from your own iliac crest, processed at the bedside, and injected in the OR in patients with arthritis or used as a surgical adjunct during cartilage repair. HSS patients may also qualify for an upcoming FDA umbilical stem cell trial (CartiSTEM). She does not offer cash-pay “stem cell” products outside this evidence-based framework, and a key part of every consultation is helping patients evaluate offers from other clinics. On this page - What Dr. Strickland Offers - BMAC — Bone Marrow Stem Cells - Umbilical Stem Cell Trial - Exosomes — Research Frontier - Lipogems — Trialed and Discontinued - Who Is a Good Candidate - What to Expect - Risks and Realistic Expectations - Evidence-Based Care First - FDA Status — Honest Picture - What “Stem Cell Therapy” Actually Is - What the Evidence Actually Says - Academic Trials vs Cash-Pay Clinics - How to Spot a Predatory Clinic - Common Patient Concerns - Insurance and Cost - When to Seek a Second Opinion - Access & Office Location - Source Grounding - Frequently Asked Questions ## What Dr. Strickland Offers Five distinct stem-cell-related pathways exist in Dr. Strickland's practice, ranging from established autologous biologics in the operating room to research-stage clinical trials at HSS: OR only #### BMAC injection Bone marrow aspirate concentrate — your own bone marrow cells harvested, processed at the bedside, and injected in the OR in patients with arthritis or used as a surgical adjunct during cartilage / meniscus / joint-preservation surgery. Routine in her practice for years. Anticipated #### Umbilical Stem Cell Trial FDA-overseen CartiSTEM umbilical stem cell trial Dr. Strickland anticipates participating in once activated — same investigational framing as a real IRB-approved clinical trial, distinct from cash-pay umbilical products. Research interest #### Exosomes Active area of research she follows closely. Not currently a clinical product; not FDA-approved as a treatment. Tracked here so patients understand what is and isn’t available now. Trialed & discontinued #### Lipogems Autologous fat-derived; trialed several years ago and discontinued after not seeing meaningful patient improvement. Each is detailed below. The honest framing across all of them: stem-cell-based products may modify symptoms in selected patients with mild-to-moderate disease over weeks to months. None has been shown to regrow hyaline cartilage in adult arthritic knees in any clinically meaningful way — a point Dr. Strickland makes a routine part of every conversation about biologics. ## BMAC — Bone Marrow Stem Cells (Routine in Her Practice) Bone marrow aspirate concentrate (BMAC) is the most-established stem-cell-based product in Dr. Strickland’s clinical practice. In her own words: “I have used bone marrow aspirate for years in the operating room to hopefully increase healing or decrease symptoms related to arthritis.” BMAC is autologous — bone marrow aspirated from the patient’s iliac crest, processed at the bedside through an FDA-cleared device, and re-introduced the same day. It contains mesenchymal stromal cells, hematopoietic precursors, and a host of growth factors and cytokines. It operates under the FDA HCT/P 361 minimal-manipulation framework, which is fundamentally different from the regulatory status of allogeneic amniotic or umbilical products marketed by cash-pay clinics. ### Where BMAC fits in Dr. Strickland’s practice - Surgical adjunct (most common) — routinely used in the operating room to augment healing of cartilage repair, support meniscus repair, and similar applications where a stem-cell-rich injectate may improve the biologic environment alongside an evidence-based surgical procedure - Research interest — BMAC combined with hyaluronic acid scaffolds is the substrate of an interesting one-step cartilage repair technique with multi-year follow-up reported in the international literature; the technique is not yet widely available in the US ### The honest framing she gives every patient BMAC may reduce pain and support function in selected patients with mild-to-moderate disease over months. It does not regrow hyaline cartilage. It is not a substitute for evidence-based cartilage repair (MACI, OATS), alignment correction (osteotomy), the MISHA implantable shock absorber, or joint replacement when those are indicated. The pre-injection conversation includes the realistic possibility that the injection does not work for you — that’s honest counseling, not pessimism. ## Umbilical Stem Cell — Anticipated FDA Trial Dr. Strickland has noted publicly that she hopes to participate in an FDA trial on umbilical stem cells. The relevant detail is the trial structure: an FDA-overseen study at a credentialed academic center under IRB approval, with the same investigational framing as the ASA and trials. This is anticipated / in process, not currently available — trial participation depends on protocol activation and your meeting trial-specific eligibility. Umbilical cord-derived “stem cell” products offered outside of FDA trials — in cash-pay commercial clinics, often at high cost, often with cartilage-regeneration claims — are an entirely different product offered in an entirely different regulatory context. They are not the same as a trial-evaluated investigational product, and the FDA has issued enforcement actions against multiple operators marketing umbilical cord products. ## Exosomes — The Next Frontier Beyond cell-based products, there is growing research interest in exosomes — tiny sac-like structures formed inside cells that carry some of the cell’s proteins, DNA, and RNA. Certain exosomes have the potential to alter how cartilage cells respond to inflammation and may meaningfully improve treatment for arthritis if early findings hold up. This is an active area of research and is not yet a clinical product. Dr. Strickland tracks the literature here closely; relevant published work includes “Exosomes in cartilage microenvironment regulation and cartilage repair” in Frontiers. The scientific reason it matters: delivering the cell’s active signaling molecules without the cell itself would simplify storage, dosing, and regulatory pathways — a fundamentally different approach from injecting cells directly. Same caution applies Exosome therapy for orthopedic use is research-stage — not FDA-approved as a clinical product, not standard of care, not currently offered as a treatment service. Any clinic selling “exosome therapy” for knee arthritis as a paid service is operating in the same gray area as the cash-pay stem cell market. The exosome research is real and exciting; the cash-pay exosome injection is the same predatory pattern with a new label. For more, see Dr. Strickland’s patient-facing commentary: stem cells, exosomes & cartilage repair and the HSS Journal webinar on stem cells & scaffolds. ## Lipogems — Trialed and Discontinued Lipogems is an FDA-cleared device that processes a small autologous fat sample — obtained by mini-liposuction — through a closed system that fragments the tissue while preserving the stromal vascular fraction, then re-injects it the same day. Adipose tissue is rich in mesenchymal stromal cells, and the technology is well-engineered. The regulatory status (autologous, minimal-manipulation, same-day) sits in the same category as BMAC. However, Dr. Strickland trialed Lipogems several years ago and chose not to continue offering it routinely. In her own words: “Several years ago, I trialed Lipogems, a fat-derived stem cell, but I didn’t see significant improvement in patients, and it was a lot of effort to obtain the fat from patients.” That clinical experience — not generic skepticism — is why Lipogems is not part of her routine practice today. ## Who Is a Good Candidate Two different candidacy questions live on this page. Most patients asking “am I a candidate?” are asking about BMAC in the operating room (as a surgical adjunct); a smaller subset are asking about HSS clinical-trial enrollment. The criteria are different. ### BMAC as a surgical adjunct in the OR Generally appropriate for: - Mild to moderate knee osteoarthritis on standing weight-bearing x-rays (Kellgren-Lawrence grade 2–3 typically) - Patients who have already given evidence-based foundational care a fair trial (PT, weight optimization where applicable, NSAIDs / topicals, activity modification, hyaluronic acid where indicated) - Patients with realistic expectations: symptom modification possible, cartilage regeneration not - Patients without focal full-thickness cartilage defects requiring surgical repair (those need MACI, OATS, or osteochondral allograft) - Patients without severe malalignment (those need alignment correction first) - Patients without mechanical block (locking, true catching) — that needs arthroscopic treatment of the underlying problem - Patients without active infection or other contraindications to injection ### HSS clinical-trial enrollment (anticipated CartiSTEM umbilical) Trial enrollment criteria are highly specific to each protocol but typically require: - A specific stage of disease — usually mild to moderate knee osteoarthritis on standardized imaging; end-stage bone-on-bone arthritis is generally excluded - Age range — most trials have upper and lower age limits - BMI within trial limits - Prior treatment requirements — many trials require failed conservative care first - No major mechanical symptoms — catching, locking, true mechanical block usually excluded - Acceptable alignment — severe varus or valgus deformity often excluded - No active infection, malignancy, or autoimmune disease per protocol - Willingness to comply with structured trial follow-up — protocol visits, outcome questionnaires, imaging - Full informed consent — understanding investigational status, possibility of no benefit, unknown long-term effects, and possibility of placebo arm Most patients are not eligible for any current HSS trial. That is not a failure — it is what makes trial-derived evidence meaningful in the first place. Patients interested in trial participation are referred to the appropriate HSS research coordinator after a clinical evaluation; trial activation status changes over time. There is no way to “buy in” to a trial. ### When stem cell options are not the right answer - End-stage bone-on-bone arthritis — the conversation should turn to partial or total joint replacement - Severe malalignment — alignment correction (osteotomy) or arthroplasty is more likely to help than any injection - Mechanical symptoms from a torn meniscus, loose body, or unstable cartilage flap — arthroscopic treatment of the mechanical problem is appropriate first - Large focal full-thickness cartilage defects — MACI, OATS, or osteochondral allograft is the evidence-based option for focal defects, not a biologic injection - Patients who have not yet tried evidence-based foundational care — structured PT, weight optimization, NSAIDs, and bracing where indicated come first - Patients seeking a substitute for indicated surgery — if the imaging and exam support partial or total knee replacement, no injection has been shown to be a substitute when replacement is indicated - Patients seeking cartilage regeneration — the realistic ceiling is symptom modification, not regeneration. Cartilage regeneration is a marketing claim, not a current clinical reality ## What to Expect ### BMAC as surgical adjunct When BMAC is used during cartilage repair, meniscus repair, or other joint-preservation surgery, the bone marrow harvest happens at the same anesthesia event as the underlying surgery, the concentrate is added to the surgical site, and there is no separate recovery beyond what the underlying procedure requires. The biologic is an addition to the surgical plan, not a separate event for the patient. ### HSS clinical trial enrollment Trial-specific protocols vary, but the general structure for an IRB-approved HSS trial: - Screening visit. Confirmation that you meet inclusion / exclusion criteria, including imaging review, history, exam, sometimes lab work - Informed consent. Detailed written consent describing the investigational nature of the product, the placebo arm if applicable, the possibility of no benefit, unknown long-term effects, and the protocol-required follow-up commitment - The injection. Outpatient procedure, typically under an hour. Specifics depend on the trial protocol (ultrasound or fluoroscopic guidance for placement) - Blinding (where applicable). In placebo-controlled trials, neither you nor the assessor knows which arm you are in - Structured follow-up. Protocol-defined visits at standardized intervals, with validated outcome measurements and imaging at protocol-required time points - Cost. Trial costs are typically covered by the sponsor — you do not pay thousands of dollars to participate. Insurance is generally not billed for the investigational product itself - Withdrawal. You retain the right to withdraw from any trial at any time This is what real research looks like. If a clinic is offering you a “clinical trial” that requires you to pay $8,000 up front and does not include a placebo arm, that is not a clinical trial — that is a marketing label. ## Risks and Realistic Expectations The risks reviewed for any stem cell pathway include both procedural risks and the realistic expectation framework: - No benefit (common). A meaningful number of patients get no clinical benefit from any current cell-based product, including BMAC. This is the single most important “risk” to set expectations around — not a side effect, but the realistic possibility that the injection does not work for you - Unknown long-term effects (research-stage). By definition, investigational products like upcoming umbilical stem cell trials have less long-term safety data than approved therapies. That is part of why they are investigational - Bleeding or bruising at the harvest / injection site — usually minor and self-limiting - Infection (rare) — any joint or tendon injection carries a small infection risk; sterile technique and ultrasound guidance minimize this - Post-injection inflammatory flare — transient, typically 1–3 days - For BMAC: additional iliac-crest aspiration site discomfort, rare hematoma, very rare iliac-site complications - For Lipogems / adipose-derived: additional fat-harvest site bruising and rare local complications - For allogeneic products (umbilical): theoretical immune-response risk, addressed in trial design and consent - Opportunity cost of delaying evidence-based surgery. Choosing a series of biologic injections in a patient whose imaging and exam already support cartilage repair, alignment correction, or replacement may delay better treatment. Biologics are not always neutral — sometimes they are a form of delay - Financial cost. For HSS trials, costs are typically covered by sponsor. For BMAC in the OR, generally not covered by insurance for orthopedic indications and out-of-pocket. For cash-pay clinic offerings outside this practice, $5,000–$15,000 per knee with no proven benefit ## Evidence-Based Care First Patients should not pursue any stem cell pathway — BMAC in the OR or trial enrollment — without first giving evidence-based options a fair trial. This is medically correct and almost always more useful than any biologic injection: - Structured physical therapy — quadriceps and hip-stabilizer strengthening, range-of-motion preservation, gait training, proprioception. The most under-executed step in arthritis care - Weight optimization — each pound of body weight loads the knee 4–6 times over with each step. Meaningful weight loss is one of the highest-leverage interventions in OA care - NSAIDs and topical agents — for short-course inflammatory control and flare management - Activity modification — substitute lower-impact activities while symptoms are flared - Bracing — offloader brace for unicompartmental disease with appropriate alignment correction - Imaging — standing weight-bearing x-rays, long-leg alignment films when alignment is in question, MRI when meniscus or focal cartilage detail is needed - Hyaluronic acid — FDA-approved for symptomatic knee OA, generally covered by insurance, with response in roughly half of treated patients - Cortisone — selectively for acute flares or as a bridge in end-stage disease - Alignment correction — osteotomy (HTO, DFO) for isolated compartment OA with malalignment - Cartilage repair for focal defects — MACI, OATS or osteochondral allograft - The MISHA implantable shock absorber — for medial-compartment OA in selected joint-preservation candidates - Partial or total knee replacement — when joint-preserving options have been exhausted or are not appropriate None of these has been shown to be replaceable by a stem cell injection. BMAC and the trial pathways are appropriate to discuss after foundational care has been given a fair trial — not as a shortcut around it. ## FDA Status — The Honest Picture The single most important fact for any patient evaluating a stem cell offering for the knee: FDA reality The FDA has not approved any stem cell therapy as a drug for orthopedic use of the knee — not for arthritis, not for cartilage damage, not for ligament or tendon healing. Any clinic, advertisement, or sales pitch claiming an “FDA-approved stem cell knee treatment” is misrepresenting the regulatory status. What is permitted: autologous, minimal-manipulation, same-day procedures (BMAC, Lipogems, PRP) operate under the FDA HCT/P 361 framework with FDA-cleared processing devices. That is the framework Dr. Strickland uses for in-BMAC in the OR. Allogeneic amniotic and umbilical products marketed by cash-pay clinics generally fall outside this framework, and the FDA has issued enforcement actions against multiple operators. The regulatory categories in this space: CategoryRegulatory frameworkWhat this means Autologous BMAC, Lipogems, PRP (same-day, minimal manipulation)HCT/P 361 minimal-manipulation framework; processing devices are FDA-clearedPermitted same-day, autologous use; not FDA-approved as a drug for any specific orthopedic indication. This is the framework Dr. Strickland uses for in-BMAC in the OR. Allogeneic amniotic / umbilical products in IRB-approved trials (HSS ASA, anticipated umbilical trial)FDA-overseen clinical trial protocol; IRB approvalInvestigational; not a marketed product outside the trial Allogeneic amniotic / umbilical products marketed by cash-pay clinicsGenerally outside FDA-cleared frameworks; multiple FDA enforcement actions on fileOften in regulatory gray area or in violation; clinical claims usually unsupported “Stem cell IV infusion” for orthopedic diseaseNo coherent regulatory pathway; not supported by orthopedic evidencePredatory marketing The 2017–2020 FDA crackdown on US Stem Cell Inc. (a Florida-based clinic operator) resulted in a federal injunction. The FDA’s public warning-letter database lists multiple operators in this space who have received enforcement actions for marketing unapproved stem cell products. Patients can search the FDA warning-letter database directly. The professional societies most relevant to orthopedic surgery — AAOS (American Academy of Orthopaedic Surgeons), AOSSM (American Orthopaedic Society for Sports Medicine), and ICRS (International Cartilage Regeneration & Joint Preservation Society) — have issued cautionary statements about overstated claims for cell-based products in arthritis care. ## What “Stem Cell Therapy” Actually Is In an orthopedic setting, “stem cell therapy” is a marketing umbrella for several biologically distinct injectable preparations that contain a mesenchymal stromal cell (MSC) fraction — sometimes loosely called “stem cells.” These are not embryonic stem cells. They are adult cells that live in bone marrow, fat tissue, and certain donated tissues, with multi-lineage differentiation potential and immune-modulatory activity. The cell biology is real. The clinical claim that injecting these cells into an adult arthritic knee “regenerates” cartilage is not supported by the evidence. Several distinctions matter when reading any clinical claim: - Autologous (from you) vs allogeneic (from a donor): Autologous = your own bone marrow (BMAC) or fat (Lipogems, trial). Allogeneic = donor-derived (amniotic membrane / amniotic fluid in ASA; umbilical cord tissue in upcoming trials). Regulatory complexity increases substantially with allogeneic products - MSC (mesenchymal stromal cell) vs HSC (hematopoietic stem cell): Orthopedic biology is interested in MSCs (multi-lineage stromal cells with immune-modulatory activity), not the HSCs used in hematology / oncology stem cell transplant. Marketing that conflates the two is misleading - Bone marrow vs adipose vs umbilical vs amniotic: Different source tissues, different cell concentrations, different processing requirements, different evidence bases. They are not interchangeable - Expanded vs minimally manipulated: “Expanded” cells are grown in a lab over weeks; “minimally manipulated” cells are processed at the bedside the same day. The FDA treats these very differently — expanded products require IND / BLA approval; minimally manipulated autologous tissue often falls under the HCT/P 361 framework - Live cells vs tissue extract: Many shelf-stable amniotic and umbilical products contain few if any viable cells after the processing required to make them shelf-stable. The marketing term “live cell” is often used in ways that are not biologically accurate The honest biological summary: when concentrated and injected into an arthritic or injured joint, mesenchymal stromal cells appear to influence the joint environment over weeks to months — modulating inflammation, supporting existing cartilage cells, and possibly slowing further degeneration. They do not regrow hyaline cartilage in adult arthritic knees in any clinically meaningful way; that claim is marketing, not evidence. The realistic ceiling for any current cell-based product is symptom modification in selected patients — and for most marketed cash-pay products, even that ceiling is not reliably achieved. ## What the Evidence Actually Says The honest summary of the orthopedic stem cell evidence base, as of 2026: - Some signal in mild OA. A subset of patients with mild to moderate knee osteoarthritis report meaningful symptom relief from autologous cell-based injections (BMAC, autologous adipose). The magnitude of benefit in responders is modest; non-response is common; and this is symptom modification, not structural repair - No evidence of cartilage regeneration. No injectable biologic — autologous BMAC, Lipogems, allogeneic amniotic, allogeneic umbilical, exosome, or any cash-pay product — has been shown to regrow functional hyaline cartilage in adult arthritic knees in any clinically meaningful way - Response variability is huge. Across published trials, the spread between responders and non-responders is wide, and the predictors of who will respond are not well established. Honest pre-injection counseling has to include the possibility of no clinical benefit - Unpublished outcomes dominate the cash-pay market. The orthopedic stem cell industry generates billions of dollars in cash-pay revenue per year in the US. The volume of peer-reviewed published outcomes from cash-pay clinics is a tiny fraction of the volume of injections delivered. That asymmetry is information - Professional societies urge caution. AAOS, AOSSM, and ICRS have issued statements urging caution about overstated cell-based product claims, particularly in arthritis care. None of these societies endorses any cash-pay stem cell product as standard of care for knee arthritis - The evidence-based options for cartilage damage have decades of follow-up. MACI (autologous chondrocyte implantation), OATS, osteochondral allograft, microfracture, alignment correction with osteotomy, the MISHA implantable shock absorber, and partial / total knee replacement all have substantial peer-reviewed long-term outcome data. They are not exciting in the way a marketing campaign for “stem cell regeneration” can be exciting, but they are evidence-based ## Academic Trials vs Cash-Pay Clinics The most important distinction in this entire space is not autologous-vs-allogeneic, BMAC-vs-Lipogems, or even cells-vs-exosomes. It is trial-based research vs unregulated commercial offering. The same source tissue can be evaluated rigorously inside an FDA-overseen academic trial and marketed irresponsibly outside one. Academic trial (HSS, FDA-overseen)Cash-pay “stem cell clinic” SettingCredentialed academic medical center, IRB approval, FDA-registered protocol, ClinicalTrials.gov listingStandalone clinic, often non-physician-led or led by a physician outside their specialty; sometimes outside the US Inclusion / outcomesStandardized inclusion / exclusion criteria; blinded outcome assessment; peer-reviewed reporting whether positive or negative“Anyone who can pay”; no controls; testimonial “before / after” outcomes; no published peer-reviewed data Product sourceCarefully characterized; cells assessed for viability and potency by the trial sponsorOften shelf-stable allogeneic products with few viable cells after processing; lot-to-lot variability not disclosed Claims madeHypothesis-driven; investigational; outcomes measured against placebo or active comparator“Regenerate cartilage,” “reverse arthritis,” “avoid surgery” — not supported by evidence CostTrial-covered or modest, with academic oversight; patient does not pay thousands to participate$5,000–$15,000 per knee “package” common; sometimes IV add-on infusions; no proven benefit ConsentFull informed consent describing investigational status, possibility of no benefit, unknown long-term effectsConsent forms (when present) may not describe the regulatory status or the absence of evidence FDA positionPre-cleared trial protocol with formal investigational statusFDA has issued enforcement actions against multiple operators in this space Long-term follow-upBuilt into the protocolOften nonexistent — patients are not tracked after the injection ## How to Spot a Predatory Stem Cell Clinic The cash-pay stem cell clinic market for knee arthritis is dominated by clinics making claims unsupported by evidence. The patterns are consistent enough to be worth recognizing. Specific red flags: - Claims an “FDA-approved stem cell knee treatment.” The FDA has not approved any stem cell therapy as a drug for the orthopedic knee. This claim is misrepresentation - Promises cartilage regeneration or arthritis “reversal” / “cure.” No injectable biologic has been shown to do this in adult arthritic knees - Non-physician-led, or led by a physician outside their specialty. Many stem cell clinics are run by chiropractors, naturopaths, or physicians whose primary specialty is not orthopedic surgery or sports medicine. Stem cell offerings for knee arthritis from a non-orthopedic-surgeon are a structural red flag - IV stem cell infusion for joint disease. There is no coherent biological or evidence basis for treating a focal joint problem with an IV infusion. This is a marketing construct - High-pressure sales of injection “packages” — particularly “buy 3 get 1 free” or prepaid bundles before any imaging review - Cash-pay only. Legitimate orthopedic care interacts with insurance for documented diagnostic and therapeutic services. A clinic that can only process cash for a non-emergency injection is a structural red flag - No consent forms describing research / investigational status. Real trials require formal consent; real medical-grade autologous procedures (BMAC) describe the framework. Clinics that hand-wave this are doing so deliberately - Exotic locations / medical tourism. Mexico, Caribbean, Eastern European clinics operating in jurisdictions with looser regulation. Outcomes are not better; downstream complications are harder to manage; recourse if anything goes wrong is essentially nonexistent - No published outcomes. A clinic injecting hundreds or thousands of patients with a product that supposedly “regenerates cartilage” should be able to point to peer-reviewed published outcomes. Most cannot - Marketing language conflates “stem cell” with “regenerative.” “Regenerative” is a marketing umbrella; “stem cell” is a specific cell type. Clinics that use them interchangeably are usually being deliberately vague about what is in the syringe - The word “cure” — appears in advertising for arthritis. Arthritis is structural cartilage loss in adult tissue with limited intrinsic capacity for repair. There is no cure in 2026 ## Common Patient Concerns The three concerns we hear most often, with honest answers: #### “Will this regrow my cartilage?” No. No injectable biologic — autologous BMAC, Lipogems, allogeneic amniotic, allogeneic umbilical, exosome, or cash-pay product — has been shown to regrow functional hyaline cartilage in adult arthritic knees in any clinically meaningful way. Adult cartilage has very limited capacity for repair. For focal full-thickness cartilage defects (not diffuse arthritis), surgical cartilage restoration procedures — MACI, OATS, or osteochondral allograft — actually do replace cartilage. Anyone telling you a stem cell injection will regrow your cartilage is making a claim not supported by the evidence. #### “I saw an ad for $5,000 stem cell knee injections — is it legit?” Almost certainly not. The FDA has not approved any stem cell injection for knee arthritis, and the cash-pay “stem cell knee” market is dominated by clinics making claims unsupported by evidence. Many clinics inject amniotic, umbilical, or “live cell” products that contain few if any viable mesenchymal cells after the processing required to make them shelf-stable, and the FDA has issued enforcement actions against multiple operators in this space. Before paying any cash-pay clinic for a stem cell injection, get a sub-specialty second opinion with a board-certified orthopedic surgeon. A second opinion costs less than a single injection and is far more likely to give you an accurate picture of what evidence-based options exist for your knee. #### “Why can’t I just go to that clinic in Mexico?” Outcomes from medical tourism stem cell clinics are not better than US cash-pay clinics — in many cases the regulatory environment is looser, the products are even less characterized, and the published outcomes are essentially nonexistent. Downstream complications (infection, persistent pain, an unexpected immune reaction to an allogeneic product) are harder to manage when the original injection is across a border, and recourse if anything goes wrong is essentially nonexistent. The marketing pitch is a lower price tag; the actual proposition is paying less for the same lack of evidence with worse follow-up. That is not a better deal — that is the same deal at higher risk. ## Insurance and Cost The cost picture differs sharply between Dr. Strickland's offerings and cash-pay clinic offerings elsewhere: - BMAC as surgical adjunct — usually billed as part of the underlying surgical procedure (e.g., cartilage repair, meniscus repair) where applicable; insurance handling depends on the primary procedure code - BMAC as a surgical adjunct — billed as part of the underlying surgical procedure; covered the same way as the indicated surgery - HSS clinical trials (anticipated umbilical) — trial costs are typically covered by the sponsor; you do not pay thousands of dollars to enroll. Insurance is generally not billed for the investigational product itself. The trade-off is strict eligibility criteria and protocol-required follow-up - Cash-pay “stem cell” clinics (elsewhere, not in Dr. Strickland's practice) — $5,000–$15,000 per knee “package” common in the US market, with no proven clinical benefit; not covered by insurance because the products are not FDA-approved for orthopedic use; opportunity cost is the evidence-based care that money could have funded - Amniotic / umbilical “stem cell” products outside trials — not FDA-approved for orthopedic use, not covered, and not offered in this practice For benefits questions on covered services (PT, MRI, evidence-based surgical procedures, hyaluronic acid where indicated, cortisone), call the office at 646-904-4664 or contact us. ## When to Seek a Sub-Specialty Second Opinion A sub-specialty second opinion with a board-certified orthopedic surgeon is particularly worth seeking when: - A clinic is selling stem cells for arthritis — this is the single most important moment to get a second opinion. Most of these clinics are predatory - You have been told an injection will let you avoid knee replacement — this claim warrants a second look - You are being asked to prepay an injection package before any imaging review or comprehensive evaluation - A non-physician-led clinic, or a non-orthopedic-surgeon, is recommending stem cells for your knee - You have a focal cartilage defect on MRI and have been offered a biologic injection — cartilage repair is the evidence-based option for focal defects - You have advanced arthritis or significant malalignment and have been told an injection will replace surgery - You want an honest answer about what the evidence does and does not say for your specific knee, your specific imaging, and your specific goals - You are interested in HSS clinical trial enrollment and want to ask whether any current trial is appropriate for your condition Most patients are not eligible for any current HSS trial — trial criteria are narrow by design. But asking is appropriate, and a sub-specialty second opinion is appropriate any time a cash-pay clinic is selling cartilage regeneration or arthritis cure. ## Access & Office Location Dr. Strickland sees patients at one office, which works with patients traveling in from outside the immediate area: - New York City: NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY 10016. Midtown Manhattan, accessible from Manhattan, the outer boroughs, Long Island, Westchester, and northern New Jersey via the Queensboro and Triboro bridges and the FDR Drive. Phone: 646-904-4664. Many out-of-state patients travel to NYU Langone specifically for an honest read on stem cell options — either to discuss whether BMAC in the OR or HSS clinical-trial enrollment is appropriate for their knee, or for a second opinion on a stem cell offer made by another clinic. The most common reason for the second-opinion visit: a cash-pay clinic has promised cartilage regeneration or arthritis cure, and the patient wants an honest read before paying. ## Source Grounding — What Informs This Page The clinical positions on this page are grounded in Dr. Strickland’s published patient education on stem cells, exosomes, and cartilage repair; her HSS clinical-trial participation; the broader HSS sub-specialty consensus on the role of orthobiologic and cell-based products in knee care; and the current FDA and professional-society regulatory framing: TopicGrounding source on this siteWhat it informs Stem cells, exosomes, and cartilage repair Stem cells, exosomes & cartilage repair Dr. Strickland’s patient-facing summary of BMAC use, past ASA trials, anticipated CartiSTEM umbilical FDA trial, exosome research, and the “we don’t have the answer yet” honest framing Amniotic suspension allograft (ASA) for knee OA HSS research study on ASA injections for knee OA Investigational status of cryopreserved amniotic-fluid cell + micronized amniotic membrane injectable, evaluated in HSS IRB-approved trials — distinct from cash-pay “amniotic stem cell” marketing HSS Journal webinar on stem cells & scaffolds HSS Journal webinar on stem cells & scaffolds Academic context for stem-cell-based and scaffold-based cartilage repair research “Dancing molecules” cartilage research Northwestern dancing-molecules research Animal-model regenerative work; promising and research-stage, not a current clinical option Sea coral / CartiHEAL scaffold Sea coral helps knee osteoarthritis (CBS News) Emerging cartilage scaffold technology — not a biologic injection, complementary to the stem-cell discussion Stanford research on knee arthritis treatment Stanford research — knee arthritis treatment Academic research context for emerging arthritis treatments Is osteoarthritis treatable / reversible? Study: is osteoarthritis treatable and reversible? Honest framing of the “reverse arthritis” marketing claim against the evidence PRP and the broader biologic injection context PRP & regenerative medicine Adjunctive biologic options including PRP, hyaluronic acid, BMAC, Lipogems, and cortisone — companion page to this one Surgeon credentials, research, and experience About Dr. Sabrina Strickland · Research and publications Sub-specialty care, board certification, and the basis for “Medically reviewed by” ## Frequently Asked Questions Does Dr. Strickland offer stem cell injections for the knee? Yes — within evidence-based limits. Dr. Strickland offers bone marrow aspirate concentrate (BMAC) stem cell injections in the operating room as a surgical adjunct during cartilage repair, meniscus repair, and joint-preservation surgery — her most common BMAC use, for years. HSS patients may also qualify for an anticipated FDA CartiSTEM umbilical stem cell trial in preparation. She does not offer cash-pay “stem cell” products outside this framework — particularly the allogeneic amniotic and umbilical products marketed by commercial clinics with cartilage-regeneration claims. Is stem cell therapy FDA-approved for my knee? No stem cell product is FDA-approved as a drug for orthopedic knee use. Some autologous procedures used as surgical adjuncts (BMAC, harvested from your own bone marrow and re-injected the same day) operate under the existing minimal-manipulation tissue framework (HCT/P 361) — that is the framework Dr. Strickland uses for BMAC in the operating room. Most cash-pay “stem cell” clinics offering amniotic, umbilical, or “live cell” injections for knee arthritis are operating in regulatory gray areas or in violation, and the FDA has issued enforcement actions against multiple operators. Any clinic claiming an “FDA-approved stem cell knee treatment” is misrepresenting the regulatory status. Will stem cells regrow my cartilage? No. No injectable biologic — autologous BMAC, Lipogems, PRP, amniotic, umbilical, or any “stem cell” product — has been shown to regrow functional hyaline cartilage in adult arthritic knees in any clinically meaningful way. Adult cartilage has very limited intrinsic capacity for repair. Any clinic claiming that an injection “regenerates” or “rebuilds” cartilage in arthritic knees is making a claim not supported by the evidence. For focal full-thickness cartilage defects (not diffuse arthritis), surgical cartilage restoration procedures — MACI, OATS, or osteochondral allograft — actually do replace cartilage, and that is the appropriate evidence-based pathway when imaging supports it. BMAC and the trial pathways may modify symptoms in selected patients; that is symptom modification, not structural repair. What HSS trials is Dr. Strickland involved in? Three areas of trial participation: (1) Three HSS trials of cryopreserved amniotic suspension allograft (ASA) — an injectable amniotic fluid cell and micronized amniotic membrane product evaluated in IRB-approved protocols. (2) — a placebo-controlled HSS Sports Medicine Institute trial of an autologous adipose-tissue-derived stem cell injection in patients with knee osteoarthritis, with trial costs typically covered for qualifying patients. (3) An anticipated FDA umbilical stem cell trial in preparation. She also uses bone marrow aspirate (BMAC) routinely in the operating room as an autologous surgical adjunct, and tracks the exosome and engineered-cartilage research literature closely. She trialed Lipogems (autologous fat-derived) several years ago and discontinued it after not seeing meaningful patient improvement. How do I tell a real clinical trial from a clinic scam? Real clinical trials are conducted at credentialed academic medical centers (HSS, Mayo, Cleveland Clinic, major university hospitals), require IRB approval, are registered on ClinicalTrials.gov, are physician-led, use full informed consent describing investigational status, do not promise outcomes, and typically have trial costs covered by the sponsor — you do not pay thousands of dollars to participate. Clinic scams are typically cash-pay (often $5,000–$15,000 per knee with no proven benefit), heavily marketed via social media or radio, claim “cartilage regeneration” or “arthritis reversal,” are often non-physician-led or led by a physician outside their specialty, and offer “free consultations” that pressure you to prepay an injection package before any imaging review. If the clinic asks for your credit card before reviewing your MRI, that is a clinic scam, not research. I saw an ad for $5,000 stem cell knee injections — is it legit? Almost certainly not. The FDA has not approved any stem cell injection for knee arthritis, and the cash-pay “stem cell knee” market is dominated by clinics making claims unsupported by evidence. Many of these clinics inject amniotic, umbilical, or “live cell” products that contain few if any viable mesenchymal cells after the processing required to make them shelf-stable, and the FDA has issued warning letters to multiple operators in this space. Before paying any cash-pay clinic for a stem cell injection, get a sub-specialty second opinion with a board-certified orthopedic surgeon. A second opinion costs less than a single injection and is far more likely to give you an accurate picture of what evidence-based options actually exist for your knee. Will stem cells help me avoid knee replacement? For end-stage bone-on-bone arthritis, no — no injection has been shown to substitute for joint replacement when replacement is indicated. For mild to moderate disease, evidence-based joint-preservation options (structured PT, weight optimization, alignment correction with osteotomy, cartilage repair for focal defects, the MISHA implantable shock absorber for medial-compartment OA, hyaluronic acid where appropriate) have meaningfully better evidence than any stem cell product currently available for cartilage regeneration. BMAC and the trial pathways may modify symptoms in selected patients with mild-to-moderate disease — useful in that subset, but not a substitute when replacement is indicated. Anyone telling you that a stem cell injection will let you “avoid” a knee replacement that your imaging and exam support is making a claim not supported by the evidence. What about exosomes — are those approved? No. Exosomes are tiny sac-like structures formed inside cells that carry some of the cell’s proteins, DNA, and RNA. Some exosomes have the potential to alter how cartilage cells respond to inflammation and may meaningfully improve treatment for arthritis if early findings hold up. Exosome therapy for orthopedic use is research-stage — not FDA-approved as a clinical product, not standard of care, and not currently offered as a treatment service. Any clinic selling “exosome therapy” for knee arthritis as a paid service is operating in the same gray area as the cash-pay stem cell market. Dr. Strickland tracks the exosome literature closely and has commented on its potential as a next-generation approach, but exosomes are not a clinical option in 2026. What should I try before considering any stem cell or biologic option? Evidence-based foundational care comes first: structured physical therapy (quadriceps and hip-stabilizer strengthening, gait, proprioception), weight optimization where applicable (each pound loads the knee 4–6 times with each step), short-course NSAIDs or topical agents for inflammatory control, activity modification, appropriate bracing for unicompartmental disease with malalignment, and standing weight-bearing imaging plus MRI when meniscus or focal cartilage detail is needed. If foundational care has been adequately tried and symptoms persist, the evidence-based next steps depend on imaging and alignment — alignment correction (osteotomy), cartilage repair for focal defects (MACI, OATS), the MISHA implantable shock absorber for medial-compartment OA, hyaluronic acid where indicated, and partial or total knee replacement when joint-preserving options have been exhausted. BMAC and the trial pathways are appropriate to discuss after foundational care has been given a fair trial. ## Related Specialty Care For PRP, hyaluronic acid, BMAC and Lipogems in adjunctive context, see PRP & regenerative medicine. For evidence-based cartilage repair options, see MACI cartilage repair and cartilage transplantation (OATS & allograft). For alignment correction in isolated compartment OA, see joint preservation & osteotomy. For the implantable shock absorber for medial compartment OA, see the MISHA Knee System. For the full knee arthritis treatment ladder, see knee arthritis. For Dr. Strickland’s patient-facing commentary on the science, see stem cells, exosomes & cartilage repair. Medical Disclaimer. This page describes Dr. Strickland's clinical use of bone marrow aspirate concentrate (BMAC), her academic clinical trial participation at NYU Langone Orthopedic Center, and the science of orthopedic stem cell research. It is for educational purposes and does not constitute medical advice, diagnosis, or treatment. The FDA has not approved any stem cell therapy as a drug for orthopedic use of the knee. No injectable biologic has been shown to regenerate cartilage in adult arthritic knees, and a meaningful number of patients receive no clinical benefit from any current cell-based product. Trial enrollment is restricted by protocol-specific eligibility criteria; most patients are not eligible. Patients considering any cash-pay stem cell injection for knee arthritis should obtain a sub-specialty second opinion with a board-certified orthopedic surgeon before paying. Individual outcomes vary based on diagnosis, stage of disease, alignment, prior care, comorbidities, and adherence to evidence-based foundational rehabilitation. Emerging and research-stage treatments referenced on this page are not standard of care. ## Talk to Dr. Strickland About Stem Cell Options Whether you’re asking about BMAC in the OR, HSS clinical-trial enrollment, or want an honest read on a stem cell offer from another clinic — bring your imaging to a sub-specialty consultation at NYU Langone in Midtown Manhattan. Book an Appointment Call 646-904-4664 --- # Case Studies ## Revision ACL Reconstruction with Osteotomy for Failed Primary Repair - Sabrina Strickland Case Study Source: https://sabrinastrickland.com/case-studies/revision-acl-reconstruction-osteotomy-failed-primary-repair/ Summary: Former high school volleyball player undergoes complex revision ACL reconstruction with high tibial osteotomy to address ACL retear and alignment issues. # Revision ACL Reconstruction with Osteotomy for Failed Primary Repair This case demonstrates a complex revision ACL reconstruction in a young, active patient who experienced failure of a primary cadaver graft reconstruction. The patient required a multi-faceted surgical approach including autograft ACL revision, lateral extra-articular tenodesis, meniscal repair, and high tibial osteotomy to address both ligamentous instability and underlying anatomic risk factors that contributed to graft failure. ## Patient Overview The patient is a young, active individual who was a high school volleyball player at the time of her original ACL injury. She maintained an active lifestyle and had goals of returning to unrestricted athletic activity. Following her initial ACL reconstruction with a cadaver allograft, she performed well for many years before experiencing a traumatic retear that prompted evaluation for revision surgery. ## Chief Complaint The patient presented with pain and instability of her knee. She described feeling unstable during activities of daily living and experienced a locking sensation when moving her leg from a figure four position to a straight position. These symptoms significantly limited her ability to participate in the active lifestyle she desired. ## Diagnostic Findings Physical examination revealed swelling in the knee with limited range of motion. The patient demonstrated instability with activities of daily living and reported a distinct locking sensation with specific leg movements. Standard X-rays appeared normal, showing no bony abnormalities or significant arthritic changes. MRI imaging revealed two significant pathologies. First, the anterior cruciate ligament was completely absent, confirming failure of the previous cadaver graft reconstruction. Second, a vertical tear was identified in the posterior horn of the lateral meniscus, likely contributing to the mechanical locking symptoms. To complete the diagnostic workup, full-length standing films from hip to ankle were obtained to assess lower extremity alignment. These studies demonstrated valgus alignment, also known as knock-knee positioning, which is a known risk factor for both primary and recurrent ACL injury. Analysis of the lateral radiographs also revealed excessive posterior tibial slope, another significant anatomic risk factor for ACL graft failure. ## Treatment Options Considered The patient's presentation required careful consideration of multiple treatment approaches. Given the complete absence of the ACL graft and the presence of a symptomatic lateral meniscus tear, non-operative management was not a viable option for this young, active patient seeking return to unrestricted activity. The key decision-making centered on whether to perform an isolated revision ACL reconstruction or to address the underlying anatomic risk factors that likely contributed to the original graft failure. The presence of both valgus alignment and excessive posterior tibial slope placed this patient at high risk for repeat graft failure if these factors were not corrected. The treatment planning also required determination of the appropriate graft choice for revision reconstruction, consideration of additional stabilization procedures beyond ACL reconstruction alone, and management strategy for the lateral meniscus tear. ## Selected Treatment Plan After thorough diagnostic imaging including full-length standing films to assess leg alignment, a comprehensive surgical plan was developed to address all contributing factors to the patient's knee instability. The treatment plan included revision ACL reconstruction using autograft tissue rather than another cadaver graft, which would provide better biological healing potential in this revision setting. To address the underlying anatomic risk factors that contributed to the initial graft failure, a closing wedge high tibial osteotomy was planned. This procedure would correct both the valgus alignment of the lower extremity and optimize the posterior tibial slope, reducing mechanical stress on the new ACL graft and decreasing the risk of repeat failure. The lateral meniscus tear required repair to restore normal knee biomechanics and prevent future degenerative changes. Additionally, a lateral extra-articular tenodesis was incorporated into the surgical plan to provide supplementary stability to the knee, particularly important given the patient's history of graft failure and high activity demands. ## Surgical Procedure The surgical approach addressed multiple pathologies in a coordinated fashion. The revision ACL reconstruction was performed using an all-inside technique with autograft tissue. This approach minimizes bone loss and soft tissue disruption compared to traditional techniques, which is particularly important in revision settings where prior tunnels may compromise bone stock. The lateral extra-articular tenodesis was performed to augment the ACL reconstruction and provide additional rotational stability. This supplementary procedure has been shown to reduce the risk of graft retear, especially in young, active patients returning to pivoting sports. The vertical tear in the posterior horn of the lateral meniscus was addressed with an all-inside meniscal repair using the newest absorbable device technology with integrated sutures. This repair technique preserves meniscal tissue and restores normal load distribution across the knee joint, which is critical for long-term joint health. The closing wedge high tibial osteotomy was performed to correct the valgus alignment and optimize the posterior tibial slope. This involves removing a precisely calculated wedge of bone from the proximal tibia and securing the correction with internal fixation. The osteotomy simultaneously addresses both alignment issues that contributed to the original graft failure, creating a more favorable biomechanical environment for the new ACL graft to function. ## Implants, Materials, and Technologies Used The revision ACL reconstruction utilized autograft tissue harvested from the patient's own body, providing superior biological healing potential compared to allograft tissue. The all-inside reconstruction technique required specialized instrumentation for graft preparation and tunnel creation, along with adjustable-loop cortical fixation devices to secure the graft. For the lateral meniscus repair, the newest generation of absorbable meniscal repair devices was used. These all-inside devices incorporate both absorbable anchors and sutures, eliminating the need for tied knots on the capsular side of the meniscus and reducing the risk of irritation to surrounding soft tissues. The absorbable nature of the devices means they do not require removal and gradually transfer load to the healing meniscal tissue over time. The closing wedge high tibial osteotomy required internal fixation hardware to maintain the bony correction while healing occurs. This typically consists of a specialized plate and screw construct designed specifically for osteotomy fixation. The hardware can be removed at any point after six months if it causes discomfort, though removal is optional if the patient remains asymptomatic. ## Clinical Challenges This case presented multiple significant challenges that required careful surgical planning and execution. The primary challenge related to the patient's underlying anatomy, specifically her excessive posterior tibial slope and valgus alignment of the lower extremity. Both of these anatomic factors are well-established risk factors for ACL tear and ACL retear after reconstruction. The presence of both risk factors in this patient meant that performing an isolated revision ACL reconstruction alone, without addressing the underlying anatomic contributors to graft failure, would place her at unacceptably high risk for repeat failure. This recognition required expanding the surgical plan to include corrective osteotomy, significantly increasing the complexity and recovery time of the procedure. Coordinating multiple procedures during a single surgical setting required careful sequencing and planning. The surgeon needed to balance the benefits of addressing all pathology simultaneously against the increased surgical time and potential for complications inherent in more complex procedures. The decision to proceed with combined reconstruction, meniscal repair, and osteotomy reflected the understanding that incomplete correction of the patient's anatomic risk factors would likely lead to poor long-term outcomes despite a technically successful ACL revision. ## Recovery and Final Outcome The recovery protocol for this case was designed to protect the multiple surgical procedures performed while progressively restoring function. The patient was placed on partial weight bearing status for four weeks following surgery to allow initial healing of the osteotomy site. During this period, she used crutches to offload stress from the operative leg while maintaining some degree of physiologic loading to promote bone healing. The patient was maintained in a protective brace and transitioned out of the brace by six weeks postoperatively. This timeline allowed adequate early healing of the soft tissue reconstructions while preventing excessive stress on the healing structures. Between six weeks and nine months, the rehabilitation protocol focused on gradually increasing aerobic activity while avoiding cutting, pivoting, or jumping movements that could jeopardize the healing ACL graft, meniscal repair, or osteotomy site. Return to sports activities was anticipated at nine months postoperatively, which is consistent with current evidence-based recommendations for ACL reconstruction rehabilitation. This extended timeline reflects the complexity of the combined procedures and the need for complete healing of all surgical sites before resuming high-demand athletic activities. The hardware used for osteotomy fixation can be removed at any point after six months if it causes discomfort to the patient. However, hardware removal is optional and only recommended if the patient experiences symptoms related to the implants. Many patients choose to retain the hardware indefinitely if they remain asymptomatic. At the time of documentation, this surgery was in the planning stages and had not yet been performed. However, the surgeon noted that similar patients with comparable conditions treated with this approach have achieved return to active lifestyles without restrictions on activity. ## Clinical Lesson for Other Surgeons This case illustrates an important principle in revision orthopedic surgery: addressing only the obvious pathology without correcting underlying anatomic risk factors often leads to repeat failure. In this patient, the initial ACL reconstruction with cadaver allograft failed despite appropriate surgical technique because the underlying anatomic contributors to ACL injury were not addressed. The presence of excessive posterior tibial slope creates an anterior tibial translation force that places increased stress on the ACL graft with each loading cycle. Similarly, valgus alignment of the lower extremity alters knee kinematics and increases strain on the ACL graft, particularly during cutting and pivoting movements. When both of these risk factors are present, as in this case, the biomechanical environment is unfavorable for ACL graft survival regardless of graft type or fixation method. The clinical lesson is that optimal outcomes in complex cases often require altering the patient's anatomic profile to create a more favorable biomechanical environment. While this increases surgical complexity and extends recovery time, it is necessary to reduce the risk of repeat failure and provide the patient with the best opportunity for long-term success. In orthopedic surgery, there is not always a simple answer to complex problems, and surgeons must be willing to perform more extensive corrective procedures when anatomic risk factors are identified. ## Treatment Results - Comprehensive revision ACL reconstruction performed with autograft tissue rather than repeat allograft to optimize biological healing potential - All-inside surgical technique utilized for ACL reconstruction to minimize bone loss and soft tissue disruption in the revision setting - Lateral extra-articular tenodesis added to provide supplementary rotational stability and reduce risk of graft retear - Vertical tear in posterior horn of lateral meniscus repaired using absorbable all-inside device technology to preserve meniscal tissue and restore normal joint mechanics - Closing wedge high tibial osteotomy performed to simultaneously correct valgus alignment and reduce excessive posterior tibial slope, addressing the underlying anatomic risk factors that contributed to primary graft failure - Structured rehabilitation protocol implemented with partial weight bearing for four weeks, brace discontinuation at six weeks, and progressive return to activities culminating in anticipated return to sports at nine months - Optional hardware removal available after six months if patient experiences discomfort from osteotomy fixation implants - Similar patients treated with this combined approach have achieved return to unrestricted active lifestyles ## Frequently Asked Questions ### Why did the original ACL reconstruction with cadaver graft fail? The original ACL reconstruction likely failed due to underlying anatomic risk factors that were not addressed during the primary surgery. This patient had both excessive posterior tibial slope and valgus alignment of the lower extremity, both of which are established risk factors for ACL tear and retear after reconstruction. These anatomic factors create unfavorable biomechanical forces on the ACL graft that increase the risk of failure over time, regardless of the quality of the surgical technique or graft used. ### Why was autograft chosen instead of another cadaver graft for the revision surgery? For the revision reconstruction, autograft tissue was selected rather than repeating the cadaver allograft approach. Autograft tissue provides better biological healing potential because it comes from the patient's own body and integrates more reliably than donor tissue. In revision settings where graft healing and incorporation are particularly critical, autograft offers advantages over allograft in terms of biological healing response. ### What is a high tibial osteotomy and why was it necessary in this case? A high tibial osteotomy is a surgical procedure where a wedge of bone is removed from the upper portion of the tibia to correct leg alignment and adjust the slope of the tibial plateau. In this case, a closing wedge osteotomy was performed to correct the patient's knock-knee alignment and reduce her excessive posterior tibial slope. These corrections were necessary because both anatomic factors contributed to the failure of the original ACL graft and would place any new graft at high risk for failure if left uncorrected. ### How long will it take to return to volleyball after this surgery? Return to volleyball and other cutting or pivoting sports is anticipated at nine months following surgery. This extended timeline is necessary because the patient underwent multiple procedures including ACL reconstruction, meniscal repair, and high tibial osteotomy, all of which require adequate healing before resuming high-demand athletic activities. Between six weeks and nine months postoperatively, the patient will progressively increase aerobic activity but will avoid cutting sports to protect the healing structures. The nine-month timeline is consistent with current evidence-based recommendations for return to sports after ACL reconstruction. ### Will the hardware from the osteotomy need to be removed? The hardware used to fix the osteotomy site can be removed at any point after six months if it causes discomfort to the patient. However, hardware removal is optional and only recommended if symptoms develop related to the implants. Once the osteotomy has fully healed, typically by six months, the hardware is no longer structurally necessary. Many patients choose to keep the hardware permanently if they are not experiencing any problems, while others prefer removal. The decision can be made based on individual patient symptoms and preferences. ## Related Orthopedic Services Dr. Strickland offers comprehensive treatment for ACL injuries and complex knee instability conditions. - ACL Reconstruction Retear and Rehabilitation Information - ACL Tears Preferred and New Surgical Technique - ACL Surgery Explained - ACL Surgery Graft Choice - Meniscal Tear or Torn Meniscus - Joint Preservation Osteotomy - How Acton Boxborough Coach Helps Players Recover from ACL Tears --- ## Patient Success Stories | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/success-stories/ Summary: Real patient stories from Dr. Sabrina Strickland Patient Stories # Real patients. Real outcomes. Knee and shoulder injuries treated by Dr. Sabrina Strickland at the Hospital for Special Surgery — and the active lives her patients returned to. In their own words and on video. Patient Video Stories ## Watch their stories in their own words. Each of these patients sat down on camera to share the injury, the surgery, and the return to the activities they love. Click any video to watch. Video Jennifer High Tibial Osteotomy & ACL Reconstruction A project manager and lifelong volleyball player struggled with recurrent knee swelling after a previous ACL and meniscus surgery. Dr. Strickland and Dr. Gomoll at HSS recommended a combined HTO (to create a protective gap in the joint) and ACL reconstruction. Watch her story. Read & watch story → Video Paul Arthroscopy, BMAC & MISHA Knee System Told by two doctors to stop running due to arthritis, Paul wanted to avoid a partial knee replacement. Dr. Strickland offered a regenerative approach: arthroscopy + Bone Marrow Aspirate Concentrate (BMAC) for one knee, and the MISHA Knee System for the arthritic knee. He's back to running and all sports with no restrictions. Read & watch story → Video Liam MPFL Reconstruction Surgery Liam had experienced a lifetime of kneecap dislocations. An avid hockey player, he needed a solution. After MPFL reconstruction surgery he's back to hockey. Watch his video to learn about his success story. Read & watch story → Video Peyton Ely Tibial Tubercle Transfer · Patella After more than two years of constant kneecap pain with no real diagnosis, NJ competitive dancer Peyton Ely came to Dr. Strickland — and was back to dancing in 4 months pain-free following a tibial tubercle transfer. Read & watch story → Video Seyward Darby "Full Knee Makeover" — TTO + MPFL Reconstruction As a teenager, Seyward was told her chronic knee dislocations were unfixable, but years later, on the cusp of her wedding, she found hope with Dr. Strickland. A “full knee makeover” — including a tibial tubercle osteotomy and an MPFL reconstruction — not only stabilized her knee but allowed her to walk and dance on her wedding day. Read & watch story → Video Anne Marie Patellofemoral Replacement A former group exercise instructor, Anne Marie was experiencing significant knee pain. After non-surgical treatments to try to resolve her issues, she chose patellofemoral replacement surgery — a partial knee replacement addressing the pain in the front of her knee — and is back to teaching classes feeling “like she has the knees of a twenty year old.” Read & watch story → Video Denise ACL Reconstruction (skiing injury) Denise was flying down the mountain at Killington when she hit a patch of ice. After ACL reconstruction surgery with Dr. Strickland, Denise is back in the game doing what she loves. Read & watch story → Video Nicholas Meniscus Repair + ACL Reconstruction (Amtrak wreck) Nicholas was a passenger in the wreck of Amtrak 188. After a meniscus repair, ACL reconstruction, and months of physical therapy, he now has 100% range of motion returned to his knee. Read & watch story → Video Joseph MPFL Reconstruction & TTO (skiing accident) Joseph shares a skiing accident that led him to see Dr. Strickland for an MPFL reconstruction and tibial tubercle osteotomy at the Hospital for Special Surgery. His success story is about the team who helped him get back to doing whatever he wants. Read & watch story → Video Mark Subpectoral Bicep Tenodesis (shoulder) Mark tried to exercise every day but was injured while changing a tire. Concerned about his ability to be active in sports, he had a subpectoral bicep tenodesis with Dr. Strickland and was able to return to his active lifestyle. Read & watch story → Written Patient Testimonials ## First-person stories — in full. Patients who shared their full recovery story for the Hospital for Special Surgery's Back in the Game series. Click any patient to read their story in full. Patient Story Gillis Frechette NYC Marathon finisher TTO + Osteochondral Allograft Patella “I ran the NYC Marathon this past Sunday — something before the surgery I NEVER thought I would be able to accomplish.” Read full story → Patient Story Avery Young athlete · Knee instability since age 8 Bilateral MPFL Reconstruction + TTO Severe bilateral patellar misalignment with both kneecaps sitting more than 10mm out of place — staged correction across two years (2018–2020). Read full story → Patient Story Carrie Craig Brooklyn, NY Biceps Tendon Repair “I came to Dr. Strickland with a completely immobile arm, unable to put a shirt on by myself. Today I am 100% back doing Pilates, weights, yoga and push-ups — less than a year later.” Read full story → Patient Story Rachel Schechter New York, NY ACL Reconstruction “A year after surgery I was even able to hike the Inca Trail, a 26-mile 4-day hike with a lot of elevation gain. My knee had no issues throughout the hike.” Read full story → Patient Story Rhona Chambers New York, NY Meniscus Root Repair “I have 10 Ironman triathlon finishes and many marathons under my belt. I'm currently 5 months post-op and can run 6 miles no problem.” Read full story → ## Ready to talk about your case? Bring your imaging and a clear question to a sub-specialty consultation with Dr. Strickland — in-person at HSS in NYC, or via telehealth. Book an Appointment About Dr. Strickland Contact --- ## Anne Marie — Aerobics Instructor Back to Teaching After Patellofemoral Replacement | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/success-stories/anne/ Summary: A lifelong group exercise instructor, Anne Marie Patient Story · Video # From cutting parts out of every class — back to teaching with "the knees of a 20 year old." A lifelong group exercise instructor, Anne Marie watched her right knee pain steal parts of every class. Patellofemoral replacement with Dr. Sabrina Strickland gave her vitality back — she says it was the best healthcare decision she ever made. Watch Anne Marie's story Transcript I love to be active I love to exercise I'd love to workout from the time I was 18 19 years old I became a group exercise instructor so I was an aerobics instructor in my early 40s I started experiencing lots of knee pain in my right knee she'd gone from being an exercise instructor to somebody who could no longer do a lot of exercise classes or if she did she had to leave out whole parts of the class because her knees hurt so much when I initially saw dr. Strickland she said that I was probably heading towards this patella femoral replacement and that would really fix the problem but what I did really liked about her was that she left it up to me and you'll know when you're ready for it we tried some non-operative measures we tried physical therapy we tried some injections and ultimately decided to go ahead with a partial knee replacement kind that she needed was just to replace the front of her knee and that's called a patella femoral replacement the best decision I ever made in terms of a healthcare decision because I just feel like it gave me my life back it gave me back my vitality that I felt like I was losing as I was getting closer to 50 now Ann Marie's doing amazingly well meaning she's back teaching classes she tells me she has the needs of a 20 year old I think one of the things that I love about dr. Strickland is not only her confidence but her energy level she's the type of doctor who tackles a problem she's confident she's well educated she's you know on top of her game whenever you see her and I think that just makes you feel good as a patient that you're going to a doctor who's confident who knows what they're looking at who's able to give you the right kind of guidance and the right care you In Anne Marie's words ## "It gave me back the vitality I felt I was losing as I was getting closer to 50." I love to be active. I love to exercise. I love to work out. From the time I was 18, 19 years old I became a group exercise instructor — so I was an aerobics instructor. In my early 40s I started experiencing lots of knee pain in my right knee. She'd gone from being an exercise instructor to somebody who could no longer do a lot of exercise classes — or if she did, she had to leave out whole parts of the class because her knees hurt so much. When I initially saw Dr. Strickland, she said that I was probably heading towards this patellofemoral replacement and that would really fix the problem. But what I really liked about her was that she left it up to me — and you'll know when you're ready for it. We tried some non-operative measures: we tried physical therapy, we tried some injections, and ultimately decided to go ahead with a partial knee replacement. The kind that she needed was just to replace the front of her knee — and that's called a patellofemoral replacement. “The best decision I ever made in terms of a healthcare decision — because I just feel like it gave me my life back.” — Anne Marie It was the best decision I ever made in terms of a healthcare decision, because I just feel like it gave me my life back. It gave me back my vitality that I felt like I was losing as I was getting closer to 50. Now Anne Marie's doing amazingly well, meaning she's back teaching classes. She tells me she has the knees of a 20 year old. I think one of the things that I love about Dr. Strickland is not only her confidence but her energy level. She's the type of doctor who tackles a problem — she's confident, she's well educated, she's on top of her game whenever you see her. And I think that just makes you feel good as a patient that you're going to a doctor who's confident, who knows what they're looking at, who's able to give you the right kind of guidance and the right care. ### About the procedure Anne Marie had Patellofemoral Arthroplasty (Replacement) is a partial knee replacement that resurfaces only the back of the kneecap and the trochlear groove — leaving the medial and lateral compartments of the knee untouched. It is appropriate for patients with isolated end-stage patellofemoral arthritis, normal medial and lateral compartments, and stable ligaments. For these patients it preserves natural knee biomechanics in the rest of the joint and is a less invasive alternative to total knee replacement, with faster recovery and a more "natural" feeling knee. More on patellar pain & patellofemoral arthritis → Anne Marie and Dr. Strickland worked through the conservative care ladder first — physical therapy and injections — before deciding the timing was right for replacement. That sequence is the standard pattern for joint-preservation candidates with patellofemoral arthritis. ## Anne Marie Group exercise / aerobics instructor Condition Isolated patellofemoral arthritis (right knee) Procedure Patellofemoral arthroplasty (partial knee replacement) Tried first Physical therapy & injections Surgeon Sabrina M. Strickland, MD Return to activity Back teaching exercise classes — "the knees of a 20 year old" Outcome From cutting parts out of every class she taught — to back teaching with her vitality restored. Related Specialty Care ## If you have isolated patellofemoral arthritis Specialty ### Patellar Pain & Patellofemoral Arthritis Sub-specialty evaluation of anterior knee pain and kneecap arthritis — from structured non-surgical care through patellofemoral arthroplasty. Specialty ### Knee Arthritis OA, RA, and post-traumatic arthritis — the full treatment ladder from PT and injections through partial and total knee replacement. Consultation ### Book an Appointment If you have isolated patellofemoral arthritis and want to understand whether partial replacement is appropriate, bring your imaging in. ## Read more patient stories Anne Marie's story is one of many. Hear from more of Dr. Strickland's patients in their own words about how they got back to the lives they love. All Success Stories Book an Appointment Contact --- ## Avery — Bilateral MPFL Reconstruction & TTO for Severe Patellar Malalignment | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/success-stories/avery/ Summary: Knee instability defined Avery Patient Story # Knee instability since age eight — back on the field after bilateral MPFL + TTO. Years of physical therapy and braces couldn’t stop Avery’s frequent subluxations and full dislocations. The diagnosis: severe bilateral patellar malalignment with both kneecaps sitting out of place. Dr. Sabrina Strickland staged the repair across two years — bilateral MPFL reconstruction in 2018–2019 as she was still growing and couldn’t have the definitive surgery, followed by bilateral tibial tubercle osteotomies with revision MPFL reconstructions in 2020. Patient Story ## From a defining lifelong challenge — to definitive correction. Since age eight, knee instability has been a defining challenge for one young athlete. Despite years of physical therapy and knee braces, Avery continued to suffer from frequent subluxations and a full dislocation. “Both kneecaps sitting severely out of place.” — Avery’s diagnosis These issues were finally diagnosed as a severe case of patellar malalignment, with both kneecaps sitting more than ten millimeters out of place. Ultimately, she had a bilateral MPFL reconstruction in 2018–2019 as she was still growing, followed by bilateral tibial tubercle osteotomies and revision MPFL reconstructions in 2020. ### About Avery’s care path — staged bilateral correction Severe patellar malalignment with bilateral involvement is one of the more anatomically challenging patellar instability presentations. With both kneecaps sitting more than 10mm out of correct position, the bony lever arm is fundamentally off, the medial soft-tissue restraints are insufficient, and standard physical therapy and bracing cannot restore the kneecaps to a stable track. The surgical answer combines two procedures, often staged across both knees over multiple operations, particularly when the patient is still growing. MPFL reconstruction rebuilds the medial patellofemoral ligament — the primary medial soft-tissue restraint to lateral patellar translation — using a hamstring allograft or autograft, or in some cases a quadriceps tendon graft. More on MPFL reconstruction surgery → Tibial tubercle osteotomy (TTO) is a controlled cut and reposition of the bony attachment of the patellar tendon. When the underlying problem is bony — as in Avery’s severe malalignment — TTO corrects the lever arm so the MPFL reconstruction is protected from the same forces that destroyed the original anatomy. More on joint preservation & osteotomy → For the broader patellar instability evaluation including the five anatomical risk factors that drive recurrent dislocation, see patellar instability. ## Avery Young athlete · Knee instability since age 8 Condition Severe bilateral patellar malalignment — both kneecaps >10mm out of place History Frequent subluxations + a full dislocation since age 8; failed PT and bracing Stage 1 (2018–2019) Bilateral MPFL reconstruction Stage 2 (2020) Bilateral tibial tubercle osteotomies + revision MPFL reconstructions Surgeon Sabrina M. Strickland, MD Hospital Hospital for Special Surgery, NYC Outcome From kneecaps >10mm out of place and a childhood defined by knee instability — to staged bilateral correction with MPFL and tibial tubercle osteotomy. Related Specialty Care ## If your kneecap keeps dislocating Specialty ### Patellar Instability Sub-specialty evaluation of recurrent patellar dislocation — the five anatomical risk factors and the treatment ladder from PT through MPFL + TTO + cartilage repair. Procedure ### MPFL Reconstruction Surgery The dedicated walk-through of MPFL reconstruction — surgical technique, graft choices, recovery timeline, and candidate criteria. Procedure ### Joint Preservation & Osteotomy Tibial tubercle osteotomy (TTO) and other realignment procedures that correct the bony lever arm causing recurrent dislocations. ## Read more patient stories Avery’s story is one of many. Hear from more of Dr. Strickland’s patients in their own words about how they got back to the lives they love. All Success Stories Book an Appointment Contact --- ## Carrie Craig — Brooklyn Mom Back to Pilates, Yoga & Lifting Her Toddler | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/success-stories/carrie-craig/ Summary: After a bad fall left her with a debilitating shoulder injury and a completely immobile arm, Brooklyn mom Carrie Craig came to Dr. Sabrina Strickland at the Hospital for Special Surgery. Less than a year later she was back to Pilates, weights, yoga, push-ups — and lifting her 30-pound child out of the crib. Patient Story # From a completely immobile arm to 100% back — Pilates, yoga, and lifting her toddler. After a bad fall left Brooklyn mom Carrie Craig with a significant shoulder injury, Dr. Sabrina Strickland and her team at the Hospital for Special Surgery restored her to her pre-injury active life within a year. I came to Dr. Strickland scared, anxious, and in immense pain as a result of a bad fall and resulting significant shoulder injury. From the outset, Dr. Strickland balanced compassion and kindness with extreme thoroughness and competency. She recognized right away that my situation required a sense of urgency and in facilitating an immediate MRI she was able to quickly uncover and repair an issue that would have likely caused lifelong pain had it not been corrected in a timely manner. I came to Dr. Strickland with a completely immobile arm, unable to put a shirt on by myself, let alone pick up any of my three young children. I really felt like I would never be the same. Dr. Strickland was able to restore me back to my previous active lifestyle and today I am 100% back doing Pilates, weights, yoga and push ups along not even a year later. Being able to lift my 30 pound child out of his crib is the greatest blessing of all and something that was impossible before my surgery. “Being able to lift my 30 pound child out of his crib is the greatest blessing of all — and something that was impossible before my surgery.” — Carrie Craig Dr. Strickland's entire staff have been wonderful to me throughout the process- knowledgeable, reassuring and very responsive to my questions which made all the difference in keeping me calm and encouraged. They recommended John Cavanaugh, a fantastic physical therapist at HSS, who played a critical role in my healing and regaining motion post surgery. Dr. Strickland is dedicated to getting her patients back to their pre-injury lifestyle and she knows what it takes to get you there. I am grateful for her amazing ability to repair my arm and fortunate to have been supported by her outstanding team. I continue to send friends with orthopedic issues to Dr. Strickland and everybody has the same positive experience that I have had with her. Thank you Dr. Strickland and John Cavanaugh! ## Carrie Craig Brooklyn, NY · Mom of three Condition Biceps tendon rupture / tear Treatment Surgical repair at the Hospital for Special Surgery Surgeon Sabrina M. Strickland, MD Physical Therapy John Cavanaugh, HSS Return to activity 100% back to Pilates, weights, yoga and push-ups in under a year Outcome From a completely immobile arm — to lifting her 30-pound child out of the crib and returning to all her favorite activities in under one year. Related Specialty Care ## If you're facing a similar shoulder injury Specialty ### Sports Injuries Shoulder, knee, and other sports-related injuries — evaluation and treatment by a fellowship-trained sports medicine surgeon. Post-Op ### Post-Surgery Guidelines Procedure-specific recovery PDFs prepared by Dr. Strickland's team — including bicep tenodesis and rotator cuff repair. Consultation ### Book an Appointment If you're dealing with a shoulder injury that's limiting your daily life, book a consultation with Dr. Strickland at HSS. ## Read more patient stories Carrie's story is one of many. Hear from more of Dr. Strickland's patients in their own words about how they got back to the lives they love. All Success Stories Book an Appointment Contact --- ## Denise — From a Killington Ski Accident to a Stable Knee | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/success-stories/denise/ Summary: Denise hit a patch of ice flying down the mountain at Killington, pulled her ACL off her shin bone, and ended up stiff and miserable after an outside doctor tried to sew it back. A revision approach with Dr. Sabrina Strickland — scar tissue removal, range-of-motion recovery, and proper ACL care — gave her a completely stable knee. Patient Story · Video # "I would rather have my leg cut off than deal with this pain" — to a completely stable knee. Denise hit a patch of ice flying down the mountain at Killington, pulled her ACL off her shin bone, and was left stiff and miserable after an outside doctor tried to sew it back. A revision approach with Dr. Sabrina Strickland transformed her sad face into a hopeful one. Watch Denise's story Transcript I'm flying down the mountain to Killington going at speed of light as far as I can see and I hit a patch of ice and I heard a racket it sounded like snap crackle pop and it was at that point I realized that something significant had happened when Denis first came to see me I think she would agree with me that she was quite miserable she'd had a ski accident she not exactly torn her ACL she pulled her ACL off her shin bone when an outside doctor tried to fix it he tried to sew that ACL back down and one of the complications with that often and he can get really stiff who was incredibly uncomfortable and I had told my doctor or my physical therapist at the time I would rather have my leg cut off then deal with this pain and that's when she said you need a second opinion something's wrong so I started out by just removing the scar tissue taking out the ACL that had not healed and getting her range of motion back and that process was I think good from the very beginning I mean she felt so much better even a week after surgery and I went from looking at a very sad face to a really hopeful face and when I finally took the brace off I walked 20 steps and I was like I could do this and I'm happy to say that she has a completely stable knee she's got excellent range of motion she smiles every time I see her and you know I think it's amazing to be able to do this for a patient who essentially given up hope the entire experience has just been pristine from the very beginning and I highly recommend her office HSS [Music] In Denise's words ## From "snap, crackle, pop" on the mountain — to walking 20 steps brace-free. I'm flying down the mountain at Killington, going at speed of light as far as I can see, and I hit a patch of ice and I heard a racket. It sounded like snap, crackle, pop. And it was at that point I realized that something significant had happened. When Denise first came to see me, I think she would agree with me that she was quite miserable. She'd had a ski accident, she had not exactly torn her ACL, she pulled her ACL off her shin bone. When an outside doctor tried to fix it, he tried to sew that ACL back down — and one of the complications with that often is that the knee can get really stiff. I was incredibly uncomfortable. And I had told my doctor — or my physical therapist at the time — I would rather have my leg cut off than deal with this pain. And that's when she said, "You need a second opinion. Something's wrong." “I went from looking at a very sad face to a really hopeful face.” — Dr. Strickland, on Denise's recovery So I started out by just removing the scar tissue, taking out the ACL that had not healed, and getting her range of motion back. And that process was, I think, good from the very beginning. I mean, she felt so much better even a week after surgery. And I went from looking at a very sad face to a really hopeful face. And when I finally took the brace off, I walked 20 steps and I was like, "I could do this." And I'm happy to say that she has a completely stable knee, she's got excellent range of motion, she smiles every time I see her. And, you know, I think it's amazing to be able to do this for a patient who essentially had given up hope. The entire experience has just been pristine from the very beginning, and I highly recommend her office. ### About Denise's care path Revision ACL care after a failed outside repair. The most common cause of post-ACL stiffness is over-aggressive scar tissue formation around a graft or repair that didn't heal cleanly. Dr. Strickland's approach for Denise was sequential: first remove the scar tissue and the unhealed ACL, restore range of motion, and only then plan the appropriate ACL reconstruction. This staged approach is what allowed her to recover function before tackling the ligament itself. More on ACL tear surgery, including revision ACL → For broader sports trauma context including the typical ski-injury pattern (planted ski + valgus rotation = ACL), see sports injuries. ## Denise Skier · Killington Injury ACL avulsion (ACL pulled off shin bone) skiing at Killington First surgery Outside doctor — attempted ACL re-attachment, resulted in stiffness Procedure Scar tissue removal, removal of unhealed ACL, range-of-motion recovery Surgeon Sabrina M. Strickland, MD Outcome Completely stable knee · excellent range of motion Outcome From "I would rather have my leg cut off than deal with this pain" — to a completely stable knee with excellent range of motion. Related Specialty Care ## If you've had a ski injury or failed prior ACL care Procedure ### ACL Tear Surgery ACL reconstruction with patient-matched graft selection, the BEAR implant for selected acute tears, ACL+ALL augmentation, and revision ACL surgery. Specialty ### Sports Injuries Skiing, ACL, multi-ligament knee injuries — the broader sports medicine context for athletic knee trauma and the structured return-to-sport approach. Consultation ### Book an Appointment If you've had a prior ACL surgery that didn't go well or have persistent stiffness or pain, bring your imaging to a sub-specialty consultation. ## Read more patient stories Denise's story is one of many. Hear from more of Dr. Strickland's patients in their own words about how they got back to the lives they love. All Success Stories Book an Appointment Contact --- ## Gillis Frechette — From a Knee Injury to Finishing the NYC Marathon | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/success-stories/gillis-frechette/ Summary: After a knee injury that took a heavy toll on her mental and physical health, Gillis Frechette had a tibial tubercle osteotomy and osteochondral allograft patella with Dr. Sabrina Strickland — and went on to finish the NYC Marathon. Patient Story # From a knee injury that took it all — to finishing the NYC Marathon. After a knee injury that took a heavy toll on her mental and physical health, Gillis Frechette had a tibial tubercle osteotomy and an osteochondral allograft of the patella with Dr. Sabrina Strickland — and crossed the finish line at the NYC Marathon. In Gillis's words — a letter to Dr. Strickland ## "Something before the surgery I NEVER thought I would be able to accomplish." I wanted to send you an update on my knee and how it's going… I ran the NYC Marathon this past Sunday… something before the surgery I NEVER thought I would be able to accomplish… “Completing the marathon was healing and rewarding in so many ways.” — Gillis Frechette It was incredibly emotional for me and for my family who knew how much this knee injury took from my mental and physical health. Completing the marathon was healing and rewarding in so many ways and I felt that I needed to share with you because I obviously could not have completed it without you and the surgery! Thank you so much… A note shared by Gillis with Dr. Strickland after running the NYC Marathon. Gillis had a tibial tubercle osteotomy and an osteochondral allograft of the patella. ### About the procedures Gillis had Tibial Tubercle Osteotomy (TTO) is a controlled cut and reposition of the bony attachment of the patellar tendon on the front of the tibia. For patellar pain or maltracking, an anteromedialization TTO offloads the worn portion of the patella and improves how the kneecap tracks through the trochlear groove. More on joint preservation & osteotomy → Osteochondral Allograft of the Patella replaces a damaged area of cartilage on the back of the kneecap with a size-matched donor cartilage and bone plug. Combined with TTO, the realignment protects the new cartilage from the same forces that destroyed the original. More on cartilage transplantation → ## Gillis Frechette NYC Marathon finisher Condition Patellar cartilage damage and patellofemoral pain Procedure Tibial tubercle osteotomy + osteochondral allograft patella Surgeon Sabrina M. Strickland, MD Hospital Hospital for Special Surgery, NYC Return to running Finished the NYC Marathon Outcome From a knee injury that took a heavy toll on her mental and physical health — to crossing the finish line at the NYC Marathon. Related Specialty Care ## If you're facing a similar kneecap problem Procedure ### Joint Preservation & Osteotomy Tibial tubercle osteotomy (TTO) and other realignment procedures to offload the worn portion of the joint and protect cartilage repair. Procedure ### Cartilage Transplantation (OATS & Allograft) Osteochondral allograft and OATS for focal cartilage damage on the patella, trochlea, or femoral condyles in active patients. Consultation ### Book an Appointment If you have patellar cartilage damage or have been told you can't return to running, bring your imaging to a sub-specialty consultation. ## Read more patient stories Gillis's story is one of many. Hear from more of Dr. Strickland's patients in their own words about how they got back to the lives they love. All Success Stories Book an Appointment Contact --- ## Jennifer — Volleyball Player Back to 3–5 Games a Week After HTO + ACL Reconstruction | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/success-stories/jennifer/ Summary: After a previous ACL and meniscus surgery left Jennifer with recurrent knee swelling, Dr. Sabrina Strickland and Dr. Andreas Gomoll at the Hospital for Special Surgery performed a combined high tibial osteotomy and ACL reconstruction. Two years later she Patient Story · Video # From recurrent knee swelling — back to volleyball 3 to 5 times a week. After a prior ACL and meniscus surgery left Jennifer with recurrent knee swelling, Dr. Sabrina Strickland and Dr. Andreas Gomoll at the Hospital for Special Surgery performed a combined high tibial osteotomy and ACL reconstruction. Two years later: 108+ Pilates classes and back to playing volleyball 3–5 times a week. Watch Jennifer's story Transcript The surgery completely changed my life. I was able to get back into a volleyball, something that I really wanted to do. My name is Jennifer. I am a project manager in a logistics company. I like to play volleyball and Pilates in my free time. I got into volleyball in high school. Injury first started with a micro tear when I was playing volleyball during my offseason. So, I went to the ER. They said I had a micro tear, but it can naturally get better. I didn't really listen to them about not playing sports. So, I went to play handball uh that summer and I completely tore it. Due to my injury, I had to have a ACL and miniscus surgery with a different doctor in town. Um, and that was in 2010. When I got back into volleyball, uh, my knee started swelling again. I specifically wanted to find a doctor from HSS. Dr. Strickland and Dr. Gamala are very active people and I felt like that caused an instant connection. They recommended the HCO surgery and also the ACL reinforcement. So I was able to do both of the surgeries with both doctors. So they had to explain to me what was going on. So they actually had a visual representation of like the knee joints and they walked through it step by step. It was actually really easy for me to make the decision because I wanted to get back into volleyball. The ultimate goal for the HCO surgery is to create a gap between my two joints to prevent swelling whenever the two joints brush up against each other whenever I do an active exercise because my meniscus was gone or like half of it was naturally degraded. Every time I did an exercise, it would brush against each other and it would cause swelling. On the day of surgery, Dr. Gal started with my HTO surgery. Afterwards, Dr. Strickland came in and did my ACL reinforcement. After surgery, I had a month where I couldn't put pressure on my left foot. So, that was quite hard and tough. Afterwards, I was able to slowly put weight on. I was doing PT almost three times a week for a couple of months. Afterwards, I was able to get into Pilates again. So, it's been 2 years since my surgery. I was able to continue to do Pilates. I actually reached over 108 classes for my Pilates. The surgery has completely changed my life for the better. I wasn't expecting to play this much volleyball. I played three to five times a week. Overall, had a very positive experience with Dr. Gamal and Dr. Strickland's team. I'm a very efficient person, so I appreciate their team being very efficient. I was able to relate to them and that helped ease my worries. I was able to get back into volleyball, something I love, and they were able to change my life for the better. In Jennifer's words ## Two surgeries, one recovery, back to the sport she loves. The surgery completely changed my life. I was able to get back into volleyball, something that I really wanted to do. My name is Jennifer. I am a project manager in a logistics company. I like to play volleyball and Pilates in my free time. I got into volleyball in high school. Injury first started with a micro tear when I was playing volleyball during my offseason. So, I went to the ER. They said I had a micro tear, but it can naturally get better. I didn't really listen to them about not playing sports. So, I went to play handball that summer and I completely tore it. Due to my injury, I had to have an ACL and meniscus surgery with a different doctor in town. And that was in 2010. When I got back into volleyball, my knee started swelling again. I specifically wanted to find a doctor from HSS. Dr. Strickland and Dr. Gomoll are very active people and I felt like that caused an instant connection. They recommended the HTO surgery and also the ACL reinforcement. So I was able to do both of the surgeries with both doctors. “Dr. Strickland and Dr. Gomoll are very active people and I felt like that caused an instant connection.” — Jennifer So they had to explain to me what was going on. They actually had a visual representation of the knee joints and they walked through it step by step. It was actually really easy for me to make the decision because I wanted to get back into volleyball. The ultimate goal for the HTO surgery is to create a gap between my two joints to prevent swelling whenever the two joints brush up against each other whenever I do an active exercise — because my meniscus was gone, or like half of it was naturally degraded. Every time I did an exercise, it would brush against each other and it would cause swelling. On the day of surgery, Dr. Gomoll started with my HTO surgery. Afterwards, Dr. Strickland came in and did my ACL reconstruction (revision). After surgery, I had a month where I couldn't put pressure on my left foot. So, that was quite hard and tough. Afterwards, I was able to slowly put weight on. I was doing PT almost three times a week for a couple of months. Afterwards, I was able to get into Pilates again. So, it's been 2 years since my surgery. I was able to continue to do Pilates. I actually reached over 108 classes for my Pilates. The surgery has completely changed my life for the better. I wasn't expecting to play this much volleyball. I played three to five times a week. Overall, had a very positive experience with Dr. Gomoll and Dr. Strickland's team. I'm a very efficient person, so I appreciate their team being very efficient. I was able to relate to them and that helped ease my worries. I was able to get back into volleyball, something I love, and they were able to change my life for the better. ### About the procedures Jennifer had High Tibial Osteotomy (HTO) is a controlled cut and reposition of the upper tibia that shifts the mechanical axis of the leg from the worn compartment toward the healthy side — opening up a protective gap on the damaged side of the knee. It's a joint-preserving alternative to partial knee replacement in younger active patients. More on joint-preservation osteotomy → ACL reconstruction rebuilds the central knee stabilizer with a tendon graft. In Jennifer's case, the original ACL surgery from 2010 was revised as part of the same operation. More on ACL tear surgery → ## Jennifer Project manager · Volleyball player Condition Recurrent knee swelling after prior ACL/meniscus surgery (2010) Procedure High tibial osteotomy + ACL reconstruction (combined) Surgeons Sabrina M. Strickland, MD & Andreas H. Gomoll, MD Hospital Hospital for Special Surgery, NYC Recovery 1 month non-weight-bearing · PT 3× weekly for several months Return to activity 108+ Pilates classes · volleyball 3–5× per week at 2 years post-op Outcome From recurrent knee swelling after a 2010 surgery — to playing volleyball 3–5 times a week and 108+ Pilates classes, two years post-op. Related Specialty Care ## If you're facing a similar knee problem Procedure ### Joint Preservation & Osteotomy HTO, DFO, and TTO — controlled bone cuts that shift load away from the worn compartment and delay or avoid joint replacement in younger active patients. Procedure ### ACL Tear Surgery ACL reconstruction with patient-matched graft selection, the BEAR implant for selected acute tears, and revision ACL — for primary and re-injury cases. Consultation ### Book an Appointment If you have recurrent knee pain or swelling after a prior surgery, bring your imaging to a sub-specialty consultation with Dr. Strickland. ## Read more patient stories Jennifer's story is one of many. Hear from more of Dr. Strickland's patients in their own words about how they got back to the lives they love. All Success Stories Book an Appointment Contact --- ## Joseph — College Skier Back to Hiking & Jumping After MPFL + TTO | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/success-stories/joseph/ Summary: Joseph, a 19-year-old neuroscience student at Binghamton, dislocated his patella the first time he tried skiing. After tibial tubercle osteotomy and MPFL reconstruction with Dr. Sabrina Strickland, he can hike, jump, and do whatever he wants — and got a tattoo of a stick figure skiing down his scar. Patient Story · Video # "Pizza, french fry" — and a stick figure skiing down his scar. Joseph, a 19-year-old neuroscience student at Binghamton, dislocated his patella the first time he tried skiing. After tibial tubercle osteotomy and MPFL reconstruction with Dr. Sabrina Strickland, he can hike, jump, and do whatever he wants. And yes — he got the tattoo. Watch Joseph's story Transcript [Music] my name is Joe I'm 19. I'm a college student I go upstate to Binghamton I'm a neuroscience student I really have a passion for healthcare so far so my injury happened because I went skiing for the first time and my friends who are really good skiers told me I could learn on the way down they taught me pizza french fry I was like yeah I could I could do that I could not do that and I fell down a bunch of times and it was all fun it was all fine and the last time I fell I could feel that my knee had done something I felt a pop and a shift and I fell and I tried getting back up and I could not put weight on it so I brought Dr sugar my scans after my mom had did some research and found her I first met Joseph about a year and a half ago and he had somewhat of an unusual story first of all instead of tearing his ACL skiing he dislocated his patella but the way Joseph was born and the way he grew his patella was high so we had patella Alta but he also was laterally translated so his patella was essentially sitting perched it wanted to slip out and after that first time patellar dislocation when he tore his MP FL it really was a losing situation he just couldn't keep it in the groove we did both the tibial tuberculosstiotomy as well as an mpfl when the time came around I was really ready to have the surgery I wanted my knee fixed I think the most important thing that Dr Strickland's team did was they were very open to questions initially I was told that I would not be able to walk for six weeks I would be an Embrace laying in bed which was a bummer because it was the start of my summer she got me involved in physical therapy pretty much as soon as my swelling had gone down and I could actually tolerate it Dr Strickland did a great job and I think by the six week Mark I was actually ahead and walking with my brace on which was really a big move for me overall it's all I could ask for and everyone was very nice very supportive and a very good experience for me I can do whatever I want with my knee it's fully back to normal I can hike I can jump I can do whatever I want and I don't really have to worry about my knee giving out which is a big change from what I had before kind of from the moment I had my injury I was like I could turn this into something good and I'm immediately knew that I kind of wanted a tattoo of a little stick figure skiing down my scar from the surgery my mom is not on board but after six weeks of me laying in bed I think I got the guilt trip from her so as soon as I had my screws removed and Dr Strickland gave me though okay Dr Strickland actually supported the idea she gave me a little giggle when I told her about it but yeah I got a tattoo of a stick figure skiing down my scarf In Joseph's words ## From his first time on skis — to fully back to normal. My name is Joe. I'm 19. I'm a college student — I go upstate to Binghamton, I'm a neuroscience student. I really have a passion for healthcare so far. So my injury happened because I went skiing for the first time, and my friends who are really good skiers told me I could learn on the way down. They taught me "pizza, french fry." I was like, "Yeah, I could do that." I could not do that. And I fell down a bunch of times, and it was all fun, it was all fine. And the last time I fell, I could feel that my knee had done something. I felt a pop and a shift, and I fell, and I tried getting back up and I could not put weight on it. So I brought Dr. Strickland my scans after my mom had done some research and found her. I first met Joseph about a year and a half ago, and he had somewhat of an unusual story. First of all, instead of tearing his ACL skiing, he dislocated his patella. But the way Joseph was born and the way he grew, his patella was high — so we had patella alta. But he also was laterally translated, so his patella was essentially sitting perched. It wanted to slip out. And after that first-time patellar dislocation when he tore his MPFL, it really was a losing situation. He just couldn't keep it in the groove. We did both the tibial tubercle osteotomy as well as an MPFL. When the time came around, I was really ready to have the surgery. I wanted my knee fixed. I think the most important thing that Dr. Strickland's team did was they were very open to questions. Initially I was told that I would not be able to walk for six weeks — I would be in a brace, laying in bed — which was a bummer because it was the start of my summer. She got me involved in physical therapy pretty much as soon as my swelling had gone down and I could actually tolerate it. Dr. Strickland did a great job, and I think by the six-week mark I was actually ahead and walking with my brace on, which was really a big move for me. “I can do whatever I want with my knee. It's fully back to normal. I can hike, I can jump, I can do whatever I want — and I don't have to worry about my knee giving out.” — Joseph Overall, it's all I could ask for, and everyone was very nice, very supportive — a very good experience for me. I can do whatever I want with my knee. It's fully back to normal. I can hike, I can jump, I can do whatever I want, and I don't really have to worry about my knee giving out — which is a big change from what I had before. Kind of from the moment I had my injury, I was like, I could turn this into something good. And I immediately knew that I kind of wanted a tattoo of a little stick figure skiing down my scar from the surgery. My mom is not on board, but after six weeks of me laying in bed, I think I got the guilt trip from her, so as soon as I had my screws removed and Dr. Strickland gave me the okay — Dr. Strickland actually supported the idea. She gave me a little giggle when I told her about it. But yeah, I got a tattoo of a stick figure skiing down my scar. ### About the procedures Joseph had Combined MPFL Reconstruction + Tibial Tubercle Osteotomy. Joseph had three of the five anatomical risk factors for recurrent patellar dislocation — patella alta (a high-riding kneecap), age and lateral patellar translation. With those bony risk factors, MPFL reconstruction alone often fails because the same forces that pulled the kneecap out of the groove will stretch the new ligament loose. Adding a TTO corrects the bony lever arm by repositioning the tibial tubercle, and the MPFL restores the medial soft-tissue restraint. Together they correct the anatomy that caused the dislocation. More on patellar instability evaluation → For dedicated walkthroughs, see MPFL reconstruction surgery and joint preservation & osteotomy (TTO). ## Joseph 19 · Neuroscience student, Binghamton Injury First-time patellar dislocation while skiing Anatomy Patella alta + lateral patellar translation Procedure Tibial tubercle osteotomy + MPFL reconstruction Surgeon Sabrina M. Strickland, MD Recovery Walking with brace ahead of schedule by 6-week mark Outcome Hiking, jumping, doing whatever he wants Outcome From a first-time patellar dislocation on his first ski day — to "fully back to normal" with the kind of confidence that gets celebrated in ink. Related Specialty Care ## If you've dislocated your kneecap Specialty ### Patellar Instability Sub-specialty evaluation of patellar dislocation — five anatomical risk factors and the treatment ladder from PT through MPFL + TTO + cartilage repair. Procedure ### MPFL Reconstruction The dedicated walk-through of MPFL reconstruction — surgical technique, graft choices, recovery timeline, and candidate criteria. Consultation ### Book an Appointment If you've had even one patellar dislocation and have anatomical risk factors, prompt sub-specialty evaluation prevents recurrence and cartilage damage. ## Read more patient stories Joseph's story is one of many. Hear from more of Dr. Strickland's patients in their own words about how they got back to the lives they love. All Success Stories Book an Appointment Contact --- ## Liam — Hockey Player Back on the Ice After Bilateral MPFL Reconstruction | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/success-stories/liam/ Summary: Travel and high school hockey player Liam has a genetic condition that made his kneecap dislocate easily. After bilateral MPFL reconstruction with Dr. Sabrina Strickland, both of his knees feel perfect — and he Patient Story · Video # A genetic predisposition to dislocate — back on the ice with bilateral MPFL reconstruction. Travel and high school hockey player Liam has a genetic condition that makes his kneecap dislocate more easily than most. After bilateral MPFL reconstruction with Dr. Sabrina Strickland, both knees feel perfect — and he's preparing for junior tryouts and a college hockey scholarship. Watch Liam's story Transcript my name is Liam got I play hockey both travel and for high school I have a genetic condition where my kneecap will dislocate much easier than a person without this condition one time in my hockey game in December of 2019 I was playing I was taking this going for a slap shot when all of a sudden I felt a intense pain in my left knee I could not bend it I couldn't move it every time I would move my leg it would be extreme pain when I came here for two Dr Strickland's office I walked in and she immediately looked at my results on the MRI it was clear to me and I think it was clear to Liam that he couldn't keep skating the way he was ultimately we did an mpfl reconstruction and everything went great literally starting at about eight weeks after surgery we started getting emails from Liam and his mom when can I skate when can I skate and so you know we had to keep holding him back so that he would have a good result because it takes a long time to regain your full strength and attend in which is what an mpfl starts out as has to turn into a ligament and that maturation process takes a while so he was back he was playing hockey everything was great until he dislocated his contralateral his other patella and luckily at this point he was a professional he was a professional knee instability patient surgery was very nerve-wracking as a 15 year old not many kids my age had have had knee surgeries or any sort of type of surgery and had felt like an eternity getting back on the ice but all through Physical Therapy you learned that it it takes time that the recovery is not it's not a joke you need to take it seriously and that if you recover well um you'll have no more problems so I'm about a year out of surgery of my right knee surgery right now both of my kneels knees are feeling perfect I've had absolutely no problems with them after the surgery and it I I feel stronger than I was going into the surgeries and I also feel more confident in both of my knees that I feel that they won't give out um and this summer I'm really looking forward to uh tryouts for juniors teams that will hopefully help me get a division one or division three scholarship for college and hockey Dr Strickland and her team were this the moment I got here I knew that they were they knew what they were doing and they were experts in this field Dr Strickland was extremely confident in her work she knew that she was the best and she proved it to me [Music] In Liam's words ## From a slap shot in 2019 — to two MPFL reconstructions and a hockey future. My name is Liam. I play hockey, both travel and for high school. I have a genetic condition where my kneecap will dislocate much easier than a person without this condition. One time in my hockey game in December of 2019 I was playing, I was taking a — I was going for a slap shot — when all of a sudden I felt an intense pain in my left knee. I could not bend it. I couldn't move it. Every time I would move my leg it would be extreme pain. When I came here for Dr. Strickland's office, I walked in and she immediately looked at my results on the MRI. It was clear to me — and I think it was clear to Liam — that he couldn't keep skating the way he was. Ultimately we did an MPFL reconstruction and everything went great. Literally starting at about eight weeks after surgery we started getting emails from Liam and his mom: "When can I skate? When can I skate?" And so we had to keep holding him back so that he would have a good result, because it takes a long time to regain your full strength. And the tendon, which is what an MPFL starts out as, has to turn into a ligament — and that maturation process takes a while. So he was back, he was playing hockey, everything was great until he dislocated his contralateral — his other patella. And luckily at this point he was a professional. He was a professional knee instability patient. “Surgery was very nerve-wracking as a 15 year old. Not many kids my age have had knee surgeries or any sort of surgery.” — Liam And it had felt like an eternity getting back on the ice. But all through physical therapy you learn that it takes time, that the recovery is not a joke, you need to take it seriously, and that if you recover well, you'll have no more problems. So I'm about a year out of surgery of my right knee surgery right now. Both of my knees are feeling perfect. I've had absolutely no problems with them after the surgery, and I feel stronger than I was going into the surgeries. I also feel more confident in both of my knees that I feel that they won't give out. And this summer I'm really looking forward to tryouts for juniors teams that will hopefully help me get a Division I or Division III scholarship for college and hockey. Dr. Strickland and her team — the moment I got here, I knew that they knew what they were doing and they were experts in this field. Dr. Strickland was extremely confident in her work. She knew that she was the best and she proved it to me. ### About the procedure Liam had MPFL Reconstruction (Medial Patellofemoral Ligament). The MPFL is the primary medial soft-tissue restraint that prevents the kneecap from sliding laterally. After a patellar dislocation it is almost always torn, and patients with anatomical risk factors — like Liam's genetic predisposition — frequently re-dislocate without it. MPFL reconstruction uses a hamstring or quadriceps tendon graft to rebuild the ligament, restoring stability. Recovery is typically 4–6 months, and the new graft needs that time to mature into ligament tissue strong enough for high-level sport. More on MPFL reconstruction surgery → For broader patellar instability evaluation including the five anatomical risk factors that drive recurrent dislocation, see patellar instability. ## Liam High school & travel hockey player Condition Recurrent patellar dislocation (bilateral) — genetic predisposition Procedure Bilateral MPFL reconstruction (staged) Surgeon Sabrina M. Strickland, MD Hospital Hospital for Special Surgery, NYC Goal Junior team tryouts · D-I or D-III college hockey scholarship Outcome From two patellar dislocations in two knees — to feeling stronger than before surgery and preparing for college hockey. Related Specialty Care ## If your kneecap keeps dislocating Procedure ### MPFL Reconstruction Surgery The dedicated walk-through of the MPFL reconstruction procedure — surgical technique, graft choices, recovery timeline, and what makes patients candidates. Specialty ### Patellar Instability Sub-specialty evaluation of recurrent patellar dislocation — the five anatomical risk factors and the treatment ladder from physical therapy to MPFL + TTO. Consultation ### Book an Appointment If you've had two or more kneecap dislocations and want a sub-specialty evaluation, bring your imaging to a consultation with Dr. Strickland. ## Read more patient stories Liam's story is one of many. Hear from more of Dr. Strickland's patients in their own words about how they got back to the lives they love. All Success Stories Book an Appointment Contact --- ## Mark — Badminton Champion Defends His Cup After Subpectoral Bicep Tenodesis | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/success-stories/mark/ Summary: Mark, in his late 40s, snapped his biceps tendon while changing a tire — threatening his ability to play badminton. Subpectoral bicep tenodesis with Dr. Sabrina Strickland let him defend his singles tournament cup the year after surgery. Patient Story · Video # From a snapped biceps changing a tire — back on court to defend his cup. Mark, in his late 40s, felt something snap in his arm while changing a tire in an awkward position. Subpectoral bicep tenodesis with Dr. Sabrina Strickland let him return to badminton — and successfully defend his singles tournament title. Watch Mark's story Transcript yeah hi I'm I'm Mark um I'm in my late 40s and generally just try to uh get some exercise each day even if it's walking the dog the injury occurred when I was changing a tire and I was in a in a bit of a rush uh I was in an awkward position and I pulled very hard and there was a uh sort of snapping pulling of of in my arm and I knew something had occurred so after that I had an MRI taken um and then I shared that MRI with Dr Strickland uh who I had been recommended by somebody else in my badminton group my main concern was that it would impair my long-term ability to be you know fully functional with my right shoulder particularly to play sports she gave me uh her recommendation which was to do the subpectoral bias of tenodesis she was very uh very good at making the time to explain it to me um fully to answer my questions and to get me comfortable after the surgery was completed I was informed about what I needed to do from both a u taking pain medication as well as keeping my arm secure I would say that after a few months I was back playing uh badminton again I had won a singles tournament the year before I set the goal of of winning that cup again in spite of the surgery turned out to be um I was able to defend my cup and and hold it again so my my right shoulder really feels great uh it's uh sometimes I I think maybe I'm I've come out ahead with the surgery in fact my left shoulder if anything is having some minor issues perhaps with the AC joint so I think I'm probably going to be seeing Dr Strickland again soon In Mark's words ## A snap, an MRI, and a defended cup. Yeah, hi. I'm Mark. I'm in my late 40s and generally just try to get some exercise each day, even if it's walking the dog. The injury occurred when I was changing a tire, and I was in a bit of a rush. I was in an awkward position and I pulled very hard, and there was a sort of snapping, pulling of — in my arm, and I knew something had occurred. So after that I had an MRI taken, and then I shared that MRI with Dr. Strickland, who I had been recommended by somebody else in my badminton group. My main concern was that it would impair my long-term ability to be, you know, fully functional with my right shoulder, particularly to play sports. She gave me her recommendation, which was to do the subpectoral bicep tenodesis. She was very good at making the time to explain it to me fully, to answer my questions, and to get me comfortable. “I had won a singles tournament the year before. I set the goal of winning that cup again in spite of the surgery — I was able to defend my cup and hold it again.” — Mark After the surgery was completed, I was informed about what I needed to do from both taking pain medication as well as keeping my arm secure. I would say that after a few months I was back playing badminton again. I had won a singles tournament the year before. I set the goal of winning that cup again in spite of the surgery — turned out to be — I was able to defend my cup and and hold it again. So my right shoulder really feels great. It's — sometimes I think maybe I've come out ahead with the surgery. In fact my left shoulder if anything is having some minor issues, perhaps with the AC joint. So I think I'm probably going to be seeing Dr. Strickland again soon. ### About the procedure Mark had Subpectoral Biceps Tenodesis. When the long head of the biceps tendon degenerates, subluxes, or becomes a chronic source of pain at its origin in the shoulder, one option is to detach it and re-attach it lower — typically below the pectoralis major muscle (sub-pectoral). This restores the biceps muscle's tension and contour, eliminates the pain at the proximal attachment, and preserves elbow flexion and forearm supination strength. It is well-tolerated and gets active patients back to overhead and racket sports with a structured rehabilitation. More on sports injuries → For procedure-specific recovery guidelines, see post-surgery guidelines — including the bicep tenodesis sheet. ## Mark Late 40s · Badminton singles champion Injury Biceps tendon rupture (R arm) while changing a tire Procedure Subpectoral biceps tenodesis Surgeon Sabrina M. Strickland, MD Hospital Hospital for Special Surgery, NYC Goal Defend his badminton singles tournament title Outcome Title successfully defended · "right shoulder feels great" Outcome From a snapped biceps tendon in an awkward tire-changing position — to defending his singles tournament cup the next year. Related Specialty Care ## If you've injured your shoulder Specialty ### Sports Injuries Shoulder, knee, and other sports-related injuries — evaluation by a fellowship-trained sports medicine surgeon with a structured return-to-sport approach. Post-Op ### Post-Surgery Guidelines Procedure-specific recovery PDFs prepared by Dr. Strickland's team — including bicep tenodesis, rotator cuff repair, and shoulder stabilization. Consultation ### Book an Appointment If you've injured your shoulder and want a sub-specialty evaluation, bring your imaging to a consultation with Dr. Strickland. ## Read more patient stories Mark's story is one of many. Hear from more of Dr. Strickland's patients in their own words about how they got back to the lives they love. All Success Stories Book an Appointment Contact --- ## Nicholas — From the 2015 Amtrak 188 Wreck to 100% Range of Motion | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/success-stories/nicholas/ Summary: Nicholas suffered a torn MCL, ACL, lateral meniscus, and fractures in the 2015 Amtrak 188 train derailment. After a staged meniscus repair followed by ACL reconstruction with Dr. Sabrina Strickland and 18 months of physical therapy, he has 100% range of motion and is back to all his prior activities. Patient Story · Video # From the wreck of Amtrak 188 — back to 100% range of motion. Nicholas suffered a torn MCL, ACL, lateral meniscus, and fractures in the 2015 Amtrak 188 train derailment. After staged surgeries with Dr. Sabrina Strickland and 18 months of physical therapy, he is back to all of his prior activities. Watch Nicholas's story Transcript I was in a 2015 train derailment and as a result of that I suffered a traumatic injury to my right knee which included torn MCL torn ACL torn lateral meniscus and a couple of fractures I was unable to walk and participate in any of the activities that I had previously participated in meeting with dr. Strickland she was very confident in her approach and very detailed in her analysis in terms of what she wanted to do with respect to the surgery she was going to perform on my name and so that detailed analysis and confidence really diminished the fears that I had in terms of being able to make a full recovery unfortunately his injury involved both an ACL tear as well as meniscal tear and the meniscus was essentially stuck in the middle of his knee and so what that meant is he really couldn't move it so I started out by just repairing the meniscus because his risk of stiffness was so high if I did they'd yell at the same time impressively not only did it to get his range of motion back that meniscus healed and I was able to go back and reconstruct his ACL it was really a rocky start I mean when a patient's knee gets that stiff before you've even had the opportunity to operate on it it makes the whole process a lot more difficult and he's done amazingly well in connection with the surgeries I underwent about a year and a half of physical therapy both pre and post-op and now that I'm out of physical therapy my leg is almost a hundred percent in terms of strength and I have a hundred percent range of motion returned so I'm able to participate in all of the activities I was able to participate in prior to the accident which was very obviously great outcome [Music] In Nicholas's words ## A traumatic injury, a confident plan, and a full recovery. I was in a 2015 train derailment, and as a result of that I suffered a traumatic injury to my right knee, which included torn MCL, torn ACL, torn lateral meniscus, and a couple of fractures. I was unable to walk and participate in any of the activities that I had previously participated in. Meeting with Dr. Strickland, she was very confident in her approach and very detailed in her analysis in terms of what she wanted to do with respect to the surgery she was going to perform on my knee. And so that detailed analysis and confidence really diminished the fears that I had in terms of being able to make a full recovery. Unfortunately, his injury involved both an ACL tear as well as a meniscal tear — and the meniscus was essentially stuck in the middle of his knee. So what that meant is he really couldn't move it. So I started out by just repairing the meniscus, because his risk of stiffness was so high if I did them all at the same time. Impressively, not only did he get his range of motion back, that meniscus healed, and I was able to go back and reconstruct his ACL. “It was really a rocky start. When a patient's knee gets that stiff before you've even had the opportunity to operate on it, it makes the whole process a lot more difficult — and he's done amazingly well.” — Dr. Strickland In connection with the surgeries, I underwent about a year and a half of physical therapy, both pre and post-op. And now that I'm out of physical therapy, my leg is almost a hundred percent in terms of strength and I have a hundred percent range of motion returned. So I'm able to participate in all of the activities I was able to participate in prior to the accident — which was very obviously a great outcome. ### About Nicholas's care path — staged multi-ligament reconstruction Multi-ligament knee injuries (two or more of the four major knee ligaments — ACL, PCL, MCL, posterolateral corner) are complex injuries usually caused by high-energy events. They require careful staging: doing everything in one operation can produce post-op stiffness so severe that the knee never recovers function. Dr. Strickland's approach for Nicholas — repair the displaced meniscus first to restore range of motion, then come back to reconstruct the ACL once the knee was moving — is the standard sequence for the highest-risk-for-stiffness patients. More on multi-ligament knee injuries → For ACL reconstruction details and graft selection, see ACL tear surgery. For meniscal repair (preferred over meniscectomy when the tear pattern allows), see meniscal tear. ## Nicholas Survivor — 2015 Amtrak 188 derailment Injury Torn MCL, ACL, lateral meniscus, multiple fractures (right knee) Stage 1 Meniscus repair to restore range of motion Stage 2 ACL reconstruction once the meniscus had healed Surgeon Sabrina M. Strickland, MD Rehabilitation ~18 months of pre- and post-op physical therapy Outcome 100% range of motion · ~100% strength · all prior activities resumed Outcome From unable to walk after a traumatic train derailment — to 100% range of motion and back to all prior activities. Related Specialty Care ## If you've had a multi-ligament knee injury Specialty ### Sports Injuries Multi-ligament knee injuries — staged reconstruction strategy, vascular/nerve clearance, and the longer rehabilitation that complex injuries require. Procedure ### ACL Tear Surgery ACL reconstruction with patient-matched graft selection, the BEAR implant for selected acute tears, and revision ACL when prior surgery has failed. Consultation ### Book an Appointment If you've had a high-energy injury affecting multiple knee structures, bring your imaging to a sub-specialty consultation with Dr. Strickland. ## Read more patient stories Nicholas's story is one of many. Hear from more of Dr. Strickland's patients in their own words about how they got back to the lives they love. All Success Stories Book an Appointment Contact --- ## Paul — Marathon Coach Avoided Knee Replacement with BMAC + MISHA Knee System | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/success-stories/paul/ Summary: Told by two doctors he had to stop running due to arthritis, Paul came to Dr. Sabrina Strickland for a regenerative path. Arthroscopy + BMAC for one knee, the MISHA Knee System for the other — and back to running, hiking, skiing, and badminton with no restrictions. Patient Story · Video # Told to stop running — back on the road with no restrictions. Two doctors told marathon coach Paul he had to stop running due to knee arthritis. Dr. Sabrina Strickland offered a regenerative path: arthroscopy and BMAC for one knee, the MISHA Knee System for the other — and Paul is back to running, hiking, skiing, and badminton with no restrictions. Watch Paul's story Transcript Most doctors that I've seen have said, "Yeah, you got to stop the running. That's the first thing you got to do." She didn't say that at all. My name is Paul Bis. Um I'm an active uh father and husband. I met my wife in Central Park running. We both coached for the New Road Runners for a while. I've really been consistently running for the whole of my life up until about 2019 where I had arthritis of my left knee. In 2021, I first uh went to see a knee surgeon. Um they gave me cortisone shots uh and physical therapy. Uh it didn't really help. I waited another 9 months or so. Uh and then went back, we got an MRI. We decided at that point surgery was the right route. So I had an arthoscopy uh in the fall of 2022. It didn't really help. So my surgeon at that point told me that uh the next step was really partial knee replacement. I wasn't ready. the restrictions were that I wouldn't be able to run. But at that point, my second knee was starting to give me issues as well. So, Dr. Strickland, she really came to the top of the pile with the regenerative work that she was doing. That was one of the things I was looking at. I I I really was trying to avoid the the partial knee replacement. At that point, I was very clear that, hey, look, this is me. I'm I'm a runner. She was quite happy to work with me to enable that to continue. In the meantime, she gave me a diagnosis for my right knee, which is basically a flap of cartilage was loose and that was what was catching up in my knee and causing pain. We decided that the best course of action was to actually have an arthoscopy on that knee. So, surgery, but in addition, she was going to do a procedure called VMAC. Recovering from that surgery was amazing. Within 5 weeks, I was back to hiking again. At the 6 week mark, the 6 week posttop, I came into the office for an appointment with Dr. Strickland where we focused on the left knee. So we started to think about that. She introduced me to the Misha knee which is a shock absorber for the knee completely. No restrictions. I can do anything that I I choose. I can run. I can ski. There's no restrictions there. There's no restrictions for racket sports. I also like to play badminton. These are all things which are still kept alive essentially by Dr. Strickland working on these newer technologies. I'm also really really looking forward to running in Shelter Island which is off the end of Long Island where we have our annual vacation. I know this for sure. I would definitely come back to Dr. Strickland. She always has options and you can pick your own path with Dr. Strickland. It's not a case of this is your treatment. That's the real key here I think with with Dr. Strickland is you get the option. In Paul's words ## "She didn't tell me to stop running. She gave me options." Most doctors that I've seen have said, "Yeah, you got to stop the running. That's the first thing you got to do." She didn't say that at all. My name is Paul. I'm an active father and husband. I met my wife in Central Park running. We both coached for the New York Road Runners for a while. I've really been consistently running for the whole of my life up until about 2019, where I had arthritis of my left knee. In 2021, I first went to see a knee surgeon. They gave me cortisone shots and physical therapy. It didn't really help. I waited another 9 months or so, and then went back, we got an MRI. We decided at that point surgery was the right route. So I had an arthroscopy in the fall of 2022. It didn't really help. So my surgeon at that point told me that the next step was really partial knee replacement. I wasn't ready. The restrictions were that I wouldn't be able to run. But at that point, my second knee was starting to give me issues as well. So, Dr. Strickland — she really came to the top of the pile with the regenerative work that she was doing. That was one of the things I was looking at. I really was trying to avoid the partial knee replacement. “At that point, I was very clear that, hey, look, this is me. I'm a runner. She was quite happy to work with me to enable that to continue.” — Paul In the meantime, she gave me a diagnosis for my right knee, which is basically a flap of cartilage was loose, and that was what was catching up in my knee and causing pain. We decided that the best course of action was to actually have an arthroscopy on that knee. So, surgery, but in addition, she was going to do a procedure called BMAC. Recovering from that surgery was amazing. Within 5 weeks, I was back to hiking again. At the 6-week mark, the 6-week post-op, I came into the office for an appointment with Dr. Strickland where we focused on the left knee. So we started to think about that. She introduced me to the MISHA knee, which is a shock absorber for the knee. Completely no restrictions. I can do anything that I choose. I can run. I can ski. There's no restrictions there. There's no restrictions for racket sports. I also like to play badminton. These are all things which are still kept alive essentially by Dr. Strickland working on these newer technologies. I'm also really really looking forward to running in Shelter Island, which is off the end of Long Island where we have our annual vacation. I know this for sure. I would definitely come back to Dr. Strickland. She always has options and you can pick your own path with Dr. Strickland. It's not a case of "this is your treatment." That's the real key here I think with Dr. Strickland — you get the option. ### About the procedures Paul had Arthroscopy + BMAC (Bone Marrow Aspirate Concentrate). Arthroscopy is a minimally invasive procedure used to address mechanical problems inside the knee — in Paul's case, removing a loose cartilage flap that was catching and causing pain. BMAC is an orthobiologic injection that uses bone marrow drawn from the patient's own iliac crest, processed to concentrate a stem-cell-rich fraction, and injected into the joint to support the cartilage environment. More on PRP & regenerative medicine → MISHA Implantable Shock Absorber (Moximed). The MISHA Knee System is an FDA-approved implantable shock absorber for medial compartment knee osteoarthritis. It is placed outside the joint, between the femur and tibia, and absorbs and redistributes load away from the worn medial compartment — letting active patients delay or avoid joint replacement. More on knee arthritis treatment → ## Paul Active father · Marathon coach (NY Road Runners) Condition Bilateral knee arthritis, loose cartilage flap (R), medial compartment OA (L) Procedure (R knee) Arthroscopy + Bone Marrow Aspirate Concentrate (BMAC) Procedure (L knee) MISHA Knee System (implantable shock absorber) Surgeon Sabrina M. Strickland, MD Recovery Back to hiking 5 weeks post-op Return to activity Running, skiing, badminton — no restrictions Outcome Told by two doctors he had to stop running — back to running, skiing, hiking, and badminton with no restrictions, and avoided partial knee replacement. Related Specialty Care ## If you've been told you need a knee replacement Treatment ### PRP & Regenerative Medicine Honest evaluation of PRP, hyaluronic acid, BMAC, and Lipogems — matched to the right patient with realistic expectations about what biologics can and cannot do. Specialty ### Knee Arthritis From structured non-surgical care through the MISHA implantable shock absorber, joint-preserving osteotomy, and partial or total knee replacement when appropriate. Consultation ### Book an Appointment If you've been told you need a knee replacement and want a second opinion on joint-preserving options, bring your imaging to a sub-specialty consultation. ## Read more patient stories Paul's story is one of many. Hear from more of Dr. Strickland's patients in their own words about how they got back to the lives they love. All Success Stories Book an Appointment Contact --- ## Peyton Ely — Competitive Dancer Back to the Stage After Tibial Tubercle Transfer | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/success-stories/peyton-ely/ Summary: After more than two years of constant kneecap pain with no real diagnosis, competitive dancer Peyton Ely came to Dr. Sabrina Strickland at the Hospital for Special Surgery. Following a tibial tubercle transfer, Peyton was back to dancing in just four months — pain-free. Patient Story # Two years of mystery kneecap pain — back to dancing in four months. After more than two years of constant pain and swelling with no real diagnosis, competitive dancer Peyton Ely found Dr. Sabrina Strickland — and was back on the competition stage four months after surgery. Watch Peyton's story Transcript my passion for dance is unbelievable I love it so much it's where I can get my emotions out I've been dancing since I was four I started young obviously and I went to this new studio and I was dancing for a while and my knee started to like swell up and it caused me like a lot of pain the pain was like happening over and over again for about two years went to the hospital and I got a check-up with my knee we got x-rays they told me everything was perfectly fine it was just a sprain a little sprain after that's when I went back to dance so when I was dancing I was still having pain I couldn't go to the floor like my knee like I couldn't train my knee all the way and then we came here to New York I first met Peyton about a year ago and she was 14 and she danced six days a week four to five hours a day and really having a lot of pain in her knee and when her parents came in they said you know this just doesn't seem normal and I said absolutely did not seem normal she'd already failed physical therapy she modified her dance schedule and nothing was making it better and her her injury was fairly unusual it wasn't something that you see every day in a sports medicine practice the way she was born is that her kneecaps were too high so instead of all the stress going through her kneecap the stress was going through the top of her patellar tendon and her fat pad and that meant that we really needed to do an operation to fix it this was not going to get better just with physical therapy so she ultimately underwent what's called a tibial tubercle osteotomy but I distal eyes dit I moved her kneecap down to take the stress off the fat pad and off the tendon and onto the kneecap because that kneecap was put there for a reason it's supposed to be a way to transfer stress when you pull on your quad and as you can see she's done amazingly well the first time we ever met her she knew exactly what was wrong with me the first time I stood up she did checks with my knee she explained it very well she told us step-by-step exactly what she was going to do my recovery time was about we said that it was about to be six to nine months but I've recovered actually pretty fast and I went back to dancing for months dr. Strickland told me that I was going to be able to dance again which I thought I was never going to dance again without pain or anything which scared me because I wanted answer like the rest of my life and when she told me that I almost started crying like that was the best thing that ever happened to me [Music] After more than 2 years of constant pain and swelling with no real diagnosis, we found Dr. Strickland. Within minutes and with just a look, Dr. Strickland knew exactly what the problem was. I am a competitive dancer and Dr. Strickland assured me that I would be back dancing within 9-12 months pain-free. It was the start of comp season and there was no way that I was going to have surgery then. But after my first competition in February 2018, the pain was unbearable and even though I was scared I decided to move forward with the surgery. “Within minutes and with just a look, Dr. Strickland knew exactly what the problem was.” — Peyton Ely On April 9th I had a tibial tubercle transfer (TTT), which is a pretty invasive surgery to move the patella down into the correct position. I was 6 weeks non-weight bearing, which was really hard as a dancer since I was very active and dancing 6 days a week. I was told I would not be able to dance for 9-12 months, which was really hard to swallow, but I did what I was supposed to do and with lots of hard work and dedication I was back to dancing in 4 months and just had my first competition. No pain whatsoever! I can't thank Dr. Strickland and her whole entire team enough for everything! Simply amazing!!! ## Peyton Ely Wall, NJ · Competitive dancer Condition Kneecap pain & patellar maltracking Procedure Tibial tubercle transfer (TTT) Surgery date April 9, 2018 Surgeon Sabrina M. Strickland, MD Return to dance 4 months post-op — pain-free first competition Outcome Told 9–12 months to return to dance — back competing pain-free in just 4 months. Related Specialty Care ## If you're facing a similar kneecap problem Procedure ### Joint Preservation & Osteotomy Tibial tubercle osteotomy (TTO) and related realignment procedures for patellar maltracking and kneecap pain. Specialty ### Patellar Pain & Arthritis Sub-specialty evaluation of anterior knee pain — non-surgical care, realignment osteotomy, and cartilage restoration. Consultation ### Book an Appointment If you've been told there's no clear diagnosis for your knee pain, bring your imaging to a sub-specialty consultation. ## Read more patient stories Peyton's story is one of many. Hear from more of Dr. Strickland's patients in their own words about how they got back to the lives they love. All Success Stories Book an Appointment Contact --- ## Rachel Schechter — Skiing ACL Tear to Hiking the Inca Trail | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/success-stories/rachel-schechter/ Summary: After tearing her ACL while skiing, Rachel Schechter came to Dr. Sabrina Strickland at the Hospital for Special Surgery for ACL reconstruction. A year later she hiked the 26-mile Inca Trail across four days — with no knee issues. Patient Story # From a torn ACL on the slopes — to hiking the Inca Trail. After tearing her ACL while skiing, Rachel Schechter had ACL reconstruction with Dr. Sabrina Strickland at the Hospital for Special Surgery — and one year later was hiking the 26-mile Inca Trail with no knee issues. I came to Dr. Strickland for help after tearing my ACL while skiing. She was so knowledgeable and professional, and I immediately trusted her. I had ACL reconstruction surgery on March 15th, 2021 and it went seamlessly. Dr. Strickland and Meghan Reed, PA then guided me through recovery, always answered my questions promptly and were happy to support me. I always felt I was in good, capable hands. “A year after surgery I was even able to hike the Inca Trail, a 26 mile 4 day hike with a lot of elevation gain and decline. My knee had no issues throughout the hike.” — Rachel Schechter A year after surgery I was even able to hike the Inca Trail, a 26 mile 4 day hike with a lot of elevation gain and decline. My knee had no issues throughout the hike. I'm so grateful to be back outdoors and doing things I love, like traveling and hiking! ## Rachel Schechter New York, NY · Hiker & traveler Condition ACL tear (skiing injury) Procedure ACL reconstruction Surgery date March 15, 2021 Surgeon Sabrina M. Strickland, MD Physical Therapy Meghan Reed, HSS Return to activity Inca Trail (26 mi / 4 days) — one year post-op Outcome From a torn ACL on the slopes to a 26-mile high-altitude hike with no knee issues — one year post-op. Related Specialty Care ## If you've torn your ACL Procedure ### ACL Tear Surgery ACL reconstruction with patient-matched graft selection (quadriceps, hamstring, BTB), the BEAR implant, and structured return-to-sport rehabilitation. Specialty ### Sports Injuries Skiing, ACL, meniscus, multi-ligament knee injuries — the broader sports medicine context for athletic knee trauma. Consultation ### Book an Appointment If you've torn your ACL or had a knee injury and want a sub-specialty evaluation, bring your imaging to a consultation. ## Read more patient stories Rachel's story is one of many. Hear from more of Dr. Strickland's patients in their own words about how they got back to the lives they love. All Success Stories Book an Appointment Contact --- ## Rhona Chambers — Ironman Triathlete Back to 6-Mile Runs After Meniscus Root Repair | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/success-stories/rhona-chambers/ Summary: Ironman triathlete and avid runner Rhona Chambers tore her meniscus root and faced six weeks of non-weight-bearing recovery. Five months after Dr. Sabrina Strickland repaired the tear at the Hospital for Special Surgery, she was running 6 miles pain-free. Patient Story # 10 Ironman finishes, a torn meniscus root, — and back running at 5 months post-op. Avid runner and 10-time Ironman triathlete Rhona Chambers tore her meniscus root, faced a six-week non-weight-bearing recovery, and was running 6 miles pain-free five months after Dr. Sabrina Strickland's repair at the Hospital for Special Surgery. Starry Night! Not enough stars for my review for Dr. Sabrina Strickland and her team. Dr. Strickland repaired a root tear to my meniscus which was a 6 week non-weight bearing nightmare for an avid runner who hates to ask for help with anything. During the 6 weeks I questioned many times if I would be able to return to the lifestyle I had lived prior to the tear. I have 10 Ironman triathlon finishes and many marathons under my belt. I am currently 5 months post-op and can run 6 miles no problem. Five months until the NYC Marathon - real good chance. “Five months until the NYC Marathon — real good chance.” — Rhona Chambers Dr. Strickland did promise me one thing - skiing by summer! ## Rhona Chambers New York, NY · 10× Ironman triathlete Condition Meniscus root tear Procedure Meniscus root repair (transtibial) Recovery 6 weeks non-weight-bearing Surgeon Sabrina M. Strickland, MD Athletic history 10 Ironman triathlon finishes & many marathons Return to running 6 miles pain-free at 5 months post-op Outcome From a 6-week non-weight-bearing root repair to a 6-mile pain-free run at 5 months — with the NYC Marathon five months out. Related Specialty Care ## If you've torn your meniscus Procedure ### Meniscal Tear & Repair Tear-by-tear evaluation: meniscal repair, root repair, partial meniscectomy, and meniscal allograft transplantation — with a strong preference for preservation when the tear pattern allows. Specialty ### Sports Injuries Endurance athletes, runners, triathletes, and pivot-sport athletes — sub-specialty knee and shoulder care with structured return-to-sport rehabilitation. Consultation ### Book an Appointment If you've torn your meniscus and want a sub-specialty evaluation — particularly for a root tear that warrants prompt repair — bring your imaging in. ## Read more patient stories Rhona's story is one of many. Hear from more of Dr. Strickland's patients in their own words about how they got back to the lives they love. All Success Stories Book an Appointment Contact --- ## Seyward Darby — A 'Full Knee Makeover' for Her Wedding Day | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/success-stories/seyward-darby/ Summary: Told as a teenager that her chronic knee dislocations were unfixable, Seyward Darby found Dr. Sabrina Strickland years later — on the cusp of her wedding. A Patient Story · Video # Told it was unfixable — walked down the aisle and danced at her wedding. As a teenager, Seyward Darby was told her chronic knee dislocations were unfixable. Years later, on the cusp of her wedding, she found Dr. Sabrina Strickland — who fixed it with a "full knee makeover": TTO, MPFL reconstruction, and cartilage work. Watch Seyward's story Transcript so when I was about 12 or 13 I was playing catch with my dad and when I stepped to throw the ball my kneecap dislocated and I saw a series of doctors who basically said hey some people have trick knees there's not much we can do keep your muscles strong stay fit so I came to see dr. Strickland and within about five minutes in the appointment she had diagnosed me but also said I can fix this we can make you better which was the first time anyone had ever told me that she couldn't even actively get her like fully straight because her kneecap was so unstable and so painful a major priority was to get her walking down the aisle and dancing at her wedding all I wanted to be able to do was walk down the aisle dance a little bit I really do love to dance you know just feel like I was really enjoying my wedding and I wasn't impaired in any way I had to break the front of her bone and do what's called the tibial tubercle osteotomy and realign her knees so that her patella could tract at the right place I had to do an MPF el reconstruction which is give her a new ligament on the inside part of her knee which is essentially like a leash and I had to do something about the fact that you really did not have very much cartilage in the front of her name she's far too young to have a knee replacement about three weeks before I got married at that point I had just recently gotten out of my huge knee brace that made me look like Iron Man I was in what ultimately became known as the wreck of Amtrak 188 what was running through my mind initially was oh I really hope my knee is okay because I worked so incredibly hard to get to the point where I was Theresa my physical therapist found out and called me and then dr. Strickland called me and she said you know as soon as you're back in New York come to the office like I want to take a look at you she also did a once-over you know look at my looking right back my ribs my neck you know just all the things that an orthopedic doctor can do because she really wanted to make sure that I was okay so I was very lucky not only to cut my knee be fine but to be fine overall words can't totally explain how much she he meant to me because she fixed a thing that I thought was unfixable I had been told was unfixable and she did so with such confidence and compassion and at no point did I ever doubt like this is the right choice [Music] In Seyward's words ## "She fixed a thing that I thought was unfixable." So when I was about 12 or 13 I was playing catch with my dad, and when I stepped to throw the ball my kneecap dislocated. And I saw a series of doctors who basically said, "Hey, some people have trick knees, there's not much we can do — keep your muscles strong, stay fit." So I came to see Dr. Strickland, and within about five minutes in the appointment she had diagnosed me but also said, "I can fix this. We can make you better." Which was the first time anyone had ever told me that. She couldn't even actively get her leg fully straight because her kneecap was so unstable and so painful. A major priority was to get her walking down the aisle and dancing at her wedding. All I wanted to be able to do was walk down the aisle, dance a little bit. I really do love to dance. You know — just feel like I was really enjoying my wedding and I wasn't impaired in any way. I had to break the front of her bone and do what's called the tibial tubercle osteotomy and realign her knees so that her patella could track at the right place. I had to do an MPFL reconstruction — which is give her a new ligament on the inside part of her knee, which is essentially like a leash. And I had to do something about the fact that she really did not have very much cartilage in the front of her knee. She's far too young to have a knee replacement. About three weeks before I got married, at that point I had just recently gotten out of my huge knee brace that made me look like Iron Man. I was in what ultimately became known as the wreck of Amtrak 188. What was running through my mind initially was, oh, I really hope my knee is okay, because I worked so incredibly hard to get to the point where I was. Theresa, my physical therapist, found out and called me, and then Dr. Strickland called me and she said, "You know, as soon as you're back in New York, come to the office — like, I want to take a look at you." She also did a once-over — you know, look at my back, my ribs, my neck, you know, just all the things that an orthopedic doctor can do — because she really wanted to make sure that I was okay. So I was very lucky not only to have my knee be fine, but to be fine overall. “She did so with such confidence and compassion, and at no point did I ever doubt — like, this is the right choice.” — Seyward Darby Words can't totally explain how much she meant to me, because she fixed a thing that I thought was unfixable — I had been told was unfixable. And she did so with such confidence and compassion, and at no point did I ever doubt — like, this is the right choice. ### About the procedures Seyward had "Full knee makeover" — combined TTO + MPFL + cartilage work. When the underlying problem is bony (patella alta, excessive TT-TG distance), MPFL reconstruction alone is not enough — the bony lever arm has to be corrected too. Tibial tubercle osteotomy (TTO) cuts and repositions the bony attachment of the patellar tendon, MPFL reconstruction restores the medial soft-tissue restraint, and cartilage work addresses any wear from years of dislocations. Done together, the procedures correct the anatomy that was causing the dislocations and protect any cartilage repair from re-injury. More on patellar instability evaluation → For the dedicated walk-through of MPFL reconstruction technique, see MPFL reconstruction surgery. For TTO and other realignment osteotomies, see joint preservation & osteotomy. ## Seyward Darby Writer · Bride Condition Chronic patellar dislocation since age 12–13 with patellofemoral cartilage damage Procedure Tibial tubercle osteotomy + MPFL reconstruction + cartilage work Surgeon Sabrina M. Strickland, MD Hospital Hospital for Special Surgery, NYC Goal Walk down the aisle and dance at her wedding Outcome From "unfixable" trick knees told to a teenager — to walking down the aisle and dancing at her wedding. Related Specialty Care ## If you've been told your knee is "unfixable" Specialty ### Patellar Instability Sub-specialty evaluation of recurrent patellar dislocation — five anatomical risk factors and the treatment ladder from PT through MPFL + TTO + cartilage repair. Procedure ### Joint Preservation & Osteotomy Tibial tubercle osteotomy (TTO) and other realignment procedures that correct the bony lever arm causing recurrent dislocations. Consultation ### Book an Appointment If multiple doctors have told you nothing can be done about your knee, bring your imaging to a sub-specialty consultation with Dr. Strickland. ## Read more patient stories Seyward's story is one of many. Hear from more of Dr. Strickland's patients in their own words about how they got back to the lives they love. All Success Stories Book an Appointment Contact --- # Patient Information ## Patient Information | Dr. Strickland Orthopedic Surgeon Source: https://sabrinastrickland.com/patient-information/ Summary: We’re glad you’ve chosen to take action in order to feel relief. Here For Patients # Patient Information Patient information and educational materials help you understand your diagnosis, treatment options, and what to expect before and after surgery as a patient in my practice. Patient information and educational materials help you understand your diagnosis, treatment options, and what to expect before and after surgery as a patient in my practice. These guides focus on patellofemoral (kneecap) problems and related procedures, and are designed to be shared with your family, physical therapist, and other members of your care team. Patient information & educational materials for pre- and post-operative care for my patients. I also provide information about what you can do prior to your visit with me, what you can expect after surgery, post-surgery guidelines for each procedure, and videos showing patient exercises for strength and stability. ## Patellofemoral Conditions ### Patellofemoral Instability Overview of kneecap instability, why the patella slides out of place, how it is evaluated, and when surgery is recommended. Download patient guide (PDF) → ### Patellofemoral Pain Syndrome Information about pain in the front of the knee, common causes, typical symptoms, and nonoperative and surgical treatment options. Download patient guide (PDF) → ### Patellofemoral Arthritis: Diagnosis and Treatment Explanation of arthritis and pain behind the kneecap, imaging findings, and how we decide between conservative care and surgery. Download patient guide (PDF) → ## Surgical Procedures ### Patellofemoral Joint Replacement Details about partial joint replacement of the kneecap and trochlea, including indications, surgical goals, recovery timeline, and long-term expectations. Download patient guide (PDF) → ### Medial Patellofemoral Ligament (MPFL) Reconstruction Guide to stabilizing the kneecap with MPFL reconstruction, who is a candidate, and what to expect during rehabilitation. Download patient guide (PDF) → ### Tibial Tubercle Transfer Description of realignment surgery for patellofemoral pain and instability, including how shifting the tibial tubercle changes the mechanics of the kneecap and helps relieve symptoms. Download patient guide (PDF) → ### Kneecap Cartilage Surgery Overview of kneecap cartilage restoration procedures, when they are considered, and key milestones in the recovery and return-to-activity process. Download patient guide (PDF) → ## Injury Prevention ### How to Prevent Skiing Injuries Practical tips on conditioning, equipment, warm-up, and technique to help reduce the risk of knee and lower-extremity injuries while skiing. Download patient guide (PDF) ## Don’t see your diagnosis? If you don’t see your exact diagnosis listed here, or you’re not sure which guide applies to you, please contact my office so we can direct you to the most appropriate information for your situation. Contact the Office Book an Appointment --- ## Day of Surgery & Anesthesia | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/patient-information/day-of-surgery/ Summary: What to expect on the day of surgery: changing into a hospital gown, storing belongings, and a review of your medications, allergies, and pain. For Patients # What to Expect the Day Before and Day of Surgery On the day of surgery at NYU Langone Orthopedic Center in New York City, you will change into a hospital gown, meet with the anesthesia team, sign your surgical consent, and be taken to the operating room — then recover in the PACU before going home the same day for most procedures. Below is a step-by-step walkthrough so you and your family know what to expect, and please contact my office with any questions before your procedure. For care after you go home, see our post surgery patient information and post surgery guidelines. ## The Day Before Surgery The day before surgery, you will receive a call with instructions about when to arrive and where to check in at the hospital. When you arrive on the day of surgery, plan to change into a hospital gown. Your belongings will be collected and a nurse will review important details such as your medications, allergies, and current pain level to help keep you safe and comfortable, so make sure you are ready to provide that information. Prescriptions for your postoperative medications will be sent to your pharmacy the day prior to surgery. We recommend picking up these medications before your procedure so they are available when you return home. ## The Day of Surgery Once you’re settled in, an anesthesiologist will meet with you to review your medical history, discuss your anesthesia options (such as spinal, general, or regional anesthesia), and answer questions about what to expect during and after surgery. An IV will be placed so you can receive fluids and medications, including medicine to help with pain during your procedure. ## Before You Go to the Operating Room Before you go back to the operating room, I or a physician assistant on my team will review and sign the surgical consent with you and answer any last‑minute questions. Multiple members of the team will confirm your identity, which procedure is being done, and which side we are operating on. This repetition can feel confusing, but it is an important safety step to make sure every detail is correct. Once everything is confirmed, the operating room staff will bring you into the operating room. The OR can feel cool, but you will be given warm blankets, and we’ll perform a brief time out so the entire team can again review your procedure, your allergies, and the correct side. At that point, your anesthesiologist will give medications to help you relax or go fully to sleep, depending on the type of anesthesia chosen, and will stay with you throughout surgery to monitor your vital signs and keep you safe. ## Anesthesia Options Your anesthesiologist will talk with you directly before surgery to recommend the safest option for you and to make sure you are comfortable with the plan. At the NYU Langone Orthopedic Center, techniques such as spinal or nerve blocks are commonly used for orthopedic surgery because they offer excellent pain control and often allow you to wake up more quickly and comfortably than with general anesthesia alone. ## Spinal Anesthesia Spinal anesthesia is one of the most common forms of anesthesia for orthopedic procedures. Similar to an epidural used during childbirth, medicine is injected into the spine to numb your body from the waist down. You typically receive light sedation at the same time, so you breathe on your own but are not aware of what is happening in the operating room. Many patients wake up more easily and quickly after spinal anesthesia compared with general anesthesia. ## General Anesthesia General anesthesia affects your entire body and brain, so you are completely asleep with no awareness of the surgery. It may be given through an IV, through a mask, or both, and a breathing tube or mask keeps your airway protected during the procedure. You will not feel anything or remember the surgery, and it is normal to have a mild sore throat afterward from the breathing tube. ## Regional (Nerve Block) Anesthesia Regional anesthesia involves injecting numbing medicine near specific nerves. For example, an injection around the neck or shoulder for shoulder surgery or near the thigh for knee surgery to block pain signals before they reach the brain. These blocks are usually combined with light sedation or general anesthesia so you remain comfortable throughout the procedure. To place the block, you lie down while the anesthesiologist numbs the skin and then injects medicine near the nerve, often using ultrasound guidance. The block may last 6–8 hours or sometimes longer, providing significant pain relief after surgery. It is important to start your postoperative pain medicine as soon as you begin to feel discomfort or when the numbness starts to wear off, so you stay ahead of the pain. ## After Surgery: Recovery Room After your surgery is complete, you will be taken to the recovery area (also called the Post-Anesthesia Care Unit or PACU). Nurses and anesthesia staff will closely monitor your breathing, heart rate, blood pressure, and comfort as you wake up from anesthesia. It is normal to feel sleepy, groggy, or slightly disoriented at first. Some patients may experience mild nausea or chills as the anesthesia wears off, which can be treated with medication if needed. Your surgical team will update your family or support person once the procedure is finished. ## Pain Control After Surgery Your care team will use a combination of medications and techniques to keep you comfortable after surgery. This may include nerve blocks, anti-inflammatory medications, acetaminophen, and sometimes stronger pain medications if needed. If you received a nerve block, the surgical area may remain numb for several hours after surgery. As the numbness begins to wear off, it is important to start your prescribed pain medication as directed so that pain does not suddenly increase. Our goal is to keep your pain manageable so you can begin moving safely and start your recovery. ## Going Home Many orthopedic procedures are performed on an outpatient basis, meaning you will go home the same day once you are fully awake, comfortable, and medically stable. Before leaving, your care team will review: - Your medications - Wound care instructions - Activity restrictions - When to begin physical therapy (if applicable) - Signs of complications to watch for You must have a responsible adult available to take you home after surgery. ## When to Call or Seek Help Please contact my office or seek urgent medical care if you notice any of the following after surgery: - Fever or chills that do not improve. - Increasing redness, warmth, drainage, or a bad smell from your incision. - Sudden or significantly worsening calf pain, swelling, or tenderness. - Chest pain, trouble breathing, or sudden shortness of breath. - Severe pain that is not improving with the prescribed plan. - New numbness, weakness, or other neurologic symptoms that concern you. If you are ever unsure whether a symptom is expected, it is always better to call and ask so we can help you decide on the safest next step. ## Questions? Let’s talk. Dr. Strickland’s team is here to help answer your questions and guide your next step. Patient Information Post Surgery Contact --- ## Frequently Asked Questions | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/patient-information/frequently-asked-questions-knee-surgery-recovery/ Summary: Read these frequently asked questions I get about knee surgery, recovery, and research. Find the answers you need to help you get back to your active lifestyle. For Patients # Frequently Asked Questions As a board-certified orthopedic surgeon and specialist in knee and shoulder surgery at the NYU Langone Orthopedic Center 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. If your question isn’t listed, please contact my office. ## Practice Logistics and Access ### Is it possible to do an observation of your surgical work? Since I already have residents and fellows observing at the NYU Langone Orthopedic Center, I typically cannot accommodate additional observers. ## Knee Treatment Options: Surgical & Non-Surgical ### How does Cartiheal compare to OCA and MACI? Definitions: - Cartiheal is a synthetic scaffold used to help regenerate cartilage and underlying bone in the knee.  - Matrix-Associated Autologous Chondrocyte Implantation (MACI) is a two-stage procedure where a patient’s own cartilage cells are grown in a lab and then implanted to repair cartilage defects.  - Osteochondral Allograft Transplantation (OCA) is a procedure where bone and cartilage from a donor are transplanted to repair a damaged area in the knee.  - Cartilage lesions are damaged areas in the smooth tissue lining the ends of bones in the joint.  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. ### What is the recovery time for Cartiheal vs. the osteochondral allograft? Both have an average full recovery of about six months. ### Are you seeing better results from Cartiheal vs. an allograft implant? Cartiheal is still new, and while recovery times are similar, osteochondral allografts have a success rate of around 85%. ### Are the customized knee replacements that insurance doesn’t cover worth paying extra for? No; current evidence does not support extra payment for these custom implants as no superior outcome data exists. ### I’m interested in Moximed MISHA and don’t want to do a total knee yet. Is this commercially available? 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.  ## Knee Injuries and Complex Diagnoses ### With a retear after a knee [ACL] reconstruction, what kind of pain and swelling is expected and what other injuries would cause instability in the knee under load while trying to pivot? Anterior Cruciate Ligament (ACL) is the main ligament that helps stabilize the knee. Pain and swelling after a re-tear 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. ### I have a child with Ehlers Danlos that suffered a tibial plateau avulsion fracture with damage to the ACL and meniscus who also has patellar instability issues in both knees. Who should we see? 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.) ## Osteotomies and Rehabilitation ### I’ve just had Tibial Tubercle Osteotomy (TTO) surgery. I’m a week post op and it’s quite painful. Any tips on what to do to get back to my active lifestyle? 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. ### Do you send the tibial tuberosity post-ops to physical therapy? 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.  ### I had a Tibial Tubercle Osteotomy (TTO). When do you recommend the screws be removed? The screw should be removed six months or later, once bone healing is confirmed. ### I had a Tibial Tubercle Osteotomy (TTO) after years of pain and irritation and they found a huge gap of cartilage in my knee. Two years later, I still can’t jog or play tennis. What should I do? If pain persists, a high-quality MRI can help evaluate remaining cartilage. Persistent defects may be treatable with cartilage transplant procedures. ## Patellar Instability and Cartilage Restoration ### I was told I can’t get surgery for my patella alta until I am fully grown. Is this true? 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. ### I have an upcoming medial patellofemoral ligament (MPFL) surgery. How much time will I have to wait until I can start (slowly) moving again? 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. ### I have patellofemoral osteoarthritis (grade IV), outerbridge cartilage loss in the patella and trochlea [femur]. Is this curable?  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.  ## Knee Deformities and Bracing ### Is bracing an effective modality for constant hyperextension (genu recurvatum)? 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. ### Is there anything done for genu recurvatum? Or any sort of prevention that can be utilized? Operative treatment is not typical. Working with a physical therapist to avoid knee locking and improve neuromuscular control can help with prevention. ## Injury Terminology & Definitions ### What is the injury called if the patella tendon pulls a piece of the tibia out? 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. ## Have More Questions? 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. ## Questions? Let’s talk. Dr. Strickland’s team is here to help answer your questions and guide your next step. Patient Information Book an Appointment Contact --- ## Patient Exercises | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/patient-information/patient-exercises-for-strength-and-stability/ Summary: Patients often ask about the best strengthening exercises for their legs. I made these videos to show some examples of safe, effective movements that build strength and improve balance. For Patients # Patient Exercises for Strength and Stability Patients often ask about the best strengthening exercises for their legs. I made these videos with my good friends to show some examples of safe, effective movements that build strength and improve balance. This series includes exercises that target the glutes, hamstrings, quads, and core to support healthy movement and joint stability. Watching these demonstrations can help you see the right form and learn how to modify each exercise to fit your ability level. Transcript This exercise is a lunge, but by doing a row at the same time, you get a lot of core, which is really helpful and helps support essentially every other exercise you do. For a lot of patients who have knee pain, it's helpful to not move through the lunge. Exercise such as walking lunges can really load the front of the knee, but the static lunge tends to be far better tolerated. ## Static Lunge With Row: Core and Knee-Friendly Strength This exercise is a lunge, but by adding a row at the same time, you get a lot of core engagement, which is helpful and supports almost every other exercise you do. For many patients with knee pain, it’s easier to tolerate a static lunge rather than moving through space. Walking lunges can really load the front of the knee, but the static lunge is often much better tolerated while still building strength and stability. In this video, you’ll see how to combine the lunge position with a controlled row to work the legs, glutes, and core together. Focus on staying tall through your torso, keeping your front knee comfortable, and using a weight that allows you to move with good form.   ## Squats With Bands: Knee-Friendly Strength and Stability This is an awesome exercise, and what makes it so helpful is the TheraBand positioned around the back of the knees. The band encourages you to lean back and keeps your weight toward your heels, which reduces stress on your kneecaps while you squat. A second feature that makes this exercise special is the added chest press, which turns it into a full-body movement that challenges both your legs and upper body. You want to make sure the weight isn’t so heavy that it pulls you forward or forces you out of good form. This variation can also be done with TRX bands, which changes the feel slightly but still helps keep your weight back and off the front of your knees. Transcript This is an awesome exercise and what makes it so great is the thera band around the back of her knees. Uh, essentially what this means is you have to lean back and it keeps your weight back which reduces the amount of stress on your kneecaps. The second part of this exercise that makes it special is the chest press. You want to make sure the weight's not so heavy that you have to lean forward. This exercise can also be done with TRX bands. Uh, it changes it a little bit, but it also keeps your weight back. Transcript Patients ask a lot of questions about what specifically to do at the gym. This exercise here, the single leg leg press, is one of my favorites. And you can do both legs at the same time if you're absolutely sure that your leg strength is the same. Here you can see that uh she's continuing uh to do this until exhaustion. So there's no magic number. It's not like you do eight reps or 12 reps. And generally I like between 20 and 30 reps. As far as how many sets, uh, I think two to three sets is usually adequate. ##  Single Leg Press: Safe Strengthening Tips for Patients Patients ask a lot of questions about what specifically to do at the gym, especially for safe leg strengthening. The single leg leg press is one of my favorite exercises because it helps build strength in each leg individually and can highlight any side-to-side differences. You can do both legs at the same time if you are absolutely sure your leg strength is the same. In this video, you’ll see the exercise performed to the point of fatigue (there’s no magic number of reps). In general, I like patients to work in the 20–30 rep range, with about 2–3 sets, focusing on control and proper form rather than rushing through the movement. Use a weight that challenges you by the end of the set but still feels safe on your joints. ##  Leg Strengthening: The Romanian Deadlift + Row Combo Patients often ask about the best strengthening exercises for their legs. I made these videos with my good friends to show some examples of simple, effective movements that build stability and strength. In this video, you’ll see a Romanian deadlift combined with a row, which is a great way to work the glutes, hamstrings, and core while improving balance. Watching someone perform the move can make it easier to understand how to get into the right position and keep good form. If balancing with the row feels challenging, try starting with just the Romanian deadlift until you’re comfortable. If this is too hard you can do it without the row or you can hold free weights in your hands and let your hands dangle for balance. Transcript This exercise is a Romanian deadlift combined with a row. So what is good about this exercise is first of all it emphasizes balance and and secondly both core, glute and hamstring strengthening. So, if this is too hard, you can do it without the row or you can hold free weights in your hands and let your hands dangle for balance. PrevPreviousPost Surgery Guidelines NextWhat to Expect the Day Before and Day of SurgeryNext ## Questions? Let’s talk. Dr. Strickland’s team is here to help answer your questions and guide your next step. Patient Information Post Surgery Guidelines Contact --- ## Post Surgery Guidelines | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/patient-information/post-surgery-guidelines/ Summary: This page brings together post surgery guidelines for the most common knee and shoulder procedures I perform, including ligament reconstructions, cartilage restoration, osteotomies, and joint replacements. For Patients # Post Surgery Guidelines Each post-surgery guideline sheet below is a procedure-specific PDF prepared by Dr. Strickland’s team at NYU Langone Orthopedic Center in New York City covering activity, wound care, pain control, and physical therapy milestones. Now that your surgery is complete, it’s important to have clear, written instructions you can refer back to at home. This page brings together post surgery guidelines for the most common knee and shoulder procedures I perform, including ligament reconstructions, cartilage restoration, osteotomies, and joint replacements. Please download the post surgery guideline sheet that matches your procedure and review it carefully before and after surgery, and reach out to my office if anything is unclear or doesn’t match what you’re experiencing. For general post-operative care and physical therapy demonstrations, see our post surgery overview and patient exercises. ## ACL, PCL & Meniscus - ACL Reconstruction - ACL and Meniscal Repair - ACL/PCL Reconstruction with MCL Repair - Meniscectomy / Arthroscopy / Chondroplasty / Biopsy - Meniscal Transplant: Lateral - Meniscal Transplant: Medial - Meniscal Repair: Horizontal / Bucket Handle - Meniscal Repair: Root / Radial ## Patellar Stabilization & TTO - MPFL Reconstruction - MPFL and Patellofemoral Joint Replacement (PFJR) - Tibial Tubercle Osteotomy - Tibial Tubercle Osteotomy with Distalization - Tibial Tubercle Osteotomy and MPFL - Tibial Tubercle Osteotomy with Distalization and MPFL - Tibial Tubercle Osteotomy / MACI - TTO with Distalization, MPFL, and Cartilage / OCA ## Cartilage Restoration - MACI / DeNovo: Patella / Trochlea - MACI / DeNovo: Condyle - OCA: Patellar and Trochlear - OCA - OCA / MPFL ## Osteotomy & Joint Replacement - Distal Femoral Osteotomy - High Tibial Osteotomy - Total Knee / Partial Knee / PFJR - Unicompartmental Replacement ## Shoulder - Bicep Tenodesis - Rotator Cuff Repair / Bicep Tenodesis - Labral Repair / Shoulder Stabilization - Total Shoulder Arthroplasty - Arthroscopic Capsular Release ## Questions? Let’s talk. Dr. Strickland’s team is here to help answer your questions and guide your next step. Patient Information Patient Exercises Contact --- ## Post Surgery Information | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/patient-information/post-surgery/ Summary: Now that you’ve gone through the procedure, it’s important to know how to care for yourself. Follow this helpful patient information post surgery. For Patients # Post Surgery Now that you’ve gone through the procedure, it’s important to know how to care for yourself. Follow this helpful patient information to ensure a healthy healing process post surgery. ### Keep it cold Use the ice machine as directed or purchase several gel ice packs and apply with fabric next to the skin for 20 minutes every 60 to 90 minutes. Ice is most important during the first week, but should still be used 3 to 4 times a day for 6 to 8 weeks post surgery, especially after a lot of activity. ### Keep it dry The initial hospital dressing stays on for the first 48 hours, then is replaced by a waterproof dressing. You can cover small arthroscopy portals with Nexcare™ bandaids; these resemble plastic wrap and keep water out of the wound. Cover larger wounds with Tegaderm™, available in most pharmacies. I usually use absorbable sutures and glue, so it is unlikely anything will need to be removed. ### Elevate Post surgery, keep your foot up on a bed, sofa, or coffee table when resting if you just had knee surgery. For shoulder surgery, it is much more comfortable to stay relatively upright, which means sleeping on the couch, a recliner, or with a lot of pillows in bed. ### Keep track of your medication You will be prescribed a prescription pain reliever. This most often contains Tylenol®, which should not be mixed with over-the-counter pain relievers. Please write down when you take your medication so you take it at regular intervals to keep your pain level at a minimum post surgery. Also, please call our office when you are starting to get low on medication — narcotics are impossible to obtain on weekends. ### Start your physical therapy The physical therapy instructions come from the physical therapist at NYU Langone Orthopedic Center. Start these exercises immediately so you get moving; this helps you avoid stiffness and hopefully a blood clot. A staff member from Dr. Strickland’s office will call you the day after surgery to answer any questions you may have and provide additional patient information. ### Recovery shop Get the materials you need for your recovery. I use The Recovery Shop for all my ice machines and other equipment, including compression socks and waterproof bandages. That’s helpful to have available around the time of surgery (especially post surgery). These items are eligible for purchase using a Health Savings Account (HSA). We will discuss which items you’ll need at your visit prior to surgery. ## Questions? Let’s talk. Dr. Strickland’s team is here to help answer your questions and guide your next step. Post Surgery Guidelines Patient Exercises Contact --- ## Prior to Visit Patient Information | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/patient-information/prior-to-visit/ Summary: We’re glad you For Patients # Prior to Visit We’re glad you’re taking action to relieve pain. Here’s how to get ready for your consultation with Dr. Strickland so we can spend the visit on what matters — understanding your injury and planning your treatment. ## Pay Attention to Your Symptoms Take note of which activities worsen your symptoms and what makes you feel better. Keep track of recent changes in activity, whether you have new running shoes or old ones, and what you think caused the injury. This information helps Dr. Strickland form a diagnosis more quickly. ## Gather Your Records Please bring your MRI, CT, or X-ray images on CD to your appointment, along with any results of relevant blood work, reports of previous surgeries, or other health information that can help Dr. Strickland form an accurate picture of your history and current injury. ## Complete Online Forms We strongly encourage patients to fill out patient information forms before their visit to reduce waiting time at the office. You should have received an email with a link to access your forms through our online portal — please check your junk and spam folders if you don’t see it. If you are having difficulty with the online forms, please contact our office at . ## Questions? Let’s talk. Dr. Strickland’s team is here to help answer your questions and guide your next step. Patient Information Book an Appointment Contact --- # Blog ## 11 Shoulder Stretches To Fight Stiffness | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/11-shoulder-stretches-fight-stiffness/ Summary: The best shoulder stretches can be done anywhere, whether integrated into your pre-workout warmup or in bite-sized sessions at your desk throughout the day. # 11 Shoulder Stretches that Fight Stiffness & Improve Posture Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: February 13, 2025 - August 16, 2024 For those of us who make daily activity a priority, yet must spend our long days in primarily sedentary postures, keeping our bodies free of aches and pains can be a real challenge. The shoulder joint is one major pain point for serial hunched-over desk job workers. Good news: The best shoulder stretches can be done anywhere, whether they are integrated into your pre-workout warmup or done in bite-sized sessions at your desk throughout the day. I contributed to this Women’s Health article: I’m A Trainer And Do These 11 Shoulder Stretches Weekly To Combat Stiffness And Improve Posture Photo by Alex Shaw on Unsplash. - at-home stretches, back stretches, best stretches, chest stretches, cool-down, deltoid, desk stretches, effective stretches, exercises, fitness, flexibility, injury prevention, mobility, neck stretches, office stretches, pilates moves, posture, range of motion, rotator cuff, routine, shoulder, shoulder pain, shoulder stretches, stress relief, tension relief, trapezius, upper body, warm-up, wellness, women's health, workout, yoga poses ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousMedial Meniscus Root Repair With Implantable Shock Absorber Placement NextStudy Following MACI Cartilage Transplantation PatientsNext --- ## 11 Stretches to Offset Shoulder Pain - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/11-shoulder-stretches-to-give-the-important-joint-some-tlc/ Summary: Dr. Sabrina Strickland was featured in this Women # 11 Shoulder Stretches To Give The Important Joint Some TLC Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - January 13, 2022 Athletes—particularly those who throw or swing things (like baseballs or tennis rackets) —are most prone to tightness and pain. Cross-training, yoga, and regular strength training can help offset shoulder pains, while shoulder stretching can help you make up for deficits caused by injury, overuse, or poor mechanics. I contributed to this article in Women’s Health Mag outlining 11 shoulder stretches you can do.   Read the whole article for daily stretches you can do to ward off pain and tightness in the shoulder.  - athlete, athletes, daily stretching, Hospital for Special Surgery, HSS, shoulder joint, shoulder stretches, sports, women's health mag ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPrevious6 Causes of Knee Pain From Running—And How to Prevent and Treat It NextGreat to See Miami Marathon Runners Back in ActionNext --- ## TV's 12 on Health | Orthopedic Medicine - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/12-on-health-with-dr-sabrina-strickland/ Summary: Common medical issues that can be serious if not addressed early – orthopedic injuries and when you need to get to a doctor. Skip to content # 12 on Health with Dr. Sabrina Strickland Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: July 18, 2025 Common medical issues that can be serious if not addressed early – orthopedic injuries and when you need to get to a doctor. Manage Cookie Consent To provide the best experiences, we use technologies like cookies to store and/or access device information. Consenting to these technologies will allow us to process data such as browsing behavior or unique IDs on this site. 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This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. --- ## Recurring Patellar Dislocation - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/3-anatomical-factors-linked-higher-risk-recurring-patellar-dislocation/ Summary: This study, authored by Lutul Farrow, shows with computer modeling which anatomical factors are linked with recurring patellar dislocation. # 3 Anatomical Factors Linked to Recurring Patellar Dislocation Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - August 10, 2023 This study, authored by Lutul Farrow (a fellow member of the International Patellofemoral Study Group), shows with computer modeling what anatomical factors are linked with recurring patellar dislocation. The last thing that I want to do is operate for no reason. Seeing that I don’t have a crystal ball, I rely on studies such as these to determine which patients are likely to dislocate their patella again and in these cases fix the knee so that it doesn’t happen again. Read more on the Cleveland Clinic site: Three Anatomical Factors Linked with Higher Risk of Recurring Patellar Dislocation - anatomical factors, computer modeling, International Patellofemoral Study Group, knee, patellar dislocation, patellofemoral, recurring patellar dislocation, study, surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousEpisode 44: Challenging Cartilage Injuries with Dr. Sabrina Strickland & Dr. Seth Sherman, Live at AOSSM 2023 NextProximal Bone Block With Distal Screw Trajectory & StabilityNext --- ## 3D Imaging of the Patellofemoral Joint | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/3d-imaging-patellofemoral-joint/ Summary: Computerized tomography (CT) provides a new, widely accessible path to improve patellofemoral surgical planning by creating 3D imaging of the patellofemoral joint. # How 3D Imaging of the Patellofemoral Joint Improves Treatment Options Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: April 4, 2025 - April 4, 2025 John Fulkerson, MD, is the father of patellofemoral surgery and continues to amaze me with his deep thinking about how the patella tracks in the front of the femur and how we can improve our understanding of this complex joint. With a better understanding, we can develop better algorithms to treat our patients. In this blog post, John discusses how using 3D imaging to build models based on CT scans with the knee in full extension and at 20 degrees of flexion has helped him understand how to best treat his patients. Very subtle anatomic variations can predispose some patients to patellar instability and others to arthritis. Ideally, we treat these patients early and avoid the disability associated with recurrent dislocations and/or arthritis.  Read his full post on Healio (Orthopedicstoday): BLOG: 3D patellofemoral joint imaging provides new path for better surgical planning There’s also an article in The Journal of Arthroscopic and Related Surgery on this topic: Three-Dimensional Imaging of the Patellofemoral Joint Improves Understanding of Trochlear Anatomy and Pathology and Planning of Realignment. Photo by Stockcake   - 3D imaging, Anteriorization, Distalization, Entry point-trochlea groove angle, knee, Knee flexion, Medialization, orthopaedics, osteotomy, patella alta, Patella entry zone, patellar instability, patellofemoral joint, Supratrochlear spur, Surgical planning, tibial tubercle transfer, Tibial tubercle-trochlear groove distance, Trochlea classification, Trochlear dysplasia ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousUsing Tendons & Ligaments in ACL Surgery NextCommon Questions About Stem Cells, Exosomes, & Cartilage RepairNext --- ## 3D Printing Patellofemoral Instability | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/3d-printing-patellofemoral-instability-rehab/ Summary: I’m not exactly sure how novel technology, such as 3d printing, can help rehabilitate patients with patellofemoral instability but I’m excited to learn more. # Novel 3D Printing Tech Realigns Patellofemoral Instability Rehab? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: February 29, 2024 - February 13, 2024 I’m not exactly sure how 3D printing can help rehabilitate patients with patellofemoral instability — but I’m excited to learn more. While as surgeons we can change certain aspects of a patient’s anatomy, we still rely on the physical therapists to help our patients improve their strength and mechanics.   I still remember seeing a lecture by the famous physical therapist, Jenny McConnell, from Australia back in 2015. Her videos of patients with patellar instability before and after rehabilitation were truly incredible. A team-based approach to these patients is ideal but not always possible. Nevertheless, I will follow this research closely.     Read the original article in Healio:  BLOG: Realigning rehabilitation of patellofemoral instability with novel technology - 3D imaging, 3D printing, novel technology, orthopedics, patellofemoral instability, patient rehab, rehab, rehabilitation, targeted core neuromuscular training, trochlea ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousKnee Pain Keeping You Up at Night? NextZKR Orthopedics’ LIFT implant Receives FDA Breakthrough Device DesignationNext --- ## 4 Ways to Manage Patellar Tendinopathy - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/4-ways-to-manage-patellar-tendinopathy/ Summary: Read this article to discover the best four ways to manage patellar tendonopathy, including cross training, replacing your shoes, and more. # 4 Ways to Manage Patellar Tendinopathy Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 Quick Summary Patellar tendinopathy — often called jumper's knee — is best managed with a combination of progressive loading, training-load adjustments, equipment review, and selective adjuncts. Heavy slow-resistance and eccentric programs build tendon capacity, while smarter cross-training and footwear changes reduce repetitive strain. Most cases improve without surgery, though stubborn tendinopathy may benefit from targeted therapies after the basics have been optimized. - December 22, 2022 I haven’t read this article yet, but I would suggest that the best four ways to manage patellar tendinopathy are: 1. Get new shoes every 300 miles 2. Cross train (don’t just run or play basketball) 3. Wear a Chopat strap just below your knee cap or use kinesiotape 4. Lift weights.   If these suggestions aren’t working, you may need a MRI as it might not be patellar tendinopathy! Read the article. - chopat strap, crosstraining, kinesiotape, kneecap, knees, MRI, patellar tendinopathy, running, weight lifting ## Frequently Asked Questions How long does patellar tendinopathy take to heal?Tendinopathy typically improves over 3–6 months with consistent loading work, and stubborn cases can take longer. Tendons remodel slowly compared to muscle, which is why people who try a few weeks of rest and stretching are often disappointed. Progressive heavy slow-resistance training is the most evidence-supported path back to full activity. Are eccentric exercises better than other strength training?Eccentric exercises — like decline single-leg squats — were the original gold standard, but more recent evidence shows heavy slow-resistance training is at least as effective and often better tolerated. The key is progressive loading, not the exact protocol. I recommend working with a sports physical therapist to individualize the program based on pain levels and goals. Should I get a PRP or cortisone injection for patellar tendinopathy?Cortisone injections are generally not recommended for patellar tendinopathy because they can weaken the tendon. PRP (platelet-rich plasma) has mixed evidence and is sometimes considered for patients who haven't improved with 3–6 months of structured rehab. Injections are an adjunct, not a substitute for the loading program. ## Related Reading - Patellar pain & patellar arthritis (specialty page) - Eccentric cycling for patellar tendinopathy - Cortisone vs gel injections ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousBEAR Implants in the News NextAnteromedialization Tibial Tubercle Osteotomy Improves Patellar Contact Forces: A Cadaveric Model of Patellofemoral DysplasiaNext --- ## 5 Torn Meniscus Symptoms Self-Heal | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/5-symptoms-of-a-torn-meniscus-that-will-self-heal/ Summary: Understanding which symptoms suggest your torn meniscus might self-heal can help you make informed decisions about your treatment and recovery. # 5 Symptoms of a Torn Meniscus That Will Self-Heal Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: April 30, 2026 Quick Summary Some meniscus tears can heal without surgery, particularly small peripheral tears in well-vascularized red-zone tissue and degenerative tears in older patients without mechanical symptoms. The symptoms that suggest a self-healing tear include intermittent pain without locking, swelling that resolves quickly, and pain that responds to a structured rehab and strengthening program. Mechanical locking, persistent catching, or a bucket-handle tear pattern usually need surgical care. - June 12, 2025 A torn meniscus is a common knee injury, but not every tear requires surgery. In fact, many minor meniscal tears can heal on their own with the right care and patience. Understanding which symptoms suggest your meniscus tear might self-heal can help you make informed decisions about your treatment and recovery. ## What Kind of Meniscus Tears Can Heal on Their Own? The meniscus has two main zones: the outer “red zone,” which has a good blood supply, and the inner “white zone,” which has little to no blood supply. Tears located in the outer third of the meniscus—especially small, longitudinal tears—are more likely to heal naturally because the blood supply in this area supports tissue regeneration. Tears in the inner two-thirds are far less likely to heal without intervention due to limited blood flow. ## Symptoms of a Meniscus Tear That May Self-Heal If you have a minor meniscal tear, you might notice these five symptoms: - Mild pain along the joint line of the knee, especially during twisting or squatting, but not enough to significantly limit daily activities. - Some swelling or stiffness that improves with rest, ice, and anti-inflammatory medication. - A sensation of tightness or mild discomfort, but you can still bend and straighten your knee fully. - No significant locking, catching, or giving way of the knee. - The ability to walk and perform light activities without your knee feeling unstable or “stuck.” If your symptoms are limited to mild pain and swelling, and you do not experience mechanical symptoms like locking or persistent instability, there’s a good chance your tear is small. With conservative treatment—such as rest, ice, compression, elevation, and physical therapy—these tears often become asymptomatic in a few weeks. ## When to Seek Medical Advice Even if your symptoms seem mild, it’s important to consult a knee specialist for a proper diagnosis. Early intervention can help you recover faster and prevent further complications. If your pain, swelling, or instability worsens, or if your knee begins to lock or catch, you should see an orthopedic surgeon to discuss your options. ## Conservative Treatment Tips For minor meniscal tears, recommendations include: - Resting your knee and avoiding activities that aggravate symptoms. - Using ice and anti-inflammatory medication to reduce swelling. - Engaging in physical therapy to strengthen the muscles around your knee and restore range of motion. - Gradually returning to normal activities as your symptoms improve. If you follow these steps and your symptoms steadily improve, you may avoid surgery altogether. However, if conservative management does not relieve your symptoms, or if your knee becomes unstable, further evaluation may be necessary. For more information on meniscal tears, their symptoms, and treatment options, read more about meniscal tears and torn meniscus. Photo by Judy Beth Morris on Unsplash - conservative treatment, locking or catching, meniscus tear, mild pain, Physical Therapy, red zone, rest, self-heal, swelling, white zone ## Frequently Asked Questions How can I tell if my meniscus tear will heal without surgery?The tears most likely to heal on their own are small, sit in the outer part of the meniscus where there is good blood supply, and cause pain but don't make the knee lock or get stuck. If your symptoms improve over 6 to 8 weeks of physical therapy and strengthening exercises and you don't feel the knee catching, the tear can usually be managed without surgery. I order an MRI first to confirm exactly where the tear is and what shape it has before recommending the non-surgical path. Does an MRI tell us if a meniscus tear can heal on its own?Yes. The MRI shows where the tear is, how long it is, what shape it has, and how the cartilage next to the tear looks. Tears in the outer part of the meniscus — where there is good blood flow — have the best chance to heal. More complex tears, tears that go straight across the meniscus (called radial tears), or tears at the root usually need surgery. The MRI also tells me if the tear is from gradual wear over time (degenerative), which is common in older patients and usually responds well to non-surgical care. What activities should I avoid while a meniscus tear is healing?I usually recommend skipping deep squats, twisting motions while loaded with weight, and high-impact pivoting until your symptoms calm down. Cycling, swimming, and the elliptical are usually fine. Strengthening your quad muscles and hip stabilizers takes pressure off the knee. The goal is to stay active in ways that don't put your knee back into the same motion that caused the tear in the first place. ## Related Reading - Meniscal tear / torn meniscus (specialty page) - 6 exercises to do with a torn meniscus - Exercises to avoid with a torn meniscus ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousExpert Insights, Preferences for BEAR Technique NextMedical Tourism: Benefits, Risks, and What to ConsiderNext --- ## Prevent & Treat Knee Pain From Running - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/6-causes-knee-pain-running/ Summary: Running offers plenty of incredible benefits for both your mind & body, it can also often come with one particularly common complaint: knee pain. # 6 Causes of Knee Pain From Running—And How to Prevent and Treat It Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 Quick Summary Knee pain in runners most often traces to patellofemoral pain syndrome, iliotibial band syndrome, patellar tendinopathy, meniscus injury, mild osteoarthritis, or training-load errors. The location of the pain — kneecap, lateral knee, joint line, or behind the knee — narrows the diagnosis quickly. Most running-related knee pain responds to load management, strength work for the hips and quadriceps, gait or shoe adjustments, and time, without requiring surgery. - August 20, 2021 Whether you’re lacing up for your first 5k, training for your next half-marathon, or enjoying an accessible way to get active, running can be a rewarding way to stay fit, get competitive, and just escape the stresses of daily life for a little while. And while pounding the pavement (or the tread!) offers plenty of incredible benefits for both your mind and your body, it can also often come with some less-than-desirable aches and pains. One particularly common complaint: knee pain. I contributed to this article on Health.com, which has a lot of useful information on preventing and treating knee pain related to running. - knee pain, running ## Frequently Asked Questions Should I run through knee pain or stop entirely?Mild discomfort that doesn't worsen during a run, isn't present the next morning, and stays below 3/10 in intensity is usually safe to run through with reduced volume. Sharp pain, swelling, mechanical symptoms, or pain that limps your gait are reasons to stop and evaluate. Smart load management — not complete rest — is usually the right answer for overuse pain. Are minimalist shoes or maximalist shoes better for runners with knee pain?Neither is universally better. Maximalist (high-cushion) shoes can reduce impact loading and help some runners with patellofemoral or osteoarthritic pain. Minimalist shoes shift load toward the calf and Achilles, sometimes helping with patellofemoral pain but stressing the foot and ankle. The best shoe is the one that matches the runner's anatomy, gait, and history — not a category. Does running cause knee arthritis?Recreational running has not been shown to cause knee arthritis in most studies — and may even be protective compared to sedentary controls. Very high-volume running and prior knee injury increase risk. The bigger drivers of knee arthritis are genetics, prior injury, body weight, and meniscal status. For most people, running is safe for the knees when training volume is sensible. ## Related Reading - Knee & shoulder specialties (hub) - Do you have knee pain? - 4 ways to manage patellar tendinopathy ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousKnees Might Hurt After Sitting – POPSUGAR Next11 Shoulder Stretches To Give The Important Joint Some TLCNext --- ## 6 Exercises To Do With Torn Meniscus | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/6-exercises-to-do-torn-meniscus/ Summary: A torn meniscus can cause pain, swelling, and instability. These 6 exercises can help you maintain strength and mobility while protecting your knee as it heals. # 6 Exercises You Should Do With a Torn Meniscus Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: June 19, 2025 Quick Summary Smart exercise selection during a meniscus tear protects the joint while maintaining strength and motion. Quad sets, straight-leg raises, mini-squats within a pain-free range, hip abduction, and low-impact cardio (cycling, swimming, elliptical) are typically well tolerated. The goal is to build the muscles that offload the knee — quadriceps, glutes, hamstrings — without reproducing the painful mechanism. Always stop short of sharp pain or true mechanical catching. - June 19, 2025 A torn meniscus can cause knee pain, swelling, and instability, making it challenging to stay active. However, the right exercises can help you maintain strength and mobility while protecting your knee as it heals. It’s important to focus on gentle, controlled movements that do not place excessive stress on the meniscus. Below are the exercises my team and I at Hospital for Special Surgery typically recommend during the early weeks of recovery — they are deliberately low-load and pain-free, and they form the base of nearly every meniscus rehab plan we send to physical therapy. ## Why Exercise Matters After a Meniscus Tear Targeted exercise after a meniscus tear protects the joint by strengthening the muscles that offload the knee — quadriceps, hamstrings, and glutes — while keeping range of motion within a pain-free arc. Loaded immobility is what drives stiffness, quad atrophy, and slower healing. The right program reduces pain, supports the body’s own meniscal healing response in the vascular peripheral zone, and prevents the deconditioning that makes return to sport much harder later. It also matters which exercises you avoid: open-chain knee extension and deep loaded flexion can shear the tear and delay recovery, so they come out of the program until later phases. Exercise helps maintain muscle strength, joint stability, and range of motion — all of which are critical for recovery from a meniscal injury. Always consult your physician or physical therapist before starting any exercise routine, as recommendations may vary depending on the severity and location of your tear. ## Safe Exercises for a Torn Meniscus ### 1. Quad Sets These exercises are simple contractions of the quadriceps muscle without moving the knee. Sit with your leg straight and tighten the muscle on the front of your thigh, holding for five seconds, then relax. Repeat several times. This exercise helps maintain muscle strength without putting stress on the knee joint ### 2. Heel Slides In this exercise, lie on your back with your legs straight. Slowly slide your heel toward your buttocks, bending your knee as far as is comfortable, then slide it back out. This gentle movement helps restore knee flexion and extension without excessive pressure on the meniscus. ### 3. Ankle Pumps While sitting or lying down, flex your foot up and down at the ankle. This simple exercise improves circulation, reduces swelling, and helps prevent blood clots, especially if you’re less mobile after injury or surgery. ### 4. Gravity-Assisted Knee Flexion Sit on a chair and let your lower leg dangle, gently swinging it back and forth. This exercises uses gravity to help regain knee motion without forcing the joint, making it a safe way to improve flexibility. ### 5. Patellar Mobilization Gently move your kneecap up, down, and side-to-side with your fingers. This exercises can help prevent scar tissue and maintain mobility in the knee joint after injury or surgery. ### 6. Stationary Bike (as approved by your doctor) Once you have regained some range of motion and your doctor or physical therapist approves, gentle cycling on a stationary bike is an exercise that can help restore mobility and build endurance without high impact. ## What to Avoid Open chain knee extension exercises (such as using a leg extension machine) and deep squats or lunges should be avoided, as they can put excessive strain on the meniscus and delay healing. ## The Importance of Professional Guidance Every meniscal tear is unique, and your exercise plan should be tailored to your specific injury and recovery stage. It’s important to follow the instructions of your orthopedic surgeon and physical therapist to ensure a safe and effective recovery. If you experience increased pain, swelling, or instability during any exercise, stop and consult your care team. For more information on meniscal tears, symptoms, and recovery — including detailed exercise guidelines — read this meniscal tear resource. If you have more questions about a torn meniscus, see these additional posts: - 5 Exercises to Avoid With a Torn Meniscus - 5 Symptoms of a Torn Meniscus That Will Self-Heal - How To Know When You Should Have a Torn Meniscus Surgically Repaired     - exercises, healing, joint, knee, mobility, pain, physical therapist, recovery, strength, torn meniscus ## Frequently Asked Questions Can I keep running with a torn meniscus?Some patients can keep running with a wear-and-tear meniscus tear or a small, stable tear in the outer part of the meniscus, as long as running doesn't cause sharp pain or swelling. If your knee locks, catches, or suddenly gives way, stop and get evaluated. Cutting your mileage, switching to softer surfaces, and adding strengthening exercises often lets you keep running while the tear settles down. How long should I stick with conservative exercise before considering surgery?I usually recommend trying 6 to 8 weeks of physical therapy and strengthening before considering surgery for a meniscus tear that isn't causing the knee to lock or catch. Many tears improve in that window. If your pain doesn't get better, or if you start having locking, catching, or ongoing swelling, it's time for a surgical evaluation. Locking and catching rarely go away with physical therapy alone. Is yoga safe with a torn meniscus?Most yoga is safe and helpful, but I recommend modifying poses that bend the knee deeply (full lotus, deep pigeon, deep squats), heavy twisting with weight on the leg, and any pose that causes sharp pain on the inner or outer side of the knee. A good instructor can offer easier alternatives. The mobility, balance, and hip-strength work in yoga pairs really well with knee rehab when you modify the deep poses. ## Related Reading - Meniscal tear / torn meniscus (specialty page) - Exercises to avoid with a torn meniscus - Meniscus symptoms that may self-heal ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousMedical Tourism: Benefits, Risks, and What to Consider NextOne Step Cartilage Repair: Targeting the TrochleaNext --- ## 6 Tips to Train Like a Pro Athlete - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/6-tips-to-train-like-a-professional-athlete/ Summary: Source: www.hss.edu/playbook/6-tips-to-train-like-a-professional-athlete/ # 6 Tips to Train Like a Professional Athlete Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: March 9, 2023 - October 4, 2015 From HSS: Ever wonder how your exercise routine stacks up against what the professionals do? Sure they might have access to more resources than you do, but a little knowledge goes a long way. The following insights can help you incorporate the best of the professionals training habits into your own fitness plan, making the most of your potential while minimizing the risk for injury. Remember to consult a physician before starting an exercise regimen.   ## 6 Tips to Train Like a Professional Athlete – HSS Playbook Source: www.hss.edu/playbook/6-tips-to-train-like-a-professional-athlete/       - athlete, professional athlete, training ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousThe Scariest Thing About Sports NextAttention Baseball PlayersNext --- ## The State of Youth Sports in the US - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/7-charts-that-show-the-state-of-youth-sports-in-the-us-and-why-it-matters/ Summary: See 7 Charts that Show the State of Youth Sports in the US and Why it Matters. Read more. # 7 Charts that Show the State of Youth Sports in the US and Why it Matters Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - October 5, 2015 This is another good article about youth sports in the United States.   ## 7 Charts that Show the State of Youth Sports in the US and Why it Matters | The Aspen Institute Source: www.aspeninstitute.org/about/blog/7-charts-that-show-the-state-of-youth-sports-in-the-us-and-why-it-matters   - Youth Sports ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousAttention Baseball Players NextRethinking Exercise as a Source of Immediate RewardsNext --- ## 7 Habits of Highly Healthy Physicians - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/7-habits-of-highly-healthy-physicians/ Summary: Healthy habits are a New Years # 7 habits of highly healthy physicians Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: March 9, 2023 - March 22, 2020 Healthy habits are a New Years’ resolution topic. These 7 habits are of the utmost importance, especially at a time when we are all trying to stay healthy. This article lists 7 habits of healthy physicians with statistics on how well physicians follow their own advice. I would like to draw attention to several of these, which I think are very important right now during the Coronavirus pandemic. 1. Get enough sleep. This is important for your immune system. 2. Eat healthy foods. With more time at home to cook and make good choices, it’s an opportune time to improve your diet. 3. Exercise. Depending on where you live, your outdoor options may be restricted, and the gyms are certainly closed. However, there are innumerable online exercise classes. Please start now. 4. Stop smoking now. Your lungs need to be as clean as possible. This is imperative right now. 5. Don’t drink too much. Moderation is important. https://www.mdlinx.com/orthopedics/article/6120 - doctor, health, healthy physician, physician ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousA Message To My Patients – COVID-19 NextGirls Take Longer Than Boys to Recover From Concussions?Next --- ## Patellar Tracking Abnormalities & Instability - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/a-deep-dive-into-patellar-tracking-abnormalities-and-patellar-instability/ Summary: In this Brawn Body Health and Fitness Podcast, Dr. Strickland joins Dan to discuss patellar tracking and patellar instability, including surgical management. # A Deep Dive into Patellar Tracking Abnormalities and Patellar Instability Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: July 5, 2024 Quick Summary Patellar tracking problems and patellar instability share overlapping symptoms but differ in cause and management. Tracking issues often stem from muscle imbalance and respond to physical therapy, while true instability — recurrent dislocations or subluxations — usually involves anatomic factors like trochlear dysplasia and a torn MPFL. Imaging-based measurements (TT-TG, Caton-Deschamps index, trochlear morphology) help distinguish the two and guide whether rehab or surgery is appropriate. - February 9, 2023 In this episode of the Brawn Body Health and Fitness Podcast, I joined Dan to discuss patellar tracking and patellar instability in detail, including surgical management such as MPFL procedures and osteotomy procedures. Listen to the podcast to learn more about our discussion of patellar tracking abnormalities and patellar instability.  - Brawn Body Health and Fitness Podcast, Hospital for Special Surgery, HSS, MPFL procedures, osteotomy procedures, patellar instability, Patellar Tracking Abnormalities, surgical management ## Frequently Asked Questions How is patellar tracking different from patellar instability?Patellar tracking refers to how the kneecap glides through the trochlear groove during knee motion — it can be off-center without ever dislocating. Patellar instability means the kneecap actually dislocates or subluxates partially. Tracking issues often respond to physical therapy targeting the quadriceps, hips, and core, while recurrent instability typically requires evaluation for surgical reconstruction. Which imaging tests evaluate patellar tracking and instability?Plain radiographs assess patellar height (Caton-Deschamps or Insall-Salvati index) and overall alignment. CT or MRI measures the tibial tubercle to trochlear groove (TT-TG) distance and trochlear dysplasia grade. MRI also evaluates the MPFL, cartilage, and any loose osteochondral fragments. Together these define the anatomic risk profile and guide treatment. Can physical therapy alone fix patellar instability?Physical therapy is the first-line treatment for first-time dislocations and for tracking issues without recurrent dislocation. It works well when anatomy is favorable. When the patient has multiple dislocations, significant trochlear dysplasia, or patella alta, rehab alone usually cannot prevent recurrence — surgical reconstruction provides more reliable stability in those cases. ## Related Reading - Patellar instability (specialty page) - Patellar pain & patellar arthritis - Femoral anteversion & patellar dislocation ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousUnderstanding Patellofemoral (Kneecap) Instability and Pain NextACL Reconstruction – Retear and Rehabilitation InformationNext --- ## A Message To My Patients – COVID-19 - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/a-message-to-my-patients-covid-19/ Summary: In these uncertain times of COVID-19, we are making plans day by day. We # A Message To My Patients – COVID-19 Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: June 4, 2025 - March 18, 2020 In these confusing, scary, and uncertain times we are making plans day by day. I had 20 patients scheduled for surgery over the next 9 days. Some patients had been waiting months for a donor cartilage graft, and others were having ACL reconstruction. It’s so hard to imagine why I can’t help these patients, and instead, I need to sit at home. However, there are shortages of hospital supplies, and the government has mandated that everything be suspended except for emergencies.  I will be available in the clinic for urgent situations such as acute injuries, patients with locked knees or swelling that is making it difficult to walk, etc. We will be doing telehealth visits for those who can be assessed via telephone. Please call my office and we will do our best to help you whether you are an existing patient or not. - blog, covid19, New York City, patient message, patients ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousChoosing to be a "surgeon-mom" Next7 habits of highly healthy physiciansNext --- ## How Achilles, ACL injury changed Klay Thompson - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/achilles-acl-injury-changed-klay-thompson/ Summary: We love comeback stories such as Klay Thompson # How Achilles, ACL injury changed Klay Thompson Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: June 4, 2025 - May 10, 2022 We have to love comeback stories such as this one. A professional basketball player suffers not one but two major injuries and comes back at the top of the game.   If you read on, you see that he isn’t the same player he was before. Suffering a major injury and then going through the extensive rehab afterwards can set most athletes back quite a bit. Only time will tell how this particular player’s game evolves over time but it’s great to see his success.   Read how ACL, Achilles injuries changed Klay Thompson on SportingNews.com. - ACL, ACL injury, ACL repair, athletes, back in the game, comeback stories, comeback story, Klay Thompson, rehab, sports injury, sports recovery, sports surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousSeveral assessments for patellofemoral instability yielded poor interrater reliability NextPrehab before ACL surgery and impact on recoveryNext --- ## ACL Injury/Recovery in Snowboarders | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/acl-injury-recovery-snowboarders/ Summary: My experience taking care of well over 1,000 ACL injuries is that snowboarding is pretty safe for you as far as ACL tears go. # ACL Injury and Recovery in Professional Snowboarders Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: February 1, 2024 Quick Summary Casual snowboarding has a much lower ACL injury rate than skiing — about 1.7% versus 17% in published comparisons. Competitive snowboardcross is the exception: in one survey of 66 elite snowboardcross athletes, 48.5% had torn an ACL at least once, and 91.3% of tears were in the front leg. Encouragingly, every responding athlete returned to sport after ACL reconstruction. Aggressive cross courses, not snowboarding itself, drive the risk. - February 1, 2024 My experience taking care of well over 1,000 ACL injuries indicates that snowboarding is pretty safe for you, at least as far as ACL tears go. This paper surveyed professional snowboard cross athletes and their data was very interesting. First of all, I was right, skiers are far more likely to tear their ACL. One study quoted 17% ACL injury in skiers versus 1.7% in snowboarders. However, snowboard cross is far more dangerous. Here is a summary of this study: [66 competitive snowboardcross athletes responded to the email surveys, 48.5% of respondents had torn their ACL at least once in their career. (female respondents, 55.6% suffered at least one ACL tear,43.6% of male respondents) 31.2% suffered more than one ACL tear during their career. Of those who tore their ACL, 91.3% (p <0.001) tore their front leg. 100.0% of the respondent athletes returned to sport post-ACL reconstruction].  Read more about this study in Cureus: Trends in Anterior Cruciate Ligament Injury and Recovery in Professional Snowboarders: The Extreme Sport of Snowboardcross.  Photo by Go Montgenevre on Unsplash - ACL injuries, ACL injury, ACL recovery, skiing, skiing injuries, snowboarders, snowboarding, snowboarding injuries ## Frequently Asked Questions Is snowboarding safer for the ACL than skiing?For recreational riders, yes. Published data cited in this post shows ACL tear rates of about 17% in skiers compared to 1.7% in snowboarders, which matches what I see in clinic. With both feet fixed to one board, snowboarders don't experience the twisting force pattern that tears most skiing ACLs. The picture is very different for elite snowboard-cross racers — that group has a very high lifetime rate of ACL tears. Why do snowboard cross athletes have such high ACL tear rates?The snowboard-cross study summarized in this post found that 48.5% of competitive athletes had torn their ACL at least once, and 31.2% had torn it more than once. Of those tears, 91.3% were in the front leg. Snowboard-cross involves fast contact, jumps, and landings on uneven terrain — the front leg absorbs most of the twisting and impact load on each landing, which puts that ACL under far more strain than the back leg. Can snowboarders return to their sport after ACL reconstruction?In the snowboard-cross study cited here, every athlete returned to their sport after ACL reconstruction. That matches what I see in motivated patients — with a good reconstruction, consistent physical therapy, and patience through the 9 to 12 months it takes to be cleared, most snowboarders get back on the mountain. The graft used to rebuild the ACL, the condition of the meniscus, and how consistently you do physical therapy matter more than the sport itself. Should the front leg dominance in snowboarding ACL tears change how the surgery is planned?Yes — it changes how I think about both the graft choice and the rehab. When the injured leg is the dominant front leg, I want a graft that can handle the twisting and impact of landing jumps — usually a quadriceps tendon or a bone-patellar tendon-bone graft rather than a hamstring graft in higher-demand athletes. The rehab also has to retrain front-leg control, balance on the edge of the board, and landing technique — not just straight-ahead strength. ## Related Reading - ACL tear surgery (specialty page) - Skier with ACL tear and meniscus tear - How to prevent skiing injuries - Why ACL tears are so devastating ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousMedial UKA improved pain, function despite patellofemoral joint degeneration NextKnee Pain Keeping You Up at Night?Next --- ## ACL Retear & Rehabilitation Information - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/acl-reconstruction-retear-and-rehabilitation-information/ Summary: Learn about the techniques that hopefully prevent a retear of the ACL after surgery and the rehabilitation process after undergoing an ACL reconstruction. # ACL Reconstruction – Retear and Rehabilitation Information Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 Quick Summary Preventing an ACL retear after reconstruction depends on graft choice, surgical technique, and disciplined rehabilitation. The highest-risk window is the first 12 months as the graft heals and matures. Structured progressive rehab — with strength, neuromuscular control, and objective return-to-sport testing — significantly lowers retear risk, especially in young pivoting-sport athletes. Adding lateral extra-articular tenodesis (LET) is also considered in higher-risk patients. - February 16, 2023 Watch this short video to learn about the techniques that will hopefully prevent a retear of the ACL after surgery and the rehabilitation process after undergoing an ACL reconstruction. When you look at the studies of ACL reconstruction, most show that there’s about a 12% chance of a retear. Those odds are pretty high, so we’re constantly looking at new ways to reduce that retear rate. We’re also looking at ways to make that surgery less invasive.       To learn more, watch the video: ACL Reconstruction – Retear and Rehabilitation - ACL reconstruction, ACL reconstruction surgery, ACL rehabilitation, ACL retear, ACL tear, Hospital for Special Surgery, HSS, knee pain ## Frequently Asked Questions What is the retear rate after ACL reconstruction?Reported retear rates vary from roughly 5% in the general population to 15–20% in young pivoting-sport athletes. Risk is highest in the first 12 months, especially when patients return to sport before achieving objective strength and movement criteria. Graft choice, surgical technique, and rehabilitation quality all influence the rate. What rehabilitation milestones matter most for preventing retear?I focus on restoring full knee extension early, building quadriceps strength symmetry to within ~90% of the uninjured side, retraining hop and landing mechanics, and confirming psychological readiness before sport return. Calendar timing alone is not enough — patients who pass objective criteria have substantially lower retear rates than those cleared by months alone. Does wearing a brace protect the ACL graft after surgery?For most ACL reconstructions, functional bracing is optional after the initial protective phase and does not meaningfully change retear rates. I individualize bracing for revision cases, hyperlaxity, or athletes returning to high-risk sports. The most protective interventions remain strength work, neuromuscular training, and respecting return-to-sport timelines. ## Related Reading - ACL tear surgery (specialty page) - ACL surgery explained - Patient exercises for strength & stability ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousA Deep Dive into Patellar Tracking Abnormalities and Patellar Instability NextDiscussing Patellar Tracking Abnormalities and Patellar InstabilityNext --- ## ACL Graft Choices, Techniques & Recovery | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/acl-surgery-explained/ Summary: Patient-focused overview of ACL surgery, graft choice, BEAR implant, and LET, explaining options for athletes and active adults considering ACL reconstruction # ACL Surgery Explained: Graft Choices, New Techniques & Recovery Insights Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: January 22, 2026 Quick Summary ACL reconstruction restores knee stability after the anterior cruciate ligament tears. Modern graft choices include hamstring tendon, quadriceps tendon, patellar tendon, and the newer BEAR implant; a lateral extra-articular tenodesis (LET) may be added in select high-risk patients to reduce retear. Recovery typically spans 9–12 months with structured rehabilitation, and the right approach depends on age, activity goals, anatomy, and meniscal status. - January 8, 2026 Tearing an Anterior Cruciate Ligament (ACL) is a major event for any athlete or active adult, and the choices made early on, especially those about surgery and graft type, can have lifelong impact. This post walks through how I approach an ACL reconstruction, what graft options mean in practical terms, and how newer techniques may reduce pain and re-injury risk. You can watch the embedded video to hear this explained in more detail and to help you prepare for a conversation with your surgeon. ## Who Typically Tears an ACL? ACL tears are especially common in cutting and pivoting sports, as well as in skiing. The two groups that most often show up in clinic are: - - High school and college athletes who play soccer, lacrosse, basketball, and other cutting sports. - Active adults, often between ages 35 and 55, who sustain ACL tears while skiing. The right treatment plan always starts with understanding a patient’s goals: returning to college-level competition, going back to recreational sports, or simply staying active without instability. ## How graft choice is personalized One of the hardest, and most important, decisions is which graft to use for ACL reconstruction. Common options include quadriceps tendon (quad), hamstring tendon, and patellar tendon autografts. In my approach to ACL surgery: - - I rarely use patellar tendon grafts because the morbidity (what you lose or what hurts after surgery at the harvest site) tends to be too high. - For someone with a smaller quad, a hamstring graft may be preferred, assuming the hamstrings are otherwise healthy. - For a patient with a strong, well-developed quadriceps muscle, a quad tendon graft can be an excellent choice. Past injuries also matter. For example, if a patient has chronic hamstring issues after a marathon, a hamstring graft is usually not a good option. ## Bridge-Enhanced ACL Restoration (BEAR implant) and Lateral Extra-Articular Tenodesis (LET) In addition to traditional reconstruction, there are techniques that aim to save and repair the existing ACL tissue while supporting it with a collagen scaffold. One such option is Bridge-Enhanced ACL Restoration (often called the BEAR implant), which uses your own tissue and a collagen-based graft to help the torn ACL heal rather than fully replacing it with a tendon from elsewhere. Another adjunct procedure discussed is lateral extra-articular tenodesis (LET). This additional step: - - Adds only about eight minutes to the ACL surgery. - Has been shown to reduce ACL re-injury rates by about 50% in appropriate patients. These techniques are not for everyone, but they expand the toolbox for tailoring ACL surgery to the individual and their specific injury pattern and risk profile. ## Advances in Minimally Invasive ACL Surgery While the overall concept of ACL reconstruction has been stable, the tools and methods have become more refined over the past decade. For about the last 10 years, the surgery has been performed “all inside,” using specialized drills that curve and allow more precise tunnel placement with smaller incisions. These advances allow the surgeon to: - - Place tunnels more precisely where they should be while being less invasive to bone and soft tissue. - Use shorter grafts and, for hamstring grafts, often take only a single tendon, which can reduce pain and morbidity from graft harvest. The goal is to restore stability and function while minimizing the collateral damage of surgery itself. ## How to Talk with Your Surgeon Choosing the “best” ACL surgery is not one-size-fits-all. The most important step is an open discussion with your surgeon about: - - Your sport, level of play, and long-term goals - Your muscle strengths, previous injuries, and any chronic issues (such as hamstring problems) - Which graft (quad vs hamstring), and whether options like the BEAR implant or LET are appropriate for your specific tear and activity level Your surgeon should be comfortable with the graft and technique you select together and be able to explain the trade-offs in plain language. Watching the video can help you come to that visit prepared, with better questions and a clearer sense of your priorities. If you want to see me or get a second opinion, please reach out. - ACL reconstruction, ACL recovery, ACL surgery, ACL tear, athlete knee injury, BEAR implant, Bridge-Enhanced ACL Restoration, graft choice, hamstring graft, knee injury, lateral extra-articular tenodesis, LET procedure, minimally invasive ACL surgery, quad graft, sports medicine ## Frequently Asked Questions How long until I can return to cutting and pivoting sports after ACL reconstruction?Most patients return to running around 4–6 months and to cutting or pivoting sports at 9–12 months. We use objective testing — quadriceps strength symmetry, hop tests, and movement quality — before clearance, not the calendar alone. Returning too early raises retear risk, so timing is individualized to each patient's progress. Who is a candidate for the BEAR implant versus a traditional graft?The BEAR implant suits select acute proximal ACL tears with enough remaining tissue, usually treated within weeks of injury. Chronic tears, distal avulsions, and certain tear patterns still do better with hamstring or quadriceps tendon grafts. Candidacy depends on MRI characteristics, time from injury, age, and activity level — I review each case individually. When do you add a LET (lateral extra-articular tenodesis) to ACL reconstruction?I consider adding LET for younger high-risk patients — those returning to pivoting sport, with hyperlaxity, high-grade pivot shift, or revision cases. Adding LET has been shown to reduce graft rerupture in this group, but it isn't needed for every patient. The decision is made together with the patient based on their specific risk profile. ## Related Reading - ACL tear surgery (specialty page) - Evolving practices in ACL graft choice - What raises arthritis risk after ACL surgery? - About Dr. Sabrina Strickland ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousCan Your Genes Predict an ACL Tear? NextWhat Happens If a Patella Dislocation Is Left Untreated?Next --- ## Evolving Practices & ACL Graft Choices | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/acl-surgery-graft-choice/ Summary: ACL surgery has evolved. Learn about modern graft options like hamstrings and quad tendons to make an informed graft choice for your surgical procedure. # ACL Surgery: Evolving Practices and Modern Graft Choices Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: August 7, 2025 Quick Summary ACL graft choice has evolved well beyond the old patellar-tendon-only era. Today the main options are hamstring tendon, quadriceps tendon, bone-patellar tendon-bone, and allograft, with the BEAR implant available for selected acute proximal tears. The right choice depends on age, sport, anatomy, kneeling demands, and prior knee surgery. Each graft has trade-offs in donor-site morbidity, retear risk, and rehabilitation pathway. - August 7, 2025 As one of my mentors said during my training, “If I only did what I learned in residency, I wouldn’t be doing any surgery.” What he meant was that there are so many new techniques and implants in orthopaedic surgery that we are constantly evolving how we do surgery, what implants and grafts we use, and how we treat injured joints. One clear example is anterior cruciate ligament (ACL) treatment. When I trained, essentially everyone got a patellar tendon reconstruction. We did it the same way every time, fixing the graft to the femur and tibia with a metallic screw. This was followed by double bundle ACL surgery, the popularity of which faded quickly as the tunnels often converged, athletes weren’t doing better, and the surgery took longer. Over 10 years ago, I started drilling the femoral tunnel from the anteromedial portal, which allowed me to place the ACL graft wherever the anatomic footprint was, rather than where I could reach doing it the old way and drilling through the tibial tunnel. Our drills got better in that they became flexible and allowed us to curve around the front of the knee. We have evolved from titanium buttons to metallic screws to absorbable screws to plastic and back to titanium buttons. There have been pros and cons to each technique, and ultimately, I have settled on buttons for everyone. They are: - small - inert - easy to get out if you need to go back and revise the surgery Also, there is no bone reaction due to a dissolvable implant or bony defect if you have to take them out (which happens with a screw). As far as graft choices go, my graft of choice initially changed from patellar tendon to allograft, but many grafts were irradiated to sterilize them. Some studies showed suboptimal results, perhaps because they used weak tendons (for example, the Achilles tendon). I then went to an all-inside hamstring graft, which allowed me to quadruple one tendon instead of taking two grafts and gave me a larger graft. I have been very satisfied with the results of this procedure and can honestly say that I have had very few re-tears. The recent trend in sports surgery has been to use the quad tendon, which is an easy graft to harvest with a scar just above the knee cap. The downside is weakness of the quad, and studies have shown that at six months post-operatively, patients only have about 60% of their strength. What I do now is discuss the pros and cons of each graft option with patients, typically settling on hamstring or quad with lateral extra-articular tenodesis (LET) in young cutting athletes (typically under age 25) or for revisions. For patients who have somewhat lower demands on their knees, they most often choose a hamstring auto or allograft (donor graft).      - ACL, graft, graft choice, hamstring, implants, orthopaedic surgery, patellar tendon, quad tendon, reconstruction, surgery, techniques ## Frequently Asked Questions Which ACL graft has the lowest retear rate?Bone-patellar tendon-bone and quadriceps tendon grafts generally show lower retear rates than hamstring grafts, particularly in younger pivoting-sport athletes. Allografts have higher retear rates in patients under 25. That said, no single graft is best for everyone — the decision balances retear risk, donor-site discomfort, kneeling demands, and the surgeon's experience with each technique. Do quadriceps tendon grafts cause less anterior knee pain than patellar tendon grafts?In my experience, quadriceps tendon grafts typically produce less long-term anterior knee pain and kneeling discomfort than bone-patellar tendon-bone, while preserving similar stability. They are an excellent choice for patients who kneel often — flooring trades, gardeners, athletes in martial arts. Patellar tendon grafts remain a strong option when kneeling demands are low. Can I use my hamstring graft if I'm a soccer player or sprinter?Hamstring grafts can work for soccer players and sprinters, but I weigh them against quadriceps or patellar tendon options because hamstring strength can stay slightly reduced after harvest. For athletes who depend on hamstring power for sprinting or kicking, I often prefer a non-hamstring graft. Each case is decided individually based on sport, anatomy, and goals. ## Related Reading - ACL tear surgery (specialty page) - ACL graft choices, techniques & recovery - Anterior knee pain after hamstring ACL reconstruction ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWhy Do I Have Knee Pain After Running? NextMy Kneecap Dislocated. What Should I Do?Next --- ## ACL Surgery: What Raises Arthritis Risk? | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/acl-surgery-what-raises-arthritis-risk/ Summary: Choosing the right ACL reconstruction graft is complex. Factors like age, sex, BMI, graft type, meniscal injury, and timing of surgery may affect long-term arthritis risk after ACL surgery. # ACL Surgery: What Raises Arthritis Risk? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: April 2, 2026 Quick Summary Long-term arthritis risk after ACL reconstruction is influenced by more than just the surgery itself. Age, sex, BMI, graft choice, meniscal injury at the time of tear, cartilage damage, and timing of surgery all play a role. Preserving the meniscus when possible, restoring stability promptly in active patients, and maintaining lifelong knee strength reduce — but do not eliminate — the risk of post-traumatic osteoarthritis. - April 2, 2026 One of the most common questions I get in clinic is which graft to choose for an ACL reconstruction. Thanks to the increasing use of AI tools, many of my patients come in much more informed than they used to. The question of ACL graft choice has been debated for over 25 years, and every month new studies are published comparing one graft type to another or assessing outcomes among different surgical techniques. The fact that this discussion continues is a clear sign that there’s still no single right answer. A recent systematic review in the American Journal of Sports Medicine analyzed multiple studies to identify risk factors for developing arthritis after ACL reconstruction. Six factors were found to be associated with higher arthritis risk: older age, male sex, higher body mass index, bone–patellar tendon–bone graft, meniscectomy, and a longer time between injury and surgery. Some of these risk factors are beyond our control—we can’t change our age at injury, sex, body weight at the time, or whether a meniscal tear occurred with the ACL injury. However, we can take proactive steps in choosing the type of graft and surgical timing. Selecting a graft with lower donor site morbidity, such as a hamstring or quadriceps tendon, and having surgery relatively soon after injury may help reduce the risk of developing arthritis later on. Read the study in AJSM here. - ACL graft choice, ACL reconstruction, ACL surgery arthritis risk, bone patellar tendon bone graft, donor site morbidity, hamstring tendon graft, knee osteoarthritis, meniscectomy, quadriceps tendon graft, research, sports medicine ## Frequently Asked Questions Does ACL reconstruction prevent arthritis?ACL reconstruction restores stability but does not fully prevent post-traumatic arthritis. The original injury — particularly meniscal tears and cartilage damage at the time of ACL rupture — drives much of the long-term arthritis risk. Reconstruction allows return to activity and protects against further meniscal damage from instability, but lifelong knee health still depends on weight, strength, and activity choices. Is a meniscal repair more important than the ACL graft choice for arthritis risk?Meniscal preservation is one of the strongest factors for long-term knee health. When the meniscus is repairable, I always favor repair over removal. Loss of meniscal tissue raises contact pressures on cartilage and accelerates arthritis. ACL graft choice influences retear rates but has a smaller direct effect on arthritis than meniscal status. Does delaying ACL surgery increase arthritis risk?In active patients with instability, prolonged delay between ACL tear and reconstruction can increase the risk of additional meniscal and cartilage damage from giving-way episodes. That secondary damage raises long-term arthritis risk more than the timing of the ACL surgery itself. For sedentary patients without instability, nonoperative management may be reasonable. ## Related Reading - ACL tear surgery (specialty page) - Knee arthritis treatment - Cortisone vs gel injections for knee pain ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWorking Your Way to Stronger Legs: How to Use the Single-Leg Leg Press NextStatic Lunge with Row: A Knee-Friendly Way to Strengthen Your Core and LegsNext --- ## ACL Tears: New Surgical Technique - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/acl-tears-preferred-and-new-surgical-technique/ Summary: ACL tears are an incredibly common injury. This video introduces new techniques we can use that show very promising results: # ACL Tears – Preferred and New Surgical Technique Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 Quick Summary ACL tears remain one of the most common sports injuries, and surgical technique continues to evolve. Newer approaches — including the BEAR implant for selected acute proximal tears, LET augmentation for high-risk patients, and refined quadriceps-tendon graft techniques — aim to reduce retear and protect the meniscus. The best technique is matched to the specific tear pattern, patient age, and activity level rather than applied universally. - October 17, 2022 ACL tears are an incredibly common injury. It’s much more common for women to tear their ACLs than men, and even teenagers often tear their ACLs. This video introduces a new technique we can use that show very promising results: - ACL, ACL reconstruction, ACL repair, ACL tear, athletes, BEAR implant, blog, Hospital for Special Surgery, HSS, knee pain, sports, sports injuries, teens, women ## Frequently Asked Questions How is ACL repair different from ACL reconstruction?ACL reconstruction uses a tendon graft to replace the torn ligament. ACL repair — including the BEAR implant approach — preserves and heals the native ACL using a scaffold and the patient's own blood. Repair only suits select acute proximal tears with healthy remaining tissue, while reconstruction remains the standard for most chronic or distal tears. Does adding a LET procedure mean a longer recovery?Adding lateral extra-articular tenodesis adds about 20 minutes of operative time but typically does not extend overall recovery. Most patients follow the same return-to-sport timeline as standard ACL reconstruction. The LET is designed to protect the graft during high-pivot activities, particularly in younger athletes and revision cases where retear risk is elevated. Is robotic or computer-navigated ACL surgery used at HSS?Computer-assisted and image-guided techniques can help with precise tunnel placement in complex or revision ACL cases. For most primary ACL reconstructions, careful arthroscopic anatomy and intraoperative landmarks remain the standard. I use advanced imaging selectively when the situation calls for it — the goal is the most accurate reconstruction for each patient, not technology for its own sake. ## Related Reading - ACL tear surgery (specialty page) - ACL surgery explained - Preventing ACL retear & rehabilitation ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousIt’s the Patellofemoral Height – Dr. Sabrina Strickland NextIf You Have Knee Pain, Try Using Your Treadmill Like ThisNext --- ## Interoperative Acupuncture for Nosocomephobia - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/acupuncture-during-surgery-help-patients-nosocomephobia/ Summary: A Qualitative Analysis of Intraoperative Acupuncture for Nosocomephobia: The Unseen Patient. # Acupuncture During Surgery May Help Patients With Nosocomephobia Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - October 19, 2023 Nosocomephobia is a fear of hospitals, an anxiety disorder. It can cause panic attacks and prevent patients from getting medical care of visiting loved ones in the hospital. I participated in this paper after Dr. Stephanie Cheng worked wonders helping a patient get through surgery. I don’t understand acupuncture, but there is no doubt that it can help people in many ways. Read the complete article: “Acupuncture During Surgery May Help Patients With Nosocomephobia, an Intense Fear of Hospitals, Get the Medical Care They Need“ - Acupuncture, Nosocomephobia, qualitative case study, research paper, study, surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousBowling after Biceps Rupture/Biceps Tear NextStudy Using an Animal Model Examines Microtrauma Role in ACL InjuriesNext --- ## AI Chatbot Model Generating Reports on ACL Tears | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/ai-chatbot-model-acl-tears-reports/ Summary: An AI chatbot called MedVisGPT can help diagnose ACL tears using knee x-rays, then produce detailed medical reports. # AI Chatbot Model Generating Reports on ACL Tears Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - November 29, 2023 For years, we have heard that artificial intelligence (AI) is going to make physicians obsolete. In medicine, our training focuses on looking for patterns of symptoms that lead us to a diagnosis. For example, a swollen knee, medial pain, and locking or catching is a medial meniscal tear until proven otherwise. Of all the medical fields, radiology seems to be the most amenable to the practical use of AI, and this session gives just one example where a chatbot can determine which patients, after knee injury, need an MRI to rule out an ACL tear after a knee x-ray. Perhaps this new chatbot will improve access to care and fast track patients who need expedited care.   Read more about the new chatbot.       - ACL tears, AI chatbot, anterior cruciate ligament tears, anteroposterior views, knee x-rays, lateral views, Massachusetts General Hospital, medical reports, Medical Visual Generative Pre-Trained Transformer, MedVisGPT, MRIs ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousDual Tibial Osteotomy Surgeries to Get Back to Lifeguarding NextNew Study Shows Osteoarthritis May Be Treatable and ReversibleNext --- ## All Athletes Need to Cross Train - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/all-athletes-including-kids-need-to-cross-train/ Summary: Here is an article by a physical therapist whom I respect recommending that all althetes - even children - need to cross train. Read more. # All athletes – including kids – need to cross train Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - October 14, 2015 Here is an article by a physical therapist who I respect, adding yet another opinion that kids need to do multiple sports. Even if the child does travel hockey, they should also do tennis or swimming once a week. All athletes need to cross train.   Keeping Kid Athletes Safe – Resident Source: resident.com/keeping-kid-athletes-safe/       - athletes, cross training, Kids, Physical Therapy ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousRethinking Exercise as a Source of Immediate Rewards NextHospital for Special Surgery Receives 5-Star Ratings from Healthgrades in Three Orthopedic CategoriesNext --- ## Amazon Entering Health Care - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/amazon-entering-healthcare/ Summary: If you have ever dealt with a specialty pharmacy, you know it is a confusing process for all parties involved. Perhaps Amazon Health will change that. # Amazon Entering Health Care Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: October 31, 2024 - November 30, 2017 As you may be aware, if you have ever dealt with a specialty pharmacy it is a confusing process – And it is confusing for all parties involved. First, you may call your insurance company when you find out you need a medication that is available only through a speciality pharmacy, such as hyaluronic acid (Euflexxa, Synvisc, Orthovisc, etc) They tell you that you are covered and to call Expess Scripts. You then call Express Scripts, get patched through to multiple different departments only to find out that you actually need to be speaking to Accredo. My office deals with this on a daily basis in an effort to obtain hyaluronic acid injections for our patients. This process can take hours and cause frustration on everyone’s part and often the consumer doesn’t find out what their co-pay is until the very end, and it can vary from free to over a thousand dollars. When I read this article in Forbes, I became a little hopeful Amazon has made my life so much easier and in many ways more economical. I no longer pay sky high prices for medicines like Advil at a Manhattan pharmacy since I can get it in 2 days with Amazon. If Amazon could streamline and simplify the process for obtaining prescription drugs I am optimistic that it would not only be cheaper, but it would save us all a lot of time. Source: https://www.forbes.com/sites/stephenbrozak/2017/10/20/amazons-invasion-looms-over-healthcare/#2c4570ee6749 - amazon, healthcare, healthcare communication ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHow to Get in Shape for Ski Season NextYour Purse Is Too HeavyNext --- ## Analysis: Acupuncture for Nosocomephobia | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/analysis-intraoperative-acupuncture-nosocomephobia/ Summary: This small study shows that acupuncture seems like a safe, noninvasive way for nosocomephobia patients to manage anxiety in a preoperative or procedural setting. # An Analysis of Intraoperative Acupuncture for Nosocomephobia Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: January 16, 2025 - January 16, 2025 Nosocomephobia, which is an extreme fear of hospitals, is a form of post-traumatic stress disorder (PTSD) that can prevent individuals from seeking necessary medical treatment. Research is limited regarding the impact of nosocomephobia on patients undergoing elective surgery and the potential benefits of acupuncture in managing this fear. Recently, we published this qualitative analysis that looked at the role of acupuncture in nosocomephobia patients’ elective surgery appraisal processes. Two patients were interviewed about their nosocomephobia and their earlier experiences with hospitals. Reviewers coded those interview transcripts and labeled meaningful content, identifying themes and potential discrepancies. Small, uncontrolled case series like this make it hard to draw definitive conclusions; however, acupuncture seems like a safe, noninvasive way for nosocomephobia patients to manage anxiety in a preoperative or procedural setting. Read more about the study in Acupuncture in Medicine. - Acupuncture, anxiety management, appraisal process, avascular necrosis, coping, elective surgery, fear rationale, hip replacement, hospital experiences, hospital phobia, knee arthrotomy, Nosocomephobia, osteochondral allograft, posttraumatic stress disorder, preoperative anxiety, PTSD, qualitative case study, stress coping, thematic analysis, transactional model of stress ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousFDA Trial for New Patella LIFT Procedure NextSmall Study of Long-Term Outcomes for One-Step Cartilage RepairNext --- ## Knee Pain | Hamstring ACL Reconstruction - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/anterior-knee-pain-following-hamstring-acl-reconstruction/ Summary: Anterior knee pain following hamstring ACL reconstruction is a very timely topic. We have been debating graft choice for ACL reconstruction for decades. # Anterior Knee Pain Following Hamstring ACL Reconstruction Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 Quick Summary Anterior knee pain after ACL reconstruction is most often associated with bone-patellar tendon-bone grafts, but it occurs after hamstring reconstruction as well — sometimes from underlying patellofemoral mechanics, residual quadriceps weakness, or kneeling sensitivity at hardware sites. Identifying the specific cause matters more than the graft choice alone. Targeted rehabilitation, occasionally hardware removal, and addressing tracking issues resolve most cases without further surgery. - February 3, 2023 Anterior knee pain following hamstring ACL reconstruction is a very timely topic. We have been debating graft choice for ACL reconstruction for decades. First, we repaired the ACL, then we used patellar tendon, then some of us transitioned to hamstring. Nowadays, the debate continues with the addition of allograft or donor tendons and quad tendon. The advantages of one graft over another have been hard to prove, but the disadvantages are a bit more clear. When you take a tendon from one part of the knee and use it to reconstruct the ACL, then you are weakening something. That is: if you take the central third of the patellar tendon, then you are weakening the patella (as you take a piece of bone). The hamstring graft has been thought to have a lower incidence of anterior knee pain than the patellar graft and this study explains why. In those patients who suffered anterior knee pain after hamstring ACL reconstruction at 4 months,  they were found to have lower quad and hamstring strength than those patients who had normal strength. This is yet another reason why good physical therapy and adherence to a recommended home exercise program is so important. The good news is that by 7 months the patient’s strength normalized and the pain went away. Read the article “Anterior knee pain following ACL reconstruction” in Physician’s Weekly to learn more.  Image credit: Marios G Lykissas, George I Mataliotakis, Nikolaos Paschos, Christos Panovrakos, Alexandros E Beris and Christos D Papageorgiou, CC BY-SA 2.0, via Wikimedia Commons   - ACL reconstruction, allograft, anterior knee pain, donor tendons, graft, graft choice, hamstring, patellar tendon, quad tendon ## Frequently Asked Questions Is anterior knee pain more common after hamstring or patellar tendon ACL grafts?Bone-patellar tendon-bone reconstruction historically has higher rates of anterior knee pain and kneeling discomfort than hamstring grafts. However, hamstring reconstruction is not pain-free — anterior pain can still occur from quadriceps weakness, patellofemoral tracking, or graft fixation hardware. The difference between grafts is real but smaller than commonly assumed, and rehabilitation drives most outcomes. Can anterior knee pain after ACL surgery be cured with physical therapy?Yes, in most cases. Targeted rehabilitation focused on quadriceps strength, hip control, patellofemoral mechanics, and gait usually resolves anterior knee pain after ACL reconstruction. Persistent pain despite a thorough rehab program may warrant evaluation for hardware sensitivity, patellofemoral cartilage damage, or other mechanical sources, and occasionally additional intervention. Should I have hardware removed if my knee hurts after ACL surgery?Hardware removal is reserved for clear hardware-related symptoms — kneeling pain over a screw, prominent fixation that produces local tenderness, or local irritation confirmed on exam and imaging. Removal is not a routine answer for general anterior knee pain. I evaluate the source carefully before recommending another surgery, since most pain has non-hardware causes. ## Related Reading - ACL tear surgery (specialty page) - Evolving practices in ACL graft choice - Patellar pain & patellar arthritis ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousMarried and Practicing Orthopaedic Surgery – Dr. Strickland and Dr. Gomoll NextUnderstanding Patellofemoral (Kneecap) Instability and PainNext --- ## Improve Patellar Contact Forces - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/anteromedialization-tibial-tubercle-osteotomy-improves-patellar-contact-forces-a-cadaveric-model-of-patellofemoral-dysplasia-2/ Summary: In this study I created a 3D printed model to assess how forces can be improved across the front of the knee with anteromedialization tibial tubercle osteotomy. # Anteromedialization Tibial Tubercle Osteotomy Improves Patellar Contact Forces: A Cadaveric Model of Patellofemoral Dysplasia Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - January 3, 2023 In this biomechanics study that I published recently, I created a 3D printed model in order to assess how forces can be improved across the front of the knee with a surgical intervention called tibial tubercle osteotomy. The issue with a lot of the research that we do in biomechanics is that we use cadaver knee specimens that actually have normal anatomy. However, many of the knees that I see that develop patellofemoral cartilage lesions or instability actually do not have normal anatomy or bone shape. Ultimately, my goal of doing research is to learn how we can do things better. I want to optimize surgical techniques and improve patient’s outcomes. Read the article on Anteromedialization Tibial Tubercle Osteotomy. 3D printed knee image via https://commons.wikimedia.org/wiki/File:3D_printed_knee_20151126.jpg © Nevit Dilmen, CC BY-SA 3.0 , via Wikimedia Commons - 3D printing, athletes, biomechanics, Hospital for Special Surgery, HSS, improve patient outcomes, knee pain, orthopaedic surgery, osteotomy, patellofemoral cartilage instability, research, surgical techniques, tibial tubercle ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPrevious4 Ways to Manage Patellar Tendinopathy NextTakeaways from Years of Patellofemoral Arthroplasty ExperienceNext --- ## Anteromedialization TTO - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/anteromedialization-tibial-tubercle-osteotomy-improves-patellar-contact-forces-a-cadaveric-model-of-patellofemoral-dysplasia/ Summary: In the setting of Patellar Contact Force dysplasia, we hypothesized that a simulated anteromedialization (AMZ) TTO would improve PF contact mechanics after TTO. # Anteromedialization Tibial Tubercle Osteotomy Improves Patellar Contact Forces: A Cadaveric Model of Patellofemoral Dysplasia Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - December 1, 2022 Study on hypothesis that a simulated anteromedialization (AMZ) TTO would improve PF contact mechanics as compared with a pure medialization TTO. ### Background: Patellofemoral (PF) dysplasia is common in patients with recurrent patellar instability. Tibial tubercle osteotomy (TTO) is performed with goals of correcting patellar maltracking and redistributing contact forces across the PF joint. The biomechanical effects of TTO in the setting of PF dysplasia have not been quantified. ### Purpose/Hypothesis: To quantify patellar contact mechanics and kinematics after TTO in the setting of PF dysplasia. We hypothesized that a simulated anteromedialization (AMZ) TTO would improve PF contact mechanics as compared with a pure medialization TTO. ### Study Design: Controlled laboratory study.   Read more about the methods, results, conclusion, and clinical relevance.  - Anteromedialization, Anteromedialization Tibial Tubercle Osteotomy, Cadaveric Model, Patellar Contact Forces, patellar maltrackin, Patellofemoral Dysplasia, tibial tubercle osteotomy, TTO ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousSurgical Treatment of Iatrogenic Patella Baja NextPhysio profiles 13 elite athletes to explore the physical and mental toll of ACL injuriesNext --- ## Patellofemoral Cartilage Restoration - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/assessment-of-patellar-vascularity-after-patellar-cartilage-restoration-via-lateral-parapatellar-approach/ Summary: Patellofemoral cartilage restoration procedures (osteochondral allograft, particulated juvenile cartilage) treat patellofemoral cartilage lesions effectively. # Assessment of Patellar Vascularity after Patellar Cartilage Restoration via Lateral Parapatellar Approach Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - March 27, 2023 Patellofemoral cartilage restoration procedures, including osteochondral allograft, particulated juvenile cartilage, and matrix-induced autologous chondrocyte implantation, have been shown to be effective treatments for patellofemoral cartilage lesions. - Lateral Parapatellar Approach, Patellar Cartilage Restoration, Patellar Vascularity ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousRunning and Knee Stress: Systematic Cartilage Changes NextEstablishing minimal detectable change thresholds and Kujala scores at one and two years after patellofemoral joint arthroplastyNext --- ## Patellar Cartilage Restoration via Lateral Parapatellar Approach - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/assessment-patellar-vascularity/ Summary: Patellofemoral cartilage restoration procedures (osteochondral allograft, particulated juvenile cartilage) treat patellofemoral cartilage lesions effectively. # Assessment of Patellar Vascularity after Patellar Cartilage Restoration via Lateral Parapatellar Approach Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - April 13, 2023 I recently published an article about assessing patellar vascularity after patellar cartilage restoration using a lateral parapatellar approach. The study is a prospective case series of five adult patients undergoing patellofemoral cartilage restoration procedures via a lateral parapatellar approach with pre-operative and post-operative dynamic contrast-enhanced MR imaging to assess changes in patellar vascularity. The full article is available on the Sage Journals website. - Dynamic Contrast-Enhanced, Hospital for Special Surgery, knee pain, Lateral Parapatellar Approach, Magnetic Resonance Imaging, orthopaedic surgery, Patellar Cartilage Restoration, Patellar Vascularity ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousEstablishing minimal detectable change thresholds and Kujala scores at one and two years after patellofemoral joint arthroplasty NextLower Donor Site Morbidity With Hamstring and Quadriceps Tendon AutograftNext --- ## Athletes & Injuries | NBA Radio - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/athletes-and-injuries-siriusxm-nba-radio/ Summary: This interview with the SiriusXM NBA Radio dives into the ramifications an injury can have on a player and how these injuries impact players and fans. Skip to content PrevPreviousYour Purse Is Too Heavy NextTrain like an OlympianNext It’s frustrating as a fan when your favorite team has a player that has to sit out because of an injury, but do we really understand what these athletes have to go through? Here’s my interview with the SiriusXM NBA Radio where we dive into the ramifications an injury can have on a player and team. Manage Cookie Consent To provide the best experiences, we use technologies like cookies to store and/or access device information. Consenting to these technologies will allow us to process data such as browsing behavior or unique IDs on this site. Not consenting or withdrawing consent may adversely affect certain features and functions. Functional Functional Always active The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network. Preferences Preferences The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user. Statistics Statistics The technical storage or access that is used exclusively for statistical purposes. The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you. Marketing Marketing The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes. - Manage options - Manage services - Manage {vendor_count} vendors - Read more about these purposes Accept Deny View preferences Save preferences View preferences - {title} - {title} - {title} Manage consent Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you'd like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointmentContact the office Medical Disclaimer This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. --- ## Warm-up and Cool-down Tips for Baseball Players - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/attention-baseball-players/ Summary: Read this if you are a baseball player or your child plays. Mickey Levinson has been our go-to physical therapist for baseball players for as long as I can remember! # Attention Baseball Players Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - October 4, 2015 Read this if you are a baseball player or your child plays. Mickey Levinson has been our go-to physical therapist for baseball players for as long as I can remember!   ## Warm-up and Cool-down Tips for Baseball Players – HSS Playbook Source: www.hss.edu/playbook/warm-up-and-cool-down-tips-for-baseball-players/   - baseball players, cool-down, tips, warm-up ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPrevious6 Tips to Train Like a Professional Athlete Next7 Charts that Show the State of Youth Sports in the US and Why it MattersNext --- ## Back in the Game After Torn Meniscus | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/back-in-the-game-torn-meniscus/ Summary: Get an inside look at how James Anagnostopoulos returned to running after a successful hip replacement at HSS. Read his full story and get back in the game. # Back in the Game After a Torn Meniscus Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: August 21, 2025 - August 21, 2025 James Anagnostopoulos was 50 years old when he completed his first full Ironman triathlon. One month later, he injured his left knee. James was used to training pain, so at first he brushed it off, but the pain persisted. For months, he tried everything – physical therapy, electrotherapy, and countless knee-strengthening workouts he found on YouTube. Nothing worked. James met with me and learned he had a torn meniscus. In June 2023, he had surgery, and the pain finally subsided. At age 52, James signed up for his first ultramarathon, completing 100 miles in 29 hours on May 17–18, 2025. Read more about James’s story on the Hospital for Special Surgery’s Back in the Game page. - athletic comeback, David Goggins, endurance athlete, HSS, Ironman, knee injury, knee surgery, meniscus tear, pain relief, Physical Therapy, recovery, running, ultramarathon ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousDo You Have Knee Pain? NextBridge Registry: What the First 100 BEAR Patients Teach UsNext --- ## BEAR Implants in the News - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/bear-implants-in-the-news/ Summary: It # BEAR Implants in the News Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - December 14, 2022 Wow, it’s amazing to see how much news there is on the new BEAR implant. We are approaching the one year mark on our first BEAR implant and so far so good. I can’t wait to see how these patients do at 3-5 years! When they report the “less invasive ACL surgery getting athletes back in the game faster,” I want to take a minute to explain. First of all, so far nothing we do: ACL reconstruction with patellar tendon, quad, hamstring, cadaver, or BEAR allows a return to cutting sports reliably before 9-12 months. The advantage of BEAR over every other option for ACL surgery is that you don’t drill tunnels and you don’t require a tendon (from one’s own leg or a cadaver) to do the surgery. With BEAR, you use a bovine (from a cow) collagen sponge to fill the gap created when the ACL ruptures. At the same time, you implant sutures to give the knee some stability until the ligament can heal. My husband, Andreas Gomoll, MD, and I have now done 22 BEAR surgeries at HSS. Our initial impressions are that patients tend to be a bit more stiff in the first few months, but throughout, the feel of the knees are quite stable. Here are a few of the stories I’ve seen about the BEAR implant lately: - Health Headlines: Less invasive ACL surgery getting athletes back in the game faster - Healing ACL injuries from the inside out - Your Health: Marshmallow implant ACL from the inside out - ACL repair, ACL restoration, anterior cruciate ligament, BEAR implants, Bridge-Enhanced ACL Restoration, Bridge-Enhanced ACL Restoration Implant, synovial fluid, torn ACL ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousPhysio profiles 13 elite athletes to explore the physical and mental toll of ACL injuries Next4 Ways to Manage Patellar TendinopathyNext --- ## BEAR Technique Insights/Preferences | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/bear-technique-insights-preferences/ Summary: Dr. Sabrina Strickland and Dr. Andreas Gomoll share Expert insights, preferences for performing bridge enhanced ACL restoration technique or BEAR technique. # Expert Insights, Preferences for BEAR Technique Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: June 12, 2025 - June 6, 2025 Recently, my husband, Dr. Andreas Gomoll, Ava G. Neijna, BA, Hannah L. Terry, BS, and I were asked by the Hospital for Special Surgery and Orthopedics Today to write about our experience using the bridge-enhanced ACL restoration technique, or BEAR technique. This article provides our expert insights into the BEAR technique, which is an alternative to traditional ACL reconstruction. It details the surgical procedure, highlighting its potential to preserve native ACL tissue, reduce the risk of post-traumatic osteoarthritis, and avoid donor site morbidity. The piece also covers the importance of refined surgical techniques and patient suitability, outlining the core aspects of the procedure per FDA guidance, and offers a preferred surgical approach for proximal and mid-substance ACL tears. Read the article: Expert insights, preferences for performing the bridge enhanced ACL restoration technique, or BEAR technique.    - Bridge-Enhanced ACL Restoration, collagen-based implant, fibrin clot, functional healing, midsubstance ACL tear, native biomechanical function, postoperative osteoarthritis, primary ACL repair, tibial ACL stump, vascularity ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPrevious5 Exercises to Avoid With a Torn Meniscus Next5 Symptoms of a Torn Meniscus That Will Self-HealNext --- ## Before Knee Replacement Surgery - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/before-knee-replacement-surgery/ Summary: For those considering knee replacement surgery: It is more effective for relieving osteoarthritis pain and improving function osteoarthritis than nonsurgical therapy # Before Knee Replacement Surgery Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 Quick Summary Knee replacement reliably relieves end-stage osteoarthritis pain when nonsurgical treatments — weight management, structured strengthening, NSAIDs, and intra-articular injections — no longer provide acceptable function. Before scheduling surgery, I confirm the diagnosis on imaging, optimize medical conditions (blood sugar, weight, smoking), prehab the quadriceps, and align expectations on recovery. Patients who arrive prepared physically and mentally consistently have better outcomes and faster return to activity. - October 24, 2015 This article had helpful information for anyone considering knee replacement surgery.   Knee replacement surgery relieves pain and improves function in patients with severe osteoarthritis much more effectively than nonsurgical therapy alone, researchers reported on Wednesday. Source: www.nytimes.com/2015/10/22/health/study-points-to-benefits-of-knee-replacement-surgery-over-therapy-alone.html     - Knee replacement surgery, nonsurgical therapy, severe osteoarthritis ## Frequently Asked Questions When is the right time to consider knee replacement?Knee replacement is appropriate when end-stage arthritis significantly limits walking, sleep, or daily activity despite a fair trial of nonsurgical care — typically 3–6 months of structured rehab, weight management, and at least one course of injections. Younger, very active patients may delay replacement with cartilage-preserving procedures. The decision balances pain, function, age, and goals. Are partial knee replacements better than total replacements?For patients with isolated medial, lateral, or patellofemoral compartment arthritis and intact ligaments, partial knee replacement (unicompartmental or PFA) preserves more native bone and ligaments, often with faster recovery and a more natural-feeling knee. Multi-compartment arthritis is better served by a total knee replacement. The choice depends on imaging, exam, and patient anatomy. How long does recovery take after knee replacement?Most patients are walking with a cane within days, off most assistive devices by 4–6 weeks, and back to full daily activities by 3 months. Full recovery — including return to lower-impact sports like cycling, golf, and doubles tennis — often takes 6–12 months as strength and confidence return. Outcomes are highly dependent on prehab, postoperative rehab, and patient effort. ## Related Reading - Knee arthritis treatment (specialty page) - Cortisone vs gel injections for knee pain - Double partial knee replacements ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousLifting Weights Twice a Week NextCaring for Young Female AthletesNext --- ## 48 Benefits of Adding Yoga - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/benefits-of-adding-yoga/ Summary: Another reason to practice yoga: balance training and core strengthening. This study showed 12 minutes a day improved bone density and with no bone fractures. # Benefits of Adding Yoga Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - January 5, 2016 Here is yet another reason to practice yoga. So I admit that I personally am not a huge fan of yoga. While I appreciate the concentration involved in practicing yoga and the balance training, as well as core strengthening that you gain, I never feel like I get the workout that I need from a 60 to 90 minute commitment of my time. As we age, however, many people can no longer participate in the same types of sports that they loved when they were younger. For some, this means no more soccer or hockey, and for others it means their knees keep them from running and hiking. Almost everyone can practice yoga, because many poses can be modified. In the study below, study participants learned simple poses and practiced for 12 minutes a day. These people were rewarded by improved bone density and no bone fractures during the study period. Adding 12 minutes of yoga to your day isn’t asking a lot, and appears to have a positive impact.   ## 12 Minutes of Yoga for Bone Health – NYTimes.com Source: mobile.nytimes.com/blogs/well/2015/12/21/12-minutes-of-yoga-for-stronger-bones/   - Bone Health, New York Times, yoga ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHealth & Exercise Trends NextWhat I Want My Daughters to Know About Working OutNext --- ## Bizarre Sports Injuries - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/bizarre-sports-injuries/ Summary: Being a professional athlete does not prevent you from random and unlucky accidents. Injures occur more often when you aren’t in optimal shape for that sport. # Bizarre Sports Injuries Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - September 22, 2015 I both love and hate these kind of stories. Being a professional athlete does not prevent you from random and unlucky accidents. I see patients every day who are injured while participating in “safe activities.” I have seen torn ACLs from losing one’s balance “scorching around a booth” at a club, torn muscles sustained while stepping off a step, torn tendons resulting from lunging while fencing, and torn menisci from squatting down to get something out from under the sink. If you have an important event coming up—whether it is your wedding, a great trip, or the New York City marathon—I would recommend you not play a pick up game of soccer or try sky diving. Wait until after your event, as you never know when you will get injured. Injures occur much more often when you aren’t in optimal shape for that particular sport. You certainly cannot avoid most injuries, but it is worth being careful if something extraordinary is coming up.   ## Rory McIlroy added to long list of bizarre sports injuries When it comes to getting injured in a bizarre fashion, Rory McIlroy isn’t alone. Johnette Howard recalls celebrations gone wrong, outlandish alibis and other head-scratching injuries. Source: espn.go.com/golf/story/_/id/13208324/rory-mcilroy-added-long-list-bizarre-sports-injuries   - Bizarre Injuries, Rory McIlroy ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousKids and Sports Injuries NextAttending Women’s Sports Events with My DaughtersNext --- ## Bowling after Biceps Rupture/Biceps Tear - Dr. Strickland Source: https://sabrinastrickland.com/bowling-after-biceps-rupture-biceps-tear/ Summary: Meet Robert Goodwin Jr, an avid bowler with extreme shoulder pain. He came to me for Biceps Tenodesis for a biceps rupture/biceps tear to return him to bowling. # Bowling after Biceps Rupture/Biceps Tear Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - October 19, 2023 Sharing another one of my patient’s stories today! Meet Robert Goodwin Jr, who came to me with extreme pain in his arm and shoulder. As an avid bowler, the pain was at times unbearable. He had sought out a few doctors, but the local ones were unsure about how to address the pain in his biceps. When he came to me, I determined that he had a biceps rupture/biceps tear and needed Bicep Tenodesis surgery to reattach his torn biceps. Robert shared his story on the Hospital for Special Surgery’s Back in the Game, but I am happy to share it here as well.  ## Biceps Rupture/Biceps Tear I had extreme pain in my arm and shoulder. Being a bowler, I had pain that was at sometimes unbearable and sought a few doctors for a diagnosis. I wasn’t comfortable with my local doctors, even though they narrowed down my pain to my biceps. They seemed to be unsure and they varied on their opinions on how to correct it. After x-rays and MRIs, I decided to do more research, knowing that my dominant arm was a very important part of my life, I researched the Hospital For Special Surgery and Dr. Sabrina Strickland. I decided that her and the hospital’s record constituted at least an appointment/diagnosis. And let me tell you, I am glad that I did. After 5 minutes in the appointment, I was confident that Dr. Strickland was at the top of her game. Her knowledge and diagnosis was precise and detailed to the point that I was ready to have my arm repaired. So, on May 11, 2015 I had the same day, Bicep Tenodesis surgery to reattach my torn bicep. Within 3 hours or so I was headed home. I wore a sling for 4 weeks and began Physical therapy only 7 days later. Around the 80 day mark, at 1 of my follow up visits, Dr. Strickland gave me the “go ahead” to begin swinging a bowling ball (of lighter weight). ## Return to Bowling This went well for a bit and at the 93 day mark, I bowled my first games with my own 15lb bowling ball. I proceeded to bowl 3 games with scores of 254,252 and 235. I was back in the game and felt better than I had in years! If you have arm pain, or are unsure, I HIGHLY recommend Dr. Sabrina Strickland and the Hospital for Special surgery for your needs. They are certainly knowledgeable, the best and their bedside manner is supreme! Robert even shared a video of himself bowling after his biceps rupture repair (biceps tenodesis) — check it out here: https://www.youtube.com/watch?v=cJic_tT0aM0 - bicep rupture, bicep surgery, bicep tear, biceps rupture, biceps surgery, biceps tear, Biceps Tenodesis, Bowling, bowling ball, diagnosis, Physical Therapy, torn bicep ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousPatella Alta Patients May Experience Less Severe Cartilage Damage after Instability NextAcupuncture During Surgery May Help Patients With NosocomephobiaNext --- ## Brawn Body Knee Injuries Skiing Injuries | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/brawn-body-health-and-fitness-podcast-knee-injuries-knee-arthritis-skiing-injuries-and-more/ Summary: Brawn Body Health and Fitness Podcast covers common knee injuries and surgical interventions, ACL tears, patellar instability, patellar tracking issues, and more. # Brawn Body Health and Fitness Podcast: Knee Injuries, Knee Arthritis, Skiing Injuries, and more! Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: July 5, 2024 - August 22, 2022 In this episode of the Brawn Body Health and Fitness Podcast, Dan is joined by Dr. Sabrina Strickland from Hospital for Special Surgery to discuss common knee injuries and surgical interventions, including ACL tears, patellar instability, patellar tracking issues, osteoarthritis of the knee, injections for knee pain, skiing injuries, and more! Dr. Sabrina Strickland is board certified in sports medicine and orthopedic surgery at HSS, where she specializes in patellofemoral surgery for instability, cartilage disease, ACL and meniscal surgery and shoulder surgery. She completed her residency and fellowship in sports medicine at HSS after completing medical school at Rush in Chicago. Prior to that, Dr. Strickland received her BA from Cornell University. Currently, Dr. Strickland is an associate professor of orthopedic surgery at Weill Cornell Medical College. She retired from her part-time position as the Chief of Orthopedics at the VA in 2012 after seven years of service. Dr. Strickland is also the co-founder of the HSS Patellofemoral Center.  Listen to the Brawn Body Health and Fitness Podcast. - ACL tears, common knee injuries, injections for knee pain, osteoarthritis of the knee, patellar instability, patellar tracking issues, skiing injuries, surgical interventions ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousShoulder Replacement – Bar Hangs 3 Months Post Surgery NextEffect of Patellofemoral Arthroplasty on Patellar Height in Patients with Patellofemoral OsteoarthritisNext --- ## Medial Meniscus Tear & Repair - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/brenda-yee-medial-meniscus-tear-and-arthroscopic-repair/ Summary: Brenda Yee had a medial meniscus tear that could be arthroscopically repaired and thus, spare her from needing knee replacement further down the road. # Brenda Yee — medial meniscus tear and arthroscopic repair Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: May 2, 2026 Quick Summary Brenda Yee came to me with a medial meniscus tear that — based on tear pattern and location — was a candidate for arthroscopic repair rather than meniscectomy. By repairing the tissue instead of removing it, we preserved the meniscus's role as the knee's shock absorber and reduced her long-term risk of needing knee replacement. She has since returned to all of her physical activities. - March 15, 2022 These are my favorite kinds of stories to share – the stories from my patients who are back in the game! Brenda Yee had a medial meniscus tear that could be arthroscopically repaired and thus, spare her from needing knee replacement further down the road. After consulting with Hospital for Special Surgery surgeon Dr. Hannafin and a referral to me, Brenda has resumed ALL of her physical activities. Read Brenda’s story in her own words. ## Why I chose repair over meniscectomy in Brenda's case When the tear pattern and tissue quality allow it, I always prefer repairing a medial meniscus tear rather than excising it. The medial meniscus is the knee's primary shock absorber on the inside of the joint. Once you remove meniscal tissue, you accelerate cartilage wear on the underlying tibia and femur — and that is the pathway that ultimately leads many patients to early osteoarthritis and, eventually, knee replacement. Brenda's tear was in the peripheral, well-vascularized zone (often called the red-red zone), which has the blood supply needed for the tissue to heal once it's stabilized arthroscopically. Whenever I see that pattern in a healthy, active patient, repair is the right call — even though the rehab is longer. ## What the arthroscopic repair looked like Through small incisions and a camera-guided approach, the torn fragment is reduced back to its anatomic position and held with sutures or all-inside repair devices. There is no large open incision, and most patients go home the same day. The first 4–6 weeks involve protected weight-bearing and a controlled range of motion to let the meniscus heal; from there, strength work, low-impact cardio, and gradual return to sport follow over the next several months. Brenda followed her rehab plan closely, which is the single biggest predictor of a durable repair. ## When meniscus repair is an option for you Not every meniscus tear is repairable — degenerative tears, complex flap tears, and tears in the avascular inner zone often heal poorly even when sutured. The honest answer for any individual patient depends on imaging (MRI), tear pattern, tissue quality, age, activity level, and the condition of the surrounding cartilage. Brenda's outcome is a reminder that when repair IS an option, choosing it almost always pays off long-term. If you have been told you need a meniscectomy, it is worth asking your surgeon whether your tear is potentially repairable instead — and if you would like a second opinion, my office is always happy to review your imaging. - arthroscopic repair, back in the game, knee injury, medial meniscus, medial meniscus tear, orthopaedic surgeons, sports medicine, success stories, women surgeons, women's sports surgery ## Frequently Asked Questions Can a medial meniscus tear be repaired instead of trimmed out?Yes — when the tear pattern and tissue quality allow it. Tears in the outer part of the meniscus, where blood supply is good, are the most repairable. A repair saves the meniscus, which protects the cartilage and lowers your long-term risk of needing a knee replacement. Whenever I can repair the meniscus instead of removing the torn piece, I do — even if it means a slower recovery. Why does meniscal repair matter for avoiding knee replacement later?The meniscus is the knee's main shock absorber. Removing meniscus tissue speeds up cartilage wear and is a known risk factor for early arthritis and eventual knee replacement. By repairing instead of removing, we keep the meniscus's shock-absorbing job intact — which is why repair has become the default whenever the tear pattern allows it. How long is recovery after arthroscopic meniscus repair?Recovery from a repair is longer than from removing the torn piece because the tissue has to heal. Most patients are protected with limited weight-bearing and limited knee bending for the first 4 to 6 weeks, then build to full weight-bearing and strengthening over 6 to 12 weeks, and return to running and cutting sports at 4 to 6 months. The trade-off — slower recovery now, healthier knee long-term — is almost always worth it. ## Related Reading - Meniscal tear / torn meniscus (specialty page) - 5 symptoms of a torn meniscus that will self-heal - 6 exercises to do with a torn meniscus - Medial meniscus root repair and implantable shock absorber - More patient success stories ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousPotential complications with BTB (patellar tendon) grafts for ACL reconstruction NextSurgical demo: MPFL/MQTFL Reconstruction: Lateral Retinacular Lengthening/ReconstructionNext --- ## Bridge Registry: First 100 BEAR Patients | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/bridge-registry-what-the-first-100-bear-patients-teach-us/ Summary: Bridge Registry study: BEAR offers a promising ACL repair, showing high knee stability and low retear rates in the first 100 real-world patients. # Bridge Registry: What the First 100 BEAR Patients Teach Us Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: August 29, 2025 - August 29, 2025 The Bridge-Enhanced ACL Restoration (BEAR) technique represents a new frontier for treating anterior cruciate ligament (ACL) injuries, offering an alternative to traditional reconstruction. Recent data from the first 100 patients in the Bridge registry provide valuable insights into the effectiveness and safety of BEAR in real-world, post-commercial settings. ## What Is BEAR? BEAR is a surgical procedure designed to help the body heal a torn ACL using a special implant, rather than replacing it with a graft from elsewhere in the body. This means restoring natural tissue instead of reconstruction, which may preserve knee function and improve recovery for certain patients. ## Outcomes After One Year At just over a year post-operation, the majority of the first 100 registry patients showed excellent knee stability and range of motion. Re-operation rates were low—8.3% at one year, rising modestly to 11.5% at the final check-in. Most importantly, the risk of ACL retears was very low, with no retears in the first year and a 2.1% rate at final follow-up. - Physical exam: 80% of patients had minimal (0-2 mm) laxity on Lachman testing, and 90% had no pivot shift at 12 months. - Patient-reported scores: The mean International Knee Documentation Committee (IKDC) score was 82.7; pain and daily living function scores were especially high, indicating robust recovery for most participants. ## Safety and Adverse Events Adverse events such as blood clots or meniscal injuries were rare. Technique modifications did not increase complication rates, and only two patients experienced recurrent ACL tears over the entire follow-up period. ## What This Means for Patients The results from this early real-world registry suggest BEAR is a promising option after ACL injury. Patients can expect high rates of knee function and stability with a relatively low risk of complications in the first year. BEAR isn’t for everyone, but for appropriate candidates, it could mean a faster, more natural recovery. For those recently diagnosed with an ACL tear, options are evolving. We are seeing that BEAR offers reliable outcomes with low risks, making it an excellent alternative for many patients considering ACL surgery. Read the study: Postcommercialisation outcomes of bridge-enhanced anterior cruciate ligament restoration: The first 100 Bridge registry patients Photo by Mick Haupt on Unsplash - ACL reconstruction, ACL repair, ACL retear, adverse events, BEAR, knee, Patient Reported Outcomes, prospective cohort, reoperations, stability ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousBack in the Game After a Torn Meniscus NextHigh Variation in Pediatric MPFL Reconstruction: Insights from the JUPITER StudyNext --- ## Can Running Backwards Help Knee Joints? - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/can-running-backwards-help-preserve-knee-joints-aaos/ Summary: Answering the question: Can running backwards help preserve knee joints? Insights from an orthopedic surgeon at the Hospital for Special Surgery. Skip to content # Can running backwards help preserve knee joints? AAOS Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: July 18, 2025 Dr. Sabrina Strickland, an orthopaedic surgeon specializing in sports medicine at Hospital for Special Surgery, answers a viewer’s question: Can running backwards help preserve knee joints? Manage Cookie Consent To provide the best experiences, we use technologies like cookies to store and/or access device information. Consenting to these technologies will allow us to process data such as browsing behavior or unique IDs on this site. Not consenting or withdrawing consent may adversely affect certain features and functions. Functional Functional Always active The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network. 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Individual results may vary based on diagnosis, anatomy, and overall health. --- ## Recovery from a dislocated patella? | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/can-you-fully-recover-dislocated-patella/ Summary: Can you recover from a dislocated patella? Learn your full recovery path: assess risk factors, understand MPFL injury, choose the right treatment. # Can You Fully Recover from a Dislocated Patella? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: November 14, 2025 Quick Summary Most patients recover fully after a first-time patella dislocation with structured rehabilitation, and many never need surgery. But recurrence risk is real — driven by anatomic factors like trochlear dysplasia, patella alta, and an elevated TT-TG distance. When dislocations repeat or imaging shows high-risk anatomy, MPFL reconstruction (sometimes combined with a tibial tubercle osteotomy) reliably restores stability and protects the cartilage. - November 14, 2025 A dislocated kneecap is a frightening and painful injury that raises immediate questions for most people about recovery and long-term outcomes. The good news is that many people can fully recover from a dislocated patella, but your journey depends on several factors, including the severity of injury, anatomical risk factors, treatment approach, and how well you follow your rehabilitation protocols. ## Understanding Patellar Dislocation When the kneecap slips out of its normal groove at the front of the knee, it causes sudden pain, swelling, and difficulty moving. In most cases, the kneecap spontaneously returns to its normal position when the leg is straightened. However, this traumatic event always tears or stretches the medial patellofemoral ligament (MPFL), which serves as the primary restraint preventing the patella from dislocating laterally.​ The MPFL attaches the inner edge of the patella to the femur, working like a leash to keep the kneecap on track as you move. When this ligament is injured, the knee becomes vulnerable to future instability.​ ## Recovery Outcomes: What the Research Shows ### For First-Time Dislocations Recovery from a first-time patellar dislocation typically takes six to eight weeks for return to normal daily activities. Most people can participate in sports after three to four months, though this timeline varies based on individual circumstances.​ However, the risk of recurrence is significant. Studies show that approximately 33% of patients who experience a first-time patellar dislocation will suffer another dislocation. Some research suggests recurrence rates may be even higher (up to 88%) in certain patient populations.​ ### Conservative Treatment Success Conservative management, which involves rest, ice, bracing, and physical therapy, remains the first-line treatment for most first-time patellar dislocations without significant bone or cartilage damage.  The treatment protocol typically includes:​ - Initial immobilization with a knee brace or stabilizer for a week or so until the leg feels stable. - Weight-bearing as tolerated, with crutches as needed​  - Physical therapy, starting within the first 2 weeks - Progressive strengthening exercises focused on the quadriceps, particularly the vastus medialis oblique (VMO), along with hip and core strengthening​ - Proprioception (your body’s ability to sense its own position and movements in space) and balance training​ Early active range of motion and strength training are typically associated with improved knee function, increased range of motion, and higher patient satisfaction compared to prolonged immobilization. Patellar taping and nonrigid bracing can also provide immediate stability and relief while promoting muscle preservation.​ ## Risk Factors Impacting Recovery from a Dislocated Patella Certain anatomical and demographic factors significantly increase the risk of recurrent dislocation and can affect your ability to fully recover. High-risk factors include: - Age: Younger patients, particularly those under 25 with open growth plates, face recurrence rates as high as 60-75%​ - Trochlear dysplasia: A shallow groove on the femur that provides inadequate containment for the patella​ - Patella alta: A high-riding kneecap that must travel further before engaging in the groove​ - Elevated tibial tubercle-trochlear groove (TT-TG) distance: Malalignment that pulls the patella laterally​ - Ligamentous laxity: Generalized joint looseness that reduces stability​ - Female gender: Women and girls experience higher rates of patellar instability​ - History of contralateral dislocation: Previous dislocation of the opposite knee increases risk​ When patients have multiple risk factors present, recurrence rates escalate dramatically. Studies show that patients with two risk factors face recurrence rates of 30-60%, while those with three or more risk factors see rates of 70-80%.​ ## Surgical Treatment for Optimal Recovery ### When Surgery Is Recommended Surgery becomes necessary when patients experience:​ - Recurrent dislocations or persistent instability after conservative treatment - Osteochondral fractures (loose bone or cartilage fragments in the joint) - Severe anatomical risk factors predicting high recurrence - First-time dislocation in high-risk patients (young age, multiple anatomic abnormalities) ### MPFL Reconstruction MPFL reconstruction has become the primary surgical treatment for patellar instability, with excellent success rates. The procedure involves creating a new ligament using donor tissue or the patient’s own tendon to stabilize the kneecap.​ Success Rates: - 92.8% of patients return to sports after MPFL reconstruction​ - 71.3% return to or surpass their preoperative activity level​ - Recurrent instability occurs in only 1.8-1.9% of patients​ - Overall complication rate is 8.8%​ ### Additional Procedures Some patients require combined procedures to address multiple anatomical abnormalities:​ - Tibial tubercle osteotomy (TTO) realigns the extensor mechanism in cases of elevated TT-TG distance or patella alta​ - Trochleoplasty reshapes the femoral groove in severe trochlear dysplasia cases, though this is complex and carries high complication risks​ and risks damage to the articular cartilage  - Cartilage restoration, which repairs or regenerates damaged cartilage from repeated dislocations​ Studies of patella stabilization surgery show that 92% of patients achieve partial to full stability post-surgery, with 48% rating outcomes as excellent and 32% as good. Most patients return to normal activities within weeks, with 80% experiencing no complications.​ ## Maximizing Recovery from a Dislocated Patella Whether you pursue conservative or surgical treatment, several factors improve your chances of making a full recovery.  ### Comprehensive Rehabilitation Physical therapy is essential regardless of treatment approach. A structured program should include:​ - Early range of motion exercises to prevent stiffness​ - Quadriceps strengthening​ - Hip and core strengthening to improve overall lower extremity control​ - Proprioceptive training and balance exercises​ - Sport-specific drills before returning to athletics​ ### Preventing Patellar Dislocation To reduce the risk of re-injury:​ - Use proper techniques for your sport - Practice exercises that strengthen and condition your legs - Follow physical therapy recommendations - Consider a patellar stabilizing brace during high-risk activities - Address any anatomical risk factors through appropriate surgical correction ### Early Medical Evaluation If you’ve dislocated your patella, seek immediate medical attention. Your healthcare provider should:​ - Perform a thorough physical examination - Order imaging studies (X-rays and MRI) to assess for osteochondral fractures, ligament damage, and anatomical risk factors​ - Develop a treatment plan based on your specific circumstances An MRI is particularly important (even after a single dislocation) to evaluate the degree of damage and identify likelihood of repeat dislocation. This information guides any treatment decisions and helps predict your outcomes.​ ## Recovering from a Dislocated Patella You can absolutely recover fully from a dislocated patella, but your success depends on the factors outlined in this post. ​The key is to recognize risk factors early on, choose appropriate treatment, and dedicate yourself to the rehabilitation process. Whether through conservative management or surgical stabilization, full recovery is an achievable goal for the majority of patients who experience a dislocated patella.  An experienced orthopedic surgeon who specializes in patellofemoral instability can help ensure the best possible outcome and minimize your risk of long-term complications. Have questions? Please reach out. Photo by Nikola on Unsplash - conservative treatment, dislocated kneecap, dislocated patella, knee instability, Medial Patellofemoral Ligament (MPFL), MPFL reconstruction, Osteochondral fractures, patella alta, patellar dislocation, Physical Therapy, Recurrence, rehabilitation, Risk factors, surgical treatment, Tibial tubercle osteotomy (TTO), Trochlear dysplasia ## Frequently Asked Questions How long does recovery from a first patella dislocation take?Most first-time kneecap dislocations recover with 6 to 12 weeks of physical therapy focused on quad strength, hip-stabilizing muscles, and retraining the way the kneecap tracks. Most patients are back to sport at around 3 months. Early imaging matters because it can pick up loose pieces of cartilage and bone or anatomical risk factors that change the plan. Pain and swelling can last several weeks during recovery. When is surgery needed after a patella dislocation?I consider surgery when a patient has dislocated more than once, when imaging shows a shallow groove on the thigh bone or a high-riding kneecap, when there is a loose piece of cartilage and bone in the joint, or when the ligament that holds the kneecap in place (the MPFL) is clearly torn and the knee still feels unstable. First-time dislocations without these factors are usually managed non-surgically. The decision balances your dislocation history, your anatomy, and your activity goals. Will I be able to play sports again after a patella dislocation?Most patients return to recreational and competitive sports after a first-time dislocation with physical therapy alone, and after MPFL reconstruction when surgery is needed. Return-to-sport timelines after surgery are usually 4 to 6 months, depending on what was done. Wearing a sleeve or brace during your first season back is reasonable but not always required. ## Related Reading - Patellar instability (specialty page) - MPFL reconstruction surgery - What happens if patella dislocation is untreated? ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWhy Does My Knee Hurt Going Down Stairs? NextInnovative new procedure uses sea coral to help people who suffer from knee osteoarthritisNext --- ## Can Your Genes Predict an ACL Tear? | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/can-your-genes-predict-acl-tear/ Summary: Can your genes reveal your risk of an ACL injury? AI and genetics might hold the answer—but we’re only starting to uncover the possibilities. # Can Your Genes Predict an ACL Tear? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 18, 2025 - December 18, 2025 It is actually incredible what you can do with a wealth of genetic information. I don’t conduct this type of research, nor have I personally sent my cells to 23andMe, but I do know several people who have discovered some very interesting findings. This report from 23andMe states that they can help predict your risk of tearing your ACL. While we know that ACL tears can run in families and that anatomical, muscular, and movement characteristics predispose athletes to ACL injury, it would be interesting to see how a purely genetic test could add to our knowledge. Sadly, there are no details reported here, so it is difficult to draw many conclusions. However, as AI and large genetic data pools become more sophisticated, we may be able to tailor our sporting activities to minimize the risk of injury. Read the article: Genetics May Explain Why Some Athletes Are More Prone to ACL Tears  Image created by AI.    - 23andMe, ACL injury, ACL tears, AI, anatomy, biomechanics, family risk, genetic data, genetic testing, injury prediction, injury prevention, movement patterns, muscular factors, personalized medicine, sports science ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousNew CPT Code for CARTIHEAL AGILI-C Procedures Approved NextACL Surgery Explained: Graft Choices, New Techniques & Recovery InsightsNext --- ## Cardio at the movies: CNN Staying Well - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/cardio-at-the-movies-cnn-staying-well/ Summary: Cardio cinema can increase endurance because chances are you are going to do it longer. # Cardio at the movies: CNN Staying Well Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: July 18, 2025 - June 1, 2023 Here’s how a trip to the gym could involve a longer workout, with a fun favorite pastime. - cardio, Cardio at the Movies, CNN, CNN Staying Well, Hospital for Special Surgery, HSS, movies, staying well ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousStaying Well on CNN: Cardio at the Movies NextUpdated: Patellofemoral Arthroplasty Conversion to Total Knee ArthroplastyNext --- ## Caring for Veterans - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/caring-for-veterans/ Summary: Join us in saluting all of our veterans on Veterans Day. Some veterans’ injuries relate to wartime or peacetime service, others are normal wear and tear on the body. # Caring for Veterans Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - August 14, 2016 Join us in saluting all of our veterans on Veterans Day. Dr. Sabrina Strickland, Orthopedic Surgeon, cares for many United States veterans. “I find great fulfillment in this role as each of the veteran patients have served and protected their country and therefore myself and my family,” says Dr. Strickland. “Some of the veterans’ injuries relate to their wartime or peacetime service, others are a result of normal wear and tear on the human body.” Dr. Strickland shares some of the common injuries she cares for in these veteran patients: 1. Recent veterans, such as those who served in the Gulf War, Operation Iraqi Freedom and the War in Afghanistan, often suffer from ACL tears and shoulder dislocations sustained while training or deployed. 2. Vietnam War veterans have wear and tear injuries that are common for people of their age. We often perform rotator cuff repairs in their shoulders, as well as knee replacements. Physical therapy and strength training can be quite helpful. 3. Korean War veterans are typically older and often suffered injuries on active duty that have lead to arthritis now. They often require joint replacement surgery to reduce their pain and improve their function. 4. World War II vets mainly suffer from arthritis. Our goal is to minimize pain and optimize mobility. - patient care, veterans ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHelping Women Overcome Shoulder Pain NextDr. Sabrina Strickland, Orthopedic Surgeon, Answers Your Questions on Frozen ShoulderNext --- ## Caring for Young Female Athletes - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/caring-for-young-female-athletes/ Summary: Everyone must eat enough to meet the demands of their lifestyle, and this is especially true for athletes. The female athletic triad must be identified and treated. # Caring for Young Female Athletes Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - October 29, 2015 Sadly this isn’t anything new. Everyone needs to eat enough to meet the demands of their lifestyle, and this is especially true for athletes. The female athletic triad has had many names over the years; the most important aspect of it is recognition. Once it is identified then it can be treated. Treatment isn’t complicated, but it is vital. The key is to make sure that the athlete’s nutrition allows enough nutrients and calories to allow for a great race, match or competition. As in all things, prevention is better than treatment. Good snacks before sports, well balanced meals rather than just carbs or “empty calories,” and an occasional evaluation of the one’s nutritional status are incredibly important aspects of long term bone health and athletic performance.   ## To Thrive, Many Young Female Athletes Need A Lot More Food : Shots – Health News : NPR Doctors and parents often miss the signs of female athlete triad syndrome — low energy, low bone density and irregular menstruation in an otherwise healthy-looking girl or teen. Source: www.npr.org/sections/health-shots/2015/08/31/435294539/to-thrive-many-young-female-athletes-need-a-lot-more-food   - female athletes, irregular menstruation, low bone density, low energy, NPR, triad syndrome ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousBefore Knee Replacement Surgery NextHSS Bone QuizNext --- ## CartiHeal Agili-C Is Back - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/cartiheal-cartilage-injury-treatment/ Summary: CartiHeal Agili-C, an FDA approved medical device, can be used to treat cartilage and joint surface lesions in the knee. Learn more. # Cartiheal Is Back: New Cartilage Injury Treatment Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - August 29, 2023 I’m happy to report that CartiHeal is back. This is a new treatment for cartilage injury that was FDA approved in 2022 and was initially launched by a large pharmaceutical firm. The banking crisis lead to a temporary halt as the company reverted to the original owner. Today I did the 13th (my third) and the 4th since the relaunch. CartiHeal Agili-C is an FDA approved medical device that can be used to treat cartilage and joint surface lesions in the knee. - Agili-C, Cartiheal, cartilage injury treatment, FDA-approved, join surface lesions, knee, knee injury, knee treatment, medical device ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousSkier with ACL Tear and Meniscus Tear NextMISHA™ Knee System Treats First Commercial Patients in the USNext --- ## How does Cartiheal compare to OCA, MACI? | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/cartiheal-oca-maci/ Summary: One question patients ask is how Cartiheal compares to osteochondral allograft transplantation (OCA) and matrix-associated autologous chondrocyte implantation (MACI) # How does Cartiheal compare to OCA and MACI? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: May 17, 2024 Quick Summary Cartiheal (Agili-C), osteochondral allograft transplantation (OCA), and matrix-associated autologous chondrocyte implantation (MACI) are three cartilage repair options with overlapping but distinct indications. Cartiheal is FDA-approved for degenerative cartilage lesions and works well for patients over 35 with bone edema or bone/cartilage involvement. OCA suits a single focal lesion larger than 2 cm² and uses donor tissue. MACI repairs single or multiple cartilage defects but requires two surgeries. - May 17, 2024 One common question patients ask me is how Cartiheal compares to osteochondral allograft transplantation (OCA) and matrix-associated autologous chondrocyte implantation (MACI). Here’s a high level answer:  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. Have other questions? Please reach out to my office or check out my most commonly asked questions and answers.  - bone edema, bone/cartilage lesion, Cartiheal, degenerative cartilage lesions, donor tissue, FAQs, MACI, matrix-associated autologous chondrocyte implantation, multiple cartilage defects, OCA, osteochondral allograft transplantation, patient questions, single cartilage defects, single focal lesion, surgeries ## Frequently Asked Questions Who is a candidate for Cartiheal versus OCA or MACI?Cartiheal is best for patients over 35 with wear-and-tear cartilage damage, especially when there is swelling in the underlying bone or a combined bone-and-cartilage defect. OCA (donor cartilage and bone) is preferred for a single full-thickness defect larger than 2 square centimeters, often in younger active patients. MACI (your own cartilage cells grown in a lab and re-implanted) is used for one or more cartilage defects, especially when we want to preserve the underlying bone — but it requires two surgeries. How long is recovery for each cartilage procedure?OCA tends to heal faster than MACI because the donor plug brings ready-made cartilage and bone with it. MACI starts with a small biopsy, followed by 4 to 6 weeks while your cells are grown in the lab, then a second surgery to implant them — with physical therapy continuing for 9 to 12 months. Cartiheal is done in a single operation, and you gradually return to activity over several months as the scaffold is replaced by your own tissue. Does Cartiheal require donor tissue or a second surgery?No. Cartiheal (Agili-C) is a synthetic scaffold made from coral-based mineral, implanted in one operation — so there is no donor tissue and no second surgery. That contrasts with OCA, which uses fresh donor cartilage and bone, and with MACI, which requires two surgeries — one to harvest your own cartilage cells and another to implant them after they are grown in a lab. Is there overlap in when these procedures are used?Yes. Many patients with medium-sized cartilage defects could reasonably be treated by more than one of these techniques. The choice depends on the size, depth, and location of the defect, whether the underlying bone is involved, your age, your activity goals, and any previous surgeries. The decision should always be made after a thorough evaluation, including imaging that shows how deep the defect is and what the underlying bone looks like. ## Related Reading - Cartiheal cartilage injury treatment overview - Cartilage transplant: OATS & allograft - MACI cartilage repair - Outcomes of cartilage restoration procedures - New CPT code for Cartiheal Agili-C ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousMOCART Scores > 55 at 6 Months Post-op ACI & Patient Satisfaction NextMedial Patellofemoral Ligament Reconstruction QuestionsNext --- ## Triston Casas Patellar Tendon Surgery | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/casas-hospital-patellar-tendon-surgery/ Summary: Triston Casas has been released from Mass General following patellar tendon surgery on Sunday. # Casas out of the Hospital Following Patellar Tendon Surgery Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: May 16, 2025 - May 16, 2025 In this Boston Globe article, Dr. Strickland shares her insight on Red Sox player Triston Casas’ recent surgery to repair his left patellar tendon. Read the article, which is in their Red Sox Notebook and titled: “Masataka Yoshida won’t return to Red Sox until he can throw pain free.” Photo by Osman Rana on Unsplash - baseball, Boston Red Sox, Casas, Dr. Sabrina Strickland, Mass General, MLB, patellar tendon, recovery, sports injury, surgery, Triston Casas ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousIs There An Ideal Hamstring Autograft Diameter for ACL Reconstruction? NextFDA Approves IDE Application for Freestyle Knee ImplantNext --- ## Case Report: Arthroscopy + Revision TTO | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/case-report-arthroscopy-revision-tto/ Summary: Grand Rounds from HSS Case Report on a 16-Year-Old female lacrosse player with failed tibial tubercle osteotomy (TTO) treated with arthroscopy and revision TTO. # Case Report: Arthroscopy + Revision TTO for a 16-Year-Old Female Lacrosse Player Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: October 31, 2024 - October 18, 2024 In this Grand Rounds from HSS case report, I shared the story of a 16-year-old female lacrosse player with pain in her left knee. She had no previous traumatic injuries to report but had suffered two noncontact lateral dislocations at ages 11 and 13. To fix her dislocation issues, she had undergone tibial tubercle osteotomy (TTO) combined with a medial patellofemoral ligament (MPFL) reconstruction and particulated cartilage implant to the patella and trochlea. Unfortunately, after the original surgery, the patient reported weakness in her quadriceps with difficulty walking. When I examined her knee, I noted anterior knee crepitus (a grinding noise with a vibration), reduced quadriceps strength, and tenderness over the tibial tubercle. We used computed tomography (CT), magnetic resonance imaging (MRI), and an X-ray of the prior TTO to analyze what was happening. This imaging showed fragmentation of the tibial tubercle shingle and patella alta. I determined that the best approach was arthroscopy and revision TTO. A final X-ray one year after this surgery, we saw complete healing of the tibial tubercle — and our young patient had returned to full range of motion and lacrosse.  Read more about this case report on Grand Rounds from HSS. (The image is from the case report.) - anterior knee crepitus, arthroscopy, Caton–Deschamps ratio, fragmentation of the tibial tubercle shingle, grand rounds, Hospital for Special Surgery, HSS, Lateral left knee CT imag, Medial patellofemoral ligament, Medial Patellofemoral Ligament Reconstruction, MPFL, particulated cartilage implant, patella, patella alta, tibial tubercle osteotomy, trochlea, TTO, TTO revision surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousA Foot Workout & How Feet Relate to Knees NextTreating Patellar Chondral Lesions with Concomitant MACI, MPFL, and TTONext --- ## Challenging Cartilage Injuries Interview - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/challenging-cartilage-injuries-sports-doc-podcast-aossm/ Summary: At AOSSM on Friday, I # Challenging Cartilage Injuries on the Sports Doc Podcast at AOSSM Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - July 12, 2023 Join me for a podcast that’s part of the American Orthopaedic Society for Sports Medicine (AOSSM), which is holding an Annual Meeting this week, July 13-16 in Washington, DC. On Friday, I’ll be joining The Sports Doc Podcast. My session is from 1:00-1:30 PM and I’ll be discussing challenging cartilage injuries with Seth Sherman, MD. The focus of the session is on the addition of an osteotomy to manage patellofemoral cartilage disease +/- instability – patient selection and technique tips. The session will be broadcast live within the Exhibit Hall and again later via The Sports Doc podcast channels (available on Apple, Spotify, etc.) and the Sports Doc website. We will focus on how to apply research and new innovations and how these findings impact the way we practice orthopedics. Learn more about the AOSSM Annual Meeting and the The Sports Doc Podcast.1 - AOSSM, AOSSM Annual Meeting, cartilage injuries, orthopaedic surgery, osteotomy, patellofemoral cartilage disease, patellofemoral cartilage instability, patient selection, podcast, sports doc, sports medicine, technique tips ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHow to Improve Long-term Prognosis for Adolescents with Patellofemoral Pain? NextClinical Reproducibility and Reliability of Lever Sign Test for Acute ACL TearNext --- ## Cartilage Injuries - The Sports Docs - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/challenging-cartilage-injuries-sports-docs/ Summary: I joined Dr. Seth Sherman and The Sports Docs to record a podcast at The American Orthopaedic Society for Sports Medicine about challenging cartilage injuries. # Challenging Cartilage Injuries with The Sports Docs Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - August 2, 2023 I was excited to join The Sports Docs — Dr. Catherine Logan and Dr. Ashley Bassett — and Dr. Seth Sherman for “Challenging Cartilage Injuries,” live at the American Orthopaedic Society for Sports Medicine (AOSSM) Annual Summit 2023. I’m an associate professor of orthopaedic surgery and an attending surgeon at the Hospital for Special Surgery and an active member of many societies and research groups, including the International Cartilage Repair Society and the International Patellofemoral Study Group. Dr. Seth Sherman is the Director of the Sports Medicine Fellowship at Stanford University Orthopaedics and is a Stanford University Football team physician. He is Chairman of the American Academy of Orthopaedic Surgeons (AAOS) Sports Medicine/Arthroscopy committee and is also a member of the International Patellofemoral Study Group. Both Dr. Sherman and I publish and lecture extensively on the topic of knee joint preservation, cartilage restoration and specifically patellofemoral cartilage disease. The Sports Docs – Dr. Bassett & Dr. Logan – are friends & former co-residents from the Harvard Combined Orthopaedic Residency Program, who went onto esteemed sports medicine fellowships at The Steadman Clinic and The Rothman Institute, respectively. The podcast is available on: Apple Podcasts Spotify YouTube Web     - cartilage restoration, challenging cartilage injuries, International Cartilage Repair Society, International Patellofemoral Study Group, knee joint preservation, patellofemoral cartilage disease, the sports docs ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousClinical Reproducibility and Reliability of Lever Sign Test for Acute ACL Tear NextEpisode 44: Challenging Cartilage Injuries with Dr. Sabrina Strickland & Dr. Seth Sherman, Live at AOSSM 2023Next --- ## Choosing to be a "surgeon-mom" - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/choosing-to-be-a-surgeon-mom/ Summary: Choosing to be a "surgeon-mom" is a decision that I never wavered on. I wanted to be a surgeon since the fifth grade and never questioned whether to have children. # Choosing to be a "surgeon-mom" Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - December 20, 2019 Choosing to be a “surgeon-mom” is a big decision that I never wavered on. I wanted to pursue surgery as a career since the fifth grade and never questioned whether or not I would have children. Many professional careers demand significant sacrifice, and surgery is certainly no exception. I read this article in the NY Times and think of all the young women who opt-out. The fact that 10 percent more women drop out of surgical residencies than men is not just because they find balancing work and home life difficult. These women are told over and over again how hard it is, and this verbal discouragement and workplace discrimination takes its toll. I try to mentor as many female medical students as I can. I want to show them that I have three happy, intelligent, and well adjusted teenage girls who think that the fact that their mom is a surgeon is pretty awesome. https://www.nytimes.com/2019/12/20/science/doctors-surgery-motherhood-medical-school.html?fbclid=IwAR1xHH6Azl3_yqgKDtUMKdY4xGbyDN1yS315pifsAdfdgdS9C_8fuTBeZ1k - blog, Hospital for Special Surgery, surgeon mom ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousConsiderations for patellofemoral joint preservation vs patellofemoral arthroplasty NextA Message To My Patients – COVID-19Next --- ## Clinical Reliability of Lever Sign Test - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/clinical-reproducibility-reliability-lever-sign-test-acute-acl-tear/ Summary: I thought this study on the Lever Sign test was interesting: it the difficulty of diagnosing an ACL tear for those not specially trained in Sports Medicine. # Clinical Reproducibility and Reliability of Lever Sign Test for Acute ACL Tear Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - July 20, 2023 I thought this study was interesting. Partly because I have never heard of the Lever Sign Test, or Lelli Test, but more importantly because it points out how hard it is to diagnose an ACL tear if you aren’t specially trained in Sports Medicine.  Patients often come in to see me after a ski injury, frequently after having been evaluated at first aid at the base of the mountain or at urgent care. They are often told that they just “strained their knee” —only for me to have to break the news that they actually tore their ACL. Read the complete article at Dove Press. Image via https://litfl.com/lelli-test/  - ACL tear, acute ACL tear, clinical reliability, clinical reproducibility, diagnosis, lelli test, lever sign test, sports medicine ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousChallenging Cartilage Injuries on the Sports Doc Podcast at AOSSM NextChallenging Cartilage Injuries with The Sports DocsNext --- ## Concussion Prevention in Soccer - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/concussion-prevention-in-soccer/ Summary: The U.S. Soccer # Concussion Prevention in Soccer Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - November 16, 2015 I think this is a great move as it isn’t the head hitting the ball, it is two players going for the same ball and colliding. This may end up changing the game of soccer going forward, but if it prevents head injuries then it is well worth it.   ## U.S. Soccer Announces Concussion Plan | Source: blogs.gotsoccer.com/?p=16451   - concussions, head injuries, soccer ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWall Street Journal – Avoiding Running Injuries NextPreparing for Ski SeasonNext --- ## Patellofemoral Joint Preservation vs. Patellofemoral Arthroplasty Source: https://sabrinastrickland.com/considerations-for-patellofemoral-joint-preservation-vs-patellofemoral-arthroplasty/ Summary: Who is a candidate for joint preservation surgery in the Patellofemoral joint? Read this article I wrote: www.healio.com/orthopedics/sports-medicine/news/blogs # Considerations for patellofemoral joint preservation vs patellofemoral arthroplasty Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - May 3, 2019 Who is a candidate for joint preservation surgery in the Patellofemoral joint? Read this article I wrote: www.healio.com/orthopedics/sports-medicine/news/blogs - joint preservation, patellofemoral arthroplasty, patellofemoral joint preservation ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWhy I Love Orthopedics NextChoosing to be a "surgeon-mom"Next --- ## Cortisone vs Gel Shots for Knee Pain | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/cortisone-vs-gel-shots-for-knee-pain/ Summary: Cortisone vs gel knee injections explained by two knee surgeons, covering when each works best, risks, and how they can help delay surgery. # Cortisone vs Gel Shots for Knee Pain: How I Decide Between Knee Injections - Published April 13, 2026 · Last reviewed April 28, 2026 Written by Dr. Sabrina Strickland, MD — Orthopedic Surgeon, Hospital for Special Surgery (HSS), New York. Medically reviewed by Dr. Sabrina Strickland, MD. Quick Summary For knee osteoarthritis, I use cortisone when the joint is acutely inflamed and the patient needs rapid relief, and hyaluronic acid (gel) injections for chronic, day-to-day knee arthritis pain when longer-lasting lubrication is the goal. Cortisone works in days; gel shots take 2–4 weeks but can last 4–6 months. The right choice depends on imaging, exam, prior treatments, and your activity goals — not on a single rule. As a knee surgeon at Hospital for Special Surgery (HSS) in New York, a large part of my practice is helping patients with knee pain stay active without rushing to surgery. Cortisone and hyaluronic acid injections are two very different tools, and choosing between them is a clinical decision based on what is actually driving the pain. In this post I'll walk through how I think about each one, when I combine them with physical therapy, and how injections fit into a long-term plan for knee osteoarthritis. Transcript We do a lot of injections so yes we are surgeons but not everything needs surgery. And we don't often know if somebody needs surgery until we we see them and we try other other stuff. So first kind of injection that we use really commonly is cortisone and cortisone kind of gets a bad name. Um People have overused cortisone and if you do it too much then yes that's true it does weaken the tissues a little bit because cortisone doesn't have a normal role in a knee joint. Um so if you use it sparingly I would say that's still okay and it works pretty quickly and it's pretty powerful. So if you have a ton of knee pain it's a flare-up um then cortisone still And cortisone's essentially the ultimate anti-inflammatory. So if you had poison ivy you'd rub cortisone cream on your skin. If you had asthma you'd inhale it and if you have a really inflamed knee joint cortisone can really help uh get the inflammation down. And yeah it works quickly but it doesn't work very long. And because of that we have other injections as well for example hyaluronan or HA lubricating gel shots also called sometimes. So hyaluronic acid is basically something that's in almost every face cream. It's in hand lotions and it's just a lubricant. It's something we naturally make except once we have uh inflammation or some early arthritis we don't make as as good of or as much uh hyaluronic acid so it can be helpful to add it. Right so it plays a natural role anyways um and that's good for more chronic pain. ## Why Not Every Painful Knee Needs Surgery Many patients arrive in our office worried that an arthritis diagnosis means an immediate knee replacement. The reality is that the majority of patients with mild-to-moderate knee osteoarthritis can manage symptoms for years without surgery using activity modification, targeted strengthening, weight management, NSAIDs, and well-timed injections. My first job is to figure out the dominant pain driver — synovitis (inflammation), cartilage thinning, meniscal pathology, or malalignment — and match the treatment to that, not to a one-size-fits-all template. That diagnostic step relies on a careful history, physical exam, and weight-bearing radiographs (often graded on the Kellgren-Lawrence scale). For higher-stage arthritis, an MRI helps me look at cartilage, meniscus, and bone marrow edema before recommending an injection. ## When I Use Cortisone Injections for Knee Pain I use a cortisone (corticosteroid) injection when the knee is acutely inflamed — visibly swollen, warm, and painful with motion — and the patient needs to function in the next few days. Cortisone is a potent anti-inflammatory that calms synovitis quickly. Most patients feel meaningful relief within 2–5 days, and the effect typically lasts 6–12 weeks. That window is often enough to break a flare cycle, get into physical therapy, and start strengthening the quadriceps and hip stabilizers that protect the joint. ### Where cortisone fits best - Acute synovitis or effusion (a swollen, hot knee) in osteoarthritis - A flare after travel, a long ski day, or a step-up in training - Pain bad enough to keep someone out of physical therapy - Bridging patients toward elective surgery when scheduling is several weeks out ### The trade-offs I discuss with every patient Cortisone is a tool, not a cure. Repeated, frequent intra-articular steroid injections can weaken cartilage and surrounding soft tissue, and there is published concern about accelerated joint damage when steroid is used too liberally. For that reason I generally limit cortisone to no more than 3 injections per knee per year, and I avoid it within roughly 3 months of a planned knee replacement to reduce infection risk. Other risks I review: a temporary post-injection flare, a small infection risk, skin atrophy or pigment change at the injection site, and transient blood-sugar elevation in patients with diabetes. Key Takeaways — Cortisone - Best for an acutely inflamed, swollen knee that needs rapid relief. - Works in days; effect lasts roughly 6–12 weeks. - Use sparingly — overuse may weaken cartilage and tendon tissue. ## When I Use Hyaluronic Acid (Gel) Shots for Chronic Knee Arthritis Hyaluronic acid (HA) viscosupplementation — what patients call "gel shots" — is my preferred injection for chronic, mild-to-moderate knee osteoarthritis where day-to-day stiffness and activity-related pain are the main complaints. HA is a glycosaminoglycan your body normally produces in synovial fluid; it gives the fluid its viscoelastic properties so that the cartilage surfaces glide instead of grinding. In an arthritic knee, the native HA becomes thinner and less protective. Adding high-quality HA back into the joint can improve lubrication and shock absorption. In my clinic I use FDA-approved HA products such as Synvisc, Euflexxa, Orthovisc and Supartz, depending on insurance coverage and the patient's prior response. Some are single-injection courses; others are weekly series of 3 to 5 shots. Most patients notice improvement at 2–4 weeks rather than days, and the benefit, when it works, often lasts 4 to 6 months — sometimes longer. ### Where gel injections fit best - Chronic, activity-related knee arthritis pain without a hot, swollen joint - Patients who want to stay active and avoid repeated steroid injections - Kellgren-Lawrence grade 2–3 osteoarthritis (mild to moderate cartilage loss) - Patients who responded only briefly to cortisone but want longer relief ### What I tell patients about realistic expectations HA does not regrow cartilage. It is a lubricant and modest anti-inflammatory, not a structural fix. About 60–70% of patients I treat get a clinically meaningful response; the rest may need to move on to other strategies. Reported risks are low but include a self-limited post-injection flare, mild swelling, and rare allergic reaction (older avian-derived products carried more allergy risk; modern bio-engineered HA is well tolerated). Insurance generally covers HA for documented osteoarthritis after conservative care has been tried. ## How I Decide Between Cortisone and Gel Injections The decision is rarely "either/or." I match the injection to what the joint is doing right now. A swollen, angry knee in front of me today usually gets cortisone. A patient with grumbling, chronic, mechanical knee pain who wants to keep skiing in Colorado or playing tennis in Central Park usually gets a hyaluronic acid series. And many patients benefit from both at different points in the same year. FactorCortisone (Corticosteroid)Hyaluronic Acid (Gel) How it worksPowerful anti-inflammatory; calms synovitisLubricant + mild anti-inflammatory; restores joint viscoelasticity Onset of relief2–5 days2–4 weeks Typical duration6–12 weeks4–6 months (sometimes longer) Best use caseAcute flare, hot/swollen kneeChronic OA, day-to-day stiffness, active patients FrequencyLimit to ~3 per knee per yearSeries can be repeated every 6 months InsuranceAlmost always coveredUsually covered with prior auth for documented OA Main risksTissue weakening with overuse, post-injection flare, transient blood-sugar risePost-injection swelling, rare allergic reaction Effect on surgery timingAvoid within ~3 months of planned knee replacementNo infection-risk window; safer near surgical planning Key Takeaways — How to Choose - Hot, swollen, acutely flared knee → cortisone first. - Chronic, mechanical, "I just want to stay active" knee → hyaluronic acid series. - The two can be sequenced — cortisone to break a flare, then HA for durable relief. ## How Injections Fit Into a Larger Knee Pain Plan An injection is rarely a standalone treatment in my practice. It is one part of a plan that typically includes targeted physical therapy (especially quadriceps and hip strength), weight management when relevant, footwear or unloader bracing, NSAIDs in selected patients, and addressing alignment or meniscal issues if imaging suggests they are part of the picture. Used this way, injections can buy real time — sometimes years — before surgery becomes the right next step. For patients who eventually progress to needing surgery, decisions about partial or total knee replacement are easier when we have clear documentation of what worked and what didn't. That is one reason I track injection responses carefully in our electronic record. ## When Injections Are No Longer the Right Answer Injections become less helpful as cartilage loss progresses. Constant pain, night pain that disrupts sleep, mechanical locking, severe deformity, and pain that no longer responds to either cortisone or HA are signals that the conversation should shift toward surgical options — partial knee replacement, total knee replacement, or, in selected younger patients, cartilage restoration. At that stage, continuing to inject often only delays the inevitable without improving function, and (for cortisone) can actually raise infection risk around an eventual replacement. ## Calming Anxiety About Knee Injections Patients are often more nervous about the needle than the procedure deserves. In our office, the injection itself takes seconds, and I numb the skin first. I use a precise intra-articular technique — and image guidance with ultrasound when anatomy or prior surgery makes the joint harder to enter — to make sure the medication actually reaches the joint space rather than the surrounding soft tissue. Most patients tell me afterward that the anticipation was worse than the experience. ## Frequently Asked Questions How long does a cortisone shot last for knee pain? Most patients feel pain relief from a cortisone knee injection within 2 to 5 days, and the effect typically lasts 6 to 12 weeks. Duration depends on the severity of inflammation, activity level, and the underlying joint condition. We generally limit cortisone to no more than 3 injections in the same knee per year to protect surrounding cartilage and tendon tissue. Are gel injections better than cortisone shots for knee arthritis? Neither is universally better — they treat different problems. Cortisone calms an acute inflammatory flare quickly. Hyaluronic acid (gel) injections work more slowly but can give longer relief in chronic, mild-to-moderate knee osteoarthritis by improving joint lubrication. In our practice, we often use cortisone first to settle a flare, then transition to gel injections for ongoing day-to-day relief. What are the risks of cortisone injections in the knee? Cortisone is generally safe when used sparingly, but risks include a temporary flare of pain in the first 24 to 48 hours, a small infection risk, skin or fat tissue thinning at the injection site, a transient rise in blood sugar in diabetics, and — with frequent repeat doses — possible cartilage and tendon weakening. We minimize these risks by limiting how often we inject and by using image guidance when needed. Are hyaluronic acid gel knee injections covered by insurance? Most major insurance plans cover hyaluronic acid (HA) viscosupplementation for documented knee osteoarthritis after conservative treatments such as physical therapy and NSAIDs have been tried. Coverage usually requires a confirmed diagnosis on imaging and prior authorization. Brand options such as Synvisc, Euflexxa, Orthovisc and Supartz vary by plan, so we verify benefits before scheduling the series. Can knee injections delay or replace surgery? Injections do not regrow cartilage or reverse osteoarthritis, but for many patients they can meaningfully delay knee replacement by reducing pain and helping you stay active. The right combination of cortisone, hyaluronic acid, physical therapy and weight management can buy years of comfortable function. When pain becomes constant, night pain disrupts sleep, and function is severely limited despite injections, that is when we discuss surgical options. ## Talk to Dr. Strickland About Knee Injection Options Choosing between cortisone and gel shots is a clinical conversation, not a marketing one. If you live with knee arthritis pain in the New York City or Stamford area, I'm happy to review your imaging, walk through what has and hasn't worked, and build an injection and rehabilitation plan around your goals. ### Schedule a Knee Pain Consultation NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY 10016 Book an Appointment Contact the Office Medical Disclaimer: This article is for general educational purposes and reflects Dr. Strickland's clinical perspective. It does not replace an in-person evaluation, diagnosis, or treatment recommendation from a qualified orthopedic specialist. Individual results vary, and the right injection plan depends on your imaging, exam findings, and overall health. ## Related Reading - The Role of Hyaluronic Acid in Healing Injuries - Knee Arthritis: Osteoarthritis, Rheumatoid & Post-Traumatic - Specialties — Knees and Shoulders - About Dr. Sabrina Strickland ← Previous: The Evolution of Knee Surgery --- ## Cost Benefit ACLR + LET Augmentation | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/cost-effectiveness-aclr-let-augmentation/ Summary: A recent study evaluated the cost-effectiveness of anterior cruciate ligament reconstruction (ACLR) with lateral extra-articular tenodesis (LET) augmentation. # Cost-Effectiveness of ACL Reconstruction with LET Augmentation Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: July 18, 2025 - June 26, 2025 For athletes facing a primary anterior cruciate ligament reconstruction (ACLR), the decision of how to reconstruct the anterior cruciate ligament (ACL) is a big one. Traditionally, ACLR  alone has been the preferred method. But what if adding something could not only improve outcomes but also save money in the long run? I recently participated in a study (with Nathan H. Varady, MD, MBA, Jacob F. Oeding, PhD, Paul M. Inclan, MD, Anil S. Ranawat, MD, Andrew D. Pearle, MD, Scott A. Rodeo, MD, and Riley J. Williams, III, MD) that suggests a lateral extra-articular tenodesis (LET) augmentation is cost-effective in primary ACLR. ## What Is ACLR + LET Augmentation? LET augmentation is an additional procedure done alongside the ACLR. “Extra-articular” means it’s performed outside the knee joint capsule, unlike the ACLR, which is “intra-articular” (inside the joint). The main goal of LET is to provide additional rotational stability to the knee. It aims to prevent excessive internal rotation of the tibia (shin bone) relative to the femur (thigh bone), which can put stress on the newly reconstructed ACL graft and contribute to re-rupture. ## How LET Augmentation Is Typically Done - A small strip of tissue, most commonly from the iliotibial band (ITB) on the outside of the thigh, is harvested. - This strip remains attached at one end (distally, near the shin bone).  - The free end is then passed under another ligament on the outside of the knee (the lateral collateral ligament, LCL) and secured to the femur (thigh bone) wit a suture anchor. This creates a “tenodesis,” which means the tendon is anchored to a bone, which is thought to help prevent the ACL graft from stretching or re-tearing, especially in athletes who put a lot of rotational stress on their knees. Why is it done? LET augmentation is often considered for patients who are at higher risk of ACL re-rupture or who have significant rotational instability. This can include: - Revision ACL surgeries: Where a previous ACL reconstruction has failed. - Young, active athletes: Especially those involved in pivoting and contact sports. - Patients with a “high-grade pivot shift”: This is a clinical test that indicates significant rotational instability in the knee. - Patients with generalized joint laxity (hypermobility). ## The Study For this study, we used a Markov chain Monte Carlo model (a class of algorithms used to draw samples from a probability distribution) that evaluated the outcomes and costs of 1,000 athletes who underwent  ACLR + LET augmentation compared to ACL alone. We pulled costs, utility values, graft failure rates, and transition probabilities from existing literature. We performed targeted meta-analysis of failure rates and patient reported outcomes from randomized control trials that compared the two procedures.  ## The Results The findings were fairly compelling: -   - Fewer Re-Tears: The meta-analysis showed that the graft failure rate for ACLR+LET was significantly lower at 5.1% compared to 11.2% for ACLR alone. That difference means more athletes stayed healthy and active without needing another surgery. - Lower Costs: Across a five-year horizon, the average total cost for ACLR+LET was $56,217±$7,349, while ACLR alone came in at $68,605±$9,472. This suggests that ACLR+LET is more cost-effective. - Better Outcomes: Patients who underwent ACLR+LET also reported higher quality-adjusted life-years (QALYs) at 1.88±0.30 compared to 1.54±0.30 QALYs for ACLR alone. In the microsimulation model, ACLR+LET was the preferred treatment in over 98% of cases. When we adjusted our assumptions in sensitivity analyses, ACLR+LET remained more cost-effective, assuming an ACLR+LET failure rate up to 11.3% or an ACLR alone failure rate down to 4.8%. ### The Takeaway Our conclusion from this study is that LET augmentation is cost-effective in athletes undergoing a primary ACLR. It suggests superior outcomes (fewer re-tears and better quality of life) but also results in lower overall costs over time. This study suggests that LET could be a valuable option for many athletes, even those who might not be considered “highest risk,” due to its ability to prevent painful and costly re-injuries. If you’re an athlete considering ACL surgery, consider discussing the potential benefits of LET augmentation with your orthopedic surgeon. Read the study abstract in The Journal of Arthroscopic and Related Surgery: Adding a Lateral Extra-Articular Tenodesis is Cost-Effective in Primary Anterior Cruciate Ligament Reconstruction: A Markov Analysis  - ACLR, Anterior Cruciate Ligament (ACL) Reconstruction, cost-effectiveness, graft failure rates, incremental cost-effectiveness ratio (ICER), lateral extra-articular tenodesis (LET), Markov analysis, primary ACL ruptures, quality-adjusted life-years (QALYs) ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousOne Step Cartilage Repair: Targeting the Trochlea NextReal-World Evidence for Miach Orthopaedics’ BEAR® Implant Highlighted at AOSSM 2025Next --- ## COVID-19 Update - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/covid-19-update/ Summary: Limited clinic May 4th and surgery for urgent cases May 11th. We will start by seeing new patients, people with a new injury, and those waiting for injections. # COVID-19 Update Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - April 24, 2020 It looks like we are starting a very limited clinic the week of May 4th and surgery for cases considered urgent on May 11th. We will start by seeing new patients, follow-up patients who have a new injury, and patients who have been waiting for injections. Please call if you have been waiting to see us in person. I can’t wait to get back to work! - blog, covid19, New York City ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousGirls Take Longer Than Boys to Recover From Concussions? NextOrthopedic Surgery Patients Become Long Term Opioid Users?Next --- ## Crested Butte Thanksgiving - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/crested-butte-thanksgiving/ Summary: My twins are at ski camp right on that hill in the photo racing giant slalom, I # Crested Butte Thanksgiving Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: October 31, 2024 - November 26, 2015 My twins are at ski camp right on that hill in the photo racing giant slalom, I’m cooking thanksgiving dinner for the head coach and a World Cup hopeful, and the snow is coming down. What could be better? - family, skiing, Thanksgiving ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousEarly Spinning! NextThanksgiving SkiingNext --- ## Study Explores Osteoarthritis Treatment | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/dancing-molecules-osteoarthritis-treatment/ Summary: Research, such as this study about dancing molecules, suggests ways that (in the future), we may be able to stop or reverse arthritis. # Could Dancing Molecules Transform Osteoarthritis Treatment? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: September 27, 2024 - September 27, 2024 Patients ask me about arthritis all the time. In fact, a patient asked me today what medication they can take to halt or reverse arthritis.   Sadly, we don’t have such a medication yet — but research, such as this study in the Journal of the American Chemical Society about dancing molecules, suggests ways that (in the future), we may be able to stop or reverse arthritis. Here’s a brief quote from the Medical Dialogues article:   “The study revealed that cyclic growth factor mimetic peptide was more effective than a linear one… these findings suggest that enhancing the movement of these epitope assemblies improves their ability to stimulate a positive response in chondrocytes compared to less mobile assemblies.”   Looking at ways to energize cartilage cells or actually get cartilage to grow is incredibly interesting and I can’t wait for it to be a reality.   Learn a bit more in this Medical Dialogues article and video: How ‘Dancing Molecules’ Could Transform Osteoarthritis Treatment, Study Provides Insights.    - arthritis care, cartilage cells, cyclic growth factor, dancing molecules, Journal of the American Chemical Society, Osteoarthritis, osteoarthritis treatment, patient care, patient questions, research, study ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousUsing Machine Learning to Predict MPFL Reconstruction Outcomes NextSurgical Technique: Staple Fixation for Combined All-Inside ACWO and ACLRNext --- ## Decorating Safely - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/decorating-safely/ Summary: From the HSS Playbook: getting festive for the holidays? Before you begin to decorate, consider these safety tips from Physical Therapist Lauren Piljic. # Decorating Safely Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - December 16, 2015 Not done decorating? Here are some safety tips.   ## Holiday Decorating Safety Tips – HSS Playbook Getting festive for the holidays? Before you begin to decorate, consider these safety tips from Physical Therapist Lauren Piljic. Source: www.hss.edu/playbook/holiday-decorating-safety-tips/   - holiday decorating, HSS Playbook, Physical Therapist Lauren Piljic ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousDo You Need Surgery? NextGet Out & ExerciseNext --- ## Difference ACL and Meniscus Tears | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/difference-between-acl-and-meniscus-tears/ Summary: Dr. Sabrina Strickland discusses the difference between ACL and meniscus tears, treatment options, and essential patient exercises to help you return to an active lifestyle. # Interview: The Difference Between ACL and Meniscus Tears Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: April 10, 2026 Quick Summary ACL and meniscus tears are the two most common surgical knee injuries and often occur together, but they cause different symptoms and need different treatment. ACL tears typically follow a non-contact pivot with a 'pop' and rapid swelling, producing instability. Meniscus tears more often cause mechanical symptoms — catching, locking, line-of-joint pain — and gradual swelling. MRI distinguishes the two and identifies combined injuries that change the surgical plan. - April 10, 2026 I recently had the pleasure of joining Hilary Topper on her podcast, Hilary Topper on Air, to discuss two of the most common knee injuries I treat: ACL and meniscus tears. Whether you are training for a marathon or simply want to enjoy a walk around the city, understanding these injuries is the first step toward a successful recovery. In this episode, we dive into the anatomy of the knee, how to choose between surgical and non-surgical treatments, and the mental dedication needed to get back to your active lifestyle. I also share specific prevention tips and patient exercises designed to help you strengthen your joints and reduce the risk of future injury. Check out the full episode here: What is the Difference Between an ACL and Meniscus Tear? ### What We Covered: - The Recovery Journey: How to stay motivated and patient during the rehabilitation process. - Understanding the Injury: Breaking down the differences between ACL and meniscus tears. - Treatment Pathways: From advanced imaging to the latest in surgical and non-surgical recovery. - Building Strength: The importance of proper training and patient exercises for injury prevention.   - A Triathlete's Diary, ACL recovery, Hilary Topper, knee injury prevention, knee strengthening, knee surgery specialist, meniscus tear treatment, meniscus vs ACL, mobility training, non-surgical knee treatment, orthopedic surgery, patella doc NYC, patient exercises, physical therapy moves, rehabilitation exercises, sports medicine, surgical recovery ## Frequently Asked Questions Can you have both an ACL tear and a meniscus tear?Yes — combined ACL and meniscus tears are common, especially in pivoting-sport injuries. The lateral meniscus is most often torn at the time of the ACL injury, while medial meniscus tears can occur acutely or develop later from instability. I always evaluate the meniscus carefully on MRI and at surgery and prioritize meniscal repair when the tear pattern allows. Which injury causes more knee swelling — ACL or meniscus?Acute ACL tears typically produce rapid, large swelling within hours from bleeding into the joint. Meniscus tears more often cause gradual swelling over the next 1–2 days and may have less dramatic effusion overall. The pattern and timing of swelling, along with the mechanism of injury, often suggest the diagnosis before MRI confirms it. Can a meniscus tear heal but an ACL tear cannot?Some peripheral meniscus tears in well-vascularized tissue can heal — the meniscus has limited blood supply but more than the ACL. The ACL itself rarely heals reliably without surgery, except for select acute proximal tears that may be amenable to BEAR repair. This biological difference is part of why combined injuries usually need surgical attention to the ACL. ## Related Reading - ACL tear surgery (specialty page) - Meniscal tear / torn meniscus - ACL surgery explained ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousStatic Lunge with Row: A Knee-Friendly Way to Strengthen Your Core and Legs NextThe Evolution of Knee SurgeryNext --- ## Patellar Tracking Abnormalities - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/discussing-patellar-tracking-abnormalities-and-patellar-instability/ Summary: The Brawn Body Health and Fitness podcast: patellar tracking abnormalities and patellar instability. Many people start having patellar or kneecap pain as teenagers. # Discussing Patellar Tracking Abnormalities and Patellar Instability Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - February 23, 2023 I recently joined Dan Braun on the Brawn Body Health and Fitness podcast. We talked about patellar tracking abnormalities and patellar instability. So first of all, the patella is the kneecap – and a lot of people start having patellar pain when they’re teenagers. It’s a little more common in girls, and they’re often told that the pain is normal or perhaps to avoid a specific sport. Far less often, they’re actually evaluated. However, there are a lot of different causes of anterior knee pain – not all anterior knee pain is patellar femoral pain syndrome.   In some cases, physical therapy or even off the shelf shoe inserts can really help. Sometimes we need to take a deeper dive, an x-ray, or even an MRI.   Listen to the whole podcast to learn more about patellar tracking abnormalities and patellar instability topic. - anterior knee pain, Hospital for Special Surgery, knee pain, orthopaedic surgery, patellar femoral pain syndrome, patellar instability, patellar pain, Patellar Tracking Abnormalities, Physical Therapy, shoe inserts ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousACL Reconstruction – Retear and Rehabilitation Information NextHow Acton-Boxborough Coach Helps Players Recover from ACL TearsNext --- ## Do You Have Knee Pain? | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/do-you-have-knee-pain/ Summary: Get expert tips for managing and preventing knee pain during running and triathlons. Learn about common causes and strategies for keeping your training strong. # Do You Have Knee Pain? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: August 21, 2025 Quick Summary Knee pain has many causes — from runner's overuse and patellofemoral syndrome to meniscus tears, ligament injuries, and early osteoarthritis. The pain's location, what makes it better or worse, and any mechanical symptoms (locking, catching, giving way) point toward the diagnosis. A focused exam and selective imaging usually identify the source within one visit, and most non-surgical knee problems improve with targeted rehabilitation, training-load adjustments, and time. - August 18, 2025 Running and triathlons put a lot of strain on your knees, making knee pain a common challenge for athletes. While a minor ache might seem like no big deal, it can quickly become a major obstacle if you don’t address it. The good news is, with the right strategies, you can manage the pain and keep doing the sports you love. Read more on A Triathlete’s Diary. Photo by yury kirillov on Unsplash - cross training, foam rolling, footwear, injury prevention, IT band syndrome, knee pain, patellofemoral pain, recovery, rest, runner's knee, runners, strength training, stretching, triathletes ## Frequently Asked Questions When should I see an orthopedic surgeon for knee pain?Persistent pain beyond 2–3 weeks despite rest and simple measures, mechanical symptoms (locking, catching, giving way), inability to bear weight, and significant swelling are reasons to seek orthopedic evaluation. Acute injuries with a 'pop,' rapid swelling, or instability warrant earlier evaluation. A primary care physician or physical therapist is also a reasonable first step for less acute, non-mechanical pain. Does knee pain always need imaging?No — many cases of knee pain are diagnosed by history and exam alone, particularly patellofemoral pain and overuse tendinopathies. I order X-rays for trauma, persistent symptoms, or arthritis evaluation, and MRI when there is suspected ligament, meniscus, or cartilage injury. Imaging without clinical context can show incidental findings that may not be the cause of pain. What's the difference between runner's knee and a meniscus tear?Runner's knee (patellofemoral pain) typically causes diffuse anterior knee pain that's worse with stairs, prolonged sitting, and running downhill, without true mechanical locking. Meniscus tears more often cause line-of-joint pain, catching, or locking and follow a specific twisting injury. The two can coexist but respond to different treatments — patellofemoral pain to rehabilitation, meniscus tears sometimes to surgery. ## Related Reading - Knee & shoulder specialties (hub) - 6 causes of knee pain in runners - Patellar pain & patellar arthritis ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousMy Kneecap Dislocated. What Should I Do? NextBack in the Game After a Torn MeniscusNext --- ## Do You Need Surgery? | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/do-you-need-surgery/ Summary: AAOS Online Newsroom official site for press releases, photos, video, audio, pr contact information, presskits and more. # Do You Need Surgery? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: March 9, 2023 - December 11, 2015 This is a good article from the American Academy of Orthopaedic Surgeons you should read.   ## AAOS Online Newsroom | Hands off! Surgery is often not required for these common conditions AAOS Online Newsroom official site for press releases, photos, video, audio, pr contact information, presskits and more. Source: newsroom.aaos.org/media-resources/Press-releases/hands-off-surgery-is-often-not-required-for-these-common-conditions.htm     - AAOS, American Association of Orthopaedic Surgeons, common conditions, surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousYour Diet and Preparing for Surgery NextDecorating SafelyNext --- ## Lindsey Vonn’s injury on NBC Sports | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/doctor-explains-lindsey-vonns-injury-nbc-sports/ Summary: Dr. Sabrina Strickland describes Lindsey Vonn Skip to content # Doctor Explains Lindsey Vonn’s Injury – NBC Sports Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: June 5, 2025 Olympic gold medalist Lindsey Vonn’s season ended on the mountain in Austria Tuesday when she lost her balance and tumbled end over end down the super-G course until eventually sliding to a stop. She tore the ACL and MCL in her right knee and suffered a lateral tibial plateau fracture, all of which will need surgery. Dr. Sabrina Strickland, an Orthopedic Surgeon at the Hospital for Special Surgery in New York, describes the injury for NBC Sports on NBC Nightly News with Brian Williams. NBC Sports VIDEO: Doctor explains Lindsey Vonn’s injury Manage Cookie Consent To provide the best experiences, we use technologies like cookies to store and/or access device information. Consenting to these technologies will allow us to process data such as browsing behavior or unique IDs on this site. Not consenting or withdrawing consent may adversely affect certain features and functions. 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Marketing Marketing The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes. - Manage options - Manage services - Manage {vendor_count} vendors - Read more about these purposes Accept Deny View preferences Save preferences View preferences - {title} - {title} - {title} Manage consent ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. --- ## Osteoarthritis, Partial Knee Replacements | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/double-partial-knee-replacements/ Summary: Here # Double Partial Knee Replacements Get Patient Back in the Game Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: April 18, 2024 - April 18, 2024 It’s important to share patient stories because I often hear from patients that their local doctors were unable to help. Here’s Rhonda Petti’s story of paratenonitis and the double partial knee replacements that got her back in the game.  ## Double Partial Knee Replacements “I sought out HSS for severe osteoarthritis in my knees since no doctor local to me would help me due to my young age. Loved Dr. Strickland from the moment I met her and she said she could help me. I had a double partial knee replacement in January 2015 and have not regretted it one bit. Dr. Strickland and everyone else at HSS were amazing, from the OR nurses to the nurses on staff. Prior to my surgery I could not walk up and down stairs or enjoy a walk with my husband. I am flying up and down those stairs and go for frequent walks now-pain free!!” Here’s Rhonda Petti’s story of paratenonitis and the double partial knee replacements that got her back in the game.   - back in the game, double partial knee replacement, Hospital for Special Surgery, HSS, knee arthritis, Osteoarthritis, paratenonitis, partial knee replacement, patient stories ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousRisk Factor for Osteochondral Allograft Failure NextPatellar Attachment Healing Post SurgeryNext --- ## FAQ Orthopedic Surgeon on Frozen Shoulder - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/dr-sabrina-strickland-orthopedic-surgeon-answers-your-questions-on-frozen-shoulder/ Summary: A frozen shoulder is initially a painful shoulder without a history of trauma that then progresses to a painful stiff shoulder and eventually just a stiff shoulder. # Dr. Sabrina Strickland, Orthopedic Surgeon, Answers Your Questions on Frozen Shoulder Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - August 14, 2016 Q1: I would like to ask your opinion on steroid injections in conjunction with therapy for frozen shoulders. Is the injection treatment effective with all stages of adhesive capsulitis, or is it recommended for only a certain stage and certain type of frozen shoulder? Injection is best for the early stages and most often ineffective for stages three and four. Q2: How much should a patient be pushed for range of motion during physical therapy with various stages of frozen shoulder? Would working through pain further accelerate the inflammatory process of the capsule and makes it worse? That is tricky – they should be stretched gently but not excessively. What’s most important for these patients is to teach them to avoid painful arcs of motion and simple stretches they should do at home. Sometimes working through pain can make it worse. For example, strengthening exercises done too early can often worsen a frozen shoulder. Q3: What is your recommendation for the treatment of extremely painful cases of frozen shoulder? Usually my recommendation is a steroid injection followed by two weeks of rest. Of course, this recommendation would be the result of an exam with the patient. Q4: For diabetic patients with poorly controlled blood sugar levels, what are your recommendations for treating these patients in terms of injections and manual therapy for frozen shoulder? Tighter control of their diabetes around the time of the injection is often all that they need. I alert diabetic patients to check their blood glucose twice as often as usual and eat very carefully for the first three to four days. It is important for them to meet with a doctor to render the best recommendation. Q5: Is frozen shoulder caused by muscle issues or nerve issues? Neither, a frozen shoulder is an inflammatory process that usually comes out of the blue without a known cause. It is more common in women, patients with diabetes and those who have suffered from a frozen shoulder in the past. Q6: What exactly is ‘frozen shoulder’ exactly? How would I know if I’m suffering from frozen shoulder? A frozen shoulder is initially a painful shoulder without a history of trauma that then progresses to a painful stiff shoulder and eventually just a stiff shoulder. It is often difficult to diagnose especially at the beginning and therefore if your shoulder is painful and not improving with rest I would recommend seeing a doctor specializing in shoulder issues. Next week, Dr. Doruk Erkan, Rheumatologist, will answer your questions on Antiphospholipid Syndrome. Post your questions to the wall. - frozen shoulder, HSS, shoulder, shoulder pain ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousCaring for Veterans NextFitness Friday: Working out Safely in the Summer HeatNext --- ## Live On CBS Radio Houston’s In The Loop - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/dr-strickland-live-on-cbs-radio-houstons-in-the-loop/ Summary: Listen to CBS Radio Houston’s In The Loop with John and Cody to discuss the Texans # Dr. Strickland Live On CBS Radio Houston’s In The Loop Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: June 4, 2025 - October 13, 2017 I had the pleasure of dialing in live to CBS Radio Houston’s In The Loop with John and Cody to discuss the Texans’ J.J. Watt’s latest tibial plateau fracture in Sunday night’s game. Click here to listen in! - CBS Radio, CBS Radio Houston’s In The Loop, HSS, radio ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousCan running backwards help preserve knee joints? AAOS NextElectrotherapy and Acupuncture Required Less Pain Medicine Following Knee Replacement SurgeryNext --- ## Early Spinning! - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/early-spinning/ Summary: I can # Early Spinning! Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - November 25, 2015 I can’t think of a better way to start the day than a 5:30am spin class!     - FlyWheel, Spin Class ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousPreparing for Ski Season NextCrested Butte ThanksgivingNext --- ## Cycling As A Treatment for Tendinopathy - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/eccentric-cycling-treatment-patellar-tendinopathy/ Summary: The typical treatment for patellar tendinopathy is a combination of activity modification and a focus on cross training as well as eccentric strengthening. # Eccentric Cycling As A Treatment for Patellar Tendinopathy Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - April 27, 2023 This is interesting. When I see a patient with patellar tendinitis, the usual culprit is overtraining or not changing one’s running shoes often enough and therefore overloading the patellar tendon. The typical treatment is a combination of activity modification and a focus on cross training as well as eccentric strengthening. Eccentric strengthening is the same as “negatives,” it’s step downs instead of step ups.   This article suggests that you can do eccentric cycling instead of just doing eccentric strengthening. It may be easier for patients to alter their cardio to treat their tendinitis rather than have to do specific strengthening exercises and this may boost compliance with exercise regimens.   Read the full article in the British Journal of Sports Medicine. Photo by Ambitious Studio* – Rick Barrett on Unsplash - activity modification, cross training, eccentric cycling, eccentric strengthening, overtraining, patellar tendinitis, patellar tendinopathy, patellar tendon, running shoes ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousLower Donor Site Morbidity With Hamstring and Quadriceps Tendon Autograft NextMISHA Knee System for People Suffering from Knee OsteoarthritisNext --- ## Osteochondral Allograft Risk Factor | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/edem-risk-factor-osteochondral-allograft-failure/ Summary: This study looked at the MRIs of patients who had osteochondral allograft failure in transplantation to their knee, focusing on increased host bone marrow edema # Risk Factor for Osteochondral Allograft Failure Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: April 11, 2024 - April 11, 2024 We are constantly trying to improve the outcomes of cartilage repair, as I mentioned in a previous post. In this study, we looked at the MRIs of patients who had undergone osteochondral allograft transplantation to their knee. We measured the area of edema or increased bone signal on MRI and then correlated it with failure rates. What we noticed is that patients with a larger area of edema on MRI had a 50% rate of graft failure, whereas patients who had smaller areas of edema had no failures. While this study does not tell us how to change things to improve outcomes, it is useful that we have data based on MRI exams that predict failure. We can also look at interventions that improve outcomes in these patients. Read more about the research in Arthroscopy: The Journal of Arthroscopic and Related Surgery. - 6-month MRI, BME, cartilage repair, host bone marrow edema, knee, MRI, OCA, osteochondral allograft, osteochondral allograft failure, postoperative magnetic resonance imaging, risk factor ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousOpioids after ACL Surgery NextDouble Partial Knee Replacements Get Patient Back in the GameNext --- ## 2 Fixation Points for MPFL Reconstruction- Dr. Sabrina Strickland Source: https://sabrinastrickland.com/editorial-commentary-two-fixation-points-are-better-for-mpfl-reconstruction/ Summary: Medial patellofemoral ligament reconstruction is popular; studies show an advantage over MPFL repair or medial imbrication for treating patellar instability. # Editorial Commentary: Two Fixation Points Are Better for MPFL Reconstruction Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 Quick Summary Medial patellofemoral ligament (MPFL) reconstruction has become the standard surgical treatment for recurrent patellar instability, outperforming MPFL repair and medial imbrication for most patients. Recent evidence supports using two femoral fixation points rather than one to better recreate the native ligament's broad insertion and improve patellofemoral kinematics — particularly relevant for patients with trochlear dysplasia or recurrent dislocations. - November 1, 2022 Medial patellofemoral ligament (MPFL) reconstruction has gained in popularity over the past 15 years, with most studies showing a clear advantage over techniques such as MPFL repair or medial imbrication for the treatment of patellar instability. A debate continues as to the type of fixation on the patella, tunnel versus suture anchor, as well as the number of fixation points. In fact, some senior patellofemoral surgeons have opted away from patellar bony fixation altogether to avoid complications associated with patellar fixation such as fracture or penetration of the articular cartilage. In my practice, I prefer to use 2 all-suture suture anchors for patellar fixation as there is minimal risk of fracture or significant cartilage damage compared with tunnel drilling or placement of larger suture anchors. The graft choice for MPFL reconstruction has been shown to be relatively unimportant, and for this reason, I typically choose gracilis allograft to avoid graft-site morbidity and hamstring weakness. Read the full article in The Journal for Arthroscopic and Related Surgery.   - arthroscopic surgery, arthroscopy, cartilage dmanage, MPFL, MPFL reconstruction, orthopaedic surgery, orthopaedics, patellar fixation, patellar instability, suture anchors, tunnel drilling ## Frequently Asked Questions Why is MPFL reconstruction usually preferred over MPFL repair?MPFL repair — suturing the torn native ligament — has higher recurrence rates than reconstruction with a tendon graft, especially when underlying anatomy (trochlear dysplasia, patella alta, elevated TT-TG distance) predisposes to instability. Reconstruction creates a stronger, more reliable restraint and is the standard for recurrent patellar dislocations in my practice. What is the advantage of two fixation points on the femur?The native MPFL has a broad fan-shaped insertion on the femur. A two-point fixation more closely recreates this anatomy, distributing force across a wider footprint and improving how the patella tracks through the early flexion arc. In selected patients — those with dysplasia or revision cases — this has been associated with improved outcomes. Is MPFL reconstruction enough on its own, or do I need a tibial tubercle osteotomy?MPFL reconstruction is sufficient for many patients with recurrent dislocations. When there's significant patella alta, an elevated TT-TG distance, or severe trochlear dysplasia, I add a tibial tubercle osteotomy — and occasionally a trochleoplasty — to address the underlying bony alignment. The decision is based on imaging measurements and exam findings, not symptoms alone. ## Related Reading - MPFL reconstruction surgery (specialty page) - Patellar instability - Recovery from a dislocated patella ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousMPFL Reconstruction Study and Follow Up NextMPFL Reconstruction & Tibial Tubercle OsteotomyNext --- ## Patellofemoral Arthroplasty on Patellar Height - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/effect-of-patellofemoral-arthroplasty-on-patellarheight-in-patients-with-patellofemoralosteoarthritis/ Summary: Knee steoarthritis (OA) is painful and may be uni- or multicompartmental. The compartment affected by arthritis may be due to trauma, malalignment (varus or valgus). # Effect of Patellofemoral Arthroplasty on Patellar Height in Patients with Patellofemoral Osteoarthritis Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 21, 2023 - September 1, 2022 Osteoarthritis (OA) in the knee is common, painful, and may be uni- or multicompartmental. The compartment affected by arthritis may be due to trauma, malalignment (varus or valgus), or in the case of patellofemoral OA, patella alta. Patellofemoral arthroplasty (PFA) is an effective partial knee replacement surgery for patellofemoral OA. Read the article in The Journal of Knee Surgery. - patella alta, patellofemoral arthroplasty, patellofemoral osteoarthritis, The Journal of Knee Surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousBrawn Body Health and Fitness Podcast: Knee Injuries, Knee Arthritis, Skiing Injuries, and more! NextThe Bridge-Enhanced ACL Restoration Implant—known as the BEAR implantNext --- ## Less Pain Medicine Required After Knee Surgery - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/electrotherapy-acupuncture/ Summary: An article in the Journal of the American Medical Association Surgery demonstrated patients using electrotherapy and acupuncture needed less narcotic pain medicine. # Electrotherapy and Acupuncture Required Less Pain Medicine Following Knee Replacement Surgery Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - October 19, 2017 This research summary discusses an article in the Journal of the American Medical Association Surgery which demonstrated that patients who use electrotherapy and acupuncture required less narcotic pain medicine (opioids). There is an epidemic in the United States of opiate abuse and any and all modalities that reduce pain after surgery are worth exploring. I routinely utilize cold therapy machines, local anesthetic injections around the knee, and nerve blocks after surgery. In addition, I believe that accupucture can help alleviate pain from many causes and therefore the fact that it can help after surgery is not surprising. https://medicalresearch.com/pain-research/acupuncture-and-electrotherapy-following-knee-replacement-may-limit-opioid-use/36468/ - knee pain, Knee replacement surgery, knee surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousDr. Strickland Live On CBS Radio Houston’s In The Loop NextWhy Playing a Sport Should Be Your Lifetime RoutineNext --- ## Are Elton John's Kneecaps Now Jewelry? | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/elton-john-kneecaps-jewelry/ Summary: Did Elton John turn his kneecaps into jewelry? Based on my experience, it # Why & How Did Elton John Turn His Kneecaps into Jewelry? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: November 25, 2025 - November 25, 2025 I have so many questions about why Elton John turned his kneecaps into jewelry. 1. I’m sure they aren’t his entire kneecaps as we don’t remove them unless they are shattered and in too many pieces to repair. In a partial or total knee replacement, a portion is removed in order to make space to put a polyethylene (plastic) cap to resurface it. 2. Why was there a hole in his patella? Short of a bullet hole or some types of cancer, it would be rare to see a hole in the patella. I do see severe cases of patellofemoral arthritis where the patient has worn their bone down pretty far. If it is very thin, I don’t have to remove much from the lateral side to do a reconstruction. 3. In the US, patients cannot keep their bones or other body parts after surgery. They can keep screws and plates but their bones/ meniscus/cartilage etc. goes to a pathologist to examine and then gets discarded. 4. Why would you want a memory of something so painful on a necklace or broach? I don’t know…it’s a pretty unusual story.  Read the Today article to learn more: Elton John Turned His Kneecaps Into Jewelry. Yes, You Read That Correctly. Photo by Kiwihug on Unsplash - bone removal, Elton John, jewelry, joint surgery, knee reconstruction, Knee replacement surgery, kneecap, medical mystery, orthopedic surgeon, patella, patellofemoral arthritis, patient keepsake, surgical procedure ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHow Serious Is a Patella Dislocation? NextKnee Surgery with Sea Coral: NYC Doctors Explain How & WhyNext --- ## Embracing Winter Wellness Outdoors - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/embracing-winter-wellness-outdoors-the-westport-library/ Summary: Dr. Strickland discusses embracing wellness in the outdoors during winter. Take a sneak peek of Dr. Strickland’s article below from The Westport Library magazine. Skip to content # Embracing Winter Wellness Outdoors – The Westport Library Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: October 31, 2024 Dr. Strickland discusses embracing wellness in the outdoors during winter. Take a peek of Dr. Strickland’s article below from The Westport Library magazine, or read the January/February print edition. Manage Cookie Consent To provide the best experiences, we use technologies like cookies to store and/or access device information. Consenting to these technologies will allow us to process data such as browsing behavior or unique IDs on this site. Not consenting or withdrawing consent may adversely affect certain features and functions. Functional Functional Always active The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network. Preferences Preferences The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user. Statistics Statistics The technical storage or access that is used exclusively for statistical purposes. The technical storage or access that is used exclusively for anonymous statistical purposes. 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This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. --- ## Engineered Cartilage Sounds Perfect | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/engineered-cartilage-sounds-perfect/ Summary: Engineered cartilage sounds perfect. This Boston Children’s Hospital report discussed research aimed to grown cartilage in a lab to treat patients with defects. # Engineered Cartilage Sounds Perfect Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: March 21, 2024 - March 21, 2024 Engineered cartilage, it sounds perfect! I can’t wait. This report out of Boston Children’s Hospital discusses research aimed at growing cartilage in a lab to treat patients with cartilage defects. Current treatments involve doing a two stage surgery to take cartilage cells from a patient, grow those cells on a collagen membrane, and then implant it. The upside is that one receives their own cartilage cells. The downside is that they have two surgeries and they have to wait for those cartilage cells to “grow” and produce new matrix to protect their joint. I anxiously await new technologies for cartilage repair. Read more about the new research in this article: Engineered cartilage could turn the tide for patients with osteoarthritis.  (Photo from the article: Michael Goderre, Boston Children’s, Cartilage tissue generated from pluripotent stem cells.) - ACL, anterior cruciate ligament, Boston Children's Hospital, cartilage, cartilage defects, cartilage repair, engineered cartilage, orthopedics, Osteoarthritis, report, research, sports medicine ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWhy ACL Tears Are So Devastating NextFocus on Pickleball BenefitsNext --- ## Ep44: Challenging Cartilage Injuries The Sports Docs Podcast Source: https://sabrinastrickland.com/episode-44-challenging-cartilage-injuries-with-dr-sabrina-strickland-dr-seth-sherman-live-at-aossm-2023/ Summary: We are so excited to host these amazing guests for “Challenging Cartilage Injuries," Live at AOSSM Annual Summit 2023 on The Sports Docs Podcast # Episode 44: Challenging Cartilage Injuries with Dr. Sabrina Strickland & Dr. Seth Sherman, Live at AOSSM 2023 Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: July 5, 2024 - August 2, 2023 We at The Sports Docs Podcast are so excited to host these amazing guests, Dr. Sabrina Strickland & Dr. Seth Sherman, for “Challenging Cartilage Injuries,” Live at AOSSM 2023. Both Dr. Strickland and Dr. Sherman publish and lecture extensively on the topic of knee joint preservation, cartilage restoration and specifically patellofemoral cartilage disease – so we’re excited to hear them speak more this topic! Listen to the podcast at: - Apple Podcasts - Spotify - YouTube - Web - or wherever you get your podcasts. - cartilage restoration, challenging cartilage injuries, International Cartilage Repair Society, International Patellofemoral Study Group, knee joint preservation, patellofemoral cartilage disease, the sports docs podcast ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousChallenging Cartilage Injuries with The Sports Docs Next3 Anatomical Factors Linked to Recurring Patellar DislocationNext --- ## MDC Thresholds After Joint Arthroplasty - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/establishing-mdc-threshholds-patellofemoral-joint-arthroplasty/ Summary: Earlier this year we published this study establishing MDC thresholds after patellofemoral joint arthroplasty # Establishing MDC Thresholds After Patellofemoral Joint Arthroplasty Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - September 28, 2023 Earlier this year we published this study looking at results of patellofemoral joint arthroplasty and establishing MDC thresholds. It can sometimes be difficult to determine how much improvement patients are getting from surgery. Questionnaires (patient reported outcome measures such as the International Knee Documentation Committee (IKDC) form and the the Kujala Anterior Knee Pain Scale (AKPS)) help us determine how much of a difference we are actually making. This study sought to establish minimal detectable change (MDC) thresholds for improvement to help us guide treatment protocols and give patients realistic expectations following patellofemoral joint arthroplasty. Read more about the study in Knee Surgery, Sports Traumatology, Arthroscopy. - IKDC, improvement thresholds, knee pain, knee surgery, kujala, minimal detectable change thresholds, patellofemoral replacement, patient expectations, research, study ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousStudy Shows Differences in Patellofemoral Joint Contact Forces after ACL Reconstruction NextTreating Patellofemoral Arthritis & Patellar InstabilityNext --- ## Evaluating the Femoral Anteversion Angle | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/evaluating-patellar-dislocation-via-the-femoral-anteversion-angle/ Summary: This study examines femoral anteversion and patellar instability, analyzing CT scans to compare knee alignment in patients with and without unstable kneecaps. # Evaluating Patellar Dislocation via the Femoral Anteversion Angle Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Published: December 12, 2024 · Last reviewed: May 2, 2026 Quick Summary Femoral anteversion — the inward rotation of the thigh bone — is an underrecognized contributor to patellar instability. Increased femoral anteversion alters how the patella sits in the trochlear groove and can drive recurrent dislocations even when other measurements look acceptable. CT-based measurement of the anteversion angle helps identify patients who may need rotational correction, in addition to MPFL reconstruction, for durable stability. - December 12, 2024 In this study in the journal Knee Surg Sports Traumatol Arthrosc. (KSSTA), Chen, et al. evaluated CT scans of patients with and without patellar instability. Not surprisingly, the patients with unstable knee caps had worse alignment as measured by tibial tubercle-trochlear groove (TT-TG), (20.1 versus 15.6). Perhaps more interesting, they found that patients with patellar instability had significantly more femoral anteversion angle (FAA) (21.6 versus 10.6). Studies like this may ultimately help us determine which patients need surgery and which patients can get away with physical therapy after a patellar dislocation. Evaluation of the hip is very important in assessing a patient with patellar instability and can easily be overlooked. Read more in this KSSTA journal study. - ACL reconstruction, anterior cruciate ligament reconstruction, FAA, Femoral Anteversion Angle, knee instability, orthopaedics, patellar instability, Patellar malalignment, Physical Therapy, Retrospective cohort study, Risk factors, sports medicine, Trochlear Groove Depth, TT-TG ## Frequently Asked Questions How is femoral anteversion measured?The rotation of the thigh bone (femoral anteversion) is most accurately measured on a CT scan, comparing the angle of the hip portion of the thigh bone to the back of the knee portion. Normal values are roughly 10 to 20 degrees; values above 30 degrees are considered increased and can contribute to kneecap tracking problems. Standard X-rays and a clinical exam alone are not reliable for this measurement. Does increased femoral anteversion always require surgery?No. Many patients with mildly increased rotation of the thigh bone do well with MPFL reconstruction and physical therapy. A derotational osteotomy (a procedure that rotates the thigh bone into a better position) is reserved for patients with severe rotation (often more than 30 degrees) and ongoing instability even after MPFL reconstruction, especially when other anatomical factors are also present. The decision is individualized using detailed imaging. Can adults change their femoral anteversion with exercise?No — the rotation of the thigh bone is a bony alignment that doesn't change with strengthening or stretching. Exercise can improve the muscle control around a rotated hip and reduce symptoms, but it cannot rotate the bone itself. When the rotation is the main driver of kneecap instability, a derotational osteotomy is the only way to correct the bone. ## Related Reading - Patellar instability (specialty page) - Patellar tracking abnormalities & instability - 3 anatomical factors linked to recurrent dislocation ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHopping Backward as an Indication of Recovery from ACL reconstruction NextPodcast: Patellofemoral Instability & Cartilage LesionsNext --- ## Evolution of Knee Surgery: Open vs. Arthroscopic | Dr. Strickland Source: https://sabrinastrickland.com/evolution-of-knee-surgery/ Summary: Explore the evolution of knee surgery with Dr. Sabrina Strickland. Learn how modern arthroscopic techniques and patient exercises lead to faster recovery. # The Evolution of Knee Surgery Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: April 13, 2026 - April 10, 2026 Knee surgery has undergone a remarkable transformation over the last few decades. In my latest feature on Hilary Topper on Air, we explore the evolution of knee surgery—moving from traditional “open” procedures that required large incisions to the sophisticated, minimally invasive arthroscopic techniques I use today at the Hospital for Special Surgery. In this article, I discuss how “keyhole” surgery and robotic-assisted technology have revolutionized the patient experience. By sparing healthy tissue and using high-definition imaging, we are able to offer faster recovery times and better long-term outcomes. Whether we are discussing a total knee replacement or specific patient exercises for rehabilitation, the goal is always to get you back to your active life as quickly as possible. Check out the full article here: The Evolution of Knee Surgery: From Open to Arthroscopic ### Highlights from the feature on the evolution of knee surgery: - The History of Open Surgery: Why older methods required longer recoveries and more downtime. - The Arthroscopic Revolution: How tiny incisions and specialized cameras changed the game for ligament and cartilage repair. - Robotic-Assisted Precision: The role of 3D modeling and robotic arms in achieving perfect implant alignment. - Future of Knee Care: A look at biological treatments and 3D-printed implants tailored to your unique anatomy.   - A Triathlete's Diary, ACL repair techniques, arthroscopic knee surgery, Hilary Topper, HSS sports medicine, knee pain solutions, knee replacement technology, knee surgery recovery, meniscus surgery, minimally invasive surgery, orthopedic innovation, orthopedic trends, outpatient knee surgery, patella doc NYC, patient exercises, robotic-assisted knee replacement ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousInterview: The Difference Between ACL and Meniscus Tears NextCortisone vs Gel Shots for Knee Pain: How We Think About InjectionsNext --- ## Exercise, Pain, and Creaky Knees | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/exercise-pain-creaky-knees/ Summary: Patients often come in to see me, complaining that they have creaky knees and can # Exercise, Pain, & the Meaning of Creaky Knees Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: January 2, 2025 - January 2, 2025 Patients often come in to see me, complaining that their knees are cracking or noisy. This article in the lay press discusses the common issue known as creaky knees or “knee crepitus.” It’s interesting to see that: “The research, published in the British Journal of Sports Medicine this week, analysed the results of 103 studies involving more than 36,000 people and found that 41 per cent of the population had creaky knees.” Overall, creaky knees are not a problem—if they don’t hurt. However, pain with swelling, exercise, or activities of daily living do merit a trip to the doctor. This visit can help you determine if there is an intervention to help these symptoms, such as an injection, physical therapy, or potentially surgery. The bottom line is that you can ignore your creaky knees unless they hurt! Read the article, “Snap, crackle, pop: What it means to have creaky knees,” to learn more.  (Image create with AI.)     - age, analysis, British Journal of Sports Medicine, cartilage, cracking, creaky knees, grinding, injection, intervention, knee crepitus, knees, lifestyle, meniscus, noisy, Osteoarthritis, pain, Physical Therapy, popping, prevention, research, snapping, strengthening, study, surgery, swelling, symptoms, treatment ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousPodcast: Patellofemoral Instability & Cartilage Lesions NextFDA Trial for New Patella LIFT ProcedureNext --- ## Exercises to Avoid With a Torn Meniscus | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/exercises-to-avoid-with-a-torn-meniscus/ Summary: A torn meniscus can cause pain, swelling, and instability. While exercise and physical therapy are important, some activities worsen the injury or delay healing # 5 Exercises to Avoid With a Torn Meniscus Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: April 30, 2026 Quick Summary Certain movements consistently aggravate meniscus tears and can extend healing or worsen the injury. Deep squatting, twisting under load, lunges with rotation, jumping/plyometrics on hard surfaces, and full-depth leg presses are common offenders. The shared theme is high compressive or shearing load through a flexed, rotated knee — the position that typically causes meniscus tears in the first place. Modifying these movements protects the meniscus while you continue strengthening. - June 5, 2025 A torn meniscus is a common knee injury that can cause pain, swelling, and instability. While exercise and physical therapy are crucial for recovery, certain movements can actually worsen the injury or delay healing. Knowing which exercises to avoid is essential to protect your knee and promote optimal recovery. ## Why Exercise Selection Matters The meniscus acts as a shock absorber between your thigh bone (femur) and shin bone (tibia). When torn, it becomes vulnerable to further symptoms, especially during activities that put excessive stress on the knee joint. Repeated twisting, pivoting, or high-impact movements are common causes of meniscal tears and can aggravate an existing injury if not avoided during recovery. ## Exercises and Activities to Avoid ### 1. Deep Squats and Lunges Movements that require bending the knee deeply, such as full squats or lunges, put significant pressure on the meniscus. These exercises can worsen pain and increase the risk of additional tearing, especially if performed with poor form or added weight. ### 2. Twisting and Pivoting Movements Sports and exercises that involve sudden changes in direction—like basketball, soccer, or tennis—are risky. These activities often require quick pivots and turns, which can catch the torn meniscus and cause further injury. ### 3. High-Impact Activities Running, jumping, and plyometric exercises place repetitive, high-impact forces on the knee. These should be avoided until your knee has healed and you’ve been cleared by your physician or physical therapist. ### 4. Leg Extensions (Open Chain Knee Extension) Open chain knee extension exercises, especially with resistance (such as using a leg extension machine), can strain the meniscus especially if the knee is swollen and irritate the patella and are generally not recommended during the early stages of recovery. ### 5. Heavy Weightlifting Any exercise that involves heavy loading of the knee joint—such as heavy squats, deadlifts, or leg presses—should be postponed. The added force can exacerbate swelling and instability. ## Safe Alternative Exercises Instead of high-risk activities, focus on gentle range-of-motion and strengthening exercises that don’t place excessive stress on the knee. Quad sets, heel slides, and ankle pumps are some safe options during the initial phase of recovery. Often use of a stationary bike can improve symptoms.. As healing progresses, a physical therapist can guide you through a tailored program to gradually restore strength and mobility. ## The Importance of Professional Guidance Every meniscus tear is unique, and your rehabilitation plan should be individualized. Always consult with your orthopedic surgeon or physical therapist before starting or modifying your exercise routine. Ignoring pain or pushing through discomfort can lead to more serious knee problems and prolong your recovery. Get more detailed information on meniscus injuries and recovery.  The following are additional posts to help you research your next steps: - How To Know When You Should Have a Torn Meniscus Surgically Repaired - Medial Meniscus Root Repair With Implantable Shock Absorber Placement - Study on Medial Meniscus Posterior Root Tears - Patient Information: Meniscectomy/Arthroscopy/Chondroplasty/Biopsy (PDF)  - Patient Success Story: Skier with ACL Tear and Meniscus Tear - Patient Success Story: Medial Meniscus Tear and Arthroscopic Repair - How Do You Know When To Take Your Knee Injury Seriously? - Frequently Asked Questions   Photo by Gabin Vallet on Unsplash   - avoid, deep squats, Exercise, heavy weightlifting, high-impact activities, instability, knee injury, leg extensions, lunges, orthopedic surgeon, pain, physical therapist, Physical Therapy, pivoting, recovery, rehabilitation plan, swelling, symptoms, torn meniscus, twisting ## Frequently Asked Questions Are squats off-limits with a torn meniscus?Not entirely — partial, controlled squats are usually fine and helpful for quad strength. What I avoid is deep squatting (where the knee bends past 90 degrees), heavy weight at the bottom, and squats with any twisting. Modifying the depth and the load, while keeping good alignment, lets most patients keep training the muscles that protect the knee without aggravating the tear. What about deadlifts and other compound lifts?Conventional deadlifts, done with neutral hips and knees that don't twist or buckle inward, are usually well tolerated. I often recommend hip-hinge variations, trap-bar deadlifts, and Romanian deadlifts during recovery. The key is avoiding twisting, the knees collapsing inward, and deep knee bending under heavy load. A coach can help refine your technique. Should I stop running while my meniscus heals?Not always. If running doesn't cause sharp pain, locking, or significant swelling, controlled mileage on flat, soft surfaces is often fine. I advise avoiding sudden cutting motions, downhill running, and high-mileage weeks during the healing phase. Cycling and pool running are excellent low-impact substitutes when regular running becomes painful. ## Related Reading - Meniscal tear / torn meniscus (specialty page) - 6 exercises to do with a torn meniscus - Meniscus symptoms that may self-heal ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHow To Know When You Should Have a Torn Meniscus Surgically Repaired NextExpert Insights, Preferences for BEAR TechniqueNext --- ## Atraumatic Medial Patellar Facet Lesions | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/exploring-risk-factors-for-atraumatic-medial-patellar-facet-lesions/ Summary: This study was to identify clinical and radiographic risk factors for medial patellar facet lesions in patients without a history of trauma or patellar instability. # Exploring Risk Factors for Atraumatic Medial Patellar Facet Lesions Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: July 12, 2024 - July 12, 2024 We recently conducted a study to identify clinical and radiographic risk factors for medial patellar facet lesions in patients without a history of trauma or patellar instability. Our hypothesis was that a posterior tibial tubercle relative to the trochlear groove would be a risk factor for atraumatic medial patellar facet lesions. While medial patellar facet lesions have been well-described in the setting of patellar instability, relatively little is known about risk factors for atraumatic medial patellar facet lesions. Read more in the Orthopaedic Journal of Sports Medicine article, “Risk Factors for Atraumatic Medial Patellar Facet Lesions.” Image from the article: Figure 5. (A) Measuring tibial tubercle-trochlear grove (TTTG) (millimeters) on axial magnetic resonance imaging (MRI) scan. (B) Measuring the tibial tubercle height (in millimeters) on axial MRI scan. Negative values correspond to a tibial tubercle that lies posterior to the trochlear groove. - Atraumatic Medial Patellar Facet Lesions, clinical risk factors, knee, Magnetic Resonance Imaging, Medial patellar facet lesions, MRI, patella, patellar instability, posterior tibial tubercle, radiographic risk factors, research, study, trauma, trochlear groove ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousThe Ortho Show with Dr. Scott Sigman NextSingle Versus Multiple-Plug OCA Transplants for Osteochondral Defects About the KneeNext --- ## Family Fun and Fitness in Colorado - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/family-fun-fitness-colorado/ Summary: I # Family Fun and Fitness in Colorado Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: October 31, 2024 - August 23, 2015 I’m having a terrific time with my friends and family in Crested Butte, CO and staying active riding my ‘townie’ bike. - Colorado, family, fitness ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWhy Women Are More Likely to Tear Their ACL NextFitness and FunNext --- ## FDA Approves IDE Freestyle Knee Implant | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/fda-approves-ide-freestyle-knee-implant/ Summary: Hyalex Orthopaedics has received FDA approval of its IDE supplement expanding its Early Feasibility Study to a cutting-edge pivotal trial of a freestyle knee implant # FDA Approves IDE Application for Freestyle Knee Implant Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: June 6, 2025 - May 23, 2025 iEarlier this week, Hyalex Orthopaedics received approval from the U.S. Food and Drug Administration (FDA) to expand its clinical trial of the HYALEX® Freestyle Knee Implant, moving from an early feasibility study to a pivotal clinical trial of its novel knee implant technology across the United States and Europe. This next-generation implant is designed for patients with cartilage damage and early osteoarthritis of the femoral condyle(s), offering new hope for those with limited treatment options who want to regain an active lifestyle. ## Freestyle Knee Implant Study As the study’s national principal investigator for the study, I shared the promising clinical results we’ve seen with Hyalex’s Early Feasibility Study (EFS) of the implant: “In our early clinical evaluations, the HYALEX Freestyle Knee Implant demonstrated exceptional promise in mimicking natural joint mechanics and helping patients return to their active lifestyle. The ability to help these patients, who have limited options today, could significantly impact the future treatment of chondral and osteochondral defects in the knee.” The pivotal trial will enroll a diverse patient population and evaluate the device’s safety and effectiveness in restoring mobility and improving outcomes. This milestone shows the rigorous research and innovation behind this knee implant and could reshape the future of knee preservation for those with cartilage damage and early arthritis, helping those patients regain an active lifestyle. ## Study Information Here’s the basic summary: “The Hyalex Early Feasibility Study is a prospective, multicenter, open-label, single-arm, 2-phase early feasibility study to evaluate the safety and technical performance of the HYALEX Knee Cartilage System for replacement of loss of articular cartilage and bone of the knee femoral condyles in symptomatic patients who require surgical treatment, will be enrolled in the study and undergo implantation of the HYALEX Knee Implant.” To learn more about this knee implant EFS, please visit: https://clinicaltrials.gov/study/NCT06368700. To learn more about my experience with Hyalex, check out this article:  - FDA Trial: HYALEX® Knee Cartilage System Photo by Chander R on Unsplash - active lifestyle, Carl Vause, cartilage damage, chondral defects, clinical trial, cutting-edge, early osteoarthritis, FDA approval, femoral condyle, Freestyle Knee Implant, Hospital for Special Surgery, HYALEX, HYALEX HYDROSURF, Hyalex Orthopaedics, IDE supplement, implant technology, joint preservation technologies, knee implant, medical device, orthopedic, orthopedic solution, osteochondral defects, patient outcomes, pivotal trial, Sabrina Strickland ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousCasas out of the Hospital Following Patellar Tendon Surgery NextHow To Know When You Should Have a Torn Meniscus Surgically RepairedNext --- ## FDA Trial: HYALEX® Knee Cartilage System | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/fda-trial-hyalex-knee-cartilage-system/ Summary: New FDA trial for the HYALEX knee cartilage system offers a synthetic cartilage replacement option for patients. Learn about the trial and why I # FDA Trial: HYALEX® Knee Cartilage System Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: June 27, 2024 - June 27, 2024 I first became interested in this new product from Hyalex Orthopaedics (now available as an FDA trial) after I demoed the HYALEX product at the American Orthopaedic Society for Sports Medicine (AOSSM) Sports Meeting two summers ago. Now that the trial has started and several have been implanted successfully, I am even more excited about the prospects of having a synthetic cartilage replacement option for patients For more information about this trial, check out the press release: Hyalex Orthopaedics Reports Treatment of First Patients with Novel HYALEX® Knee Cartilage System.    - American Orthopaedic Society for Sports Medicine, AOSSM sports meeting, FDA Trial, HYALEX, Hyalex Orthopaedics, knee cartilage, knee cartilage repair, medical device company, synthetic cartilage technology ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousPeyton’s Tibial Tubercle Osteotomy NextThe Ortho Show with Dr. Scott SigmanNext --- ## FDA Trial for New Patella LIFT Procedure | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/fda-trial-patella-lift-procedure/ Summary: ZKR Orthopedics # FDA Trial for New Patella LIFT Procedure Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: January 9, 2025 - January 9, 2025 Quick Summary ZKR Orthopedics' Patella LIFT is a minimally invasive implant designed to unload the kneecap in patients with patellofemoral cartilage wear or arthritis. The FDA PELICAN trial compares it against tibial tubercle osteotomy. The procedure allows immediate weight-bearing — a meaningful advantage over osteotomy's six-week crutch recovery. Hospital for Special Surgery plans to participate. This new Patella LIFT implant from ZKR Orthopedics is exciting as it may alleviate pain in patients suffering from anterior knee pain due to patellofemoral cartilage wear or arthritis. I first heard of this implant from its designer, Jeff Halbrecht, MD, at the International Patellofemoral Study Group. According to the press release, the PELICAN study will assess patients with advanced cartilage degeneration and osteoarthritis in the patellofemoral joint. It will compare outcomes of the ZKR Patella LIFT Implant, performed at U.S. centers, against a control group of tibial tubercle osteotomies performed at European centers. The trial’s primary endpoints include patient-reported outcomes, safety, and radiographic confirmation, while the secondary endpoints will focus on pain, function, and recovery speed. The Patella LIFT implant can be placed relatively quickly, and the patient can bear weight immediately, which is a huge advantage over current techniques. We plan to participate in this clinical trial and are optimistic that it may help patients currently unable or unwilling to spend six weeks on crutches after an osteotomy. As with any investigational device, candidacy and outcomes will vary based on the degree of cartilage damage, joint alignment, and individual anatomy — eligibility for the trial is determined on a case-by-case basis. Read more about the study in the ZKR Orthopedics press release. Related reading from Dr. Strickland - Patellofemoral joint preservation vs. arthroplasty — how I choose - Patellar pain and patellar arthritis — treatment options - CartiHEAL for cartilage injury treatment - About Dr. Sabrina Strickland — HSS patella specialist Photo by Anna Auza on Unsplash - cartilage degeneration, chondromalacia, clinical research, European Pilot study, FDA PELICAN trial, FDA Trial, IDE trial, innovative orthopedic solutions, knee pain, knee replacement, minimally invasive, OHSU, orthopedic care, Osteoarthritis, outpatient surgery, Patella LIFT procedure, patellofemoral arthritis, Patient Reported Outcomes, radiographic confirmation, range of motion, safety measures, tibial tubercle osteotomy, weight bearing, ZKR Orthopedics ## Frequently Asked Questions What problem is the Patella LIFT implant designed to address?The Patella LIFT, developed by ZKR Orthopedics, is designed for patients with front-of-knee pain from cartilage wear or arthritis behind the kneecap. The implant mechanically takes pressure off the kneecap. It is being studied as an alternative to a tibial tubercle osteotomy (a procedure that moves the bony bump on the front of the shinbone where the kneecap tendon attaches) in selected candidates, with the goal of relieving pain without the recovery burden of a bony procedure. How does Patella LIFT compare to a tibial tubercle osteotomy?The biggest difference for patients is recovery time. After a tibial tubercle osteotomy, patients are usually on crutches for around six weeks while the bone heals. With the Patella LIFT implant, you can put weight on the leg right away. Whether the long-term outcomes are equivalent will be answered by the PELICAN trial — the main measures include patient-reported outcomes, safety, and confirmation on imaging. Will Hospital for Special Surgery participate in the PELICAN trial?Yes — we plan to participate. PELICAN is enrolling patients with advanced cartilage wear or arthritis behind the kneecap. Eligibility is decided case by case, based on the degree of cartilage damage, the alignment of the knee, and individual anatomy. As with any investigational device, candidacy and outcomes vary, and a clinical trial is the right setting until the implant is more broadly approved. ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousExercise, Pain, & the Meaning of Creaky Knees NextAn Analysis of Intraoperative Acupuncture for NosocomephobiaNext --- ## First Patella LIFT™ Implant Surgeries | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/first-patella-lift-surgeries/ Summary: First Patella LIFT™ implant surgeries performed by Dr. Strickland and Dr. Gomoll. Learn about this FDA Breakthrough device for patellofemoral arthritis. # First Patella LIFT™ Surgeries on the East Coast at HSS in Enrollment of FDA PELICAN Trial Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: October 17, 2025 - October 17, 2025 ZKR Orthopedics announced today that the first Patella LIFT™ procedures on the East Coast were successfully performed as part of the PELICAN TRIAL, at the renowned Hospital for Special Surgery (HSS) in New York City. Esteemed orthopedic surgeons Dr. Sabrina Strickland and Dr. Andreas Gomoll led the groundbreaking initiative, completing four Patella LIFT™ implant surgeries in patients suffering from advanced patellofemoral joint disease. Learn more in Ortho Spine News: ZKR Orthopedics Announces First Patella LIFT™ Surgeries on the East Coast at Hospital for Special Surgery in Enrollment of FDA PELICAN Trial - Dr. Sabrina Strickland, FDA clinical trial, Hospital for Special Surgery, joint-preserving, knee disorders, orthopedic implant, Patella LIFT™, patellar tracking, patellofemoral arthritis, ZKR Orthopedics ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousOn Staying Active After Injuries NextNovel MRI Scoring System to Evaluate Patellofemoral OsteoarthritisNext --- ## Fitness and Fun - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/fitness-and-fun/ Summary: A recent study proved the effectiveness of a relatively simple 12 minute high intensity interval and the benefit of mixing up your workouts. # Fitness and Fun Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: March 7, 2024 - August 26, 2015 I love reading about new workouts that actually have data to support their effectiveness. We know that the human body likes when we mix it up a bit – rather than doing the same work out day in and day out. This study proved the effectiveness of a relatively simple 12 minute high intensity interval training program called the 10-20-30. In a nutshell, you work out at a easy pace for 30 seconds, a moderate pace for 20 seconds, and at maximum effort for 10 seconds for five repetitions, and then rest for two minutes, and then repeat the five consecutive intervals one more time. They studied this workout in a runner’s group with half of the group substituting this workout a couple of times per week and the other half continuing their usual daily run. The group who tried this 10-20-30 program actually improved their running performance while spending less time exercising, and at the same time they showed increased satisfaction. This is great news for everyone. It shows that we can create shorter workouts that people like and can stick to. It also showed that we don’t necessarily need to exercise longer in order to improve our fitness. Source: well.blogs.nytimes.com/2015/07/29/a-way-to-get-fit-and-also-have-fun/?_r=0 - fitness, health ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousFamily Fun and Fitness in Colorado NextSilkworms and Synthetic Substitutes for Cartilage, Ligaments, and TendonsNext --- ## Working out Safely in the Summer Heat - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/fitness-friday-working-out-safely-in-the-summer-heat/ Summary: Tips to help you stay safe while keeping fit in the summer heat. Many won’t let the rising temperatures get in the way of their exercise routines. # Fitness Friday: Working out Safely in the Summer Heat Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - August 14, 2016 With summer on its way, many won’t let the rising temperatures get in the way of their exercise routines. Dr. Sabrina Strickland, Orthopedic Surgeon, has tips to help you stay safe while keeping fit in the summer heat: - Don’t stop working out just because of the heat, but it is a good excuse to take it a bit easy. - If you have asthma or other respiratory issues, certainly take a break. Work out inside or skip the hottest days. - Bring water, drink it every 20 minutes and start your workout well hydrated. - Work out during the coolest hours, early in the morning or late at night. - Warning signs to look out for: dizziness, cramping, headache and at the extreme a lack of sweating. These may signify dehydration and possible early heat stroke. - athlete, athletes, fitness ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousDr. Sabrina Strickland, Orthopedic Surgeon, Answers Your Questions on Frozen Shoulder NextHospital for Special Surgery – Dr. Sabrina StricklandNext --- ## Focus on the Benefits of Pickleball | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/focus-on-pickleball-benefits/ Summary: There is so much negative press about pickleball. How about how great pickleball is at getting sedentary people working out and improving cardiovascular health? # Focus on Pickleball Benefits Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: March 28, 2024 - March 27, 2024 There is so much negative press about pickleball. How about how great pickle ball is as far as getting sedentary people out on a court and working out? How about it’s cardiovascular benefits? How about the social benefits of meeting friends and playing a sport? This article talks about the bone fracture risks of pickleball — but I think that we should focus on the benefits, not the risks. As far as injury prevention goes, I would suggest that the surgeons interviewed for this article are correct. Patients should be screened for osteoporosis and learn the sport. However, the most important factor to injury prevention is to cross train and weight lift to improve balance and bone strength to optimize performance for any cutting sport. Read the article: Pickleball-related injuries are on the rise, doctors say Photo by Ben Hershey on Unsplash - bone fractures, cardiovascular health, orthopaedic surgeons, pickleball, sedentary, sport, working out ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousEngineered Cartilage Sounds Perfect NextOpioids after ACL SurgeryNext --- ## Foods that can help speed your recovery - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/foods-that-can-help-speed-your-recovery/ Summary: Good article from Paspa Physical Therapy to keep in mind when your body is trying to heal. 7 Foods That Fight Inflammation # Foods that can help speed your recovery Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - March 15, 2016 Good article from Paspa Physical Therapy to keep in mind when your body is trying to heal.   ## 7 Foods That Fight Inflammation – Paspa Physical Therapy Source: paspapt.com/7-foods-fight-inflammation/   - Be Young Be Green, foods, patellar tracking ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousSee the Muscles You’re Stretching NextWhat to worry about when undergoing a knee replacementNext --- ## Relationship Between Feet and Knees | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/foot-workout-how-feet-relate-to-knees/ Summary: I tend to think about the knee but not much about the feet. I # A Foot Workout & How Feet Relate to Knees Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: October 31, 2024 - October 10, 2024 As a sports medicine surgeon, I tend to think a lot about the knee, but not very much about the feet. Recently, as I’ve watched my daughter train for the New York City marathon, I’ve come to appreciate a bit more about how important both foot alignment and foot strength are. I do look at patients’ feet when I examine their knees, especially looking to see how their ankle stability is, as well as how flexible their arches are. A lot of athletes talk about whether or not they pronate, and certainly, patients who have a fair amount of pronation or flat feet do better with a better arch support in their sneakers. The vast majority of patients do well with off-the-shelf inserts, such as Superfeet. I’m not sure about a twelve-minute foot workout, as this New York Times article describes, as my schedule rarely includes twelve extra minutes, but it certainly doesn’t sound like a bad idea.  Read more in this NYT article: A 12-Minute Workout to Build Foot Strength.    Image credit: photo by Manki Kim on Unsplash. - ankle stability, arch flexibility, arch support, athletes, foot alignment, foot strength, foot workout, knee, knee health, marathon, pronation, shoe inserts ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousSurgical Technique: Staple Fixation for Combined All-Inside ACWO and ACLR NextCase Report: Arthroscopy + Revision TTO for a 16-Year-Old Female Lacrosse PlayerNext --- ## Foods that can help speed your recovery - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/get-out-exercise/ Summary: A recent study in the published in Neurocase showed that one of the most successful nonagenarian track-and-field athletes in history had a better looking brain. # Get Out & Exercise Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - December 17, 2015 This is for everyone who needed one last reason to go out and exercise. A recent study in the published in Neurocase showed that one of the most successful nonagenarian track-and-field athletes in history had in essence a better looking brain. The brain scan showed that the white matter where the different parts of the brain connect had less abnormalities. The hippocampus, which is involved in memory, was larger than similarly aged volunteers. Another study done by the same group of researchers also supported the idea that exercise makes a difference in aging brains. They found that the most physically active elderly volunteers had better oxygenation and healthier patterns of brain activity than the the volunteers who were not physically active. Finally, a study published in the JAMA compared two groups of patients aged 70-89, one of which did a walking program and light resistance training and a second that attended health education classes. At two years, both groups had less decline in their brain function than expected for their ages. My takeaway here is to be active and stay active.   ## Does Exercise Change Your Brain? – NYTimes.com Source: mobile.nytimes.com/blogs/well/2015/09/02/physed-4/?referrer   - brain, Exercise, JAMA, Neurocase, New York Times ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousDecorating Safely NextUsing Soft RollersNext --- ## Girls & Boys Recovery From Concussions - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/girls-take-longer-than-boys-to-recover-from-concussions/ Summary: According to this article, “Master said it could be that [girls] have less access to on-site athletic trainer expertise when the injury occurs. # Girls Take Longer Than Boys to Recover From Concussions? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - March 31, 2020 Sex differences between men and women continue to mystify me, but this article explains why there may be differences in recovery between girls and boys who get concussions. According to this article, “Master said it could be that [girls] have less access to on-site athletic trainer expertise when the injury occurs. That’s because the sports girls tend to do — such as soccer, basketball, and cheerleading — are considered “moderate risk” activities. Those activities often provide less sideline medical care than the male-dominated sports of football, ice hockey, and basketball.” The take-home message here is that if your daughter suffers a head injury playing a sport, have a low threshold for taking them to the doctor as they will then recover faster with appropriate treatment. Read the article in US News & World Report. - blog, concussions, woman sports, women sports ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPrevious7 habits of highly healthy physicians NextCOVID-19 UpdateNext --- ## ACL Reconstruction Outcomes - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/good-article-on-acl-reconstruction-outcomes/ Summary: Evaluation ACL reconstruction outcomes is important as techniques change and types of graft vary (hamstring, patellar tendon, quad tendon and cadaver tendon). # Good Article on ACL Reconstruction Outcomes Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - November 5, 2015 It is hard to do good clinical research, especially when following a young, active and mobile patient population. Evaluation of outcomes of ACL reconstruction is important because techniques change — and the type of graft used (hamstring, patellar tendon, quad tendon and cadaver tendon) is variable. In some studies, the outcome is whether or not the athlete re-injures their knee, but there are many things we really want to know, such as: 1) when they went back 2) what sport they got back to 3) whether they returned to the same level of competition they were performing at prior to their knee injury 4) whether their knee was stable and asymptomatic with day to day activities, and so on. Many times we don’t have outcome scores from patients before their surgery, and with this relatively young population it can be difficult to track them down after surgery to fill out surveys to assess how they are doing. Technology is helping, as we now have automated patient databases to help keep track of how our patients are doing.   ## High Variability in Outcome Reporting Patterns in High-Impact ACL Literature | The Journal of Bone & Joint Surgery Source: jbjs.org/content/97/18/1529   - clinical research, High Variability, High-Impact ACL Literature, Outcome Reporting Patterns, The Journal of Bone & Joint Surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHSS Bone Quiz NextRunners in the NYC MarathonNext --- ## Good Information on Sesamoiditis - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/good-information-on-sesamoiditis/ Summary: The sesamoids are not connected to any other bone, but only to tendons or are embedded in muscle. The kneecap (patella) is the largest sesamoid. # Good Information on Sesamoiditis Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - October 20, 2015 Here’s some information from OrthoInfo about Sesamoiditis: ## Sesamoiditis-OrthoInfo – AAOS Most bones in the human body are connected to each other at joints. But there are a few bones that are not connected to any other bone. Instead, they are connected only to tendons or are embedded in muscle. These are the sesamoids. The kneecap (patella) is the largest sesamoid. Two other very small sesamoids (about the size of a kernel of corn) are found in the underside of the forefoot near the great toe, one on the outer side of the foot and the other closer to the middle of the foot. Source: www.orthoinfo.org/topic.cfm?topic=A00164   - OrthoInfo, Sesamoiditis ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHospital for Special Surgery Receives 5-Star Ratings from Healthgrades in Three Orthopedic Categories NextLifting Weights Twice a WeekNext --- ## Grand Rounds from HSS: A Revision TTO | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/grand-rounds-hss-revision-tto/ Summary: In HSS’s Grand Rounds, I shared the case of an adolescent athlete who needed a TTO revision a year after having a tibial tubercle osteotomy and MPFL reconstruction. # Grand Rounds from HSS: Revision TTO Returns Young Athlete to Sports Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: September 12, 2024 - September 12, 2024 I recently contributed to the Hospital for Special Surgery’s Grand Rounds, which shares complex cases and provides a great educational resource for knee surgeons. My contribution to the September issue was related to the diagnosis and treatment of an adolescent athlete who continued to have knee pain a year after she had undergone tibial tubercle osteotomy (TTO) combined with medial patellofemoral ligament (MPFL) reconstruction and particulated cartilage implant to the patella and trochlea. My case report walks through my initial exam and through the process we took (specifically a revision TTO) to enable her to achieve full range of motion and return to sport.  Although studies have shown TTOs to be effective for treating patellofemoral joint conditions, failures do occur, including delayed union and nonunion, which can potentially profoundly impact a patient’s quality of life. There is not a lot of literature available on the outcomes of revision surgery following a TTO, even though a nonunion following a TTO is a serious complication. Fortunately, experienced knee surgeons at HSS have been able to help patients undergoing revision TTO return to sports. Read the complete case report in Grand Rounds from HSS: Management of Complex Cases. - athletes, chondromalacia, delayed union, Hospital for Special Surgery, HSS, knee surgeons, lacrosse, nonunion, orthopaedic surgery, patellar maltracking, patellofemoral instability, patellofemoral joint, patellofemoral joint pathologies, revision surgery, sports, tibial tubercle, tibial tubercle osteotomy, TTO ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHSS Presents: Practice Management Pearls and Pitfalls for Young Physicians NextUsing Machine Learning to Predict MPFL Reconstruction OutcomesNext --- ## Health & Exercise Trends - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/health-exercise-trends/ Summary: Gretchen Reynolds reviews articles associating exercise with better brain function. One study found greater brain volume in the twin with stronger leg muscles. # Health & Exercise Trends Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - December 29, 2015 Gretchen Reynolds from the New York Times writes excellent articles about exercise and health. In this recap of 2015 she reviews several articles associating exercise with better brain function, especially as we age. The one study that stood out, however, was looking at twins. The study found that the twin with stronger leg muscles had greater brain volume. As the mother of twins, I find this very interesting. As a mom, I offer my twins the same foods and the same opportunities for exercise and sports, however, they do not necessarily take advantage of these opportunities in the same way or at the same rate.   Source: well.blogs.nytimes.com/2015/12/23/fit-body-fit-brain-and-other-fitness-trends/?_r=1   - Exercise, Gretchen Reynolds, health, New York Times, twins ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousUsing Soft Rollers NextBenefits of Adding YogaNext --- ## Helping Women Overcome Shoulder Pain - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/helping-women-overcome-shoulder-pain/ Summary: Skiing is one sport where common sense can truly prevent a high proportion of injuries and help avoid the most catastrophic problems. # Helping Women Overcome Shoulder Pain Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - August 13, 2016 Women are playing sports well into their senior years, and some of those sports mean exerting the shoulder overhead—leading to a bunch of shoulder problems seen more in women than in men. READ ARTICLE - pain, shoulder, shoulder pain, women ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHow to Prevent Skiing Injuries NextCaring for VeteransNext --- ## Hopping Backwards and ACL Reconstruction | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/hopping-backwards-recovery-acl-reconstruction/ Summary: This study found that assessing how well patients are able to hop backward may be a better way of evaluating patients’ strength as they recover from ACL surgery. # Hopping Backward as an Indication of Recovery from ACL reconstruction Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: November 21, 2024 - November 21, 2024 In a study in the Journal of Sport and Health Science, they found that assessing how well patients are able to hop backward may be a better way of evaluating patients’ strength as they recover from ACL surgery.  “People may not think of knee function or hopping backward as a natural part of movement, but people do use backward direction, such as walking backwards regularly in rehab,” Song said. We are constantly looking for relatively simple ways of assessing patient’s strength after surgery in order to determine when they are ready to get back to sports, perhaps a backward hop may be better than what our physical therapists currently do when testing a patient to return to sport. Read more in Journal of Sport and Health Science: Backward hopping may be better indication of recovery from ACL reconstruction Photo by whereslugo on Unsplash - ACL, ACL reconstruction, ACL reconstruction surgery, anterior cruciate ligament, anterior cruciate ligament reconstruction, bilateral asymmetry, biomechanics, hopping, hopping backward, Physical Therapy, quadriceps strength, return to sport ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousTips for Doing Squats without Knee Pain NextEvaluating Patellar Dislocation via the Femoral Anteversion AngleNext --- ## Hospital for Special Surgery – Dr. Sabrina Strickland | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/hospital-for-special-surgery-dr-sabrina-strickland/ Summary: Dr. Sabrina Strickland on helping veterans at the Bronx V.A. Hospital, helping veterans getting back to an active life without pain. Skip to content # Hospital for Special Surgery – Dr. Sabrina Strickland Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: July 18, 2025 Dr. Sabrina Strickland on helping veterans at the Bronx V.A. Hospital, helping veterans getting back to an active life without pain. Manage Cookie Consent To provide the best experiences, we use technologies like cookies to store and/or access device information. Consenting to these technologies will allow us to process data such as browsing behavior or unique IDs on this site. Not consenting or withdrawing consent may adversely affect certain features and functions. 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Individual results may vary based on diagnosis, anatomy, and overall health. --- ## JointStem Research Study - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/hospital-for-special-surgery-jointstem-research-study/ Summary: HSS Sports Medicine Institute physicians investigating the effects of an autologous adipose tissue-derived stem cell injection in patients with knee osteoarthritis. # Hospital for Special Surgery – JointStem Research Study Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - September 14, 2022 Excited to share that Hospital for Special Surgery is participating in this JointStem Research Study. Physicians at the HSS Sports Medicine Institute are conducting a study investigating the effects of an autologous adipose tissue-derived stem cell injection in patients with knee osteoarthritis. If you qualify for the study you will receive either the adipose tissue-derived injection or a placebo injection. The costs will be completely covered.  Learn more about the study.  - autologous adipose tissue, HSS, jointstem, knee osteoarthritis, patients, research study, stem cell injection ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousThe Bridge-Enhanced ACL Restoration Implant—known as the BEAR implant NextLiam’s Story – MPFL Reconstruction SurgeryNext --- ## 3 Five Star Ratings for HSS Orthopedics - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/hospital-for-special-surgery-receives-5-star-ratings-from-healthgrades-in-three-orthopedic-categories/ Summary: Healthgrades Gives Hospital for Special Surgery 5-Star Ratings in 3 orthopedic categories: total hip replacement, back and neck surgery, and spinal fusion surgery. # Hospital for Special Surgery Receives 5-Star Ratings from Healthgrades in Three Orthopedic Categories Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - October 20, 2015   ## Hospital for Special Surgery Receives 5-Star Ratings from Healthgrades in Three Orthopedic Categories Hospital for Special Surgery Receives 5-Star Ratings from Healthgrades in Three Orthopedic Categories, Hospital for Special Surgery Receives 5-Star Ratings from Healthgrades in Three Orthopedic Categories Source: www.hss.edu/newsroom_hss-receives-5-star-ratings-from-healthgrades-in-three-orthopedic-categories.asp   - 100 Best Hospitals for Spine Surgery, back and neck surgery, Healthgrades, HSS, spinal fusion surgery, total hip replacement ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousAll athletes – including kids – need to cross train NextGood Information on SesamoiditisNext --- ## How Acton-Boxborough Coach Helps Players Recover from ACL Tears Source: https://sabrinastrickland.com/how-acton-boxborough-coach-helps-players-recover-from-acl-tears/ Summary: This article about an assistant soccer coach at Acton-Boxborough High School in Massachusetts caught my attention because this is where I grew up. # How Acton-Boxborough Coach Helps Players Recover from ACL Tears Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - March 3, 2023   This article about an assistant soccer coach at Acton-Boxborough High School in Massachusetts caught my attention because this is where I grew up.   As ACL injuries are incredibly common in female soccer players, it isn’t surprising that a coach would have suffered several ACL injuries herself. One study showed that a multi-sport female athlete had a nearly 10 percent risk of ACL injury during high school.   The data regarding ACL injury in female soccer players is very concerning, with studies showing that two thirds of female soccer players who returned to soccer after ACL reconstruction re-injured their knee within 5-10 years and 42% re-tore their ACL.   It has been 26 years since I started my orthopaedic residency, and so far we haven’t figured out: 1. How to prevent ACL injury in the first place and 2. How to reconstruct the ACL in such a way as to minimize re-injury.   The article is from the New England Soccer Journal, but unfortunately it’s gated for subscribers only.  (Image is a courtesy photo from the article.) - ACL, ACL injury, ACL reconstruction, ACL reinjury, ACL retear, ACL tear, athletes, Hospital for Special Surgery, HSS, orthopaedic surgery, sports ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousDiscussing Patellar Tracking Abnormalities and Patellar Instability NextPatellofemoral Joint Loading, Early Osteoarthritis after ACL ReconstructionNext --- ## How Long Does MPFL Recovery Really Take? | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/how-long-does-mpfl-recovery-really-take/ Summary: Wondering when you’ll recover from medial patellofemoral ligament (MPFL) reconstruction? This information will help understand how long MPFL recovery takes. # How Long Does MPFL Recovery Really Take? Timeline & Tips for Success Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: September 17, 2025 - September 17, 2025 Quick Summary Most patients recover from MPFL reconstruction in 6 to 12 months, with daily-activity comfort returning around weeks 6 to 12 and full sport-specific clearance typically between months 4 and 6. High-impact athletes may need 12 to 18 months. Recovery advances by milestones — quadriceps strength, range of motion, and stability — not by the calendar alone. Strict adherence to physical therapy is the single biggest predictor of a successful outcome. Wondering when you’ll fully recover from medial patellofemoral ligament (MPFL) reconstruction? You’re not alone. Whether you’re an athlete, a parent of a young patient, or anyone eager to return to a pain-free, active lifestyle, understanding how long the MPFL recovery process will take is important. This guide draws on my expertise and provides direct links to detailed resources, so you can equip yourself with the information that will help you recover with minimal confusion or stress. ## What is MPFL Reconstruction? MPFL reconstruction is a surgical procedure designed to restore stability to the kneecap (patella) after a patellar dislocation or chronic instability. The surgery rebuilds the medial patellofemoral ligament — the soft-tissue tether on the inner side of the knee that keeps the patella in its trochlear groove — using a graft (commonly from a hamstring tendon) anchored between the femur and patella. This ligament is essential for normal knee function and preventing future dislocations.  If you have additional procedures performed alongside MPFL reconstruction (such as a tibial tubercle osteotomy), your MPFL recovery timeline and rehabilitation recommendations may differ somewhat. Be sure to discuss your individualized protocol with your surgical team. Remember, advancing from one phase to the next is based not only on time but also on meeting specific clinical and functional milestones. Your surgeon or therapist will assess your strength, range of motion, and pain levels before clearing you to move forward. ## MPFL Recovery Timeline The timeframes that follow are general guidelines. Your specific plan may change, especially if you have additional procedures. Always follow your care team’s personalized instructions.  ### Phase 1: Immediate Post-Operative (Weeks 1–2) Goal: Minimize swelling, protect surgical repair, begin gentle movement. What to expect: - Use of crutches and a knee brace - Protected weight-bearing on the operated leg - Gentle range-of-motion exercises - Return to sedentary work or school is possible within a week depending on how much walking is required Practical tips for the first few weeks: - The leg is placed in a brace for up to six weeks to keep it straight during walking until the quad is strong enough to control the leg; follow all instructions for use. For some patients, the brace is worn nearly full-time (except for physical therapy or hygiene reasons), per your surgeon’s orders. - Begin rehabilitation as directed to restore quadriceps strength, which is essential for stability and safe brace removal. - Patients can walk with weight on the operated leg immediately, while wearing the brace. - Devices, including muscle stimulators (for example, Zynex NexWave | Prescription Pain Management Tens Unit) and cold compression machines (such as the NICE, available in my recovery shop) can help reduce swelling and pain and support muscle recovery. - Strictly follow all post-operative instructions, especially any restrictions on knee movement or activity ### Phase 2: Early Rehabilitation (Weeks 3–6) Goal: Increase range of motion, start muscle activation, decrease use of crutches. What to expect: Under the guidance of a physical therapist, strength and motion work intensifies. You’ll gradually transition to out of the brace as tolerated. Practical tips for weeks 3-6: - The brace should remain on during walking and other weight-bearing activities until you have good quad control (ask your physical therapist). - Begin bending and straightening the knee as recommended by the physical therapist, but only within the limits set by the surgeon to protect healing tissues. - Patients usually bear full weight on the leg while using the brace. Be cautious and avoid activities that may risk a slip or fall. - Engage in prescribed exercises to activate and strengthen the quadriceps, which helps prepare for brace removal and future mobility. - Continue to use cold therapy devices and muscle stimulation devices (if recommended) to reduce inflammation and support healing. - Attend all physical therapy sessions, perform home exercises, and promptly communicate any new or worsening symptoms, such as swelling, pain, or instability, to your care team. Staying consistent and proactive is key to a safe recovery. - Refrain from running, jumping, or rapid direction changes during this phase to protect the new ligament and healing tissues. ### Phase 3: Advanced Strengthening (Weeks 7–12) Goal: Recover muscle strength, balance, and coordination. What to expect: Start low-impact activities such as stationary cycling, elliptical, and bodyweight exercises. You can also slowly return to household chores and basic activities. Practical tips for weeks 7-12:  - As approved by your surgeon, discontinue the knee brace as your quadriceps strength and stability improve. - Work with the physical therapist to restore full knee bending and straightening, advancing the range of motion exercises as tolerated and cleared. - Transition to more challenging strengthening exercises for the quadriceps, hamstrings, and hip muscles, incorporating light resistance and functional movements. - Begin balance drills and proprioceptive activities (such as standing on one leg or both legs on a bosu ball) to enhance joint stability and neuromuscular control. - Activities such as stationary cycling, elliptical, and swimming (if cleared) can improve fitness without risking the healing ligament. - Continue to watch for swelling, pain, or instability. Report any concerning changes to your orthopedic team promptly. - Continue to avoid high-impact activity, such as running, jumping, and pivoting even if the knee feels stronger, to ensure safe healing of the repaired ligament. - Maintain regular physical therapy visits and perform prescribed home exercises daily to support your ongoing recovery progress. - Understand that healing is continuing; pushing too hard or rushing this phase can jeopardize your surgical outcome. ### Phase 4: Functional and Sport-Specific Training (Months 3–4) Goal: Prepare the knee for higher loads and dynamic movement. What to expect: At this point, you’ll probably be able to add jogging on flat surfaces, agility drills, and proprioception training. For athletes, now is the time to lay the foundation for a gradual return to practice. Practical tips for months 3-4:  - Under the guidance of the physical therapist, begin light plyometric (jumping) exercises, agility drills, and sport-specific movements as your strength, balance, and confidence improve. - Initiate a graduated running program, starting with straight-line jogging before moving on to cutting, pivoting, or directional changes, which you should start only when cleared by the surgeon or physical therapist. - Maintain a comprehensive strengthening program for the quadriceps, hamstrings, hips, and core to ensure muscular balance and protect the knee during dynamic activities. - Incorporate advanced balance, coordination, and single-leg activities to prepare for unpredictable environments. - Stay alert for pain, swelling, or instability during higher-intensity training. If it occurs, stop the activity and notify your orthopedic surgeon or physical therapist for assessment and guidance. These symptoms can indicate overuse, or a potential complication such as ligament failure or graft irritation. - If you’re an athlete, progressively add drills that mimic the movements and demands of your particular sport, focusing first on technique before increasing speed and intensity. - Participate in functional and readiness assessments as directed by the rehabilitation team to ensure it’s safe to return to competitive sports. - Don’t advance to full participation until cleared; early return increases the risk of reinjury or graft failure. - Keep open communication with your surgeon, physical therapist, and coach to adjust training and address concerns throughout your transition back to sport. ### Phase 5: Return to Full Activity (Months 4–6+) Goal: Restore full function, resume normal sports and life activities. What to expect: This is the phase you’ve been working towards. You can now return to running, jumping, and contact sports as cleared by your surgeon and physical therapist. Typically, safe return to sport is considered only when your surgical leg matches or exceeds 90% of your non-operative leg in strength and hop tests, in addition to demonstrating good balance and confidence during sport-specific movements. It’s normal for recovery to include occasional setbacks, such as episodes of stiffness, discomfort, or slower progress. Communicate any concerns to your care team promptly. Most issues can be managed with adjustments to your rehabilitation plan. Practical tips for months 4-6+: - Ensure that you pass all return-to-play functional and strength tests before fully resuming sports participation, as advised by your surgeon or physical therapist. - Maintain a consistent training program for leg strength, endurance, balance, and core stability, while closely monitoring for any renewed pain, swelling, or instability. If symptoms return, reduce activity and consult your care team before resuming higher-intensity movements. - Gradually increase training intensity, volume, and sport-specific drills. Don’t jump back to full competition immediately. - Incorporate a structured warm-up before every session and prioritize recovery strategies, such as stretching and ice, after high-intensity activity. - Consider using supportive gear (such as knee sleeves or braces) if recommended during initial return to high-risk sports or movements. - Remember, recovery is unique for each person. Don’t rush your process. Safe progression depends on milestone achievement, not just the passage of time or comparison to others. Listen closely to your body and your care team. ## When You Are “Fully Recovered” from MPFL Reconstruction Once you’ve met these important recovery benchmarks, continued maintenance and self-monitoring are essential for keeping your knee strong and healthy. Here’s what to expect:  - Pain, swelling, or instability should be fully resolved. - Range of motion and strength should closely match your non-operative side. - You are able to perform all work, sports, or daily activities with confidence. Often, this happens between 6 to 12 months after surgery. However, high-impact athletes may need up to 12–18 months for full sports readiness. Even after achieving these benchmarks, it’s important to continue working on strength, flexibility, and endurance to protect your knee and support long-term recovery. Maintaining these habits will help you prevent reinjury and support your return to all activities. ## Patient Stories and Success Hear from patients who’ve completely recovered from MPFL reconstruction surgery—what worked for them, lessons they learned, and words of encouragement: - Liam’s Story – MPFL Reconstruction Surgery  - Joseph’s Story – MPFL Reconstruction and Tibial Tubercle Osteotomy Surgery ## Pro Tips for Optimal MPFL Recovery - Stick to your rehab plan: Commitment to a structured rehabilitation program is the top predictor of success. - Be patient and proactive: Some days will be easier than others; don’t get discouraged. Tracking your progress in a document can help you see the milestones you’ve already achieved. - Communicate: Keep your surgeon and physical therapist informed about any new pain, swelling, or concerns. - Prioritize mental readiness: Addressing confidence and emotional well-being is often just as important as physical recovery. Talk to your care team if you have any anxiety or concerns about returning to sport or activity or seek out help from a sports psychologist as they can really help your on your road to recovery. These guidelines provide a general road map, but always rely on recommendations from your surgical team and physical therapist for guidance tailored specifically to you. ## Accessing Expert Help and Next Steps Recovering from MPFL reconstruction is a gradual journey that requires dedication, patience, and close partnership with a skilled care team. By following a structured timeline, embracing rehabilitation, and listening to your body through each phase, you can maximize your chances of regaining strength, stability, and confidence. With thoughtful guidance and the right resources, most people can safely return to their favorite sports and activities, enjoying renewed mobility for years to come. If you have questions about whether an MPFL reconstruction is right for you or want a second opinion, please reach out. ## Related Reading on Patellar Instability and MPFL Surgery - MPFL Reconstruction Surgery — overview of the procedure, indications, and surgical technique. - Patellar Instability — diagnosis and treatment options for chronic kneecap dislocation. - How to Tell If Your MPFL Reconstruction Failed — warning signs that warrant a follow-up evaluation. - Can You Fully Recover from a Dislocated Patella? — non-surgical and surgical recovery realities. - Tibial Tubercle Osteotomy (TTO) — the companion procedure often performed alongside MPFL reconstruction. - About Dr. Sabrina Strickland — board-certified orthopedic surgeon at Hospital for Special Surgery. ## Frequently Asked Questions About MPFL Recovery ### How long does it take to recover from MPFL reconstruction surgery? Most patients return to daily activities within 6 to 12 weeks after MPFL reconstruction, with full sport-specific recovery typically taking 6 to 12 months. High-impact athletes may need 12 to 18 months for full sports readiness. Recovery is based on hitting milestones, not just on the calendar — your surgical team will check strength, range of motion, and stability before clearing you to move through each phase. ### How soon can I walk after MPFL reconstruction? Patients can usually put weight on the operated leg right after MPFL reconstruction, while wearing a knee brace. The brace keeps the leg straight during walking until the quad muscle is strong enough to control the knee — usually for up to six weeks. Crutches are used for extra support and balance during the first few weeks. ### When can I return to sports after MPFL reconstruction? Return to sport is usually considered between 4 and 6 months after MPFL reconstruction, but only when your surgical leg matches or exceeds 90% of the strength and hop-test performance of your other leg. High-impact and contact athletes may need up to 12 to 18 months. Functional readiness — not the calendar — determines a safe return to play. ### How long do I need to wear a knee brace after MPFL surgery? Most patients wear the knee brace for up to six weeks after MPFL reconstruction, mainly during walking and weight-bearing activity. The brace keeps the knee straight until your quad strength is enough to stabilize the joint on its own. Your surgeon will clear you to stop using the brace once you show good quad control. ### Is MPFL reconstruction painful during recovery? Most patients report manageable post-surgery discomfort that improves significantly within the first 1 to 2 weeks. Pain is controlled with prescribed medication, cold-compression devices, and muscle stimulators. Sharp pain, increasing swelling, or new instability beyond the first weeks should be reported to your surgical team right away — these can signal a complication. ### What slows down MPFL recovery the most? The two biggest things that slow MPFL recovery are skipping physical therapy sessions and rushing back to high-impact activity before clearance. Missing rehab sessions delays the quad strength gains needed to come out of the brace and progress. Going back to running, jumping, or pivoting before milestone clearance increases the risk of the graft failing or the kneecap dislocating again. - functional milestones, knee brace, knee recovery, MPFL reconstruction, MPFL recovery, pain management, patellar instability, patient recovery, Physical Therapy, post-operative care, quadriceps strengthening, range of motion, rehabilitation timeline, return to sport, surgical procedure, surgical success ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHow to Tell If Your MPFL Reconstruction Failed NextWhy Do I Have Knee Pain When Squatting?Next --- ## How serious is a patella dislocation? | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/how-serious-is-a-patella-dislocation/ Summary: How serious is a patella dislocation? The more you understand about this injury, the better your decisions about treatment and recovery will be. # How Serious Is a Patella Dislocation? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: November 26, 2025 Quick Summary A patella dislocation is a serious knee injury — even a single event tears the medial patellofemoral ligament (MPFL) and can bruise bone or damage cartilage. Without treatment, between 33% and 88% of patients dislocate again, and each repeat episode raises the risk of long-term cartilage loss and early patellofemoral arthritis. Prompt orthopedic evaluation, MRI imaging, and a structured rehabilitation or surgical plan protect the joint and lower the chance of recurrence. - November 17, 2025 When your kneecap slips out of its groove, it’s not just painful. It can really slow you down and bring risks that go way beyond those first few hours or days of pain and swelling. The more you understand about this injury, the better your decisions about treatment and recovery will be. ## What Actually Happens in a Patella Dislocation? When the patella pops out and moves off to the side of the knee (patella dislocation) it’s usually because of a sudden twist, a direct hit while your knee is bent, or sometimes because of natural factors in your anatomy that make your kneecap less stable. A patella dislocation means the kneecap has come all the way out of its groove, while subluxation means it only partially slips out and may quickly go back into place. Both can be painful and cause joint damage. These injuries often affect adolescents and young adults, particularly females and those active in pivoting sports. When this happens, you’ll notice it right away. The shape of your knee looks different, it swells up fast, and straightening your leg can be next to impossible. Even if the kneecap slips back into place quickly, you might be dealing with hidden damage that needs attention. If you think your kneecap is dislocated, don’t force it back into place on your own. Rest your leg and try to straighten it if possible, and use a cold pack to help with pain and swelling. Seek medical attention promptly if it doesn’t reduce on its own. Imaging and a thorough exam are needed within a week or so to confirm that there wasn’t additional damage done to the knee. ## What Happens Right After a Patella Dislocation? Some people think a kneecap dislocation is a simple fix, but it nearly always hurts important tissues in your knee and needs a real management plan. The occurrence of patella dislocation signals a traumatic force strong enough to tear the medial patellofemoral ligament (MPFL), the primary soft tissue stabilizer that prevents the kneecap from shifting laterally.  A kneecap dislocation always injures the MPFL, and often results in bruising of the bone and possible cartilage injury. Common immediate consequences include: - Tearing of the MPFL. - Bone bruising along the lateral femur and medial patella. - Cartilage damage, sometimes significant enough to require surgery. - Swelling and joint effusion (a swollen joint). - Instability and loss of confidence in the affected knee. - Acute pain and loss of function. Sometimes you may need crutches at first and/or a brace to help you walk. After your first patella dislocation, I almost always suggest an MRI. It helps us spot cartilage damage and anatomic abnormalities you can’t see from the outside, and shapes the best plan for getting your knee back to normal. After the first few days, your provider should start gentle motion and physical therapy unless there is a significant loose fragment. This transition helps restore movement, build strength, and protect your knee as you heal. ## Why Is Future Instability a Concern? This isn’t always a one-time event. At least one third of people who skip surgery have another kneecap dislocation, and some individuals have a higher risk of repeat dislocations (up to 88%), depending on their unique knee anatomy or activity level. Recurring patellar dislocation risk is especially high if you are young, female, or have certain anatomical risk factors such as: - Shallow trochlear groove (trochlear dysplasia) - High-riding kneecap (patella alta) - Increased lateral pull on the patella (elevated TT-TG distance) - Ligamentous laxity or generalized hypermobility Published studies show between 33-88% of patients will experience another dislocation, sometimes more, without corrective intervention. Each repeat dislocation increases the chance of more joint damage and early arthritis. ## Can You Prevent Another Dislocation? The best way to protect your knee is to strengthen your thigh, hip, and core muscles with exercises prescribed by your physical therapist. They may recommend a brace for certain activities. You can also modify your workouts to avoid sudden twists or direct impacts to reduce your risk. ## Cartilage Injury and Early Arthritis A lesser-known but major consequence of kneecap dislocation/patella dislocation is the potential for cartilage injury. The shearing force of dislocation often scrapes the cartilage surface of the kneecap or the underlying femur, sometimes dislodging fragments into the joint (osteochondral fracture). Even a single event can accelerate cartilage breakdown, raising the risk for early arthritis in the patellofemoral joint, especially if instability or further dislocations occur. If imaging shows loose bone or cartilage, surgery is often indicated to retrieve or repair these fragments, and decisions about ligament reconstruction versus nonoperative care become more urgent. ## Recovery and the Psychological Toll It’s not just about ligaments and cartilage, either. This injury can really shake your confidence, especially if you’re active. Many of my patients worry about their knees giving out again, and rehab is just as much about rebuilding trust as it is about strength.  A detailed, supervised rehabilitation program addresses both strength and confidence, but the risk of reinjury can still alter people’s lifestyle and activity choices. Understanding exactly what happened and how to resolve it, as well as recovery timelines, can help you return to an active lifestyle with confidence. Most people start gentle movement in the first week. Return to full activity can take several months and depends on the degree of injury or surgery performed. ## When Is a Patella Dislocation Most Serious? - You’re dealing with large loose fragments in the joint. When a dislocation knocks off a chunk of bone and/or cartilage, those loose pieces can get stuck, causing pain, swelling, and locking in the knee. These often need surgery to remove or repair, since leaving them alone can increase the risk of long-term damage or accelerated arthritis.​ - Your kneecap doesn’t pop back into place on its own. Normally, most patella dislocations reduce spontaneously or with gentle straightening before patients get to the ER. If your kneecap is stuck and can’t be relocated, it might be trapped by tissue, bone fragments, or damage inside the joint, which always requires prompt attention.​ - The knee gets stuck and won’t extend. If your knee can’t straighten fully after a dislocation, it may be because of mechanical blockage from a loose fragment or significant swelling inside the joint. This calls for urgent imaging and often aspiration to remove the fluid in the knee to restore normal motion.​ - You’ve had several episodes, or you have high-risk anatomy. If patella dislocation has happened more than once, or you have factors like a shallow trochlear groove, a high-riding patella, and/or ligamentous laxity, you’re at much higher risk for repeated instability. Each repeat event can worsen cartilage or bone damage, increasing the risk of early arthritis.​ - You’re a high-level athlete worried about getting back to your sport. Athletes place greater demands on their knees, and recurrent instability or delay in restoring normal function can threaten both performance and long-term knee health. Early, targeted treatment (sometimes surgical) can be important for protecting the joint and supporting return to play at your level. Each of these scenarios warrants close evaluation with an orthopedic specialist, and often consideration of surgical intervention (such as MPFL reconstruction surgery) to restore knee stability and protect your joint health. ## More Than a Temporary Setback A patella dislocation is a serious injury because even a single event creates significant damage to the ligament and can set the stage for long-term instability, repeat injuries, and degenerative joint changes. Accurate assessment, including imaging, and creating a management plan that addresses both the initial injury and any underlying anatomical risk factors are essential for you to achieve the best long-term outcome. If you (or someone close to you) have had a kneecap dislocation, don’t wait. Getting the right orthopedic evaluation as soon as possible helps protect your knee for the long haul and can minimize future problems. For additional information on knee cap dislocation and joint instability, see the American Academy of Orthopaedic Surgeons guide. For more treatment options and recovery stories, take a look at these resources on my site:  - Patellar instability - MPFL surgery - Real-world success stories from my patients While some people recover easily from a patella dislocation, don’t underestimate the injury’s seriousness and its long-term impact. Getting the right treatment and follow-up care can make all the difference in returning to full activity and avoiding future problems. Regular check-ins with your orthopedic team are important to track your progress and adjust your recovery plan if needed. Have questions? Please reach out.   - early arthritis, knee injury, knee pain, kneecap dislocation, Medial patellofemoral ligament, MPFL, MPFL reconstruction, orthopedic specialist, osteochondral fracture, patella alta, patella dislocation, patella subluxation, patellar instability, repeat dislocation, Trochlear dysplasia ## Frequently Asked Questions How long does it take to recover from a patella dislocation?Most first-time kneecap dislocations treated without surgery require 6 to 12 weeks of physical therapy and strengthening before returning to full activity. Patients who have MPFL reconstruction typically return to running at 3 to 4 months and to cutting or pivoting sports at 6 to 9 months. Recovery depends on the amount of cartilage or bone injury, what procedure was done, and how consistently you stick with physical therapy. Should I have surgery after my first patella dislocation?Surgery is not always required after a first dislocation, but it is recommended when imaging shows a loose piece of cartilage and bone in the joint, significant cartilage damage, or when the kneecap will not stay in place. In patients with high-risk anatomy — a shallow groove on the thigh bone, a high-riding kneecap, or a large kneecap-tendon offset — early MPFL reconstruction can substantially lower the risk of another dislocation. The decision is individualized based on your MRI, anatomy, age, and activity level. What are the chances of dislocating my kneecap again?Without surgery, between 33% and 88% of patients have another kneecap dislocation, depending on age, sex, and anatomy. The risk is highest in young female athletes with a shallow groove on the thigh bone, a high-riding kneecap, naturally loose joints, or a large kneecap-tendon offset. Each repeat dislocation damages more cartilage and raises the long-term risk of arthritis behind the kneecap. What is the difference between patella dislocation and subluxation?A dislocation is when the kneecap fully comes out of the groove on the thigh bone, usually shifting to the outside and needing to be put back in place. A subluxation is a partial slip in which the kneecap moves out of position briefly and slides back on its own. Both can stretch or tear the MPFL (the ligament that holds the kneecap in place), and both can damage cartilage — but a full dislocation usually causes more swelling, more ligament injury, and more risk of bruising the bone or chipping cartilage. Can a patella dislocation lead to arthritis?Yes — even a single kneecap dislocation can damage the cartilage on the kneecap or on the groove of the thigh bone and increase the long-term risk of arthritis behind the kneecap. The shearing force of the dislocation can shave off cartilage or chip a small piece of bone, and repeat dislocations speed up joint wear. Early evaluation, MRI, and treatment of any cartilage injury or instability help reduce the long-term arthritis risk. ## Related Reading - Patellar instability (specialty page) - MPFL reconstruction surgery - 3 anatomical factors linked to recurring patellar dislocation - Can you fully recover from a dislocated patella? - How long does MPFL recovery really take? ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousInnovative new procedure uses sea coral to help people who suffer from knee osteoarthritis NextWhy & How Did Elton John Turn His Kneecaps into Jewelry?Next --- ## How to Get in Shape for Ski Season - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/how-to-get-in-shape-for-ski-season/ Summary: Learn how Olympic athletes, trainers, and pros get in shape for ski season plus some top tips from me on how to best avoid injuries during your next ski trip. # How to Get in Shape for Ski Season Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: October 31, 2024 - November 22, 2017 Ski season is here! It’s important to get in shape to reduce your chance of injury. View this article (Olympic Athletes, Trainers and Pros Share How to Get in Shape for Ski Season) to get some top tips from me, olympic athletes, and trainers on how to best avoid injuries during your next ski trip. - cross country skiing, cross training, prevention, skiing ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWhy Playing a Sport Should Be Your Lifetime Routine NextAmazon Entering Health CareNext --- ## Improve Prognosis for Patellofemoral Pain- Dr. Sabrina Strickland Source: https://sabrinastrickland.com/how-to-improve-long-term-prognosis-for-adolescents-with-patellofemoral-pain/ Summary: This appears to be a PhD student # How to Improve Long-term Prognosis for Adolescents with Patellofemoral Pain? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - July 5, 2023 This appears to be a PhD student’s research thesis on adolescent patellofemoral pain. I strongly dislike this term in that it is really just a fancy word for anterior knee pain. In order to appropriately treat patellofemoral pain, one must first find the cause of the pain. The treatment of patellar tendonitis is quite different from patellar alta or patellar maltracking. One must first separate these patients by specific diagnoses in order to intervene. Take a look at the original thesis information here in the British Journal of Sports Medicine.  Image credit:  Anterior knee pain | Radiology Reference Article | Radiopaedia.org   - adolescents, anterior knee pain, diagnoses, orthopaedic surgery, patellar alta, patellar maltracking, patellar tendonitis, patellofemoral pain, self-management ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousTibial Tubercle Osteotomy With Distalization for the Treatment of Patella Alta NextChallenging Cartilage Injuries on the Sports Doc Podcast at AOSSMNext --- ## How to Prepare for an MPFL Reconstruction Source: https://sabrinastrickland.com/how-to-prepare-mpfl-reconstruction/ Summary: Understanding what to expect and how to prepare for an MPFL reconstruction empowers you through each stage, minimizing stress and improving outcomes. # How to Prepare for an MPFL Reconstruction  Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: May 2, 2026 Quick Summary Preparing for an MPFL reconstruction mostly comes down to two situations: acute dislocation that may need urgent surgery, or chronic instability where you have weeks to plan. For elective cases I recommend 4–6 weeks of prehab focused on quad, hip, and core strength, full range of motion, a clear medication and supplement review, and a plan for transportation and home support. Knowing what to expect at each stage reduces stress and supports a smoother recovery. - October 9, 2025 Understanding what to expect and how to prepare for an MPFL reconstruction empowers you through each stage, minimizing stress and improving outcomes. There are essentially two categories of patients who undergo an MPFL reconstruction or related surgery.  ## Acute Dislocation with an Osteochondral Fragment There are those patients who have an acute dislocation with an osteochondral fragment (a piece of cartilage off), and in these cases, it’s fairly urgent to take them to the operating room as often their knee is locked and they have difficulty weight-bearing. (This surgery may involve fragment fixation/removal, and not always require an MPFL reconstruction.)  In these cases, it’s best to manage pain and swelling and try to get to the operating room as soon as possible. If possible, you may do gentle quad sets and gentle range of motion activities. Stay off the affected leg, use crutches as directed, and apply ice to help minimize swelling. Always notify your care team if you experience increasing pain, fevers, or new symptoms. ## Chronic Instability In patients with chronic instability (the primary group for elective MPFL reconstruction), preparation is key to a smoother surgery and recovery. Ideally, you prepare for surgery by: - Finding a good physical therapist who you trust and enjoy working with. - Familiarizing yourself with the planned rehab protocol. - Doing a home exercise program to ensure that you have full range of motion and good quad and hip strength. Proactive “prehab” with your physical therapist, focusing on building quadriceps, hip, and core strength, may shorten your post-op recovery and reduce risk of stiffness. I recommend finding physical therapists with expertise in knees or sports medicine. Ask about their experience with MPFL reconstruction to ensure optimal guidance and care, both before and after surgery. ## Additional Steps to Prepare for an MPFL Reconstruction ### Medical Evaluation and Imaging Before surgery, ensure all required preoperative imaging (MRI or X-rays) is complete so your provider can assess your injury accurately and identify any complicating factors. Bring any images to the surgical center, or confirm that they’ve been uploaded in advance. Learn more about knee imaging from AAOS ### Medication and Supplement Review Discuss your current medications and supplements with your orthopedic surgeon. You may need to stop taking some drugs, including anti-inflammatories and blood thinners, before your procedure. Bring an up-to-date medication list to your pre-op visit. Hospital for Special Surgery: Preparing for Surgery ### Plan for Postoperative Support Arrange transportation to and from the hospital and prepare your home for limited mobility. Store essentials at an accessible height, clear walkways, and consider a firm chair for easy sitting and standing. Enlist help from family or friends to assist with meals, errands, or childcare during the first week after surgery. OrthoInfo: Recovery after Surgery ### Local Physical Therapy Resources Find a PT clinic specializing in sports medicine or knee rehab.  ChoosePT may help you find one near you. ### Pre-Surgery Checklist Download Use a checklist to keep track of appointments, medications, and home prep. Download helpful guides and forms. ### Pre-Op Exercise Videos Follow instructional videos for quad sets, hip strengthening, and gentle range-of-motion work to maximize your knee’s readiness. HSS Knee Exercise Library ### Practical Day-of and Pre-Op Visit Tips On surgery day, wear loose clothes and bring identification, insurance details, and your medication list. For appointments, consider a notebook for instructions and questions. For more information, read how long MPFL recovery takes and this overview of MPFL reconstruction surgery.  ## Make Sure You Prepare for an MPFL Construction Although knee surgery and recovery can be challenging, if you take the time to  prepare for an MPFL reconstruction and and are committed to open communication with your healthcare team, you will be set up for the best possible outcome. Please reach out if you would like to schedule a surgical consultation or get a second opinion. With the right support and resources, a full return to activity is an attainable goal. Hear from one of my patients about his MPFL reconstruction: https://www.youtube.com/watch?v=BsLj88MDWlU Photo by Imani Bahati on Unsplash - acute dislocation, chronic instability, knee surgery, medical evaluation, MPFL reconstruction, osteochondral fragment, patellar dislocation, Physical Therapy, postoperative support, pre-op preparation, Prehab, quad strength, range of motion, rehab protocol ## Frequently Asked Questions How early should I start prehab before an MPFL reconstruction?For elective MPFL reconstruction in patients with chronic instability, I recommend starting prehab (the strengthening and motion work you do before surgery) at least 4 to 6 weeks before the operation. The goals are full pain-free range of motion, a strong quad, and good hip and core control. Patients who arrive at surgery with a quiet knee and active quads tend to regain motion and strength faster after the operation. What is the difference between an acute and chronic MPFL situation?An acute case usually involves a recent dislocation, sometimes with a loose piece of cartilage and bone in the joint, a swollen knee, and difficulty putting weight on the leg. These patients often need urgent imaging and may go to the operating room sooner. A chronic case involves repeated dislocations or instability over months or years — that's the typical setting for an elective MPFL reconstruction with planned prehab. What medications usually need to be stopped before MPFL reconstruction?Many anti-inflammatories, blood thinners, and certain supplements increase bleeding risk and may need to be paused before surgery. The exact list and timing depend on your overall medical history and what your surgeon and primary care team recommend. Always bring an up-to-date medication and supplement list to your pre-op visit so the team can make a clear plan with you. What should I have at home before an MPFL reconstruction?Plan for limited mobility in the first week. Helpful items include crutches or a walker as directed, ice or a cold-therapy unit, a firm chair that's easy to sit and stand from, clear walkways, and essentials stored at counter height. Arrange transportation home and ask a family member or friend to help with meals and errands during the first several days. Are there risks I should be aware of with MPFL reconstruction?As with any knee surgery, MPFL reconstruction carries risks including infection, bleeding, blood clots, stiffness, the kneecap dislocating again, and graft-related complications. Outcomes are generally good in well-selected patients, but results depend on your individual anatomy, how consistently you stick with rehab, and your overall health. We discuss your specific risk factors at the pre-op visit so expectations are realistic. ## Related Reading - MPFL reconstruction surgery (specialty page) - How long does MPFL recovery really take? - How to tell if your MPFL reconstruction failed - Patellar instability (specialty page) - About Dr. Sabrina Strickland ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWhy Does My Knee Hurt When Going Up the Stairs? NextOn Staying Active After InjuriesNext --- ## How to Prevent Skiing Injuries - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/how-to-prevent-skiing-injuries/ Summary: Skiing is one sport where common sense can truly prevent a high proportion of injuries and help avoid the most catastrophic problems. # How to Prevent Skiing Injuries Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - August 13, 2016 Skiing is one sport where common sense can truly prevent a high proportion of injuries and help avoid the most catastrophic problems. READ ARTICLE - cross country skiing, prevention, skiing ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWhat to worry about when undergoing a knee replacement NextHelping Women Overcome Shoulder PainNext --- ## How to Identify Dislocated Kneecap | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/how-to-tell-your-kneecap-slightly-dislocated/ Summary: Learn how to recognize a slight kneecap dislocation (patellar subluxation), including symptoms and options to keep your knee strong and stable # How Can You Tell If Your Kneecap Is Slightly Dislocated? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: February 26, 2026 - February 26, 2026 In everyday language, a slight knee dislocation usually means the kneecap (patella) has partially slipped out of its groove, a condition doctors call a subluxation, rather than a true dislocation of the entire knee joint. A full dislocation of the knee joint itself is rare and an emergency, so this article focuses specifically on kneecap (patellar) subluxation. It’s more common than a full dislocation and can feel like a quick shift or twist that’s easy to miss. Some people are more prone to subluxation because of factors like looser joints or certain alignment differences in the hip, knee, or kneecap. Even though it feels minor, a subluxation still signals some instability in the knee, which can affect long-term health if untreated. Knowing what to look for, when to see a specialist, and how to protect your knee can help you recover with confidence. This post will help you learn how to tell if your kneecap is slightly dislocated (patellar subluxation), including pointers to trusted resources. ## What Is Patellar Subluxation? Patellar subluxation occurs when the kneecap partially slides out of its normal groove on the femur, then either quickly returns or remains slightly shifted known as patellar instability or patellar maltracking. This event can damage the medial patellofemoral ligament (MPFL) and cause a sense of giving way in the knee. Unlike a full dislocation, a subluxation may be missed unless you know what to look for. Younger patients, people who are more loose‑jointed or hypermobile, and those with certain bone alignment differences are at higher risk for patellar instability and repeat episodes. ## Signs and Symptoms of a Slightly Dislocated Kneecap (Patellar Subluxation) ### 1. Sudden Giving Way or Instability You may feel a sudden shift, as if the kneecap briefly moved out of position and popped back in. This can happen when changing direction, pivoting, or simply rising from a chair. ### 2. Pain at the Front of the Knee The pain is often sharp during the event, followed by pain or tenderness along the inner or outer edge of the kneecap. Swelling can range from mild to much more noticeable, and in some cases it is subtle enough that the episode is easy to miss. ### 3. Mechanical Symptoms You might hear or feel a popping, snapping, or grinding sensation  from the kneecap, especially when moving the knee. However many patients do not notice this.  ### 4. Instinct to Straighten the Knee Many people instinctively straighten their knee to alleviate pain or the sensation that something is out of place. If the kneecap seems to slide back into its groove with this motion, it strongly suggests a subluxation, but a specialist exam is still needed to confirm what happened. ### 5. Apprehension or Fear with Certain Movements A lingering sense of instability, particularly when squatting, descending stairs, or making lateral movements, is common after a subluxation and points to patellar instability. ### 6. Chronic Symptoms If you notice these signs, your knee may have been more than just tweaked at some point. It’s worth getting checked to rule out a true subluxation or related injury. ## What To Watch For After Suspected Subluxation Common things to watch for include: - Swelling or fluid accumulation - Difficulty fully bending or straightening the knee - Weakness, giving way, or favoring the opposite leg - Visible change in kneecap position, especially during activity - Episodes of locking, catching, or persistent pain Any combination of these symptoms increases the likelihood that you’ve experienced more than just a minor sprain or strain. ## When to Seek Medical Evaluation Even if your symptoms seem mild, ongoing kneecap instability can worsen with activity or time. Early diagnosis improves outcomes and can prevent more severe dislocations or cartilage damage. If you recently felt your kneecap move out of place, you can review step‑by‑step guidance in my article on what to do after a kneecap dislocation. An orthopaedic specialist can help by performing: - A detailed clinical exam, including a patellar apprehension test - Imaging studies, such as an X-ray to assess alignment and/or MRI, to assess ligament integrity, bone, and cartilage  These steps help confirm whether you had a true subluxation or dislocation, identify cartilage or ligament damage, and uncover underlying anatomical risk factors. ## Addressing the Underlying Problem If your exam and imaging confirm a subluxation or dislocation, treatment often includes: - Rest, ice, and elevation immediately after the event - Supervised physical therapy to strengthen the quadriceps, especially the vastus medialis obliquus (VMO) - Bracing or taping to support the kneecap, particularly during activities  - Surgical intervention in cases with repeated episodes or demonstrable anatomical risk factors; most commonly, MPFL reconstruction offers successful stabilization For more on recovery timelines and what to expect after a dislocated kneecap, you can read about recovery from a dislocated patella. ## Long-term Considerations Leaving a partially dislocated or unstable kneecap untreated can lead to ongoing knee instability, cartilage wear, and even early arthritis. In some cases, we use CT imaging to assess alignment issues such as femoral anteversion, which can contribute to patellar instability. The earlier you address it, the better your long-term knee function and comfort will be. For further explanation and illustrations, see the American Academy of Orthopaedic Surgeons AAOS guide to patellar instability.  ## Next Steps for a Stronger, More Stable Knee Try not to ignore a slight kneecap dislocation, even if it doesn’t hurt much. Watch for recurring pain, popping, or a feeling of giving way. Getting an early evaluation and tailored treatment plan can make all the difference for keeping your knee strong and stable so you can move comfortably and confidently again. For further reading and specific recovery recommendations, explore these resources: - Patellar Instability - Patellofemoral Instability PDF - What To Do If Your Kneecap Dislocates - Recurring Patellar Dislocation - MPFL Reconstruction Surgery If you’re unsure whether what you felt was a subluxation or something else, it’s always reasonable to schedule an evaluation rather than wait and see. Photo by Miri Mina on Unsplash. - active lifestyle, healthy lifestyel, knee health, knee pain, kneecap, kneecap instability, orthopedics, patellar instability, Patellar Subluxation, sports medicine ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousBreaking Down the Hype Around ChondroFiller and Cartilage Repair NextRomanian Deadlift for Stronger Legs and Better BalanceNext --- ## How to Use the Single-Leg Leg Press | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/how-to-use-the-single-leg-leg-press/ Summary: Learn how to safely use the single-leg leg press, how many reps and sets to do, and train to fatigue to build balanced, knee-friendly leg strength. # Working Your Way to Stronger Legs: How to Use the Single-Leg Leg Press Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: March 27, 2026 - March 27, 2026 Patients ask all the time what they should actually be doing at the gym to support their knees and build strength safely. The single-leg leg press is one of my favorites because it helps you target each leg individually and uncover any side-to-side strength differences that could affect your joints. When you use the leg press, you can work one leg at a time or both legs together. If you choose to press with both legs, only do that when you are absolutely sure your leg strength is the same on each side so you are not unknowingly letting the stronger leg take over. A common question is, “How many reps should I do?” There is no magic number. In the video, you can see the patient continuing until exhaustion, which is a safe and effective way to use this machine when you have good form. Transcript Patients ask a lot of questions about what specifically to do at the gym. This exercise here, the single leg leg press, is one of my favorites. And you can do both legs at the same time if you're absolutely sure that your leg strength is the same. Here you can see that uh she's continuing uh to do this until exhaustion. So there's no magic number. It's not like you do eight reps or 12 reps. And generally I like between 20 and 30 reps. As far as how many sets, uh, I think two to three sets is usually adequate.   As a general guide, I usually like to see people in the 20–30 repetition range for the leg press. That higher rep range helps build muscular endurance and control around the knee, which is critical if you are recovering from an injury or trying to prevent one. For sets, two to three sets are usually adequate for most people. If you reach true fatigue by the end of your last set—where you could not perform many more good-quality reps—you are likely working in the right zone. When you watch the embedded video, pay attention to controlled movement, full but comfortable range of motion, and avoiding any sudden, jerky pushing. If you have pain during the exercise, especially sharp pain, reduce the weight, shorten your range of motion, or pause and talk with your physical therapist or orthopedic specialist. Check out my other patient exercise videos. - gym exercise, leg exercise, leg press, leg press machine, leg strength, patient exercises, single leg leg press, single-leg leg press exercise ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousAnterior Knee Pain: Why “Runner’s Knee” Isn’t a Real Diagnosis NextACL Surgery: What Raises Arthritis Risk?Next --- ## HSS Bone Quiz - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/hss-bone-quiz/ Summary: Take this quiz! HSS Bone Quiz - HSS Playbook Source: www.hss.edu/playbook/hss-bone-quiz/ # HSS Bone Quiz Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - October 31, 2015 Take this quiz!   ## HSS Bone Quiz – HSS Playbook Source: www.hss.edu/playbook/hss-bone-quiz/   - Bone Quiz, Halloween, Hospital for Special Surgery, HSS ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousCaring for Young Female Athletes NextGood Article on ACL Reconstruction OutcomesNext --- ## HSS Webinar From Stem Cells to Scaffolds | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/hss-journal-webinar-stem-cells-scaffolds/ Summary: Join us on November 12 from 7-8 PM ET for an HSS Webinar: "From Stem Cells to Scaffolds: The Pros & Cons of Regenerative Medicine in Musculoskeletal Care." # An HSS Webinar: From Stem Cells to Scaffolds Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: June 4, 2025 - August 1, 2024 November seems like a long ways away, but it’ll be here before you know it! We’ll be doing a webinar on Tuesday, November 12 from 7-8 PM ET with Hospital for Special Surgery eAcademy. It’s titled, “From Stem Cells to Scaffolds: The Pros & Cons of Regenerative Medicine in Musculoskeletal Care | An HSS Journal® Webinar.” - Thomas Best, MD, PhD and Marc J. Philippon, MD will discuss Efficacy of Bone Marrow Stem Cell Therapy in Hip Osteoarthritis at 7:05 PM - Dean Wang, MD will cover Complications of Stem Cell-Based Injections for Knee Osteoarthritis at 7:20 PM - My husband, Andreas H. Gomoll, MD, and I will talk through Short-Term Outcomes of Bridge-Enhanced ACL Restoration (BEAR) at 7:35 PM - We have a Q&A at 7:50 PM.   Charles N. Cornell, MD, will be introducing the webinar and moderating the Q&A. If you’re interested in any of these topics, please register to join us.   - ACL, Andreas H. Gomoll MD, BEAR implant, Bone Marrow Stem Cell Therapy, Dean Wang MD, Hip Osteoarthritis, Hospital for Special Surgery, HSS, HSS Journal, HSS Journal Webinar, knee osteoarthritis, Marc J. Philippon MD, orthopaedic surgery, Sabrina Strickland MD, Scaffolds, Short-Term Outcomes of Bridge-Enhanced ACL Restoration, Stem Cell-Based Injections, Stem Cells, Thomas Best MD PhD, webinar ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousSingle Versus Multiple-Plug OCA Transplants for Osteochondral Defects About the Knee NextKnee Chondromalacia Symptoms & TreatmentNext --- ## Practice Management Pearls and Pitfalls | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/hss-presents-practice-management-pearls-pitfalls-for-young-physicians/ Summary: Practice management is challenging, and there are many things young physicians don’t know when they’re starting out. I shared pearls and pitfalls on HSS Presents. # HSS Presents: Practice Management Pearls and Pitfalls for Young Physicians Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: September 5, 2024 - September 5, 2024 Pearls & Pitfalls for Young Physicians Practice management is challenging, and there are many things young physicians don’t know when they’re starting out. I spoke to Dr. Hailey Huddleston, a fourth-year resident at HSS, during a recent episode of HSS Presents: Young Physician Series. I shared some of my experience in building my practice, which I now share with my husband, Dr. Andreas Gomoll. Most doctors, even if you’re in a group, are expected to manage their practice, and management is not typically why we went into medicine.  Here are a few of the things I’ve learned: - - Develop a Niche Over Time: You don’t have to specialize immediately. Your practice will naturally evolve as you gain experience and treat more patients. By keeping good track of your patients and having them fill out some patient-reported outcomes before surgery, you can publish a lot of research even if you’re not at an academic institution. - Build a Good Team: Hiring the right staff, such as PAs and athletic trainers, can help streamline patient care and improve efficiency. Your team can help manage tasks like post-op visits and MRI orders to free up your time for surgeries. One of the most important things is finding people you really like working with and who are friendly with patients. Having unfriendly staff is a pitfall that you need to look out for throughout your career.  - Communicate Effectively: Use tools like patient portals or office emails to ensure patients feel heard.  If someone on my team is out sick and my husband and I are busy seeing patients all day, it’s important for my office staff to be able to return emails and let people know that we will get back to them.  - Learn Business Management: We don’t really learn the business side of medicine in medical school. Managing finances, staff, and contract negotiations is all crucial to running a successful practice. When you’re just starting out, make sure your first hire has knowledge and experience with running a practice because you can’t completely learn everything together.  I shared a lot more of my experience in the podcast, which you can listen to on Spotify or Apple Podcasts.  - Hospital for Special Surgery, HSS Presents, Pearls & Pitfalls, Practice Management, Young Physicians Series ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousYoung Physician Series: Practice Management 101 – Pearls and Pitfalls NextGrand Rounds from HSS: Revision TTO Returns Young Athlete to SportsNext --- ## The Role of Hyaluronic Acid in Healing | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/hyaluronic-acid-healing-injuries/ Summary: A new study shows we may be able to use our body’s cells into anti-inflammatory cells, in combination with hyaluronic acid, which improved healing and limited damage # The Role of Hyaluronic Acid in Healing Injuries Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: February 28, 2025 Quick Summary Hyaluronic acid is best known as a knee injection for osteoarthritis, but emerging research is exploring its broader role in tissue healing. Studies are investigating whether HA, combined with the body's own anti-inflammatory cells, can improve healing and reduce damage in tendon, cartilage, and soft-tissue injuries. While clinical use beyond intra-articular knee injection remains investigational, the underlying biology supports HA's role in modulating inflammation and supporting repair. - February 28, 2025 In our clinic, we often use a series of injections of hyaluronic acid to treat knee pain due to early to moderate arthritis. Many patients are already aware of the benefits of hyaluronic acid use topically, as it is now in most facial creams. Indeed, dermatologists have used a form of hyaluronic acid to fill wrinkles for many years. We know hyaluronic acid has many benefits, as it serves as a joint lubricant and can decrease inflammation. We also know that with surgery, the natural hyaluronic acid is washed away and can take weeks to months to reach normal levels. This study is interesting as it shows that a new drug in development may be able to turn our body’s own cells into anti-inflammatory cells combined with hyaluronic acid, which improves healing and limits damage. Stay tuned. We don’t have good interventions (injection or oral therapy) that can stop or reverse arthritis, but for now, we can be comfortable using hyaluronic acid for more than just patients with arthritis. We recently decided to start offering hyaluronic acid injections as a supplement to patients after surgery; while insurance does not cover this type of treatment, it may pay off in the long run. Read the full article: Revolutionizing cartilage repair: The role of macrophages and hyaluronic acid in healing injuries Image source NYU Tandon School of Engineering, adjusted for this post. - anti-inflammatory), balance, cartilage, cartilage defect repair, chondrocytes, chronic inflammation, complications, cytokines, damage, degraded, early onset, extracellular matrix, fibrosis, findings, healing, hyaluronan), hyaluronic acid (HA, immune modulation, immune response, inflammation, interactions, joint functionality, joint replacement, knee injuries, limitations, macrophages (pro-inflammatory, mesenchymal stem cells (MSCs), novel solution, osteoarthritis (post-traumatic), outcomes, pain, peptide (P15-1), prevention, quality of life, rabbit model, regenerative medicine, repair, research, RHAMM (Receptor for Hyaluronan-Mediated Motility), study, surgical procedures, therapeutic formulation ## Frequently Asked Questions What does hyaluronic acid actually do in the knee?Hyaluronic acid is a natural component of synovial fluid that lubricates the joint and provides shock absorption. In osteoarthritic knees, native HA breaks down and loses viscoelasticity. Injecting HA can restore viscosity, modulate inflammation, and stimulate the body's own HA production. Effects build over weeks and typically last 4–6 months in patients who respond. How does HA differ from cortisone for knee pain?Cortisone is a strong anti-inflammatory with rapid onset (days) but shorter duration (4–8 weeks). Hyaluronic acid works more slowly (over weeks) but lasts longer (4–6 months) and avoids cortisone's side effects on cartilage and blood sugar. I generally use cortisone for acute flares and HA for sustained osteoarthritis pain — and sometimes combine them based on the clinical picture. Is HA used for tendon or ligament injuries?HA injection for tendon and ligament injuries remains largely investigational. Some studies show promise for tendinopathy and adhesive capsulitis, but the evidence is mixed and use is mostly off-label. For most tendon injuries I rely on structured loading rehabilitation as the primary treatment, considering injections only when loading work hasn't produced enough improvement. ## Related Reading - Cortisone vs gel injections for knee pain - Knee arthritis treatment - Knee & shoulder specialties (hub) ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHow Do You Know When To Take Your Knee Injury Seriously? NextUnderstanding Patellofemoral Instability & Cartilage LesionsNext --- ## Chondrofiller and Cartilage Repair | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/hype-chondrofiller-cartilage-repair/ Summary: ChondroFiller isn’t new and lacks strong data. Learn why we don’t recommend traveling for it and which proven cartilage treatments we use instead. # Breaking Down the Hype Around ChondroFiller and Cartilage Repair Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: May 2, 2026 - February 18, 2026 Quick Summary ChondroFiller is a type I collagen injectable that has been used in parts of Europe for nearly 20 years to treat cartilage defects. It is not new, has very limited high-quality clinical data for knee cartilage repair, has no active FDA trial, and is not available in the United States. For most patients, traveling abroad for it is not worthwhile — proven cell-based options like osteochondral allograft transplantation are available here. Lately, more patients are asking about ChondroFiller, a so‑called “new” cartilage treatment from Germany that’s seemingly gone viral on social media. On the surface, it sounds exciting: an injectable material that could potentially fill cartilage defects and help rebuild damaged joint surfaces. But when you look past the marketing, the story is very different. Transcript We increasingly get questions about chondroiller, which is this quote unquote new thing from Germany. >> So when when we first started hearing about it, we're like, what is this? Well, so interestingly, um there's no FDA trial currently underway in the United States. Um it has been used in Europe for 20 years, but um there's very little data that show that it works and it's just type one collagen. >> Yeah. My patients ask whether they should fly to Germany to uh to get this treatment done and my answer is always even though I am German so I'm all all for it but um we actually have much better stuff in the US ironically um and as we were saying has been around for almost 20 years so it it's not new I think they just changed something about their marketing strategy that's why it went viral >> so it's not available in the United States and honestly it doesn't look particularly good. We we now that people have been talking about it, we've been looking up their data and and there really isn't a whole lot of data, especially in the need to even support that it works. Ultimately, you know, the holy grail is to have a product that fills cartilage defects with cells that grow and that's partly why we do research >> or or bring living cartilage of the final product into the place and that's called ostronograph. The two of us among the highest users of that even in the US and nothing is perfect but we've been really happy with that.   As my husband, Dr. Andreas Gomoll, and I explain in the video above (here’s a link in case it’s not working), ChondroFiller is not actually new. It has been used in parts of Europe for nearly 20 years. It is essentially type I collagen, and despite its longevity on the market, there is very limited high‑quality data showing that it reliably works, especially for knee cartilage defects. There is currently no active FDA trial in the United States, and it is not available here. ## Is It Worth Traveling for ChondroFiller? Patients sometimes ask whether they should fly to Germany to get ChondroFiller. Even with strong ties to Germany, the answer is no. Interestingly, we actually have better, more advanced options in the United States. The true “holy grail” in cartilage restoration is using living cells to fill a defect so those cells can integrate and function like normal cartilage. That is why we focus on procedures such as osteochondral allograft transplantation, which bring living cartilage into the damaged area. Nothing is perfect, but we’ve been very happy with the outcomes and the quality of evidence behind these treatments. The bottom line: ChondroFiller is more of a marketing resurgence than a medical breakthrough. Before you consider traveling abroad for a trendy procedure, make sure you understand the data, the alternatives, and whether there are proven options available closer to home. Photo by National Cancer Institute on Unsplash, which I chose to highlight the research we do related to knee health.  Related Reading - CartiHEAL — what we use for one-step cartilage repair - Outcomes of cartilage restoration procedures - Why I would rather repair cartilage than replace a knee - Knee chondromalacia: symptoms and treatment - About my knee surgery practice ## Frequently Asked Questions What exactly is ChondroFiller made of? ChondroFiller is essentially type I collagen delivered as an injection or gel to fill small cartilage defects. It has been marketed in parts of Europe for nearly 20 years, so it isn't a new technology — and despite its time on the market, it doesn't have the volume of high-quality clinical evidence we expect from a treatment we would routinely recommend for knee cartilage damage. Is ChondroFiller approved or available in the United States? No. ChondroFiller is not currently available in the United States and there is no active FDA trial for it that we are aware of. If you see U.S. clinics or social-media posts implying it is available here, it's worth confirming exactly what product is being used — it may be a different scaffold or filler with its own data and risks. What cartilage repair options do you actually use at HSS instead? For appropriate candidates we focus on procedures that bring living cells into the defect, because living cartilage is the closest functional replacement for what was lost. Osteochondral allograft transplantation is one of the workhorses, and depending on the defect we also use cell-based and one-step scaffold options such as CartiHEAL and MACI. The right choice depends on the size, location, and depth of the lesion and on the patient's anatomy and goals. Are there real risks to traveling overseas for an unproven cartilage procedure? Yes. Beyond the financial cost, you are accepting a procedure with limited published outcomes, no follow-up pathway at home, and uncertain coverage if a complication or revision is needed. Cartilage procedures can fail, can require revision surgery, and can limit what surgical options are available to you later. Individual results always vary based on your anatomy, the size of the defect, and overall joint health — please discuss any procedure you are considering with a board-certified orthopedic surgeon before traveling. - cartilage defect treatment, ChondroFiller, FDA trials, knee cartilage, knee cartilage restoration, osteochondral allograft transplantation ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousSkiers Must Prioritize Knee Health as ACL Injuries Rise During Ski Season NextHow Can You Tell If Your Kneecap Is Slightly Dislocated?Next --- ## An Ideal Hamstring Autograft Diameter? | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/ideal-hamstring-autograft-diameter-acl/ Summary: Hamstring autograft for ACL reconstruction has been thought to be inferior to the patellar tendon or quad. Indeed, it continues to be used in many ACL surgeries. # Is There An Ideal Hamstring Autograft Diameter for ACL Reconstruction? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: May 2, 2025 - May 2, 2025 Historically, hamstring autografts for ACL reconstruction have been thought to be inferior to the patellar tendon or quad. Despite this fact, they continue to be used in a high percentage of ACL surgeries around the world. The reason for this is that we do see excellent outcomes using hamstring tendons. In this large study (nearly 6,000 patients) from the Kaiser Permanente registry, they were able to show that patients whose graft was less than or equal to 8mm had a 32 percent higher failure rate. Large studies, such as this one, help us understand surgical failures and educate our patients on the optimal graft for their ACL surgery. It is very rare that I see a hamstring graft that is 8 mm, as we can add the gracilis (a second hamstring) to the graft if need be. Every graft has a downside; weakening the hamstrings, patella, or quad is not without morbidity. Read the article on ResearchGate to learn more about this study: Is There a Hamstring Autograft Diameter Threshold for Anterior Cruciate Ligament Reconstruction? Image source: Wikimedia (edited slightly for size and content).  - ACL reconstruction, ACLR, anterior cruciate ligament, anterior cruciate ligament reconstruction, aseptic revision, AUC, cohort study, Cox regression, failure risk, graft diameter, graft size, hamstring autograft, Hamstring Autograft Diameter Threshold, hazard ratio, Kaiser Permanente, minimum graft diameter, orthopaedic, propensity score, receiver operating characteristic curve, registry, revision surgery, sports medicine, threshold ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousLower Revision Rates After Patellofemoral Arthroplasty for High-Volume Surgeons NextCasas out of the Hospital Following Patellar Tendon SurgeryNext --- ## For Knee Pain, Use A Treadmill Like This - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/if-you-have-knee-pain-try-using-your-treadmill-like-this/ Summary: I did a short video a few years ago specifically about walking backward on a treadmill. If you have knee pain, this may help. # If You Have Knee Pain, Try Using Your Treadmill Like This Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - October 20, 2022 I did a little video a few years ago specifically about walking backward on a treadmill. Here is an article in Health Digest that explains the benefits of this specific type of workout. Take a look and try it. Read more in Health Digest  - Exercise, Health Digest, Hospital for Special Surgery, HSS, knee pain, treadmill, walking, walking backward ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousACL Tears – Preferred and New Surgical Technique NextMPFL Reconstruction Study and Follow UpNext --- ## Risk for Osteochondral Allograft Failure | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/increased-host-bone-marrow-edema-as-a-risk-factor-for-osteochondral-allograft-failure/ Summary: The purpose of this research was to evaluate the presence of host bone marrow edema (BME) surrounding osteochondral allograft (OCA) plugs as a risk of subsequent failure. # Increased Host Bone Marrow Edema as a Risk Factor for Osteochondral Allograft Failure Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: November 7, 2024 - November 7, 2024 We conducted this study to see if, when there’s swelling (bone marrow edema, or BME) surrounding osteochondral allografts (or OCA) on routine post-operative MRI scans 6 months after surgery, this swelling is linked to subsequent osteochondral allograft failure.  Of the 85 patients eligible for the study, 56 patients (30 female, mean age 31.69 ± 11.34 years) had a minimum 2-year follow-up. Patients were divided into two groups: those with a lot of swelling (BME ≥ 10 cm³) and those with less swelling (BME < 10 cm³).  All OCA failures of the study cohort were in the BME ≥10 cm³ group, representing 50% of this group, leading us to conclude that host BME with a volume greater than 10 cm³ on 6-month postoperative MRI is predictive of an increased subsequent failure rate after OCA transplantation with a failure rate of 50%. Read more in Arthroscopy, The Journal of Arthroscopic and Related Surgery: Increased Host Bone Marrow Edema on 6-Month Magnetic Resonance Imaging Is a Risk Factor for Osteochondral Allograft Failure The image is taken from the article.    - BME, bone marrow edema, host bone marrow edema, Increased Host Bone Marrow Edema, OCA transplantation, osteochondral allograft failure, osteochondral allograft plugs, postoperative MRI, risk factor ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousOne Step Cartilage Repair with CARTIHEAL: Multi-Compartment Pathology with Osteoarthritis NextTips for Doing Squats without Knee PainNext --- ## Sagittal Tibial Tubercle-Trochlear Groove- Dr. Sabrina Strickland Source: https://sabrinastrickland.com/increased-risk-patellofemoral-arthritis/ Summary: Read this commentary about how posterior tibial tubercle relative to the trochlear groove is associated with increased risk of patellofemoral arthritis. # Increased Risk of Patellofemoral Arthritis: The Sagittal Tibial Tubercle-Trochlear Groove Distance Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - May 18, 2023 Sreetha Sidharthan M.D. and I recently published this commentary about how posterior tibial tubercle relative to the trochlear groove is associated with increased risk of patellofemoral arthritis. Arthritis of the patellofemoral compartment affects up to 24% of women and 11% of men over the age of 55 years who have symptomatic osteoarthritis of the knee. Recently, there has been interest in the sagittal TTTG distance, which measures the position of the tibial tubercle with respect to the trochlear groove. This measurement is now being used in patients presenting with patellofemoral pain and/or cartilage pathology and may help guide surgical decision-making as we gain more data on how changing the tibial tubercle alignment relative to the patellofemoral joint can improve outcomes. Read more about this topic in the article in Elsevier’s Science Direct. - cartilage pathology, HSS, orthopaedic surgery, patellofemoral arthritis, patellofemoral pain, posterior tibial tubercle, symptomatic osteoarthritis, tibial tubercle, trochlear groove ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousMISHA Knee System for People Suffering from Knee Osteoarthritis NextSimilar Revision, Reoperation Rates for Quadriceps Grafts Vs. Patellar, Hamstring GraftsNext --- ## CNN Interview - Lindsey Vonn Injury - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/injured-vonn-faces-race-against-time-cnn-news/ Summary: Lindsey Vonn had a devastating injury while skiing that usually takes nine to 12 months for an elite athlete to get back to a full level of training. Skip to content # Injured Vonn Faces Race Against Time – CNN News Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: October 31, 2024 Well, ski champ Lindsey Vonn had a scary crash today during the Alpine Ski World Championships in Austria. The doctor treating the 28-year-old says she has a complex torn ligament in her right knee. The U.S. ski team says Vonn will be out for the rest of the season. They do say they expect her back in time for the 2014 Olympic Games. You may say that’s so far away. Well, Dr. Sabrina Strickland of the Hospital for Special Surgery talked to us today and said it’s a devastating injury that usually takes nine to 12 months for an elite athlete like Vonn to get back to a full level of training after something like this. Read the transcript. Photo by Nicolai Berntsen on Unsplash Manage Cookie Consent To provide the best experiences, we use technologies like cookies to store and/or access device information. Consenting to these technologies will allow us to process data such as browsing behavior or unique IDs on this site. Not consenting or withdrawing consent may adversely affect certain features and functions. Functional Functional Always active The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network. Preferences Preferences The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user. Statistics Statistics The technical storage or access that is used exclusively for statistical purposes. 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Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. --- ## Is Robot-assisted MPFL Reconstruction Better? | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/is-robot-assisted-mpfl-reconstruction-better-than-freehand/ Summary: This study compared two groups of patients undergoing MPFL reconstruction for recurrent instability using robot-assisted and freehand surgery. # Is Robot-assisted MPFL Reconstruction Better than Freehand? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: May 16, 2025 - April 18, 2025 Using a robot to improve surgery sounds like a no-brainer. More accurate is better, right? Well, not necessarily. In this study, which was done in China, they compared two groups of patients undergoing MPFL reconstruction for recurrent instability using robot-assisted and freehand surgery. At final follow-up, the study showed that the robotic-assisted group had the femoral tunnel in closer to a specific anatomic landmark, but both groups had similar rates for achievement of the minimal clinically important difference (MCID) for patient-reported outcomes (PROs). The robotic-assisted surgery took longer and required expensive technology. Furthermore, anatomic variations from patient to patient mean that not all ligaments should be placed in exactly the same spot. Read more about this study in Orthopedicstoday: Robotic-assisted MPFL reconstruction may yield improved outcomes vs. freehand technique Photo by Stockcake   - Chronic patellar dislocation, Clinically significant, Femoral tunnel, Fluoroscopies, Follow-up, Freehand surgery, Freehand technique, Functional scores, Kujala score, Length of stay, Lysholm score, MCID, MPFL reconstruction, Operation duration, Patellar re-dislocation, Patient Reported Outcomes, Radiation exposure, Robotic-assisted MPFL reconstruction, Schöttle’s point, Tunnel positioning ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousCommon Questions About Stem Cells, Exosomes, & Cartilage Repair NextLower Revision Rates After Patellofemoral Arthroplasty for High-Volume SurgeonsNext --- ## It’s the Patellofemoral Height - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/its-the-patellofemoral-height-stupid/ Summary: Is it patella baja (abnormally lying patella) or patella alta (a high patella)? Study shows patellofemoral height may be more consequential than previously thought. # It’s the Patellofemoral Height – Dr. Sabrina Strickland Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - October 7, 2022 Patella baja (abnormally lying patella) or patella alta (a high patella)? In terms of patient outcomes, cartilage health or malalignment, how the patella lies may be more consequential than previously thought—according to a new study. The researchers, from the University of Pennsylvania, Hospital for Special Surgery (HSS), and Northwestern University in Chicago, designed a retrospective cohort study of patellofemoral arthroplasty patients from 2012 to 2020. Read more in Orthopedics This Week. - cartilage health, knee malalignment, patella, patella alta, patella height, patellar tendon, patellofemoral arthoplasty, patellofemoral height, patient outcomes, study ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousIt’s the Patellofemoral Height NextACL Tears – Preferred and New Surgical TechniqueNext --- ## It’s the Patellofemoral Height, Stupid! - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/its-the-patellofemoral-height/ Summary: Is it patella baja (abnormally lying patella) or patella alta (a high patella)? Study shows patellofemoral height may be more consequential than previously thought. # It’s the Patellofemoral Height Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: June 4, 2025 - October 7, 2022 I was a co-author on this study about how the patella lies, “We know that any type of knee surgery, especially an arthrotomy, can cause scarring and patella baja (an abnormally low lying patella, which is associated with restricted range of motion). I hypothesized that after a patellofemoral arthroplasty, patients may have scarring of their patellar tendon and/or fat pad leading to a decrease in patellar height.”   Read more in Orthopedics This Week   - blog, Hospital for Special Surgery, knee surgery, patella, patella baja, patellafemoral height, patellofemoral, patellofemoral arthroplasty, patellofemoral height, patellofemoral osteoarthritis, scarring ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousLiam’s Story – MPFL Reconstruction Surgery NextIt’s the Patellofemoral Height – Dr. Sabrina StricklandNext --- ## Keeping Active in Unseasonable Weather - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/keeping-active-in-unseasonable-weather/ Summary: Even if the weather won # Keeping Active in Unseasonable Weather Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - January 10, 2016 Sadly it is in the 50’s and raining in Windham, so no skiing for me. Happily I got to have an amazing ride with the awesome Michael McNeal at THE MONSTER CYCLE in SOHO. Thank you!   Source: www.themonstercycle.com/   - MonsterCycle, Soho, Weather ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWhat I Want My Daughters to Know About Working Out NextStanding Desk PostureNext --- ## Kids and Sports Injuries - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/kids-and-sports-injuries/ Summary: Jimmy Andrews, MD is a father of modern sports medicine, and has taken care of athletes at every level. Read his blog if you have kids who participate in sports. # Kids and Sports Injuries Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - September 15, 2015 I suggest all of you with kids who participate in sports read this excellent blog by Jimmy Andrews, MD. He is one of the fathers of modern sports medicine, and has taken care of innumerable athletes at every level throughout his career. This excerpt summarizes his blog: “Some people may consider young athletes not to be very vulnerable to injury, however, that is certainly not true. Youth are particularly at-risk for injury because of improper technique, ill-fitting equipment, training errors, coach/parental pressure, failure of early injury recognition, a shift to single-sport specialization, and inherent musculoskeletal imbalance. In reality, these problems are magnified because the younger the athlete is, the more vulnerable he or she may be for injury.”  So what should we be doing? We should try to encourage coach training and pressure schools and private programs to hire the best trained coaches—and to send them for continuing education programs. We should also monitor our kids’ equipment. My daughter grew five inches over the past 12 months, and certainly many shoe sizes. Her shoes and other equipment need to fit her properly. Kids’ sports equipment needs to be checked often. We should also make sure that our kids are actually in good shape for their sports. Many sports programs now incorporate a strength and conditioning program, or have a strength and conditioning coach. If we don’t have that available, we should get them to the gym or do a home program of exercise to stay in optimal shape for their chosen sports. We should get our kids to participate in several sports during the year; they don’t all need to be at the highest level. Finally, take all complaints seriously. If a joint is swollen, then a child needs an MRI in almost all cases. The saddest days I have at work are when I see an adolescent on whom I may not be able to save their meniscus or cartilage injury because they have waited for six weeks to “see if it would just get better.”   ## BLOG: Time is right to make a major impact on the prevention of youth sports injuries | Orthopedics Blogs | James R. Andrews, MD Orthopedics Blogs | James R. Andrews, MD | My first Healio.com/Orthopedics blog is to introduce and describe the STOP Sports Injuries program. Under the direction and leadership of the American Orthopaedic Society for Sports Medicine, the STOP Sports Injuries program was developed during the past 4 to 5 years as a comprehensive public outreach program. The program focuses on the importance of sports safety, specifically as it relates to Source: www.healio.com/orthopedics/sports-medicine/news/blogs/{0d58c2a9-c5e3-4291-808c-046973f40b88}/james-r-andrews-md/blog-time-is-right-to-make-a-major-impact-on-the-prevention-of-youth-sports-injuries   - children, Healio.com/Orthopedics blog, Jimmy Andrews, Kids, MD, sports injuries ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousSilkworms and Synthetic Substitutes for Cartilage, Ligaments, and Tendons NextBizarre Sports InjuriesNext --- ## Knee Chondromalacia Symptoms & Treatment | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/knee-chondromalacia-symptoms-treatment/ Summary: You may be suffering from a condition called knee chondromalacia or chondromalacia patella if you’ve been experiencing dull, achy pain around or under your kneecap. # Knee Chondromalacia Symptoms & Treatment Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: August 8, 2024 - August 8, 2024 You may be suffering from a condition called knee chondromalacia or chondromalacia patella if you’ve been experiencing dull, achy pain around or under your kneecap. In the past, any pain over the kneecap or patella (the anterior aspect of the knee) was often referred to as patellofemoral chondromalacia, but it actually describes a specific condition.  Most joints in your body are protected by a type of tissue called articular cartilage. This tissue covers the ends of bones inside a joint, which helps cushion the bones and allows them to glide smoothly against one another. It’s called chondromalacia (or knee chondromalacia) when the cartilage inside a joint softens and breaks down. Because the cartilage provides a smooth surface for the knee to bend and straighten, deterioration can result in pain, swelling, and decreased mobility. The primary symptoms of chondromalacia patella include: - A dull, aching pain around or under the kneecap that worsens with activity - Swelling and stiffness of the knee - A grinding, catching, or popping sensation when the knee is bent - Knee pain when climbing stairs or hills - Increased pain when sitting for extended periods of time with knees bent Knee chondromalacia can’t be cured, but you can slow down progression by making lifestyle changes and modifications to your exercise routines. Physical therapy can also help, as can injection treatments, such as cortisone, hyaluronic acid, and platelet rich plasma (PRP). I share more information and non-surgical and surgical treatments for knee chondromalacia in the specialties section of my website. - arthroscopy, Articular cartilage, cartilage repair, cartilage thinning, chondromalacia, chronic tendonitis, early arthritis, knee chondromalacia, knee pain, Knee Realignment Surgery, Ligament reconstruction procedures, orthopaedic surgery, patellofemoral chondromalacia, regeneration techniques, tibial tubercle osteotomy ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousAn HSS Webinar: From Stem Cells to Scaffolds NextMedial Meniscus Root Repair With Implantable Shock Absorber PlacementNext --- ## Knee Pain Keeping You up at Night? | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/knee-pain-at-night/ Summary: Patients often come to the office when their knee pain starts to affect their sleep. Why does knee pain often get worse at night and what is causing it? # Knee Pain Keeping You Up at Night? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: February 8, 2024 - February 8, 2024 Patients often present to the office when their knee pain starts to affect their sleep. I looked at this article with interest but quickly found that I disagreed with most of the information. Perhaps this is why “Doctor Google” isn’t always so great. However, the topic is a good one. ## Why does knee pain often get worse at night and what is causing it? - At night, your body has less distractions, so you are more likely to notice mild pain - You are active all day and inflame your knee, so naturally it is at its worst at night - Circadian variations in hormones, such as cortisol, may affect inflammation - Unstable flaps of cartilage or meniscus may be more symptomatic when you aren’t putting weight on your leg If your knee pain is keeping you up at night, see a doctor and get X-rays at a minimum. The solution often is a physical therapy and/or cortisone or hyaluronic acid injections — but in some cases cartilage repair, meniscal surgery or partial or total knee replacement is the answer. The complete article is available at Livestrong.com, but as I mentioned, it doesn’t have the best information.   - cartilage, cartilage repair, Circadian variations, cortisone injections, Dr. Google, hormones, hyaluronic acid injections, inflamed knee, knee pain, knee pain at night, knee x-rays, meniscal surgery, meniscus, partial knee replacement, Physical Therapy, sleep, sleep disruption, total knee replacement, X-rays ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousACL Injury and Recovery in Professional Snowboarders NextNovel 3D Printing Tech Realigns Patellofemoral Instability Rehab?Next --- ## Knee Surgery Scars & Minimally Invasive Surgery Source: https://sabrinastrickland.com/knee-surgery-scars-minimally-invasive-surgery/ Summary: Something I often discuss with patients before surgery is how long their knee surgery scars will actually be. In residency and fellowship, we are taught that the size and appearance of the scar doesn # Knee Surgery Scars & Minimally Invasive Surgery Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 21, 2023 - December 21, 2023 Something I often discuss with patients before surgery is how long their knee surgery scars may actually be. In residency and fellowship, we are taught that the size and appearance of the scar doesn’t really matter.   Still, it’s something that I know patients think about when they look at their scar after surgery. I certainly hear patients commenting about their scar after they come back from physical therapy post-surgery, saying: “Wow, my therapist was so impressed by my scar!”   Well, what does it take to make a smaller scar? First of all, in order to do a less invasive surgery, I think that you have to have considerable experience doing that type of surgery. It’s certainly easier to make a much longer scar, and one can potentially visualize the problem more easily if you create a massive incision.   However, patients can recover a lot more quickly with a less invasive surgery. Over the past 20 years, there has been a focus on minimally invasive surgery. Partial and some total knee replacements are now done with a robot in an effort to make them less invasive. Certainly for surgery such as MPFL reconstruction, tibial tubercle osteotomy, and cartilage transplants, as well as ACL reconstruction, I have really tried to make surgery less invasive and the recovery faster.   I’m sharing a photo of the surgical scar for one of my patients next to another, more invasive surgical scar so you can see the difference. - ACL reconstruction, cartilage transplants, healing, knee surgery, knee surgery scar, knee surgery scars, minimally invasive surgery, MPFL reconstruction, partial knee replacement, recovery, scarring, scars, tibial tubercle osteotomy, total knee replacement surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousTwo-Year Follow-up for the LIFT Implant NextPatellar Instability Modified Delphi ConsensusNext --- ## Knee Surgery with Sea Coral | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/knee-surgery-with-sea-coral-nyc-doctors-explain-how-why/ Summary: NYC surgeons are using sea coral to treat knee osteoarthritis. The procedure uses a coral-based implant to stimulate cartilage growth and avoid knee replacement. # Knee Surgery with Sea Coral: NYC Doctors Explain How & Why Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: February 12, 2026 - November 25, 2025 In New York City, surgeons are pioneering an innovative procedure to treat knee osteoarthritis. This technique involves implanting a porous structure derived from sea coral into the damaged joint. The coral acts as a scaffold, encouraging the patient’s own cells to grow new cartilage, offering an alternative to traditional, invasive full knee replacement surgery. Read the article on CBS News to learn more: Coral from the sea is being used in some knee surgeries in NYC. Here’s how, and why. Photo by Jim Beaudoin on Unsplash - cartilage growth, cartilage regeneration, coral implant, innovative procedure, joint treatment, knee osteoarthritis, knee replacement alternative, knee surgery, medical breakthrough, NYC surgeons, orthopedic medicine, porous structure, sea coral, surgical scaffold ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWhy & How Did Elton John Turn His Kneecaps into Jewelry? NextMeasuring the Lateral Trochlear Inclination AngleNext --- ## POPSUGAR: Why Knees Hurt After Sitting - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/knees-hurt-after-sitting-popsugar/ Summary: I had the opportunity to give a little insight into why your knees might hurt after sitting still for a few hours. Click the POPSUGAR link to learn more! Skip to content # Knees Might Hurt After Sitting – POPSUGAR Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 I had the opportunity to give a little insight into why your knees might hurt after sitting still for a few hours. Read this POPSUGAR article to learn how to end the aches due to sitting for long periods of time.   Manage Cookie Consent To provide the best experiences, we use technologies like cookies to store and/or access device information. Consenting to these technologies will allow us to process data such as browsing behavior or unique IDs on this site. Not consenting or withdrawing consent may adversely affect certain features and functions. Functional Functional Always active The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network. Preferences Preferences The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user. Statistics Statistics The technical storage or access that is used exclusively for statistical purposes. The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you. Marketing Marketing The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes. - Manage options - Manage services - Manage {vendor_count} vendors - Read more about these purposes Accept Deny View preferences Save preferences View preferences - {title} - {title} - {title} Manage consent ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. --- ## Liam’s Story: MPFL Reconstruction Surgery- Dr. Sabrina Strickland Source: https://sabrinastrickland.com/liams-story-mpfl-reconstruction-surgery/ Summary: An avid hockey player, Liam turned to Dr. Sabrina Strickland of the Hospital for Special Surgery in New York City for MPFL reconstruction surgery. # Liam’s Story – MPFL Reconstruction Surgery Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - October 6, 2022 Liam had been dealing with a lifetime of kneecap dislocations. As an avid hockey player, he needed to find an answer to this problem. One of my sub-specialties is treating kneecap instability, and I was able to get Liam back to hockey and playing better than ever. This short video tells Liam’s story about his MPFL reconstruction surgery in his own words.   - athlete, athletes, back in the game, hockey, hockey player, Hospital for Special Surgery, HSS, kneecap dislocations, MPFL Reconstruction Surgery, sports injuries ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHospital for Special Surgery – JointStem Research Study NextIt’s the Patellofemoral HeightNext --- ## LIFT implant FDA Breakthrough Device | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/lift-implant-fda-breakthrough-device/ Summary: The FDA breakthrough device status granted to ZKR Orthopedics for the LIFT implant. We are optimistic an FDA trial will be starting soon. # ZKR Orthopedics’ LIFT implant Receives FDA Breakthrough Device Designation Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: February 29, 2024 - February 21, 2024 I have been aware of the LIFT implant device for a few years but was excited to see a publication recently about its early results in Europe. Now the FDA has granted it breakthrough device status and we are optimistic that an FDA trial will be starting soon. This minimally invasive surgery will involve implanting a small device or spacer to elevate the patellar tendon in patients with anterior knee pain due to patellar cartilage lesions and arthritis.  Read more in Healio: ZKR Orthopedics receives FDA breakthrough device designation for LIFT implant - FDA breakthrough device designation, late-stage cartilage degeneration, LIFT implant, Osteoarthritis, pain, patella tendon, patellofemoral compartment, patellofemoral osteoarthritis, ZKR Orthopedics ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousNovel 3D Printing Tech Realigns Patellofemoral Instability Rehab? NextWiberg Patellar Type Impact on Outcomes and SurvivalNext --- ## Lifting Weights Twice a Week - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/lifting-weights-twice-a-week/ Summary: Yet another reason to lift weights! Lifting light weights twice a week slowed down memory loss and improved gait in this study. # Lifting Weights Twice a Week Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - October 22, 2015 Yet another reason to lift weights! Lifting light weights twice a week slowed down memory loss and improved gait in this study.   ## Lifting Weights, Twice a Week, May Aid the Brain – NYTimes.com Source: mobile.nytimes.com/blogs/well/2015/10/21/lifting-weights-twice-a-week-may-aid-the-brain/     - improved gait, memory loss, New York Times ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousGood Information on Sesamoiditis NextBefore Knee Replacement SurgeryNext --- ## Lower Donor Site / Hamstring Autograft - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/lower-donor-site-morbidity-hamstring-quadriceps-tendon-autograft/ Summary: Kyle Kunze published a systematic review that looked at ACL surgery, specifically which tendon is harvested to reconstruct the ligament. # Lower Donor Site Morbidity With Hamstring and Quadriceps Tendon Autograft Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - April 20, 2023 Congratulations to Kyle Kunze for publishing this important paper. This systematic review looked at the ACL surgery, specifically which tendon is harvested to reconstruct the ligament. By analyzing multiple studies together, this paper showed that there was less morbidity (defined as “the condition of suffering from a disease or medical condition”) when using a hamstring or a quad tendon as compared to a patellar tendon. Furthermore, the type of tendon used “was not associated with complications, all-cause reoperations, or revision ACLR. Based on the current data, there is sufficient evidence to recommend that autograft selection should be personalized through considering differential rates of donor-site morbidity in the context of patient expectations and activity level without concern for a clinically important change in the rate of adverse events.” Read the article in Knee Surgery, Sports Traumatology, Arthroscopy. - ACL, ACL surgery, autograft, donor site morbidity, hamstring tendon, ligament, patellar tendon, quadriceps tendon, revision ACLR ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousAssessment of Patellar Vascularity after Patellar Cartilage Restoration via Lateral Parapatellar Approach NextEccentric Cycling As A Treatment for Patellar TendinopathyNext --- ## High-Volume Surgeons=Lower Revision Rates | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/lower-revision-rates-patellofemoral-arthroplasty-high-volume-surgeons/ Summary: An NJR study found surgeons who do more than 5 patellofemoral replacements (PFJs) per year have better outcomes and lower complication rates than those who do less. # Lower Revision Rates After Patellofemoral Arthroplasty for High-Volume Surgeons Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: April 25, 2025 - April 25, 2025 In this interesting study that used National Joint Registry data in Great Britain, the authors looked at the results of patellofemoral replacement (PFJ). They found that surgeons who do more than 5 PFJs a year have better outcomes and lower complication rates than surgeons who do less. This is far from surprising, and it is part of the reason that I have focused my practice over the years. You get better by doing a lot of something. I do about 50-60 patellofemoral replacements each year and am certainly more likely than most to consider the option of patellofemoral replacement for my patients. Another aspect of this study was that the outcomes were better with onlay implants than with inlay. I have long favored this type of implant as it allows me to optimize patellar tracking by rotating the trochlear component. Read more in this Orthopedicstoday article on Healio: High-volume surgeons linked with lower revision rates after patellofemoral arthroplasty. - complication rates, hazard ratio, High-volume surgeons, implant designs, lower revision rates, National Health Service, National Joint Registry, odds ratio, patellar disorders, patellofemoral arthroplasty, PJF, PJFs, progressive osteoarthritis, revision surgery, surgical volume ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousIs Robot-assisted MPFL Reconstruction Better than Freehand? NextIs There An Ideal Hamstring Autograft Diameter for ACL Reconstruction?Next --- ## Managing Shoulder Pain from Swimming | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/managing-shoulder-pain-swimming/ Summary: Discover strategies to prevent and manage shoulder pain in swimmers, including strengthening exercises and recovery advice, to help triathletes train smarter. # Managing Shoulder Pain from Swimming Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: August 21, 2025 - July 31, 2025 Swimming is a core component of triathlon training, but many athletes struggle with shoulder pain due to overuse, improper technique, or muscular imbalances. Common causes include rotator cuff inflammation and errors like crossing your hand over the midline or entering the water thumb-first. To prevent shoulder pain, focus on proper technique—such as a flat or pinky-first hand entry, avoiding overreaching, and rolling your body as you breathe. Strengthening supportive muscles, particularly the rotator cuff, shoulder blades, and core, is also important. Read more on A Triathlete’s Diary.   Photo by Serena Repice Lentini on Unsplash - injury prevention, muscular imbalance, overuse injury, Physical Therapy, recovery, rehabilitation, rest, rotator cuff, shoulder pain, sports medicine, swimmer’s shoulder, swimming, technique, triathletes ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousReal-World Outcomes for BEAR® Implant Shared at AOSSM 2025 NextWhy Do I Have Knee Pain After Running?Next --- ## Married & Practicing Orthopaedic Surgery - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/married-and-practicing-orthopaedic-surgery-dr-strickland-and-dr-gomoll/ Summary: Dr. Sabrina Strickland and Dr. Andreas Gomoll are married and practicing orthopaedic surgery together at NYU Langone Orthopedic Center in New York City # Married and Practicing Orthopaedic Surgery – Dr. Strickland and Dr. Gomoll Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Published January 26, 2023 · Last reviewed: May 2, 2026 - January 26, 2023 Quick Summary Dr. Sabrina Strickland and her husband Dr. Andreas Gomoll are board-certified orthopedic surgeons who met at the International Patellofemoral Study Group meeting in Chicago and now share a joint practice at Hospital for Special Surgery in New York City. They are both Associate Attending Orthopedic Surgeons at HSS specializing in cartilage repair, patellofemoral surgery, and knee preservation, and they collaborate frequently on complex cases. Dr. Sabrina Strickland and Dr. Andreas Gomoll are a husband-and-wife team of orthopedic surgeons at Hospital for Special Surgery in New York City, where they share a joint practice focused on cartilage repair, patellofemoral disorders, and knee preservation. They met at the International Patellofemoral Study Group meeting in Chicago — a small, invite-only gathering of surgeons who sub-specialize in disorders of the kneecap — and they have continued to collaborate clinically and academically ever since. In this video, Dr. Strickland and Dr. Gomoll discuss how they met, how they manage a shared practice while raising a family, and what their joint expertise means for patients with complex knee problems. For more on Dr. Strickland’s training and clinical focus, see her CV and biography. Watch the video on YouTube. ## How They Met at the International Patellofemoral Study Group The International Patellofemoral Study Group (IPSG) is a small, invitation-only society of orthopedic surgeons and researchers who sub-specialize in disorders of the patellofemoral (kneecap) joint. Membership is limited and adds a new member only when an existing member nominates a candidate whose research and clinical work meet the group’s standards. Both Dr. Strickland and Dr. Gomoll were invited to join because of their published work on cartilage repair and patellofemoral instability, and the IPSG annual meeting in Chicago is where they first met. This is the same society that publishes much of the consensus literature on procedures like MPFL reconstruction, tibial tubercle osteotomy, and trochleoplasty — the surgeries Dr. Strickland performs most often for patients with recurrent kneecap dislocations and patellar instability. ## What Their Joint Practice Looks Like Dr. Strickland and Dr. Gomoll both practice at NYU Langone Orthopedic Center in Manhattan. They share an office at 333 East 38th Street, 4th Floor, and frequently consult on each other’s complex cases — particularly when a patient presents with combined cartilage loss and patellofemoral malalignment, which often requires staged or simultaneous procedures. In Dr. Strickland’s experience, having a spouse who is also a fellowship-trained cartilage surgeon means second opinions happen at the dinner table. Patients of one of them are often discussed with the other when the case is unusual or when a different surgical perspective could help — a level of collaboration that is unusual even at a high-volume specialty hospital. Read more about why Dr. Strickland chooses to work at HSS. ## Shared Clinical Focus: Cartilage Repair and Knee Preservation Both surgeons are recognized authorities in joint-preservation surgery — operations that aim to restore a damaged knee instead of replacing it. Procedures they perform include MACI (autologous chondrocyte implantation), osteochondral allograft transplantation, meniscus transplantation, and the newer CartiHeal Agili-C scaffold for cartilage defects. Each surgeon publishes independently, but they have also co-authored peer-reviewed papers on patellofemoral cartilage outcomes — see Dr. Strickland’s research and publications for the full list. For patients, the practical benefit is that complex cases — for example, a young patient with both a cartilage defect and a high-riding kneecap — can be evaluated by two cartilage-specialist surgeons in the same practice. This is uncommon outside of academic centers and is one of the reasons HSS is a national referral destination for patellofemoral surgery. ## Frequently Asked Questions Where do Dr. Strickland and Dr. Gomoll practice? Both surgeons practice at NYU Langone Orthopedic Center in New York City. Their office is at 333 East 38th Street, 4th Floor, New York, NY 10016. Do they operate together on the same patient? Most surgeries are performed by one surgeon as the primary, but they consult on each other’s complex cases routinely. In rare situations involving combined cartilage and patellofemoral pathology, they may each contribute to a staged surgical plan, with one performing the cartilage portion and the other performing the alignment correction. What is the International Patellofemoral Study Group? The International Patellofemoral Study Group (IPSG) is an invitation-only society of orthopedic surgeons and researchers who specialize in disorders of the kneecap joint. Membership is limited and is extended only after nomination by an existing member based on published research and clinical contributions. What conditions do Dr. Strickland and Dr. Gomoll specialize in? Both are fellowship-trained in sports medicine and cartilage repair. Their shared clinical focus includes kneecap instability, recurrent kneecap dislocation, cartilage defects, meniscus injuries, ACL injuries, and knee preservation in younger and active patients. Dr. Strickland also treats shoulder conditions in athletes. How do I request an appointment with Dr. Strickland? You can request an appointment online or call the office at . New patients should bring any prior MRI or X-ray imaging to the visit. - Hospital for Special Surgery, HSS, joint practice, patellofemoral research, patellofemoral study, patellofemoral surgery ## Related Reading - Knee surgeon specialist (practice hub) - Dr. Strickland’s team & office - One-step cartilage repair (with Dr. Gomoll) - About Dr. Sabrina Strickland ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousReturning to Climbing After an ACL Tear NextAnterior Knee Pain Following Hamstring ACL ReconstructionNext --- ## MCL Injuries and Recovery - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/mcl-injuries-and-recovery/ Summary: MCL injuries may heal on their own, depending on where and how badly the MCL is torn. Many low grade injuries respond well to PT and immediate range of motion. # MCL Injuries and Recovery Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - November 29, 2022 MCL injuries usually heal on their own, but it really depends on where the MCL is torn and how badly it is torn. Many injuries are low grade and respond well to physical therapy and immediate range of motion.   For higher grade injuries, the knee should be braced in a hinged knee brace and recovery can take 3-4 months. Rarely, the MCL is torn off of the shin bone (tibia) and these injuries require repair or in some cases reconstruction with a hamstring tendon from either the same knee or a donor tendon.   In summary, all MCLs are not the same — and in most cases an MRI can predict time to full recovery.   Read about Marvin Bagley III’s injury.      - hinged knee brace, Hospital for Special Surgery, HSS, knee brace, MCL, MCL injuries, MCL injury, MCL reconstruction, MCL repair, MCL tear, Physical Therapy, range of motion, recovery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousTwo Fixation Points Are Better for Medial Patellofemoral Ligament Reconstruction NextSurgical Treatment of Iatrogenic Patella BajaNext --- ## Lateral Trochlear Inclination Angle | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/measuring-lateral-trochlear-inclination-angle/ Summary: Surgeons need practical, efficient diagnostic skills, not an overwhelming list of measurements, such as measuring the trochlear inclination angle. # Measuring the Lateral Trochlear Inclination Angle Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 5, 2025 - December 5, 2025 This post is really for the surgeons who treat patellar instability. Every month there is another article describing how to measure MRI or CT scans to determine anatomic factors leading to patellar instability or patellar cartilage overload. It literally becomes alphabet soup with TTTG, C/D index, PT-LTR, etc. In fact, very few surgeons are going to measure every possible angle on every possible imaging available because it will take too long and it will not necessarily help plan surgery. As one scrolls through an MRI, you get a very good sense of where the patella is tracking and why. It is then up to the surgeon to determine if they can get away with small surgery, such as an MPFL, or if they need to realign the knee. This can involve a tibial tubercle osteotomy to move the patella medially or distally or a femoral osteotomy to straighten or rotate the knee. The femoral osteotomy has a much higher complication rate and changes the mechanics of the entire lower extremity.  Read the full article in the Orthopaedic Journal of Sports Medicine: Validity of the 2-Image Lateral Trochlear Inclination to Determine Patellar Instability Due to Trochlear Dysplasia. - cartilage overload, femoral osteotomy, knee realignment, MPFL, MRI measurements, patellar instability, Surgical planning, tibial tubercle osteotomy, Trochlear dysplasia, TTTG ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousKnee Surgery with Sea Coral: NYC Doctors Explain How & Why NextNew CPT Code for CARTIHEAL AGILI-C Procedures ApprovedNext --- ## Study on Medial Meniscus Posterior Root Tears | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/medial-meniscus-posterior-root-tears/ Summary: This study in the The American Journal of Sports Medicine looks at contact pressure in a knee during simulated gait after medial meniscal root tears. # Study on Medial Meniscus Posterior Root Tears Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: February 29, 2024 - January 11, 2024 Quick Summary Dr. Sabrina Strickland's study in The American Journal of Sports Medicine examined how medial meniscus posterior root tears change knee joint contact mechanics during simulated gait. The study confirmed that root tears significantly increase contact pressure as contact area is reduced, with notable variability between knees — a finding that may help individualize treatment for patients with these injuries. The study we just published in the The American Journal of Sports Medicine looks at contact pressure in a knee during simulated gait after a medial meniscal root tear.   I started planning this study back in 2017 — unfortunately, we had delays due to COVID and staffing changes in our biomechanics lab. Nevertheless, we made it to the finish line and showed that meniscal root tears do significantly increase contact pressure as contact area is reduced, which was not a surprise.   What was most interesting to me was the variability between different knees. If we can sort out which patients do okay without surgery to repair a root and which patients’ knees will fail despite surgery, we can individualize treatment.   A recent study from Aaron Krych, MD at the Mayo Clinic highlights how catastrophic meniscal root tears are to the knee: [53% had had a total knee replacement and at a minimum 10-year follow-up, 37 of 39 living patients (95%) had failed nonoperative treatment.]   Read the study “Medial Meniscus Posterior Root Tears Lead to Changes in Joint Contact Mechanics at Low Flexion Angles During Simulated Gait” in The American Journal of Sport Medicine.   - american orthopaedic society, joint contact mechanics, low flexion angles, medial meniscus, medial meniscus posterior root tears, oossm, root tears, simulated gait, sports medicine, study ### Related on this site - Meniscal tear or torn meniscus — overview of meniscus injuries and treatment options. - Medial meniscus root repair with implantable shock absorber — related research on root tear treatment. - Do you need surgery? — how to decide between operative and nonoperative care. - About Dr. Sabrina Strickland — HSS orthopedic surgeon specializing in knee preservation. ## Frequently Asked Questions What did the AJSM study find about medial meniscus posterior root tears?Our study, published in The American Journal of Sports Medicine, used a lab-based simulated-walking model to measure the pressure between the thigh bone and shin bone after creating a tear at the root of the inner (medial) meniscus. As expected, the pressure rose significantly while the contact area dropped. The most clinically interesting finding was the wide variability from knee to knee, which may help explain why some patients tolerate these tears and others don't. How serious is an untreated medial meniscus posterior root tear?A natural-history study from the Mayo Clinic that we cite reports that, at minimum 10-year follow-up, 53% of patients with untreated posterior root tears had progressed to total knee replacement, and 95% had failed non-surgical treatment. Once the root is detached, the meniscus can no longer convert the load into the hoop-like compression it normally provides, and rapid cartilage wear usually follows. Why does treatment for posterior root tears need to be individualized?The variability we observed between knees in the simulated-walking study suggests that not every root tear behaves the same way mechanically. If we can identify which knees will tolerate a tear and which will rapidly wear down, we can offer surgery to those most likely to benefit and avoid it for those who would do well without it. That is the next phase of research. ## Related Reading - Meniscal tear / torn meniscus - Medial meniscus root repair with shock absorber - Symptoms of a torn meniscus that may self-heal - About Dr. Sabrina Strickland ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousPatellar Instability Modified Delphi Consensus NextMedial UKA improved pain, function despite patellofemoral joint degenerationNext --- ## Medial Meniscus Root Repair Technique | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/medial-meniscus-root-repair-implantable-shock-absorber/ Summary: This technique combines an implantable shock absorber w/ medial meniscal root repair to protect the medial tibiofemoral compartment & faster return to weightbearing. # Medial Meniscus Root Repair With Implantable Shock Absorber Placement Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: August 15, 2024 - August 15, 2024 Quick Summary This technique combines an implantable shock absorber with medial meniscal root repair to protect the medial tibiofemoral compartment and enable a faster return to weightbearing. This article and the technique we discuss is focused on aiding younger, working-age patients with early medial compartment arthritis. This unique patient population has limited treatment options, which generally consist of either an osteotomy or arthroplasty. Another surgical treatment option involves unloading the medial compartment with an implantable shock absorber, known as the MISHA Knee System (this system is from Moximed in Fremont, CA). One use of this implant is for treating medial meniscal root tears (MMRTs). Left untreated, MMRTs can result in the rapid degeneration of the medial tibiofemoral compartment with high rates of conversion to arthroplasty. Although it’s important to address MMRTs surgically, recovery can be difficult for patients because they must adhere to 6 weeks of non-weightbearing. In this surgical technique, we combine an implantable shock absorber with a concomitant medial meniscal root repair in order to both protect the medial tibiofemoral compartment and enable a faster return to weightbearing. The open access version of my article Medial Meniscus Root Repair with Implantable Shock Absorber Placement: A Combined Technique for Early Partial Weightbearing is now available online in Arthroscopy Techniques, where you can read the whole article and watch a short video.  - arthroplasty, early medial compartment arthritis, Early Partial Weightbearing, Implantable shock absorber, Implantable Shock Absorber Placement, medial meniscal root tears, Medial Meniscus Root, Medial Meniscus Root Repair, MISHA Knee System, MMRTs, Moximed, osteotomy, partial knee arthroplasty, Total Knee Arthroplasty, unloading the medial compartment ### Related reading - NYC Knee Surgeon Specialist - Medial Meniscus Posterior Root Tears - MISHA Knee System for U.S. Patients - MISHA Knee System & Knee Osteoarthritis - Before Knee Replacement Surgery ## Frequently Asked Questions What is the MISHA Knee System?The MISHA Knee System is an implantable shock absorber from Moximed designed to take pressure off the inner (medial) side of the knee. It sits outside the joint and shifts weight-bearing forces away from damaged cartilage and meniscus on that side. It is one option for treating tears at the root of the inner meniscus in younger or working-age patients who are not yet candidates for joint replacement. Why combine an implantable shock absorber with a meniscal root repair?A standard repair of an inner meniscus root tear usually requires six weeks without bearing weight to protect the repair while it heals. By placing the implantable shock absorber at the same time, the inner side of the knee is mechanically unloaded — which protects the root repair while allowing the patient to bear weight earlier. The full combined technique is described in our Arthroscopy Techniques article. Who is a candidate for this combined technique?This approach is most relevant for younger, working-age patients with an inner meniscus root tear and early inner-compartment arthritis, whose treatment options would otherwise be limited to a high tibial osteotomy or joint replacement. Final candidacy depends on alignment, cartilage status, and individual goals — that decision is made after imaging review and an exam. ## Related Reading - Meniscal tear / torn meniscus - Medial meniscus posterior root tears - Before knee replacement surgery - About Dr. Sabrina Strickland ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousKnee Chondromalacia Symptoms & Treatment Next11 Shoulder Stretches that Fight Stiffness & Improve PostureNext --- ## Medial Patellofemoral Ligament Questions Source: https://sabrinastrickland.com/medial-patellofemoral-ligament-reconstruction-questions/ Summary: Liam had been dealing with a lifetime of kneecap dislocations; a medial patellofemoral ligament reconstruction was the best way to get him back to playing hockey. # Medial Patellofemoral Ligament Reconstruction Questions Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: May 24, 2024 - May 24, 2024 One of my patient stories gets a lot of questions — Liam’s story about his medial patellofemoral ligament reconstruction. It’s a great one because it really shows how important the recovery process is in terms of getting back to your active lifestyle — in Liam’s case, he had surgery in both knees, but after following my post-op protocols, he was able to return to playing hockey. It takes time to return to your full strength, but once you do, you really can get back to an active lifestyle.  Clearly, Liam’s story resonates with others who are worried about what to expect, like this commenter:  I have an upcoming medial patellofemoral ligament (MPFL) surgery. How much time will I have to wait until I can start (slowly) moving again? 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. While most of the questions center around how quickly you can return to full activity, some people wonder about using a brace while others just want to learn more about what’s involved in the procedure.   Watch Liam’s story and read other frequently asked questions (and my answers).  - hockey, knee instability, knee surgery, kneecap dislocation, knees, ligament, Medial Patellofemoral Ligament Reconstruction, medial patellofemoral ligament tear treatment, MPFL reconstruction, MPFL Reconstruction Surgery, sports, tendon ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHow does Cartiheal compare to OCA and MACI? NextPeyton’s Tibial Tubercle OsteotomyNext --- ## Medial UKA improved pain, function | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/medial-uka-improved-pain-function-despite-patellofemoral-joint-degeneration/ Summary: Study shows medial UKA or partial knee replacement patients had the same results, even with degeneration of arthritis of the front of their knee. # Medial UKA improved pain, function despite patellofemoral joint degeneration Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: January 25, 2024 - January 25, 2024 This study in the Journal of Arthroplasty analyzed results of medial unicompartmental knee arthroscopy (medial UKA) or partial knee replacements and determined that at one year post surgery, patients had the same results whether or not they also had degeneration of arthritis of the front of their knee (patellofemoral joint). In my practice, whether or not I recommend a partial knee depends on where a patient has symptoms. If the majority of symptoms are on the medial or inside part of the knee and the patient is a candidate for a partial knee replacement, then I think it is reasonable to proceed. The only issue is that insurance companies do not understand this and we are getting more and more denials due to the fact that the X-ray or MRI shows patellofemoral degeneration. Read more in this Healio article: “Medial UKA improved pain, function despite patellofemoral joint degeneration” or in The Journal of Arthroplasty: “What Role Does Patello-Femoral Joint Degeneration Have on Pain and Function After Unicompartmental Knee Arthroplasty? A Prospective Observational Cohort Study.” - anterior knee pain, degeneration of arthritis, improved function, improved pain, knee, medial UKA, medial unicompartmental knee arthroplasty, partial knee replacement, patellofemoral joint degeneration, patellofemoral joint OA, results ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousStudy on Medial Meniscus Posterior Root Tears NextACL Injury and Recovery in Professional SnowboardersNext --- ## Medical Tourism: Benefits and Risks | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/medical-tourism-benefits-risks-and-what-to-consider/ Summary: Medical tourism is an interesting concept. In the USA, we have a pretty amazing health care system but the costs can be high. What are the benefits and risks? # Medical Tourism: Benefits, Risks, and What to Consider Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: June 12, 2025 - June 12, 2025 Medical tourism is an interesting concept. In the United States, we tend to think that we have a pretty amazing health care system, and therefore, why would we travel for healthcare? I often hear about patients traveling to far-off destinations such as Turkey for hair transplants, Costa Rica for dental surgery, and Brazil or Korea for plastic surgery. But what about non-cosmetic treatment? Health care costs are so high in the US and insurance coverage so spotty that for some patients, it may make sense to seek treatment abroad. I often see patients who bring in MRIs from China or India that they obtained while visiting family overseas. The cash cost of these studies is far less than most patients’ deductibles or co-pays here. The problem with invasive medical treatment is how to vet the doctor, the hospital, or the actual treatment being offered. I’m at a loss here and would advise significant caution prior to undergoing treatments such as “stem cell” injections or surgical procedures abroad. Here’s an article that explores the idea of medical tourism further: The Best Centers for Regenerative Cartilage Implants Photo by National Cancer Institute on Unsplash - cosmetic treatment, healthcare costs, insurance coverage, medical tourism, non-cosmetic treatment, stem cell injections, surgical procedures, treatment abroad, US healthcare, vet the doctor ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPrevious5 Symptoms of a Torn Meniscus That Will Self-Heal Next6 Exercises You Should Do With a Torn MeniscusNext --- ## Miach Orthopaedics’ BEAR® Implant | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/miach-orthopaedics-bear-implant/ Summary: Miach Orthopaedics announced the presentation of the one- and two-year results of the Bridge Registry study at the AOSSM annual meeting. # Real-World Evidence for Miach Orthopaedics’ BEAR® Implant Highlighted at AOSSM 2025 Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: July 18, 2025 - July 14, 2025 Miach Orthopaedics, Inc., a company transforming the treatment of anterior cruciate ligament (ACL) tears with the BEAR® Implant, today announced the presentation of one- and two-year results of the Bridge Registry study at the recent American Orthopaedic Society for Sports Medicine (AOSSM) annual meeting. Real-World Evidence for Miach Orthopaedics’ BEAR® Implant Highlighted at AOSSM 2025 Photo by CHUTTERSNAP on Unsplash - ACL tears, BEAR implant, Bridge Registry, real-world outcomes, retear rate ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousCost-Effectiveness of ACL Reconstruction with LET Augmentation NextReal-World Outcomes for BEAR® Implant Shared at AOSSM 2025Next --- ## Miami Marathon Runners in Action | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/miami-marathon-runners/ Summary: I walked alongside runners this morning who are about 10 miles into the Miami marathon. It # Great to See Miami Marathon Runners Back in Action Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: June 4, 2025 - February 6, 2022 I walked alongside runners this morning who are about 10 miles into the Miami marathon. As you can see they got some great weather. I’m so glad things are getting a little bit closer to back to normal! - COVID, fitness, Miami marathon, runners, running, Weather ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPrevious11 Shoulder Stretches To Give The Important Joint Some TLC NextOrthobiologics – study: Can ACLs heal faster using platelet rich plasma?Next --- ## Setting MDC Thresholds, Kujala Scores - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/minimal-detectable-change-thresholds-kujala-scores/ Summary: Establishing minimal detectable change thresholds for the IKDC and Kujala scores at one and two years after patellofemoral joint arthroplasty # Establishing minimal detectable change thresholds and Kujala scores at one and two years after patellofemoral joint arthroplasty Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - March 30, 2023 In this study, we looked at which patients improved the most after patellofemoral joint replacement. Our goal was to define the minimal detectable change (MDC) for the international knee documentation committee (IKDC) and Kujala scores one and two years after patellofemoral joint arthroplasty (PFA). We used distribution-based method (one-half the standard deviation of the mean difference between postoperative and preoperative outcome scores) to establish MDC thresholds among 225 patients undergoing primary PFA at a single high-volume musculoskeletal-care center. Stability of change in MDC achievement was explored by quantifying the proportion of achievement at one- and two-year postoperative timepoints. Multivariable logistic regression analysis was performed to explore the association between sociodemographic and operative features on MDC achievement. The image is from https://orthotoolkit.com/kujala/ – you can learn more about Kujala Scores here, enter information, and download a completed PDF report.  Read the study abstract. - IKDC, international knee documentation committee (IKDC), Kujala Scores, minimal detectable change thresholds, patellofemoral joint arthroplasty, PFA ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousAssessment of Patellar Vascularity after Patellar Cartilage Restoration via Lateral Parapatellar Approach NextAssessment of Patellar Vascularity after Patellar Cartilage Restoration via Lateral Parapatellar ApproachNext --- ## MISHA Knee System Knee Osteoarthritis - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/misha-knee-system-knee-osteoarthritis/ Summary: Congratulations to Moximed for getting FDA approval for their new device, MISHA Knee System for people suffering from knee osteoarthritis. # MISHA Knee System for People Suffering from Knee Osteoarthritis Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: June 4, 2025 - May 12, 2023 Congratulations to Moximed for getting FDA approval for their new device, MISHA™ Knee System! Whenever I see an active patient with knee arthritis who has started to limit their activity, I run through a long list of options ranging from exercise modifications and physical therapy to injections to a knee replacement.   A common question I then get asked is: What is currently in development or what new surgery will be available to them if they can wait? By and large, the answer has been… nothing. I would sadly reply that here was nothing in development that can reverse degenerative arthritis.   However, there is a new device that may be able to decrease symptoms due to arthritis and delay or potentially avoid the need for arthroplasty. Moximed developed an implantable device for the knee that decreases the stress from activity and therefore the pain due to arthritis on the medial aspect of the knee.   While I haven’t used this device, my husband, Dr. Andreas Gomoll, participated in their clinical trials that led to the recent FDA approval. For now, I cannot tell patients that there is a clear way to avoid a knee replacement, but there is some hope that we may have better solutions to delay this surgery and decrease symptoms.   Read the press release.   - arthritis, arthroplasty, clinical trials, Hospital for Special Surgery, knee arthritis, knee arthritis pain, knee replacement #exercisemodifications #physicaltherapy #injections, medial aspect ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousEccentric Cycling As A Treatment for Patellar Tendinopathy NextIncreased Risk of Patellofemoral Arthritis: The Sagittal Tibial Tubercle-Trochlear Groove DistanceNext --- ## MISHA™ Knee System Treats Patients in US - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/misha-knee-system-treats-us-patients/ Summary: The Moximed MISHA™ knee system is now treating the first patients in the United States. The Implantable shock absorber (ISA) relieves pain and improves function # MISHA™ Knee System Treats First Commercial Patients in the US Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - September 7, 2023 The Moximed MISHA™ knee system is now treating the first commercial patients in the United States. This Implantable shock absorber (ISA) relieves pain and improves function for people who are ineligible for a joint replacement. This article in OrthoSpineNews includes information about the MISHA™ knee system and quotes from Anton Clifford, Ph.D., founder and CEO of Moximed, and Dennis C. Crawford, M.D., Ph.D., Professor of Orthopaedics and Rehabilitation, School of Medicine, Oregon Health and Science University, who treated the first commercial patient. It also included my comments about how I saw firsthand that an implantable shock absorber can meet a real unmet need in my practice. “My first MISHA case was a 47-year-old female with painful, early OA and a meniscal root tear. The ability to reduce compartment loads with the ISA and concomitantly repair the root without having to cut bone is a significant step toward the goal of providing long term joint preservation. I’m excited to offer this treatment to many OA patients who might benefit from a joint unloading procedure and who demand a shorter path to recovery or the potential for high activity.”     - clinical study, ISA, joint disease, knee OA, knee system, long term joint preservation, meniscal root tear, MISHA, Moximed, OA, Osteoarthritis ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousCartiheal Is Back: New Cartilage Injury Treatment NextMoximed’s MISHA™ Knee System Treats First Commercial Patients in United StatesNext --- ## MOCART Scores >55 at 6 Months Postop ACI | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/mocart-scores-aci-patient-satisfaction/ Summary: The relationship between MOCART scores and patient satisfaction for patients undergoing autologous chondrocyte implantation (ACI) for patellofemoral chondral defects # MOCART Scores > 55 at 6 Months Post-op ACI & Patient Satisfaction Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: May 2, 2024 - May 2, 2024 We are constantly evaluating our patients after cartilage transplants to assess their progress, both as far as pain relief and a return to activity. Furthermore, we look at MRIs to see the cartilage repair quality as well as how the bone is responding post-operatively. In this study, we looked at matrix-induced autologous chondrocyte implantation (MACI). This is a type of cartilage repair using one’s own cartilage (grown outside the body onto a collagen membrane) to repair defects in the front of the knee (patella and trochlea). What we discovered was that a radiologic scoring system was able to predict good outcomes down the road. None of the techniques we have at present work all of the time as we rely on many factors, such as the ability of cells to produce matrix and mature over time. Learn more about this study in Sage Journals: Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) Scores > 55 at 6 Months Postoperative Predict Ability to Achieve Patient Acceptable Symptomatic State at Minimum 1 Year Postoperative Following Autologous Chondrocyte Implantation for Grade IV Chondral Defects About the Patellofemoral Joint The image is a screenshot of the MOCART scoring system. - ACI, autologous chondrocyte implantation, cartilage, focal Grade IV patellofemoral chondral defects, Knee Injury and Osteoarthritis Score Quality of Life, KOOS QoL, magnetic resonance image, Magnetic Resonance Observation of Cartilage Repair Tissue, MCID, minimal clinically important difference, MOCART, MOCART score, PASS, patella, patellofemoral ACI, Patient Acceptable Symptomatic State, patient satisfaction, trochlea ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousPatellar Attachment Healing Post Surgery NextHow does Cartiheal compare to OCA and MACI?Next --- ## Most Common Tennis Injuries - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/most-common-tennis-injuries/ Summary: The first step of injury prevention is learning how and where tennis affects your body and what you can do to lessen the stress. Lear about common tennis injuries. # Most Common Tennis Injuries Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - September 26, 2012 The first step of injury prevention is learning how and where tennis affects your body and what you can do to lessen the stress. Read on to find out about four of the most common tennis injuries and how to prevent them. - Tennis Elbow (cumulative) is a condition in which the tendons holding the forearm to the outside of the elbow become damaged and accrue small tears. This is caused by a combination of overusing the forearm extensor muscles and the repeated impact of the ball. Prevention Tips: Lessen the strength of the ball’s impact on your elbow by practicing correct technique, increasing your muscle strength, and developing muscle flexibility. All of these strategies will help absorb the shock of the ball hitting the racket, so that it doesn’t deflect to the tendons. Additionally, taking shots two-handed instead of single-handed or using a racket with a bigger head and looser strings will help distribute the impact more evenly. - Rotator Cuff Tendonitis (cumulative) is an inflammation of the shoulder muscles which results from overuse of the muscles and tendons connecting the shoulder blade and the upper arm. Prevention Tips: This condition is most often caused by improper serving technique in which the arm does not extend upwardly enough. Ideally, it should be at least at a 135 degree angle to the body, with the elbow up higher than the shoulder. - Wrist Tendonitis (acute and cumulative) is an inflammation of the wrist when its tendons are damaged. This most often occurs as a result of overuse and improper technique which puts more stress on the wrist than usual. Prevention Tips: Make sure to use the neutral L-shape grip, in which the tennis racket and your forearm are perpendicular, forming the letter “L”. If your wrist begins to hurt (due to an acute injury) give it some rest and let it recover fully before starting to play again. Don’t ignore the pain – if you decide to play through it, the acute injury may become a chronic one. - Back Pain (acute) is caused by high stress on the back affecting the small joints, lumbar discs, ligaments, tendons, and even muscles around the spine.  These parts of the back are constantly under since they’re responsible for the sudden start-and-stop lateral movements of the player. Prevention Tips: When playing, try not to over-arch your back on a power serve. When you’re off the court, you can still work to prevent this injury by strengthening your back and core muscles and developing their flexibility. This will alleviate stress on the spine’s small joints and the lumbar discs during play. Long play without pause or stretching leads to a tightening and “shortening” of the arm muscles, which then can’t as easily absorb the shock from hitting the ball. Always taking a shot with the same arm puts too much stress on it specifically – the impact can be reduced by sharing the shot between two hands instead of one or using a racket with a bigger head and looser strings that help absorb the ball’s energy more evenly. Play it safe. In addition to the tips above, keep these 5 Golden Rules in mind and you will be well on your way to playing tennis without letting injuries slow you down: - Follow Proper Technique - Develop Flexibility - Build Strength - Increase Endurance - Up Your Training Gradually - Tennis, Tennis Elbow ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. NextDoctor Explains Lindsey Vonn’s Injury – NBC SportsNext --- ## Moximed MISHA™ Knee System Treatment - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/moximed-misha-knee-system-patients-united-states/ Summary: Moximed announced the first commercial cases of the MISHA™ Knee System, an implantable shock absorber (ISA) for the knee. It treats people with medial knee OA. # Moximed’s MISHA™ Knee System Treats First Commercial Patients in United States Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - September 7, 2023 Moximed, a medical device company on a mission to improve the standard of care for people with knee osteoarthritis (OA), today announced the first commercial cases of the MISHA™ Knee System, an implantable shock absorber (ISA) for the knee. The FDA-cleared MISHA Knee System is indicated to treat people with medial knee OA who failed to find relief from non-surgical or surgical treatment, continue to experience pain that interferes with daily activities, and are ineligible for, or unwilling to undergo, joint replacement due to age or absence of advanced OA. Read the complete article at OrthoSpineNews. - FDA-approved, Implantable shock absorber, ISA, joint replacement alternatives, knee OA, knee osteoarthritis, medical device, MISHA Knee System, surgeons ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousMISHA™ Knee System Treats First Commercial Patients in the US NextKnock Knee Surgery — And Valerie Bridges is Back in the GameNext --- ## MPFL Reconstruction Study and Follow Up - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/mpfl-reconstruction-study-and-follow-up/ Summary: Beware of studies like this one about MPFL reconstruction that only have one year of follow-up. Most patients are just resuming pivoting sports at stage. # MPFL Reconstruction Study and Follow Up Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - November 1, 2022 Beware of studies like this one about MPFL reconstruction that only have one year of follow-up. In this small study of only 43 patients who underwent MPFL reconstruction (some bilateral) with a strong suture, they demonstrated that most patients were stable at a year. We know that most patients are just resuming pivoting sports at a year and may not have really put their knee to the test at that point. What is concerning about this study is that they didn’t risk stratify the patients. That is, they didn’t look at the types of sports the patients were participating in and did not appear to tailor the type of surgery to specific bony risk factors. While there is nothing like long term follow-up, it isn’t possible with new techniques — but it means we should proceed with caution. The editorial to this study follows in the attached link and points out several deficiencies with this paper. ### MPFL reconstruction with suture tape, knotless anchors may improve outcomes - Hospital for Special Surgery, MPFL reconstruction, orthopedics, risk stratification, strong suture ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousIf You Have Knee Pain, Try Using Your Treadmill Like This NextEditorial Commentary: Two Fixation Points Are Better for MPFL ReconstructionNext --- ## MPFL Reco & Tibial Tubercle Osteotomy - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/mpfl-reconstruction-tibial-tubercle-osteotomy/ Summary: Joe # MPFL Reconstruction & Tibial Tubercle Osteotomy Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - November 9, 2022   Today I’m sharing a story about Joe’s first skiing experience. He had a somewhat unusual experience — he didn’t tear his ACL skiing, he dislocated his patella. The way Joseph was born, and the way he grew, his patella was high, so he had patella alta, but he was also laterally translated. In this short video I walk through his injury and recovery after an MPFL reconstruction and tibial tubercle osteotomy surgery. Best of all, you get to hear from Joe, who is funny and brings his own little twist to the tale.   Watch it on YouTube and check out my other success stories.      - knee injury recovery, MPFL, MPFL reconstruction, orthopaedic surgery, patella alta, skiing, skiing injury, sports injuries, tibial tubercle osteotomy ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousEditorial Commentary: Two Fixation Points Are Better for MPFL Reconstruction NextTwo Fixation Points Are Better for Medial Patellofemoral Ligament ReconstructionNext --- ## MPFL Reconstruction and TTO Questions | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/mpfl-reconstruction-tto-questions/ Summary: I # MPFL Reconstruction and TTO Questions Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: August 29, 2024 - August 29, 2024 I’ve had quite a few questions lately on my videos about medial patellofemoral ligament (MPFL) reconstruction and tibial tubercle osteotomy surgery. What often happens is people have had one surgery or the other (or both) and they’re looking for information about what to expect after surgery, when they will regain range of motion, and a positive story during their own recovery. My YouTube channel has these questions and answers available. While I can’t provide specific medical advice based only on a YouTube comment, I can reassure you about typical recovery timelines and the healing process. I’m re-sharing Joseph’s story about his own MPFL and TTO surgery today as one of those great recovery stories. - Hospital for Special Surgery, knee surgery, Medial patellofemoral ligament, Medial Patellofemoral Ligament Reconstruction, MPFL, MPFL reconstruction, orthopaedic surgery, patient stories, recovery, success stories, tibial tubercle osteotomy, tibial tubercle osteotomy surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousStudy Following MACI Cartilage Transplantation Patients NextYoung Physician Series: Practice Management 101 – Pearls and PitfallsNext --- ## MRI Scoring Patellofemoral Osteoarthritis | Dr. Strickland Source: https://sabrinastrickland.com/mri-scoring-patellofemoral-osteoarthritis/ Summary: New MRI scoring system objectively quantifies patellofemoral arthritis severity. Improves surgical planning & research to optimize patient outcomes. # Novel MRI Scoring System to Evaluate Patellofemoral Osteoarthritis Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: October 23, 2025 - October 23, 2025 We have created a new MRI scoring system to quantify the degree of patellofemoral arthritis. By creating an objective scoring system, we can then look at outcomes of different surgical procedures for patients with varying degrees of arthritis and hopefully optimize outcomes. ## Overview Patellofemoral osteoarthritis (PFOA) is one of the most common causes of anterior knee pain, particularly in women over age 50. Despite its prevalence, clinicians have lacked a standardized MRI-based framework to quantify disease severity. This new study, published in The Journal of Knee Surgery (DOI: 10.1055/a-2585-4964), introduces a new MRI scoring system that provides detailed, reproducible evaluation of patellofemoral joint degeneration. This work was led by me and my colleagues at the Hospital for Special Surgery. ## Study Design The research team analyzed preoperative MRIs from 72 patients who underwent patellofemoral arthroplasty at HSS between 2012 and 2021. All scans were obtained using 3-Tesla MRI systems with extremity coils and standardized imaging protocols that conform to International Cartilage Regeneration and Joint Preservation Society (ICRS) guidelines. The new MRI-based scoring system incorporated the most critical structural and pathological features associated with PFOA, including: - Patellar and trochlear cartilage damage - Subchondral bone edema, cysts, and remodeling - Osteophytes (bone spurs) - Alignment parameters, such as patellar height - Synovial inflammation ## Reliability and Statistical Validation MRI images were reviewed and scored by a fellowship-trained musculoskeletal radiologist, a musculoskeletal radiology fellow, and a fellowship-trained orthopedic knee surgeon independently scored each MRI to test for consistency. Agreement was measured using Cohen’s kappa coefficient for categorical variables and the intraclass correlation coefficient (ICC) for overall score reliability. - Patellar bone edema (κ = 0.61) and patellar cysts (κ = 0.59) achieved moderate agreement. - Features like cartilage damage, osteophytes, subchondral remodeling, and synovitis demonstrated good interobserver reliability (κ > 0.61). - Patellofemoral alignment and total composite scores achieved excellent reliability (κ > 0.81).   These findings confirm that the MRI scoring system is consistent across different interpreters, highlighting its reproducibility for both clinical and research applications. ## Clinical Implications of the MRI Scoring System The system provides a quantitative and objective framework for categorizing the severity of patellofemoral joint degeneration. Unlike traditional X-rays, which only demonstrate obvious joint space narrowing in one plane and osteophytes, MRI offers insight into early and subtle changes in the cartilage and subchondral bone. This improved visualization of subchondral and soft-tissue structures can lead to more individualized surgical planning and better-informed patient counseling about prognosis and recovery potential. This MRI scoring system can be applied to: - Assess and stage isolated PFOA - Predict outcomes for surgical interventions, such as patellofemoral arthroplasty, tibial tubercle osteotomy, or cartilage restoration procedures - Facilitate clinical research aimed at correlating imaging features with patient-reported outcomes By standardizing how MRI findings are scored, the MRI scoring system enables consistent patient stratification across institutions, improving comparability of results and the development of tailored treatment plans. This scoring system may also benefit radiologists, physical therapists, and sports medicine specialists by offering a common framework to communicate disease severity, monitor progress, and refine rehabilitation protocols across multidisciplinary care teams. ## Future Directions Ongoing work aims to expand this scoring approach to better integrate biochemical MRI sequences that quantify cartilage composition (for example, T2 mapping) and to explore correlations between MRI findings and long-term surgical outcomes. Large, prospective studies will help validate the predictive value of this MRI scoring system for postoperative recovery and joint preservation success. ## Learn More For additional information about patellofemoral arthritis assessment, knee arthroplasty, or treatment options, explore: - Patellofemoral Arthritis Overview  - MRI Evaluation for Knee Pain  - Patellofemoral Arthroplasty  - Research and Publications  This MRI scoring system represents a step toward precision evaluation of patellofemoral arthritis, allowing surgeons and researchers to better classify disease severity, individualize treatment, and ultimately improve patient outcomes. Read the complete original article in The Journal of Knee Surgery: Reliability of a Novel Magnetic Resonance Imaging Scoring System to Evaluate Patellofemoral Osteoarthritis. Photo by Accuray on Unsplash   - cartilage damage, clinical research, Disease Severity, ICRS Guidelines, joint preservation, knee pain, MRI Scoring System, patellofemoral arthritis, patellofemoral arthroplasty, patellofemoral joint degeneration, patellofemoral osteoarthritis, patient outcomes, PFOA, Subchondral Bone, Surgical planning ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousFirst Patella LIFT™ Surgeries on the East Coast at HSS in Enrollment of FDA PELICAN Trial NextWhy Does My Knee Hurt Going Down Stairs?Next --- ## Bridge-Enhanced ACL Restoration Implant - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/my-first-bridge-enhanced-acl-restoration-bear-implant/ Summary: Miach Orthopaedics shared a post congratulating me and the Hospital for Special Surgery for our first Bridge-Enhanced ACL Restoration (BEAR) implant surgery. # My first Bridge-Enhanced ACL Restoration (BEAR) Implant Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: June 4, 2025 - May 20, 2022 Sharing this a link to Miach Orthopaedics, who shared a post congratulating me and the Hospital for Special Surgery for our first Bridge-Enhanced ACL Restoration (BEAR) implant surgery.  Learn more about the BEAR implant on their website.  - ACL, ACL surgery, ACL tear, BEAR ACL, BEAR implant, Bridge-Enhanced ACL Restoration, ortho, orthopaedic surgery, orthopedics ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousPrehab before ACL surgery and impact on recovery NextNFL Injuries After COVID Stopped Professional SportsNext --- ## My Kneecap Dislocated. What To Do? | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/my-kneecap-dislocated-what-should-i-do/ Summary: Get expert advice on what to do for a kneecap dislocation. Learn about diagnosis, treatment, and recovery options to help you get back on your feet. # My Kneecap Dislocated. What Should I Do? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: April 30, 2026 Quick Summary A dislocated kneecap (patella) happens when the patella slips out of its groove at the front of the knee, usually after a twisting or direct-blow injury. If the kneecap has not slid back into place on its own, seek immediate medical care for reduction, then arrange an MRI with an orthopedic specialist to check for cartilage or ligament damage. Most first-time dislocations heal with bracing and physical therapy, but recurrent dislocations or significant cartilage injury often need MPFL reconstruction or related stabilization surgery. - August 15, 2025 If your kneecap has dislocated, seek immediate medical attention so the patella can be reduced (placed back in the groove), then have an orthopedic specialist evaluate the knee with an MRI to check for cartilage or ligament injury. A dislocated patella, or kneecap, occurs when the patella slips out of its normal groove at the front of the knee, usually causing sudden pain, swelling, and difficulty moving the knee. Here’s what you should know and the steps you should take if you have a kneecap dislocation. ## Immediate Steps After a Kneecap Dislocation If your kneecap hasn’t returned to its normal position on its own, go to an emergency room or call 911 — a clinician will gently guide the patella back into place in a process called reduction. A healthcare provider (an orthopaedic surgeon, emergency room doctor, or, in some cases, a trained EMT or paramedic) is the right person to perform this maneuver. Do not try to forcibly reduce the kneecap yourself, since the surrounding cartilage and ligaments are vulnerable while the patella is out of place. In most cases, this can happen spontaneously as you straighten your knee, where the kneecap “pops” back into place on its own. After the kneecap is back in position, your knee will likely be swollen and painful. Rest, ice, and elevation can help reduce swelling in the first few days. Your doctor may also recommend a knee brace or splint and crutches to keep weight off the joint while it heals from the kneecap dislocation. ## Diagnosis and Imaging After a kneecap dislocation, an MRI is the best way to assess damage to the cartilage, ligaments (especially the MPFL), and bone — even if the patella has returned to its groove. X-rays alone can miss the soft-tissue injury that often accompanies a dislocation, so I always recommend an MRI in our practice. Even after a single kneecap dislocation, cartilage damage can occur, and the risk of future dislocations increases, especially in younger patients or those with certain anatomical risk factors. Learn more about patellar instability, including risk factors and treatment options. ## Treatment Options ### Non-Surgical Care For many first-time kneecap dislocations without significant cartilage or bone injury, non-surgical treatment — bracing followed by physical therapy — is the appropriate first step. This typically involves a very short period of immobilization in a brace or splint, followed by physical therapy to restore range of motion and strengthen the muscles around the knee. Early physical therapy is important for you to regain normal movement and be able to support the kneecap, helping to prevent future instability (and kneecap dislocations).  ### Surgical Care Surgery is generally considered when you have a high risk of recurrence, multiple kneecap dislocations, or imaging evidence of loose cartilage or bone fragments that could cause locking or further damage. Procedures may include reconstructing the medial patellofemoral ligament (MPFL), repairing or replacing the cartilage, or realigning the bones to better support the kneecap. The goal of these surgeries is to stabilize the knee joint, protect the cartilage, and reduce the risk of arthritis.  ## Recovery and Prevention Recovery from a kneecap dislocation typically takes 6–12 weeks for non-surgical cases and 4–6 months when MPFL reconstruction or related stabilization surgery is needed. Exact timelines vary depending on the severity of the injury, the presence of cartilage damage, and whether surgery is required. Read more about MPFL recovery timelines. Physical therapy is an important element of both surgical and non-surgical recovery, helping you regain strength, flexibility, and confidence in the stability of your knee. It’s important to follow your care team’s instructions closely and to avoid returning to high-risk activities until your knee is fully healed. ## When to Seek Further Help If you experience repeated dislocations, persistent pain, or a sense of instability in your knee, consult an orthopedic specialist promptly. Ongoing instability can lead to progressive cartilage damage and increase the risk of arthritis in the future. Key articles for further reading: - Patellar Instability - Patient Information - Patellar Pain and Patellar Arthritis - Patellofemoral Instability PDF If you’ve experienced a kneecap dislocation, timely evaluation and appropriate care are important ways to help you make a full recovery and protect your knee in the future. Photo by Keagan Henman on Unsplash. - arthritis, cartilage damage, dislocated patella, kneecap dislocation, Medial patellofemoral ligament, MPFL, MRI, non-surgical treatment, orthopedic specialist, patella, patellar instability, patellar reduction, Physical Therapy, recovery, surgical care ## Frequently Asked Questions How long does it take to recover from a kneecap dislocation?For first-time dislocations without major cartilage injury, most patients recover in 6 to 12 weeks with bracing and physical therapy. If MPFL reconstruction or another stabilization procedure is required, expect a 4 to 6 month recovery before returning to high-impact sports. The exact timeline depends on the severity of the injury, whether there is cartilage damage, and how consistently you complete physical therapy. Will my kneecap dislocate again after the first time?The risk of a second dislocation after a first-time kneecap dislocation is significant — published data suggests roughly 30 to 50%, with higher rates in teenagers and patients with anatomical risk factors like a shallow groove on the thigh bone or a high-riding kneecap. That is one of the reasons I always recommend an MRI and an in-person evaluation after a first dislocation, so we can identify whether early stabilization is warranted. Do I need surgery after a dislocated kneecap?Most first-time dislocations are managed without surgery. Surgery — most commonly MPFL reconstruction, sometimes combined with cartilage repair or a tibial tubercle osteotomy — is typically reserved for patients with multiple dislocations, loose cartilage or bone fragments on MRI, or significant anatomical risk factors. The goal of surgery is to stabilize the joint and protect the cartilage, not to chase a single event. Can I walk on a dislocated kneecap?Even after the kneecap has been put back in place, you should avoid putting full weight on the knee until you have been evaluated by a clinician. Most patients use crutches and a brace or knee immobilizer for the first few days while the swelling settles. Walking on an unstable knee with cartilage or ligament injury risks making the damage worse. What is the difference between a dislocation and a subluxation?A dislocation means the kneecap fully comes out of its groove; a subluxation means it partially shifts out and slips back in. Both are part of the kneecap instability spectrum and both deserve evaluation — subluxations can damage cartilage and can predict future full dislocations. Read more about telling whether your kneecap is slightly dislocated. ## Related Reading - Patellar instability (specialty page) - MPFL reconstruction surgery - How serious is a patella dislocation? - Can you fully recover from a dislocated patella? - Can urgent care treat a dislocated kneecap? - 3 anatomical factors linked to recurring dislocations ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousACL Surgery: Evolving Practices and Modern Graft Choices NextDo You Have Knee Pain?Next --- ## New CPT Code for CARTIHEAL AGILI-C | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/new-cpt-code-cartiheal-agili-c/ Summary: Cartiheal, a coral-based knee implant, now has a CPT code—making cutting-edge cartilage repair more accessible and likely to be covered by insurance. # New CPT Code for CARTIHEAL AGILI-C Procedures Approved Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 11, 2025 - December 11, 2025 While this press release from an orthopedic implant company may not seem important, since many patients don’t even know what a CPT code is, it’s actually very significant. New procedures are typically not covered by insurance companies, so when we try to get approval to perform these surgeries, we often hear back that the procedure has been denied as “investigational.” However, when an implant is given a CPT, or Common Procedural Terminology, code, the pathway for reimbursement becomes streamlined, increasing the likelihood that patients can actually receive state-of-the-art care. The CARTIHEAL AGILI-C Cartilage Repair Implant is made from coral and designed to treat cartilage defects of the knee. It can be used in patients with early arthritis. The implant received Breakthrough Device approval from the FDA over three years ago and has shown considerable promise in the 35 to 40 patients in whom I have used it so far. The American Medical Association (AMA) CPT Editorial Panel has established a Category I CPT code for procedures involving its CARTIHEAL AGILI-C Cartilage Repair Implant, effective January 1, 2027.  Read the Smith+Nephew press release: Smith+Nephew announces new category I CPT® code for its CARTIHEAL™ AGILI-C™ Cartilage Repair Implant. - Agili-C, breakthrough device, Cartiheal, cartilage defect treatment, Category I CPT, coral-based knee implant, CPT code, early knee arthritis, knee cartilage repair, orthopedic surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousMeasuring the Lateral Trochlear Inclination Angle NextCan Your Genes Predict an ACL Tear?Next --- ## New Technology in Orthopaedics - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/new-technology-in-orthopaedics/ Summary: The jury is still out as to whether or not an artificial meniscus can help patients suffering from knee pain after removing most or all of their meniscus. # New Technology in Orthopaedics Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - December 3, 2015 One of the most interesting things about being an orthopedic surgeon is new technology. Sometimes there are good innovations, and sometimes the new technology doesn’t work. In the case of a synthetic meniscus, the jury is still out as to whether or not an artificial meniscus can help patients suffering from knee pain after having surgery to remove most or all of their meniscus. The clinical trial mentioned in this news story is being conducted internationally in order to find out if relatively young patients can delay or avoid a knee replacement by inserting an artificial meniscus. Please note that this implant would be for patients who have not yet developed arthritis. Currently patients who have pain and early arthritis are treated with hyaluronic (gel) injections, physical therapy, and when this doesn’t work, I consider a bone realigning procedure to take the stress off the part of the knee with less meniscus and thinner articular cartilage.   ## Groundbreaking knee surgery eases pain with fast recovery | Health – WCVB Home A Brockton man is the first person in New England to undergo what could be a groundbreaking knee surgery, offered at Brigham and Women’s Hospital. Source: www.wcvb.com/health/groundbreaking-knee-surgery-eases-pain-with-fast-recovery/36732324     - Brigham and Women's Hospital, fast recovery, knee surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousThanksgiving Skiing NextYour Diet and Preparing for SurgeryNext --- ## NFL Injuries After COVID Stop Pro Sports - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/nfl-injuries-after-covid-stopped-professional-sports/ Summary: This study looked at 1370 NFL injuries in the year after COVID stopped professional sports. This is proof that getting in shape for your sport is important for all. # NFL Injuries After COVID Stopped Professional Sports Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - June 15, 2022 This study looked at 1370 NFL injuries in the year after COVID stopped professional sports.   It isn’t surprising to hear that: “The 2020-2021 NFL season had a significantly higher incidence of soft tissue injuries compared to the 2018-2019 regular NFL season, which may have been associated with the absent preseason due to the COVID-19 pandemic and an abrupt increase in the athletic workload of players.”   This is just further proof that getting in shape for your sport is important no matter who you are. Gifted athletes, such as those who play in the NFL, have proven their resilience and expertise — yet they still benefit from a rigorous preseason. I hope data like this will seep down to the high school and club coaches so that they implement strength and conditioning programs before their players start competing.   Read more in this Cureus article.  - athletes, conditioning programs, COVID, getting in shape, injuries, injury rates, NFL, NFL injuries, soft tissue injuries, strength training ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousMy first Bridge-Enhanced ACL Restoration (BEAR) Implant NextPaulette Gangemi: Back in the Game – Patella DislocationNext --- ## One Step Cartilage Repair with CARTIHEAL | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/one-step-cartilage-repair-cartiheal/ Summary: Dr. Sabrina Strickland and Dr. Andreas Gomoll discuss how CARTIHEAL AGILI-C has expanded their cartilage treatment algorithm. # One Step Cartilage Repair with CARTIHEAL: Multi-Compartment Pathology with Osteoarthritis Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: October 31, 2024 Quick Summary In this VuMedi conversation, Dr. Sabrina Strickland and Dr. Andreas Gomoll explain how the CARTIHEAL AGILI-C implant has expanded their cartilage treatment algorithm at Hospital for Special Surgery. AGILI-C lowers the threshold to treat narrow central trochlear lesions with bone edema, small symptomatic condyle defects, and multi-lesion defects with early arthritis — cases that previously had no good surgical option short of arthroplasty. - October 31, 2024 In this video on VuMedi, my husband, Andreas Gomoll, joined me in talking about CARTIHEAL. CARTIHEAL AGILI-C gives me a slightly lower threshold to treat certain defects, ones for which I didn’t have a great answer in the past. This includes: - A more narrow central trochlear, especially when there was significant bone edema - Smaller lesions on the condyles that were very symptomatic - Multi-lesion defects in a patient with some early arthritis that isn’t advanced enough to consider arthroplasty These defects are really well treated with CARTIHEAL. My patients are also most satisfied in these areas because they didn’t have any other surgical option in the past. This allows us to expand to treat a new patient population. For related context on how this fits into our broader cartilage protocol, see how AGILI-C compares with OCA and MACI and the new CPT code for CARTIHEAL AGILI-C. To learn more about the process, watch the video “One Step Cartilage Repair: Multi-Compartment Pathology with Osteoarthritis. ”  The image is a still from the video. - arthroplasty, bone edema, Cartiheal, cartilage repair, condyles, early arthritis, lesions, multi-compartment pathology, multi-lesion defects, narrow central trochlear, Osteoarthritis ## Frequently Asked Questions What is CARTIHEAL AGILI-C?CARTIHEAL AGILI-C is a single-stage cartilage and bone implant used to treat focal cartilage defects in the knee. It is placed during one operation rather than requiring a biopsy followed by a second implant surgery, which simplifies the patient experience compared with cell-based options. We use it for selected defects on the groove of the thigh bone (the trochlea) and the rounded surfaces at the bottom of the thigh bone (the femoral condyles). Which cartilage defects are best suited for AGILI-C?In our practice, AGILI-C is particularly useful for narrow central defects on the groove of the thigh bone with swelling in the underlying bone, smaller symptomatic defects on the rounded surfaces of the thigh bone, and multi-lesion defects in patients with some early arthritis — but not yet advanced enough to consider joint replacement. These categories of patients used to have very limited surgical options short of joint replacement. Has AGILI-C changed how you approach cartilage repair?Yes. It has lowered the threshold to offer surgery in cases where, in the past, we would have just observed or treated symptoms because there was no good answer. Patients in those previously-untreatable categories tend to be highly satisfied. That said, careful selection is still essential — alignment, defect size, and overall joint condition all still drive whether AGILI-C is the right choice. ## Related Reading - MACI cartilage repair - How does CartiHEAL compare to OCA, MACI? - Chondrofiller and cartilage repair - About Dr. Sabrina Strickland ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousTreating Patellar Chondral Lesions with Concomitant MACI, MPFL, and TTO NextIncreased Host Bone Marrow Edema as a Risk Factor for Osteochondral Allograft FailureNext --- ## Cartilage Repair: Targeting the Trochlea | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/one-step-cartilage-repair-trochlea/ Summary: In this video, Dr. Sabrina Strickland discusses using CARTIHEAL AGILI-C to treat trochlea lesions. # One Step Cartilage Repair: Targeting the Trochlea Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: July 18, 2025 - June 20, 2025 Dr. Sabrina Strickland discusses using CARTIHEAL AGILI-C to treat trochlea lesions. - CARTIHEAL AGILI-C, cartilage repair, lesions, one-step cartilage repair, Smith+Nephew, VUMEDI ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPrevious6 Exercises You Should Do With a Torn Meniscus NextCost-Effectiveness of ACL Reconstruction with LET AugmentationNext --- ## Opioids after ACL Surgery | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/opioids-after-acl-surgery/ Summary: In the 90 # Opioids after ACL Surgery Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: April 4, 2024 - April 4, 2024 Many of us have watched the TV series Dopesick and have been impacted in one way or another by the opioid epidemic. I was a resident in the 1990s when pain was considered a vital sign and it was considered malpractice to not prescribe tremendous amounts of narcotics. Fast forward 20 years and many pharmacies flat out refuse to fill opioid prescriptions for patients. This study showed that ACL patients really only need a few doses of narcotics after surgery. Indeed, 83% of the patients prescribed 15 tablets felt that they had enough or too many. We will continue to fine tune how we treat post-operative patients as patients have different tolerances to narcotic pain medications. Studies such as this are quite helpful to practice. Read the Healio article: Lower opioid quantity did not impact pain control, satisfaction after ACL reconstruction Photo source: free public domain CCO image.    - ACL, ACL reconstruction, ACL surgery, addiction, IKDC scores, medical providers, morphine milligram equivalents, opioids, oxycodone, pain, pain control, pain medication, patient satisfaction, postoperative pain control, prescriptions, VAS scores ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousFocus on Pickleball Benefits NextRisk Factor for Osteochondral Allograft FailureNext --- ## Opt-out Preferences | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/opt-out-preferences/ Summary: Opt-out preferences describe a model where you must take action to stop the collection, use, or sharing of your personal information. Set your opt-out preferences here. Review your opt-out preferences. We believe in giving you control over your personal data. Here, you can easily manage your opt-out preferences and opt out of various data uses, helping us tailor your experience while respecting your privacy. 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Contact details For questions and/or comments about our Cookie Policy and this statement, please contact us by using the following contact details: Dr. Sabrina Strickland NYU Langone Orthopedic Center 333 East 38th Street, 4th Floor New York, NY 10016 United States Website: Phone number: 9782352556 This Cookie Policy was synchronized with cookiedatabase.org on February 20, 2026. Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you'd like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointmentContact the office Medical Disclaimer This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. --- ## Do ACLs heal faster with plasma? - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/orthobiologics-study-can-acls-heal-faster-using-platelet-rich-plasma/ Summary: A relatively small study suggests we may be able to get ACLs to heal faster by using platelet rich plasma (PRP). Can ACLs heal faster using platelet rich plasma? # Orthobiologics – study: Can ACLs heal faster using platelet rich plasma? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - February 10, 2022 Here’s a relatively small study that suggests that we may be able to get ACLs to heal faster by using platelet rich plasma (PRP). While we commonly use PRP in the clinic, insurance has yet to pay for it, so that it remains an out of pocket expense for patients. I’m interested to see how we can improve healing with orthobiologics such as PRP and bone marrow aspirate. Read the study on this orthobiologics approach. - bone marrow aspirate, healing, Hospital for Special Surgery, HSS, insurance, orthobiologics, out of pocket expenses, platelet rich plasma, PRP ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousGreat to See Miami Marathon Runners Back in Action NextResearch on potential cures for arthritis — green tea & gallnutsNext --- ## Orthopedic Surgery, Long Term Opioid Use - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/orthopedic-surgery-patients-become-long-term-opioid-users/ Summary: According to a study in the orthopaedic journal, JBJS, 5.3% of patients who underwent orthopedic surgery were still taking narcotics one year after surgery. # Orthopedic Surgery Patients Become Long Term Opioid Users? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - April 30, 2020 According to a study in the orthopaedic journal, JBJS, 5.3% of patients who underwent orthopedic surgery were still taking narcotics one year after surgery. These are patients who were not chronic opiate users before surgery. The highest rates were found after revision spine surgery. In an accompanying editorial, “Does Orthopaedic Surgery Often Cause New Chronic Opioid Use? (https://bit.ly/2Ys4ZQ5)” Jacques T. YaDeau, M.D., Ph.D., who is an anesthesiologist at HSS, wrote that this study should have an impact on the informed consent process. Certainly, we have started to talk to patients a lot more about the risks of taking pain medicine for a prolonged period. I do think for high-risk procedures we should alert patients before surgery for a better possible outcome. Managing pain is complicated. As doctors, we don’t like to see patients in pain, and we were trained to give medication to reduce pain. The crisis in America of drug addiction has led to being very restrictive in how many pills are prescribed and how often. However, we need more research to find out which patients are at the highest risk and programs to alleviate their pain without prolonged medication. Read the article. - blog, opioid, orthopedics, surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousCOVID-19 Update NextEmbracing Winter Wellness Outdoors – The Westport LibraryNext --- ## The Key to Preventing Osteoarthritis? Dr. Sabrina Strickland Source: https://sabrinastrickland.com/osteoarthritis-could-researchers-have-found-the-key-to-prevention/ Summary: Patients ask me how they can prevent, slow down, or reverse the damages caused by osteoarthritis. We do research on how to stop the breakdown of cartilage in joints. # Osteoarthritis: Could researchers have found the key to prevention? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: October 31, 2024 - March 21, 2018 Patients ask me daily what they can do to prevent, slow down, or reverse the damages caused by Osteoarthritis. As we learn more and more about what contributes to the breakdown of cartilage in joints, we also develop new ways to halt and prevent damage. Unfortunately, some types of arthritis are genetic, but that doesn’t stop further research on how to stop the mechanisms of degeneration! Similarly in patient’s who suffer from traumatic injuries, there’s also a growing need for novel drugs or treatments that prevent their joints from failing at a later date. This article summarizes a study done at the Scripps Institute in San Diego, California, where they identified a protein, FoxO, associated with cartilage health and disease. If this protein could be boosted in certain patients or in certain joints, arthritis could potentially be slowed or eliminated. ARTICLE: READ MORE - knee pain, Osteoarthritis, prevention ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousTrain like an Olympian NextWhy women’s ice hockey has a higher concussion rate than footballNext --- ## Osteoporosis and Broken Bones | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/osteoporosis-and-broken-bones/ Summary: Source: www.huffingtonpost.com/barbara-hannah-grufferman/bone-fractures-after-50_b_7248374.html # Osteoporosis and Broken Bones Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: March 9, 2023 - July 24, 2015 The media has done a great job teaching our population, especially women, to worry about breast cancer and heart disease, but I’m not sure they have done enough to get us to worry about our bones. I don’t take care of broken bones very often these days, but I do try to tell as many of my patients as possible to worry about their bone health. I tell them that they start losing bone at age 30, so they should be doing everything in their power to keep it, which means calcium and vitamin D and weight bearing exercise. Hopefully we avoid a fracture in the first place, but if you suffer from a low energy fracture defined as a fracture from falling from a standing height or essentially any broken bone that occurs without a significant trauma, then you need to have a work up looking for risk factors for osteoporosis or osteopenia. This article discusses the fact that hospitals and doctors in general have a very poor track record of diagnosing and treating weak bones. Part of the reason for this is that doctors and hospital workers are not trained in what to include in the work up following a fracture, and how to properly treat patients with weak bones. We know to worry about smokers and lung cancer. But a broken wrist is much more likely to predict a broken hip, and in most cases it gets treated and then ignored without further evaluation and treatment to prevent the next broken bone.   ## So You Broke A Bone . . . Now What? Source: www.huffingtonpost.com/barbara-hannah-grufferman/bone-fractures-after-50_b_7248374.html   - Bone Health, Broken Bones, Osteoperosis ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousProud to Work at the Hospital for Special Surgery NextWorking and MotherhoodNext --- ## Good Outcomes with Cartilage Restoration - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/outcomes-cartilage-restoration-procedures/ Summary: This study evaluated the outcomes, survivorship, and complications following multi-surface cartilage restoration procedures at minimum 2-year follow-up. # Good Outcomes with Cartilage Restoration Procedures Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - November 9, 2023 Treatment of young patients with multiple cartilage lesions is difficult. I did this study to look at how patients actually did with multiple cartilage transplants because this is somewhat of a controversial topic. I wanted to know the outcomes of cartilage restoration procedures to evaluate what makes the most sense for treating these young patients.  Moreover, insurance companies often refuse to approve surgery when there is more than one cartilage defect. It is unfair for young patients to be denied surgery and told to wait till they get old enough for a knee replacement. ## Investigate Outcomes The objective of this research was to evaluate the outcomes, survivorship, and complications following multi-surface cartilage restoration procedures at minimum 2-year follow-up. ## Cartilage Restoration Procedures “Cartilage restoration procedures, including osteochondral allograft (OCA) transplantation, autologous chondrocyte implantation (ACI), and osteochondral autograft transfer (OATS), have become more prevalent in the United States over the past 2 decades. Given the growing popularity of the aforementioned procedures, the rate of development of novel cartilage restoration techniques continues to increase. However, despite numerous recent advances in the field of cartilage restoration, the short-term, midterm, and long-term results of these procedures remain mixed in the literature.“ “Although the incidence of multi-surface grade-IV chondral or osteochondral defects about the knee has yet to be elucidated, it is not uncommon for patients to present with grade-IV chondral or osteochondral defects on multiple surfaces of a joint, particularly in joints such as the knee, that experience high loads during weight-bearing. These lesions can be severely debilitating, and patients with focal chondral defects can have an impairment in their quality of life to the same degree as a patient with end-stage knee osteoarthritis.6 Young patients with multi-surface grade-IV chondral or osteochondral defects pose a particular challenge to surgeons. The decision must be made to either proceed with partial or total knee arthroplasty, which has numerous disadvantages in this population, or consider multi-surface cartilage restoration procedures.” Read the full research article in Sage Journals: Multi-Surface Cartilage Defects about the Knee Treated with Cartilage Restoration Procedures Show Good Outcomes and Survivorship at Minimum 2-Year Follow-Up Photo by Jeffrey F Lin on Unsplash - articulated juvenile cartilage implantation, Cartilage Restoration Procedures, DeNovo, grade IV chondral, MACI, MACI/DeNovo procedures, minimum 2-year follow-up, Multi-Surface Cartilage Defects, multiple-surface OCAT, OCAT, osteochondral defects, outcomes, single-surface osteochondral allograft transplantation, Survivorship, third-generation matrix-induced autologous cultured chondrocyte implantation ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousThe Ortho Show – Dr. Sabrina Strickland – Orthopedic Surgeon, Sports Med Specialist, and Patellofemoral Joint Expert NextDual Tibial Osteotomy Surgeries to Get Back to LifeguardingNext --- ## Cartilage Damage: Patella Alta Patients - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/patella-alta-patients-cartilage-damage/ Summary: In this study, done at the Rothman Institute, they compared the amount of cartilage damage in patients undergoing patellar realignment surgery. # Patella Alta Patients May Experience Less Severe Cartilage Damage after Instability Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - October 12, 2023 Patella alta is when the patella sits higher than normal. This often lead to arthritis and is a risk factor for patellar instability. In this study (done at the Rothman Orthopaedic Institute), they compared the amount of cartilage damage in patients undergoing patellar realignment surgery.   They found less damage in patients with patella alta than in those with patellas sitting at a normal height. While this is interesting, it doesn’t help us make decisions. That is, I wouldn’t suggest to a patient to treat their patellar instability non-operatively just because they have patella alta. Nor would I recommend that patients with normal alignment be treated for a first time dislocation more aggressively.   The best approach is to assess all risk factors for recurrence and recommend surgery early enough to avoid cartilage damage.   Read the complete study on Healio: Patients with patella alta may experience less severe cartilage damage after instability. - cartilage damage, full thickness defects, instability, normal patella, patella alta, patella norma, patellar height, patellar instability ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousTreating Patellofemoral Arthritis & Patellar Instability NextBowling after Biceps Rupture/Biceps TearNext --- ## Patellar Attachment Healing Post Surgery | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/patellar-attachment-healing-post-surgery/ Summary: This study looked at where the patellar attachment healing actually occurs after surgery for patients who have patella alta or high patellas. # Patellar Attachment Healing Post Surgery Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: April 25, 2024 - April 25, 2024 This study looked at where the patellar attachment healing actually occurs after surgery for patients who have patella alta or high patellas. We assessed on MRI where the attachment site of the distal aspect of the patellar tendon attached and found that it healed closer to the knee joint, which is exactly what we were hoping for. Reducing the effective length of the tendon means that there is less excursion of the patella and hopefully this results in greater stability. Read more in the Orthopaedic Journal of Sports Medicine: Decreased Effective Patellar Tendon Length following Distalization Tibial Tubercle Osteotomy without Patellar Tendon Tenodesis Image source: Wikimedia Commons: PatellaAlta XRay B.png - cartilage lesions, Distalization, distalization tibial tubercle osteotomy, Distalization TTO, improved radiographic outcomes, osteotomy, patella alta, patellar tendon tenodesis, patellofemoral cartilage stresses, patellofemoral instability, patellofemoral pathology, patient-reported outcome measures, tibial tubercle osteotomy ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousDouble Partial Knee Replacements Get Patient Back in the Game NextMOCART Scores > 55 at 6 Months Post-op ACI & Patient SatisfactionNext --- ## A Patellar Instability Infographic | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/patellar-instability-infographic/ Summary: I draw pictures daily for patients and explain the patellofemoral joint instability risk factors; this patellar instability infographic is available for everyone. # A Useful Patellar Instability Infographic for Everyone Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: March 7, 2024 - March 7, 2024 Recently, I came across this excellent infographic and description of anatomic risk factors for patellofemoral joint instability in Cureus. I spend all day drawing pictures for patients and explaining the risk factors for patellar instability. It’s complicated, that’s for sure! When it comes to sorting out which surgery is required for patellar instability, it comes down to how significant a patient’s anatomic pathology is and what is easily modifiable. Here are a few things to keep in mind:  1. The MPFL is always torn or stretched after a patellar dislocation, so if a patient requires surgery then we reconstruct the MPFL. 2. For patients with elevated TTTG or lateralized tibial tubercles, we consider a tibial tubercle osteotomy to realign the extensor mechanism. 3. Many of these patients suffer from patella alta, which increases the contact stress on the inferior patella and proximal fat pad. This also may lead to patellar instability as the patients must flex their knee more in order to engage the patella in the trochlear groove. In these patients, we may need to distalize or move the patellar tendon attachment more distal in order to change the contact forces or increase the arc of motion in which the patella sits in the trochlear grove. 4. Some patients suffer from severe trochlear dysplasia in which the front of their knee has significant pathology or malformation of the bone. Occasionally, these patient may benefit from trocheoplasty to reshape the groove, which is a difficult surgery fraught with complications. It ultimately results in a “square peg in a round hole” as one doesn’t reshape the patella. This is a complicated issue and it takes a lot of thought to sort out these problems. Take a look at the article and accompanying infographic to get more detail: Anatomic Risk Factors for Patellofemoral Joint Instability: An Infographic as a Visual Learning Tool. The header image is a clip of the full infographic to give you an idea of what it looks like, but you really should check out the full image.     - anatomic risk factors, Cureus, infographic, lateralized tibial tubercles, Medial Patellofemoral Ligament Reconstruction, MPFL, patella alta, patellar instability, patellofemoral joint instability, tibial tubercle osteotomy, trochlear displasia, visual learning tool ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWiberg Patellar Type Impact on Outcomes and Survival NextWhy ACL Tears Are So DevastatingNext --- ## Patellar Instability Modified Delphi Consensus | Dr. Strickland Source: https://sabrinastrickland.com/patellar-instability-modified-delphi-consensus/ Summary: I was part of this modified Delphi consensus statement, which showed consensus on patellar instability treatment and the success of surgical treatment options # Patellar Instability Modified Delphi Consensus Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: February 1, 2024 - January 3, 2024 I was part of this Delphi consensus statement, which endeavored to come up with a consensus of treatment of patellar instability. When I finished my fellowship in 2002, I was taught that most cases of patellar instability could and should be treated with physical therapy. We have learned over the past 21 years that this is not the case, as we have surgical options for the vast majority of patients suffering from patellar instability or unstable knee caps. ## Modified Delphi Consensus Statement  Check out the research here, which was published in two parts in The Bone & Joint Journal: A modified Delphi consensus statement on patellar instability: part I: https://boneandjoint.org.uk/article/10.1302/0301-620X.105B12.BJJ-2023-0109.R1 A modified Delphi consensus statement on patellar instability: part II: https://boneandjoint.org.uk/article/10.1302/0301-620X.105B12.BJJ-2023-0110.R1 - Delphi consensus statement, Medial Patellofemoral Ligament Reconstruction, Modified Delphi Consensus, patellar instability, Physical Therapy, rehabilitation, return to sport, surgical options, The Bone & Joint Journal, tibial tubercle osteotomy, trochleoplasty, unstable knee caps ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousKnee Surgery Scars & Minimally Invasive Surgery NextStudy on Medial Meniscus Posterior Root TearsNext --- ## Patellar Resurfacing in Knee Replacement: 20-Year Results | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/patellar-resurfacing-total-knee-replacement-20-year-results/ Summary: A 20-year Lancet trial reports on whether resurfacing the patella during a knee replacement is worthwhile. Dr. Sabrina Strickland on what the results show. # Patellar Resurfacing in Total Knee Replacement: 20-Year Results Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: August 25, 2026 - August 25, 2026 This interesting study published in the Lancet they report on the 20 year clinical and economic results of a large multicenter trial. What they looked at is whether or not it was worthwhile to resurface the patella when doing a knee replacement. As a surgeon who takes care of a lot of patellofemoral issues I’ve always favored resurfacing the patella, but it’s good to see this large study supporting my experience. Many patients who suffer from knee osteoarthritis have disease that also affects the patella and in my patients this percentage is quite high. According to this study patella resurfacing produced more quality adjusted life years. Read the study: - Patellar resurfacing in total knee replacement: 20-year clinical and economic results of a large multicentre, randomised controlled trial in the UK — Murray DW, Hudson J, Dakin H, et al. The Lancet, 2026. doi:10.1016/S0140-6736(26)00652-5   ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousSquats With Bands: Keeping Weight Off the Kneecaps NextAnterior Knee Pain: Why “Runner’s Knee” Isn’t a Real DiagnosisNext --- ## Patellofemoral Arthroplasty Conversion - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/patellofemoral-arthroplasty-conversion-to-total-knee-arthroplasty/ Summary: Studying a clinical correlation to look at high rates of infection after conversion of patellofemoral arthroplasty (PFA) to total knee arthroplasty (TKA). # Updated: Patellofemoral Arthroplasty Conversion to Total Knee Arthroplasty Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - June 19, 2023 I recently participated in a study to perform a retrieval analysis with clinical correlation to look at high rates of infection after conversion of patellofemoral arthroplasty (PFA) to total knee arthroplasty (TKA) seen in an earlier study. That study was limited by a small sample size, so analyzing it on an expanded group of patients provided more information. We used the following method: A retrospective review of an implant retrieval registry identified 62 conversions of PFA to TKA between 2004-2021. Implants were analyzed for wear pattern and cement fixation. Patient charts were reviewed for demographic information, perioperative data, prior and subsequent surgical procedures, complications and outcomes. Radiographs performed prior to index PFA and conversion procedures were assessed for KL grading. We concluded that the most common reason for PFA conversion to TKA was progression of osteoarthritis. PFA conversion to TKA is technically similar to primary TKA, but complication rates are more consistent with revision TKA in this study. Read more about the results. - arthroplasty, complications, conversion, Hospital for Special Surgery, HSS, implants, knee, orthopaedic surgery, patellofemoral, patellofemoral arthroplasty, Patellofemoral Arthroplasty Conversion, PFA, research, study, TKA, Total Knee Arthroplasty ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousCardio at the movies: CNN Staying Well NextTibial Tubercle Osteotomy With Distalization for the Treatment of Patella AltaNext --- ## Patellofemoral Arthroplasty Takeaways - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/patellofemoral-arthroplasty/ Summary: Studying a clinical correlation to look at high rates of infection after conversion of patellofemoral arthroplasty (PFA) to total knee arthroplasty (TKA). # Takeaways from Years of Patellofemoral Arthroplasty Experience Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - January 10, 2023 This article discussed outcomes of patellofemoral arthroplasty, which is one type of partial knee replacement. When I first started doing this type of surgery it was very rare. I had never seen one done in residency or fellowship. The reason I became interested in it was that a new generation of implants had been introduced. The old implants required a lot of freehand cutting (not very reproducible), a short implant so some patients would feel their kneecap slip off the implant, and a higher complication rate. The new implants, however, aimed to make the surgery more reliable with implants that better reproduced the patient’s own anatomy. I found this study lacking in that they only had 45 patients (and this included several surgeons over several years). I do more than fifty of these surgeries a year and therefore when I look at my results, I think that I can draw more concrete observations. Over the years, I have learned a lot about how to optimize this surgery. For example, I rarely do a standard medial approach, because most of these patients are lateral patellar trackers and benefit from a lateral lengthening approach (rather than a lateral release). Furthermore, I typically get a MRI on all patients to make sure that I can see early arthritis in their medial or lateral compartment. I do that so I can (hopefully) minimize the risk of revision to total knee arthroplasty after patellofemoral replacement due to progressive knee arthritis.  There is no perfect operation, but for many patients with patellofemoral arthritis, I think patellofemoral arthroplasty is a pretty good option. Read the original Cureus article: “Functional Outcomes, Survival Rate, and Complications of Patellofemoral Arthroplasty: Mid-Term Results From Independent Center.“ Image source: X-ray of severe patellofemoral osteoarthritis via https://commons.wikimedia.org/wiki/File:Patellofemoral_Osteoarthritis_Severe.jpg , via Wikimedia Commons - Hospital for Special Surgery, HSS, knee pain, lateral lengthening approach, lateral patellar trackers, lateral release, partial knee replacement, patellofemoral arthroplasty, standard medial approach ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousAnteromedialization Tibial Tubercle Osteotomy Improves Patellar Contact Forces: A Cadaveric Model of Patellofemoral Dysplasia NextReturning to Climbing After an ACL TearNext --- ## Patellofemoral Joint Contact Forces after ACL Reconstruction Source: https://sabrinastrickland.com/patellofemoral-joint-contact-forces-acl-reconstruction/ Summary: Study on patellofemoral joint contact forces shows even patients who appear strong after recovering from ACL surgery still have deficient quadriceps strength. # Study Shows Differences in Patellofemoral Joint Contact Forces after ACL Reconstruction Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - September 22, 2023 We know that patients are more likely to develop patellofemoral or anterior knee cartilage disease after ACL surgery. Here is a study showing that even in patients who appear to be strong after recovering from ACL surgery, they still have very deficient quadriceps strength. It found differences in patellofemoral joint contact forces after ACL reconstruction. ## Takeaways from study of patellofemoral joint contact forces after ACL reconstruction: - Patients with return to sport clearance exhibited low patellofemoral joint contact force - Contralateral and control groups exhibited higher patellofemoral joint contact forces “Quadriceps force, as measured in terms of body weight, at the time of peak patellofemoral joint contact force was 10.9 in the ACL reconstruction group, 15.1 in the contralateral group and 13.7 in the control group.” I recommend that all my patients use blood flow restriction at physical therapy to improve their strength after knee surgery. We need more research to learn how to prevent arthritis in these patients and optimize strength and function. Read more about this study on  in this Healio article about the study that found differences in patellofemoral joint contact forces after ACL reconstruction. - ACL reconstruction, Patellofemoral Joint Contact Forces, rehabilitation, research, return to sport, study ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousKnock Knee Surgery — And Valerie Bridges is Back in the Game NextEstablishing MDC Thresholds After Patellofemoral Joint ArthroplastyNext --- ## Early Osteoarthritis after ACL Reco - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/patellofemoral-joint-loading-early-osteoarthritis-after-acl-reconstruction/ Summary: For young adults, lower patellofemoral joint (PFJ) loading is associated with an increased likelihood of early PFJ osteoarthritis at one year after ACL reconstruct # Patellofemoral Joint Loading, Early Osteoarthritis after ACL Reconstruction Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - March 9, 2023 ACL injury is a catastrophic injury for any athlete, but the long term complications are especially worrisome. I see many athletes 5-10 years after ACL surgery who now present with early arthritis. Research assessing which patients are at higher risk for arthritis can potentially help develop protocols to decrease the risk of arthritis. This study shows that patients who have lower loads across the knee joint are at higher risk of patellofemoral or anterior knee arthritis. In this study, they found “altered PFJ loading during a standardized forward hopping task” in some ACL patients. Furthermore, according to this study: “Monitoring indices of PFJ loading during relevant functional tasks as early as possible after ACLR might represent an opportunity to identify those at greatest risk of developing end-stage PFJOA.” Read the article in Physician’s Weekly. Image source: https://en.wikipedia.org/wiki/File:Osteoarthritis_left_knee.jpg   - ACL reconstruction, ACLR, anterior cruciate ligament reconstruction, early osteoarthritis, Journal of Orthopaedic Research, lower patellofemoral joint, patellofemoral joint loading, PFJ ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHow Acton-Boxborough Coach Helps Players Recover from ACL Tears NextRunning and Knee Stress: Systematic Cartilage ChangesNext --- ## Paulette Gangemi: Patella Dislocation - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/paulette-gangemi-back-in-the-game-patella-dislocation/ Summary: Paulette Gangem had a patella dislocation and a lifetime of knee problems starting with a patella dislocation at age 14. Read her Back in the Game story now. # Paulette Gangemi: Back in the Game – Patella Dislocation Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - June 23, 2022 I have had a lifetime of knee problems starting with a patella dislocation at age 14. In spite of repeated dislocations and unsuccessful surgeries I still managed to ski race in college in Vermont, Rock Climb, Backpack and competitive cycle and mountain bike. Recently in the past 5 years, as I approached 40 years old I noticed I was unable to do basic life activities and athletics. It was a slow progression to inactivity and very upsetting. Other orthopedic surgeons told me to “stop all activity to preserve the joint” and I was truly at a low point. I was planning on training to become a volunteer ski patroller at a local mountain in PA and after seeing non-HSS physicians this goal seemed so far past my capabilities I had almost given up hope. I decided I was going to do everything possible to remain as active as I could, so I started researching HSS. (Best reputation in the world for Orthopedics, so I thought why not, I have nothing to lose) I made a list of qualities I wanted in a doctor. I preferred a female surgeon, because I felt they may understand my situation better, I wanted a doctor who skied and understood the “skiing culture” and a doctor who went to a top university and specialized in knee instability. Honestly, I had low hopes of finding anyone who fit that description, until I read Sabrina Strickland’s profile. Read Paulette Gangemi’s Back in the Game story about her patella dislocation. - back in the game, cartilage, dislocated knee, Hospital for Special Surgery, HSS, injury, knee injury, MPFL reconstruction, patella dislocation, sports surgery, women's sports, women's sports surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousNFL Injuries After COVID Stopped Professional Sports NextTibial Tublercle Osteotomy or Tibial Tubercle TransferNext --- ## JUPITER Study Pediatric MPFL Reconstruction | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/pediatric-mpfl-reconstruction-jupiter-study/ Summary: JUPITER study finds pediatric MPFL reconstruction techniques vary widely, with differences in graft, fixation, and practices among experienced surgeons. # High Variation in Pediatric MPFL Reconstruction: Insights from the JUPITER Study Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: September 5, 2025 - September 5, 2025 Treating patellofemoral instability (PFI) in children and adolescents remains a challenge given the lack of clear clinical guidelines, especially when it comes to surgical intervention. Recent research from the JUPITER study analyzed surgeries performed between 2016 and 2021 and highlights that, even among 20 high-volume orthopedic surgeons across 13 academic centers, substantial variation persists in how MPFL reconstruction is performed in skeletally immature patients. Among 245 qualifying knee surgeries in the JUPITER study, there were large discrepancies in tendon graft selection (59% allograft vs. 41% autograft), methods of patellar fixation (62% suture anchor, 32% bone bridge/tunnel), and femoral fixation strategies (76% screw, 23% suture anchor). Every case utilized fluoroscopic guidance and bone-sparing principles to protect the growing skeleton, while a minority included additional procedures, such as lateral release or fracture treatment. The JUPITER study is a general survey of the different ways that surgeons perform MPFL surgery. I don’t think it will change the way surgeons do surgery, but it is interesting to see how different surgeons practice. The findings reinforce that, despite common goals and similar patient populations, specific surgical decisions remain highly individualized among experts. Read the study in the Orthopaedic Journal of Sports Medicine: Variation in Surgical Technique for Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients: Data From the JUPITER Prospective Multicenter Study Group   - adjunctive procedures, allograft, autograft, femoral fixation, JUPITER study, Medial Patellofemoral Ligament Reconstruction, MPFL, orthopedic surgery, patellar fixation, patellofemoral instability, pediatric knee surgery, skeletally immature patients, surgical technique variation, tendon graft type ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousBridge Registry: What the First 100 BEAR Patients Teach Us NextHow to Tell If Your MPFL Reconstruction FailedNext --- ## Peyton's Tibial Tubercle Osteotomy | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/peytons-tibial-tubercle-osteotomy/ Summary: Watch Peyton # Peyton’s Tibial Tubercle Osteotomy Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: June 6, 2024 - June 6, 2024 Quick Summary Peyton was a lifelong dancer born with patella alta — kneecaps that sat too high, transferring stress through her patellar tendon and fat pad instead of the joint. Physical therapy could not resolve it. Dr. Sabrina Strickland performed a tibial tubercle osteotomy with distalization, moving the kneecap downward to offload the tendon. Peyton returned to dance pain-free. People frequently comment on my videos about how helpful it is to see someone else’s story. This is the story of Peyton, who was a dancer from age four on. Her injury was fairly unusual – she was born with her knee caps too high, so the stress was going through the top of her patellar tendon and her fat pad instead of through her knee cap. This meant we really had to do an operation to fix it – it wouldn’t heal on its own or with physical therapy. So we did a tibial tubercle osteotomy and I distalized it, moving her kneecap down to take the stress off her patellar tendon and fat pad. She’s done amazingly well, which is really important – but it’s also important for others to see that they don’t have to be in pain and they can get back to doing what they love. For more on the underlying condition, see our overview of patellar instability and the related joint preservation osteotomy service. Watch Peyton’s story. You can also read Peyton’s full success story with photos and recovery details. - dancer, Distalization, fat pad, knee cap, patellar tendon, tibial tubercle osteotomy ## Frequently Asked Questions What is patella alta?Patella alta is a condition where the kneecap sits higher than normal on the thigh bone. In Peyton's case, this anatomical pattern was present from birth and meant the stress of dancing was carried through the upper kneecap tendon and fat pad, rather than spread through the joint. Front-of-knee pain that persists despite physical therapy is a common consequence. Why didn't physical therapy resolve Peyton's pain?Physical therapy can strengthen the muscles around the kneecap, but it cannot change the underlying bony anatomy. Because Peyton's pain came from the kneecap sitting too high — a structural problem — strengthening alone could not redirect the load away from the kneecap tendon. In situations like this, surgically correcting the position of the bony bump on the front of the shinbone (the tibial tubercle) is the only way to durably take pressure off the tendon. What does a tibial tubercle osteotomy with distalization do?The tibial tubercle is the bony bump on the front of the shinbone where the kneecap tendon attaches. In a distalization, the bump is detached, moved downward, and re-fixed with screws. That brings the kneecap into a more normal height, which redistributes the load away from the upper kneecap tendon and the fat pad and into the joint surfaces designed to handle it. ## Related Reading - Patellar instability - Joint preservation osteotomy - TTO with distalization for patella alta - About Dr. Sabrina Strickland ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousMedial Patellofemoral Ligament Reconstruction Questions NextFDA Trial: HYALEX® Knee Cartilage SystemNext --- ## Elite Athletes on the Toll of ACL Injury - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/physio-profiles-13-elite-athletes-to-explore-the-physical-and-mental-toll-of-acl-injuries/ Summary: An Australian physiotherapist who treats sports injuries interviewed 13 elite athletes after their ACL injury and surgery to explore recovering from ACL injury. # Physio profiles 13 elite athletes to explore the physical and mental toll of ACL injuries Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - December 6, 2022 It’s hard to believe that someone wrote a whole book about recovering from ACL injuries. However, as anyone familiar with this injury knows, it is a devastating injury whether you are 14 or 44. The author of  the book: “Pop, When sports brings us to our knees” is an Australian physiotherapist who treats sports injuries. She interviewed 13 athletes after their ACL injury and surgery and states:  “If it’s done well with your rehab, you can still be surrounded by your team and have all that support, but definitely, the mental side of it is huge because it’s such a long injury, and it takes you away from what you love for a year if you have surgery.”  Read the article about Jess Cunningham’s book.  - ACL, ACL injuries, ACL injury, ACL surgery, athlete, athletes, Australia, book, elite athletes, Hospital for Special Surgery, HSS, knee pain, orthopaedic surgery, physiotherapist, sports, sports injuries ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousAnteromedialization Tibial Tubercle Osteotomy Improves Patellar Contact Forces: A Cadaveric Model of Patellofemoral Dysplasia NextBEAR Implants in the NewsNext --- ## Podcast on Patellofemoral Instability | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/podcase-patellofemoral-instability-cartilage-lesions/ Summary: In this episode of the Braun Performance & Rehab Podcast, Dr. Sabrina Strickland and Dr. Andreas Gomoll join Dan to discuss the patellofemoral joint in detail. # Podcast: Patellofemoral Instability & Cartilage Lesions Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: February 13, 2025 - December 30, 2024 In this episode of the Braun Performance & Rehab Podcast, Dr. Andreas Gomoll and I joined Dan Braun to discuss cartilage lesions and the patellofemoral joint in detail, with considerations to instability, cartilage defects, and more. Listen to this episode of the BraunPR podcast now. - anatomy, Andreas Gomoll, biomechanics, diagnosis, dislocation, Exercise, femoral groove, healthcare, joint health, knee injuries, knee instability, knee pain, medical education, musculoskeletal health, orthopaedic surgery, orthopedics, patella, patellofemoral instability, Physical Therapy, podcast, recovery, rehabilitation, Sabrina Strickland, sports injuries, sports medicine, subluxation, surgery, treatment ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousEvaluating Patellar Dislocation via the Femoral Anteversion Angle NextExercise, Pain, & the Meaning of Creaky KneesNext --- ## BTB Grafts for ACL Reconstruction - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/potential-complications-with-btb-patellar-tendon-grafts-for-acl-reconstruction/ Summary: One of the complications I see occasionally with BTB (patellar tendon) grafts for ACL reconstruction is scarring of the patellar tendon and resulting patella baja. # Potential complications with BTB (patellar tendon) grafts for ACL reconstruction Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - March 10, 2022 One of the complications I see occasionally with BTB (patellar tendon) grafts for ACL reconstruction is scarring of the patellar tendon and resulting patella baja. This can lead to quad weakness, anterior knee pain and limited knee range of motion. Furthermore, it is really hard to treat. This small study showed very minimal lowering of the patella after BTB ACL surgery and did not correlate size of the graft harvested with post-operative x-ray changes. I think it would take thousands of patients to really assess this phenomena. Read the study: Changes in patellar height after anatomical ACL reconstruction with BTB autograft with a focus on patellar tendon removal volume. - ACL ACL surgery, ACL reconstruction, anterior knee pain, BTB, BTB ACL, BTB ACL surgery, BTB grafts, Hospital for Special Surgery, HSS, limited knee range of motion, patella baja, patellar tendon, patellar tendon grafts, women surgeons ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousInvestigating Amniotic Suspension Allograft injections NextBrenda Yee — medial meniscus tear and arthroscopic repairNext --- ## Predicting the SB Based on Injury Score? - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/predicting-super-bowl-njury-score/ Summary: If it was easy to predict a Super Bowl win based on the injury score of a team, doctors would be betting on the game outcome and winning. # Predicting the Super Bowl Based on Injury Score? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - February 19, 2021 It is interesting that reporters try to predict a Super Bowl win based on the injury score of a team. Clearly, if it was this easy, doctors would be betting on the game outcome and winning. As far as I know, however, no sports doctor is retiring based on their Super Bowl predictions. There is so much variation in the degree of injury for a specific diagnosis and how quickly a player can rehab and return to play. As an example, let’s discuss the meniscal surgery that kept one of the Kansas Chiefs, Willie Gay, out of the Super Bowl. Surgery for a meniscal tear could be a 15 minute meniscectomy with a very quick (2-6 week recovery) – or it could be a meniscal repair, where we sew the meniscus, limit post-operative weight bearing, and rehab the knee for 4-6 months. Read the original article on The Athletic. - blog, injuries, sports, Super Bowl ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousEmbracing Winter Wellness Outdoors – The Westport Library NextKnees Might Hurt After Sitting – POPSUGARNext --- ## ACL Surgery Prehab Impact on Recovery - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/prehab-before-acl-surgery-and-impact-on-recovery/ Summary: Prehab is often prescribed before ACL surgery to ensure nearly full range of motion and minimal swelling before surgery. Most patients try to "save" PT visits. # Prehab before ACL surgery and impact on recovery Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - May 18, 2022 Prehab is often prescribed before ACL surgery as we aim to have nearly full range of motion and minimal swelling before surgery. However, most patients have a limited number of physical therapy visits and therefore was try to “save” visits for after surgery when most patients go to PT for 6-9 months.   This study showed that “Preoperative quadriceps muscle strength deficit had a significant negative relationship with postoperative function at 1 year following ACL reconstruction.”   I typically use electrical stim after surgery to try to get the quad working as quickly as possible. In some cases, we start the stim before surgery and this may be the direction we are heading in as data accumulates to show that the stronger you are before surgery the better off you are after.   This doesn’t mean that surgery should be delayed, however, as waiting on ACL surgery has been shown to increase the risk of meniscal injury, especially in adolescent patients.   Read this article in Nature to learn more about how muscle strength deficit severity predicts knee function after ACL reconstruction.  - ACL, ACL repair, ACL surgery, Hospital for Special Surgery, HSS, Prehab, PT, rehab, sports medicine, sports surgeon, women's sports surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHow Achilles, ACL injury changed Klay Thompson NextMy first Bridge-Enhanced ACL Restoration (BEAR) ImplantNext --- ## Preparing for Ski Season - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/preparing-for-ski-season/ Summary: This a good article: How to Avoid an ACL Injury This Ski Season - Paspa Physical Therapy Source: paspapt.com/avoid-acl-injury-ski-season/ # Preparing for Ski Season Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - November 20, 2015 This a good article:   ## How to Avoid an ACL Injury This Ski Season – Paspa Physical Therapy Source: paspapt.com/avoid-acl-injury-ski-season/   - ACL injury, Paspa Physical Therapy, ski season ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousConcussion Prevention in Soccer NextEarly Spinning!Next --- ## Preseason Workouts for Pro Musicians - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/preseason-workouts-for-pro-musicians/ Summary: From an amateur pianist with a triceps tear to a professional guitarist with a clavicle fracture, professional musicians benefit from a preseason workout regimen. # Preseason Workouts for Pro Musicians Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - January 19, 2016 I’ve never thought about a preseason workout regimen for a professional musician, however I have taken care of many of them with very individual needs. Whether it was the amateur pianist who fell and tore his triceps or the professional guitarist with a clavicle fracture right before he went on tour, upper extremity injuries are hard to recover from when your livelihood or passion depends on them. Everyone should exercise with their job and hobbies in mind. Keeping postural muscles in your core and upper back strong is a first step. Addressing aches and pains early is equally important. Finally, if you are recovering from a traumatic injury, make sure to follow a graduated return to activity – guided by an experienced physical therapist.   ## How to train like the Pops | Health – WCVB Home The Boston Pops are sharing how they prepare for their busiest season of the year, the holidays. Source: www.wcvb.com/health/how-to-train-like-the-pops/36404834   - Boston Pops, Preseason workouts, Professional Musicians ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousStanding Desk Posture NextSee the Muscles You’re StretchingNext --- ## Protect Your ACL During Ski Season | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/prioritize-acl-knee-health-ski-season/ Summary: As ski season peaks, tips from an orthopaedic surgeon who has performed more than 1,000 ACL surgeries to help prevent knee injuries. # Skiers Must Prioritize Knee Health as ACL Injuries Rise During Ski Season Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: February 5, 2026 - February 5, 2026 New York, NY — February 5, 2026 — As ski season reaches its peak, orthopaedic surgeon Dr. Sabrina Strickland of the Hospital for Special Surgery (HSS), an expert who has performed over 1,000 ACL surgeries, reminds recreational and competitive skiers to stay vigilant about knee safety. Anterior cruciate ligament (ACL) injuries remain one of the most common and debilitating injuries on the slopes, and often require specialized surgical intervention to restore full function. Skiing’s combination of high speeds and twisting falls places intense strain on the knees. ACL tears frequently occur when a skier’s bindings fail to release or when the knee rotates unexpectedly during a fall. “ACL injuries are a frequent result of skiing mishaps,” Dr. Strickland explains. “But with prompt, expert care and the right surgical approach, whether traditional ACL reconstruction or ACL repair, patients can return to the activities they love.” Dr. Strickland is a nationally recognized expert in complex knee surgery and joint preservation, performing more than 600 surgeries a year. She is also an active researcher, focusing on clinical and biomechanics research on improving surgical outcomes. Since 2002, she has completed more than one thousand ACL surgeries and is a co-principal investigator on the Bridge-Enhanced ACL Repair (BEAR®) registry. This innovative technique promotes the ligament’s natural healing. Having completed more than 45 of these pioneering procedures, she is at the forefront of the shift toward ACL preservation. Injury Prevention on the Slopes  “The key to a successful season is early diagnosis and individualized treatment,” Dr. Strickland notes. “However, the best outcome is always avoiding the injury in the first place.”  To reduce the risk of knee injury, Dr. Strickland recommends: - Pre-season conditioning: Strengthen the quadriceps, hamstrings, and glutes. - Equipment calibration: Have bindings professionally adjusted to your weight, height, and skill level annually. - The last run rule: Skip the final run when fatigued, as many ACL tears occur late in the day. - Learn to fall: Do not try to stand up during a fall; go with the momentum and fall to the side. Anyone experiencing knee instability, swelling, or a popping sensation after a fall should seek evaluation from an orthopaedic specialist before returning to the slopes. About Dr. Sabrina Strickland  Dr. Sabrina Strickland is an orthopaedic surgeon at the Hospital for Special Surgery (HSS) with more than two decades of experience. A former ski instructor, she specializes in knee and sports medicine injuries with a focus on ACL reconstruction, cartilage restoration, and patellofemoral surgery. She is an Associate Professor at Weill Cornell Medical College and a member of the International Patellofemoral Study Group, The Forum, the Society for Women’s Sports Medicine, The International Cartilage Regeneration & Joint Preservation Society, The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine. For more information or to schedule an interview, visit www.sabrinastrickland.com. Media Contact Haidee LeClair Photo by Sebastian Staines on Unsplash. Originally published on EIN Presswire. - ACL injury symptoms, ACL reconstruction, ACL surgeon New York, ACL surgery, ACL tear, Dr. Sabrina Strickland, HSS orthopaedic surgeon, knee injury prevention skiing, ski knee injury, skiing knee brace ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousCan Urgent Care Treat a Dislocated Kneecap? NextBreaking Down the Hype Around ChondroFiller and Cartilage RepairNext --- ## Proud to Work at the Hospital for Special Surgery | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/proud-to-work-at-the-hospital-for-special-surgery/ Summary: We # Proud to Work at the Hospital for Special Surgery Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: March 9, 2023 - July 22, 2015 We’re happy to announce that U.S. News and World Report has named Hospital for Special Surgery #1 in Orthopedics and #3 in Rheumatology in their 2015-16 Best Hospitals rankings! We’d like to thank all our outstanding physicians and staff for all of their hard work! Serving over 120,000 patients per year from 105 countries, HSS is truly Where the World Comes to Get Back in the Game! - 2015-16 Best Hospitals rankings, Hospital for Special Surgery, U.S. News and World Report ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousInjured Vonn Faces Race Against Time – CNN News NextOsteoporosis and Broken BonesNext --- ## Proximal Bone Block With Distal Screw - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/proximal-bone-block-distal-screw-trajectory/ Summary: Dr. Strickland studies how a proximal bone block with distal screw trajectory improves mechanical stability during distalization tibial tubercle osteotomy. # Proximal Bone Block With Distal Screw Trajectory & Stability Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - August 15, 2023 This biomechanics study looks at how a proximal bone block with distal screw trajectory improves mechanical stability during distalization tibial tubercle osteotomy. I conducted the study with my husband, Dr. Andreas Gomoll.  We looked at our technique for fixation for tibial tubercle distalization and demonstrated that the strength of fixation is much higher than the traditional technique for this surgery. Read more in Knee Surgery, Sports Traumatology, Arthroscopy - distal screw trajectory, distalization tibial tubercle osteotomy, mechanical stability, patellar instability, patellofemoral pain, Proximal bone block, tibial tubercle osteotomy, TTO ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPrevious3 Anatomical Factors Linked to Recurring Patellar Dislocation NextSkier with ACL Tear and Meniscus TearNext --- ## Real-World BEAR® Implant Outcomes AOSSM | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/real-world-outcomes-bear-implant-aossm/ Summary: At AOSSM 2025, Dr. Brian Lau and Dr. Jocelyn Wittstein of Duke University presented the two-year results of the Bridge Registry on the BEAR® Implant for ACL injuries. # Real-World Outcomes for BEAR® Implant Shared at AOSSM 2025 Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: July 18, 2025 - July 18, 2025 Last week, the American Orthopaedic Society for Sports Medicine (AOSSM) held its annual meeting in Nashville, TN. At the event, Dr. Brian Lau and Dr. Jocelyn Wittstein of Duke University presented the two-year results of the Bridge Registry on the BEAR® Implant for ACL injuries. ## Key Bridge Registry Findings Presented at AOSSM ### Retear Rate (first 100 patients): - Overall: 5% - Ages 19 and older: 4% (3 out of 74) - Ages 18 and under: 8% (2 out of 26) ### Functional and Stability Outcomes: - Knee function assessed by the International Knee Documentation Committee (IKDC) subjective score at two years - Knee stability measured by the Lachman test at one year ### Registry Enrollment: As of July 2025, 300 patients from leading U.S. orthopedic centers have enrolled at the following sites: - AdventHealth (Florida) – Dr. Sean Keyes and Dr. Daryl Osbahr - Boston Children’s Hospital (Massachusetts) – Dr. Dennis Kramer - Duke University (North Carolina) – Dr. Brian Lau, Dr. Dean Taylor and Dr. Jocelyn Wittstein - Hospital for Special Surgery (New York) – Dr. Greg DiFelice, Dr. Andreas Gomoll and Dr. Sabrina Strickland - Oregon Health and Science University (Oregon) – Dr. Jacqueline Brady - Stanford University School of Medicine (California) – Dr. Seth Sherman - Steamboat Orthopaedic & Spine Institute (Colorado) – Dr. Alex Meininger - Victory in Motion / Auburn Community Hospital (New York) – Dr. Marc Pietropaoli - Virtua Health (New Jersey) – Dr. Sean McMillan Dr. Jacqueline Brady and Dr. Jocelyn Wittstein are co-principal investigators with me, assessing the real-world outcomes for the BEAR implant. The BEAR Implant offers an approach for ACL healing that preserves native knee anatomy, eliminating the need for a tendon graft. Our data shows encouraging results with low re-tear rates and meaningful functional recovery. ## An Evolving Practice It’s critical that we rigorously study new technologies as they move from clinical trials to broader practice. Real-world use can bring changes in surgical technique, suture materials, and fixation approaches, which is why ongoing registry work is so important. These data help us ensure that innovations truly benefit the wide spectrum of patients we see every day. I look forward to sharing further updates as we continue enrolling patients and collecting long-term outcomes from the Bridge Registry. Read the press release: Real-World Evidence for Miach Orthopaedics’ BEAR® Implant Highlighted at AOSSM 2025. Photo of Nashville, Tennessee, where AOSSM was held, by mana5280 on Unsplash. - ACL injuries, BEAR implant, Bridge Registry, knee function, knee stability, Miach Orthopaedics, orthopedic centers, real-world data, retear rate, surgical technique, tendon graft ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousReal-World Evidence for Miach Orthopaedics’ BEAR® Implant Highlighted at AOSSM 2025 NextManaging Shoulder Pain from SwimmingNext --- ## Green Tea & Gallnuts for Arthritis? - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/research-potential-cures-arthritis/ Summary: When reading research on potential cures for arthritis, you must consider the many complexities of how supplements and medication can actually work in the human body # Research on potential cures for arthritis — green tea & gallnuts Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: June 4, 2025 - February 24, 2022 When reading research on potential cures for arthritis, you have to take into account the many complexities of how supplements and medication can actually work in the human body. This article discusses how, on the cellular level, researchers were able to use gallic acid (found in gallnuts and green tea) and a micro cell stretcher to decrease inflammation in arthritic cartilage cells. I’m optimistic that we will be able to slow or reverse arthritis some day soon. In the meantime, it might be worth drinking some green tea and moving throughout the day. If you have a sedentary job, set your timer to get up and take a few steps every 30 minutes. Read more in Science Daily. - arthritic cartilage cells, arthritis, arthritis pain, arthritis relief, Exercise, gall nuts, gallic acid, get up and move, green tea, inflammation, micro cell stretcher, research, sedentary, sedentary jobs ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousOrthobiologics – study: Can ACLs heal faster using platelet rich plasma? NextWhat does it mean if you injure your knee and you hear a pop?Next --- ## Investigating ASA Injections - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/research-study-investigating-amniotic-suspension-allograft-asa-injections-for-knee-osteoarthritis/ Summary: HSS Sports Medicine Institute conduct a research study investigating the effects of Amniotic Suspension Allograft (ASA) injections for knee osteoarthritis. # Investigating Amniotic Suspension Allograft injections Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - March 8, 2022 At the HSS Sports Medicine Institute, we are conducting a research study investigating the effects of Amniotic Suspension Allograft (ASA) injections for knee osteoarthritis. This randomized controlled trial is a follow-up to a previous study that demonstrated safety and better pain relief of the ASA injection compared to a gel shot. If you qualify for this study, you will receive either the ASA injection or a placebo injection, and the costs of your injection will be covered. For more information, please visit https://www.hss.edu/clinical-trials_112187.asp.  - Amniotic Suspension Allograft (ASA) injections, ASA injection, Hospital for Special Surgery, HSS, HSS Sports Medicine Institute, knee osteoarthritis, pain relief, placebo injection, randomized controlled trial, research study, sports medicine ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWhat does it mean if you injure your knee and you hear a pop? NextPotential complications with BTB (patellar tendon) grafts for ACL reconstructionNext --- ## Rethink Exercise as an Immediate Reward - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/rethinking-exercise-as-a-source-of-immediate-rewards/ Summary: Jane Brody talks about her own experiences, making her easier to relate to. This article about rethinking exercise as a source of immediate rewards is a good read. # Rethinking Exercise as a Source of Immediate Rewards Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - October 8, 2015 Jane Brody writes an excellent health column because she almost always talks about her own experiences, which makes her a lot easier to relate to. In my opinion, she tends to be far more accurate than many health writers who comment on fads that don’t work. She is absolutely correct about why some people succeed in their exercise program. I define success as a lifetime of exercise. I see patients every day who are injured due to an aggressive exercise program, which was undertaken to make up for a sedentary period. This plan of attack rarely works. When you don’t go to the gym for three years and then join a 16 week boot camp to get back on track, you easily develop overuse injuries such as tendinitis and patellofemoral syndrome. By far the best plan is to stay on track and not get off. That said, many people do end up out of shape and then they gain weight and finally decide that it is time to restart a program. I strongly suggest that they do so in a reasonable way that they can continue indefinitely. Follow Jane Brody’s advice!   Rethinking Exercise as a Source of Immediate Rewards – NYTimes.com Source: mobile.nytimes.com/blogs/well/2015/07/20/rethinking-exercise-as-a-source-of-immediate-rewards/   - Exercise ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPrevious7 Charts that Show the State of Youth Sports in the US and Why it Matters NextAll athletes – including kids – need to cross trainNext --- ## Returning to Climbing After an ACL Tear - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/returning-to-climbing-after-an-acl-tear/ Summary: I # Returning to Climbing After an ACL Tear Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 Quick Summary Climbers who tear their ACL — typically from a bouldering fall or twisting auto-belay drop — almost always need ACL reconstruction before safely returning to the wall. Recovery is structured over 9–12 months: protected motion early, progressive strength work, then sport-specific reloading on slab and top-rope before overhangs and hard heel-hooks. Climbers cleared by objective hop and strength testing — not calendar months alone — return with much lower retear risk. - January 19, 2023 For the climbers out there, I found an article in climbing.com. As an orthopaedic surgeon in New York City, I don’t see a lot of climbing injuries.   That said, I have seen some pretty bad ligament injuries over the years, including several ACL injuries sustained from a fall, typically when bouldering or falling on a climbing wall.   The advice in this article is overall sound. If you injure your knee when climbing and you felt a pop, or if it hurts for more than a few days or if it swells, seek out an orthopaedic surgeon to make sure that you didn’t tear something.   If you get some bad news and you did tear your ACL, then you are going to need surgery to safely return to a sport like rock climbing. After surgery you will need extensive rehab over 9-12 months in order to get back to tip top shape.    Read “How to Return to Climbing After an ACL Tear” on climbing.com.  Photo by Cade Prior on Unsplash - ACL, ACL injuries, ACL tear, bouldering, climbing, climbing wall, knee pain, ligament injuries, rehab, rock climbing, sports ## Frequently Asked Questions Can you climb again after an ACL reconstruction?Yes — most climbers can return to bouldering, sport, and trad climbing after a properly reconstructed ACL. The timeline is usually 9 to 12 months, and clearance is based on specific strength and hop tests rather than just the calendar. I generally start patients with low-angle slab and top-rope before progressing to overhanging routes or hard heel-hooks that load the graft. How does climbing injure the ACL in the first place?Most climbing-related ACL tears I see come from awkward falls — usually bouldering falls onto a pad or auto-belay drops where the foot lands fixed and the knee twists or hyperextends. Heel-hook positions and dynamic moves can also produce twisting loads. The pivot-and-land pattern is mechanically similar to the cutting injuries we see in soccer or basketball. When should I see an orthopedic surgeon after a climbing knee injury?See a surgeon if you felt or heard a pop, the knee swelled within a few hours, or pain and instability persist beyond a few days. Those signs strongly suggest a ligament or meniscus tear, and an MRI plus exam will confirm the diagnosis. Early evaluation lets us protect the meniscus and plan surgery, if needed, before secondary damage occurs. ## Related Reading - ACL tear surgery (specialty page) - ACL surgery explained - ACL retear and rehabilitation information - What it means if you hear a pop in your knee - About Dr. Sabrina Strickland ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousTakeaways from Years of Patellofemoral Arthroplasty Experience NextMarried and Practicing Orthopaedic Surgery – Dr. Strickland and Dr. GomollNext --- ## Quadriceps vs. Patellar/Hamstring Grafts - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/revision-reoperation-rates-quadriceps-grafts/ Summary: The 40 year plus search for the best way to reconstruct the ACL continues as new studies show that quadriceps grafts are no better than the alternatives. # Similar Revision, Reoperation Rates for Quadriceps Grafts Vs. Patellar, Hamstring Grafts Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - May 26, 2023 The 40 year plus search for the best way to reconstruct the ACL continues as new studies show that quadriceps grafts are no better than the alternatives. I was just down in New Orleans at the Arthroscopy Association of North America and I listened to the paper. Using the Kaiser Medical database, which has a fairly captive audience, they showed that there isn’t an advantage to quad ACL grafts over patellar tendon. The limitations to this study is that there were many surgeons and they did not standardize technique. Read more in this Healio article.  - ACL, Arthroscopy Association of North America, Hamstring Grafts, Hospital for Special Surgery, orthopaedic surgery, Patellar Grafts, quad ACL grafts, Quadriceps Grafts, Reoperation Rates, Revision Rates, standardization, surgeons, technique ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousIncreased Risk of Patellofemoral Arthritis: The Sagittal Tibial Tubercle-Trochlear Groove Distance NextStaying Well on CNN: Cardio at the MoviesNext --- ## Romanian Deadlift for Strength & Balance | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/romanian-deadlift-stronger-legs-better-balance/ Summary: Strengthen your legs and improve balance with a Romanian deadlift and row exercise with simple modifications and safe form for movement and recovery. # Romanian Deadlift for Stronger Legs and Better Balance Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: February 27, 2026 - February 27, 2026 Regaining strength and balance doesn’t have to mean spending hours at the gym. One simple and effective exercise I often share with patients is the Romanian deadlift combined with a row. This movement strengthens key muscles that support your hips and knees: the glutes, hamstrings, and core. Those same muscles play an important role in walking, climbing stairs, and preventing falls. If balancing during the row feels challenging, skip the row at first and focus on the deadlift only. Over time, as your stability improves, you can add the row to increase strength through your upper body and core. The goal isn’t perfection; it’s progress. Practicing this exercise regularly helps you build control, confidence, and strength where it matters most, in everyday movement. Here’s a short video of the Romanian deadlift with row so you can see how to do it. Transcript This exercise is a Romanian deadlift combined with a row. So what is good about this exercise is first of all it emphasizes balance and and secondly both core, glute and hamstring strengthening. So, if this is too hard, you can do it without the row or you can hold free weights in your hands and let your hands dangle for balance. - balance exercises, leg strengthening exercises, lower body workout, orthopedic recovery, patient exercise program, Romanian deadlift, row, safe strength training ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHow Can You Tell If Your Kneecap Is Slightly Dislocated? NextWhat Is Joint Preservation and Who Is It For?Next --- ## Runners in the NYC Marathon - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/runners-in-the-nyc-marathon/ Summary: If it weren # Runners in the NYC Marathon Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - November 9, 2015 This is an inspiring story.   ## Watch What Runners Do When Wheelchair Breaks Mid-Marathon in NYC If it weren’t for strangers, and the determination of these brothers, a broken wheel would have ended their NYC marathon race. Source: www.goodnewsnetwork.org/watch-what-runners-do-when-mans-wheelchair-breaks-mid-marathon-in-nyc/   - marathon, NYC marathon, runners, wheelchair ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousGood Article on ACL Reconstruction Outcomes NextWall Street Journal – Avoiding Running InjuriesNext --- ## Runner's Knee Isn't a Diagnosis | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/runners-knee-isnt-a-diagnosis/ Summary: Persistent pain in the front of your knee shouldn’t be dismissed as runner’s knee. It may be patellar tendonitis, cartilage damage, patellar instability # Anterior Knee Pain: Why “Runner’s Knee” Isn’t a Real Diagnosis Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: March 27, 2026 - March 20, 2026 Anterior knee pain is one of the most common complaints I see, but it is also one of the most commonly dismissed. Many patients are told they have “runner’s knee” or “patellofemoral pain syndrome” and sent away with a generic prescription: do more physical therapy. Some have followed that advice for years with little or no improvement. In this video, my husband, Dr. Andreas Gomoll, and I explain why runner’s knee is not a real diagnosis and walk through the most common true causes of pain in the front of the knee. Transcript So, one of my pet peeves is when patients are told by another doctor that they have runner's knee or patellofemoral pain syndrome because Chondromalacia patella is also sort of a Because at least the first two aren't very specific diagnoses and since there's specific things that can cause pain in the front of the knee, it's much more helpful if you actually diagnose exactly what's wrong because that can help determine how to treat it. Yeah, and a lot of surgeons at least dismiss patients who come in with pain in the front of the knee and and they just tag them based on x-rays alone or maybe just a story with kind of these terms and then essentially say, "No, go away, do PT, do more PT." And some patients have tried that for years without improvement. So, starting with the simple, there's patellar tendonitis. It's usually in runners or jumpers and it can be treated with physical a specific type of targeted physical therapy, platelet-rich plasma, and even shockwave. And then there's cartilage pathology. Yeah, so sometimes there's a true structural damage inside the knee like cartilage pathology and that again is a completely different type of treatment. So, type of surgical treatment oftentimes. And there are injections sometimes. So, lots of different options, but you need to know why exactly you're hurting. And and then there's patients who have instability and so if they have patellar instability causing their anterior knee pain, then by and large that needs to be stabilized and and that's something that we can do pretty pretty well and with pretty good outcomes. Yeah, but like we said, we don't like to dismiss people just based on their story. ## Vague Labels Aren’t Real Diagnoses The problem is that these labels are not specific diagnoses. There are several distinct causes of pain in the front of the knee, and identifying the true source of the problem is the key to choosing the right treatment. When we stop at a vague term, we risk missing targeted options that could actually help you get back to the activities you love. ## Patellar Tendonitis: A Common but Treatable Cause One common cause is patellar tendonitis, often seen in runners and jumpers. This is typically treated with a specific, targeted physical therapy program, and in some cases advanced options like platelet-rich plasma (PRP) injections or shockwave therapy. When the tendon is the issue, these focused treatments are much more effective than a one‑size‑fits‑all PT approach. Learn more about treatment options for patellar tendon problems. ## Cartilage Damage: When the Joint Surface Is Injured Another important category is cartilage pathology—true structural damage inside the knee. Cartilage injuries usually require a completely different approach, often including surgical treatment designed to address the damaged area. Treating cartilage damage like simple overuse pain means you may never get the improvement you’re looking for. Learn more about cartilage restoration procedures. ## Patellar Instability: When the Kneecap Won’t Stay in Place Some patients have patellar instability as the main driver of their anterior knee pain. In these cases, the kneecap does not track or stay in place properly, and by and large that instability needs to be stabilized. Fortunately, we can often correct this with well‑established procedures and see very good outcomes. ## Why You Shouldn’t Settle for a Runner’s Knee Diagnosis The takeaway is that persistent anterior knee pain deserves more than a quick label and a dismissal. With a careful evaluation and an accurate diagnosis, we can match your treatment to the true underlying problem—whether that means targeted PT, injections, biologics, shockwave, or surgery. You should not be told to simply live with it when there are specific, effective options available. If you’re dealing with ongoing pain in the front of your knee and haven’t gotten clear answers, consider scheduling a consultation so we can determine what’s really causing your symptoms and discuss the best treatment options for you.   - anterior knee pain, cartilage restoration, joint preservation, knee cartilage damage, knee pain treatment, knee physical therapy, knee specialist New York, patellar instability, patellar tendonitis, patellofemoral pain syndrome, PRP injections knee, runner's knee, shockwave therapy knee, sports medicine surgeon ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousNew Stanford Research Hints at the Future of Knee Arthritis Treatment NextWorking Your Way to Stronger Legs: How to Use the Single-Leg Leg PressNext --- ## Running and Knee Stress - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/running-and-knee-stress-systematic-cartilage-changes/ Summary: Many people think that running is bad for the knees, causing knee stress and long term damage. This study takes a closet look at cartilage changes after running # Running and Knee Stress: Systematic Cartilage Changes Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - March 16, 2023 Patients often come in and sheepishly admit to the fact that they enjoy running. It seems that there is a misconception that running is bad for one’s knees. However, the fact is that runners often have very good knees and there is little to no data to support that running is actually harmful. We do know that most of us with bad knees cannot run. This study looked at a compilation of studies analyzing magnetic resonance imaging (MRI) images after running to assess cartilage changes. According to this study: “The amount of weight-bearing femoral cartilage fell by 3.3% and the volume of patellar cartilage reduced by 4.9%” — but it appears that after 90 minutes most parameters returned to normal. Read more about running and knee stress in this article in Physician’s Weekly. Photo by sporlab on Unsplash - HSS, knee stress, Osteoarthritis, running, systematic cartilage changes ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousPatellofemoral Joint Loading, Early Osteoarthritis after ACL Reconstruction NextAssessment of Patellar Vascularity after Patellar Cartilage Restoration via Lateral Parapatellar ApproachNext --- ## Saliva and Concussions - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/saliva-and-concussions/ Summary: Kids are missing more school due to concussions than any other injury and the diagnosis and treatment continues to be controversial, with different levels of trauma. # Saliva and Concussions Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - May 22, 2018 Concussions seem to be the “hot” injury right now. Kids are missing more school because of concussions than any other injury and the diagnosis and treatment continues to be controversial. The scale of these are very broad as well. Sometimes there is minimal trauma and the athlete has symptoms for weeks, but other times the injury appears more severe and the symptoms resolve quickly.  This new study reported in JAMA found that microRNA levels in saliva were able to predict the recovery period for individuals who suffered a concussion. An objective test that could predict when patients could go back to school, work and sports. I think this would be very helpful. CLICK HERE TO READ THE ARTICLE - athlete, athletes, concussions, sports ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWhy women’s ice hockey has a higher concussion rate than football NextCommunicating Electronically With Your PhysicianNext --- ## Sea coral helps knee osteoarthritis | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/sea-coral-helps-knee-osteoarthritis/ Summary: CBS News New York # Innovative new procedure uses sea coral to help people who suffer from knee osteoarthritis Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: November 17, 2025 - November 17, 2025 CBS News New York’s Jenna DeAngelis got an exclusive look inside the operating room at the Hospital for Special Surgery and spoke with patients about how sea coral is being used to treat those with knee osteoarthritis. The CBS team spoke  with me and my husband, Dr. Andreas Gomoll as well as two patients who tried out the new procedure. Check out the CBS video to learn more about sea coral, the CARTIHEAL AGILI-C cartilage repair implant, and the patients using it to get back to doing the things they love.        - CARTIHEAL AGILI-C, CBS News, Hospital for Special Surgery, HSS, Jenna DeAngelis, knee osteoarthritis, New York, sea coral, Video ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousCan You Fully Recover from a Dislocated Patella? NextHow Serious Is a Patella Dislocation?Next --- ## See the Muscles You’re Stretching - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/see-the-muscles-youre-stretching/ Summary: Whether you’re a chronic sitter, a daily exerciser, or a weekend warrior, you know stretching is a critical habit. 36 pictures to see which muscle you’re stretching. # See the Muscles You’re Stretching Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - January 22, 2016 This is a great visual to see what muscles you’re stretching. ## 36 Pictures To See Which Muscle You’re Stretching – Be Young Be Green Whether you’re a chronic sitter, a daily exerciser, or a weekend warrior, you probably know stretching is a critical habit. By sending blood flow to your muscles and helping your joints move through their full range of motion, stretching improves your posture and athletic performance while lowering your risk of pain and injury.Whether you’re a chronic sitter, a daily exerciser, or a weekend warrior, you probably know stretching is a critical habit. By sending blood flow to your muscles and helping your joints move through Source: beyoungbegreen.com/36-pictures-see-muscle-youre-stretching/   - Be Young Be Green, foods, patellar tracking ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousPreseason Workouts for Pro Musicians NextFoods that can help speed your recoveryNext --- ## Patellofemoral Instability Assmt - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/several-assessments-for-patellofemoral-instability-yielded-poor-interrater-reliability/ Summary: This study looked at different measurements on x-rays and MRIs to assess patellofemoral instability. # Several assessments for patellofemoral instability yielded poor interrater reliability Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - May 5, 2022 I was a part of this study where we looked at different measurements on x-rays and MRIs of patellar instability patients. Ultimately, many decisions we make are based on how we measure a patient’s images and therefore accuracy in measurement is important. As we learn more and more about patellar instability, and stop telling patients to just live with their patellar instability, we will learn which measurements actually correlate with recurrent instability and which anatomic factors should be addressed surgically. Read more in this Healio article on patellofemoral instability.  - Hospital for Special Surgery, HSS, measurements, MRIs, orthopaedic sucgeon, Patellarinstability, patellofemoral instability, patient images, poor interrater reliability, women's sports surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousStudy: combined reconstruction for patellar instability may be more anatomic NextHow Achilles, ACL injury changed Klay ThompsonNext --- ## Shoulder Replacement Recovery Story - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/shoulder-replacement-bar-hangs-3-months-post-surgery/ Summary: Coming off of a full left shoulder replacement, Steve is out here doing chin ups with Dr. John! This is awesome! Amazing progress and recovery! # Shoulder Replacement – Bar Hangs 3 Months Post Surgery Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - August 9, 2022 Coming off of a full left shoulder replacement, Steve is out here doing chin ups with Dr. John! This is awesome! Amazing progress and recovery! Check out his story on Instagram.  - bar hangs, orthopaedic surgeon, orthopaedic surgery, Physical Therapy, recovery, shoulder replacement, shoulder surgery, sports medicine ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousTibial Tublercle Osteotomy or Tibial Tubercle Transfer NextBrawn Body Health and Fitness Podcast: Knee Injuries, Knee Arthritis, Skiing Injuries, and more!Next --- ## Synthetic Substitutes for Cartilage & More - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/silkworms-and-synthetic-substitutes-for-cartilage-ligaments-and-tendons/ Summary: Scientists and surgeons have search for a synthetic substitute for cartilage, ligaments, and tendons for 40 years. Some scientists using implants made by silkworms. # Silkworms and Synthetic Substitutes for Cartilage, Ligaments, and Tendons Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - September 3, 2015 I am not sure how likely it is that we will be using implants made by silkworms; however, this is an interesting idea. Scientists and surgeons have been looking for a synthetic substitute for cartilage, ligaments, and tendons for at least 40 years – and so far there is little evidence that any of these products have actually worked. The ideal substance to replace cartilage needs be easily attachable to the surrounding or healthy cartilage, and at the same time it needs to encourage the body to turn the synthetic substance into real cartilage. Meanwhile, it needs to function as a strong enough substitute to bear the stresses incurred in a joint while the healing occurs. The same parameters must be met for ligament reconstruction or replacement. You can string a piece of Gore-Tex across the knee joint to substitute for the ACL, and it will feel strong and stable for the first few weeks, but two bad things will then happen: 1. It will wear out because everyday stresses will cause too much strain and stress. In the native ACL, there is a blood supply and healing response to constantly remodel and heal from everyday wear and tear. 2. Less important and less likely to occur: the body may form an inflammatory response to the foreign material or it may scar over time. The real hope is to create (and perhaps silkworm products are the answer, I really don’t know yet) a temporary structure or cord that we can seed with the patient’s own cells and then the patient can grow their own replacement tissue.   ## Future knee implants will be made by silkworms | Health24 It may sound like science fiction but researchers are currently developing knee implants to improve osteoarthritis pain and inflammation using the silk produced by silkworms! Source: www.health24.com/Medical/Arthritis/About-joint-pain-arthritis/Silk-worm-biomedical-implants-to-be-used-to-treat-osteoarthritis-20150709   - biomedical implants, cartilage, ligament, silkworms, synthetic substitutes ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousFitness and Fun NextKids and Sports InjuriesNext --- ## Single vs. Multiple-Plug OCA Transplants | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/single-vs-multiple-plug-oca-transplants/ Summary: This study aimed to describe initial outcomes of single versus multiple-plug knee OCA transplants at minimum 1-year follow-up, hypothesizing little difference. # Single Versus Multiple-Plug OCA Transplants for Osteochondral Defects About the Knee Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: July 25, 2024 - July 25, 2024 There have been a number of  studies that described the outcomes of osteochondral allograft (OCA) transplantation for single osteochondral lesions, but there is not a lot of information available that compares outcomes of single versus multiple OCA transplants. We designed this study to describe the initial outcomes of single versus multiple-plug knee OCA transplants with follow up at a minimum of one year. Our hypothesis was that there would be no difference in patient-reported outcome measures between patients undergoing single versus multiple-plug OCA transplants at minimum 1-year follow-up. In this study, we retrospectively reviewed prospectively collected data for patients undergoing OCA transplantation for large (>2cm2) osteochondral defects about the knee.  Read the original article in The Journal of Knee Surgery: Initial Outcomes of Single Versus Multiple-Plug Osteochondral Allograft Transplantation for Osteochondral Defects About the Knee: A Matched Cohort Analysis Photo by Bruno Nascimento on Unsplash - knee, matched cohort analysis, Multiple-Plug Osteochondral Allograft Transplantation, OCA transplantation, OCA transplants, osteochondral defects, Single Osteochondral Allograft Transplantation, single osteochondral lesions, study ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousExploring Risk Factors for Atraumatic Medial Patellar Facet Lesions NextAn HSS Webinar: From Stem Cells to ScaffoldsNext --- ## Skier with ACL Tear and Meniscus Tear -Dr. Sabrina Strickland Source: https://sabrinastrickland.com/skier-acl-tear-meniscus-tear/ Summary: Today I # Skier with ACL Tear and Meniscus Tear Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: May 2, 2026 Quick Summary Caroline Silver tore her ACL and meniscus in a single skiing fall — a pattern I see often in ski-related knee trauma because the binding mechanism loads both structures at once. I reconstructed her ACL and addressed her meniscus tear in the same operation, which preserved her shock-absorbing tissue and protected her long-term cartilage health. She was running at three months and went on to ski as a college ski patroller, with the operative knee often feeling better than the other after a long day of moguls. - August 25, 2023 When a skier tears the ACL, there is almost always a meniscus tear with it — and Caroline Silver’s case is a textbook example of why I evaluate both structures together before planning surgery. My favorite stories are from my patients, so today I’m sharing one from Caroline, who had both an ACL tear and a meniscus tear while skiing. Once I fixed her knee, Caroline was running three months later. Not only was she able to become a ski patroller after finishing college, her operative knee usually hurts less than the other one after a long day of moguls and woods! Read her Back in the Game story about her ACL injury on the Hospital for Special Surgery website. ## Why skiing tears the ACL and the meniscus together The classic ski mechanism is a fall in which the binding fails to release while the tibia is forced forward and rotated against a fixed femur. That single moment loads the ACL and the medial meniscus at the same time — which is why combined injuries are one of the most common patterns I see in ski-related knee trauma at Hospital for Special Surgery. In Caroline’s case, the imaging showed exactly what the exam suggested: a complete ACL tear plus a meniscus tear that was a candidate for repair rather than removal. Recognizing the dual injury before going to the operating room matters, because it changes the surgical plan, the rehab timeline, and the long-term cartilage outlook. Female skiers are at higher risk for this pattern than male skiers, which is also why I review the contralateral knee carefully on every female patient with one ACL injury. ## Why I repair the meniscus during ACL reconstruction whenever I can When an ACL tear is paired with a repairable meniscus tear, doing both in the same operation is, in my experience, the right call. Repair preserves the meniscus’s shock-absorbing function — which is the single biggest factor in protecting articular cartilage and avoiding early osteoarthritis later in life. There is also a healing-biology advantage: the bone tunnels drilled for the ACL graft release growth factors that support meniscal healing, so meniscus repair done at the same time as ACL reconstruction heals at a higher rate than meniscus repair done in isolation. Caroline’s tear pattern allowed for repair, and that decision is part of why her operative knee feels better today than the uninjured one — the meniscus is still doing its job. ## Risks and a realistic recovery timeline I want to be honest about what combined ACL and meniscus surgery involves, because patient expectations are often shaped by social media highlight reels rather than clinical data. Risks of ACL reconstruction include graft re-tear, stiffness, infection, and persistent anterior knee pain — and adding a meniscus repair lengthens the protected weight-bearing and range-of-motion phase of rehab. Most patients are running by three months and cleared for cutting and pivoting sports between 6 and 9 months, depending on graft choice, meniscus repair status, and rehab progression. Caroline’s timeline was on the faster end, and she earned it through disciplined rehab — not because her case was unusually easy. Returning to skiing earlier than your surgeon clears you for puts the graft and the repaired meniscus at real risk of re-injury, and I always counsel patients on this directly. If you have torn your ACL skiing and want to discuss whether your meniscus is repairable, my office at HSS is happy to review your imaging. - ACL, ACL tear, anterior cruciate ligament, anterior cruciate ligament reconstruction, back in the game, Hospital for Special Surgery, HSS, knee, knee injury, meniscus, meniscus tear, skier, Success Story ## Related Reading - ACL tear surgery - Meniscal tear / torn meniscus - Returning to climbing after an ACL tear - About Dr. Sabrina Strickland ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousProximal Bone Block With Distal Screw Trajectory & Stability NextCartiheal Is Back: New Cartilage Injury TreatmentNext --- ## Skier Tim's BEAR® Implant Comeback Story | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/skier-tim-bear-implant/ Summary: Determined to ski again after a sudden ACL tear, 55-year-old Tim Braun, a lifelong skier, opted for the BEAR Implant, facilitating his return to the sport he loves. # Skier Tim’s BEAR® Implant Comeback Story Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: March 13, 2025 - March 13, 2025 Tim Braun is an experienced downhill skier with over 47 years of skiing without any injuries. Unfortunately, he suddenly tore his anterior cruciate ligament (ACL) during the winter 2023 ski season. Despite this injury, he was determined to return to the sport he loves as quickly as possible. Luckily, Tim’s son is a physical therapist and familiar with various ACL surgery methods. He introduced Tim to the BEAR® Implant. Tim chose to proceed with this option, and I was his surgeon. In this article, Tim shares why he chose the BEAR Implant, how his rehab process went, and—best of all—his recent return to skiing. I love sharing stories like this because they help people understand their different options, why a patient chose one method over another, and what rehab is like (at least for this patient, everyone is a little different). Read Tim’s whole story on the Miach Ortho blog. Photo by Glade Optics on Unsplash - ACL, ACL repair, ACL tear, BEAR implant, healing, injury, knee, orthopedic, recovery, rehabilitation, skiing, sports, surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousUnderstanding Patellofemoral Instability & Cartilage Lesions NextUsing Tendons & Ligaments in ACL SurgeryNext --- ## Playing Sports: A Lifetime Routine? - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/sports-new-workout/ Summary: This Time magazine article discusses a study in the British Medical Journal saying "people who play a sport are more likely to stay healthy and fit as they age.” # Why Playing a Sport Should Be Your Lifetime Routine Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: October 31, 2024 - October 25, 2017 This Time magazine article discusses a study in the British Medical Journal saying “people who play a sport are more likely to stay healthy and fit as they age”. We know that our activity level tends to decrease over the years and sports keep people engaged. My question is, which sports are best and which sports did these people play throughout their lifetime? In my practice I see a lot of men who play basketball through their 30’s but it is rare to see many guys playing into their 40’s. I also see both men and women who love soccer and play into their 40’s but once again it is rare to continue beyond 50. Hockey seems to be a sport enjoyed mostly by men who play into their 50’s. So what sports are really possible to continue throughout our lifetime? Tennis, skiing, golf, squash, swimming, and jogging are the ones that come to my mind. If one suffers from arthritis, then jogging and other high impact sports may be more difficult to continue. Bottom line- find a sport that you like and that feels good and keep playing! Source: http://time.com/4950641/workout-sports-exercise/ - athlete, athletes, sports ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousElectrotherapy and Acupuncture Required Less Pain Medicine Following Knee Replacement Surgery NextHow to Get in Shape for Ski SeasonNext --- ## Squats With Bands Patient Exercise | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/squats-with-bands-patient-exercise/ Summary: Squats with bands use a TheraBand behind the knees to keep weight in your heels, reduce stress on your kneecaps, and build strength and stability. # Squats With Bands: Keeping Weight Off the Kneecaps Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: March 20, 2026 - March 10, 2026 Squats with bands are an awesome exercise, especially if you’re trying to strengthen your legs while being careful with your knees. What really makes this version special is the TheraBand placed around the back of the knees. That setup gently cues you to lean back, which keeps your weight back and reduces the amount of stress on your kneecaps. Transcript This is an awesome exercise and what makes it so great is the thera band around the back of her knees. Uh, essentially what this means is you have to lean back and it keeps your weight back which reduces the amount of stress on your kneecaps. The second part of this exercise that makes it special is the chest press. You want to make sure the weight's not so heavy that you have to lean forward. This exercise can also be done with TRX bands. Uh, it changes it a little bit, but it also keeps your weight back. ## How Squats with Bands Protect Your Kneecaps By shifting the load away from the front of the knee, many people find squats with bands more comfortable than regular squats. This variation lets you work on strength and control without feeling like you’re dropping all your weight onto the patellofemoral joint at the front of the knee. ## Adding a Chest Press for Full-body Work The second part of this exercise that makes it unique is the chest press. You’re not only training your legs; you’re also engaging your upper body and core at the same time. The key is to choose a weight that’s not so heavy that you have to lean forward. If you feel yourself pitching forward to push the weight, it’s a sign to lighten it up so you can keep your weight back and your form solid. ## TRX Variation for the Same Knee-Friendly Benefits You can also perform a variation of this move with TRX bands. It changes the exercise slightly, but the idea is the same: the setup helps keep your weight back, which can be much kinder to the front of the knee and the kneecap. For some patients, this TRX version of squats with bands feels more stable and supported. ## Is This Version Right for Your Knees? Squats with bands can be a great option if you want to build strength while minimizing stress on the kneecap, especially when traditional squats don’t feel good.  Check out more patient exercises. - chest press with squat, knee friendly squats, knee strengthening, patellofemoral pain relief, reduce kneecap stress, squats with bands, TheraBand behind knees, TRX squat variation, weight back in heels ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWhat Is Joint Preservation and Who Is It For? NextNew Stanford Research Hints at the Future of Knee Arthritis TreatmentNext --- ## Standing Desk Posture - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/standing-desk-posture/ Summary: Useful article from Paspa Physical Therapy: "Do You Have Proper Posture at Your Standing Desk?" It # Standing Desk Posture Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - January 13, 2016 This article from Paspa Physical Therapy is useful:   ## Do You Have Proper Posture at Your Standing Desk? – Paspa Physical Therapy Source: paspapt.com/proper-posture-standing-desk/   - Paspa Physical Therapy, posture, standing desk ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousKeeping Active in Unseasonable Weather NextPreseason Workouts for Pro MusiciansNext --- ## Stanford Research: Knee Arthritis | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/stanford-research-knee-arthritis-treatment/ Summary: New Stanford research in mice hints at a future injection to regrow knee cartilage and prevent arthritis. Learn what it means for knee pain today. # New Stanford Research Hints at the Future of Knee Arthritis Treatment Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: March 12, 2026 - March 12, 2026 A recent press release from Stanford Medicine stated that scientists have discovered a treatment that can reverse cartilage loss in aging joints and prevent arthritis after knee injuries. If this is as good as it sounds, it may indeed be akin to finding the holy grail. ## What Did Stanford Researchers Discover? As we age, our bodies make more of a protein that leads to the breakdown of cartilage, which is the covering of the bones in our joints. In this mouse study, researchers showed that they could block the function of this protein and therefore prevent the development of arthritis and even reverse it. They were also able to show that mice who injured their ACL and were given this injection into the knee did not develop arthritis. ## Why We’re Not There Yet While this research is very exciting, there is no data on the use of this drug in human joints. We do not yet know the possible effects on humans or the potential side effects. Unfortunately, we aren’t close to simply getting a knee injection and reversing arthritis, but I hope this will be possible in the future. If you want to learn more about the research, check out these links: - Stanford Medicine: Inhibiting a master regulator of aging regenerates joint cartilage in mice - Science Daily: Stanford scientists found a way to regrow cartilage and stop arthritis If you’re interested in how these kinds of breakthroughs connect to real-world knee surgery, I’ve been involved in multiple studies on cartilage restoration and joint preservation in the knee. Learn more about my research. The image in the header shows healthy joint cartilage under the microscope — this smooth, purple-stained tissue is the hyaline cartilage that normally cushions the ends of the bones in your knee. Photo by Bioscience Image Library by Fayette Reynolds on Unsplash.   - ACL injury, aging joints, arthritis treatment, cartilage loss, cartilage regeneration, experimental injection, joint preservation, knee arthritis, knee injection research, mouse study, osteoarthritis prevention, protein blocking therapy, reversing arthritis, Stanford Medicine, Stanford research ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousSquats With Bands: Keeping Weight Off the Kneecaps NextAnterior Knee Pain: Why “Runner’s Knee” Isn’t a Real DiagnosisNext --- ## Static Lunge with Row Exercise | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/static-lunge-with-row-exercise/ Summary: Static lunge with row is a knee-friendly exercise that strengthens your core and legs while reducing stress on the front of the knee. # Static Lunge with Row: A Knee-Friendly Way to Strengthen Your Core and Legs Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: April 13, 2026 - April 9, 2026 Static lunge with row is a knee-friendly exercise that strengthens your core and legs while reducing stress on the front of the knee. You hold a stationary lunge position while performing a rowing motion, which adds a lot of core engagement and helps support essentially every other exercise you do. This combination is especially helpful for people who find walking lunges too irritating but still need single-leg strength and balance work. For many patients with knee pain, it is easier to tolerate a static lunge instead of moving through space. Walking lunges can really load the front of the knee, but the static lunge is often much better tolerated while still building strength and stability. That makes static lunge with row a practical option for home programs, gym routines, and return‑to‑activity plans. ## What Is a Static Lunge With Row? Static lunge with row combines a stationary lunge position with a rowing motion using a dumbbell, cable, or resistance band. You step into a lunge, hold your feet in place, and perform a row with the arm holding the weight or band, which works the upper back and core while your legs support your body weight. Because your feet do not travel forward or backward with each rep, the exercise is more stable and often more comfortable than walking lunges for people with knee pain. ## Why It’s Knee‑Friendly Static lunges tend to feel more controlled than walking lunges because you avoid the repeated stepping and deceleration that can increase load on the front of the knee. For many patients with anterior knee pain, keeping the lunge in place is better tolerated while still targeting the quadriceps, glutes, and hamstrings for strength and stability. The row adds core and trunk involvement, helping you feel more stable with everyday tasks. ## How to Perform a Static Lunge With Row - Stand with your feet hip‑width apart, holding a dumbbell, cable handle, or band handle in one hand - Step one foot into a lunge stance, keeping your front knee roughly over the middle of your foot and your torso upright. - Lower into a comfortable lunge depth and hold that position; you do not have to move through the lunge if your knee is sensitive. - From this position, pull your elbow back into a row, keeping your shoulder down and your core braced. - Slowly return your arm to the starting position, maintain the lunge, and repeat for the desired reps before switching sides. ## Progressions and When to Modify If you have more knee pain or balance issues, start with a shallower lunge and consider light support from a counter or rail. You can begin by practicing the static lunge position first, then add the row once you feel stable. As strength improves, gradually increase lunge depth, resistance, or time under tension while monitoring how the front of the knee feels. If pain becomes sharp, catches, or swelling increases, it may be a sign to adjust or temporarily avoid this exercise and focus on lower-load options like partial squats or supported sit‑to‑stands. The goal is steady progress without flaring symptoms. Check out my other patient exercise videos for more ideas as well.  ## FAQ Is static lunge with row better than walking lunges if I have knee pain? For many people with knee pain, a static lunge is easier to tolerate than walking lunges, which can really load the front of the knee as you move through space. Why add a row to the static lunge? Adding a row gives you a lot of core engagement on top of the lunge, which is helpful and supports essentially every other exercise you do. Do I have to move up and down in the lunge? You do not have to move through the lunge; holding a static position is often more comfortable for patients who have knee pain yet still want to strengthen their legs and core. This exercise is intended for people who want to build strength and stability while being mindful of knee symptoms. If your knee pain worsens, becomes sharp, or lingers after you finish, it is always best to discuss this with your treating clinician before progressing. Watch the short video for a demonstration and practical form cues. Transcript This exercise is a lunge, but by doing a row at the same time, you get a lot of core, which is really helpful and helps support essentially every other exercise you do. For a lot of patients who have knee pain, it's helpful to not move through the lunge. Exercise such as walking lunges can really load the front of the knee, but the static lunge tends to be far better tolerated. - core and knee stability, core strengthening exercise, knee friendly lunge, low impact leg exercise, lunge alternative for knee pain, patient exercises, physical therapy knee exercise, safe lunge variation, static lunge for knee pain, static lunge with row ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousACL Surgery: What Raises Arthritis Risk? NextInterview: The Difference Between ACL and Meniscus TearsNext --- ## On Staying Active After Injuries | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/staying-active-after-injuries/ Summary: Weekend warrior, an athlete, or interested in joint health, this episode of Hilary Topper on Air has advice on staying active after injuries. # On Staying Active After Injuries Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: October 17, 2025 - October 17, 2025 I was delighted to join Hilary Topper for this episode of Hilary Topper on Air. Drawing on my extensive experience as an orthopedic sports surgeon at the Hospital for Special Surgery, I shared my insights on treating complex knee and shoulder injuries and the strategies I use to help patients with staying active after injuries — and getting back to lifestyles they love. Listen to the podcast, which covers staying active after injuries. Photo by Matt Botsford on Unsplash - ACL injuries, active lifestyles, cartilage repair, joint health, knee injuries, knee replacement, non-surgical treatment, Orthopedic sports surgeon, patient stories, podcase, shoulder injuries ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHow to Prepare for an MPFL Reconstruction  NextFirst Patella LIFT™ Surgeries on the East Coast at HSS in Enrollment of FDA PELICAN TrialNext --- ## Staying Well on CNN-Cardio at the Movies - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/staying-well-cnn-cardio-movies/ Summary: I recently was interviewed for the CNN Staying Well series, discussing how a trip to the gym could involve a longer workout, with a fun favorite pastime. # Staying Well on CNN: Cardio at the Movies Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - June 1, 2023 I was recently interviewed for the CNN Staying Well series, discussing how a trip to the gym could involve a longer workout, with a fun favorite pastime. As I shared in the interview, cardio cinema is watching a movie while you do low impact exercise. The benefit of pairing a movie with fitness equipment is that it offers another way to distract you while you are working out. Cardio cinema can increase endurance because chances are you are going to do it longer. You’re going to want to see what happens in the movie!  Watch the segment on CNN to learn more.  - cardio, cardio cinema, CNN, fitness, Hospital for Special Surgery, HSS, low impact exercise, movies, staying well, wellness ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousSimilar Revision, Reoperation Rates for Quadriceps Grafts Vs. Patellar, Hamstring Grafts NextCardio at the movies: CNN Staying WellNext --- ## Stem Cells, Exosomes, & Cartilage Repair | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/stem-cells-exosomes-cartilage-repair/ Summary: I # Common Questions About Stem Cells, Exosomes, & Cartilage Repair Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: April 10, 2025 - April 10, 2025 It seems as if every day, I am asked about stem cells. Common questions are: - Can I get stem cells injected into my knee? - Would stem cells help my problem? - Could stem cells heal my knee faster? Usually, my answer is one of these three possibilities: - We don’t have them available in the US market - Maybe, but there isn’t a lot of data, or - I don’t know I have now participated in three different trials at HSS for a cryopreserved amniotic suspension allograft (ASA) containing amniotic fluid cells and a micronized amniotic membrane. I have used bone marrow aspirate for years in the operating room to hopefully increase healing or decrease symptoms related to arthritis. Several years ago, I trialed lipograms, a fat-derived stem cell, but I didn’t see significant improvement in patients, and it was a lot of effort to obtain the fat from patients.   We hope to participate in an FDA trial on umbilical stem cells next year. There is a lot of research looking into ways to halt or reverse arthritis or cartilage disease, but so far, we don’t have the answer. Lately, there is a lot of interest in exosomes, tiny sac-like structures that are formed inside a cell and contain some of the cell’s proteins, DNA, and RNA. Certain exosomes have the potential to alter how cells respond to inflammation and potentially improve a cartilage cell’s ability to heal, which could drastically improve treatment for arthritis. Read this study in Frontiers: Exosomes in cartilage microenvironment regulation and cartilage repair.  The photo is by Priss Enri on Unsplash. It is not a picture of exosomes.   - amniotic fluid cells, amniotic suspension allograft (ASA), arthritis, bone marrow aspirate, cartilage cell, cartilage disease, cartilage microenvironment, cartilage repair, exosomes, fat derived stem cell, FDA Trial, healing, inflammation, knee, lipogems, mechanism of action, micronized amniotic membrane, Osteoarthritis, Stem Cells, treatment, umbilical stem cell ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHow 3D Imaging of the Patellofemoral Joint Improves Treatment Options NextIs Robot-assisted MPFL Reconstruction Better than Freehand?Next --- ## Study: Microtrauma Role in ACL Injuries - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/study-animal-model-microtrauma-acl-injuries/ Summary: This Penn State study is amazing, suggesting that playing sports causes significant microtrauma to our ACLs and that potentially sets us up for an ACL injury. # Study Using an Animal Model Examines Microtrauma Role in ACL Injuries Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - October 26, 2023 Wow, this Penn State study is amazing. I don’t think that I’ve ever considered the possibility that playing sports causes significant microtrauma to our ACLs and that potentially sets us up for an ACL injury. I’ve always assumed that when one tears one’s ACL, it’s a situation where the force of injury is more than the strength of the native ACL. If this rabbit study actually mimics the human response, perhaps there is some way to treat or prevent microtrauma to reduce the risk of ACL injury, especially in female athletes. Here’s a brief excerpt:  In the study, which was published in the Journal of Orthopaedic Research, researchers placed ACLs from deceased male and female rabbits in a custom-made bioreactor that simulated the conditions of a living animal but allowed direct observation and measurement of the tissue. Next, they applied repetitive forces to the ACLs that mimicked those that would naturally occur during activities such as standing, walking and trotting and measured the expression of genes related to healing. In male samples, the team found that low and moderate applied forces, such as those that would occur during standing or walking, resulted in increased expression of anabolic genes, which are related to building molecules needed for healing. By contrast, larger applied forces, such as those that would occur with repetitive trotting, decreased expression of these anabolic genes. For female samples, however, the amount of force applied did not influence the level of anabolic gene expression. “Some studies have found that the overall effect of estrogen on ACL injury is negative,” Paschall said. “Specifically, studies have shown that human women are more likely to tear their ACLs during the preovulatory phase, when estrogen levels are high, than during the postovulatory phase, when estrogen levels are low.” She said the team plans to further investigate the role of estrogen on ACL injury. Read the complete article on the Penn State website: “Females less likely to heal from ACL injuries than males” Photo by Alliance Football Club on Unsplash - ACL injury, ACL tear, athletes, female athletes, penn state, rabbits, research, study ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousAcupuncture During Surgery May Help Patients With Nosocomephobia NextThe Ortho Show – Dr. Sabrina Strickland – Orthopedic Surgeon, Sports Med Specialist, and Patellofemoral Joint ExpertNext --- ## Patellar Instability Reco May Be Anatomic - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/study-combined-reconstruction-for-patellar-instability-may-be-more-anatomic/ Summary: Portuguese researchers describe another procedure to treat patellar instability. Instead of a 2 arm ligament reconstruction, they describe a 4 arm reconstruction. # Study: combined reconstruction for patellar instability may be more anatomic Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - March 31, 2022 A new study from researchers in Portugal describe yet another procedure to treat patellar instability. Instead of a two arm ligament reconstruction, they describe a four arm reconstruction — which could have some advantages. However, a vital consideration with MPFL surgery is avoiding overtightening and this is somewhat more likely if four different grafts need to be attached to the soft tissue in the front of the knee. I caution patients to ask their surgeons about their specific experience with the surgery being considered. Ultimately it is best to have the surgery your surgeon is most comfortable and experienced with. Read more in this Healio article. - Hospital for Special Surgery, HSS, knee surgery, ligament reconstruction, MPFL reconstruction, MPFL surgery, orthopaedic surgery, patellar instability, Portugal ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousSurgical demo: MPFL/MQTFL Reconstruction: Lateral Retinacular Lengthening/Reconstruction NextSeveral assessments for patellofemoral instability yielded poor interrater reliabilityNext --- ## MACI Cartilage Transplantation Patients | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/study-following-maci-cartilage-transplantation-patients/ Summary: We followed our patients who have undergone MACI cartilage transplantation after surgery in the office as well as by getting MRI imaging. # Study Following MACI Cartilage Transplantation Patients Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: August 22, 2024 - August 22, 2024 I’m proud to report that our paper, “Management of Patellar and Trochlear Cartilage Lesions with Matrix-Induced Autologous Chondrocyte Implantation in Conjunction with Patellofemoral Realignment Procedures Improves Patient Reported Outcomes and Magnetic Resonance Image Appearance,” just got published in The Journal of ISAKOS (JISAKOS).   We have followed our patients who have undergone MACI cartilage transplantation after surgery — both in the office as well as by getting MRI imaging. Overall, this is a very successful technique to improve symptoms in patients with symptomatic cartilage lesions, especially with malalignment. The combination of realignment with osteotomy and MACI is optimal for the majority of these patients.   Please read the complete article to learn about the objectives, methods, surgical technique, results, and conclusion.        - MACI, MACI cartilage transplantation, Magnetic Resonance Image Appearance, Matrix-Induced Autologous Chondrocyte Implantation, MRI imaging, orthopedic surgery, Patellar and Trochlear Cartilage Lesions, Patellofemoral Realignment Procedures, Patient Reported Outcomes, study, surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPrevious11 Shoulder Stretches that Fight Stiffness & Improve Posture NextMPFL Reconstruction and TTO QuestionsNext --- ## Small Study on One-Step Cartilage Repair | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/study-long-term-outcomes-one-step-cartilage-repair/ Summary: This very interesting study was published in a top US sports journal this past November showing good outcomes with a one-stage cartilage repair technique. # Small Study of Long-Term Outcomes for One-Step Cartilage Repair Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: January 24, 2025 - January 24, 2025 This very interesting study, which showed good outcomes with a one-step cartilage repair technique, was published in a top US sports journal this past November. Unfortunately, the study was quite small, with only 26 patients, and it did not have a control group. In summary, this study population was of an average age of 48 with an average lesion size of 6.6 cm and 14-year outcomes. Four patients were considered treatment failures, but the other 22 appeared to have excellent results. This product is not available in the United States. It is a membrane made of hyaluronic acid, a liquid we use for injection routinely, combined with bone marrow aspirate concentrate (a product we use routinely to optimize healing). Hopefully, the FDA will make it easier to approve products such as these without costly studies that take years. As long as a product is deemed safe, it sometimes seems better to let the doctors and patients decide if it is worth trying than to limit our options so severely. Read the complete study in The American Journal of Sports Medicine. Image via https://www.researchgate.net/figure/Chemical-structure-of-hyaluronic-acid_fig4_339321466 under the Creative Commons Attribution-ShareAlike 4.0 International, modified to adjust size and clarity.  - 14-year follow-up, Bone marrow aspirate concentrate (BMAC), cartilage repair, Full-thickness chondral lesions, hyaluronic acid, Hyaluronic acid-based scaffold (HA), knee, Knee injury and Osteoarthritis Outcome Score (KOOS), Long-term outcomes, one-step cartilage repair, One-step cell-based technique, Visual analog scale (VAS) ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousAn Analysis of Intraoperative Acupuncture for Nosocomephobia NextTestosterone Hormone Therapy May Increase ACL Injury RiskNext --- ## New Study Shows Osteoarthritis May Be Treatable and Reversible | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/study-osteoarthritis-treatable-reversible/ Summary: New study shows osteoarthritis may be treatable and reversible, but more research is needed before we can support use of available stem cell treatments for humans. # New Study Shows Osteoarthritis May Be Treatable and Reversible Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 7, 2023 - December 7, 2023 The possibility of osteoarthritis being treatable and reversible sounds too good to be true — but if researchers are able to see cartilage regrowth in mice, there is a bit of hope for the rest of us. Targeted stem cell treatment may indeed be the way to go, but so far there has been very limited data to support use of available stem cell treatments for humans. Read the article: Osteoarthritis may be treatable and reversible, new study shows Image source: https://commons.wikimedia.org/wiki/File:Osteoarthritis.jpg - cartilage regrowth, mice, Osteoarthritis, researchers, reversible, study, Targeted stem cell treatment, treatable ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousAI Chatbot Model Generating Reports on ACL Tears NextTwo-Year Follow-up for the LIFT ImplantNext --- ## MPFL/MQTFL/Lateral Retinacular Lengthening - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/surgical-demo-mpfl-mqtfl-reconstruction-lateral-retinacular-lengthening-reconstruction/ Summary: Surgical demo: "MPFL/MQTFL Reconstruction; Lateral Retinacular Lengthening/Reconstruction" by Kristofer Jones, MD, part of this year # Surgical demo: MPFL/MQTFL Reconstruction: Lateral Retinacular Lengthening/Reconstruction Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - March 23, 2022 I’ll be moderating this surgical demo: “MPFL/MQTFL Reconstruction; Lateral Retinacular Lengthening/Reconstruction” by Kristofer Jones, MD, which is part of this year’s ISMF Conference surgical demos! The International Sports Medicine Fellows Conference (ISMF) is the longest running annual gathering of orthopaedic sports medicine fellows, providing an opportunity for fellows to enhance their knowledge of orthopaedic sports medicine through a variety of lectures, case presentations and surgical demonstrations.   Watch the surgical demos for free by registering at https://ismf-conference.com/meetings/2022/ISMF/Registration. - Hospital for Special Surgery, International Sports Medicine Fellows Conference, ISMF, ISMF Conference, lateral retinacular, lengthening, MPFL, MQTFL, reconstruction, surgical demo ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousBrenda Yee — medial meniscus tear and arthroscopic repair NextStudy: combined reconstruction for patellar instability may be more anatomicNext --- ## Staple Fixation for Combined ACWO, ACLR | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/surgical-technique-staple-fixation/ Summary: The aim of this Technical Note with video is to illustrate our preferred surgical technique (staple fixation) for a single-stage combined ACWO and all-inside ACLR. # Surgical Technique: Staple Fixation for Combined All-Inside ACWO and ACLR Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: October 4, 2024 - October 4, 2024 While often successful, anterior cruciate ligament surgery sometimes does fail. What we’ve seen is that failure can be caused by various factors, including technical, anatomic, and patient-related factors. The shape of the knee joint is one of those anatomic factors, specifically an increased posterior tibial slope. This factor is associated with an increased risk of failure, both after primary and revision ACL reconstruction. We believe that this is a result of increased load across the ACL graft.     To address this surgically, we recommend this surgical technique: using staple fixation. Our technique is a combined, single-stage, all-inside reconstruction of the ACL and an anterior closing-wedge osteotomy. The technique we propose in this article and video provides adequate fixation of the osteotomy while also minimizing hardware interference with the ACL tunnel placement and maximizing the proximal femoral bone stock.    To learn more about this staple fixation surgical technique, read the complete article in Arthroscopy Techniques and watch the included video: Combined All-Inside Anterior Cruciate Ligament Reconstruction and Tibial Anterior Closing Wedge Tibial Osteotomy Using Staple Fixation: Surgical Technique.    The image in this post is taken from the video.    - All-Inside Anterior Cruciate Ligament Reconstruction, anterior cruciate ligament reconstruction, combined ACWO ACLR, staple fixation, surgical technique, Tibial Anterior Closing Wedge, tibial osteotomy ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousCould Dancing Molecules Transform Osteoarthritis Treatment? NextA Foot Workout & How Feet Relate to KneesNext --- ## Treat Iatrogenic Patella Baja Surgically - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/surgical-treatment-of-iatrogenic-patella-baja/ Summary: Patella baja is characterized by a loss of patellar height and can develop as either an acute or chronic complication following a knee injury or surgical procedure. # Surgical Treatment of Iatrogenic Patella Baja Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: May 2, 2026 Quick Summary Iatrogenic patella baja is an abnormally low-riding kneecap that develops as a complication of knee surgery — most often ACL reconstruction with bone-patellar tendon-bone autograft, high tibial or tibial tubercle osteotomy, and total knee replacement. The pathology involves quadriceps dysfunction, immobilization, and infrapatellar scarring. Symptomatic patients can be treated with tibial tubercle proximalization, patellar tendon lengthening, or patellar tendon reconstruction, often using allograft or autograft tissue. - November 29, 2022 Patella baja is characterized by a loss of patellar height and can develop as either an acute or chronic complication following a knee injury or surgical procedure. The purpose of this review is to describe the diagnosis and management of patella baja and highlight the senior author’s surgical technique. ### Recent Findings The pathogenesis of patella baja involves a complex interaction between quadriceps dysfunction, immobilization, and inflammation leading to infrapatellar scarring and adhesions. It is associated with fractures about the knee and can result as a complication of surgical procedures such as anterior cruciate ligament (ACL) reconstruction, particularly bone-patellar tedon-bone autografts, high tibial osteotomies (HTOs), tibial tubercle osteotomies (TTOs), and total knee arthroplasties (TKAs). Patients with patella baja can have limited knee range of motion, anterior knee pain, significant weakness with active knee extension, and an extensor lag. Surgical intervention is indicated in cases of symptomatic patella baja. Treatment strategies include tibial tubercle proximalization, patellar tendon lengthening, and patellar tendon reconstruction. Allografts and autografts can be utilized to augment tendon lengthening or reconstructive procedures. Various small case series have reported favorable outcomes for these procedures. Read more in Current Reviews in Musculoskeletal Medicine. - ACL reconstruction, adhesions, iatrogenic patella baja, infrapatellar scarring, knee injuries, knee injury, patella baja, patellar height, quadriceps dysfunction, surgical procedure, surgical technique, surgical treatment ## Frequently Asked Questions What causes iatrogenic patella baja after knee surgery?Patella baja caused by a prior surgery develops when scarring and adhesions just below the kneecap pull it downward. It happens most often after ACL reconstruction with a bone-patellar tendon-bone graft, high tibial osteotomy, tibial tubercle osteotomy, or total knee replacement. Quad weakness, long periods in a brace, and inflammation after surgery all contribute. The lower kneecap position affects the system that straightens the knee, and imaging confirms the diagnosis using a specific height ratio. What are the symptoms of patella baja?Patients with patella baja typically have limited knee range of motion, front-of-knee pain, weakness with active knee straightening, and an extensor lag (where the leg can't fully straighten under power). Symptoms often appear weeks to months after the original injury or surgery. Some patients also feel that the kneecap sits too low and may have grinding sensations when bending the knee. Imaging confirms the diagnosis. Which surgical options treat symptomatic patella baja?Surgical options include moving the kneecap tendon attachment higher on the shinbone, lengthening the kneecap tendon, and reconstructing the kneecap tendon. Donor or your own tissue may be used to augment the lengthening or reconstruction. The choice depends on the cause, the severity of the kneecap-height loss, the condition of the tendon system that straightens the knee, and whether prior hardware needs to be addressed. Surgery is reserved for patients with symptoms — limited motion, front-of-knee pain, or weakness on straightening — not for incidental findings on imaging alone. ## Related Reading - Patellar instability (specialty page) - It’s the patellofemoral height: why patellar height matters - Tibial tubercle osteotomy & distalization for patella alta - Effect of patellofemoral arthroplasty on patellar height - About Dr. Sabrina Strickland ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousMCL Injuries and Recovery NextAnteromedialization Tibial Tubercle Osteotomy Improves Patellar Contact Forces: A Cadaveric Model of Patellofemoral DysplasiaNext --- ## When to Take Your Knee Injury Seriously | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/take-knee-injury-seriously/ Summary: Recently, my nephew injured his knee in a soccer game but was able to keep playing, while soreness continued. When do you need to take your knee injury seriously? # How Do You Know When To Take Your Knee Injury Seriously? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery, New York City · Last reviewed: May 2, 2026 Quick Summary A knee injury should be taken seriously when there is significant swelling, an audible pop, the knee gives way, you cannot bear weight, or pain persists more than a few days — especially in teenagers and active patients. These are the signs that point to ACL, meniscal, or cartilage injury rather than a simple sprain, and they warrant MRI and orthopedic evaluation before returning to sport. - February 20, 2025 I want to share a story about my adorable 13-year-old nephew. He is the typical 8th-grade boy who loves to ski, plays travel soccer, and runs track and cross country at his middle school. Just before Christmas, he had a knee injury at a soccer game but was able to keep playing. His mom, my sister, said it didn’t seem like he had really injured himself — it seemed like a pretty normal tackle. She thought he had hurt it, but not really badly. But on the 5-hour drive from Danville, PA, where they live, to my house in Quogue, NY, he complained to his parents that his knee was sore. My sister wasn’t particularly worried because he was walking just fine. The holiday was crazy with 16 people at my house, and somehow, I never got a chance to look at his knee. Yet his pain persisted. He could walk and even run, but then the knee injury felt worse.  On my recommendation, he got an MRI the next week. It showed that he had torn his meniscus and sprained his ACL. In my practice at Hospital for Special Surgery in New York, I do see this happen quite often — a patient comes in with a remote history of a knee injury that was brushed off, and then presents months later with recurrent instability, a giving-way knee, and a meniscal tear that has now extended. The first injury was the warning shot; the second one is the one that ends a season. I would suggest that any injury resulting in swelling, limping, an audible pop, or a knee that gives way be taken seriously — especially in teenagers and active adults. Significant swelling within the first few hours of injury (a hemarthrosis) is one of the strongest predictors of an internal derangement such as an ACL tear, a peripheral meniscal tear, or a patellar dislocation with cartilage injury. In my nephew’s case, the MRI confirmed that his knee injury was indeed serious. He started physical therapy, and his local doctor has now allowed him to return to running — and he’s planning to participate in spring soccer with his school. In some cases, patients are not so fortunate. They return to cutting sports — soccer, basketball, lacrosse, skiing — on a knee that is missing an intact ACL or has an unrecognized meniscal tear, and the knee gives way again. Each giving-way episode can extend a meniscal tear, damage articular cartilage, and accelerate the long-term arthritis risk. That secondary damage often does more long-term harm than the original injury. ## Warning signs that a knee injury is serious Any of these findings after a knee injury should prompt evaluation rather than waiting to see if it settles: - Swelling within the first few hours — a hemarthrosis suggests bleeding inside the joint and is associated with ACL tears, peripheral meniscal tears, and cartilage injuries. - An audible pop at the moment of injury — frequently reported with ACL ruptures and patellar dislocations. - The knee giving way — a sense that the knee buckled or shifted, which points to ligamentous injury. - Inability to bear weight — particularly in adolescents, where it can indicate a fracture, an osteochondral injury, or a displaced meniscal tear. - True mechanical locking — when the knee gets stuck and won’t fully straighten, this often signals a displaced bucket-handle meniscal tear that needs prompt treatment. - Pain that persists or worsens after several days of relative rest, ice, and activity modification. For families in the New York metro area, evaluation by a sports-trained orthopedic surgeon — combined with a focused physical exam and, when warranted, an MRI — is the fastest way to distinguish a sprain from a structural injury. The cost of an MRI and a single visit is far smaller than the cost of returning to play on an unrecognized ACL tear and re-injuring the meniscus or cartilage. ## Risks and what to expect It is reasonable to feel some hesitation about seeing an orthopedic surgeon for a knee injury — many patients tell me they were worried we would jump straight to surgery. We don’t. The first visit is an evaluation: history, physical exam, and imaging if needed. Many knee injuries — including some meniscal tears and partial ligament sprains — are managed without an operation. When surgery is the right choice, MRI imaging, anatomy, and the patient’s sport and goals all factor into the plan. Like any procedure, knee surgery carries risks including infection, stiffness, and graft retear, and we discuss those individually for each patient. - ACL injury, ACL sprain, back in the game, cross country, cutting sports, knee, knee injury, meniscal tear, MRI, ski, soccer injury, sports, sports injury, track ## Frequently Asked Questions What knee injury symptoms mean I should see a doctor?Significant swelling within hours of the injury, an audible pop at the time of injury, the feeling that the knee gives way, inability to put weight on the leg, the knee locking or getting stuck, or pain that gets worse after several days are all reasons to seek evaluation. In children and teenagers, any injury that produces swelling or limping should be taken seriously because growth plates and ligaments respond differently than in adults. Can a teenager keep playing on a knee that hurts after a tackle?Continuing to play on an injured knee that swells or causes limping risks turning a sprain into a more serious tear and adding cartilage or meniscus damage. Young athletes often mask injuries because they want to stay in the game. If swelling, limping, or instability persist beyond the first day, the athlete should stop activity and be evaluated. Do I need an MRI for a knee injury, or is an X-ray enough?X-rays show fractures and bone alignment but cannot show the ACL, meniscus, or cartilage. When a sports injury is followed by swelling, instability, or persistent pain, MRI is the imaging study that identifies ACL tears, meniscus tears, and cartilage injuries. I order an MRI when the story and the exam suggest a soft-tissue injury rather than a simple bone bruise. What happens if a knee injury is ignored and someone returns to cutting sports?Returning to pivoting and cutting sports on an unstable knee — particularly with an unrecognized ACL or meniscus tear — often produces repeated giving-way episodes. Each episode can extend the original meniscus tear, damage cartilage, and speed up long-term arthritis risk. That is why I encourage prompt evaluation rather than waiting to see if symptoms settle on their own. How is a sprained ACL different from a torn ACL?A sprained ACL is a partial-thickness injury where the ligament is stretched or partly disrupted but still intact, while a torn ACL is a complete rupture. MRI grading helps distinguish the two. Many partial sprains stabilize with physical therapy and strengthening, while complete tears in active patients usually need reconstruction to safely return to cutting sports. ## Related Reading - ACL tear surgery (specialty page) - Meniscal tear / torn meniscus (specialty page) - Skier’s ACL & meniscus tear story - Kids and sports injuries - Why ACL tears are so devastating - About Dr. Sabrina Strickland ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousTestosterone Hormone Therapy May Increase ACL Injury Risk NextThe Role of Hyaluronic Acid in Healing InjuriesNext --- ## How to Tell If MPFL Reconstruction Failed | Dr. Strickland Source: https://sabrinastrickland.com/tell-if-mpfl-reconstruction-failed/ Summary: Knowing the signs of a failed MPFL reconstruction can help ensure the best outcome possible. Learn how to tell if your MPFL reconstruction failed. # How to Tell If Your MPFL Reconstruction Failed Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: April 30, 2026 - September 10, 2025 Medial patellofemoral ligament (MPFL) reconstruction is a proven surgical solution for those experiencing recurrent kneecap (patellar) instability. While the vast majority of patients experience restored stability and a return to active lifestyles, a small number may face complications or failure after surgery. But how can you easily tell if your MPFL reconstruction failed? Quick Summary A failed MPFL reconstruction typically presents as recurrent kneecap dislocation or subluxation, persistent anterior knee pain, loss of range of motion, or no functional progress in physical therapy. Failure rates remain low when surgery is performed by an experienced surgeon and unaddressed anatomical factors — patella alta, trochlear dysplasia, or limb malalignment — are corrected. Early evaluation with X-ray and MRI is essential to identify the cause and determine whether revision surgery is warranted. Recognizing the signs of a failed MPFL reconstruction early can help ensure the best outcome possible. For in-depth information about MPFL surgery and recovery, read this comprehensive overview: MPFL Reconstruction Surgery. ## What Is Considered a Failed MPFL Reconstruction? A failed MPFL reconstruction is one that does not restore stable, pain-free patellar tracking — usually defined by recurrent dislocation, persistent anterior knee pain, stiffness, or postoperative complications that limit a patient’s return to activity. Surgeons typically diagnose failure by combining the patient’s reported symptoms with a physical exam, X-ray imaging, and MRI to evaluate graft integrity, bone alignment, and soft-tissue changes. A failed MPFL reconstruction is generally defined by: - Persistent or recurrent patellar instability: This includes continued episodes where the kneecap dislocates or feels like it may “give way,” especially during twisting movements, sports, or daily activities. - Disabling anterior knee pain: Ongoing pain at the front of the knee that significantly limits your function or activity. - Stiffness and loss of range of motion: Difficulty straightening or bending the knee, which may require more aggressive physical therapy or even surgical intervention. - Postoperative complications: Infection, ongoing swelling, or abnormal wound healing that affects recovery and function. ## Signs Your MPFL Reconstruction May Have Failed The clearest signs of a failed MPFL reconstruction are recurring kneecap dislocation or subluxation, persistent anterior knee pain, new or worsening loss of range of motion, unresolved swelling, and the absence of functional progress in physical therapy. Any of these warrants a focused orthopedic re-evaluation rather than waiting to “push through.” Consider speaking with your orthopedic team if you experience any of the following after MPFL reconstruction: - Recurring Instability: If your kneecap continues to dislocate, sublux (shift partially out of place), or feels unstable, particularly during motion or athletic activity. - Persistent Pain: Ongoing, moderate to severe pain at the front or inner side of the knee, especially if it is similar to or worse than before the surgery. - Loss of Range of Motion: You notice new or worsening stiffness, inability to extend or flex the knee, or “catching” sensations that restrict movement. - Swelling or Heat: Swelling or warmth around the knee joint that does not improve with time. - No Functional Improvement: Lack of progress in physical therapy, difficulty returning to normal activities, or regression post-surgery. If you’ve had MPFL reconstruction and notice a return or worsening of instability, pain, or stiffness, don’t hesitate to seek an evaluation. Early intervention can often make a great difference in your outcome. ## What Causes MPFL Reconstruction to Fail? MPFL reconstruction most often fails because of unaddressed underlying anatomy — not because the ligament repair itself was performed incorrectly. Patella alta, trochlear dysplasia, an elevated tibial tubercle–trochlear groove (TT–TG) distance, or generalized ligamentous laxity can all overload the new ligament. Technical factors at surgery (graft tunnel placement, tensioning), graft healing, and infection are the other recognized causes. According to clinical experience and recent studies, failure may be attributed to: - Technical factors: Incorrect placement or tensioning of the reconstructed ligament during surgery. - Unaddressed anatomical factors: Such as patella alta (high-riding kneecap), trochlear dysplasia (shallow groove at the femur), or limb alignment issues. - Graft problems: Stretching or tearing of the new ligament. - Poor healing or infection: Delayed wound healing, infection, or scar tissue formation. - Unrecognized risk factors: Generalized ligament laxity may predispose to recurrent instability. ## MPFL Reconstruction Failed: Now What? If you suspect failure, the immediate next step is a clinical and imaging re-evaluation by an experienced patellofemoral surgeon — not a wait-and-see approach. Identifying the specific cause (anatomic, technical, or healing-related) is what determines whether the right answer is targeted rehabilitation, a TT osteotomy, a revision MPFL, or a combined procedure. If you suspect your MPFL reconstruction has failed: - Consult your orthopedic surgeon. A thorough history, exam, and imaging (X-rays, MRI) are often required to precisely define the cause of failure, including evaluation of graft integrity and bone structure. - Do not delay evaluation. Persistent pain or instability could lead to additional problems if not promptly addressed. - Consider a second opinion. If symptoms are unexplained or persist despite treatment, specialized assessment may be necessary. - Revision surgery can often address persistent problems, but outcomes depend on finding and correcting the underlying cause(s). ## How to Recognize Success (and When to Get Help) First and foremost, don’t worry: most patients experience excellent outcomes after MPFL reconstruction if performed by an experienced surgeon and followed by proper rehabilitation. However, recognizing early warning signs of a failed MPFL reconstruction can help ensure that you manage any setbacks promptly, maximizing your chance of a full and lasting recovery. Key Takeaways - Recurring dislocation, persistent pain, or stalled rehab progress are the most reliable signs of failure. - Most failures trace back to unaddressed anatomy — not the ligament reconstruction itself. - Imaging (X-ray and MRI) plus an experienced specialist evaluation is the diagnostic standard before considering revision surgery. Learn more about MPFL reconstruction, including how to ensure the best possible outcome following surgery. If you’d like to make an appointment for a second opinion, please reach out.  Photo by yury kirillov on Unsplash ## Frequently Asked Questions How common is MPFL reconstruction failure? Reported failure rates after primary MPFL reconstruction are generally low, typically in the single digits in published series, when surgery is performed by an experienced surgeon and predisposing anatomy (patella alta, trochlear dysplasia, elevated TT–TG distance) is identified and addressed. Higher failure rates are reported when underlying anatomy is left untreated. How soon after surgery can MPFL reconstruction be considered to have failed? A clear redislocation during routine activity, ongoing locking or giving-way after the initial healing window, or stalled progress in physical therapy beyond the expected recovery curve all warrant re-evaluation. Some patients have post-op pain or stiffness early on that improves with rehab; ongoing or recurring instability is the most concerning sign and should not be dismissed. What imaging is needed to diagnose a failed MPFL reconstruction? A focused workup typically includes weight-bearing X-rays to assess patellar height, alignment, and tunnel position, plus MRI to evaluate graft integrity, cartilage status, and any associated lesions. CT may be added to measure tibial tubercle–trochlear groove (TT–TG) distance or to plan a revision when bony anatomy needs to be corrected. Is revision MPFL surgery successful? Outcomes after revision MPFL reconstruction are generally good when the cause of the original failure is correctly identified and addressed — this often means combining a revision MPFL with a tibial tubercle osteotomy, trochleoplasty, or correction of limb malalignment. Outcomes are less predictable when anatomic risk factors are still left untreated, which is why a thorough patellofemoral workup matters. When should I get a second opinion on a possible failed MPFL reconstruction? A second opinion is reasonable any time symptoms of instability or pain return, progress in supervised physical therapy stalls, or the cause of ongoing problems has not been clearly explained. A patellofemoral specialist who routinely treats recurrent instability can review prior imaging, examine the knee, and lay out the realistic options — including non-operative paths. - failed reconstruction, functional improvement, graft problems, knee surgery, ligament laxity, loss of range of motion, MPFL reconstruction, MPFL reconstruction failed, orthopedic surgeon, patella alta, patellar instability, persistent pain, postoperative complications, recurrent kneecap dislocation, rehabilitation, revision surgery, surgical failure, Trochlear dysplasia ## Related Reading - MPFL reconstruction surgery (specialty page) - How long does MPFL recovery really take? - Patellar instability - About Dr. Sabrina Strickland ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHigh Variation in Pediatric MPFL Reconstruction: Insights from the JUPITER Study NextHow Long Does MPFL Recovery Really Take? Timeline & Tips for SuccessNext --- ## Testosterone Therapy & ACL Injury Risk | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/testosterone-hormone-therapy-acl-injury-risk/ Summary: In a new study out of the Mayo Clinic, patients on testosterone replacement therapy may have an increased risk for ACL injury, possibly due to physiological changes. # Testosterone Hormone Therapy May Increase ACL Injury Risk Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: January 31, 2025 - January 31, 2025 This study out of the Mayo Clinic showed that both men and women on testosterone hormone therapy may be at increased risk of tearing their ACL. The men in their group had about a 3x risk of tearing their ACL, and the women were about 2x compared to an age-matched control group. For the past 30 to 40 years, we have struggled to find out why some patients are so much more likely than others to tear their ACLs. Certainly, the cause is multifactorial. Genetics, strength, limb alignment, hormones, etc., have all been implicated. This does not mean that patients should not take testosterone; it simply alerts physicians and patients that there may be a higher risk of injury and hopefully helps us sort out ways to mitigate that risk in the future. Read the complete article in Healio: Patients on testosterone replacement therapy may have increased risk for ACL injury .  Photo by Mykenzie Johnson on Unsplash (slightly edited).  - ACL injury risk, hormone therapy, knee injury, ligament injury, men's health, orthopedics, physiological changes, sports medicine, study, testosterone, testosterone replacement therapy, TRT, women's health ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousSmall Study of Long-Term Outcomes for One-Step Cartilage Repair NextHow Do You Know When To Take Your Knee Injury Seriously?Next --- ## Thanksgiving Skiing - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/thanksgiving-skiing/ Summary: Enjoying a family cross country adventure. If you enjoy Nordic skiing, I highly recommend: Devil # Thanksgiving Skiing Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - November 28, 2015 Enjoying a post-Thanksgiving family cross country adventure. Watch my video on Facebook: www.facebook.com/Dr.Strickland/videos/1064569696928374/?theater If you enjoy Nordic skiing, I highly recommend this spot. ## Devil’s Thumb Ranch – Colorado Resort and Spa Devil’s Thumb Ranch is a highly regarded and environmentally friendly year-round Ranch resort and spa offering rustically upscale accommodations, fine dining and an array of winter and summer outdoor and wilderness recreation activities. Source: www.devilsthumbranch.com/         - Colorado Resort and Spa, cross country skiing, Devil's Thumb Ranch, Nordic skiing ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousCrested Butte Thanksgiving NextNew Technology in OrthopaedicsNext --- ## Bridge-Enhanced ACL Restoration Implant - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/the-bridge-enhanced-acl-restoration-implant-known-as-the-bear-implant/ Summary: The Bridge-Enhanced ACL Restoration Implant (BEAR)—encourages the stumps of a torn ACL to grow back together. Learn how we # The Bridge-Enhanced ACL Restoration Implant—known as the BEAR implant Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - September 7, 2022 Excited to share that Hospital for Special Surgery is participating in this JointStem Research Study. This study investigates the effects of an autologous adipose tissue-derived stem cell injection in patients with knee osteoarthritis.   This is a 48-week, phase 2B/3A, double-blind, randomized, placebo controlled, multi-center, superiority study to evaluate the efficacy and safety of jointstem, autologous adipose tissue derived mesenchymal stem cells in patients diagnosed with knee osteoarthritis. Learn more on the Hospital for Special Surgery website.  - ACL healting, ACL reconstruction, ACL recovery, ACL restoration, ACL surgery, ACL tear, BEAR implant, biologics, Bridge-Enhanced ACL Restoration Implant, orthopaedic surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousEffect of Patellofemoral Arthroplasty on Patellar Height in Patients with Patellofemoral Osteoarthritis NextHospital for Special Surgery – JointStem Research StudyNext --- ## The Ortho Show with Dr. Scott Sigman | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/the-ortho-show-dr-sabrina-strickland/ Summary: Dr. Sabrina Strickland joins Dr. Sigman on The Ortho Show to discuss her specialization with patellofemoral joint and ACLs, education, professional background, more. # The Ortho Show – Dr. Sabrina Strickland – Orthopedic Surgeon, Sports Med Specialist, and Patellofemoral Joint Expert Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: July 5, 2024 - November 8, 2023 In November, I joined Dr. Scott Sigman on The Ortho Show to discuss my specialization with patellofemoral joint and ACLS, my education and professional background, and more. The podcast episode is brought to you by MIACH Orthopedic’s BEAR Implant, which I have talked about quite a bit in the past. To learn more, listen to the podcast: “Dr. Sabrina Strickland – Orthopedic Surgeon, Sports Med Specialist, and Patellofemoral Joint Expert” - ACLs, anterior cruciate ligament, BEAR implant, Bridge-Enhanced ACL Restoration, cartilage repair, donor cartilage, Dr. Sabrina Strickland, Dr. Scott Sigman, MACI, MIACH Orthopedics, patellofemoral joint, patellofemoral joint repair, research, The Ortho Show ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousStudy Using an Animal Model Examines Microtrauma Role in ACL Injuries NextGood Outcomes with Cartilage Restoration ProceduresNext --- ## The Ortho Show with Dr. Scott Sigman | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/the-ortho-show-with-dr-scott-sigman/ Summary: In this episode, Dr. Sabrina Strickland joined Dr. Sigman,to discuss my specialization with patellofemoral joint and ACLs, education, & professional background. # The Ortho Show with Dr. Scott Sigman Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: July 5, 2024 - July 5, 2024 In November, I joined Dr. Scott Sigman on The Ortho Show, where we discussed the BEAR Implant among other things. Dr. Sigman introduced me as an orthopedic surgeon and sports medicine specialist at HSS, the Hospital for Special Surgery. I’ve dedicated my professional life to the patellofemoral joint, working to advance the technology and research that’s has gone into repairing the patellofemoral joint and anterior cruciate ligaments (ACLs) to help patients return to their active lifestyle. Listen to the podcast Dr. Sabrina Strickland – Orthopedic Surgeon, Sports Med Specialist, and Patellofemoral Joint Expert on The Ortho Show. It’s entertaining and you can get to know me a bit better through my conversation with Dr. Sigman.    - ACLs, anterior cruciate ligament, back surgery, body cast, Chicago, clinical research, Colorado, Cornell, Crested Butte, education, Hospital for Special Surgery, HSS, Italy, MCAS, medical school, mentors, orthopedic surgeon, patellofemoral joint, premed requirements, professional background, research, residency, Rush Medical School, ski team, skiing, skiing injuries, spinal fusion, spinal fusion surgery, sports medicine, study abroad, women in orthopedics ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousFDA Trial: HYALEX® Knee Cartilage System NextExploring Risk Factors for Atraumatic Medial Patellar Facet LesionsNext --- ## The Scariest Thing About Sports - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/the-scariest-thing-about-sports/ Summary: There is nothing scarier about sports than permanent cognitive defects due to head injury. This article in Bloomberg news talks about new helmet technology. # The Scariest Thing About Sports Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - September 29, 2015 There is nothing scarier about sports than permanent cognitive defects due to head injury. This article in Bloomberg news talks about new helmet technology. This could be the answer. If helmets can measure how hard the player is getting hit and keep track over a season, then we may be able to not only monitor these injuries, but stop the athlete from playing before it is too late. This seems well within the possibility of technology and hopefully these helmets will be in popular use soon. ## Football’s Most Dangerous Practice – Bloomberg View Confronting head injury will require changes to programs at every level.” data-ephemeral=”true Source: www.bloombergview.com/articles/2015-09-23/football-s-most-dangerous-practice   - sports ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousAttending Women’s Sports Events with My Daughters Next6 Tips to Train Like a Professional AthleteNext --- ## Dual Tibial Osteotomy Surgeries to Get Back to Lifeguarding | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/tibial-osteotomy-surgeries-lifeguarding/ Summary: Kristen DiTommaso returns to lifeguarding after dual tibial osteotomy surgeries. Read her story about getting back to her normal activities. # Dual Tibial Osteotomy Surgeries to Get Back to Lifeguarding Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - November 16, 2023 Sharing another one of my patient’s stories today! Meet Kristen DiTomasso, who came to me after being told she needed a full knee replacement. When she came to me, I determined that she needed tibial osteotomy surgeries on both knees. This enabled her to return to lifeguarding and the rest of her very active lifestyle!  Kristen shared her story on the Hospital for Special Surgery’s Back in the Game stories, but I am happy to share it here as well.  ## Tibial Osteotomy Surgeries I made an appointment with Dr. Strickland after dislocating my left kneecap. I had seen doctors in New Jersey who told me I needed a full knee replacement. This shocked me since I never hurt my left knee before. I was discouraged until I saw Dr. Strickland who told me there was hope and that I did not need a knee replacement. I had back to back tibial osteotomy surgeries on my left knee and then my right knee. Every time I have an appointment with Dr. Strickland she is always so positive in my recovery. Because of her and her team, I am back to my normal activities of being a CrossFit athlete, an ocean lifeguard, and a member of the Monmouth County and USA National Lifeguard teams. I could not be thankful enough for all Dr. Strickland has done for me! ## Return to Lifeguarding (and more) Since undergoing surgery, I became the USLA Beach Flags National Champion the last 4 out of 5 years. I have also become one of the top 100 yard sand sprinters in Monmouth County and the nation, while beating lifeguards that are half my age. Read Kristen’s story, see more pictures, and watch her videos on the HSS Back in the Game website.  - CrossFit athlete, knee surgery, kneecap, kneecap dislocation, kneecap injury, lifeguarding, Monmouth County Lifeguard team, ocean lifeguard, patella injury, recovery, surgeries, tibial osteotomy, USA National Lifeguard team, USLA Beach Flags National Champion ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousGood Outcomes with Cartilage Restoration Procedures NextAI Chatbot Model Generating Reports on ACL TearsNext --- ## Tibial Tubercle Osteotomy w/ Distalization for Patella Alta Source: https://sabrinastrickland.com/tibial-tubercle-osteotomy-distalization-treatment-patella-alta/ Summary: A distalizing tibial tubercle osteotomy is a relatively rare operation as far as knee surgery goes; I do it for patients who have patella alta or high knee caps # Tibial Tubercle Osteotomy With Distalization for the Treatment of Patella Alta Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: May 2, 2026 - June 28, 2023 Quick Summary A distalizing tibial tubercle osteotomy (TTO) lowers a high-riding kneecap (patella alta) by detaching a small block of bone from the front of the tibia and reattaching it in a more anatomically correct position. The procedure relieves chronic anterior knee pain, fat pad impingement, patellar tendinitis, and inferior patellar cartilage wear, and can also stabilize a kneecap that dislocates. Modern fixation techniques have substantially reduced the historical risks of fracture and non-union when performed by an experienced patellofemoral surgeon. A relatively rare operation as far as knee surgery goes is a distalizing tibial tubercle osteotomy. I do this surgery for patients who have patella alta or high knee caps. This can result in chronic anterior knee pain, fat pad impingement, patellar tendinitis and inferior patellar cartilage wear. It can also contribute to patellar instability in some patients. The surgical treatment has historically been associated with significant complications such as fracture, delayed union or non-union or failure to unite. This modification of the technique is how I have been doing this surgery for the past 6-7 years and has resulted in a lot of satisfied patients. The image shows lateral radiographs of the right knee from a 19-year-old female patient with patella alta and patellar instability who was indicated for tibial tubercle osteotomy with distalization. Read more in Arthroscopy Techniques. ## What Is Patella Alta and Why Does It Need Surgical Correction? Patella alta — or a high-riding kneecap — is an anatomical variation in which the patella sits abnormally high relative to the trochlear groove of the femur, reducing bony engagement and predisposing the joint to instability and pain. Because the kneecap is "perched" above the groove during early flexion, the soft tissues take on a disproportionate share of the load, leading to chronic anterior knee pain, fat pad impingement, patellar tendinitis, inferior patellar cartilage wear, and recurrent patellar instability in some patients. When non-operative care — activity modification, focused physical therapy, bracing, and addressing soft-tissue imbalance — fails to restore stability or relieve pain, surgical correction of the bony anatomy may be indicated. A distalization tibial tubercle osteotomy directly addresses the height of the patella by moving the tubercle (and therefore the patellar tendon attachment) further down the tibia, restoring more normal patellofemoral mechanics. ## How the Distalization TTO Procedure Works During a distalizing TTO, a precise block of bone containing the tibial tubercle is detached from the front of the tibia, repositioned distally (and sometimes medialized), and rigidly fixed with screws so the patella now tracks correctly through the trochlear groove. The modification of the technique used at HSS prioritizes a long bone block, controlled cuts, and rigid fixation, which together support reliable bone-to-bone healing. The osteotomy is often combined with other patellofemoral procedures — such as MPFL reconstruction for ligament instability or cartilage restoration when an inferior pole lesion is present — based on the patient's underlying anatomy. Surgical planning relies on weight-bearing X-rays for patellar height, MRI for cartilage and ligament status, and CT in selected cases to measure tibial tubercle–trochlear groove (TT–TG) distance. ## Risks and Complications Like any orthopedic procedure, a distalizing TTO carries real risks — historically including tibial fracture, delayed union or non-union of the bone block, infection, hardware irritation, blood clots, stiffness, and recurrent instability when underlying anatomic factors are not fully addressed. Modern fixation strategies and careful patient selection have substantially reduced complication rates compared with earlier techniques, but no procedure is risk-free, and outcomes depend on diagnosis, anatomy, and adherence to the post-op rehabilitation plan. This is one of the reasons distalization is reserved for patients in whom patella alta is clearly contributing to symptoms and where conservative care has been exhausted — not as a first-line treatment. ## Recovery and Rehabilitation Recovery after a distalizing TTO typically involves a period of protected weight bearing, knee bracing, and structured physical therapy, with most patients walking unassisted by 6–8 weeks and returning to higher-impact activities by 4–6 months as the bone block fully heals. Timelines are individualized based on bone healing, concurrent procedures, and the patient's pre-operative function. Adherence to the rehab program is one of the strongest predictors of a successful outcome — underloading the bone block too early risks loss of fixation, while pushing too aggressively can aggravate anterior knee pain. Key Takeaways - Distalization TTO addresses the bony cause of patella alta — not just the symptoms. - Modern fixation techniques have substantially reduced the historical risks of fracture and non-union. - The procedure is often combined with MPFL reconstruction or cartilage restoration based on the patient's specific anatomy. - Outcomes are best when the operation is performed by a fellowship-trained patellofemoral specialist. If you have been diagnosed with patella alta or recurrent patellar instability and would like a personalized evaluation, learn more about joint preservation osteotomy or contact the office to schedule a consultation with Dr. Strickland. ## Frequently Asked Questions Who is a candidate for a distalizing TTO? A distalizing TTO is generally indicated for patients with symptomatic patella alta — confirmed on imaging — who have failed structured non-operative treatment and who continue to experience anterior knee pain, fat pad impingement, patellar tendinitis, inferior patellar cartilage wear, or recurrent kneecap instability. The decision is individualized based on patellar height (Caton-Deschamps Index, Insall-Salvati ratio), trochlear morphology, alignment, and overall function. How long does the surgery take and what is the hospital stay? A distalizing TTO is typically performed as a same-day or short-stay procedure, often taking 1.5–3 hours depending on whether additional procedures — such as MPFL reconstruction or cartilage restoration — are performed at the same time. Most patients go home the day of surgery in a knee brace with crutches. When can I return to sports after a distalization TTO? Return to higher-impact activities and sports is typically targeted at 4–6 months postoperatively, once the bone block has fully healed and quadriceps strength, range of motion, and patellar tracking have been restored. The exact timing depends on bone healing on imaging, completion of structured rehabilitation, and any concurrent procedures. Will the screws need to be removed later? Hardware removal is not routine, but the screws used to fix the bone block can become symptomatic in a subset of patients — particularly thin individuals where the screw heads can be palpable or irritate when kneeling. If hardware is symptomatic after the bone has fully healed, removal can be discussed as a separate, smaller outpatient procedure. Is a distalization TTO the same as an anteromedialization (AMZ) TTO? No — both are tibial tubercle osteotomies, but they correct different problems. A distalization moves the tubercle "down" the tibia to address patella alta, while an anteromedialization (Fulkerson) shifts the tubercle medially and forward to offload an isolated lateral or distal patellar cartilage lesion. The two can also be combined when patients have both excessive patellar height and a maltracking pattern that needs to be unloaded. - chronic anterior knee pain, Distalization, fat pad impingement, high knee caps, Hospital for Special Surgery, HSS, inferior patellar cartilage wear, knee pain, orthopaedic surgery, patella alta, Patella Alta Treatment, patellar tendinitis, tibial tubercle osteotomy ## Related Reading - Joint preservation osteotomy - Patellar instability - Peyton’s tibial tubercle osteotomy (patient story) - About Dr. Sabrina Strickland ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousUpdated: Patellofemoral Arthroplasty Conversion to Total Knee Arthroplasty NextHow to Improve Long-term Prognosis for Adolescents with Patellofemoral Pain?Next --- ## Tibial Tublercle Osteotomy or Tubercle Transfer - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/tibial-tublercle-osteotomy-or-tibial-tubercle-transfer/ Summary: This video shows what to expect when undergoing a tibial tublercle osteotomy for patellofemoral arthritis or patellar instability. # Tibial Tublercle Osteotomy or Tibial Tubercle Transfer Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - July 14, 2022 - Hospital for Special Surgery, HSS, knee, knee surgery, orthopaedic surgeon, patellar instability, patellofemoral arthritic, sports surgeon, sports surgery, tibial tubercle osteotomy, tibial tubercle transfer ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousPaulette Gangemi: Back in the Game – Patella Dislocation NextShoulder Replacement – Bar Hangs 3 Months Post SurgeryNext --- ## Tips for Doing Squats without Knee Pain | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/tips-squats-without-knee-pain/ Summary: This article in the New York Times has good videos that show how you can modify your squats to minimize knee pain and allow you to keep working out. # Tips for Doing Squats without Knee Pain Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: November 14, 2024 - November 14, 2024 This article in the New York Times has good videos that show you how you can modify your squats to minimize knee pain and allow you to keep working out. It also quotes Chris Powers, DPT, who is among the best PT researchers in the country. There are many misconceptions about squats. - First of all, you don’t need to go deep. In fact, I would discourage squats deeper than 90 degrees. - Second, the old adage to keep your knees over your ankles is unnecessary, and it hurts my knees. - The “knees over toes” workout encourages the opposite form. Ultimately, I would adjust your form in order to minimize pain in your knees. - Last of all, if you use weights, hold them in the position that feels best. I like to extend my elbows and hold the weights back, as this reduces the stress on my kneecaps. Holding weights forward may do the opposite, increasing the stress on the patellas and increasing pain. “It turns out, most people can effectively squat while navigating all sorts of issues, like kneecap pain, arthritis, meniscus tears, ligament and tendon strains and postoperative recovery, said Jarlo Ilano, a physical therapist in Seattle.” Read the article in The New York Times to learn more: How to Make Squats Easier on Your Knees The photo is by Benjamin Klaver and available on Unsplash. - Chris Powers, knee pain, kneecaps, minimize knee pain, misconceptions, PT researchers, reduce knee stress, squats, weights ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousIncreased Host Bone Marrow Edema as a Risk Factor for Osteochondral Allograft Failure NextHopping Backward as an Indication of Recovery from ACL reconstructionNext --- ## Surgical Repair for Torn Meniscus | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/torn-meniscus-surgically-repaired/ Summary: Torn meniscus? Surgery isn # How To Know When You Should Have a Torn Meniscus Surgically Repaired Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: April 30, 2026 Quick Summary A torn meniscus does not always require surgery — the right call depends on your symptoms, tear pattern, age, and activity goals. Surgery is typically recommended when mechanical symptoms (locking, catching, giving way) are present, when conservative care fails after several weeks, or when imaging shows a large or displaced tear in the vascular red zone. Small, stable tears with minimal symptoms often heal with rest, physical therapy, and activity modification. - May 28, 2025 A torn meniscus does not always require surgery. The decision is based on a combination of your symptoms, the characteristics of the tear, age, activity level, and response to conservative treatment. In my practice at Hospital for Special Surgery, I evaluate each meniscal tear on its own merits before recommending surgery — many patients improve with focused rehabilitation alone. ## Key Indicators for Torn Meniscus and Meniscus Surgery - Persistent Symptoms After Conservative Care: If you continue to have knee pain, swelling, weakness, or instability after a period of rest, physical therapy, and medications, meniscus surgery may be recommended. - Mechanical Symptoms: Locking, catching, or the knee “giving way” are strong indications for surgery, especially if these symptoms interfere with daily activities or prevent you from fully straightening or bending your knee. - Tear Characteristics: Large, complex, or high-grade tears, especially those in the outer (red) zone of the meniscus, where blood supply is better, are more likely to require surgical repair. Tears in the inner (white) zone, which has poor blood supply, are less likely to heal on their own and may require removal of the damaged tissue (partial meniscectomy). - Desire to Remain Active: Active individuals and/or athletes who wish to return to their previous activity often benefit from surgery, particularly if symptoms persist. - Failure of Non-Surgical Management: If non-surgical options (rest, ice, NSAIDs, physical therapy, and in some cases a cortisone injection) do not relieve symptoms after several weeks, surgery for the torn meniscus may be considered. ## When Meniscal Surgery May Not Be Necessary for a Torn Meniscus - Minor Meniscus Tears with Minimal Symptoms: Small tears, especially in older adults or those associated with arthritis, may improve with conservative treatment and often do not require surgery. - Tears without Mechanical Symptoms: If your knee is not locking or catching and you have minimal pain, non-surgical management is often preferred. ## Types of Surgery for Torn Meniscus Surgery Type Indication Recovery Time Meniscus Repair Younger patients, tears in the red zone, suitable meniscus tear 4-6 months Partial Meniscectomy Tears in the white zone, irreparable or degenerative tears 3-6 weeks Meniscus Transplant Young patients, previous meniscectomy, persistent symptoms 6-12 months ## Risks and Considerations for Meniscus Surgery - Surgery carries risks such as infection, blood clots, nerve damage, and the potential for arthritis, especially after meniscectomy. - Not all meniscus tears are repairable; the decision depends on tear location, size, and patient factors. ## Summary You should consider having a torn meniscus surgically treated if: - You have persistent pain, swelling, or instability after conservative treatment, - You experience mechanical symptoms like locking or catching, - Imaging shows a large or complex tear, especially in the vascular (red) zone, - You are young, active, and wish to maintain a high level of activity. Always consult with an orthopedic surgeon to discuss your specific case and to weigh the risks and benefits of surgery versus continued conservative management. Additional patient information and post-surgery care guidelines can be found here: Patient Information. If you want to learn more about meniscus root tears, see: Medial Meniscus Posterior Root Tears. The following are additional posts to help you research your next steps: - 5 Exercises to Avoid With a Torn Meniscus - 6 Exercises To Do With a Torn Meniscus - 5 Symptoms of a Torn Meniscus That Will Self-Heal - Medial Meniscus Root Repair With Implantable Shock Absorber Placement - Study on Medial Meniscus Posterior Root Tears - Patient Information: Meniscectomy/Arthroscopy/Chondroplasty/Biopsy (PDF)  - Patient Success Story: Skier with ACL Tear and Meniscus Tear - Patient Success Story: Medial Meniscus Tear and Arthroscopic Repair - How Do You Know When To Take Your Knee Injury Seriously? - Frequently Asked Questions       - ACL injuries, cartilage repair, conservative treatment, knee catching, knee giving way, knee instability, knee locking, knee pain, knee swelling, mechanical symptoms, meniscus repair, meniscus surgery, meniscus transplant, non-surgical meniscus treatment, NYC, orthopedic surgeon, partial meniscectomy, patellofemoral instability, Physical Therapy, red zone tear, sports medicine, tear characteristics, torn meniscus, white zone tear ## Frequently Asked Questions Will my torn meniscus heal without surgery?Some torn meniscus tears heal without surgery — it depends on where the tear is, how big it is, and what symptoms you have. Tears in the outer (red) zone of the meniscus have a blood supply and may heal with rest, physical therapy, and activity modification. Tears in the inner (white) zone don't have blood flow and rarely heal on their own. Small, stable tears with little to no locking or catching — especially in older adults with wear-and-tear changes — often respond well to non-surgical care over 6 to 12 weeks. How do I know if I need meniscus surgery?You should consider meniscus surgery if your knee locks, catches, or gives way; if pain, swelling, or instability persist after several weeks of rest, anti-inflammatories, and physical therapy; if imaging shows a large, complex, or displaced tear; or if you are young and active and want to preserve the meniscus long-term. The decision is always individualized — the tear pattern, age, activity goals, and response to non-surgical care all factor in. What is the difference between meniscus repair and meniscectomy?Meniscus repair stitches the torn tissue back together, preserving the meniscus and its shock-absorbing function — it is preferred when the tear is in the outer (red) zone with good blood supply and the patient is young or active. Recovery takes 4 to 6 months. A partial meniscectomy trims away the damaged, unrepairable tissue and has a much shorter recovery of 3 to 6 weeks — but removing meniscus tissue raises the long-term arthritis risk. Whenever it is technically possible, I prefer to repair rather than remove. How long is recovery after meniscus surgery?Recovery depends on the procedure. Partial meniscectomy is the fastest — most patients walk without crutches within a week and return to most activities in 3 to 6 weeks. Meniscus repair requires protected weight-bearing and limited knee bending for several weeks to allow healing, with full return to sport at 4 to 6 months. Meniscus transplant is the longest, with 6 to 12 months before unrestricted activity. Sticking with physical therapy is the single biggest factor in a good outcome. What are the risks of meniscus surgery?Like any surgery, meniscus procedures carry small risks of infection, bleeding, blood clots, stiffness, and nerve injury. The most important long-term consideration is that removing meniscus tissue speeds up cartilage wear and raises the risk of knee arthritis years down the road. That is why I prioritize repair over removal whenever the tear allows it. We discuss the specific risks for your tear and your activity profile before committing to a plan. ## Related Reading - Meniscal tear / torn meniscus (specialty page) - 5 exercises to avoid with a torn meniscus - 6 exercises to do with a torn meniscus - Meniscus symptoms that may self-heal - Medial meniscus posterior root tears ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousFDA Approves IDE Application for Freestyle Knee Implant Next5 Exercises to Avoid With a Torn MeniscusNext --- ## Train like an Olympian - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/train-like-an-olympian/ Summary: This article gives an inside look at the tips and tricks the top athletes use to improve. These skills are essential for anyone who wants to advance as an athlete. # Train like an Olympian Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - March 6, 2018 With the Winter Games coming to an end, this article (Click here to read article) gives an inside look at the tips and tricks the top athletes use to always improve. I believe these skills are essential for anyone who wants to advance as an athlete. Three that I feel are extremely important to do are: #1- Cross train: Don’t just do one thing. Even if you love to run, you should do things like lifting weights a couple times a week. #2- Work on flexibility – This doesn’t mean that you need to do yoga, but knowing which specific muscles are tight for you, such as calf muscles, and stretching those to improve mobility. #3- Set goals, keep them, and don’t go overboard: Using accessories like Fitbit’s are very helpful because they not only track your daily activities, but they make sure you hit whatever you set as your minimum goal of steps each day. - athlete, athletes, training ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousAthletes and Injuries – SiriusXM NBA Radio NextOsteoarthritis: Could researchers have found the key to prevention?Next --- ## Treating Patellofemoral Arthritis & Patellar Instability Source: https://sabrinastrickland.com/treating-patellofemoral-arthritis-patellar-instability/ Summary: This study shows good results for treating concurrent patellofemoral arthritis and patellar instability for patellofemoral arthroplasty and MPFL reconstruction. # Treating Patellofemoral Arthritis & Patellar Instability Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - October 5, 2023 As I strive to find answers for patients who have had patellar instability for years and have been told that there is nothing that can be done aside from a knee replacement I continue to do research. My recent study evaluated the efficacy of combined patellofemoral arthroplasty (PFA) and medial patellofemoral ligament (MPFL) reconstruction in patients with patellofemoral arthritis in the setting of concomitant patellar instability. Patients often develop arthritis from years of dislocating their patella and this can typically be treated well with a partial knee replacement (patellofemoral replacement) but this does not address the patellar instability and therefore in these cases I recommend adding a MPFL reconstruction. This study shows good results in this patient population. Read more in The Journal of Knee Surgery: Short-Term Outcomes of Concomitant Patellofemoral Arthroplasty and Medial Patellofemoral Ligament Reconstruction to Treat Concurrent Patellofemoral Arthritis and Patellar Instability - Medial Patellofemoral Ligament Reconstruction, MPFL reconstruction, patellar instability, patellofemoral arthritis, patellofemoral arthroplasty, PFA ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousEstablishing MDC Thresholds After Patellofemoral Joint Arthroplasty NextPatella Alta Patients May Experience Less Severe Cartilage Damage after InstabilityNext --- ## Patellar Chondral Lesions | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/treatments-of-patellar-chondral-lesions/ Summary: Treating Patellar Chondral Lesions With Concomitant MACI, Medial Patellofemoral Ligament Reconstruction, and Tibial Tubercle Osteotomy # Treating Patellar Chondral Lesions with Concomitant MACI, MPFL, and TTO Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: October 31, 2024 - October 22, 2024 In 2016, the US Food and Drug Administration approved matrix-induced autologous chondrocyte implantation (MACI) for use in the United States. It has proven to be an effective treatment for articular cartilage defects in the knee, such as patellar chondral lesions. In these cases, concomitant patellar stabilization and realignment procedures, such as tibial tubercle osteotomy (TTO) and medial patellofemoral ligament (MPFL) reconstruction, are often performed with MACI to prevent further damage to the knee and to sustain the integrity of the cartilage repair. We published this Technical Note to describe MACI in the patella with concomitant patellar stabilization and realignment and to provide a treatment algorithm for when various simultaneous procedures are indicated. My co-authors and I believe that correcting patellar malalignment and instability is critical for the success of cartilage repair procedures. For this reason, we recommend that TTO and MPFL reconstruction be performed with MACI procedures of the patella when the anatomic pathology and pertinent patient history, such as articular cartilage defects with patellar instability and abnormal patellar alignment, are present.  Read the complete article in Arthroscopy Techniques and watch the accompanying video. The image is a still from the video included in the article.     - Concomitant Matrix-Induced Autologous Chondrocyte Implantation, MACI, Medial Patellofemoral Ligament Reconstruction, patellar chondral lesions, tibial tubercle osteotomy, TTO ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousCase Report: Arthroscopy + Revision TTO for a 16-Year-Old Female Lacrosse Player NextOne Step Cartilage Repair with CARTIHEAL: Multi-Compartment Pathology with OsteoarthritisNext --- ## Fixation Points for MPFL Reconstruction - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/two-fixation-points-are-better-for-medial-patellofemoral-ligament-reconstruction/ Summary: Medial patellofemoral ligament reconstruction is increasingly popular; most studies show an advantage over MPFL repair or medial imbrication for patellar instability # Two Fixation Points Are Better for Medial Patellofemoral Ligament Reconstruction Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - November 15, 2022 Medial patellofemoral ligament reconstruction has gained in popularity over the past 15 years, with most studies showing a clear advantage over techniques such as medial patellofemoral ligament (MPFL) repair or medial imbrication for the treatment of patellar instability. A debate continues as to the type of fixation on the patella, tunnel versus suture anchor, as well as the number of fixation points. In fact, some senior patellofemoral surgeons have opted away from patellar bony fixation altogether to avoid complications associated with patellar fixation such as fracture or penetration of the articular cartilage. ## To Minimize Complications, Bone Tunnels Should Be Avoided In my practice, I prefer to use 2 all-suture suture anchors for patellar fixation as there is minimal risk of fracture or significant cartilage damage compared with tunnel drilling or placement of larger suture anchors. The graft choice for MPFL reconstruction has been shown to be relatively unimportant, and for this reason, I typically choose gracilis allograft to avoid graft-site morbidity and hamstring weakness. Read the full editorial in The Journal of Arthroscopic and Related Surgery. - bone tunnels, Medial patellofemoral ligament, MPFL, MPFL reconstruction, MPFL Reconstruction Surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousMPFL Reconstruction & Tibial Tubercle Osteotomy NextMCL Injuries and RecoveryNext --- ## Two-Year Follow-up for the LIFT Implant | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/two-year-followup-lift-implant/ Summary: The LIFT implant) is designed to reduce stress on the patellofemoral joint with a minimally invasive surgery. # Two-Year Follow-up for the LIFT Implant Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - December 14, 2023 I’m constantly asked by patients about new technology to avoid knee replacement surgery. This new device (the LIFT implant) is designed to reduce stress on the patellofemoral joint with a minimally invasive surgery. Currently, the surgical options for patients with cartilage wear or arthritis localized the the front of the knee ranges from cartilage transplants to osteotomies (bone-cutting surgery to realign the knee) to partial knee replacements. This new device has encouraging early results in a small European trial and I look forward to the FDA trial in the United States. Read more about the completion of the two-year follow-up for the first in-human clinical trial of the LIFT Implant. - bipolar osteoarthritis, clinical stage medical device company, first-in-human clinical trial, Inc., Kujala Scale, LIFT implant technology, Outerbridge Grade 2, patella LIFT implant, patellar function, patellar pain, patellofemoral cartilage degeneration, radiographic imaging, surgical alternative, two-year follow up, Visual Analog Scale, ZKR Orthopedics ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousNew Study Shows Osteoarthritis May Be Treatable and Reversible NextKnee Surgery Scars & Minimally Invasive SurgeryNext --- ## Patellofemoral Instability & Cartilage | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/understanding-patellofemoral-instability-cartilage-lesions/ Summary: Dr. Andreas Gomoll and I joined the Braun Performance & Rehab Podcast to discuss patellofemoral instability, cartilage defects, and other relevant topics. # Understanding Patellofemoral Instability & Cartilage Lesions Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: March 7, 2025 - March 7, 2025 Recently, Dr. Andreas Gomoll (my husband) and I joined the Braun Performance & Rehab Podcast to discuss the patellofemoral joint in detail and address specific considerations related to patellofemoral instability, cartilage defects, and other relevant topics. ## Patellofemoral Pain Syndrome and Instability Patellofemoral pain syndrome is often diagnosed without a thorough investigation into the underlying causes. This can lead to oversimplification, where conditions like patellar instability are treated solely with medial patellofemoral ligament (MPFL) reconstruction. However, MPFL is primarily for addressing instability rather than pain. Other factors, such as cartilage defects, patella alta (high-riding patella, where the patella sits high on the femur), and dysplasia, must be considered for pain treatment. ## Cartilage Defects and Treatment Options Cartilage defects are common in both ACL injuries and patellofemoral instability. While minor defects may not be symptomatic, larger ones do require attention. Treatments include osteochondral autograft transplantation (OATS) and osteochondral allograft (OCA) procedures. The choice between single and multi-plug techniques depends on the defect’s shape and size. Multi-plug methods are used for larger, more complex defects. ## Rehabilitation and Recovery For the best recovery outcomes, you need a motivated patient, a good surgeon, and a great physical therapist. Early mobilization, blood flow restriction, and appropriate physical therapy are also important for recovery. One of the reasons your surgeon’s skills are so important is that they can minimize tissue disruption (smaller incisions) during surgery, which also aids in quicker recovery. And, of course, the relationship between the patient and their physical therapist is vital, especially for younger patients. It’s really important to get younger patients, who are used to being very active, to buy into physical therapy as part of the recovery process.  Listen to the rest of our discussion on the Braun Performance and Rehab Podcast. The image is from the podcast page.      - blood flow restriction, cartilage defects, dysplasia, mobilization, MPFL reconstruction, OATS, OCA, pain syndrome, patella alta, patellofemoral, patellofemoral instability, Physical Therapy, recovery, rehabilitation, surgeon, treatment, young patients ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousThe Role of Hyaluronic Acid in Healing Injuries NextSkier Tim’s BEAR® Implant Comeback StoryNext --- ## Understanding Kneecap Instability & Pain - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/understanding-patellofemoral-kneecap-instability-and-pain/ Summary: In this short video I explain what patellofemoral instability is, what causes pain, how it feels, why it happens, and how it can be fixed. # Understanding Patellofemoral (Kneecap) Instability and Pain Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: April 13, 2026 - February 9, 2023 ## Patellafemoral Instability In the front of the knee the kneecap slides up and down in a groove in the thigh bone. Sometimes it can slip out causing pain, swelling and cartilage injury. ## How does it feel? It can feel unstable and in severe cases it can be difficult to fully extend the knee. Sometimes patients have to go to the ER to get the patella back into the groove. Often these injuries are accompanied by swelling and it can take weeks to months to feel normal again. ## How does it happen? In some patients it happens without any trauma and at a young age. In others it can occur playing sports with or without a contact injury. It can recur especially when it first happens before the age of 25. ## How can it be fixed?  In most cases it can be fixed by reconstructing the MPFL (Medial PatelloFemoral Ligament) which is a minimally invasive surgery with a 4-6 month recovery. In patients who have suffered cartilage damage the surgery may be more complicated with the addition of a bone re-aligning surgery such as a tibial tubercle osteotomy and/or a cartilage replacement surgery.  ### Watch my video on patellofemoral instability and pain. ## Patellar Pain And Arthritis In the front of the knee the kneecap slides up and down in a groove (trochlea) in the thigh bone. Sometimes it can be malaligned or arthritic causing pain, swelling, and cartilage injury. ## How does it feel? It can feel unstable and hurt especially going down stairs, sitting for a long time, wearing high heels or doing squats or lunges. Often these conditions have caused pain for years and a change in weight or activity level can make it feel much worse. ## How does it happen? In some patients it happens without any trauma and at a young age. In others it can occur when they either get out of shape or ramp up activity quickly in an effort to get back in shape. ## How can it be fixed? In most cases it can be fixed by avoiding exacerbating activities, going to physical therapy, using injection treatments such as cortisone, hyaluronic acid and PRP. In some cases surgery is required to realign the patella within the groove (tibial tubercle osteotomy) or to replace the cartilage on either the kneecap or the front of the thigh bone (trochlea). - cartilage replacement surgery, Hospital for Special Surgery, kneecap instability, kneecap pain, Medial patellofemoral ligament, MPFL reconstruction, orthopaedic surgery, patellofemoral instability, patellofemoral pain, tibial tubercle osteotomy ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousAnterior Knee Pain Following Hamstring ACL Reconstruction NextA Deep Dive into Patellar Tracking Abnormalities and Patellar InstabilityNext --- ## Can Urgent Care Treat Dislocated Kneecap | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/urgent-care-treat-dislocated-kneecap/ Summary: Learn when urgent care can treat a dislocated kneecap, when to visit the ER, and how an orthopaedic specialist guides full recovery after patella dislocation # Can Urgent Care Treat a Dislocated Kneecap? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: January 26, 2026 - January 26, 2026 A dislocated knee, specifically a patella (kneecap) dislocation, is a sudden, painful injury that often happens during sports, a twisting injury, a fall, or direct trauma. It is especially common in younger patients, including teenage and young adult athletes, and is seen more often in females. Many people wonder whether urgent care is the right place to seek help and what immediate steps are required for a safe recovery. Let’s break down what urgent care can and cannot do, drawing from my expertise as an orthopaedic surgeon specializing in knee injuries. ## What Happens in a Patellar Dislocation? The patella slides out of its normal groove on the femur, typically shifting to the outer (lateral) side of the knee. This event tears or severely stretches the medial patellofemoral ligament (MPFL), causes joint swelling, and results in immediate, sometimes severe, pain. Even a first-time dislocation can damage the cartilage on the back of the kneecap or in the groove, which is one of the reasons advanced imaging is so important after this injury. It may also result in patellar instability or recurrent patellar dislocation. Usually, the kneecap either pops back into place on its own or remains visibly out of position, making the knee impossible to bend or bear weight on. ## Can Urgent Care Fix a Patella Dislocation? Urgent care can sometimes help with a simple patella (kneecap) dislocation in otherwise healthy patients, when there are no signs of a more serious injury. However, you should go directly to the Emergency Room if there is a clear severe injury, signs of nerve or blood vessel damage (numbness/circulation changes), or an open wound. Here’s what urgent care can do well: - Initial Assessment: Urgent care centers are equipped to provide first-line evaluation for traumatic knee injury events. They can confirm patella dislocation with a physical exam and  X-rays. Please note that a normal X‑ray result does not rule out significant cartilage or MPFL injury, which is why it’s so important to follow-up with a specialist and often get Magnetic Resonance Imaging (MRI). - Closed Reduction: If the patella remains out of place, urgent care practitioners can often guide it back into position using gentle maneuvers (without needing surgical incisions). This is called a closed reduction. A prompt reduction relieves pain and allows you to start bending your knee and weight bearing.. - Pain Control: Urgent care staff can provide ice, pain medication, and in rare cases mild sedation (if needed) during the reduction process. - Immobilization: They may place your leg in a supportive brace or splint to limit movement and support your knee, usually for a short period, followed by guided physical therapy to restore motion and strength. - Instructions for Rest & Elevation: Urgent care practitioners should refer you for an orthopaedic evaluation and advise you on how to manage swelling in the hours and days ahead. Keep in mind that not all urgent care centers have X‑ray equipment or staff who are comfortable performing reductions, so you should be prepared to be redirected to a hospital emergency room. ## When to Seek Further Care After a Patella Dislocation While urgent care can stabilize a simple patella dislocation through reduction and help with basic pain management, it’s almost never the definitive end of treatment. You will require specialized follow-up care to make a full recovery.  Your next steps are likely to include:  ### Immediate Higher Level Care Go directly to the ER, not just urgent care, if you notice any of the following: - Obvious deformity of the whole leg or suspicion of a tibiofemoral dislocation (knee looks grossly out of alignment, not just the kneecap). - Open wounds, active bleeding, or concern for fracture (heard a crack, cannot move the leg at all, foot looks rotated). - Signs of compromised circulation or nerve injury: pale or cool foot, weak or absent pulses, numbness or inability to move the ankle or toes. - Inability to reduce the patella in urgent care or persistent locking/blocking of motion. ### Specialized Follow-up As urgent care centers typically lack the necessary resources for comprehensive treatment, you must follow up with an orthopaedic specialist or Sports Medicine doctor as soon as possible after an injury. This specialist will almost always order advanced imaging (MRI), which is critical for identifying cartilage damage, ligament tears (especially the MPFL), and loose cartilage or small bone fragments that may not show up on X‑rays. Using this information, your surgeon will then have enough information about your injury to plan your next steps. ### Long-Term Rehabilitation Recovery relies on early, guided physical therapy after a brief period in a brace, which is essential for restoring motion, strength, and stability and helping to prevent future dislocations. These services are not available at urgent care facilities. ## What About Complete Knee (Tibiofemoral) Dislocation? This post focuses on dislocation of the kneecap (patella), which is common and usually treated non‑surgically in the short term. A complete knee dislocation between the femur and tibia (not just the kneecap) is a true orthopaedic emergency, much rarer and more dangerous than patellar dislocation. Such injuries can compromise arteries and nerves, and must be handled in a hospital. Urgent care facilities cannot address these types of injuries and will call for immediate EMS transport. ## Urgent Care Provides Stabilization, Not Definitive Care Urgent care centers are a helpful and timely first stop after a patellar dislocation. They can do a closed reduction, control pain, and apply a brace. However, to get a definitive diagnosis, long-term guidance, and corrective treatment, you’ll need to see an orthopaedic specialist. It’s always wise to pursue follow-up with an expert to minimize the risk of future problems and maximize your recovery. For further information, see: Unstable Kneecap (Patellar Instability) – OrthoInfo.  For more on recovery steps and guidance on when to seek urgent vs. specialty care, here are  some resources on my website: - Patellar Instability - My Kneecap Dislocated. What Should I Do? - How Long Does MPFL Recovery Really Take? - MPFL Reconstruction Surgery - Patellofemoral Instability (PDF) Without proper evaluation and treatment, repeated dislocations and untreated cartilage injury can increase the risk of arthritis in the kneecap joint later in life. Prompt care for your dislocated kneecap is the first step; next, follow up with a knee specialist to protect the cartilage, reduce the risk of future dislocations and arthritis, and give your knee the best chance at a full recovery. If you want an assessment or a second opinion, schedule an appointment with me.  - dislocated kneecap recovery, dislocated kneecap treatment, how to fix a dislocated kneecap, how to prevent kneecap dislocation, knee brace for dislocated kneecap, knee dislocation vs kneecap dislocation, knee injury from sports, knee pain after dislocation, knee specialist near me, MPFL tear, MRI for kneecap injury, patella dislocation urgent care, patellar instability treatment, physical therapy after patella dislocation, when to go to urgent care for knee injury ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWhat Happens If a Patella Dislocation Is Left Untreated? NextSkiers Must Prioritize Knee Health as ACL Injuries Rise During Ski SeasonNext --- ## Machine Learning + MPFL Reconstructions | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/using-machine-learning-to-predict-mpfl-reconstruction-outcomes/ Summary: It makes sense that emerging technologies, such as machine learning, will help us choose the best combination of surgical interventions for patellar instability. # Using Machine Learning to Predict MPFL Reconstruction Outcomes Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: September 24, 2024 - September 20, 2024 As I’m not a computer scientist or an engineer, I don’t know a whole lot about or really understand machine learning. However, it makes perfect sense that these emerging technologies will help us make better decisions when we’re trying to figure out the best combination of surgical interventions for patellar instability. This field has changed drastically over the last 10 to 15 years. And I anticipate major changes again over the next 5 to 10 years. Computer modeling, where they feed a lot of data that we already have into the model, has already started to yield some very interesting results. I’m looking forward to seeing what comes next and how we can use it to improve MPFL reconstruction outcomes.  Read more in this Healio article: Machine learning models may predict outcomes of MPFL reconstruction. Photo by Markus Spiske on Unsplash - computer modeling, Machine Learning, Medial patellofemoral ligament, Medial Patellofemoral Ligament Reconstruction, MPFL reconstruction, MPFL reconstruction outcomes, patellar instability, predicting surgical outcomes, predictions ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousGrand Rounds from HSS: Revision TTO Returns Young Athlete to Sports NextCould Dancing Molecules Transform Osteoarthritis Treatment?Next --- ## Using Soft Rollers - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/using-soft-rollers/ Summary: It doesn # Using Soft Rollers Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - December 22, 2015 I contributed to this article in the LA Times:   ## It doesn’t have to hurt: How to use soft rollers and balls to gently melt away aches and pains – LA Times Sue Hitzmann developed the MELT Method of balls and soft rollers to massage muscles and alleviate pain. Source: www.latimes.com/health/la-he-melt-20151121-story.html   - balls, MeltMethod, muscles, pain, soft rollers, Sue Hitzmann ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousGet Out & Exercise NextHealth & Exercise TrendsNext --- ## Using Tendons & Ligaments in ACL Surgery | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/using-tendons-ligaments-acl-surgery/ Summary: When I do ACL surgery, I typically use a graft. This means I take a tendon and configure it to reconstruct a ligament. Apparently, many people aren # Using Tendons & Ligaments in ACL Surgery Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: March 21, 2025 - March 21, 2025 There are some things that are so second nature about my job that I don’t even think about them. For example, when I do ACL surgery, I typically use a graft. This means I take a tendon and configure it to reconstruct a ligament. This method of doing ACL surgery has been commonplace in orthopaedics for over 40 years—but to a layperson, it sounds kind of crazy. My 23-year-old daughter, who is a law student, recently was talking to a friend who told her that they “took his quad” to make a new ACL. My daughter thought this was outlandish. Why on earth would they do this? I feel like I talk about work all the time at home, but clearly, there is a lot that I have never mentioned! Here are a few other examples: - Elbow surgeons use a small tendon in the forearm for Tommy John Surgery (also known as ulnar collateral ligament reconstruction) and for medial collateral ligament (MCL) of the elbow reconstruction - Foot and ankle surgeons use a small tendon in the calf or foot to repair ligaments and tendons in the foot - Knee surgeons like me use hamstrings, quads, and sometimes the patellar tendon to reconstruct the ACL, MCL (of the knee, of course), and occasionally other ligaments and tendons in the knee. It’s lucky that we have some expendable tendons in our body that can be used to make repairs! Photo by Marcus Wallis on Unsplash. - ACL surgery, Elbow surgery, Expendable tendons, Foot and ankle surgery, graft, Hamstrings, knee surgery, ligament, Medial collateral ligament (MCL), orthopaedics, patellar tendon, Quad, reconstruction, tendon, Tommy John Surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousSkier Tim’s BEAR® Implant Comeback Story NextHow 3D Imaging of the Patellofemoral Joint Improves Treatment OptionsNext --- ## Knock Knee Surgery — And Valerie Bridges is Back in the Game Source: https://sabrinastrickland.com/valerie-bridges-knock-knee/ Summary: Valerie Bridges was born with a deformative condition called knock knee, causing her to be prone to patellar dislocation. Surgeries put her back in the game! # Knock Knee Surgery — And Valerie Bridges is Back in the Game Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 14, 2023 - September 14, 2023 Today I’m delighted to share another story of a patient I was able to help. Valerie was born with a deformative condition called knock knee that caused her to be prone to patellar dislocation.  Knock knee, which is also referred to as knock-knee deformity, knock-knee syndrome, knocked knee, or genu valgum,  is when there is an incorrect alignment around the knee. Just like it sounds, in this condition the knees bend inward and touch one another, which places force on the outside of the knee. It causes pain and damage over time. It can affect people of all ages, but Valerie was born with this condition. She fell in her 20s and had a total patellar dislocation of her left kneecap, causing her years of instability, pain, and osteoarthritis, but no doctors would take her case.  At 45, she found HSS, me, and Dr. Fragomen. She’s had a total of six surgeries, three on each leg. On March 10, 2023, Valerie had her final hardware removal surgery. Her legs are straight for the first time in her life and I’m happy to report that she has no more pain and no more patella dislocations!   Read more about Valerie’s story (and see more pictures) on the Hospital for Special Surgery Back in the Game site. - back in the game, deformative condition, HSS, knee instability, knee pain, knee surgery, knock knees, Osteoarthritis, patellar dislocation ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousMoximed’s MISHA™ Knee System Treats First Commercial Patients in United States NextStudy Shows Differences in Patellofemoral Joint Contact Forces after ACL ReconstructionNext --- ## WSJ Article: Avoiding Running Injuries - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/wall-street-journal-avoiding-running-injuries/ Summary: How to avoid injuries, knee pain and foot problems when you run: Experts are turning to a tool that precisely spots stride problems and stops joint pain and injury. # Wall Street Journal – Avoiding Running Injuries Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - November 9, 2015 How to avoid injuries, knee pain and foot problems when you run: Experts are turning more to a tool that precisely spots stride problems and stops joint pain and injury. Source: on.wsj.com/1qq4KZi   - injuries, plantar fasciitis, proximal hamstring tendinosis, runner's knee, running, stress fractures, Wall Street Journal ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousRunners in the NYC Marathon NextConcussion Prevention in SoccerNext --- ## What To Do if You Injure Your Knee - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/what-does-it-mean-if-you-injure-your-knee-and-you-hear-a-pop/ Summary: What does it mean if you injure your knee and you hear a pop? It means you injured something, but what depends on where the pain is and what caused the injury. # What does it mean if you injure your knee and you hear a pop? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: June 4, 2025 - March 2, 2022 What does it mean if you injure your knee and you hear a pop? Usually it means that you really injured something, but what that something is really depends on where one feels the pain and what actually happened to cause the injury. The classic knee injury where you hear a pop is an ACL tear. This can occur when an athlete changes direction suddenly playing a cutting sport, such as soccer or basketball, or gets their ski caught on an edge and the binding doesn’t release. Occasionally you can hear or feel a pop on the inside or outside of your knee due to a meniscal tear; this isn’t always due to a trauma, it can occur just walking at times. A third cause of a pop in your knee is an MCL tear, this occurs with a valgus or knock-kneed type force directed at your knee. This Lakers player was likely hit from the outside, forcing his knee inward and popping his MCL. The last common cause of a pop in the knee is rupture of a baker’s cyst. This occurs without any trauma and can be accompanied by significant bruising and swelling in the calf. None of these are an actual emergency, but most will lead to some difficulty walking and most patients would benefit from crutches at least for a few days until they get evaluated by a doctor. Read about Anthony Davis’s left knee injury.  - ACL, ACL tear, anterior cruciate ligament, baker's cyst, basketball injury, hear a pop, Hospital for Special Surgery, HSS, injure your knee, knee injury, knee pop, knee popping sound, knee pops, MCL tear, medial collateral ligament, meniscal tear, orthopaedic surgeon, orthopaedic surgery, valgus ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousResearch on potential cures for arthritis — green tea & gallnuts NextInvestigating Amniotic Suspension Allograft injectionsNext --- ## What If Patella Dislocation Is Untreated? | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/what-happens-patella-dislocation-untreated/ Summary: What happens if a patella dislocation is left untreated? Explore the consequences, long-term risks, and best practices based on my experience with knee injuries. # What Happens If a Patella Dislocation Is Left Untreated? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: January 19, 2026 Quick Summary An untreated patella dislocation can lead to recurrent dislocations, progressive cartilage damage, and patellofemoral arthritis. After a first dislocation, the MPFL is usually torn, and without proper rehab — and surgery when anatomy warrants it — the kneecap may dislocate again with progressively less force. Each event risks chondral injury and long-term pain. Early evaluation and imaging guide whether nonoperative or surgical treatment is appropriate. - January 19, 2026 A patella dislocation, where your kneecap is forced out of its normal groove and shifts laterally, is a serious injury that requires prompt evaluation and management. Yet, some people try to wait it out or do not seek orthopedic care, especially if the kneecap slips back into place on its own and the swelling improves over a few days. It’s completely understandable to hope it will get better on its own, but that’s often when important injuries are missed. What truly happens if a patella dislocation is left untreated? Let’s explore the consequences, long-term risks, and best practices based on my decades of experience with knee injuries. ## Understanding Patella Dislocation When the patella dislocates, it often tears or stretches the medial patellofemoral ligament (MPFL), a crucial structure that keeps your kneecap tracking properly in its groove. In addition to ligament damage, it’s common for patients to have cartilage injuries and sometimes bone fragments that break loose during the initial trauma. Some people have underlying anatomic risk factors that make a dislocation more likely and make recurrence more common, such as a shallow groove on the femur (trochlear dysplasia), a high-riding kneecap (patella alta), or an increased distance between the tibial tubercle and the trochlear groove (TT–TG distance). When a patient comes in after a first dislocation, one of the first things I look for is whether any of these underlying factors are present, because they help predict how likely your kneecap is to slip out again and what kind of treatment will give you the most confidence going forward. ## Immediate Consequences of Untreated Patella Dislocation ### 1. Ongoing Knee Instability and Repeat Patella Dislocation One of the most common outcomes of neglecting a dislocated patella is that the knee remains unstable. Once the MPFL is torn, it does not heal back to its original strength or tension by itself. That’s why you might feel like you can never fully trust your knee again, even if the pain settles down between episodes. This leaves the patella much more likely to dislocate again, sometimes during normal activities, not just when you’re playing sports. In fact, depending on your age and anatomy, the risk of recurrence after a first dislocation can range from about 15% in low‑risk patients to 80% or higher in younger, high‑risk individuals, especially when you have underlying structural issues in your knee. ### 2. Worsening Cartilage and Bone Damage When the kneecap shifts out and back in, it can chip or gouge the smooth cartilage on the undersurface of the patella or the front or lateral side of the femur. Without medical attention, these injuries may go unrecognized and unaddressed, leading to loose fragments in the joint or progressive cartilage wear.  This is particularly worrisome because cartilage does not regenerate, and injuries here set the stage for early joint degeneration and arthritis. ## Long-term Risks ### 1. Development of Patellofemoral Arthritis Recurrent instability and untreated cartilage damage dramatically increase the chances of developing patellofemoral (kneecap) arthritis, even years or decades later. Patients with a history of multiple untreated dislocations may begin experiencing persistent pain, swelling, stiffness, and grinding in the knee. Ultimately, this can limit walking, exercising, or stair climbing, and may lead to the need for cartilage repair or even partial or total  knee replacement down the road. ### 2. Chronic Pain and Activity Limitations Many patients tell me that the worst part is not just the pain, but the constant worry that a simple misstep, a turn on the field, or even walking down stairs could make the kneecap pop out again. This loss of confidence can profoundly impact your involvement in athletic activities, work capacity, and quality of life. Some patients report a constant feeling of apprehension during basic activities like walking, going down stairs, or rising from a chair. ### 3. Muscle Atrophy, Weakness, and Poor Knee Function When pain, swelling, or apprehension prevents normal use of the leg, the thigh muscles (especially the quadriceps) quickly weaken. This weakening can start within days to weeks of unloading the limb, which is why guided early motion and strengthening are important once you have the initial acute pain and swelling under control.  This weakness can further destabilize your knee and create a vicious cycle of increased instability. In severe cases, chronic atrophy may develop, making functional recovery much harder, even if you do eventually seek surgical intervention. The good news is that with the right plan, the quadriceps usually respond well to targeted strengthening especially with blood flow restriction therapy in physical therapy. It’s much easier to build and maintain that strength early than to rebuild it after months of guarding and avoidance. ## Who Is Most at Risk? Certain patients are much more likely to develop recurrent dislocations and long‑term damage if the initial event is not fully evaluated and treated, and part of my job during your visit is to sort out which group you fall into so you’re not guessing about your risk based only on a single scary event. Younger patients (particularly those with open growth plates, a shallow trochlear groove, patella alta, or an increased TT–TG distance) are at a high risk for recurrence and progressive cartilage injury.​ When two or more of these risk factors are present, recurrence rates can approach 60–70% or more, which is why a tailored plan with imaging, rehab, and sometimes early surgery is so important.​ ## Delayed or Missed Diagnosis of Associated Injuries Sometimes a dislocation is associated with other serious injuries, such as osteochondral fractures (loose chunks of cartilage and bone), meniscus tears, or additional ligament injuries like damage to the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), or medial collateral ligament (MCL).  These are easy to miss without an MRI and a careful orthopedic exam. In most patients, especially those who are young or have a high‑energy injury, I strongly recommend an early MRI to look for osteochondral fragments and risk factors, with rare exceptions when a patient is asymptomatic and the clinical exam is completely normal. Delays in diagnosis can mean missing the window for effective cartilage surgery or leaving your knee vulnerable to further breakdown. ## Patella Dislocation Standard of Care Expert consensus and published guidelines recommend prompt evaluation and consultation with an orthopedic or sports medicine specialist after any kneecap dislocation. Most patients benefit from imaging: X‑rays to rule out obvious fractures and, in most cases, MRI to evaluate cartilage, bone, and the key risk factors outlined above.  I recommend treatment plans based on your anatomy and goals, ranging from bracing and supervised physical therapy to advanced surgical stabilization. In practice, that means we sit down together, review your imaging, talk about your sport or work demands, and decide whether a carefully structured rehab program, surgery, or a combination is the best way to get you back to the activities you care about. For a first‑time dislocation without a major osteochondral fracture or high‑risk anatomy, nonoperative care with early supervised physical therapy remains the standard initial approach in many guidelines. Often, surgery is reserved for patients who develop recurrent instability or have significant loose fragments. When there are multiple risk factors or repeated dislocations, I consider early surgical stabilization more carefully to protect the cartilage and restore your confidence in that knee. ## Bottom Line If you simply ignore a dislocated patella, there’s a high likelihood of recurring instability, progressive cartilage injury, arthritis, chronic pain, and diminished function over time. When you come in early and we create a plan, whether that’s focused physical therapy, bracing, surgery, or a combination, you greatly reduce the risk of recurrent dislocation, cartilage damage, and early arthritis, and you give yourself the best chance to stay active over the long term.  My goal with every patient is to help you understand your specific risks, choose the least invasive option that will actually protect your knee, and get you back to moving with confidence instead of fear. For more best practices and patient resources, check out the AAOS patellar instability guide. For detailed diagnosis, risk evaluation, treatment, and recovery information, explore more of the resources on my website, including: - Patellar Instability  - MPFL Reconstruction Surgery  - What To Do After Kneecap Dislocation  It’s important that you don’t leave a patella dislocation untreated. Please seek appropriate medical care if you dislocate your patella; it’s an investment in your lifelong knee health and mobility. - chondral injury, knee cartilage damage, knee instability, knee ligament damage, kneecap dislocation, MPFL tear, orthopedic knee evaluation, osteochondral fracture, patella alta, patella dislocation, patellar instability, patellofemoral arthritis, quadriceps atrophy, recurrent patellar dislocation, Trochlear dysplasia ## Frequently Asked Questions Can a patella dislocation heal on its own without medical care?The MPFL can heal in scar after a single dislocation, but without structured rehab the knee often remains unstable and prone to redislocation. Imaging is also important to rule out osteochondral fragments — loose cartilage-bone pieces that don't heal on their own and can cause locking or further damage. I recommend prompt evaluation after any dislocation. What are the long-term risks of repeated patella dislocations?Each dislocation can cause additional cartilage damage on the patella and trochlea, accelerating patellofemoral arthritis. Recurrent instability also weakens the surrounding soft tissues and makes the knee feel unreliable. Patients with three or more dislocations, or with high-risk anatomy, generally do better with surgical stabilization than continued nonoperative care. Is surgery always needed after a recurrent patella dislocation?Not always, but recurrent dislocations are a strong indication. I evaluate imaging for trochlear dysplasia, patella alta, TT-TG distance, and any cartilage damage. When anatomy is favorable and the patient prefers nonoperative care, structured rehab can be effective. When imaging shows high-risk anatomy or there's a chondral injury, MPFL reconstruction is usually the better path. ## Related Reading - Patellar instability (specialty page) - Recovery from a dislocated patella - MPFL reconstruction surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousACL Surgery Explained: Graft Choices, New Techniques & Recovery Insights NextCan Urgent Care Treat a Dislocated Kneecap?Next --- ## What You Should Know about Working Out - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/what-i-want-my-daughters-to-know-about-working-out/ Summary: I enjoyed this article - these are definitely things I want my daughters to know about health and exercise. "10 Things I Want My Daughter to Know About Working Out." # What I Want My Daughters to Know About Working Out Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - January 9, 2016 I enjoyed this article – these are definitely things I want my daughters to know about health and exercise. ## 10 Things I Want My Daughter to Know About Working Out | wellfesto Mid-way through a recent group exercise class, the teacher lost me.  She didn’t lose me because of some complicated step sequence or insanely long set of burpees; I mentally checked out because of a few words she kept saying over and over.  “Come on!  Get that body ready for your winter beach vacation!  Think about… Source: wellfesto.com/2013/11/19/10-things-i-want-my-daughter-to-know-about-working-out/   - daughters, fitness, girls, women, working out ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousBenefits of Adding Yoga NextKeeping Active in Unseasonable WeatherNext --- ## What Is Joint Preservation | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/what-is-joint-preservation-and-who-is-it-for/ Summary: Knee joint preservation specialist Sabrina Strickland explains modern options for cartilage defects for younger patients not yet ready for knee replacement. # What Is Joint Preservation and Who Is It For? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: March 20, 2026 - March 5, 2026 Joint preservation is about keeping your own knee for as long as possible by preventing arthritis from getting worse and, when we can, even reversing some of the damage.​ I think about many of my patients as “young people with old knees.” They are not really candidates for knee replacement yet, but their pain and swelling are significant enough that ignoring it is no longer an option.​ My husband, Dr. Andreas Gomoll, and I recently made a short video discussing joint preservation.  Transcript Okay. >> So, joint preservation. >> So, um basically joint preservation is um a a phrase that talks about trying to preserve the knee. And usually what we're talking about is trying to prevent further arthritis or reverse it if we can. >> Yeah. In a way, young people with old knee is not really candidate for knee replacement, but enough pain that something needs to be done. >> And sometimes it's just a little defect. So, there's just sometimes a little piece of cartilage that's peeling away. And you can do something quite minor like a gel injection or you can do what's called a condroplasty where you arthoscopically go in and you just clean up the little flap and it can make the knee feel much better. Um often it stops the swelling but that's not enough for everybody. >> No, because sometimes the defects are bigger um and then you need to kind of fill them like you fill a pothole on a road hopefully just better. >> So you can fill them with something that's called cellbased treatment. So cellbased treatment is we go in, we do an arthoscopy. We take a little piece of cartilage size of a fingernail clipping and we send that to a lab and they can grow more cartilage from that >> and that's called Macy. Or we can do something called denovo where there's uh juvenile cells. So a a younger organ donor when we take their cells and we transplant it into the knee. And in both those cases, we're asking those cartilage cells to grow, which can take a long time, and >> it it worked pretty well, but it doesn't give you the cartilage that you started with. >> No, it it it comes fairly close. Nothing is perfect. And that's a little bit more like seeding grass. So truly something grows inside your knee, but then there are other options called osteocchondrial options. Either um taking a piece of cartilage and bone from you or from a donor. And >> when you take it from a donor, um we try to size match them. So we we're we're not taking um we want to match the anatomy as much as possible. And the nice thing about that is the cartilage is fully formed and cartilage um can live in another in somebody else's body. It doesn't it doesn't have rejection per se. It's not like a heart transplant where you have to take drugs to prevent rejection. Um but you do still have to have growth or bone ingrowth into that um that cartilage plug. >> And to uh stick with the landscaping analogies, that's a little bit more like sawing. So yeah, it still needs to kind of heal. The roots, quote unquote, the bone needs to heal, but at least it's fully grown cartilage. >> And then lastly, we have some new techniques, which we have cardial, which is coral, which we put into cartilage defects, and the body is pretty good at growing cartilage over [laughter] >> the dog bomb. Um, yeah, it it tries to help your body heal itself. >> It's way too ## When Cartilage Damage Is Small Sometimes the problem inside the knee is just a small defect, almost like a little flap of cartilage peeling away from the surface.​ In those cases, we can often use relatively minor interventions such as a gel injection or an arthroscopic chondroplasty, where I go in with a camera and small instruments to gently clean up that flap so it no longer catches and causes swelling.​ ## When Defects Are Larger Larger cartilage defects behave less like a flap and more like a pothole in the road that really needs to be filled in properly.​ To address those, we use cell-based treatments: during arthroscopy I take a tiny piece of your cartilage (about the size of a fingernail clipping), send it to a lab where they grow more cells, and then we place those cells back into the defect so they can grow, a bit like seeding new grass.​ One approach is called MACI, which uses your own cells, and another is de novo, where juvenile cartilage cells from a younger organ donor are transplanted into your knee to encourage new cartilage growth.​ ## Osteochondral Options For some patients, an osteochondral approach is more appropriate, where we transplant a plug of cartilage and bone either from you (autograft) or from a donor (allograft).​ When we use a donor graft, we carefully size-match it to your knee so the plug fits the defect as closely as possible, and one key advantage is that the cartilage is already fully formed and can survive in another person’s body without the type of rejection issues seen in a heart transplant, though the bone beneath still has to heal and grow in.​ If seeding grass is a good analogy for cell-based treatments, osteochondral options are more like laying sod: the cartilage is already mature, but it needs time for the “roots” (the bone) to heal and integrate.​ ## Newer Techniques: CartiHeal We also have newer techniques such as CartiHeal, which uses a coral-based material placed into cartilage defects to act as a scaffold for your body to heal itself.​ The body is actually quite good at working with cartilage when we give it the right environment, and implants like this aim to guide that healing process in a more predictable way.​ If you have knee pain, swelling, or cartilage damage and have been told you are too young for a knee replacement, joint preservation may give you options that match the size and type of your defect rather than jumping straight to replacement. - avoid knee replacement, Cartiheal, cartilage defect knee, cartilage plug, chondroplasty knee, coral implant knee, de novo cartilage, gel injection knee, joint preservation, juvenile cartilage transplant, knee arthritis in young patients, knee arthroscopy, knee cartilage repair, knee joint preservation, knee pain treatment options, MACI knee, osteochondral allograft, osteochondral graft, young people with old knees ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousRomanian Deadlift for Stronger Legs and Better Balance NextSquats With Bands: Keeping Weight Off the KneecapsNext --- ## Knee Replacement: What to Worry About - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/what-to-worry-about-when-undergoing-a-knee-replacement/ Summary: This study was an interesting discussion of how they close the wound and how this improves the alignment of the patella after knee replacement surgery. # What to worry about when undergoing a knee replacement Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - March 23, 2016 There are many things to worry about when undergoing a knee replacement, but instability of the kneecap is rarely one of them. This blog post discussing how to prevent instability of the patella after a knee replacement discusses a specific technique of wound closure to prevent the possibility that the kneecap will not track well after surgery. Careful attention during surgery to the way the whole knee moves is incredibly important. It is important to assess the interaction between the thigh bone and the shin bone as well as how the patella track in the groove in the front part of the knee replacement. As a surgeon specializing in disorders of the patella, I pay a lot of attention to this aspect of surgery and try to optimize the patellar tracking (or how the kneecap moves throughout motion in the groove at the front of the femur bone). This study was interesting in their discussion of how they close the wound and how they found that this improves the alignment of the patella after surgery.   ## BLOG: Patellar instability remains an issue in modern total knee replacement | Orthopedics Blogs | Patellofemoral Update Orthopedics Blogs | Patellofemoral Update | Patellar instability remains a challenging issue in modern total knee replacement patients. Total knee replacement has consistently been shown as a highly successful treatment for degenerative arthritis of the knee, but 33% to 50% of revision surgeries for this procedure in the 2-year to 5-year postoperative period have been attributed to patellar instability. In addition, patellar positioning in Source: www.healio.com/orthopedics/business-of-orthopedics/news/blogs/{ce071abd-b7a5-40a4-86b9-aec58703f5e4}/patellofemoral-update/blog-patellar-instability-remains-an-issue-in-modern-total-knee-replacement - Be Young Be Green, foods, patellar tracking ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousFoods that can help speed your recovery NextHow to Prevent Skiing InjuriesNext --- ## Why ACL Tears Are So Devastating | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/why-acl-tears-are-so-devastating/ Summary: This article in The Cut is actually a very accurate review of an ACL injury. It outlines why ACL tears are so devastating and what to expect in recovery. # Why ACL Tears Are So Devastating Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: March 14, 2024 - March 14, 2024 This article in The Cut is actually a very accurate review of an ACL injury. I wish every patient who googled ACL tears came up with an article that is so well written. This author reviews why ACL tears are so common, who tends to tear their ACL, what the surgery entails, and most importantly, the recovery. I also like that this article discussed how functional some patients can be without an ACL. While this isn’t an option for many patients, it is a reasonable option for some, especially someone who has failed several reconstructions. For more details, read the article Why Is Tearing Your ACL So Devastating?     - ACL reconstruction, ACL recovery, ACL surgery, ACL tear, ACL tears, failed reconstructions. ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousA Useful Patellar Instability Infographic for Everyone NextEngineered Cartilage Sounds PerfectNext --- ## Why Do I Have Knee Pain When Squatting? | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/why-do-i-have-knee-pain-when-squatting/ Summary: If you experience knee pain when squatting, there may be an issue with your patella or meniscus. This pressure on the knee joint can signal a few underlying issues. # Why Do I Have Knee Pain When Squatting? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: April 30, 2026 - September 26, 2025 Quick Summary Knee pain when squatting most often points to a patellofemoral problem (chondromalacia, patellar tendinitis, or kneecap malalignment) or a meniscal tear, because squatting compresses the kneecap and loads the meniscus. Pain that is sharp, swells, locks, or follows an injury should be evaluated by an orthopedic specialist. Most cases improve with relative rest, technique correction, and targeted physical therapy. If you have knee pain when squatting, the cause is usually a problem with the kneecap (patella), the cartilage beneath it, or the meniscus. Squatting compresses the patellofemoral joint and loads the meniscus far more than walking — joint contact forces can reach several times bodyweight at deep flexion. Persistent pain during this movement is the knee’s way of telling you a structure is not tolerating that load. ## What Are the Most Common Causes of Knee Pain When Squatting? In our practice at Hospital for Special Surgery, the four diagnoses we see most often for squat-related knee pain are chondromalacia patella, meniscal tears, patellar or quadriceps tendinitis, and kinetic-chain weakness involving the hips and glutes. Identifying which one is driving your pain determines whether you need rest, physical therapy, or a surgical evaluation. ### Knee Chondromalacia (Chondromalacia Patella) Chondromalacia is the softening and breakdown of the cartilage under the kneecap. This can lead to pain, swelling, and decreased mobility, especially after activity. It is more common in women, in part because of hip-knee biomechanics and patellar tracking. The pain is usually felt around or under the kneecap and can worsen with squatting — particularly with weighted squats or deep squats — or with prolonged sitting (the so-called “movie-theater sign”). Related reading: chondromalacia symptoms and treatment. ### Meniscal Tear A meniscal tear can also cause pain during squats, particularly if aggravated by bending and twisting motions. The meniscus acts as a shock absorber in the knee, and a tear can cause pain, swelling, and sometimes a catching or locking sensation. You may feel pain along the sides or back of your knee, especially if you squat and twist at the same time. If you suspect a tear, see exercises to avoid with a torn meniscus and six exercises that can help. ### Tendinitis Repetitive force from activities like running, jumping or squatting can inflame the tendons around the knee, especially the patellar tendon (just below the kneecap) and the quadriceps tendon (just above the kneecap). This inflammation, known as tendinitis, can cause pain during squats and other knee-bending activities. For a deeper look at managing this, see our piece on managing patellar tendinopathy. ### Muscle Imbalances or Weakness Weakness in your glutes, hips, or thigh muscles can put extra stress on your knee joint during squats. Limited ankle mobility or poor squat technique often contribute as well — the knee gets blamed for what the hip or ankle is not doing. Strengthening the muscles around your knee and improving your squat form can meaningfully reduce discomfort. Band-assisted squats are one technique we recommend for offloading the kneecap during rehab. ## When Should You See a Doctor for Squatting Knee Pain? See an orthopedic surgeon with knee expertise if your pain appears suddenly after an injury, if you have severe swelling or instability, if your knee locks or catches, or if pain has not improved after 4–6 weeks of rest and activity modification. Early imaging — typically an MRI — is the fastest way to rule out meniscal tears or significant cartilage damage that will not resolve on their own. Persistent or worsening pain warrants a professional evaluation. Most patients I see for squat-related knee pain have already tried 4–8 weeks of self-care; the imaging tells us whether we are dealing with a structural problem (a tear, a cartilage lesion) or a load-management problem (technique, strength, training volume). The treatment paths are very different. ## What Can You Do at Home to Reduce Squat-Related Knee Pain? For most squat-related knee pain, the right starting point is relative rest, ice after activity, and shallower squats that stop before pain begins. A short course of physical therapy that strengthens the glutes, quads, and hip stabilizers — combined with technique correction — resolves a large fraction of cases without imaging or surgery. - Rest and modify activities that aggravate your knee pain. - Do not squat as deep — stop before it hurts. Partial squats above 60 degrees of flexion dramatically reduce patellofemoral pressure. - Apply ice for 15–20 minutes after activity to reduce swelling. - Try physical therapy to strengthen the muscles around the knee and improve your squat technique. - Gradually increase activity to avoid overloading the joint — the “10% rule” for weekly volume increase is a reasonable guideline. - Consult a specialist if pain persists more than 4–6 weeks or interferes with your daily life. ## Related Reading on Knee Pain and Activity For more information about knee pain when squatting, its causes, and different treatment options, visit these resources: - Patellar Pain and Patellar Arthritis - Knee Chondromalacia, Arthritis, and Tendonitis - Meniscal Tear or Torn Meniscus - Why Knees May Hurt Going Up Stairs - Why Does My Knee Hurt Going Down Stairs? - 6 Common Causes of Knee Pain When Running Do not ignore knee pain with squatting. Early attention can help you recover faster and prevent further injury to your knee — and in many cases avoids the need for surgery entirely. To discuss your symptoms with a knee specialist, you can request an appointment with our New York City office. ## Frequently Asked Questions ### Should I stop squatting if my knees hurt? Not necessarily — but you should modify the movement. Stop squatting as deep, avoid weighted squats, and pause before the point of pain. If pain persists with a shallow, body-weight squat, rest the joint and consult an orthopedic specialist before resuming. ### Is knee pain when squatting a sign of arthritis? It can be, but not always. Pain under or around the kneecap during squats is more often patellofemoral pain, chondromalacia (early cartilage softening), or patellar/quadriceps tendinitis. Persistent pain with stiffness and swelling — especially in patients over 50 — should be evaluated for osteoarthritis. ### Why does my knee only hurt on deep squats and not partial squats? Contact pressure on the kneecap increases sharply once the knee bends past 60 degrees. Deeper squats also load the meniscus and the cartilage at the back of the joint more heavily. Pain isolated to deep squatting often points to cartilage involvement behind the kneecap or to a meniscus tear, particularly when combined with twisting. ### Will squatting cause long-term damage to my knees? Squatting with proper technique is generally safe and even beneficial for knee health. Pain during squatting is the warning sign — pushing through pain can accelerate cartilage wear or worsen a meniscal tear. Modify depth, fix technique, and address pain early to avoid long-term damage. ### When should I see an orthopedic surgeon for squatting knee pain? See an orthopedic specialist if pain persists more than 4–6 weeks despite rest and activity modification, if the knee swells, locks, catches, or gives way, or if pain follows a specific injury. Early evaluation rules out meniscal tears or significant cartilage damage that may require surgical care.   - chondromalacia, glutes, hips, knee joint, knee pain, meniscal tear, meniscus, patella, Physical Therapy, poor squat technique, quadriceps tendon, squatting, swelling, tendinitis, thigh muscles ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousHow Long Does MPFL Recovery Really Take? Timeline & Tips for Success NextWhy Does My Knee Hurt When Going Up the Stairs?Next --- ## Why Knees May Hurt Going Up Stairs | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/why-does-knee-hurt-going-up-stairs/ Summary: Why does my knee hurt when going up stairs? Common causes include patellar malalignment, arthritis, and tendinitis. Learn when to see an expert. # Why Does My Knee Hurt When Going Up the Stairs? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: May 2, 2026 - October 3, 2025 Quick Summary Knee pain when going up stairs almost always points to the front of the knee — the kneecap (patella) and the cartilage beneath it. The most common causes are patellar malalignment, chondromalacia patella (cartilage softening), early knee arthritis, and patellar tendinitis. Persistent stair-related knee pain that lasts more than a few weeks, swells, or follows an injury should be evaluated by an orthopedic specialist. If your knee hurts when you go up the stairs, you’re experiencing a very common symptom that can signal a few underlying knee problems. Climbing stairs places significant stress on the front of your knee, especially the kneecap (patella) and the cartilage beneath it. This pain is often a sign that something isn’t functioning optimally in your knee joint. ## Common Causes of Knee Pain When Going Up Stairs ### 1. Patellar Malalignment Pain in the front of the knee, often called patellar pain, is one of the most frequent reasons for discomfort while climbing stairs. The kneecap slides in a groove on the thigh bone, and if it’s out of alignment, you might feel pain, swelling, or even hear grinding sounds. This pain can be dull and achy or sharp, and it tends to worsen with activities that require bending or straightening the knee, such as stair climbing, squatting, or lunging.  ### 2. Knee Chondromalacia (Patellar chondromalacia) Chondromalacia patella is the softening and breakdown (early arthritis) of the cartilage under the kneecap. When this cartilage deteriorates, the knee can feel achy, swollen, or stiff, and you may notice grinding or popping sensations. Pain from chondromalacia is often worse when you climb stairs or hills, or after sitting for long periods with your knee bent. This condition can affect anyone, but it’s particularly common in women, athletes, and people who have recently increased their activity level.  ### 3. Knee Arthritis Osteoarthritis and other forms of arthritis can cause pain and swelling, especially during activities that put pressure on the knee, such as stair climbing. Arthritis results from thinning or damage to the cartilage that protects your bones and it can develop gradually over time or after an injury. If you notice pain, swelling, and stiffness that worsens with activity, arthritis may be the cause. ### 4. Patellar Tendinitis Patellar tendinitis can be caused by running, jumping or sometimes even seemingly benign activities such as hiking. This condition involves degeneration and/or inflammation of the attachment of the patellar tendon to the patella and is often painful with jumping or stair climbing. If the pain is right under your kneecap and worse with sports this may be the problem.  ## What Should You Do? If you experience knee pain when going up the stairs, try to avoid activities that aggravate your symptoms. Rest, ice, and over-the-counter anti-inflammatory medications are all easily accessible and can help you manage pain and swelling. Physical therapy is often very effective for people who have knee pain going up the stairs. Strengthening the quadriceps, hamstrings, and hip muscles are all ways you can help stabilize your knee and relieve pressure on the kneecap. Sometimes, lifestyle changes or modifications to your exercise routine are enough to manage the pain. However, if your pain is persistent, severe, or accompanied by swelling, instability, or a history of injury, it’s important to consult an orthopaedic expert. Early diagnosis and treatment can prevent further damage and help you return to the activities you enjoy, whether that’s a walk in the park or a triathlon. ## Learn More For a deeper dive into knee pain causes, symptoms, and treatment options, please check out these resources: - Patellar Pain and Patellar Arthritis - Knee Chondromalacia Symptoms & Treatment - Knee Arthritis - Knee Chondromalacia, Arthritis, and Tendonitis - Why Do I Have Knee Pain When Squatting? - Why Does My Knee Hurt Going Down Stairs? - Managing Patellar Tendinopathy If knee pain is interfering with your daily life, don’t ignore it. Identifying the cause and addressing it early on can make a significant difference in your ability to go up and down the stairs without pain. To discuss your symptoms with a knee specialist, you can request an appointment with our New York City office. ## Frequently Asked Questions ### What is the most common cause of knee pain when climbing stairs? Patellofemoral pain — pain originating from the kneecap and the cartilage beneath it — is the single most common cause. Stair climbing increases pressure across the patellofemoral joint several times above bodyweight, so any irritation, malalignment, or early cartilage softening in that joint tends to show up first on the stairs. ### Why does my knee hurt going up stairs but not on flat ground? Walking on flat ground creates relatively low forces across the kneecap. Going up stairs forces the quad to lift your entire body against gravity, which presses the kneecap into the groove on the thigh bone. If the cartilage, alignment, or tendon is irritated, that extra load is what reproduces the pain. ### Should I keep climbing stairs if my knee hurts? Short term, modify the activity rather than push through pain. Use one stair at a time, lead with the unaffected leg, and use a handrail. If the pain lasts more than a few weeks despite rest and modification, or if you also have swelling, locking, or the knee giving way, see an orthopedic specialist before resuming. ### Is knee pain on stairs always a sign of arthritis? No. While osteoarthritis can cause stair-related knee pain — especially in patients over 50 — younger and active patients more often have chondromalacia patella, patellar tendinitis, or patellar malalignment. Imaging and a physical exam tell us which one is driving the symptoms. ### When should I see an orthopedic surgeon for knee pain on stairs? See a knee specialist if pain is severe, lasts more than 4–6 weeks despite rest and physical therapy, follows an injury, or is accompanied by swelling, instability, locking, or grinding. Early evaluation rules out structural problems like cartilage damage or a meniscal tear that may need surgical care. Photo by George Van Gosh on Unsplash - cartilage damage, knee arthritis, knee chondromalacia, knee joint, knee pain, kneecap, Orthopaedic expert, Osteoarthritis, patella, Patellar malalignment, patellar tendinitis, Physical Therapy, stair climbing, stairs, swelling ## Related Reading - Patellar pain and patellar arthritis - Why does my knee hurt going down stairs? - Why do I have knee pain when squatting? - About Dr. Sabrina Strickland ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWhy Do I Have Knee Pain When Squatting? NextHow to Prepare for an MPFL Reconstruction Next --- ## Why does my knee hurt going down stairs | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/why-does-my-knee-hurt-going-down-stairs/ Summary: Why does my knee hurt going down stairs? Learn about some causes: Patellofemoral Pain Syndrome, chondromalacia, and meniscal tears and how to feel better. # Why Does My Knee Hurt Going Down Stairs? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: October 30, 2025 - October 30, 2025 Quick Summary Descending stairs forces the patellofemoral joint to absorb roughly 3.5 times your body weight through eccentric quadriceps loading, which is why anterior knee pain often shows up here first. The three most common causes are patellofemoral pain syndrome, chondromalacia patella, and a posterior-horn meniscal tear. Most cases improve with quadriceps and hip strengthening; persistent or mechanical symptoms should be evaluated by an orthopedic specialist. If your knee hurts every time you step down a staircase, you are noticing a real biomechanical signal — not weakness, not "getting old." Going downstairs loads the patellofemoral joint with roughly 3.5 times your body weight, far more than walking on level ground, which is why subtle problems with kneecap tracking, cartilage, or meniscus tend to surface here first. This is one of the most common reasons patients book an evaluation with me at Hospital for Special Surgery in New York, and the good news is that most causes respond well to targeted treatment. ## Why does going downstairs hurt the knee specifically? Descending stairs requires eccentric quadriceps contraction — the muscle generates force while lengthening — which drives the patella hard into the trochlear groove of the femur. Walking on flat ground generates roughly 0.5x body weight across the patellofemoral joint. Climbing stairs generates about 2.5x. Going down generates 3.5x or more. That is the biomechanical reason the front of the knee tends to complain here before anywhere else. Because the joint reaction force is so high, descending stairs is the screening test I use in clinic. If a patient can do everything else but not stairs, the source is almost always anterior (patellofemoral) rather than the inside or outside of the joint. Quadriceps weakness, hip abductor weakness, a high Q-angle, or a tight iliotibial band can all change how the kneecap sits in the trochlear groove and amplify that load. ## What are the most common causes? The three most common diagnoses for "pain only going downstairs" are patellofemoral pain syndrome (PFPS), chondromalacia patella, and a posterior-horn meniscal tear. They are not the same condition, the imaging findings differ, and the treatment paths diverge — which is why the comparison below matters. Condition Where it hurts Hallmark sign First-line treatment Patellofemoral pain syndrome (PFPS)Around or behind the kneecapPain with stairs, squats, prolonged sitting ("theatre sign")Quadriceps + hip strengthening, activity modification Chondromalacia patellaBehind the kneecap, deep acheCrepitus / grinding, MRI shows softened cartilagePT, NSAIDs; cartilage repair if focal lesion Meniscal tear (posterior horn)Joint line, back or side of kneeCatching, locking, joint-line tendernessPT first; arthroscopic repair if mechanical ### 1. Patellar pain or patellar arthritis (PFPS) Patellar pain, also called patellofemoral pain syndrome, runner's knee, or anterior knee pain, is the single most common cause of pain going downstairs. The kneecap fails to track smoothly in the trochlear groove of the femur, often because of malalignment, a high Q-angle, weak vastus medialis obliquus (VMO), tight lateral retinaculum, or early patellofemoral arthritis. Pain sits around or behind the kneecap and is worse with knee flexion under load — squats, lunges, and stairs. Some patients also notice swelling, instability, or the knee "giving way." ### 2. Knee chondromalacia (chondromalacia patella) Chondromalacia is the softening, fissuring, or breakdown of the articular cartilage on the underside of the patella. It is a structural diagnosis — visible on MRI or arthroscopy — and it produces a deeper, more achy pain than PFPS, with crepitus (grinding) on stairs and stiffness after sitting with the knee bent (the "theatre sign"). Long-standing PFPS often progresses into chondromalacia, which is why we treat the biomechanics aggressively before cartilage damage becomes irreversible. ### 3. Meniscal tear A torn meniscus, particularly in the posterior horn, can present primarily as pain going downstairs because deep knee flexion at the top of each step compresses the back of the meniscus. The pain typically sits along the joint line — back or inside of the knee, not behind the kneecap — and is often accompanied by joint-line tenderness, catching, or locking. Mechanical symptoms (a feeling that the knee "catches" mid-motion) are the strongest pointer toward a tear rather than PFPS. Key takeaways - Pain only going downstairs almost always points to the front of the knee (patellofemoral joint). - PFPS and chondromalacia overlap clinically; the distinction is structural cartilage damage on imaging. - Catching, locking, or joint-line pain shifts suspicion toward a meniscal tear. ## When should you see an orthopedic specialist? See a specialist if knee pain on stairs lasts more than 4-6 weeks, comes with swelling, instability, locking, or a history of injury, or if it is interfering with sleep or work. Early evaluation matters: PFPS that is treated with the right strengthening program in the first 6-8 weeks rarely progresses, while ignored cases can develop cartilage damage that is much harder to reverse. In my New York practice, the patients who do best are the ones who come in early — runners, dancers, parents going up and down apartment stairs, or anyone who has noticed a clear loss of function. An MRI is rarely needed at the first visit; a focused clinical exam plus a careful history is usually enough to point us at the right diagnosis. If imaging is needed, we order it on the same visit. ## What can you do at home before your appointment? Most patellofemoral pain improves with relative rest, activity modification, and a structured quadriceps and hip strengthening program — not with complete rest. Going completely off your feet causes muscle atrophy that worsens the loading problem. The goal is to lower load while you rebuild the muscles that protect the joint. - Modify, do not quit. Step down one stair at a time, lead with the non-painful leg, and use the railing while symptoms calm down. - Ice after activity for 15-20 minutes to reduce swelling and pain. - Strengthen the right muscles. Targeted physical therapy for the quadriceps (especially VMO), hip abductors, and gluteus medius improves patellar tracking and offloads the patellofemoral joint. - Avoid pain-provoking depths. Limit deep squats and lunges past 60 degrees of flexion temporarily. - Try a brief NSAID course if your medical history allows it, and discuss patellar bracing or taping with your physical therapist. For related reading on the same anatomy and treatment options, see why your knee can hurt going up stairs, knee pain when squatting, knee chondromalacia symptoms and treatment, and exercise, pain, and creaky knees. ## Worried it means surgery? Most cases do not. Many patients arrive convinced they need surgery because the pain is so reproducible. The reality: the majority of patellofemoral pain — even with mild chondromalacia — is managed without an operation. Surgical options like tibial tubercle osteotomy, cartilage repair (MACI), or partial knee replacement are reserved for specific structural problems that do not respond to a focused 3-6 month program. The exam tells us which group you fall into. ## Frequently asked questions Why does my knee hurt only going down stairs and not on flat ground? Going down stairs puts about 3.5 times your body weight across the kneecap joint, while walking on level ground generates only about 0.5 times your body weight. That much higher load is why early cartilage wear, off-center kneecap tracking, or quad weakness shows up first when going downstairs, even when flat walking still feels normal. Is it patellofemoral pain syndrome or chondromalacia patella? Patellofemoral pain syndrome (PFPS, a clinical diagnosis based on symptoms) is named for kneecap pain with no visible cartilage damage. Chondromalacia patella is a structural finding seen on MRI or arthroscopy — softened or fissured cartilage behind the kneecap. You can have PFPS without chondromalacia, but long-standing PFPS is often what eventually develops into chondromalacia. Should I stop using the stairs if my knee hurts going down? You don't need to avoid stairs entirely. Modify temporarily by stepping down with the non-painful leg first, holding the handrail, and limiting repeated descents while you rebuild quad and hip strength. Completely avoiding stairs leads to muscle weakening that makes the problem worse. If the pain lasts more than 4 to 6 weeks despite modification, see an orthopedic specialist. Can a meniscal tear cause pain only when going down stairs? Yes — a meniscus tear can show up primarily as pain with descending stairs, especially when the tear sits in the back portion of the meniscus. The deep knee bending required at the top of the descent loads the back of the meniscus. Pain along the joint line, the knee catching, or the knee locking alongside stair pain are key signs that point toward a meniscus tear rather than kneecap pain. When should I see an orthopedic surgeon for knee pain on stairs? See an orthopedic specialist if knee pain on stairs lasts more than 4 to 6 weeks, comes with swelling, instability, locking, or a history of injury, or if it limits work or sleep. An MRI is rarely needed at first, but persistent symptoms or mechanical signs warrant imaging and a clinical exam to rule out cartilage damage, meniscus tears, or off-center kneecap tracking. If your knee pain is interfering with daily life, do not ignore it. Early assessment and intervention — whether through exercise modification, structured physical therapy, or, in select cases, surgery — can make a meaningful difference in your recovery timeline and the long-term health of your knee. To request an evaluation with Dr. Sabrina Strickland at Hospital for Special Surgery in New York, please book an appointment. Photo by Frank Eiffert on Unsplash - anterior knee pain, descending stairs, knee chondromalacia, knee pain, kneecap, meniscal tear, patellar arthritis, patellofemoral pain syndrome, Physical Therapy, runner's knee ## Related Reading - Patellar pain and patellar arthritis - Why knees may hurt going up stairs - Why do I have knee pain when squatting? - About Dr. Sabrina Strickland ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousNovel MRI Scoring System to Evaluate Patellofemoral Osteoarthritis NextCan You Fully Recover from a Dislocated Patella?Next --- ## Why I Love Orthopedics - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/why-i-love-orthopedics-2/ Summary: My medical student mentees, residents, and fellows often ask why I love orthopedics. For one, my ability to improve a patient # Why I Love Orthopedics Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - August 29, 2018 I hear this question quite frequently. Whether it be from my medical student mentees or from the residents and fellows I teach. The answer is that I love orthopedics for many reasons. For one, the fact I help improve a patient’s quality of life is immeasurable. Patient’s goals always vary from returning to sports, to being able to walk pain free. The important thing for me to focus on is helping people achieve these goals and to get back to a more active lifestyle. Another reason is that I have autonomy. I can work when I want and take time off when I want. Many of my friends have high powered jobs, but their time at work is not within their control. With that being said, if my patients need me, I don’t like spending too much time away. If a patient is injured, they should be seen within a few days. Third, I really like using my hands. Surgery is technically demanding at times and it’s rewarding to get the job done just right. Finally, I like the variety within my patient population. It’s great meeting a wide range of individuals and I have even taken care of families before where I helped three generations, each varying in different orthopedic needs. Every patient has a different story, but that’s what keeps my job so interesting. I am happy with what I do and enjoy spreading my knowledge and experiences. Transcript [Music] words can't totally explain how much she meant to me because she fixed the thing that I thought was unfixable I had been told was unfixable you're going to a doctor who's confident who knows what they're looking at who's able to give you the right kind of guidance and the right care I can very often bring my patients back to a level where they can ski again or they can play tennis again and for some of my patients they can go up and down stairs again and these are things that we sometimes take for granted the day I went in and when I finally took the brace off I walked 20 steps and I was like I do this and then that was the beginning of getting back and realizing I'm gonna be back in the game my specialty within orthopedics and sports medicine what that means is that I do shoulder and knee surgery but my passion is patellofemoral disorders i co-founded with my partner patellofemoral Center at the Hospital for Special Surgery something that's really important to me as a doctor is making my patients feel comfortable it's pretty scary to have surgery and it's pretty scary to be injured I have a team that works with me that is amazing meaning the most important thing about when I hire an employee is that they're nice and that patients feel comfortable with them and the thing goes for me I never felt that she rushed through any of the detailed explanations that she gave me and obviously should perform two successful surgeries on me that got me back on my feet I have three kids three girls their ages 13 13 and 15 and theft's twins the most rewarding part of my job is getting people back to the things they want to do having patients see me in clinic three months six months a year after surgery and say gosh I never thought I'd ride a horse again and I'm back riding a horse or I used to get up from a table and worried that I was gonna stumble because my knees hurt so much and now I get up and I don't even think about it so it can be a huge range of what patients are telling me but having a job where people say thank you all day long is pretty often [Music]   - Dr. Sabrina Strickland, Hospital for Special Surgery, New York City, orthopedics, why I love orthopedics ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWhy I Would Rather Repair Cartilage Than Replace A Knee NextConsiderations for patellofemoral joint preservation vs patellofemoral arthroplastyNext --- ## Repairing Cartilage vs Replacing a Knee - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/why-i-would-rather-repair-cartilage-than-replace-a-knee/ Summary: Patients come in often asking if I can replace or repair the damaged cartilage in their knee. I wish I could answer yes every time, but this isn # Why I Would Rather Repair Cartilage Than Replace A Knee Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - June 21, 2018 Patients come in all the time asking if I can replace or repair the damaged cartilage in their knee. I wish I could answer yes every time, but this isn’t always the case. When we think of cartilage lesions we sometimes use the term “pothole” to describe the types that are presumed to be fixable. Patients develop defects or these “potholes” in their cartilage due to varying reasons; - Trauma- from an occurrence such as a car accident, a ligament tear, a patellar dislocation, or a fracture. - Avascular necrosis– a condition where the blood supply to bone is compromised due to oral steroid use, alcohol consumption, and often for no known cause. If this occurs under the cartilage in the knee, it can loosen and peel off. - Osteochondritis Dissecans– a condition where an area of bone and cartilage can become loose or unstable in the knee. It affects growing kids and can become symptomatic in young adults. - Degeneration- due to arthritis either inflammatory or degenerative osteoarthritis. - Idiopathic causes– which means for reasons we don’t understand. In the first four described conditions, we can often use either donor cartilage (particulated or osteochondral allograft,) or tissue engineered cartilage (MACI) to fill the hole. In cases where the damage is arthritis and affects both sides of a joint, then we start talking about a joint replacement, partial or total. In summary, in patients with cartilage loss in just one area of their knee, I can often repair or replace the cartilage, but once a joint degenerates to the point where the cartilage is lost on both sides (femur and tibia,) it’s usually too late. At that point, the patient and I consider a partial or total joint replacement. - joint preservation, knee cartilage repair, sports medicine ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousCommunicating Electronically With Your Physician NextWhy I Love OrthopedicsNext --- ## Why Do I Have Knee Pain After Running? | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/why-knee-pain-after-running/ Summary: Identify causes of knee pain after running, including overuse, poor form, chondromalacia, & tendinitis. Get relief with rest, new shoes, PT, or orthopedic help. # Why Do I Have Knee Pain After Running? Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: August 1, 2025 - August 1, 2025 If you’re experiencing knee pain after running, you’re not alone. This is one of the most common complaints among runners of all levels. Knee pain can be caused by a variety of factors, from overuse and improper running technique to underlying (and possibly undiagnosed) knee conditions. Understanding the reasons behind your discomfort is the first step toward effective relief and even prevention. ## Why Does Running Cause Knee Pain? Running is a high-impact activity that places significant repetitive stress on the knee joint. Each stride sends force through your knee, and over time, this can lead to irritation, inflammation, or injury, especially if you ramp up your mileage too quickly, wear improper or old  footwear, or have muscle imbalances. Overuse from activities like running and jumping is a frequent cause of irritation in the tissues surrounding the kneecap, resulting in patellar pain or even early arthritis. ## Common Causes of Knee Pain After Running ### Patellar Pain (Runner’s Knee) Patellar pain, also known as runner’s knee or patellofemoral pain syndrome, is one of the most frequent causes of knee pain after running. This condition causes discomfort around or behind the kneecap, often worsened by activities that involve bending the knee, such as running, squatting, or climbing stairs. Misalignment of the kneecap, muscle imbalances, or overuse can all contribute to this pain. Learn more about patellar pain and patellar arthritis. ### Knee Chondromalacia Chondromalacia patella occurs when the cartilage under the kneecap softens and deteriorates, causing pain, swelling, and sometimes a grinding sensation. This condition is common in runners and can be triggered by overuse, poor alignment, or a sudden increase in activity. This is an early form of arthritis. ### Tendinitis Repetitive running can inflame the tendons around the knee, particularly the patellar tendon (just below the kneecap) and the quadriceps tendon (just above the kneecap). Tendinitis causes pain during and after running and can worsen if not addressed. ### Other Factors Improper footwear, poor running form, weak hip or thigh muscles, and running on hard surfaces can all increase your risk of knee pain. Overtraining—running too much, too soon, or without adequate rest—can also lead to overuse injuries. ## What Should You Do If You Have Knee Pain After Running? - Rest and Ice: Take a break from running and apply ice to reduce swelling and pain. - Evaluate Your Shoes: Make sure you’re running in supportive, well-fitting shoes that aren’t worn out, typically shoes should be changed every 300-500 miles. - Check Your Form: Consider a gait analysis to identify and correct poor running mechanics. - Strengthen Supporting Muscles: Focus on strengthening your quadriceps, glutes, and hip muscles to help stabilize your knee. - Modify Your Training: Gradually increase your mileage and intensity, and include rest days to allow your body to recover. - Physical Therapy: If pain persists, physical therapy can help address muscle imbalances and improve knee function. If your pain is severe, does not improve with rest, or is accompanied by swelling, instability, or a sense of your knee “giving way,” it’s important to see an orthopedic surgeon for a thorough evaluation. Keeping track of which activities worsen your symptoms and any recent changes in your routine can help your doctor make an accurate diagnosis.  ## When to Seek Medical Advice Sudden, severe pain after a specific injury, persistent pain that doesn’t improve with conservative care, or symptoms of instability should prompt a visit to your doctor. Early intervention can help prevent further damage and get you back to running safely. For more information on knee pain, its causes, and treatment options, explore these resources: - Patellar Pain and Patellar Arthritis - Knee Chondromalacia, Arthritis, and Tendonitis - Patient Information Don’t ignore knee pain after running. Addressing it early can help you recover faster and prevent future injuries. Photo by Charles Gaudreault on Unsplash - improper footwear, improper running technique, knee chondromalacia, knee pain, muscle imbalances, orthopedic surgeon, overuse, patellar pain, patellofemoral pain syndrome, Physical Therapy, rest and ice, runner's knee, running, running form, tendinitis ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousManaging Shoulder Pain from Swimming NextACL Surgery: Evolving Practices and Modern Graft ChoicesNext --- ## Women Are More Likely to Tear Their ACL - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/why-women-are-more-likely-to-tear-their-acl/ Summary: This article explains women are more likely to tear their ACL because they fire quads rather than hamstrings when suddenly stopping & land with knees closer together # Why Women Are More Likely to Tear Their ACL Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: June 4, 2025 - August 17, 2015 This article correctly explains that women are more likely to tear their ACL, because they fire their quads rather than their hamstrings when suddenly stopping, and land with their knees closer together. It also states that the second reason women are at risk for knee injury is fatigue. I’m not sure that is fair or even remotely correct. Are women more tired than men? There are a lot of factors that contribute to the higher rate of ACL injury seen in girls and women, and hormonal fluctuations, general laxity or flexibility, hip or glut strength are important facts. Someday we should be able to evaluate adolescents – and tailor at least some of their workout specifically to address or compensate for their body type, degree of flexibility, strength deficits, and landing patterns.   ## 2 Surprising Reasons Women Are at Risk for Knee Injury – Health Essentials from Cleveland Clinic You feel it. Sometimes you even hear it. You’re running, jumping, playing hard. Suddenly, there’s a “pop.” Have you may have torn the anterior cruciate ligament (ACL) in your knee. Find out why women are more at risk. Source: health.clevelandclinic.org/2015/07/2-surprising-reasons-women-at-risk-for-knee-injury/   - ACL, ACL tear, sports, women ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWounded Warriors and Physical Fitness NextFamily Fun and Fitness in ColoradoNext --- ## Ice Hockey Concussion Rate vs. Football- Dr. Sabrina Strickland Source: https://sabrinastrickland.com/why-womens-ice-hockey-has-a-higher-concussion-rate-than-football/ Summary: A new finding revealed higher concussion rates in women’s collegiate sports, such as ice hockey, than in men’s football. But why is this happening? # Why women’s ice hockey has a higher concussion rate than football Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: June 4, 2025 - March 30, 2018 A new finding revealed that rates of concussion are higher in women’s collegiate sports than in men’s. This sparked my interest and brings up the question; Why do female athletes, who play the same sport at the same level as men, report higher concussion rates? There are several reasons that have been suggested including reporting bias, playing style, hormonal differences, neck strength, and nerve fiber structure, according to this article. READ ARTICLE - athlete, athletes, football, ice hockey, women ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousOsteoarthritis: Could researchers have found the key to prevention? NextSaliva and ConcussionsNext --- ## Wiberg Patellar Type Impacts | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/wiberg-patellar-type-impact-outcomes-survival/ Summary: This study evaluated the relationship between Wiberg patellar type and outcomes after cell-based cartilage repair for treating patellar chondral lesions. # Wiberg Patellar Type Impact on Outcomes and Survival Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: February 29, 2024 Quick Summary This midterm study found that Wiberg patellar type — the anatomical shape of the kneecap — does not significantly affect outcomes or graft survival after cell-based cartilage repair for patellar chondral lesions. Patients with all three Wiberg types showed comparable patient-reported outcomes and similar survivorship at midterm follow-up. The takeaway for surgeons: kneecap shape alone should not exclude a patient from cell-based cartilage repair such as MACI. - February 29, 2024 When I discuss cartilage repair surgery with patients, I typically go through a multitude of different options, such as cell-based repair such as MACI (one’s own cartilage grown onto a scaffold) versus donor cartilage (osteochondral allograft) versus denovo (donor cartilage fragments). For a fuller overview of the procedures themselves, see my page on cartilage transplantation, OATS, and osteochondral allograft. The risks and benefits of each are more or less the same in that it doesn’t always work. Sometimes the cartilage cells don’t grow and fill the defect with extracellular matrix and sometimes the donor cartilage does not survive or heal. We are constantly looking to optimize this surgery by looking at outcomes based on anatomical factors and patient characteristics — work I’ve continued in companion studies on bone-marrow edema as a predictor of allograft failure and long-term MACI follow-up. In this study on Wiberg patellar type, I showed that the shape of the kneecap (patella) does not influence outcomes of cartilage transplantation with cell based therapy. At least this is one factor that we can ignore. For patients curious about the underlying repair technique, my procedure page on MACI cartilage repair walks through how the surgery is performed. Read the full article in Sage Journals:Impact of Wiberg Patellar Type on Outcomes and Survival Following Cell-Based Cartilage Repair for Patellar Chondral Lesions at Midterm Follow-up Case courtesy of Samir Benoudina, Radiopaedia.org. From the case rID: 40376 - cartilage transplantation, cell-based cartilage repair, cell-based repair, cell-based therapy, DeNovo, donor cartilage, donor cartilage fragments, extracellular matrix, impact on outcomes, impact on survival, kneecap shape, MACI, osteochondral allograft, patella shape, patellar chondral lesions, Wiberg Patellar Type ## Frequently Asked Questions What is the Wiberg patellar classification?The Wiberg classification describes the shape of the kneecap based on the relative size and angle of its inner and outer surfaces seen on a specific view. Type I has roughly equal inner and outer surfaces; Type II has a smaller, more upright inner surface (the most common); and Type III has a very small or convex inner surface. Surgeons use this anatomical descriptor when planning kneecap procedures and when interpreting cartilage outcomes. Does kneecap shape affect cartilage repair outcomes?In this midterm study, the Wiberg kneecap type did not significantly influence patient-reported outcomes or graft survival after cell-based cartilage repair for kneecap cartilage defects. That means a less favorable kneecap shape is not, by itself, a reason to avoid cell-based repair such as MACI. Other factors — defect size, alignment, lesion location, and kneecap tracking — remain more important predictors of success. What cartilage repair options are available for patellar chondral lesions?For cartilage defects behind the kneecap, the main biologic repair options are MACI (cartilage cells grown from your own tissue and re-implanted), osteochondral allograft (donor cartilage and bone), and DeNovo NT (small fragments of donor juvenile cartilage). The choice depends on the size, depth, and location of the defect, the patient's age, and whether bony correction or realignment — such as a tibial tubercle osteotomy — is also needed. ## Related Reading - MACI cartilage repair (procedure overview) - Cartilage transplant, OATS & osteochondral allograft - Patellar pain & patellar arthritis - Outcomes of cartilage restoration procedures - Long-term outcomes of one-step cartilage repair - About Dr. Sabrina Strickland ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousZKR Orthopedics’ LIFT implant Receives FDA Breakthrough Device Designation NextA Useful Patellar Instability Infographic for EveryoneNext --- ## Women's Sports Events - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/womens-sports-events/ Summary: At a playoff game for the New York Liberty with my daughter. Women # Attending Women’s Sports Events with My Daughters Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: June 4, 2025 - September 23, 2015 At a playoff game for the New York Liberty with my daughter. Women’s sports events are awesome and best enjoyed with one’s daughter! - daughters, Events, New York Liberty, playoff, sports, sports events, women's sports, women's sports events ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousBizarre Sports Injuries NextThe Scariest Thing About SportsNext --- ## Working and Motherhood - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/working-and-motherhood/ Summary: Harvard study says "Working Mothers Raise More Successful Daughters and Empathetic Sons." Moms can stop feeling guilty about working outside the home. # Working and Motherhood Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - July 29, 2015 Aha! This article reduces my guilt. I’m lucky to have a great job and great daughters.   ## Working Mothers Raise More Successful Daughters and Empathetic Sons | Inc.com Thanks to a new Harvard study, you can stop beating yourself up and feeling guilty about working outside the home, Mom. Source: www.inc.com/larry-kim/working-mothers-raise-more-successful-daughters-amp-empathetic-sons-harvard-stud.html?cid=sf01002   - Mothers, Working ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousOsteoporosis and Broken Bones NextWounded Warriors and Physical FitnessNext --- ## Communicate Electronically w/ Physician - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/would-patients-prefer-to-communicate-with-their-surgeon-electronically-more-than-coming-into-the-office/ Summary: Do patients prefer to communicate with their surgeon electronically over an office visit? The answer depends on the patient, type of problem, and office visit goal. # Communicating Electronically With Your Physician Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - June 5, 2018 Question of the day: Would patients prefer to communicate with their surgeon electronically more than coming into the office?  I think the answer depends on the patient, the type of problem they are facing, and what the office visit was supposed to accomplish. Certainly, I wouldn’t be able to evaluate a patient for the very first time without seeing them in person. However, after surgery there are many times I tell patients to just call or email me if they are doing well and come into the office if they still have questions or concerns.  I know that if I were a patient, I would not want to take time off of work to travel to a doctor’s office for a routine check up after surgery. Some patients however have more complicated issues that require a complete evaluation, further imaging such as an x-ray, MRI, or etc. Click here to read how Orthopedists are starting to adopt virtual continuity in their care and call my office with any questions. - healthcare communication, patient care ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousSaliva and Concussions NextWhy I Would Rather Repair Cartilage Than Replace A KneeNext --- ## Wounded Warriors and Physical Fitness - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/wounded-warriors-physical-fitness/ Summary: Sports and physical activity can contribute in a positive way to many people’s lives. However, I worry that competition has negatively impacted sports for many kids. # Wounded Warriors and Physical Fitness Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - August 7, 2015 Sports and physical activity can contribute in a positive way to many people’s lives. However, I worry that competition has negatively impacted sports for many kids. Tryouts for kids are held four or more months in advance of the season for kids as young as nine or 10. Burnout for these kids happens in middle school, when kids stop participating in sports because they don’t think they are good enough. In the United States, we need to shift our focus for our kids from creating professional athletes to creating individuals with a love of sport who will exercise for the fun of it and therefore glean the benefits, both physical and mental, throughout their lifetimes.  This article by the Associated Press about wounded warriors is a sad but happy tale. Having worked as the chief of orthopedics at the Bronx VA for seven years, and now serving as a consulting surgeon at the same facility, I have seen many vets who have been limited physically by their injuries. I hope such programs supported by the Wounded Warrior Project continue and expand, as this is good for veterans, which is good for our country.   ## Injured vets find healing, hope through sports The DoD Warrior Games give focus and purpose to veterans. Source: www.navytimes.com/story/sports/2015/05/18/injured-vets-find-healing-hope-through-sports/27529077/   - competition, sports, veterans, wounded warriors ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousWorking and Motherhood NextWhy Women Are More Likely to Tear Their ACLNext --- ## HSS Presents: Practice Management 101 | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/young-physician-series-practice-management-101-pearls-and-pitfalls/ Summary: Dr. Hailey Huddleston, a 4th-year resident at HSS, speaks to Dr. Sabrina Strickland about Practice Management 101, networking with other physicians, and management. # Young Physician Series: Practice Management 101 – Pearls and Pitfalls Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: September 5, 2024 - September 5, 2024 In this episode of HSS presents, Dr. Hailey Huddleston, a 4th-year resident at HSS, speaks to Dr. Sabrina Strickland, a sports medicine physician at HSS. Join them as they discuss how a young surgeon chooses a practice model, networks with other physicians, and manages others. Listen on Spotify or Apple Podcasts.  - athletic trainer, hiring, Hospital for Special Surgery, HSS, HSS Presents, management, networking, PA, Pearls and Pitfalls, physician assistant, podcast, Practice Management 101, practice model, Young Physician Series ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousMPFL Reconstruction and TTO Questions NextHSS Presents: Practice Management Pearls and Pitfalls for Young PhysiciansNext --- ## Your Diet and Preparing for Surgery - Dr. Sabrina Strickland Source: https://sabrinastrickland.com/your-diet-and-preparing-for-surgery-hss-edu-hss/ Summary: This article has some good information about your diet and preparing for surgery, including two weeks before surgery, the day before, and the day of surgery. # Your Diet and Preparing for Surgery Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023 - December 9, 2015 This article has some good information.  The pre-surgical diet guidelines are for general purposes only. However, your physician or surgeon may require you to follow an alternative plan. In that case, follow your physician’s instructions rather than the guidelines in this document. It outlines how to change your diet fourteen days prior to surgery, the day before surgery, the night before surgery, and the day of surgery. It also includes some examples of what is allowed on a clear fluid diet and what is not allowed.  Presurgical diet guidelines are provided by the specialists at Hospital for Special Surgery. Source: https://www.hss.edu/files/pre-surgical-diet-guidelines_2023-07-12.pdf - diet, Hospital for Special Surgery, HSS, preparation, surgery ### Considering treatment for a knee or shoulder concern? Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below. Book an appointment Contact the office Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health. PrevPreviousNew Technology in Orthopaedics NextDo You Need Surgery?Next --- # Other Pages ## Sports Medicine News & Insight | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/blog-sports-medicine-news/ Summary: This blog contains sports medicine news & insight from Dr. Sabrina Strickland on orthopaedic sports innovations, injuries, and more. Stay tuned! Blog # Orthopedic and Sports Medicine News & Insight Trusted resource for up-to-date information on orthopedic and sports medicine. Dr. Strickland shares the latest advancements in surgical techniques, non-operative treatments, and rehabilitation strategies. August 25, 2026 ## Patellar Resurfacing in Total Knee Replacement: 20-Year Results Read More → April 13, 2026 ## Cortisone vs Gel Shots for Knee Pain: How We Think About Injections Read More → April 10, 2026 ## The Evolution of Knee Surgery Read More → April 10, 2026 ## Interview: The Difference Between ACL and Meniscus Tears Read More → April 9, 2026 ## Static Lunge with Row: A Knee-Friendly Way to Strengthen Your Core and Legs Read More → April 2, 2026 ## ACL Surgery: What Raises Arthritis Risk? Read More → March 27, 2026 ## Working Your Way to Stronger Legs: How to Use the Single-Leg Leg Press Read More → March 20, 2026 ## Anterior Knee Pain: Why "Runner's Knee" Isn't a Real Diagnosis Read More → March 12, 2026 ## New Stanford Research Hints at the Future of Knee Arthritis Treatment Read More → March 10, 2026 ## Squats With Bands: Keeping Weight Off the Kneecaps Read More → March 5, 2026 ## What Is Joint Preservation and Who Is It For? Read More → February 27, 2026 ## Romanian Deadlift for Stronger Legs and Better Balance Read More → Page 1 of 24 · 284 posts --- ## In the Press | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/category/in-the-press-sabrina-strickland/ Summary: All press features — articles, audio interviews, and video appearances. In the Press # In the Press All press features — articles, audio interviews, and video appearances. All Articles Audio Videos Articles April 10, 2026 ## Evolution of Knee Surgery: Open vs. Arthroscopic Explore the evolution of knee surgery with Dr. Sabrina Strickland. Learn how modern arthroscopic techniques and patient exercises lead to faster recovery. Read more → Audio April 10, 2026 ## Difference ACL and Meniscus Tears Dr. Sabrina Strickland discusses the difference between ACL and meniscus tears, treatment options, and essential patient exercises to help you return to an active lifestyle. Read more → Articles February 5, 2026 ## Protect Your ACL During Ski Season As ski season peaks, tips from an orthopaedic surgeon who has performed more than 1,000 ACL surgeries to help prevent knee injuries. Read more → Articles November 25, 2025 ## Knee Surgery with Sea Coral NYC surgeons are using sea coral to treat knee osteoarthritis. The procedure uses a coral-based implant to stimulate cartilage growth and avoid knee replacement. Read more → Videos November 17, 2025 ## Sea coral helps knee osteoarthritis CBS News New York's Jenna DeAngelis saw how doctors are using sea coral (CartiHeal Agili-C) for knee osteoarthritis at HSS. Read more → Articles October 17, 2025 ## First Patella LIFT™ Implant Surgeries First Patella LIFT™ implant surgeries performed by Dr. Strickland and Dr. Gomoll. Learn about this FDA Breakthrough device for patellofemoral arthritis. Read more → Audio October 17, 2025 ## On Staying Active After Injuries Weekend warrior, an athlete, or interested in joint health, this episode of Hilary Topper on Air has advice on staying active after injuries. Read more → Articles August 18, 2025 ## Do You Have Knee Pain? Get expert tips for managing and preventing knee pain during running and triathlons. Learn about common causes and strategies for keeping your training strong. Read more → ## Questions about your knee or shoulder? Book a consultation with Dr. Strickland or learn more about her practice. Book an Appointment About Dr. Strickland --- ## In the Press — Articles | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/category/in-the-press-sabrina-strickland/articles/ Summary: Press articles featuring Dr. Sabrina Strickland. In the Press # Articles Press articles featuring Dr. Sabrina Strickland. All Articles Audio Videos Articles April 10, 2026 ## Evolution of Knee Surgery: Open vs. Arthroscopic Explore the evolution of knee surgery with Dr. Sabrina Strickland. Learn how modern arthroscopic techniques and patient exercises lead to faster recovery. Read more → Articles February 5, 2026 ## Protect Your ACL During Ski Season As ski season peaks, tips from an orthopaedic surgeon who has performed more than 1,000 ACL surgeries to help prevent knee injuries. Read more → Articles November 25, 2025 ## Knee Surgery with Sea Coral NYC surgeons are using sea coral to treat knee osteoarthritis. The procedure uses a coral-based implant to stimulate cartilage growth and avoid knee replacement. Read more → Articles October 17, 2025 ## First Patella LIFT™ Implant Surgeries First Patella LIFT™ implant surgeries performed by Dr. Strickland and Dr. Gomoll. Learn about this FDA Breakthrough device for patellofemoral arthritis. Read more → Articles August 18, 2025 ## Do You Have Knee Pain? Get expert tips for managing and preventing knee pain during running and triathlons. Learn about common causes and strategies for keeping your training strong. Read more → Articles July 31, 2025 ## Managing Shoulder Pain from Swimming Discover strategies to prevent and manage shoulder pain in swimmers, including strengthening exercises and recovery advice, to help triathletes train smarter. Read more → Articles July 14, 2025 ## Miach Orthopaedics’ BEAR® Implant Miach Orthopaedics announced the presentation of the one- and two-year results of the Bridge Registry study at the AOSSM annual meeting. Read more → Articles June 6, 2025 ## BEAR Technique Insights/Preferences Dr. Sabrina Strickland and Dr. Andreas Gomoll share Expert insights, preferences for performing bridge enhanced ACL restoration technique or BEAR technique. Read more → ## Questions about your knee or shoulder? Book a consultation with Dr. Strickland or learn more about her practice. Book an Appointment About Dr. Strickland --- ## In the Press — Audio | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/category/in-the-press-sabrina-strickland/audio/ Summary: Podcast and radio interviews with Dr. Sabrina Strickland. In the Press # Audio Podcast and radio interviews with Dr. Sabrina Strickland. All Articles Audio Videos Audio April 10, 2026 ## Difference ACL and Meniscus Tears Dr. Sabrina Strickland discusses the difference between ACL and meniscus tears, treatment options, and essential patient exercises to help you return to an active lifestyle. Read more → Audio October 17, 2025 ## On Staying Active After Injuries Weekend warrior, an athlete, or interested in joint health, this episode of Hilary Topper on Air has advice on staying active after injuries. Read more → Audio December 30, 2024 ## Podcast on Patellofemoral Instability In this episode of the Braun Performance & Rehab Podcast, Dr. Sabrina Strickland and Dr. Andreas Gomoll join Dan to discuss the patellofemoral joint in detail. Read more → Audio September 5, 2024 ## HSS Presents: Practice Management 101 Dr. Hailey Huddleston, a 4th-year resident at HSS, speaks to Dr. Sabrina Strickland about Practice Management 101, networking with other physicians, and management. Read more → Audio November 8, 2023 ## The Ortho Show with Dr. Scott Sigman Dr. Sabrina Strickland joins Dr. Sigman on The Ortho Show to discuss her specialization with patellofemoral joint and ACLs, education, professional background, more. Read more → Audio August 2, 2023 ## Ep44: Challenging Cartilage Injuries The Sports Docs Podcast We are so excited to host these amazing guests for “Challenging Cartilage Injuries," Live at AOSSM Annual Summit 2023 on The Sports Docs Podcast Read more → Audio February 9, 2023 ## Patellar Tracking Abnormalities & Instability In this Brawn Body Health and Fitness Podcast, Dr. Strickland joins Dan to discuss patellar tracking and patellar instability, including surgical management. Read more → Audio August 22, 2022 ## Brawn Body Knee Injuries Skiing Injuries Brawn Body Health and Fitness Podcast covers common knee injuries and surgical interventions, ACL tears, patellar instability, patellar tracking issues, and more. Read more → ## Questions about your knee or shoulder? Book a consultation with Dr. Strickland or learn more about her practice. Book an Appointment About Dr. Strickland --- ## In the Press — Videos | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/category/in-the-press-sabrina-strickland/videos-press/ Summary: Video appearances featuring Dr. Sabrina Strickland. In the Press # Videos Video appearances featuring Dr. Sabrina Strickland. All Articles Audio Videos Videos November 17, 2025 ## Sea coral helps knee osteoarthritis CBS News New York's Jenna DeAngelis saw how doctors are using sea coral (CartiHeal Agili-C) for knee osteoarthritis at HSS. Read more → Videos June 20, 2025 ## Cartilage Repair: Targeting the Trochlea In this video, Dr. Sabrina Strickland discusses using CARTIHEAL AGILI-C to treat trochlea lesions. Read more → Videos June 1, 2023 ## Cardio at the movies: CNN Staying Well Cardio cinema can increase endurance because chances are you are going to do it longer. Read more → Videos August 14, 2016 ## Can Running Backwards Help Knee Joints? Answering the question: Can running backwards help preserve knee joints? Insights from an orthopedic surgeon at the Hospital for Special Surgery. Read more → Videos August 14, 2016 ## TV's 12 on Health Common medical issues that can be serious if not addressed early – orthopedic injuries and when you need to get to a doctor. Read more → Videos August 14, 2016 ## Hospital for Special Surgery – Dr. Sabrina Strickland Dr. Sabrina Strickland on helping veterans at the Bronx V.A. Hospital, helping veterans getting back to an active life without pain. Read more → ## Questions about your knee or shoulder? Book a consultation with Dr. Strickland or learn more about her practice. Book an Appointment About Dr. Strickland --- ## Newsletter | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/newsletter/ Summary: The Strickland Gomoll Orthopaedic Surgery newsletter — current research and patient education on advanced knee care, joint preservation, and sports medicine from Drs. Sabrina Strickland and Andreas Gomoll. Media # Newsletter The Strickland Gomoll Orthopaedic Surgery newsletter — current research and patient education on advanced knee care, joint preservation, and sports medicine. Welcome to the Strickland Gomoll Orthopaedic Surgery newsletter. Each issue shares current research and up-to-date information on common sports injuries, joint preservation, and advanced knee care from Drs. Sabrina Strickland and Andreas Gomoll. Select an issue below to read it in full or download the PDF. Vol. 2 · July 1, 2026 ## Meniscal Tears ⬇ PDF Vol. 1 · April 2, 2026 ## Inaugural Issue ⬇ PDF --- ## Newsletter Vol. 1: Inaugural Issue | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/newsletter/vol-1/ Summary: Vol. 1 · April 2026 of the Strickland Gomoll Orthopaedic Surgery newsletter — Inaugural Issue. Current research and patient education on advanced knee care, joint preservation, and sports medicine from Drs. Sabrina Strickland and Andreas Gomoll. Vol. 1 · April 2026 # Inaugural Issue Strickland Gomoll Orthopaedic Surgery Newsletter — published April 2, 2026. Inside this issue: Meet Your Surgeons · Our Areas of Expertise · Research & Innovation · Clinical Topic Vol. 1 · April 2026 ## Inaugural Issue ⬇ Download the full newsletter (PDF) ⬇ Download the full newsletter (PDF) ← All newsletter issues --- ## Newsletter Vol. 2: Meniscal Tears | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/newsletter/vol-2/ Summary: Vol. 2 · July 2026 of the Strickland Gomoll Orthopaedic Surgery newsletter — Meniscal Tears. Current research and patient education on advanced knee care, joint preservation, and sports medicine from Drs. Sabrina Strickland and Andreas Gomoll. Vol. 2 · July 2026 # Meniscal Tears Strickland Gomoll Orthopaedic Surgery Newsletter — published July 1, 2026. Inside this issue: Clinical Topic: Meniscal Tear · Treatment Options · Research · Meniscus Recovery FAQs · Myths about Meniscal Tears Vol. 2 · July 2026 ## Meniscal Tears ⬇ Download the full newsletter (PDF) ⬇ Download the full newsletter (PDF) ← All newsletter issues --- ## Search | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/search/ Summary: Search articles, service pages, FAQs, and patient information across Dr. Sabrina Strickland # Search the site Find articles, service pages, FAQs, and patient information. Try keywords like meniscus, MPFL, ACL recovery, or patellar instability. --- ## Your Purse Is Too Heavy | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/your-purse-is-too-heavy/ Summary: A woman # Your Purse Is Too Heavy Published: January 22, 2018 A woman's purse carries everything; it's a big black hole of random items and must-haves that we search for a year for, only to have them show up randomly when we least expect to find them. Most women's purses weigh about 6 pounds- even more in some cases. Because of this, we have to lean our bodies to one side to keep it from falling off. This misalignment can lead to pain in your neck, back, shoulders, muscles, and even lead to worsening problems like herniated disks. I had the pleasure of giving some insight in this TIME article on how to best avoid these problems on a day to day basis. Read the article: "Your Purse Is Too Heavy. Here's Why You Should Care" ← Back to Blog --- # Contact ## Complete Your Appointment Request | Dr. Sabrina Strickland Source: https://sabrinastrickland.com/appointment-details/ Summary: Please provide a few more details to complete your appointment request with Dr. Sabrina Strickland at NYU Langone Orthopedic Center. Appointment # Complete Your Appointment Request Just a couple more details and we'll be in touch to confirm your visit. Prefer to call? We'd love to hear from you! Call 646-904-4664 --- ## Book an Appointment with Dr. Sabrina Strickland Source: https://sabrinastrickland.com/appointment/ Summary: Book an appointment with Dr. Sabrina Strickland online through NYU Langone Health or call 646-904-4664. NYU Langone Orthopedic Center, 333 East 38th Street, NYC. Schedule # Book an Appointment Whether you want to be seen for a new condition or are returning for a follow-up, you can book an appointment with Dr. Strickland. Her team can also provide an independent second opinion of your diagnosis. ## Book Your Appointment Online Appointments are scheduled through NYU Langone Health, where Dr. Strickland is seeing patients. Book online at NYU Langone See Dr. Strickland’s openings and schedule your visit directly through NYU Langone Health. Book at NYU Langone Health → Scheduling around travel, or need help booking? Call 646-904-4664 and the office will point you in the right direction. Whether you want to be seen for a new condition or are returning for a follow-up, you can book an appointment with Dr. Strickland. Her team can also provide an independent second opinion of your diagnosis. ## Our Office NYU Langone Orthopedic Center 333 East 38th Street, 4th Floor New York, NY 10016 Phone: 646-904-4664 Hours: Monday–Friday, 8:00 am–5:00 pm Get Directions ## Questions before booking? Learn more about Dr. Strickland’s approach, her team, and patient information. About Dr. Strickland Patient Information Contact --- ## Contact Dr. Sabrina Strickland - Knee Orthopedic Surgeon NYC Source: https://sabrinastrickland.com/contact-dr-sabrina-strickland/ Summary: Contact Dr. Sabrina Strickland, orthopedic surgeon, for knee and shoulder surgery. Dr. Strickland is in New York City. Get back in the game. Contact # Contact Dr. Sabrina Strickland Please contact us if you have questions or need help scheduling an appointment with Dr. Strickland. Whenever you are ready, my team will be happy to help you get the appointment you need for your knee and shoulder questions. To reach Dr. Sabrina Strickland’s office, call 646-904-4664 for the office at NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor. Office hours are 8:00 am–5:00 pm, Monday through Friday. ## Send Us a Message Have a question or need help scheduling? Send us a message and my team will get back to you within one business day. For urgent matters, please call the office directly. ## Our Office ### NYU Langone Orthopedic Center 333 East 38th Street, 4th Floor New York, NY 10016 Phone:646-904-4664 Get Directions ### Mailing Address NYU Langone Orthopedic Center 333 East 38th Street, 4th Floor New York, NY 10016 ### Office Hours - Mon–Fri:8:00 am – 5:00 pm - Sat–Sun:Closed ### Coming to NYU Langone Orthopedic Center? Directions, parking, and visitor information are on the NYU Langone Orthopedic Center location page. 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PROHIBITED ACTIVITIES You may not access or use the Sites for any other purpose other than that for which Dr. Sabrina Strickland makes it available. The Sites may not be used in connection with any commercial endeavors except those that are specifically endorsed or approved by Dr. Sabrina Strickland. Prohibited activity includes, but is not limited to:   - attempting to bypass any measures of the Sites designed to prevent or restrict access to the Sites, or any portion of the Sites  - attempting to impersonate another user or person or using the username of another user  - criminal or tortious activity  - deciphering, decompiling, disassembling or reverse engineering any of the software comprising or in any way making up a part of the Sites  - deleting the copyright or other proprietary rights notice from any Sites’ content  - engaging in any automated use of the system, such as using any data mining, robots or similar data gathering and extraction tools  - except as may be the result of standard search engine or Internet browser usage, using or launching, developing or distributing any automated system, including, without limitation, any spider, robot (or “bot”), cheat utility, scraper or offline reader that accesses the Sites, or using or launching any unauthorized script or other software  - harassing, annoying, intimidating or threatening any Company employees or agents engaged in providing any portion of the Company Services to you  - interfering with, disrupting, or creating an undue burden on the Sites or the networks or services connected to the Sites  - making any unauthorized use of the Company Services, including collecting usernames and/or email addresses of users by electronic or other means for the purpose of sending unsolicited email, or creating user accounts by automated means or under false pretenses  - selling or otherwise transferring your profile  - systematic retrieval of data or other content from the Sites to create or compile, directly or indirectly, a collection, compilation, database or directory without written permission from Company  - tricking, defrauding or misleading Company and other users, especially in any attempt to learn sensitive account information such as passwords  - using any information obtained from the Sites in order to harass, abuse, or harm another person  - using the Company Services as part of any effort to compete with Company or to provide services as a service bureau  - using the Sites in a manner inconsistent with any and all applicable laws and regulations  INTELLECTUAL PROPERTY RIGHTS The content on the Sites (“Dr. Sabrina Strickland Content”) and the trademarks, service marks and logos contained therein (“Marks”) are owned by or licensed to Dr. Sabrina Strickland, and are subject to copyright and other intellectual property rights under United States and foreign laws and international conventions. Dr. Sabrina Strickland Content, includes, without limitation, all source code, databases, functionality, software, Sites’ designs, audio, video, text, photographs and graphics. All Dr. Sabrina Strickland graphics, logos, designs, page headers, button icons, scripts and service names are registered trademarks, common law trademarks or trade dress of Dr. Sabrina Strickland in the United States and/or other countries. Dr. Sabrina Strickland trademarks and trade dress may not be used, including as part of trademarks and/or as part of domain names, in connection with any product or service in any manner that is likely to cause confusion and may not be copied, imitated, or used, in whole or in part, without the prior written permission of the Dr. Sabrina Strickland.  Dr. Sabrina Strickland Content on the Sites is provided to you “AS IS” for your information and personal use only and may not be used, copied, reproduced, aggregated, distributed, transmitted, broadcast, displayed, sold, licensed, or otherwise exploited for any other purposes whatsoever without the prior written consent of the respective owners. Provided that you are eligible to use the Sites, you are granted a limited license to access and use the Sites and the Dr. Sabrina Strickland Content and to download or print a copy of any portion of the Dr. Sabrina Strickland Content to which you have properly gained access solely for your personal, non-commercial use. Dr. Sabrina Strickland reserves all rights not expressly granted to you in and to the Sites and Dr. Sabrina Strickland Content and Marks.  ## THIRD PARTY WEBSITES AND CONTENT The Sites contains (or you may be sent through the Sites or the Dr. Sabrina Strickland Services) links to other websites (“Third Party Websites”) as well as articles, photographs, text, graphics, pictures, designs, music, sound, video, information, applications, software and other content or items belonging to or originating from third parties (the “Third Party Content”). Such Third Party Websites and Third Party Content are not investigated, monitored or checked for accuracy, appropriateness, or completeness by us, and we are not responsible for any Third Party accessed through the Sites or any Third Party Content posted on, available through or installed from the Sites, including the content, accuracy, offensiveness, opinions, reliability, privacy practices or other policies of or contained in the Third Party Websites or the Third Party Content. Inclusion of, linking to or permitting the use or installation of any Third Party Websites or any Third Party Content does not imply approval or endorsement thereof by us. If you decide to leave the Sites and access the Third Party Websites or to use or install any Third Party Content, you do so at your own risk and you should be aware that our terms and policies no longer govern. You should review the applicable terms and policies, including privacy and data gathering practices, of any websites to which you navigate from the Sites or relating to any applications you use or install from the Sites. Any purchases you make through Third Party Websites will be through other websites and from other companies, and Dr. Sabrina Strickland takes no responsibility whatsoever in relation to such purchases which are exclusively between you and the applicable third party. SITE MANAGEMENT Dr. Sabrina Strickland reserves the right but does not have the obligation to: - monitor the Sites for violations of this Agreement; - take appropriate legal action against anyone who, in Dr. Sabrina Strickland sole discretion, violates this Agreement, including without limitation, reporting such user to law enforcement authorities; - in Dr. Sabrina Strickland sole discretion and without limitation, refuse, restrict access to or availability of, or disable (to the extent technologically feasible) any user’s contribution or any portion thereof that may violate this Agreement or any Dr. Sabrina Strickland policy; - in Company’s sole discretion and without limitation, notice or liability to remove from the Sites or otherwise disable all files and content that are excessive in size or are in any way burdensome to Dr. Sabrina Strickland ‘s systems; - otherwise manage the Sites in a manner designed to protect the rights and property of Dr. Sabrina Strickland and others and to facilitate the proper functioning of the Sites. TERM AND TERMINATION This Agreement shall remain in full force and effect while you use the Sites or are otherwise a user or member of the Sites, as applicable. You may terminate your use or participation at any time, for any reason, by following the instructions for terminating user accounts in your account settings, if available, or by contacting us using the contact information below.  WITHOUT LIMITING ANY OTHER PROVISION OF THIS AGREEMENT, COMPANY RESERVES THE RIGHT TO, IN COMPANY’S SOLE DISCRETION AND WITHOUT NOTICE OR LIABILITY, DENY ACCESS TO AND USE OF THE SITES AND THE COMPANY SERVICES, TO ANY PERSON FOR ANY REASON OR FOR NO REASON AT ALL, INCLUDING WITHOUT LIMITATION FOR BREACH OF ANY REPRESENTATION, WARRANTY OR COVENANT CONTAINED IN THIS AGREEMENT, OR OF ANY APPLICABLE LAW OR REGULATION, AND COMPANY MAY TERMINATE YOUR USE OR PARTICIPATION IN THE SITES AND THE COMPANY SERVICES, DELETE YOUR PROFILE AND ANY CONTENT OR INFORMATION THAT YOU HAVE POSTED AT ANY TIME, WITHOUT WARNING, IN COMPANY’S SOLE DISCRETION.  In order to protect the integrity of the Sites and Company Services, Company reserves the right at any time in its sole discretion to block certain IP addresses from accessing the Sites and Company Services. Any provisions of this Agreement that, in order to fulfill the purposes of such provisions, need to survive the termination or expiration of this Agreement, shall be deemed to survive for as long as necessary to fulfill such purposes. YOU UNDERSTAND THAT CERTAIN STATES ALLOW YOU TO CANCEL THIS AGREEMENT, WITHOUT ANY PENALTY OR OBLIGATION, AT ANY TIME PRIOR TO MIDNIGHT OF COMPANY’S THIRD BUSINESS DAY FOLLOWING THE DATE OF THIS AGREEMENT, EXCLUDING SUNDAYS AND HOLIDAYS. TO CANCEL, CALL A COMPANY CUSTOMER CARE REPRESENTATIVE DURING NORMAL BUSINESS HOURS USING THE CONTACT INFORMATION LISTING BELOW IN THIS AGREEMENT OR BY ACCESSING YOUR ACCOUNT SETTINGS. THIS SECTION APPLIES ONLY TO INDIVIDUALS RESIDING IN STATES WITH SUCH LAWS. If Company terminates or suspends your account for any reason, you are prohibited from registering and creating a new account under your name, a fake or borrowed name, or the name of any third party, even if you may be acting on behalf of the third party. In addition to terminating or suspending your account, Company reserves the right to take appropriate legal action, including without limitation pursuing civil, criminal, and injunctive redress. MODIFICATIONS To Agreement Company may modify this Agreement from time to time. Any and all changes to this Agreement will be posted on the Sites and revisions will be indicated by date. You agree to be bound to any changes to this Agreement when you use the Company Services after any such modification becomes effective. Company may also, in its discretion, choose to alert all users with whom it maintains email information of such modifications by means of an email to their most recently provided email address. It is therefore important that you regularly review this Agreement and keep your contact information current in your account settings to ensure you are informed of changes. You agree that you will periodically check the Sites for updates to this Agreement and you will read the messages we send you to inform you of any changes. Modifications to this Agreement shall be effective after posting.  To Services Company reserves the right at any time to modify or discontinue, temporarily or permanently, the Company Services (or any part thereof) with or without notice. You agree that Company shall not be liable to you or to any third party for any modification, suspension or discontinuance of the Company Services.  DISPUTES Between Users If there is a dispute between users of the Sites, or between users and any third party, you understand and agree that Company is under no obligation to become involved. In the event that you have a dispute with one or more other users, you hereby release Company, its officers, employees, agents and successors in rights from claims, demands and damages (actual and consequential) of every kind or nature, known or unknown, suspected and unsuspected, disclosed and undisclosed, arising out of or in any way related to such disputes and/or the Company Services.   With Company - Governing Law; Jurisdiction. This Agreement and all aspects of the Sites and Company Services shall be governed by and construed in accordance with the internal laws of the State of New York, without regard to conflict of law provisions. With respect to any disputes or claims not subject to informal dispute resolution or arbitration (as set forth below), you agree not to commence or prosecute any action in connection therewith other than in the state and federal courts located in New York County County, State of New York, and you hereby consent to, and waive all defenses of lack of personal jurisdiction and forum non conveniens with respect to, venue and jurisdiction in such state and federal courts. Application of the United Nations Convention on Contracts for the International Sale of Goods is excluded from this Agreement. Additionally, application of the Uniform Computer Information Transaction Act (UCITA) is excluded from this Agreement. In no event shall any claim, action or proceeding by you related in any way to the Sites or Company Services be instituted more than two (2) years after the cause of action arose. - Informal Resolution. To expedite resolution and control the cost of any dispute, controversy or claim related to this Agreement (“Dispute”), you and Company agree to first attempt to negotiate any Dispute (except those Disputes expressly provided below) informally for at least thirty (30) days before initiating any arbitration or court proceeding. Such informal negotiations commence upon written notice from one person to the other. - Binding Arbitration. If you and Company are unable to resolve a Dispute through informal negotiations, either you or Company may elect to have the Dispute (except those Disputes expressly excluded below) finally and exclusively resolved by binding arbitration. Any election to arbitrate by one party shall be final and binding on the other. YOU UNDERSTAND THAT ABSENT THIS PROVISION, YOU WOULD HAVE THE RIGHT TO SUE IN COURT AND HAVE A JURY TRIAL. The arbitration shall be commenced and conducted under the Commercial Arbitration Rules of the American Arbitration Association (“AAA”) and, where appropriate, the AAA’s Supplementary Procedures for Consumer Related Disputes (“AAA Consumer Rules”), both of which are available at the AAA website www.adr.org. The determination of whether a Dispute is subject to arbitration shall be governed by the Federal Arbitration Act and determined by a court rather than an arbitrator. Your arbitration fees and your share of arbitrator compensation shall be governed by the AAA Consumer Rules and, where appropriate, limited by the AAA Consumer Rules. If such costs are determined by the arbitrator to be excessive, Company will pay all arbitration fees and expenses. The arbitration may be conducted in person, through the submission of documents, by phone or online. The arbitrator will make a decision in writing, but need not provide a statement of reasons unless requested by a party. The arbitrator must follow applicable law, and any award may be challenged if the arbitrator fails to do so. Except where otherwise required by the applicable AAA rules or applicable law, the arbitration will take place in New York County County, State of New York. Except as otherwise provided in this Agreement, you and Company may litigate in court to compel arbitration, stay proceedings pending arbitration, or to confirm, modify, vacate or enter judgment on the award entered by the arbitrator. - Restrictions. You and Company agree that any arbitration shall be limited to the Dispute between Company and you individually. To the full extent permitted by law, (1) no arbitration shall be joined with any other; (2) there is no right or authority for any Dispute to be arbitrated on a class-action basis or to utilize class action procedures; and (3) there is no right or authority for any Dispute to be brought in a purported representative capacity on behalf of the general public or any other persons. - Exceptions to Informal Negotiations and Arbitration. You and Company agree that the following Disputes are not subject to the above provisions concerning informal negotiations and binding arbitration: (1) any Disputes seeking to enforce or protect, or concerning the validity of any of your or Company’s intellectual property rights; (2) any Dispute related to, or arising from, allegations of theft, piracy, invasion of privacy or unauthorized use; and (3) any claim for injunctive relief. If this Section is found to be illegal or unenforceable then neither you nor Company will elect to arbitrate any Dispute falling within that portion of this Section found to be illegal or unenforceable and such Dispute shall be decided by a court of competent jurisdiction within the courts listed for jurisdiction above, and you and Company agree to submit to the personal jurisdiction of that court.   CORRECTIONS Occasionally there may be information on the Sites that contains typographical errors, inaccuracies or omissions that may relate to service descriptions, pricing, availability, and various other information. Company reserves the right to correct any errors, inaccuracies or omissions and to change or update the information at any time, without prior notice.  DISCLAIMERS Company cannot control the nature of all of the content available on the Sites. By operating the Sites, Company does not represent or imply that Company endorses any blogs, contributions or other content available on or linked to by the Sites, including without limitation content hosted on third party websites or provided by third party applications, or that Company believes contributions, blogs or other content to be accurate, useful or non-harmful. We do not control and are not responsible for unlawful or otherwise objectionable content you may encounter on the Sites or in connection with any contributions. The Company is not responsible for the conduct, whether online or offline, of any user of the Sites or Company Services. YOU AGREE THAT YOUR USE OF THE SITES AND COMPANY SERVICES WILL BE AT YOUR SOLE RISK. TO THE FULLEST EXTENT PERMITTED BY LAW, COMPANY, ITS OFFICERS, DIRECTORS, EMPLOYEES, AND AGENTS DISCLAIM ALL WARRANTIES, EXPRESS OR IMPLIED, IN CONNECTION WITH THE SITES AND THE COMPANY SERVICES AND YOUR USE THEREOF, INCLUDING, WITHOUT LIMITATION, THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NON-INFRINGEMENT. COMPANY MAKES NO WARRANTIES OR REPRESENTATIONS ABOUT THE ACCURACY OR COMPLETENESS OF THE SITES CONTENT OR THE CONTENT OF ANY WEBSITES LINKED TO OUR SITES AND ASSUMES NO LIABILITY OR RESPONSIBILITY FOR ANY (A) ERRORS, MISTAKES, OR INACCURACIES OF CONTENT AND MATERIALS, (B) PERSONAL INJURY OR PROPERTY DAMAGE, OF ANY NATURE WHATSOEVER, RESULTING FROM YOUR ACCESS TO AND USE OF OUR SITES, (C) ANY UNAUTHORIZED ACCESS TO OR USE OF OUR SECURE SERVERS AND/OR ANY AND ALL PERSONAL INFORMATION AND/OR FINANCIAL INFORMATION STORED THEREIN, (D) ANY INTERRUPTION OR CESSATION OF TRANSMISSION TO OR FROM THE SITES OR COMPANY SERVICES, (E) ANY BUGS, VIRUSES, TROJAN HORSES, OR THE LIKE WHICH MAY BE TRANSMITTED TO OR THROUGH OUR SITES BY ANY THIRD PARTY, AND/OR (F) ANY ERRORS OR OMISSIONS IN ANY CONTENT AND MATERIALS OR FOR ANY LOSS OR DAMAGE OF ANY KIND INCURRED AS A RESULT OF THE USE OF ANY CONTENT POSTED, TRANSMITTED, OR OTHERWISE MADE AVAILABLE VIA THE SITES. COMPANY DOES NOT WARRANT, ENDORSE, GUARANTEE, OR ASSUME RESPONSIBILITY FOR ANY PRODUCT OR SERVICE ADVERTISED OR OFFERED BY A THIRD PARTY THROUGH THE SITES OR ANY HYPERLINKED SITES OR FEATURED IN ANY BANNER OR OTHER ADVERTISING, AND COMPANY WILL NOT BE A PARTY TO OR IN ANY WAY BE RESPONSIBLE FOR MONITORING ANY TRANSACTION BETWEEN YOU AND THIRD-PARTY PROVIDERS OF PRODUCTS OR SERVICES.   LIMITATIONS OF LIABILITY IN NO EVENT SHALL COMPANY OR ITS DIRECTORS, EMPLOYEES, OR AGENTS BE LIABLE TO YOU OR ANY THIRD PARTY FOR ANY DIRECT, INDIRECT, CONSEQUENTIAL, EXEMPLARY, INCIDENTAL, SPECIAL OR PUNITIVE DAMAGES, INCLUDING LOST PROFIT, LOST REVENUE, LOSS OF DATA OR OTHER DAMAGES ARISING FROM YOUR USE OF THE SITES OR COMPANY SERVICES, EVEN IF COMPANY HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. NOTWITHSTANDING ANYTHING TO THE CONTRARY CONTAINED HEREIN, COMPANY’S LIABILITY TO YOU FOR ANY CAUSE WHATSOEVER AND REGARDLESS OF THE FORM OF THE ACTION, WILL AT ALL TIMES BE LIMITED TO THE AMOUNT PAID, IF ANY, BY YOU TO COMPANY FOR THE COMPANY SERVICES DURING THE PERIOD OF THREE (3) MONTHS PRIOR TO ANY CAUSE OF ACTION ARISING. CERTAIN STATE LAWS DO NOT ALLOW LIMITATIONS ON IMPLIED WARRANTIES OR THE EXCLUSION OR LIMITATION OF CERTAIN DAMAGES. IF THESE LAWS APPLY TO YOU, SOME OR ALL OF THE ABOVE DISCLAIMERS OR LIMITATIONS MAY NOT APPLY TO YOU, AND YOU MAY HAVE ADDITIONAL RIGHTS. IF YOU ARE A CALIFORNIA RESIDENT, YOU WAIVE CALIFORNIA CIVIL CODE SECTION 1542, WHICH SAYS: “A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH, IF KNOWN BY HIM MUST HAVE MATERIALLY AFFECTED HIS SETTLEMENT WITH THE DEBTOR.” INDEMNITY You agree to defend, indemnify and hold Company, its subsidiaries, and affiliates, and their respective officers, agents, partners and employees, harmless from and against, any loss, damage, liability, claim, or demand, including reasonable attorneys’ fees and expenses, made by any third party due to or arising out of your contributed content, use of the Company Services, and/or arising from a breach of this Agreement and/or any breach of your representations and warranties set forth above. Notwithstanding the foregoing, Company reserves the right, at your expense, to assume the exclusive defense and control of any matter for which you are required to indemnify Company, and you agree to cooperate, at your expense, with Company’s defense of such claims. Company will use reasonable efforts to notify you of any such claim, action, or proceeding which is subject to this indemnification upon becoming aware of it. NOTICES Except as explicitly stated otherwise, any notices given to Company shall be given by email to the address listed in the contact information below. Any notices given to you shall be given to the email address you provided during the registration process, or such other address as each party may specify. Notice shall be deemed to be given twenty-four (24) hours after the email is sent, unless the sending party is notified that the email address is invalid. We may also choose to send notices by regular mail. USER DATA Our Sites will maintain certain data that you transfer to the Sites for the purpose of the performance of the Company Services, as well as data relating to your use of the Company Services. Although we perform regular routine backups of data, you are primarily responsible for all data that you have transferred or that relates to any activity you have undertaken using the Company Services. You agree that Company shall have no liability to you for any loss or corruption of any such data, and you hereby waive any right of action against Company arising from any such loss or corruption of such data. ELECTRONIC CONTRACTING Your use of the Company Services includes the ability to enter into agreements and/or to make transactions electronically. YOU ACKNOWLEDGE THAT YOUR ELECTRONIC SUBMISSIONS CONSTITUTE YOUR AGREEMENT AND INTENT TO BE BOUND BY FOR SUCH AGREEMENTS AND TRANSACTIONS. YOUR AGREEMENT AND INTENT TO BE BOUND BY ELECTRONIC SUBMISSIONS APPLIES TO ALL RECORDS RELATING TO ALL TRANSACTIONS YOU ENTER INTO RELATING TO THE COMPANY SERVICES, INCLUDING NOTICES OF CANCELLATION, POLICIES, CONTRACTS, AND APPLICATIONS. In order to access and retain your electronic records, you may be required to have certain hardware and software, which are your sole responsibility.   MISCELLANEOUS This Terms of Use Agreement constitutes the entire agreement between you and Company regarding the use of the Company Services. The failure of Company to exercise or enforce any right or provision of this Agreement shall not operate as a waiver of such right or provision. The section titles in this Agreement are for convenience only and have no legal or contractual effect. This Agreement operates to the fullest extent permissible by law. This Agreement and your account may not be assigned by you without our express written consent. Company may assign any or all of its rights and obligations to others at any time. Company shall not be responsible or liable for any loss, damage, delay or failure to act caused by any cause beyond Company’s reasonable control. If any provision or part of a provision of this Agreement is unlawful, void or unenforceable, that provision or part of the provision is deemed severable from this Agreement and does not affect the validity and enforceability of any remaining provisions. There is no joint venture, partnership, employment or agency relationship created between you and Company as a result of this Agreement or use of the Sites and Company Services. Upon Company’s request, you will furnish Company any documentation, substantiation or releases necessary to verify your compliance with this Agreement. You agree that this Agreement will not be construed against Company by virtue of having drafted them. You hereby waive any and all defenses you may have based on the electronic form of this Agreement and the lack of signing by the parties hereto to execute this Agreement. CONTACT US ABOUT TERMS OF USE In order to resolve a complaint regarding the terms of use for Company Services or to receive further information regarding use of the Company Services, please contact Company as set forth below or, if any complaint with us is not satisfactorily resolved, and you are a California resident, you can contact the Complaint Assistance Unit of the Division of Consumer Services of the Department of Consumer Affairs in writing at 400 “R” Street, Sacramento, California 95814 or by telephone at 1-916-445-1254. Dr. Sabrina Strickland  NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor  New York, NY 10016  Phone: Terms of Use Last Updated: October 27, 2022 ---