Wednesday, April 18th, 2012
This is a 30 something dancer who came to us originally with complaints of left knee pain that was preventing her from dancing. A diagnosis was made of patellafemoral mal- alignment. She failed initial non-surgical treatment which was physical therapy to strengthen the muscles selectively around the knee to improve patella tracking.
We proceeded with surgical treatment of the condition. The diagnosis made by X-rays, MRI and clinical exam was confirmed at the time of surgery and the patella was noted to be laterally tilted and somewhat translated (image 1). The problem was corrected with purely soft tissue procedure to lengthen the lateral retinaculum and tighten the medial soft tissues using a tissue advancement and suturing technique. The procedure was successful in centering the patella (image 2) and was accomplished arthroscopically and with a 1 inch incision and no skeletal work.
She recovered well from the surgery and her knee pain resolved. She subsequently developed pain in the hip and having had a satisfactory experience with treatment of her knee condition began treatment of her hip. A diagnosis was made of anterior labrum tearing with FAI (femeroacetabular impingement) with a CAM lesion. The condition was corrected with an arthroscopic hip procedure.
The ace tabular hyaline cartilage had the characteristic chondrolabral separation associated with FAI and CAM lesions (image 1,2). The labrum was repaired back to the acetabulum rim following preparation of the osseous surface (image 3,4,5). The final step was eliminating the CAM impingement by recontouring the femoral neck to allow acetabular relief (image 5,6,7). The client recovered well following rehabilitation and has returned to dancing.
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Thursday, April 12th, 2012
50s female that sustained a comminuted fracture of the elbow – olecranon process, coronoid and proximal ulna- when she fell onto the arm. The preoperative X-rays ( image 1,2) show the displaced fracture with multiple separated fragments of bone.
Surgery was recommended to restore the form and function to the elbow and arm. The postoperative X-rays (image 3,4) shows the fracture anatomically repaired with restoration of alignment and rigid fixation of the fractured segments.
After the surgery she was started in an early program of motion and rehabilitation with excellent results- restoration of normal appearance, motion, strength without any pain (video after surgery and rehabilitation)
Friday, March 16th, 2012
80s female with disabling bilateral knee pain secondary to advanced osteoarthritis (image 1,2,5,6) and history of prior femur fracture on the right side with existing orthopedic hardware from the fracture surgery ( image 1,2) In order to resolve her pain and disability we took her through a staged bilateral procedure of total knee replacement. Both sides were done using Pre-surgical MRI driven Navigation.
This procedure involves using MRI acquired images to generate a computer model of the knee. This model is then used to plan the surgery including where and how the skeletal rejections are made, the size of the implants, the placement and alignment of the implants in relation to the existing skeletal architecture as well as the relative positions of the hip and knee. Once the surgery is performed on the computer model and an acceptable final result is achieved the plan is then sent to the implant company where it is used to generate custom resection guides.
These guides are then made available at the time of surgery which allows for precise surgery with minimal surgical dissection. In this case the end result achieved was excellent with ideal sizjng and alignment of the implants ( image 3,4,7,8) despite the complexity of the anatomy especially the right knee where she had prior surgery, skeletal deformity and an existing orthopedic implant which was not removed for the purpose of reconstructing the knee ( image 3,4).
Thursday, March 8th, 2012
This is a female mid 40s that presented to the office with disabling and progressive left knee pain. An arthroscopic procedure confirmed advance cartilage loss in the patella femoral compartment with the weight bearing compartments in good condition with no significant cartilage damage or loss (Image 1,2,3).
The problem was effectively addressed with a resurfacing procedure providing a replacement surface only to the area of the knee affected by the degenerative condition with the remainder of the knee including both weight bearing compartments, meniscus and cruciate ligaments natural (Image 4,5,6).
Note how the implants match the natural curvatures of the knee therebye allowing an anatomic reconstruction of the patellafemoral articulation creating the context and the potential for a full restoration of natural function and complete pain relief.
Sunday, March 4th, 2012
This is a 30 something year old male who injured the left shoulder while working. He was diagnosed by MRI to have a complete and retracted tear of the pectorals major tendon.
Given his desire to return to a physically demanding job position we chose to treat the rupture by surgically repairing it. 6 weeks after the surgery the client is seen in the office and demonstrates full motion, no swelling and minimal skin/scarring.
Sunday, March 4th, 2012
This is a 44yo male who sustained a sports related injury rupturing his distal biceps tendon. He presented to our office with the typical deformity related to proximal retraction of the muscle. He initially opted for nonsurgical treatment but then returned unhappy with the result and requested surgical treatment.
The surgery was complicated by the delay in repair and also by the small remaining stump of tendon still attatched to the muscle (Image 1). The small segment of tendon remaining on the muscle was accessed through a small horizontal incision made in the mid portion of the arm (Image 1).
The tendon stump was then reconstructed using a anterior tibialis allograft tendon. This donor tendon was grafted onto the end of the muscle (Image 2). Following successful grafting the muscle – tendon complex was restored and now ready for re- attachment to the skeleton. A second small horizontal incision was made at the elbow crease and the tendon was passed under a soft tissue bridge to reach the elbow.
This was done to maintain the aesthetic of the surgery and also reduce post surgical scarring by minimizing the size of the surgical exposure/ dissection. Through the distal incision the tendon was re-attatched to the skeleton achieving the end result of functioning muscle-tendon-bone reconstruction.
Sunday, March 4th, 2012
This is a 48yo male whom sustained a work related injury and was diagnosed with a complete rupture of the left distal biceps tendon. Given his work requirements which required forceful use of the arm and a desire to return the arm to it’s pre-injury level of health a repair of the tendon was performed. A 2 incision approach was utilized with with each incision approximately 1 inch in length and barely visible; he also has full range of motion of the left elbow without restrictions This video also demonstrates the muscle to be restored to it’s normal appearance and also demonstrates the normal function of the muscle with muscular activity comparing the left injured/ surgery and right uninjured/no surgery.
Watch Video
Sunday, March 4th, 2012
This patient sustained a knee injury and as a result lost nearly his entire medial meniscus. As a result of the injury and loss of the meniscus he went on to develop symptomatic articular cartilage loss in the medial weight bearing compartment of the knee (Image 1). Note in this arthroscopic photo the absent meniscus and full thickness cartilage loss. Given his age and desire to return to a physically demanding job a knee replacement was not felt to be a good option. Instead the problem was addressed using a resurfacing implant- Arthrosurface- to resurface and cover the area of cartilage loss on both the medial femoral and tibia condyle (Image 2).
Notice hoe the implants are placed to recess into the existing joint surface. In addition to the resurfacing implants meniscus allograft was placed (Image 3) and (Image 4). Following mixed biologic and synthetic reconstruction the client is seen in the office nearly 3 years later and X-rays (Image 4) shows the knee joint preserved with no collapse of the joint space and no signs of progressive degeneration. He is currently back to work at full duty and has only occasional discomfort in the knee. Overall he is extremely satisfied with the result and grateful that we were able to successfully treat him without performing a knee replacement. Read Patient’s Testimonial…
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Monday, February 20th, 2012
This is a 40s female who presented with progressive and disabling anterior knee pain . Her condition had been getting progressively worse to the extent that she was no longer able to participate in even routine activities without having substantial discomfort followed by swelling. She had undergone prior surgery for the knee and recently had a second procedure done which was a lateral release and micro fracture. She was scheduled to have the same procedure performed for the opposite knee however since she had not gotten acceptable pain relief came to see us for a second opinion.
We made a diagnosis of advanced osteoarthritis of the patellafemoral compartment and based on the advanced nature and pattern of the cartilage loss recommended a resurfacing procedure for effective and durable pain relief. Arthrosurface implants were used for the resurfacing ( image 1,2). Note the implants and how they are surgically implanted to match the complex curved geometry of the knee. She achieved an excellent result from the procedure with no further symptoms of pain or swelling.
The following video is at her most recent visit to schedule the identical procedure for the opposite knee. The video shows the cosmetic incision as well as restoration of full knee motion (video).
Watch Video
Sunday, February 19th, 2012
This is a 50 something male who was a client of ours having undergone a hip replacement. He was extremely satisfied with the results and care he received and asked us to evaluate his shoulder. He complained of severe pain in the shoulder and restricted motion. He was tentative about undergoing treatment for the condition having been told he would need a shoulder replacement and not able to return to playing golf.
After evaluating his problem we recommended a shoulder resurfacing procedure as an effective surgical intervention that would eliminate his pain and still allow a return to sports activity including golf. Based on our reassurances and the confidence we had built as a result of the successful hip surgery he decided to proceed. The following video shows his motion at 4 weeks from the surgery. He is extremely pleased with the results and looking forward to returning to the golf course this spring.
Shoulder resurfacing is a new procedure and is a substitute for shoulder replacement surgery. The procedure is radically less invasive and allows for a much more complete restoration of function and return to sports.
Watch Video (Shoulder Resurfacing)
Read Client’s Testimonial (after hip replacement)
