Anatomy: The meniscus is a cartilaginous structure that acts to spread the load of the femur across the proximal tibia. It along with the articular cartilage acts as a shock absorber for the knee. Premature damage to the meniscus is correlated to degenerative arthritis.

Symptoms: Localized pain and tenderness to a region of the knee, sometimes activity related. Swelling, inability to bend and sometimes straighten the knee.

Diagnosis: Relatively normal appearing X-Rays, Physical Exam findings and sometimes an MRI.

Treatment:The meniscus is an important shock-absorbing structure that has a relatively low chance of healing. If the symptoms warrant, an arthroscopic debridement or repair is the treatment of choice.

Anatomy: The ACL is one of the four main ligamentous stabilizers of the knee. It prevents the tibia from translating anteriorly in reference to the femur.

Symptoms: Usually associated with a non-contact sports injury. Patients may recall a "pop" and almost immediate swelling when they were decelerating and twisting. This type of history alone is associated with a 70% probability of ACL disruption. There is a high probability of concurrent meniscal and medial collateral ligament injury.

Diagnosis: Positive provocative tests such as a Lachman's, pivot shift and anterior drawer test.

Treatment: The ACL has almost no self-reparative capacity; therefore, reconstruction usually the only option for patients that want to return athletic activities. We offer various techniques of reconstruction, including hamstring, patellar tendon, to allographic options.

Anatomy: The MCL is the primary stabilizer on the medial or inside of the knee. It prevents the knee from buckling inward and can be injured when the outside of the knee is struck.

Treatment: Most all MCL injuries can be treated non-operatively, sometimes with a brace. Surgery is indicated in only the most severe cases when instability is profound.

Anatomy:These structures allow for knee extension and hip flexion. Injuries to these tendons occur under extreme strain conditions, such as falling or jumping.

Treatment: Surgery is almost always indicated for complete tears to these tendons.

Anatomy:The patella acts to provide mechanical advantage to the quadriceps mechanism. It is tethered to the tibia at the tibial tuberacle and also to the quad muscle.

Symptoms: Abnormality of the anatomy and biomechanics or injury can cause inflammation of the patellar and femoral cartilage. Inflammation of this cartilage causes a diffuse anterior knee pain that is exacerbated by stair climbing and sitting.

Treatment: Non-operative treatment with physical therapy and exercise is highly successful. Surgery may be indicated in the most refractory cases.

Anatomy: The rotator cuff is a group of muscles and associated tendons that support and give mobility to the glenoid and the humerus. They are composed of the supraspinatous, infraspinatous, subscapularis, and the teres minor muscles.

Symptoms: These muscles are essential to normal shoulder function for daily activities and for sports performance. Inflammation and/ or degeneration of these tendons may cause pain at rest or with activity, especially with motion of the arm away from the trunk. Patients may note pain that originates in the shoulder with provocative motion that may radiate down the arm. Pain may be present at rest and also when sleeping. Degeneration of the rotator cuff could advance and could present in the form of a rotator cuff tear. Tears of the rotator cuff may present as a gradual or post-traumatitic onset of weakness.

Treatment: Tendonitis and/ or tears of these tendons and be treated with a number of non-invasive as well as invasive medical options. The mainstay of treatment is exercise and physical therapy. This rehabilitation regiment is augmented with oral and sometimes injectable anti-inflammatory medications. Surgical treatment consists of removing and bony spurs (osteophytes) on the acromion and debriding or repairing and tears down to is normal insertion sites on the humerus. The gold standard remains treatment with open surgical debridement and open rotator cuff repair. However, mini-open, modified mini-open, and arthroscopic rotator cuff repair are considered the future of shoulder surgery. These techniques in the right circumstances allow for fastest rehabilitation, less pain, and quicker return to normal function following surgery.

Anatomy: The shoulder joint is the body's most mobile joint, it consequently it has the propensity for dislocation. The shoulder joint is stabilized by rotator cuff muscles, hydrostatic pressure, and the capsule of the shoulder. Instability of the glenohumeral joint arises from injury to one of the aforementioned anatomic structures. This is known as traumatic instability. It can also arise from the dysfunction of the muscles around the shoulder and laxity of the soft tissues. Atramatic instability of shoulder is known as multidirectional instability.

Symptoms: Patients often complain of pain in the shoulder joint. They also complain of a sense of instability and unease when the shoulder is placed into certain provocative positions.

Treatment: The mainstay of treatment is physical therapy and exercise. In the case of refractory instability, operative intervention and reconstruction of the soft tissues for stabilization is performed. For traumatic anterior dislocation a combination labral reconstruction and tightening of the anterior capsule, traditionally called a bankhart repair, is performed. Multidirectional instability may be addressed with a procedure that tightens the anterior and inferior capsule is known as a capsular shift. Both these procedures have a high degree of success and maybe performed in a open fashion but also may be performed arthroscopically. Open for procedure for shoulder instability is the gold standard; however, arthroscopic reconstruction offers the patient faster initiation of rehabilitation and less post-operative pain.

Anatomy: Arthritis can develop in the glenohumeral joint, between the humerus and the glenoid. Acromial-clavicular arthritis develops between the clavicle and the acromion.

Symptoms: Pain with activities as well as with rest. Lack of a range of motion, grinding and tenderness to touch are some of the symptoms that patients state.

Treatment: Arthritis of the acromial-clavicular joint may be diagnosed and treated with an injection. Non-operative treatment of the AC joint involves medications and injections. Refractory cases may be treated with an open or arthroscopic distal clavicle excision. Arthritis of the glenohumeral joint may necessitate a total shoulder replacement if the muscles are intact.