20Shoulder Care
AC Joint Injuries
Arthritis
Biceps Tendon Injuries
Calcific Tendinitis
Clavicle Fractures
Frozen Shoulder
Labral and SLAP Tears
Rotator Cuff Injuries
Shoulder Dislocation/Instability
Subacromial Impingement/Busitis
A-C Joint Stabilization
Biceps Tenodesis
Clavicle Fracture Fixation
Pectoralis Major Repair
Rotator Cuff Repair
Shoulder Instability Surgery – Bankart Repair
Shoulder Instability Surgery – Latarjet Procedure
Subacromial Decompression and Acromioplasty
Superior Capsular Reconstruction
Total Shoulder Replacement
28Knee Care
ACL Tear
Cartilage Injury
Lateral Meniscus Tear
LCL Injury
MCL Injury
Medial Meniscus Tear
Osteoarthritis
Patellar Instability
Patellofemoral Chondromalacia
Posterolateral Corner Injury
Trochlear Dysplasia
Anterior Cruciate Ligament (ACL) Reconstruction
Cartilage Restoration Surgery – Autologous Chondrocyte Implantation (ACI-Carticel)
Cartilage Restoration Surgery – Donor Graft
Collagen Meniscal Implant (CMI)
Lateral Collateral Ligament (LCL) Reconstruction
Medial Collateral Ligament (MCL) Reconstruction
Meniscus Repair
Meniscus Root Repair
Meniscal Transplant
Nanofracture
Osteochondral Allograft Transfer
Osteochondral Autograft Transfer (OATS)
Partial Meniscectomy
Posterior Cruciate Ligament (PCL) Reconstruction
Posterolateral Corner (PLC) Surgery
Tibial Tubercle Osteotomy
Trochleoplasty
17Hip Care
Cartilage Injury
Femoroacetabular Impingement (FAI)
Gluteal Tears
Hamstring Tears
Hip Instability
Labral Tears
Psoas Impingement (Internal Snapping Hip)
Trochanteric Bursitis
Acetabuloplasty
Chondroplasty
Femoroplasty
Gluteal Repair
Labral Debridement
Labral Repair
Labral Reconstruction
Nanofracture
Trochanteric Bursa Debridement
2Biologics
Bone Marrow Aspirate Stem Cell Concentrate (BMC)
Platelet-Rich Plasma “PRP”

NANOFRACTURE

The ends of the femur and acetabulum – the hip bones – are capped with a smooth surface called articular cartilage.  Cartilage protects the ends of bone; it can withstand a tremendous amount of force and is significantly smoother than ice, which allows smooth motion in the hip joint. An articular cartilage injury (chondral injury), may occur following a twisting injury to the hip, a direct blow, or wear and tear as a one ages. The cartilage has a very limited bloody supply, and full-thickness cartilage lesions cannot heal without surgical intervention. In those patients with full-thickness cartilage damage and recurrent symptoms, surgical intervention may be the best option.

During surgery, Dr. Keller introduces a camera through one small incision and surgical instruments through two other small incisions.   Dr. Keller uses surgical instruments to remove the loose pieces of cartilage and areas of fraying. Dr. Keller then identifies the full-thickness cartilage damage (in which bone is exposed). If the cartilage damage is relatively small, Dr. Keller uses a small, sharp device to make tiny holes in the bone beneath the damaged cartilage. This technique (nanofracture) stimulates bone marrow cells to migrate to the damaged area and produce new cartilage. Usually, the cells produce a layer of cartilage called fibrocartilage that helps protect the exposed bone. Another emerging option for cartilage surgery is the use of healthy, donor cartilage cells to treat the area of full thickness cartilage damage.

Postoperative Rehabilitation

Following surgery, Dr. Keller recommends a guided physical therapy program with a licensed physical therapist. Early motion following surgery is very important for cartilage surgery, and Dr. Keller recommends that each patient either use a stationary bike or a continuous passive motion machine daily. Dr. Keller also recommends limited weight bearing and crutch use for 4-6 weeks after surgery. Dr. Keller may also recommend the use of a brace for approximately two weeks to help protect the hip.

Following surgery, Dr. Keller prescribes appropriate pain medication as well as an anti-inflammatory medication. Anti-inflammatory medication (such as Naprosyn) is important because it can help eliminate pain and also may prevent the formation of abnormal bone (heterotopic ossification).