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”

CARTILAGE RESTORATION SURGERY – DONOR GRAFT

The ends of the femur, tibia, and undersurface of the patella (kneecap), the knee bones, are capped with a smooth surface called articular cartilage.  Cartilage protects the ends of bone; it can withstand a significant amount of impact and is significantly smoother than ice, which allows smooth motion in the knee joint. An articular cartilage injury (or “chondral” injury), may occur following a twisting injury to the knee, a direct blow to the knee, or wear and tear as a one ages. Some patients with cartilage injuries can be treated with a combination of activity modification and other non-surgical options, such as a focused physical therapy program. Other patients with persistent symptoms or larger defects may require surgery.

Surgical treatment options for isolated cartilage injuries include the use of donor cartilage to replace the damaged area of cartilage. Donor cartilage is cleaned and stored in a way that preserves the health of the donor cartilage cells. There are two techniques available to Dr. Keller. In one technique – the DeNovo technique – Dr. Keller matches the shape of the donor cartilage tissue to the area of damaged cartilage and then places the donor graft into the defect in the patient’s knee. Dr. Keller then seals the cartilage tissue with fibrin glue. In the second technique – the ProChondrix technique – Dr. Keller places a pre-shaped donor graft made of cartilage cells and natural scaffolding into the damaged area of cartilage in the knee. The donor graft is then sealed with fibrin glue. Following surgery, the healthy donor cartilage tissue matures over many months and replaces the area of damaged cartilage.

Post-Operative Rehabilitation

Following surgery, patients are placed in a hinged brace that is locked straight. Dr. Keller recommends no weight-bearing for 4-6 weeks in the brace. When the patient is sitting or lying down, Dr. Keller encourages knee range of motion exercises with the brace removed. Dr. Keller also recommends intermittent icing and straight leg raise exercises to strengthen the quadriceps muscles. Dr. Keller recommends starting physical therapy two weeks after surgery. Physical therapy focuses on reducing swelling in the knee, restoring full range of motion, and eventually, restoring strength to the knee. Most patients can start full weight bearing on the affected leg 6-12 weeks after surgery, depending on the location of the defect. Most patients start cutting activities and sporting activity approximately 4-6 months after surgery.