Pediatric Orthopedics

The Montefiore Approach

The Division of Pediatric Orthopedics at Children’s Hospital at Montefiore is internationally renowned, providing both surgical and medical excellence as well as a tremendous sensitivity to the needs of patients and their families. Nationally recognized by U.S. News and World Report and ranked # 1 in New York State, the Division is equipped to provide the highest quality of care in the diagnosis and management of even the most complicated pediatric musculoskeletal conditions.

Children’s Hospital at Montefiore is one of the few freestanding hospitals in the region completely comitted to the specialized needs of pediatric patients and their families. As one of the top NIH-funded children’s hospitals in the country, Montefiore is fully invested in the advancement of both pediatric care and pediatric research. These resources, combined with dedicated specialists, healthcare providers, and support staff, allow us to deliver care of the highest caliber.

As an academic children’s hospital, we are always striving to develop innovations and advancements in pediatric orthopedic care. Together with our Albert Einstein College of Medicine, one of the highest NIH-funded institutions in the country, we are constantly engaged in a wide array of research projects with the goal of developing improved care within our own health system and beyond.

  • Our Patient-Centered Care

    The experience of our patients and their loved ones—not simply their ailments—demands our full attention. Your child’s dedicated care team will be there to discuss their condition, answer questions, assess treatment options, and develop a treatment strategy that is best for them. Our team of doctors, nurses, and healthcare professionals work to ensure your child and your family is its central focus.

  • Our Expertise

    Pediatric musculoskeletal conditions present their own set of challenges. We understand that parents and caregivers may have anxieties, concerns, and questions that need to be thoroughly and carefully addressed. At Montefiore, we believe that optimal outcomes are achieved through thorough evaluations, accurate diagnoses, and intelligent patient-specific treatment plans developed through years of clinical experience and evidence-based medicine.

    The hallmark of the Division is a coordinated and comprehensive approach. With the shared goal of providing exceptional care, our leading surgeons are supported by a team of subspecialists, physician assistants, research staff, and support staff. We continue to garner both national and international attention for our innovative research and leading-edge approaches, such as our treatments for growing limbs and spines, as well as limb and spine deformities.

  • Our Dedication to Research

    As an academic medical center, we are deeply committed to advancing the science of medicine. Together with our Albert Einstein College of Medicine, one of the highest NIH-funded institutions in the country, we work towards excellence in pediatric orthopedic study and care. Our research efforts endeavor to better understand musculoskeletal conditions in children, and aim to improve both operative and non-operative treatments. We routinely present our research findings in national and international forums and publish our results in peer-reviewed medical journals.

Conditions We Treat

The Pediatric Orthopedic Division at Children’s Hospital at Montefiore treats a vast spectrum of conditions, a selection of which you will find listed below. In addition to these, we have experience treating many other conditions. Please contact us today to schedule a consultation so that we can review and discuss your specific healthcare needs.

Some Common Conditions

  • Legg-Calve-Perthes
  • Slipped capital femoral
  • Avascular necrosis
  • Congenital deformities of the hip
  • Post-traumatic deformities of the hip
  • Clubfoot (congenital talipes equinovarus)
  • Early onset scoliosis
  • Adolescent idiopathic scoliosis
  • Cerebral palsy
  • Neuromuscular disorders
  • Muscle contractions
  • Anterior cruciate ligament (ACL) injuries
  • Osteochondritis dissecans
  • Patella subluxation/dislocation
  • Discoid meniscus
  • Shoulder instability

Our Treatments

Treatment plans are designed to maximize our patients’ outcomes, returning them to health as quickly as possible. We treat children from birth to age 21, and have robust experience in conditions ranging from light sprains to complex musculoskeletal disorders. The Division is organized into five programs of focus: the Scoliosis Surgery Program, the Cerebral Palsy and Neuromuscular Disorder Program, the Hip Preservation Program, the Pediatric Sports Medicine Program, and the Lower Limb Deformity Program. For those seeking further information on these programs, more details are provided here.

Highlighted Treatments

  • Cerebral Palsy & Neuromuscular Disorder Program

    Cerebral palsy is defined as a non-progressive abnormality affecting the central nervous system that occurs during infancy or early childhood. This can be caused by either a development problem or an injury to the central nervous system. Cerebral palsy commonly results in a movement disorder that is expressed in a variety of forms, ranging from mild incoordination and muscle stiffness, to disordered and uncontrolled movements in the trunk and limbs. Over time, the muscle stiffness can lead to muscle contraction, deformities in bone growth, and dislocation of bone joints. The Program also manages other neuromuscular diseases that often require similar strategies and approaches.

    Tendon Lengthening

    A tendon is made up of very strong specialized collagen fibers that attach muscle to bone. In cerebral palsy and other neuromuscular disorders, the muscles and their tendons may become tighter as a result of disorganized nerve signals to the muscles. Over time, the muscles can shorten, resulting in pain and deformity. When muscle stretching exercises and medicines are not successful in alleviating this tightness, surgical intervention can be considered.

    Tendon lengthening is a surgical procedure designed to partially or completely cut a tendon in order to create a longer, more functional one. Tendons that are commonly lengthened include the Achilles, the hamstrings, and the hip flexors. Achilles lengthening allows for improved foot positioning and brace wear. Hamstring lengthening permits extension of the knee, and hip flexor lengthening allows for improved hip extension.

    As a minimally invasive surgery that employs small incisions, the patient can frequently return home the same day. Tendon lengthening must be combined with stretching and bracing to be effective, but in many cases can significantly improve function and minimize deformity.

    Tendon Transfer

    A tendon is made up of very strong specialized collagen fibers that attach muscle to bone. In cerebral palsy and other neuromuscular disorders, the muscles and their tendons may become tighter as a result of disorganized nerve signals to the muscles. Over time, the muscles can shorten, resulting in pain and deformity. When muscle stretching exercises and medicines are not successful in alleviating this tightness, surgical intervention can be considered.

    Sometimes the tight muscles in cerebral palsy and other conditions result in the patient being unable to move a joint, such as the knee, elbow, or wrist, from one position to another. Together with tendon lengthening, tendon transfer can be used to reroute a tendon so that it becomes helpful rather than harmful with respect to a desired movement.

    A tendon transfer is a procedure designed to reroute the path of a given tendon from one part of the body to another. This enables a change to the movement pattern of a muscle as it contracts and relaxes.

    As a minimally invasive surgery that employs small incisions, the patient can frequently return home the same day. Tendon transfer is often combined with other treatment techniques, such as stretching and bracing. In many cases, this approach can significantly improve function and minimize deformity.

    Osteotomy

    In cerebral palsy and other neuromuscular disorders, the muscles and their tendons may become tighter as a result of disorganized nerve signals to the muscles. Over time, muscles can shorten, resulting in abnormal forces across numerous joints. This, in turn, can lead to abnormal limb positioning and eventual joint dislocation. When muscle stretching exercises and medicines are not successful, realignment of affected bones or joints can be considered.

    An osteotomy is a surgical procedure designed to cut a bone to change its shape, length, or alignment. Bones that are commonly osteotomized include the pelvis, the femur, the tibia, and those within the foot. Osteotomy and fixation of the pelvis and/or femur allows for improved positioning of the femoral head (the ball) within the acetabulum (the socket). Osteotomy and fixation of the tibia corrects rotational alignment, helping to fix the foot point in the proper direction. Osteotomy and fixation of the foot bones allow for better shoe and brace fitting, and can help restore the typical appearance of the foot.

    Surgery may require a short hospital stay or, in some cases, may be scheduled as an outpatient procedure. Sometimes casting or bracing is needed following surgery; however, this is determined on a case-by-case basis.

  • Scoliosis Surgery Program

    Scoliosis is an excessive or abnormal curvature of the spine. Most of the time, it can be managed non-operatively with close monitoring and/or or bracing. If scoliosis reaches a certain point, however, further progression is likely. This can affect quality of life, can cause pain, or can even impact the function of organs, such as the lungs. The need for surgery is uncommon, required in fewer than one in every 1,000 patients.

    Scoliosis is grouped into types dependent on cause and age of the patient. An annual exam performed by a pediatrician or school nurse will usually reveal the curvature in the back. This is followed by prompt referral to a specialist. The specialist will then perform a detailed physical exam and may obtain specialized spine X-rays if necessary. An MRI might subsequently be obtained as well. After this assessment, a treatment method will be recommended, taking into account individual considerations and evidence-based guidelines.

    Adolescent Idiopathic Scoliosis Surgery

    Adolescent scoliosis is the most common type of scoliosis. It generally occurs in patients with no other known medical conditions and its cause is not entirely clear. Treatment for this form of scoliosis depends on how much growth the patient will undergo before reaching skeletal maturity and on the severity of the curve. While it can often be managed non-operatively, for patients with curves greater than 45 to 50 degrees, surgery is typically needed.

    A posterior spinal fusion is a surgery generally performed to treat adolescent idiopathic scoliosis. This procedure involves making an incision in the middle of the back and exposing the spine. Screws are carefully placed in the appropriate bones of the spine (vertebrae), and specialized rods are then connected to the screws. Together, these implants straighten and maintain the spine in an improved position. Bone graft is frequently used to promote healing of the bone in its new alignment. Over time, the bones grow together, preventing recurrence of the curve.

    Scoliosis surgery generally requires a hospital stay of three to five days. The duration of stay depends on the complexity of the surgery and patient considerations. Once discharged, a brace is generally not needed and patients are encouraged to resume normal everyday activities as soon as possible. Patients usually return to school within three to five weeks and can resume unrestricted sports activities by six months.

    Early Onset Scoliosis Surgery

    Early onset scoliosis is defined as a curvature occurring in patients under the age of 10 and is treated slightly differently than in older children. Scoliosis that affects young children often requires a “growth-friendly” surgical approach, which allows for curve control while maintaining growth of the spine and thorax. These patients merit additional consideration due to associated conditions like poor pulmonary function.

    The surgery generally performed for early onset scoliosis involves making a number of small incisions. Screws are carefully placed in the lower and upper bones of the spine (vertebrae), and a magnetically controlled growing rod is then connected to the screws. Once the wound has healed, a magnet can be placed over the rod for a short period of time, resulting in gradual lengthening and straightening of the spine. These lengthening procedures are scheduled every three to six months until the end of growth. Other surgical techniques are also employed when appropriate, including VEPTR, Shilla, and traditional growing rods.

    Scoliosis surgery generally requires a hospital stay, the duration of which depends upon the complexity of the surgery and patient considerations. Once discharged, a brace is generally not needed and patients are encouraged to resume normal everyday activities as soon as possible.

  • Lower Limb Deformity Program

    Lower limb deformities are conditions that affect the length, rotation, alignment, and ultimately the function of the lower extremity. They generally develop in utero or during early childhood, but can also occur in adolescence as a result of trauma, vitamin deficiencies, infections, or other causes. These deformities can vary in severity, anatomic location, and impact, differing from one patient to the next. In some cases, they can cause aesthetic concern, while in others they can greatly affect functional ability and quality of life.

    Clubfoot

    Clubfoot, otherwise known as congenital talipes equinovarus, is a well-described orthopedic condition of childhood in which the foot appears twisted or out of position. It can occur in one or both feet and is often an isolated finding in an otherwise perfectly healthy infant. This is one of the most common of all birth defects, affecting about one in 400 babies born in the United States each year. Boys are twice as likely to be diagnosed with clubfoot than girls.

    Treatment for clubfoot is started soon after birth, preferably during the first week of life. The goal is to correct the twisted foot slowly and gently into a more normal position. This is achieved by a series of corrective casts that gradually stretch the tightened soft tissues of the foot. After serial cast treatment, many children require heel cord lengthening surgery, which is a minor procedure performed to complete the correction. This is usually done when the child is a few months of age.

    Serial casting can be done in the office as an outpatient procedure and without the need for anesthesia or hospitalization. Though routine office visits and careful monitoring are required, this is a safe, well-described, and well-tolerated treatment that yields excellent results in many cases. Cord lengthening is an outpatient procedure, after which the child can return home the same day.

    Hemiepiphysiodesis

    Angular deformities or leg length deformities sometimes arise from abnormal or unequal growth across the physis, also known as the growth plate. These deformities may impact the mechanics of the lower limb and can affect standing, walking, running, and similar routine day-to-day activities. This can, in turn, lead to pain in adjacent joints or anatomic regions, thereby preventing children from achieving or realizing their desired goals and/or potential.

    Hemiepiphysiodesis is a minimally invasive procedure designed to correct angular deformities or leg length discrepancies by modulating the growth across a growth plate, either temporarily or permanently. This procedure is performed by placing screws or plates across the growth plates, effectively tethering or slowing the growth of the faster-growing side of the bone. Proper planning, timing, and follow-up are essential to optimize the correction and achieve as symmetric and normal an outcome as possible.

    Surgery is generally performed as an outpatient procedure. Patients may require protected weight bearing devices, such as crutches, for a short period of time. Physical therapy is sometimes prescribed if needed as well.

    Computer Assisted Multiplanar External Fixator Deformity Correction

    Lower limb deformities can at times be much more complicated or severe. These deformities might involve abnormalities across multiple planes, severe angular and/or rotational defects, or other aberrations, all of which make simple correction insufficient. In such instances, a more involved and complicated surgical correction may prove necessary.

    A multiplanar external fixator is a surgical technique employed for deformity correction that allows for slow correction across numerous planes. This gradual realignment permits ongoing assessment, avoids over- or undercorrection, and allows for very minor adjustments or fine-tuning.

    The surgery is performed by making an incision and exposing the bone at the apex of the deformity, where the angulation is most severe. The bone is cut at this level and external fixation wires or pins are placed into the bone above and below the cut. These wires or pins are then connected to an external fixator, a device that surrounds the limb on the outside of the body and provides stability or support like a cast. The surgeon will usually wait one to two weeks before progressively correcting the deformity by slowly adjusting or turning struts on the external fixator. Each turn will either lengthen or shorten the given strut. Since many struts are used and adjusted in a coordinated and prescribed manner, the bone can be very accurately realigned.

    The initial surgery requires a short hospital stay, after which the patient is usually seen as an outpatient. The movement or adjustment of the bone does not hurt, as it is done at a very slow rate (1mm per day). Provided with a special educational program and very clear instructions, the patient can even make these minor daily adjustments by turning struts on their own at home. Once the correction is complete, the bone is allowed to heal with the fixator in place for three to six months.

    Magnetically Controlled Lengthening Nail (Limb Lengthening)

    In some instances, limb length discrepancy is severe enough that simple lifts or shoe modifications are insufficient. In such cases, patients can experience abnormal mechanics, greatly affecting routine activities like standing, walking, running, and stair-climbing. This impairment can, in turn, prove very disruptive and may have a tremendous impact on a patient’s quality of life.

    These patients may benefit from an intramedullary lengthening surgery. The Food and Drug Administration (FDA) recently approved an intramedullary device that utilizes an electromagnetic motor to allow for precise, non-invasive lengthenings. The surgery involves cutting the femur through a small incision in the thigh. A nail is then inserted into the center of femur through a second small incision over the hip. Once inserted, the nail can be lengthened by applying a magnet over the nail and activating it using an external controller. The patient can do this on their own at home. As the lengthening is precise and slow, it is generally comfortable and well-tolerated. Once the appropriate length is realized, the bone is allowed to heal for three to six months, after which the nail is usually removed in another short procedure.

    Surgery may involve a short hospital stay and will require careful weight bearing protection during the lengthening and healing process. Crutch use is usually needed for many months to protect the bone and the nail, and to ensure optimal results. Physical therapy is an important aspect of the lengthening process and generally prescribed to aid stretching of the muscles and soft tissues. The benefits of this procedure largely outweigh these restrictions, and most patients tolerate these temporary limitations.

  • Hip Preservation Program

    Abnormalities involving the hip joint can cause substantial disability and pain, and can lead to early arthritis if left untreated. There are a number of underlying causes or conditions that involve the hip joint, including developmental dysplasia, Legg-Calve-Perthes, slipped capital femoral epiphysis, femoroacetabular impingement, avascular necrosis, congenital deformities of the hip, and post-traumatic deformities of the hip. Regardless of cause, early intervention may offer the chance to minimize pain and disability while protecting the hip from further damage. Advanced surgical techniques are now available to correct improper hip mechanics before degenerative disease sets in and causes permanent damage to the hip joint.

    Periacetabular Osteotomy (PAO)

    Adolescent and young adult hip dysplasia is a condition in which the hip joint may not have properly formed during early childhood, and can result in a shallow and abnormal hip socket. In these instances, forces that are normally distributed across a large joint surface are instead focused across a much smaller area. This, in turn, leads to abnormal demands on the joint’s cartilage and to excessive stretching or loading of its soft tissues. If left untreated, a dysplastic hip can develop early wear and tear or arthritis. In many cases, the joint can slowly slip out of position. In severe instances, the joint can entirely dislocate or fall out of its socket.

    A periacetabular osteotomy is a surgical procedure designed to rotate and reposition the hip socket. The goal of this procedure is to improve the coverage of the femoral head and increase the joint’s surface area, thereby minimizing pain and the development of premature arthritis. In most cases, the surgery takes from three to four hours to perform, and involves making four cuts in the pelvic bone around the hip joint to loosen the socket. Once loosened, the hip socket can be rotated and repositioned into a more normal anatomic position over the femoral head. During surgery, X-rays are used to help direct the bone cuts and to ensure correct positioning. Thereafter, several small screws are employed to hold the bone in place until it heals.

    Surgery requires a short stay in the hospital. Patients are generally required to protect the hip during the months following surgery, allowing time for the bone to unite or heal. This generally requires the temporary use of crutches. Physical therapy is commonly prescribed once the bone has healed. Specific recommendations and instructions are offered on a case-by-case basis dependent upon patient-specific conditions and needs.

    Femoral Osteotomy (FO)

    The hip is a ball-and-socket joint comprised of the femoral head and the acetabulum, respectively. In some cases, such as congenital and acquired hip deformities, it is not sufficient to only realign or reposition the acetabulum. For these patients, a femoral osteotomy may be recommended in order to reposition the ball as well. Together with an acetabular or pelvic osteotomy, this can help change the hip mechanics, allow hip forces to be transmitted on a healthier region, and improve the position of the femoral head within the acetabulum.

    A femoral osteotomy is a procedure designed to realign the upper part of the femur. After making an incision, the bone is cut in the proper location using X-ray guidance. It is then redirected into an improved position and held in place using a specialized plate and screws. Once the bone has healed, these implants are sometimes removed through a separate surgery.

    Surgery requires a short stay in the hospital. Patients are generally required to protect the hip during the months following surgery, allowing time for the bone to unite or heal. This generally requires the temporary use of crutches. Physical therapy is commonly prescribed once the bone has healed. Specific recommendations and instructions are offered on a case-by-case basis dependent upon patient-specific conditions and needs.

    Hip Arthroscopy

    Hip pain can develop from a number of causes and involve abnormalities of the bone, the articular cartilage, or other tissues, such as the labrum. These abnormalities can develop over time or result from a specific injury. Following careful exam and diagnostic imaging, some of these conditions require surgical intervention in order to treat pain, improve the hip mechanics, and avoid progressive damage to the hip joint and its various structures.

    Hip arthroscopy is a minimally invasive surgical technique designed to visualize and surgically treat damaged or abnormal structures within the hip joint. It is performed by making a small incision near the hip joint through which an arthroscope, a specialized miniature camera, can be inserted. Additional small incisions allow for other specialized instruments to be introduced as well. This technique can be employed to treat labral injuries, either by debriding them and/or repairing them back to their anatomic location. It can also be used to reshape the femoral head and neck by removing bone deformities in the cases of femoroacetabular impingement.

    Surgery is generally an outpatient procedure and patients can return home the same day. Patients may be required to protect the hip following surgery, allowing time for the bone and soft tissues to heal. This generally requires the temporary use of crutches. Physical therapy is commonly prescribed. Specific recommendations and instructions are offered on a case-by-case basis dependent upon patient-specific conditions and needs.

    Surgical Hip Dislocation (SHD)

    The hip is a ball-and-socket joint comprised of the femoral head and the acetabulum, respectively. In some hip conditions, treatment requires unimpeded surgical access in order to adequately visualize the anatomy and properly address the underlying issue. These instances include some cases of femoroacetabular impingement, select tumors, intra-articular fractures of the femoral head, select pelvic fractures, and select instances of developmental dysplasia of the hip. In cases such as these, a conventional open approach, rather than a minimally invasive one, may prove more appropriate.

    A surgical hip dislocation is a surgical procedure designed to carefully remove or dislocate the femoral head from within the acetabulum. This is performed in a controlled and deliberate manner, sparing the surrounding muscles and preserving the essential blood supply to the hip joint. A conventional incision is made near the hip and the overlying soft tissues are dissected. A small bone osteotomy is performed and the hip capsule is incised, exposing the hip joint. This technique affords a 360-degree view of the affected area and allows correction of deformities or abnormalities on both the femoral and acetabular side of the joint. Once surgery is complete, the bone and soft tissues are repaired.

    Surgery requires a short stay in the hospital. Patients are generally required to protect the hip during the months following surgery, allowing time for the bone and soft tissues to heal. This generally requires the temporary use of crutches. Physical therapy is commonly prescribed once the bone has healed. Specific recommendations and instructions are offered on a case-by-case basis dependent upon patient-specific conditions and needs.

    Core Decompression

    The hip is a ball-and-socket joint comprised of the femoral head and the acetabulum, respectively. Avascular necrosis (osteonecrosis) is a process that arises from a poor or disrupted blood supply within the hip joint that frequently affects the femoral head. This compromised blood supply leads to ischemic or dead bone in the region just below the femoral head’s surface. Without adequate support from healthy bone, the femoral head can collapse, resulting in hip pain, limited hip motion, and eventually advanced arthritis of the hip.

    Core decompression is a procedure designed to save or preserve the patient’s femoral head by encouraging new bone growth in the region of ischemic or unhealthy bone. It is performed by creating one larger hole or several smaller holes in the femoral head. This relieves pressure within the bone and creates channels for new blood vessels that will nourish and heal the affected region.

    When osteonecrosis of the hip is diagnosed early, core decompression is often successful in preventing collapse, improving pain, and restoring blood supply and healthy bone to the region. Core decompression is often combined with bone grafting to help with the regeneration process. Frequently, this graft is taken from the patient’s bone marrow at the time of the procedure and injected into the femoral head following the decompression.

    Surgery is generally an outpatient procedure and patients can return home the same day. Patients may be required to protect the hip following surgery, allowing time for the bone and soft tissues to heal. This generally requires the temporary use of crutches. Physical therapy is commonly prescribed. Specific recommendations and instructions are offered on a case-by-case basis dependent upon patient-specific conditions and needs.

  • Pediatric Sports Medicine Program

    More young people are participating in sports today than ever before. Not only are children and adolescents engaging in more competitive sports, they are also suffering increasing numbers of sports-related injuries.

    At Montefiore, we specialize in treating children who have suffered a sports injury. This expertise is particularly valuable, as there are unique aspects of the pediatric anatomy that are imperative to growth and development. Understanding these and other pediatric distinctions are essential to realizing the best possible outcomes and preventing future injuries.

    Sports-related injuries can range from common to complex, and can include sprains, strains, growth plate injuries, injuries of the anterior cruciate ligament (ACL), osteochondritis dissecans (OCD), patella subluxation/dislocation, discoid meniscus, and shoulder dislocations.

    If recognized early, many of these conditions can be successfully treated without surgery. At times, however, surgery offers better potential outcomes. In these instances, surgery can often be performed in a minimally invasive manner, resulting in less pain and faster recovery.

    ACL Reconstruction

    The anterior cruciate ligament is a ligament within the knee joint that provides knee stability, particularly during pivoting, planting, cutting, or landing. It is important for both contact and non-contact sports. Patients who tear or rupture this ligament experience knee instability, making return to competitive sports unlikely. Although they maintain the ability to walk and bend at the knee, most athletes will require surgery to regain the knee stability needed for return to their pre-injury level of competition.

    Anterior cruciate ligament reconstruction is a surgery designed to rebuild a new ligament that will take the place of the damaged or torn ACL. This reconstructed ligament is usually borrowed from the patient’s own tissue, and involves using the patellar tendon with some adjacent bone or one of the hamstring tendons. The selected tissue is then passed through a tunnel created within the tibia, across the knee joint, and into another tunnel created in the femur. It is secured on either end using an implant, often in the form of a screw. Because children and young adults have open growth plates that need to be protected, this surgical technique is modified in order to ensure that the growth plate is preserved and that subsequent growth will proceed normally.

    Surgery is generally an outpatient procedure and patients can return home the same day. Patients are required to protect the knee following surgery, allowing time for the reconstructed tissues to heal. This generally requires the temporary use of crutches. Physical therapy is commonly prescribed. Specific recommendations and instructions are offered on a case-by-case basis dependent upon patient-specific conditions and needs.

    Osteochondritis Dissecans

    Osteochondritis dissecans is a condition that occurs when the supporting layer of bone below the articular cartilage becomes ischemic as a result of poor blood flow. The affected bone and cartilage can loosen or dislodge entirely, leading to pain and other mechanical symptoms. This condition most commonly affects the cartilage within the knee, but can be encountered in many other joints. Non-operative treatment is often effective, particularly in young patients. In some instances, however, surgery offers better results.

    Osteochondritis dissecans is generally managed in a minimally invasive manner using arthroscopic techniques. Surgery is performed by making a small incision through which a specialized miniature a camera is inserted. Additional small incisions allow for other arthroscopic instruments to be be introduced as well. The unhealthy bone is drilled or prepared in order to stimulate new and healthy blood flow to the region. Thereafter, the detached fragment is reattached to its original anatomic location.

    Surgery is generally an outpatient procedure and patients can return home the same day. Patients will be required to protect the joint following surgery, allowing time for the bone and soft tissues to heal. For the lower extremity, this generally requires the temporary use of crutches. Physical therapy is commonly prescribed. Specific recommendations and instructions are offered on a case-by-case basis dependent upon patient-specific conditions and needs.

    Patellar Subluxation or Dislocation

    Patellar dislocation occurs when the patella (kneecap) shifts out of its normal position entirely. Patellar subluxation occurs when the patella continues to shift out of place partially, an event that commonly follows a frank dislocation. Sometimes this occurs owing to loose ligaments or bony anatomy, both of which make the kneecap less stable. Aside from causing pain, continued dislocations or subluxation can result in abnormal forces across the knee and may lead to early arthritis. Although conservative methods can sometimes address these conditions, ongoing instability is often best managed with surgery.

    Medial patellofemoral instability surgery is designed to recreate one of stabilizing ligaments that tethers the patella and is responsible for its proper tracking/movement as the knee bends and extends. This reconstructed ligament, or graft, may be harvested from the patient or procured from a tissue bank. The selected tissue is then attached to anatomically accurate positions, tethering the patella to the femur and preventing it from slipping out of place during knee movement. In some cases, the procedure is combined with a lateral release, which frees up some of the tight tissue on the opposing side of the kneecap.

    Surgery is generally an outpatient procedure and patients can return home the same day. Patients will be required to protect the joint following surgery, allowing time for the bone and soft tissues to heal. This may require the temporary use of a knee brace and/or crutches. Physical therapy is commonly prescribed after a period of rest. Specific recommendations and instructions are offered on a case-by-case basis dependent upon patient-specific conditions and needs.

    Discoid Meniscus

    The meniscus is a specialized cartilaginous structure within the knee. It is located between the leg bone and the thigh bone, serving as a shock absorber. It is normally C-shaped or O-shaped and runs along the periphery of each compartment within the knee. A discoid meniscus is a condition in which the meniscus is misshapen and therefore prone to causing mechanical locking or catching in the knee. It can also cause pain if it tears. In such cases, surgery is sometimes needed in order to minimize pain, restore function, and prevent further tearing of the meniscus.

    Discoid meniscus surgery is generally managed in a minimally invasive manner using arthroscopic techniques. Surgery is performed by making a small incision through which a specialized miniature a camera is inserted into the knee joint. Additional small incisions allow for other arthroscopic instruments to be introduced as well. The meniscus is then trimmed back to a more normal shape and contour. In some instances, the meniscus is also repaired or reattached to its normal anatomic position using very small sutures to secure it in place.

    Surgery is generally an outpatient procedure and patients can return home the same day. Patients will be required to protect the knee following surgery, allowing time for the soft tissues to heal. This generally requires the temporary use of crutches. Physical therapy is commonly prescribed. Specific recommendations and instructions are offered on a case-by-case basis dependent upon patient-specific conditions and needs.

    Shoulder Instability

    Shoulder instability most commonly occurs following a shoulder dislocation resulting from a trauma or an accident. When the shoulder dislocates, it oftentimes tears the labrum as well. The labrum is a rim of specialized tissue that surrounds the socket of the shoulder, serving as a bumper to provide added stability to the joint. Once a child or adolescent sustains a shoulder dislocation, the risk of recurrent instability is extremely high. Surgery is frequently required to repair the labrum and restore stability to the joint.

    Shoulder instability surgery is generally managed in a minimally invasive manner using arthroscopic techniques. Surgery is performed by making a small incision through which a specialized miniature a camera is inserted into the shoulder joint. Additional small incisions allow for other arthroscopic instruments to be introduced as well. The labrum is then repaired or reattached to its normal anatomic position using anchors or very small sutures to secure it in place.

    Surgery is generally an outpatient procedure and patients can return home the same day. Patients will be required to protect the shoulder joint following surgery, allowing time for the soft tissues to heal. This generally requires the temporary use of a sling or a brace. Physical therapy is commonly prescribed to help regain strength and motion. Specific recommendations and instructions are offered on a case-by-case basis dependent upon patient-specific conditions and needs.