There are two types of cartilage in the knee: articular cartilage and the meniscus. Articular cartilage provides a smooth surface for bones to glide against one another and as a shock absorber. Unlike most tissues in the body, the articular cartilage that lines the surfaces of our joints has no inherent ability to regenerate. We are born with what we have and protecting it is of paramount importance, as progressive cartilage injury and loss can lead to degenerative wear and arthritis. Focal cartilage injuries from trauma can affect any of the surfaces of the knee including the femoral, tibial and patellar surfaces. Bipolar or “kissing” defects occur when opposing surfaces of a joint have pathologic lesions. These are among the most difficult and problematic to treat.

Cartilage injuries often result from a twisting or pivoting motion. Patients complain of sharp pain in the knee, usually localized to the area of the cartilage injury. Swelling, catching, clicking or locking in the knee may occur. X-rays and MRIs are both extremely useful in diagnosing the condition. Certain cartilage injuries respond well to a period of rest, anti-inflammatory medication and physical therapy. Sometimes, however, surgery is necessary. If a piece of cartilage is missing, leaving exposed bone, the goal of surgery is to try to fill the defect with repair tissue.

According to Dr. Thomas Wickiewicz, a sports medicine specialist at Hospital for Special Surgery and the former president of the American Orthopedic Society for Sports Medicine, “Microfracture surgery has become a widely used first line treatment for focal cartilage injuries in athletic individuals.”

Microfracture is a marrow stimulation that is commonly utilized to treat focal, symptomatic cartilage defects in the knee. In a microfracture surgery, small channels are created by the surgeon, which provide access to the bone marrow deep to the cartilage surface. Stem cells can then migrate from the marrow to fill the defect and form an enriched blood clot. The cells then differentiate into a cartilage-like tissue that fills the defect and provides a smooth contact surface. This procedure is done arthroscopically, with patients going home the same day of the surgery.

“There is variability in the clinical success, but in those that get a reasonable 'fill' on the defect with fibrocartilage, the improvements have been noticeable,” says Wickiewicz.

Outcomes can be influenced by a number of factors, including the severity and size of the defect, number of defects, patient age, compliance and rehabilitation. A number of...

In the past, the sources and reasons of shoulder injuries for these athletes were often mis-diagnosed, which sometimes led to unnecessary procedures and drawn-out, painful recovery. Recently, research by the Orthopedic Foundation for Active Lifestyles (OFALS) resulted in a discovery that may prove to end one of the most commonly misdiagnosed shoulder problems.

Led by founder and sports medicine orthopaedic surgeon Dr. Kevin Plancher, OFALS has confirmed the existence of a little-known ligament called the spinoglenoid. The spinoglenoid ligament stretches from the spine into the shoulder, traveling through a bony structure called the spinoglenoid notch.

The ligament is to blame in some cases of shoulder dysfunction, causing misdiagnosed patients to undergo ineffective physical therapy and other treatments. “Until recently, little was known about the spinoglenoid ligament,” said Dr. Plancher. In the OFALS study, he and his team of researchers were able to confirm the existence of the spinoglenoid ligament in each cadaver examined.

According to Dr. Plancher, the ligament runs through the back of the shoulder, often constricting the suprascapular nerve - one of the major nerves in the shoulder region that delivers sensation and messaging to the two main tendons of the rotator cuff, the supraspinatus and the infraspinatus. It is the suprascapular nerve that is responsible for the major shoulder functions. Dr. Plancher adds, “The spinoglenoid ligament can compress the [suprascapular] nerve, similar to carpal tunnel in the hand, leading to marked weakness and pain that mimics the symptoms of rotator cuff injury.

A pinpoint diagnosis of whether an injury is muscle- and/or tendon-related or nerve related can be obtained through MRI and electrodiagnostic study of the suprascapular nerve. If compression of the suprascapular nerve is the problem, physical therapy rehabilitation may alleviate pain, but it is not effective for the long-term.

In the past, the most frequently prescribed treatment for nerve compression in the shoulder was to cease the root-cause activity and undergo months of intensive, targeted physical therapy. More often than not, athletes with this type of compression never returned to their sports of choice; however, in 2007, Dr. Plancher unveiled a new arthroscopic approach.

This new approach, which Dr. Plancher presented at the 2007 San Diego Shoulder Meeting, involves arthroscopically detaching the ligament at the shoulder site and removing it from its position overlying the suprascapular nerve. Says Dr. Plancher, "With this procedure, patients experience much faster relief of pain and weakness in the shoulder, and can often return ...