How do we accurately place screws in the knee and shoulder joints when we are using an arthroscope or even in some open surgeries?

We use a technique called cannulation. A guide pin, which is quite small and commonly around 3 mm in diameter or smaller, is placed. If the guide pin is not in a perfect position it is not a big issue to readjust the guide pin and make a second entry side into the bone.

Then we use the appropriate size drill over the guide pin. So the drill is hollow therefore the guide pin can fit through the drill. After the drill is removed from the bone, the guide pin is left in the bone. The screw is also cannulated or is hollow. The screw gets placed over the guide pin, the cannulated screwdriver is seated into the screw head, and the screw is placed. This allows accurate placement within the bone. The drill bits are also marked with measurements so we know how deep the drill is going into the bone.

These images show a cannulated drill bit:

1. When ramping up your mileage do not increase your mileage more than 10% per week.
2. Listen to your body. If you start to have pain, you need to back off and increase your cross training activities.
3. Keep a detailed training log. A training log is also very useful if you get a stress fracture so you can go back and see what caused the stress fracture activity wise. You will not want to repeat that in the future.
4. Check your vitamin D levels. Have your  primary care physician check those levels. You would want them to be between 50–60 as an athlete .
5. Mix up your training surfaces and activities. It is a repetitive force on the lower extremity that can cause a stress fracture. By mixing up your training surfaces and activities you will apply different forces to your feet and your lower extremities, which will decrease the repetitive force to the pelvis, hip, legs and feet.

When you have a joint in your body that is arthritic it is painful to move that joint. The body tries to prevent joint mobility by forming bone spurs around the joint to limit the range of motion. The body is essentially trying to fuse the joint that is painful.

Surgically going in and removing the bone spurs does not help because the body will quickly reform the bone spurs after they have been surgically excised. Imaged below is a picture of a foot. The great toe has a significant amount of bone spurs. The red circle shows the great toe joint with all the bone spurs and narrowed joint space. The third toe,with the yellow circle, shows a normal looking joint. This patient has almost no motion at her great toe joint.

Imaged below is a bio composite screw that I used in a knee. The screw will actually incorporate into your bone over time. One of the big advantages of this type of screw is if you ever need to have an MRI of the knee in the future, it will not cause any artifact. Retained metal will cause an MRI image to have streaks and make the study difficult to read.

My 12 year old son, poo poos it because we don’t have 4K monitors in the operating room and it’s only 1080p, however in 1080p this is what knee osteoarthritis looks like:

The first image (upper left ) is a normal knee with normal white, smooth cartilage covering the end of the femur bone. Image number two at the top right reveals a large arthritic area which is the pale orange color surrounded by the white articular cartilage. The pale orange area is the exposed bone with the cartilage missing (the definition osteoarthritis). The middle row left is my metal probe in the knee joint pointing at the area of osteoarthritis.

Yep! While X-rays are excellent at showing bones, they are bad at showing anything else.

An MRI can show not only the bone but bleeding, swelling and fluid within the bone. The detail is amazing. Imaged below to the left is a MRI view of a knee joint. The red circle reveals a stress reaction or pre-stress fracture of a tibia. You can clearly see the white area which represents bleeding or fluid within the tibial bone. 

This next image is an x-ray of the same knee. Nowhere on the image can you see the stress reaction or pre-stress fracture. The yellow circle represents the area where the stress reaction is located and is identified by the corresponding MRI scan.

When you tear your anterior cruciate ligament (ACL), and undergo surgery, you cannot “repair” the ligament tear. You have to reconstruct the ligament. Reconstruction means you have to take some other ligament or tendon in the patient’s body and turn it into an ACL.

There are many options. I commonly use two of the hamstring tendons that attach near the knee joint.
The hamstring tendons will reform as a scar tissue type tendon, hamstring strength returns back to normal, and the neuro function to the hamstring tendons returns back to normal within one year. So as surgeons we steal from Peter to feed Paul, but eventually we get back to Peter, so to speak…

Pictured below are the hamstrings after I have harvested them from the patient. The second image reveals the new ACL that I I have constructed in the operating room. After the surgery the athlete will be back to their game within five months.

This is a commonly asked question and tends to be confusing to many of my patients.

Osteoarthritis is the breakdown of the cartilage that covers the ends of each long bone. Think of each long bone in your body as having a hat over each end. The hat is the cartilage. As the hat material wears out, the end of the bone becomes exposed. Osteoarthritis is the process where the cartilage is wearing down, similar to the hat material. Eventually the bone becomes exposed and that is extremely painful.