When a patient presents with persistent or recurrent pain and swelling in the knee, there are 3 main structural causes for this to occur. In this narrated video, I show what meniscus tears, loose bodies, and unstable articular cartilage looks like, and how they might be repaired.
I will be moving all my clinical operations to a new office in Sugar Land, beginning August 1st. Most of my patients know I have had an office in Sugar Land for the last 16 years. I now plan to concentrate my practice there with the Methodist Sugar Land Hospital.
I have enjoyed my years as full-time faculty at Baylor College of Medicine having helped start the Baylor Sports Medicine Institute in the mid-90′s. However, I think that my priorities and those of Baylor have drifted apart recently, and I strongly feel I can better care for my patients going forward at Methodist. I will retain a voluntary faculty appointment at Baylor.
My office staff is committed to making this transition as seamless as possible for my patients. New office address and phone numbers will be posted here soon. The present appointment and office numbers will continue to forward patients to me.
Many patients come to my office after a shoulder that has dislocated for the first time. Often this follows a trip to the emergency room where x-rays can be helpful in confirming the diagnosis and the direction of the dislocation. Most commonly the acute traumatic dislocation is anterior. What is the right thing to do at this point?
Numerous, well- controlled studies still support non-operative treatment of most patients with a first time dislocation. Over the age of 27, about 2 out of 3 will not have another dislocation or symptoms of instability. The rate of recurrence, however, can be much higher in the younger, active patient. In some studies, this recurrence rate was found to be as high as 90%. The military academies for many years have surgically fixed these first time dislocations. In this setting there is often an important reason a recurrence could be a serious problem.
As surgical treatment has become less invasive with arthroscopic techniques becoming just as successful as open techniques, an increased interest has arisen in perhaps fixing the younger, active athlete after a traumatic, anterior, first time dislocation. It is my typical recommendation, though, to treat the first time dislocation conservatively with a temporary sling and shoulder rehab exercises as soon as discomfort allows. I then allow a return to sports as tolerated. However, if the shoulder comes out a second time, it will inevitably come out again. Recurrence or any persistent symptoms of instability despite appropriate rehab are indications for surgical repair.
Today, there are plenty of options available for the treatment of arthritis in the knee. Here are just a few…
1. Activity modification – Certain changes in lifestyle may be necessary to accommodate degenerative changes in the knee. Sometimes if more stressful impact activities stop, then other types of activities are possible without symptoms. Typically, activities like jogging, tennis, basketball, etc. are not a good idea, and these limitations may be permanent. Think of substituting biking, stationary bike, elliptical machine, and swimming instead. (Continue reading this article…)
Dr. Maffet’s chapter on “Superior Labral Injuries” of the shoulder has just been published in the latest edition of Orthopedic Sports Medicine.