Minimally Invasive Rotator Cuff Repair

The rotator cuff tendons of the shoulder function to raise our arm and allows us to perform activities as exciting as throwing baseballs and shooting baskets as well as merely combing our hair without pain or discomfort. Tendons are structures which connect muscle to bone and they are like pulleys which raise and rotate our shoulders. In normal, pain free shoulders the tendons glide under the bony roof of the scapula and allow us to perform over-the-shoulder activities pain free.
The tendons, however, can tear secondary to trauma such as a fall onto the shoulder or they can tear secondary to overuse and cause pain and weakness of our shoulder.
The treatment of a rotator cuff tear is surgical and we perform minimally-invasive arthroscopic techniques to repair the rotator cuff. These mini-incisions cause MUCH LESS discomfort and the recovery following surgery is much faster and more dependable.
Please contact us if you have shoulder pain and certainly contact us if another orthopaedic surgeon has recommended a rotator cuff repair to see if you are a candidate for a minimally invasive arthroscopic rotator cuff repair.

Dr. Sisto

Top Orthopaedic Surgeon in SoCal

Castle Connolly Medical LTD just publisehd the Top Doctors in Southern California in 2012. I am fortunate enough to have been selected as one of the TOP ORTHOPAEDIC SURGEONS in Southern California.
The mission of Castle Connolly Medical Ltd. since its finding 20 years ago has been helping consumers find the best healthcare in identifying top doctors.
Every year they survey hundreds of thousands of physicians and ask them to nominate those they believe to be amoung the very best in their specialty or specialties in their communities across the nation. In addition to surveys conducted by mail and internet, their physician-led research team makes thousands of phone calls to identify excellent doctors and reinforce the survey responses. As a result of this intense research process, their years of experience and the medical professionals leading the company, Castle Connolly has become the nations most trusted source for identifying top doctors.
Physicians DO NOT AND CANNOT PAY to be in any Castle Connolly guide or list.
The Top Doctor listing can be found at http://www.topdoctorssoutherncalifronia.com.
I am proud of this recognition and hope to offer the highest level of care to all of my patients for many years to come.

KEEP MOVING!
Dr. Sisto

How About A Partial Patellofemoral Joint Replacement?

An article title “Patellofemoral Arthroplasty in Arthritis Patients” was published in the most recent issue of Current Trends from the Department of Orthopaedic Surgery at Mayo Clinic. The authors presented their results of the minimally invasive, partial joint replacement surgery of the patellofemoral joint and they are excellent.  The Mayo Clinic is advocating patellofemoral arthroplasty for isolated arthritis of the patellofemoral joint (“knee-cap”).
I have recently submitted my ten year results of my patients who have undergone a “partial” joint replacement (arthroplasty) of the patellofemoral joint.   My results are fantastic and all of the patients are still satisfied 10 years later and none of them have had any additional surgery.  I will be presenting this paper at The American Academy of Orthopaedic Surgeons Meeting in Chicago March 2013.
Many surgeons will recommend a Total Knee Arthroplasty (replacement) to treat patients with arthritis of the knee.  This is an acceptable treatment but a full knee replacement does have increased complications, more post operative pain and requires a longer recovery time.  A PARTIAL Knee Arthroplasty utilizes a minimally invasive technique, usually a same-day discharge from the surgery center, significantly less post-operative discomfort, less complications and a quicker, more natural recovery.
At the Los Angeles Orthopaedic Institute we specialize in this minimally invasive technique and invite you to consult with us if you have significant knee pain and, especially, if another surgeon has recommended a Full Knee Replacement.  Hopefully, you will be able to undergo a partial replacement and enjoy a much easier recovery and enjoy your minimally invasive surgical experience!
Keep Moving!
Dr. Sisto

ACL Tears

Mariano Rivera, the star pitcher of the Yankees, and Derrick Rose, the top point guard in the NBA, both recently tore the Anterior Cruciate Ligament (ACL) which is the main stabilizing ligament of the knee. Their notoriety has thrust the importance of the ACL into the national headlines but for thousands of athletes all over the country an ACL tear is a common and serious injury to their own knees.
We are the Team Physicians for Cal State Northridge (CSUN), Antelope Valley and Mission Community Colleges. In addition, Chaminade and Milken High Schools as well as the Lancaster Jet Hawks which is the Single A affiliate of the Houston Astros professional baseball team. We have taken care of many high school athletes with torn ACL’s and we recognize the magnitude of the injury and the program which is required to overcome the surgery and return to the same level of athletic performance.
ACL injury is extremely common with more than 100,000 ACL reconstructions performed annually in the United States. The majority of the ACL injuries occur in athletes but work and auto accidents also are common. Associated injuries include meniscus tears (the shock absorber of the knee) and bone contusions.
An untreated ACL tear will lead to an unstable knee and there is an increased incidence of additional injury to the knee if surgery is avoided. Patients who participate in aggressive cutting and pivoting sports, such as basketball, soccer, volleyball, lacrosse and tennis have a high rate of recurrent instability without ACL reconstruction. In view if this, athletic patients who choose to return to these sports generally undergo surgery soon after the injury.
The technique for ACL reconstruction involves placing a free tendon graft in the anatomic position of the ACL. The tendon graft can be taken from the patient’s injured knee or from a donor. All graft choices have advantages and disadvantages.
We perform over 200 ACL reconstructions each year at our Sports Center at The Los Angeles Orthopaedic Institute. We take care of the most elite athletes in Southern California. If you have an ACL tear, please contact us for an in-depth discussion of which treatment option will be best for you to maximize your recovery and return to your highest level of athletic performance.
 

Top Doctor Award

I have been selected as one of the TOP DOCTORS in Los Angeles for the third straight year. This is a prestigious award as the TOP DOCTORS are voted in by their peers which is the highest source of praise>

There are a number of reasons which contributed to my selection and I believe that my specialty in minimally invasive surgery of the knee and shoulder is my most significant contribution to my peers and to my patients. I have published multiple peer-reviewed articles on PARTIAL ARTHROPLASTY (Replacement) of the knee and, in fact, will be presenting our ten-year results of partial knee arthroplasty at the Academy Meeting in San Francisco in February. Our ten-year survivorship is 100% and my implant design and techniques have been shared with all of the other orthopaedic surgeons in the country who now utilize this procedure. My peers have benefited from my research and my patients have certainly benefited as well.

Please call me if you have been told by another orthopaedic surgeon that you require a total knee arthroplasty. You may, in fact, be able to undergo a PARTIAL KNEE ARTHROPLASTY which has a much quicker recovery time and a much lower complication rate. The post-operative pain is much less and the results are superior as well.

Please contact me if you have knee pain and your life has been altered by pain and a restriction of activities. A more youthful knee is definitely in your future!

Stay Active!
Dr. Sisto

PRP Treatment Now Available

A number of new studies have been published discussing the role of Platelet-Rich Plasma in treating patients with degenerative arthritis of the knee. Platelets are found in our blood and are responsible for blood clotting to prevent excessive bleeding. Platelets are also sources of cytokines, which regulate healing and tissue regeneration in the body. The theory of Platelet-Rich Plasma (PRP) therapy is the hope that if a concentrated amount of our own platelets are injected into the knee that it may lead to a healing of the degenerative changes which have occurred in the knee. In essence, it is a process of healing damaged cartilage in the knee.

The surfaces of our bones are lined by a smooth, glistening surface called articular cartilage which allows the bones to glide over each other. The loss of the articular cartilage allows bone to be exposed and the bone on bone grinding causes pain, swelling and stiffness in the knee. This is called degenerative arthritis.

We have been treating a number of patients with PRP in the office with exciting success at short term follow up. The process is done in the office and starts with the patient having a small amount of blood drawn by our staff. The blood is prepared by a special process which concentrates the platelets and other growth factors into a syringe. The “super-healing” concentrate (PRP) is then injected into the knee.

Recent studies in the American Journal of Physical Medicine and Rehabilitation and The American Journal of Sports Medicine have indicated that PRP can be helpful in treating degenerative arthritis.
We are all committed at The Los Angeles Orthopaedic Institute to making our patients’ knees younger and, hopefully, avoiding surgery. Please contact us if you have knee pain and wish to discuss the new non-operative techniques which are now available.

Stay Healthy,
Dr. Sisto

Who’s Who Recognition

I was just selected into Marquis Who’s Who in Medicine and Healthcare in 2011-2012.  This is the publisher of the Who’s Who in America since 1899.  This award distinguished me as one of the leading healthcare professionals from around the world.

I was told that I was selected because I have developed a minimally invasive surgical procedure to grow “new cartilage” in the knee to make the knee “young again”.

I am proud of this recognition and I encourage anyone who has knee pain and is disabled because of pain to be evaluated and we can recommend a minimally invasive surgical procedure to eliminate years off the knee and allow you to function at a higher level.

I am proud of this recognition by the Who’s Who of America and I look forward to treating all of your knees in the years to come.

Dr. Don

New ACL Technique

The anterior cruciate ligament (ACL) is the prime stabilizer of the knee to prevent anterior instability. Ligaments are the “ropes” of the knee which connect bone-to-bone and stabilize the knee. When ligaments tear the two ends spring apart like a “torn guitarstring” and the ligament loses its blood supply and it dissolves. The patient will have an unstable knee without an ACL which can lead to a meniscus tear and early degenerative arthritis of the knee.
The reconstruction of an ACL tear utilizing the patients own tendons  (structures which connect muscle to bone) or a allograft (cadaver donor) is a successful procedure but one that, unfortunately, does not prevent and may accelerate the development of early degenerative arthritis. The reason for this is that in the past we have used a Trans-Tibial technique to perform our drill holes in the bone to stabilize the ligament. This technique cannot put the ACL graft back to its “Anatomic Footprint Position” and will change the function (kinematics) of the knee which will lead to early arthritis.
A new technique has been devised to create our bone tunnels in the femur and tibia at the “Anatomic Footprint Position” which enhances stability and restores the normal kinematics of the knee and prevents the development of early arthritis.
We routinely use this new “Anatomic” ACL reconstruction and our results have been fantastic! If you have an ACL tear, ask your surgeon if they use the new “Anatomic reconstruction technique” and if they do not, get a second opinion with us to discuss the new technique and how it will improve the long-term outcome of you surgical result!

Keep moving!
Dr. Sisto

What Is “PRP”?

Kobe Bryant has just traveled to Germany to have a “PRP” injection and everyone wants to know what this is about. PRP stands for Platelet Rich Plasma which is a new injectible, non-surgical technique to stimulate healing of chronic soft-tissue injuries of the knee, shoulder, elbow and ankle joints. The technique is perfomed in thw office and a small amount of blood is taken from the patient and this is placed in a special machine which concentrates the “healing portion” of the blood into a concentrated healing “super fluid.” It is than injected into the patient’s joint under ultrasonic visualization.
  The early results for lateral epicondylitis (Tennis elobw), patellar tendonitis (Jumping knee) and rotator cuff tendonitis have been great. We are the team physicians for Cal-State Northridge (CSUN) and have performed PRP successfully for these problems. The role of PRP in the treatment of degenerative arthritis (Kobe’s diagnosis) is very controversial and is unknown at this time.
  Schedule an appointment if you have a chronic soft-tissue injury or degenerative arthritis and we can discuss whether PRP is an option for you.

Stay young!
Dr. Sisto

Meniscus Transplantation

I performed a lateral meniscus allograft transplantation today and this procedure reminded me of the amazing technological advances that knee injuries have made recently.

A meniscus allograft transplantation is performed when a patient has had a previous removal of the majority of the medial or lateral meniscus.

The meniscus is the cartilage soft tissue shock absorber of the knee which is located between the femur (thigh bone) and tibia (shin bone). There are two menisci in each knee. One on the inside which is the medial meniscus and one on the outside which is the lateral meniscus.

A twisting injury with a combined compressive force across the knee can tear the meniscus and lead to pain and locking of the knee
.

The meniscus has a poor blood supply and rarely heals when it is torn. The treatment of a meniscus tear is arthroscopic surgery. “Arthro” is the greek work for joint and “scope” is to look inside so we put a small camera in the knee to visualize the joint. The ideal treatment of a meniscus tear is to surgically repair the meniscus with multiple sutures. Unfortunately, many meniscus tears are not able to be repaired and require a meniscectomy or a removal of the torn portion preserving as much of the normal meniscus as possible. Rarely, the entire meniscus is removed and these unfortunate patients are now at risk for early degenerative arthritis because the normal shock absorber between the femur and tibia is absent.

A relatively new technique is now performed which transplants a “cadaver” meniscus (a young person who has died and donates their meniscus) to give the patient a brand new meniscus. The success rate is high and the early results following this surgery eliminate knee pain and, hopefully, prevent or delay the onset of degenerative arthritis.

We perform meniscus transplantation as well as many “new age” procedures to repair cartilage to keep the knee “young” and maximize the patients’ ability to return to sports and a high level of physical activity. Our goal is to avoid or significantly delay the need for a joint replacement surgery.

Please contact us if another surgeon has told you that there is “nothing else to be done” for your knee or a joint replacement has been recommended for you. Our advanced techniques may keep you and your “own” knee at a high level of function.

Have a great summer!
Dr. Sisto