Patello-Femoral Replacement (PFR)

Do you have severe pain under or around your kneecap?
Have you been told by your doctor that you may need knee replacement surgery?
Are you interested in learning about a less-invasive partial knee replacement that is custom made just for you?

What are your options?
If you have severe pain under and around your kneecap, your doctor may first recommend conservative treatment involving rest, physical therapy and analgesics. If your pain is not manageable with these measures, you may be a candidate for surgery.

Types of surgery for arthritis around the kneecap

There are several types of surgery intended to treat severe arthritis around the kneecap. These options include soft tissue procedures (such as a lateral release), cartilage replacement, chondroplasty, microfracture, bone and tendon realignment procedures, and replacement of the painful portion of the knee (partial and total knee replacement).
 Replacement of the entire knee joint (total knee replacement) has been used to treat arthritis that is isolated to the kneecap portion of the knee. With total knee replacement, however, all portions of the knee are replaced, even if they are healthy!
Many experts believe that total knee replacement is too aggressive for someone who suffers from arthritis in just one portion of the knee. These experts believe that your knee will function better if you are able to keep the healthy portions in your knee and only replace the area that is damaged. Another consideration is that total knee replacement requires removal of bone from your entire knee and, if the implant does not last you for the rest of your life, the challenges of subsequent repair are increased because there is simply less bone to work with for implantation of the revision knee components.

Read more about PRF at the Los Angeles Orthopaedic Institute…

“Breakthrough” – We’ve Been Doing for 5 Years

LA_knee_surgeryThere has been an explosion of radio, televsion and newspaper advertisements announcing a “breakthrough” in non-operative treatment of the knee. These centers claim that they are offering a “new, innovative treatment” for knee arthritis which is NOT available at other doctors offices.
This is obviously false advertising and the Knee Centers should be ashamed of themselves.
All they are offering is a routine treatment which we have been routinely performing at the LOS ANGELES ORTHOPAEDIC INSTITUTE for the past FIVE YEARS.
We have been injecting a high molecular weight Hyaluronan into the knee to “oil” the joint and replace the natural lubrication which is missing in patients with degenerative arthritis. We use either ORTHOVISC or SUPARTZ which are both FDA-approved, non-drug therapy made from ultra-pure hyaluronan. It restores the natural joint fluid (hyaluronan) that cushions, protects and lubricates your knee joint. With better cushioning, your knee can move and function better.
Hyaluronon injections are indicated for patients with mild, moderate and severe degenerative arthritis.
At the Los Angeles Orthopaedic Insititute we have injected thousands of knees with many repeat patients who have been able to return to most if not all of their prior activites WITHOUT SURGERY!
Please call us if you have been told that you have degenerative or osteoarthritis of the knee and have been told you may need surgery. We can determine the BEST treatment for you and, hopefully, begin a series of Hyaluronan injections and start you moving your knees as soon as possible.
Keep Moving!

Dr. Sist0

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

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