Rotator cuff tears are typically an overuse injury common in older patients and athletes competing in overhead sports such as baseball, basketball, swimming, tennis, and golf. Less commonly, you can suffer a rotator cuff tear from an acute shoulder injury such as dislocation. Symptoms include pain with some or all movement, limited range of motion, and weakness, particularly with overhead activity. Rotator cuff tears can be partial thickness or full thickness. Biceps tendon pathology and bursitis/impingement can be closely associated with rotator cuff pathology. A lot of non-traumatic rotator cuff tears will respond well to conservative treatment including injection and physical therapy. Surgery is reserved for patients not seeing improvement with appropriate conservative treatment and for patients with acute tears.

Meniscal tears can be acute or chronic/degenerative. Acute tears typically happen in younger patients as the result of a sports injury. Patients can report hearing a pop, can develop a knee effusion (swelling of the joint) and can have difficulty with range of motion or weight-bearing. Depending on the morphology of the tear pattern, some tears can be repaired and some tears are debrided back to a stable base. When a tear is repaired with stitches, weight-bearing and range of motion will be restricted for 6 weeks. When a tear is debrided there are no restrictions. Degenerative tears happen over time in the setting of arthritis and are debrided back to a stable base. This will address the episodic pain of meniscal tears but will not address the constant dull ache background pain of arthritis.

ACL tears can happen in both contact and non-contact sports from a hyperextension pivoting injury. Athletes usually report hearing a pop and experience significant swelling of the knee. To return to an active lifestyle, especially with cutting and pivoting sports, surgical reconstruction is recommended. The ACL can be reconstructed using your own tissue from your hamstring, patellar, or quadriceps tendons or can be donated tissue. Multiple studies demonstrate a lower re-tear rate from using your own tissue for reconstruction in patients under 30 years old. Total rehabilitation time is approximately 9 months to 1 year.

Traumatic shoulder dislocations are typically anterior (out in the front), and can result in anterior labral tears, Bankart lesions and/or Hill Sachs lesions in younger patients, and rotator cuff tears in older patients. Teenage patients suffering a shoulder dislocation have a 99% chance of repeat dislocation and should strongly consider surgical stabilization of the shoulder with labral/Bankart repair before repeat dislocation. A surgical decision for older patients is made based on a physical exam and MRI findings. Acute rotator cuff tears from a shoulder dislocation should be surgically repaired.

Patellar dislocations are usually from a non-contact twisting motion with the leg straight. They typically reduce on their own. Reduction of the patella can cause fractures of the bone and cartilage. An MRI is obtained to ensure there are no loose cartilage or cartilage and bone pieces in the knee known as “loose bodies”. If loose bodies are present the treatment is surgery to remove them and attempt to fix them. Repair or reconstruction of the Medial Patellofemoral Ligament (MPFL) is typically undertaken as well. First-time dislocations without loose cartilage or bone pieces can be treated conservatively in a brace and with rehab.

Diagnosed with an MRI, focal cartilage damage can be treated with surgery. Multiple techniques exist depending on the size of the lesion/defect and the age of the patient. Diffuse or generalized cartilage changes are osteoarthritis and are treated conservatively with injections (steroid and viscosupplementation), anti-inflammatories, glucosamine/chondroitin, bracing, therapy, activity modification, and weight loss until the patient wants to consider knee replacement.

Distal biceps ruptures happen from a sudden excessive eccentric contraction. Patients report a pop with the immediate onset of pain and can experience significant bruising around the elbow. This can result in a “reverse Popeye” deformity. Surgery is recommended for young patients and laborers, particularly for patients utilizing repetitive supination (screwdrivers, wrenches).

Disruption of the extensor mechanism is a surgical indication. Patients report a pop and the inability to straighten their leg or hold it in a straight position. Depending on the location of the tear, a combination of sutures, drill holes through the patella and anchors can be used for repair.