At Meier Orthopedic Sports Medicine, Steven W. Meier, M.D. provides each patient with the quality of care given to professional athletes. In this book, learn more about our award-winning Beverly Hills practice and find out how Dr. Meier can help you with your orthopedic surgery needs.

2. TABLE OF CONTENTS
About&Meier&Orthopedic&Sports&Medicine..........................................................................................2510&
Shoulder&Conditions&and&Treatment..................................................................................................11532&
&&&&&&&&&&Rotator&Cuff&Tears&and&Treatment...........................................................................................18519&
&&&&&&&&&&Shoulder&Instability,&Damage&and&Treatment......................................................................20522&
&&&&&&&&&&Arthritis&and&Joint&Degeneration&of&the&Shoulder..............................................................23526&
&&&&&&&&&&Fractures&and&Separations&of&the&Upper&Extremity..........................................................27531&
Knee&Conditions&and&Treatment..........................................................................................................33562&
&&&&&&&&&&Ligament&Injuries.............................................................................................................................40546&
&&&&&&&&&&Cartilage&Injuries..............................................................................................................................47551&
&&&&&&&&&&Fractures&and&Other&Injuries&of&the&Lower&Extremity.....................................................52563&
&&&&&&&&&&R.I.C.E...........................................................................................................................................................64&
Cartilage&Restoration.......................................................................................................................................65&
&&&&&&&&&&Articular&Cartilage&Damage.........................................................................................................66567&
&&&&&&&&&&Autologous&Chondrocyte&Implantation&(ACI)......................................................................68572&
Follow&Us&On&Facebook...................................................................................................................................76
1

3. MEIER ORTHOPEDIC
SPORTS MEDICINE
2
Whether&working&with&recreational&athletes,&injured&
workers&or&any&other&individuals,&Dr.&Meier&provides&
each&patient&with&the&quality&of&care&given&to&
professional&athletes.&
!
Dr.&Meier&utilizes&multiple&therapeutic&techniques&
which&may&include&an&exercise&program,&
rehabilitation,&or&minimally&invasive&surgery.&
!
When&surgery&is&necessary,&the&most&current&and&
leading5edge&technologies&are&employed&which&
result&in&less&postoperative&pain&and&faster&recovery.

4. ABOUT DR. MEIER
Steven&W.&Meier&is&a&board5certi[ied&orthopedic&surgeon&
with&special&training&in&sports&medicine&and&
arthroscopic&surgery.&&
!
He&received&his&Medical&Degree&from&the&Loyola&
University&Chicago&Stritch&School&of&Medicine.&He&
completed&his&fellowship&at&University&of&California,&San&
Diego&for&Sports&Medicine&and&Arthroscopic&Surgery.&
!
Dr.&Meier&is&a&leader&in&his&[ield&in&the&surgical&treatment&
of&shoulder&conditions&and&knee&conditions,&as&well&as&
arthroscopic&surgical&techniques.
3

5. PATIENT CARE PHILOSOPHY
Dr.&Meier&uses&a&multi5faceted&approach&to&patient&treatment.&&
!
He&believes&that&in&order&to&achieve&the&best&possible&outcome&
for&any&particular&patient,&a&strategic&combination&of&surgical&
and&non5surgical&techniques&should&be&utilized.&
!
Dr.&Meier&often&uses:&
!
•&&Strengthening&and&exercise&programs&
•&&Formal&physical&therapy&and&rehabilitation&
•&&Minimally5invasive&surgery
4

6. ACADEMIC MEMBERSHIP
5

7. WORLD RENOWNED
Dr.&Meier&regularly&publishes&and&lectures&internationally.&&
!
He&is&often&called&upon&to&treat&dif[icult&cases&that&other&surgeons&may&not&be&
comfortable&with.&He&performs&revisional&surgeries,&as&well,&for&people&who&have&
not&had&an&optimal&outcome&from&previous&surgeries&performed&by&other&surgeons.&
!
Dr.&Meier&serves&as&an&Assistant&Clinical&Professor&at&the&University&of&California,&
Irvine&Department&of&Orthopedic&Surgery.&&
6

8. SHOULDER CONDITIONS
Dr.&Meier&treats&many&injuries&and&abnormal&
conditions&of&the&shoulder.&The&common&conditions&
he&treats&include:&
!
•&&Rotator&cuff&tears&
•&&AC&joint&sprains/separations&and&overuse&injuries&
•&&Shoulder&dislocation&
•&&Fractures&of&the&humerus&(upper&arm&bone)&
•&&Tears&of&the&cartilage&of&the&shoulder&joint&
•&&Arthritis&and&degeneration&of&the&shoulder&joint&
•&&Shoulder&instability&
7

9. KNEE CONDITIONS
8
Dr.&Steven&Meier&treats&many&knee&conditions,&
especially&sports&and&activity5related&injuries.&
!
Dr.&Meier&also&treats&complications&from&old&
injuries&and&previous&surgeries,&as&well&as&
knee&conditions&related&to&age.&

10. KNEE CONDITIONS
Dr.&Meier&treats:&
!
•&Anterior&cruciate&ligament&(ACL)&injuries&
•&Medial&collateral&ligament&(MCL)&injuries&
•&Posterior&cruciate&ligament&(PCL)&injuries&
•&Lateral&collateral&ligament&(LCL)&injuries&
•&Meniscus&tears&and&fraying&
•&Cartilage&lesions&and&degeneration&
•&Osteoarthritis&&
•&Fractures&and&contusions&&
•&Patellofemoral&instability&
•&Patellofemoral&Pain&Syndrome&
•&Baker’s&Cyst&
•&Patellar&tendinitis&(Jumper’s&knee)
9

11. CARTILAGE RESTORATION
Cartilage&restoration&is&a&new&and&progressive&
technique&used&to&replace&damaged&cartilage.&&
!
The&idea&is&that,&instead&of&removing&the&damaged&
joint&and&replacing&it&with&an&arti[icial&joint&or&
surface,&your&own&cartilage&may&be&grown&in&a&
laboratory,&and&later&placed&into&the&affected&joint&
in&order&to&provide&healing&and&pain&relief.&
!
Dr.&Meier&is&one&of&a&few&physicians&in&the&country&
who&perform&this&cutting&edge&procedure.&
10

12. SHOULDER CONDITIONS
AND TREATMENTS
11

13. SHOULDER ANATOMY
Your&shoulder&is&made&up&of&three&bones:&&
!
•&Humerus&(upper&arm&bone)&
•&Scapula&(shoulder&blade)&
•&Clavicle&(collarbone)&
!
The&shoulder&is&a&ball5and5socket&joint.&The&
ball,&or&head,&of&your&upper&arm&bone&[its&
into&a&shallow&socket&in&your&shoulder&blade.
12

14. SHOULDER INJURIES
The&shoulder’s&unique&structure&allows&for&
nearly&unrestrained&positioning&and&rotation&
of&the&arm&in&many&directions&and&planes.&
!
However,&the&price&of&the&shoulder’s&great&
mobility&is&that&it&can&easily&be&injured&if&one&
is&not&careful.
13

15. SHOULDER INJURIES
How&do&you&know&if&you&have&injured&your&shoulder?&
!
Many&patients&feel&a&pop,&pain,&weakness,&swelling,&or&an&inability&to&move&the&
arm&after&injuring&their&shoulder.&
!
If&you&have&decreased&mobility&and&pain&for&more&than&357&days,&you&should&call&
Dr.&Meier,&or&another&doctor,&in&order&to&make&an&appointment&to&be&examined.&
!
Certain&shoulder&injuries&can&lead&to&more&serious&conditions&if&left&untreated.
14

16. COMMON SHOULDER INJURIES
Dr.&Meier&routinely&performs&surgery&to&treat&
shoulder&injuries.&He&performs:&
!
•&Arthroscopic&rotator&cuff&repair&
•&Arthroscopic&shoulder&decompression&
•&Biceps&tendon&relocation&
•&Shoulder&cartilage&repair/shaping&
•&Arthroscopic&shoulder&capsule&release&
•&Fracture&[ixation
15

17. SHOULDER ARTHROSCOPY
Arthroscopic&procedures&are&commonly&used&to&treat&
shoulder&injuries&and&conditions&that&cannot&heal&on&their&
own.&Shoulder&arthroscopy&provides&the&following&bene[its:&
!
•&Less&invasive&
•&Requires&less&heal&time&
•&Causes&less&blood&loss&
•&Less&painful&than&open&surgery
16

18. 17
SHOULDER ARTHROSCOPY
Arthroscopic&surgery&is&a&minimally&invasive&
surgical&technique&where&small&incisions&are&
made&into&the&tissue&surrounding&the&shoulder.&
!
Dr.&Meier&inserts&a&light&and&camera&through&
one&portal&and&an&extremely&specialized&
instrument&through&another&portal.&
!
Shoulder&arthroscopy&can&be&used&to&treat&
many&different&shoulder&conditions.

19. ROTATOR CUFF TEARS
The&rotator&cuff&is&a&network&of&four&tendons&
that&keep&the&humerus&and&shoulder&blade&
fastened&together.&
!
The&rotator&cuff&allows&the&shoulder&to&move&
freely&while&keeping&the&shoulder&in&place.&&
!
The&tendons&of&the&rotator&cuff&can&be&torn&
either&partially&or&completely.&&
!
Did&you&know?&It&is&estimated&2&million&adults&
suffer&from&rotator&cuff&injuries&each&year.
18

20. ARTHROSCOPIC
ROTATOR CUFF REPAIR
When&the&rotator&cuff&is&torn,&Dr.&Meier&can&perform&
surgery&to&repair&the&rotator&cuff.&
!
Signi[icant&tears&of&the&rotator&cuff&not&only&present&
with&pain&and&lack&of&mobility,&but&noticeable&
weakness&of&the&arm,&and&decreased&function.&
!
Rotator&cuff&repair&surgery&is&performed&
arthroscopically&in&order&to&reattach&the&rotator&
cuff&to&the&humerus.
19

21. SHOULDER DISLOCATION
The&shoulder&is&one&of&the&most&[lexible&joints&in&the&
human&body.&
!
Because&of&its&great&mobility,&the&shoulder&can&be&very&
prone&to&injury,&and&the&arm&bone&can&become&
dislodged&from&its&socket.&
!
A&dislocated&shoulder&is&very&painful&and&debilitating.&
!
If&you&suspect&you&have&dislocated&your&shoulder,&it&is&
important&to&see&a&good&orthopedist.&
!
The&damage&from&a&dislocated&shoulder&can&become&
very&severe&or&irreversible&if&left&for&too&long.
20

22. SHOULDER DISLOCATION
Important)Note),)
!
A&general&practitioner’s&of[ice&typically&does&not&have&
the&equipment&necessary&to&treat&a&dislocated&shoulder.&
!
It&is&best&to&head&to&an&emergency&room&if&you&think&you&
have&very&recently&dislocated&your&shoulder.&
!
Severe&cases&may&require&surgery&to&realign&the&
shoulder&and&restore&proper&function.
21

23. SHOULDER INSTABILITY
When&the&arm&bone&of&the&shoulder&has&a&recurring&
tendency&to&come&out&of&its&normal&position,&this&is&
called&shoulder&instability.&
!
Shoulder&instability&is&due&to&a&de[iciency&in&stabilizing&
forces,&typically&resulting&from&prior&injury.
22

24. BANKART REPAIR
A&Bankart&repair&is&a&type&of&surgery&done&to&correct&
habitual&shoulder&dislocations&or&shoulder&instability.&
!
Also&known&as&an&arthroscopic&glenohumeral&
capsulorrhaphy,&this&procedure&involves&repairing&the&
over5stretched&or&torn&labrum&and&capsule&deep&
within&the&shoulder&joint.
23

25. SHOULDER CARTILAGE
REPAIR/RESHAPING
The&cartilage&in&the&shoulder&can&be&damaged&due&to&injury&or&overuse.&
Dr.&Meier&can&perform&surgery&to&repair&damaged&cartilage&and&remove&
any&loose&[laps&or&fraying&that&can&cause&pain&and&instability.&
!
This&procedure&is&typically&performed&with&an&arthroscope.
24

26. ARTHRITIS/JOINT DEGENERATION
People&may&also&develop&arthritis&over&time&due&to&overuse&and&
overexertion&of&the&shoulder.
25

27. ARTHROSCOPIC SHOULDER
DECOMPRESSION
Shoulder&decompression&is&a&procedure&used&to&treat&
shoulder&impingement&syndrome.&
!
Shoulder&decompression&is&an&option&when&patients&have&not&
responded&well&to&non5surgical&techniques.
26
Dr.&Meier&will&insert&an&arthroscope&to&visualize&the&shoulder&
joint,&tendons,&and&ligaments.&
!
He&will&then&remove&any&fraying&and&bone&spurs&that&are&
present.&This&can&signi[icantly&reduce&pain&for&the&patient.

28. ARTHROSCOPIC SHOULDER
CAPSULE RELEASE
A&shoulder&can&become&“frozen”&and&patients&may&
[ind&it&dif[icult&to&reach&overhead&or&lift&the&arm&
above&shoulder&level.&
!
A&rigorous&physical&therapy&program&may&help,&but&if&
the&patient&does&not&respond&well&to&physical&
therapy,&Dr.&Meier&can&perform&arthroscopic&surgery&
to&release&the&shoulder&from&its&“frozen”&position.
27
Dr.&Meier&will&perform&an&arthroscopic&procedure&to&surgically&remove&the&
adhesions&in&the&shoulder&that&are&preventing&a&normal&range&of&motion.

29. AC JOINT
SPRAINS AND SEPARATIONS
A&few&ligaments&connect&these&two&bones&together,&
and&these&ligaments&can&be&separated&or&torn.
28
The&acromioclavicular&joint,&or&AC&joint,&is&the&joint&between&
the&clavicle&(collarbone)&and&scapula&(shoulder&blade).

30. BICEPS TENDON
REPAIR/RELOCATION
The&biceps&tendon&can&tear&with&activity&or&trauma.&
!
When&surgery&is&necessary,&Dr.&Meier&can&surgically&
repair&or&reposition&the&ruptured&tendon.
29

31. FRACTURES OF THE HUMERUS
The&humerus&is&the&upper&arm&bone&that&ends&in&
the&shoulder&socket.&Humerus&fractures&can&often&
occur&from&falling.&
!
Treatment&for&a&broken&humerus&depends&on&the&
location&of&the&fracture&and&the&age&of&the&patient.&
!
Typically,&a&fractured&humerus&may&be&able&to&heal&
without&surgery&if&there&is&minimal&displacement.&
!
The&x5ray&image&is&a&spiral&fracture&of&the&humerus.
30

32. FRACTURE FIXATION
A&severe&fracture&requires&surgery&to&repair&and&realign&the&bone.&
!
Dr.&Meier&may&utilize&pins,&plates,&or&rods&to&ensure&the&bone&is&
correctly&re5aligned&to&heal&properly.
31

33. 32

34. KNEE CONDITIONS
AND TREATMENTS
33

35. KNEE ANATOMY
The&knee&is&incredibly&[lexible&and&able&
to&withstand&tremendous&pressure&
while&we&run,&jump,&move,&and&stand.&
!
The&structure&of&the&knee&includes&
tendons,&ligaments,&and&bone.&
!
Tendons&are&[ibrous&bands&that&connect&
the&muscle&tissue&to&the&bone.&
!
Ligaments&are&bands&of&[ibrous&tissue&
which&connect&two&bones&together.
34

36. KNEE ANATOMY
The&knee&has&four&main&ligaments:&&
!
•&Anterior&Cruciate&Ligament&(ACL)&
•&Posterior&Cruciate&Ligament&(PCL)&
•&Medial&Collateral&Ligament&(MCL)&&
•&Lateral&Collateral&Ligament&(LCL)&
!
These&ligaments&are&essential&to&the&overall&
stability&of&the&knee,&and&they&can&be&injured&
during&activity.&
!
It&is&important&to&avoid&excessive&twisting&to&
the&knee&in&order&to&maintain&the&health&of&
the&stabilizing&ligaments.
35

37. KNEE PROCEDURES
Dr.&Meier&performs&the&following&surgical&knee&procedures:&
!
•&Cartilage&restoration&
•&Arthroscopic&knee&surgery&
•&Arthroscopic&ligament&reconstruction/repair&
•&Arthroscopic&meniscus&repair/shaping/smoothing&
•&Fracture&[ixation
36

38. KNEE PROCEDURES
When&surgery&is&required,&Dr.&Meier&uses&the&latest&minimally&invasive&techniques&to&
treat&his&patients.&
!
The&utilization&of&minimally&invasive&techniques&allows&patients&to&be&back&on&their&
feet&and&doing&the&things&they&love&in&less&time&than&traditional&surgical&techniques.
37

39. KNEE ARTHROSCOPY
Arthroscopic&surgery&is&a&minimally&invasive&surgical&technique&where&
small&incisions&are&made&into&the&tissue&surrounding&the&knee.&
!
Dr.&Meier&inserts&a&light&and&camera&through&one&portal&and&an&
extremely&specialized&instrument&through&another&portal.&
!
Knee&arthroscopy&can&be&used&to&treat&many&different&knee&conditions.
38

40. KNEE ARTHROSCOPY
Compared&to&open&procedures,&in&which&the&surgical&work&
is&done&through&one&big&incision,&knee&arthroscopy&is:&
!
•&Less&invasive&
•&Carries&fewer&risks&of&complications&
•&Has&a&quicker&healing&time&
•&Causes&less&blood&loss
39

41. ACL INJURY
Injuries&to&the&anterior&cruciate&ligament&(ACL)&can&be&very&
common&among&professional&and&recreational&athletes.&
!
ACL&injuries&are&often&caused&by:&
!
•&Sudden&increase&or&decrease&in&intensity&of&activity&
•&Rapid&deceleration&while&in&motion&
•&Twisting&the&knee&&
•&Impact&to&the&knee&
•&Landing&improperly&on&the&leg
40

42. ACL INJURY
Treatment&for&an&ACL&injury&depends&on&the&
severity&of&the&injury.&
!
If&the&ACL&is&completely&torn,&then&it&will&
usually&have&to&be&reconstructed.&
!
If&the&ACL&is&not&torn,&then&rest&and&ice&will&be&
used&in&conjunction&with&rehabilitation&in&order&
to&help&restore&the&knee&to&proper&function.&&
!
Dr.&Meier&uses&the&latest&advances&in&orthopedic&
surgery&to&reconstruct&a&torn&ACL.
41

43. PCL INJURY
The&posterior&cruciate&ligament&(PCL)&is&one&of&the&two&cruciate&ligaments&that&
maintain&stability&of&the&knee&and&correct&alignment&of&the&femur&and&tibia&bones.
42
Did&you&know?&
!
•&The&posterior&cruciate&ligament&is&the&strongest&ligament&in&the&knee.&&
•&A&PCL&injury&often&occurs&with&other&ligament&injuries.&&
•&PCL&injuries&are&commonly&found&after&major&trauma&to&the&knee&(i.e.&in&a&car&
accident).

44. PCL INJURY
The&treatment&for&a&PCL&injury&is&determined&
on&an&individual&basis.&
!
Some&patients&do&not&require&surgery&and&can&
bene[it&from&physical&therapy&rehabilitation&
and&strength&training&alone.&
!
Dr.&Meier&will&perform&an&examination&to&
determine&the&best&therapy&for&any&patient&
who&has&an&injury&of&the&PCL.&
43

45. ARTHROSCOPIC LIGAMENT
RECONSTRUCTION & REPAIR
Some&ligament&injuries&are&unable&to&heal&without&surgical&repair.&A&
complete&ACL&tear,&for&instance,&cannot&heal&properly&without&surgery.&
!
There&is&more&than&one&way&to&reconstruct&an&ACL.&
!
If&a&patient&is&a&candidate&for&ACL&reconstruction,&Dr.&Meier&will&discuss&the&
best&techniques&for&that&person&speci[ically&to&[ind&the&best&choice&for&them.
44

46. MCL INJURY
The&medial&collateral&ligament&(MCL)&is&the&ligament&that&attaches&
from&the&inner&side&of&the&femur&to&the&inner&side&of&the&shin&bone.&
!
The&MCL&is&a&stabilizer&of&the&knee&against&lateral&forces&traveling&
from&the&outside&toward&the&inside&of&the&knee.
45
Quick&Fact:&an&MCL&injury&may&occur&along&with&an&ACL&or&meniscus&injury.

47. MCL INJURY
There&are&three&grades&of&MCL&injury:&
!
Grade&1:&The&MCL&is&partially&torn.&The&injury&is&
not&severe&and&will&heal&in&152&weeks.&&
!
Grade&2:&The&MCL&is&partially&torn,&but&more&
severe&than&grade&1.&Surgery&is&not&required,&but&
will&take&between&354&weeks&to&fully&heal.&&
!
Grade&3:&The&MCL&is&fully&torn.&A&knee&brace&will&
be&worn&to&allow&the&MCL&to&heal&properly.&It&will&
take&6+&weeks&for&the&ligament&to&fully&heal,&or&
surgical&intervention&might&be&indicated.
46

48. MENISCUS INJURY
The&menisci&are&C5shaped&discs&that&provide&shock&absorption&for&the&knee&joint&and&are&
often&prone&to&tearing&or&“fraying”.&
!
Twisting&the&knee&while&the&foot&is&planted&on&the&ground&can&cause&the&meniscus&to&tear.&
!
Additionally,&as&we&age,&the&meniscus&wears&down&and&becomes&more&prone&to&tearing&
and&injury.
47

49. MENISCUS INJURY
The&treatment&for&a&meniscus&injury&not&only&
depends&on&the&severity&of&the&injury,&but&the&
location&of&the&injury&on&the&meniscus.&
!
If&the&injury&is&minor&to&moderate,&and&in&an&
area&of&good&blood&[low,&then&the&tear&may&be&
able&to&heal&on&its&own&with&time&and&rest.&
!
However,&if&the&tear&is&in&an&area&of&the&meniscus&
that&receives&poor&blood&supply,&the&meniscus&
will&not&be&able&to&heal&on&its&own&even&given&
time&and&rest.&
!
The&meniscus&and&may&continue&to&cause&pain&
and&discomfort&until&it&is&surgically&repaired.
48

50. ARTHROSCOPIC MENISCUS REPAIR
Dr.&Meier&uses&arthroscopic&knee&surgery&to&treat&some&meniscus&tears.&Dr.&
Meier&can&trim&or&repair&the&meniscus&depending&on&how&it&is&damaged.
49

51. CARTILAGE RESTORATION
Dr.&Meier&is&one&of&a&few&orthopedic&surgeons&on&the&
West&Coast&to&perform&a&technique&known&as&
Autologous&Chondrocyte&Implantation&(ACI).&
!
This&procedure&restores&cartilage&to&areas&of&the&
knee&that&are&seriously&damaged.&This&procedure&
can&replace&damaged&cartilage&due&to:&
!
•&Injury/overuse/trauma&
•&Osteoarthritis
50

52. CARTILAGE RESTORATION
ACI&is&a&cutting5edge&treatment&that&helps&to&repair&damaged&articular&cartilage&
by&[illing&in&large&gaps&and&lesions&of&the&joint&cartilage&using&the&patient’s&own&
cartilage&cells.&
!
Dr.&Meier&will&determine&if&this&procedure&is&an&option&during&your&consultation.
51

53. FRACTURES
When&a&bone&is&cracked&or&split,&it&is&called&
a&break&or&a&fracture.&
!
There&are&many&different&types&of&bone&
fractures,&and&they&are&classi[ied&by&how&
the&bone&is&broken.&
!
The&treatment&for&fractures&depends&on&the&
severity&and&location&of&the&broken&bone.&
!
In&severe&cases,&surgery&is&required&to&set&
the&bone&and&ensure&the&surrounding&
tissues&are&not&damaged.
52

54. FRACTURES
Did&you&know?&
!
•&The&average&adult&has&two&fractures&in&their&lifetime.&
•&Women&can&be&more&prone&to&stress&fractures&than&men.&
•&Fractures&commonly&occur&in&children&and&seniors.&
•&After&radiation&therapy,&the&bones&in&the&affected&area&
are&weakened&and&become&more&susceptible&to&fractures.
53

55. FRACTURE FIXATION
Surgical&repair&is&sometimes&necessary&for&a&fracture&that&is&out&of&place.&
!
If&that&is&the&case&then&pins,&rods,&and&screws&can&be&utilized&to&properly&set&a&
fracture&and&ensure&that&it&heals&well.
54

56. PATELLAR TENDINITIS
Patellar&tendinitis&is&a&condition&where&the&
patellar&tendon&just&under&the&knee&cap&
becomes&in[lamed&and&irritated&due&to&overuse.&
!
The&treatment&for&patellar&tendinitis,&often&
called&Jumper’s&Knee,&rarely&involves&surgery.&
!
Rest,&ice,&anti5in[lammatory&medication,&a&
brace,&and&stretching&can&be&used&to&help&
alleviate&the&pain&from&patellar&tendinitis.
55

57. PATELLAR TENDINITIS
Those&who&are&prone&to&this&condition&tend&to&participate&in&
activities&in&which&there&is&a&considerable&amount&of&jumping.&
!
These&activities&include:&
!
•&Volleyball&
•&Basketball&
•&Running&
•&Soccer
56

58. PATELLOFEMORAL INSTABILITY
Patellofemoral&instability&is&a&condition&where&
patients&feel&as&though&their&patella&(knee&cap)&is&
“slipping&out&of&place”.&
!
This&condition&can&be&caused&by&either&laxity&or&
tearing&of&the&ligaments&and&tendons&around&the&knee.&
!
The&treatment&for&patellofemoral&instability&may&
utilize&non5surgical&techniques&to&strengthen&the&
muscles&and&ligaments&that&support&the&knee.&
!
If&the&ligament&is&torn,&or&too&stretched&to&provide&
support,&then&surgical&intervention&may&be&required.
57

59. PATELLOFEMORAL PAIN SYNDROME
Patellofemoral&pain&syndrome&(PFPS)&is&a&very&
common&sports&condition&characterized&by&pain&
or&discomfort&originating&from&the&underside&of&
the&patella&(knee&cap).&
!
Who&is&prone&to&PFPS?&
!
•&Women&
•&Basketball&players&
•&Runners&
•&People&who&have&“knock&knees”&
!
The&treatments&for&PFPS&often&include&exercise&
programs,&activity&modi[ications,&and&rest.
58

60. PATELLOFEMORAL PAIN SYNDROME
PFPS&is&often&caused&by&prolonged&running&
and&jumping,&as&well&as&knee&trauma&or&
dislocation&of&the&knee&cap.&
!
Over&time,&these&repetitive&forces&acting&on&
the&patella&thin&the&cartilage&attached&to&the&
undersurface&of&the&knee&cap,&which&
articulates&with&the&femur.&
!
This&thinning&causes&pain&from&decreased&
smoothness&of&tracking,&and&increased&friction&
of&the&patella&as&it&moves&over&the&femur.
59

61. BAKER’S CYST
Baker’s&cyst&is&a&condition&where&joint&[luid&
builds&up&behind&the&knee.&
!
This&condition&may&be&caused&by&excessive&
swelling&of&the&knee,&and&is&often&correlated&
with&other&knee&conditions&including:&
!
•&Meniscus&tears&
•&Osteoarthritis&of&the&knee&
•&Rheumatoid&arthritis
60

62. CONTUSIONS
Contusions,&also&known&as&tissue&bruises,&occur&when&the&
capillaries&or&blood&vessels&are&damaged&by&trauma,&and&blood&
seeps&into&the&surrounding&tissues.&
!
Typically,&contusions&are&not&serious&and&heal&on&their&own.&
!
However,&an&injury&involving&a&contusion&can&be&life&threatening&
when&a&fracture&results&from&a&high5impact&contusion.
61

63. OSTEOARTHRITIS
Osteoarthritis,&also&referred&to&as&age5related&
arthritis,&is&a&common&condition&that&may&occur&with&
age&in&which&joint&cartilage&wears&down&over&time.&
!
There&are&many&forms&of&arthritis,&which&all&require&
different&forms&of&treatment.&Osteoarthritis&can&be&
common&among:&
!
•&Older&adults&
•&Overweight&individuals&
•&People&who&have&jobs&that&require&movement&and&
heavy&lifting
62

64. OSTEOARTHRITIS
Many&patients&with&osteoarthritis&experience&
decreased&mobility&of&the&joints,&decreased&
joint&[lexibility,&pain,&and&swelling.&
!
The&diminishing&cartilage&can&often&lead&to&
painful&bone&spurs&as&the&movements&of&the&
bone&are&not&cushioned&by&suf[icient&cartilage&
between&them,&and&bones&may&rub&directly&
against&each&other&to&cause&pain.&
!
While&osteoarthritis&cannot&be&cured,&there&
exist&many&techniques&that&can&increase&
mobility&and&reduce&pain.
63

65. RICE
What&is&RICE?&&
!
•&Rest&
•&Ice&
•&Compression&
•&Elevation&
!
RICE&is&often&used&as&a&[irst5line&method&to&
treat&sports&injuries&including:&
!
•&Sprains&
•&Ligament&tears&
•&In[lammation&
•&Patellar&tendinitis&
•&Other&knee&and&shoulder&injuries
64

66. CARTILAGE RESTORATION
65

67. WHAT IS ARTICULAR CARTILAGE?
Articular&joint&cartilage&is&the&smooth&tissue&
that&covers&the&articulating&surfaces&of&bones&
inside&the&joints.&
!
Cartilage&allows&you&to&move&your&joints&easily&
with&minimal&friction.&It&also&provides&
cushioning&between&the&bones&so&that&
movement&may&be&pain&free.
66

68. CARTILAGE DAMAGE
What&causes&cartilage&damage?&There&are&
three&things&that&can&wear&down&cartilage:&
!
•&Traumatic&injury&
•&Overuse&
•&Normal&wear&and&tear&with&activity&and&age
67

69. AUTOLOGOUS CHONDROCYTE
IMPLANTATION (ACI)
ACI&is&an&extremely&promising&technique&which&has&the&
ultimate&goal&of&restoring&new&cartilage&to&an&area&inside&a&
joint&that&has&been&torn&away&or&worn&down&over&time.
68
The&goal&of&any&articular&cartilage&restoration&procedure&is&to&
stimulate&and/or&encourage&new&hyaline&cartilage&growth.

70. THE PROCEDURES
This&procedure,&which&ultimately&results&in&cartilage&
restoration,&will&require&two&surgeries&to&complete.&
!
The&[irst&procedure&is&arthroscopic,&while&the&second&
procedure&is&traditional&"open"&surgery.
69

71. ABOUT ACI
THE FIRST PROCEDURE
The&[irst&procedure&will&be&done&through&knee&arthroscopy.&
!
Dr.&Meier&will&go&into&your&joint&with&arthroscopic&instruments&to&take&a&biopsy&
(small&piece)&of&your&healthy&cartilage&cells&out.&At&the&same&time,&he&will&also&
address&and&take&care&of&any&other&surgical&issues&that&might&be&causing&pain&
within&the&knee&joint.
70
The&cells&are&then&sent&to&a&lab&
to&be&cultivated.&
!
Over&the&next&several&weeks,&
the&cells&multiply&and&grow&to&
a&point&where&they&can&be&
surgically&implanted.

72. ABOUT ACI
THE SECOND PROCEDURE
The&next&step&is&the&implantation&of&the&
new,&healthy&cartilage&cells.&
!
To&implant&the&newly&grown&cells,&Dr.&Meier&
will&perform&an&open&surgical&procedure.
71

73. ABOUT ACI
THE SECOND PROCEDURE
Once&the&incision&has&been&made,&the&area&that&
will&receive&the&new&cells&will&be&prepared.&
!
Then,&a&layer&of&tissue&matrix&is&seeded&with&the&
cultured&cartilage&cells,&sewn&over&the&defect&
(the&area&that&needs&new&cartilage),&and&then&
sealed&into&place&with&[ibrin&glue.&
!
Dr.&Meier&will&then&inject&the&new&cartilage&cells&
into&the&defect&under&the&cover,&where&the&new&
cartilage&will&grow&into&the&de[ined&area&and&[ill&
in&the&hole&of&the&defect&until&it&has&become&like&
the&surrounding&healthy&cartilage.
72

74. THE IMPORTANCE OF
PROPER REHABILITATION
Rehabilitation&is&essential&to&the&success&of&cartilage&restoration.&
!
It#is#critical#that#any#potential#ACI#patients#commit#to#6412#months#of#
physical#therapy#and#rehabilitation#in#order#to#achieve#the#best#results#and#
hopefully#return#to#a#condition#of#low#to#absent#pain#levels.
73

75. REHABILITATION
Dr.&Meier&strongly&recommends&this&extensive&course&of&physical&therapy&to&
help&ensure&that&the&joint&heals&properly&and&mobility&returns.&
!
Additionally,&the&new&cartilage&must&be&protected&and&allowed&to&grow&
without&interference&and&pain&resulting&from&a&poorly&rehabilitated&joint.&
!
If&the&patient&does&not&comply&with&the&physical&therapy&and&rehabilitation&
program,&then&the&improvement&outcome&of&the&cartilage&restoration&will&
not&be&as&dramatic&and&promising&as&expected.
74

76. QUESTIONS?
If&you&have&any&questions,&comments,&or&
concerns&based&upon&anything&you&just&read&
in&this&book,&feel&free&to&talk&to&Dr.&Meier&or&a&
member&of&his&staff.&
!
Contact&us&today&to&schedule&a&consultation!&
!
Of[ice&Address:&
8641&Wilshire&Blvd,&Suite&215&
Beverly&Hills,&CA&90211&
!
PHONE:&(310)&77757845&
EMAIL:&info@mosm.com
75

77. MEIER ORTHOPEDIC
SPORTS MEDICINE
Follow&us&on&Facebook:&
www.Facebook.com/MeierOrthopedic&
!
www.MOSM.com
76