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Cartilage is the tissue that coats the ends of all of our bones. It is what forms the bony side of a joint.

This is a few millimeter thick coating depending on what joint is involved. It is

somewhat cushiony and is extremely slippery. This gives some shock absorbing

quality to the joint and also allows the two bones of the joint to slide and role on one

another decreasing the amount of friction.

The slow loss of cartilage and degeneration of the cartilage is what we call arthritis.

This is a normal progression in the weightbearing joints and essentially is unavoidable

as long as we are weightbearing. However, this does not always result in patient

having symptoms from this. It is only when a joint becomes painful, stiff, swollen and

range of motion begins to decrease, then we truly consider a condition of arthritis.

There are multiple nonsurgical measures to minimize the symptoms from arthritis,

however to this date nothing reliable has been developed that will actually heal the

cartilage or re-grow the cartilage.

For more information regarding conditions involving arthritis, please refer to the patient

education section.

David A. Sugar, M.D., FAAOS



The anterior cruciate ligament is perhaps the most vital ligament of the knee joint. As

ligaments connect one bone to another and the anterior cruciate ligament is one of two

ligaments deep within the knee joint that helps to connect the thighbone to the

shinbone. This ligament’s main function is to prevent the shinbone from translating

forward in relationship to the thighbone.

This is a ligament that when injured is frequently the result of a noncontact deceleration

type of movement. An example of this would be when one is running fast, plants the

leg to pivot and cut into a different direction, the foot and shinbone are planted and

remain stable and then the weight of the body slides the thighbone in an abnormal

manner in relationship to the tibia tearing the ligament.

A torn ACL is for anyone who wishes to perform activities, which require a great deal of

pivoting and shifting of direction at a rapid pace can result in a complete inability to

perform these activities. The knee will be unstable, which could result in not only pain

but injury to the meniscus as well as the cartilage coating of the joint. Typically in these

types of patients, the recommendation is to undergo an ACL reconstruction.

For further information regarding anterior cruciate ligament and care of the anterior

cruciate ligament, please refer to the patient education section.

David A. Sugar, M.D., FAAOS



When one has arthritis, which is the loss of the cartilage coating of the joint, the

symptoms can progress to the point of having pain, swelling, stiffness and loss of

motion. This can result in an inability to perform not only activities for pleasure such as

running and dancing, but can also result in difficulty performing activities of daily living.

Nonsurgical treatment measures initially consist of alternating ice and heat, antiinflammatories,

cortisone shots and activity modification. When these treatment

methods are no longer providing adequate relief of one’ symptoms, we then begin to

have discussions about surgical intervention. If the arthritis is widespread enough in

the knee, the discussion will usually entail performing a total knee replacement. If the

symptoms are limited to only one area of the knee, we would consider a partial knee


In these procedures, basically the ends of the bone that are arthritic are shaved off and

the surface of the bone is replaced with a metal cap at the bottom of the shinbone and

the top of the thighbone.

This is extremely reproducible operation with excellent long-term outcomes, but is still a

rather large undertaking and involves a significant commitment on the patient’s part for

rehabilitation and physical therapy.

For further information, please refer to the patient education section.

David A. Sugar, M.D., FAAOS



Arthroscopic surgery has been utilized by the orthopedic surgery community for the

past four decades. This was truly the first minimally invasive surgery to be performed.

These operations involve making approximately three 1/4-inch incisions around the

joint introducing a fiberoptic camera into the joint and then through the other incision

sites introducing instrumentation that allows the surgeon to perform various


The shoulder and the knee are the joints that most commonly undergo arthroscopic

procedures and of these two by far the knee is most prevalent.

These procedures can typically involve treating cartilage injuries whether it be the

cartilage coating of the knee or the meniscus cartilage of the knee. However, ligament

reconstruction, procedure that addresses cartilage injury, tendon reconstruction, and

even cartilage stimulation procedures are all performed in an arthroscopic manner.

The benefits of these procedures being done in such a minimally invasive manner are

a much shorter rehabilitation time and a much quicker return to one’s desired activity


This is a rapidly evolving area of orthopedic surgery and new techniques are constantly


For further information regarding arthroscopy, please refer to the patient education


David A. Sugar, M.D., FAAOS



Pediatric orthopedics is the area of orthopedics that deals with children. In almost all

subspecialties of medicine, it is important to think of a child is not just a small version of

an adult. Children have very specific conditions that either only occur during childhood

or when they do occur in childhood present and are treated very differently then those

in an adult.

One of the most significant examples of this is the fact that children have open growth

plates. The growth plate is the portion of the bone, which contains a specific type of

cell that results in bone growth. There are specific injuries that occur to the growth

plate that obviously cannot occur in an adult whose growth plates have fused and are

no longer growing. These can range from strains to the growth plate up to fractures of

the growth plate. It sometimes takes a very skilled eye to discern the difference

between these and also requires a great deal of expertise to determine whether an xray

is revealing only normal anatomy or a fracture through a growth plate.

Other examples of specific pediatric orthopedic conditions are scoliosis, angular

deformities of the lower extremities such as bowlegs or being bowlegged or knockkneed.

In my practice, a large percentage of my care is devoted to pediatric conditions and I

strive to present a very child friendly atmosphere in the office even having a treasure

chest full of toys for the little ones to pick from on each of their visits.

In my mind an important aspect of caring for a child is to speak directly to the child and

not talk about them to the parents as if they were not even in the room. I find that this

goes a long way to put the child at ease and if they are at ease, it can only result in

better care for them.

For further information regarding pediatric orthopedic condition, please refer to the

patient education section.

David A. Sugar, M.D., FAAOS



A fracture is a break in ones bone. There are many terms that are used to describe a

fracture, all of which are synonymous. These include a fracture, a break, a crack and

even stress fractures.

Typically these are the result of a traumatic event, which can be either high energy or

low energy. It never seizes to amaze me how some fractures occur with an injury that

one would not necessarily think would result in a broken bone. However, there is

something called a stress fracture that is not necessarily the result of one traumatic

event. This can be the result of a small amount of stress applied to the bone on a

repetitive basis.

Fortunately, the overwhelming majority of fractures that present to my office do well

with nonsurgical treatment. It is only when one’s outcome will be compromised with

nonsurgical treatment that I entertain surgical intervention. Even in these cases, I still

strive to achieve an excellent outcome with a minimally invasive technique.

Our ability to provide total fracture care within the office entails our ability to do on-site x

-rays in a digital manner, exposing the patient to less radiation, casting and splinting

and cast removal right in the office. When appropriate some fractures can even be set

or “reduced” right in the office.

One thing I have learned over the years is that even when one is able to move the joint

or walk on the leg, this does not rule out the presence of a fracture. I have had patients

literally walking to the office, who had a hip fracture that needed to be admitted to the

hospital and have a surgical procedure. Even the presence or absence of swelling is

not an indication of whether the fracture is present or not.

If you have any concerns whatsoever, always call my office. We make every effort to

see these types of injury the same day.

For more information regarding fractures, please refer to patient education section.

David A. Sugar, M.D., FAAOS



Scoliosis is a condition, which affects the bony elements of the spine. The result is a

curvature of the spine. Most commonly this is an S-shaped curved in the spine when

we are looking at the spine while standing behind someone.

For the most part, we do not know why scoliosis occurs. The most common form of

scoliosis we call idiopathic scoliosis meaning that there is no specific cause for the

scoliosis. There are times, however, where vertebrae do not form properly are wedgeshaped

or fused to another vertebra and this will result in a curvature of the spine.

A majority of times a patient has scoliosis they present in the pediatric-age range.

Fortunately, the majority of these patients only need simple observation to monitor the

curve and whether it progresses over time. It is very infrequent that they progress to a

point where the curvature needs a brace and even less so progresses to a point where

it needs surgical intervention.

A recent addition to my practice is the utilization of a genetic test to determine the

likelihood the scoliosis will progress to the point of needing a brace or surgery. There

are specific patient criteria for needing the genetic requirements, but this is a simple

saliva test that is done here in the office.

For further information regarding scoliosis, please refer to the patient education


David A. Sugar, M.D., FAAOS



The meniscus is a cushion shock absorber like pad that is within certain joints of the

body. The knee is the joint containing the meniscus that presents problems to patients

most often.

The meniscus is a type of cartilage. The meniscus of the knee has a consistency

similar to that of the tip of one’s nose. The function of the meniscus within the knee is

to absorb some of the forces across the knee joint. This in fact then protects the

cartilage coating of the knee. It is the gradual loss and eventual complete loss of the

cartilage coating in the knee that results in arthritis. So, the meniscus plays a very

important role in the evolution of arthritis.

The meniscus is a tissue that commonly causes the patient symptoms. This is usually

the result of the tear of the meniscus. When one is young, the tear usually occurs

during a one-time event and one knows that they have injured their knee. However, as

we get older, the fibers begin to weaken and one could have a tear of the meniscus

and not necessarily realize they tore the meniscus at that moment. Things such as

squatting and twisting can result in a tear and overtime the tear becomes larger and

eventually begins to cause symptoms.

The nonsurgical treatment of the meniscus tear usually consists of ice and antiinflammatories

and activity modification. Although a cortisone shot will help with

symptomatic relief, it will not heal the meniscus. The meniscus essentially has no

healing potential as it for the most part has no blood supply.

Only when a patient symptoms are significant enough to cause persistent pain and

trouble do we consider surgical intervention.

The surgical intervention for a meniscus tear is in the form of arthroscopic surgery.

This is an outpatient procedure and usually it results in patients returning to activities

very quickly.

For more information regarding the meniscus, please refer to the patient education


David A. Sugar, M.D., FAAOS



The shoulder is a complex joint where the arm is essentially attached to trunk of the

body. It is complex in that there are no bony constraints to the joint. The joint is kept

stable extensively by soft tissue attachments. Because of this, the shoulder has an

almost universal range of motion, but also a subject to conditions that can affect

stability and tendinitis and bursitis.

Fortunately, the shoulder is not a weightbearing joint, so arthritis of the shoulder is not

that common.

In the majority of patients, shoulder conditions respond very well to nonsurgical

treatment methods and surgical intervention is only used as a last resort.

For more information, please review different shoulder conditions and shoulder

treatment options within the patient education section.

David A. Sugar, M.D., FAAOS



The rotator cuff is a name given to a collection of tendons that cross the shoulder joint.

These tendons are responsible for rotation and elevation of the arm. As is the case

with all tendon structures, they are susceptible to developing tendinitis and tears.

Typically when one is having symptoms of rotator cuff tendinitis, it is associated with

some element of bursitis in the area. Symptoms will typically involve pain with

elevation and rotation of the arm and are not necessarily associated with any type of

traumatic event.

In younger population, tears of the rotator cuff are usually associated with a one time

traumatic event, but as we get older, these are typically injury of attrition where the

tendon slowly wears thin and frays and eventually tears over time.

As is the case with many orthopedic conditions, nonsurgical treatment methods are

extremely successful and surgical intervention is infrequently needed to resolve one’s


For more information on the rotator cuff conditions and treatment options, please

review the patient education section.

David A. Sugar, M.D., FAAOS



Sports medicine is the area of orthopedics that predominantly deals with soft tissue

conditions affecting the shoulder, elbow and knee. Although other areas can be

affected, these are usually conditions that are due to overuse or to one-time traumatic

event where tendons, ligaments or cartilages are injured.

These conditions are typically treated with a combination of rest, physical therapy and

occasionally do need surgical intervention to restore someone to their previous level of

function. You may have heard of arthroscopic surgery. Sports medicine is the area of

orthopedics that predominately deals with arthroscopic surgery. These are procedures

where 1/4-inch incisions are made and instruments and a camera are placed through

these and the entire surgical procedure is performed through the small incisions, truly

the definition of minimal invasive surgery.

David A. Sugar, M.D., FAAOS



Carpal tunnel is a condition that affects a nerve that crosses the wrist and enters the

hand. It is typically associated with numbness, tingling, burning and even weakness

and clumsiness of the hands in particular the thumb, index and middle finger.

It can be associated with repetitive activities of the hand and wrist, but certainly does

occur in patients who are not necessarily performing these activities.

Initial treatment consists of rest, bracing and anti-inflammatories.

Occasionally a nerve test will be performed and a surgical procedure where the nerve

is basically released for instant strength.

For more information on carpal tunnel syndrome, its surgical and nonsurgical

treatment, please review the patient education section.

David A. Sugar, M.D., FAAOS



Conditions affecting the knee are very common reason for a visit to an orthopedist’s

office. The knee has a tremendous range of motion as well as many planes of motion.

Because of this, it is subjected to tremendous shear forces, rotational forces,

compressive forces and weightbearing load. This can lead to a large variety of

conditions affecting the knee from sprain, strains, cartilage injuries, ligament and

tendon injuries and arthritis.

Due to the fact that the knee is a weightbearing joint, it is the joint that is most

commonly affected by arthritis.

The types of condition affecting the knee may vary depending on age and activity level

as well as any history of trauma.

For more information on conditions affecting the knee and their treatment option,

please review the patient education section.

David A. Sugar, M.D., FAAOS



Arthritis is a condition that affects the joints of one’s body. All joints are comprised of a

cartilage, which coats the ends of the bone. The cartilage is a soft cushioning material

that not only cushions the joints but allows the joint to have smooth motion.

Overtime, the cartilage slowly wears thin and as it does so it could become chipped,

cracked and rough. This process is arthritis.

As this progresses, it eventually can reach a point where it is causing pain, catching,

inflammation, swelling and stiff joints. The weightbearing joint specifically the knee and

the hip are the joints that are most commonly affected by arthritis.

Initial treatment usually consists of some form of activity modification and antiinflammatories

for symptomatic relief, potential use of supplements and emphasis on a

low-impact program. Occasionally cortisone shots will be used to help relieve the pain,

swelling and stiffness.

There are times however when one’ symptoms become so significant that these

nonsurgical measures are not giving adequate relief and one’s lifestyle is becoming

compromised. It is only the point at which the patient can no longer do things that they

would like to be doing then I recommend any type of surgical intervention.

For more information regarding arthritis, please review the patient education section.

David A. Sugar, M.D., FAAOS