ACL Injuries

ACL-Injury-300dpi-illustrationThe ACL connects the shinbone (tibia) to the thighbone (femur) and acts as a stabilizer to help prevent the shinbone from sliding forward beneath the thighbone. When the knee undergoes a severe twist or excessive pressure, the ACL can tear causing the knee to give out. With a ruptured ACL, the knee can feel wobbly and may easily become unstable by the sudden planting or pivoting on the leg. The ligament is like a tightly-braided rope and when torn, is not repairable, even when the tear is partial.

Each year, at least 1 in 3,000 Americans between the ages of 14 and 55 tear an anterior cruciate ligament while exercising or playing sports. Skiers, and basketball, soccer and football players are more likely to rupture their ACL, although risk for this injury in not limited to a particular level of athlete or age group.

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Cartilage Injuries – Meniscal Tear

The meniscus is the cartilage in the knee that serves as a shock absorber and stabilizer. A wedge-shaped, rubbery cushion in the form of the letter “C”, the menisci help distribute the weight of the body evenly across the knee joint. Damage to the meniscus often happens during a ligament tear.

Symptoms of a meniscus tear include:

  • Knee pain, stiffness or swelling
  • Tenderness in the joint line
  • Popping or clicking in the knee
  • Reduced mobility in the joint
  • A sense the knee may “give out”

Meniscus Repair

When a meniscus tear becomes symptomatic and interferes with daily activities, surgery may be considered. The surgeon can trim or remove the damaged pieces of the cartilage or sew the damaged pieces together.

Depending on the age and condition of the patient and the severity of the injury, a cartilage transplant to repair damaged meniscus may be an option.


Illustrations are reproduced with permission from Fischer S, (interim ed): Your Orthopaedic Connection. Rosemont, IL, American Academy of Orthopaedic Surgeons. Available at

Common Knee Conditions

Baker’s Cyst

A Baker’s cyst may occur in the back of the joint, and is usually an indication of another problem such as a meniscus tear.


Osgood-Schlatter Disease

Osgood-Schlatter Disease is a common condition in adolescents who are very active in sports. The condition is characterized by pain, swelling and enlargement of the tubercle, the raised area just below the kneecap. Osgood-Schlatter is caused by irritation of the growth plate just at the front of the joint.

Hip Arthritis

normal hip - CopyAlso known as degenerative or “wear and tear” arthritis, osteoarthritis of the hip typically occurs in adults aged 45 and older, when the cartilage that cushions the joint breaks down and eventually wears away. Characterized by pain and stiffness, severe cases can be profoundly debilitating.

Arthritis frequently occurs in individuals who have a family history of the disease and sometimes develops due to subtle irregularities in how the hip developed at an early age. Hip arthritis is more common in patients who are obese. Other factors that may contribute include trauma to the hip and fractures in the bone but many people get hip arthritis who have no risk factors.

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Hip Bursitis

A “bursa” is a fluid-filled sac and functions as a cushion between bones and the overlying soft tissues.hipbursitis It helps minimize friction between the gliding muscles and the bone. Bursitis is a common problem that causes pain and inflammation on the outside of the joint each time the tendon moves over the bone bursa. Symptoms include tenderness over the upper/outer thigh and swelling over the bursa.

Hip bursitis may be brought on by a number of factors including repetitive use, injury to the point of the hip or bone spurs. It is often associated with athletes who participate in running-oriented sports like jogging, soccer, football, etc.) and athletes who have experienced a fall. However in many cases, there is no identifiable cause.


The main symptom is pain in the outside of the thigh that may initially be characterized as sharp and intense. Later on, the pain may feel more achy and spread out. The pain is often worse at night, when lying on the affected hip and when standing up from a chair after being seated for a while. Prolonged walking, stair climbing or squatting may also bring on pain.

Treatments for Hip Bursitis

Hip Fracture

Hip fractures are a serious problem for elderly patients with osteoporosis. A hip fracture is usually a break near the top of the thighbone (femur) where it angles into the hip socket and usually makes it too painful to stand. In most cases, hospitalization and surgery are required to either replace the broken portion or repair it with a metal plate and screws. A hip replacement may be required depending on where the break occurs.

After surgery, treatment focuses on getting the patient back on their feet again as soon as possible, while the broken bone heals. A physical therapy program is an important factor for a good recovery.

Illustration reproduced with permission from Fischer S, (interim ed):

Your Orthopaedic Connection. Rosemont, IL, American Academy of Orthopaedic Surgeons. Available at

Hip Impingement

hip impingement 1Not all chronic hip pain is due to arthritis. Hip impingement, also known as femoroacetabular impingement (FAI), can cause significant pain in the groin during sports activity, as well as during daily routines like getting dressed, climbing stairs, and even sitting comfortably in a chair.

Hip impingement tends to occur in active young adults, and especially athletes. It is a painful and often unrecognized condition that involves a tear in the labrum. The problem may occur for various reasons, including the way the bones are formed at a young age, causing bone spurs to develop that pinch the labrum and damage the joint cartilage.

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Knee Replacement Surgery

knee anatomyThere are several different treatment options for knee arthritis. Each patient is unique and some will respond to certain treatments better than others. It is usually best to begin with the most conservative treatments.

If conservative treatments for arthritis pain stop being effective and simple activities such as walking or climbing stairs become difficult or impossible, total knee replacement may be an option. In this procedure, the cartilage and bone surface is removed and resurfaced with a metal and plastic implant.

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MCL Injuries

MCL TearThe medial collateral ligament (MCL) connects the thighbone to the shinbone and helps stabilizes the inner side of the knee. A blow to the outside of the knee may cause injury to the MCL which may be accompanied by sharp pain on the inside of the knee.

Conservative treatment is usually effective if the medial collateral ligament (MCL) has a small partial tear: RICE: Rest, Ice, Compression, Elevation. Physical therapy and an exercise program are usually recommended to promote healing and restore knee strength.


Osteonecrosis, or avascular necrosis of the hip, is a disabling condition that can lead to the collapsing of the hip joint. The condition occurs when the blood vessels gradually cut off nourishment to the top of the thighbone (femur) where it fits in the hip socket. This can be a very painful problem, causing arthritis and the development of a limp. When one hip gets osteonecrosis, the second hip will also be prone to the disease.

A condition that usually occurs in people ages 20 to 50 years, the initial symptoms of osteonecrosis may include a dull ache or throbbing pain in the side of the hip, in the groin or buttock.

Treatment for Osteonecrosis

Total hip replacement surgery is often the best option to eliminate pain and restore hip mobility. An artificial ball and socket replaces the joint.

PCL Injuries

knee anatomyThe posterior cruciate ligament (PCL) is located in the back of the knee connecting the thighbone (femur) to the shinbone (tibia) and prevents the shinbone from moving too far backward. It provides stability and helps control movement in the knee.

Players of contact sports like football or soccer are most prone to a PCL injury. The PCL can tear when the athlete receives a blow to the front of the knee or makes a misstep on the field.

Symptoms of a PCL Tear

  • Immediate swelling around the knee
  • Difficulty walking
  • Pain with mobility
  • Occasionally, a feeling of instability

Minor PCL tears should be treated with RICE: rest, ice, compression and elevation. Anti-inflammatory drugs may also be recommended. When the swelling subsides, a physical therapy program is usually undergone to strengthen the quadriceps muscle and regain range of motion. In some cases where the PCL is completely torn, arthroscopic surgery may be done to repair the ligament using a portion of the patellar tendon or a cadaver tendon.

Arthritis of the Knee

OsteoarthriticKnee copyOsteoarthritis of the knee is one of the most common sources of knee pain and typically affects patients over 50 years of age. The disease is a degenerative condition characterized by the gradual wearing away of the joint cartilage.

Knee arthritis is often caused by being overweight. It may also be caused by trauma to the knee, a meniscus tear, ligament damage, fractures to the bone or a genetic predisposition. Degenerative changes in the joint may also be caused by rheumatoid arthritis, a systemic inflammatory form of arthritis.

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James G. Cunningham, MD

James G. Cunningham, MD is an orthopedic surgeon who specializes in sports medicine. His practice focuses on adolescent sports medicine, knee and shoulder surgery. Dr. Cunningham graduated from Manhattan College and attended medical school at New York University. He completed his residency for orthopedic surgery at Mount Sinai Hospital in New York City and his fellowship in sports medicine at New England Baptist Hospital in Boston, Massachusetts. Dr. Cunningham has served as team physician for Greenwich High School athlete teams for over 20 years and for the Iona Preparatory School for 10 years. He is board certified in sports medicine by the American Board of Orthopaedic Surgery.

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Demetris Delos, MD

Demetris Delos, MD

Dr. Delos earned his medical degree at Weill Medical College of Cornell University in New York.  He did his internship and residency in orthopedics at Hospital for Special Surgery (HSS) /New York-Presbyterian Hospital. He completed a research fellowship at the HSS Laboratory for Soft Tissue Research prior to a surgical fellowship in Sports Medicine and Shoulder Surgery also at HSS, where he was Chief Administrative Fellow. He served as Assistant NFL Team Physician for the New York Football Giants and also as team physician for a number of local high school and college athletes.

Dr. Delos’s practice focuses on sports medicine and arthroscopic treatment of knee and shoulder disorders including knee preservation surgery, knee replacement, surgery for shoulder instability and rotator cuff repair. He has a specific interest in the comprehensive care of athletic knee disorders including meniscus, ligament, and cartilage injuries. His practice incorporates the latest operative methods including meniscal preservation and transplantation, ACL and multiple ligament knee reconstruction and repair surgery, osteotomies to realign joints, and cartilage repair and restoration.

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Frank A. Ennis, MD

Dr. Frank Ennis specializes in hip and knee replacement, hip arthroscopy, complex revision arthroplasty of the hip and knee, and treatment of complications from hip fractures. He is fellowship-trained in adult reconstructive surgery.  Dr. Ennis is a staff orthopedic surgeon at Greenwich hospital and was among the first orthopedic surgeons in the New York Metropolitan area to do computer-assisted surgery for total knee and hip replacement. This cutting edge technique uses computerized navigation to guide the surgeon which may improve the accuracy of joint replacement surgery.

After completing undergraduate studies at Yale University and post-baccalaureate pre-medical studies at Harvard University, Dr. Ennis graduated from Duke University School of Medicine. He completed his residency at Yale University Department of Orthopaedic Surgery. He completed Fellowship training in adult reconstructive surgery at New England Baptist Hospital in Boston.

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Tim Greene, MD

Tim Greene, MD is an orthopedic surgeon who is fellowship trained in sports medicine and hip arthroscopy, a technique that has revolutionized the treatment of various hip problems. Dr. Greene graduated Princeton University and earned his medical degree at the Medical College of Georgia. He performed a residency in orthopedics at Emory University and served as associate team physician to the athletic teams at Georgia Tech.

Dr. Greene completed fellowship training at the Steadman Hawkins Clinic in Vail, Colorado under the direction of Dr. Marc Philippon. While there, he served as associate team physician for the U.S. Ski Team.

Dr. Greene’s interest in sports medicine derives from his ongoing personal interest in sports. In college at Princeton University, he played varsity football, served as team captain and earned numerous awards for outstanding athletic achievement.

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