Departments

The Yale Avascular Necrosis & Osteonecrosis program focuses on maintaining joint function in patients with avascular necrosis (AVN), a condition in which bone tissue dies as a result of a temporary or permanent loss of blood supply to the bone. Our patients receive coordinated care across a spectrum of treatments, including 3D surgical planning, regenerative medicine, osteoinductive adjuvants, hyperbaric oxygen treatments, and stem cell therapies. The goal is to provide the best opportunity for patients to maintain their native joints, as well as continuity, if they eventually require total joint replacement. As a leader in AVN treatments, our innovative program merges evidence-based regenerative medicine with novel surgical techniques. AVN and osteonecrosis can be medically complex. Coordination of services is necessary to understand the cause of the disease, evaluate the extent of the necrosis, and prevent further occurrences. Our program directly works with Yale School of Medicine’s Hematology, Oncology, Infectious Disease, Pathology, Radiology, and Alcohol Cessation services to help streamline care for patients and their families. We offer the following treatments for AVN- and osteonecrosis-related conditions: Hip and knee Lesion treatment: We offer a minimally invasive 3D personalized surgery to address AVN of the hip joint. This procedure, developed at Yale School of Medicine by a team of biomedical engineers, aims to improve patient outcomes and reduce the need for total joint replacement. Shoulder lesion treatment: We treat AVN-related shoulder conditions, with the goal of preserving the shoulder joint whenever possible. Our physicians are experts at both traditional and reverse total shoulder replacement surgery as well as minimally invasive techniques to allow patients to return to their normal activities as soon as possible. Foot and Ankle lesion treatment: Our specialists have developed treatment options for AVN of the foot and ankle joints that range from traditional, conservative approaches, such as generic or custom braces, to surgical management, including joint-preserving or -sacrificing procedures. The treatment options are tailored to each patient, depending on the stage and extent of their necrosis. Hand and Elbow lesion treatment: Our Hand & Upper Extremity experts offer treatment for Keinbock’s disease, Hegemann's disease, and Panner's disease. These include custom braces, joint-preserving procedures, and surgical treatments. Our specialists design treatment plans based on each patient’s stage of necrosis to improve functionality and quality of life. Hyperbaric oxygen treatment: Our specialists are recognized experts in the use of hyberbaric oxygen for the treatment of AVN with the femoral head. Our team is able to create individualized treatment plans for patients seeking this procedure. Stem cell treatment: During the procedure, a patient’s bone marrow is harvested, and stem cel

The Division of Hip & Knee Joint Reconstruction is dedicated to providing comprehensive care for patients with hip and knee joint-related issues. Our skilled orthopaedic surgeons use the latest scientific research and innovative surgical techniques to relieve pain and improve joint function, ultimately enhancing the quality of life for our patients. Our specialists treat a wide range of conditions, including: Inflammatory arthritis and degenerative osteoarthritis Avascular necrosis (loss of blood supply to the bone) Congenital and post-traumatic injuries Infections Fractures One of our primary research areas is understanding the outcomes of joint replacement surgeries. By analyzing data from large national databases, we evaluate the effectiveness of different surgical techniques, implant designs, and patient-specific factors. This research helps us improve surgical methods and ensure the best possible care for our patients. We are also focused on developing and testing new biomaterials and designs for implants. Our team collaborates with experts in biomedical engineering and materials science to create better joint replacement options. These efforts aim to improve the durability and compatibility of implants, leading to longer-lasting and more effective treatments. In addition, our division is committed to reducing surgical infections. We study various factors that influence infection rates, including patient characteristics, surgical methods, and perioperative (around the time of surgery) management strategies, to develop ways to minimize these risks. Our tradition of surgical innovation is inspired by the late Dr. Kristaps J. Keggi, who was the first surgeon in the United States to use the Direct Anterior Approach (DAA) for hip reconstruction at Yale in the 1970s. This minimally invasive technique has transformed patient care and remains the gold standard in hip surgery today.

The orthopaedic surgery team is dedicated to improving function in patients of all ages who have been injured, developed a problem such as arthritis, or who were born with a bone or joint problem. Although there are standard ways of treating some of these problems, our team can more precisely address many orthopaedic issues with the use of 3-D modeling and virtual surgical planning using 3-D printed, patient-specific surgical guides. To find out more about this program, please fill out a brief survey . We have orthopaedic surgical specialists who are currently using 3-D technology to correct spinal deformity, post-traumatic mal-unions of long bones, congenital upper and lower limb deformities, complex joint replacement surgery (for hips, knees, shoulders, and elbows) and mal-alignment of joints and bones. We work closely with engineers, radiologists, and cutting-edge medical companies who assist in deploying this technology for our patients. Patients that have complex orthopaedic problems are evaluated by our specialists. If the problem is amenable to treatment with custom 3-D surgical correction techniques, a specialized high-resolution CT or MRI scan is obtained focusing on just the injured side (if only bone models are needed) or of the injured and non-injured analogous body part if virtual surgical planning and intra-operative patient specific guides are necessary. Using the data in the CT or MRI scan, a unique 3-D model is built on the computer using specialized image processing software. The 3-D models are then used to study the deformity/injury in detail prior to the actual surgery. The planning is completed with the surgeon and biomedical engineer working together to manipulate the images on a computer to plan the necessary cuts or bone excision to correct the deformity. Surgeons are able to make certain that the bones are corrected and straight, joints can bend and extend, and muscles and nerves are properly positioned. Patient specific guides are then printed in 3-D for use in the operating room during surgery, so that the virtual model can be replicated in the surgery for precise correction of each patient’s problem. These techniques have been shown to decrease surgical time and blood loss, as well as provide a more precise correction of the problem.

Hip injuries are common in the young athletic population, and conditions such as femoroacetabular impingement (FAI), labral tears, and microinstability are underdiagnosed. Traditional surgical techniques for treatment involved open surgery, but recent advances have allowed for minimally invasive, arthroscopic treatment for many of these conditions. Patients undergoing these arthroscopic hip procedures are able to recover faster and can be managed on an outpatient basis. To find out more about this program, please fill out a brief survey . The Sports Medicine and Hip Preservation Surgeons at Yale are experts in hip arthroscopy for the treatment of common nonarthritic hip conditions, such as femoroacetabular impingement (FAI) and labral tears. Our surgeons are specifically trained in hip preservation and are using cutting-edge arthroscopic techniques, including treatment of cam/pincer impingement, labral repair, labral augmentation, and labral reconstruction surgery. In addition, they are actively involved in advancing the field of hip preservation by conducting nationally and internationally presented research. All hip preservation patients will be evaluated with the latest diagnostic modalities, including high resolution MRI and 3D CT scans to ensure accurate diagnoses and optimized treatment plans. In addition, the latest nonoperative biologic treatments are available, including ultrasound-guided bone marrow aspirate concentrate (BMAC) and platelet rich plasma (PRP) injections. If surgery is necessary, the new state-of-the-art facilities at the McGivney Advanced Surgery Center in New Haven allow our surgeons to provide the highest level of surgical care to our patients. Our surgeons are able to view intraoperative 3D models to execute precise and patient-specific care to provide the best outcomes. Postoperatively, our hip preservation team surgical team works closely with physical therapists on validated and tailored regiments. This collaboration allows for individualized treatment plans to optimize recovery and return to function. The main purpose of the dynamic and multidisciplinary hip preservation team is to help our patients achieve their goals.

Shoulder injuries are common in an active population, as well as in middle-aged and older adults. Structural injuries can range from labral tears, which can cause shoulder instability, to muscle and tendon injuries, such as a rotator cuff tear, resulting in pain and weakness. Traditional, or open, surgery entails repair of the injuries through large skin incisions. Unfortunately, this causes structural damage to the skin and underlying musculature. Advancements in video technology and surgical instrumentation has allowed the surgical procedures to be undertaken through minimally invasive techniques (non-muscle damaging) through “keyhole,” or arthroscopic surgery. While the repaired structures still need time to allow for biological healing, this minimally invasive technique allows for decreased post-surgical pain, which results in a faster recovery and return back to activities of daily living. To find out more about this program, please fill out a brief survey . The Sports Medicine and shoulder surgeons at Yale Medicine are proficient in shoulder arthroscopy and typically utilize arthroscopic techniques for the majority of shoulder surgeries. Open surgery is reserved for specialized indications, such as shoulder replacements and other unique situations. Prior to surgery, our board-certified and fellowship-trained orthopaedic surgeons collaborate with our highly experienced musculoskeletal radiologists, who utilize high-resolution MRI imaging in order to ensure the most accurate structural diagnosis. This allows for a highly individualized and tailored surgical plan. If surgery is necessary, most cases are performed on an outpatient basis at the McGivney Advanced Surgery Center or Greenwich Hospital. At these facilities, patients receive concierge-style care, which allows for as stress-free a surgical experience as possible. Patients are cared for by board-certified and fellowship-trained surgeons and anesthesiologists, physician assistants, as well as highly trained nurses. The facilities at the McGivney Advanced Surgery Center in New Haven and Greenwich Hospital allow our surgeons to provide state-of-the-art, cutting-edge surgical treatments in order to give patients the best potential for maximal recovery. After surgery, our team also works closely with affiliated physical therapists who are well-versed in managing patients in their recovery phase of healing. This collaboration ensures individualized treatment plans, aimed to optimize recovery and return to function.

We are committed to excellence in all areas of musculoskeletal care. Our physicians treat a variety of bone, joint, nerve, and muscle ailments across many orthopaedic specialties. Our physicians work in conjunction with primary care and specialty physicians to treat both common and complex musculoskeletal problems. We're here to help with all aspects of orthopedic care. Whether you are seeking treatment for a minor injury or a serious orthopedic concern, our skilled doctors are experienced in minimally invasive improvements, as well as procedures like joint reconstruction and replacement surgery to help you get moving again. Some of the more common conditions our specialists treat include: Spinal problems, including degenerative conditions, disk herniations, scoliosis, spinal stenosis, fractures, and tumors Shoulder problems, including rotator cuff disease, arthroscopic surgery, arthritis, joint replacement, fractures, and instability Elbow problems, including arthritis, fractures and dislocations, joint replacement, and instability Hand and wrist problems, including arthritis, fractures, arthroscopic surgery, joint replacement, and artery and nerve repairs Pelvis and hip problems, including arthritis, arthroscopic surgery, joint replacement, and fractures Knee problems, including ligament and meniscal tears, arthritis, arthroscopic surgery, joint replacement, and fractures Foot and ankle problems, including tendon and ligament repairs, fractures, arthritis, and joint replacement Pediatric problems, including congenital deformities and fractures Tumor and limb salvage surgery

Patella instability causes a variety of problems ranging from mild shifting or clicking of the patella (kneecap) to frank patella dislocation, chronic disability, trouble with stairs, inability to run, giving way of the knee, complete collapse of the knee, chronic pain, and accelerated arthritis of the knee. Fortunately, many patients with patella instability respond to nonsurgical treatments such as bracing, taping, modification of activities, and physical therapy. The Sports Medicine Division of Yale Medicine Orthopaedics & Rehabilitation provides specialized care for adults and children with patella instability. While nonsurgical options are almost always the first-step recommendation, Yale Medicine’s Patella Instability Program offers the best possible current technology and expertise to enable patients to have a successful return to normal activities. To find out more about this program, please fill out a brief survey . The Patella Instability Program utilizes the highest quality advanced imaging, including magnetic resonance imaging (MRI) and computerized tomography (CT), for patient evaluation, in collaboration with Yale Medicine’s Department of Radiology & Biomedical Imaging. Our Orthopaedic specialists work with the Radiology departments and the Yale School of Engineering to offer a major initiative in three-dimensional (3-D) imaging and printing, such that a patient’s knee can, in certain complex situations, be printed into a 3-D model for detailed analysis and optimal surgical planning. 3-D analysis is particularly important for patients with trochlea dysplasia, a condition in which the femur’s groove for the patella is too shallow and deformed, worsening the patient’s symptoms of patella instability and recurrent dislocation of the patella. Yale Medicine Orthopaedics & Rehabilitation’s Division of Sports Medicine is actively researching the complexities of patellofemoral dysplasia in order to offer every patient the best possible outcome. Our program is also engaged in national and international education of orthopedic surgeons and other care providers about optimal treatment of patella instability patients. When surgery becomes necessary for patients with patella instability, Yale Medicine’s Orthopaedics and Rehabilitation Sports Medicine division offers extensive expertise and long experience. The goal is to minimize surgery whenever possible, but also to recognize when more definitive surgical treatment is necessary. Our surgeons offer over 50 years of cumulative experience with tibial tubercle transfer (TTO or AMZ) and medial stabilization (MPFL or MQTFL) surgery and can manage most patients with these procedures on an outpatient basis at the McGivney Surgery Center, and Greenwich Hospital. The facilities at the McGivney Advanced Surgery Center in New Haven and Greenwich Hospital allow our surgeons to provide state-of-the-art, cutting-edge surgical treatments in order to give patients the best potential f

ACL injuries are common. Approximately 175,000 ACL reconstructions are performed every year in the United States. An ACL tear renders the knee unstable and without surgery most people cannot return to cutting and pivoting types of activity and athletics. Furthermore, a knee with an ACL tear that is not operated on has a significantly higher risk of developing subsequent tearing of the meniscus (cartilage) and degenerative arthritis. For these reasons, most athletically active patients opt to have their ACL reconstructed. Advancements in video technology and surgical instrumentation have allowed ACL operations to be carried out using very minimally invasive techniques. However, not all surgeons are able to offer these cutting-edge techniques as they require the development of new and often more challenging surgical skills that have a steep learning curve and take time to master. Several of our Yale Sports Medicine surgeons are involved in the teaching of these techniques at courses offered throughout the U.S. To find out more about this program, please fill out a brief survey . The surgical faculty are all fellowship-trained and board-certified in Orthopaedic Surgery and the majority are sub-specialty board certified in Orthopaedic Sports Medicine. The team also includes a number of renowned musculoskeletal radiologists who we routinely consult and collaborate with on all aspects of imaging, including plain X-ray, CT scan, and high-resolution MRI. Our anesthesia colleagues are experts in the most up-to-date regional anesthesia techniques so that post-operative pain is kept to a minimum. Experienced and skilled physical therapists also play a critical role on our team. Utilizing the most current machinery and “return to sport” assessment tools, they help us determine when patients are ready to get back into the game. A team of orthopaedic physician assistants, skilled nurses, and athletic trainers round out our comprehensive and compassionate approach to care. ACL reconstructive surgery involves “replacing” the torn tissue with a tendon either from the patient’s body (called an autograft) or from a cadaver (called an allograft). Traditionally, the two most common autografts used in ACL reconstruction have been the bone-patellar tendon-bone graft and hamstring tendons autograft. Recently, the use of the central third of the quadriceps tendon (from the front of the knee) has become more popular, and surgeons in our program are now utilizing this graft on a routine basis for ACL reconstruction. The quadriceps tendon graft is robust and very strong and has a lower incidence of some of the more common complications seen with other graft sources such as anterior knee pain and numbness about the knee. While use of the quadriceps tendon still only represents approximately 11% of all ACL operations, our Sports Medicine division is on the vanguard of this movement as we strive to offer our patients what we feel is the best possible treatment for their cond

The treatment of cartilage injuries remains one of the most difficult challenges in medicine. The Cartilage Repair & Restoration Program brings together world-renowned scientists and physicians to meet this challenge. Our team is dedicated to providing patients with the most advanced and effective treatments for knee meniscus and articular cartilage injuries of the knee and elbow. Our research helps shape the future of cartilage repair and regeneration, with the hope that our patients will benefit from it. We offer the best possible current technology and expertise to enable patients to have a successful return to normal activities. To find out more about this program, please fill out a brief survey . There are two types of cartilage in the body—the meniscus cartilage (the most common example is the shock absorbers of the knee) and articular cartilage, which covers the bones in joints like the knee and elbow to allow smooth joint motion. In cases of extreme or extensive articular cartilage wear, patients develop osteoarthritis and may require a joint replacement. In young and active patients, cartilage injuries or defects can do more than just limit activities due to pain and swelling. If left untreated, these injuries can lead to more serious disability and, in severe cases, arthritis and possible joint replacement. Currently, procedures to repair articular cartilage are not designed to treat the extensive cartilage loss seen in osteoarthritis. However, there are procedures that are highly effective in the treatment of cartilage defects in a particular location, such as those associated with acute injury. In the case of extensive meniscus tissue loss in the knee, however, there are options for treatment such as meniscus allograft transplantation or osteotomy or even non-operative treatments such as the use of unloader braces. Not every patient is a suitable candidate for cartilage restoration or meniscus transplant surgery. These procedures are ideal for active people under age 50. Our experienced providers will assess each patient’s condition and help them make an informed decision. Our Sports Medicine Surgeons are fellowship trained and have expertise in meniscus transplant, osteochondral autograft and allograft procedures, and 2nd and 3rd generation cartilage restoration procedures. The Cartilage Repair & Restoration Program utilizes the highest quality advanced imaging, including magnetic resonance imaging (MRI) for patient evaluation, in collaboration with Yale University’s Department of Radiology & Biomedical Imaging to determine the size and extent of cartilage injury to optimize patient treatment and surgical planning. When surgery becomes necessary for patients with cartilage and meniscus injury, our program offers extensive expertise. Not all surgeons are able to offer “cutting-edge” technology in cartilage restoration, as it entails development of new and sometimes more challenging surgical skills that can re

We provide diagnostic treatment and rehabilitation for individuals with degenerative and inflammatory arthritis. Our team’s primary goal is to relieve patients of their pain, restore their function, and improve quality of life. Our orthopaedic surgeons are experts in primary and revision joint care and reconstruction surgeries. We also provide comprehensive services for patients who require primary and revision joint reconstruction. Our physicians guide patients every step of the way, from diagnosis and treatment options to postoperative care and physical therapy. Our team offers the following specialized services: Hip and knee replacement Primary and revision surgery Arthroscopic procedures