Dr. Sabrina Strickland

We recently conducted a study to identify clinical and radiographic risk factors for medial patellar facet lesions in patients without a history of trauma or patellar instability. Our hypothesis was that a posterior tibial tubercle relative to the trochlear groove would be a risk factor for atraumatic medial patellar facet lesions.

While medial patellar facet lesions have been well-described in the setting of patellar instability, relatively little is known about risk factors for atraumatic medial patellar facet lesions. Read more in the Orthopaedic Journal of Sports Medicine article, “Risk Factors for Atraumatic Medial Patellar Facet Lesions (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11179489/pdf/10.1177_23259671241255681.pdf).”

Image from the article: Figure 5. (A) Measuring tibial tubercle-trochlear grove (TTTG) (millimeters) on axial magnetic resonance imaging (MRI) scan.

Dr. Sabrina Strickland - Orthopedic Surgeon in New York Dr. Sabrina Strickland, an Orthopedic Surgeon in New York & specializes in sports medicine—focusing on knees & shoulders to return you to your active lifestyle.

In November, I joined Dr. Scott Sigman on The Ortho Show, where we discussed the BEAR Implant among other things. Dr. Sigman introduced me as an orthopedic surgeon and sports medicine specialist at HSS, the Hospital for Special Surgery. I've dedicated my professional life to the patellofemoral joint, working to advance the technology and research that's has gone into repairing the patellofemoral joint and anterior cruciate ligaments (ACLs) to help patients return to their active lifestyle.

Listen to the podcast Dr. Sabrina Strickland – Orthopedic Surgeon, Sports Med Specialist, and Patellofemoral Joint Expert on The Ortho Show. It's entertaining and you can get to know me a bit better through my conversation with Dr. Sigman. Here's the direct link: https://podcasts.apple.com/us/podcast/dr-sabrina-strickland-orthopedic-surgeon-sports-med/id1478466659?i=1000634121815

Dr. Sabrina Strickland - Orthopedic Surgeon in New York Dr. Sabrina Strickland, an Orthopedic Surgeon in New York & specializes in sports medicine—focusing on knees & shoulders to return you to your active lifestyle.

I first became interested in this new product from Hyalex Orthopaedics (now available as an FDA trial) after I demoed the HYALEX product at the American Orthopaedic Society for Sports Medicine (AOSSM) Sports Meeting two summers ago.

Now that the trial has started and several have been implanted successfully, I am even more excited about the prospects of having a synthetic cartilage replacement option for patients.

For more information about this trial, check out the press release: Hyalex Orthopaedics Reports Treatment of First Patients with Novel HYALEX® Knee Cartilage System (https://www.prnewswire.com/news-releases/hyalex-orthopaedics-reports-treatment-of-first-patients-with-novel-hyalex-knee-cartilage-system-302122967.html).

Dr. Sabrina Strickland - Orthopedic Surgeon in New York Dr. Sabrina Strickland, an Orthopedic Surgeon in New York & specializes in sports medicine—focusing on knees & shoulders to return you to your active lifestyle.

People frequently comment on my videos about how helpful it is to see someone else's story. This is the story of Peyton, who was a dancer from age four on. Her injury was fairly unusual - she was born with her knee caps too high, so the stress was going through the top of her patellar tendon and her fat pad instead of through her knee cap.

This meant we really had to do an operation to fix it - it wouldn't heal on its own or with physical therapy. So we did a tibial tubercle osteotomy and I distalized it, moving her kneecap down to take the stress off her patellar tendon and fat pad. She's done amazingly well, which is really important - but it's also important for others to see that they don't have to be in pain and they can get back to doing what they love.

Watch Peyton's story: https://www.youtube.com/watch?v=Nz1we0JpCGo

Dr. Sabrina Strickland - Orthopedic Surgeon in New York Dr. Sabrina Strickland, an Orthopedic Surgeon in New York & specializes in sports medicine—focusing on knees & shoulders to return you to your active lifestyle.

One of my patient stories gets a lot of questions — Liam’s story about his medial patellofemoral ligament reconstruction. It’s a great one because it really shows how important the recovery process is in terms of getting back to your active lifestyle — in Liam’s case, he had surgery in both knees, but after following my post-op protocols, he was able to return to playing hockey. It takes time to return to your full strength, but once you do, you really can get back to an active sport like hockey.

Clearly, Liam’s story resonates with others who are worried about what to expect, like this commenter:

"I have an upcoming medial patellofemoral ligament (MPFL) surgery. How much time will I have to wait until I can start (slowly) moving again?"

My response: After MPFL surgery, you can weight bear immediately and bend your knee when sitting. Usually you can get back to nearly full activity in four months if you are strong going into the surgery.

While most of the questions center around how quickly you can return to full activity, some people wonder about using a brace while others just want to learn more about what’s involved in the procedure.

Watch Liam’s story here: https://www.youtube.com/watch?v=Xhef-M3R7OM and read other frequently asked questions (and my answers) https://sabrinastrickland.com/about-dr-sabrina-strickland/frequently-asked-questions/.

Dr. Sabrina Strickland - Orthopedic Surgeon in New York Dr. Sabrina Strickland, an Orthopedic Surgeon in New York & specializes in sports medicine—focusing on knees & shoulders to return you to your active lifestyle.

One common question patients ask me is how Cartiheal compares to osteochondral allograft transplantation (OCA) and matrix-associated autologous chondrocyte implantation (MACI). Here’s a high level answer:

Cartiheal is approved in patients with degenerative cartilage lesions; I think it is a good option in those with bone edema or a bone/cartilage lesion, especially in those over 35. Matrix-associated autologous chondrocyte implantation (MACI) is indicated for repair of single or multiple cartilage defects and requires two operations.

Osteochondral allograft transplantation (OCA) is for a single focal lesion that is greater than two square cm. It heals more quickly than MACI and requires donor tissue. There is a lot of overlap in their indications.

Have other questions? Please reach out to my office or check out my most commonly asked questions and answers: https://sabrinastrickland.com/about-dr-sabrina-strickland/frequently-asked-questions/

Dr. Sabrina Strickland - Orthopedic Surgeon in New York Dr. Sabrina Strickland, an Orthopedic Surgeon in New York & specializes in sports medicine—focusing on knees & shoulders to return you to your active lifestyle.

Here at the Arthroscopy Association of North America speaking about Patella and Cartilage surgery.

Interested? Join me and my colleagues!

Join me at the Moximed reception this Thursday night, May 9, at AANA. As an early adopter of the MISHA Knee System, I will share my insight. Dennis Crawford, MD, PhD, David Flannigan, MD, Andreas Gomoll, MD, and Sabrina Strickland, MD will also be participating.

RSVP at https://moximedaanareception.rsvpify.com/

Arthroscopy Association of North America Dr. Sabrina Strickland David Flanigan MD Dr. Andreas Gomoll

We are constantly evaluating our patients after cartilage transplants to assess their progress, both as far as pain relief and a return to activity. Furthermore, we look at MRIs to see the cartilage repair quality as well as how the bone is responding post-operatively.

In this study, we looked at matrix-induced autologous chondrocyte implantation (MACI). This is a type of cartilage repair using one’s own cartilage (grown outside the body onto a collagen membrane) to repair defects in the front of the knee (patella and trochlea).

What we discovered was that a radiologic scoring system was able to predict good outcomes down the road. None of the techniques we have at present work all of the time as we rely on many factors, such as the ability of cells to produce matrix and mature over time.

Learn more about this study in Sage Journals: Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) Scores > 55 at 6 Months Postoperative Predict Ability to Achieve Patient Acceptable Symptomatic State at Minimum 1 Year Postoperative Following Autologous Chondrocyte Implantation for Grade IV Chondral Defects About the Patellofemoral Joint (link is https://journals.sagepub.com/doi/full/10.1177/19476035241244491?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org)

The image is a screenshot of the MOCART scoring system.

Dr. Sabrina Strickland - Orthopedic Surgeon in New York Dr. Sabrina Strickland, an Orthopedic Surgeon in New York & specializes in sports medicine—focusing on knees & shoulders to return you to your active lifestyle.

This study looked at where the patellar attachment healing actually occurs after surgery for patients who have patella alta or high patellas. We assessed on MRI where the attachment site of the distal aspect of the patellar tendon attached and found that it healed closer to the knee joint, which is exactly what we were hoping for.

Reducing the effective length of the tendon means that there is less excursion of the patella and hopefully this results in greater stability.

Read more in the Orthopaedic Journal of Sports Medicine: Decreased Effective Patellar Tendon Length following Distalization Tibial Tubercle Osteotomy without Patellar Tendon Tenodesis: https://journals.sagepub.com/doi/10.1177/23259671241227201

Image source: Wikimedia Commons: https://commons.wikimedia.org/wiki/File:PatellaAlta_XRay_B.png

Dr. Sabrina Strickland - Orthopedic Surgeon in New York Dr. Sabrina Strickland, an Orthopedic Surgeon in New York & specializes in sports medicine—focusing on knees & shoulders to return you to your active lifestyle.

It's important to share patient stories because I often hear from patients that their local doctors were unable to help. Here's Rhonda Petti's story of paratenonitis and the double partial knee replacements that got her back in the game:

"I sought out HSS for severe osteoarthritis in my knees since no doctor local to me would help me due to my young age. Loved Dr. Strickland from the moment I met her and she said she could help me. I had a double partial knee replacement in January 2015 and have not regretted it one bit. Dr. Strickland and everyone else at HSS were amazing, from the OR nurses to the nurses on staff. Prior to my surgery I could not walk up and down stairs or enjoy a walk with my husband. I am flying up and down those stairs and go for frequent walks now-pain free!!"

Read the rest of her story on the Hospital for Special Surgery's Back in the Game section: https://backinthegame.hss.edu/story/rhonda-petti/

We continue to do research and find new ways to help our patients so we can get more people back to their active lifestyle.

Dr. Sabrina Strickland - Orthopedic Surgeon in New York Dr. Sabrina Strickland, an Orthopedic Surgeon in New York & specializes in sports medicine—focusing on knees & shoulders to return you to your active lifestyle.

We are constantly trying to improve the outcomes of cartilage repair, as I mentioned in a previous post. In this study, we looked at the MRIs of patients who had undergone osteochondral allograft transplantation to their knee.

We measured the area of edema or increased bone signal on MRI and then correlated it with failure rates. What we noticed is that patients with a larger area of edema on MRI had a 50% rate of graft failure, whereas patients who had smaller areas of edema had no failures.

While this study does not tell us how to change things to improve outcomes, it is useful that we have data based on MRI exams that predict failure. We can also look at interventions that improve outcomes in these patients.

Read more about the research in Arthroscopy: The Journal of Arthroscopic and Related Surgery (https://www.arthroscopyjournal.org/article/S0749-8063(24)00013-6/abstract)

Dr. Sabrina Strickland - Orthopedic Surgeon in New York Dr. Sabrina Strickland, an Orthopedic Surgeon in New York & specializes in sports medicine—focusing on knees & shoulders to return you to your active lifestyle.

Many of us have watched the TV series Dopesick and have been impacted in one way or another by the opioid epidemic. I was a resident in the 1990s when pain was considered a vital sign and it was considered malpractice to not prescribe tremendous amounts of narcotics.

Fast forward 20 years and many pharmacies flat out refuse to fill opioid prescriptions for patients. This study showed that ACL patients really only need a few doses of narcotics after surgery. Indeed, 83% of the patients prescribed 15 tablets felt that they had enough or too many.

We will continue to fine tune how we treat post-operative patients as patients have different tolerances to narcotic pain medications. Studies such as this are quite helpful to practice.

Read the Healio article: Lower opioid quantity did not impact pain control, satisfaction after ACL reconstruction (https://www.healio.com/news/orthopedics/20240206/lower-opioid-quantity-did-not-impact-pain-control-satisfaction-after-acl-reconstruction)


Image source: https://www.rawpixel.com/image/6041970

Dr. Sabrina Strickland - Orthopedic Surgeon in New York Dr. Sabrina Strickland, an Orthopedic Surgeon in New York & specializes in sports medicine—focusing on knees & shoulders to return you to your active lifestyle.

There is so much negative press about pickleball. How about how great pickle ball is as far as getting sedentary people out on a court and working out? How about it’s cardiovascular benefits? How about the social benefits of meeting friends and playing a sport?

This article talks about the bone fracture risks of pickleball — but I think that we should focus on the benefits, not the risks. As far as injury prevention goes, I would suggest that the surgeons interviewed for this article are correct. Patients should be screened for osteoporosis and learn the sport. However, the most important factor to injury prevention is to cross train and weight lift to improve balance and bone strength to optimize performance for any cutting sport.

Read the article: "Pickleball-related injuries are on the rise, doctors say" (link: https://www.nbcnews.com/health/health-news/pickleball-injuries-rising-bone-fractures-rcna137044)

Photo by Ben Hershey on Unsplash: https://unsplash.com/photos/a-yellow-tennis-ball-sitting-on-top-of-a-racket-J0OKd9h_aLQ

Dr. Sabrina Strickland - Orthopedic Surgeon in New York Dr. Sabrina Strickland, an Orthopedic Surgeon in New York & specializes in sports medicine—focusing on knees & shoulders to return you to your active lifestyle.

Engineered cartilage, it sounds perfect! I can’t wait. This report out of Boston Children’s Hospital discusses research aimed at growing cartilage in a lab to treat patients with cartilage defects.

Current treatments involve doing a two stage surgery to take cartilage cells from a patient, grow those cells on a collagen membrane, and then implant it. The upside is that one receives their own cartilage cells. The downside is that they have two surgeries and they have to wait for those cartilage cells to “grow” and produce new matrix to protect their joint.

I anxiously await new technologies for cartilage repair.

Read more about the new research in this article, "Engineered cartilage could turn the tide for patients with osteoarthritis"
https://answers.childrenshospital.org/engineered-cartilage-research/

(Photo from the article: Michael Goderre, Boston Children’s, Cartilage tissue generated from pluripotent stem cells.)

Dr. Sabrina Strickland - Orthopedic Surgeon in New York Dr. Sabrina Strickland, an Orthopedic Surgeon in New York & specializes in sports medicine—focusing on knees & shoulders to return you to your active lifestyle.

This article in The Cut is actually a very accurate review of an ACL injury. I wish every patient who googled ACL tears came up with an article that is so well written. This author reviews why ACL tears are so common, who tends to tear their ACL, what the surgery entails, and most importantly, the recovery. I also like that this article discussed how functional some patients can be without an ACL. While this isn’t an option for many patients, it is a reasonable option for some, especially someone who has failed several reconstructions.

For more details, read the article Why Is Tearing Your ACL So Devastating?
https://www.thecut.com/article/torn-acl-symptoms-treatment-recovery.html

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Dr. Sabrina Strickland - Orthopedic Surgeon in New York Dr. Sabrina Strickland, an Orthopedic Surgeon in New York & specializes in sports medicine—focusing on knees & shoulders to return you to your active lifestyle.

Recently, I came across this excellent infographic and description of anatomic risk factors for patellofemoral joint instability in Cureus.

I spend all day drawing pictures for patients and explaining the risk factors for patellar instability. It’s complicated, that’s for sure! When it comes to sorting out which surgery is required for patellar instability, it comes down to how significant a patient’s anatomic pathology is and what is easily modifiable. Here are a few things to keep in mind:

1. The MPFL is always torn or stretched after a patellar dislocation, so if a patient requires surgery then we reconstruct the MPFL.

2. For patients with elevated TTTG or lateralized tibial tubercles, we consider a tibial tubercle osteotomy to realign the extensor mechanism.

3. Many of these patients suffer from patella alta, which increases the contact stress on the inferior patella and proximal fat pad. This also may lead to patellar instability as the patients must flex their knee more in order to engage the patella in the trochlear groove. In these patients, we may need to distalize or move the patellar tendon attachment more distal in order to change the contact forces or increase the arc of motion in which the patella sits in the trochlear grove.

4. Some patients suffer from severe trochlear dysplasia in which the front of their knee has significant pathology or malformation of the bone. Occasionally, these patient may benefit from trocheoplasty to reshape the groove, which is a difficult surgery fraught with complications. It ultimately results in a “square peg in a round hole” as one doesn’t reshape the patella. This is a complicated issue and it takes a lot of thought to sort out these problems.

Take a look at the article and accompanying infographic to get more detail: Anatomic Risk Factors for Patellofemoral Joint Instability: An Infographic as a Visual Learning Tool: https://www.cureus.com/articles/223298-anatomic-risk-factors-for-patellofemoral-joint-instability-an-infographic-as-a-visual-learning-tool #!/
The header image is a clip of the full infographic, but you should check out the full image.

Dr. Sabrina Strickland - Orthopedic Surgeon in New York Dr. Sabrina Strickland, an Orthopedic Surgeon in New York & specializes in sports medicine—focusing on knees & shoulders to return you to your active lifestyle.

Driving to Kitzbuhel for a few days of skiing before speaking at the Open Medical Institute in Salzburg, Austria on ACL, Patellar instability and Patellofemoral Cartilage Pathology and Arthritis. Photos do not do the Alps justice. The scenery here is incredibly beautiful and at the top of nearly every chairlift we literally had 360 degree views of the mountains.

When I discuss cartilage repair surgery with patients, I typically go through a multitude of different options, such as cell-based repair such as MACI (one’s own cartilage grown onto a scaffold) versus donor cartilage (osteochondral allograft) versus denovo (donor cartilage fragments).

The risks and benefits of each are more or less the same in that it doesn’t always work.

Sometimes the cartilage cells don’t grow and fill the defect with extracellular matrix and sometimes the donor cartilage does not survive or heal. We are constantly looking to optimize this surgery by looking at outcomes based on anatomical factors and patient characteristics.

In this study on Wiberg patellar type, I showed that the shape of the kneecap (patella) does not influence outcomes of cartilage transplantation with cell based therapy. At least this is one factor that we can ignore.

Read the full article in Sage Journals: https://journals.sagepub.com/doi/10.1177/03635465231220028?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

Case courtesy of Samir Benoudina, Radiopaedia.org. From the case rID: 40376
https://radiopaedia.org/cases/patellar-shape-wiberg-classification-1?lang=us

Dr. Sabrina Strickland - Orthopedic Surgeon in New York Dr. Sabrina Strickland, an Orthopedic Surgeon in New York & specializes in sports medicine—focusing on knees & shoulders to return you to your active lifestyle.

I have been aware of the LIFT implant device for a few years but was excited to see a publication recently about its early results in Europe. Now the FDA has granted it breakthrough device status and we are optimistic that an FDA trial will be starting soon.
This minimally invasive surgery will involve implanting a small device or spacer to elevate the patellar tendon in patients with anterior knee pain due to patellar cartilage lesions and arthritis.
Read more in Healio: ZKR Orthopedics receives FDA breakthrough device designation for LIFT implant at https://www.healio.com/news/orthopedics/20231215/zkr-orthopedics-receives-fda-breakthrough-device-designation-for-lift-implant

I’m not exactly sure how 3D printing can help rehabilitate patients with patellofemoral instability — but I’m excited to learn more. While as surgeons we can change certain aspects of a patient’s anatomy, we still rely on the physical therapists to help our patients improve their strength and mechanics.

I still remember seeing a lecture by the famous physical therapist, Jenny McConnell, from Australia back in 2015. Her videos of patients with patellar instability before and after rehabilitation were truly incredible. A team-based approach to these patients is ideal but not always possible. Nevertheless, I will follow this research closely.

Read the original article in Healio: "BLOG: Realigning rehabilitation of patellofemoral instability with novel technology"
https://www.healio.com/news/orthopedics/20231207/blog-realigning-rehabilitation-of-patellofemoral-instability-with-novel-technology

Patients often present to the office when their knee pain starts to affect their sleep. I looked at this LIVESTRONG article with interest but quickly found that I disagreed with most of the information.

Perhaps this is why “Doctor Google” isn’t always so great. However, the topic is a good one.

Why does knee pain often get worse at night and what is causing it?

1. At night, your body has less distractions, so you are more likely to notice mild pain
2. You are active all day and inflame your knee, so naturally it is at its worst at night
3. Circadian variations in hormones, such as cortisol, may affect inflammation
4. Unstable flaps of cartilage or meniscus may be more symptomatic when you aren’t putting weight on your leg

If your knee pain is keeping you up at night, see a doctor and get X-rays at a minimum. The solution often is a physical therapy and/or cortisone or hyaluronic acid injections — but in some cases cartilage repair, meniscal surgery or partial or total knee replacement is the answer.

The complete article is available at Livestrong.com, but as I mentioned, it doesn’t have the best information: https://www.livestrong.com/article/13778919-knee-pain-at-night/



The image was created with ChatGPT

Dr. Sabrina Strickland - Orthopedic Surgeon in New York Dr. Sabrina Strickland, an Orthopedic Surgeon in New York & specializes in sports medicine—focusing on knees & shoulders to return you to your active lifestyle.

My experience taking care of well over 1,000 ACL injuries indicates that snowboarding is pretty safe for you, at least as far as ACL tears go. This paper surveyed professional snowboard cross athletes and their data was very interesting. First of all, I was right, skiers are far more likely to tear their ACL. One study quoted 17% ACL injury in skiers versus 1.7% in snowboarders.

However, snowboard cross is far more dangerous. Here is a summary of this study:
[66 competitive snowboardcross athletes responded to the email surveys, 48.5% of respondents had torn their ACL at least once in their career. (female respondents, 55.6% suffered at least one ACL tear,43.6% of male respondents) 31.2% suffered more than one ACL tear during their career. Of those who tore their ACL, 91.3% (p

Dr. Sabrina Strickland - Orthopedic Surgeon in New York Dr. Sabrina Strickland, an Orthopedic Surgeon in New York & specializes in sports medicine—focusing on knees & shoulders to return you to your active lifestyle.