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Nanofracture - Tyler Welch, MD
York, ME (207) 363 3490 | Portsmouth, NH (603) 431 1121

20Hip Care
10Hip-Conditions and Injuries
Cartilage Injury
Femoroacetabular Impingement (FAI)
Gluteal Tears
Hamstring Tears
Hip Instability
Deep Gluteal Space Syndrome
Labral Tears
Psoas Impingement (Internal Snapping Hip)
PVNS
Trochanteric Bursitis
10Hip-Treatment and Surgeries
Acetabuloplasty
Chondroplasty
Femoroplasty
Gluteal Repair
Labral Debridement
Labral Reconstruction
Labral Repair
Nanofracture
Psoas Release
Trochanteric Bursa Debridement
33Knee Care
13Knee Conditions and Injuries
ACL Tear
Cartilage Injury
Discoid Meniscus
Lateral Meniscus Tear
LCL Injury
MCL Injury
Medial Meniscus Tear
Osteoarthritis
Osteochondritis Dessicans
Patellar Instability
Patellofemoral Chondromalacia
Posterolateral Corner Injury
Trochlear Dysplasia
20Knee Treatment and Surgeries
Anterior Cruciate Ligament (ACL) Reconstruction
Cartilage Restoration Surgery – Autologous Chondrocyte Implantation (ACI-Carticel)
Cartilage Restoration Surgery – Donor Graft
Collagen Meniscal Implant (CMI)
Lateral Collateral Ligament (LCL) Reconstruction
Medial Collateral Ligament (MCL) Reconstruction
Meniscus Repair
Meniscus Root Repair
Meniscal Transplant
Medial Patellofemoral Ligament (MPFL) Reconstruction
Nanofracture
Osteochondral Allograft Transfer
Osteochondral Autograft Transfer (OATS)
Partial Knee Replacement (MAKO)
Partial Meniscectomy
Posterior Cruciate Ligament (PCL) Reconstruction
Posterolateral Corner (PLC) Surgery
Tibial Tubercle Osteotomy
Total Knee Replacement (MAKO)
Trochleoplasty
20Shoulder Care
10Shoulder-Conditions and Injuries
AC Joint Injuries
Arthritis
Biceps Tendon Injuries
Calcific Tendinitis
Clavicle Fractures
Frozen Shoulder
Labral and SLAP Tears
Rotator Cuff Injuries
Shoulder Dislocation/Instability
Subacromial Impingement/Busitis
10Shoulder-Treatment and Surgeries
A-C Joint Stabilization
Biceps Tenodesis
Clavicle Fracture Fixation
Pectoralis Major Repair
Rotator Cuff Repair
Shoulder Instability Surgery – Bankart Repair
Shoulder Instability Surgery – Latarjet Procedure
Subacromial Decompression and Acromioplasty
Superior Capsular Reconstruction
Total Shoulder Replacement

NANOFRACTURE

The ends of the femur and acetabulum – the hip bones – are capped with a smooth surface called articular cartilage.  Cartilage protects the ends of bone; it can withstand a tremendous amount of force and is significantly smoother than ice, which allows smooth motion in the hip joint. An articular cartilage injury (chondral injury), may occur following a twisting injury to the hip, a direct blow, or wear and tear as a one ages. The cartilage has a very limited bloody supply, and full-thickness cartilage lesions cannot heal without surgical intervention. In those patients with full-thickness cartilage damage and recurrent symptoms, surgical intervention may be the best option.

During surgery, Dr. Welch introduces a camera through one small incision and surgical instruments through two other small incisions.   Dr. Welch uses surgical instruments to remove the loose pieces of cartilage and areas of fraying. Dr. Welch then identifies the full-thickness cartilage damage (in which bone is exposed). If the cartilage damage is relatively small, Dr. Welch uses a small, sharp device to make tiny holes in the bone beneath the damaged cartilage. This technique (nanofracture) stimulates bone marrow cells to migrate to the damaged area and produce new cartilage. Usually, the cells produce a layer of cartilage called fibrocartilage that helps protect the exposed bone. Another emerging option for cartilage surgery is the use of healthy, donor cartilage cells to treat the area of full thickness cartilage damage.

Postoperative Rehabilitation

Following surgery, Dr. Welch recommends a guided physical therapy program with a licensed physical therapist. Early motion following surgery is very important for cartilage surgery, and Dr. Welch recommends that each patient either use a stationary bike or a continuous passive motion machine daily. Dr. Welch also recommends limited weight bearing and crutch use for 4-6 weeks after surgery. Dr. Welch may also recommend the use of a brace for approximately two weeks to help protect the hip.

Following surgery, Dr. Welch prescribes appropriate pain medication as well as an anti-inflammatory medication. Anti-inflammatory medication (such as Naprosyn) is important because it can help eliminate pain and also may prevent the formation of abnormal bone (heterotopic ossification).


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