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)
Trochanteric Bursitis
10Hip-Treatment and Surgeries
Gluteal Repair
Labral Debridement
Labral Reconstruction
Labral Repair
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
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
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)
20Shoulder Care
10Shoulder-Conditions and Injuries
AC Joint Injuries
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


The ends of the femur, tibia, and undersurface of the patella (kneecap) – the knee bones – are capped with a smooth surface, which is called articular cartilage.  Cartilage protects the ends of bone. It can withstand a significant amount of impact and is significantly smoother than ice, which allows smooth motion in the knee joint. An articular cartilage injury (or “chondral” injury) may occur following a twisting injury to the knee, a direct blow to the knee, or wear and tear as a one ages. Small pieces of articular cartilage can break off and float around in the knee as loose bodies, causing locking, catching and/or swelling.


  • Knee swelling
  • Instability with walking, turning and pivoting
  • Catching or locking in the knee

Diagnosis And Treatment

Dr. Welch considers each patient’s symptoms, as well as a detailed physical examination, x-rays, and usually and MRI of the knee to make the diagnosis. MRI is a very important part of the evaluation because many cartilage injuries are associated with bone injury and bone swelling. Dr. Welch can identify bone swelling and injury on an MRI, but usually not on x-rays.

Some patients with cartilage injuries can be treated with a combination of activity modification and a focused physical therapy program. Physical therapy focuses on maintaining knee range of motion and strengthening certain muscle-tendon unit that provide stability to the knee, such as the quadriceps and hamstrings. Other options for non-surgical management include oral anti-inflammatories, activity modification, as well as injections. There are several types of injections that may help alleviate symptoms, including steroid injections, visco-supplementation injections, and platelet-rich plasma (PRP) or stem cell injections.

Some patients with persistent symptoms or larger defects may require surgery. When patients sustain an injury to articular cartilage and the bone underneath the cartilage, they require a certain type of treatment. Other patients with isolated cartilage injuries can be treated with different techniques. In those patients who have larger, more advanced damage to articular cartilage in one part of the knee, the best surgical option is usually partial knee replacement. In those patients with advanced cartilage damage (“arthritis”) in multiple areas in the knee, the best surgical option is total knee replacement.