From shoulder pain to knee pain: this new technique for using stem cells to help patients cope with knee pain is garnering attention even before the results are in. The procedure is something of a hybrid, combining hyaluronic acid (HA) with concentrated stem cells to promote healing and “seed” the creation of new cartilage:

Patients who undergo the Abicus operation have the cartilage cut and tidied and undergo microfracture, but their cartilage tissue is then coated with a substance made up of bone marrow cells, platelet gel and hyaluronic acid.

During the 30-minute procedure, the bone marrow sample is spun in a centrifuge in the operating theatre to give a concentrated amount of the patient’s own stem cells.

These cells are then mixed with the gel and acid to create a “glue” substance which is placed over the cartilage defect and allowed to set.

If clinical trials show a clear benefit, it will represent yet another advance in our treatment of knee pain, and a new avenue forward for orthopedic knee surgeons who are always on the lookout for the latest innovations in patient care.

If you have chronic knee pain and want to avoid a more invasive knee replacement procedure, I urge you to contact my San Diego knee surgery offices today.


Knee injuries are not only a ‘pain in the knee’.  It gets in the way of maintaining an active lifestyle.  I often tell my patients that the best way to avoid knee surgery is to practice good preventive habits – stretch well, warm up right, and limit direct impacts at both work and at play.

But injuries have a tendency to happen without warning, laying waste even to the best-laid plans. A knee injury can cause damage to the meniscus, cartilage, or ligaments of the knee.  Some recently published research has shown that the trauma leading an ACL tear causes damage to the cartilage that only manifests itself decades later.

The term “recovery time” has something of a fluid definition in orthopedic surgery. Typically it describes the wait time before a patient can resume his or her normal life, but it does not speak to the lingering aftereffects which may be more subtle, and which in the case of knee surgery can be far more extensive:

Famous athletes such as quarterback Tom Brady and alpine skier Lindsey Vonn have come back after ACL surgery, so how bad can it be? The truth is that surgery can restore knee function, but it does little to diminish the risk of arthritis 15 to 20 years down the line. Regardless of whether an athlete has surgery, the risk of arthritis skyrockets later in life from an ACL tear. Kids who tear their ACL today are often left with 60-year-old knees when they’re 30.

My San Diego orthopedic knee surgery practice takes care to minimize pain and accelerate healing with a number of cutting edge technologies. If you’d like to learn more, please contact me here today.


The march of medical technology is swift; constantly punctuating the industry with clever new ideas. As a specialist in San Diego knee surgery, I am particularly attuned to any mention of medical devices that might save patients the discomfort and commitment of the need for surgery.

One such device has been receiving a good deal of press recently. Designed to help patients who suffer with knee pain maintain mobility without wearing a cumbersome brace, the product is comprised of tights that contain rigid guides:

Opedix has struggled to differentiate itself from another type of garment that’s popular with runners and looks very similar: compression tights. What sets Opedix tights apart, Mr. Gustafson says, are the bands of stiff fabric that descend down the leg from the hips, wrap around the knees and extend to the ankles.

It is a promising idea, and a nice reminder that we still have much to learn and invent in the field of sports medicine. But until such devices are clinically proven, your best bet to relieve chronic knee pain is to visit a San Diego knee surgery expert today.


Scheduling a San Diego knee surgery appointment with an experienced orthopedic surgeon shouldn’t have to take days. Nor should it take weeks to be seen.  Many practices have succumbed to the pressure to see tons of patients to make ends meet.  Patients, as educated consumers of medicine, know better.  They know when they are being cattled-hearded through the practice.  In contrast, we very intentionally have opted not to take the easy way out.  We take our time with patients at each and every visit; we listen to what patients feel is necessary to share to aid us in making a proper diagnosis and render the treatment that is right for them as an individual (as an athlete, as a professional, as a mother, etc).  The process should be seamless from start to finish, especially if you already have a primary care physician who can offer good advice and pass along a few names.

But for many San Diego patients who suffer with chronic knee pain or stiffness or for those who sustain an acute injury on the soccer field or elsewhere, entering this world can seem like a daunting enterprise. For them and for you, I have created this quick guide to walk you through the steps of planning a knee surgery procedure here in San Diego.

1. Get the Best Diagnosis

Good sports medicine starts with effective, careful diagnosis. Although you may have heard differing opinions from your neighbor, friend, or masseuse, you will want to check in with credentialed professionals who can evaluate details such as your range of motion, pain level and medical history. At my San Diego orthopedic surgery practice, we offer assistance with every part of this diagnostic process, up to and including help with imaging.

2. Exhaust the Other Options

Knee surgery is a fairly involved undertaking, even if your surgeon uses minimally invasive techniques– despite how seemingly easy everyone and I mean everyone makes it appear.  Yes, it’s easy to do a mediocre job;  achieving excellent results takes diligence, attention, and most importantly, care. That’s why it is wise to exhaust the full range of medical treatments before you commit to surgery, including taking anti-inflammatories, if indicated, as well as physical therapy, rest and even accupuncture. At times, injections may be warranted.  Injections come in different flavors, based on the problem at hand.  Sometimes we use injectable medications to decrease inflammation; other times we might use injectable concoctions that promote an inflammatory process, such as platelet rich plasma (PRP).  If you continue to experience distress despite the best efforts of the right medical personnel, then it’s time to move onto the next step.

3. Find a Great Knee Surgeon

Orthopedic knee surgery is a skill, like any part of medicine. The physicians who achieve the best outcomes tend to work in cutting-edge facilities and boast experience and credentials from some of the world’s finest medical institutions. I am proud to say that I am the former Chief of Sports Medicine at UCSD, and that I specialize in cartilage, ligament reconstruction, and kneecap issues, advanced surgical areas on which I speak throughout the country.  Many surgeons are able to perform knee arthroscopy; however that is not the proper question to ask.  On point, it is the sports medicine surgeon who has developed the mastery of arthroscopy.  It is the sports medicine surgeon who accomplishes the task with minimal damage to the surrounding healthy structures in the knee; which minimizes the postoperative pain and accelerates the recovery process.

4. Get Started

If your knee pain has begun to interfere with your life, it’s time to intervene. Feel free to contact my San Diego knee surgery center for more information today.  We will do the right thing for you in the right way!


As a San Diego orthopedic surgeon, I field a lot of questions about how to minimize joint pain from repetitive and everyday activities. One of the most common: “How can I minimize knee pain when I’m going down the stairs?”

The short answer is a healthy dose of stretching and exercise.

But a more detailed answer has recently surfaced in the New York Times’ Well column, which outlined a simple prescription:

This discomfort is magnified if you have weak quadriceps or thigh muscles, [Dr Bozic] added, since the force that might otherwise be absorbed by those large muscles moves through the knee instead. So to strengthen your quadriceps, try straight leg raises, [he] said. Simply lie on your back with one leg bent. Lift the other leg, straightened, at least six inches off the ground; tighten the thigh muscles and hold for a few seconds. Lower and repeat several times. Then do the same exercise with the other leg. Your physician or an athletic trainer can suggest other safe exercises that target those muscles.

Dr Bozik’s approach is a fairly simple answer.  The more complex answer lies in the practice of yoga and pilates.  Yogi and pilates practitioners learn to engage the ‘core’.  Strengthening the thigh muscles (one of which is the quads) and strengthening the ‘core’ takes you a tremendous way.  But the holy grail is a concept called ‘muscular co-contraction’; this activity entails teaching your core muscles to activate with the use of the thigh muscles.  This is what all exercises aimed at protecting athletes from ACL tears and preventing the resurgence of anterior knee pain is all about.  There, the genie is out of the bottle!  Further recommendations included stay in motion, avoid sitting in a chair all day, take a stretch break from computer work (say 5 min every hour) when you can.…if all else fails call it a bathroom break.

And if your knee pain should require knee surgery in San Diego? Contact the knee surgery experts here to schedule an appointment today.

© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow