ACL tears that undergo delayed intervention can lead to further cartilage and meniscus damage. Although many such injuries eventually earn a referral for orthopedic knee surgery, it’s not unusual for kids and their parents to wait several weeks to see how the healing process is going on its own.  ACL tears don’t heal.  The inflammation that is caused by an injury may improve.  But the athlete remains indefinitely vulnerable to recurrent episodes of knee instability.  The knee repeatedly giving out puts the young athlete at risk of further damage with meniscus tears and cartilage loss.

Now researchers think too much caution may be unwise:

Compared to children who had surgery within six weeks, those who had surgery six to 12 weeks after their ACL injury were 45 percent more likely to have a lateral meniscus injury – on the outside of the knee – and those waiting more than 12 weeks were almost three times more likely to have a lateral meniscus tear.

Children who waited at least six weeks for surgery were about four times more likely to have a medial meniscus tear – on the inside of the knee – than those who had prompt treatment, Anderson said.

It is a stark finding, but one which makes sense on its surface: when trauma occurs, often the best chance to reverse its potentially ongoing damage is to hasten the repair process right away.

If you or your child has suffered an ACL tear, I recommend seeing an expert San Diego orthopedic surgeon sooner rather than later.  The longevity of your knee may be at risk.


Knee injury while at rest.  Seemingly contradictory.   It has long been suspected that an active life and daily movement represent good ways to reduce your likelihood of getting arthritis. Now some researchers have finally looked at the numbers to see if this popular notion withstood statistical scrutiny. Their conclusion?

When they analyzed the step data from the pedometers, they found a strong link between participants’ activity level and knee health. Their results suggest 6,000 steps marks an important threshold: 70% of participants who developed knee impairments walked less than this amount while 70% of those who remained healthy walked more.

Using nothing more advanced than off-the-shelf fitness trackers, these researchers were able to study and control for a variety of factors in a population of about 2,000 people. Sure enough, the more active participants seemed considerably less likely to develop knee pain and other symptoms associated with this progressive disorder.  From a scientific standpoint, this makes sense.  Cartilage and the locomotion machine (i.e., body) function better when the ‘engine’ is kept warm.  Not turned off and allowed to collect dust; and not when the engine is ‘revved’ too high, wherein the parts fall into disrepair.  For example, the fascinating thing about cartilage is that cartilage requires, as a part of its normal maintenance, it’s use (such as with walking) to deliver the nutrients from the joint fluid into the cartilage structure.  It’s use actually prolongs it’s longevity!

Of course a cohort study like this cannot officially separate causation from correlation; it is possible, for instance, that people who walk fewer steps do so because they already have bad knees. Yet this study remains a tantalizing clue in support of the idea that sedentary lives can be injurious lives, and that we would all do better to move around more during our active years.


Knee injury:  Warm weather brings many of us outdoors; here in San Diego, that can mean year-round soccer, lacrosse, football, gardening, golf, tennis and more. Sadly these same activities are often closely associated with osteoarthritis knee pain, a debilitating symptom which can hit the brakes on an otherwise active lifestyle.

My practice offers a number of remedies for chronic knee pain in San Diego, including some Tips of the latest revolutionary treatments such as Platelet Rich Plasma injections (PRP). Our goal is quite simply to Tips you as a whole person, and to help you avoid knee surgery through gentler, noninvasive techniques.

As one article recently advised:

Don’t wait too long to see a specialist. A doctor who specializes in knee pain can be very helpful in guiding you through all the treatment options, even in the early stages of knee osteoarthritis. The most common specialists for knee osteoarthritis are orthopedic surgeons, pain management, physical medicine and rehabilitation, and rheumatologists.

If you’re suffering from knee pain and want to relieve yourself of this daily struggle, I urge you to contact the knee pain specialists at my San Diego orthopedic surgery offices today.


One of my main responsibilities as an orthopedic surgeon is to listen carefully when patients tell me about their pain. Sports medicine is largely defined by pain – shoulder pain, knee pain , elbow pain and more. People whose everyday activities have been curtailed by crippling pain are often desperate for solutions; understanding precisely where and how the pain arises is the first step toward a solid diagnosis. Once we have the diagnosis in hand, step two is to explore some reasonable ways we can draw down the pain and increase movement and mobility. I remain bullish about the many nonsurgical techniques that can help patients diminish the anguish of knee and shoulder pain. This article covers a few tips you should know. Money quote:

A recent publication in the Journal of Arthritis & Rheumatology reported that one out of every two people will suffer from arthritic knee pain at some point in their lives, but the good news was that they also determined some very specific exercises that target a particular muscle group were the most significant factor in a reducing knee pain .

If you’ve been looking for low-impact and highly effective ways to reduce knee pain on your own, I strongly recommend you clip and save these exercises. Extensions and lifts may seem simple, but their effects can be long-lasting indeed. Want to learn more about the best ways to relieve knee pain ? Please contact my San Diego orthopedic knee surgery offices today.


It is a question that has bedeviled physicians, nutritionists and trainers for generations: Why do some people hit the gym every day without fail, while others can barely find the motivation to hit the restroom in the morning?

Now scientists may have found a clue. A new study in the Journal of Physiology suggests genetic loading may influence the level of activity in which most of us engage on a daily basis. A rat study suggested that identical twins have a tendency to exercise a similar amount no matter what environment with which they are faced. Researchers then bred rats that were inclined to be highly active, and a separate group inclined to be more sedentary. Once again, the rats did as their genes predicted:

Even so, Dr. Booth said, his group’s data would seem to suggest “that humans may have genes for motivation to exercise and other genes for motivation to sit on the couch,” and over generations, one set of these genes could begin to predominate within a family. But predispositions are never dictatorial.

The silver lining in this particular study, however, is that rats who spent more time sedentary soon began to mimic their active counterparts; studies indicated that their brains actually began to look more like their motivated cousins across the lab. It seems possible that you, too, can raise your energy level just by, well, raising your energy level.  Just say to yourself “I will do it!”  Get out there and move!

We have plenty of hard data that tells us exercise can prevent knee pain and back pain, and prevent costly orthopedic knee surgeries. This study should be a strong reminder that exercise is a choice we can all make when necessary.


There is a growing momentum in sports medicine to encourage athletes and their coaches to warm up in more effective ways. Born partly out of the Santa Monica Sports Medicine Foundation’s PEP program, and spurred on by success stories such as this one, these new exercises are widely touted as simple and powerful, reducing knee surgery numbers by a substantial percentage:

These programs, formally known as neuromuscular training, use a series of exercises to teach athletes how to land, cut, shift directions, plant their legs, and otherwise move during play so that they are less likely to injure themselves. Studies have found that the programs can reduce the number of A.C.L. tears per season by 50 percent or more, particularly among girls, who tear their A.C.L.s at a higher rate than boys do (although, numerically, far more boys are affected).

The good news: these are easy-to-perform and familiar exercises which resemble the calisthenics we all learned growing up. Educating yourself or your local sports team is as simple as watching a few online videos. Yet the savings in medical care costs can be staggering, especially as you diminish the likelihood of ACL tears and their attendant recovery measures.

While a warm up run to get the juices flowing and proper stretching prior to the main work out helps to prevent muscle strains, neuromuscular training is an entirely different concept.  Neuromuscular training is really nothing more than a functional core workout.  Yup, that’s it!  What you do in martial arts, or yoga, or pilates….these strengthening activities helps the young female soccer athlete avoid that infamous ACL tear.  The muscles in the torso, abdominal wall, pelvis, and proximal thigh help the athlete to properly position the knee, which minimizes risk of ACL tear.  It has been proven!!!

For some mature athletes, in addition to neuromuscular training, further measures to maximize knee longevity and function include oral supplements (glucosamine, chondroitin, MSM), platelet rich plasma (PRP) or stem cell injections, and hyluronic acid (HA) injections.

I specialize in knee surgery and orthopedic surgery in San Diego, and encourage all my patients to take every precaution they can to stay active and nimble. Please call my offices today to learn more about how you can prevent knee surgery.


The medical community is never short on opinions on how to manage chronic pain. Common recommendations range from the use of anti-inflammatories such as NSAIDs, to stretches, exercises, even meditation. One effective fix that isn’t usually mentioned: weight loss. Now a new study has appeared which suggests the effects can be profound:

The study included 20 obese patients who had weight-loss surgery and 40 patients who had total knee replacement due to arthritis.

One year after their procedure, the patients who had weight-loss surgery reported significant improvements in knee pain. Their results were comparable to the patients who had a knee replacement, according to the study, which was presented Friday at the annual meeting of the American Academy of Orthopaedic Surgeons, in New Orleans.

It is yet another reminder that our knees are complex mechanical systems, and that ensuring their safe operation has as much to do with reducing loads as reducing stress. The collateral health benefits of weight loss only shore up the case, of course, and lend credence to a holistic view of sports medicine that incorporates the entire body as a single system.

Furthermore, there is growing scientific evidence that injections of PRP (platelet rich plasma) and/or stem cells into the arthritic knee provide significant pain improvement.  In fact more and more evidence seems to indicate that PRP is more effective in reducing knee pain than the highly touted hyaluronic acid (HA) injections, such as Synvisc, Hyalgan, Orthovisc, and Suppartz.

Want to learn more about knee pain or knee surgery in San Diego? Please contact my orthopedic surgery offices here today.

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