Dr. Charles Petit
Board Certified Orthopaedic Surgeon
Graduated from Yale University in 1999 where he was captain of the men’s basketball team. He then attended UC San Diego School of Medicine, after which he completed his orthopedic surgical residency at the Harvard Combined Orthopedic Residency Program. He received advanced training in sports medicine and knee, shoulder, and hip arthroscopy at The Steadman-Hawkins Clinic in Vail, Colorado where he was an associate team physician for the Denver Broncos and the US Ski and Snowboard Teams.
From 2009 to 2014, Dr. Petit was in private practice in Hood River and The Dalles. He remains an active assistant team physician for the US Ski and Snowboard teams. His practice focuses on the arthroscopic treatment of knee, shoulder and hip injuries in athletes of all ages.
Dr. Petit is one of only a few surgeons in the northwest who is an expert in arthroscopic hip surgery. He also has a very strong background in joint reconstruction including knee and hip replacements, as well as complex shoulder reconstruction. In his free time, Dr. Petit enjoys flyfishing, basketball, snowboarding, and mountain biking.
Shoulder Conditions Treated
- AC Joint injuries and AC Separation
- AC Joint Arthritis
- Proximal Biceps Injuries
- Biceps Tendonitis
- Clavicle Fractures
- Calcific Tendonitis
- Frozen Shoulder
- Labral Tears
- Multidirectional Instability
- SLAP Tears
- Rotator Cuff Tears
- Shoulder Dislocations and Instability
- Shoulder Arthritis
- Shoulder Fractures and Proximal Humerus Fractures
- Subacromial Impingement
Shoulder Procedures Performed
Shoulder Arthroscopy
During a shoulder arthroscopy, Dr. Petit will make a few small incisions on the front, back and side of the shoulder. Using a small high definition camera, the joint is evaluated and needed procedures are performed. Recent technologic advances have allowed many shoulder procedures to be performed arthroscopically.
AC Separation Treatment and AC Joint Reconstruction
AC joint reconstruction is a procedure usually reserved for only the most severe AC joint separations. Usually Dr. Petit uses a combination of arthroscopic and open surgery to realign the AC joint and hold it in place. In cases where the AC joint has been injured for a significant period of time, a cadaver graft is often needed to enhance healing.
Biceps Tenodesis
When the biceps tendon becomes inflamed or torn, Dr. Petit prefers to perform a biceps tenodesis. The biceps tendon’s normal attachment point is at the superior labrum within the shoulder joint. It passes between two rotator cuff tendons as it enters the joint and is often damaged when the rotator cuff is damaged or torn. When this occurs, Dr. Petit releases the biceps from within the joint and reattaches the tendon to the humerus, underneath the pectoralis muscle, through a small incision in the armpit.
Clavicle Fracture Fixation or ORIF Clavicle
When a patient suffers a displaced clavicle fracture, Dr. Petit prefers to perform an open reduction and internal fixation of the fracture. Traditionally, clavicle fractures were treated without surgery and allowed to heal on their own. However research has shown that surgical treatment has better results for displaced fractures with minimal risk. This typically involves an incision over the front of the clavicle and a plate and screws are used to hold the clavicle in place while the bone heals.
Capsular Release and Manipulation for Frozen Shoulder
Frozen shoulder, or adhesive capsulitis, is an extremely common condition for middle aged men and women. Most of the time, non operative treatment such as physical therapy and steroid injections are successful in restoring motion. Occasionally, non operative measures do not work and the shoulder needs a little help getting motion back. Dr. Petit prefers an arthroscopic approach where the tight tissue is precisely released and the shoulder gently manipulated to gain range of motion back. Aggressive, daily physical therapy is required postoperatively. Often patients resume normal activities within days of surgery.
Arthroscopic Subacromial Decompression
During this procedure, Dr. Petit uses small arthroscopic instruments to remove any bone spurs causing impingement or damage to the rotator cuff.
Arthroscopic Distal Clavicle Excision (Mumford Procedure)
During this procedure, Dr. Petit uses small arthroscopic instruments to access the acromioclavicular joint. A small amount of bone is cleared from the joint to remove impingement on the underlying rotator cuff and keep the clavicle and acromion from rubbing and causing pain.
Arthroscopic Rotator Cuff Repair
The newest technological advances in cameras and surgical instruments have allowed Dr. Petit to perform nearly all rotator cuff repairs arthroscopically. This leads to decreased pain post operatively. Despite the procedure being minimally invasive, the rotator cuff tendon still takes a significant amount of time to heal. Most patients will need to avoid any active shoulder motion for 6 weeks after surgery.
Superior Capsular Reconstruction for Irreparable Rotator Cuff Repair
Superior capsular reconstruction is a procedure where a piece of cadaver skin is anchored in the shoulder to keep the shoulder joint centered when the rotator cuff is not reparable. It is an operation reserved for younger patients with an irreparable rotator cuff tear. Popularized in Japan prior to them having access to the reverse total shoulder, this operation has recently gained popularity in the US to treat rotator cuff disease. Learn more about the superior capsular reconstruction here (link to Arthrex scr)
Ultrasound Guided Calcific Tendonitis Lavage
For some patients suffering from calcific tendonitis, Dr. Petit can find the calcium using ultrasound and place one or two large needles in the calcium deposit and break the deposit up. Occasionally, Dr. Petit is able to suck out a portion of the calcium. This procedure is usually combined with a steroid injection to decrease inflammation and pain.
Ultrasound Guided Injections
The addition of ultrasound to our office has completely changed our diagnostic and therapeutic abilities. In just a few minutes Dr. Petit can often diagnose rotator cuff tears, biceps tendon problems, and shoulder impingement. Using the ultrasound he can place injections more precisely and safely than the traditional method. ?sonosite link?
Total Shoulder Replacement
Total shoulder replacement is Dr. Petit’s preferred treatment for shoulder arthritis for patients with an intact rotator cuff and no or minimal bone deformity. The operation can be performed on either an outpatient basis or with an overnight stay. Dr. Petit’s mentor and former partner, Dr. Paul Switlyk, pioneered shoulder replacement in the state of Oregon and Dr. Petit aims to continue his dedication to excellence in the field. Learn more about total shoulder replacement here (link to biomet tsa)
Reverse Total Shoulder Replacement
Reverse Total shoulder replacement is Dr. Petit’s preferred treatment for shoulder arthritis for patients with a previous rotator cuff tear or with significant bone deformity. It is also used for patients over 60 with an irreparable rotator cuff tear who do not have arthritis. The reverse total shoulder is the preferred implant for most revision or redo shoulder replacements. In this operation the “ball and socket” are reversed allowing the deltoid, pectoralis and surrounding muscles to do the work of the rotator cuff. Learn more about reverse total shoulder replacement here (link to biomet reverse tsa)
Revision Total Shoulder Replacement
Revision or redo shoulder replacement is an incredibly complex procedure used when a previously performed shoulder replacement has failed. Dr. Petit is one of the few surgeons in the state that performs revision shoulder replacements routinely. Often these operations require complex bone grafting and in some cases a custom 3D printed implant is used. Learn more about that here (link to biomet VRS)
Latarjet Procedure
The Latarjet procedure is an open procedure used to stabilize the shoulder. Dr. Petit uses this procedure when there is bone loss associated with a shoulder dislocation. During this procedure a piece of bone called the coracoid is harvested and attached to the front of the glenoid (shoulder socket) to enhance stability.
SLAP Repair
SLAP tears (Superior Labrum Anteiror-Posterior) occur commonly in competitive overhead athletes (baseball, tennis, volleyball, rock climbers) and patients who do any repetitive overhead motion. These tears are managed either by biceps tenodesis or arthroscopic labral repair.
Bankart Repair (Anterior Labral Repair)
When the shoulder dislocates out of the front of the shoulder, the labrum detaches from the front of the shoulder socket. Dr. Petit can reattach the labrum and repair the damaged shoulder ligaments arthroscopically through 3 small incisions.
Capsulorrhaphy
This procedure is where the capsule is “tightened” for shoulder instability. Somewhat synonymous with the Bankart repair. Often in cases with multidirectional instability, Dr. Petit will perform a Capsulorrhaphy where the whole shoulder capsule is tightened.
Posterior Labral Repair
Posterior labral tears can occur over time with repetitive use (throwers, swimmers, tennis players) or from a traumatic posterior (out the back) dislocation. In the setting of a posterior labral tear, Dr. Petit will arthroscopically repair the posterior labrum using sutures attached to anchors which are drilled into the glenoid bone.
Fixation of Proximal Humerus Fracture (Orif Proximal Humerus Fracture)
Severe shoulder injuries often result in fractures to the upper arm bone (proximal humerus fractures). Many of these injuries can be treated without surgery. For those that need surgery, Dr. Petit most often uses a plate and screw construct with or without bone graft to secure the bones while they heal. Occasionally these fractures cannot be reconstructed with a plate and screws and need a replacement.
Hip Procedures Performed
Hip Arthroscopy
Dr. Petit is one of the few surgeons in the Northwest who is an expert in hip arthroscopy. Through two or three small incisions around the hip, Dr. Petit can repair labral tears, remove impinging bone, and remove loose cartilage. Traditionally, this type of surgery was performed with a large open incision and a dislocation of the hip; however, arthroscopic techniques offer a quicker recovery and more immediate motion. Full recovery from this surgery is approximately 6 months, although by 3 months patients are often in less pain and more functional than they were prior to surgery.
Hip arthroscopy can also be used to address iliopsoas, or hip flexor, impingement. This is usually encountered after a total hip replacement. If conservative measures fail, Dr. Petit can release the iliopsoas from its attachment on the femur using two small incisions, which offers a quick recovery.
Hip Replacement/Total Hip Arthroplasty
When patients have failed conservative management for hip arthritis, hip replacement is often the best option. Using a minimally invasive posterior approach, Dr. Petit replaces the hip joint. Surgery typically takes less than an hour, and this approach allows immediate weight bearing and mobility. Often, patients can have this procedure done and go home the same day. Physical therapy starts within 3 weeks, and most patients are walking well without any assistive devices by 4 to 6 weeks after surgery.
Patients often ask about the difference between an anterior approach and a posterior approach. Each approach has pros and cons. With the anterior approach, there is typically higher blood loss and a higher risk of femoral fracture. With the posterior approach, there is a slightly higher risk of dislocation postoperatively. This risk has been significantly reduced by changes in implant designs and surgical technique. The bottom line on surgical approach is that patients can have a great result with a well-done posterior approach or anterior approach.
Gluteus Medius/Minimus Repair
Occasionally, patients can develop tears of their abductor tendons at their attachment point to the femur. This causes pain on the lateral aspect of the hip and often causes a significant limp due to weakness. These tears are repaired through an open incision on the side of the hip. At the same time, the inflamed trochanteric bursa is removed, and if the iliotibial band is tight, it is partially released. Recovery from this surgery depends on the size of the tear treated.
Trochanteric Bursectomy/Iliotibial Band Release
In rare cases, trochanteric bursitis requires surgery. Most often, this condition is treated with injections and physical therapy. In severe refractory cases, Dr. Petit can remove the bursa and release the tight iliotibial band through a small incision on the side of the hip.
Knee Procedures Performed
Knee Arthroscopy
Small high-definition cameras have totally revolutionized the treatment of knee conditions over the past 20 years. Many knee conditions that previously required a large open incision and casting are now treated with two or three small incisions and immediate motion.
ACL Reconstruction
This is perhaps the most common knee procedure Dr. Petit performs. During this procedure, Dr. Petit harvests tissue from the patient’s quadriceps, hamstrings, or patellar tendon and creates a new ACL graft, which is fixed in the knee to replicate the function of the torn ACL. Occasionally, Dr. Petit uses cadaver grafts; however, recent research shows a higher graft failure rate in those cases. The choice of graft depends on many factors, and Dr. Petit will discuss the options to tailor the operation to each patient’s specific needs.
Revision ACL Reconstruction
A revision, or redo, ACL reconstruction is a repeat ACL reconstruction. Occasionally, patients who have had a previous ACL reconstruction unfortunately tear the graft again. Treating the second ACL tear can be quite tricky, and occasionally a revision ACL operation needs to be performed in two separate surgeries. The first stage consists of bone grafting the previous tunnels in the femur and tibia. The second stage consists of reconstructing the ACL. Occasionally, in addition to reconstructing the ACL, a lateral extra-articular tenodesis, or LET, is performed to provide additional stability to the knee.
Articular Cartilage Restoration Surgery
In order to preserve the knee joint and prevent arthritis, some patients are candidates for articular cartilage restoration. During these surgeries, different techniques are used to grow or transplant new cartilage into an area of the knee where the cartilage has been damaged. Patients with extensive arthritis of the knee are not candidates for these procedures.
Microfracture
Microfracture is a procedure where small holes are drilled or punched into the bone to create a cartilage-like “scar” to fill in a cartilage defect present in the knee. This is one of the original cartilage restoration surgeries. Although this procedure has fallen out of favor in many circumstances, for the right defect, it is the correct choice.
OATS Allograft Cartilage Transplant
This is a procedure where a core of bone and cartilage is transplanted into the knee where cartilage and bone are damaged. Depending on the size and location of the defect, patients may need to wait for a size-matched donor graft to become available. This procedure is done with a small open incision on the knee.
Autologous Chondrocyte Implantation (ACI or MACI)
MACI is a procedure where a small piece of a patient’s cartilage is harvested, grown, implanted into a membrane, and then transplanted back into the knee. It is done in two stages: first a cartilage biopsy, then the implantation.
LCL and Posterolateral Corner Reconstruction
The lateral, or outside, of the knee is a complicated network of ligaments and tendons that provide stability. Occasionally, these ligaments are damaged alone or along with other ligaments in the knee. These ligaments are reconstructed with an open incision, usually using cadaver tendons.
MCL Repair and Reconstruction
Most medial collateral ligament, or MCL, tears heal well on their own. Occasionally, the ligament is so severely damaged that it needs to be repaired or reconstructed. This usually happens along with an ACL tear or PCL tear. These injuries can be reconstructed using a patient’s own hamstrings or repaired and augmented with an “internal brace” made of suture tape.
MPFL Reconstruction for Patellar Dislocations
When a patient dislocates their kneecap, or patella, the medial patellofemoral ligament is torn. In many cases, this can be treated non-operatively with rehabilitation. In recurrent or severe cases, the MPFL needs to be reconstructed to keep the patella from dislocating again. If a patient has abnormal patellar alignment, a tibial tubercle osteotomy can be performed at the same time to correct that alignment.
Tibial Tubercle Osteotomy
This is a procedure that is done for patellar dislocations or for patellar cartilage damage. Dr. Petit uses a precise saw to cut the tibial tubercle, where the patellar tendon attaches to the tibia, moves it to a preplanned position, and secures it.
PCL Reconstruction
The posterior cruciate ligament, or PCL, is commonly injured but rarely needs surgical treatment. In certain situations of severe laxity, or when the PCL is injured along with other ligaments, Dr. Petit recommends PCL reconstruction. Typically, this is done with a cadaver graft.
Meniscus Repair and Partial Meniscectomy
As a joint preservation specialist, Dr. Petit always prefers to repair, or stitch, a meniscus when it is torn rather than remove it. When the meniscus cannot be repaired, a partial meniscectomy may be performed to remove only the damaged portion of the meniscus while preserving as much healthy tissue as possible.
Total Knee Replacement
When a patient has developed severe arthritis in the knee, often a total knee replacement is the correct choice. This is usually done after conservative measures such as physical therapy and injection therapy have failed. Dr. Petit utilizes the latest knee replacement technology, including robotic and computer-navigated methods, to perform knee replacements.
Partial Knee Replacement
The knee is composed of three separate compartments: medial, lateral, and patellofemoral, or kneecap. When one of these compartments develops arthritis and the other compartments are free of disease, Dr. Petit may recommend doing a partial knee replacement, also called a unicompartmental knee replacement. Partial knee replacements may offer a quicker recovery and more natural function of the knee compared with total knee replacements.