Endocrinologist (diabetes, hormones), Surgical Specialist, Pediatrician
35 years of experience
Video profile
Accepting new patients
350 Parnassus Ave
Suite 510
San Francisco, CA 94117
415-476-8936
Locations and availability (3)

Education ?

Medical School Score Rankings
University of Virginia (1975)
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Awards  
Patients' Choice Award (2012)
Compassionate Doctor Recognition (2012)
Appointments
University of California, San Francisco School of Medicine
Associate Clinical Professor
California Pacific Medical Center
Associations
American Board of Orthopaedic Surgery
American Orthopaedic Society for Sports Medicine

Affiliations ?

Dr. Dye is affiliated with 9 hospitals.

Hospital Affilations

Score

Rankings

  • John Muir Medical Center, Walnut Creek Campus
    Orthopaedic Surgery
    1601 Ygnacio Valley Rd, Walnut Creek, CA 94598
    • Currently 4 of 4 crosses
    Top 25%
  • UCSF Medical Center / Moffitt-Long Hospitals
    Orthopaedic Surgery
    521 Parnassus Ave, San Francisco, CA 94143
    • Currently 3 of 4 crosses
    Top 50%
  • California Pacific Medical Center - Davies Campus
    Orthopaedic Surgery
    2333 Buchanan St, San Francisco, CA 94115
    • Currently 3 of 4 crosses
    Top 50%
  • California Pacific Medical Center- Davies Campus
    Orthopaedic Surgery
    45 Castro St, San Francisco, CA 94114
    • Currently 1 of 4 crosses
  • California Pacific
  • Brown & Toland Physicians Opens in new window
  • California Pacific Medical Center Opens in new window
  • John Muir Medical Center-Concord Campus
  • Ucsf Med Ctr
  • Publications & Research

    Dr. Dye has contributed to 20 publications.
    Title Dr Hughston's Legacy: a Dedication to the Fundamentals.
    Date April 2006
    Journal The American Journal of Sports Medicine
    Title The Pathophysiology of Patellofemoral Pain: a Tissue Homeostasis Perspective.
    Date September 2005
    Journal Clinical Orthopaedics and Related Research
    Excerpt

    Fundamental to rational, safe, and effective treatment for any orthopaedic condition is an accurate understanding of the etiology of the symptoms. The decades-old paradigm of a pure structural and biomechanical explanation for the genesis of patellofemoral pain is giving way to one in which biologic factors are being given more consideration. It is increasingly evident that a variable mosaic of possible pathophysiologic processes, often caused by simple overload, best accounts for the etiology of patellofemoral pain in most patients. Inflamed synovial lining and fat pad tissues, retinacular neuromas, increased intraosseous pressure, and increased osseous metabolic activity of the patella all have been documented as contributing to the perception of anterior knee pain. Considered together, these processes can be characterized as loss of tissue homeostasis and can be seen as providing a new and alternative explanation for the conundrum of anterior knee pain. Certain high loading conditions of the patellofemoral joint can be of sufficient magnitude to induce the symptomatic loss of tissue homeostasis so that, once initiated, they may persist indefinitely. From this new biologic perspective, it clinically matters little what structural factors may be present in a given joint (such as chondromalacia, patellar tilt or a Q angle above a certain value) if the pain free condition of tissue homeostasis is safely achieved and maintained. LEVEL OF EVIDENCE: Level V (expert opinion). See the Guidelines for Authors for a complete description of levels of evidence.

    Title Soft-tissue Anatomy Anterior to the Human Patella.
    Date July 2003
    Journal The Journal of Bone and Joint Surgery. American Volume
    Excerpt

    The purpose of this anatomic study is to report the results of dissections of the soft-tissue structures anterior to the human patella.

    Title Functional Morphologic Features of the Human Knee: an Evolutionary Perspective.
    Date June 2003
    Journal Clinical Orthopaedics and Related Research
    Excerpt

    The complex functional morphologic characteristics of the knee are of ancient origin. The multiple asymmetries of anatomy can be traced back more than 300 million years to the pelvic appendages of Sarcoptorigian lobe-finned fish. The knee functions as a biologic transmission with ligaments acting as sensate linkages and the menisci acting as sensate, mobile bearings. Cine-computed tomography and magnetic resonance imaging studies of intact knees from cadavers reveal a combined rolling and gliding motion, with posterior displacement of the femorotibial contact point with increasing flexion. The posterior displacement of the femorotibial contact point is greater in the lateral compartment by approximately a factor of two. The anatomy of the lateral compartment, including the inferior sloping of the posterior tibial plateau, reflects and accommodates this greater motion. This asymmetry of kinematics between the medial and lateral compartment, an established characteristic of human and many other extant mammalian knees, results in an internal rotation of the tibia relative to femur with increasing flexion. By taking into account the complexities of functional morphologic features of the knee, the design of joint replacements and bracing systems may be improved.

    Title Magnetic Resonance Imaging of Articular Cartilage in the Knee. An Evaluation with Use of Fast-spin-echo Imaging.
    Date October 1999
    Journal The Journal of Bone and Joint Surgery. American Volume
    Title Factors Contributing to Function of the Knee Joint After Injury or Reconstruction of the Anterior Cruciate Ligament.
    Date May 1999
    Journal Instructional Course Lectures
    Title Conscious Neurosensory Mapping of the Internal Structures of the Human Knee Without Intraarticular Anesthesia.
    Date February 1999
    Journal The American Journal of Sports Medicine
    Excerpt

    The conscious neurosensory characteristics of the internal components of the human knee were documented by instrumented arthroscopic palpation without intraarticular anesthesia. With only local anesthesia injected at the portal sites, the first author (SFD) had both knees inspected arthroscopically. Subjectively, he graded the sensation from no sensation (0) to severe pain (4), with a modifier of either accurate spatial localization (A) or poor spatial localization (B). The nature of the intraarticular sensation was variable, ranging from 0 on the patellar articular cartilage to 4A on the anterior synovium, fat pad, and joint capsule. The sensation arising from the cruciate ligaments ranged from 1 to 2B in the midportion, and from 3 to 4B at the insertion sites. The sensation from the meniscal cartilages ranged from 1B on the inner rim to 3B near the capsular margin. Innervation of most intraarticular components of the knee is probably crucial for tissue homeostasis. Failure of current intraarticular soft tissue reconstructions of the knee may be due, in part, to the lack of neurosensory restoration. Research studies of the knee designed to delineate factors that restore neurosensory characteristics of the musculoskeletal system may lead to techniques that result in true restoration of joint homeostasis and function.

    Title The Use of Scintigraphy to Detect Increased Osseous Metabolic Activity About the Knee.
    Date June 1997
    Journal Instructional Course Lectures
    Title The Knee As a Biologic Transmission with an Envelope of Function: a Theory.
    Date January 1997
    Journal Clinical Orthopaedics and Related Research
    Excerpt

    The knee can be characterized as a complex set of asymmetrical moving parts acting together as a living biologic transmission. The purpose of this system is to accept, transfer, and dissipate loads generated at the ends of the long mechanical lever arms of the femur and tibia. In this analogy, the various ligaments represent sensate adaptive linkages, the articular cartilages represent bearings, and the menisci, mobile sensate bearings within the transmission. The muscles represent both living engines providing motive forces, and brakes and dampening systems under complex neurologic control mechanisms. The range of load that can be applied across an individual joint in a given period without supraphysiologic overload or structural failure can be termed the envelope of function. This range of homeostatic loading can be graphed with increasing applied loads on the vertical axis and the frequency of loading on the horizontal axis. At least 4 categories of factors together determine the envelope of function for a given joint including anatomic, kinematic, physiologic, and treatment factors. This theory of joint function can result in a more rational clinical approach to treating patients with knee injuries and other orthopaedic conditions. Orthopaedic therapy should be designed to maximize the envelope of function of musculoskeletal systems with the least degree of risk.

    Title The Future of Anterior Cruciate Ligament Restoration.
    Date January 1997
    Journal Clinical Orthopaedics and Related Research
    Excerpt

    Advancements in the understanding of anatomy, kinematics, and physiology should improve future treatment of anterior cruciate ligament injured knees. The ultimate goal of full restoration of an anterior cruciate ligament injured knee to preinjury status, may be possible in the distant future through genetic manipulation inducing regeneration of tissues. In the midterm future, resorbable stents with incorporated bioactive growth factors have the potential of inducing normal anterior cruciate ligament anatomy without the need for detrimental harvesting of the patient's tissues, or risk of microbial transmission with the use of an allograft. In the near future, the development of more benign autografts and allografts is possible along with methods of resorbable fixation of the graft to bone. Future development of 3-dimensional arthroscopic visualization and robotic surgical techniques have the potential for improvement in graft placement. Advancements in treatment of anterior cruciate ligament deficient knees also can be expected from nonsurgical areas, such as control of muscle atrophy, enhancing cerebellar-proprioceptive rehabilitation, and better bracing techniques. The basic principle of therapy should be to maximize the functional load acceptance and transference capacity of the knee with the least degree of risk to the patient.

    Title Radionuclide Imaging of the Knee with Chronic Anterior Cruciate Ligament Tear.
    Date April 1994
    Journal Orthopaedic Review
    Excerpt

    We studied the results of bone scans in 50 consecutive patients with symptomatic, unilateral, chronic anterior cruciate ligament (ACL) tears. All patients had failed conservative therapy and underwent radionuclide imaging of the knee prior to arthroscopic ACL reconstruction. The scintigraphic activity in each of the three knee compartments was quantitatively scaled from 1 (normal scintigraphic activity) to 4 (marked activity). Quantitative activity in each of the three compartments was correlated with plain radiographic, arthroscopic, and clinical findings. All but four of the scans (92%) showed abnormal scintigraphic activity. The quantitative activity was highest overall in the medial compartment (2.9), followed by the lateral (2.4) and patellofemoral compartments (1.9). In the subgroup of patients with normal menisci (10 patients), most of the abnormal activity was in the lateral compartment (2.9), implying that when the medial meniscus remains competent in the presence of a torn ACL, there is increased stress on the lateral compartment. There was little correlation with scintigraphy and roentgenographic changes, except in the presence of moderate or severe radiographic degenerative arthritis. Similarly, there was little correlation between increased scintigraphic activity and chondromalacia. These results provide a baseline for future studies that use scintigraphic imaging in monitoring restoration of bone homeostasis following ACL reconstruction.

    Title Imaging of the Knee.
    Date January 1994
    Journal Orthopaedic Review
    Title Restoration of Osseous Homeostasis After Anterior Cruciate Ligament Reconstruction.
    Date December 1993
    Journal The American Journal of Sports Medicine
    Title Tibial Meniscal Dynamics Using Three-dimensional Reconstruction of Magnetic Resonance Images.
    Date September 1991
    Journal The American Journal of Sports Medicine
    Excerpt

    The human knee joint represents a complex biomechanical system of which the menisci are an integral component. At present, little data exists describing the meniscal kinematics of the intact knee. Accordingly, a three-dimensional reconstruction magnetic resonance image model was used to explore this issue. Five fresh cadaveric knees were examined by magnetic resonance imaging throughout a full range of motion at 10 degrees intervals. Computer three-dimensional images of the menisci were generated and evaluated for anteroposterior excursion and deformation. During flexion, the posterior excursion of the medial meniscus was 5.1 mm, while that of the lateral meniscus was 11.2 mm. The anterior horn segments were shown to be more mobile than the posterior horn segments bilaterally. Prior limitations of meniscal kinematic assessment may be overcome with advanced imaging techniques such as magnetic resonance imaging and three-dimensional reconstruction. The menisci are highly mobile and easily deformed structures within the intact, cadaveric knee. This imaging technique may prove useful in the elucidation of meniscal dynamics. In the future, similar techniques may be applied clinically to aid in the diagnosis of joint dysfunction.

    Title Mr Imaging of the Knee with a 0.064-t Permanent Magnet.
    Date June 1990
    Journal Radiology
    Excerpt

    Magnetic resonance (MR) imaging has proved beneficial in the evaluation of internal derangements of the knee. A limitation to general acceptance of MR imaging of the knee has been availability and cost. The recent introduction of low-field-strength MR imaging has shown promise in decreasing the cost and increasing the availability of this modality. High-resolution (pixel size, 0.7 mm2), three-dimensional Fourier transform (3DFT), thin-section (3.5 mm) imaging performed on a 0.064-T permanent magnet was used to evaluate 117 knees in 114 consecutive patients. The appearance of normal anatomy and internal derangements of the knee at low-field-strength imaging is described. Arthroscopic correlation was available for 28 knees. Findings from low-field-strength MR imaging and arthroscopy agreed in 79% of cases in the determination of meniscal tears. Partial-flip-angle techniques with 3DFT produced thin-section images of the knee of diagnostic quality. The authors conclude that in patients with internal derangements of the knee, low-field-strength (0.064-T) MR imaging may provide useful information.

    Title Anatomy and Biomechanics of the Anterior Cruciate Ligament.
    Date December 1988
    Journal Clinics in Sports Medicine
    Excerpt

    The ACL is an important living soft-tissue component of ancient origin that acts in combination with other complex structures to provide control of femorotibial kinematics. The effect on the knee of its loss, resulting in disruptive kinematics and often subsequent degenerative changes, probably occurs not only because of its lack of structural integrity but also perhaps because of disruption of its proprioceptive function. The complexity of this ligament and associated normal kinematics of the knee challenges the ability of orthopaedists to devise effective therapeutic measures to reconstitute its function when lost. A clearer understanding of the normal role of the ACL will aid in this effort.

    Title Functional Dynamics of the Knee Joint by Ultrafast, Cine-ct.
    Date April 1988
    Journal Investigative Radiology
    Excerpt

    An ultrafast, cine-CT scanner was used to demonstrate the differential mobility of the lateral and medial femoral condyles on their respective tibial plateaus in cadaver knees and to show the kinematic type of motion of the knee joint. Current imaging techniques cannot accomplish this because they do not perform combined quantitative, tomographic, and dynamic studies. Accordingly, this preliminary report presents the data from cine-CT scans of 12 normal intact adult cadaver knees. Scans were obtained at the rate of 14 or 17 per second at 50 or 100 ms exposures through midsagittal planes of the medial and lateral condyles and intercondylar notch. The cine-CT scans were displayed on a CRT and analyzed as closed-loop movies and as isolated images. Each cadaver femoral condyle demonstrated a different combined rolling and gliding motion. Preliminary results on the cadaver knee suggest the lateral femoral condyle moved 2.3 times further on the tibial plateau than its medial counterpart. The percentage of rolling for the lateral condyle was 43%-49%; the percentage of gliding was 51%-57%, with a ratio of rolling to gliding of 1:1.2. The percentage of rolling for the medial condyle was 16%-26%; the percentage of gliding 74%-84% with a ratio of rolling to gliding of 1:3.8. The femoral condyles, tibia, and cruciate ligaments acted as a crossed four-bar linkage in concordance with kinematic theory. The applicability of the cadaver knee results to patient dynamics and diagnosis cannot be determined from this study and awaits further investigations on the in vivo knee. However, ultrafast cine-CT demonstrated the complex knee motion in the cadaver knee joint.

    Title An Evolutionary Perspective of the Knee.
    Date November 1987
    Journal The Journal of Bone and Joint Surgery. American Volume
    Excerpt

    The complex asymmetrical design of the human knee is ancient in origin. The distinctive characteristics of this design were well established more than 300 million years ago. The knees of most classes of tetrapods exhibit similar morphological characteristics, including a bicondylar cam-shaped distal part of the femur, intra-articular ligaments, menisci, and asymmetrical collateral ligaments. The functional characteristics are also similar, with the dynamic point of femorotibial contact moving posteriorly on the tibia in flexion, approximating a four-bar linkage system. The common design and function among knees of tetrapods imply a profound underlying similarity of kinematic principles. Despite the over-all similarity of the design of knees in tetrapods, no ideal animal model exists for the human knee. The human is the only known species that is both plantigrade and biped. By taking into account the retained complex asymmetry of motion of the human knee, such as the differentially greater femoral rollback of the lateral compartment as compared with the medial compartment, external bracing systems and designs for total knee replacement might be improved.

    Title Radionuclide Imaging of the Patellofemoral Joint in Young Adults with Anterior Knee Pain.
    Date July 1986
    Journal The Orthopedic Clinics of North America
    Excerpt

    Young patients with symptoms of anterior knee discomfort represent a most difficult and often enigmatic clinical group, in large part because of the highly subjective nature of the condition. A primary clinical research goal over the past several years has been a search for reliable objective indicators of a presumed underlying pathologic process to account for the symptoms. We believe that the use of the bone scan along with other clinical and experimental data has provided a new and previously unappreciated perspective of a dynamic osseous process occurring in many such patients. With further investigation, this process may clarify certain confusing aspects of the symptoms experienced by patients with patellofemoral pain. The technique and its clinical applications are still in its infancy, yet it appears to hold promise for the future. It is hoped that exposure to this method of evaluation will serve as a basis for an understanding of the benefits, limitations, and implications of this technique as further developments occur.

    Title The Female Knee: Anatomic Variations and the Female-specific Total Knee Design.
    Date
    Journal Clinical Orthopaedics and Related Research
    Excerpt

    The concept and need for a gender-specific or female-specific total knee prosthesis have generated interest and discussion in the orthopaedic community and the general public. This concept relies on the assumption of a need for such a design and the opinion that there are major anatomic differences between male and female knees. Most of the information regarding this subject has been disseminated through print and Internet advertisements, and through direct-to-patient television and magazine promotions. These sources and a recent article in a peer-reviewed journal, which support the need for a female-specific implant design, have proposed three gender-based anatomic differences: (1) an increased Q angle, (2) less prominence of the anterior medial and anterior lateral femoral condyles, and (3) reduced medial-lateral to anterior-posterior femoral condylar aspect ratio. We examined the peer-reviewed literature to determine whether women have had worse results than men after traditional TKAs. We found women have equal or better results than men. In addition, we reviewed the evidence presented to support these three anatomic differences. We conclude the first two proposed differences do not exist, and the third is so small that it likely has no clinical effect. Level of Evidence: Level IV, systematic review. See the Guidelines for Authors for a complete description of levels of evidence.


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