Surgical therapy

You can find information on artificial knee joints here .

Sports knee injuries can affect the meniscus, the joint cartilage or ligaments, or a combination of all three.

Many of these injuries can be treated conservatively, i.e. using specially adapted bandages or splints (so-called orthoses) and physiotherapy where necessary.

Meniscus injuries and tears require refixation or removal of the damaged parts. Suture techniques or so-called meniscus anchors can be used for refixation. If refixation is not possible, special instruments are used to sparingly resect the damaged sections of the meniscus. These procedures are performed with an arthroscope and, as a rule, on an outpatient basis. In certain cases short-term hospitalisation may be necessary.

While medial collaterate ligament injuries can often be treated conservatively, cruciate ligament ruptures frequently require surgical procedures using autografts. The procedure involves substituting the missing posterior cruciate ligament with strong replacement tissue. Tendon autografts are usually used for this. A section of the patella tendon (the tendon between the kneecap and the shin) and the semitendinosus tendon (one of the hamstring muscles) are particularly suitable as replacement tissue.

These procedures generally require short hospitalisation. Rehabilitation typically takes approx. 6 weeks. Intensive sport is however not recommended for three to six months, depending on the type of sport. As this is a decision that must be taken on an individual basis, we will gladly advise you in more detail if required.

Arthritis of the knee develops as the protective cartilage becomes progressively thinner. The bones rub directly against each other. The patient experiences pain and restriction of movement.

Wear and tear of the joint is treated based on the stage of deterioration and the level of intensity. Therapy also depends on the age of the patient. In the early stages, physical and drug therapy are first considered, such as anti-inflammatory medication or joint infiltrations with so-called joint regeneration compounds (e.g. hyaluronic acid). Special insoles are also an option.

In advanced stages, arthroscopic and/or axis correction surgery are recommended. In arthroscopic procedures we implement a minimally invasive technique to resurface the cartilage and meniscus structures, using the camera as our eyes. Any inflammatory cells originating from the synovial membrane are also removed (synovectomy). In the case of leg axis deformities, which frequently lead to early arthritis, revision surgery is performed (see below).

Where wear and tear in young people has occurred as a result of angular malignment (knock knees, bandy legs), angle correction revision surgery can be performed. Typically, corrections are made at the position of malignment, i.e. either in the thigh or lower leg.

For example, by correcting the angle in the case of bandy legs it is possible to shift the load from the worn inside of the knee joint to the outside which is still intact. This is an excellent way of staving off knee joint replacement (knee joint prosthesis) especially in patients with early-stage or moderately severe arthritis of the knee joint.

Hospitalisation for revision surgery of the knee is approx. 5 to 10 days. This is followed by outpatient physiotherapy. The load is gradually increased under guidance. The metal implant is removed again approx. 12 months after surgery. This is generally also possible as an outpatient procedure.

At a later stage, joint replacement surgery (implant) will be necessary, which then either involves a partial or full replacement, depending on the location and degree of deterioration (see Arthroplasty).

The most common injuries of the upper ankle joint are ligament related, which, with a few exceptions, can successfully be treated conservatively with appropriate ankle braces. Injury to the bone we generally treat surgically. We use screws and/or plates in this surgical procedure to attach the torn-off bone or cartilage pieces. Torn ligaments are sutured and in case of severe damage replaced by tendon autografts.

In any event, it is extremely important to have the injury examined and analysed by a specialist in our practice. X-rays are also required, in conjunction with specific MRI examinations where necessary, to identify possible ligament injuries.

Severe damage to the upper ankle joint may require major surgical intervention, such as joint replacement. This affects patients with advanced joint deterioration (arthritis) or rheumatic joint destruction. Besides implantation of an artificial ankle joint, fusion (arthrodesis) of the upper ankle joint is still a valuable treatment technique. Contrary to common belief, this approach leads to a stable, pain-free and steady gait without obvious gait abnormalities in the long term as well. Hospitalisation for this procedure is generally 7 days. Once the bone has healed after approximately 8 to 10 weeks, a plastic cast or surgical shoe must continue to be worn. Thereafter, patients can walk free from pain in standard shoes (with a midfoot wedge to assist rolling of the foot, where necessary).

From the notorious skier’s thumb to sprains to fractures, hand injuries are often due to sports injuries. Besides bone injuries, which can be treated with appropriate implants (mini-screws, mini-plates), ligament injuries (e.g. skier’s thumb) occur often.

In mild cases, the injury can be treated with a finger/thumb splint or plaster cast. Verified joint instability generally requires ligament suturing. Tendon injuries are treated with sutures or plastic reconstruction.

Dangerous scaphoid injuries must, almost without exception, be treated surgically (Herbert screw).

Wear and tear can occur either on the joints or tendons of the hand. Wear and tear of the joints leads to arthritis in late-stage cases. Tendon ailments often result in tendonitis.

In many cases, arthritis of the hand affects the heavily used thumb joint and the crucial thumb saddle joint (rhizarthritis). The thumb saddle joint connects the thumb to the carpal bones. Typical symptoms of rhizarthritis are pain when grasping something. The first step is always to try and achieve an improvement with conservative measures. These include anti-inflammatory medication and ergotherapy. If these measures do not help, surgery should be considered. This involves removing a small bone from a row of carpal bones. A tendon from the patient’s body is inserted as a replacement. The tendinous strip is usually obtained from the wrist area. This tendon replacement is known as the Epping resection-suspension arthroplasty procedure.

In severe cases, pain relief can be achieved through surgical fusion (arthodesis), without significantly restricting the functionality of the hand. In exceptional cases, total joint replacement may be recommended.

If conservative therapy does not lead to the desired result in the case of tendonitis, surgery is also indicated here. This involves expanding the overly tight tendon sheath by splitting it and removing the inflamed tissue.

Dupuytren’s contracture is a disease of the tendons in the hand. Shortening of the tendons in the palm of the hand and calluses in the hand cause increasing retraction of the affected fingers. As a result, the fingers can no longer be (completely) straightened. In this case, the thickened connective tissue is surgically removed (on an outpatient or inpatient basis) and the palm of the hand reconstructed.

The carpal tunnel is on the inside of the wrist. An important nerve, the median nerve (nervus medianus) runs through this tunnel. It innervates the thumb, index finger and middle finger. Extreme strain on the nerve can lead to tendonitis. The inflamed tendons compress the median nerve. Neural stimuli are no longer conducted as efficiently or not at all. This results in so-called carpal tunnel syndrome.

As part of the diagnosis, abnormal nerve conduction velocity of the median nerve is measured. The decision whether or not to operate is based on the result and, more importantly, on the intensity of the patient’s suffering. The aim of the surgical procedure is to expand the tunnel, thereby reducing the pressure on the nervous tissue. Follow-up treatment involves wearing a removable wrist splint until the wrist has healed (approx. 12 days after surgery). Physiotherapy is carried out simultaneously.

The “trigger finger”, frequently the trigger thumb, is difficult to straighten and suddenly snaps into the extended position. It is also often called a “snapping finger”.

Trigger finger is a disease where the flexor tendon of the involved finger thickens and nodules form at the base joint. As a result, the tendon can no longer glide freely through the tight annular ligament and the affected finger can then only be bent and straightened in a sudden motion.

If conservative therapies are not successful, surgery is possible. Surgical therapy is very simple and involves splitting the overly tight annular ligament. The procedure can be performed on an outpatient basis under local anaesthetic.