Knee Surgery in Germany

Prof. Dr. med Sven Ostermeier, Orthopaedic Specialist, Senior Consultant for Orthopaedic Shoulder and Knee Surgery

• Senior Orthopaedic Consultant
• Orthopaedic Specialist since 2007
• Professor university Hanover since 2013
• Assistant Professor since 2008
• Dissertation and medical PHD since 2001
• Major contributor to medical research on knee surgery, particularly patella disorders
• Expert Consultant and academic teacher for Arthroscopic knee surgery, Knee Replacement Surgery, Meniscus Repair, Unicompartmental Knee Replacement (Repicci), Cartilage Replacement, Anterior Cruciate Ligaments Reconstruction, Arthroscopic Shoulder Surgery, Shoulder Prosthetics
• Languages: English, French, German

• Orthopaedics, surgery and trauma surgery
• Sports medicine
• Mountain and altitude medicine

PD Dr. med. habil. Bastian Marquaß, Orthopaedic Consultant and Trauma Surgeon

Since 2013: Instructor for Orthopaedics and trauma surgery at the Medical University Leipzig

• 2002: Graduation and license as Physician
• 2004: International Diploma in Mountain Medicine
• 2005: Organisation of the medical support and active care of the athletes of the Fencing World Cup in Leipzig
• 2006: Organisation of the medical logistics and standby treatment of the athletes in the FIFA-Klinik during the Soccer World Cup
• 2007: Organisation of the medical support and active care of the athletes of the Bow World Championship in Leipzig
• 2006 bis 2008: Athlete treatment of the Soccer players from BBV Leipzig
• 2008 bis 2017: Athlete treatment of the Handball players from DHFK Leipzig
• 2013 bis 2017: Chief physician in the Klinik für Unfall-, Wiederherstellungs- und Plastische Chirurgie, Leipzig
• Since 2017: Senior Orthopaedic Consultant in the Gelenk-Klinik in Gundelfingen

A torn meniscus can be operated on in two different ways. In meniscectomy, the surgeon removes part of the damaged meniscus to smooth the surface. In meniscal suturing, the damaged part of the meniscus is sutured back in order to achieve healing of the fragments. Suturing the meniscus is only possible if the torn meniscus is close to the base of the meniscus, which is well supplied with blood. © Alila Medical Media

A meniscus tear is one of the most common knee joint injuries. Any accident that leads to a forceful twisting or bending of the knee joint can cause a meniscus tear. The risk of injury is greater the more weight or speed is applied to the knee at the moment of injury. The more the knee joint is rotated inwards and bent into a knock-knee position, the greater the risk of a meniscus injury.

The knee joint has a medial and a lateral meniscus. These are half-round fibrocartilaginous soft tissue structures located between the shinbone (tibia) and thigh bone (femur) and work like shock absorbers. An acute meniscus tear will immediately cause sharp pain, swelling of the knee joint, and noticeable restriction in motion when bending or extending it. Sometimes the knee seems “locked”. On the other hand, a meniscus that has worn over time will gradually cause symptoms such as stress-related pain and the knee will occasionally lock up.

In some cases, a meniscus tear will heal on its own with immobilisation, rest and physiotherapy. When there is chronic pain or the knee locks up, meniscus surgery can help resolve the problem.

The anterior and posterior cruciate ligament are clearly located at the middle of the knee. The cartilage surfaces and the menisci on the tibial end are identified in purple. The cruciate ligament can easily be stretched or injured due to twisting (distortion) or impact on the knee. When it is ruptured, we refer to a cruciate ligament tear. © Istockphoto.com/MedicalArtInc

At the middle of the knee are two crossing ligaments which connect the thigh (femur) and shin (tibia) and keep them in place. A rupture (tear) of one or two cruciate ligaments makes the knee unstable. A cruciate ligament tear is most common in the anterior cruciate ligament. It is often caused by sports injuries just as twisting (distortion) of the knee whilst skiing or a collision during ball games.

A torn cruciate ligament will cause severe swelling of the knee and stabbing pain. Often, a crack or pop can be heard when the cruciate ligament tears and the person feels a jerk in the knee. The patient is unable to move the knee to the full extent. To stabilise the knee and prevent knee arthrosis, the orthopaedist can either sew the cruciate ligament or replace it with a ligament transplant.

The certification as foot and ankle surgery centre (ZFS) certifies the superior quality of patient consultations, diagnostics, surgery and after-care for foot and ankle conditions and injuries at the orthopedic hospital Gelenk-Klinik, Gundelfingen.

Highest quality:

• The foot and ankle experts must possess a very high level of surgical experience in foot and ankle joint surgeries.
• The training and advanced training of our specialists is constantly reviewed.
• The quality of diagnostic procedures, surgeries and follow-up care for surgeries is well documented and proven.
• Our patients benefit from tested expert advice and thorough clarification with regard to medical matters.
• Quality assurance is ensured through regular clinic inspections.

There are many causes for painful worn cartilage in the knee joint: arthritis, arthrosis, traumas with bone- or cartilage lesions or metabolic disorders like gout or hemochromatosis. © bilderzwerg @ fotolia

Osteoarthritis (worn cartilage) is the most common joint condition. The most common form of osteoarthritis is osteoarthritis of the knee. Osteoarthritis of the knee causes chronic pain and limits movement. The cartilage in the knee wears away over many years. Since the cartilage has no sensitive nerve endings (pain sensors), damage is only noticed when the defects already affect the bone beneath the cartilage.

A cartilage transplant, or cartilage cell or chondrocyte transplant, is a new surgical procedure: in which cartilage damage is repaired using cartilage cells from the patient’s own body. Few knee specialists in Germany successfully perform this procedure. Dr Baum was the first physician in the world to perform an entirely arthroscopic cartilage transplant of the knee. He co-developed this procedure and trained other physicians in this surgical procedure.

The Orthopaedic Gelenk-Klinik was the first orthopaedic provider to be certified as a Centre for Endoprosthetic Surgery in Baden-Württemberg, Germany according to the strict guidelines (national regulations) of the supervising DGOOC e.V. "EndoprothetikZentrum" (EPZ). This certificate shows:

• Surgical experience of more than 200 successful prosthesis/year
• Excellent surgical quality
• Diagnostic excellence
• Quality of documentation
• Quality of patient counseling and patient support

We congratulate the Senior Doctor Dr. Thomas Schneider and the official coordinator of the auditing process Prof. Dr. Sven Ostermeier for this success on behalf of the team of Orthopaedic Gelenk-Klinik.

Knee specialist approach to knee investigation ©Fotolia.com

The most suitable treatment for you will depend not only on the stability of your knee, but also on your age and your general medical condition. What is required by a knee specialist to diagnose your knee condition?

Specialist approach to osteoarthritis of the knee © Viewmedica

Treatment for knee osteoarthritis aims primarily to alleviate the pain it causes, reduce any associated inflammation, maintain patient mobility, minimize disabilities and improve the patient's long-term quality of life.

Arthroscopic knee surgery is a joint preserving therapy ©Viewmedica

Arthroscopic surgery (key hole surgery of the knee) involves a minimally invasive technique usually done as day case surgery and is conducive to a remarkably quick recovery.

©Viewmedica

The path to osteoarthritis is reversible

Patients benefitting from the regeneration of their cartilage with autologous cartilage transplantation, can enjoy something that no generation before them was able to experience: enhanced agility, flexibility and overall knee performance.

Knee specialist approach to the reconstruction of the anterior cruciate ligament (ACL) ©Viewmedica

The anterior cruciate ligaments (ACL) at the front and back of the knee, are the central pillars of the joint and as such, the essential stabilisers. They connect the front top of the tibia (lower leg bone), to the rear bottom of the femur (thigh bone). A rupture of one of the ligaments causes instability, which if not treated, leads to considerable attritional damage to the cartilage in the knee joint (arthrosis). Clinical and experimental examinations have proven that a damaged frontal cruciate knee ligament will not heal by itself.

Anatomy of the knee joint: Knee osteoarthritis may occur locally in the individual compartments of the knee joint. Either the inner knee, the outer knee or the retropatellar joint behind the kneecap can be worn out by osteoarthritis. © Istockphoto.com, MedicalArtInc

In many patients only part of the knee joint is affected by osteoarthritis (destruction of the joint surfaces). The medial (inner) compartment of the knee and the area behind the patella are particularly susceptible to cartilage wear. This is often the case in patients with more severe bow-leg deformity (varus knee). For such patients, a partial knee replacement is better than a total knee prosthesis: the healthy parts of the bone and cartilage are preserved and only the damaged parts of the knee joint are replaced.

Knee specialist approach to total knee replacement ©Viewmedica

Total knee replacement (endoprosthesis)

If a partial knee replacement is no longer possible (the damage to the joint surface is too great), the knee joint surface is replaced completely with an "artificial knee joint". This means that the worn ends of the bones are replaced with metal and plastic parts.

With a total knee replacement, the choice of method used to connect the upper and lower leg components, is most important. There are two prosthesis options for this, "fixed bearing" and "mobile bearing". The mobile bearing prosthesis uses a moving "meniscus" disc, more closely resembling the natural structure of the knee.

Knee specialists approach to osteoarthritis of the knee ©Viewmedica

Knee pain may be due to Patella Tacking Disorder (PTD). The patella syndrome may be caused by a problem with the bones, muscles or ligaments which support the patella (knee cap), helping it to remain in the correct place.

Knee experts approach to arthroscopic menisc repair ©Viewmedica

The Role of the Meniscus in the knee joint

Located in the space between the distal femur and the tibial plateau, the elastic crescent-shaped menisci (the medial meniscus and the lateral meniscus) play a number of important roles in the proper functioning of the knee. Their remarkable physical properties enable them to function as shock absorbers between the weight bearing surfaces of the knee and distribute compressive forces from the femur more evenly across the tibial plateau.

Knee realigment can prevent osteoarthritis of the knee ©Viewmedica

Tibial Osteotomy with Open Wedge

This surgical procedure is used in cases where osteoarthritis has affected only one side of the knee joint. The tibia is cut and re aligned so that pressure is shifted from the damaged side of the joint to the healthier side.

An in patient stay of two nights is normally required.