Staying active during the healing process

Dancer and acrobat Anne-Marie Kot wanted to avoid surgery at all costs following a rupture of her posterior cruciate ligament. A long break would have threatened her professional livelihood. Associate Professor Dr. Philip Rößler from Mittelrhein Joint Center in Koblenz saw opportunities for conservative treatment – supported by the new flexible SecuTec Genu Flex frame brace.

Perhaps Associate Professor Dr. Philip Rößler, orthopedist and trauma surgeon, likes the song “Time Is On My Side” by the Rolling Stones. It would correspond with his philosophy that time and patience are key for the healing process after a knee ligament injury. But how can you advocate patience if a patient is in tears because her profession and her career hang by a thread because of her posterior cruciate ligament?

That was the case on June 6, 2024 when Anne-Marie Kot visited him in Coblenz at Mittelrhein Joint Center. “Five physicians recommended surgery after my accident during training in May,” explains the 34-year-old dancer and acrobat from Cologne, “but first surgery and then a long time in rehabilitation? I simply couldn’t afford being out for such a long time, canceling my performances and workshops.” For her follow-up appointment, she is back at Dr. Rößler’s practice, a Bauerfeind brace on her left leg, the SecuTec Genu Flex with its distinctive look consisting of mobile Flex-Links.

The brace must work during everyday activities

“Ms. Kot came to me after rupturing her posterior cruciate ligament. This injury usually heals relatively well and can be treated conservatively with excellent results in many cases,” Dr. Rößler says, remembering past experiences. “The decision of what treatment will be pursued must always be based on personal criteria as well as purely medical reasons: what is the patient’s current situation? What is the work load like? How much time off can the patient afford? What goal does the patient want to achieve with treatment? What is the patient’s overall physical condition?” In Anne-Marie Kot’s case, the basic conditions were clear: as a freelancer in a profession that requires maximum mobility, she wanted to get back to work as quickly as possible and with the fewest restrictions. Her work equipment includes a pole for pole dancing and silks for aerial acrobatics. “With Ms. Kot, it was perfectly clear that she would continue to train. Physical activity is essentially connected with her job. We had to bear this in mind when choosing the treatment method. When selecting the medical aid, having something lightweight was key. It would have to provide both sufficient stabilization and as much mobility as possible. A good choice of medical aid is something that works during everyday activities and meets the patient’s needs.”

Treatment innovation: SecuTec Genu Flex

At that point, Dr. Rößler, the knee expert, already had experience with Bauerfeind’s SecuTec Genu Flex that was launched in September 2023. “For such an active patient, this was and is exactly the right brace.” Anne-Marie Kot confirms this with current videos on her Instagram channel, showing her during training with the SecuTec Genu Flex. This is a way of showing her followers what Dr. Rößler is explaining: “It’s easy to think of compliance straight away – a lightweight, flexible frame brace helps enormously. It’s about protecting key structures but allowing movement and activity. A brace that accompanies patients during everyday activities is much more effective than a product that is perceived as an obstacle, resulting in the patient taking it off again quickly. I have 50-year-olds, 55-year-olds who said: “Oh no, I’ve already tried a brace, I’m not doing that again.” After eight weeks of wearing the SecuTec Genu Flex, they return, saying: “I even play tennis with it.”

“A good choice of medical aid is something that works during everyday activities and meets the patient’s needs.”

Associate Professor Dr. Philip Rößler

Used in conservative and post-operative settings

Following surgery, too, Dr. Rößler, who performs more than 500 knee procedures every year, prefers to prescribe the SecuTec Genu Flex. “During the acute phase, patients have a swollen knee. After surgery, it often briefly swells even more but afterwards, it reduces relatively quickly. This means: sooner or later, the brace will no longer fit properly and must be adjusted. I feel that the Flex, with its adjustable fit, compensates for minor fluctuations in volume differently because there is no rigid frame that is positioned on the thigh muscle. It can also be adapted by a medical supply retailer to the leg circumference by simply adding or removing individual Flex-Links. For some patients, this has to be done several times, for others, it’s not necessary.” He still uses classic hard-frame braces as well: “In comparison, the SecuTec Genu provides a little more stability, and I still use it with patients who suffer from multi-directional instabilities because it has proven effective when several ligaments are affected after a serious injury.”

Addressing muscle deficits with training

Since Anne-Marie Kot’s first visit to Dr. Rößler’s private sports medicine practice, she has returned every 14 days for follow-up appointments. At the end of August, her penultimate check-up included an MRI examination. Despite her injury and even with the knee brace, the slender woman is more agile than most people. There is just one thing that worries her: she still cannot bend her left knee further than 90 degrees; sitting on her heels, which is important for her choreographies, is out of the question. A stabbing pain prevents this. When palpating the left knee, Dr. Rößler notices something: “There’s a muscle deficit and the joint capsule has shrunk a little during the healing process. This can and has to be addressed with training. Depending on the exertion, the muscles provide up to two thirds of the force absorption and therefore of the leg stabilization.” Anne-Marie Kot flinches when the physician bends her leg. This is what causes her pain. Dr. Rößler explains the MRI images to his patient and shows her a cyst that has formed at the posterior outer joint capsule in the area of the posterolateral corner – a consequence of the additional partial tear in the popliteus tendon. This cyst is now causing pain and blocking deep bending movements. “The cyst may have to be removed. But I’d like to wait for further recovery first because the tendon is mainly intact and shows a positive healing trend. There’s a chance that the cyst will simply reduce. Even though it’s a minor procedure, I’d rather spare Ms. Kot.”

It’s all about patience now

The expert is very pleased with what he sees: “The image shows the progressive healing of the posterior cruciate ligament. We now have to look at the subsequent healing stages from a functional perspective. Ms. Kot doesn’t have the muscle stability that she needs yet. But that’s completely normal three months after the injury. At this point, I always have to explain to patients that they simply need patience. This isn’t always easy in the field of orthopedics. The locomotor system, primarily the ligaments and tendons, generally heal very slowly and only present objective treatment success much later, not to mention the patient’s own perception. Unfortunately, it’s not like uncomplicated high blood pressure and the appropriate medication for example, where I measure after a few weeks and I can see: everything is OK. I have to convey why it’s quite normal that patients still have problems after three months and still can’t do everything after six months that wasn’t a big deal before the injury.” Anne-Marie Kot, who actually has in-depth knowledge relating to anatomy and sports medicine as a sports scientist specializing in physiotherapy, would also like to have progressed much more by this stage. But she just has to be patient. The orthopedist Dr. Rößler estimates six to nine months for conservative treatment, which is still a few months less than surgery followed by rehabilitation would require. 

Her confidence needs to return

Anne-Marie Kot is working with intensity on her return-to-sports which, in her case, also corresponds to her return-to-work. She knows that she has to regain confidence in her leg. “Two days ago, I tried to suspend myself by my leg during training but I noticed that I took the load off my leg with my arms. I can’t quite trust my leg to hold the bent position yet.” This is a critical factor for her because she sometimes works at a height of five to eight meters during her acrobatics shows. The same applies to the pain: “I can’t risk involuntarily flinching from the pain.”

“During training, I pay better attention to my leg than during everyday activities. And I’m definitely always wearing the brace.”

Anne-Marie Kot, dancer

Practicing confidence and remembering

Every day, she works on regaining her movement routines and confidence. “Immediately after getting up, I do the first strengthening exercises like squats. This is followed by physiotherapy using weights and a ball. After that, I start my specific training that includes pliés, the splits and, supported by yoga blocks, oversplits. Of course, I’ve had to adjust some of the exercises. I can only do floorwork limited to one leg for example.” The young blonde woman stops as she realizes that her personal training program may sound unusual to outsiders. She adds: “During training, I pay better attention to my leg than during everyday activities. And I’m definitely always wearing the brace.”

The SecuTec Genu Flex has accompanied her for three months. “The brace reminds me to be careful.” She also wears it at night, restricted to 90 degrees flexion, because she moves a lot during her sleep. She appreciates the quality of workmanship in particular. “The Velcro fastenings are perfect! They only attach where they’re meant to and don’t damage other materials. And the tabs for tightening slide into position easily. You don’t have to fiddle around much.”

Expectations and reality

Dr. Rößler feels that he made the right decision treating conservatively. “Not all patients are like Ms. Kot. You have to thoroughly explain and justify a decision like this to many. People have specific expectations, and if the physician doesn’t approach the problem invasively with surgery but prescribes a brace, some don’t understand this, thinking: the physician didn’t really do much.” In these cases, it needs to be explained clearly that the advantages include avoiding burdensome surgery and an overall shorter healing duration. One of the myths surrounding the use of braces is that patients will lose muscle mass. “Braces and supports provide relative protection in favor of an appropriate level of activity during the healing phase. They support proprioception and depth perception,” summarizes Dr. Rößler. “If this means that the patient can be active, there will not be an actual net loss of muscle. That’s the compromise between stabilization and movement that is often made in these cases.”

“Braces and supports aid proprioception and depth perception.”

Associate Professor Dr. Philip Rößler

Return to top performance

Anne-Marie Kot still faces several months of healing. Months where she has to gradually wean herself off the brace and learn to accept strain without her protection. She needs to feel confident that she can rely on her knee again and not think about it with every step. During follow-up care, she will be prescribed a stabilizing compression support to increase proprioception, during her training sessions in particular.

Dr. Rößler believes that every patient should have a specific treatment goal. What is your personal goal, Ms. Kot? “I want to do the exercise again where I suffered my injury in May and overwrite the experience. During that movement, I come out of a rotation and take a controlled fall onto the left knee, sliding forward on it. That is my goal.”

The SecuTec Genu Flex used in knee treatment
The SecuTec Genu Flex stabilizes the knee joint according to the four-point principle. Its lightweight plastic frame consists of unique mobile Flex-Links that adapt to the thigh and lower leg. Find out more.

Pictures: Stefan Durstewitz, Bauerfeind AG