Team work for maximum knee stability

The art of medicine can be witnessed in the operating theater and in the use of orthopedic technology. In the German Offenbach, two specialists ensure ideal results for cruciate ligament reconstruction: Dr. med. Adalbert Missalla uses the gentle Press-Fit-Hybrid® procedure he further developed to perform transplants without foreign material. On the first day after surgery, expert orthotist Christopher Mayer treats his knee patients with the SecuTec Genu brace that is placed on the front of the leg.

It is quite busy at Ortho-Klinik Rhein-Main GmbH on this Friday morning. Anna M. is here, too. She bravely puts aside her crutches and sits down on the examination couch. The day before, the petite, young finance manager had anterior cruciate ligament reconstruction on her left knee and is relieved that she has nearly completed all her tasks for the day: the drainage tube has been removed, and an X-ray was taken. Dr. Adalbert Missalla is now inspecting the knee that just underwent surgery and shows his patient the scan on his computer: “Look, this is your knee. Yesterday, we replaced the torn cruciate ligament. The anchors are looking really good,” he explains to his patient. Her knee is hardly swollen at all, one of the many advantages of the gentle Press-Fit-Hybrid® technique the founder of the joint medical practice in Offenbach uses during surgery. Together with certified engineer Helmut Reinhard, Dr. Missalla developed this procedure that does not use foreign material for the reconstruction of the anterior cruciate ligament. It is based on the All-Press-Fit technique by Dr. Gernot Felmet.

Improved in-growth, low re-rupture rate

“Felmet’s technique that uses only the body’s own material has inspired me,” Dr. Missalla explains. “It promised improved in-growth and healing, fewer revision procedures and fewer complications overall.” When he used it, he identified specific opportunities for optimization and subsequently developed new solutions with the developer and manufacturer of the original instrument, resulting in very good outcomes and an extremely low re-rupture rate (see interview on page 21). Right after the procedure, Dr. Missalla’s patients can and should bend and stretch their knee again. Just like Anna M., who just underwent surgery. Dr. Missalla is showing her various exercises he would like her to do regularly at home, because she now needs to rebuild her strength and mobility quickly. For this, Dr. Missalla works with orthotists, often with Christopher Mayer from Sanitätshaus Schneider und Piecha medical supply retailer in Offenbach. The knee care expert knows the requirements associated with the specific surgical procedure. And if patients agree, Dr. Missalla refers them to his post-operative care.

SecuTec Genu from the first day after surgery

Expert orthotist Christopher Mayer squats down in front of Anna M. “How are you? Do you feel any pain?” he asks. “It’s fine, just a minor pulling sensation,” she responds. She is given a new bandage. Then recovery can begin, which also includes a stabilizing frame brace. Christopher Mayer has brought the frontal version of the SecuTec Genu, which is put on the leg and secured from the front. That means it is easy to adjust without causing pain, and patients can put it on and take it off by themselves. “You’re now getting a brace to support you,” he explains after applying a wound dressing, elastic bandages, and a compression bandage to the knee. “You don’t have to wear it when you’re lying or sitting down, but you should as soon as you leave your home and are active for any length of time, even when taking the stairs.”

Readjustment over the course of treatment

Mayer puts the bright green SecuTec Genu on Anna M. with practiced skill and explains each step to her so she can do it at home: “It’s easiest to do when you’re sitting down. The Velcro straps to secure it are numbered from one to six. It’s important that you start with number one and secure them in order. That ensures that the brace fits properly straight away.” The 34-year-old nods. “The frame must fit snugly to give you support and confidence when walking,” Mayer continues. With the patient’s consent, he obtained her measurements from the hospital. He used them to prepare a selection of suitable preassembled braces and bring them to the first appointment, allowing him to provide her with the right product right away.

Anna M. gets up carefully, takes a few steps, and smiles. “You can put weight on the leg,” Mayer encourages her and recommends that she should make sure to keep her back straight for good posture. As with all his patients, he suggests that she should come by his store to have the fit of the brace checked over the course of her treatment and to have it readjusted, for example, when the compression bandage is taken off after a few days, and the swelling has fully reduced, and after her stitches have been removed. Although it is rarely the case that the brace needs to be readjusted, the service offer guarantees quality of care and therefore an ideal overall outcome, explains the expert orthotist and says good-bye to Anna M., who confidently leaves the practice with crutches and the SecuTec Genu on her leg.

Coordinated cooperation in follow-up care

Anterior cruciate ligament reconstructions are some of the most common procedures in the practice because of the high incidence rate. Anna M. fell when hiking in the woods, but most patients are injured during exercise, playing contact sports or during skiing in particular. In addition to targeted physiotherapy and guided strength and mobility training, Dr. Missalla relies on the specialists at Sanitätshaus Schneider und Piecha medical supply retailer for the post-operative care of cruciate ligament reconstruction patients. They have been treating knees together for many years and have gained a lot of experience with different problems. Christopher Mayer introduced the frontal version of the SecuTec Genu as an option. After a few patients were fitted with the product, the physician and technician agreed on its benefits in post-operative follow-up care. “Patients can easily don and doff the SecuTec Genu and are protected more effectively from rotation in cases of falls or excessive strain,” Dr. Missalla explains. After an injury, some patients have to regain trust in their body. Others, especially athletes, want to get back to full action quickly. They agree that the brace provides confidence and protection, and that patients are less worried that something might go wrong when they move. But it is also a reminder to take care of their knees.

„The SecuTec Genu is great for patients and technicians.“

Christopher Mayer

Christopher Mayer adds: “The SecuTec Genu is great for patients and technicians. It’s easy for me to fit it to the patient and use the Velcro straps for individual adjustment. The frame features a cut-out for the tibial edge, Which prevents pressure and ensures a secure fit.” The idea of this product is stabilizing guidance. Limitation is not used following isolated cruciate ligament reconstruction, only in cases of additional meniscal suturing. Both experts have noticed a high level of compliance. “The SecuTec Genu is lightweight and clings flat to the body. That means patients like to wear it,” reports Christopher Mayer. Dr. Missalla highlights that this is crucial because the earlier activity is resumed, the quicker the healing process will be: “Early activity reduces the risk of thrombosis. It stimulates circulation, improves the oxygen supply for cellular metabolism and accelerates muscle development.”



Stabilizing frame brace

The SecuTec Genu stabilizes the knee joint according to the four-point principle and protects it against damaging, incorrect movements. This helps relieve the ligaments. Flexion and extension can be restricted independently.

The frontal version of this brace is put on the leg from the front. Its anatomically shaped frame considers the tibial edge, making it rotationally stable on the leg, and has a height-adjustable calf strap to ensure perfect fit.

A dorsal version with an adjustable calf shell is also available. Both versions can easily be secured using quick-fit fasteners, they remain in position, and fit comfortably.

You can receive further information from your local Bauerfeind Sales Representative or from International Customer Service, email: export@bauerfeind.com.

Images: Udo Schönewald, Bauerfeind