Specialty knee

Dr. med. Bernd Lasarzewski

Chief of

Shoulder, Elbow and Knee Surgery

Specializing in the treatment of knee joints has a very long tradition at the Hellersen Sports Clinic and it was not without reason that it used to be called the "knee clinic".

For more than 30 years, Dr. Bernd Lasarzewski, who was the team doctor of the DFB women's national soccer team for many years until 2021, has been treating patients with knee problems. Both acute accidents and degenerative changes are treated by him carefully and professionally.

Especially in the care of top athletes, it is important to recover quickly and to be able to play for one's own team as soon as possible. For this purpose, many arthroscopic as well as minimally invasive treatment methods have been developed in recent years, which benefit high-performance athletes as well as amateur athletes.

These surgical methods ensure tissue-sparing interventions, allowing for a rapid recovery.

In meniscus surgery today, preserving procedures are used whenever possible.

In the case of cruciate ligament tears, replacement is carried out with the patient's own tendons, since sutures of the torn cruciate ligament are not successful. Various tendons are available for this purpose (patellar tendon, semitendinosus tendon or quadriceps tendon), which are used individually as cruciate ligament replacements, depending on the load level.

Patellar dislocations can also be treated minimally invasively. This also results in a rapid recovery.

In the case of cartilage damage and wear of the knee joint, we have various cartilage-preserving or cartilage-regenerating methods as well as leg axis corrections at our disposal.

Dr. Bernd Lasarzewski performs these procedures hundreds of times a year and provides patients with the best possible support before, during and after knee surgery.

Treatment focus

arthroscopic and open knee surgery
Cruciate ligament surgery
cruciate ligament revision surgery
surgical treatment of the unstable patella
joint-preserving orthopedic operations
leg axis corrections
differentiated cartilage treatments (cartilage/bone grafts, microfracturing, abrasion arthroplasties)
meniscus therapy
complex ligament operations

Disease patterns

Rupture of the anterior cruciate ligament almost always occurs as a result of an acute accident. Only in cases of significant arthrosis can the anterior cruciate ligament slowly fray. Most cruciate ligament tears occur in soccer and handball. Typical accident events are the press hit in soccer, a twisting of the knee joint in a duel, the uncontrolled landing after a header (with simultaneous strong body contact by an opponent) or an uncontrolled landing after a jump shot in handball. Examination The examination is initially performed as for meniscal damage. An x-ray examination is performed to rule out bony injuries. If these are not present, further examination of the knee joint is performed. This includes the examination of the mobility, the lateral hinging, the patellar examination, the examination of an effusion formation and especially the examination of the anterior drawer, the Lachmann sign and the pivot -shift sign. The examination may also include puncture of the joint, as in some patients the physical examination is not productive due to the pain. If a bloody effusion is found, surgery should follow as soon as possible. Diagnosis If the diagnosis of anterior cruciate ligament rupture is not clear from the physical examination, an MRI examination may be helpful. However, this should only be performed if the patient is not sure of the correct diagnosis on physical examination. Therapy Therapy consists of surgical treatment of the torn cruciate ligament. In the vast majority of injuries, the anterior cruciate ligament must be replaced plastically.

Several procedures are available for this purpose:

the middle third of the patellar tendon
the semitendinosus tendon
the patellar tendon of a deceased person after arthroscopy of the joint has been performed and accompanying injuries have been repaired, the torn parts of the cruciate ligament are removed with a rotating knife (shaver).

This is followed by removal of the designated tendon. After the appropriate tendon is harvested, it is prepared for implantation. This surgical step is almost the same if both tendons are used.

After the tendon is prepared for implantation, the drill hole is drilled into the head of the tibia using a targeting instrument. Once the reaming of the tibial head is complete, the femoral drill hole is fixed with a targeting hook and pull-out wire. The femur is then reamed with a previously established drill bit. The prepared tendon is then pulled into the knee joint through the lower drill hole and further into the upper drill hole using special instruments.

Screws or staples are available to fix the patellar tendon. We prefer the PressFit technique, in which the upper part of the tendon is pushed into the upper drill hole and wedged firmly there. In the lower leg, we usually use special screws for locking. The semitendinosus tendon is fixed using strong sutures and a special plat e and staples or buttons.

After one or two drains have been inserted into the knee and the wider wound area, the skin is closed with intracutaneous sutures or with skin staples. Immediately after the operation, the knee joint is immobilized in a cuff in a slightly flexed position. This is followed by an X-ray control to document the operation performed.

Special surgical techniques on the anterior cruciate ligament, such as cruciate ligament suture, cruciate ligament refixation in the case of femoral avulsion, augmentation (reinforcement) with a flexor tendon or replacement with special tendons, are not described by me here because they are performed quite rarely and would go beyond the scope of these explanations.

Aftercare
After replacement of the anterior cruciate ligament, physiotherapy is started immediately after the first change of bandages, initially on the motorized splint, and later passively and actively with the help of the physiotherapist.

Until the 4th week after the operation, the patient is allowed to move from full extension (0°) to a right angle (90°). During this time, the operated leg may only be loaded with half the body weight. After the 4th week, the load as well as the flexion may be increased, so that in the 6th week after the operation the full load and also, if necessary, the full mobility is achieved. However, hyperextensibility of the operated knee joint is not desired, as this can lead to loosening of the implanted ligament.

After the 6th week, intensive outpatient rehabilitation is started, and if there are no special features (e.g. swelling) after 12 weeks, the patient may also start cautious jogging. Only after 6 months should sports requiring physical contact (soccer, handball, etc.) be started.