Surgical Techniques in Orthopedics

In modern cruciate ligament surgery, there is no single ideal surgical technique. Many factors have to be weighed when deciding on the ideal treatment concept for a particular patient. Whether the patient is a top athlete or not, and whether the procedure is a revision or follows a primary rupture – graft choice, preparation and fixation system are just some of the factors to consider in achieving the best possible result.

In recent years, anterior cruciate ligament reconstruction with the semitendinosus tendon has attracted a great deal of attention. This technique fits perfectly with the Richard Wolf product range, allowing ACL reconstruction with the tendon and the fixation options listed here:

In hip arthroscopy, a clear distinction is usually made between the central compartment (the joint area between femur and acetabulum where the articular surfaces wear) and the peripheral compartment (the part of the joint distal to the acetabular labrum, involving the femoral neck). Arthroscopy of the central compartment is performed with traction on the affected leg to overcome the strong holding force of the joint capsule.

A telescope with a 70° direction of view is standard for hip arthroscopy. Portals are created with puncture cannulas and a dilation system; in the first stage of access, the portals are positioned under X-ray guidance. However, there is a residual risk of injuring the tissue around this joint, so creating further portals with an aiming device is very important, especially at the beginning.

Together with Dr. Wolfgang Mielke of the ARCUS Sports Clinic in Pforzheim, Richard Wolf developed the COXARTIS instrument set especially for hip arthroscopy. Easy to handle and ergonomically designed, it is ideal for both experienced surgeons and newcomers to hip arthroscopy.

The Richard Wolf instrument set for arthroscopic shoulder reconstruction allows safe, effective arthroscopic rotator cuff reconstruction and shoulder stabilization.

The basic set consists of a standard 4 mm arthroscope with a 30° direction of view, a probe hook, grasping forceps and an Arthroline punch. The complete set includes suture anchors, a suture cutter and a range of hand instruments, such as the "Endospike" shoulder suture instrument for rotator cuff repair and various suture management instruments.

For the working portals, transparent sterile cannulas with an external thread and reusable, exchangeable trocars are available.

The instrument set also includes the following devices:

The wrist is a very complex joint in the human body and actually consists of several separate joints.

Physicians can assess and diagnose the condition of the cartilage, ligament instability and changes in the synovial membrane, and take biopsies. Injuries to the ulnar side of the wrist (the triangular fibrocartilage complex), for example, can be treated arthroscopically. Resective and reconstructive procedures use very different arthroscopic techniques: synovectomy, arthroplasty, cartilage smoothing and debridement are resective, while refixation of the ulnar disc and its ligamentous attachment to the ulna (TFCC repair) are reconstructive.

Richard Wolf offers ideal solutions for treating all small joints, including telescopes with diameters of 1.9 mm, 2.4 mm or 2.7 mm and a comprehensive range of instruments developed specifically for these applications.

Elbow arthroscopy is a relatively new field. Its advantages include shorter rehabilitation, less wound pain, a lower risk of infection and less surgical trauma. The diagnostic possibilities of elbow arthroscopy add another significant advantage: precise assessment of underlying pathologies, especially instability.

Elbow arthroscopy allows the severity and direction of acute and chronic instability to be assessed and the necessary treatment strategy to be developed from the findings. This includes the indication for innovative capsuloligamentous suture or ligamentoplasty (ligament reconstruction) in cases of chronic instability.

Richard Wolf has designed a new elbow set to provide full support. A practical combination of instruments and an outstandingly functional design provide the basis for successful, safe procedures.

Surgeons can adapt all components perfectly to the anatomy, with ideal coordination, so that all conditions can be treated effectively. These features also help reduce the risks caused by delays and severe swelling during surgery.

Endoscopically assisted ulnar nerve decompression gives physicians a new option: through a small skin incision, constrictions proximal and distal to the nerve can be released without a skin incision of the same length.

The advantage of this endoscopic technique is a much smaller incision with a longer release of the nerve. Compared with conventional surgery, it reduces postoperative morbidity, improves symptoms quickly and speeds up recovery.

Together with Prof. Dr. Peter Hahn of the Vulpius Klinik in Bad Rappenau, Richard Wolf has created a dedicated instrument set for endoscopically assisted ulnar nerve decompression.

Since the early 1990s, extracorporeal shockwaves have also been used successfully to treat chronic pain conditions.

Extracorporeal shockwave therapy (ESWT) and trigger point shockwave therapy (TPST) treat chronic pain of the musculoskeletal system efficiently and non-invasively. ESWT has been used successfully for a growing number of indications in the treatment of acute and chronic musculoskeletal pain and has thus earned a firm place in conservative medical treatment.

Mechanisms of action and effects of ESWT described in the literature:

• Neovascularization

• Induction of the release of growth factors such as TGF-ß1 and VEGF

• Stimulation of fibroblast proliferation

• Stimulation of mesenchymal stem cell migration

• Antibacterial effect

• Promotes local blood circulation and inhibits pro-inflammatory processes

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Extracorporeal shockwaves

Typical orthopedic indications for shockwave therapy (ESWT) are disorders at tendon insertions, such as soft-tissue changes of the rotator cuff in the shoulder, tennis or golfer's elbow, patellar tip syndrome in the knee, or plantar fasciitis with heel pain.

In sports medicine, insertional tendinopathy (enthesopathy) is one of the standard indications for focused shockwave therapy.

When clinical studies evaluate the effect of ESWT in this field, the focus is on stimulating or activating tissue substances that play a key role in self-healing, rather than on tissue destruction.

Trigger point shockwave therapy

With trigger point shockwave therapy (TPST), the penetration depth, intensity, power and pulse frequency of the shockwave pulses can easily be adapted to each indication.

Before treatment, trigger points can be located precisely with a precisely defined focus. Thanks to the variable penetration depth, even trigger points deep in the muscle tissue can be located and treated precisely. This greatly increases treatment efficiency.

The FP4 planar therapy source of the PiezoWave device significantly extends the treatment range of ESWT/TPST, so large myofascial syndromes close to the skin surface can be treated successfully. Combining the FP4 planar therapy source with the F10 G4 focused therapy source also makes it possible to treat many orthopedic indications.