Surgical techniques in orthopedics
Joint disorders caused by sports accidents, symptoms of wear and tear, or degenerative processes are now common diseases. Many current interventions on joints would be inconceivable without advanced arthroscopic procedures. Arthroscopy today is a patient-friendly and low-risk method of joint diagnostics and therapy.
Richard Wolf produces and markets arthroscopic systems for treating all joints.
The area of application covers large joints like hip, shoulder, elbow, and knee joints, as well as wrist, finger and ankle joints. Comprehensive medical know-how is a constituent element of our research and development activities.
Product systems in advanced technologies, optimized endoscopic instruments or innovative new developments - as a full service provider Richard Wolf offers more than 800 products in orthopedics.
There is no single optimum surgical technique in modern cruciate ligament surgery. Many factors need to be weighed up and play a part in the decision about the optimum therapeutic concept for the particular patient. Irrespective of whether the patient is an elite athlete or a normal individual, or whether the intervention relates to a revision operation or an initial rupture, graft selection, graft preparation, and fixation system are only a few of the aspects that need to be taken into account for optimum care.
The anterior cruciate ligament set using the semitendinosus tendon has attracted increasing interest over recent years. This technology combined with the product range of Richard Wolf enables ACL reconstruction to be performed using the tendon and fixation options set out here:
Products for this technique
When carrying out hip arthroscopy, a distinction is generally drawn between the central compartment (joint region with worn joint surface between femur and acetabulum) and the peripheral compartment (area of the joint involving the neck of the femur, distal to the acetabular labrum). Arthroscopy is carried out on the central compartment with distraction of the affected leg in order to overcome the massive retention force of the capsule.
A telescope with a 70° direction of view is used as standard for hip arthroscopy. The portals are created using puncture cannula and dilation systems. The first stage of access involves the position of the portal being established under X-ray guidance. However, there is a residual risk of injury to the surrounding tissues of this joint and it is therefore important to use an alignment device, especially in the initial stages, to create additional portals.
Richard Wolf joined forces with Dr. Wolfgang Mielke from the ARCUS Sports Hospital in Pforzheim, to create a "COXARTIS" Instrument Set developed specifically for hip arthroscopy. The easy handling and ergonomic design is ideal for experienced surgeons and for users who are new to the application of hip arthroscopes.
Products for these technique
The instrument set for reconstructive shoulder arthroscopy supplied by Richard Wolf offers a safe and efficient approach for arthroscopic rotator cuff reconstruction and shoulder stabilization.
A standard 4 mm arthroscope with 30° direction of view, a hooked probe, grasping forceps, and Arthroline punch constitute the basic instrument set. The comprehensive equipment includes suture anchors, suture cutters and a range of hand instruments, e.g. the "Endospike" shoulder suture instrument for the rotator cuff suture and various instruments for suture management.
Transparent, sterile instrument sleeves with external thread and reusable, interchangeable trocars are supplied for the work portals.
The instrument set is complemented by the following devices:
Products for this technique
The wrist joint is a very complex joint in the human body and it is, in fact, made up of a number of individual joints.
Assessments of the cartilage status, ligament instabilities and changes to the mucus membrane can be diagnosed and biopsies can be taken. For example, lesions to the attachment of the hand joint at the ulna (triangular fibrocartilage disk) can be treated arthroscopically. A distinction is drawn in arthroscopic interventions between resecting and reconstructing procedures. Synovectomies, arthrolyses, cartilage smoothing interventions and debridement procedures are some of the resecting procedures. Refixation of the ulnar discoid cartilage and its ligament connections to the ulna (TFCC repair) are included among the reconstruction methods.
Richard Wolf supplies the ideal solution for all small joints. The range of options includes telescopes with diameters of 1.9 mm, 2.4 mm or 2.7 mm and a comprehensive instrument portfolio specially matched to these applications.
Products for this technique
Arthroscopy of the elbow is a relatively new procedure. Faster rehabilitation, lower levels of wound pain, reduced risk of infection and less surgical trauma are some of the benefits. However, the precise assessment of underlying pathologies, in particular instabilities, has derived significant benefit through the diagnostic possibilities offered by elbow arthroscopy.
Elbow arthroscopy allows the severity and direction of new and chronic instabilities to be assessed and any necessary treatment strategy to be derived from the findings. This includes the treatment indications for fresh capsule-ligament suture or syndesmoplasty (ligament reconstruction) in cases of chronic instability.
The new Elbow Set has been designed by Richard Wolf to provide adequate support. A practical combination of instruments and specific, highly functional design form the platform for safe and successful intervention.
The surgeon benefits from the perfect tuning of all components to the anatomical circumstances and optimum harmonization with all the pathologies being treated. These features also help reduce the risks caused by delays and any resultant critical swellings.
Endoscopically assisted decompression of the ulnar nerve offers a new option involving a small incision being made in the skin in order to release the proximal and distal constrictions of the nerve without having to make an incision of the same length in the skin.
The advantage of this endoscopic technique is that a much smaller incision can be used while at the same time extending the length of neurolysis. This leads to less morbidity, rapid improvement of the symptoms, and fast rehabilitation compared with conventional procedures.
Richard Wolf have worked with Professor Dr. Peter Hahn at the Vulpius Klinik, Bad Rappenau, to create a special instrument set for endoscopically assisted decompression of the ulnar nerve.
Since the early 1990s, extracorporeal shockwaves have also been successfully used for the treatment of chronic pain conditions.
Extracorporeal shockwave therapy (ESWT) and trigger point shockwave therapy (TPST) are highly efficient, non-invasive treatments of chronic pain in the musculoskeletal system. Through its successful use in other indications for the treatment of acute and chronic pain of the musculoskeletal system, ESWT has firmly established itself in the conservative treatment spectrum of physicians.
Mechanisms and effects of ESWT described in the literature:
Induced release of growth factors such as TGF-ß1, VEGF
Stimulates proliferation of fibroblasts
Stimulation of mesenchymal stem cell migration
Local circulation promotion and suppression of proinflammatory processes
Detailed information is provided at www.elvation.de.
The classic orthopaedic indications for shockwave therapy (ESWT) are diseases of the tendon attachment sites, such as changes in the soft tissue area of the rotator cuff at the shoulder, tennis or golfer elbow, patella tip syndrome at the knee or plantar fascia in heel pain.
In sports medicine, tendon attachment tendinoses (enthesiopathy) is one of the standard indications for treatment with focused shockwave therapy.
Clinical studies evaluate the effects of ESWT in this area with lesser emphasis on the destruction of tissue, but rather with more emphasis on stimulation or activation of tissue substances, which thus stimulate the self-healing process.
Trigger point shockwave therapy
In trigger point shockwave therapy (TPST), the penetration depth, intensity, power and pulse frequency of the shockwave pulses can be easily applied for the various indications.
Before treatment, the trigger points can be located exactly with the precisely defined focus point. Due to the variable penetration depth, even triggers in the depth of the muscles can be localized and treated with pinpoint accuracy. Thereby treatment achieves maximum efficiency.
The planar therapy source FP4 for the PiezoWave therapy unit considerably expands the treatment spectrum in ESWT/TPST. This makes it possible to successfully treat large-area, near-surface myofascial syndromes. The combined use of planar therapy source FP4 and focused therapy source F10 G4 also enables therapy of many orthopedic indications.