Cartilage Surgery Specialist Dr Kniffler

Dr/Univ. Libre de Bruxelles Heino Kniffler is a specialist in cartilage surgery and co-owner of the orthopaedic practice clinic at the Kelkheim Health Centre.

At the heart of the expert’s and his team’s activity promoting the holistic preservation and restoration of the musculoskeletal system stands the patient who is competently accompanied on his way to active health.

Experienced Specialist Physician in Orthopaedics and Orthopaedic Surgery

Dr Heino Kniffler is not only a professional in orthopaedics but also holds an additional voluntary sub-specialisation in orthopaedic surgery. With his broad knowledge and experience, he and his team stand for optimal patient care in the Rhine-Main area.

Practice Focus: ModernTreatment of Cartilage Damage and Osteoarthritis

Dr Kniffler and his team cater to the individual needs of patients and offer innovative treatment methods with a special focus on joint preservation. Depending on size, location and degree of the joint damage, and taking into consideration the patient's requirements in relation to his/her joint, individually tailored cartilage therapy can be offered thanks to the practice clinic's broad range of conservative and surgical treatments.

PRP Therapy (Platelet-Rich Plasma): Numerous Areas of Application

This method is considered to be particularly gentle and promising, since a patient is treated using her or his own body's growth factors. In PRP therapy, the body's own platelet-rich plasma is injected into the joint. This process contains growth factors initiating self-healing and regenerative processes at the site of the injection. These promising therapies - as PRP therapy just mentioned or hyaluronic acid therapy (improving the viscoelastic properties of the diseased tissue) - involve numerous applications: for example after cartilage operations such as micro-fracturing, mosaicplasty or autologous chondrocyte transplantation. Even after surgery on tendons (cruciate ligament, Achilles tendon or rotator cuff injuries), the treatments promise great success as tissue regeneration is stimulated and homeostasis in the joint is improved.

Autologous Fat Transplantation

AMFAT (autologous micro-fragmented adipose tissue) therapy with Lipogems® is an innovative therapy which processes, micro-fragments, purifies, and concentrates the patient’s own body fat in a closed system. The liquid thus obtained is then injected into the affected joint. When applying this biological treatment, physicians take advantage of the fact that there are 500 to 1000 times more active reparative cells (mesenchymal stem cells) processed in adipose tissue than in the same quantity of bone marrow. Immunomodulatory and anti-inflammatory effects
are activated in the damaged joint treated with Lipogems and different growth factors are released. This method initiates repair processes, restoring homeostasis (metabolic balance) in the joint. The processed adipose tissue acts like a biological reactor in the joint, reducing inflammation and initiating regenerative processes that support the body's own healing powers and protecing the cartilage from further damage.

Subchondroplasty

Very often, joint pain is caused by bone cysts lying directly underneath the cartilage layer. These cysts can be filled with a calcium phosphate paste in a minimally invasive puncture procedure under x-ray monitoring control. The paste, which is made up of bone constituents then converts into endogenous bone over time. Bone cysts are like microfractures. When they are stabilised, the associated pain is significantly reduced. This very effective treatment method can also be used in joints affected by osteoarthritis. Even in these damaged joints, elimination of the painful cysts can result in significant alleviation of symptoms, thereby avoiding joint replacement, or at least delaying it for several years. Painful, chronic bone oedemas and bone necrosis can also be treated successfully by applying this method.

Modern Regenerative Surgical Cartilage Therapy: Endoprosthesis Not Necessarily Required

Depending on the size, location and degree of the joint cartilage damage, various surgical procedures are available.

For small cartilage damage, so-called micro-fracturing, or now nano-fracturing (drilling into the bone and inserting a matrix), is performed arthroscopically (= AMIC: autologous matrix-induced chondrogenesis).

An alternative to this approach is the minced cartilage method. Here, the body's own cartilage is chopped into small cartilage chips, which are then placed into the defective area and fixed with a matrix. This procedure has the advantage that the subchondral bone lamella is not damaged, unlike in microfracturing.

Large cartilage defects can be successfully biologically reconstructed by means of cartilage cell transplantation: so-called matrix-coupled autologous chondrocyte transplantation, or MACT.

If cartilage and the underlying bone are damaged at the same time and the affected area is not too large, then cartilage bone transplantation can be successfully performed with 1–2 cylinders from a peripheral zone (osteochondral transplantation = OCT). If the damaged area is larger, such as in the case of osteochondritis dissecans, the bone bed must be built up. In this case, the patient’s own cultured cartilage cells can be placed on top of it at the same time (MACT).

Frequently, the described procedures need to be combined with an adjustment of the leg's mechanical axis or a ligamentoplasty to achieve best possible results.

Modern Endoprosthetics at the Knee Joint: Less Is More

In some cases – such as exclusive damage to the cartilage at an older age or advanced osteoarthritis in young patients – a biological form of therapy like cartilage transplantation is no longer possible, yet, at the same time, implantation of a total or partial artificial joint is not (yet) necessary. In these cases, we use mini implants.

If only one segment of the joint is affected by osteoarthritis, it can be replaced by a unicompartmental prosthesis or an artificial knee joint. The rest of the joint is preserved.

If the entire knee joint is destroyed by osteoarthritis and there are no longer any possible alternatives, the joint is completely replaced. Either a surface replacement is inserted, as a total prosthesis, or a stem-supported total prosthesis, in case of ligament instability.

If a prosthesis has become loose or an implantation has gone wrong, we also perform complex prosthesis replacement operations at the knee joints.

Dr Kniffler's team performs all endoprosthetic procedures routinely navigated. Navigation means that a computer supports the surgeon integrating the endoprosthesis as precisely as possible. Thus, the operated patient can be sure that her or his endoprosthesis will sit perfectly in balanced ligament conditions, and the leg's mechanical axis will be restored to normal.

Thanks to the navigated surgical technique, long lasting postoperative pain, limited movement and loosening after surgery can be reduced as well as faulty implantation ruled out.

Click here to visit Dr Kniffler's website.