Dr. Paessler is one of Germany's premier orthopedic surgeons. His current responsibilities include leading the Center for Knee, Foot & Ankle Surgery and Sports Trauma at the ATOS-Klinik in Heidelberg. It is a position he has held since 1993. He was appointed as Medical Director in 1997. Dr. Paessler has served as President of the European Federation of National Associations of Orthopaedic Sports Traumatology (EFOST) and Vice-President of the Collège Européenne de Traumatologie du Sport (CETS). He has also taught as a Visiting Professor at the University of Pittsburgh under Dr. Freddie Fu, the University of Ioannina and the Chinese General Hospital, PLA in Beijing. Dr. Paessler is the current Editor-in-Chief of the European Journal of Sports Traumatology and Related Research.
Knee1: What drew you to sports medicine?
Dr. Paessler: When I returned 1970 from a 1 year fellowship cardiovascular surgery with Dr. Michael DeBakey at Baylor College of Medicine in Houston, Texas, I joined within my residency in general and trauma surgery Prof. Burri from the AO-group in Switzerland. (There, Dr. Burri) asked me to study the possibility of functional treatment of knee ligament surgery. So I started immediately an extensive cadaveric study, which resulted in the development of a hinged cast, which became later our currently used brace system.
Knee1: What are you focusing on in your current clinical research?
Dr. Paessler: Tunnel widening in ACL reconstruction, new fixation techniques, new technique for PCL reconstruction, cytokin levels of the knee 5 years following ACL reconstruction, effect of non-accelerated vs. accelerated rehabilitation on outcome after ACL reconstruction. I (also) worked with Smith & Nephew Endoscopy on (their) new fixation device for tibial fixation of ACL grafts, the Fast-Fix. We (are conducting) a clinical study on the use of (this) new meniscus refixation system.
Knee1: What is tunnel widening and what does it mean for a patient's recovery?
Dr. Paessler: Tunnel widening is a not-desired side effect of ACL reconstruction and occurs mainly when hamstrings are used for reconstruction. From a lot of clinical studies, we know that (it possibly) does not affect stability and clinical outcome, but it may be a problem when revision is necessary after graft failure. (When doing this procedure) those large tunnels have to be closed with bone grafting in a first stage before doing reconstruction. (That) means 2 surgeries and long period of (recovery). Therefore, it is important to find means to avoid tunnel widening (perfect positioning of graft tunnels, adequate fixation and rehabilitation).
Knee1: How do you approach the treatment for and prevention of ACL damage?
Dr. Paessler: Prevention is possible, as some studies good demonstrate. Conditioning and special proprioceptive training belong to these possibilities. If an athlete has an instable knee due to a rupture of the ACL, I recommend early reconstruction, because we know that the outcome is then the best. For a good functional outcome, precise tunnel placement is the most important surgical rule. The choice of the graft is secondary. To obtain always a most correct tunnel position, we recommend to verify the position of our K-wire for tunnel drilling with the tip in the notch wall using fluoroscopy in all cases. By these means we obtain correct tunnel placements in practically 100% of our cases.
Knee1: The medical community in the U.S. is sometimes criticized for taking so long to approve medical procedures, devices, medications that have shown positive results on other countries. What do you see as the major hurdles (if any) in implementing the latest technologies from the US in Europe and vice versa?
Dr. Paessler: European administration is faster than US, therefore we get sometimes new products, which are not yet released in the US. For example, the collagen meniscus implant (CMI), fibrin glue, (and) PDS suture material, like the PDS cord.
Knee1: How do you see the easier administration of European medicine as an aid to your work in developing new techniques and tools to help your patients?
Dr. Paessler: Administration should not be too complicated and should have realistic and practical goals. In some countries, like Japan and the US, regulations for certification of new developed products or techniques seems to be extremely complicated, requiring expensive and long lasting experimental and clinical work. This may be in most of European countries regulated in a less complicated manner.
Knee1: What do you see as your greatest contribution to sports medicine and the treatment of knee injuries?
Dr. Paessler: The development of non-immobilizing, functional rehabilitation techniques following knee ligament surgery. [The original study - Funktionelle Behandlung nach Bandnaht und - plastik am Kniegelenk – was first published in Germany in 1972. An English version - Functional postoperative care after reconstruction of knee ligaments - was published two years later.] Furthermore, the development of a percutaneous repait technique for Achilles tendon ruptures with immediate functional postoperative treatment and early full weight bearing (at 1 week). (First presented in 1988.)
Knee1: Is there one case that really stands out in your career that you were completely amazed that the patient recovered beyond all expectations?
Dr. Paessler: Yes, a sports medicine doctor, (it was a patient) who presented 9 years ago with bilateral ACL deficiencies and varus gonarthritis on one knee and valgus gonarthritis on the other one. He was down to bone bilaterally. He insisted on having his ACL reconstructed bilaterally and in one operation. I (performed) just patellar tendon autografts on both knees. He recovered fast, took up his office after 1 week and his sports at 3 months. Four years later, he came for a first check up, the other ones before he had neglected. He said that he has passed his hardest tests by doing helicopter skiing on black routes in Canada, and that he never before in his life had such perfect skiing without any pain. His knees were perfect, and on weight bearing x-rays, the joint space had improved in both knees. Last year, 8 years after surgery, he showed up again with his daughter, who had ruptured her ACL. He (was still doing) perfectly well and continues every winter helicopter skiing on black routes in Canada. I still don’t know how his cartilage recovered.
Image courtesy of http://www.atos.de