Bruderholz known for knee function findings, strong orthopaedic tradition

In the 1980s, the department’s first head, Werner Müller, MD, helped found the European Society of Sports Traumatology, Knee Surgery and Arthroscopy.

The Department of Orthopaedic Surgery and Traumatology at Kantonsspital Bruderholz, in Basel, Switzerland, which began in 1978 with just two orthopaedic surgeons and 15 beds, is recognized worldwide for its many orthopaedic contributions. In particular, it is known for having positively impacted the field of sports medicine and furthered the understanding of knee function.

Under Werner Müller, MD, first head of orthopaedic surgery at Bruderholz from 1978 to 1998, “gradually it went from a little division of surgery to develop into its own fully established department. Today the department is 22-people strong and has evolved into a rather big enterprise,” said Niklaus F. Friederich, MD, head of the Department of Orthopaedic Surgery, Kantonsspital Bruderholz. Friederich joined the staff as a trainee in 1986 and has led the department since 1998.

This year the University of Basel, the department’s academic affiliate, celebrates the 550th anniversary of its founding in 1460.

Impressive staff

“It has been a department with very broad orthopaedic experience to compare with any department in the United States in terms of depth and breadth of orthopaedic service, experience, expertise,” John A. Feagin, MD, of Vail, Colo., USA, said.

Kantonsspital Bruderholz was established in 1975 in Basel, Switzerland, where the juxtaposition of parts of Switzerland, Germany and France has led to recent population growth. Images: Müller WE

Kantonsspital Bruderholz was established in 1975 as the need for more medical care for the expanding population in the greater Basel area increased. “They started slowly and were not sure if they should have an orthopaedic department,” Müller said.

Feagin first encountered the Bruderholz orthopaedic staff during a visit with Müller in the 1980s, when he observed joint replacement, sports medicine and knee surgery cases. “I was tremendously impressed by their expertise, team work, techniques and particularly with their care of the surgical patient — sterility techniques and just in the management of safety of the patient involved in a difficult surgical procedure,” he told Orthopaedics Today Europe.

Experience at Bruderholz

Müller’s landmark book, The Knee: Form, Function, and Ligamentous Reconstruction, published in German in 1982 and English in 1983, was a major contribution to the specialty, according to Feagin.

The book explained the complex anatomy of the knee, including the concepts of the Burmester curve, pathomechanics of the pivot shift and why the knee does not roll or glide — some of them for the first time.

Müller was trained at Basel University by such international experts as George Chapchal, MD, professor of orthopaedic surgery from 1964 to 1970, Erwin Morscher, MD, and Martin Allgöwer, MD; he was also influenced by leaders from Lyon, France, and elsewhere.

OAK and IKDC scores

Friederich told Orthopaedics Today Europe he considers Müller’s classic text the first of four orthopaedic cornerstones which make the department at Bruderholz what it is today. “The second cornerstone was that Müller co-founded the Swiss OAK group,” he said.

In December 1984, Werner Müller, MD, (left) and John A. Feagin, MD, dined at Basel’s Walliser Kanne. There, Feagin proposed the concept of the current AOSSM-ESSKA travelling fellowship.

Members of the OrthopaAdische Arbeitsgruppe Knie (OAK) developed a standard method of measuring knee function: the OAK score. Their efforts soon led to formation of the International Knee Documentation Committee (IKDC). At about the same time, Müller reached out to Feagin and others to develop the IKDC score now used worldwide for evaluating knee outcomes.

ESSKA established

The IKDC project produced the department’s third cornerstone, according to Friederich, which was when Müller, Ejnar Eriksson, MD, and multinational sports medicine leaders established ESSKA among the first orthopaedic specialty societies in Europe.

“Werner Müller was in the true sense a diplomat. He made the foundation of ESSKA possible,” Friederich said.

As first president of ESSKA from 1984 to 1988, Müller — and Bruderholz — hosted the society’s second meeting in Basel in 1986.

Final cornerstone

The fourth key cornerstone was the publication of Müller’s key papers in the East German orthopaedic literature. “He was not afraid to talk to his orthopaedic colleagues behind the Iron Curtain, which helped make it possible for members of Eastern European countries to join ESSKA and attend the first meetings,” Friederich said.

A past team physician for Swiss football team FC Basel, Müller was admitted to the American Orthopaedic Society for Sports Medicine (AOSSM) Hall of Fame in 2007 and honored with the Friedrich Pauwels medal in 2008 at the Annual Meeting of the Deutsche Gesellschaft für Orthopaedie und Orthopaedische Chirurgie.

Full growth ahead

In his 12 years at the helm of the department, Friederich has aided its success by being a strong leader, surgeon and clinical investigator and encouraged the same from his talented staff.

“Nik has had his own style of leadership that has been exemplary,” said Feagin. He described Friederich as a scientific leader who is a member of nearly every important international orthopaedic organization.

Orthopaedic education has long been important in the department. Bruce Reider, MD, editor of the American Journal of Sports Medicine, trained there for 6 months and it is the usual stop that the AOSSM and ESSKA travelling fellows make. Today, orthopaedic trainees can participate in a number of department investigations into orthobiologics, cartilage repair, orthopaedic imaging, hydrogel technology and more. While Friederich believes all these areas will be essential to the orthopaedic surgery practice of tomorrow, studying the knee, for which Bruderholz is best known, should remain in the orthopaedic spotlight for years to come. – by Susan M. Rapp

References:

• Müller W. The Knee: Form, Function, and Ligamentous Reconstruction. New York: Springer-Verlag. 1982.
• Müller WE, Biedert R, Hefti F, et al. The OAK evaluation system. A new way to document knee ligament injuries. Clin Orthop Relat Res. 1988;(232):37-50.
• www.bruderholzspital.ch

• John A. Feagin, MD, can be reached at PO Box 1413, Vail, CO 81658, U.S.A.; e-mail: jafduke@aol.com.
• Niklaus F. Friederich, MD, can be reached at Kantonsspital Bruderholz, CH-4101, Bruderholz, Switzerland; +41-61-436 27 41; e-mail: Niklaus-f.friederich@unibas.ch.
• Werner Müller, MD, can be reached at Spechtweg 10, CH-4125 Riehen, Switzerland; e-mail: w.u.mueller@datacomm.ch.