@article{HacklBuessKammerlohretal.2021, author = {Hackl, Michael and Buess, Eduard and Kammerlohr, Sandra and Nacov, Julia and Staat, Manfred and Leschinger, Tim and M{\"u}ller, Lars P. and Wegmann, Kilian}, title = {A "comma sign"-directed subscapularis repair in anterosuperior rotator cuff tears yields biomechanical advantages in a cadaveric model}, series = {The american journal of sports medicine}, volume = {49}, journal = {The american journal of sports medicine}, number = {12}, publisher = {Sage}, address = {London}, issn = {1552-3365}, doi = {10.1177/03635465211031506}, pages = {3212 -- 3217}, year = {2021}, abstract = {Background: Additional stabilization of the "comma sign" in anterosuperior rotator cuff repair has been proposed to provide biomechanical benefits regarding stability of the repair. Purpose: This in vitro investigation aimed to investigate the influence of a comma sign-directed reconstruction technique for anterosuperior rotator cuff tears on the primary stability of the subscapularis tendon repair. Study Design: Controlled laboratory study. Methods: A total of 18 fresh-frozen cadaveric shoulders were used in this study. Anterosuperior rotator cuff tears (complete full-thickness tear of the supraspinatus and subscapularis tendons) were created, and supraspinatus repair was performed with a standard suture bridge technique. The subscapularis was repaired with either a (1) single-row or (2) comma sign technique. A high-resolution 3D camera system was used to analyze 3-mm and 5-mm gap formation at the subscapularis tendon-bone interface upon incremental cyclic loading. Moreover, the ultimate failure load of the repair was recorded. A Mann-Whitney test was used to assess significant differences between the 2 groups. Results: The comma sign repair withstood significantly more loading cycles than the single-row repair until 3-mm and 5-mm gap formation occurred (P≤ .047). The ultimate failure load did not reveal any significant differences when the 2 techniques were compared (P = .596). Conclusion: The results of this study show that additional stabilization of the comma sign enhanced the primary stability of subscapularis tendon repair in anterosuperior rotator cuff tears. Although this stabilization did not seem to influence the ultimate failure load, it effectively decreased the micromotion at the tendon-bone interface during cyclic loading. Clinical Relevance: The proposed technique for stabilization of the comma sign has shown superior biomechanical properties in comparison with a single-row repair and might thus improve tendon healing. Further clinical research will be necessary to determine its influence on the functional outcome.}, language = {en} } @article{LeschingerBirgelHackletal.2019, author = {Leschinger, Tim and Birgel, Stefan and Hackl, Michael and Staat, Manfred and M{\"u}ller, Lars Peter and Wegmann, Kilian}, title = {A musculoskeletal shoulder simulation of moment arms and joint reaction forces after medialization of the supraspinatus footprint in rotator cuff repair}, series = {Computer Methods in Biomechanics and Biomedical Engineering}, journal = {Computer Methods in Biomechanics and Biomedical Engineering}, number = {Early view}, publisher = {Taylor \& Francis}, address = {London}, doi = {10.1080/10255842.2019.1572749}, year = {2019}, language = {en} } @inproceedings{KahmannUschokWegmannetal.2018, author = {Kahmann, Stephanie Lucina and Uschok, Stephan and Wegmann, Kilian and M{\"u}ller, Lars-P. and Staat, Manfred}, title = {Biomechanical multibody model with refined kinematics of the elbow}, series = {6th European Conference on Computational Mechanics (ECCM 6), 7th European Conference on Computational Fluid Dynamics (ECFD 7), 11-15 June 2018, Glasgow, UK}, booktitle = {6th European Conference on Computational Mechanics (ECCM 6), 7th European Conference on Computational Fluid Dynamics (ECFD 7), 11-15 June 2018, Glasgow, UK}, pages = {11 Seiten}, year = {2018}, abstract = {The overall objective of this study is to develop a new external fixator, which closely maps the native kinematics of the elbow to decrease the joint force resulting in reduced rehabilitation time and pain. An experimental setup was designed to determine the native kinematics of the elbow during flexion of cadaveric arms. As a preliminary study, data from literature was used to modify a published biomechanical model for the calculation of the joint and muscle forces. They were compared to the original model and the effect of the kinematic refinement was evaluated. Furthermore, the obtained muscle forces were determined in order to apply them in the experimental setup. The joint forces in the modified model differed slightly from the forces in the original model. The muscle force curves changed particularly for small flexion angles but their magnitude for larger angles was consistent.}, language = {en} } @inproceedings{BirgelLeschingerWegmannetal.2017, author = {Birgel, Stefan and Leschinger, Tim and Wegmann, Kilian and Staat, Manfred}, title = {Calculation of muscle forces and joint reaction loads in shoulder area via an OpenSim based computer calculation}, series = {2nd YRA MedTech Symposium 2017 : June 8th - 9th / 2017 / Hochschule Ruhr-West}, booktitle = {2nd YRA MedTech Symposium 2017 : June 8th - 9th / 2017 / Hochschule Ruhr-West}, editor = {Erni, Daniel and Fischerauer, Alice and Himmel, J{\"o}rg and Seeger, Thomas and Thelen, Klaus}, publisher = {Universit{\"a}t Duisburg-Essen}, address = {Duisburg}, organization = {MedTech Symposium}, isbn = {978-3-9814801-9-1}, doi = {10.17185/duepublico/43984}, pages = {116 -- 117}, year = {2017}, language = {en} } @article{BirgelLeschingerWegmannetal.2018, author = {Birgel, Stefan and Leschinger, Tim and Wegmann, Kilian and Staat, Manfred}, title = {Calculation of muscle forces and joint reaction loads in the shoulder area via an OpenSim based computer model}, series = {tm - Technisches Messen}, volume = {85}, journal = {tm - Technisches Messen}, number = {5}, publisher = {De Gruyter}, address = {Berlin}, issn = {2196-7113}, doi = {10.1515/teme-2017-0114}, pages = {321 -- 330}, year = {2018}, abstract = {Using the OpenSim software and verified anatomical data, a computer model for the calculation of biomechanical parameters is developed and used to determine the effect of a reattachment of the Supraspinatus muscle with a medial displacement of the muscle attachment point, which may be necessary for a rupture of the supraspinatus tendon. The results include the influence of the operation on basic biomechanical parameters such as the lever arm, as well as the calculated the muscle activations for the supraspinatus and deltoid. In addition, the influence on joint stability is examined by an analysis of the joint reaction force. The study provides a detailed description of the used model, as well as medical findings to a reattachment of the supraspinatus. Mit der Software OpenSim und {\"u}berpr{\"u}ften anatomischen Daten wird ein Computermodell zur Berechnung von biomechanischen Parametern entwickelt und genutzt, um den Effekt einer Refixierung des Supraspinatusmuskels mit einer medialen Verschiebung des Muskelansatzpunktes zu ermitteln, wie sie unter anderem nach einem Riss der Supraspinatussehne notwendig sein kann. Die Ergebnisse umfassen hierbei den Einfluss der Operation auf grundlegende biomechanische Parameter wie den Hebelarm sowie die berechneten Muskelaktivierungen f{\"u}r den Supraspinatus und Deltoideus. Zus{\"a}tzlich wird der Einfluss auf die Gelenkstabilit{\"a}t betrachtet und durch eine Analyse der Gelenkreaktionskraft untersucht. Die Studie bietet eine detaillierte Beschreibung des genutzten Modells, sowie medizinische Erkenntnisse zu einer Refixierung des Supraspinatus.}, language = {en} } @article{WegmannHacklStaatetal.2016, author = {Wegmann, Kilian and Hackl, Michael and Staat, Manfred and Mayer, Katharina and M{\"u}ller, Lars-Peter}, title = {Double plate osteosynthesis of proximal ulna fractures: biomechanical and clinical results}, series = {Knee surgery, sports traumatology, arthroscopy}, volume = {Volume 24}, journal = {Knee surgery, sports traumatology, arthroscopy}, number = {Supplement 1}, publisher = {Springer}, address = {Berlin}, issn = {0942-2056}, doi = {10.1007/s00167-016-4079-0}, pages = {58 -- 59}, year = {2016}, abstract = {While plate fixation of proximal ulna fractures might lead to superior clinical results compared to tension band wiring, regular plates represent an established risk factor for wound complications. The olecranon double plates (Medartis, Basel, CH) might decrease complications related to the osteosynthesis because of their low profile and better anatomical fit. This study aimed to evaluate the biomechanical performance and clinical results of the olecranon double plates.}, language = {en} } @inproceedings{KahmannHacklWegmannetal.2016, author = {Kahmann, Stephanie and Hackl, Michael and Wegmann, Kilian and M{\"u}ller, Lars-Peter and Staat, Manfred}, title = {Impact of a proximal radial shortening osteotomy on the distribution of forces and the stability of the elbow}, series = {1st YRA MedTech Symposium 2016 : April 8th / 2016 / University of Duisburg-Essen}, booktitle = {1st YRA MedTech Symposium 2016 : April 8th / 2016 / University of Duisburg-Essen}, editor = {Erni, Daniel}, publisher = {Universit{\"a}t Duisburg-Essen}, address = {Duisburg}, organization = {MedTech Symposium}, doi = {10.17185/duepublico/40821}, pages = {7 -- 8}, year = {2016}, abstract = {The human arm consists of the humerus (upper arm), the medial ulna and the lateral radius (forearm). The joint between the humerus and the ulna is called humeroulnar joint and the joint between the humerus and the radius is called humeroradial joint. Lateral and medial collateral ligaments stabilize the elbow. Statistically, 2.5 out of 10,000 people suffer from radial head fractures [1]. In these fractures the cartilage is often affected. Caused by the injured cartilage, degenerative diseases like posttraumatic arthrosis may occur. The resulting pain and reduced range of motion have an impact on the patient's quality of life. Until now, there has not been a treatment which allows typical loads in daily life activities and offers good long-term results. A new surgical approach was developed with the motivation to reduce the progress of the posttraumatic arthrosis. Here, the radius is shortened by 3 mm in the proximal part [2]. By this means, the load of the radius is intended to be reduced due to a load shift to the ulna. Since the radius is the most important stabilizer of the elbow it has to be confirmed that the stability is not affected. In the first test (Fig. 1 left), pressure distributions within the humeroulnar and humeroradial joints a native and a shortened radius were measured using resistive pressure sensors (I5076 and I5027, Tekscan, USA). The humerus was loaded axially in a tension testing machine (Z010, Zwick Roell, Germany) in 50 N steps up to 400 N. From the humerus the load is transmitted through both the radius and the ulna into the hand which is fixed on the ground. In the second test (Fig. 1 right), the joint stability was investigated using a digital image correlation system to measure the displacement of the ulna. Here, the humerus is fixed with a desired flexion angle and the unconstrained forearm lies on the ground. A rope connects the load actuator with a hook fixed in the ulna. A guide roller is used so that the rope pulls the ulna horizontally when a tensile load is applied. This creates a moment about the elbow joint with a maximum value of 7.5 Nm. Measurements were performed with varying flexion angles (0°, 30°, 60°, 90°, 120°). For both tests and each measurement, seven specimens were used. Student's t-test was employed to determine whether the mean values of the measurements in native specimen and operated specimens differ significantly.}, language = {en} } @article{LenzKahmannBehbahanietal.2022, author = {Lenz, Maximilian and Kahmann, Stephanie Lucina and Behbahani, Mehdi and Pennig, Lenhard and Hackl, Michael and Leschinger, Tim and M{\"u}ller, Lars Peter and Wegmann, Kilian}, title = {Influence of rotator cuff preload on fracture configuration in proximal humerus fractures: a proof of concept for fracture simulation}, series = {Archives of Orthopaedic and Trauma Surgery}, journal = {Archives of Orthopaedic and Trauma Surgery}, publisher = {Springer}, address = {Berlin, Heidelberg}, issn = {1434-3916}, doi = {10.1007/s00402-022-04471-9}, year = {2022}, abstract = {Introduction In regard of surgical training, the reproducible simulation of life-like proximal humerus fractures in human cadaveric specimens is desirable. The aim of the present study was to develop a technique that allows simulation of realistic proximal humerus fractures and to analyse the influence of rotator cuff preload on the generated lesions in regards of fracture configuration. Materials and methods Ten cadaveric specimens (6 left, 4 right) were fractured using a custom-made drop-test bench, in two groups. Five specimens were fractured without rotator cuff preload, while the other five were fractured with the tendons of the rotator cuff preloaded with 2 kg each. The humeral shaft and the shortened scapula were potted. The humerus was positioned at 90° of abduction and 10° of internal rotation to simulate a fall on the elevated arm. In two specimens of each group, the emergence of the fractures was documented with high-speed video imaging. Pre-fracture radiographs were taken to evaluate the deltoid-tuberosity index as a measure of bone density. Post-fracture X-rays and CT scans were performed to define the exact fracture configurations. Neer's classification was used to analyse the fractures. Results In all ten cadaveric specimens life-like proximal humerus fractures were achieved. Two III-part and three IV-part fractures resulted in each group. The preloading of the rotator cuff muscles had no further influence on the fracture configuration. High-speed videos of the fracture simulation revealed identical fracture mechanisms for both groups. We observed a two-step fracture mechanism, with initial impaction of the head segment against the glenoid followed by fracturing of the head and the tuberosities and then with further impaction of the shaft against the acromion, which lead to separation of the tuberosities. Conclusion A high energetic axial impulse can reliably induce realistic proximal humerus fractures in cadaveric specimens. The preload of the rotator cuff muscles had no influence on initial fracture configuration. Therefore, fracture simulation in the proximal humerus is less elaborate. Using the presented technique, pre-fractured specimens are available for real-life surgical education.}, language = {en} } @article{HacklNacovKammerlohretal.2021, author = {Hackl, Michael and Nacov, Julia and Kammerlohr, Sandra and Staat, Manfred and Buess, Eduard and Leschinger, Tim and M{\"u}ller, Lars P. and Wegmann, Kilian}, title = {Intratendinous Strain Variations of the Supraspinatus Tendon Depending on Repair Technique: A Biomechanical Analysis Regarding the Cause of Medial Cuff Failure}, series = {The American Journal of Sports Medicine}, volume = {49}, journal = {The American Journal of Sports Medicine}, number = {7}, publisher = {Sage}, address = {London}, issn = {1552-3365}, doi = {10.1177/03635465211006138}, pages = {1847 -- 1853}, year = {2021}, language = {en} } @article{LeschingerBeschAydinetal.2019, author = {Leschinger, Tim and Besch, Katharina and Aydin, Cansu and Staat, Manfred and Scaal, Martin and M{\"u}ller, Lars Peter and Wegmann, Kilian}, title = {Irreparable rotator cuff tears: a biomechanical comparison of superior capsuloligamentous complex reconstruction techniques and an interposition graft technique}, series = {The Orthopaedic Journal of Sports Medicine}, volume = {7}, journal = {The Orthopaedic Journal of Sports Medicine}, number = {8}, doi = {10.1177/2325967119864590}, pages = {1 -- 5}, year = {2019}, language = {en} }