@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} } @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} } @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} } @article{MeyerGaalenLeschingeretal.2019, author = {Meyer, Carolin and Gaalen, Kerstin van and Leschinger, Tim and Scheyerer, Max J. and Neiss, Wolfram F. and Staat, Manfred and M{\"u}ller, Lars P. and Wegmann, Kilian}, title = {Kyphoplasty of Osteoporotic Fractured Vertebrae: A Finite Element Analysis about Two Types of Cement}, series = {BioMed Research International}, journal = {BioMed Research International}, doi = {10.1155/2019/9232813}, pages = {Article ID 9232813}, year = {2019}, language = {en} } @article{RauschHarbrechtKahmannetal.2020, author = {Rausch, Valentin and Harbrecht, Andreas and Kahmann, Stephanie Lucina and Fenten, Thomas and Jovanovic, Nebojsa and Hackl, Michael and M{\"u}ller, Lars P. and Staat, Manfred and Wegmann, Kilian}, title = {Osteosynthesis of Phalangeal Fractures: Biomechanical Comparison of Kirschner Wires, Plates, and Compression Screws}, series = {The Journal of Hand Surgery}, volume = {45}, journal = {The Journal of Hand Surgery}, number = {10}, publisher = {Elsevier}, address = {Amsterdam}, issn = {0363-5023}, doi = {10.1016/j.jhsa.2020.04.010}, pages = {987.e1 -- 987.e8}, year = {2020}, abstract = {Purpose The aim of this study was to compare several osteosynthesis techniques (intramedullary headless compression screws, T-plates, and Kirschner wires) for distal epiphyseal fractures of proximal phalanges in a human cadaveric model. Methods A total of 90 proximal phalanges from 30 specimens (index, ring, and middle fingers) were used for this study. After stripping off all soft tissue, a transverse distal epiphyseal fracture was simulated at the proximal phalanx. The 30 specimens were randomly assigned to 1 fixation technique (30 per technique), either a 3.0-mm intramedullary headless compression screw, locking plate fixation with a 2.0-mm T-plate, or 2 oblique 1.0-mm Kirschner wires. Displacement analysis (bending, distraction, and torsion) was performed using optical tracking of an applied random speckle pattern after osteosynthesis. Biomechanical testing was performed with increasing cyclic loading and with cyclic load to failure using a biaxial torsion-tension testing machine. Results Cannulated intramedullary compression screws showed significantly less displacement at the fracture site in torsional testing. Furthermore, screws were significantly more stable in bending testing. Kirschner wires were significantly less stable than plating or screw fixation in any cyclic load to failure test setup. Conclusions Intramedullary compression screws are a highly stable alternative in the treatment of transverse distal epiphyseal phalangeal fractures. Kirschner wires seem to be inferior regarding displacement properties and primary stability. Clinical relevance Fracture fixation of phalangeal fractures using plate osteosynthesis may have the advantage of a very rigid reduction, but disadvantages such as stiffness owing to the more invasive surgical approach and soft tissue irritation should be taken into account. Headless compression screws represent a minimally invasive choice for fixation with good biomechanical properties.}, language = {en} } @article{MichaelMayerWeberetal.2017, author = {Michael, Hackl and Mayer, Katharina and Weber, Mareike and Staat, Manfred and van Riet, Roger and Burkhart, Klau Josef and M{\"u}ller, Lars Peter and Wegmann, Kilian}, title = {Plate osteosynthesis of proximal ulna fractures : a biomechanical micromotion analysis}, series = {The journal of hand surgery}, volume = {42}, journal = {The journal of hand surgery}, number = {10}, publisher = {Elsevier}, address = {Amsterdam}, issn = {0363-5023}, doi = {10.1016/j.jhsa.2017.05.014}, pages = {834.e1 -- 834.e7}, year = {2017}, language = {en} } @article{RauschKahmannBaltschunetal.2020, author = {Rausch, Valentin and Kahmann, Stephanie Lucina and Baltschun, Christoph and Staat, Manfred and M{\"u}ller, Lars P. and Wegmann, Kilian}, title = {Pressure distribution to the distal biceps tendon at the radial tuberosity: a biomechanical study}, series = {The Journal of Hand Surgery}, volume = {45}, journal = {The Journal of Hand Surgery}, number = {8}, publisher = {Elsevier}, address = {Amsterdam}, issn = {0363-5023}, doi = {10.1016/j.jhsa.2020.01.006}, pages = {776.e1 -- 776.e9}, year = {2020}, abstract = {Purpose Mechanical impingement at the narrow radioulnar space of the tuberosity is believed to be an etiological factor in the injury of the distal biceps tendon. The aim of the study was to compare the pressure distribution at the proximal radioulnar space between 2 fixation techniques and the intact state. Methods Six right arms and 6 left arms from 5 female and 6 male frozen specimens were used for this study. A pressure transducer was introduced at the height of the radial tuberosity with the intact distal biceps tendon and after 2 fixation methods: the suture-anchor and the cortical button technique. The force (N), maximum pressure (kPa) applied to the radial tuberosity, and the contact area (mm²) of the radial tuberosity with the ulna were measured and differences from the intact tendon were detected from 60° supination to 60° pronation in 15° increments with the elbow in full extension and in 45° and 90° flexion of the elbow. Results With the distal biceps tendon intact, the pressures during pronation were similar regardless of extension and flexion and were the highest at 60° pronation with 90° elbow flexion (23.3 ± 53.5 kPa). After repair of the tendon, the mean peak pressure, contact area, and total force showed an increase regardless of the fixation technique. Highest peak pressures were found using the cortical button technique at 45° flexion of the elbow and 60° pronation. These differences were significantly different from the intact tendon. The contact area was significantly larger in full extension and 15°, 30°, and 60° pronation using the cortical button technique. Conclusions Pressures on the distal biceps tendon at the radial tuberosity increase during pronation, especially after repair of the tendon. Clinical relevance Mechanical impingement could play a role in both the etiology of primary distal biceps tendon ruptures and the complications occurring after fixation of the tendon using certain techniques.}, language = {en} } @article{HacklMuellerStaatetal.2016, author = {Hackl, Michael and M{\"u}ller, Lars-Peter and Staat, Manfred and Kahmann, Stephanie Lucina and Wegmann, Kilian}, title = {Proximal phalangeal neck fractures of the hand — a biomechanical comparison of three fixation techniques}, 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/s00167-016-4080-7}, pages = {148 -- 149}, year = {2016}, abstract = {Plate osteosynthesis of displaced proximal phalangeal neck fractures of the hand allows early mobilization due to a stable internal fixation. Nevertheless, joint stiffness—because of soft tissue irritation—represents a common complication leading to high complication rates. Del Pinal et al. recently reported promising clinical results for a new, minimally invasive fixation technique with a cannulated headless intramedullary compression screw. Hence, the aim of this study was to compare plate fixation of proximal phalangeal neck fractures to less two less invasive techniques: Crossed k-wire fixation and intramedullary screw fixation. We hypothesized that these fixation techniques provide inferior stability when compared to plate osteosynthesis.}, language = {en} } @article{HacklWegmannKahmannetal.2017, author = {Hackl, Michael and Wegmann, Kilian and Kahmann, Stephanie Lucina and Heinze, Nicolai and Staat, Manfred and Neiss, Wolfram F. and Scaal, Martin and M{\"u}ller, Lars P.}, title = {Radial shortening osteotomy reduces radiocapitellar contact pressures while preserving valgus stability of the elbow}, series = {Knee Surgery, Sports Traumatology, Arthroscopy}, volume = {25}, journal = {Knee Surgery, Sports Traumatology, Arthroscopy}, number = {7}, publisher = {Springer}, address = {Berlin}, issn = {1433-7347}, doi = {10.1007/s00167-017-4468-z}, pages = {2280 -- 2288}, year = {2017}, language = {en} } @article{HacklLeschingerStaatetal.2016, author = {Hackl, Michael and Leschinger, T. and Staat, Manfred and M{\"u}ller, Lars-Peter and Wegmann, Kilian}, title = {Reconstruction of the interosseous membrane in the Essex Lopresti lesion — a biomechanical evaluation}, 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/s00167-016-4080-7}, pages = {130 -- 131}, year = {2016}, abstract = {Surgical reconstruction of the interosseous membrane (IOM) could restore longitudinal forearm stability to avoid persisting disability due to capituloradial and ulnocarpal impingement in Essex Lopresti lesions. This biomechanical study aimed to assess longitudinal forearm stability of intact specimens, after sectioning of the IOM and after reconstruction with a TightRope construct using either a single or double bundle technique.}, language = {en} } @article{HacklKahmannWegmannetal.2016, author = {Hackl, Michael and Kahmann, Stephanie Lucina and Wegmann, Kilian and Ries, Christian and Staat, Manfred and M{\"u}ller, Lars-Peter}, title = {Shortening osteotomy of the proximal radius — a treatment option for isolated osteoarthritis of the lateral column of the elbow joint?}, 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/s00167-016-4080-7}, pages = {128 -- 129}, year = {2016}, abstract = {Treatment of posttraumatic osteoarthritis of the radial column of the elbow joint remains a challenging yet common issue. While partial joint replacement leads to high revision rates, radial head excision has shown to severely increase joint instability. Shortening osteotomy of the radius could be an option to decrease the contact pressure of the radiohumeral joint and thereby pain levels without causing valgus instability. Hence, the aim of this biomechanical study was to evaluate the effects of radial shortening on axial load distribution and valgus stability of the elbow joint.}, language = {en} }