@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{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} }