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  • 1
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    Biomechanische Auswirkungen von isolierten, massiven sowie irreparablen posterosuperioren Rotatorenmanschettenrupturen auf das glenohumerale Gelenk : Eine dynamische biomechanische Studie über Rotatorenmanschettenrupturen
    Springer Science and Business Media LLC ; 2021
    In:  Obere Extremität Vol. 16, No. 2 ( 2021-06), p. 120-129
    Details
    In: Obere Extremität, Springer Science and Business Media LLC, Vol. 16, No. 2 ( 2021-06), p. 120-129
    Type of Medium: Online Resource
    ISSN: 1862-6599 , 1862-6602
    URL: Article
    DOI: 10.1007/s11678-021-00622-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
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  • 2
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    Comparison of Different Fixation Techniques of the Long Head of the Biceps Tendon in Superior Capsule Reconstruction for Irreparable Posterosuperior Rotator Cuff Tears: A Dynamic Biomechanical Evaluation
    SAGE Publications ; 2021
    In:  The American Journal of Sports Medicine Vol. 49, No. 2 ( 2021-02), p. 305-313
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 49, No. 2 ( 2021-02), p. 305-313
    Abstract: In the past decade, superior capsular reconstruction has emerged as a potential surgical approach in young patients with irreparable posterosuperior rotator cuff tears (RCT) and absence of severe degenerative changes. Recently, the use of locally available and biological viable autografts, such as the long head of the biceps tendon (LHBT) for SCR has emerged, with promising early results. Purpose/Hypothesis: The purpose of this study was to investigate the effect of using the LHBT for reconstruction of the superior capsule on shoulder kinematics, along with different fixation constructs in a dynamic biomechanical model. The authors hypothesized that each of the 3 proposed fixation techniques would restore native joint kinematics, including glenohumeral superior translation (ghST), maximum abduction angle (MAA), maximum cumulative deltoid force (cDF), and subacromial peak contact pressure (sCP). Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric shoulders (mean age, 53.4 ± 14.2 years) were tested using a dynamic shoulder simulator. Each specimen underwent the following 5 conditions: (1) intact, (2) irreparable posterosuperior rotator cuff tear (psRCT), (3) V-shaped LHBT reconstruction, (4) box-shaped LHBT reconstruction, and (5) single-stranded LHBT reconstruction. MAA, ghST, cDF and sCP were assessed in each tested condition. Results: Each of the 3 LHBT techniques for reconstruction of the superior capsule significantly increased MAA while significantly decreasing ghST and cDF compared with the psRCT ( P 〈 .001 and P 〈 .001, respectively). Additionally, the V-shaped and box-shaped techniques significantly decreased sCP ( P = .009 and P = .016, respectively) compared with the psRCT. The V-shaped technique further showed a significantly increased MAA ( P 〈 .001, respectively) and decreased cDF ( P = .042 and P = .039, respectively) when compared with the box-shaped and single-stranded techniques, as well as a significantly decreased ghST ( P = .027) when compared with the box-shaped technique. Conclusion: In a dynamic biomechanical cadaveric model, using the LHBT for reconstruction of the superior capsule improved shoulder function by preventing superior humeral migration, decreasing deltoid forces and sCP. As such, the development of rotator cuff tear arthropathy in patients with irreparable psRCTs could potentially be delayed. Clinical Relevance: Using a biologically viable and locally available LHBT autograft is a cost-effective, potentially time-saving, and technically feasible alternative for reconstruction of the superior capsule, which may result in favorable outcomes in irreparable psRCTs. Moreover, each of the 3 techniques restored native shoulder biomechanics, which may help improve shoulder function by preventing superior humeral head migration and the development of rotator cuff tear arthropathy in young patients with irreparable rotator cuff tears.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546520981559
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
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  • 3
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    The Distal Triceps Tendon Footprint and a Biomechanical Analysis of 3 Repair Techniques
    SAGE Publications ; 2010
    In:  The American Journal of Sports Medicine Vol. 38, No. 5 ( 2010-05), p. 1025-1033
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 38, No. 5 ( 2010-05), p. 1025-1033
    Abstract: Anatomic repair of tendon ruptures is an important goal of surgical treatment. There are limited data on the triceps brachii insertion, footprint, and anatomic reconstruction of the distal triceps tendon. Hypothesis An anatomic repair of distal triceps tendon ruptures more closely imitates the preinjury anatomy and may result in a more durable repair. Study Design Descriptive and controlled laboratory studies. Methods The triceps tendon footprint was measured in 27 cadaveric elbows, and a distal tendon rupture was created. Elbows were randomly assigned to 1 of 3 repair groups: cruciate repair group, suture anchor group, and anatomic repair group. Biomechanical measurement of load at yield and peak load were measured. Cyclic loading was performed for a total of 1500 cycles and displacement measured. Results The average bony footprint of the triceps tendon was 466 mm2. Cyclic loading of tendons from the 3 repair types demonstrated that the anatomic repair produced the least amount of displacement when compared with the other repair types (P 〈 .05). Load at yield and peak load were similar for all repair types (P 〉 .05). Conclusion The triceps bony footprint is a large area on the olecranon that should be considered when repairing distal triceps tendon ruptures. Anatomic repair of triceps tendon ruptures demonstrated the most anatomic restoration of distal triceps ruptures and showed statistically significantly less repair-site motion when cyclically loaded. Clinical Relevance Anatomic repair better restores preinjury anatomy compared with other types of repairs and demonstrates less repair-site motion, which may play a role in early postoperative management.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546509358319
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2010
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  • 4
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    Stability of Double-Row Rotator Cuff Repair Is Not Adversely Affected by Scaffold Interposition Between Tendon and Bone
    SAGE Publications ; 2012
    In:  The American Journal of Sports Medicine Vol. 40, No. 5 ( 2012-05), p. 1148-1154
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 40, No. 5 ( 2012-05), p. 1148-1154
    Abstract: Background: Rotator cuff reconstructions may be improved by adding growth factors, cells, or other biologic factors into the repair zone. This usually requires a biological carrier (scaffold) to be integrated into the construct and placed in the area of tendon-to-bone healing. This needs to be done without affecting the constructs mechanics. Hypothesis/Purpose: The hypothesis was that scaffold placement, as an interposition, has no adverse effects on biomechanical properties of double-row rotator cuff repair. The purpose of this study was to examine the effect of scaffold interposition on the initial strength of rotator cuff repairs. Study Design: Controlled laboratory study. Methods: Twenty-five fresh-frozen shoulders (mean age: 65.5 ± 8.9 years) were randomly assigned to 5 groups. Groups were chosen to represent a broad spectrum of commonly used scaffold types: (1) double-row repair without augmentation, (2) double-row repair with interposition of a fibrin clot (Viscogel), (3) double-row repair with interposition of a collagen scaffold (Mucograft) between tendon and bone, (4) double-row repair with interposition of human dermis patch (ArthroFlex) between tendon and bone, and (5) double-row repair with human dermis patch (ArthroFlex) placed on top of the repair. Cyclic loading to measure displacement was performed to 3000 cycles at 1 Hz with an applied 10- to 100-N load. The ultimate load to failure was determined at a rate of 31 mm/min. Results: There were no significant differences in mean displacement under cyclic loading, slope, or energy absorbed to failure between all groups ( P = .128, P = .981, P = .105). Ultimate load to failure of repairs that used the collagen patch as an interposition (573.3 ± 75.6 N) and a dermis patch on top of the reconstruction (575.8 ± 22.6 N) was higher compared with the repair without a scaffold (348.9 ± 98.8 N; P = .018 and P = .025). No significant differences were found for repairs with the fibrin clot as an interposition (426.9 ± 103.6 N) and the decellularized dermis patch as an interposition (469.9 ± 148.6 N; P = .73 and P = .35). Conclusion: Scaffold augmentation did not adversely affect the zero time strength of the tested standard double-row rotator cuff repairs. An increased ultimate load to failure was observed for 2 of the augmentation methods (collagen patch as an interposition and decellularized dermis patch on top of the reconstruction) compared with the nonaugmented repairs. Clinical Relevance: Scaffolds intended for application of growth factors or cellular components in a repair situation did not adversely jeopardize the stability of the operative construct.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546512437835
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
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  • 5
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    Pectoralis Major Repair: A Biomechanical Analysis of Modern Repair Configurations Versus Traditional Repair Configuration
    SAGE Publications ; 2017
    In:  The American Journal of Sports Medicine Vol. 45, No. 12 ( 2017-10), p. 2858-2863
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 45, No. 12 ( 2017-10), p. 2858-2863
    Abstract: Pectoralis major (PM) ruptures are increasingly common, and a variety of surgical techniques have been described. However, tested techniques have demonstrated diminished strength with inadequate restoration of the footprint and suture failure at relatively low loads. Purpose/Hypothesis: The purpose was to biomechanically compare PM transosseous suture repair (current gold standard) to modern PM repair techniques that use larger caliber sutures, suture tape, and unicortical button fixation (UBF). The null hypothesis was that there would be no mechanical difference between repair techniques and no difference in the amount of footprint restoration. Study Design: Controlled laboratory study. Methods: Twenty-four fresh-frozen cadaveric shoulders controlled for age and bone mineral density were randomized equally to 4 groups: (1) UBF, suture tape; (2) UBF, No. 5 suture, suture tape; (3) bone trough with No. 2 suture; and (4) native PM tendon group; all groups were tested to failure. The specimens were tested under cycling loads (10 N to 125 N) with a final load-to-failure test at 1 mm/s. Failure modes were classified by location and cause of rupture based on optical markers, while tendon footprint length was measured to determine amount of footprint restoration. Results: For fixation strength, the mean peak load was significantly greater in the native tendon (1816 ± 706 N) versus UBF/No. 5 suture/suture tape (794 ± 168 N), UBF/suture tape (502 ± 201 N), and bone trough (492 ± 151 N) ( P 〈 .001 for all). UBF/No. 5 suture/suture tape featured the lowest displacement superiorly (1.09 ± 0.47 mm) and inferiorly (1.14 ± 0.39 mm) with a significant difference compared with bone trough. With regard to tendon footprint reapproximation, cortical button fixation best approximated native tendon footprint length versus bone trough. Conclusion: Based on peak failure load, the UBF/No. 5 suture/suture tape construct demonstrated 61% greater construct strength than a traditional bone trough technique. Moreover, displacement after cyclic loading was by far smallest in the UBF/No. 5 suture/suture tape construct. Therefore, repair constructs with larger caliber suture and suture tape provide a measurable improvement in construct strength versus traditional PM repair techniques in a biomechanical model and may be advantageous for repair. Clinical Relevance: Cortical button fixation with larger caliber suture and suture tape allows for a significantly better PM repair than more traditional techniques at the time of surgery, which may ultimately result in improved clinical outcomes if implemented in surgical practice.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546517716175
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
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  • 6
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    An Anatomic and Biomechanical Comparison of Bankart Repair Configurations
    SAGE Publications ; 2017
    In:  The American Journal of Sports Medicine Vol. 45, No. 13 ( 2017-11), p. 3004-3009
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 45, No. 13 ( 2017-11), p. 3004-3009
    Abstract: Suture anchor repair for anterior shoulder instability can be performed using a number of different repair techniques, but none has been proven superior in terms of anatomic and biomechanical properties. Purpose/Hypothesis: The purpose was to compare the anatomic footprint coverage and biomechanical characteristics of 4 different Bankart repair techniques: (1) single row with simple sutures, (2) single row with horizontal mattress sutures, (3) double row with sutures, and (4) double row with labral tape. The hypotheses were as follows: (1) double-row techniques would improve the footprint coverage and biomechanical properties compared with single-row techniques, (2) horizontal mattress sutures would increase the footprint coverage compared with simple sutures, and (3) repair techniques with labral tape and sutures would not show different biomechanical properties. Study Design: Controlled laboratory study. Methods: Twenty-four fresh-frozen cadaveric specimens were dissected. The native labrum was removed and the footprint marked and measured. Repair for each of the 4 groups was performed, and the uncovered footprint was measured using a 3-dimensional digitizer. The strength of the repair sites was assessed using a servohydraulic testing machine and a digital video system to record load to failure, cyclic displacement, and stiffness. Results: The double-row repair techniques with sutures and labral tape covered 73.4% and 77.0% of the footprint, respectively. These percentages were significantly higher than the footprint coverage achieved by single-row repair techniques using simple sutures (38.1%) and horizontal mattress sutures (32.8%) ( P 〈 .001). The footprint coverage of the simple suture and horizontal mattress suture groups was not significantly different ( P = .44). There were no significant differences in load to failure, cyclic displacement, or stiffness between the single-row and double-row groups or between the simple suture and horizontal mattress suture techniques. Likewise, there was no difference in the biomechanical properties of the double-row repair techniques with sutures versus labral tape. Conclusion: Double-row repair techniques provided better coverage of the native footprint of the labrum but did not provide superior biomechanical properties compared with single-row repair techniques. There was no difference in footprint coverage or biomechanical strength between the simple suture and horizontal mattress suture repair techniques. Clinical Relevance: Although the double-row repair techniques had no difference in initial strength, they may improve healing in high-risk patients by improving the footprint coverage.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546517717671
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
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  • 7
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    Posterior Rotational and Translational Stability in Acromioclavicular Ligament Complex Reconstruction: A Comparative Biomechanical Analysis in Cadaveric Specimens
    SAGE Publications ; 2020
    In:  The American Journal of Sports Medicine Vol. 48, No. 10 ( 2020-08), p. 2525-2533
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 48, No. 10 ( 2020-08), p. 2525-2533
    Abstract: Persistent posterior instability of the acromioclavicular (AC) joint is a reported complication after isolated coracoclavicular (CC) reconstruction. Thus, multiple techniques have been proposed attempting to restore biomechanics of the AC ligament complex (ACLC). Purpose/Hypothesis: The purpose was to evaluate the posterior translational and rotational stability of an ACLC reconstruction with a dermal allograft (ACLC patch) as compared with 3 suture brace constructs. It was hypothesized that the ACLC patch would better restore AC joint posterior stability. Study Design: Controlled laboratory study. Methods: A total of 28 cadaveric shoulders (mean ± SD age, 57.6 ± 8.3 years) were randomly assigned to 1 of 4 surgical techniques: ACLC patch, oblique brace, anterior brace, and x-frame brace. The force and torque to achieve 10 mm of posterior translation and 20° of posterior rotation of the AC joint were recorded in the following conditions: intact, transected ACLC, ACLC patch/brace repair, ACLC patch/brace repair with dissected CC ligaments, and ACLC patch/brace repair with CC ligament repair. Results: For posterior translation, transection of the ACLC reduced resistance to 16.7% of the native. With the native CC ligaments intact, the ACLC patch (59.1%), oblique brace (54.1%), and anterior brace (60.7%) provided significantly greater stability than the x-frame brace (33.2%; P 〈 .001, P = .008, P 〈 .001, respectively). ACLC patch, oblique brace, and anterior brace continued to have significantly higher posterior translational resistance than the x-frame (35.1%; P 〈 .001, P = .003, P 〈 .001) after transection and subsequent CC ligament repair. For posterior rotation, transection of the ACLC decreased the resistance to 5.4% of the intact state. With the CC ligaments intact, the ACLC patch (77.1%) better restored posterior rotational stability than the oblique (35.3%), anterior (48.5%), and x-frame (23.0%) brace repairs ( P 〈 .001, P = .002, P 〈 .001). CC ligament transection and subsequent repair demonstrated the ACLC patch (41.0%) to have improved stability when compared with the oblique (16.0%), anterior (14.0%), and x-frame (12.7%) repairs ( P = .006, P = .003, P = .002). Conclusion: ACLC reconstruction with a dermal allograft better restored native posterior rotational stability than other brace constructs, with translational stability similar to the oblique and anterior brace technique at the time of surgery. Clinical Relevance: Horizontal stability of the AC joint is primarily controlled by the ACLC. Inability to restore AC joint biomechanics can result in persistent posterior instability and lead to functional impairment.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546520939882
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
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  • 8
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    Effect of Slope and Varus Correction High Tibial Osteotomy in the ACL-Deficient and ACL-Reconstructed Knee on Kinematics and ACL Graft Force: A Biomechanical Analysis
    SAGE Publications ; 2021
    In:  The American Journal of Sports Medicine Vol. 49, No. 2 ( 2021-02), p. 410-416
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 49, No. 2 ( 2021-02), p. 410-416
    Abstract: Correction of high posterior tibial slope is an important treatment option for revision of anterior cruciate ligament (ACL) failure as seen in clinical and biomechanical studies. In cases with moderate to severe medial compartment arthritis, an additional varus correction osteotomy may be added to improve alignment. Purpose: To investigate the influence of coronal and sagittal correction high tibial osteotomy in ACL-deficient and ACL-reconstructed knees on knee kinematics and ACL graft load. Study Design: Controlled laboratory study. Methods: Ten cadaveric knees were selected according to previous computed tomography measurements with increased native slope and slight varus tibial alignment (mean ± SD): slope, 9.9°± 1.4°; medial proximal tibia angle, 86.5°± 2.1°; age, 47.7 ± 5.8 years. A 10° anterior closing-wedge osteotomy, as well as an additional 5° of simulated varus correction osteotomy, were created and fixed using an external fixator. Four alignment conditions—native, varus correction, slope correction, and combined varus and slope correction—were randomly tested in 2 states: ACL-deficient and ACL-reconstructed. Compressive axial loads were applied to the tibia while mounted on a free-moving X-Y table and free-rotating tibia in a knee testing fixture. Three-dimensional motion tracking captured anterior tibial translation (ATT) and internal tibial rotation. Change of tensile forces on the reconstructed ACL graft were recorded. Results: In the ACL-deficient knee, an isolated varus correction led to a significant increase of ATT by 4.3 ± 4.0 mm ( P = .04). Isolated slope reduction resulted in the greatest decrease of ATT by 6.2 ± 4.3 mm ( P 〈 .001). In the ACL-reconstructed knee, ATT showed comparable changes, while combined varus and slope correction led to lower ATT by 3.7 ± 2.6 mm ( P = .01) than ATT in the native alignment. Internal tibial rotation was not significantly altered by varus correction but significantly increased after isolated slope correction by 4.0°± 4.1° ( P 〈 .01). Each isolated or combined osteotomy showed decreased forces on the graft as compared with the native state. The combined varus and slope osteotomy led to a mean decrease of ACL graft force by 33% at 200 N and by 58% at 400 N as compared with the native condition ( P 〈 .001). Conclusion: A combined varus and slope correction led to a relevant decrease of ATT in the ACL-deficient and ACL-reconstructed cadaveric knee. ACL graft forces were significantly decreased after combined varus and slope correction. Thus, our biomechanical findings support the treatment goal of a perpendicular-aligned tibial plateau for ACL insufficiencies, especially in cases of revision surgery. Clinical Relevance: This study shows the beneficial knee kinematics and reduced forces on the ACL graft after combined varus and slope correction.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546520976147
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
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  • 9
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    Augmentation of Distal Biceps Tendon Ruptures With the Lacertus Fibrosus: A Biomechanical Study in a Tendon-Deficient Model
    SAGE Publications ; 2022
    In:  The American Journal of Sports Medicine Vol. 50, No. 3 ( 2022-03), p. 725-730
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 50, No. 3 ( 2022-03), p. 725-730
    Abstract: Chronic distal biceps tendon ruptures may require tendon graft augmentation secondary to tendon attrition or retraction. The lacertus fibrosus is a local, cost-effective graft that can be used to supplement reconstruction. Purpose: To compare the biomechanical strength of distal biceps tendon repairs with and without lacertus fibrosus augmentation in a tendon-deficient cadaveric model. Study Design: Controlled laboratory study. Methods: Sixteen fresh-frozen matched cadaveric pairs of elbows were randomized into 2 groups: (1) standard distal biceps tendon repair and (2) tendon-deficient (50% step cut) repair with lacertus fibrosus augmentation. All repairs were completed using an oval bone trough and 2 double-loaded No. 2 braided nonabsorbable sutures in a locked Krackow fashion tied over a lateral bone bridge. For the lacertus augmentation group, the lacertus was wrapped circumferentially in a tubular fashion around the tendon to restore the native size and incorporated into the Krackow suture. All specimens underwent cyclic loading and then were loaded to failure. Displacement, stiffness, load to failure, and mode of failure were recorded. Results: The standard repair and lacertus augmentation groups had similar displacements on cyclic loading (1.66 ± 0.62 vs 1.62 ± 0.58 mm, respectively; P = .894). The stiffness was significantly greater for the standard repair group (21.3 ± 2.5 vs 18.5 ± 3.5 N/mm; P = .044). Both groups provided excellent mean peak load to failure strengths, despite the standard repair group having significantly greater strength (462.4 ± 140.5 vs 377.3 ± 101.1 N; P = .022). The primary mode of failure in the standard repair group was fracture at the bone bridge (n = 5/8) compared with suture pullout (n = 4/8) in the lacertus augmentation group. Conclusion: Lacertus fibrosus augmentation of a tendon-deficient biceps repair was less stiff and had lower mean load to failure compared with repair of the native tendon in this cadaveric model, but these values remained biomechanically acceptable above critical thresholds. Consequently, lacertus fibrosus augmentation is a viable option for chronic distal biceps tendon ruptures with tendon attrition. Clinical Relevance: Chronic distal biceps tendon ruptures may require autograft or allograft reconstruction secondary to tendon scarring, shortening, attrition, and degeneration. The lacertus fibrosus is a cost-effective and low-morbidity local autograft that can be used to augment repairs.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465211065450
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
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  • 10
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    Biomechanical evaluation of an arthroscopic transosseous repair as a revision option for failed rotator cuff surgery
    Springer Science and Business Media LLC ; 2018
    In:  BMC Musculoskeletal Disorders Vol. 19, No. 1 ( 2018-12)
    Details
    In: BMC Musculoskeletal Disorders, Springer Science and Business Media LLC, Vol. 19, No. 1 ( 2018-12)
    Type of Medium: Online Resource
    ISSN: 1471-2474
    URL: Article
    DOI: 10.1186/s12891-018-2089-4
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2018
    detail.hit.zdb_id: 2041355-5
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