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Werthel JD, Dufrenot M, Schoch BS, Walch A, Morvan Y, Urvoy M, Walch G, Gauci MO. Are glenoid retroversion, humeral subluxation, and Walch classification associated with a muscle imbalance? J Shoulder Elbow Surg 2024; 33:1493-1502. [PMID: 38242526 DOI: 10.1016/j.jse.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/07/2023] [Accepted: 11/27/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND The etiology of humeral posterior subluxation remains unknown, and it has been hypothesized that horizontal muscle imbalance could cause this condition. The objective of this study was to compare the ratio of anterior-to-posterior rotator cuff and deltoid muscle volume as a function of humeral subluxation and glenoid morphology when analyzed as a continuous variable in arthritic shoulders. METHODS In total, 333 computed tomography scans of shoulders (273 arthritic shoulders and 60 healthy controls) were included in this study and were segmented automatically. For each muscle, the volume of muscle fibers without intramuscular fat was measured. The ratio between the volume of the subscapularis and the volume of the infraspinatus plus teres minor (AP ratio) and the ratio between the anterior and posterior deltoids (APdeltoid) were calculated. Statistical analyses were performed to determine whether a correlation could be found between these ratios and glenoid version, humeral subluxation, and/or glenoid type per the Walch classification. RESULTS Within the arthritic cohort, no statistically significant difference in the AP ratio was found between type A glenoids (1.09 ± 0.22) and type B glenoids (1.03 ± 0.16, P = .09), type D glenoids (1.12 ± 0.27, P = .77), or type C glenoids (1.10 ± 0.19, P > .999). No correlation was found between the AP ratio and glenoid version (ρ = -0.0360, P = .55) or humeral subluxation (ρ = 0.076, P = .21). The APdeltoid ratio of type A glenoids (0.48 ± 0.15) was significantly greater than that of type B glenoids (0.35 ± 0.16, P < .01) and type C glenoids (0.21 ± 0.10, P < .01) but was not significantly different from that of type D glenoids (0.64 ± 0.34, P > .999). When evaluating both healthy control and arthritic shoulders, moderate correlations were found between the APdeltoid ratio and both glenoid version (ρ = 0.55, P < .01) and humeral subluxation (ρ = -0.61, P < .01). CONCLUSION This in vitro study supports the use of software for fully automated 3-dimensional reconstruction of the 4 rotator cuff muscles and the deltoid. Compared with previous 2-dimensional computed tomography scan studies, our study did not find any correlation between the anteroposterior muscle volume ratio and glenoid parameters in arthritic shoulders. However, once deformity occurred, the observed APdeltoid ratio was lower with type B and C glenoids. These findings suggest that rotator cuff muscle imbalance may not be the precipitating etiology for the posterior humeral subluxation and secondary posterior glenoid erosion characteristic of Walch type B glenoids.
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Affiliation(s)
| | | | | | | | | | | | - Gilles Walch
- Ramsay Générale de Santé, Centre Orthopédique Santy, Jean Mermoz Private Hospital, Lyon, France
| | - Marc-Olivier Gauci
- Institut Universitaire Locomoteur et du Sport - Centre Hospitalier Universitaire (IULS-CHU) de Nice, Nice, France
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Lannes X, Goetti P, Boubat M, Eghbali P, Becce F, Farron A, Terrier A. Three-dimensional evaluation of the transverse rotator cuff muscle's resultant force angle in relation to scapulohumeral subluxation and glenoid vault morphology in nonpathological shoulders. J Shoulder Elbow Surg 2024; 33:1157-1168. [PMID: 37898420 DOI: 10.1016/j.jse.2023.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 09/20/2023] [Accepted: 09/24/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Static posterior subluxation of the humeral head (SPSH) results in glenohumeral osteoarthritis. Treatment strategies for SPSH with or without resulting osteoarthritis remain challenging. There is growing interest in evaluating the rotator cuff muscle volume, fatty infiltration, or forces in osteoarthritic shoulders with SPSH, mainly due to a possible transverse force imbalance. In nonpathological shoulders, the transverse angle of the rotator cuff muscle's resultant force may be associated with scapulohumeral alignment and glenoid vault morphology, despite an assumed transverse force balance. The purpose of this study was to assess the transverse rotator cuff muscle's resultant force angle (TRFA) and its relationship with the scapulohumeral subluxation index (SHSI) and selected glenoid vault parameters using computer modeling. METHODS Computed tomography scans of 55 trauma patients (age 31 ± 13 years, 36 males) with nonpathological shoulders were analyzed and all measurements performed in 3-dimension. We placed landmarks manually to determine the humeral head center and the rotator cuff tendon footprints. The contours of the rotator cuff muscle cross-sectional areas were automatically predicted in a plane perpendicular to the scapula. Each rotator cuff muscle was divided into virtual vector fibers with homogeneous density. The resultant force vector direction for each muscle, corresponding to the rotator cuff action line, was calculated by vectorially summing the normalized fiber vectors for each muscle, weighted by the muscle trophic ratio. The resultant force vector was projected on the axial plane, and its angle with the mediolateral scapular axis was used to determine TRFA. The SHSI according to Walch, glenoid version angle (GVA), glenoid anteroposterior offset angle (GOA), glenoid depth, glenoid width, and glenoid radius were also evaluated. RESULTS The mean values for TRFA, SHSI, GVA, GOA, glenoid depth, glenoid width, and glenoid radius were 7.4 ± 4.5°, 54.3 ± 4.8%, -4.1 ± 4.4°, 5.1 ± 10.8°, 3.3 ± 0.6 mm, 20 ± 2 mm, and 33.6 ± 4.6 mm, respectively. The TRFA correlated strongly with SHSI (R = 0.731, P < .001) and GVA (R = 0.716, P < .001) and moderately with GOA (R = 0.663, P < .001). The SHSI was strongly negatively correlated with GVA (R = -0.813, P < .001) and moderately with GOA (R = -0.552, P < .001). The GVA correlated strongly with GOA (R = 0.768, P < .001). In contrast, TRFA, SHSI, GVA, and GOA did not correlate with glenoid depth, width, or radius. CONCLUSION Despite an assumed balance in the transverse volume of the rotator cuff muscles in nonpathological shoulders, variations exist regarding the transverse resultant force depending on the SHSI, GVA, and GOA. In healthy/nonosteoarthritic shoulders, an increased glenoid retroversion is associated with a decreased anterior glenoid offset.
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Affiliation(s)
- Xavier Lannes
- Service of Orthopedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Patrick Goetti
- Service of Orthopedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthieu Boubat
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Pezhman Eghbali
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alain Farron
- Service of Orthopedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alexandre Terrier
- Service of Orthopedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Akgün D, Gebauer H, Paksoy A, Schafer F, Herbst E, Karczewski D, Pastor MF, Moroder P. Differences in Osseous Shoulder Morphology, Scapulothoracic Orientation, and Muscle Volume in Patients With Constitutional Static Posterior Shoulder Instability (Type C1) Compared With Healthy Controls. Am J Sports Med 2024; 52:1299-1307. [PMID: 38488401 PMCID: PMC10986147 DOI: 10.1177/03635465241233706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Constitutional static posterior humeral decentering (type C1 according to ABC Classification) has been recognized as a pre-osteoarthritic deformity that may lead to early-onset posterior decentering osteoarthritis at a young age. Therefore, it is important to identify possible associations of this pathologic shoulder condition to find more effective treatment options. PURPOSE To perform a comprehensive analysis of all parameters reported to be associated with a C1 shoulder-including the osseous shoulder morphology, scapulothoracic orientation, and the muscle volume of the shoulder girdle in a single patient cohort. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A retrospective, comparative study was conducted analyzing 17 C1 shoulders in 10 patients who underwent magnetic resonance imaging (MRI) with the complete depiction of the trunk from the base of the skull to the iliac crest, including both humeri. The mean age of the patients was 33.5 years, and all patients were men. To measure and compare the osseous shoulder morphology (glenoid version, glenoid offset, humeral torsion, anterior acromial coverage, posterior acromial coverage, posterior acromial height, and posterior acromial tilt) and scapulothoracic orientation (scapular protraction, scapular internal rotation, scapular upward rotation, scapular translation, scapular tilt, and thoracic kyphosis), these patients were matched 1 to 4 according their age, sex, and affected side with shoulder-healthy patients who had received positron emission tomography (PET)-computed tomography. To measure and compare the muscle volume of the shoulder girdle (subscapularis, infraspinatus/teres minor, supraspinatus, trapezius, deltoid, latissimus dorsi/teres major, pectoralis major, and pectoralis minor), patients were matched 1 to 2 with patients who had received PET-MRI. Patients with visible pathologies of the upper extremities were excluded. RESULTS The C1 group had a significantly higher glenoid retroversion, increased anterior glenoid offset, reduced humeral retrotorsion, increased anterior acromial coverage, reduced posterior acromial coverage, increased posterior acromial height, and increased posterior acromial tilt compared with controls (P < .05). Decreased humeral retrotorsion showed significant correlation with higher glenoid retroversion (r = -0.742; P < .001) and higher anterior glenoid offset (r = -0.757; P < .001). Significant differences were found regarding less scapular upward rotation, less scapular tilt, and less thoracic kyphosis in the C1 group (P < .05). The muscle volume of the trapezius and deltoid was significantly higher in the C1 group (P < .05). CONCLUSION Patients with C1 shoulders differ from healthy controls regarding osseous scapular and humeral morphology, scapulothoracic orientation, and shoulder girdle muscle distribution. These differences may be crucial in understanding the delicate balance of glenohumeral centering.
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Affiliation(s)
- Doruk Akgün
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Henry Gebauer
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alp Paksoy
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Frederik Schafer
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Daniel Karczewski
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Kim E, Cho YH, Lee JY, Park JH. Relationship between rotator cuff posterior delamination and subscapularis tear: A large cross-sectional analysis. JSES Int 2023. [DOI: 10.1016/j.jseint.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
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Ishikawa H, Smith KM, Wheelwright JC, Christensen GV, Henninger HB, Tashjian RZ, Chalmers PN. Rotator cuff muscle imbalance associates with shoulder instability direction. J Shoulder Elbow Surg 2023; 32:33-40. [PMID: 35961497 DOI: 10.1016/j.jse.2022.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/07/2022] [Accepted: 06/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although muscle weakness and/or imbalance of the rotator cuff are thought to contribute to the development of shoulder instability, the association between muscular dysfunction and shoulder instability is not completely understood. The purpose of this study was to evaluate rotator cuff and deltoid muscle cross-sectional areas in different types of shoulder instability (anterior, posterior, and multidirectional instability [MDI]) and to determine the associations between muscular imbalance and shoulder instability direction. METHODS Preoperative magnetic resonance images of patients with shoulder instability who subsequently underwent arthroscopic glenohumeral labral repair or capsular plication were evaluated. Shoulder instability was classified into 3 categories by direction: (1) anterior, (2) posterior, and (3) MDI. The rotator cuff (supraspinatus, subscapularis, and infraspinatus + teres minor) and deltoid (anterior and posterior portions, and total) muscle areas were measured on T1 sagittal and axial slices, respectively. The ratios of the subscapularis to infraspinatus + teres minor area and the anterior deltoid to posterior deltoid area were calculated to quantify the transverse force couple imbalance. RESULTS A total of 189 patients were included, where each group consisted of 63 patients. The infraspinatus + teres minor muscle area was smaller than the subscapularis muscle area in the anterior instability group (P = .007). The subscapularis muscle area was smaller than the infraspinatus + teres minor muscle area in the posterior instability and MDI groups (P ≤ .003). The anterior deltoid muscle area was smaller than the posterior deltoid muscle area in all groups (P ≤ .001). The subscapularis-to-infraspinatus + teres minor area ratio in the anterior instability group (1.18 ± 0.40) was higher than that in the posterior instability and MDI groups (0.79 ± 0.31 and 0.93 ± 0.33, respectively; P < .001). There was no difference in the anterior deltoid-to-posterior deltoid area ratio among the 3 groups. CONCLUSION Patients with anterior instability have smaller muscle area of the posterior rotator cuff as compared with the anterior rotator cuff. In contrast, patients with posterior instability and MDI have smaller muscle area of the anterior rotator cuff as compared with the posterior rotator cuff. Thus, the direction of shoulder instability is associated with rotator cuff muscle area.
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Affiliation(s)
- Hiroaki Ishikawa
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Karch M Smith
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - J Cade Wheelwright
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Garrett V Christensen
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Heath B Henninger
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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Mitterer M, Matis N, Steiner G, Vasvary I, Ortmaier R. Muscle volume imbalance may be associated with static posterior humeral head subluxation. BMC Musculoskelet Disord 2021; 22:279. [PMID: 33722224 PMCID: PMC7958704 DOI: 10.1186/s12891-021-04146-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 03/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The transverse force couple (TFC) of the rotator cuff (subscapularis vs. infraspinatus and teres minor muscle) is an important dynamic stabilizer of the shoulder joint in the anterior-posterior direction. In patients with posterior static subluxation of the humeral head (PSSH), decentration of the humeral head posteriorly occurs, which is associated with premature arthritis. We hypothesize that not only pathologic glenoid retroversion but also chronic muscle volume imbalance in the transverse force couple leads to PSSH. METHODS A retrospective analysis of the TFC muscle volumes of 9 patients with symptomatic, atraumatic PSSH, within 8 were treated with glenoid correction osteotomy, was conducted. The imaging data (CT) of 9 patients/10 shoulders of the full scapula and shoulder were analyzed, and the muscle volumes of the subscapularis (SSC), infraspinatus (ISP) and teres minor muscles (TMM) were measured by manually marking the muscle contours on transverse slices and calculating the volume from software. Furthermore, the glenoid retroversion and glenohumeral distance were measured. RESULTS The mean glenoid retroversion was - 16° (- 7° to - 31°). The observed mean glenohumeral distance was 4.0 mm (0 to 6.8 mm). Our study population showed a significant muscle volume imbalance between the subscapularis muscle and the infraspinatus and teres minor muscles (192 vs. 170 ml; p = 0.005). There was no significant correlation between the subscapularis muscle volume and the glenohumeral distance (r = 0.068), (p = 0.872). CONCLUSION The muscle volume of the SSC in patients with PSSH was significantly higher than the muscle volume of the posterior force couple (ISP and TMM). This novel finding, albeit in a small series of patients, may support the theory that transverse force couple imbalance is associated with PSSH. LEVEL OF EVIDENCE Level 4 - Case series with no comparison group.
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Affiliation(s)
- Marian Mitterer
- Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Nicholas Matis
- Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Gernot Steiner
- Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Imre Vasvary
- Department for Radiology, Private Hospital Wehrle-Diakonissen, 5020 Salzburg, Austria
| | - Reinhold Ortmaier
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe, Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Seilerstätte 4, 4010, Linz, Austria. .,Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), Tirol Kliniken GmbH, Innsbruck and UMIT, 6060 Hall, Austria.
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Monroe EJ, Flores SE, Zhang AL, Feeley BT, Lansdown DA, Ma CB. Do Outcomes of Arthroscopic Subscapularis Tendon Repairs Depend on Rotator Cuff Fatty Infiltration? Orthop J Sports Med 2020; 8:2325967120913036. [PMID: 32284947 PMCID: PMC7139190 DOI: 10.1177/2325967120913036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Rotator cuff fatty infiltration has been correlated with poorer radiographic
and clinical outcomes in supraspinatus and infraspinatus tendon repairs, but
this has not been well-studied in subscapularis tendon repairs. Purpose: To evaluate the influence of preoperative rotator cuff fatty infiltration on
postoperative outcomes for patients undergoing arthroscopic subscapularis
tendon repair. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent arthroscopic subscapularis repair between 2010 and
2016 were retrospectively identified, and demographic data and surgical
findings were recorded. The extent of fatty infiltration was determined on
preoperative magnetic resonance imaging by the Fuchs modification of the
Goutallier classification. At the most recent follow-up, patients completed
the Patient-Reported Outcomes Measurement Information System for Upper
Extremity (PROMIS-UE) computer adaptive test and a postoperative visual
analog scale for pain. The distribution of fatty infiltration was compared
between patients undergoing subscapularis tendon repair versus subscapularis
tendon repair combined with a posterior cuff repair. Outcomes were compared
for patients using Goutallier grade 0-1 versus grade ≥2 changes in each
rotator cuff muscle. Multivariate linear regression analysis was performed
to evaluate the influence of muscle quality, as well as demographic factors,
on PROMIS-UE scores. Significance was defined as P <
.05. Results: There were 140 shoulders included (mean age, 61.8 years; 42.1% female; mean
follow-up, 51.7 months). The prevalence of Goutallier grade 2 changes or
higher was significantly greater in patients with multitendon repair
relative to isolated subscapularis tendon repair. For the overall group of
all patients undergoing subscapularis tendon repair, whether in isolation or
as part of a multitendon repair, PROMIS-UE scores were significantly lower
for patients with infraspinatus muscle grade 2 or higher Goutallier changes
relative to grade 0 or 1. After adjustment for age, body mass index, patient
sex, and fatty infiltration in other rotator cuff muscles, poor
infraspinatus muscle quality remained the only significant predictor for
lower PROMIS-UE scores. Conclusion: Patients undergoing arthroscopic subscapularis tendon repair with poor
infraspinatus muscle quality had worse patient-reported outcomes. This was
true whether subscapularis tendon repair was isolated or was performed in
conjunction with supraspinatus and infraspinatus tendon repairs.
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Affiliation(s)
- Emily J Monroe
- Heartland Orthopedic Specialists, Alexandria, Minnesota, USA
| | - Sergio E Flores
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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Risikofaktoren für Rotatorenmanschettenrupturen bei Paraplegikern. DER ORTHOPADE 2018; 47:561-566. [DOI: 10.1007/s00132-018-3546-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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