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Ryskalin L, Morucci G, Soldani P, Gesi M. Do the fasciae of the soleus have a role in plantar fasciitis? Clin Anat 2024; 37:413-424. [PMID: 37539773 DOI: 10.1002/ca.24102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/21/2023] [Accepted: 07/16/2023] [Indexed: 08/05/2023]
Abstract
Plantar fasciitis is a chronic, self-limiting, and painful disabling condition affecting the inferomedial aspect of the heel, usually extending toward the metatarsophalangeal joints. There is compelling evidence for a strong correlation between Achilles tendon (AT) loading and plantar aponeurosis (PA) tension. In line with this, tightness of the AT is found in almost 80% of patients affected by plantar fasciitis. A positive correlation has also been reported between gastrocnemius-soleus tightness and heel pain severity in this condition. Despite its high prevalence, the exact etiology and pathological mechanisms underlying plantar heel pain remain unclear. Therefore, the aim of the present paper is to discuss the anatomical and biomechanical substrates of plantar fasciitis with special emphasis on the emerging, though largely neglected, fascial system. In particular, the relationship between the fascia, triceps surae muscle, AT, and PA will be analyzed. We then proceed to discuss how structural and biomechanical alterations of the muscle-tendon-fascia complex due to muscle overuse or injury can create the conditions for the onset of PA pathology. A deeper knowledge of the possible molecular mechanisms underpinning changes in the mechanical properties of the fascial system in response to altered loading and/or muscle contraction could help healthcare professionals and clinicians refine nonoperative treatment strategies and rehabilitation protocols for plantar fasciitis.
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Affiliation(s)
- Larisa Ryskalin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Gabriele Morucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Paola Soldani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Marco Gesi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
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2
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Mizuno D, Otsuka S, Shan X, Umemoto K, Naito M. Variation in the origin of the plantar aponeurosis and its relationship to the origin of the abductor hallucis muscle. Clin Anat 2024. [PMID: 38581285 DOI: 10.1002/ca.24164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/21/2024] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
The plantar aponeurosis comprises medial, central, and lateral bands, which arise from the calcaneal tuberosity. Descriptions of the origin of the abductor hallucis vary among different textbooks. The central band and abductor hallucis muscles are related to the windlass mechanism. Given the uncertainties regarding the details of the origins of the central band and the abductor hallucis muscle, we examined those origins in 100 feet of 50 cadavers (25 males and 25 females) by dissection. There were three central band patterns, depending on the attachment sites of the origins of the central and lateral bands: Pattern Ia, the central band covers the lateral band completely; Pattern Ib, the central band covers part of the lateral band; Pattern II, the lateral band covers part of the central band. The origin of the abductor hallucis muscle was confirmed. It showed two types of variation: attachment type, originating from the central band; non-attachment type, not originating from the central band. Central band Patterns Ia, Ib, and II were found in 23 feet (17 males, 6 females), 24 feet (25 males, 28 females), and 24 feet (eight males, 16 females), respectively. Pattern Ia predominated in males and Pattern II in females. The attachment and non-attachment types of abductor hallucis muscle were observed in 28 feet (28%) and 72 feet (72%), respectively. The attachment type with Patterns Ia, Ib, and II was shown in 17 feet, 10 feet, and one foot, respectively. Thus, we revealed variation and sex differences in the central band, which could affect foot morphology and the efficacy of the windlass mechanism.
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Affiliation(s)
- Daisuke Mizuno
- Department of Anatomy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Shun Otsuka
- Department of Anatomy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Xiyao Shan
- Department of Anatomy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kanae Umemoto
- Department of Anatomy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Munekazu Naito
- Department of Anatomy, Aichi Medical University School of Medicine, Nagakute, Japan
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3
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Flores DV, Goes PK, Damer A, Huang BK. The Heel Complex: Anatomy, Imaging, Pathologic Conditions, and Treatment. Radiographics 2024; 44:e230163. [PMID: 38512730 DOI: 10.1148/rg.230163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
The differential diagnosis for heel pain is broad but primarily involves abnormalities of the Achilles tendon, calcaneus, and plantar fascia. Achilles tendon disorders include tendinosis, tendinitis, and partial or complete tears. Tendinosis refers to tendon degeneration, while tendinitis is inflammation after acute overload. Untreated tendinosis can progress to partial or complete tears. Tendon disorders can be accompanied by paratenonitis or inflammation of the loose sheath enclosing the tendon. Initial management involves rehabilitation and image-guided procedures. Operative management is reserved for tendon tears and includes direct repair, tendon transfer, and graft reconstruction. The calcaneus is the most commonly fractured tarsal bone. The majority of fractures are intra-articular; extra-articular fractures, stress or insufficiency fractures, medial process avulsion, and neuropathic avulsion can also occur. Posterosuperior calcaneal exostosis or Haglund deformity, retrocalcaneal bursitis, and insertional Achilles tendinosis form the characteristic triad of Haglund syndrome. It is initially managed with orthotics and physiotherapy. Operative management aims to correct osseous or soft-tissue derangements. The plantar fascia is a strong fibrous tissue that invests the sole of the foot and contributes to midfoot stability. Inflammation or plantar fasciitis is the most common cause of heel pain and can be related to overuse or mechanical causes. Acute rupture is less common but can occur in preexisting plantar fasciitis. Conservative treatment includes footwear modification, calf stretches, and percutaneous procedures. The main operative treatment is plantar fasciotomy. Plantar fibromatosis is a benign fibroblastic proliferation within the fascia that can be locally aggressive and is prone to recurrence. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Dyan V Flores
- From the Department of Radiology, Radiation Oncology, and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); and Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
| | - Paola Kuenzer Goes
- From the Department of Radiology, Radiation Oncology, and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); and Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
| | - Alameen Damer
- From the Department of Radiology, Radiation Oncology, and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); and Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
| | - Brady K Huang
- From the Department of Radiology, Radiation Oncology, and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); and Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
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4
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Ito R, Igawa T, Urata R, Ito S, Suzuki K, Suzuki M, Kubo A. Immediate effects of elastic tape application on the foot sole: a randomized controlled trial. J Phys Ther Sci 2023; 35:497-501. [PMID: 37405190 PMCID: PMC10315200 DOI: 10.1589/jpts.35.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/03/2023] [Indexed: 07/06/2023] Open
Abstract
[Purpose] In this study, we investigated the effectiveness of elastic tape in increasing the dorsiflexion angle and plantar flexor strength in healthy individuals. [Participants and Methods] This randomized controlled trial included 24 healthy university students who were categorized into the following groups (12 participants in each group): the intervention group (elastic tape was applied to the dominant foot) and the control group (no intervention was performed). We performed intergroup comparison of the pre- and post-intervention dorsiflexion angles and plantar flexor strength. Additionally, we performed subgroup analyses based on a straight-leg raise angle of 70°. [Results] We observed no significant intergroup differences in the dorsiflexion angle or plantar flexor strength. However, the post-intervention dorsiflexion angle was significantly greater than the pre-intervention angle in the subgroup with a straight-leg raise angle of <70° among participants in the elastic tape group. [Conclusion] Elastic tape application may effectively increase the dorsiflexion angle in individuals without hamstring extensibility.
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Affiliation(s)
- Riyaka Ito
- Department of Rehabilitation, International University of
Health and Welfare Hospital: 537-3 Iguchi, Nasushiobara, Tochigi 329-2763, Japan
- Department of Health and Welfare Sciences, Graduate School
of International University of Health and Welfare, Japan
| | - Tatsuya Igawa
- Department of Rehabilitation, International University of
Health and Welfare Hospital: 537-3 Iguchi, Nasushiobara, Tochigi 329-2763, Japan
- Department of Health and Welfare Sciences, Graduate School
of International University of Health and Welfare, Japan
- Department of Physical Therapy, School of Health Sciences,
International University of Health and Welfare, Japan
| | - Ryunosuke Urata
- Department of Rehabilitation, International University of
Health and Welfare Mita Hospital, Japan
| | - Shomaru Ito
- Department of Rehabilitation, International University of
Health and Welfare Narita Hospital, Japan
| | - Kosuke Suzuki
- Department of Rehabilitation, International University of
Health and Welfare Hospital: 537-3 Iguchi, Nasushiobara, Tochigi 329-2763, Japan
- Department of Health and Welfare Sciences, Graduate School
of International University of Health and Welfare, Japan
| | | | - Akira Kubo
- Department of Health and Welfare Sciences, Graduate School
of International University of Health and Welfare, Japan
- Department of Physical Therapy, School of Health Sciences,
International University of Health and Welfare, Japan
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Bitenc-Jasiejko A, Walińska A, Konior K, Gonta K, Skomro P, Kijak K, Kowacka M, Lietz-Kijak D. Characteristics of Pressure on the Apophysis in the Course of Paediatric Heel Pain-Preliminary Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5403. [PMID: 37048018 PMCID: PMC10094411 DOI: 10.3390/ijerph20075403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 06/19/2023]
Abstract
Increased pressure on the heel apophysis is often implicated as a cause of paediatric heel pain. However, there are few reports on the causes of the increased pressure and its origin. Therefore, the aim of this study was to analyse the distribution of pressure on the feet in children with heel pain. The study included 33 paediatric patients with non-traumatic heel pain, i.e., 24 boys (73%) and 9 girls (27%), aged on average 11.2 years (±3 years). Pedobarographic diagnostics proved a decrease in the pressure on the heels in relation to the ground and the transfer of the projection of the centre of gravity to the forefoot. While standing, the average contribution of the pressure on the heel was 0.52, SD = 0.14 in children with normal and reduced weight. In overweight children, the average pressure on the heel was higher (0.60, SD = 0.08), but the small number of children with this characteristic (n = 4) did not allow conclusions to be drawn in this area. Heel underload was also demonstrated during gait. However, the assessment of this aspect requires additional observational analyses in the field of propulsion and gait phases. The reduced pressure on the heel promotes apophysis traction, causing intracanal compression. Studies have shown that the causes of apophysis traction may be postural defects (in particular, forward inclination of body posture) and overpronation of the foot, or defects in the metatarsal area.
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Affiliation(s)
- Aleksandra Bitenc-Jasiejko
- Department of Propaedeutics, Physical Diagnostics and Dental Physiotherapy, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Anna Walińska
- PODOLOGIA.pl, FIKOU Physiotherapy, 44-100 Gliwice, Poland
| | - Krzysztof Konior
- Doctoral Study Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Kinga Gonta
- Orthogenic Rehabilitation and Podology Center, 45-573 Wroclaw, Poland
| | - Piotr Skomro
- Department of Propaedeutics, Physical Diagnostics and Dental Physiotherapy, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Konrad Kijak
- Student Scientific Society at the Department and Clinic of Internal Diseases, Angiology and Physical Medicine, Medical University of Silesia, 40-055 Katowice, Poland
| | | | - Danuta Lietz-Kijak
- Department of Propaedeutics, Physical Diagnostics and Dental Physiotherapy, Pomeranian Medical University, 70-204 Szczecin, Poland
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SHIOTANI HIROTO, TAKAHASHI KATSUKI, HONMA YUKI, TOMARI KAZUKI, HAYASHI HIDETAKA, SADO NATSUKI, KAWAKAMI YASUO. Mechanical Linkage between Achilles Tendon and Plantar Fascia Accounts for Range of Motion of Human Ankle-Foot Complex. Med Sci Sports Exerc 2023; 55:66-73. [PMID: 35977106 PMCID: PMC9770132 DOI: 10.1249/mss.0000000000003020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The human ankle-foot complex possesses a passive range of motion (ROM) through changes in tibiocalcaneal ( θcal ) and foot arch ( θarch ) angles. Based on the anatomical linkage between the Achilles tendon (AT) and plantar fascia (PF), we hypothesized that AT and PF with different mechanical properties conjointly modulate the passive ROM of the human ankle-foot complex. We examined the association of AT and PF stiffness with passive ankle-foot ROM and further addressed differences between sexes. METHODS A series of sagittal magnetic resonance images of the foot and passive ankle plantar flexion torque were obtained for 20 men and 20 women with their ankle-foot passively rotated from 30° of plantar flexion to 20° of dorsiflexion. Based on the measured changes in AT and PF lengths, θcal , θarch , and passive torque, AT and PF stiffness were determined. RESULTS Upon passive ankle dorsiflexion, AT and PF were lengthened; their length changes were inversely correlated. Men showed a stiffer AT, more compliant PF, less calcaneal rotation, and greater foot arch deformation compared with women. Furthermore, we found inverse correlations between AT stiffness and ROM of θcal , and between PF stiffness and ROM of θarch in men and women. CONCLUSIONS Passive AT and PF extensibility counter each other. AT and PF stiffness and passive ROM of ankle-foot components were countered between sexes; however, associations between stiffness and passive ROM of the ankle-foot complex were consistent between sexes. Our findings support the notion that the balanced mechanical interaction between the AT and PF can account for the passive ROM of the human ankle-foot complex in vivo , and the differences between sexes.
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Affiliation(s)
- HIROTO SHIOTANI
- Faculty of Sport Sciences, Waseda University, Tokorozawa, JAPAN,Human Performance Laboratory, Comprehensive Research Organization of Waseda University, Tokyo, JAPAN
| | - KATSUKI TAKAHASHI
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, JAPAN,Research Fellow of Japan Society for the Promotion of Science, Tokyo, JAPAN
| | - YUKI HONMA
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, JAPAN
| | - KAZUKI TOMARI
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, JAPAN
| | - HIDETAKA HAYASHI
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, JAPAN
| | - NATSUKI SADO
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, JAPAN
| | - YASUO KAWAKAMI
- Faculty of Sport Sciences, Waseda University, Tokorozawa, JAPAN,Human Performance Laboratory, Comprehensive Research Organization of Waseda University, Tokyo, JAPAN
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7
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Koh DTS, Yeo W, Koo KOT, Singh IR, Yeo NEM. Radiofrequency Plantar Fascia Coblation With and Without Gastrocnemius Recession in the Management of Recalcitrant Plantar Fasciitis. Foot Ankle Int 2022; 43:1167-1173. [PMID: 35652744 DOI: 10.1177/10711007221091807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Plantar fasciitis is the most common cause of plantar heel pain. Although most are self-limiting, recalcitrant conditions can be debilitating, significantly reducing patient's quality of life. A myriad of surgical procedures are available for the treatment of recalcitrant plantar fasciitis (RPF) with little consensus on best practice. This purpose of this study was to assess the efficacy of radiofrequency coblation with and without gastrocnemius release on the surgical management of RPF. METHODS Between June 2013 and June 2019, a total of 128 patients with RPF and tight gastrocnemius were treated surgically. Presence of tight gastrocnemius was assessed clinically by a positive Silfverskiold test. Group A (n = 73) consisted of patients who underwent radiofrequency coblation alone; group B (n = 55) consisted of patients who underwent radiofrequency coblation and endoscopic gastrocnemius recession. The primary outcome measure was visual analog scale (VAS) score. Secondary outcome measures included (1) American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score; (2) physical (PCS) and mental component summaries (MCS) of the 36-Item Short Form Health Survey; (3) overall assessment of improvement, expectation fulfilment, and satisfaction; and (4) complication rates. RESULTS Both groups reported significant improvement in VAS, AOFAS, and PCS scores postoperatively at 6 and 24 months. Group B (radiofrequency coblation with gastrocnemius recession) was associated with better VAS at both 6 months (3.0 ± 2.9 vs 1.7 ± 2.6, P < .05) and 24 months postoperatively (1.9 ± 3.1 vs 0.8 ± 2.0, P < .05) compared with group A (radiofrequency coblation without gastrocnemius recession). At 24 months postoperatively, no differences were found in AOFAS, PCS, MCS scores, expectation fulfilment, or overall satisfaction. No wound complications were reported in either group. One patient (group B) has persistent symptoms consistent with tarsal tunnel syndrome. CONCLUSION In this retrospective cohort comparative study, treatment of RPF with radiofrequency coblation alone was associated with slightly inferior results than radiofrequency coblation combined with endoscopic gastrocnemius recession in terms of pain relief without an increase in complication rates. However, at 2 years, we did not find a significant difference in other measures of outcome. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
| | - William Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Kevin Oon Thien Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.,The Bone and Joint Centre, Mount Elizabeth Hospital, Singapore
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Steel S, Pearcy Q, Li K, Scholze M, Zwirner J. The relationship between the pH value of a hydration solution and the biomechanical properties of Crosado-embalmed human iliotibial bands. J Mech Behav Biomed Mater 2022; 132:105266. [DOI: 10.1016/j.jmbbm.2022.105266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/27/2022] [Accepted: 05/03/2022] [Indexed: 11/16/2022]
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9
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Gabriel A, Konrad A, Roidl A, Queisser J, Schleip R, Horstmann T, Pohl T. Myofascial Treatment Techniques on the Plantar Surface Influence Functional Performance in the Dorsal Kinetic Chain. J Sports Sci Med 2022; 21:13-22. [PMID: 35250329 PMCID: PMC8851122 DOI: 10.52082/jssm.2022.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/19/2021] [Indexed: 12/30/2022]
Abstract
Prior studies have shown that self- and manual massage (SMM) increases flexibility in non-adjacent body areas. It is unclear whether this also influences performance in terms of force generation. Therefore, this study investigated the effect of SMM on the plantar surface on performance in the dorsal kinetic chain. Seventeen young participants took part in this within-subject non-randomized controlled study. SMM was applied on the plantar surface of the dominant leg, but not on the non-dominant leg. A functional performance test of the dorsal kinetic chain, the Bunkie Test, was conducted before and after the intervention. We measured the performance in seconds for the so-called posterior power line (PPL) and the posterior stabilizing line (PSL). The performance of the dominant leg in the Bunkie Test decreased significantly by 17.2% from (mean ± SD) 33.1 ± 9.9 s to 27.4 ± 11.1 s for the PPL and by 16.3% from 27.6 ± 9.8 s to 23.1 ± 11.7 s for the PSL. This is in contrast to the non-dominant leg where performance increased significantly by 5.1% from 29.7 ± 9.6 s to 31.1 ± 8.9 s for the PPL and by 3.1% from 25.7 ± 1.5 s to 26.5 ± 1.7 s for the PSL. SMM interventions on the plantar surface might influence the performance in the dorsal kinetic chain.
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Affiliation(s)
- Anna Gabriel
- Technical University of Munich, Munich, Germany, Associate Professorship for Conservative and Rehabilitative Orthopedics, Technical University of Munich, Georg Brauchle-Ring 60/62, 80992 Munich, Germany
| | - Andreas Konrad
- Institute of Human Movement Science, Sport and Health, Graz University, Austria
| | - Anna Roidl
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | | | - Robert Schleip
- Technical University of Munich, Munich, Germany,Diploma University of Applied Sciences, Germany, Department of Sports Medicine and Health Promotion, Friedrich Schiller University, Germany
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10
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Zwirner J, Ondruschka B, Pregartner G, Berghold A, Scholze M, Hammer N. On the correlations of biomechanical properties of super-imposed temporal tissue layers and their age-, sex-, side- and post-mortem interval dependence. J Biomech 2021; 130:110847. [PMID: 34753030 DOI: 10.1016/j.jbiomech.2021.110847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 10/20/2022]
Abstract
Obtaining biomechanical properties of biological tissues for simulation purposes or graft developments is time and resource consuming. The number of samples required for biomechanical tests could be reduced if the load-deformation properties of a given tissue layer could be estimated from adjacent layers or if the biomechanical parameters were unaffected by age, bodyside, sex or post-mortem interval. This study investigates for the first time potential correlations of multiple super-imposed tissue layers using the temporal region of the human head as an area of broad interest in biomechanical modelling. Spearman correlations between biomechanical properties of the scalp, muscle fascia, muscle, bone and dura mater from up to 83 chemically unfixed cadavers were investigated. The association with age, sex and post-mortem interval was assessed. The results revealed sporadic correlations between the corresponding layers, such as the maximum force (r = 0.43) and ultimate tensile strength (r = 0.33) between scalp and muscle. Side- and age-dependence of the biomechanical properties were different between the tissue types. Strain at maximum force of fascia (r = -0.37) and elastic modulus of temporal muscle (r = 0.26) weakly correlated with post-mortem interval. Only strain at maximum force of scalp differed significantly between sexes. Uniaxial biomechanical properties of individual head tissue layers can thus not be estimated solely based on adjacent layers. Therefore, correlations between the tissues' biomechanical properties, anthropometric data and post-mortem interval need to be established independently for each layer. Sex seems not to be a relevant influencing factor for the passive tissue mechanics of the here investigated temporal head tissue layers.
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Affiliation(s)
- J Zwirner
- Department of Anatomy, University of Otago, Dunedin, New Zealand; Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute of Legal Medicine, University of Leipzig, Leipzig, Germany.
| | - B Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Pregartner
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - A Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - M Scholze
- Institute of Materials Science and Engineering, Chemnitz University of Technology, Chemnitz, Germany; Institute of Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria
| | - N Hammer
- Institute of Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria; Department of Orthopedic and Trauma Surgery, University of Leipzig, Germany; Fraunhofer IWU, Dresden, Germany.
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11
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Weinrich L, Paraskevaidis M, Schleip R, Agres AN, Tsitsilonis S. Does the Calcaneus Serve as Hypomochlion within the Lower Limb by a Myofascial Connection?-A Systematic Review. Life (Basel) 2021; 11:life11080745. [PMID: 34440492 PMCID: PMC8398293 DOI: 10.3390/life11080745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022] Open
Abstract
(1) Background: Clinical approaches have depicted interconnectivity between the Achilles tendon and the plantar fascia. This concept has been applied in rehabilitation, prevention, and in conservative management plans, yet potential anatomical and histological connection is not fully understood. (2) Objective: To explore the possible explanation that the calcaneus acts as a hypomochlion. (3) Methods: 2 databases (Pubmed and Livivo) were searched and studies, including those that examined the relationship of the calcaneus to the Achilles tendon and plantar fascia and its biomechanical role. The included studies highlighted either the anatomical, histological, or biomechanical aspect of the lower limb. (4) Results: Seventeen studies were included. Some studies depicted an anatomical connection that slowly declines with age. Others mention a histological similarity and continuity via the paratenon, while a few papers have brought forward mechanical reasoning. (5) Conclusion: The concept of the calcaneus acting as a fulcrum in the lower limb can partially be supported by anatomical, histological, and biomechanical concepts. Despite the plethora of research, a comprehensive understanding is yet to be investigated. Further research exploring the precise interaction is necessary.
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Affiliation(s)
- Luise Weinrich
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.W.); (M.P.)
| | - Melissa Paraskevaidis
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.W.); (M.P.)
| | - Robert Schleip
- Technische Universität München, 80333 München, Germany;
- Diploma University of Applied Sciences, 37242 Bad Sooden-Allendorf, Germany
| | - Alison N. Agres
- Julius Wolff Institute, Berlin Institute of Health and Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Serafeim Tsitsilonis
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.W.); (M.P.)
- Correspondence:
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12
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Why heel spurs are traction spurs after all. Sci Rep 2021; 11:13291. [PMID: 34168232 PMCID: PMC8225903 DOI: 10.1038/s41598-021-92664-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 06/11/2021] [Indexed: 11/24/2022] Open
Abstract
It is unclear whether plantar and posterior heel spurs are truly pathological findings and whether they are stimulated by traction or compression forces. Previous histological investigations focused on either one of the two spur locations, thereby potentially overlooking common features that refer to a uniform developmental mechanism. In this study, 19 feet from 16 cadavers were X-ray scanned to preselect calcanei with either plantar or posterior spurs. Subsequently, seven plantar and posterior spurs were histologically assessed. Five spur-free Achilles tendon and three plantar fascia entheses served as controls. Plantar spurs were located either intra- or supra-fascial whereas all Achilles spurs were intra-fascial. Both spur types consistently presented a trabecular architecture without a particular pattern, fibrocartilage at the tendinous entheses and the orientation of the spur tips was in line with the course of the attached soft tissues. Spurs of both entities revealed tapered areas close to their bases with bulky tips. Achilles and plantar heel spurs seem to be non-pathological calcaneal exostoses, which are likely results of traction forces. Both spur types revealed commonalities such as their trabecular architecture or the tip direction in relation to the attached soft tissues. Morphologically, heel spurs seem poorly adapted to compressive loads.
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13
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Pan W, Zhou J, Lin Y, Zhang Z, Wang Y. Elasticity of the Achilles Tendon in Individuals With and Without Plantar Fasciitis: A Shear Wave Elastography Study. Front Physiol 2021; 12:686631. [PMID: 34234693 PMCID: PMC8257043 DOI: 10.3389/fphys.2021.686631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/31/2021] [Indexed: 12/03/2022] Open
Abstract
The elastic properties of the Achilles tendon (AT) are altered in local injury or other diseases and in response to changes in mechanical load. Recently, elastography has been used to evaluate variations in tendon elastic properties, mainly among healthy individuals or athletes. Therefore, this study evaluated the biomechanical changes in ATs in individuals with and without plantar fasciitis (PF). The purposes were as follows: (1) to evaluate the passive stiffness of three regions of the AT which defined as 0 (AT0 cm), 3 (AT3 cm), and 6 cm (AT6 cm) above the calcaneal tuberosity in participants with and without PF, (2) to investigate the interplay between the passive stiffness in patients with PF and pain, (3) to detect optimal cut-off points of stiffness of the AT in assessing individuals with chronic PF, and (4) to determine the correlation between the plantar fascia thickness (PFT) and pain. This cross-sectional study included 40 participants (mean age = 51 ± 13 years). When the ankle was in a relaxed position, patients with PF experienced increased passive stiffness in AT0 cm (p = 0.006) and AT3 cm (P = 0.003), but not in the neutral position. Significant correlations were observed between pain and stiffness of AT (AT0 cm r = 0.489, P = 0.029; AT3 cm r = 487, P = 0.030; AT6 cm r = 0.471, P = 0.036), but not in the PFT (P = 0.557). Optimal cut-off stiffness was AT (452 kPa) in the relaxed ankle position. The plantar fascia of patients with PF was significantly thicker than that of the controls (P < 0.001). Findings from the present study demonstrate that tendon stiffness is a good indicator of the clinical situation of patients with PF. Monitoring passive tendon stiffness may provide additional information to assess severity of the condition and guide therapeutic. The treatment programs for PF should also be tailored to the distal AT, as conventional therapy might not be targeted to tight tendons.
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Affiliation(s)
- Weiyi Pan
- Shenzhen Dapeng New District Nan'ao People's Hospital, Branch of the First Affiliate of Shenzhen University, Shenzhen, China
| | - Jiping Zhou
- Shenzhen Dapeng New District Nan'ao People's Hospital, Branch of the First Affiliate of Shenzhen University, Shenzhen, China
| | - Yuyi Lin
- Shenzhen Dapeng New District Nan'ao People's Hospital, Branch of the First Affiliate of Shenzhen University, Shenzhen, China
| | - Zhijie Zhang
- Luoyang Orthopedics Hospital of Henan Province, Luoyang, China
| | - Yulong Wang
- ShenZhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
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14
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Singh A, Zwirner J, Templer F, Kieser D, Klima S, Hammer N. On the morphological relations of the Achilles tendon and plantar fascia via the calcaneus: a cadaveric study. Sci Rep 2021; 11:5986. [PMID: 33727610 PMCID: PMC7966405 DOI: 10.1038/s41598-021-85251-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/17/2021] [Indexed: 02/08/2023] Open
Abstract
Current treatments of plantar fasciitis are based on the premise that the Achilles tendon (AT) and plantar fascia (PF) are mechanically directly linked, which is an area of debate. The aim of this study was to assess the morphological relationship between the AT and PF. Nineteen cadaveric feet were x-ray imaged, serially sectioned and plastinated for digital image analyses. Measurements of the AT and PF thicknesses and cross-sectional areas (CSA) were performed at their calcaneal insertion. The fiber continuity was histologically assessed in representative subsamples. Strong correlations exist between the CSA of the AT and PF at calcaneal insertion and the CSA of PF's insertional length (r = 0.80), and between the CSAs of AT's and PF's insertional lengths. Further correlations were observed between AT and PF thicknesses (r = 0.62). This close morphological relationship could, however, not be confirmed through x-ray nor complete fiber continuity in histology. This study provides evidence for a morphometric relationship between the AT and PF, which suggests the presence of a functional relationship between these two structures following the biological key idea that the structure determines the function. The observed morphological correlations substantiate the existing mechanical link between the AT and PF via the posterior calcaneus and might explain why calf stretches are a successful treatment option for plantar heel pain.
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Affiliation(s)
- A Singh
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - J Zwirner
- Department of Anatomy, University of Otago, Dunedin, New Zealand
- Institute of Legal Medicine, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - F Templer
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - D Kieser
- Department of Orthopedic Surgery and MSM, Christchurch Hospital, Christchurch, New Zealand
| | - S Klima
- Orthopaedicus, Leipzig, Germany
- Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany
| | - N Hammer
- Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany.
- Department of Clinical and Macroscopic Anatomy, Medical University of Graz, Harrachgasse 21, 8010, Graz, Austria.
- Fraunhofer Institute for Machine Tools and Forming Technology, Section of Medical Engineering, Dresden, Germany.
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15
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Zwirner J, Ondruschka B, Scholze M, Schulze-Tanzil G, Hammer N. Biomechanical characterization of human temporal muscle fascia in uniaxial tensile tests for graft purposes in duraplasty. Sci Rep 2021; 11:2127. [PMID: 33483525 PMCID: PMC7822884 DOI: 10.1038/s41598-020-80448-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 12/16/2020] [Indexed: 01/03/2023] Open
Abstract
The human temporal muscle fascia (TMF) is used frequently as a graft material for duraplasty. Encompassing biomechanical analyses of TMF are lacking, impeding a well-grounded biomechanical comparison of the TMF to other graft materials used for duraplasty, including the dura mater itself. In this study, we investigated the biomechanical properties of 74 human TMF samples in comparison to an age-matched group of dura mater samples. The TMF showed an elastic modulus of 36 ± 19 MPa, an ultimate tensile strength of 3.6 ± 1.7 MPa, a maximum force of 16 ± 8 N, a maximum strain of 13 ± 4% and a strain at failure of 17 ± 6%. Post-mortem interval correlated weakly with elastic modulus (r = 0.255, p = 0.048) and the strain at failure (r = − 0.306, p = 0.022) for TMF. The age of the donors did not reveal significant correlations to the TMF mechanical parameters. Compared to the dura mater, the here investigated TMF showed a significantly lower elastic modulus and ultimate tensile strength, but a larger strain at failure. The human TMF with a post-mortem interval of up to 146 h may be considered a mechanically suitable graft material for duraplasty when stored at a temperature of 4 °C.
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Affiliation(s)
- Johann Zwirner
- Department of Anatomy, University of Otago, Dunedin, New Zealand. .,Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Legal Medicine, University of Leipzig, Leipzig, Germany
| | - Mario Scholze
- Institute of Materials Science and Engineering, Chemnitz University of Technology, Chemnitz, Germany.,Department of Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria
| | - Gundula Schulze-Tanzil
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Salzburg and Nuremberg, Germany
| | - Niels Hammer
- Department of Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria. .,Department of Orthopaedic and Trauma Surgery, University of Leipzig, Leipzig, Germany. .,Fraunhofer IWU, Dresden, Germany.
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16
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Zwirner J, Scholze M, Ondruschka B, Hammer N. What is Considered a Variation of Biomechanical Parameters in Tensile Tests of Collagen-Rich Human Soft Tissues? - Critical Considerations Using the Human Cranial Dura Mater as a Representative Morpho-Mechanic Model. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E520. [PMID: 33027931 PMCID: PMC7600870 DOI: 10.3390/medicina56100520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 12/23/2022]
Abstract
Background and Objectives: Profound knowledge on the load-dependent behavior of human soft tissues is required for the development of suitable replacements as well as for realistic computer simulations. Regarding the former, e.g., the anisotropy of a particular biological tissue has to be represented with site- and direction-dependent particular mechanical values. Contrary to this concept of consistent mechanical properties of a defined soft tissue, mechanical parameters of soft tissues scatter considerably when being determined in tensile tests. In spite of numerous measures taken to standardize the mechanical testing of soft tissues, several setup- and tissue-related factors remain to influence the mechanical parameters of human soft tissues to a yet unknown extent. It is to date unclear if measurement extremes should be considered a variation or whether these data have to be deemed incorrect measurement outliers. This given study aimed to determine mechanical parameters of the human cranial dura mater as a model for human soft tissues using a highly standardized protocol and based on this, critically evaluate the definition for the term mechanical "variation" of human soft tissue. Materials and Methods: A total of 124 human dura mater samples with an age range of 3 weeks to 94 years were uniformly retrieved, osmotically adapted and mechanically tested using customized 3D-printed equipment in a quasi-static tensile testing setup. Scanning electron microscopy of 14 samples was conducted to relate the mechanical parameters to morphological features of the dura mater. Results: The here obtained mechanical parameters were scattered (elastic modulus = 46.06 MPa, interquartile range = 33.78 MPa; ultimate tensile strength = 5.56 MPa, interquartile range = 4.09 MPa; strain at maximum force = 16.58%, interquartile range = 4.81%). Scanning electron microscopy revealed a multi-layered nature of the dura mater with varying fiber directions between its outer and inner surface. Conclusions: It is concluded that mechanical parameters of soft tissues such as human dura mater are highly variable even if a highly standardized testing setup is involved. The tissue structure and composition appeared to be the main contributor to the scatter of the mechanical parameters. In consequence, mechanical variation of soft tissues can be defined as the extremes of a biomechanical parameter due to an uncontrollable change in tissue structure and/or the respective testing setup.
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Affiliation(s)
- Johann Zwirner
- Department of Anatomy, University of Otago, Dunedin 9016, New Zealand
| | - Mario Scholze
- Institute of Materials Science and Engineering, Chemnitz University of Technology, 09125 Chemnitz, Germany;
- Department of Macroscopic and Clinical Anatomy, Medical University of Graz, 8010 Graz, Austria
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany;
| | - Niels Hammer
- Department of Macroscopic and Clinical Anatomy, Medical University of Graz, 8010 Graz, Austria
- Department of Orthopaedic and Trauma Surgery, University of Leipzig, 04103 Leipzig, Germany
- Fraunhofer IWU, 01187 Dresden, Germany
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