Olaf Lorbach

Universität des Saarlandes, Saarbrücken, Saarland, Germany

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Publications (92)136.51 Total impact

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    ABSTRACT: Evaluation of the biomechanical performance of repairs of 25 % (Fox/Romeo II) and 50 % (Fox/Romeo III) full-thickness subscapularis tears using a single-suture anchor. Six pairs of human cadaver specimens were used for the testing. Artificial subscapularis tears were created in order to simulate a 25 % (6) and a 50 % (6) full-thickness tear. The reconstructions were made with a double-loaded suture anchor (5.5-mm Bio-Corkscrew with two No. 2 Fiberwire) creating a double-mattress suture repair. Reconstructions were cyclically loaded from 10 to 60 N. The load was increased stepwise up to 100 and 180 N. Cyclic displacement (means + standard dev.) as well as load-to-failure was determined, and mode of failure was recorded. In the reconstructed shoulders at 60 N, a mean cyclic displacement of 3.2 ± 0.7 mm was found in the 25 % tear, 2.6 ± 0.6 mm in the 50 % tear. At 100 N, 5.1 ± 1.2 mm was seen in the 25 % tear and 4.3 ± 0.3 mm in the 50 % tear. At highest load of 180 N, 7.6 ± 2.2 mm was recorded in the 25 % tear, 6.5 ± 0.8 mm was found in the 50 % tear. Ultimate failure load was 486 ± 167 N in the 25 % tear and 455 ± 213 N in the 50 % tear. Statistically significant differences between the tested repairs were seen neither in cyclic displacement nor in ultimate failure loads (p > 0.05). Mode of failure revealed bone fractures and anchor pull-out as major cause in the 25 % group, whereas failure of the suture-tendon interface was the major cause of failure in the 50 % group. Subscapularis repair using a single double-loaded suture anchor revealed similar biomechanical performance in 25 % compared to 50 % full-thickness subscapularis tears. With increased tear size, however, an optimized suture-tendon interface seems to become more relevant in order to decrease failure rate of the repair. A single double-loaded suture anchor provides sufficient biomechanical strength even in Fox/Romeo grade III tears of the subscapularis tendon. However, a modified suture configuration is recommended, especially in grade III tears as the suture-tendon interface is the weakest point of the construct.
    Knee Surgery Sports Traumatology Arthroscopy 08/2015; DOI:10.1007/s00167-015-3767-5 · 3.05 Impact Factor
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    ABSTRACT: The preservation of meniscal structure and function after segmental meniscal loss is of crucial importance to prevent early development of osteoarthritis. Implantation of artificial meniscal implants has been reported as a feasible treatment option. The purpose of this study was to assess the clinical and magnetic resonance imaging (MRI) results 4 years after implantation of a polyurethane scaffold for chronic segmental medial meniscus deficiency following partial medial meniscectomy. Eighteen patients received arthroscopic implantation of an Actifit(®) polyurethane meniscal implant (Orteq Sports Medicine, London, UK) for deficiency of the medial meniscus. Patients were followed at 6, 12, 24, and 48 months. Clinical outcome was assessed using established patient-reported outcome scores (KOOS, KSS, UCLA Activity Scale, VAS for pain). Radiological outcome was quantified by MRI scans after 6, 12, 24, and 48 months evaluating scaffold morphology, tissue integration, and status of the articular cartilage as well as signs of inflammation. Median patient age was 32.5 years (range 17-49 years) with a median meniscal defect size of 44.5 mm (range 35-62 mm). Continuing improvement of the VAS and KSS Knee and Function Scores could be observed after 48 months compared to baseline, whereas improvement of the activity level according to UCLA continued only up to 24 months and decreased from there on. The KOOS Score showed significant improvement in all dimensions. MRI scans showed reappearance of bone bruises in two patients with scaffold extrusion. No significant changes in the articular cartilage could be perceived. Arthroscopic treatment for patients with chronic segmental meniscal loss using a polyurethane meniscal implant can achieve sustainable midterm results regarding pain reduction and knee function. IV.
    Knee Surgery Sports Traumatology Arthroscopy 08/2015; DOI:10.1007/s00167-015-3759-5 · 3.05 Impact Factor
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    ABSTRACT: To review the literature concerning surgical treatment options for chronic patellar tendinosis (jumper's knee), a common problem among athletes. When conservative treatment fails, surgical treatment is required. Systematic review of the literature concerning the results of current surgical treatment options for chronic patellar tendinosis. All articles of studies with an evidence level ≥IV from January 2000 until February 2015 presenting the surgical outcome after arthroscopic as well as open treatment of chronic patellar tendinosis were included. The literature research of the PubMed database was performed using the following key words: "patellar" and "tendinitis," "tendonitis," "tendinosis" or "tendinopathy"; "inferior patellar pole"; "jumper's knee"; "surgical treatment" and "open" or "arthroscopic patellar tenotomy." A systematic review of the literature was performed especially to point out the effectiveness of arthroscopic treatment of chronic patellar tendinosis. The results revealed good clinical results for arthroscopic as well as open treatment of chronic patellar tendinosis that is refractory to conservative treatment in athletes. An average success rate of 87% was found for the open treatment group and of 91% for the arthroscopic treatment group. However, after open surgery, the mean time of return to the preinjury level of activity is 8 to 12 months, with a certain number of patients/athletes who cannot return to the preinjury level of activity. Minimally invasive, arthroscopically assisted or all-arthroscopic procedures may lead to a significantly faster return to sporting activities and may, therefore, be the preferred method of surgical treatment. Level IV, systematic review of Level I-IV studies. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 08/2015; DOI:10.1016/j.arthro.2015.06.010 · 3.21 Impact Factor
  • P Mosser · D Kohn · O Lorbach
    Deutsche Zeitschrift für Sportmedizin 04/2015; 2015(04):98-103. DOI:10.5960/dzsm.2014.159 · 0.58 Impact Factor
  • Olaf Lorbach · Alexander Haupert
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    ABSTRACT: Hintergrund Trotz der hervorragenden klinischen Resultate findet sich sowohl nach offener als auch nach arthroskopischer Rekonstruktion von Rupturen der Rotatorenmanschette insbesondere in chronischen großen Rupturen eine hohe Rate an Rerupturen. Material und Methode Um die biomechanischen Voraussetzungen für die Heilung der Sehne an den Knochen zu optimieren, wurden das Konzept der Doppelreihenrekonstruktion sowie der „Transosseous-equivalent-Rotatorenmanschettenrekonstruktion“ eingeführt. Diese Techniken waren zunächst nicht nur in der Lage, die biomechanischen Eigenschaften im Vergleich zur Einreihenrekonstruktion mit einfachen Nahttechniken zu verbessern, sondern es konnte damit auch eine anatomischere Wiederherstellung des flächigeren Sehnenansatzes erreicht werden, was theoretisch zu einer günstigeren Heilung führen sollte. Insbesondere im Vergleich zu Einreihenrekonstruktionen unter Verwendung von Fadenankern mit multiplen Fäden und modifizierten Nahttechniken konnte die Verwendung der Doppelreihenrekonstruktionen weder eine signifikante Verbesserung der klinischen Ergebnisse, noch eine Reduktion der Rerupturrate erreichen. Da die Sehnen-Faden-Verbindung das schwächste Glied in der Kette darstellt, ist biomechanisch nicht die Menge an Ankern entscheidend, die verwendet werden, sondern die Anzahl an Fäden, welche die Sehne penetrieren und die verwendete Nahttechnik. Ergebnisse Der entscheidende Faktor bezüglich der Sehnenheilung scheint jedoch die Biologie und die damit verbundene Sehnenqualität zu sein, denn trotz vieler Technikinnovationen und einer dramatischen Anzahl an Publikationen bezüglich dieses Themengebiets konnten über die letzten Jahre weder die klinischen Ergebnisse verbessert werden, noch konnte die Rerupturrate entscheidend gesenkt werden.
    Obere Extremität 03/2015; 10(1). DOI:10.1007/s11678-014-0302-0
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    ABSTRACT: Although there are various new scaffold-based techniques for cartilage regeneration it remains unclear up to which defect size they can be used. The present study reports of a cell-free collagen type I gel matrix for the treatment of large cartilage defects of the knee after a two-year follow-up. Twenty-eight patients with a mean cartilage defect size of 3.71 ± 1.93 cm² were treated with a cell-free collagen type I gel matrix (CaReS-1S®, Arthro Kinetics AG, Krems/Donau, Austria) via a mini-arthrotomy. Clinical outcome was assessed preoperatively and six weeks as well as six, 12 and 24 months after surgery using various clinical outcome scores (IKDC, Tegner, KOOS, VAS). Cartilage regeneration was evaluated via MRI using the MOCART score. Seventeen male and 11 female patients with a mean age of 34.6 years were included in this study. Significant pain reduction (VAS) could be noted after six weeks already. Patient activity (IKDC, Tegner) could be significantly improved from 12 months on and nearly reached reported pre-operative values. All subject categories of the KOOS except for symptom (swelling) showed significant improvements throughout the study. Constant significant improvements of the mean MOCART score were observed from 12 months on. MR images did not yield any signs of infection or synovitis. After 24 months a complete defect filling could be noted in 24 out of 28 cases with a mainly smooth surface, complete integration of the border zone and homogenous structure of the repaired tissue. Cell-free collagen type I matrices appear to be a safe and suitable treatment option even for large cartilage defects of the knee. Results of this study were comparable to the better-established findings for small cartilage defects. Mid- and long-term results will be needed to see if clinical and MR-tomographic outcome can be maintained beyond 24 months.
    International Orthopaedics 02/2015; DOI:10.1007/s00264-015-2695-9 · 2.11 Impact Factor
  • Alexander Haupert · Olaf Lorbach
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    ABSTRACT: The medial patellofemoral ligament (MPFL) ensures stability of the patella against lateral forces. In cases of recurrent lateral patellar luxation, surgical reconstruction of the MPFL has an important role in treating lateral patellar instability. Several biomechanical studies have presented valuable pieces of information about various techniques for re-creating this medial patellofemoral complex mainly using the gracilis tendon as an autograft. However, with the increasing number of MPFL reconstructions, there are also an increasing number of patients requiring revision MPFL reconstruction. Therefore alternative graft options may become more relevant. Furthermore, the gracilis tendon as a tubular graft may not be able to fully restore patellofemoral kinematics compared with the native MPFL. This article introduces a surgical technique using the fascia lata as an alternative graft option for the anatomic reconstruction of the MPFL.
    Arthroscopy Techniques 02/2015; 4(1). DOI:10.1016/j.eats.2014.11.005
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    ABSTRACT: High initial fixation strength, mechanical stability and biological healing of the tendon-to-bone interface are the main goals after rotator cuff repair surgery. Advances in the understanding of rotator cuff biology and biomechanics as well as improvements in surgical techniques have led to the development of new strategies that may allow a tendon-to-bone interface healing process, rather than the formation of a fibrovascular scar tissue. Although single-row repair remains the most cost-effective technique to address a rotator cuff tear, some biological intervention has been recently introduced to improve tissue healing and clinical outcome of rotator cuff repair. Animal models are critical to ensure safety and efficacy of new treatment strategies; however, although rat shoulders as well as sheep and goats are considered the most appropriate models for studying rotator cuff pathology, no one of them can fully reproduce the human condition. Emerging therapies involve growth factors, stem cells and tissue engineering. Experimental application of growth factors and platelet-rich plasma demonstrated promising results, but has not yet been transferred into standardized clinical practice. Although preclinical animal studies showed promising results on the efficacy of enhanced biological approaches, application of these techniques in human rotator cuff repairs is still very limited. Randomized controlled clinical trials and post-marketing surveillance are needed to clearly prove the clinical efficacy and define proper indications for the use of combined biological approaches. The following review article outlines the state of the art of rotator cuff repair and the use of growth factors, scaffolds and stem cells therapy, providing future directions to improve tendon healing after rotator cuff repair. Level of evidence Expert opinion, Level V.
    Knee Surgery Sports Traumatology Arthroscopy 01/2015; 23(2). DOI:10.1007/s00167-014-3487-2 · 3.05 Impact Factor
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    ABSTRACT: Purpose: The purpose of this study was the evaluation of knee laxity in the ACL-deficient knee with combined meniscal tear, meniscal suture and partial medial meniscectomy. Methods: Kinematics of the intact knee were determined in 18 human cadaver specimens in response to a 134-N anterior tibial load (aTT) as well as a combined rotatory load of 10 Nm valgus and 4 Nm internal tibial rotation using a robotic/universal force moment sensor testing system. The anterior cruciate ligament was resected. Subsequently, a vertical bucket-handle medial meniscal tear was created followed by a standard meniscus repair using horizontal inside-out stitches or a partial medial meniscectomy. Knee kinematics were calculated following every sub-step. Results: A significant increase of anterior tibial translation was found in the ACL-deficient knee compared to the intact knee at 30° and 90° of flexion (p = 0.001; p ≤ 0.001). Additional tear of the medial meniscus significantly increased anterior tibial translation (p = 0.01). In response to a simulated pivot shift, anterior tibial translation of the intact knee did not increase significantly after ACL resection (p = 0.067). However, ACL deficiency with an additional medial meniscus tear led to a significant increase compared to the intact knee at 0° of flexion (p = 0.009). Conclusions: Additional injury of the medial meniscus increased aTT as well as aTT under a combined rotatory load in the ACL-deficient knee whereas repair of the meniscus significantly decreased aTT. Therefore, the meniscus status does have a significant impact on knee kinematics in the ACL-deficient knee. The present biomechanical study further highlights the importance of preserving the meniscus especially in patients with additional ACL injuries.
    International Orthopaedics 11/2014; 39(4). DOI:10.1007/s00264-014-2581-x · 2.11 Impact Factor
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    Olaf Lorbach · Philipp Mosser · Dietrich Pape
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    ABSTRACT: Hintergrund Valgisierende Orthesen stellen eine kostengünstige Alternative in der Behandlung der medialen Gonarthrose dar. Sie helfen zum einen in der präoperativen Diagnostik als Entscheidungshilfe, ob ein Patient aller Voraussicht nach von einer valgisierenden Osteotomie des Tibiakopfes profitiert. Darüber hinaus ist ein direkter klinischer Nutzen in Form einer Schmerzlinderung und Besserung der Kniegelenkfunktion in einigen Arbeiten gezeigt worden. Diskussion Die genauen Wirkungsmechanismen werden kontrovers diskutiert. Es wird eine Verringerung der mechanischen Last im medialen Kompartiment des Kniegelenks durch Verringerung des Varus, sowie eine Reduktion des gesteigerten Muskeltonus angenommen. Schlussfolgerung Ein langfristiger Nutzen der entlastenden Kniegelenkorthesen ist jedoch umstritten, da zum einen der degenerative Gelenkverschleiß fortschreitet, zum anderen aufgrund des oft fehlenden Tragekomforts der Orthesen die Bereitschaft zum Tragen der Orthese mit der Zeit abnimmt.
    Der Orthopäde 11/2014; DOI:10.1007/s00132-014-3030-7 · 0.36 Impact Factor
  • Olaf Lorbach · Philipp Mosser · Dietrich Pape
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    ABSTRACT: Unloader knee braces are a viable and cost-effective alternative in for treatment of medial osteoarthritis of the knee in selected patients. They provide the potential to predict which patients could benefit from a high tibial osteotomy (HTO) and which patients should better be treated which a unicondylar or bicondylar knee replacement.
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    ABSTRACT: Purpose Biomechanical comparison of three different fixation techniques for a proximal biceps tenodesis. Methods Eighteen human cadaver specimens were used for the testing. A tenodesis of the proximal biceps tendon was performed using a double-loaded suture anchor (5.5-mm Corkscrew, Arthrex), a knotless anchor (5.5-mm SwiveLock, Arthrex) or a forked knotless anchor (8-mm SwiveLock, Arthrex). Reconstructions were cyclically loaded for 50 cycles from 10–60 to 10–100 N. Cyclic displacement and ultimate failure loads were determined, and mode of failure was evaluated. Results Cyclic displacement at 60 N revealed a mean of 3.3 ± 1.1 mm for the Corkscrew, 5.4 ± 1.4 mm for the 5.5-mm SwiveLock and 2.9 ± 1.6 mm for the 8-mm forked SwiveLock. At 100 N, 5.1 ± 2.2 mm were seen for the Corkscrew anchor, 8.7 ± 2.5 mm for the 5.5-mm SwiveLock and 4.8 ± 3.3 mm for the 8-mm forked SwiveLock anchor. Significant lower cyclic displacement was seen for the Corkscrew anchor (p
    Arthroscopy The Journal of Arthroscopic and Related Surgery 10/2014; 29(10). DOI:10.1007/s00167-014-3365-y · 3.21 Impact Factor
  • O Lorbach · D Pape · P Mosser · D Kohn · K Anagnostakos
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    ABSTRACT: Hintergrund Die monokondyläre Kniegelenkprothese stellt eine gute Alternative zur Umstellungsosteotomie und zur bikondylären Knieprothese in der Behandlung der medialen Gonarthrose dar. Mit der korrekten Indikation sind die zu erwartenden Ergebnisse von Umstellungsosteotomie und unikondylärer Prothese vergleichbar. Ergebnisse Im Vergleich zum bikondylären Oberflächenersatz führt die monokondyläre Knieprothese zu einer schnelleren Rehabilitation sowie einer besseren postoperativen Beweglichkeit und einem höheren postoperativen Aktivitätsniveau. Trotz der exzellenten Langzeitergebnisse werden die Überlebensraten von bikompartimentellen Knieprothesen jedoch nicht erreicht. Die häufigsten Ursachen für eine Revision stellen das Fortschreiten der Arthrose der lateralen und patellofemoralen Kompartimente sowie die Lockerung der tibialen Komponente dar. Schlussfolgerung Die Konversion in eine bikompartimentelle Prothese ist in der Regel unproblematisch, führt jedoch zu schlechteren Ergebnissen sowie zu einer höheren Komplikationsrate im Vergleich zum primären bikompartimentellen Kniegelenkersatz.
    Der Orthopäde 09/2014; DOI:10.1007/s00132-014-3012-9 · 0.36 Impact Factor
  • K Anagnostakos · O Lorbach · D Kohn · P Orth
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    ABSTRACT: Changes of patellar position (height, tilt, and shift) and arthritis of the patellofemoral joint might potentially influence outcome after unicompartmental knee replacement. The purpose of this work is to evaluate the influence of the aforementioned parameters on postoperative outcome. Literature analysis via PubMed. A total of 12 relevant studies (three about Patellar height, two about patellar tilt and shift, seven about patellofemoral osteoarthritis) could be identified. Regarding Patellar height, two out of three studies demonstrated a postoperative decrease. With regard to patellar tilt and shift, only one study identified postoperative lateralization of the patella to be a predictor for poor outcome. The radiological appearance of arthritis of the patellofemoral joint does not significantly influence postoperative knee function except for cases where only the lateral patellar facet is affected. Anterior knee pain has no influence on clinical outcome. Literature data do not allow for a precise statement about the possible influence of patellar position on the outcome after unicompartmental knee replacement. With proper patient selection, good results can be achieved despite patellofemoral osteoarthritis.
    Der Orthopäde 08/2014; 43(10). DOI:10.1007/s00132-014-3004-9 · 0.36 Impact Factor
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    ABSTRACT: Purpose: To evaluate knee laxity after anatomic ACL reconstruction with additional suture repair of a medial meniscus tear. Methods: Kinematics of the intact knee were determined in 12 human cadaver specimens in response to a 134-N anterior tibial load (aTT) and a combined rotatory load of 10 Nm valgus and 4 Nm internal tibial rotation (aTTPS) using a robotic/universal force moment sensor testing system. Subsequently, the ACL was resected following the creation of a standardized tear of the medial meniscus, a standard meniscus repair and an ACL reconstruction using an anatomic single-bundle (6) or an anatomic double-bundle technique (6). Knee kinematics were determined following every sub-step. Results: Significant increase of aTT in the ACL-deficient knee was found (p ≤ 0.001) with a further increase in the ACL-deficient knee with additional medial meniscal rupture (p ≤ 0.001). ACL reconstructions significantly decreased aTT compared with the ACL and meniscus-ruptured knee. No significant differences were seen between the intact knee and the ACL-reconstructed knee with additional meniscal repair (p < 0.05). In response to a simulated pivot shift, aTTPS in the intact knee significantly increased in the ACL-deficient knee and meniscus-ruptured knee (p = 0.005). No significant differences in knee kinematics were found between SB as well as DB ACL reconstruction with additional medial meniscal repair compared with the intact knee. Comparison of SB versus DB ACL reconstruction did not reveal any significant differences in a simulated Lachman test or simulated pivot shift test (n.s.). Conclusions: aTT as well as aTTPS significantly increased with ACL deficiency compared with the intact knee; additional medial meniscal rupture further increased aTT. Anatomic ACL reconstruction with medial meniscal repair did not reveal significant differences in knee kinematics compared with the intact knee. Comparison of anatomic SB versus DB ACL reconstruction with additional repair of the medial meniscus did not show significant differences neither in a simulated Lachman nor in a simulated pivot shift test.
    Knee Surgery Sports Traumatology Arthroscopy 05/2014; 23(9). DOI:10.1007/s00167-014-3071-9 · 3.05 Impact Factor
  • Arthroscopy The Journal of Arthroscopic and Related Surgery 10/2013; 29(10):e39-e40. DOI:10.1016/j.arthro.2013.07.014 · 3.21 Impact Factor
  • O. Lorbach · M. Herbort · M. Engelhardt · M. Kieb
    09/2013; 1(4 Suppl). DOI:10.1177/2325967113S00073
  • Arthroscopy The Journal of Arthroscopic and Related Surgery 06/2013; 29(6):e30–e31. DOI:10.1016/j.arthro.2013.03.071 · 3.21 Impact Factor
  • PD Dr. K. Anagnostakos · D. Kohn · O. Lorbach
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    ABSTRACT: Mit der zunehmenden Zahl implantierter Hüftendoprothesen stieg auch die Anzahl der Revisionsoperationen. Die Trochanterosteotomie bietet sich als Zugang für die Revisionsendoprothetik an, falls mit weichteiligen Standardzugängen keine genügende Übersicht geschaffen werden kann oder falls der weichteilige Zugang mit einer Traumatisierung funktionell wichtiger Strukturen verbunden wäre. Die Trochanterosteotomien sind muskelschonende Verfahren. Sie werden deshalb auch in der Traumachirurgie und der gelenkerhaltenden Hüftchirurgie (chirurgische Hüftluxation) erfolgreich eingesetzt. Neben einer präzisen Osteotomietechnik ist die stabile Refixierung von besonderer Bedeutung, aber gleichzeitig aufgrund der hohen auf den Trochanter major einwirkenden Muskelkräfte und der in diesem Bereich zarten Kortikalis technisch anspruchsvoll. Es existiert eine Vielzahl an Operationstechniken und Implantaten. Im vorliegenden Beitrag werden gängige traditionelle und neue Osteotomieverfahren am Trochanter major wie die „klassische“ Trochanterosteotomie nach Charnley, die Trochanterverschiebeosteotomie, die erweiterte Trochanterosteotomie und die stufenförmige Trochanterosteotomie sowie die jeweilige Refixationstechnik beschrieben.
    Der Orthopäde 05/2013; 42(5). DOI:10.1007/s00132-012-2013-9 · 0.36 Impact Factor
  • D. Kohn · O. Lorbach
    Der Orthopäde 05/2013; 42(5):301-301. · 0.36 Impact Factor

Publication Stats

529 Citations
136.51 Total Impact Points


  • 2008–2015
    • Universität des Saarlandes
      • Klinik für Orthopädie und Orthopädische Chirurgie
      Saarbrücken, Saarland, Germany
  • 2007–2013
    • Universitätsklinikum des Saarlandes
      Homburg, Saarland, Germany
  • 2012
    • Orthopädische Universitätsklinik Friedrichsheim
      Frankfurt, Hesse, Germany
  • 2008–2011
    • Centre Hospitalier de Luxembourg
      Letzeburg, Luxembourg, Luxembourg
  • 2010
    • Klinikum Osnabrück GmbH
      Osnabrück, Lower Saxony, Germany
  • 2009
    • Klinikum Osnabrück
      Osnabrück, Lower Saxony, Germany
  • 2006
    • ATOS Klinik Heidelberg
      Heidelburg, Baden-Württemberg, Germany