M Tingart

University Hospital RWTH Aachen, Aachen, North Rhine-Westphalia, Germany

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Publications (152)172.27 Total impact

  • Zeitschrift fur Orthopadie und Unfallchirurgie 04/2015; 153(02):123-126. DOI:10.1055/s-0035-1550323 · 0.62 Impact Factor
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    ABSTRACT: Morphologically, bone marrow edema (BME) is an accumulation of fluid in the bone marrow. The BME is per se non-specific but can be identified at an early stage with magnetic resonance imaging (MRI). The underlying pathomechanism remains unclear. The BME can occur as an individual entity and as an accompanying condition of many diseases. The BME can be divided into three groups, ischemic, reactive and mechanical BME. Mechanical BME occurs after trauma or repetitive strain. Typical histological changes are present and there is no clear boundary between edema and microfracture. Some forms of trauma show BME in typical localizations. Both the trauma and the possible accompanying injuries can be indirectly indicated in this way in cases with an unknown trauma mechanism. The BME can be present as an isolated entity or as a comorbidity. For initiation of therapy, a comprehensive medical history and targeted diagnostics are indispensable. In some cases BME is indicative of the trauma mechanism and possible further accompanying injuries.
    Der Unfallchirurg 03/2015; 118(3):199-205. DOI:10.1007/s00113-014-2688-y · 0.61 Impact Factor
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    ABSTRACT: Optical Coherence Tomography (OCT) is an evolving imaging technology allowing non-destructive imaging of cartilage tissue at near-histological resolution. This study investigated the diagnostic value of real time 3-D OCT in comparison to conventional 2-D OCT in the comprehensive grading of human cartilage degeneration. Fifty-three human osteochondral samples were obtained from eight total knee arthroplasties. OCT imaging was performed by either obtaining a single two-dimensional cross-sectional image (2-D OCT) or by collecting 100 consecutive parallel 2-D OCT images to generate a volumetric data set of 8 mm X 8 mm (3-D OCT). OCT images were assessed qualitatively according to a modified version of the DJD classification and quantitatively by algorithm-based evaluation of surface irregularity, tissue homogeneity and signal attenuation. Samples were also graded by Outerbridge and statistically analysed by one-way ANOVA, Kruskal Wallis and Tukey's or Dunn's post hoc tests. Overall, the generation of 3-D volumetric datasets and their multiple reconstructions such as rendering, surface topography, parametric and cross-sectional views proved to be of potential diagnostic value. With increasing distance to the mid-sagittal plane and increasing degeneration, score deviations increased, too. In conclusion, 3-D imaging of cartilage with image analysis algorithms adds considerable potential diagnostic value to conventional OCT diagnostics. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Orthopaedic Research 01/2015; 33(5). DOI:10.1002/jor.22828 · 2.97 Impact Factor
  • Biomedical Optics Express 01/2015; 6(7):2398. DOI:10.1364/BOE.6.002398 · 3.50 Impact Factor
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    ABSTRACT: A consideration of the patient-specific biomechanical situation in the context of the surgical planning of total hip arthroplasty is highly recommended and may have a positive impact on the therapeutic outcome. In current clinical practice, surgical planning is based on the status of the individual hip and its radiographic appearance. Several authors proposed different biomechanical modeling approaches for the calculation of the resultant hip force R on the basis of parameters gathered from plain radiography. The comparative study presented in this paper shows that the biomechanical models by Pauwels, Debrunner, Blumentritt and Iglič provide a good approximation of the magnitude of R when compared to the in vivo data from instrumented prostheses. In contrast, the Blumentritt model resulted in abnormally high values. However, the computational results for the orientation of R show a high variability of all modeling approaches and seem to depend more on the model used than on patient-specific parameters. Georg Thieme Verlag KG Stuttgart · New York.
    Zeitschrift fur Orthopadie und Unfallchirurgie 12/2014; 152(6):603-15. DOI:10.1055/s-0034-1383221 · 0.62 Impact Factor
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    ABSTRACT: Spondylodiscitis is a rare disease which is associated with high mortality. No guidelines for treatment exist and the available studies are not homogeneous. Attempts have been made in recent years to structure therapy using algorithms. Early recognition of the disease is above all important for its later outcome. Therapy takes place in not only orthopaedic/trauma surgery clinics but also in neurosurgical clinics. We sent an online survey on this subject to orthopaedic clinics, trauma surgery and neurosurgery clinics in Germany. The aim was to ascertain current care strategies in Germany. A further objective was to elicit differences between the specialist fields. A total of 164 clinics responded to the survey. The response rate was 16 % of the orthopaedic/trauma surgery clinics and 32 % of the neurosurgical clinics. Differences between the two specialist fields can be found particularly in the use of systemic and local antibiotics, in the choice of surgical access to the thoracic spine and the lumbar spine and in post-operative imaging. In both specialist fields, patients with neurological dysfunctions are treated primarily in clinics with high case numbers. In terms of surgery, 2/3 of the responding clinics choose a one-stage operative treatment. Minimally invasive procedures and the use of cages are widespread. The participants estimate that, on the whole, a better outcome and higher patient satisfaction tend to exist after operative treatment. The lack of homogeneity regarding treatment strategies which is indicated here clearly shows the need for therapy guidelines as an aid to orientation. This will be a challenge for the future due to the low incidence and the situation regarding currently available studies. Georg Thieme Verlag KG Stuttgart · New York.
    Zeitschrift fur Orthopadie und Unfallchirurgie 12/2014; 152(6):577-83. DOI:10.1055/s-0034-1383131 · 0.62 Impact Factor
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    ABSTRACT: Optical Coherence Tomography (OCT) yields microscopic cross-sectional images of cartilage in real time and at high resolution. As yet, comprehensive grading of degenerative cartilage changes based on OCT has rarely been performed. This study investigated the potential of quantitative OCT using algorithm-based image parameters such as irregularity (OII – Optical Irregularity Index), homogeneity (OHI – Optical Homogeneity Index) and attenuation (OAI – Optical Attenuation Index) in the objective grading of cartilage degeneration. Therefore, OCT was used to image and assess 113 human osteochondral samples obtained from total knee replacements. Processing included the analysis of OII (by calculation of the standard deviation with regards to a fitted surface), of OHI (by edge detection of tissue signal changes) and of OAI (by analysis of relative imaging depth). Additionally, samples were subject to macroscopic (Outerbridge grading), biomechanical (elastic stiffness), qualitative OCT and histological evaluation (Modified Mankin grading). Significant correlations were found between all outcome measures. OII and OHI were effective in assessing cartilage surface, integrity and homogeneity, while OAI could discriminate between unmineralized and mineralized cartilage, respectively. Therefore, quantitative OCT holds potential as a diagnostic tool for more reliable, standardized and objective assessment of cartilage tissue properties. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res
    Journal of Orthopaedic Research 10/2014; 32(10). DOI:10.1002/jor.22673 · 2.97 Impact Factor
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    ABSTRACT: PURPOSE. To compare outcome after total hip arthroplasty (THA) through the mini-incision approach versus the standard transgluteal approach. METHODS. 80 women and 63 men aged 33 to 89 (mean, 62) years with primary osteoarthritis of the hip were randomised to undergo unilateral THA through a mini-incision approach (Micro-hip, n=55) or standard, lateral, transgluteal approach (Bauer, n=88). Levels of haemoglobin, haematocrit, serum creatine kinase, and C-reactive protein, length of hospital stay, mobilisation, and any complication were recorded. Visual analogue scale (VAS) for pain was assessed. Hip function was assessed using the Harris Hip Score and the Oxford Hip Score, whereas general health was assessed using the EQ-5D general health questionnaire. The cup inclination and varus/valgus of the stem position were measured using a goniometer. RESULTS. The Micro-hip group achieved a significantly lower mean incision length (9.3 vs. 13.4 cm, p<0.001), mean surgical time (60 vs. 68 minutes, p=0.021), mean reduction in haemoglobin level (2.1 vs. 2.8 g/dl, p<0.001), and mean VAS for pain from hour 6 to day 6 (all p<0.05). One patient in the Micro-hip group developed early aseptic loosening of the cup and underwent revision surgery at month 4. Three patients in the Bauer group and one patient in the Micro-hip group sustained intra-operative nondisplaced fractures of the proximal femur, which were fixed with cerclages. Two patients in the Microhip group developed deep vein thrombosis during week 1. CONCLUSION. THA through the Micro-hip approach achieved faster pain relief.
    Journal of orthopaedic surgery (Hong Kong) 08/2014; 22(2):168-72.
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    Computer Assisted Orthopaedic Surgery 2014 – 14th Annual Meeting, Milano; 06/2014
  • G Gradl, H-C Pape, M Tingart, D Arbab
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    ABSTRACT: Expected changes in population demographics will have significant implications for society and health care provision for the treatment of proximal humeral fractures in the elderly. This article presents the incidence and clinical characteristics of geriatric fractures of the proximal humerus, a description of therapeutic options and treatment recommendations. The published scientific data were reviewed and current opinion available to guide patient care are presented. The majority of fractures of the proximal humerus that require operative treatment are amenable to reconstruction. Primary arthroplasty is usually reserved for comminuted fractures with delayed presentation, head-splitting fractures or those in which the humeral head is devoid of soft tissue attachments. Secondary replacement may be required in cases of fixation failure and symptomatic avascular necrosis. Decision-making is dependent on the fracture pattern as well as on patient and surgeon-related factors.
    Der Orthopäde 03/2014; 43(4). DOI:10.1007/s00132-013-2161-6 · 0.67 Impact Factor
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    ABSTRACT: Background. Isolated peroneus longus tendon tears are rare and represent a frequently overlooked source of lateral ankle pain and dysfunction. Only few cases of isolated peroneus longus tendon tears have been reported and a common treatment algorithm does not exist. The purpose of this study was to give an overview of the literature and to present our experience of 6 consecutive cases that have been treated successfully by operation and immobilizing cast. Methods. A comprehensive chart review was performed to compile each patient's age, sex, onset of symptoms, time between first symptoms and diagnosis, surgical findings, surgical treatment, length of follow-up, and outcome. The average patient age was 48 years (range 20-63 years). Results. Acute tears occurred in 4 cases, and 2 patients reported about a chronic onset of symptoms. The cause for acute tears was an acute inversion ankle sprain in all cases. Diagnosis was made after an average of 11 months (range 0.75-24 months). There were 2 complete tears, and other 4 were incomplete. An os peroneum was present in 2 cases. In 5 of 6 cases, the results after surgical treatment were excellent or good after a mean follow-up of 28.6 months (range 12-78 months). Conclusion. This study indicates that lateral ankle pain may be due to isolated acute or chronic peroneus longus tendon tears. Thorough clinical and radiological diagnosis is necessary to detect this uncommon injury in time. Patients with acute onset of symptoms and short time between symptoms and diagnosis tend to fare better than the chronic tears and delayed diagnosis. Surgical intervention yields successful and predictable results.Levels of Evidence: Level III, Retrospective comparative study.
    Foot & Ankle Specialist 12/2013; DOI:10.1177/1938640013514273
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    ABSTRACT: Revision total knee arthroplasties (TKA) have been performed with increasing frequency over the last 25 years. In this study, we retrospectively analyzed 78 patients who underwent 78 revision TKAs during the years 2003-2007 with an average follow-up of 81 months (range 60-108 months). All patients were treated with a standard rotating hinge prosthesis (TC3, DePuy, Warsaw, IN, USA) due to significant instability. We evaluated the postoperative results using the Knee Society clinical rating system and the WOMAC rating system. Clinical results revealed significant improvements in both scores. Complications occurred in almost one-third of the cases, with a reoperation rate of 26 %. Our mid-term findings show that revision TKAs lead to an improvement in patient-perceived outcomes of physical variables. While revision TKA is a useful option for patients, procedure-associated complications should not be neglected. During the course of the procedure, it is important to collect patient-oriented data and focus on responsive and valid scores.
    Journal of Orthopaedic Science 09/2013; 18(6). DOI:10.1007/s00776-013-0467-1 · 1.01 Impact Factor
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    Biomedizinische Technik/Biomedical Engineering 09/2013; DOI:10.1515/bmt-2013-4116 · 2.43 Impact Factor
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    ABSTRACT: Traumatic ruptures of the tibialis posterior tendon are very rare and often associated with ankle fractures. They may result from forced pronation with external rotation and dorsiflexion of the foot. The tibialis posterior muscle is an important dynamic stabilizer of the longitudinal arch during gait. Complete ruptures or continuous dysfunction due to partial ruptures may result in progressive plano-valgus foot deformity. As diagnosis in association with fractures is difficult, lesions of the tibialis posterior tendon are most frequently noticed during surgery. Complete ruptures and distinctive partial ruptures of the tendon should be repaired with suture. In older traumatic ruptures the tendons are often retracted and direct reconstruction is not possible. In these cases, tendon transfer or tendon transplantation could be used. Results for operative treatment are good if surgery is performed before plano-valgus foot deformity evolves. Medial ankle fracture due to forced pronation injury is highly suspicious for a concomitant tibialis posterior tendon injury which should be excluded. We present a case of a complete traumatic rupture of the posterior tibial tendon without pre-existing, degenerative damage and give an overview of the literature.
    Fuß & Sprunggelenk 09/2013; 11(3):148–154. DOI:10.1016/j.fuspru.2013.05.002
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    ABSTRACT: Background: One of the biggest health insurance companies in Germany (AOK, Allgemeine Ortskrankenkasse) has published new results focussing on process quality of total knee replacement in 2010. These results were published in the online portal "Weiße Liste", which is based on health insurance routine data. The German Association of Orthopeadic Surgery questions the credibility of the rating system of the "Weiße Liste". To prove the system an interdisciplinary task force was created. Material and Methods: The task force identified patient-specific parameters, which influence the outcome of total knee replacement based on the literature and expert opinions. Out of 907 orthopaedic departments, 4 above average and four below average were identified. The AOK was asked to provide 80 data sets for each department. These anonymised data sets could be converted into patient-specific data sets in the identified departments. Statistical analysis was performed to answer the question of whether there are differences between the below and the above average groups. Results: 625 cases could be investigated. We found an increased rate of postoperative complications in the below average group. There are differences between both groups in terms of factors influencing the procedure. In the below average group an increased rate of patients with one or more comorbidities and a preoperative extension lag of over 10° was found. The above average group has a higher rate of operations before the knee replacement. Conclusion: The results need to be proven on a larger scale. Further, prospective investigations are planned.
    Zeitschrift fur Orthopadie und Unfallchirurgie 08/2013; 151(4):401-6. DOI:10.1055/s-0033-1350627 · 0.62 Impact Factor
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    ABSTRACT: Aim: Patellar dislocations are a common injury of the knee joint. During patella dislocations injuries of soft-tissue structures can occur that can destabilise the patella and lead to recurrent dislocations. There are also congenital pathologies that predispose to patella dislocations. In the current literature, diagnostics and treatment of patellar dislocations are frequently discussed. Therefore the aim of our survey was to analyse and summarise actual diagnostic and therapeutic strategies regarding primary and recurrent patella dislocations. Methods: An online questionnaire form was sent to 735 orthopaedic and/or trauma departments in Germany. The departments were invited to participate in an anonymous survey concerning diagnostics and treatment of primary and recurrent patellar dislocations. The questionnaire consisted of multiple choice questions and was divided into three sections. The first section included questions concerning the department structure. The second part contained questions regarding diagnostics and treatment of primary patella dislocations. The third part involved diagnostic and treatment strategies for recurrent patella dislocations. A systematic review of outcome after treatment of patellar dislocation was performed and discussed with the results of the survey. Results: 245 hospitals (33.3 %) returned the questionnaire. Among the participants were 23 % orthopaedic surgery departments, 32 % trauma surgery departments and 45 % combined departments. 12 % were university hospitals and 53 % academic teaching hospitals. Clinical examination was performed by nearly all participants after primary and recurrent patella dislocations. MRI was used as diagnostic tool in 81 % after primary patella dislocation and in 85 % after recurrent patella dislocation. Conventional X-rays were performed in 58 % (primary) and 51 % (recurrent patella dislocations). Computed tomography scans for measurement of the tuberositas tibiae-trochlea groove distance were used in 35 % after recurrent dislocations and in 20 % after primary patella dislocations. 69 % of the participating departments performed non-operative therapies after primary patella dislocations, especially when no associated injuries and no congenital pathologies were observed. Reconstruction of the medial retinaculum was the most frequent surgical therapy (52 %) followed by the reconstruction of the medial patellofemoral ligament (36 %) after primary patella dislocation. Following recurrent patella dislocations reconstruction of the medial patellofemoral ligament (58.5 %) was the most performed surgery and a tuberositas transfer was done in 58 % of participating departments after recurrent patella dislocation. Conclusion: The results of our survey showed diagnostic and therapeutic procedures in the participating departments which are in accordance with recommendations in recent publications. The clinical importance of the MPFL reconstruction was observed for primary and recurrent patella dislocation. In addition, conservative treatment is still the most common treatment after primary dislocation of the patella.
    Zeitschrift fur Orthopadie und Unfallchirurgie 08/2013; 151(4):380-8. DOI:10.1055/s-0032-1328692 · 0.62 Impact Factor
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    13th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery; 06/2013
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    ABSTRACT: Der Talus verticalis ist eine seltene, angeborene Deformität des Fußes, die isoliert oder in Assoziation mit anderen Fehlbildungen auftritt. Pathoanatomisch liegt eine Luxation des Talonavikulargelenks und des subtalaren Gelenks vor. Ätiologie und Pathogenese der Fehlbildung sind weiterhin nicht abschließend geklärt, wobei für wenige Fälle eine genetische Komponente nachgewiesen werden konnte. Klinisch imponieren eine konvexe Ausbildung der kindlichen Fußsohle (Schaukelfuß), eine Abduktion und Extension des Vorfußes sowie ein Fersenhochstand bei Achillessehnenverkürzung. Die Diagnose wird durch die konventionelle Röntgenuntersuchung des Fußes gesichert. Differenzialdiagnostisch sollte eine Abgrenzung zum flexiblen Plattfuß, sekundären neurogenen Knick-Senk-Fuß, Talus obliquus und Hackenfuß erfolgen. Die Behandlung des Talus verticalis strebt eine physiologische Rekonstruktion der anatomischen Verhältnisse an, um damit einen schmerzfreien, funktionell gut belastbaren Fuß zu schaffen. Die operative Behandlung erzielt gute Ergebnisse, ist jedoch mit intra- und postoperativen Komplikationen assoziiert. Gute Kurzzeitergebnisse einer modifizierten, konservativen Behandlung mittels Reposition, Gipsredression und minimal-invasiver Maßnahmen könnten, ähnlich der Behandlung des Klumpfußes, zu einem Wandel im Therapiekonzept des Talus verticalis führen.
    Der Orthopäde 06/2013; 42(6). DOI:10.1007/s00132-013-2089-x · 0.67 Impact Factor
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    Dr. D. Arbab, M. Tingart
    Der Orthopäde 06/2013; 42(6). DOI:10.1007/s00132-013-2076-2 · 0.67 Impact Factor
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    ABSTRACT: Congenital vertical talus is a rare condition which presents as an isolated deformity or in association with neuromuscular and/or genetic disorders. Pathoanatomically the deformity shows a dislocated talonavicular and subtalar joint. The etiology and pathogenesis are still not finally determined although in some cases a genetic basis has been identified. The clinical picture is that of a flat, convex longitudinal arch with abduction and dorsiflexion of the forefoot and an elevated heel. Clinical diagnosis is confirmed by plain radiographic imaging. Congenital vertical talus should not be confused with other deformities of the foot, such as congenital oblique talus, flexible flat feet or pes calcaneus. The object of treatment of congenital vertical talus is to restore a normal anatomical relationship between the talus, navicular and calcaneus to obtain a pain-free foot. Major reconstructive surgery has been reported to be effective but is associated with substantial complications. Good early results of a modified non-operative treatment using serial manipulation, cast treatment and minimally invasive surgery may change therapeutic concepts.
    Der Orthopäde 05/2013; · 0.67 Impact Factor

Publication Stats

1k Citations
172.27 Total Impact Points


  • 2011–2015
    • University Hospital RWTH Aachen
      • Department of Orthodontics
      Aachen, North Rhine-Westphalia, Germany
  • 2011–2014
    • RWTH Aachen University
      Aachen, North Rhine-Westphalia, Germany
  • 2012–2013
    • University Hospital Regensburg
      • Klinik und Poliklinik für Innere Medizin I
      Ratisbon, Bavaria, Germany
  • 2004–2011
    • Universität Regensburg
      • Department of Orthopaedics
      Ratisbon, Bavaria, Germany
  • 2007
    • University of Wuerzburg
      Würzburg, Bavaria, Germany
  • 2006
    • Asklepios Klinikum Bad Abbach
      Abach, Bavaria, Germany
  • 2002–2004
    • Orthopädische Universitätsklinik Friedrichsheim
      Frankfurt, Hesse, Germany
  • 2001
    • Harvard University
      Cambridge, Massachusetts, United States
  • 1999
    • University of Cologne
      • Center for Experimental Medicine
      Köln, North Rhine-Westphalia, Germany