Jörn Kircher

ATOS Klinik Fleetinsel Hamburg · Shoulder and Elbow Surgery

Background: Large and massive rotator cuff tears and tears after failed surgical repair are a challenging clinical problem with different treatment options. The purpose of the study was to evaluate the mid-term outcomes following rotator cuff repair (RCR) with autologous hamstring tendon graft bridging (TEAR patch) with the hypothesis, that outcom...

Humeral avulsion of the glenohumeral ligament (HAGL lesion) is a challenging problem in surgery for shoulder instability. Open and arthroscopic approaches and techniques have been described to address this issue. Especially posterior HAGL lesions increase the surgical complexity, as open anterior approaches provide limited visibility and access for...

The endoprosthesis register (SEPR) of the D‑A-CH Association for Shoulder and Elbow Surgery e. V. (DVSE) collects data on the implantation of shoulder and elbow endoprostheses. The question arises as to whether the data is only used to monitor trends in arthroplasty, or whether it can also be used as an early warning system for risks and possible c...

Functional outcomes are relatively poor when a shoulder prosthesis is implanted in a joint that has had a previous infection. High revision rates of approximately 30% in small case series are reported in the literature. The aim of this paper is to analyze the DVSE (“D-A-CH Vereinigung für Schulter- und Ellenbogenchirurgie”) shoulder prosthesis regi...

Fokale Knorpelschäden am Glenohumeralgelenk entziehen sich bis heute oft der Standarddiagnostik und stellen therapeutisch bisweilen Herausforderungen dar. Die Inzidenz von arthroskopisch gesicherten Knorpeldefekten liegt in der Literatur in Abhängigkeit von weiteren Pathologien zwischen 5–46 % aller Arthroskopien. Die klinische Diagnostik wird häuf...

We can observe increasing numbers for the implantation of shoulder endoprostheses in developed industrial countries. This is accompanied by a certain number of revision surgeries. The conversion to reverse arthroplasty systems is by far the most common revision procedure. Depending on the primary implant and the individual situation, the surgical e...

Purpose Assessment on whether radiographic parameters of the acromion measured in radiographs change significantly after antero-lateral acromioplasty. Methods This retrospective study included patients that underwent an arthroscopic antero-lateral acromioplasty between January 2014 and September 2020. N=435 subjects with high quality pre- and post...

Zusammenfassung Hintergrund Die letzten Jahre sind geprägt von weiteren Fallzahlsteigerungen der Implantation von Schulterendoprothesen in Deutschland. Die Registerforschung bietet die Möglichkeit, Trends in der Versorgung im Hinblick auf die demografischen Daten als auch der verwendeten Implantate frühzeitig zu erkennen und sichtbar zu machen. M...

Introduction To date there is no generally accepted specific definition or classification of acromioclavicular (AC) joint osteoarthritis. The aim of this study is to analyze morphological parameters using magnetic resonance imaging (MRI) and to develop a scoring system as a basis for decision making to perform an AC-joint resection. Materials and...

Posterior glenoid bone defects are a frequent clinical problem impacting the surgical technique and choice of implant in total shoulder arthroplasty (TSA). Bone grafting with autologous or allogenic bone is one option for filling the defect and correcting pathological glenoid version. The use of posteriorly augmented glenoid implants, which were mo...

Purpose The purposes of this in vitro study were to investigate whether the addition of dexamethasone can compensate for any cytotoxic effects of the amide-type local anesthetics (LA) bupivacaine and ropivacaine and whether morphine and morphine-6-glucuronide (M6G) may be a safe alternative for peritendinous application. Methods Biopsies of human...

Elbow arthroscopy has evolved to be a powerful tool for the treatment of a broad spectrum of pathologies over the past almost 40 years. The small joint with a complex arthroscopic anatomy demands special training and exceptional skills from the orthopaedic surgeon. On the basis of this fact and in light of the close proximity of the neurovascular s...

Purpose The objective of this study is to assess tendon integrity, shoulder function and subscapularis (SCP) power in comparison to the contralateral normal shoulder after arthroscopic SCP repair using the SICK stitch technique. Methods This study assessed 32 patients with arthroscopically repaired SCP lesions. The mean age was 63.3years. All patie...

Multidirectional shoulder instability and hyperlaxity can be treated with arthroscopic shoulder stabilization and capsular shift. In these patients, the joint capsule often becomes the weak link in terms of pullout strength and cutting through of the used sutures, which can further be compromised by reduced quality of the capsular tissue. The descr...

Introduction Although arthroscopic acromioclavicular (AC) joint resection is a frequently performed procedure, the pathophysiology of non-traumatic AC joint degeneration is still unclear. The purpose of this study was to investigate whether non-traumatic AC joint degeneration shows a typical pattern and whether it starts at the posterior part of th...

Purpose The purpose of this study is to identify and analyze primary revision arthroplasties of the shoulder in the Germany Shoulder Arthroplasty Registry (SPR). The objective is to provide demographic and clinical data of the included cases, information about the revision surgery itself and to compare the findings to other registry studies and cli...

Introduction Rotator cuff tears are one of the most common reasons for shoulder pain, and patients often present initially to general practitioners. However, subscapularis tears are especially difficult to diagnose and hence adequate therapy is often delayed. General practitioners or non-specialist orthopedic surgeons need reliable MRI findings to...

Die altersabhängige Abnahme der Abduktionskraft der Schulter ist allgemein anerkannt und findet z.B. ihre Berücksichtigung im age-adjusted Constant score. In der zur verfügung stehenden Literatur finden sich keine Hinweise, ob es sich um ein besonderes Phänomen des M. supraspinaus handelt, oder ob die gleichen Effekte für alle Muskeln der Rotatoren...

Background: Osteochondral defects (OCDs) of the shoulder represent a typical clinical problem and are difficult to manage. OCDs of the upper extremity are less common than those of the lower extremity. The incidence is reported to be between 5-17% in which the humerus is affected more frequently than the glenoid. OCD is often accompanied with symp...

Total shoulder arthroplasty (TSA) with anatomical implants and reverse shoulder arthroplasty (RSA) have developed in parallel and each has its own specific field of application. The clinical success is reflected in the increasing number of implantations in the last decades. Reverse shoulder implants are in certain respects the endpoint in endoprost...

Hemangiomas belong to the benign tumors, that can occur in any bone of the human body. The typical localization are the vertebral spine and the skull. There is no reported case of an intraarticular glenoidal hemangioma so far. The current paper presents a case of a 48-year-old female with joint pain that started 2 years before. The clinical manifes...

Zusammenfassung Laterale Klavikulafrakturen machen einen Anteil von bis zu 28 % aller Klavikulafrakturen aus und neigen zur Entstehung von Pseudarthrosen. In diesem Beitrag wird ein spezielles Operationsverfahren beschrieben. Hierbei erfolgte die Therapie durch eine Resektion des lateralen Fragments und Rekonstruktion der lateralen Klavikula mit Be...

Zusammenfassung Hintergrund Charakteristisch für den lateinamerikanischen Formationstanz (LFT) sind den Schulter-Arm-Bereich belastende Dreh-, Schleuder- und Zugbewegungselemente. Ziel dieser Studie ist die Analyse von Schulterverletzungen im LFT. Material und Methoden Insgesamt nahmen n=81 Tanzsportler*innen (TS) (m: n= 43; w: n= 38) an einer re...

Background Arthroplasty registries provide opportunities to obtain statistical information about geographical care and clinical results. Revision is an inevitable sequelae of shoulder arthroplasty. The main goals of our study were analysis of all revisions documented within the German shoulder arthroplasty registry (SPR) and determination of freque...

Background Since 2015, total elbow arthroplasty and radial head arthroplasty procedures including distal humeral hemiarthroplasty and capitellar replacement have been documented in the elbow arthroplasty registry of the DVSE (“Deutsche Vereinigung für Schulter- und Ellenbogenchirurgie e. V.”). Methods Primary arthroplasties that have been document...

The measurement of anterior knee laxity in anterior cruciate ligament injuries is an established method for both clinical practice and clinical studies in regard to anterior cruciate ligament surgery. Stress radiography was succeeded or paralleled by instrumented testing with the development of standardized devices starting in the 1980s. Because kn...

Steigende Operationszahlen machen heute in den entwickelten Industrieländern die Implantation von Schulterendoprothesen zur Regelversorgung, die überwiegend in spezialisierten Zentren erfolgt. Die Wiederherstellung einer schmerzfreien Schulterfunktion nach Schultertotalendoprothese erfordert eine intensive gezielte und individuelle Nachbehandlung....

Neben der Standardversorgung mit anatomischen Schultertotalendoprothesen rückt bei älteren Patienten die Implantation von inversen Schulterendoprothesen immer mehr in den Vordergrund. Ursachen sind die steigende Lebenserwartung, die altersabhängige Degeneration der Rotatorenmanschette mit Ausbildung der Defektarthropathie, posttraumatische Zustände...

Zusammenfassung Rotatorenmanschetten-Läsionen sind häufige Erkrankungen mit einer altersabhängigen Zunahme in den entwickelten Ländern. Frühstadien und Partialläsionen zeigen sehr gute Langzeitresultate nach operativer Therapie. Verspätet erkannte Läsionen oder Re-Rupturen nach operativer Therapie sind oft nicht mehr rekonstruierbar und durch einen...

High-resolution 3-dimensional cartilage-specific magnetic resonance imaging (MRI) was performed at 3 T to test the following hypotheses: (1) there is a nonuniform cartilage thickness distribution both on the proximal humerus and on the glenoid surface and (2) the glenohumeral joint as a combined system is congruent with the level of the joint carti...

Purpose To prospectively evaluate elbow flexion force, cosmetic and clinical outcome of all-arthroscopic suprapectoral biceps tenodesis for isolated biceps lesions. Methods Tenodesis was performed using a 6.25-mm absorbable interference screw for intraosseous fixation. Seventeen out of 24 patients (70.8 %, median age 49.0 ± 10.1 years; 10 = male) c...

Restoration of subscapularis function is essential for long-term maintenance of good clinical results for both traumatic and nontraumatic rotator cuff tears. The anatomic repair of partially and completely torn tendons from the footprint at the lesser tuberosity is the goal of surgical repair. The described technique, with a combination of an inter...

Electronic Poster

Cartilage biochemical imaging modalities that include the magnetic resonance imaging (MRI) techniques of T2* mapping (sensitive to water content and collagen fiber network) and delayed gadolinium-enhanced MRI of cartilage (dGEMRIC, sensitive to the glycosaminoglycan content) can be effective instruments for early diagnosis and reliable follow-up of...

It is commonly accepted that the glenohumeral joint space remains unchanged until the onset of osteoarthritis, at which point progressive degenerative changes, and joint space narrowing occur. The aim of this study was to evaluate the radiographic width of the glenohumeral joint space in patients of different ages: Those with otherwise normal radio...

Instabilitätssymptome sind ein häufiges Problem bei Kindern und Jugendlichen im Wachstumsalter. Echte Dislokationen und operationspflichtige Befunde unterhalb des 12. Lebensjahres sind selten. Eine eingehende Anamnese und gezielte körperliche Untersuchung wird durch eine erweiterte Schnittbilddiagnostik (MRT) ergänzt. In die Therapieplanung sollte...

The force-fit glenohumeral joint is stabilized by a fine interaction of passive and active stabilizers. Only in this way is a painless harmonious and powerful movement in all directions feasible. Besides the genuine functional disorders of this interplay, structural lesions are common causes of instability symptoms and dislocations. The classificat...

Liebe Leserinnen und Leser,die vorliegende Ausgabe der ObEx ist dem Thema „Instabilität“ des Glenohumeralgelenkes gewidmet.Das Problem ist uralt und bereits seit der Zeit des alten Ägypten in Wandmalereien dokumentiert. Und dennoch ist die Therapie dieses Krankheitsbildes die Königsdisziplin der gelenkerhaltenden Schulterchirurgie geblieben.Unser W...

Recently, the safety profile of local anaesthetics in intra-articular use became into focus of investigation. Opioid drugs have a different mode of action and may be a safe and potent alternative for intra-articular application. The purpose of this in vitro study is to provide evidence for significant chondrotoxicity of amide-type local anaesthetic...

We report a case of multifocal avascular osteonecrosis (AVN) following steroid administration in a case of tuberculous encephalitis in a young patient. The risk of joint-related AVN as a side effect of adjunctive steroid therapy should be taken into consideration when evaluating the dosage and treatment duration in tuberculous encephalitis.

Patello-femoral disorders are a common problem in Orthopaedic practice especially acute patellar dislocation with the peak incidence at the age of thirteen to fifteen years. In almost all cases the direction of patellar displacement is to the lateral side with a high risk of recurrence. Usually there is a combination of several risk factors such as...

Shoulder instability is a common problem in Orthopaedic practice for children and adolescents. Dislocations under the age of 12 are rare. The group of adolescents and young adults, especially male, who are active in high risk sports have the highest reported recurrence rates. There are no widely-accepted classification systems for shoulder instabil...

Hintergrund Zur arthroskopischen suprapektoralen Bizepstenodese mit intraossärer Sehnenrefixation ist in der Literatur wenig beschrieben. Ziel war die Analyse der klinischen Ergebnisse basierend auf Scores und Kraftmessung in Relation zur Gegenseite. Hypothetisiert wurde eine Verbesserung von Ellenbogenflexionskraft und klinischen Scores auf das Ni...

This manuscript describes the successful treatment of a steroid-induced avascular necrosis of the humeral head using arthroscopically assisted retrograde drilling of a stage II lesion using a guiding device. At the final follow-up 19 month post-operatively, the patient presented pain-free without functional limitations although the osteonecrosis ha...

Reduced bone stock and difficult intraoperative orientation are challenges in glenoid replacement surgery. New implant designs and methods for fixation, such as locking screws, extra-long central pegs and/or central compression screws are targeting these issues. The objective of this study is the analysis of the glenoid dimension regarding maximum...

Objectives: To establish baseline T2* and T1Gd values of glenohumeral cartilage at 3 T. Methods: Forty asymptomatic volunteers (mean age: 24.8 ± 2.2 years) without shoulder abnormalities were included. The MRI protocol comprised a double-echo steady-state (DESS) sequence for morphological cartilage evaluation, a gradient-echo multiecho sequence...

Arthroscopic suprapectoral techniques for tenodesis of the long head of the biceps tendon (LHB) are appropriate for the treatment of proximal biceps lesions. Several types of techniques and fixation devices have been described and evaluated in biomechanical studies regarding primary stability. In this technical note, we describe an all-arthroscopic...

Osteoarthritis of the shoulder is a common disorder in clinical practice especially in specialized treatment centres with a peak incidence in the seventh decade of life. The underlying pathomechanism of primary osteoarthritis remains uncertain but there are more and more predisposing factors being identified which can lead to secondary omarthrosis....

Biomechanical studies have shown increased glenohumeral translation and loading of the long head biceps (LHB) tendon after superior labrum anterior to posterior (SLAP) tears. This may explain some of the typical clinical findings, including the prevalence of humeral chondral lesions, after SLAP lesions. The first hypothesis was that SLAP repair cou...

The purpose of this study was to assess the clinical and radiographic presentation of young adults in the mid-term follow-up after pinning in situ for mild to moderate slipped capital femoral epiphysis (SCFE). We postulated that there was a correlation between the degree of head-neck-offset decrease and clinical and radiographic signs of hip joint...

The rupture of the pectoralis major tendon is an uncommon pathological condition that is reported in literature to prevail among athletes, although also case reports and case series of nursing home residents or workers can be found, as well as traumatic lesions. Among athletes, pectoralis major tendon ruptures have shown a significant increase in i...

Osteoarthritis (OA) is one of the most common chronic diseases, with increasing importance due to increased life expectancy. On a cellular level, the pathophysiology of joint function impairment and ultimate destruction associated with OA remains poorly understood. Free radicals are highly reactive molecules involved in both normal intracellular si...

To evaluate the relationship of a large acromion index and calcifying tendinitis of the supraspinatus tendon at the shoulder. Between 2002 and 2008, 109 consecutive patients with isolated calcifying tendinitis of the supraspinatus tendon were prospectively analysed by clinical investigation and standardized radiographs. Deposit size and appearance...

The purpose of this study was to evaluate the prevalence of SLAP and biceps reflection pulley lesions. The hypothesis was that these lesions do not occur concomitantly and they have a different etiology. We prospectively analyzed 3,395 shoulder arthroscopies that were independently performed by 2 surgeons between 2004 and 2008 regarding the prevale...

Osteoarthritis of the shoulder is a common problem in orthopedic practice usually affecting people in the seventh decade of life. The underlying pathomechanism of primary osteoarthritis of the shoulder remains unclear whereas more and more predisposing factors and conditions leading to secondary omarthrosis are identified. Pain during allday activi...

We report the rare case of a recurrent antero-inferior shoulder dislocation in a 10-year-old girl with hyperlaxity. After closed reduction of the locked dislocation and conservative treatment, multiple further dislocations occurred while the shoulder was immobilized in a sling. Arthroscopy including antero-inferior and postero-inferior capsular shi...

The complete rupture of the pectoralis major tendon is an uncommon injury but has become increasingly common among athletes in recent years. This may be due to a higher number of individuals taking part in high-impact sports and weightlifting as well as the use of anabolic substances, which can make muscles and tendons vulnerable to injury. In rece...

Arthroplasty is the treatment of choice for severely damaged humeral heads in chronic locked posterior dislocation of the shoulder. We retrospectively reviewed the results of 12 shoulder arthroplasties (11 patients) between 1999 and 2005. Mean follow-up was 37.4 +/- 16.8 months. Mean postoperative Constant score (CS) was 59.4 +/- 21.6 (normative ag...

Fragestellung Ein Makrotrauma als Ursache von SLAP- als auch Pulley-Läsionen ist generell akzepiert. Beide Entitäten sind durch die lange Bizepssehne in ihrem intraartikulären Verlauf verbunden und stehen biomechanisch in enger Beziehung. Ziel dieser Arbeit ist die Untersuchung der Fragestellung, ob ein Zusammenhang zwischen traumatischen SLAP- und...

The aim of this study was to evaluate the relationship between a low acromion index and osteoarthritis of the shoulder. Three patient groups were used: (I) instability, n = 53; (II) calcifying tendonitis, n = 109; and (III) osteoarthritis, n = 120. Standardised digital X-rays were evaluated from the true anteroposterior and axillary views. Joint sp...

From 2004 to 2008 we evaluated 431 SLAP lesions during 3,395 shoulder arthroscopies and compared two groups of patients, one with SLAP lesion as group I and one without SLAP lesions as group II. Exclusion of type I SLAP lesions, rotator cuff tears and history of dislocation of the shoulder in both groups left 182 cases in group I, and additionally,...

Loss of joint space, formation of osteophytes and deformation are common features of osteoarthritis. Little information exists about the radiological features of arthrosis in relation to clinical findings and the radiological appearance in degenerative shoulder joint disease especially with regard to decision making about the timing of joint replac...

The correct implantation of the glenoid component is of paramount importance in total shoulder arthroplasty (TSA). We hypothesized that the accuracy of the glenoid positioning in the transverse plane can be improved using intraoperative navigation. This prospective, randomized clinical study comprised 2 groups of 10 patients each with osteoarthriti...