Mirco Herbort

• Prof. Dr. med.
• Consultant at OCM Clinic Munich

Zusammenfassung Die Ruptur des vorderen Kreuzbands (VKB) ist eine häufige Sportverletzung. Nach ihrer Therapie kehren, trotz kontinuierlicher Verbesserung, nicht alle Patienten zu ihren präoperativen Aktivitäten zurück. Individualisierte Behandlungsansätze, basierend auf Transplantatwahl, Rekonstruktionstechnik und biomechanischen Faktoren wie tibi...

Purpose The medial collateral ligament (MCL), and posterior oblique ligament (POL) are the primary valgus stabilisers of the knee, and clinical examinations in grading valgus instability can be inherently subjective. Stress radiography of medial‐sided knee injuries provides objective diagnosis and was analysed in this study. We hypothesised that (1...

Summary: Not previously described ligaments stabilising medial meniscus have been found during cadaver dissection and then their presence has been confirmed in MRI scans.

This chapter provides a comprehensive over- view of contemporary anatomical research, transforming our understanding of knee liga- ment anatomy. The objective is to present recent discoveries that challenge traditional perspectives and unveil the complexities of ligamentous structures within the knee joint. An in-depth understanding of knee anatomy...

Purpose To biomechanically evaluate a flat posterior cruciate ligament (PCL) reconstruction utilizing rectangular femoral bone tunnels. Methods Eight fresh‐frozen human knee specimens were tested in a six‐degrees‐of‐freedom robotic test setup. In each testing step, a force‐controlled test protocol was performed, including 89 N posterior tibial tra...

Chronic refractory pain poses a significant challenge in knee joint pathologies, especially after exhaustion of conservative, arthroscopic, and endoprosthetic therapy options. This case report illustrates an innovative approach using MRI-assisted chemical neurolysis of a genicular nerve to manage persistent knee pain after arthroscopy. A 62-year-ol...

Background Injuries of the superficial medial collateral ligament (sMCL) and anteromedial structures of the knee result in excess valgus rotation and external tibial rotation (ER) as well as tibial translation. Purpose To evaluate a flat reconstruction of the sMCL and anteromedial structures in restoring knee kinematics in the combined MCL- and an...

The peroneus longus tendon split graft is a universally usable tendon graft that is not yet widely used in Europe. The graft is a very good alternative to the semitendinosus tendon, as its dimensions are very similar to those of the semitendinosus tendon. The peroneus longus split graft can be harvested in a minimally invasive procedure using a con...

Each individual ligament structure of the knee joint has both specialized and synergistic functional tasks for knee joint stability. The most important prerequisite for the treatment of multiple ligament instability is therefore a comprehensive analysis of all affected ligament tears. In addition to magnetic resonance imaging (MRI) diagnostics, cli...

Purpose This study aimed to investigate the length change patterns of the native deep medial collateral ligament (dMCL) and potential anteromedial reconstructions (AMs) that might be added to a reconstruction of the superficial MCL (sMCL) to better understand the control of anteromedial rotatory instability (AMRI). Methods Insertion points of the...

Background The incidence of anterior cruciate ligament (ACL) reconstruction is increasing, and quadriceps tendon (QT) autograft is gaining popularity for both primary and revision ACL reconstruction. Purpose To evaluate the differences in the patient-reported functional outcomes, concomitant injuries, and graft failure in primary versus revision A...

Purpose The aim of this consensus project was to give recommendations regarding surgical treatment of the anterior cruciate ligament (ACL) injured patient. Methods For this consensus process, an expert, steering and rating group was formed. In an initial online meeting, the steering group, together with the expert group, formed various key topic c...

Research question: There is currently no validated measurement instrument for research and clinical use that can be used in the early rehabilitation process after surgical treatment of lower extremity injuries in competitive and amateur athletes. Therefore, a new questionnaire (Lower Extremity Early Rehabilitation Score-13, LERAS-13) was developed...

Purpose: The aim of this biomechanical cadaver study was to evaluate the effects of high-grade posterolateral tibia plateau fractures on the kinematics of anterior cruciate ligament (ACL)-deficient joints; it was hypothesized that, owing to the loss of the integrity of the osseous support of the posterior horn of the lateral meniscus (PHLM), these...

Purpose: The purpose of this study was to evaluate the patient-reported outcomes, graft failure, quadriceps rupture and sports preference after arthroscopic ACL reconstruction in patients older than 50 years who underwent arthroscopic ACL reconstruction with a quadriceps tendon (QT) autograft. Methods: Between 2010 and 2020, prospectively collec...

Isolated posterior cruciate ligament (PCL) ruptures are relatively rare, but they more commonly occur in multiligament knee injuries. To date, in isolated or combined injuries with grade III step-off, surgical treatment is recommended to restore joint stability and improve knee function. Several techniques for PCL reconstruction have been described...

PurposeWe sought to externally validate ultrasonography (US) for quantification of suprapatellar effusion size to improve diagnosis and individualised rehabilitation strategies in knee rehabilitation after anterior cruciate ligament reconstruction (ACLR) surgery.MethodsUS was performed on 35 patients as part of the ongoing CAMOPED study. Data were...

PurposeThe aim of this consensus project was to create a treatment algorithm for the management of the ACL-injured patient which can serve as an aid in a shared decision-making process.Methods For this consensus process, a steering and a rating group were formed. In an initial face-to-face meeting, the steering group, together with the expert group...

Purpose This study aimed to evaluate and compare the time required to return to sports (RTS) after surgery, the rate of revision surgery and the time required for RTS after revision surgery in elite athletes undergoing meniscal repair or partial meniscectomy, particularly analysing the difference between medial and lateral menisci. It was hypothesi...

Fragestellung: Grundlage für die leitliniengerechte Empfehlung und weitere Entwicklung von kosteneffektiven und wirksamen Innovationen in der frühen postoperativen Rehabilitation nach Knieverletzungen ist die standardisierte Erfassung der tatsächlichen Versorgungsrealität. Methodik: Im Rahmen der laufenden prospektiven, stratifiziert randomisierte...

Purpose The purpose of this study was to evaluate the differences in the patient-reported functional outcomes, and graft failure in revision ACL reconstruction using quadriceps tendon (QT), Hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) autografts. Methods Between 2010 and 2020, 97 patients who underwent revision ACL reconstruction (40...

Purpose: Given the paucity of literature on the re-revision of ACL, the current study was undertaken. The purpose of this systematic review was to synthesise and qualitatively assess the currently available evidence in the literature regarding the re-revision of ACL reconstruction (rrACLR). Methods: A systematic review was conducted based on the...

Background Injuries of the medial collateral ligament complex are one of the most frequent knee injuries. They can frequently be treated conservatively with good clinical results; however, persisting instability results in increased load on the cruciate ligaments and especially by their involvement need adequate treatment.Anatomy and biomechanicsTh...

Background Technical innovation has led to the renaissance of anterior cruciate ligament (ACL) repair in the past decade. Purpose/Hypothesis The present study aimed to compare instrumented knee joint laxity and patient-reported outcomes (PROs) after ACL repair with those after primary ACL reconstruction for acute isolated ACL tears. It was hypothe...

Background: Primary device fixation and the resistance against gap formation during repetitive loading influence the quality of meniscal repair. There are limited biomechanical data comparing primary tensioning and cyclic behavior of all-inside versus inside-out repair. Hypothesis: All-inside devices provide higher initial load on the meniscal r...

Background Both the superficial medial collateral ligament (sMCL) and the deep MCL (dMCL) contribute to the restraint of anteromedial (AM) rotatory instability (AMRI). Previous studies have not investigated how MCL reconstructions control AMRI. Purpose/Hypothesis The purpose was to establish the optimal medial reconstruction for restoring normal k...

After anterior cruciate ligament reconstruction (ACLR), continuous active motion (CAM) devices are part of knee rehabilitation programs over the last 20 years. These devices are usually prescribed in addition to physiotherapy. However, a standardised validated physiotherapy program after ACLR is lacking in clinical reality. Objectives: Explorative...

PurposeThe aim of this consensus project was to validate which endogenous and exogenous factors contribute to the development of post-traumatic osteoarthritis and to what extent ACL (anterior cruciate ligament) reconstruction can prevent secondary damage to the knee joint. Based on these findings, an algorithm for the management after ACL rupture s...

The main principles of the present medial collateral ligament (MCL) reconstruction techniques are (1) to approximate the natural anatomy and (2) to restore the main passive restraining structures in anteromedial and posteromedial knee instability. Therefore, we describe a technique using a flat tendon graft instead of tubular grafts with point-to-p...

Objective: The goal of the modified Ellison operation as a supplement to a conventional anterior cruciate ligament (ACL) reconstruction is to decrease anterolateral rotational instability of a knee joint after ACL rupture, to improve the stability and prevent ACL re-rupture. Indications: An ACL rupture with high risk of re-rupture (young age, hi...

Background Different indications and treatment options for combined injuries to the anterior cruciate ligament (ACL) and medial collateral ligament complex (MCL) are not clearly defined. Purpose To perform a modified Delphi process with the Committee for Ligament Injuries of the German Knee Society (DKG) in order to structure and optimize the proc...

Background The microvascular anatomy of the meniscus of the human knee is regarded as a crucial factor in the injury response. Previous studies have investigated the zone-dependent distribution pattern, but no quantitative data exist on vascular density and its age-related changes. Hypothesis/Purpose The aim of the present study was to histologica...

Background Anterior cruciate ligament (ACL) surgery is the subject of intensive further development. Nevertheless, increased rates of rerupture in particularly active and young patients represent a major challenge. The drilling technique (transtibial versus medial portal technique), the choice of graft, and graft fixation are the most important fac...

Background The use of the interference screw (IFS) for the cortical fixation of tendon grafts in knee ligament reconstruction may lead to converging tunnels in the multiligament reconstruction setting. It is unknown whether alternative techniques using modern suture anchor (SA) or bone staple (BS) fixation provide sufficient primary stability. Pur...

Keywords: Active Motion Device, CAMOPED, ACL, Physiotherapy, Rehabilitation Background After anterior cruciate ligament (ACL) reconstruction, continuous active (CAM) or passive (CPM) motion devices are part of knee rehabilitation programs over the last 20 years. However, there is not a single high-quality clinical trial without severe bias investi...

Keywords: Active Motion Device, CAMOPED, ACL, Use And Acceptance, Satisfaction Background Continuous active motion devices (CAM) are been used in daily routine as part of knee rehabilitation programs, especially after anterior cruciate ligament (ACL) reconstruction (ACLR) over the last 20 years. Despite their established use, there is no data avai...

Aims and Objectives: Clinical assessment of knee joint effusion as part of routine physical knee examination is gold standard, but lacks criteria and accuracy that would make it suitable for quantitative objective and reproduceable assessment across centres in scientific context or for individual adaptations in knee rehabilitation after surgical in...

Background Various meniscal suture systems and techniques are available for treatment of a ruptured meniscus. All-inside systems in particular have recently been increasingly criticized through legal decisions.Objective The objective of this study was to analyze the treatment reality among members of the AGA- Society for Arthroscopy and Joint Surge...

The exact anatomy in relation to the individual fixation of the menisci in the knee joint and their vascular supply are the most important prerequisites for adequate surgical treatment. This article aims to give an up to date overview of the anatomical features of the menisci with a focus on these specific aspects. A zonal classification of the men...

Background: In contrast to the majority of existing techniques for reconstruction of the medial patellofemoral ligament (MPFL), the technique described in this article uses the adductor magnus muscle tendon to gain a flat, broad graft, leaving its distal femoral insertion intact, and does not require drilling within or near the femoral physis. It...

Purpose The goal of the present study was to evaluate a potential tunnel convergence in combined anterior cruciate ligament (ACL) reconstruction using the anteromedial portal (AMP) technique and lateral extra-articular tenodesis (LET). Methods Ten fresh frozen femora were dissected and a K-wires were inserted into the middle of the ACL stump accor...

Purpose The purpose of this study was to examine the length change patterns of the native medial structures of the knee and determine the effect on graft length change patterns for different tibial and femoral attachment points for previously described medial reconstructions. Methods Eight cadaveric knee specimens were prepared by removing the ski...

Introduction The aim of this study was to investigate the distraction forces of the medial and lateral posterior meniscal roots after repair (PMMR, PLMR) at different degrees of flexion and axial load. Hypotheses It was hypothesized that with increasing axial load and flexion angle, the distraction forces on the meniscal roots increase continuousl...

Introduction Aim of the study was to investigate the length changes of the medial structures and related reconstructions. It was assumed that the three fibre sections (anterior/middle/posterior) of the superficial medial collateral ligament (sMCL) have different length change patterns, which cannot be imitated by current reconstructions. Hypothese...

Peripheral ligamentous instabilities of the knee joint have received much attention in recent years. Especially, as concomitant lesions of anterior (ACL) or posterior cruciate ligament (PCL) injury, they seem to be of great importance for the successful therapy of these combined knee injuries. There is a synergistic function between the ligaments o...

Background Graft rupture is a devastating outcome after anterior cruciate ligament (ACL) reconstruction (ACLR). Little is known about graft rupture rates as well as clinical and functional outcomes after ACLR with quadriceps tendon (QT) autografts. Purpose To compare QT with hamstring tendon (HT) autografts in terms of the rates of graft and contr...

PurposeThis study aimed to compare the biomechanical properties of the popliteus bypass against the Larson technique for the reconstruction of a combined posterolateral corner and posterior cruciate ligament injury.Methods In 18 human cadaver knees, the kinematics for 134 N posterior loads, 10 Nm varus loads, and 5 Nm external rotational loads in 0...

Background Microfracture (MF) is an established operative treatment for small, localized chondral defects of the knee joint. There is evidence from animal studies that matrix augmentation of bone marrow stimulation (m-BMS) can improve the quality of the repair tissue formation. Purpose To evaluate the therapeutic outcome of a matrix made of polygl...

Aims and Objectives Microfracture is the gold standard for the treatment of small localized chondral defects of the knee joint. There is evidence from animal studies that the augmentation of bone marrow stimulation by a matrix improves the quality of the repair tissue (matrix-augmented bone marrow stimulation = m-BMS). Aim of this randomized contro...

Aims and Objectives Recently, due to the development of new techniques, ACL repair has returned back into focus of experimental and clinical research. Newer studies highlight the fact that ACL repair can lead to satisfying functional results and healing rates. Aim of the present study was to compare the functional results after ACL repair in compar...

Aims and Objectives The main goal of the presented study was to evaluate the anatomical and biomechanical properties of the proposed surgical technique for anatomical Medial Patellofemoral ligament (MPFL) reconstruction using the flat Adductor tendon (AT) graft in order to primarily determine its overall plausibility and application potential, as w...

Aims and Objectives Anteromedial rotatory instability (AMRI) may result from combined lesions to the medial capsuloligamentous structures and anterior cruciate ligament (ACL). However, the contribution made by individual structures to controlling AMRI remains controversial. The purpose of the present study was to determine how the medial structures...

Aims and Objectives Lateral extra-articular tenodesis (LET) procedures are being increasingly performed as concomitant procedures to both primary and revision intra-articular ACL reconstructions with the purpose of controlling excessive anterolateral rotatory instability and to reduce tension on the ACL graft. There is, however, a lack of evidence...

Aims and Objectives Chronic medial instability presents a severe problem both for the patient and the surgeon, and may result into anterior cruciate ligament graft failure in a combined anteromedial instability. Thus, reconstructions have been developed to conquer this problem. However, these are not capable of mimicking the flat anatomy of the med...

The aim of this technique is to reconstruct the medial patellofemoral ligament using a distally attached strip of the quadriceps tendon. Minimally invasive instruments are used to harvest a strip of the quadriceps tendon using a superomedial incision. The isometric insertion site is determined using an image intensifier. This is crucial in order to...

Many surgeons use quadriceps tendon (QT) graft for anterior cruciate ligament (ACL) revision surgery; however, despite excellent clinical results, the QT has not achieved universal acceptance for primary ACL reconstruction. One of the reasons for this may be that the QT is technically demanding to harvest, and the scar from open harvesting techniqu...

PurposeThe purpose of the present study was to determine how the medial structures and ACL contribute to restraining anteromedial instability of the knee.Methods Twenty-eight paired, fresh-frozen human cadaveric knees were tested in a six-degree of freedom robotic setup. After sequentially cutting the dMCL, sMCL, POL and ACL in four different cutti...

Background Arthroscopically assisted reduction and fixation (ARIF) of tibial plateau fractures offers advantages regarding visualization of the injury and use of minimally invasive fixation techniques.Objectives Identification of indications, techniques and limits of ARIF for the treatment of tibial plateau fractures.Materials and methodsAnalysis o...

Introduction: The purpose of this study was to determine the variability of femoral tunnel positions applying two different lateral extra-articular tenodesis (LET) techniques, guiding on the tactile identification (1) of the lateral epicondyle (Lemaire procedure) and (2) of the Kaplan fibre attachments on the distal femur (MacIntosh procedure) and...

Background Anterior cruciate ligament (ACL) repair has once again become a focus of research because of the development of new techniques. Purpose/Hypothesis The purpose of the present study was to compare the functional results and recurrent instability rates in patients undergoing ACL repair with dynamic intraligamentary stabilization (DIS) vers...

The article describes a single stage surgical treatment of a complex knee injury of a 28-year-old professional football player and the clinical course. The patient suffered a rupture of the anterior cruciate ligament (ACL) with a medial meniscus bucket handle tear, a type 2 posterior meniscus root tear and a traumatic grade 4 cartilage injury cover...

According to recent anatomic studies, the anterior cruciate ligament (ACL) appears to be a flat, "ribbon-like" structure, with a thin, oval-shaped insertion on the femur and a C-shaped tibial insertion. According to this anatomy, we describe an ACL-reconstruction technique that aims to approximate this natural anatomy. The basic principle of this t...

Background Anteromedial rotatory instability (AMRI) frequently occurs from combined injuries to the medial capsuloligamentous structures and anterior cruciate ligament (ACL). The purpose of the present study was to determine the contribution of each medial structure in restraining AMRI.Material and methodsA total of 28 paired human cadaveric knees...

Die klinische Untersuchung des Kniegelenks stellt zum einen eine große Herausforderung, zum anderen aber auch eine große Chance dar. Insbesondere ligamentäre Verletzungen werden trotz ihrer Komplexität immer besser verstanden und somit auch differenzierter therapiert. Eine rein radiologische Diagnosestellung ist v. a. bei chronischen Verletzungen n...