Philipp Moroder

• Prof. Dr.med.univ.
• Schulthess Klinik, Zürich

Background Recurrence rates after primary traumatic shoulder dislocation are distinctly high. We hypothesized that concomitant isolated fractures of the greater tuberosity are associated with low rates of persistent instability but decreased range of motion. Methods Between 2007 and 2013, 66 consecutive shoulders in 64 patients were treated for pr...

To date, specific surgical procedures are available for the treatment of anterior shoulder instability with substantial bony glenoid defects, as well as for patients without osseous lesions. However, specific treatment options are lacking for the frequently observed small to intermediate glenoid defects, which may not necessitate glenoid reconstruc...

Background: Posterior glenohumeral instability (PGHI) is an often unrecognized or misdiagnosed type of shoulder instability due to its heterogenic clinical and radiological presentation. Classification: The ABC classification for PGHI is based on the different pathomechanisms and recommended treatment standards and is therefore a guide to findin...

Background: The J-bone graft is presumably representative of iliac crest bone grafts in general and allows anatomic glenoid reconstruction in cases of bone defects due to recurrent traumatic anterior shoulder dislocations. As a side effect, these grafts have been observed to be covered by some soft, cartilage-like tissue when arthroscopy has been...

A well focused clinical and radiological assessment to identify the extent of the involved structural lesions is a crucial prerequisite for the successful therapy of ventral shoulder instability. Furthermore, the choice of treatment must be adapted individually according to patient-specific instability-associated risk factors and functional demands...

Functional posterior shoulder instability (Polar Type III) can lead to posterior subluxation and/or dislocation during shoulder movement. Disturbed activation of external rotators and periscapular muscles generating a force imbalance in the shoulder can result in instability, weakness and pain as the leading symptoms patients present. Recommended c...

Background: The coracoid transfer procedure is commonly and successfully used to treat shoulder instability in young patients. However, there is concern that the outcome of this procedure might be inferior in older patients because of decreased bone graft quality and the potential concomitant presence of irreparable rotator cuff tears (RCTs). Met...

Die superiore Kapselrekonstruktion (SCR) stellt einen innovativen Behandlungsansatz bei irreparabler posterosuperiorer Rotatorenmanschettenruptur dar. Ziel ist es, einer vertikalen Translation des Humeruskopfs entgegenzuwirken und die superiore Stabilität des Glenohumeralgelenks wiederherzustellen. Der vorliegende Artikel gibt einen Überblick zur...

Purpose: To analyze the effect of lack of standardization on the reliability of current measurement techniques for glenoid bone loss in clinical practice. Methods: Ten consecutive patients with anterior glenoid bone loss due to recurrent anterior shoulder instability and available computed tomographic (CT) scans of the affected shoulder were inc...

Purpose: To assess the iliac crest bone graft (ICBG) position in the en-face view and axial plane comparing arthroscopic with open procedures. Methods: A total of 40 consecutive patients with recurrent anterior shoulder instability and glenoid bone loss over 10% treated by 2 independent orthopaedic departments were included. Two independent obse...

Background: In the current literature a consensus on the specific management of primary anterior traumatic shoulder instability has not been reached. While the steps of the initial diagnostic and therapeutic procedures are mostly well-defined, a variety of factors need to be considered for the planning of further treatment. Objective: This artic...

Extreme mountain biking has gained enormous popularity in recent years, especially some subdisciplines. The industry and some experts estimate that several millions of athletes perform and practice this sport all over the world. Unfortunately, detailed demographic data about each subdiscipline is lacking. In the following chapter, information about...

Background: The risk of re-engagement of bipolar bone defects in posterior shoulder instability has not yet been investigated. Hypothesis: Posterior glenoid defects can lead to the engagement of supposedly noncritical reverse Hill-Sachs lesions (RHSLs). Study design: Descriptive laboratory study. Methods: In a retrospective multicenter study...

Abstract BACKGROUND: Acromial morphology has previously been defined as a risk factor for some shoulder pathologies. Yet, study results are inconclusive and not all major shoulder diseases have been sufficiently investigated. Thus, the aim of the present study was to analyze predictive value of three radiological parameters including the critica...

Introduction: The anterosuperior rotator cuff lesion (ASRCL) denotes the concomitant injury of the subscapularis and supraspinatus tendons, which is usually associated with a pathology on the rotator interval. The full-scale of the ASRCL ranges from the higher-grade lesion of the biceps pulley through the transmural tear of the supraspinatus tendon...

Posterior glenohumeral instability (PGHI) is a commonly under- and misdiagnosed pathology owing to its variety of clinical presentations. In order to facilitate diagnosis and treatment, the simple yet comprehensive ABC classification for PGHI is based on the underlying pathomechanical principles and current standard of treatment. Three main groups...

Background Functional shoulder instability (polar type III) is caused by underactivity of rotator cuff and periscapular muscles, which leads to subluxation or dislocation during shoulder movement. While surgical treatment has shown no benefits, aggravates pain, and frequently diminishes function even further, conservative treatment is often ineffec...

Background Fractures of the acetabulum in younger patients are commonly treated by open reduction and internal fixation. For elderly patients, stable primary total hip arthroplasty with the advantage of immediate postoperative mobilization might be the adequate treatment. For this purpose, a sufficiently stable fixation of the acetabular component...

Background: Reconstruction of the medial patellofemoral ligament (MPFL) is the most frequent surgical procedure performed in patients with patellar instability. Recently, concerns regarding physeal injury during femoral tunnel placement for anatomical MPFL reconstruction in children have been discussed. Methods: This is the first case to report...

Die inverse Schulterendoprothese wird neben der Defektarthropathie auch erfolgreich für andere Indikationen eingesetzt. Mit zunehmendem Einsatz und erweitertem Indikationsspektrum rückt das Auftreten und Management von Komplikationen immer mehr in den Vordergrund. Aufgrund langfristiger Erfahrung in der chirurgischen Anwendung und dem steigenden Ve...

Background: Promising short-term outcomes after pectoralis major tendon transfer for the treatment of an irreparable anterosuperior rotator cuff tear have been reported. The purpose of this study was to evaluate the long-term outcome. Methods: Twenty-seven consecutive patients with irreparable anterosuperior rotator cuff tears without advanced c...

Background: Treatment of young, active patients with symptomatic glenohumeral osteoarthritis, excessive glenoid retroversion, and static posterior humeral subluxation is challenging. Correction of glenoid retroversion may lead to centric loading and perhaps recenter the humeral head. We describe the functional and radiologic outcomes after correct...

We congratulate Hsu et al. for their important contribution to the existing knowledge on the treatment options for failed shoulder arthroplasty with suspected infection. The goal of their study was to answer the highly relevant question of whether single-stage revision shoulder arthroplasty performed because of pain, stiffness, or component looseni...

Background. Surgical treatment of proximal humeral fractures (PHF) in osteoporotic bone of elderly patients is challenging. The aim of this retrospective study was to evaluate the clinical and radiological outcome after percutaneous reduction and internal fixation of osteoporotic PHF in geriatric patients using the semirigid Humerusblock device. Me...

Auch wenn die konsequente Weiterentwicklung aktueller Operationstechniken immer stabilere Rekonstruktionen erlaubt, stellen Redefekte der Rotatorenmanschette nach wie vor die Hauptkomplikation nach Rotatorenmanschettenrekonstruktionen dar. Diese strukturellen Redefekte unterliegen vornehmlich einer multifaktoriellen Genese. Für das therapeutische M...

Objectives The bony shoulder stability ratio (BSSR) allows for quantification of the bony stabilisers in vivo. We aimed to biomechanically validate the BSSR, determine whether joint incongruence affects the stability ratio (SR) of a shoulder model, and determine the correct parameters (glenoid concavity versus humeral head radius) for calculation o...

This technically oriented book on medicine as applied to extreme sports offers broad coverage of the field extending well beyond the usual focus on major trauma and acute injuries. In addition to the injuries and diseases associated with individual extreme sports, this book also addresses the topics of psychology, dermatology, ophthalmology, infect...

Background Current glenoid defect measurement techniques only quantify bone loss in terms of defect diameter or surface. However, the glenoid depth plays an important role in shoulder stabilization by means of concavity compression. Case presentationWe present a case of a professional wrestler who suffered from anterior shoulder instability after s...

Purpose: Little scientific evidence on the clinical and radiological outcome after stemless reverse shoulder arthroplasty (RSA) exists. The hypothesis of this study was that stemless RSA has an inferior outcome compared to RSA with stem. Methods: All cases of cuff-arthropathy fullfilling strict selection criteria (selection rate 18.4 %) were tre...

Objective: To describe rates, patterns, and causes of acute injuries in an increasingly popular outdoor sport. Design: Prospective cohort study. Setting: One winter season ranging from November 2011 to March 2011. Participants: Seventy ice climbers from 13 different countries and various performance levels. Main outcome measures: Participa...

Periprosthetic infections represent a rare but severe complication after shoulder arthroplasty. Depending on the timing of the occurrence and the clinical symptoms, classification into early, delayed, and late infections as well as low- and high-grade infections can be made. Common causes of infection are Staphylococcus aureus, streptococci, entero...

Background: Femoral torsion is a critical parameter in hip and knee disorders. The unproven assumption is that the femoral neck exclusively contributes to the overall torsion of the femur. Purpose/hypothesis: The aim of this study was to measure femoral torsion at different levels in patients with abnormally high or low femoral torsion and to co...

Posterior shoulder instability is much less common, more difficult to diagnose, and even more challenging to manage compared to anterior instability. Moreover, true posterior and multidirectional instability can be easily overlooked because the presentation can be confusing and oftentimes they are overlapping entities. A detailed clinical examinati...

Objective Treatment of displaced periprosthetic acetabular fractures in elderly patients. The goal is to stabilize an acetabular fracture independent of the fracture pattern, by inserting the custom-made roof-reinforcement plate and starting early postoperative full weight-bearing mobilization. IndicationsAcetabular fracture with or without previou...

Background: Little scientific evidence regarding reverse Hill-Sachs lesions (RHSLs) in posterior shoulder instability exists. Recently, standardized measurement methods of the size and localization were introduced, and the biomechanical effect of the extent and position of the defects on the risk of re-engagement was determined. Purpose: To anal...

Background: Arthroscopically assisted single-bundle (SB) or double-bundle coracoclavicular (CC) ligament reconstruction using autologous tendon grafts has been reported to provide acromioclavicular (AC) joint (ACJ) stability in chronic instability cases. Recently, additional AC ligament reconstruction to provide triple-bundle (TB) stabilization ha...

We report a case of recurrent Achromobacter xylosoxidans infections including bacteremia, sepsis, septic joints and endocarditis in a 72 year old female with granulomatosis with polyangiitis. Achromobacter xylosoxidans is a gram negative bacteria increasingly identified in immunocompromised patients. Surgical and medical therapy may need to be comb...

Introduction: The goal of this study was to investigate if S100B serum protein could predict secondary intracranial haemorrhagic events (SIHEs) after mild head injury (mHI) in patients taking low-dose acetylsalicylic acid (LDA), making routinely repeated head computed tomography (RRHCT) scans unnecessary. Methods: Three hundred and eight-two pat...

Introduction: Freestyle Motocross (FMX) is an emerging extreme sport in which motocross riders perform risky jumps and tricks, which are graded by judges for their degree of difficulty, originality, and style. To this date, injury, patterns and causes in Freestyle Motocross have not been determined. Methods: Over the time period from January 200...

Background: The purpose of this study was to analyze the pathomorphology of proximal humeral fractures to determine relevant and reliable parameters for fracture classification. Methods: A total of 100 consecutive acute proximal humeral fractures in adult patients were analyzed by 2 non-independent observers from a single shoulder department usi...

Background: Because of detachment of the pectoralis minor and variation of the vector of the conjoint tendons, we hypothesized that the Latarjet procedure may alter scapular position and motion. The purpose of this study was to evaluate scapular position and motion in patients who underwent a Latarjet or a modified iliac crest bone graft transfer...

Background Osseous lesions of the glenoid cavity after anterior dislocation of the shoulder joint are a common accompanying pathology. The incidence ranges from 41 % after first time dislocations to 90 % with recurrent dislocations. Investigations searching for possible reasons for unsatisfactory results of Bankart operations with soft tissue stabi...

A technique of percutaneous pinning of proximal humerus fractures had already been described in 1962. Due to the problem of K-wire migration which often lead to a loss of reduction, this method of fixation had consequently been less favored. The main goal with the further on described technique is not necessarily to achieve a perfectly anatomical r...

Neglected osseous glenoid defects are thought to be one of the reasons for the reported high rates of recurrent instability at long-term follow-up after Bankart repair. We hypothesized that open Bankart repair for the treatment of anterior glenohumeral instability in the absence of a substantial osseous glenoid defect would result in a lower long-t...

The goal of this present study was to precisely determine the dimension and location of the impaction fracture on the lateral femoral condyle in patients with an ACL rupture. All patients with post-injury bi-plane radiographs and MRI images after sustaining a tear to the anterior cruciate ligament were included. Lateral radiographs of the affected...

To evaluate the effectiveness of arthroscopic debridement (DB), partial (PR), and complete repair (CR) for massive rotator cuff tears (mRCT) in terms of functional and subjective parameters, and repair integrity. For this single-centre study, 68 consecutive shoulders with mRCT involving at least three tendons and treated with arthroscopic DB (n = 2...

Arthroplasty of symptomatic sequelae after fractures of the proximal humerus is a demanding procedure for surgeons. Exact preoperative planning is crucial in order to achieve acceptable functional results. Discussion of preoperative considerations in planning the procedure and choosing the appropriate implant taking the osseous anatomy and surround...

The Humerusblock (HB) represents a minimally invasive implant allowing for the stabilisation of proximal humeral fractures after closed or percutaneous reduction. The aim of the study was to perform a general clinical and radiological midterm follow-up focusing on the quality and complications in a large series of patients of younger age (<70 years...

RESULTS: The mean BSSR of atraumatic instability patients was 17.9% ± 8.5% and therefore significantly lower than the mean BSSR of 31.1% ± 7.5% of the control group (13.2%; 95% confidence interval [CI], 9.1% to 17.4%; P < .001). The mean BSSR of the traumatic instability group was higher, at 23.9% ± 8.5% (P = .007), but still showed a deficit of 7....

Reverse Hill-Sachs (RHS) lesions can cause recurrent posterior shoulder instability because of engagement with the posterior glenoid rim; however, the effect of defect size and localization have yet to be determined. Both size and localization are critical for the engagement of an RHS defect with the posterior glenoid rim. Controlled laboratory stu...

Purpose: We set out to compare osteosynthesis using the minimally invasive, semi-rigid, Humerusblock to reverse shoulder arthroplasty (RSA) for primary fracture treatment in three- and four-part fractures in patients over 65 years old. Methods: In the study period from 2008 to 2011, we conducted a matched-pair analysis of 25 patients treated wit...

The Humerusblock is a minimally invasive device allowing fixation of proximal humeral fractures. A drawback of the device is possible K-wire perforation of the head with the need for early removal of the implant. We assessed the amount of humeral head impaction and its role in the postoperative varus/valgus deviation of the humeral head in fracture...

Extensive glenoid bone loss after failed shoulder arthroplasty represents a challenge for revision arthroplasty. Treatment options vary widely and have been a source of controversy among experts. Between 2004 and 2010, a total of 17 patients underwent glenoid reconstruction surgery using an autologous iliac crest bone graft and secondary revision a...

Proximal humerus fractures are often difficult to treat, especially in the case of displaced and comminuted fractures in combination with poor bone quality owing to osteoporosis. Because of constantly improving implants and evolving surgical techniques, the reduction and fixation of even the most complex proximal humeral fractures might be technica...

The presence of a significant bony defect in anterior shoulder instability cases warrants glenoid reconstruction surgery typically by means of an autograft. Some surgeons use the same graft techniques even in the absence of a significant bony defect, thus augmenting the glenoid surface. The goal of this study is to investigate the clinical and comp...

The purpose of this study was to examine the incidence and mechanisms of acute injuries in the sport of fistball. No scientific studies on injury characteristics have yet been conducted in this traditional sport game. The study was conducted prospectively over the course of 12 months. During a total of 40.308 h of sport-specific exposure, 240 playe...

Recurrence after first-time traumatic anterior shoulder dislocation is frequent. The prevalence of glenoid bone loss ranges from 41% after a first-time dislocation to 86% with recurrent dislocation. Postoperative recurrence can occur in up to 10% of cases. Thus, misdiagnosis of bony glenoid rim lesions has been assumed a major cause for failure. We...

Background: The goal of this study was to investigate the incidence of a medial bony ridge at the scapular neck in patients with recurrent anterior shoulder instability and analyze its reliability in identifying anterior glenoid rim bone loss. Methods: A total of 109 shoulders in 105 consecutive patients underwent primary surgical stabilization...

Background: Shoulder stability primarily depends on concavity compression, which relies on the concave shape of the glenoid not mere glenoid width. This study analyzed the effect of anatomic glenoid reconstruction surgery on concavity morphology. Methods: Thirty-one consecutive patients with recurrent anterior shoulder instability and glenoid bo...

Purpose: The purpose of this study was to determine whether standardized measurements are more reliable than mere estimation in determining the extent of the defect in reverse Hill-Sachs lesions. Methods: Twelve patients with 13 reverse Hill-Sachs lesions and available computed tomographic scans were included in this study. Based on the computed...

Background: Downhill mountain biking (DMB) has become an increasingly popular extreme sport in the last few years with high velocities and bold manoeuvres. The goal of this study was to provide information on the pattern and causes of injuries in order to provide starting points for injury prevention measures. Methods: We performed a monthly e-m...

Background: MRI is the current pre-operative imaging standard in recurrent anterior shoulder instability; however, CT has increasingly gained interest due to its advantages in the detection of bony glenoid defects. This study compares the value of CT imaging and MRI for pre-operative surgical planning in recurrent anterior shoulder instability. M...

The purpose of the present study was to compare the intra- and interobserver reliability of two different measurement methods for volar angulation of the 5th metacarpal (MC) in an attempt to establish a new standard measurement method to reduce interobserver discrepancies for therapeutic decisions. Twenty patients with subcapital fractures of the 5...

The J-bone graft technique has previously been reported for anatomic restoration of the bony glenoid surface in cases of posttraumatic recurrent anterior shoulder instability with significant glenoid bone loss. To analyze the physiological remodeling process of the J-bone graft over time. Case series; Level of evidence, 4. Thirty-one consecutive pa...

Kite surfing and snow kiting are two of the newest and trendiest disciplines in outdoor sports and gained enormous popularity in recent years. It is estimated by experts and the industry that actually more than 500,000 people are practicing these extreme sports. Unfortunately, detailed demographic data about these popular sports are actually lackin...

To evaluate the long-term radiographic and clinical results of anterior cruciate ligament (ACL) reconstruction by comparing the injured knee with the contralateral knee in athletes with isolated ACL tear returning to preinjury sports. Twenty-eight patients with isolated ACL tears without concomitant injuries at baseline returning to previous sports...

PURPOSE: To evaluate the long-term radiographic and clinical results of anterior cruciate ligament (ACL) reconstruction by comparing the injured knee with the contralateral knee in athletes with isolated ACL tear returning to preinjury sports. METHODS: Twenty-eight patients with isolated ACL tears without concomitant injuries at baseline returning...

Anterior impression fractures of the humeral head (reverse Hill-Sachs lesions) are typical concomitant bony injuries of posterior shoulder dislocations. When more than 20% of the humeral articulating surface is affected, surgical treatment is required, typically necessitating open surgery. Recently, cases of successful arthroscopic treatment of sma...

The suture-bridge technique using anchors as established transosseous-equivalent technique in arthroscopic rotator cuff repair was compared to a modified transosseous technique suitable for arthroscopic cuff repair. In 10 fresh-frozen matched pairs of human cadaveric shoulders (mean age 67.1, SD 8.5 years), two different surgical techniques of cuff...

Snowkiting is becoming an increasingly popular extreme sport; however, its injury rates and patterns are unknown to date. The authors surveyed the injuries in a group of snowkiters over 1 season. Descriptive epidemiology study. The study was conducted over the course of 1 winter season ranging from November 2009 until March 2010; 80 snowkiters were...

Low back pain (LBP) is known to affect both older and younger adults. Medical schools tend to have time-consuming curricula, possibly perpetuating a sedentary lifestyle, and a high prevalence of LBP among medical students. The purpose of this study was to evaluate the extent of sedentary lifestyle and the 12-month prevalence of LBP in a sample grou...

The mechanical and electrical properties of polycaprolactone fumarate-polypyrrole (PCLF-PPy) scaffolds were studied under physiological conditions to evaluate their ability to maintain the material properties necessary for application as conductive nerve conduits. PC12 cells cultured on PCLF-PPy scaffolds were stimulated with regimens of 10 μA of e...

Low-dose acetylsalicylate acid (LDA) therapy is accepted as a major risk factor for intracranial hemorrhages (ICH) in head injuries. Coincidentally, patient admissions that might be indicated for in hospital observation of neurologic function causes increased health care costs. In the literature, there is no evidence concerning the incidence of sec...