Philip Kasten

Carl Gustav Carus-Institut, Pforzheim, Baden-Württemberg, Germany

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Publications (138)253.02 Total impact

  • Jörg Nowotny · C. Kopkow · F. Mauch · P. Kasten
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    ABSTRACT: For a balanced scapulohumeral rhythm in arm elevation, it is necessary to have an optimal position, motion, stability and muscle performance of the scapula and scapular muscles. In the case of abnormal movements, so-called scapular dyskinesis, the tendons (e.g. biceps tendon, rotator cuff) can be irritated and may cause pain in overhead activity. There are various causes for scapular dyskinesis and, therefore, the treatment is a challenge for therapists. The aim of conservative treatment is to restore normal position and movement of the scapula and furthermore dynamic scapular stability during overhead activities. Rehabilitation based on effective exercises should be tailored individually and the complexity of the exercises should be increased slowly.
    No preview · Article · Jan 2016 · Obere Extremität
  • Julian Dexel · Philip Kasten
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    ABSTRACT: Die Epicondylitis humeri radialis („Tennisellenbogen“) und ulnaris („Golferellenbogen“) sind schmerzhafte Erkrankungen des Sehnenansatzgewebes der Extensoren- bzw. Flexorengruppe, die ätiologisch auf eine berufliche oder sportliche Überbelastung der Muskelgruppen zurückgehen. Pathomorphologisch findet sich ein verändertes Gewebe im Ansatzbereich der Muskeln. Der Muskel-Sehnenansatz kann auch partiell oder komplett gerissen sein. Die konservative Therapie stellt den Kernbereich der Behandlung mit Basismaßnahmen (auslösende Noxe erkennen und meiden, NSAR, Handgelenksorthese, Physiotherapie mit exzentrischem Dehnen) dar, die mit neueren Verfahren wie die Applikation von PRP (Plättchen-reichem-Plasma), extrakorporelle Stoßwellentherapie oder die Injektion von Botulinumtoxin ergänzt werden können. Nach frustraner konservativer Behandlung können offene oder arthroskopische operative Maßnahmen zur Anwendung kommen.
    No preview · Article · Jan 2016
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    ABSTRACT: Purpose: Tissue regeneration can be improved by local application of autologous bone marrow derived progenitor cells (BMSC) and platelet rich plasma (PRP). However, there is a lack of standardized application procedures for clinical use. Therefore, a technique in accordance with the guidelines for advanced therapies medical products of the European Medicine Agency was developed and established. Methods: In detail, a process for the isolation and formulation of autologous bone marrow cells (BMC) and PRP in a clinical setting was validated. To investigate the influence of storage time and temperature on gel formation and gel stability, different concentrations of BMC were stored with and without additional platelets, thrombin and fibrinogen and analyzed over a period of 28 days. In addition, cell vitality using a live-dead staining and migration ability of human mesenchymal stem cells (hMSC) in the gel clot was investigated. Results: For an optimized stable gel clot, human BMC and PRP should be combined with 10% to 20% fibrinogen (9 mg/mL to 18 mg/mL) and 5% to 20% thrombin (25 I.E. to 100 I.E.). Both freshly prepared and stored cells for 1 to 7 days had a stable consistence over 28 days at 37°C. Different platelet concentrations did not influence gel clot formation. The ratio of living cells did not decrease significantly over the observation period of 5 days in the live-dead staining. Conclusions: The study identified an optimal gel texture for local application of BMC and PRP. Seeded hMSC could migrate therein and were able to survive to initiate a healing cascade.
    No preview · Article · Dec 2015 · Journal of Applied Biomaterials and Fundamental Materials
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    ABSTRACT: Background: Total shoulder arthroplasty has been shown to improve function and to reduce pain in cases of osteoarthritis. To assess loosening of the glenoid component, serial evaluation of frontal plane radiographs of the scapula has been established as the "gold standard." The aim of this study was to evaluate the reliability of different bone landmarks when the scapula is tilted compared with the ideal view. Methods: Glenoid components were implanted into 6 human cadaveric scapulae. Radiographs were taken exactly anterior-posterior in the frontal plane as well as craniocaudal tilted (±15° and ±30°) and mediolateral tilted (±10° and ±20°). The following landmarks were evaluated: lateral margin of the scapula, medial margin of the scapula, floor of the fossa supraspinatus line, spine of the scapula line, glenoid fossa line, and coracoid base line. Results: In evaluating the inclination of the glenoid component, the medial margin of the scapula had the best intraobserver and interobserver reliability with a variance for each of 2° ± 1° (P < .0001), whereas the lateral margin of the scapula had an acceptable intraobserver and interobserver reliability with a variance of 4° ± 1° and 3° ± 1°. In measuring medial migration, the glenoid fossa line had a significantly lower intraobserver and interobserver reliability than the coracoid base line (each 1 ± 0 mm vs. 3 ± 1 mm and 3 ± 2 mm; P < .0001). Conclusion: To assess the inclination of the glenoid component, the medial margin of the scapula has proven best, and the lateral margin of the scapula has acceptable reliability. For measuring medial migration, the coracoid base line has proven acceptable reliability, whereas the glenoid fossa line would be subject to change when osteolysis occurs at the glenoid.
    Full-text · Article · Dec 2015 · Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]
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    ABSTRACT: It has been demonstrated that physical exercise benefits younger patients undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT). We designed a prospective pilot study investigating whether elderly patients (>60 years) would also be able to participate in such a programme. It consisted of physiotherapist-supervised alternating endurance and resistance workouts on 6 of 7 days a week. Sixteen consecutive patients undergoing allo-HSCT were enrolled into the study. The median age was 64.5 years. Twelve patients participated in the programme until the time of discharge (75%) from the transplant unit. Therefore, the predefined criteria regarding feasibility were met. The reason for drop out was transplantation associated mortality in all patients (n = 4). Adherence was very good with a median of 85% attended training sessions. No adverse events were recorded. The endurance capacity dropped by 7% and lower extremity strength improved by 2% over time. Quality of life decreased during the study period, with global health being significantly worse at the time of discharge. In conclusion, a combined and intensified strength and endurance exercise programme is feasible and safe in a population of elderly patients undergoing allo-HSCT. Further research should focus on exploring effect sizes of such an intervention by conducting randomised controlled trials.
    No preview · Article · Nov 2015 · European Journal of Cancer Care
  • Christian Kopkow · Julian Dexel · Philip kasten

    No preview · Article · Sep 2015
  • P. Kasten · S. Zwingenberger · J. Nowotny · M. Maier
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    ABSTRACT: Die Verwendung eines zementierten Glenoids beim Schultergelenkersatz hat im Gegensatz zur zementfreien Versorgung entsprechend der aktuellen Datenlage die längeren Überlebensraten. Deshalb wird das zementierte Glenoid als der Goldstandard betrachtet. Ob Polyethylenpfannen mit einem Kiel oder Zapfen überlegen sind, kann aufgrund mangelnder Langzeitergebnisse von Stiftglenoiden nicht abschließend entschieden werden: beide haben gute kurz- und mittelfristige Überlebensraten, für das Kielglenoid existieren auch Langzeitergebnisse (> 15 Jahre). Entscheidend für das Langzeitüberleben sind die korrekte Platzierung der Pfanne unter Vermeidung einer zu starken Retroversion und der Erhalt der Knochensubstanz. Weitere Faktoren sind eine sorgfältige Zementiertechnik, um einen Zementmantel von 1,0–1,5 mm Dicke ohne Zementdefekte zu erreichen. Eine standardisierte Zementiertechnik unter Verwendung einer Jetlavage und eines Zementverdichters kann das Zementierergebnis vereinheitlichen und dieses Ziel zuverlässiger erreichen. Abstract Long-term studies support the use of cemented glenoids in the treatment of osteoarthritis of the shoulder in total shoulder arthroplasty. Therefore, the cemented glenoid currently is referred to as the gold standard. Both keeled and pegged glenoids have good midterm outcome, whereby keeled glenoids also have long-term results (> 15 years). Exact placement of the glenoid component and a careful cementation technique are cruciate for good long-term survival. Reaming of the glenoid should avoid retroversion and removing too much bone. Cementation should result in a cement mantle of 1–1.5 mm thickness without cement defects. This can be achieved by good surgical exposure and with a standardized cementation technique using, e.g., jet lavage and a cement pressurizer.
    No preview · Article · May 2015 · Obere Extremität
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    ABSTRACT: Failed shoulder arthroplasty and failed internal fixation in fractures of the proximal humerus can benefit from implantation of a reverse total shoulder arthroplasty (RSA). While there is some evidence that RSA can improve function regarding range of motion (ROM), pain, satisfaction, and strength, there is sparse data how this translates into activities of daily living (ADLs). A marker-based 3D video motion analysis system has recently been designed that can measure changes of ROM in dynamic movements in every plane. The hypothesis was that a gain of maximum ROM also translates into the ability to perform ADLs and into a significant increase of ROM in ADLs.
    No preview · Article · Apr 2015 · Revue de Chirurgie Orthopédique et Traumatologique
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    Christian Kopkow · Toni Lange · Jochen Schmitt · Philip Kasten
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    ABSTRACT: Prospective, blinded interrater reliability study. To determine the interrater reliability of the modified Scapular Assistance Test (mSAT) with and without the use of additional handheld weights. 110 Shoulder patients with various shoulder pathologies were consecutively recruited. Tests were performed independently and randomly on each participant by 2 different examiners, which were blinded to further clinical information (e.g. patient history, former diagnostic results). Percent agreement, Cohen's kappa (Κ), proportion of positive/negative agreement, maximum Κ, prevalence and bias indexes and prevalence-adjusted-bias-adjusted kappa (PABAK) were calculated as estimates of interrater reliability of the mSAT with and without additional handheld weights. Weights were chosen according to body weight. The reliability measures for the mSAT (Cohen's Κ: 0.68, confidence interval (CI): 0.51-0.85; PABAK: 0.78, CI: 0.67-0.90) as well as for the mSAT with handheld weights (Cohen's Κ: 0.63, CI: 0.44-0.81; PABAK: 0.76, CI: 0.64-0.88) showed substantial agreement according to the classification system proposed by Landis and Koch. Based on the results of this study, the mSAT with and without additional weights can be considered as reliable for clinical use. Since both tests showed substantial agreement, the use of additional handheld weights might not be necessary in case of obvious scapula dyskinesis. However, to perform the mSAT with/without additional weights should depend not only on its reliability values. Name of the public trials registry and the registration number: German Clinical Trials Register, protocol number DRKS00005377. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Apr 2015 · Manual therapy
  • J. Nowotny · P. Kasten

    No preview · Article · Feb 2015 · Orthopädie und Unfallchirurgie up2date
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    ABSTRACT: Background: Failed shoulder arthroplasty and failed internal fixation in fractures of the proximal humerus can benefit from implantation of a reverse total shoulder arthroplasty (RSA). While there is some evidence that RSA can improve function regarding range of motion (ROM), pain, satisfaction, and strength, there is sparse data how this translates into activities of daily living (ADLs). A marker-based 3D video motion analysis system has recently been designed that can measure changes of ROM in dynamic movements in every plane. The hypothesis was that a gain of maximum ROM also translates into the ability to perform ADLs and into a significant increase of ROM in ADLs. Materials and methods: Six consecutive patients (5 women, 1 man; 2× failed arthroplasty, 4× failed open reduction and internal fixation) who received RSA were examined the day before and 1 year after shoulder replacement. A 3D motion analysis system using a novel upper extremity model measured active maximum values and ROM in four ADLs. Results: Comparing the pre- to the 1-year postoperative status, RSA resulted in a significant increase in mean maximum values for active flexion (humerus to thorax) of 37° (S.D. ±23°), from 50 to 87° [P=0.005], and for active abduction averaging of 17° (S.D. ±13°), from 52 to 69° [P=0.027]. The extension decreased significantly by about 8° (S.D. ±16°), from a mean of 39 to 31° [P=0.009]. For active adduction and internal and external rotation, there were trends for improvements, but no significant changes. Only three additional tasks of the ADL (out of 13/24 preoperatively) could be performed after revision surgery. Comparing the preoperative to the postoperative ROM in the ADLs in flexion/extension, ROM improved significantly in one ("tying an apron") of four ADLs. There were no significant changes in the abduction/adduction and internal/external rotation in any ADLs. Conclusion: RSA in revision cases significantly improved maximum active flexion and abduction, but decreased extension in this series. However, the patients were only able to use this greater ROM to their benefit in one of four ADLs.
    No preview · Article · Feb 2015 · Orthopaedics & Traumatology Surgery & Research
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    ABSTRACT: Background Total shoulder arthroplasty (TSA) can improve function in osteoarthritic shoulders, but the ability to perform activities of daily living (ADLs) can still remain impaired. Routinely, shoulder surgeons measure range of motion (ROM) using a goniometer. Objective data are limited, however, concerning functional three-dimensional changes in ROM in ADLs after TSA in patients with degenerative glenohumeral osteoarthritis. Methods This study included ten consecutive patients, who received TSA for primary glenohumeral osteoarthritis. The patients were examined the day before, 6 months, and 3 years after shoulder replacement as well. We compared them with a control group (n = 10) without any shoulder pathology and measured shoulder movement by 3D motion analysis using a novel 3 D model. The measurement included static maximum values, the ability to perform and the ROM of the ADLs “combing the hair”, “washing the opposite armpit”, “tying an apron”, and “taking a book from a shelf”. Results Six months after surgery, almost all TSA patients were able to perform the four ADLs (3 out of 40 tasks could not be performed by the 10 patients); 3 years postoperatively all patients were able to carry out all ADLs (40 out of 40 tasks possible). In performing the ADLs, comparison of the pre- with the 6-month and 3-year postoperative status of the TSA group showed that the subjects did not fully use the available maximum flexion/extension ROM in performing the four ADLs. The ROM used for flexion/extension did not change significantly (preoperatively 135°-0° -34° vs. 3 years postoperatively 131° -0° -53°). For abduction/adduction, ROM improved significantly from 33°-0° -27° preoperatively to 76° -0° -35° postoperatively. Compared to the controls (118°) the TSA group used less ROM for abduction to perform the four ADLs 3 years postoperatively. Conclusion TSA improves the ability to perform ADL and the individual ROM in ADLs in patients with degenerative glenohumeral osteoarthritis over the course of 3 years. However, TSA patients do not use their maximum available abduction ROM in performing ADLs. This is not related to limitations in active ROM, but rather may be caused by pathologic motion patterns, impaired proprioception or both.
    Full-text · Article · Jul 2014 · BMC Musculoskeletal Disorders
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    ABSTRACT: Background: Reverse total shoulder arthroplasty (RSA) can improve function in cuff tear arthropathy (CTA) shoulders, but limited exact data are available about the maximum values in 3D motion analysis, and as to how improvements translate into the normal range of motion (ROM) in activities of daily living (ADLs). Methods: This study included nine consecutive patients (n = 9) who received RSA for CTA without muscle transfers. We measured shoulder movement by a novel 3D motion analysis using the Heidelberg upper extremity model (HUX) which can eliminate compensatory movements of the scapula, and the trunk. The measurement included active maximum values, and four ADLs. Results: Comparing the pre- to the 1-year postoperative status, RSA was associated with a significant increase in the mean maximum values for active flexion of about 43° (SD ± 31) from 66° to 109° (p = 0.001), for active abduction of about 37° (SD ± 26) from 57° to 94° (p = 0.001), and for the active adduction of about 28° (SD ± 10) from 5° to 33° (p = 0.002). Comparing the preoperative to the postoperative ROM in the ADLs in flexion/extension, ROM improved significantly in all ADLs, in abduction/adduction in three of four ADLs. No significant changes were observed in internal/external rotation in any ADLs. Conclusion: RSA improves the active maximum ROM for flexion, abduction, and adduction. The patients are able to take advantage of this ROM increase in ADLs in flexion and in most ADL in abduction, but only in trend in internal and external rotation.
    No preview · Article · Jun 2014 · Archives of Orthopaedic and Trauma Surgery
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    ABSTRACT: The study aimed to investigate the prognosis of osteochondral affection (e. g., osteochondritis dissecans (OCD), cartilage lesions, fractures and bone edema in the elbows of high-performance gymnasts (n=30) compared to prognosis results with athletes not undergoing excessive stress on the upper extremity (n=29). The study also tested a novel isotropic 3D-FSE-sequence (CUBE) technique as an early diagnostic modality. Standard protocol was used to conduct the MRI examinations, which were then compared to results from the CUBE - sequence. The gymnast group (p=0.012) presented a significantly higher prevalence of complaints in the elbow joint compared to the other athlete group. Furthermore, osteochondral lesions in MRIs appeared more frequently in the group of gymnasts (n=10, 33%, p=0.033), including 7 cases (23%) of OCD. In the control athlete group 2 asymptomatic cases of OCD and one case of bone edema were detected. The MRI investigation with the CUBE - sequence showed similar results as the standard MRI protocol in terms of the diagnosis sensitivity. The current study indicates that juvenile gymnasts are at a higher risk for osteochondral lesions of the elbow than athletes without excessive stress on the upper extremities.
    No preview · Article · May 2014 · International Journal of Sports Medicine
  • J Dexel · C Kopkow · P Kasten
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    ABSTRACT: A key element for movement of the arm is the position and motion of the scapula. A stable basis for efficient arm function is only possible if the scapula makes three dimensional movements coordinated with the upper arm. This article presents a discussion of causes, diagnosis and therapy options for scapular dyskinesis. The article is based on a literature search in the PubMed database and taking own experience into account. Soft tissue and bony injuries, muscle insufficiency and dysbalance can alter the position and function of the scapula. This pathological position and motion is called scapular dyskinesis. This clinically presents as a prominent medial border and malrotation (lacking external rotation and posterior tilt) of the scapula when raising the arm. The clinical examination includes a visual inspection followed by clinical tests of the scapula at rest and during movement. Specific exercises of the musculature surrounding the scapula and specific techniques for schooling the senses for positioning and movement can harmonize the sequence of movements and restore the dynamic scapular stability. A conservative stepwise and stage-adapted exercise program can be used to treat scapular dyskinesis with good results.
    No preview · Article · Mar 2014 · Der Orthopäde
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    J. Dexel · C. Kopkow · P. Kasten
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    ABSTRACT: Background A key element for movement of the arm is the position and motion of the scapula. A stable basis for efficient arm function is only possible if the scapula makes three dimensional movements coordinated with the upper arm. Aim This article presents a discussion of causes, diagnosis and therapy options for scapular dyskinesis. Material and methods The article is based on a literature search in the PubMed database and taking own experience into account. Results Soft tissue and bony injuries, muscle insufficiency and dysbalance can alter the position and function of the scapula. This pathological position and motion is called scapular dyskinesis. This clinically presents as a prominent medial border and malrotation (lacking external rotation and posterior tilt) of the scapula when raising the arm. The clinical examination includes a visual inspection followed by clinical tests of the scapula at rest and during movement. Specific exercises of the musculature surrounding the scapula and specific techniques for schooling the senses for positioning and movement can harmonize the sequence of movements and restore the dynamic scapular stability. Conclusion A conservative stepwise and stage-adapted exercise program can be used to treat scapular dyskinesis with good results.
    Full-text · Article · Mar 2014 · Der Orthopäde
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    ABSTRACT: Low back pain (LBP) is a common symptom in the populations of western countries, and adolescent athletes seem to be prone to LBP. The main objective of this study was to analyze the point (LBP within the last 48 h), 1-year (LBP within the last 12 months) and lifetime (LBP within the entire life) prevalence rates of LBP in adolescent athletes participating in various sports. We also assessed the characteristics of LBP and its association with potential risk factors. To this end, 272 competitive adolescent athletes involved in 31 different sports (158 males, 113 females, 15.4±2.0 years, body mass index [BMI] 20.3±2.4 kg/m2) were enrolled in a 10-month prospective clinical trial that included a questionnaire and physical examination. We found a point prevalence of 14%, a 1-year prevalence of 57%, and a lifetime prevalence of 66% for LBP. The mean age of first appearance of LBP was 13.1±2.0 years. The lifetime prevalence was significantly higher in volleyball than in biathletes (74.3 vs. 45.7%, p=0.015). Our findings confirm that LBP is a common symptom in adolescent athletes; LBP prevalence correlates with sports participation and individual competitive level. Adolescent athletes with LBP should receive a thorough diagnostic work-up and adapt training and technique correspondingly when indicated.
    No preview · Article · Jan 2014 · International Journal of Sports Medicine
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    ABSTRACT: Die autologe Chondrozytentransplantation (ACT) hat sich seit ihrer Einführung in den klinischen Alltag zu einem Standardverfahren zur Behandlung von großen umschriebenen Knorpeldefekten im Kniegelenk etabliert. Trotz der zunehmenden Ausweitung des Verfahrens bestehen noch viele Fragen hinsichtlich der optimalen postoperativen Therapie. Ziel unserer Untersuchung war eine Bestandserhebung der Nachbehandlung bei den Mitgliedern der AG Klinische Geweberegeneration und basierend auf den Ergebnissen die Erstellung einer Empfehlung auf der Basis einer Expertenmeinung (Level IVb nach EBM).Alle Mitglieder der AG Klinische Geweberegeneration wurden anhand eines standardisierten Fragebogens zu Nachbehandlungsschemata, Nachsorgeuntersuchungen und Empfehlungen zur Wiederaufnahme der sportlichen Betätigung nach ACT am Kniegelenk befragt.Keiner der Befragten wendete die konventionelle ACT mit der Periostlappenplastik an, alle verwenden zellbesiedelte Matrices (MACT). 94% der Befragten wenden in Abhängigkeit von der Lage des Defekts (femoral vs. patellar) spezifische Belastungs- und Bewegungseinschränkungen an. Die breiteste Übereinstimmung fand sich bei der Entlastung für durchschnittlich 6 Wochen nach femoraler MACT (78%). Hinsichtlich der Behandlung nach patellarer MACT variierten die Angaben zum Belastungsaufbau und der Bewegungslimitierung am stärksten. Regelmäßige postoperative MRT-Kontrollen werden durchgeführt, jedoch waren auch diese in Bezug auf Zeitpunkt und angewendete MRT-Sequenz starken Variationen unterworfen. Routinemäßige Second-look-Arthroskopien werden nicht durchgeführt. Circa 75% der Operateure empfehlen ihren Patienten eine Sportkarenz für 6–12 Monate nach MACT. Am häufigsten werden knieschonende Sportarten wie Radfahren (94%), Schwimmen (83%) oder Nordic Walking (44%) empfohlen.Klare Nachbehandlungsschemata existieren bisher nicht, obgleich eine Übereinstimmung zu elementaren Fragen wie der lokalisationsabhängigen differenzierten Bewegungseinschränkung und Belastung besteht. Die Magnetresonanztomographie (MRT) besitzt eine zentrale Rolle bei der routinemäßigen Nachkontrolle, aber auch hier liegen erheblich Unterschiede bei der Durchführung vor. Es bedarf einer weiteren Verbesserung der Empfehlungen zur Nachbehandlung nach MACT am Kniegelenk, um einen Standard zu entwickeln, der den behandelnden Ärzten Sicherheit gibt und einen besseren Vergleich der Ergebnisse nach MACHT zwischen verschiedenen Patientengruppen ermöglicht.
    Full-text · Article · Jan 2014 · Der Unfallchirurg
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  • No preview · Article · Nov 2013 · Gait & Posture

Publication Stats

2k Citations
253.02 Total Impact Points

Institutions

  • 2010-2015
    • Carl Gustav Carus-Institut
      Pforzheim, Baden-Württemberg, Germany
  • 2009-2014
    • Technische Universität Dresden
      • Institute of Chemistry and Laboratory Medicine
      Dresden, Saxony, Germany
  • 2013
    • Universitätsklinikum Dresden
      • Klinik und Poliklinik für Unfall- und Wiederherstellungschirurgie
      Dresden, Saxony, Germany
  • 2002-2012
    • Universität Heidelberg
      Heidelburg, Baden-Württemberg, Germany
    • Hannover Medical School
      • Trauma Department
      Hannover, Lower Saxony, Germany
  • 2005-2010
    • Universitätsklinikum Freiburg
      • Department of Orthopedics and Traumatology
      Freiburg an der Elbe, Lower Saxony, Germany
  • 2004-2009
    • Orthopädische Universitätsklinik Friedrichsheim
      Frankfurt, Hesse, Germany
  • 2006
    • University of Freiburg
      • Department of Orthopedics and Traumatology
      Freiburg, Baden-Württemberg, Germany