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Schmaranzer F, Lerch TD, Steppacher SD, Siebenrock KA, Schmaranzer E, Tannast M. Femoral cartilage damage occurs at the zone of femoral head necrosis and can be accurately detected on traction MR arthrography of the hip in patients undergoing joint preserving hip surgery. J Hip Preserv Surg 2021; 8:28-39. [PMID: 34567598 PMCID: PMC8460158 DOI: 10.1093/jhps/hnab038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/12/2022] Open
Abstract
The primary purpose was to answer the following question: What is the location and pattern of necrosis and associated chondrolabral lesions and can they be accurately detected on traction MR arthrography compared with intra-operative findings in patients undergoing hip preservation surgery for femoral head necrosis (FHN)? Retrospective, diagnostic case series on 23 patients (23 hips; mean age 29 ± 6 years) with diagnosis of FHN undergoing open/arthroscopic joint preserving surgery for FHN and pre-operative traction MR arthrography of the hip. A MR-compatible device for weight-adapted application of leg traction (15-23 kg) was used and coronal, sagittal and radial images were acquired. Location and pattern of necrosis and chondrolabral lesions was assessed by two readers and compared with intra-operative findings to calculate diagnostic accuracy of traction MR arthrography. On MRI all 23 (100%) hips showed central FHN, most frequently antero-superiorly (22/23, 96%) where a high prevalence of femoral cartilage damage was detected (18/23, 78%), with delamination being the most common (16/23, 70%) damage pattern. Intra-operative inspection showed central femoral head cartilage damage most frequently located antero-superiorly (18/23, 78%) with femoral cartilage delamination being most common (14/23, 61%). Traction MR arthrography enabled detection of femoral cartilage damage with a sensitivity/specificity of 95%/75% for reader 1 and 89%/75% for reader 2. To conclude, femoral cartilage damage occurs at the zone of necrosis and can be accurately detected using traction MR arthrography of the hip which may be helpful for surgical decision making in young patients with FHN.
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Affiliation(s)
- F Schmaranzer
- Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital Bern, University of Bern, Freiburgstrasse 3010 Bern, Switzerland
| | - T D Lerch
- Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital Bern, University of Bern, Freiburgstrasse 3010 Bern, Switzerland
| | - S D Steppacher
- Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - K A Siebenrock
- Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - E Schmaranzer
- Department of Radiology, District Hospital St. Johann in Tirol, Freiburgstrasse, 6380 St. Johann in Tirol, Austria
| | - M Tannast
- Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Chemin des Pensionnats, 1752 Villars-sur-Glâne, Switzerland
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Lerch TD, Vuilleumier S, Schmaranzer F, Ziebarth K, Steppacher SD, Tannast M, Siebenrock KA. Patients with severe slipped capital femoral epiphysis treated by the modified Dunn procedure have low rates of avascular necrosis, good outcomes, and little osteoarthritis at long-term follow-up. Bone Joint J 2019; 101-B:403-414. [PMID: 30929481 DOI: 10.1302/0301-620x.101b4.bjj-2018-1303.r1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS The modified Dunn procedure has the potential to restore the anatomy in hips with severe slipped capital femoral epiphyses (SCFE). However, there is a risk of developing avascular necrosis of the femoral head (AVN). In this paper, we report on clinical outcome, radiological outcome, AVN rate and complications, and the cumulative survivorship at long-term follow-up in patients undergoing the modified Dunn procedure for severe SCFE. PATIENTS AND METHODS We performed a retrospective analysis involving 46 hips in 46 patients treated with a modified Dunn procedure for severe SCFE (slip angle > 60°) between 1999 and 2016. At nine-year-follow-up, 40 hips were available for clinical and radiological examination. Mean preoperative age was 13 years, and 14 hips (30%) presented with unstable slips. Mean preoperative slip angle was 64°. Kaplan-Meier survivorship was calculated. RESULTS At the latest follow-up, the mean Merle d'Aubigné and Postel score was 17 points (14 to 18), mean modified Harris Hip Score was 94 points (66 to 100), and mean Hip Disability and Osteoarthritis Outcome Score was 91 points (67 to 100). Postoperative slip angle was 7° (1° to 16°). One hip (2%) had progression of osteoarthritis (OA). Two hips (5%) developed AVN of the femoral head and required further surgery. Three other hips (7%) underwent implant revision due to screw breakage or change of wires. Cumulative survivorship was 86% at ten-year follow-up. CONCLUSION The modified Dunn procedure for severe SCFE resulted in a low rate of AVN, low risk of progression to OA, and high functional scores at long-term follow-up. The slip deformities were mainly corrected but secondary impingement deformities can develop in some hips and may require further surgical treatment. Cite this article: Bone Joint J 2019;101-B:403-414.
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Affiliation(s)
- T D Lerch
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - S Vuilleumier
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - F Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - K Ziebarth
- Department of Paediatric Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - S D Steppacher
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - M Tannast
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - K A Siebenrock
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, Switzerland
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Schmaranzer F, Arendt L, Lerch TD, Steppacher SD, Nuss K, Wolfer N, Dawson HE, von Rechenberg B, Kircher PR, Tannast M. Femoral osteochondroplasty can be performed effectively without the risk of avascular necrosis or femoral neck fractures in an experimental ovine FAI model. Osteoarthritis Cartilage 2018; 26:128-137. [PMID: 29061495 DOI: 10.1016/j.joca.2017.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/05/2017] [Accepted: 10/10/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The experimental induction of cam-type femoroacetabular impingement (FAI) in sheep is established. To tap the full potential of this ovine model, one should be able to perform a femoral osteochondroplasty safely. This study was based on previous cadaver experiments on the blood supply to the ovine femoral head and on the biomechanical strength of the proximal femur following offset creation. We hypothesized that offset creation in this ovine FAI model does not lead to (1) avascular necrosis (AVN) of the ovine femoral head or (2) iatrogenic femoral neck fractures and (3) can be performed effectively. DESIGN In this experimental, controlled, prospective study nine sheep underwent unilateral FAI induction through an intertrochanteric, varus osteotomy. Seventy days following FAI induction, femoral osteochondroplasty was performed. Sheep were sacrificed after another 140 days. Radiographs, computed tomography (CT) scans and MRI were acquired. Histologic samples were stained with hematoxylin-eosin. (1) The multimodal Association Research Circulation Osseous (ARCO) classification was used for assessment of AVN. (2) Femoral neck fractures were assessed with the multimodal imaging approach. (3) Pre- and postoperative (=after sacrifice) alpha angles and femoral neck diameters were compared. RESULTS (1) No signs for AVN according to the ARCO classification or (2) for femoral neck fractures were detected. (3) Mean alpha angles and femoral neck diameters decreased significantly (p < 0.001) superiorly by at least 30° respectively 4 mm after the offset creation. CONCLUSIONS Femoral osteochondroplasty can be performed effectively and without the risk of AVN or femoral neck fractures in this ovine FAI model.
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Affiliation(s)
- F Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - L Arendt
- Musculoskeletal Research Unit (MSRU), Equine Hospital, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - T D Lerch
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S D Steppacher
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - K Nuss
- Musculoskeletal Research Unit (MSRU), Equine Hospital, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - N Wolfer
- Musculoskeletal Research Unit (MSRU), Equine Hospital, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - H E Dawson
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - B von Rechenberg
- Musculoskeletal Research Unit (MSRU), Equine Hospital, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - P R Kircher
- Department of Small Animals, Division of Diagnostic Imaging, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - M Tannast
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Musculoskeletal Research Unit (MSRU), Equine Hospital, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
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Lerch TD, Steppacher SD, Liechti EF, Siebenrock KA, Tannast M. [Bernese periacetabular osteotomy. : Indications, technique and results 30 years after the first description]. Orthopade 2017; 45:687-94. [PMID: 27250618 DOI: 10.1007/s00132-016-3265-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The Bernese periacetabular osteotomy (PAO) is a surgical technique for the treatment of (1) hip dysplasia and (2) femoroacetabular impingement due to acetabular retroversion. The aim of the surgery is to prevent secondary osteoarthritis by improvement of the hip biomechanics. In contrast to other pelvic osteotomies, the posterior column remains intact with this technique. This improves the inherent stability of the acetabular fragment and thereby facilitates postoperative rehabilitation. The birth canal remains unchanged. Through a shortened ilioinguinal incision, four osteotomies and one controlled fracture around the acetabulum are performed. The direction of acetabular reorientation differs for both indications while the sequence of the osteotomies remains the same. This surgical approach allows for a concomitant osteochondroplasty in the case of an aspherical femoral head-neck junction. The complication rate is relatively low despite the complexity of the procedure. The key point for a successful long term outcome is an optimal reorientation of the acetabulum for both indications. With an optimal reorientation and a spherical femoral head, the cumulative survivorship of the hip after 10 years is 80-90 %. For the very first 75 patients, the cumulative 20-year survivorship was 60 %. The preliminary evaluation of the same series at a 30-year follow-up still showed a survivorship of approximately 30 %. The PAO has become the standard procedure for the surgical therapy of hip dysplasia in adolescents and adults.
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Affiliation(s)
- T D Lerch
- Klinik und Poliklinik für Orthopädische Chirurgie, Inselspital, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz
| | - S D Steppacher
- Klinik und Poliklinik für Orthopädische Chirurgie, Inselspital, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz
| | - E F Liechti
- Klinik und Poliklinik für Orthopädische Chirurgie, Inselspital, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz
| | - K A Siebenrock
- Klinik und Poliklinik für Orthopädische Chirurgie, Inselspital, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz
| | - M Tannast
- Klinik und Poliklinik für Orthopädische Chirurgie, Inselspital, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz.
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Steppacher SD, Lerch TD, Gharanizadeh K, Liechti EF, Werlen SF, Puls M, Tannast M, Siebenrock KA. Size and shape of the lunate surface in different types of pincer impingement: theoretical implications for surgical therapy. Osteoarthritis Cartilage 2014; 22:951-8. [PMID: 24857978 DOI: 10.1016/j.joca.2014.05.010] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 04/25/2014] [Accepted: 05/07/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Acetabular rim trimming is indicated in pincer hips with an oversized lunate surface but could result in a critically decreased size of the lunate surface in pincer hips with acetabular malorientation. There is a lack of detailed three-dimensional anatomy of lunate surface in pincer hips. Therefore, we questioned how does (1) size and (2) shape of the lunate surface differ among hips with different types of pincer impingement? METHOD We retrospectively compared size and shape of the lunate surface between acetabular retroversion (48 hips), deep acetabulum (34 hips), protrusio acetabuli (seven hips), normal acetabuli (30 hips), and hip dysplasia (45 hips). Using magnetic resonance imaging (MRI) arthrography with radial slices we measured size in percentage of the femoral head coverage and shape using the outer (inner) center-edge angles and width of lunate surface. RESULTS Hips with retroversion had a decreased size and deep hips had normal size of the lunate surface. Both had a normal shape of the outer acetabular rim. Protrusio hips had an increased size and a prominent outer acetabular rim. In all three types of pincer hips the acetabular fossa was increased. CONCLUSION Size and shape of the lunate surface differs substantially among different types of pincer impingement. In contrast to hips with protrusio acetabuli, retroverted and deep hips do not have an increased size of the lunate surface. Acetabular rim trimming in retroverted and deep hips should be performed with caution. Based on our results, acetabular reorientation would theoretically be the treatment of choice in retroverted hips.
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Affiliation(s)
- S D Steppacher
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Bern, Switzerland.
| | - T D Lerch
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Bern, Switzerland.
| | - K Gharanizadeh
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Bern, Switzerland.
| | - E F Liechti
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Bern, Switzerland.
| | - S F Werlen
- Department of Radiology, Sonnenhof Clinic, Bern, Switzerland.
| | - M Puls
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Bern, Switzerland.
| | - M Tannast
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Bern, Switzerland.
| | - K A Siebenrock
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Bern, Switzerland.
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Zheng G, von Recum J, Nolte LP, Grützner PA, Steppacher SD, Franke J. Validation of a statistical shape model-based 2D/3D reconstruction method for determination of cup orientation after THA. Int J Comput Assist Radiol Surg 2011; 7:225-31. [DOI: 10.1007/s11548-011-0644-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 07/04/2011] [Indexed: 10/18/2022]
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Babst D, Steppacher SD, Ganz R, Siebenrock KA, Tannast M. The iliocapsularis muscle: an important stabilizer in the dysplastic hip. Clin Orthop Relat Res 2011; 469:1728-34. [PMID: 21128036 PMCID: PMC3094621 DOI: 10.1007/s11999-010-1705-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 11/15/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND The iliocapsularis muscle is a little known muscle overlying the anterior hip capsule postulated to function as a stabilizer of dysplastic hips. Theoretically, this muscle would be hypertrophied in dysplastic hips and, conversely, atrophied in stable and well-constrained hips. However, these observations have not been confirmed and the true function of this muscle remains unknown. QUESTIONS/PURPOSES We quantified the anatomic dimensions and degree of fatty infiltration of the iliocapsularis muscle and compared the results for 45 hips with deficient acetabular coverage (Group I) with 40 hips with excessive acetabular coverage (Group II). PATIENTS AND METHODS We used MR arthrography to evaluate anatomic dimensions (thickness, width, circumference, cross-sectional area [CSA], and partial volume) and the amount of fatty infiltration. RESULTS We observed increased thickness, width, circumference, CSA, and partial volume of the iliocapsularis muscle in Group I when compared with Group II. Additionally, hips in Group I had a lower prevalence of fatty infiltration compared with those in Group II. The iliocapsularis muscle typically was hypertrophied, and there was less fatty infiltration in dysplastic hips compared with hips with excessive acetabular coverage. CONCLUSION These observations suggest the iliocapsularis muscle is important for stabilizing the femoral head in a deficient acetabulum. This muscle serves as an anatomic landmark when performing a periacetabular osteotomy. Additionally, preoperative evaluation of morphologic features of the muscle can be used as an adjunct for decision making when treating patients with borderline hip dysplasia or femoroacetabular impingement.
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Affiliation(s)
- D. Babst
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Murtenstrasse, 3010 Bern, Switzerland
| | - S. D. Steppacher
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Murtenstrasse, 3010 Bern, Switzerland
| | - R. Ganz
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Murtenstrasse, 3010 Bern, Switzerland
| | - K. A. Siebenrock
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Murtenstrasse, 3010 Bern, Switzerland
| | - M. Tannast
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Murtenstrasse, 3010 Bern, Switzerland
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Affiliation(s)
- T M Ecker
- New England Baptist Hospital, Tufts University School of Medicine, Ste 545, 125 Parker Hill Ave, Boston, MA 02120, USA
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Affiliation(s)
- S D Steppacher
- New England Baptist Hospital, Tufts University School of Medicine, Boston, Massachusetts, USA
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Steppacher SD, Tannast M, Werlen S, Siebenrock KA. Femoral morphology differs between deficient and excessive acetabular coverage. Clin Orthop Relat Res 2008; 466:782-90. [PMID: 18288550 PMCID: PMC2504673 DOI: 10.1007/s11999-008-0141-7] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Accepted: 01/17/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Structural deformities of the femoral head occurring during skeletal development (eg, Legg-Calvé-Perthes disease) are associated with individual shapes of the acetabulum but it is unclear whether differences in acetabular shape are associated with differences in proximal femoral shape. We questioned whether the amount of acetabular coverage influences femoral morphology. We retrospectively compared the proximal femoral anatomy of 50 selected patients (50 hips) with developmental dysplasia of the hip (lateral center-edge angle [LCE] < or = 25 degrees ; acetabular index > or = 14 degrees ) with 45 selected patients (50 hips) with a deep acetabulum (LCE > or = 39 degrees ). Using MRI arthrography we measured head sphericity, epiphyseal shape, epiphyseal extension, and femoral head-neck offset. A deep acetabulum was associated with a more spherical head shape, increased epiphyseal height with a pronounced extension of the epiphysis towards the femoral neck, and an increased offset. In contrast, dysplastic hips showed an elliptical femoral head, decreased epiphyseal height with a less pronounced extension of the epiphysis, and decreased head-neck offset. Hips with different acetabular coverage are associated with different proximal femoral anatomy. A nonspherical head in dysplastic hips could lead to joint incongruity after an acetabular reorientation procedure. LEVEL OF EVIDENCE Level IV, retrospective comparative study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- S. D. Steppacher
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Murtenstrasse, 3010 Bern, Switzerland
| | - M. Tannast
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Murtenstrasse, 3010 Bern, Switzerland
| | - S. Werlen
- Department of Radiology, Sonnenhof Clinic, Bern, Switzerland
| | - K. A. Siebenrock
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Murtenstrasse, 3010 Bern, Switzerland
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