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PubMed1979

Replacement of the trapezium for arthritis of the basal articulations: a new technique with stabilization by tenodesis.

Forty-six patients (fifty hands) had replacement of the trapezium by a silicone implant that incorporated a local tendon strip to stabilize the device. The patients had intractable pain due to degenerative changes of multiple facets of the trapezium. The over-all rate of subluxation and dislocation was 10 per cent. In all hands, pain-free improved movement resulted. The pinch strength approximated the normal, averaging six kilograms for women and eight kilograms for men.

Adult↗
PubMed1995

Combined single-strand distal semitendinosus-iliotibial band tenodesis (Puddu) for anterior cruciate ligament augmentation.

Anterior cruciate ligament (ACL) reconstruction using the semitendinosus tendon has seen renewed interest recently. Puddu described a procedure in which the tendon is harvested at its insertion on the tibia with a bone plug. This study evaluates the efficacy of this approach and examines the long-term results. Between 1982 and 1986, 77 patients underwent this type of procedure; 51 (66%) patients who were reexamined comprised the study group. Thirty-five patients had acute tears, and 16 patients had chronic tears. Follow-up was both objective and subjective with an average follow-up of 7 years and 3 months (range: 5.8 to 9.2 years). In the acute group, six patients (17%) had a 2+ Lachman and seven (22%) had a 1+ Lachman. Pivot shift was 2+ to 3+ in three patients (8.6%) and 1+ in seven patients (22%). KT-100 results were > 5 mm in eight patients (23.3%). In the chronic group, four patients (25%) had 2+ and four had a 1+ Lachman. Seven patients (44%) had a positive pivot shift test. Five patients had > 5 mm difference. Using regression analysis, the KT-1000 results correlated well with the Lachman and pivot shift tests. Chronicity and partial meniscectomy were associated with a poor result. Although this technique has undergone an evolution and improvement to a four-strand reconstruction in recent years, the results of this review indicate satisfactory results can be obtained, especially in the acute setting.

Acute Disease↗
PubMed1993

Achilles tenodesis for calcaneus deformity in the myelodysplastic child.

Calcaneus deformity in patients with neurologic disorders leads to gait disturbances, a high incidence of osteomyelitis, cellulitis, and skin breakdown, and a major problem in the fitting of shoes of orthoses. Correction of this deformity remains a difficult challenge for the orthopedic surgeon. Twelve tenodeses of the tendo Achillis to the fibula or tibia were performed in eight patients with myelodysplasia in an attempt to control calcaneus deformity. The average age of the patients at the time of surgery was 7.4 years (range, 3.1-13.5 years) with an average follow-up period of 6.3 years (range, two to 10.9 years). The clinical examination demonstrated definite improvement in the ability to brace, prevent skin breakdown, and improve gait in all but one patient who had progressive hindfoot valgus. Roentgenographically, there was improvement in the tibiocalcaneal angle in 67%, fibular station in 58%, talar tilt in 25%, and growth of the posterior aspect of the calcaneus in 58%.

Achilles Tendon↗
PubMed1976

Triple tenodesis of the knee. A soft-tissue operation for the correction of paralytic genu recurvatum.

There are two types of genu recurvatum: one with bone deformity, which responds well to osteotomy, and one with posterior soft-tissue laxity with secondary bone changes. To date, no reliable treatment short of arthrodesis has been effective for the second type. An operation for this type of genu recurvatum (post-poliomyelitic) is described: a soft-tissue reconstruction of the lax tissues posterior to the knee joint done in three layers. The operation was done on sixteen knees in fourteen patients, with an average follow-up of four years and three months. The average recurvatum before surgery was 42 degrees and at the time of follow-up it was 6 degrees. Preliminary surgery is often required and precise surgical technique and prolonged bracing after surgery also are needed. All but one patient was made brace-free provided the limb operated on was not flail.

Adolescent↗
PubMed1997

[Design of noninvasive steel miniplate for tenodesis and its clinical application].

To fix the ligaments, tendons or other transplantation materials by passing through bone channels was commonly used and a relialde method in the reconstruction of joint stability. Usually an additional incision was necessary on the side of the outlet of the bone channel, that the screws, plates or U-shaped staple could be applied. An instrument was designed that the steel miniplate could be fixed to the bone by noninvasive method. This technique was applied in 20 cases in which anterior cruciate ligament in 14, posterior cruciate ligament in 4, and collateral ligaments in 2 with carbon fibers. The result was successful in all patients. It was shown that it gave simple manipulation, reliable fixation and no need to have an additional incision, and it could lessen patients' suffering and lead to satisfactory clinical result.

Adult↗
PubMedDate not supplied

Sports activity level after surgical treatment for chronic anterolateral ankle instability. A multicenter study.

The objective of this retrospective multicenter study was to determine whether anatomic reconstruction or tenodesis produces better results in athletic patients with lateral ankle instability. Forty-one patients who underwent anatomic reconstruction and 36 patients who underwent tenodesis were followed up. The median preinjury Tegner score for both groups was 9 (range, 7 to 10). At follow-up, 2 to 10 years after surgical treatment, the median Tegner score for both groups was 8 (range, 4 to 10). In the tenodesis group, 17 patients had a lower Tegner score than before the operation, but in the anatomic reconstruction group only 4 patients had lower scores. Significantly more patients in the tenodesis group (15) had limited ankle dorsiflexion than in the anatomic reconstruction group (3). Plain radiographs revealed that 11 patients in the tenodesis group had medially located osteophytes, compared with only 2 patients in the anatomic reconstruction group. Stress radiographs revealed that more patients in the anatomic reconstruction group had normal laxity values than in the tenodesis group (38 and 28, respectively). According to the rating system developed by Good et al., 36 patients in the anatomic reconstruction group had a good or excellent result, versus 21 patients in the tenodesis group. Anatomic reconstruction was found to be superior to tenodesis in all of the investigated outcome measures.

Adult↗
PubMedDate not supplied

Disorders of the long head of the biceps tendon.

Without a clear understanding of the functional role of the biceps tendon, treatment recommendations have been a subject of controversy. An objective review of the available information would suggest that some humeral head stability may be imparted through the tendon. However, the magnitude of this function is likely to be small and possibly insignificant. In contrast, the symptomatic significance of the long head of the biceps is less controversial, and it has become increasingly recognized as an important source of persistent shoulder pain when not specifically addressed. When present, persistent pain from the long head of the biceps is likely to have more negative functional consequences than loss of the tendon itself. Given these concerns, evaluation and treatment of patients with long head of the biceps disorders should be individualized, based on the likelihood that biceps-related pain will resolve. Although not universally accepted, we recommend tenodesis of the long head of the biceps in those cases in which there are either chronic inflammatory or structural changes, which would make it unlikely that the pain would resolve. These clinical situations in which tenodesis would be required include greater than 25% partial thickness tearing of the tendon, chronic atrophic changes of the tendon, any luxation of the biceps tendon from the bicipital groove, any disruption of associated bony or ligamentous anatomy of the bicipital groove that would make autotenodesis likely (i.e., 4-part fracture), and any significant reduction or atrophy of the size of the tendon that is more than 25% of the normal tendon width. Relative indications for biceps tenodesis also include biceps disease in the context of a failed decompression for rotator cuff tendinitis. It should be emphasized that routine tenodesis is not recommended during operative treatment for the rotator cuff. Rather, we avoid tenodesis whenever it is believed that inflammatory changes to the biceps tendon are reversible. Because of this, tenodesis is not required in most cases.

Elbow Joint↗
PubMed2003

A biomechanical analysis of two reconstructive approaches to the posterolateral corner of the knee.

The objective of this study was to evaluate the effects of the biceps femoris tenodesis and popliteofibular ligament reconstruction on knee biomechanics. Ten human cadaveric knees were tested in the intact, posterolateral corner (PLC)-deficient, and PLC-reconstructed conditions using a robotic/universal force moment sensor testing system. The knees were subjected to: (1) a 134 N posterior tibial load, and (2) a 10 Nm external tibial torque applied to the tibia at full extension, 30 degrees and 90 degrees of flexion. External tibial rotation of the intact knee ranged from 18.3+/-4.6 degrees at full extension to 27.9+/-4.6 degrees at 30 degrees under the 10 Nm external tibial torque. These values increased after sectioning the PLC by 2.8 degrees -7.5 degrees at 30 degrees and 90 degrees respectively. After the popliteofibular ligament reconstruction, external tibial rotation values were not significantly different from those for the intact knee at any angle tested, while values following the biceps tenodesis were as much as 5.7 degrees greater than the intact knee. Under the 134 N posterior tibial load, there were minimal decreases in posterior tibial translation of up to 0.9 mm with the biceps tenodesis and up to 1.6 mm with the popliteofibular ligament reconstruction compared to the intact knee. The in situ forces in the biceps tenodesis were not significantly different than the intact PLC at full extension or 30 degrees, while the in situ forces in the popliteofibular graft were not significantly different at any flexion angle. Our data suggests that by restoring external tibial rotation the popliteofibular ligament reconstruction more closely reproduces the primary function of the PLC as compared to the biceps tenodesis.

Adult↗
PubMed1997

Intrinsic balancing in reconstruction of the tetraplegic hand.

This article reviews 183 hand reconstructions in 135 consecutive tetraplegic patients. Comparisons were made between 103 extrinsic reconstructions with intrinsic balancing procedures and 80 extrinsic reconstructions without intrinsic balancing procedures. Extrinsic reconstructions (tendon transfers and tenodesis in the forearm muscles) were augmented by intrinsic reconstructive procedures (tendon transfers or tenodesis to improve the intrinsic balance of the fingers) in patients exhibiting digital imbalance. Intrinsic procedures included primarily the flexor digitorum superficialis (FDS) lasso procedure or the intrinsic tenodesis procedure. The patients were stratified by level of spinal cord injury and by type of extrinsic and intrinsic reconstruction. Hands reconstructed with intrinsic balancing versus without intrinsic balancing, as well as intrinsic balancing using a FDS lasso procedure versus an intrinsic tenodesis procedure, were compared with patients with the same level of spinal cord function. Patients who underwent reconstructions with intrinsic balancing had more grip strength, by an average of 13-26 N, than those who did not undergo intrinsic balancing. When different intrinsic procedures were compared, there was improvement in grip strength and function in activities of daily living for all hands, but there was no significant difference between FDS lasso or intrinsic tenodesis procedures. The indications for intrinsic balancing during extrinsic reconstruction are developed into treatment algorithms based on the senior author's surgical experience. The authors recommended that digital intrinsic procedures be included in hand reconstruction for tetraplegic patients exhibiting intrinsic imbalance to help improve digital function and provide increased grip strength.

Adolescent↗
PubMed1997

Treatment algorithm of chronic ankle and subtalar instability.

From 1981 to 1984, 131 reconstructive procedures and 113 Evans tenodesis procedures (1972-1984) were performed for patients with chronic instability of the ankle joint. From 1981 to 1985, 42 Christman/Snook procedures were performed for patients with isolated or combined subtalar instability. Reevaluation was conducted for 223 patients (102 reconstructive procedures, 87 Evans tenodesis procedures, and 34 Christman/Snook tenodesis procedures). The follow-up protocol comprised standard and stress radiograms, subjective patient evaluation, and objective functional data. No patient in either treatment group had clinically important ankle instability. Patients who had undergone the Evans tenodesis had a 3.3 degrees mean less talar tilt than did patients treated with reconstructive procedure. Of 87 patients who underwent Evans tenodesis, 33 had a mean supination deficit of 7.5 degrees. According to the +/- 100 points classification, 90% of the patients in both groups achieved good or excellent results. For subtalar instability, the Christman/Snook techniques resulted in a mean supination deficit of 7.2 degrees in 20 patients. Of 34 patients, 31 were rated good or excellent.

Algorithms↗
PubMed1982

Surgical treatment of lesions of the long head of the biceps.

A follow-up study was carried out on 20 patients with a Hitchcock type of biceps tenodesis performed during the past seven years at the Hospital for Special Surgery. Thirteen cases were diagnosed as biceps tendinitis and seven as biceps instability. At follow-up, there was a 30% failure rate; the failures were related to misdiagnosing biceps instability, not identifying an impingement syndrome, or glenohumeral instability. Those patients who were relieved of symptoms had in addition to biceps tenodesis, an excision of a portion of the coracoacromial ligament. In four of the six failures, the coracoacromial ligament was not released. Two patients had a fixed dislocation of the biceps tendon noted preoperatively by arthrography and confirmed at surgery, and were successfully treated by biceps tenodesis. Two other patients who had unsuccessful biceps tenodesis and coracoacromial ligament excision were subsequently shown to have humeral head impingement with the coracoid process. Coracoid osteotomy relieved their pain. The role of the biceps tendon in the production of shoulder pain is difficult to assess and is easily overestimated, The biceps tendon inflammation may be a secondary manifestation of an impingement syndrome and unless treated as such, surgery will not be successful. Conversely, biceps lesions secondary to disorders of the bicipital groove can be treated by tenodesis. Instability of the biceps tendon can be difficult to evaluate preoperatively. Arthrography was noted to be diagnostic in dislocation of the biceps tendon.

Adolescent↗
PubMed2005

Arthroscopic transfer of the long head biceps to the conjoint tendon.

Pathology of the biceps tendon is often a factor in the etiology of shoulder pain. However, diagnosis and treatment of such pathology remains controversial. When conservative management fails to relieve symptoms, surgical options include tenotomy or tenodesis. Tenotomy has provided excellent results with regard to local pain relief, but a potential cosmetic deformity and occasional painful cramping are common in younger patients. Tenodesis has also had high failure rates resulting from persistent local pain. We have used an all-arthroscopic technique for transfer of the long-head biceps to the conjoint tendon instead of traditional tenodesis. We believe that this transfer more closely recreates the normal axis of the biceps muscle and may offer improved results over conventional tenodesis.

Arthroscopy↗