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At least 217 records · Page 12Linked to original sources
PubMed2004

Treatment of stage II posterior tibial tendon deficiency with flexor digitorum longus tendon transfer and calcaneal osteotomy.

BACKGROUND: To assess the efficacy of surgical correction of stage II tibial tendon deficiency with medial translational calcaneus osteotomy and flexor digitorum longus tendon transfer to the navicular, the authors retrospectively reviewed results of treatment of stage II posterior tibial tendon deficiency in 129 patients for whom surgery was performed between 1990 and 1997. METHODS: The indication for surgery included tendon weakness, flexible deformity, and foot pain refractory to nonsurgical treatment. All patients had a painful flexible flatfoot without fixed forefoot supination deformity (stage II). A medial translational osteotomy of the calcaneus and transfer of the flexor digitorum longus tendon into the navicular were done. The patients were examined, radiographs were obtained, and isokinetic evaluation of both feet was performed at a mean of 5.2 years postoperatively. The American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot Scale and Short Form Health Surgery (SF-36) were used to evaluate patients postoperatively. RESULTS: The mean AOFAS score at follow-up was 79 points (range, 54-93). There were seven significant complications in six patients. Isokinetic inversion and plantarflexion power and strength were symmetric with the contralateral limb in 95 patients, mildly weak in 18 patients, and moderately weak in eight patients. Subtalar joint motion was normal in 56 (44%), slightly decreased in 66 (51%), and moderately decreased in seven patients (5%). Correction was significant (p < .05) in all four radiographic parameters evaluated. Patients were entirely satisfied (118 patients), partially satisfied (seven patients), or dissatisfied (four patients). Further, 125 (97%) experienced pain relief, 121 (94%) showed improvement of function, 112 (87%) experienced improvement in the arch of the foot, and 108 (84%) were able to wear shoes comfortably without shoe modifications or orthotic arch support. CONCLUSIONS: The surgical correction of stage II posterior tibial tendon deficiency with medial translational calcaneus osteotomy and flexor digitorum longus tendon transfer to the navicular yielded excellent results with minimal complications and a high patient satisfaction rate.

Adult↗
PubMed2006

Staged reconstruction for chronic rupture of both peroneal tendons using Hunter rod and flexor hallucis longus tendon transfer: a long-term followup study.

BACKGROUND: Long-term followup (over 5 years) of staged reconstruction for chronic ruptures of both peroneal tendons using a Hunter rod and the flexor hallucis longus (FHL) tendon is presented. METHODS: Seven patients with chronic ruptures of both peroneal tendons who had at least two previous surgeries that failed were treated with excision of the remaining portion of the peroneal tendons and implantation of a Hunter rod to the insertion of the peroneus brevis. Patients performed passive range of motion exercises for 3 months before removal of the Hunter rod and transfer of the FHL into the newly formed sheath, attaching it to the insertion of the peroneus brevis on the fifth metatarsal. The patients' ages ranged from 30 to 57 (average 38) years. All were women. All had at least two previous failed procedures (range two to six). The average time from initial injury to the index surgery was 4.6 (range 2 to 7) years. Patients were evaluated by physical examination and a questionnaire. The average range of followup was 8.5 years (range 143 to 167 months). RESULTS: All wounds healed without complications. One patient (a workers' compensation patient) had continued complaints of pain and ambulated with a molded ankle-foot orthosis (MAFO). The remaining six patients reported complete relief of symptoms and returned to full preinjury levels of activity. One patient required a Broström ankle ligament repair 2 years after tendon transfer for a new injury but has remained pain free for the last 62 months. There were five excellent, one good, and one fair result. All patients stated they would repeat the surgery. CONCLUSION: Staged reconstruction with excision of the remaining portion of the peroneal tendons and reconstruction with a Hunter rod and FHL transfer has been shown to be an effective long-term treatment for chronic peroneal tendon ruptures.

Adult↗
PubMed1995

Ipsilateral peroneus brevis tendon grafting in a complicated case of traumatic rupture of tibialis anterior tendon.

Ruptures of tibialis anterior tendon can be caused by open, closed, direct, or indirect trauma, as well as spontaneously. Sixty-three cases of tibialis anterior tendon ruptures have been reported in the international literature. The treatment of choice is the surgical end-to-end or side-to-side anastomosis after previous Z-lengthening. The case of a 28-year-old world-class female triathlete who sustained an open laceration of the tibialis anterior tendon from the bicycle chain guard is reported. The primarily applied tendon suture became infected and a wound revision with wide resection of the tendon stumps was necessary. This lead to an extensive defect of the tendon combined with a deep-seated keloidal scar reaction of the skin. The surgical closure was performed using free ipsilateral peroneus brevis tendon grafting. Four months after the operation the patient was completely rehabilitated. Eight months later she became the second European triathlon champion.

Adult↗
PubMed1999

Risk of avulsion of the Achilles tendon after partial excision for treatment of insertional tendonitis and Haglund's deformity: a biomechanical study.

Surgical treatment of posterior heel pain caused by insertional (calcific) Achilles tendonitis or retrocalcaneal bursitis includes resection of diseased tendon or exostectomy. Currently, no guidelines exist to determine how much tendon may be excised without risking rupture of the Achilles tendon. Anatomic dissections revealed the average height of the insertion measured 19.8 mm (range, 13-25 mm). Average width at the proximal aspect of the insertion measured 23.8 mm (range, 17-30 mm) and distally measured 31.2 (range, 25-38 mm). To assess the risk of avulsion, the tendon insertion was partially released in 25% increments of its measured height or width by one of the four methods: (1) from superior to inferior, (2) from the central portion outward, (3) from medial to lateral, and (4) from lateral to medial. Repeated cyclic loading of body weight x 3 was applied, and, if the tendon remained intact, the next 25% increment was released. This process was repeated until failure occurred. Failure occurred in all specimens by an oblique intratendonous separation or shear between the intact portion remaining on the calcaneus and the resected fibers remaining in the clamp. Fibers inserting into the bone did not avulse. Superior-to-inferior resection was found to be superior to the other three methods with eight of nine specimens remaining intact after 75% resection. We therefore conclude that superior-to-inferior offers the greatest margin of safety when performing partial resections of the Achilles insertion, and as much as 50% of the tendon may be resected safely.

Achilles Tendon↗
PubMed1992

MR imaging of the quadriceps tendon: normal layered configuration and its importance in cases of tendon rupture.

OBJECTIVE: The quadriceps tendon is a multilayered structure with separate layers arising from different muscle groups. We examined this layered configuration on MR images to determine if it is relevant in the evaluation of the traumatized quadriceps tendon. MATERIALS AND METHODS: Sagittal and axial T1-weighted MR images of 52 knees with normal tendons were reviewed to determine the number and the muscle origins of these layers. Five knees with traumatized quadriceps tendons were imaged with T1 and T2 weighting to determine the relationship between the layered configuration and the injury. RESULTS: All the normal quadriceps tendons had a laminated appearance with either four (6%), three (56%), or two (30%) layers. In 8%, the laminations were barely perceptible. The site of origin of each layer was consistent, and each favored a given muscle. The superficial layer originated from the posterior fascia of the rectus femoris muscle, and the deep layer originated from the anterior fascia of the midline vastus intermedius muscle. The middle layer(s) arose from the deep fascia separating the vastus medialis and the vastus lateralis muscles from the vastus intermedius muscle. When only two layers were present, the middle layer merged with the superficial and deep layers. In the injured tendon, complete rupture produced transection of all the layers. Incomplete ruptures were seen as focal discontinuities of individual layers; other layers remained intact. CONCLUSION: The existence of a layered configuration of the quadriceps tendon is significant in the MR examination of partial ruptures. It can help not only in detecting and localizing injuries but also in determining appropriate treatment based on the number or thickness of injured layers.

Female↗
PubMed1975

The role of the digital synovial sheath in tendon grafting. An experimental and clinical study on autologous tendon grafting in the digit.

The mechanism of healing of a free tendon graft and also the role played by the synovial sheath is still obscure and debated. In the present study an effort is made to further elucidate these problems. In rabbits and dogs an experimental model was developed where a free tendon graft would be nourished by synovial fluid only. Macroscopically the grafts remained smooth, white and glistening without vascular ingrowth or adhesions during an observation period of 12 weeks. By histological and histochemical techniques the grafts as a whole were found viable up to 3 weeks. In a clinical series of 40 free flexor tendon grafts within the digital area as much as possible of the tendon sheath was preserved during grafting. The functional recovery was generally very good. The best results were obtained in those cases where most of the tendon sheath was preserved during grafting. The functional recovery was generally very good. The best results were obtained in those cases where most of the tendon sheath was preserved. No signs of defective graft survival were observed. Based on both experimental and clinical results from the present study it is concluded that there is no reason to excise the remaining tendon sheath within the critical zone in the digits. On the contrary preservation of the sheath contributes to survival of the graft and helps maintaining the integrity of gliding surfaces with maximal functional restoration and minimal formation of adhesions.

Acid Phosphatase↗
PubMed2003

[Flexor tendoplasty with a tendon prosthesis for zone II flexor tendon injuries].

OBJECTIVES: We evaluated two-staged flexor tendoplasty with tendon prosthesis in patients with flexor tendon injuries in which conventional tendon grafting would fail to yield an acceptable result. METHODS: We performed flexor tendoplasty with tendon prosthesis in 37 hands of 31 patients (24 males, 7 females; mean age 23 years; range 4-46 years). Twenty-six patients had penetrating injuries, four had occupational injuries, and one patient had an electric burn. Preoperatively, all patients were evaluated according to the Boyes' classification. At the first stage, a silicone prosthesis, 4-6 mm in diameter was placed according to the patient's age and the recipient bed; after 3 to 5 months, silicone prosthesis was removed and flexor tendoplasty with a tendon graft was performed. The results were calculated according to the Strickland's formula. The mean follow-up period after the second operation was 37 months (range 12-80 months). RESULTS: The results were excellent in 11 hands (Strickland 75-100%), good in 15 hands (50-74%), moderate in nine hands (25-49%), and poor in two hands (0-24%), with a mean of 58%. Tenolysis was performed in seven patients at least four months after the second stage. Removal of the tendon prosthesis was required in one patient because of infection. CONCLUSION: Satisfactory results can be obtained with two-staged flexor tendoplasty with a tendon prosthesis in patients with joint injuries restricting finger movements, digital nerve injuries causing trophic changes in the finger, and multiple tissue injuries.

Adolescent↗
PubMed2004

[Treatment of chronic Achilles tendon rupture by use of allogeneic tendon].

OBJECTIVE: To evaluate the clinical result of allogeneic tendon in treatment of chronic Achilles tendon rupture. METHODS: From July 1996 to November 2000, 6 cases of chronic Achilles tendon rupture were treated by use of allogeneic flexor tendon to repair Achilles tendon with Bosworth way. Five cases were followed up 27-53 months with an average of 38.5 months. RESULTS: According to Arner-Lindholm criteria for curative result, the result was excellent in 1 case and good in 4 cases. CONCLUSION: Allogeneic tendon in repair of chronic Achilles tendon is effective. It can avoid the injury and complication caused by autograft.

Achilles Tendon↗
PubMed1985

Flexor tendon physiology: tendon nutrition and cellular activity in injury and repair.

Scientific studies of the past 20 years have done much to redefine the mechanisms by which flexor tendons heal. Several points have become increasingly clear: Flexor tendons are nourished to a greater extent by synovial fluid diffusion than vascular perfusion. Tendon cells are capable of proliferating, producing collagen, and reconstructing their own gliding surface in the absence of adhesion ingrowth. The key to a successful outcome after flexor tendon repair appears to be an early restoration of tendon continuity, reconstruction of the sheath, if possible, and early passive mobilization. This complex stimulates the tendon's intrinsic repair potential, which is contained within the cells of the tendon itself but appears to be expressed only under ideal experimental and clinical situations.

Adult↗
PubMed1998

[Tendon rupture of the extensor pollicis longus tendon in rheumatoid arthritis].

Seven patients with subcutaneus of the extensor pollicis longus tendon (EPL) in rheumatoid arthritis were studied. There were one man and six women. The mean age of the patients was 56. 9 years, with a range of 47 to 83 years. The duration of the disease was from 0.2 to 6 years, its average 3 years. An interval between rupture of the tendon and operation was 9 days to 18 months. Tendon transfers of the extensor indicis proprius tendons were performed in 3 cases, sutures in 2 cases and free tendon graft of the palmaris longus in one case. All cases showed very active tenosynovitis around the EPLs, which were ruptured near Lister's tubercle. The histopathological findings of the ruptured EPL revealed that synovial proliferative tissue with chronic inflammatory cells infiltration were invading into the tenion tissue directly. The synovial granulatins might weaken the tendon and repetitive mechanical stress on the tendon at Lister's tubercle could result in the rupture of EPLs.

Aged↗
PubMed2004

Reliability in the assessment of tendon volume and intratendinous signal of the Achilles tendon on MRI: a methodological description.

The purpose is to introduce a method for accurately and objectively evaluating volume and mean intratendinous signal within the Achilles tendon using MRI. We prospectively studied MRI from 33 patients with chronic Achilles tendinosis (20 males and 13 females) with a median age of 52 years (range 29-70). In all patients, both Achilles tendons were investigated with T1-WI as well as PD-WI MRI. Thus, 66 Achilles tendons were evaluated in the study. Tendon volume and mean intratendinous signal were evaluated using a computerized 3-D seed-growing technique. In general, the computerized 3-D seed-growing technique resulted in an excellent overall observer reliability of the MRI-measurements. The reliability (R) for tendon volume measurements was highest for the T1-WI sequence (R=97.9%). For the mean intratendinous signal, the PD-WI sequence showed the highest reliability (R=88.1%). The same pattern was present when we studied the coefficient of variation (CV). For the CV, lower figures indicate more reliable estimates. CV was 4.9% for tendon volume and 8.9% for mean intratendinous signal. In conclusion, it could be said that a computerized 3-D seed-growing technique to monitor and evaluate the volume of the Achilles tendon and mean intratendinous signal, using MRI, shows an overall excellent reliability regarding inter- as well as intra-observer reliability.

Achilles Tendon↗
PubMed2000

Insertion of autologous tendon grafts to the bone: a histological and immunohistochemical study of hamstring and patellar tendon grafts.

This study examined the structure of the insertion of autologous tendon grafts used for anterior cruciate ligament reconstruction. Biopsy specimens of the femoral paragraph signand tibial bone graft interface were obtained at revision surgery in 14 patients (6 with hamstring grafts, 8 with a patella tendon graft). The specimens were analyzed by light microscopy and immunohistochemistry (confirming type I, type II, and type III collagen). The insertions of hamstring autografts to the bone tunnel have three characteristic histological zones. Zone 1 is composed of the dense connective tissue of the graft. The collagen fibers of the graft enter the bone under oblique angles. Zone 2 is composed of woven bone with a sharp transition to the lamellar bone of the tibia (zone 3). Immunohistochemistry revealed the presence of type I and type III collagen within the dense connective tissue of the graft. The woven and lamellar bone showed positive immunostaining for antibodies against type I collagen only. This structure resembled a fibrous ligament or tendon insertion. In the majority of patients with a patella tendon graft the structure of the insertion resembled a chondral enthesis. The chondral insertion of the graft to the bone is composed of four characteristic zones. Between the dense connective tissue of the graft (zone 1) and bone (zone 4) there is a zone of fibrocartilage (zone 2). Close to the bone the fibrocartilage is mineralized (zone 3). Within the fibrocartilage the immunohistochemical analysis confirmed type II collagen. This structure resembled the chondral enthesis of the normal anterior cruciate ligament. However, in cases in which the distal bone bloc has been fixated outside the tibial tunnel, the tibial insertion of the patellar tendon graft resembled a fibrous insertion. While both types of tendon grafts heal to the bone of femur and tibia, the insertion of patella tendon grafts healing by bone plug incorporation resembles the chondral insertion of the normal anterior cruciate ligament and may have a more physiological connection to the bone than hamstring grafts.

Humans↗
PubMed2006

Magic angle effect in MR imaging of ankle tendons: influence of foot positioning on prevalence and site in asymptomatic subjects and cadaveric tendons.

The influence of foot positioning on prevalence of the magic angle effect (MAE) in ankle tendons was investigated. In 30 asymptomatic volunteers and five cadaveric feet, MR imaging of the ankle was performed in the supine (neutral position of the foot) and prone (plantar-flexed foot) position. MAE was considered if increased T1-weighted signal at a certain site was seen in one position only. Histological correlation was obtained at 25 sites of the cadaveric posterior tibialis tendons (PTT). MAE occurred in 6/30 vs 1/30 (supine vs prone) anterior tibialis tendons (ATT), 30/30 vs 0/30 extensor hallucis longus and 27/30 vs 0/30 extensor digitorum longus tendons, 29/30 vs 0/30 PTTs, 30/30 vs 0/30 flexor digitorum and flexor hallucis longus tendons, 30/30 vs 1/30 peroneus brevis and 23/30 vs 1/30 peroneus longus tendons. At 12/25 cadaveric PTT sites where MAE was exclusively responsible for the increased signal, histology revealed normal tissue (11/12) or minimal degeneration (1/12). In conclusion, the supine body position with neutral position of the foot, a high prevalence (77-100%) of MAE in ankle tendons except for the ATT (20%) is seen. MAE is almost absent in the prone body position with plantar flexion of the foot.

Adult↗
PubMed1995

Absorbable sutures in tendon repair. A comparison of PDS with prolene in rabbit tendon repair.

The risks of foreign implantation may be avoided in tendon repair by the use of absorbable sutures, for example polydioxanone. In this study, the in vivo tensile strength half-life of 4/0 polydioxanone was found to be approximately 4 weeks. Using a rabbit model, we compared polydioxanone tendon repairs with polypropylene tendon repairs. Unilateral flexor digitorum longus repairs were performed on 46 rabbits using either polydioxanone or polypropylene. Tendons were harvested at 3 days, 2 weeks and 4 weeks and the tensile breaking strengths were obtained. 30 intact rabbit flexor digitorum longus tendons and 20 freshly repaired tendons were also tested. By 4 weeks, the repair strength had increased eight-fold from approximately 20 N to 166 N. The sutures made little contribution to the overall strength of a 4-week-old repair. There was no significant difference between polydioxanone and polypropylene repairs at any stage. These results show that polydioxanone repairs were as strong as polypropylene during the first critical weeks of tendon healing.

Absorption↗
PubMed1997

Tendon repair--cellular activities in rabbit deep flexor tendons and surrounding synovial sheaths and the effects of hyaluronan: an experimental study in vivo and in vitro.

One deep flexor tendon and its surrounding sheath of each hindpaw of 48 rabbits were transected and repaired in order to investigate the abilities of rabbit flexor tendons and synovial sheaths to synthesize DNA and matrix components during healing and to study the effects of hyaluronan (HA). After repair, HA or saline was injected between the tendon and the sheath. Short-term culture and labeling in vitro were used up to 6 weeks after surgery to determine synthesis of DNA, proteoglycan, collagen, and noncollagen protein. Within tendon repair sites, the rate of cell proliferation increased and reached a maximum 5 days after surgery; within repaired synovial sheaths, the rate immediately decreased. In the healing tendons, the rate of collagen synthesis decreased and the rate of noncollagen protein synthesis remained unchanged. The opposite results were found within the healing synovial sheaths. HA did not affect the rate of cell proliferation or matrix synthesis in healing tendons or surrounding sheaths. These results show that cellular activities differ between tendons and synovial sheaths during healing and that those activities may not be affected by HA.

Animals↗
PubMed2001

Effects of human amniotic fluid on peritendinous adhesion formation and tendon healing after flexor tendon surgery in rabbits.

The effect of the topical application of human amniotic fluid (HAF) on peritendinous adhesion formation and tendon healing was investigated in 32 New Zealand adult rabbits. The long flexor tendons of the digits of each hind paw were completely divided and repaired with a modified Kessler technique. The rabbits were randomly divided into 4 experimental groups according to the type of repair used: sheath excision, sheath excision and local HAF application, sheath repair, and sheath repair and local HAF application. The extent of adhesions and the healing status of the tendons were macroscopically and histologically evaluated at 12 weeks. Tensile strength of the repaired tendons was measured biomechanically at 20 weeks. The least adhesion and the best healing were observed in tendons treated with sheath repair and HAF application. Tendons treated with HAF had significantly higher tensile load values. Topical application of HAF immediately after tenorrhaphy is significantly effective in preventing peritendinous adhesion formation without impairment of tendon healing in this rabbit model.

Amniotic Fluid↗
PubMed2003

Spontaneous flexor tendon rupture in the palm: the role of a variation of tendon anatomy.

Spontaneous flexor tendon rupture is rare. We report 2 cases that occurred in association with a common flexor digitorum profundus (FDP) tendon to the ring and small fingers. The tendon bifurcated at the midpalmar level and ruptured at the point of bifurcation. To our knowledge this tendon variation has not been reported previously and has not been associated with spontaneous tendon rupture. Both ruptures occurred in the dominant small finger of elderly men in the absence of trauma. We believe that this unusual tendon arrangement represents a potential weak point in the musculotendinous unit. We discuss the role of this anatomic variant in the pathomechanics of tendon rupture.

Aged↗
PubMed1998

Electrical stimulation over muscle tendons in humans. Evidence favouring presynaptic inhibition of Ia fibres due to the activation of group III tendon afferents.

Electrical stimulation over muscle tendons produces a transient suppression of voluntary EMG activity; its onset latency is approximately 55 ms in the forearm extensor muscles. This phenomenon has been attributed to the activation of a polysynaptic inhibitory pathway originating from Ib afferent fibres. To clarify its origin we conducted several experiments in 10 normal healthy subjects. The EMG silence after tendon stimulation appeared at relatively high stimulus intensities (> 50 mA); conditioning cutaneous stimulation left it unchanged, and the inhibition had a short recovery cycle (50 ms). Tendon stimulation still evoked EMG suppression during an ischaemic block of fast-conducting afferents. The motor potentials evoked by transcranial magnetic stimulation of the motor cortex during the EMG silence remained almost unchanged, whereas the H reflex was strongly inhibited. Hence we conclude that tendon stimulation activates slow-conducting tendon afferents, possibly group III fibres, connected not through a polysynaptic pathway originating from Ib afferents but through an oligo- or disynaptic inhibitory circuit. The EMG suppression after tendon stimulation probably represents a dysfacilitation of the alpha-motor neurons due to presynaptic inhibition of Ia fibres produced by tendon afferent input to the spinal cord.

Adult↗