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PubMed1983

Tendon transfers in hand surgery.

The need for skilled surgeons, trained in the proper techniques of hand surgery, to reconstruct paralytic hands has been emphasized. The most useful techniques for radial nerve paralysis have been found to be transfer of the pronator teres to the extensor carpi radialis brevis, of the flexor carpi ulnaris into the extensor digitorum communis, and of the palmaris longus into a rerouted extensor pollicis longus. For treatment of clawhand, the Bunnell sublimis transplantation is recommended for mild deformities in patients without normally hyperextensible joints and for patients who need a powerful flexor force on the proximal phalanges for strong gripping of tools, such as those used by mechanics and carpenters. The modified Fowler extensor transplant is also recommended for cases detected early and can be used for more advanced cases. The recent Brand procedure, which uses the extensor carpi radialis longus and a four-tailed tendon graft to the palmar side through the carpal tunnel and lumbrical canal, is also recommended, but further experience is needed for full evaluation of this procedure. Of the static methods of overcoming clawed hands, the Zancolli procedure of advancing the palmar plate proximally provides good results, although it probably should be reserved for those patients in whom no active tendon transfer can be provided. Long-term experience has shown that this capsulodesis seems to gradually stretch out and allow some recurrence of the hyperextension of the proximal joint. The Fowler tenodesis, which has an advantage over the Riordan method, is a semiactive tenodesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Hand Deformities, Acquired↗
PubMed1985

Trapezium implant arthroplasty: evaluation of a semiconstrained implant.

Twenty-five patients who presented with symptoms of disabling pain secondary to arthritis at the base of thumb had 29 arthroplasties with silicone rubber trapezium implants. Stabilization was achieved with tenodesis using a strip of abductor pollicis longus as described by Eaton. All patients had relief of pain after surgery. We examined 23 hands in 19 patients for follow-up. Average follow-up was 31 months. Assessment of functional status and measurements of prehensile capabilities showed that all patients had improved after surgery. Range of motion of the thumb was measured (radial abduction averaged 40 degrees; 80% had full opposition). Average key pinch was 8 pounds. Stability of the implant was assessed with standard posteroanterior, lateral, and stress views of the trapeziometacarpal joint. Comparisons were made with previously reported results for Eaton and Swanson trapezium implants. The tenodesis effect may provide a more stable, although possibly less mobile, CMC joint of the thumb.

Aged↗
PubMed1996

[Stabilization of the distal radioulnar joint by Hui-Lindscheid ligamentoplasty. Report of 10 cases].

The surgical treatment of chronic sprain of the distal radio-ulnar joint remains a difficult problem. Some authors have proposed a radio-ulnar stabilization procedure which involves some loss of mobility of the forearm. Other, more radical authors, have suggested partial or complete resection of the ulnar head. In this case, they restore mobility in prono-supination, but often with a loss of stability and discomfort or pain. Hui and Lindscheid modified a technique of tenodesis which had been previously proposed by Bunnell. They perfected a tenodesis based on the use of the flexor carpi ulnaris tendon. We feel that this procedure should ensure stability of the distal radio-ulnar joint, while preserving its mobility. We used this technique in 9 patients who were reviewed with a follow-up of 2.7 years. The authors obtained 2/3 of good and very good results. This procedure will be compared with other techniques currently used and differences of the results will be discussed. Unfortunately, few articles have been published on this subject.

Adult↗
PubMed2002

[Dorsal instability of the ulnar stump following distal resection: hemi extensor-carpi-ulnaris stabilization procedure].

Dorsal instability of the ulnar stump may be a complication of Darrach and Sauve-Kapandji procedures. Stabilizing procedures are numerous using flexor carpi ulnaris, extensor carpi ulnaris tendons or a combination of both tendons, the palmaris longus, and even synthetic or free grafts. The authors report nine cases of ulnar stump instability, five times post-traumatic and four as a result of rheumatoid arthritis. A tenodesis using a strip half of the extensor carpi ulnaris was performed in all these patients. Post-operatively eight patients were pain-free with in one case occasional pain after heavy work. All stumps were clinically stable. Forearm rotation and grip strength were maintained. Radiological dorsal ulnar subluxation was always reduced. Treatment of these instabilities should be preventive. When dorsal instability of the ulnar stump occurs, the half strip extensor carpi ulnaris tenodesis provides consistent satisfactory results in both arthritic and post-traumatic-related instability.

Adult↗
PubMed1992

The hyperflexed seemingly useless tetraplegic hand: a method of surgical amelioration.

In a series of 65 tetraplegic hands with severe disabling spasticity and/or flexion contracture, selective flexor tendon elongation procedures were employed to improve their static and kinetic postures. A kinetic approach was adopted, utilizing local anesthesia in a wide-awake patient. This was employed to allow for the patient's cooperation in determining at surgery the desired length of digital extension at the time of wrist tenodesis action. Elongation of the extensor digitorum communis (EDC), extensor indicis proprius (EIP), and extensor digiti quinti (ED V) were added to correct an 'extrinsic-plus' posture observed in 16 patients following flexor tendon lengthening. With the resultant improvement in the static posture of the digits, tendon transfers could then be employed to provide a more functional tenodesis action. These measures provided both improved palmar contact and prehension.

Adolescent↗
PubMedDate not supplied

Posterolateral rotatory instability treated by a modified biceps rerouting technique: technical considerations and results in cases with and without posterior cruciate ligament insufficiency.

PURPOSE: This study compared the clinical results of modified biceps femoris tenodesis with posterolateral rotatory instability (PLRI) injuries and PLRI combined with PCL injuries. TYPE OF STUDY: Case series. METHODS: Of 46 patients treated for PLRI, 21 had isolated PLRI (group 1), and 25 had PLRI with PCL injuries (group 2). The most common cause of injury was motor vehicle accident. The PCL was reconstructed using an arthroscopic 1-incision technique. The advantages of the modified Clancy technique include fixation of the biceps tendon to the isometric position and reduced surgical damage to the iliotibial band by dissection to the lateral femoral epicondyle through the interval between the iliotibial band and biceps muscle. RESULTS: All knees tested positive in the preoperative reverse pivot shift test, and 43 patients (93%) tested negative postoperatively. The side-to-side difference of an average external rotation thigh-foot angle (ERTFA) at both 30 degrees and 90 degrees of knee flexion was 15 degrees and 11 degrees in group 1 and 21 degrees and 26 degrees in group 2 preoperatively. Postoperative ERTFA tested at 30 degrees and 90 degrees of knee flexion were 10 degrees less than the uninvolved knee in both groups. At a mean follow-up of 40.3 months, the postoperative Lysholm knee score was 93.6 in group 1 and 90.4 in group 2. The postoperative HSS mean value was 91.1 in group 1 and 87.9 in group 2. A correction loss of more than 5 degrees was found in 3 patients of group 1 and in 5 patients of group 2 at an average 12 months after surgery. In 5 of 8 patients, severe scar tissues were found at the insertion site of the biceps tendon to the fibula during surgery. These tissues were associated with damage of the involved structures at the time of injury. CONCLUSIONS: Based on our experience, we recommend the modified biceps tenodesis for the reconstruction of both PLRI injuries and PLRI combined with PCL injuries except in patients with severe damage at the attachment site of the biceps tendon.

Adolescent↗
PubMed1996

[Weber fibular ligament-plasty with plantar tendon with Segesser modification].

UNLABELLED: Ankle joint injuries are one of the most frequently diagnosed sports injuries. In our clinic we observed between 1981-92 18% ankle joint injuries in 11.350 patients. The acute injury was generally handled conservatively by functional treatment with a special shoe; only comminute injuries like fractures, luxations or tendon injuries would lead to the decision to perform surgery. The ratio of acutely performed surgery compared to late surgery was decreasing: 1981 1:3, compared to 1992 1:50. Reconstructive surgery of the lateral ligament complex is indicated under the following conditions: patient suffering from recurrent trauma and feeling of instability and/ or in case of comminuted overuse injuries caused by instability like the entrapment of the tibial nerve in the tarsal tunnel, achilodynia caused by instability of the rearfoot or luxation of the peroneal tendons. Reconstruction of the lateral ligaments of the ankle should be done anatomically, operations with effect of tenodesis should be avoided. TECHNIQUE: We modified the technique of Weber to reconstruct the lateral ligaments. An autograft (plantaris tendon) is used for this procedure. The plantaris tendon is removed through a medial sided minimal incision on the injured leg with a special stripper. Through the lateral incision on the lateral malleolus drill wholes are made at the anatomical ligament insertions of the calcaneus, talus and fibula. The graft is passed through the drill wholes this way the Lcf and Ltfa are anatomically reconstructed. The tendon sheat of the peroneal tendons will be closed if needed with residual plantaris tendon. The postoperative treatment is the same as conservative treatment with full-weight-bearing in a special shoe three days after surgery with 30 degrees (10-0-20) range of motion. ROM will be increased to 50 degrees after three weeks. For the first three weeks the leg will be positioned in a 90 degrees splint over night. Two series of patients altogether 584 patients in the time from 1981-1991 were operated. The difference of the two groups lied in the technique of surgery (in group 2 the calcaneofibular ligament was reconstructed as well as the peroneal tendon sheat) as well as the postoperative treatment was altered (group one removable cast for the first three weeks versus functional treatment after surgery in group 2 as described in the postop treatment). RESULTS: 443 (76%) out of 584 operated patients were followed at least one year after OP. Working ability: 19% (group 1)/25% (group 2) of the patients after two weeks, 31/42% after 2-4 weeks and 79/88% after 4-6 weeks. Full sports activity to previous sport 8/17% after 4-6 weeks, 26/38% after 6-8 weeks, 65/70% after 8-12 weeks. The group 2 achieved full sports activity and working ability on average two weeks before the patients of group one. Personal evaluation: 88/90% felt their ankle joint to be more stable postoperatively, 10/9% as stable as before and 2/1% described it as less stable. Clinical evaluation: The modified Benedetto score showed in 76/81% very good results, in 9/7% good and 13/8% bad results. In conclusion the described reconstruction of the fibular ligaments without damaging the active stabilizing muscles is a valid technique. The reconstruction of the calcaneofibular ligament improved the long term results of surgery. The functional postoperative rehabilitation (special shoe and night brace) does shorten the time for the patients working ability as well as the return to full sports activity. The long term results on the other hand appeared to be similar for both groups. The advantage of our technique using the plantaris tendon as a graft. The use of autograft material having the same tensile strength as the original ligaments anatomically reconstructed. Surgery with tenodesis effects should be abandoned. The good results occurring while performing late surgery leave the chance for primary conservative treatment of lateral ligament injuries.

Adult↗
PubMed1994

[Distal femoral fixation of the iliotibial tract].

Two femoral fixation areas were defined in the distal iliotibial tract (ITT) system. They were named supracondylar insertion and insertion near the septum. Biomechanical studies on these insertions revealed tension peaks in the insertion near the septum with anterior translation of the knee, with varus stress and rotational movements. We conclude that the fibers inserting here are secondary restraints against anterior and lateral knee instability. 5 lateral extraarticular procedures were investigated to evaluate their biomechanical effect on knee instability. A standardized cadaver knee model was used with two basic experiments: an excentric quadriceps contraction from 0 to 90 degrees of flexion and an anterior translation with 100 N in 30 degrees of flexion. 5 knees were investigated for each procedure. Results from the excentric quadriceps contraction study imply reduced ACL strain with all extraarticular procedures except the Andrews tenodesis. The quantitative effect was related to the mechanical strength of the fixation of the ITT. All lateral procedures reduced ACL strain with anterior translation of the knee. The last part of the study included simultaneous registration of rotation and translation of the knee. We demonstrated a close relation of decreased ACL strain due to a lateral procedure and pathological external rotation of the knee. The knee no longer reached the physiological neutral rotation angle after an effective lateral tenodesis procedure. The significance of this effect is not clear at the present time.

Anterior Cruciate Ligament↗
PubMed1993

[Comparison of combined extra- and intra-articular stabilization versus isolated arthroscopic semitendinosus repair after rupture of the anterior cruciate ligament].

In a prospective study we examined 32 patients with a combined reconstruction of the anterior cruciate ligament, with arthroscopical use of a loop of semitendinosus tendon for the intraarticular portion and an iliotibial band tenodesis for the extraarticular augmentation in comparison to an isolated intraarticular semitendinosus reconstruction in 26 patients. Additionally the importance of a standardized rehabilitation program in this study was evaluated in comparison to a study on 58 athletes without standardized rehabilitation after an arthroscopic ACL-semitendinosus reconstruction. Lysholm-Score, clinical and radiological findings, KT-1000 stability values and isokinetic tests were evaluated monthly over a year. This data suggests that while both procedures under standardized rehabilitation conditions may obtain excellent functional results, adding the iliotibial band tenodesis to an intraarticular reconstruction significant improvement in stability and muscular strength was observed. Patients were able to resume all activities without pivoting.

Adolescent↗
PubMed2000

Bicipital tendinitis and tenosynovitis in the dog: a study of 15 cases.

AIM: To describe the clinical, radiographic, and sonographic features of 15 dogs with bicipital tendinitis and tenosynovitis, classify them according to cause, and evaluate the long-term efficacy of treatment. METHODS: Dogs exhibiting forelimb lameness with pain localised to the biceps tendon were included in the study. Sonographic examination of the tendon and tendon sheath, and radiographic examination including positive contrast arthrograms of the shoulder joint were performed, and assessed for features consistent with biceps tendon disease. In some cases, synovial-fluid analysis and surgical investigation were also undertaken. The causes of the conditions were classified as either traumatic, mechanical, neoplastic or inflammatory. Dogs were treated conservatively with rest and anti-inflammatory drugs, or surgically by either transection of the transverse humeral ligament or tenodesis of the biceps tendon. Assessment of the effects of treatment was made by re-examination at six weeks and from information gained by telephone interview with the dog's owner at longer-term follow-up. RESULTS: Bicipital tendinitis and tenosynovitis were common causes of forelimb lameness in active, middle-aged or older, medium to large-breed dogs. The most sensitive physical tests for localising pain to the biceps apparatus were shoulder flexion with the elbow extended, focal digital pressure applied directly to the biceps origin, and the biceps retraction test. Sonographic assessment was found to be more sensitive than shoulder radiography or arthrography for characterising the lesion. Conservative treatment of 11 traumatic cases resulted in good or excellent function at long-term follow-up. One mechanical bicipital tendinitis secondary to mineral deposits within the supraspinatus tendon improved following transection of the transverse humeral ligament and removal of the deposits. One of two cases of inflammatory tendinitis/ tenosynovitis improved following tenodesis. One dog with neoplastic disease did not improve and was euthanased. CONCLUSIONS: The diagnosis of bicipital tendinitis and tenosynovitis requires a careful examination using a combination of physical tests. Of the ancillary tests, sonography was the most reliable, however information gained from all tests was useful in fully evaluating the biceps apparatus and shoulder joint. The classification system employed in this study was helpful in selecting a treatment protocol and determining the likely prognosis.

Journal Article↗
PubMed2002

Twenty-year results of the Evans operation for lateral instability of the ankle.

Twenty-four patients (25 ankles), operated on using the static modification of the Evans tenodesis for lateral instability, were evaluated 19 to 21 years after surgery. Twelve of the patients (12 ankles) had excellent results, seven patients (eight ankles) had good results, three patients (three ankles) had fair results, and two patients (two ankles) had poor results. The subjective results had no clear correlation to the stress radiographs, which showed minor or moderate anterior talar translation in 10 ankles. Moreover, the difference between the surgically treated and the contralateral ankle was not significant. Static modification of the Evans tenodesis is recommended if an anatomic reconstruction of the lateral ligaments is not feasible (general laxity of joints, reoperation).

Adolescent↗
PubMed2006

A new modification of trapeziectomy and soft tissue interposition arthroplasty with abductor pollicis longus advancement.

A new modification of trapeziectomy, soft-tissue interposition arthroplasty with a one-half slip of the flexor carpi radialis tendon and advancement of the abductor pollicis longus tendon for treatment of thumb carpometacarpal degenerative arthritis and instability is presented. This procedure facilitates tenodesis of the flexor carpi radialis slip at the first metacarpal and realigns and rebalances the thumb posture by using and advancing the abductor pollicis longus tendon. Therefore, this new modification eliminates the need for perioperative pin fixation of the first metacarpal, offers better soft tissue tenodesis of the ligament reconstruction component of the procedure, and results in improved intraoperative thumb alignment.

Arthroplasty↗
PubMed2005

Intra-articular repair of an isolated partial articular-surface tear of the subscapularis tendon.

BACKGROUND: Partial-thickness tear of the subscapularis tendon in the articular surface is common. HYPOTHESIS: Intra-articular repair of a partial articular-surface tear of the subscapularis tendon will provide a successful outcome. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 29 shoulders with an isolated partial articular-surface tear of the subscapularis tendon without another rotator cuff lesion were treated with arthroscopic intra-articular repair using suture anchors. Biceps tenodesis was performed in 16 patients. Outcomes were prospectively evaluated at a mean of 27 months (range, 19-41 months) using 3 objective (University of California at Los Angeles, American Shoulder and Elbow Surgeons Shoulder Index, Simple Shoulder Test) and 2 subjective (pain and function visual analog scales) measurements. RESULTS: There were 21 men and 8 women, with a mean age of 54 years (range, 41-65 years). Tear widths were small (<1 cm) in 16 shoulders and large (>1 cm) in 13 shoulders. Twenty-six shoulders had articular cartilage erosion on the adjacent humeral head. Lesions of the biceps tendon were noted in 25 patients (partial tear in 15 shoulders; subluxation in 13 shoulders). Shoulder pain scores improved after surgery (5.0 +/- 2.7 to 0.3 +/- 0.7, P < .05). According to American Shoulder and Elbow Surgeons Shoulder Index scores, 18 were excellent; 10, good; and 1, fair. Internal rotation strength deficit improved from 32% to 4%. Twenty-six patients returned to more than 90% of previous activity. There were no surgical complications; tear size and biceps tenodesis did not affect outcome (P > .05). CONCLUSION: Arthroscopic intra-articular repair of a partial articular-surface tear of the subscapularis tendon is an effective procedure that spares the intact tendon attachment in the bursal surface. Short-term outcomes were reliable by both objective and subjective measurements.

Adult↗
PubMedDate not supplied

Secondary reconstruction of anterior cruciate ligament in athletes by using the semitendinosus tendon. Preliminary report of 78 cases.

Secondary reconstruction of the torn anterior cruciate ligament has been accomplished by semitendinosus tenodesis in 78 athletes (average age, 20 years; range, 13 to 45 years old). This series was limited to patients who had isolated tears of the ligament or tears of the anterior cruciate ligament associated with tears of one or both menisci. Meniscectomies were performed in 71 knees and reefing of the posteromedial capsular ligament in 35 knees. After an average of 11 months of follow-up (range, 6 to 29 months postoperatively), 67 (86%) of the patients have obtained significant improvement (0 to 1+ on a scale of 0 to 3+) in anteroposterior and anteromedial rotational instability of the joint. The viability and function of the reconstructed ligament was confirmed by direct visualization in three patients at 12, 25 and 26 months postoperatively. Reefing of the posteromedial capsular ligament appears to increase anteromedial rotation stability. This series will be expanded and the follow-up evaluations will continue over a period of years in an effort to determine whether or not semitendinosus tenodesis is superior to other methods of intraarticular reconstruction for a torn anterior cruciate ligament.

Adolescent↗
PubMedDate not supplied

Surgical treatment of anterolateral rotatory instability. A follow-up study.

Anterolateral rotatory instability in 31 acutely injured knees and 31 chronically unstable knees was surgically stabilized with a previously unreported method of iliotibial band tenodesis. The anterior cruciate ligament was stretched, torn, or absent in all 62 knees. Thirty-one patients, 20 with acute injury and 11 with chronic instability, were reviewed at a minimum of 2 years. A meniscal tear was present in 80% of the acute and in 91% of the chronic injuries. The anterior cruciate ligament was repaired, in addition to the iliotibial band tenodesis in 16 of the 20 acute injuries; there was no difference in the overall results between those repaired and not repaired. The evaluation of the patients was based on four subjective criteria (including functional parameters) and five objective criteria. Ninety-three percent of the patients had returned to competitive or recreational athletic activities involving cutting or pivoting movements. Both subjective and objective results were excellent or good in 93.6% of the patients. These results, based on our evaluation, warrant continued use of this procedure, according to the prescribed indications and technique.

Adolescent↗
PubMedDate not supplied

Anterior cruciate ligament repairs in world class skiers.

From 1979 to 1984, 27 skiers who were either present or past members of the United States Ski Team or professional skiers had 30 ACL tears that were repaired primarily. Only two of the repairs were augmented with autogenous patellar tendon grafts. Five patients had complete knee dislocations, including tears of both cruciate ligaments. Nineteen patients had a concomitant extraarticular iliotibial band tenodesis. Twenty-seven knees (24 patients) were followed an average of 57.6 months postoperatively. Recreational skiing was resumed at 5.4 months on average, and in ski racing and pivot-requiring sports all but three patients resumed participation at an average of 9.1 months. In 78% of the knees there was pain-free function. Mild pain was reported in 19%, the majority of which (4/5) was related to vigorous activity. Of the total, only two knees were reported to have a sensation of giving way. On clinical examination 85% (23/27) had normal pivot shift examination with no evidence of abnormal motion. Four percent (1/27) had a 1+ test and 11% (3/27) had "glides." Arthrometer measurements revealed an average of 7.76 mm anterior displacement with 20 pounds of force on the knee with an ACL repair as compared to 5.56 mm on the uninjured knee. The laxity measurements of knees with repaired ACLs fell within the range reported for uninjured knees in the normal population. Five patients had reinjuries to the ACL at an average time of 28 months postoperatively, with two of five undergoing rerepair. Only one patient had an iliotibial band tenodesis to supplement the original ACL repair.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

An in vitro study of an intraarticular and extraarticular reconstruction in the anterior cruciate ligament deficient knee.

The biomechanical effectiveness of an extraarticular ACL reconstruction, an intraarticular ACL reconstruction, and the combination of these on both anterior stability and internal rotational stability of the ACL deficient knee was investigated in six cadaver knees. The extraarticular reconstruction consisted of the Müller anterolateral femorotibial ligament iliotibial band tenodesis, and the intraarticular reconstruction used the middle third of the patellar tendon in the manner of Clancy. The extraarticular reconstruction was found to overconstrain internal tibial rotation of the ACL excised knee between 30 degrees and 90 degrees (P less than 0.05). While the isolated extraarticular reconstruction did not return normal anterior stability to the ACL deficient knee (P less than 0.05), it did significantly reduce the anterior laxity of the ACL deficient knee between 30 degrees and 90 degrees of knee flexion (P less than 0.05). For the combined reconstruction, the intraarticular procedure was performed and then only enough tension was applied to the extraarticular reconstruction to take up slack in the tenodesis without shifting the rotatory position of the tibia from that produced by the intraarticular procedure alone. Neither the intraarticular reconstruction nor the combined procedure resulted in any significant shifts from normal (P less than 0.05) in the rotatory position of the unloaded tibia; during loading neither resulted in rotational displacements significantly different from normal; and both of these procedures reduced the increased anterior laxity of the ACL deficient knee to a level not statistically different from normal. Because the extraarticular reconstruction shared the load when performed with the intraarticular reconstruction as part of a combined procedure, we concluded that it would be useful as an adjunctive procedure in appropriate clinical situations.

Adult↗
PubMed2006

Distal anatomical relationship of the flexor hallucis longus and flexor digitorum longus tendons.

BACKGROUND: The distal attachment of the flexor hallucis longus (FHL) tendon with the flexor digitorum longus (FDL) tendon varies antomically. The presence of a strong link between the two tendons can preserve distal function if one of the tendons is used for transfer. METHODS: Twenty-four cadaver legs were dissected, and the distal relationship of the FHL tendon with the FDL tendon was analyzed. The width of the tendons and their attachments were measured to the closest 0.5 mm. RESULTS: Three different configurations were found. In type 1, a tendinous slip branched from the FHL to the FDL (10 of 24 feet). In type 2, a slip branched from the FHL to the FDL and another from the FDL to FHL (10 of 24). In type 3, no attachment was present (four of 24). In four cadavers the attachment was different in the right and left feet. CONCLUSION AND CLINICAL RELEVANCE: The absence of a cross connection between the two tendons in the foot may be more frequent than previously reported. Three configurations of the anatomical relationship of the distal FDL to FHL tendons were found in this study with a small sample size. Based on these findings, to preserve the distal function of the FDL after transfer of the proximal FDL tendon, routine tenodesis should be done or a wider exposure and tenodesis in type 3 variations.

Aged↗