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At least 235 records · Page 13Linked to original sources
PubMed1990

The treatment of spastic planovalgus foot deformity in the neurologically impaired adult.

The surgical correction of 14 feet with spastic planovalgus in the neurologically impaired adult is reviewed. Evaluation of the patterns of lower extremity muscle activity preoperatively by dynamic EMG showed overactivity of the peroneus longus. A new gait pattern which has not been previously reported was observed. This "combination foot" deformity, noted in six patients, consists of equinovarus in swing, and planovalgus in stance during the gait cycle. The remaining eight patients exhibited planovalgus in swing and stance. Transfer of the peroneus longus tendon to either the cuboid or navicular was performed in seven (50%) patients. Release of the peroneus longus was performed in four (29%) patients. Two patients had Z-lengthening of the peroneus longus, and tenodesis of the peroneus longus to posterior tibialis was performed in one patient. The mean postoperative follow-up time was 34.6 months. All feet were plantigrade. Ten (71%) feet were balanced. Four (29%) feet were improved. There were no failures or complications. Thirteen patients were able to ambulate independently after surgery and one patient continued to require only stand-by-assistance secondary to balance problems. No patient decreased in ambulation level. Seven (64%) of the 11 patients who required bracing, preoperatively became brace free. Peroneus longus was found to be the major deforming force in spastic planovalgus. Release, transfer, or tenodesis of the peroneus longus is effective in correcting planovalgus.

Adult↗
PubMed1991

Repair of fibular ligaments: comparison of reconstructive techniques using plantaris and peroneal tendons.

The results of treatment of chronic ligamentous insufficiency of the lateral hindfoot using plantaris tendon grafting (52 ankles) or peroneal tenodesis (128 ankles) were compared with an average followup of 66 months. In two-thirds of all cases an instability of the subtalar joint was present, isolated or combined with an instability of the talocrural joint. The overall outcome with both methods was good, but the results after plantaris repair were slightly more favorable. This fact is underlined by the frequency of reoperations: 1.9% after plantaris repair compared with 9.4% after peroneal tenodesis. We conclude that plantaris repair is the method of choice.

Adolescent↗
PubMed1992

Stabilization of the interphalangeal joint of the big toe: comparison of three methods.

Three methods of stabilizing the IP of the big toe were compared. In group A, 10 patients underwent tenodesis of the extensor hallucis longus to the extensor digitorum brevis tendon. All of them developed a toe-drop; two patients had significant symptoms that required IP fusion. In group B, 19 patients underwent IP fusion using smooth or threaded intramedullary Kirschner wire fixation. There were nine nonunions, three requiring refusion. In group C, 32 patients underwent IP fusion using intramedullary screw fixation. There was one nonunion with screw failure that required revision. Although none of our patients considered the toe-drop after extensor hallucis longus tenodesis cosmetically unacceptable, this may not be so in other cultures. All complications following IP fusion with screw fixation were technical and are avoidable. When stabilization of IP is required, we recommend fusion of IP with screw fixation.

Adolescent↗
PubMed1986

Anterior cruciate ligament reconstruction using part of the patellar tendon as a free graft.

We have reviewed 40 patients after replacement of a ruptured anterior cruciate ligament with a free graft of the medial third of the patellar tendon, combining this in 17 of the cases with a MacIntosh extra-articular tenodesis. The average age of the patients at operation was 25.4 years; instability of the knee had been present for 1.5 to 9 years, and the mean follow-up was 2.9 years. The results, assessed on subjective stability, were good in 29 patients, over half being able to return to their original sport, and fair in eight. The technique of operation for free patellar tendon grafting is described in detail and the indications for this and for an additional MacIntosh tenodesis are discussed.

Adolescent↗
PubMed1995

The role of the long head of the biceps brachii in superior stability of the glenohumeral joint.

We studied seven patients who had isolated loss of the proximal attachment of the tendon of the long head of the biceps brachii, documented operatively or with magnetic resonance imaging, in order to identify and measure superior translation of the humeral head on the glenoid. Four true anteroposterior radiographs were made of both shoulders, before and after the operation, with 0, 45, 90, and 120 degrees of humeral abduction in the scapular plane. Four patients were managed with arthroscopic acromioplasty with an open biceps tenodesis; one, with open biceps tenodesis alone; and one, with debridement of a ruptured biceps stump; the remaining patient was managed non-operatively. Two to six millimeters of superior translation of the humeral head was noted in each patient in all positions of humeral abduction except 0 degrees. This translation was significant compared with the contralateral (control) shoulder. Kappa statistical analysis showed excellent reproducibility and interobserver reliability of the technique of radiographic measurement. The results of this study support the role of the tendon of the long head of the biceps brachii as a stabilizer of the humeral head in the glenoid during abduction of the shoulder in the scapular plane.

Adult↗
PubMed1998

Results of the modified Sauvé-Kapandji procedure in the treatment of chronic posttraumatic derangement of the distal radioulnar joint.

We reviewed the results of a modified Sauvé-Kapandji procedure with tenodesis of the flexor carpi ulnaris to the carpus in eighteen patients who had chronic derangement of the distal radioulnar joint. There were fourteen men and four women. The mean supination of the forearm had improved from 16 degrees (range, 0 to 75 degrees) preoperatively to 76 degrees (range, 40 to 90 degrees) at the time of the latest follow-up, and the mean pronation had improved from 42 degrees (range, 0 to 80 degrees) preoperatively to 81 degrees (range, 60 to 90 degrees) at the time of follow-up. Pain relief was satisfactory, and the mean grip strength had improved from 36 percent of that on the unaffected side preoperatively to 73 percent at the time of follow-up. One patient had moderate pain over the ulnar stump associated with residual volar instability of the proximal ulnar segment, and he had a tenodesis of the extensor carpi ulnaris as a second procedure. Another patient had mild instability of the stump only after he had a second operation, which was an excision of a bone mass (ossification) in the resected area. The ulnar stump was stable in sixteen patients. Eight of the eleven patients who had performed heavy manual labor before the injury were able to return to work full-time without restrictions. According to a modification of the wrist-scoring system of the Mayo Clinic, at a mean of four years and two months (range, two years to eight years and four months), six patients had an excellent result; seven, a good result; four, a fair result; and one, a poor result. On the basis of our findings, we believe that the index operation is an excellent salvage procedure for the treatment of chronic posttraumatic derangement of the distal radioulnar joint, especially when nonoperative treatment has been unsuccessful and rotation of the forearm is severely limited.

Adult↗
PubMed1999

Treatment of posterior tibial tendon dysfunction with tendon procedures from the posterior muscle group.

The use of tendons from the posterior muscle group, specifically the FDL, as a means to repair PTTD is useful for the early stages of the deformity. Once the patient has reached the later stages and the foot becomes rigidly deformed with loss of the medial longitudinal arch, however, any attempt to reconstruct the area with tendon work alone fails. Tendon repair, tenodesis, and tendon transfer are attractive treatment options for PTTD, but care should be taken in choosing the correct patient for these procedures. Some authors note that side-to-side tenodesis does not address arch realignment. Other procedures combined with tendon work perhaps can help to reduce the shortcomings of isolated tendon procedures. Subtalar joint arthroeresis in combination with the tendon work seems to solve this problem. The authors have begun to explore this option and have performed this procedure on some patients. It is premature to address the effectiveness of this combined procedure. Similarly, tendon procedures augmented with other soft-tissue-type procedures also remains an option and is mostly ignored in the medical literature. Deland et al experimented with reconstruction of the spring ligament in a cadaver study, and believed that it should be considered in any reconstructive flatfoot surgery. Likewise, Myerson used some capsular reefing of the talonavicular joint in his tendon reconstruction to aid the correction of the forefoot-to-rearfoot relationship. The treatment of the patient with PTTD remains driven by the surgeon's preference, with little scientific research to guide him or her. There is much controversy regarding the efficacy of tendon procedures and the specific surgical technique of each procedure. Some variations may prove inconsequential, whereas others may prove revolutionary. The authors believe that the use of the tendon work as a means of treatment for PTTD is viable alone or in combination with other procedures. Much research is still needed to identify the best technique for each stage of the deformity. Wiekland has attempted to do this, but unfortunately has not offered any long-term follow-up to justify his treatment algorithms. Foot and ankle specialists should strive for clinical research, which allows better understanding of the appropriate treatment options for each progressive stage of PTTD.

Ankle↗
PubMed1999

Management of anterior cruciate ligament lesions: surgical fashion, personal whim or scientific evidence? Study of medium- and long-term results.

The medium- and long-term results of conservative and surgical treatment of ACL lesions were evaluated by analysis of the current literature. Only reports with a minimum follow-up of 4 years were taken into account. Concerning conservative treatment, the literature search revealed only 7 papers with a total of 636 cases. Reports on the results of surgical treatment were separated into four categories: primary repair, with 13 papers (1205 cases), extraarticular tenodesis, with 4 papers (232 cases), ACL reconstruction, with 26 papers (2693 cases) and ACL prosthetic replacement (reconstruction using synthetics) with 5 papers (370 cases). The mean functional scores show about 70% good and excellent results for all treatment regimens. Clinical laxity persists in almost all conservatively treated cases, in almost half of the cases with primary repair, extra-articular tenodesis, and synthetic substitution, and in almost one-third of the cases with ACL reconstruction. The incidence of secondary ACL surgery was lowest in the conservative group (4.6%), whereas secondary meniscus surgery was lowest in the ACL reconstruction group (3.5%). Compared with the conservative group (12%), surgical treatment evolved to a higher osteoarthritic morbidity. Sports participation was higher in the ACL reconstruction group. This analysis may provide a more realistic view on the outcome of treatment of ACL lesions, and on the relationship between treatment, activity level and osteoarthritis.

Anterior Cruciate Ligament↗
PubMed2000

[Injuries of the inferior tibiofibular syndesmosis].

The incidence of isolated distal tibiofibular syndesmotic ruptures in acute ankle sprains lies between 1% and 11%. These injuries are frequently overseen or misdiagnosed as anterolateral rotational instability of the ankle and often become apparent through protracted courses. Although the pathomechanics and extent of syndesmotic injuries have been systematically described by Lauge-Hansen and Weber, no generally accepted guidelines exist as to when these complex injuries are to be treated surgically to ensure sufficient and stable healing of the syndesmosis besides correct alignment of the distal fibula. So far, systematic follow-up regarding syndesmotic injuries in ankle fractures is missing, although it has long been recognized that tibiofibular diastasis secondary to chronic syndesmotic instability leads to external rotation of the talus. In combination with a valgus position of the talus, this instability leads to a decrease in the contact area which results in posttraumatic arthritic changes. This paper reviews the standard diagnostic and therapeutic procedures for acute syndesmotic ruptures in fracture dislocations of the ankle. Among the few corrective procedures advocated for chronic syndesmotic insufficiency are tibiofibular arthrodesis, synthetic ligament substitutes, and tenodesis with the peroneus brevis tendon. A sufficient reconstruction must restore the stability of the ankle mortise and alignment of the fibula in the tibiofibular incisura to ensure limitation of talar rotation. Therefore, a tenodesis was developed which substitutes the three important ligaments of the syndesmotic complex. The Casting procedure for chronic syndesmotic insufficiency was modified with reconstruction of the interosseous tibiofibular ligament in addition to the anterior and posterior tibiofibular ligaments. The resulting three-point fixation of the distal fibula appears more anatomically, physiologically, and biomechanically advantageous. The operative procedure is given in detail. Distal tibiofibular syndesmosis. Persistent instability of the distal syndesmosis. Ankle fractures. Syndesmotic screw.

Ankle Injuries↗
PubMed2001

[Intra- and extra-articular hamstring reconstruction of anterior cruciate ligament tears].

We examined a reconstruction technique for tears of the anterior cruciate ligament using the hamstring tendons. The tendons were harvested en bloc, leaving the tibial insertion intact. Three intra-articular strands (two semitendinous and one gracilis) and lateral tenodesis were used with continuity via the gracilis. The intra-articular procedure was performed arthroscopically with tunneling laterally to medially to achieve the best position. Ligamentoplasty was performed in 262 cases. Outcome was satisfactory. This method preserves the lateral iliotibial sheath and spares the extensors apparatus. It is particularly interesting for reconstruction of anterior cruciate ligament tears when a lateral tenodesis appears to be necessary.

Anterior Cruciate Ligament Injuries↗
PubMed2002

[Seventeen year outcome after anterior cruciate ligament reconstruction with a intact or repaired medial meniscus].

PURPOSE OF THE STUDY: Ten-year outcome of anterior cruciate ligament (ACL) reconstruction was previously reported (1992-1993) for 148 patients who had ACL free grafts associated with extra-articular tenodesis. In this retrospective study, we examined the functional and radiological changes observed 17 years after surgery in patients whose menisci were intact or repaired at ACL reconstruction (46 cases). These patients were operated on between 1978 and 1983. MATERIAL AND METHODS: Between January and April 1999, 28 patients were reviewed clinically and radiographically. Nine other patients responded to a questionnaire and three of them sent their x-rays. Two patients had died since the last review and 7 were lost to follow-up. Mean age at follow-up was 41 years. The IKDC classification was A 18.5%, B 51%, C 22.2%, D 7.4% in 26 patients reviewed with the passive radiological Lachman. At subjective analysis (n=37), 70% of the patients were very satisfied and 27% were satisfied. At radiological analysis (n=31), the AP or lateral single-limb stance views and the AP two-limb weight bearing views at 45% flexion demonstrated preosteoarthritis in 22% and osteoarthritis in 3%. Residual anterior tibial translation was the same at 11 years and 17 years follow-up. DISCUSSION: This study clearly demonstrates that ACL reconstruction associated with extra-articular tenodesis can provide good functional and radiological results at 17 years mean follow-up for patients with preserved (sound or sutured) menisci. The status of the medial meniscus at long-term follow-up appears to be the key feature determining the low rate of degenerative changes.

Adult↗
PubMed1992

[Results of surgical treatment of proximal biceps tendon rupture].

During a 9-year period we operated on 19 patients in whom the proximal tendon of the biceps brachii muscle had been disruptured. Various surgical techniques were employed, such as refixation at the processus coracoideus, tenodesis in the sulcus intertubercularis, keyhole operation, in combination with an intraarticular inspection, revision, or if necessary widening of a narrow passage ("defile"). Follow-up was possible in 15 patients for an average period of 3 years after the operation, in respect of clinical, roentgenological and isokinetic findings. Results were mainly good while employing a variety of different surgical techniques; in only 3 patients the shoulder function remained restricted, painful and/or weakened. The isokinetic maximum torque was either increased on the operated side (after coracoid refixation) or reduced (after tenodesis in the sulcus). The underlying biomechanical causes are explained. Good results can be obtained in surgical treatment of the rupture of the proximal biceps tendon provided the procedure is accurately executed while taking into consideration, at the same operation stage, the associated pathology of the rotatory cuff. For biomechanical reasons, preference should be given to the operations according to Hitchcock and Bechtol in respect of refixation, and to the keyhole operation method.

Adult↗
PubMed2003

[Entrapment of the long head of the biceps: the "hourglass biceps". Another cause of pain and locking of the shoulder].

PURPOSE OF THE STUDY: We describe a mechanical condition affecting the long head of the biceps tendon (LHBT) causing potentially unrecognized entrapment within the joint and subsequent pain and locking. This is caused by a hypertrophic intra-articular portion of the tendon that is unable to slide into the bicipital groove during elevation of the arm. MATERIALS AND METHODS: Twenty one patients were identified, during open (14 cases) or arthroscopic (7 cases) surgery, with a so called "hourglass biceps" i.e., hypertrophic intraarticular portion of the LHBT and incarceration of the tendon during elevation. All cases occurred in conjunction with a rotator cuff rupture except one who had a partial deep tear. All patients were treated by excision of the biceps, after tenodesis or bipolar tenotomy, and appropriate treatment of the concomitant lesions. RESULTS: All patients presented with anterior shoulder pain and loss of passive elevation averaging 10-20 degrees. A dynamic intraoperative test involving forward elevation with the elbow extended demonstrated entrapment of the tendon within the joint in each case. This test creates a characteristic "buckling" of the tendon and "squeezing" of the tendon between the humeral head and the glenoid ("hourglass test"). Excision of the tendon allowed immediate restoration of complete elevation. Mean Constant score increased from 38 points to 76 points postoperatively. DISCUSSION: The "hourglass biceps" is caused by a hypertrophic intraarticular portion of the tendon that is unable to slide into the bicipital groove during elevation of the arm. Loss of 10-20 degrees of passive elevation, bicipital groove tenderness, and radiographic findings of a hypertrophied tendon can aid in diagnosis. The "hourglass biceps" should not be misdiagnosed for a frozen shoulder. Definitive diagnosis is made at surgery with the "hourglass test": incarceration and squeezing of the tendon within the joint during forward elevation of the arm with the elbow extended. Simple tenotomy cannot resolve this mechanical block. Either tenotomy with excision of the intraarticular portion of the LHBT or tenodesis must be performed. The "Hourglass" biceps is an addition to the familiar pathologies of the long head of the biceps tendon (tenosynovitis, prerupture, rupture, instability), and should be considered in any case of chronic anterior shoulder pain associated with a loss of shoulder elevation.

Aged↗
PubMed1985

Lesions of the long head of the biceps tendon.

Lesions of the long head of the biceps tendon are generally a component of a diffuse degenerative process involving the subacromial space including the rotator cuff, bursa, biceps tendon, and possibly the acromioclavicular joint. As such, surgical approaches should be designed to treat each component not restricting the surgery to a biceps tenodesis. On occasion bony injury directly to the bicipital groove may result in an inflammatory process in the tendon or even dislocation of the tendon if there was damage to the lesser tuberosity and subscapularis tendon. In these patients biceps tenodesis and coracoacromial ligament excision is advised. The entity of a "subluxating biceps tendon" without damage to the lesser tuberosity or subscapularis is a diagnosis that we are unable to reliably arrive at. It appears that most patients with biceps instability have combined tuberosity or rotator cuff injury allowing the tendon to migrate medially. Ruptures of the long head of the biceps are generally associated with rotator cuff disease, but a localized process secondary to trauma or injections may account for some ruptures. Nearly all are managed conservatively, but the patient is followed closely and forewarned regarding possible rotator cuff degeneration. In young patients a more aggressive approach including shoulder arthrography and early repair, if a cuff tear is noticed, would be recommended if one would hopefully arrest the degenerative process.

Humans↗
PubMed1985

Reconstruction of the thumb in tetraplegia following spinal cord injury.

Functional positioning of the thumb is paramount to the restoration of lateral pinch to the hands in patients with tetraplegia as the result of spinal cord injury. Useful lateral pinch can be provided to patients with at least wrist extension control preserved by use of a combination of flexor pollicis longus tenodesis or transfer and carpometacarpal and inter phalangeal joint stabilization. In patients who retain function in the brachioradialis, extensor carpi radialis longus and brevis, pronator teres, and flexor carpi radialis, strong grasp as well as effective lateral pinch can be restored to the hand by surgery. Thumb control for flexion and extension is provided by tendon transfer to the flexor pollicis longus and tenodesis or transfer to the extensor pollicis longus. Proper positioning for lateral pinch can be accomplished by either arthrodesis of the first metacarpal-trapezial joint or tendon transfer to restore adduction-opposition to the thumb. The surgical concepts presented in this paper have been applied to the functional reconstruction of the hands of more than 50 patients with spinal cord injury during the last 15 years. The patients have been pleased with the significant improvement in function, strength, and speed that has resulted from surgery and have been cooperative advocates as the alternate methods of thumb control have been evaluated.

Arthrodesis↗
PubMed1981

[Biomechanics, technique and results of fibular ligamentous grafting at the ankle joint (author's transl)].

The grafting operations according to Watson-Jones and Evans in old fibular capsular ligament lesions of the ankle joint have the effect of tenodesis as far as the talo-calcaneo-navicular joint ist concerned, since especially the natural course of the ligamentum calcaneofibulare, which requires substitution, is not considered. The authors conducted a search for the most favourable course when replacing the ligamenta talofibulare anterius and calcaneofibulare, using a thread model on ankle joint preparations. It is only the direct replacement of these ligaments which is most likely to ensure free mobility of ankle joint and the talo-calcaneonavicular joint with optimal joint stabilization. Courses proceeding differently will lead either to tenodesis or to slackening of the ligamentous replacement without producing a stabilizing effect. From the author's own patient, two groups with anatomically compatible ligamentous replacement with lyodura (n = 12) or with a modified graft of the short peroneal muscle (n = 8) were compared with each other. In accordance with the experimental results, the main difference between the two processes was the restriction in supination of the talo-calcaneo-navicular joint. The authors conclude from their results that duraplasty, which follows the anatomical course of the ligaments to be replaced, is indicated particularly in such patients who require free supination of the foot because they are active in certain types of sport where this is essential.

Ankle Injuries↗
PubMed1982

[Treatment of anterior sternoclavicular dislocations. Apropos of 18 cases].

Eighteen cases of subluxation or dislocation of the sterno clavicular joint are reported. Six subluxations have been treated conservatively with prompt and good recovery. Out of twelve dislocations, three have not been operated on : two have recovered satisfactorily, after wiring and capsular suture (two recent cases) and after wiring and ligamentoplasty with palmaris longus (two old cases). But capsular suture and wiring gave only a fair result in one case of recurring dislocation, while tenodesis after Jackson Burrows gave excellent results in three cases. In recent cases, open reduction with wiring and capsular suture is advised, and tenodesis with subclavius, every time capsular suture is unsatisfactory and in all ancient and recurring cases, when troublesome.

Adolescent↗
PubMed1984

[Electromyographic analysis of the leg muscles in the hemiplegic patients with equinovarus deformity of the foot].

A series of EMG study of the leg muscles was carried out with a wire electrode in 86 hemiplegic patients of stroke to visualize the role of each muscle either in the development of equinovarus deformity of the foot or in correcting the deformity through tendon transfer. The muscles examined were anterior tibialis, posterior tibialis, gastrocnemius, soleus, flexor digitorum longus and peroneus brevis of the affected side. Tonic discharge of those muscles was recorded as the patients were elevating the affected leg in supine, sitting or standing posture or were standing on legs. On lifting up the affected limb, most patients showed electrical activity of anterior tibialis with or without simultaneous activity of other muscles, most frequently with that of flexor digitorum longus or gastrocnemius. When the patient stood on legs electromyographic discharge appeared most frequently in soleus. Varus deformity of the foot significantly correlated to the lack of the electrical activity of peroneus brevis. Both such abnormal activity of anterior tibialis and the lack of activity of peroneus seemed to be the main causes for the varus deformity. Postoperative EMG study in the patients who underwent Watkins-Barr procedure of anterior transfer of the posterior tibialis tendon, showed that the posterior tibialis was rather inactive both in elevating the leg and in standing on legs. Varus deformity was corrected independent of the discharge of posterior tibialis. The author concluded that the correction of the varus deformity after Watkins-Barr procedure was mainly obtained from the tenodesis effect. The tenodesis provides the checkline effect on the equinus and varus deformity, which reinforces the dorsiflexing action of anterior tibialis and attenuates its inverting action of the same muscle.

Adult↗