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At least 253 records · Page 14Linked to original sources
PubMed1998

Free tendon interposition grafting for the repair of ruptured extensor tendons in the rheumatoid hand. A clinical and biomechanical assessment.

Sixteen ruptured extensor tendons were repaired in seven rheumatoid hands using autogenous palmaris longus tendon as a free interposition graft. The patients were reviewed at an average of 17 months (range, 5-45) after repair. Subjectively all patients were satisfied with the clinical results, and achieved a return to their level of ability before tendon rupture. A biomechanical model suggests that tendon repair using an interposition graft, rather than a traditional end-to-side tendon transfer retains the anatomical axis of tendon function, and achieves greater forces during active finger extension.

Adult↗
PubMed1988

Recent simple flexor tendon injuries in zone I, II, III of Verdan. Results of tendon repairs concerning 115 fingers in 99 patients.

In this study, the authors analyze 197 recent injuries of the flexor tendons of fingers in zones I, II and III of Verdan, without complex cutaneous lesions, associated with an injury of one or both digital nerves, but leaving safe at least one digital artery. Tendon repair is either followed by strict immobilization or by Kleinert's method of immobilization. Results concerning 115 reviewed injuries evaluated according to Kleinert's criteriae, show a net superiority of Kleinert's technique compared to strict immobilization. Global results are analysed according to the age, the finger injured and the presence of a work accident. Lesions treated by Kleinert's technique have been analyzed according to the zone of injury, the tendon injured in zone II and the existence or not of an injured digital nerve. After Kleinert's method, factors affecting the prognosis are lesions in zone II, injury of both tendons, lesions of the fifth finger, the responsibility of a "work accident". The authors conclude as to the correct time for repair, the tendons to be repaired and the type of injuries to be immobilized. They also emphasize the progress brought to the surgery of flexor tendons by Kleinert's method.

Adolescent↗
PubMedDate not supplied

Combined anterior tibial tendon rupture and posterior tibial tendon dysfunction in advanced flatfoot.

The combination of spontaneous anterior tibial tendon rupture and posterior tibial tendon dysfunction has rarely been reported in the literature. This is a case report of a 78-year-old patient presenting with a history of longstanding, progressive flatfoot deformity, clinically grade III posterior tibial tendon dysfunction, and dropfoot gait. Radiographic films revealed severe flatfoot, and the clinical examination was consistent with a complete rupture of the anterior tibial tendon and severe posterior tibial tendon degeneration as well as rupture of the spring and deltoid ligaments. Treatment by triple arthrodesis and repair of the anterior tibial tendon affected pain relief and clinical as well as radiographic correction at the 4-month postoperative assessment.

Aged↗
PubMed2001

Zone II tendon repairs augmented with autogenous dorsal tendon graft: a biomechanical analysis.

We investigated the biomechanical properties of a new technique for tendon repair that reinforces a standard suture with an autogenous tendon graft. A dynamic in situ testing apparatus was used to test 40 flexor digitorum profundus tendons harvested from fresh-frozen cadaver hands. The tendons were cut and repaired using 1 of 4 suture techniques: 2-strand modified Kessler, 4-strand modified Kessler, 6-strand modified Savage, and 2-strand modified Kessler augmented with autogenous dorsal tendon graft. The augmented repair uses 1 slip of the flexor digitorum superficialis tendon secured to the dorsal surface of the repair site with a continuous stitch. Ultimate tensile strength, resistance to gap formation, and work of flexion were measured simultaneously on an in situ tensile testing apparatus. No significant difference in tensile strength was found between the augmented repair and the 6-strand Savage repair. The augmented repair and the 6-strand Savage repair showed significantly greater ultimate tensile strength than the 2- and 4-strand repairs. The augmented repair had significantly greater resistance to 2 mm gap formation than the other 3 repairs. We were unable to show a significant difference in work of flexion between the repairs with the numbers tested (n = 10). Our findings suggest that the augmented repair is strong enough to tolerate the projected forces generated during active motion without dehiscence or gap formation at the repair site.

Biomechanical Phenomena↗
PubMed2004

Contralateral tendon rupture risk is increased in individuals with a previous Achilles tendon rupture.

The purpose of this study was to examine the outcome after surgery for an acute Achilles tendon rupture. In particular, we wanted to study whether persons who have suffered an Achilles tendon rupture are at greater risk of a contralateral tendon rupture. From September 1990 to April 1997, 168 acute Achilles tendon ruptures in 26 women and 142 men were treated operatively. In August 1998 (median: 4.2 years post injury), 154 of these patients (92%) responded to a follow-up questionnaire. Local symptoms (pain, decreased strength and/or reduced range of motion) were reported pre injury by 25% of the patients; at follow-up this had increased to 52%. Ten patients (6%) experienced a rupture on the contralateral side during the follow-up period (OR: 176 [70-282] vs. the expected rate based on the general population risk of this injury, P<0.001). Thus, this study suggests that patients with an Achilles tendon rupture are at significantly increased risk of a contralateral tendon rupture, as well. Also, as many as half of the patients suffered from post-injury problems at long-term follow-up.

Achilles Tendon↗
PubMed2005

Structural Achilles tendon properties in athletes subjected to different exercise modes and in Achilles tendon rupture patients.

The prevalence of Achilles tendon (AT) injury is high in various sports, and AT rupture patients have been reported to have a 200-fold risk of sustaining a contralateral rupture. Tendon adaptation to different exercise modes is not fully understood. The present study investigated the structural properties of the AT in male elite athletes that subject their AT to different exercise modes as well as in Achilles rupture patients. Magnetic resonance imaging of the foot and leg, anthropometric measurements, and maximal isometric plantar flexion force were obtained in 6 male AT rupture patients and 25 male elite athletes (kayak/control group n = 9, volleyball n = 8 and endurance running n = 8). AT cross-sectional area (CSA) was normalized to body mass. Runners had a larger normalized AT CSA along the entire length of the tendon compared with the control group (P < 0.05). The volleyball subjects had a larger normalized CSA compared with the control group (P < 0.05) in the area of thinnest tendon CSA. No structural differences of the AT were found in the rupture subjects compared with the control group. Rupture subjects did not subject their AT to greater force or stress during a maximal voluntary isometric plantar flexion than the other groups. The CSA of the triceps surae musculature was the strongest predictor of AT CSA (r(s) = 0.569, P < 0.001). This study is the first to show larger CSA in tendons that are subjected to intermittent high loads. AT rupture patients did not display differences in structural or loading properties of the tendons.

Achilles Tendon↗
PubMed2001

Outcome following addition of peroneus brevis tendon transfer to treatment of acquired posterior tibial tendon insufficiency.

The flexor digitorum longus, the tendon most often used for transfer in posterior tibial tendon insufficiency, is one-half to one-third the size of the posterior tibial tendon. Occasionally it may be particularly small or may have been previously used for transfer. In these cases, the senior author has felt that the addition of a transfer of the Peroneus Brevis (PBr) tendon may be helpful in maintaining sufficient tendon and muscle mass to rebalance the foot. Thirteen patients who underwent this procedure were retrospectively identified and matched by age and length of follow-up to patients who underwent a more standard tendon transfer operation minus the addition of the PBr transfer. Pain and functional status were then assessed by the American Orthopaedic Foot and Ankle Society's ankle/hindfoot rating scale. Each patient was tested by an independent physical therapist to evaluate inversion and eversion strength. The mean duration of follow-up was 20.6 months (12 to 34 months). The average AOFAS score of the PBr group was 75.8 compared to 71.5 for the standard control group. There was no significant difference between the groups when inversion or eversion strengths were compared. Inversion strength and eversion strength was rated good or excellent (4 or 5) in 12 out of 13 of the PBr transfer group patients. No major complications were encountered in either group. Although it does not increase inversion strength, a PBr transfer can be used to augment a small FDL without causing significant eversion weakness. This can be useful when the FDL is particularly small or in revision surgery.

Calcaneus↗
PubMed1997

Rupture of the posterior tibial tendon. Evaluation of injury of the spring ligament and clinical assessment of tendon transfer and ligament repair.

Eighteen of twenty-two patients who were having a tendon transfer to treat rupture of the posterior tibial tendon had evidence of injury to the spring ligament. The injury consisted of a longitudinal tear in the ligament in seven patients, a lax ligament without a gross tear in seven, and a complete rupture of the ligament in four. The ruptured posterior tibial tendon was treated with transfer of the flexor digitorum longus in twenty of the twenty-two patients. A variety of methods were used to repair the ligament. It is essential to determine the status of the spring ligament when patients are managed for rupture of the posterior tibial tendon. Patients who have a torn or lax spring ligament in addition to the ruptured posterior tibial tendon may have more severe abnormalities of the hindfoot than those who have only a ruptured tendon.

Adult↗
PubMed2002

Reconstruction of a ruptured patellar tendon with achilles tendon allograft following total knee arthroplasty.

BACKGROUND: Rupture of the patellar tendon after total knee arthroplasty is a rare and debilitating complication. Proper surgical management of this condition remains controversial. The purpose of this study was to review the results of reconstruction of a ruptured patellar tendon with an Achilles tendon allograft following total knee arthroplasty. METHODS: We reviewed our experience with the use of a fresh-frozen Achilles tendon allograft with an attached calcaneal bone graft to restore extensor function in nine patients with patellar tendon rupture following total knee arthroplasty (five primary and four revision). All patients were examined clinically and radiographically at an average of twenty-eight months. RESULTS: The average knee and functional scores improved from 26 and 14 points, respectively, before the surgery to 81 and 53 points after the surgery. The average extensor lag decreased from 44 degrees preoperatively to 3 degrees postoperatively, and the average range of motion of the knee increased from 88 degrees to 107 degrees. Two grafts failed in the early postoperative period. Both were repaired successfully. Radiographs showed an average proximal patellar migration of 17.8 mm, which did not appear to affect extensor function. CONCLUSIONS: This short-term follow-up study showed that once an Achilles allograft has healed, it can serve as a reliable reconstruction of a ruptured patellar tendon following total knee arthroplasty. This technique may be particularly suited for patients in whom the extensor mechanism was compromised by multiple prior operations. Continued follow-up is necessary to determine the long-term durability of these results.

Achilles Tendon↗
PubMed2001

A growth and differentiation factor-5 (GDF-5)-coated suture stimulates tendon healing in an Achilles tendon model in rats.

Growth and differentiation factor-5 (GDF-5) is essential for normal skeletal development and induces tendon-and ligament-like structures at ectopic sites. Therefore, we investigated the influence of a GDF-5-coated suture on the healing Achilles tendon in rats. The right Achilles tendon in 80 rats was transected and sutured with an absorbable polyglactin suture. Animals were randomized to an uncoated-suture control and a GDF-5-coated suture group. At 1, 2, 4 and 8 weeks after surgery the repair tissue was evaluated biomechanically and histologically. Biomechanical testing revealed significantly thicker tendons, which were stiffer at 1, 2, and 4 weeks, in the experimental group than in the control group. The maximum tensile strength was significantly increased at 2 weeks after surgery. Histologically we found cartilage-like cell nests 4 weeks after tendon repair, which were positive for type II collagen. In conclusion, local growth factor delivery by a coated suture material showed a promising beneficial effect on tendon repair. The appearance of cartilage-like structures may demonstrate the chondroinductive capacity of GDF-5, which in these circumstances, however, might be overcome by modifications of the GDF-5 dose and/or the suture material.

Achilles Tendon↗
PubMed2006

[Primary surgical repair with the Krackow technique combined with plantaris tendon augmentation in the treatment of acute Achilles tendon ruptures].

OBJECTIVES: We evaluated the long-term results of acute Achilles tendon ruptures treated with primary end-to-end repair with the Krackow technique combined with augmentation using the plantaris tendon. METHODS: Thirty-six patients (31 males, 5 females; mean age 34 years; range 21 to 42 years) underwent primary surgical repair for acute Achilles tendon ruptures. Most of the patients (31/36) were involved in regular sportive activities. Surgery included end-to-end repair with the Krackow technique (locking-loop) combined with plantaris tendon augmentation. All the patients received a standardized progressive postoperative rehabilitation program. The results were evaluated with respect to time to return to work and preinjury activity levels and by a scoring system covering objective and subjective parameters. The mean follow-up was 54 months (range 28 to 78 months). RESULTS: At surgery, 34 patients (94.4%) and two patients (5.6%) were found to have complete and partial ruptures, respectively. The mean operation time was 50 minutes (range 40 to 70 minutes). The patients returned to work after a mean of eight weeks (range 6 to 9 weeks) and to preinjury sportive activities after a mean of 17 weeks (range 14 to 20 weeks). The overall mean scoring was good (88 out of 100) at the end of a year follow-up. Early or late complications included superficial wound infections in five patients and partial rupture recurrence in one patient. CONCLUSION: Our results showed that the Krackow technique combined with plantaris tendon augmentation and a rehabilitation protocol aiming early motion enabled physiological tendon healing.

Achilles Tendon↗
PubMed2006

Microarray analysis of healing rat Achilles tendon: evidence for glutamate signaling mechanisms and embryonic gene expression in healing tendon tissue.

Tendon healing is a complex process consisting of a large number of intricate pathways roughly divided into the phases of inflammation, proliferation, and remodeling. Although these processes have been extensively studied at a variety of levels in recent years, there is still much that remains unknown. This study used microarray analyses to investigate the process at a genetic level in healing rat Achilles tendon at 1, 7, and 21 days postinjury, roughly representing the inflammation, proliferation, and remodeling phases. An interesting temporal expression profile was demonstrated, identifying both known and novel genes and pathways involved in the progression of tendon healing. Both inflammatory response and pro-proliferative genes were shown to be significantly upregulated from 24 h postinjury through to 21 days. Day 7 showed the largest increase in genetic activity, particularly with the expression of collagens and other extracellular matrix genes. Interestingly, there was also evidence of central nervous system-like glutamate-based signaling machinery present in tendon cells, as has recently been shown in bone. This type of signaling mechanism has not previously been shown to exist in tendon. Another novel finding from these analyses is that there appears to be several genes upregulated during healing which have exclusively or primarily been characterized as key modulators of proliferation and patterning during embryonic development. This may suggest that similar pathways are employed in wound healing as in the tightly regulated progression of growth and development in the embryo. These results could be of use in designing novel gene-based therapies to increase the efficacy and efficiency of tendon healing.

Achilles Tendon↗
PubMed1993

[Genesis and treatment of hand para-articular, painful tendon and tendon sheath changes].

Many patients suffer from wrist disorders caused by tendon- and tendon-sheath-affections. Apart from this the successful treatment of these affections is an important implication concerning national economy. In Lower Saxony 2.3% of all RVO-insured patients have these disorders. Most tendon- and tendon-sheath-affections are due to chronic stress which is generally treated by a non-operative therapy. Only some need be treated by a surgical intervention. In this paper the most frequent painful tendon- and tendon-sheath-diseases are listed, their clinical appearance is shown and the different methods of treatment are discussed.

Adult↗
PubMed2001

An anatomical study of the relationship between excursion of the flexor tendons and digital mobility: proposition of an intraoperative test for flexor tendon tenolysis.

The excursion of the flexor tendons of the thumb and fingers was studied in ten fresh cadaveric upper limbs. For each centimetre of tendon movement, obtained by traction of the flexor tendons at the wrist, the angular changes of the digital articulations were measured; movement started at extension and proceeded to maximum flexion. A further five upper limbs were used to evaluate the effect of pressure over the musculotendinous area of the flexor tendons of the fingers and thumb. Pressure on the muscle bellies in the forearm causes movement of the tendons, different for each finger, with the accompanying digital flexion depends on the magnitude of the movement. On the basis of this anatomical study a test is described which may be beneficial in the diagnosis of pathology and trauma of the flexor tendons and, particularly, in the intraoperative evaluation of the quality of motion obtained during tenolysis.

Cadaver↗
PubMed1986

Demonstration of cellular retinoic acid binding protein (CRABP) in chick embryo tendon cells and effects of retinoids on collagen synthesis in tendon and sterna.

The binding of all-trans-retinoic acid (all-trans RA) to specific cytosol proteins and the effects of retinoids on procollagen synthesis were studied in chick-embryo tendon cells. For the receptor assay, tendon cytosols were incubated with [3H]all-trans-RA in the presence or absence of 100-fold excess of nonlabeled all-trans-RA up to 20 hr at +4 degrees and unbound retinoid was removed by charcoal-dextran treatment or by gel filtration chromatography. The results indicated that chick-embryo tendon cells contained cellular retinoic acid binding protein (CRABP). The binding of [3H]all-trans-RA could be displaced by 13-cis-retinoic acid, but not by retinol or etretinate. In contrast no CRABP could be found in cartilage cells isolated from sterna or in whole sterna. The treatment of tendon cytosol with proteases (pronase, trypsin, chymotrypsin) abolished the specific binding of [3H]all-trans-RA. Gel filtration studies on Sephadex G-100 indicated an apparent molecular weight of 14,500-15,000 daltons for the all-trans-retinoic acid binding protein. All-trans-RA markedly decreased procollagen synthesis in isolated chick-embryo tendon cells, the inhibition being concentration dependent; the decrease was about 58% of the control in the presence of 10(-5) M all-trans-RA. Similar decrease was noted with 13-cis-RA and etretinate, while retinol was less effective. In isolated cartilage cells the dose of 10(-5) M of all-trans-retinoic acid decreased drastically total protein and collagen synthesis. The mannosylation of procollagen, the conversion of procollagen to collagen and the size of procollagen chains were not significantly affected. The results of the present study indicate that CRABP is not expressed in sterna of chick-embryos, and in contrast high levels of CRABP could be found in tendons. However, retinoids modulated collagen synthesis in both tissues. Thus it is possible that retinoids can affect the metabolism of different collagen types also in clinical use.

Animals↗
PubMed1987

Analysis of cumulative strain in tendons and tendon sheaths.

Twenty-five fresh frozen flexor digitorum profundus tendons stratified by sex were subjected to uniaxial step stress and cyclic loads in twelve intact human cadaver hands. By attaching specially designed clip strain gage transducers on tendons just proximal and distal to an undisrupted carpal tunnel, the interactions of the tendons, tendon sheath and retinacula were measured. The elastic and viscous response of the tendon composites to step stresses were found to fit fractional power functions of stress and time respectively. A significant and quantifiable decrease in strain from the proximal to the distal tendon segment was found to be a function of wrist deviation. The results indicate that an accumulation of strain does occur in tendinous tissues during physiologic loading.

Aged↗
PubMed2004

Revision anterior cruciate ligament reconstruction using the regenerated semitendinosus tendon: analysis of ultrastructure of the regenerated tendon.

In this report, we present a case of a college skier who sustained a rerupture of the reconstructed anterior cruciate ligament (ACL) 8 months after surgery in which an autogenous semitendinosus tendon graft was used. At the revision surgery, the harvested semitendinosus tendon appeared to be regrown. Thus the regenerated tendon was reharvested, and in combination with the gracilis tendon, was used as a graft. The electron microscopic examination revealed a difference in fibril diameter between the regenerated tissue and the normal tendon. Although the regenerated semitendinosus tendon could be reharvested, the feasibility of its use for revision surgery is still to be determined.

Adult↗
PubMedDate not supplied

[Percutaneous tenodesis of the Achilles tendon. A new surgical method for treatment of acute Achilles tendon rupture using percutaneous tenodesis].

APPROACH TO THE PROBLEM: Various studies (3, 6, 9, 14, 22, 28, 30, 33) have shown that, on average (26), the surgical treatment of a freshly ruptured Achilles tendon can be considered a more appropriate and better treatment than a conservative immobilisation therapy. On the other hand the rate of complications in openly executed reconstructions is quite considerable at 11-29% (13, 19, 20, 31). It therefore seems reasonable to develop a process which, by using minimal invasive measures on the tendon, reduces the risk of complications arising from surgery and simultaneously makes an early post operative treatment encouraging maximum mobility possible. METHOD: We have developed a percutaneous tenodesis of the Achilles tendon using two Lengemann extension wires and fibrin bonding at the point of rupture (8, 18). This process has been applied to 21 patients since 1995. Check-up period for further examination: 1 year. RESULTS: Exclusively male patients have been treated, average age 42 years. The Achilles tendon ruptures occurred in sporting activities and were handled with operations in an average time span of 22 hours. In one case there was a re-rupture resulting from traumatic conditions. All other results were good to very good and free of complications. CONCLUSIONS: The percutaneous tenodesis of the Achilles tendon using Lengemann extension wires and fibrin bonding provides a simple, good value and reliable process which should be used for freshly occurred Achilles tendon ruptures. CLINICAL RELEVANCE: Particularly worthy of mention are the problem-free treatment, the good results and the broad acceptance by the patients. These advantages make the demonstrated process ideal for routine clinical application.

Achilles Tendon↗