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PubMed2003

Radial half of extensor carpi radialis longus tendon as graft to elongate muscle tendon unit for correction of finger clawing.

In 12 patients, the extensor carpi radialis longus muscle tendon unit was elongated using the radial half of the parent tendon so that it could reach the site of new insertion, the A1-A2 pulley of flexor sheath or lateral bands, after routing the transfer through the carpal tunnel. The tendon was of appropriate thickness and could be split into two halves to be used as a graft. Further splitting of the tendon into four tails was possible. The transferred slips retained adequate strength to activate the fingers after the operation. It is suggested that splitting of the extensor carpi radialis longus tendon to use one half as a tendon graft be considered in patients in whom extensor carpi radialis longus transfer is planned to correct finger clawing. This technique is simple, needs minor modification in the sequence of operative steps, reduces operating time, and saves the patient from postoperative discomfort, muscle herniation, and scarring at the donor site (usually the thigh).

Fingers↗

PubMed1992

The effect of regional nerve blocks on the lameness caused by collagenase induced tendonitis in the midmetacarpal region of the horse: a study using gait analysis, and ultrasonography to determine tendon healing.

The influence of regional nerve blocks on lameness resulting from tendon injury was studied in six horses. Tendonitis was induced in the midmetacarpal region of the Superficial Digital Flexor Tendon (SDF), Deep Digital Flexor Tendon (DDF) and the Suspensory Ligament (SL) through collagenase injections. The results were evaluated through sequential clinical examinations, ultrasonographic imaging and kinetic gait analysis (force plate) during a period of 144 days post injury and subsequently compared with gross and microscopic findings. The lameness corresponding to the SDF and DDF tendon lesions was completely abolished by a high palmar nerve block. The SL desmitis was partly abolished by high palmar nerve block and completely blocked with an additional ulnar nerve block. The ultrasonic evaluations showed the lesions, expanding until approximately 30 days post injection (p.i.) and subsequently decreasing. The texture of the lesion also improved markedly after 30 days p.i. The post-mortem macro- and microscopic evaluation revealed still considerable abnormalities at 145 days p.i. At that time the tendon lesions were no longer detectable ultrasonographically.

Animals↗

PubMed1998

Postoperative patellar tendon healing: an ultrasound study. VIS Tendon Study Group.

The patellar tendon donor site of 20 patients who underwent anterior cruciate ligament (ACL) reconstruction using the patellar tendon tissue as autograft was examined with high resolution 7.5 MHz ultrasound. The patients were randomly divided into four groups and studied at 3, 6, 9 or 12 months postoperatively. The size of the postoperative tendon defect was measured just distal to the lower pole of the patella. The size of the tendon defect diminished progressively from a mean of 109 mm2 at 3 months to a mean of 23 mm2 at 12 months. Increasing echogenicity was first noticed 12 months after tendon repair. Seven patients developed clinical features postoperatively of jumper's knee (patellar tendinosis). There were no ultrasound signs that differentiated these patients from asymptomatic patients. It is concluded that ultrasound provides objective evidence of patellar tendon healing after ACL reconstruction: the surgical defect diminished in size and became echogenic after a period of 12 months.

Adult↗

PubMed2006

Microarray analysis of the tendinopathic rat supraspinatus tendon: glutamate signaling and its potential role in tendon degeneration.

Degenerative tendon injury or "tendinopathy" is one of the most common disorders of the musculoskeletal system. We used a rat model (Soslowsky LJ, Thomopoulos S, Tun S, Flanagan CL, Keefer CC, Mastaw J, and Carpenter JE. J Shoulder Elbow Surg 9: 79-84, 2000) to identify novel gene expression in the exercised-induced degenerated supraspinatus tendon by microarray and real-time PCR analyses. We identified several novel groups of differentially expressed genes, including those involved in apoptosis and related stress responses, and also genes that appear to be involved in glutamate signaling in tendon tissue, similar to recent findings by us in a microarray study of healing in the transected Achilles tendon of the rat (24). Until recently this kind of cellular communication was thought only to exist in cells of the central nervous system (CNS), where it is vital for CNS function. We further show that glutamate appears to induce a proapoptotic response in cultured tendon cells, similar to the "excitotoxic" response of cells in the CNS that become overstimulated. This may prove to be at least a partial cause of degeneration in overused tendon tissue and allow the development of treatments or "prehibilitation" regimens for tendinopathy based on currently used non-toxic glutamate antagonists.

Back↗

PubMed2002

Initial pull-out strength of tendon sutures: an in vitro study in sheep Achilles tendon.

Forty-eight fresh frozen sheep Achilles tendons were used to compare the pull-out strengths of Kessler, Bunnell and locking loop techniques which are the standard configurations described for Achilles tendon repair. A simulated Achilles tendon rupture was done with a tenotomy made 2 cm proximal to the calcaneal insertion. One of the configurations was placed at the distal end of the proximal portion of the tendon specimens using No. 5 Ticron. The distal ends of the suture materials were left free and were not used to connect the proximal and distal portions of the tendon. Using a servohydraulic materials testing machine, each tendon was tested to failure in tension at a displacement rate of 20 mm/min. All the specimens failed due to pull-out of the suture material. Since the cause of failure was suture material breakage in the previous studies reporting repair strength, they were unable to represent the effect of configuration on the strength. This study is the first to represent the effect of configuration on the initial strength since there is no failure due to suture material breakage.

Achilles Tendon↗

PubMed1995

Late flexor digitorum longus tendon rupture after transfer for posterior tibial tendon insufficiency: a case report.

A 64-year-old woman was treated for an idiopathic complete rupture of the posterior tibial tendon with transfer of the flexor digitorum longus tendon to the navicular. After an initial excellent result, she returned 41 months later after experiencing a sudden pop in the medial retromalleolar area, followed by progressive medial ankle pain. At reoperation, a complete rupture of the flexor digitorum longus tendon was noted at its insertion into the navicular. Reconstruction was performed utilizing a sliding lengthening of the flexor digitorum longus tendon and reattachment to the navicular with a suture anchor. Clinical improvement was noted at the 12-month follow-up evaluation. This case presentation is of clinical interest, as late acute failure of a flexor digitorum longus tendon transfer for posterior tibial tendon rupture has not been reported previously.

Ankle↗

PubMed2005

Comparing 2-year outcomes of anterior cruciate ligament reconstruction using either patella-tendon or semitendinosus-tendon autografts: a non-randomised prospective study.

PURPOSE: To compare the results of anterior cruciate ligament (ACL) reconstructions using either a patella-tendon autograft or a semitendinosus-tendon autograft. METHODS: Based on surgeon experience and preference, 68 patients underwent ACL reconstruction using either a quadruple-strand semitendinosus autograft (n = 34) or a central one-third bone-patella tendon-bone autograft (n = 34). Each patient was assessed preoperatively and postoperatively at 3, 6, and 24 months using the International Knee Documentation Committee (IKDC) knee score, Biodex muscle strength and endurance testing, and the KT1000 instrumented arthrometer test of knee laxity to anterior translation. All assessments at the 2-year follow-up were performed by the same physician and physiotherapist. RESULTS: While ACL reconstruction improved knee stability and IKDC knee scores significantly, there was no statistically significant difference between semitendinosus- and patella-tendon autograft reconstructions in terms of long-term knee score or laxity to anterior translation. Semitendinosus graft reconstruction was associated with less donor-site morbidity and hamstring weakness. Meniscectomy was associated with poorer long-term knee scores. CONCLUSION: ACL reconstruction is associated with a significantly better IKDC knee score and laxity measurement at 2-year follow-up. However, we were unable to demonstrate a significantly better long-term outcome in knee score or laxity to anterior translation with either a patella-tendon autograft or a semitendinosus-tendon autograft.

Adolescent↗

PubMed1999

Quantification of intact quadriceps tendon, quadriceps tendon insertion, and suprapatellar fat pad: MR arthrography, anatomy, and cryosections in the sagittal plane.

OBJECTIVE: The purpose of this study was to quantify quadriceps tendon length, thickness, and insertion in relation to the suprapatellar fat pad. SUBJECTS AND METHODS: We used three methods to analyze the anatomy of intact quadriceps tendons and insertions into the patellar base: MR arthrography (53 knees with intact extensor mechanisms), gross anatomy (16 cadaveric knees), and cryosections (four cadaveric knees). With an electronic cursor, two observers independently quantified the extensor mechanism on midline sagittal T1-weighted spin-echo sequences acquired on a low-field-strength (0.23 T) scanner. RESULTS: On MR arthrograms, quadriceps tendon length, determined from the superior patellar pole to the most superior part of the suprapatellar recess, measured 49 +/- 7 mm in women and 50 +/- 9 mm in men. Thickness of quadriceps tendon at three sites (suprapatellar recess, center, and superior patellar pole) measured 7 +/- 1 mm in women and 8 +/- 1 mm in men. Thickness was significantly larger in men at all measurement locations. Quadriceps tendon insertion and the suprapatellar fat pad along the patellar base measured 16 +/- 2 and 6 +/- 2 mm, respectively, in women, and 18 +/- 3 and 7 +/- 2 mm, respectively, in men. CONCLUSION: On midline MR images, sagittal thickness of the quadriceps tendon and its insertion was significantly larger in men than in women. The prevalence of the suprapatellar fat pad was 100%.

Adipose Tissue↗

PubMed1993

Tendon collagens: extracellular matrix composition in shear stress and tensile components of flexor tendons.

Outer synovial tissues were separated from the remainder of avian flexor tendon and the collagens characterized biochemically and compared with those of the internal portion of tendon and sheath. The collagen content of tendon synovium was 23%, whereas that of tendon and sheath were 78% and 73%, respectively, based on dry weight. Four genetic types of collagen were found in the pepsin solubilized matrices: in the synovium, types I (78%) and III (19%) predominated; types V and possibly VI were present as minor collagens. Purified synovial type V collagen was a heterotrimer, with chain composition [alpha 1(V)]2 alpha 2(V). In contrast, the internal portion of tendon and sheath were comprised of only type I collagen. There was a large amount (41%) of ethanol extractable, noncollagenous material present in synovium, a part of which was proteoglycans. In addition, collagen cross-links of these tissues were quantified: the internal tendon had an abundant concentration of pyridinoline; synovium exhibited high amounts of labile, reducible cross-links, particularly dihydroxylysinonorleucine. In the case of sheath, lysine aldehyde-derived cross-links appeared to be predominant. These results indicate that each tissue has its own collagen type distribution as well as cross-linking pattern reflecting their maturational and functional differences.

Animals↗

PubMed2002

[Influence of patellar height on patellar tendon donor site closing after harvesting a bone-tendon-bone graft for ligamentoplasty].

PURPOSE OF THE STUDY: Ligamentoplasty using an autologous transplant provides an effective and long-lasting solution for anterior instability of the knee. The most widely used transplant is the mid third of the patellar tendon. The short- and long-term stability has been proven, but there are reports of morbidity at the donor site affecting the extensor system. Different attitudes have been proposed. Certain authors leave the site open, only suturing the peritendon. Others suture the two peripheral thirds together, either directly or after combing. This different therapeutic options may modify patellar height and affect the tissue at the donor site that some authors suggest can provide transplants for repeated ligamentoplasties. The purpose of this work was to assess the influence of closing the donor site of the patellar tendon on patellar height. MATERIAL AND METHOD: Two groups of 40 patients were compared. These patients underwent arthroscopic ligamentoplasty for anterior instability of the knee, excluding all other knee pathology. In the first group, the pretendon fibrous plane was closed alone at the end of the procedure without bringing together the edges of the tendon donor site. In the second group, the peripheral thirds of the patellar tendon were sutured together directly. Patellar height was assessed according to Caton, to Blackburn and to Insall and Salvati on lateral views (20 degrees flexion) of the knee six months after arthroscopy. RESULTS: Irrespective of the method used to measure patellar height, there was no statistical difference between post-operative patellar heights between the two groups (Caton=1.002 +/- 0.176/1.023 +/- 0.215; Blackburne=0.844 +/- 0.183/0.882 +/- 0.196; Insall and Salvati=1.118 +/- 0.213/1.184 +/- 0.146 for group 1 "open tendon" and group 2 "closed tendon" respectively). Pre- and post-operative heights were not different for either group (Student t - Fisher, p=0.05). DISCUSSION: Patellar height is not significantly changed after ligamentoplasty using the mid third of the patellar ligament with or without closing of the donor site.

Adult↗

PubMed2003

A novel biodegradable PCL film for tendon reconstruction: Achilles tendon defect model in rats.

This study aims to investigate applicability of poly(epsilon-caprolactone) (PCL) biodegradable films for repair of gaps in Achilles tendons in a rat model, also comparing surgical repair versus no repair approaches. PCL was synthesized with tailor-made properties, then, PCL films were prepared by solvent casting. Seventy-five outbred Sprague-Dawley rats were randomly allocated into five groups: (i) sham operated (skin incision only); (ii) no repair (complete division of the Achilles tendon and plantaris tendon without repair); (iii) Achilles repair (with a modified Kessler type suture); and (iv) plasty of Achilles tendon defects with the biodegradable PCL films, and (v) animals subjected to 1 cm mid-substance defect with no repair. Functional performance was determined from the measurements of hindpaw prints utilizing the Achilles functional index. The animals were killed 8 weeks after surgery and histological and biomechanical evaluations were made. All groups subjected to Achilles tendon division had a significant functional impairment that gradually improved so that by day 28 there were no functional impairments in any group whereas animals with a defect remained impaired. The magnitude of the biomechanical and morphological changes at postoperative 8 weeks were similar for no repair group (conservative), Achilles repair group and tendonplasty group (biodegradable PCL film group). The initial rate of functional recovery was significantly different for primary suture, Achilles repair group and PCL film group (p>0.01). But, at the 28th day, functional recovery was quite similar to the other groups. In summary, our results suggest that the PCL film can be an alternative biomaterial for tendon replacement.

Absorbable Implants↗

PubMed2004

Arthroscopically assisted anterior cruciate ligament reconstruction: comparison of bone-patellar tendon-bone versus hamstring tendon autograft.

BACKGROUND: The bone-patellar tendon-bone (BPTB) and the hamstring tendons are commonly used for arthroscopially-assisted anterior cruciate ligament (ACL) reconstruction. PURPOSE: To compare the results of arthroscopically-assisted ACL reconstruction using bone-patellar tendon-bone and hamstring tendons grafts in terms of postoperative knee stability, knee functions and clinical rating scale, and patient satisfaction. HYPOTHESIS: There was no difference in the outcomes of the two grafts. STUDY DESIGN: Retrospective non-randomized clinical trial. MATERIAL AND METHOD: Two groups of patients, 45 in the BPTB group and 30 in the hamstring group, were followed for at least one year. RESULTS: The two groups had similar pre-operative data except the hamstring group which had a significantly shorter duration of injury before operation (9.5 versus 18 months, p < 0.05). There was no difference in median pre-operative Lysholm knee score (74 in the BPTB group versus 75 in the hamstring group, p > 0.05) and the post-operative one (95 in the BPTB group versus 99 in the hamstring group, p > 0.05). There was also no difference in the median pre-operative HSS knee score (58 in the BPTB group versus 61 in the hamstring group, p > 0.05). Although there was a statistically significant difference in the median post-operative HSS knee score between the two groups (95 in the BPTB group versus 96 in the hamstring group, p < 0.05), this was not clinically significant since both scores were rated as an excellent result. Both groups had a significantly improved knee stability and knee functions (Lysholm and HSS knee scores). The hamstring group, however, had significantly higher patient satisfaction (88% in the BPTB group versus 93% in the hamstring group, p < 0.05). CONCLUSION: Both the BPTB and the hamstring tendon grafts resulted in significantly improved knee stability and functions with high patient satisfaction. The hamstring tendon group, however, had a significantly better post-operative patient satisfaction (Visual Analog Scale, VAS).

Anterior Cruciate Ligament↗

PubMed1996

[Longstanding flexor tendon lesions treated by two-stage tendon graft].

46 fingers in 42 patients undergoing 2-stage flexor tendon grafting for traumatic injury in zone 2 were evaluated with an average follow up of 13 months (range 6 to 120 months). 24 anastomoses between FDS and FDP were performed according to the Paneva Holevitch procedure. In all other cases, palmaris longus or plantaris were used as tendon grafts during the second stage. Proximal fixation was always performed in the palm. 3 or more pulleys were reconstructed in all cases. In 21 cases, pulley reconstruction required the use of excised tendon remnants or retina-culum dorsalis. Distal fixation was performed to the distal phalanx in 42 cases and to the second phalanx in 4 cases, during the second stage. Overall, 85% patients obtained a good or fair result in terms of TAM (total active motion) with < >. 7 cases obtained a poor result. 12 fingers required complementary surgery: --2 cases with poor active flexion had been treated by shortened suture. --3 ruptures of tendon graft required P2 fixation and DIP arthrodesis in distal rupture (2 cases), and anastomosis with next flexor tendon in proximal rupture (1 case). --7 cases of PIP stiffness were treated by PIP arthrolysis. DIP arthrodesis was associated in 2 cases.

Adolescent↗

PubMedDate not supplied

Achilles tendon repair using a bone-tendon graft harvested from the knee extensor system: three cases.

The authors describe a new surgical technique of Achilles tendon reconstruction using bone-tendon graft from the knee extensor system. This technique is for those unusual cases of neglected or partial Achilles tendon rupture with distal tendon-substance loss at calcaneal insertion level, requiring transbone plasty fixation. Three cases are reported; the first two, followed up over a 5-year period, had excellent functional, morphological, and clinical outcomes. This new technique is compared with other available solutions: triceps plasty, other local tendon plasty, artificial plasty, and allograft.

Achilles Tendon↗

PubMed1994

Donor-site morbidity after harvest of a bone-tendon-bone patellar tendon autograft.

The effects of closure of the peritendineum and bone grafting of the patellar defect after harvest of the bone-tendon-bone patellar tendon autograft was investigated prospectively in two groups of 25 patients. Anterior cruciate ligament (ACL) reconstruction was performed with minimally invasive techniques either arthroscopically or via mini-arthrotomy. Patellar height, size of bony and tendon defects, and overall result were followed up for 2 years postoperatively. The results showed that closure of the peritendineum enhances healing of the patellar tendon defect and restores a normal appearance of the tendon within 2 years. We have stopped bone grafting the patellar defect with cancellous bone because of the risk of formation of painful spurs at the inferior pole of the patella which occurred in 36% of patients.

Adult↗

PubMed1983

Flexor superficialis tendon transfers to the thumb--an alternative to the free tendon graft for treatment of chronic injuries within the digital sheath.

Transfer of a flexor digitorum superficialis tendon is an effective procedure in restoring active flexion of the thumb following old lacerations or ruptures of the flexor pollicis longus tendon within the digital sheath when tendon repair or advancement is not possible. The ample length of the transferred tendon and, more importantly, its normal excursion make it the preferred procedure to the alternative tendon graft. The operation is usually carried out as a one-stage procedure, but, if there is severe scarring, it can follow the preliminary insertion of a silicone rod. For 23 patients, the operation was performed in a single stage in 18 and in 5 after insertion of a silicone rod. Postoperative mobility of the interphalangeal joint averaged 53.5 degrees. Mobility of the donor ring finger was complete in all patients.

Adolescent↗

PubMed1997

Staged flexor tendon reconstruction using pedicled tendon graft from the flexor digitorum superficialis.

The use of pedicled flexor digitorum superficialis tendon as a tendon graft in the second stage of flexor tendon reconstruction has the advantage of employing local intrasynovial tendon graft and allowing early active range of motion. This method of staged flexor tendon reconstruction was used in 47 patients between 1983 and 1993. Thirty-three patients were evaluated 1 year or longer after the second stage of surgery. The follow-up period averaged 3.7 years. Sixty-four percent of the injuries were in zone II, and 30% were Boyes grade V in severity. Good to excellent results were achieved in 64% of patients. Three patients needed graft tenolysis. Postoperative persistent flexion contractures ranging from 8 degrees to 55 degrees of the proximal interphalangeal or distal interphalangeal joints or both were present in 88% of patients. Several factors that influenced the final outcome were identified: age over 25 years, zone II injuries of Boyes grade V, and the lack of a regular postoperative rehabilitation program were associated with relatively less successful final results.

Adolescent↗

PubMed1993

[Fresh sections of the flexor tendons of the fingers and thumb. New therapeutic trends. Apropos of a clinical series of 77 tendon lesions].

In flexor tendon surgery, the main concern of hand surgeons in the last two decades has been to find an effective and reproducible means to avoid post-operative adhesions. For most authors, these adhesions were responsible for the bad results. Since 1960, a constant progress has been achieved with the progress in operative procedures and the better understanding of tendon healing process. Post-operative rehabilitation, especially Kleinert's and Duran's active and passive methods, have radically transformed the prognosis of fresh tendon lesions. In spite of all this progress, zone II tendon injuries are still a difficult problem. In this clinical study, we wanted to introduce two new orientations in order to improve the overall results, the use of human fibrin sealant instead of the epitendinous running suture and an improvement of Duran's technique, developed by the Bichat rehabilitation team since 1987. Seventy-seven tendon lesions treated according to our technique (55 fingers and 22 thumbs) between 1987 and 1991, were reviewed. All the lesions studied were in zone II and T II. The mean follow-up is 14.4 months. The evaluation is based on the International Federation of Hand Surgery score for fingers, and the Tubiana score for thumbs. 74% of fingers and 86% of thumbs were scored as good and excellent.

Adult↗