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At least 289 records · Page 16Linked to original sources
PubMed2001

The effect of flexor tendon repair bulk on tendon gliding during simulated active motion: an in vitro comparison of two-strand and six-strand techniques.

The gliding function of 2-strand (Tajima) and 6-strand (Savage) techniques of flexor tendon repair were compared in an in vitro biomechanical model. Stainless steel beads were inserted directly into the metacarpals, phalanges, and flexor digitorum profundus tendons of 22 human cadaver specimens. The FDP tendons were loaded from 5 to 25 N using a pneumatic actuator. The angular rotation and tendon excursion of the cadaver specimens were measured radiographically. The gliding function of the repairs was compared with core suture only, core suture plus epitenon repair, and sheath repair. There was no significant difference in angular rotation or linear excursion between the 2-strand and 6-strand techniques of flexor tendon repair. The addition of the epitendinous suture to the core suture improved the angular rotation and linear excursion for the 2-strand technique. Although the 6-strand repair tended to increase the repair site bulk more than the conventional 2-strand technique, the gliding function of the repair techniques was equivalent.

Aged↗
PubMedDate not supplied

[Medial flexor digitorum longus tendon augmentation and lateral foot column lengthening or reorienting triple arthrodesis as surgical therapy of posterior tibial tendon dysfunction].

QUESTION: The purpose of this study was to evaluate the alignment and functional outcome after surgical augmentation of the tibialis posterior by tendon transfer and lateral column lengthening by osteotomy of the os calcis, calcaneo-cuboidal arthrodesis or reorientating triple arthrodesis. METHODS: From 1991 to 1999 41 patients with the clinical and radiological diagnosis of dysfunction of the tibialis posterior tendon underwent surgical exploration and repair. These 41 patients (22 women, 19 men) had an average age of 44.3 years (range, 19-69 years) and had been symptomatic for an average of 2.3 years (range, 6 months to 6 years). All patients had the symptoms of a painful flatfoot deformity without dynamic support along the medioplantar aspect. Flexor digitorum longus (FDL) tendon transfer as reconstruction of the tibialis posterior tendon was performed in the cases without major deformity (n = 77). Patients underwent FDL transfer and lengthening osteotomy (n = 15) of the os calcis or calcaneocuboidal (c-c) arthrodesis (n = 12) if passive correction of the foot deformity was still possible and reorientating triple arthrodesis (n = 7) when a fixed flatfoot deformity had developed. AOFAS score and radiological examination were used preoperatively and in the follow-up. RESULTS: The AOFAS score improved for stage 1 patients after a mean follow-up of 43 months with FDL transfer from a preoperative mean of 54 to 84 points, for stage II patients with FDL transfer and lengthening osteotomy (mean follow-up 36 m) from 47 to 92 points, with c-c arthrodesis (follow-up 66 m) from 48 to 86 points, and for stage III patients with triple arthrodesis from 42 to 72 points. In two patients, the deformity failed to improve (stage I) necessitating a revision surgery with a calceneo-cuboidal lengthening arthrodesis for relapsing deformity. CONCLUSION: In order to correct deformity and provide substantial relief of foot pain and dysfunction, we recommend the transfer of the FDL tendon in flexible flat foot deformity together with lengthening osteotomy. This treatment will provide optimal restoration of a dynamic support along the medioplantar aspect of the foot and is functionally superior to a c-c arthrodesis. Reorientating triple arthrodesis showed fair functional results and is recommended--for fixed flatfoot deformity.

Adult↗
PubMed2003

Biomechanics of tendons and tendon failure.

Research into the biomechanical properties of tendons had led to a better understanding of the functional and pathophysiologic processes that occur in vivo, particularly in the setting of tendon injury and failure. Increasingly, biomechanical information is being utilized in the clinical setting, guiding patient management in certain circumstances. Differentiating minor and self-limiting abnormalities from those in which specific treatment may prevent further disability from altered biomechanics may become an important role for imaging. This article examines normal tendon anatomy and its relationship to tendon biomechanics under both physiological and pathologic conditions. Imaging characteristics of tendons in the physiologic and pathologic states are discussed. We have focused primarily on MRI, as this modality has been studied most intensively and has been shown to offer additional information regarding unsuspected pathology.

Biomechanical Phenomena↗
PubMed2006

How can one platelet injection after tendon injury lead to a stronger tendon after 4 weeks? Interplay between early regeneration and mechanical stimulation.

BACKGROUND: Mechanical stimulation improves the repair of ruptured tendons. Injection of a platelet concentrate (platelet-rich plasma, PRP) can also improve repair in several animal models. In a rat Achilles tendon transection model, 1 postoperative injection resulted in increased strength after 4 weeks. Considering the short half-lives of factors released by platelets, this very late effect calls for an explanation. METHODS: We studied the effects of platelets on Achilles tendon regenerates in rats 3, 5 and 14 days after transection. The tendons were either unloaded by Botulinum toxin A (Botox) injections into the calf muscles, or mechanically stimulated in activity cages. No Botox injections and ordinary cages, respectively, served as controls. Repair was evaluated by tensile testing. RESULTS: At 14 days, unloading (with Botox) abolished any effect of the platelets and reduced the mechanical properties of the repair tissue to less than half of normal. Thus, some mechanical stimulation is a prerequisite for the effect of platelets at 14 days. Without Botox, both activity and platelets increased repair independently of each other. However, at 3 and 5 days, platelets improved the mechanical properties in Botox-treated rats. INTERPRETATION: Platelets influence only the early phases of regeneration, but this allows mechanical stimulation to start driving neo-tendon development at an earlier time point, which kept it constantly ahead of the controls.

Achilles Tendon↗
PubMed1996

Late rupture of a flexor tendon after electrical injury: tendon localization using magnetic resonance imaging. A case report.

Rupture of a flexor tendon in the nonrheumatoid population is rare. Localizing the level of the tendon rupture can be a difficult task. We describe an individual who presented with the sudden inability to flex the index finger of the hand, which had been subjected to a severe electrical injury. Physical exam demonstrated lack of index finger flexion at the distal joint. The patient denied any pain or history of recent trauma. Preoperative magnetic resonance imaging (MRI) successfully located the proximal and distal ends of the ruptured flexor digitorum profundus tendon in the forearm. MRI allows for accurate preoperative assessment of tendon position and degree of retraction, thereby facilitating surgical planning and approach. Accurate localization of tendon pathology preoperatively minimizes unnecessary dissection, shortens the operative procedure, and clarifies operative planning.

Arm Injuries↗
PubMed1979

Achilles tendon repair with the plantaris tendon compared with repair using polyglycol threads.

Therapeutic results in 56 surgically treated patients with rupture of the Achilles tendon are presented. Results with repair using plantaris tendon and by suture of polyglycol threads are compared in 41 patients in a long-term followup study. Although 54 patients returned to their pre-accident physical activity, in all cases residual phenomena like calf atrophy, thickening of tendon, and tendon excursion were analyzed. The use of synthetic absorbable threads shortens the convalescence period. Covering the repair site with the fanned plantaris tendon seems to help to avoid painful adhesions with the skin.

Achilles Tendon↗
PubMed2003

Acellular and glutaraldehyde-preserved tendon allografts for reconstruction of superficial digital flexor tendon in bovines: Part I--Clinical, radiological and angiographical observations.

Sixteen tenorrhaphies were performed at the mid-metatarsal region in eight buffalo calves under lignocaine epidural analgesia. A 2 cm long gap was created in the superficial digital flexor (SDF) tendon and immediately repaired with acellular grafts in animals of group I, 1% glutaraldehyde-preserved tendon allografts in group II. In group III, the defect was repaired with autografts. This group served as control. The contralateral limb in each animal was operated after an interval of 60 days and the animals underwent the same procedure according to the designed groups. Diclofenac sodium and Enrofloxacin was given post-operatively for 5 days. Clinical examination revealed significant increase (P < 0.05) in rectal temperature, heart and respiratory rate for 3-4 postoperative days in all the animals. Mild pain and exudation as well as early restoration of tendon gliding movements and weight-bearing were observed earlier in group I in comparison with group II. Air-tendograms revealed early organization, minimal adhesion formation and lesser thickening of tendon at the reconstructive site in the acellular group whereas in the glutaraldehyde group dense homogenous swelling with adhesions was seen along the flexors. Angiography on day 30 showed that the area of proximal and distal host tendon graft junction appeared hypervascularized, whereas the area occupied by the graft appeared relatively less vascularized. Normal vascularization was observed on day 90 in all the three groups.

Angiography↗
PubMed2003

Acellular and glutaraldehyde-preserved tendon allografts for reconstruction of superficial digital flexor tendon in bovines: Part II--Gross, microscopic and scanning electron microscopic observations.

Sixteen tenorrhaphies were performed at mid-metatarsal region in eight buffalo calves. A 2-cm long gap was created in the superficial digital flexor (SDF) tendon in all animals. The gap was immediately repaired with acellular grafts in animals of group I, 1% glutaraldehyde-preserved tendon allografts in group II, and in group III the defect was repaired with autografts (control group). The contralateral limb in each animal was operated after an interval of 60 days and the animals underwent the same procedure according to the designed groups. Gross observation revealed filling of host tendon-graft junction with fibrous connective tissue. Increased vascularity was seen in group I when compared with group II and III. Graft was resorbed in animals of group I and III, whereas partial absorption of graft was seen in group II. Histological observations on day 30 revealed restoration of cellularity in acellular graft and fragmentation and resorption of glutaraldehyde-preserved graft. Graft was replaced by newly formed fibrous connective tissue. Tissue reaction around polygalactin suture consisted of plasma cells, lymphocytes and macrophages. On day 90, most of the acellular graft was replaced by newly formed fibrous connective tissue. In group II the majority of graft portion remained at the site and was in a state of resorption. In the control group it was difficult to distinguish between the host tendon and the graft. Scanning electron microscopical observation showed densely packed neoformed tissue at host tendon-graft junction. Hydrolysis and invasion of connective tissue between polygalactin suture filaments, resorption of graft with cavity formation and dissolution of ground substance were observed.

Animals↗
PubMed1995

Tendon transfer combined with calcaneal osteotomy for treatment of posterior tibial tendon insufficiency: a radiological investigation.

We present the radiographic results after flexor digitorum longus tendon transfer combined with a medial displacement calcaneal osteotomy for the treatment of posterior tibial tendon insufficiency. Eighteen patients with posterior tibial tendon insufficiency were reviewed from 12 to 26 months after surgery. The 15 women and 3 men had a mean age of 54 years (range, 38-72 years). The talar-first metatarsal and talonavicular coverage angles were measured before and after surgery on the anteroposterior weightbearing radiographs. The mean preoperative talar-first metatarsal and talonavicular coverage angles were 21 degrees (range, 3-45 degrees) and 34 degrees (range, 0-55 degrees), respectively. The mean postoperative values for these angles were 8.5 degrees (range, 0-35 degrees) and 21 degrees (range, -30-45 degrees), respectively. The mean talar-first metatarsal angle decreased from 21 degrees to 8.5 degrees, a mean improvement of 12.5 degrees, and the mean talonavicular coverage angle decreased from 34 degrees to 21 degrees, a mean improvement of 13 degrees. On the lateral weightbearing radiographs, the talar-first metatarsal angle and the distance from the medial cuneiform to the floor were measured before and after surgery. The mean preoperative values were -22 degrees (range, -10 to -40 degrees) and 9 mm (range, 1-19 mm), respectively. The mean postoperative values were -9 degrees (range, +5 to -25 degrees) and 16 mm (range, 10-28 mm), respectively. The mean talar-first metatarsal angle decreased from -22 to -9 degrees (a mean improvement of 13 degrees), and the distance from the medial cuneiform to the floor increased from 9 to 16 mm (a mean improvement of 7 mm). We conclude that the use of a combined medial displacement osteotomy of the calcaneus with a tendon transfer for treatment of posterior tibial tendon insufficiency may offset the inherent weakness of the flexor digitorum longus transfer by reducing the antagonistic deforming force of heel valgus.

Adult↗
PubMed1999

Role of the peroneal tendons in the production of the deformed foot with posterior tibial tendon deficiency.

Ten patients were identified with traumatic, complete common peroneal nerve palsy, with no previous foot or ankle surgery or trauma distal to the knee, who had undergone anterior transfer of the posterior tibial tendon to the midfoot. Six of these patients had a transfer to the midfoot and four had a Bridle procedure with tenodesis of half of the posterior tibial tendon to the peroneus longus tendon. Average follow-up was 74.9 months (range, 18-351 months). All patients' feet were compared assessing residual muscle strength, the longitudinal arch, and motion at the ankle, subtalar, and Chopart's joint. Weightbearing lateral X-rays and Harris mat studies were done on both feet. In no case was any valgus hindfoot deformity associated with posterior tibial tendon rupture found. It seems that the pathologic condition associated with a posterior tibial tendon deficient foot will not manifest itself if peroneus brevis function is absent.

Adolescent↗
PubMed1992

[Experimental study of intrinsic healing of the flexor tendon: collagen synthesis of the cultured flexor tendon cells of the canine].

The roles of the tendon cells, such as epitenon cells and tenocytes, through the reparative process of the flexor tendon are controversial. This study was performed to investigate the collagen synthesis of cultured tendon cells derived from the sheathed flexor tendons of the canine under electron microscopy using "Floating Sheet" method introduced by Arnold, J. R., et al (1983). Morphologically epitenon cells gave an appearance of large and oval fibroblasts, while tenocytes were small, spindle shaped fibroblasts. Electron microscopy revealed large amount of collagen and non-collagen fibers in the intercellular spaces of both cell populations. The collagen fibers produced by tenocyte populations were 200 A to 400 A in thickness, whereas those of the cultured epitenon cells ranged from 150 A to 300 A. These results indicated that tenocytes secreted larger and more matured collagen fibers than epitenon cells. Promotion of collagen synthesis by the tenocytes in the early stage of the flexor tendon repair was thought to be more favorable for its quality of the healing process.

Animals↗
PubMed1991

Repair of a ruptured calcaneal tendon by transposition of the tendon of the peroneus longus muscle in a goat.

Traumatic rupture of the calcaneal tendon was diagnosed in a 3-year-old female goat. Clinical features included tarsal hyperflexion and diffuse swelling in the area of the calcaneal tendon. Surgical repair consisted of debridement of devitalized tissue and transposition of the tendon of the peroneus longus muscle to bridge the calcaneal tendon defect. Adequate postoperative immobilization followed by gradual introduction of tendon loading allowed a favorable outcome.

Animals↗
PubMedDate not supplied

Latissimus dorsi and teres major tendons: separate or conjoint tendons?

Latissimus dorsi and teres major are used for tendon transfer about the shoulder in treating weakness that results from brachial plexus palsy. Anatomy textbooks describe separate insertion sites for these two tendons. During a surgical procedure, which included releasing these two tendons off the humerus from a posterior approach, they appeared to be joined together. Cadaver shoulders were subsequently dissected to determine if the tendons had conjoint or separate insertions. We found that although the two tendons do have separate insertion sites, they were joined to one another and difficult to separate. For this reason, when performing releases or transfers with these muscles, surgeons should consider the two as one structure in order to avoid damage to the important surrounding neurovascular structures (axillary and radial nerves, posterior humeral circumflex artery).

Brachial Plexus↗
PubMed1986

Flexor tendon injuries. Part 2. Flexor tendon repair.

The principles of atraumatic flexor tendon repair are reviewed. It is noted that tendon repair of the profundus and superficialis tendons-primary or delayed primary-should be carried out in all zones of flexor tendon interruption. Whenever possible, repair of the flexor tendon sheath also seems appropriate. A supervised program of early motion may prove beneficial, though restoration of function to a digit may be long and tedious, thus requiring a high degree of patient motivation and participation.

Finger Joint↗
PubMed1988

Tendon transfers in muscle and tendon loss.

Tendon transfers in muscle and tendon loss offer some of the most gratifying results to both patient and surgeon. Poor results do occur at times in tendon transfer. When patients whose results were found to be less than expected were studied, the following problems were identified: 1. Acceptance of less than full passive range of motion before transfer. In some instances, this will be unavoidable. The use of pretransfer hand therapy techniques may improve the situation; or, if possible, pretransfer capsulotomies may better prepare the patient for the tendon transfer. 2. Adhesions along the course of the transfer. At times the transfer route can be better prepared by the use of skin grafts adding subcutaneous tissue to the transfer bed. The use of a staged technique in which a silicone rubber tendon implant is installed along the transfer route, to prepare for a later transfer, is occasionally indicated. 3. Technical failures: a. juncture breakdown, b. transfer put in under too little tension. 4. Patient noncompliance. A recent experience in which a patient removed his postoperative cast and came in 2 weeks later with his transfer disrupted is an extreme example. Many other patients are not prepared to undertake what may be a rigorous and time-consuming postoperative transfer program. Adequate preoperative evaluation, including patient selection as well as careful attention to the details of the procedure during surgery, along with attentive postoperative care, should eliminate most of these problems.

Adult↗
PubMed1976

[Reconstruction of the injured flexor tendon in the proximal half of the "no man's land" by a modified method (tendon sheath reconstruction using a vein graft)].

On the basis of long years' experiences the "no man's land" has been divided by the author into 2 parts: the proximal and the distal part. For the treatment of the flexor tendon lesions occurred in the distal part of the author advocates his method already published: in the "tendon sheath" formed from the vein its "bridging" by free tendon transplant. If the lesion occurred in the proximal part, the formation of a long "tendon sheath" from a vein and then its "bridging" by long tendon transplant are advocated by the author.

Adult↗
PubMed1994

[Rupture of the Achilles tendon--case report of a rare form of Achilles tendon damage].

The great increase in the number of persons engaged in sports in the 30-50 years age group has led to a marked increase in injuries of the tendon of Achilles. In this case there is tearing loose of the Achilles tendon; the bone and the tendon come apart, as in a rupture of Sharpey's fibres. The tack was made in webbing the tendon of Achilles with polydioxanone ligaments to the tuberosity of calcaneus. The question about prophylactic webbing of the degenerated tendon of Achilles on the other side has to be discussed. Assessment of this injury from the viewpoint of the accident insurance company is explained.

Achilles Tendon↗
PubMed1990

Golgi tendon organs in the proximal tendon of sheep extraocular muscles.

Sheep extraocular muscles were prepared for light and electron microscopy and their proximal tendons searched for Golgi tendon organs (GTO). An extensive aponeurotic lamina on the orbital surfaces contained numerous GTO 250-1350 microns in length with characteristic terminal form and relationship with collagen. They differed from usual GTO structure in containing large fluid-filled spaces dividing collagen into several well separated compartments and a muscle fiber entered and terminated in about one third of the receptors. The fibers, Felderstruktur in type, often penetrated deep within tendon organs, and in a few instances two or more fibers entered. This feature is shared by the rare GTO of monkey extraocular muscles. That the presence of GTO in the proximal tendons of extraocular muscles is previously unrecorded may be attributed to the practice of restricting attention to the long distal tendons. The possibility that receptors may be so placed in other species warrants further work especially in those purported to lack any receptor.

Animals↗