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At least 325 records · Page 18Linked to original sources
PubMed1983

Separation of tendon ends after suture of achilles tendon.

Ten patients treated for an acute rupture of the achilles tendon were studied. During the operation a marker was attached to each tendon end. The postoperative separation of the markers was studied by repeated X-ray examinations. Despite immobilization a small initial separation was found during the first 4 days, followed by a period of no separation. After about 20 days a second separation started. No re-ruptures occurred. Both in the rabbit and in man a small initial separation of sutured tendon ends seemed to indicate an adequate tendon suture and therefore also a good tendon healing.

Achilles Tendon↗
PubMed1999

[Treatment of spastic equinovarus foot in the hemiplegic adult by retrograde fixation of the peroneus brevis tendon onto the anterior tibialis tendon].

PURPOSE OF THE STUDY: The purpose of the present study was to assess the Bardot procedure in the treatment of equinovarus deformities of the foot in spastic hemiplegia. This procedure associates the fixation of the peroneus brevis distal tendon onto the tibialis anterior, heel-cord lengthening, and tenotomies of the flexores digitorum. MATERIAL AND METHODS: Fifty-six patients underwent this procedure between 1989 and 1996. The indication for surgery was equinovarus deformity in adult spastic hemiplegia. Preoperatively all the patients had an instability and 80.5 per cent of them had to wear an ankle and foot orthesis. Postoperatively forty-one patients with a mean follow up of 3.5 years (range: one to 9 years), were available for examination including 24 females and 17 males with a mean age of 46 years at time of surgery (range: 27 to 76). RESULTS: All the patients were objectively improved. Seven of them had a discreet residual varus deformity, but none felt unstable. They all were able to walk barefooted, only one patient still required an adapted shoe. The gait and the quality of live were subjectively improved for 92.7 per cent of the patients. None of the patients has been worsened. DISCUSSION: When spastic equinovarus disturbs significantly quality of live, tendon re-balancement of the hemiplegic foot should be proposed. The fixation of the distal tendon of the peroneus brevis onto the tibialis anterior is effectively performed only if this latter is efficient in the swing phase of gait. If there is no fixed contracture, neurosurgery or chemotherapy are preferable. In case of irreducible articular deformities arthrodesis could be indicated. CONCLUSION: Tendon re-balancement in hemiplegic foot using a peroneus tendon fixation onto the tibialis anterior should be carried out after examination by a team of specialists (surgeon, neurosurgeon, rehabilitation team). In such conditions it offers constantly an improvement to the patients.

Adult↗
PubMed2000

Ligament reconstruction tendon interposition arthroplasty for basal joint arthritis: simplifying flexor carpi radialis tendon passage through the thumb metacarpal.

During the ligament reconstruction tendon interposition arthroplasty for basal joint arthritis, the flexor carpi radialis tendon is passed through the base of the thumb and out an exit hole on its dorsum. When the entire width of the tendon is harvested, this aspect of the procedure can be difficult. Tapering the width of the proximal tendon and using a Carroll tendon retriever simplify the procedure and eliminate the need for enlarging the transosseous hole in the thumb metacarpal.

Arthroplasty↗
PubMedDate not supplied

Reconstruction of the anterior cruciate ligament with the tendons of the semitendinosus and gracilis doubled: a comparison with reconstruction using the patellar tendon.

A total of sixty consecutive cases of anterior chronic laxity of the knee the pre- and intraoperative features of which corresponded to the criteria of inclusion considered, hospitalized in our institute between September and December 1998 and submitted to reconstruction of the ACL were reviewed at a follow-up of 74 months. The series was made up of two groups that were homogeneous in terms of sex, age, degree of preoperative laxity and number and type of associated meniscal lesions; in the first group (20 cases) reconstruction was carried out using the patellar tendon (BPTB) and in the other (40 cases) the doubled semitendinosus and gracilis tendons (DGST) were used with the association in cases with greater rotatory laxity (20 cases) of peripheral reinforcement reconstruction. An accelerated rehabilitation protocol was used in the first group, a more prudent one with immobilization in extension for two weeks was used in the second group. The results, evaluated based on the IKDC form, appeared to be better in the DGST group, with a statistically significant difference; joint stability, evaluated at follow-up with a KT1000 arthrometer also proved to be better in the DGST group, with a difference that was not statistically significant. The present study seems to show that reconstruction of the ACL with DGST, a prudent rehabilitation protocol and peripheral reinforcement reconstruction in selected cases is capable of providing better long-term results as compared to standard reconstruction with the patellar tendon and accelerated rehabilitation protocol. Among methods used to reconstruct the anterior cruciate ligament (ACL), those that utilize the central third of the patellar tendon (BPTB) or the semitendinosus and gracilis tendons (DGST) continue to be those used most frequently. Although the debate between orthopedics is still going on as to which of the two methods is to be preferred, studies that compare the two methods do not seem to report essential differences in medium-term results. In a recent meta-analysis of the most important international literature, to this regard Freedman et al. concluded that despite a significant major presence of anterior pain reconstruction with BPTB is capable of guaranteeing better joint stability and patient satisfaction, with a minor incidence of transplant failure. Nonetheless, if methods of reconstruction with BPTB seem to be rather standardized in terms of the method used to obtain the specimen and that used for stabilization (with very few differences between interference screws and transverse stabilization), and in postoperative rehabilitation (so-called accelerated), when DGST is used there are many technical variables capable of influencing the final results (choice of methods of stabilization, postoperative rehabilitation in particular). For this reason we still cannot obtain an absolute comparison of the two methods, but can only compare reconstruction with BPTB and a particular method used with DGST. It is the purpose of this study to present the medium-term results not so much of ACL reconstruction with the semitendinosus and gracilis doubled, but as a more articulate approach to the pathology of the ACL, so that DGST is only one phase, even if it is the most important one. Because we wished to verify whether it is possible, even in terms of joint stability and patient satisfaction, to improve the results of the so-called gold standard for reconstruction of the ACL, reconstruction by BPTB with transverse femoral reconstruction and accelerated postoperative rehabilitation protocol was chosen as a term of paragon.

Adult↗
PubMed1995

[Fibrino-purulent flexor tendon tendinitis in infected tendovaginitis of the digital flexor tendon sheath in cattle].

Seven cattle with purulent tenovaginitis of the digital flexor tendon sheath were examined. The highly inflamed portions of the deep and superficial digital flexor tendons were resected and submitted for pathologic examination in five cases. The histopathologic results confirmed the diagnosis fibrino-purulent or purulent tendinitis. In addition to the classic route of infection via the tendon sheath, it is thought that direct hematogenous infection of the tendon may be possible. The possibility of a purulent tendinitis should be considered when evaluating prognosis and treatment of an infected tendon sheath.

Animals↗
PubMedDate not supplied

Tendon reconstruction in posterior tibial tendon dysfunction.

Successful treatment of posterior tibial tendon dysfunction depends on accurate staging and the appropriate selection of surgical procedures. Magnetic resonance imaging is the most sensitive diagnostic modality for evaluating the tendon and is also the best predictor of clinical outcome following surgery. Procedural selection for patients with posterior tibial tendon dysfunction depends on many factors, including the underlying cause, age, weight, apex of the deformity, and relative integrity of the posterior tibial tendon.

Contraindications↗
PubMed1993

Mesovascularized island flexor tendon: new concepts and techniques for flexor tendon salvage surgery.

Hand surgeons have long sought ways of avoiding adhesions in flexor tendon repair. We report a new concept in tendon surgery--the use of flexor tendons with perfect mesotendon blood supply and an inherent gliding mechanism composed of the paratendon and the common carpal sheath to minimize adhesions during tendon healing. This technique, inspired by reversed ulnar island forearm transfers, makes use of the flexor superficialis of the ring finger, which is supplied by a vascular mesotendon emerging from the ulnar pedicle just before Guyon's canal, and ensures a perfect blood supply, a favorable environment for suturing, and, consequently, impressive digital excursion.

Adult↗
PubMed1995

Anterior cruciate ligament patellar tendon reconstruction: it is probably better to leave the tendon defect open!

The purpose of our prospective study was to establish whether or not in anterior cruciate ligament (ACL) patellar tendon reconstruction the tendon defect has to be closed. In 50 consecutive ACL patellar tendon reconstructions, the tendon defect was randomly closed (group I) or left open (group II). The following data were recorded from all patients on the 4th and 14th days post operation: range of motion (ROM), pain at rest, pain and validity at isometric contraction, ability of bent leg raising (at 4th day) and straight leg raising (at 14th day). All the patients underwent ultrasonographic examination after 3 months and X-ray scanning at 6 months post operation. Forty patients underwent a CT-scan examination at 6 months. Thirty patients underwent isokinetic testing between 10 and 12 months post operation. Evaluating the immediate post operation data, no statistically significant differences emerged between the two groups. Ultrasonography showed in 68% of the knees of group I (defect closed) a thickened patellar tendon (PT), while in 60% of group II it was of normal thickness. No patients of either group developed patella infera by X-ray evaluation 6 months post operation. CT scans at 6 months showed that 100% of the knees of group I had a thickened PT in toto (nearly twice as thick as normal). Scar tissue was present not only in its central third but also in more than half of the cases in the medial and lateral third. In group II 75% of the patients had a normal thickness PT and 25% presented with only a minimal thickening. Scar tissue was distinguished only at its central third.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

[Damage to large tendons: Achilles, patellar and quadriceps tendons].

The etiology and mechanisms of Achilles, patellar and quadriceps tendon ruptures are very similar. Age dependent changes in tendon structure and disorders such gout, diabetes, rheumatic diseases and chronic renal failure are associated causes. The main mechanism of rupture is indirect trauma. Although clinical diagnosis is easy, ruptures are still frequently missed. Sonography is the main standard diagnostic tool. MRI is indicated only in special cases. Open operative repair is the most common treatment for quadriceps and patellar tendon ruptures. Treatment of Achilles tendon ruptures is moving towards an individualized choice of therapy. Percutaneous and other "minimally invasive" techniques will play an increasingly important role.

Achilles Tendon↗
PubMed1992

Flexor digitorum profundus tendon excursions during controlled motion after flexor tendon repair in zone II: a prospective clinical study.

Intratendinous metal markers were used to study flexor digitorum profundus tendon excursions during early controlled motion with dynamic flexion traction and to evaluate their significance for results after flexor tendon repair in zone II. The mean excursion was 1 mm along the middle phalanx and 5.6 mm along the proximal phalanx. This corresponded to a mean excursion per 10 degrees of controlled distal and proximal interphalangeal joint motion of 0.3 and 1.2 mm, respectively. Compared to active motion, controlled motion of the distal interphalangeal joint mobilized the tendon with an efficiency of 36% and controlled motion of the proximal interphalangeal joint mobilized the tendon with an efficiency of 90%. Controlled-motion excursions induced by the distal interphalangeal joint along the middle phalanx had little influence on subsequent active range of motion in the distal interphalangeal joint, whereas excursions along the proximal phalanx (for which the proximal interphalangeal joint was largely responsible) did have a significant influence on subsequent total active interphalangeal range of motion.

Adolescent↗
PubMed2004

Combined posterior cruciate ligament-posterolateral reconstructions with Achilles tendon allograft and biceps femoris tendon tenodesis: 2- to 10-year follow-up.

PURPOSE: This study presents the 2- to 10-year (24 to 120 month) results of 41 chronic arthroscopically assisted combined posterior cruciate ligament (PCL)-posterolateral reconstructions evaluated preoperatively and postoperatively using Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scales, KT-1000 arthrometer testing, stress radiography, and physical examination. TYPE OF STUDY: Case series. METHODS: This study population included 31 men and 10 women with 24 left and 17 right chronic PCL-posterolateral knee injuries with functional instability. The knees were assessed before and after surgery with arthrometer testing, 3 different knee ligament rating scales, stress radiography, and physical examination. PCL reconstructions were performed using the arthroscopically assisted single femoral tunnel-single bundle transtibial tunnel PCL reconstruction technique using fresh-frozen Achilles tendon allografts in all 41 cases. In all 41 cases, posterolateral instability reconstruction was performed with combined biceps femoris tendon tenodesis, and posterolateral capsular shift procedures. RESULTS: Postoperative physical examination revealed normal posterior drawer and tibial stepoff in 29 of 41 (70%) knees. Posterolateral stability was restored to normal in 11 of 41 (27%) knees, and tighter than normal knee was found in 29 of 41(71%) knees evaluated with the external rotation thigh foot angle test. A 30 degrees varus stress testing was normal in 40 of 41 (97%) knees, and grade 1 laxity in 1 of 41 (3%) knees. Postoperative KT-1000 arthrometer testing mean side to side difference measurements were 1.80 mm (PCL screen) and 2.11 mm (corrected posterior; P =.001). The postoperative stress radiographic mean side-to-side difference measurement measured at 90 degrees of knee flexion and 32 lb of posterior directed force applied to the proximal tibia using the Telos device was 2.26 mm (P =.001). Postoperative Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scale mean values were 91.7, 4.92, and 88.7, respectively (P =.001). All objective parameters showed a statistically significant improvement from preoperative status. CONCLUSIONS: Chronic combined PCL-posterolateral instabilities can be successfully treated with arthroscopic PCL reconstruction using fresh-frozen Achilles tendon allograft combined with posterolateral corner reconstruction using biceps tendon tenodesis combined with posterolateral capsular shift procedure. Statistically significant improvement is noted (P =.001) from the preoperative condition at 2 to 10 years' follow-up evaluation using objective parameters of knee ligament rating scales, arthrometer testing, stress radiography, and physical examination. LEVEL OF EVIDENCE: Level IV, case series (no historical or control group).

Achilles Tendon↗
PubMed2005

The biomechanical analysis of a tendon fixation device for flexor tendon repair.

PURPOSE: Stainless steel suture is high in tensile strength but is not widely used in flexor tendon repair because of difficulty with handling and knot tying. The purpose of this study was to examine the biomechanical characteristics of the single-strand multifilament stainless steel Teno Fix device (Ortheon Medical, Winter Park, FL) designed for zone II flexor digitorum profundus (FDP) tendon repair. METHODS: Sixty cadaveric flexor tendons were transected and randomized to receive a Teno Fix or 4-stranded (3-0 or 4-0 braided polyester) suture repair; all repairs were tested with and without a 5-0 monofilament polypropylene circumferential epitendinous suture. By using a material testing system all tendons were tested to failure in tension using a linear model with a loading rate of 1 mm/s. Stiffness, force, and energy at both 2-mm gap and peak force were calculated from the resulting force-displacement curves. RESULTS: The 2-mm gapping force was significantly greater for the Teno Fix and the 3-0 repairs than for the 4-0 repairs. The energy absorbed up to 2-mm gap was significantly greater for the Teno Fix, however, than for all suture repairs both with and without a circumferential suture. There was no statistically significant difference in peak force or energy absorbed at peak force between the Teno Fix and suture repairs; the average gap at peak force for all repairs was 5.2 mm. The addition of a circumferential suture increased the 2-mm gapping and peak forces of the Teno Fix repair to 54.5 N and 66.7 N, respectively. CONCLUSIONS: Increased strength and energy absorbed at 2-mm gap and ease of installation makes the Teno Fix a promising repair method.

Biomechanical Phenomena↗
PubMed1977

Flexor tendon graft through intact superficialis tendon.

During a 14-year period, the flexor profundus mechanism was reconstructed with a free tendon graft in 25 fingers. The graft was passed either through or alongside the intact superficialis tendon. Five of the profundus tendons had ruptured, and 21 had been severed. One patient was under 10 years of age and only three were over 21 years of age. The result was considered to be satisfactory if the finger flexed to 3.2 cm or less of the mid-palm, had at lease 20 degrees of voluntary flexion of the distal joint, and lacked no more than 30 degrees of extension of the proximal interphalangeal joint. Additionally, to be satisfactory, the combined loss of extension of the proximal interphalangeal and distal interphalangeal joints ahd to be 40 degrees or less for an index or middle finger, and 60 degrees or less for a ring or little finger. Using these criteria, 20 patients were satisfactory, four were unsatisfactory, and one was unchanged. Selected patients who are between the ages of 10 and 21 years will benefit from this operation, providing that the finger had limber joints and minimal scar, and the superficialis tendon flexes the proximal interphalangeal joint at least 80 degrees.

Adolescent↗
PubMed1997

[Replacement of flexor digitorum profundus tendons by transfer of flexor superficialis tendons. An anatomical study].

To date, the functional results of surgical treatment of flexor tendons lesions, particularly secondary repair, usually remain disappointing. However, experience has shown that tendon transfers, particularly for restoration of thumb flexion, constantly gives good results. In this anatomical study, the hands of 3 fresh cadavers were dissected in order to study the length of superficial flexor tendons prior to advancement on the same finger to replace the deep flexor or their transfer to adjacent long fingers in the case of destruction of both flexor tendons. The authors observed that, with the exception of the superficial flexor of the little finger, the other 3 superficial flexors can be used for advancement or transfer, either alone or associated with proximal elongation according to Rouhier's technique. The advantages and disadvantages of this method are discussed and compared with other deep flexor repair techniques (free graft, vascularized graft).

Biomechanical Phenomena↗
PubMed2002

Carbon fibres and plasma-preserved tendon allografts for gap repair of flexor tendon in bovines: clinical, radiological and angiographical observations.

Twenty-four tenorrhaphies were performed at the mid-metatarsal region in 12 crossbred calves under xylazine-ketamine spinal analgesia. A 2.5-cm long gap was created in the superficial digital flexor (SDF) tendon and immediately repaired with carbon fibres in the animals of group I and with plasma-preserved tendon allografts in group II. Clinical examination revealed a slight increase (P > 0.05) in rectal temperature, heart and respiratory rate for 2-4 days postoperation in both groups. Milder pain and exudation as well as earlier restoration of tendon gliding movements and weight bearing were observed in group I as compared to group II. Air-tendogram in the carbon fibre group on day 30 revealed restoration of continuity across the defect of the tendon. whereas, in the allograft group, a dense homogeneous swelling was seen along the flexors. Regression of peritendinous adhesions and swelling at the reconstructed site at later stages was seen in both groups. Angiography showed hypervascularization at the reconstructed site on day 14 in the carbon fibre group, however, in the allograft group the site appeared to be relatively avascular. On days 30 and 90, blood vessels were normally organized in both groups.

Angiography↗
PubMed2001

Patellar tendon rupture 3 years after anterior cruciate ligament reconstruction with a central one third bone-patellar tendon-bone graft.

Use of the central one third bone-patellar tendon-bone autograft is an accepted technique for anterior cruciate ligament (ACL) reconstruction. Patellar tendon rupture following ACL reconstruction is an acknowledged, although rarely reported, complication of this procedure. Of the limited patellar tendon rupture cases reported in the literature, most are described early in the postoperative period. We present a case of late patellar tendon rupture more than 3 years after uneventful ACL reconstruction in a 32-year-old man.

Adult↗
PubMed2002

[Narrowing of the third extensor tendon compartment in minimal displaced distal radius fractures with impending rupture of the EPL tendon].

Delayed ruptures of the extensor pollicis longus tendon (EPL) occur in about 0.7 percent following undisplaced distal radius fractures. Two possible mechanisms are mainly discussed in the literature: A mechanical irritation of the tendon caused by a sharp edge of the fractured bone and a direct microvascular compromise of the poorly vascularized tendon. In undisplaced fractures, however, a mechanical irritation seems less likely. In the cases here described we were able to demonstrate a fragment displacement in the area of Lister's tubercle suspected by the native X-ray and further evaluated by a CT scan. The use of CT scans even in minor displaced distal radius fractures involving Lister's tubercle may demonstrate a direct contact of the EPL tendon with a sharp edge of this fractured bone and make adequate surgery possible.

Bone Screws↗
PubMed1996

Repair of chronic distal biceps brachii tendon rupture using free autogenous semitendinosus tendon.

Distal biceps brachii tendon ruptures occur much less frequently than do their proximal counterparts. Distal tendon ruptures usually are associated with considerable function deficits and may require surgical treatment. Repair of chronic distal biceps brachii ruptures are extremely unusual. A free autogenous semitendinosus tendon graft was used to reconstruct the distal biceps tendon by reattaching the graft to the radial tuberosity via a 2-incision technique in a patient with symptoms and a chronic injury.

Arm Injuries↗