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PubMed1986

Decrease in mass of slow and fast tenotomized muscles of guinea pigs: role of nerve impulses and neurogenic factors.

The role of nerve impulses and neurogenic factors in the decrease in muscle mass following tenotomy was investigated in 30 adult (15 males, 15 females) guinea pigs. Unilateral tenotomy, neurectomy and simultaneous tenotomy and neurectomy of slow and fast hindlimb muscles were performed in 3 groups respectively. Each group comprised 10 guinea pigs. The unoperated hindlimb of each animal in each group served as control. The weight loss occurred in both slow and fast muscles but was greater in the slow soleus muscle as compared to the fast gastrocnemius muscle. In each muscle the weight loss was least in the tenotomized group. This was followed by the weight loss in the neurectomized group. The greatest weight loss was observed in the simultaneously tenotomized and neurectomized group. These observations agree with the suggestion of other workers that a possible neurogenic factor flowing from the nerves to the muscles was very significant in maintenance of muscle fibre stability. It indicated also that simultaneous neurectomy and tenotomy did not prevent degenerative changes in slow and fast muscles and that it was not nerve impulses reaching the tenotomized muscles that were responsible for degenerative changes observed but that other factors were responsible.

Animals↗
PubMed1976

Surgical treatment of true Brown's syndrome.

In 1950 H. W. Brown reported the superior oblique tendon sheath syndrome and cut the sheath as treatment for the condition. My results (as well as those of other surgeons) with similar surgery have been disappointing. Consequently, I carried out different operations consisting of Z tenotomy of superior oblique tendon in nine patients, split tendon lengthening in two patients, complete tenotomy in 16 patients, and a tenectomy in two patients. One of the latter was done on a patient after an unsatisfactory tenotomy where I missed the tendon. Tenotomy of the superior oblique tendon gave the best results. Experiments with the superior oblique tendon in cadavers several hours after death showed that after cutting the tendon just medial to the superior rectus muscle, the cut end of the tendon moved medially only about 8 to 10 mm due to restrictions of the capsular attachments to the trochlea. The cause of "true" Brown's syndrome is a tight tendon, and a safe and effective surgical treatment consists of cutting it just medial to the superior rectus muscle.

Humans↗
PubMedDate not supplied

A multicenter study of 210 rotator cuff tears treated by arthroscopic acromioplasty.

We followed 210 cases of rotator cuff tears treated in four French centers by arthroscopic acromioplasty in 195 cases and by a tenotomy of the Long Head of Biceps (LHB) in 15 cases. All patients were evaluated by means of the Constant score (CS) and radiographic imaging. The mean age was 61 years and the mean follow-up period was 26.6 months (range, 12 to 93 months). The preoperative CS was 38.2 points; 41% were supraspinatus tears, 40.2% were supra and infraspinatus tears, 10.5% were three-tendon tears, and 8.1% were supraspinatus and subscapularis tears. The LHB was altered or disrupted in 77% of cases, dislocated or subluxated in 44% of cases. Acromioplasty was associated to tear debridement in 183 cases (88%) and to a tenotomy of the LHB in 38 cases (19%) of which 15 did not benefit from an associated acromioplasty. Global objective results shown by the corrected CS reached 79.7% and were satisfying in 73% of cases. Poor clinical factors were preoperative shoulder stiffness, postoperative painful crises, worker compensation, a preoperative history longer than 4 years, and young age. The poor anatomic factors were osteoarthritis, a lesion of the acromioclavicular joint or of the LHB tendon. An isolated supraspinatus tear will produce much better results than a triple-tendon tear. The persistence of an aggressive acromion was a prejudicial factor. The benefits of LHB tenotomy were evident and could be isolated in case of massive rotator tears. It seems that LHB tenotomy was particularly effective for massive tears of two or more tendons. Arthroscopic acromioplasty is an excellent indication for elderly patients without professional activity, functionally less demanding that a younger patient.

Acromion↗
PubMedDate not supplied

Selective soft tissue release preserves growth plate architecture during limb lengthening.

Although distraction osteogenesis has proven successful in children, concerns remain regarding potential growth inhibition of the lengthened limb. Twenty-one 8-week-old New Zealand White rabbits underwent a unilateral 40% tibial lengthening with the contralateral tibia as control. The animals were divided into Achilles tendon release and non-release groups. Radiographs and histomorphometric analysis of the proximal tibial growth plate was performed 5 and 10 weeks after distraction. The corrected length of tibias without tenotomy was significantly shorter than the contralateral controls, whereas those with tenotomy were statistically equivalent to the contralateral control tibias. Histologically, the operated limbs without tenotomy showed a significant decrease in thickness and loss of cellular architecture of the proximal tibial growth plate compared with the tenotomy groups, which were of near-normal appearance. A concomitant tendo Achilles lengthening performed with 40% tibial lengthening preserves proximal tibial growth plate architecture in this model.

Achilles Tendon↗
PubMed2002

Development of new treatments for congenital nystagmus.

The use of ocular motor data as the basis for the development of both nonsurgical and surgical therapies for congenital nystagmus (CN) has been underway since the mid-1960s. This paper presents three nonsurgical therapies (composite prisms, soft contact lenses, and afferent stimulation) and a new surgical therapy (four-muscle tenotomy) hypothesized from analysis of ocular motor data. The expanded nystagmus acuity function test was developed to both predict and measure the effectiveness of CN therapies and for intersubject comparisons. Base-out prisms may be used to damp CN during distance fixation in patients whose CN damps during near fixation and who are binocular (i.e., they have no strabismus). Soft contact lenses may be used in those whose CN damps with afferent stimulation of the ophthalmic division of the trigeminal nerve. Cutaneous afferent stimulation (rubbing, vibration, or electricity) of the forehead or neck damps CN in some individuals. Finally, as first demonstrated in an achiasmic Belgian sheepdog and later in humans, tenotomy of the four horizontal rectus muscles and reattachment at their original sites may also damp CN. Taken together, these findings suggest the existence of one or more proprioceptive feedback loops acting to change the small-signal gain of the extraocular plant. Four-muscle tenotomy provides a needed therapeutic option for the many individuals with CN for whom other surgical therapies are contraindicated. Tenotomy may also prove useful in see-saw nystagmus (it abolished it in the aforementioned canine) or other types of nystagmus; further studies of the latter are required.

Animals↗
PubMedDate not supplied

Circulatory disturbance of the first metatarsal head after Chevron osteotomy as shown by bone scintigraphy.

Distal osteotomies, such as Chevron osteotomies, have a potentially high risk for circulatory disturbance, since they transect part of the circulatory apparatus. An increased risk of up to 40% of avascular necrosis diagnosed radiographically has been reported when the osteotomy is combined with adductor tenotomy. On the other hand, new circulatory studies indicate that the circulation does not go in direct proximity to the adductor tendon. In this prospective study, 38 consecutive patients (41 feet) were randomized to Chevron osteotomy alone or Chevron osteotomy with adductor tenotomy. They were investigated 2 to 9 days postoperatively with 99mTc-methylene diphosphonate scintigraphy as well as x-rays and clinical examination. The average follow up was 19 months (range 12-48 months). Three defects were found in those operated with Chevron osteotomy alone, and one defect was found in a patient operated with Chevron osteotomy and adductor tenotomy. None of the patients had symptoms attributable to reduced circulation of the metatarsal head. Repeat scans showed healing in all four cases. Radiographs failed to show any signs of necrosis. Thus, Chevron osteotomy is a safe method in the treatment of hallux valgus which can be combined with adductor tenotomy without increasing the risk for circulatory disturbance.

Adult↗
PubMed2006

Treatment of idiopathic club foot using the Ponseti method. Initial experience.

We report our initial experience of using the Ponseti method for the treatment of congenital idiopathic club foot. Between November 2002 and November 2004 we treated 100 feet in 66 children by this method. The standard protocol described by Ponseti was used except that, when necessary, percutaneous tenotomy of tendo Achillis were performed under general anaesthesia in the operating theatre and not under local anaesthesia in the out-patient department. The Pirani score was used for assessment and the mean follow-up time was 18 months (6 to 30). The results were also assessed in terms of the number of casts applied, the need for tenotomy of tendo Achillis and recurrence of the deformity. Tenotomy was required in 85 of the 100 feet. There was a failure to respond to the initial regimen in four feet which then required extensive soft-tissue release. Of the 96 feet which responded to initial casting, 31 (32%) had a recurrence, 16 of which were successfully treated by repeat casting and/or tenotomy and/or transfer of the tendon of tibialis anterior. The remaining 15 required extensive soft-tissue release. Poor compliance with the foot-abduction orthoses (Denis Browne splint) was thought to be the main cause of failure in these patients.

Casts, Surgical↗
PubMed2006

Surgical outcomes in correction of Brown syndrome.

PURPOSE: To evaluate the outcomes of surgery for Brown syndrome. METHODS: We reviewed the charts of 15 patients who underwent surgery for Brown syndrome. The limitation of elevation in adduction (LEA) ranged from -2 to -4 degrees. A superior oblique muscle (SO) tenotomy was performed in 4 patients, a silicone expander was inserted in the SO of 9 patients, and a SO recession was performed in 2 patients. The results of surgery were analyzed with a follow-up period of more than 6 months, 42.3 +/- 48.42 months on average. RESULTS: Nine female patients and 6 male patients with unilateral Brown syndrome were selected for this study. The left eye was the affected eye in 9 patients. The degree of preoperative LEA was -2 to -4 in 4 patients in whom SO tenotomy was performed, -3 to -4 in 9 patients treated with the silicone expander, and -2 to -4 in 2 patients treated with SO recession. The LEA was released after surgery in all patients without postoperative adhesion. However, unilateral overaction of the inferior oblique muscle due to excessive weakening of the SO occurred in 1 patient with tenotomy (25%) and in 1 patient with insertion of a silicone expander (11%). CONCLUSIONS: LEA was released after tenotomy, insertion of a silicone expander and recession of the SO in 13 of 15 patients with Brown syndrome. SO palsy due to overcorrection and under-correction with postoperative adhesion should be avoided.

Adult↗
PubMedDate not supplied

Treatment of congenital adduction palsy with synergistic divergence.

OBJECTIVE: To report on successful management of congenital adduction palsy with synergistic divergence by performing weakening surgery on the superior and inferior oblique muscles. METHODS: We performed a total tenotomy of the lateral rectus muscle, followed by resection of the medial rectus muscle and tenotomy of the superior oblique and myectomy of the inferior oblique muscles in a patient who had congenital adduction palsy with synergistic divergence. RESULTS: Total tenotomy of the lateral rectus muscle had no effect on synergistic divergence, resection of the medial rectus muscle reduced it to some extent and tenotomy of the superior oblique and myectomy of the inferior oblique muscles further reduced this phenomenon. The improvement in synergistic divergence was maintained at 2 1/2 years later at follow up. CONCLUSIONS: Weakening surgery on the superior and inferior oblique muscles should be considered in the management of synergistic divergence.

Adolescent↗
PubMed2000

[Arthroscopic debridement of full-thickness tears of the rotator cuff: a retrospective multicenter study of 283 cases with 3-year follow-up].

PURPOSE OF THE STUDY: The purpose of this study was to assess clinical and radiological course of full-thickness rotator cuff tears treated by arthroscopic debridement and to discuss surgical indications according to patient demands and anatomical lesions. MATERIAL AND METHODS: This retrospective and multicentric study included patients with a minimal 3 years follow-up. The coronal extent of the supraspinatus tear was described as distal, intermediate or retracted. The sagittal extent to the infraspinatus and/or subscapularis and rotator interval was detailed. All patients were evaluated pre and post-operatively using Constant score and radiological A-P view for sub-acromial space measurement. In order to assess the influence of age, anatomical extent of the tear and follow-up, results were analyzed for 4 groups of patients according to their age: group I (19 cases less than 50 years), group II (88 cases from 51 to 60 years), group III (58 cases from 61 to 65 years) and group IV (118 cases over 65 years). Results were finally evaluated according the arthroscopic procedure (isolated acromioplasty and biceps tenotomy, or association of both). RESULTS: 283 patients, aged 63.1 years (range 32 to 82) entered this study. A complete antero-posterior tear of the supra-spinatus tendon was noticed in 93.2 p. 100 of cases. The tear extended to the infraspinatus tendon in 57.3 p. 100, and to the subscapularis tendon in 29 p. 100 of cases. The long head of the biceps was involved in 73 p. 100 of cases. 218 acromioplasties and 116 biceps tenotomies were performed. The 2 procedures were combined in nearly 25 p. 100 of cases. At final revision (mean follow-up of 4.7 years), 98 patients (34.6 p. 100) were very satisfied, 122 (43.1 p. 100) satisfied, 43 (15.2 p. 100) moderatly satisfied and 20 (7.1 p. 100) were disappointed. The average Constant score increased from 42.4 to 67.6 points. The radiological study showed a 1 mm narrowing of the sub-acromial space. Objective results were surprisingly good for group I at a 5.4 years follow-up but dropped from group II to group IV, mainly in relation with the extent of the tear. A deleterious effect of the isolated biceps tenotomy was demonstrated in case of subacromial space superior to 7 mm. Inversely after this procedure patients with a narrowed space improved. DISCUSSION: Even if traditional bias of retrospective and mullticentric study could not be avoided, the large number of patients and long follow-up of this study are superior to most of the published papers. The extent of the supraspinatus tear seems to progress during the 50-60 years decade. Objective results appeared to be much more related to the anatomical lesions than to the arthroscopic procedure. CONCLUSION: This series did not demonstrate a secondary clinical or radiological deterioration after an endoscopic treatment without repair of full-tickness rotator cuff tears. Subacromial decompression and/or biceps tenotomy indications depend on age and extension of the tear.

Adult↗
PubMed2001

[Anterior iliopsoas impingement after total hip arthroplasty: diagnosis and conservative treatment in 9 cases].

PURPOSE OF THE STUDY: Impingement of the iliopsoas muscle due to a protruding acetabular component is an uncommon cause of pain after total hip arthroplasty. Diagnostic signs may be misleading and therapeutic management has varied, leading to divergent findings reported in the literature. The purpose of this prospective work was to determine the frequency of groin pain due to iliopsoas impingement (with or without an identified causal mechanism) in patients with painful total hip arthroplasties and to identify diagnostic criteria that can be used to determine the appropriate therapeutic strategy. MATERIAL AND METHODS: This prospective study was conducted between 1998 and 2000 and included 206 painful total hip arthroplasties. From this series, we excluded cases where pain was related to loosening (139 cases, 67%), infection (45 cases, 21.7%), bursitis on trochanteric sutures (2 cases, 1%), and aortic aneurysm with gluteal claudication and resulting from a lumbosacral disorder (10 cases, 4.8%). This left 9 cases (4.3%) with a clinical picture suggestive of iliopsoas impingement. These 9 patients (mean age 50 years, age range 38 - 65) had 8 uncemented press-fix cups and 1 cemented cup with an acetabular mesh. Mean delay to the development of pain after the arthroplasty procedure was 7.3 months (1 - 48 months). The most suggestive clinical sign was groin pain triggered by active flexion of the hip and flexion of the hip against force with a painful arc measuring 30 degrees to 70 degrees. None of these 9 patients had any sign of material loosening and puncture aspiration ruled out infection. The final diagnosis was confirmed by sedation of pain after extra-articular infiltration at the anterior border of the cup (overhanging cup in 6/9 cases) under computed tomographic guidance. RESULTS: Infiltrations with xylocaine and long-release corticosteroids led to complete sedation of pain in 4 out of 9 patients and partial sedation in 1 other. Recurrent pain led to terminal tenotomy of the iliopsoas in 4 patients, that provided total sedation in 3 and partial sedation in 1. In all, successful pain relief was achieved in 7 out of 9 cases: 4 after infiltration (repeated in 1 cases) and 3 after tenotomy. At last follow-up physical examination has not identified any loss of flexion force. DISCUSSION AND CONCLUSION: Irritation of the iliopsoas muscle can be the cause of pain in 4.3% of patients experiencing pain after total hip arthroplasty. The delay to symptom onset is variable but there appears to be a pain-free period after implantation. An anatomic element (anterior cup overhang) is not necessary for diagnosis since the infiltration test was positive in 1 out of 3 cases without any identified acetabular factor. The infiltration test is an important element for positive diagnosis and should be the first therapeutic measure taken. We achieved success in 4 out of 9 cases. Tenotomy is indicated in case of recurrence, providing complete cure in 3 out of 4 cases in our series. Cure may be achieved without changing the cup by simple infiltration or tenotomy of the iliopsoas that led to complete cure in 7 out of 9 cases in our series, even in patients with an overhanging cup (6 out of 9 cases). An elective procedure might be indicated if a specific anomaly is identified (overly long screw, cement leakage) or for a screwed cup. The infiltration test should however be performed beforehand to confirm the diagnosis.

Adrenal Cortex Hormones↗
PubMed2003

Experimental study on the prevention of anterior segment ischemia by preservation of anterior ciliary vessels.

PURPOSE: To observe the effect of preserving anterior ciliary vessels (ACVs) on anterior segments of rabbit eyes undergoing tenotomy of extraocular muscles. METHODS: Thirty-two adult New Zealand white rabbits were divided into four groups. Same procedures were done in both eyes in each group except that left eyes underwent preservation of ACVs. In the first group medial and lateral recti, in the second group, superior and inferior recti, in the third group, medial, lateral and superior or inferior recti and in the fourth group, all four recti, underwent tenotomy. Slit-lamp examination, intraocular pressure (IOP) measurement, total protein and lactic acid quantification in aqueous humor were done in all eyes pre- and post-operatively. By four weeks after operation, the eyes were enucleated for histological examination and electron microscopy. All data were analyzed using SPSS version 10. RESULTS: In the left eyes of both group 1 and group 2, no inflammatory response was observed. In the left eyes of group 3 and 4, we observed mild inflammatory response with slit-lamp examination, which disappeared in one wk. However, we did not find significant changes in IOP, total protein and lactic acid of aqueous humor, histology and electron microscopic examination in these groups. In the right eyes in group 2, 3 and 4, we observed moderate to severe inflammatory changes, a few even developed anterior segment ischemia, appeared as decreased IOP, increased total protein and lactic acid in aqueous humor, along with pathological and electron-microscopic changes. CONCLUSION: Simultaneous tenotomy of three or four recti or two vertical recti on one eye may decrease anterior segment blood flow even lead to ischemia. ACVs preservation may protect the blood circulation in anterior segment. Our study suggests that ACVs preservation in strabismus surgeries especially those involving multi-recti tenotomies may prevent potential anterior segment ischemia.

Animals↗
PubMed1991

The effect of indomethacin on Achilles tendon healing in rabbits.

In a randomized, blind study, percutaneous tenotomy was performed on the right Achilles tendon complex of 32 male, New Zealand rabbits. The rabbits were placed in long-leg casts to approximate the tendon. Sixteen rabbits received oral therapeutic doses (1.5 mg/kg/day) of indomethacin elixir; the remaining 16 rabbits received no medication and comprised the control group. At two and six weeks following tenotomy, eight rabbits in each group were sacrificed and the Achilles tendon complexes were resected. Each tendon was evaluated for tensile force-to-failure by uniaxial tensile loading using an Instron Materials Testing Machine at a velocity of 0.85 cm/second. Histologic evaluation assigned the specimens to categories of either "relatively mature" or "relatively immature," based on the degree of cellularity, neovascularity, and collagen orientation that had occurred in the healing process. The mean force-to-failure two weeks post-tenotomy for the experimental group was 75.7 +/- 42.3 Newtons (N), and 96.6 +/- 35.2 N for the control group; at six weeks post-tenotomy, the mean force-to-failure for the experimental group was 165.5 +/- 34.3 N and 160.2 +/- 31.6 N for the control group. Statistical analysis revealed no significant differences in tensile force-to-failure or histologic appearance between the experimental and control groups at either time interval. These results suggest that indomethacin, and potentially other nonsteroidal antiinflammatory drugs, may be used in conjunction with a tendon injury without significantly affecting the early healing process.

Achilles Tendon↗
PubMed1985

The development of central cores in both fiber types in tenotomized muscle.

Using the histochemical reaction for myosin adenosine triphosphatase (ATPase), a study of the rat soleus muscle following tenotomy was undertaken. It was demonstrated that both type 2A and 2C fibers undergo degenerative changes following tenotomy. All previous studies have stated that only type 1 fibers were affected and developed central core lesions and that type 2 fibers were somehow protected from the degenerative process. The results of this experiment illustrate that central core lesions will develop in all three fiber types (types 1, 2A, and 2C) of the soleus following tenotomy.

Adenosine Triphosphatases↗
PubMed1991

Muscle regeneration following segmental necrosis in tenotomized muscle fibers.

The aim of this study was to determine how the new myotendinous junctions were re-established at the proximal and distal ends of the soleus muscle after tenotomy. Both proximal and distal tendons of the soleus muscle in mature female rats were severed. The animals were killed and the soleus muscles were removed and prepared for light and electron microscopic examination 1, 3, 5, 7, 14, 21, 28, and 42 days after the operation. It was found that segmental fiber destruction followed by removal by macrophages occurred at the ends of the soleus muscle fibers. This resulted in the liberation and myogenic activation of satellite cells. By 3 days after tenotomy the fusion of myoblasts to form myotubes could be seen. The myotubes developed within the original basal lamina and reattached to the surviving non-necrotic segments and grew in both length and width so that by 6 weeks postoperation, normal myotendinous junctions had been reformed. This study is the first to show that re-establishment of the myotendinous junction following tenotomy is accomplished by regeneration of the necrotic ends of the tenotomized fibers.

Animals↗
PubMed1994

Surgical prevention of paralytic dislocation of the hip in cerebral palsy.

Paralytic dislocation of the hip in cerebral palsy may be prevented by soft tissue surgery and the results of two procedures are reported. Twenty hips were treated by adductor tenotomy alone and this was unsuccessful in every case. An alternative method was carried out in 42 hips in 25 patients. The procedure combined adductor tenotomy with release of the hip muscles including iliac crest resection, tenotomy of the rectus femoris, recession of the iliopsoas and, when necessary, either release or transposition of the knee flexors. This was much more successful in decreasing migration of the femoral head.

Adolescent↗
PubMed1986

Biomechanical and biochemical studies of tendon healing after conservative and surgical treatment.

Based on clinical studies, it has been proposed that conservative treatment of Achilles tendon ruptures is feasible. However, no biomechanical or biochemical confirmation of this proposal has been presented. In the present investigation the biomechanical and biochemical properties of tendons treated surgically and conservatively after transverse tenotomy were studied. Sixty-eight New Zealand White rabbits were used. A transverse tenotomy of the plantaris longus tendon of the left hind leg was performed. In half of the animals the tenotomy was repaired with a criss-cross silk suture and the limb was immobilized; the other half were treated with immobilization alone. The immobilization was maintained for 4 weeks with a long-leg plastic splint in both groups. After 4, 8, and 16 weeks the tendons were examined regarding biomechanical and biochemical parameters. There were no detectable differences in biomechanical parameters or in tendon elongation between the groups, nor was there any difference in the total hydroxyproline content, the amount of mature and of immature collagen, or the water content. The present findings are compatible with previous favorable reports on conservative treatment of Achilles tendon ruptures and thus suggest interesting clinical possibilities.

Achilles Tendon↗
PubMed1985

Recapillarization of tenotomized skeletal muscles after delayed tendon suture. I. Experimental study.

The investigation was under taken to study the long-term effect of tendon suturing on the capillarization of guinea-pig crural muscle after Achilles tenotomy. The results indicate that the capillary density has been greatly decreased by the tenotomy. The recapillarization and the time of restitution of the crural muscle are influenced by the interval between tenotomy and tendon suture.

Adenosine Triphosphatases↗