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At least 415 records · Page 23Linked to original sources
PubMed2001

Peroneus brevis tendon tears.

Tears of the peroneus brevis tendon are more frequent than reported in the literature. Because of the vague pain associated with structures of the lateral ankle, peroneal tears are frequently misdiagnosed. Physical signs such as swelling along the course of the peroneal tendon sheath, pain with eversion, and subluxing tendons are diagnostic of peroneal pathologic conditions. The cause of peroneal tears is not completely understood. Possible causes include subluxing peroneal tendons, a sharp posterior ridge of the fibula, overcrowding of the peroneal groove, instability of the superior peroneal retinaculum, lateral ankle instability, contraction of the peroneus longus, hypovascularity of the peroneus brevis tendon, and a shallow peroneal groove of the fibula. Although conservative measures are almost always attempted, surgical repair of peroneus brevis tears remains the standard of care. Débridement and tubularization are recommended for less extensive tears. In more severe cases, resection of the damaged tendon and tenodesis of the proximal and distal segments to the peroneus longus are necessary. Return to maximum activity is prolonged, but with proper patient selection, evaluation, and treatment, good to excellent results can be expected.

Ankle Injuries↗
PubMedDate not supplied

Subcutaneous rupture of the tendon of the long head of the biceps brachii in subacromial impingement syndrome.

Ruptures of the long head of the biceps brachii are mostly of degenerative nature, secondary to subacromial impingement and morphological changes in the bicipital groove. Clinical findings are typical. Treatment is controversial, as it may either be surgical or non-surgical. The authors considered only those cases in which tendinous rupture was the first manifestation of pathology caused by wearing, with typical deformity of the profile of the arm. The favorable results of surgical treatment in 14 patients aged from 38 to 70 years, followed-up after an average of 10.9 years, are reported. Among surgical methods used, tenodesis at the bicipital groove currently constitutes the method of choice.

Adult↗
PubMed2001

Surgical technique and functional results of irreparable cuff tears reconstructed with the long head of the biceps tendon.

The purpose of the study was to evaluate the results obtained from patients who were treated with open surgical technique using the long head of the biceps tendon for irreparable tears of the rotator cuff tendons. Between May 1992 and January 1997, 14 patients underwent rotator cuff reconstruction of irreparable tears at our clinic. These patients were evaluated before and after a minimum follow-up of 26 months (mean: 40.2 months) following surgery with the Constant's functional score. The long heads of the biceps tendons were found to be hypertrophied in all 14 shoulders and in 10 of them they were also subluxated. After re-seating the surgically enlarged biceps tendon onto the center of the uncovered head region, the biceps tendon to cuff tendon repair and the biceps tenodesis were done in all shoulders. The mean functional Constant's score before surgery was 46.7 points (poor) and the mean postoperative score at the final follow-up was 75.35 points (good). Satisfactory results were achieved in 85.7% of the patients. These results suggest that this surgical technique can be used to attain a painless and functional shoulder after irreparable cuff tear reconstruction.

Aged↗
PubMed2002

[Anesthetic management of a patient with hereditary spastic paraplegia].

We experienced the anesthetic management of a 39 year-old-male with hereditary spastic paraplegia (HSP) associated with pain due to pes cavus. He underwent orthomorphia ostectomy and tenodesis. Preoperative neurological examination revealed that he had slight dementia, symptoms of the pyramidal tract, lower limb bathyhypesthesia, and neurogenic bladder in addition to spastic paraplegia, and he was diagnosed as having combined type of HSP. Spinocerebellar degeneration is often accompanied with this type of HSP. To avoid the use of muscle relaxants and narcotics, we tried to induce anesthesia with inhalation of nitrous oxide (N2O), oxygen and sevoflurane (sevo). A laryngeal mask (LM) was inserted at the expiratory concentration of sevo 3.5%. Anesthesia was maintained by N2O, oxygen and sevo (2-3%) under spontaneous respiration. The patient recovered from anesthesia after the end of surgery, and the LM was removed smoothly. The patient's respiratory condition was stable, and no problems were found in the postoperative period.

Adult↗
PubMed2002

[Arthroscopic reconstruction of the anterior cruciate ligament].

PURPOSE OF THE STUDY: We report a retrospective series of 83 patients (86 knees) who underwent reconstruction surgery for chronic anterior knee laxity. The purpose of this study was to analyze mid-term results and assess prognosis factors. MATERIAL AND METHODS: All patients underwent artrhoscopic reconstruction of the anterior cruciate ligament using a central one-third patellar tendon graft. Full follow-up data were available for 51 patients (52 knees) and partial data for 24 others (25 knees). Eight patients (9 knees) were lost to follow-up. The IKDC criteria were used to analyze outcome at a mean 6 years post-surgery. RESULTS: Graft failure was observed in 5 knees and a graft tears after a new sprain was seen at 3 years. The patients were satisfied or very satisfied in 88.5% of the cases. The Trillat-Lachman test revealed a persistent dampened brake in 5 knees and a frank click in 4 (7.7%). Complete movement was recovered in all knees excepting 2 exhibiting persistent flexion. Residual laxity (active Lachman test) was 5 mm in 81.5% of the cases, between 6 and 10 mm in 17%, and greater than 10 mm in only 1 case (2.5%). IKDC scores were A=25%, B=50%, C=21% and D=4%. Forty-two patients (61%) returned to their sports activities and 9 of the 12 high-level athletes resumed competition at the same level as preoperatively. Arthroscopy enabled a well- or very well-positioned femoral tunnel in 88% of the cases, conditioning final IKDC outcome (p<0.02). There was a correlation between the meniscal status and residual laxity. DISCUSSION: This study demonstrated a high proportion (21%) of patients with an incomplete repair (21% IKDC class C) with a residual laxity greater than 5 mm and a late hard brake. Simple patellar tendon graft provided insufficient repair of the anterior cruciate ligament. The subjective outcome was better than the objective outcome since 88.5% of the patients were satisfied or very satisfied (patients seen at last follow-up or contacted by telephone). Good objective outcome was correlated with good femoral position of the transplant and preservation of the meniscus. Failures were explained by poor position of the transplant, long-standing laxity, and renewal of sports activities too early. CONCLUSION: Arthroscopic repair of the anterior cruciate ligament is a reliable procedure, but as failures are observed, indications should take into consideration the type of laxity and the status of the meniscus. For unique anterior laxity, the central one-third patellar tendon graft gives good results. For advanced anterior laxity, augmentation with an extra-articular lateral tenodesis would be necessary.

Anterior Cruciate Ligament↗
PubMedDate not supplied

Management and complications of anterior cruciate ligament injuries in skeletally immature patients: survey of the Herodicus Society and The ACL Study Group.

Expert opinion regarding experience with the management and complications of pediatric anterior cruciate ligament (ACL) injuries was studied by surveying members of The Herodicus Society and The ACL Study Group. There was large practice variation in initial management and ACL reconstruction technique. There were 15 reported cases of growth disturbance: 8 cases of distal femoral valgus deformity with arrest of the lateral distal femoral physis, 3 cases of tibial recurvatum with arrest of the tibial tubercle apophysis, 2 cases of genu valgum without arrest, and 2 cases of leg length discrepancy. Associated factors included fixation hardware across the lateral distal femoral physis in 3 cases, bone plugs of a patellar tendon graft across the distal femoral physis in 3 cases, large (12 mm) tunnels in 2 cases, fixation hardware across the tibial tubercle apophysis in 3 cases, lateral extra-articular tenodesis in 2 cases, and over-the-top femoral position in 1 case. Based on this experience, we recommend a guarded approach to ACL reconstruction in the skeletally immature patient with careful attention to technique and follow-up.

Age Factors↗
PubMed1992

[Extension of the fingers. V. Anatomic approach to lesions of the extensor apparatus].

The physiopathology of the main deformities of the fingers, induced by the injury of the dorsal aponeurosis of the fingers, is caused by an imbalance of forces: proximally between extrinsic and intrinsic muscles; distally between central and collateral structures. The ulna Claw, caused by the whole paralysis of the intrinsic muscles, can be corrected by an interosseous tenodesis on the basis of the finger. The boutoniere is induced by the exaggeration of the action of the collateral structures with respect to this of the central structures. The swan neck is induced by the exaggeration of action of the central structures with respect to this of the collateral structures. The surgical treatment consist to give back those structures their normal lengthening and way, or else to create new detours or shortenings, allowing to give back the balance. So, any structures, spared by the traumatism, will not injure by the surgeon.

Finger Injuries↗
PubMed1992

[Treatment of post-traumatic swan-neck deformities of the fingers. Apropos of a series of 43 patients].

Thirty three patients with 51 swan neck deformities were reviewed with a mean follow up of 35 months (6 to 86 months). 8 fingers presenting some stiffness necessitated a first step of splinting before operation giving nevertheless 5 excellent and good results. Among the other fingers with full range of passive motion surgery was performed in 38 cases with 81.5 per cent of excellent and good results. According to etiology, articular or extrinsic, excellent and good results were respectively 71 per cent and 94 per cent. The most frequently used operations were Littler type II (12 cases) and Littler type III (S.O.R.L. 11 cases) giving respectively 75 per cent and 82 per cent of excellent and good results, despite frequent minor complications. Tenodesis with translocation of a lateral extensor band gave in half the cases some extension lack at DIPJ (less than 20 degrees in 62.5 per cent). Finally direct surgery of mallet finger complicated by a swan-neck deformity led constantly to good correlation at the PIP level.

Adolescent↗
PubMedDate not supplied

[Palliative surgical treatment of spastic paralysis in the upper extremity].

AIMS: In this paper we review the main studies conducted on therapy applied to the bony and soft parts in spastic paralysis of the upper extremity. DEVELOPMENT: Spasticity presents muscular hypertonia and hyperexcitability of the stretch reflex, which are typical of upper motoneuron syndrome. Physiopathologically, spasticity is due to the medullar and supramedullar alteration of the afferent and efferent pathways. Treatment is multidisciplinary and involves the collaboration of rehabilitators, neurophysiologists, neurologists, paediatricians, orthopaedic surgeons and psychologists, who all contribute with their different therapeutic aspects and characteristics (which can be pharmacological, peripheral neurological blockages, surgical, etc.). The characteristic posture of the upper extremities in spastic cerebral palsy is the inward rotation of the shoulder, flexion of the elbow and pronated forearm, and the deformity of the fingers (swan-neck and thumbs-in-palm). The primary objectives in these patients will be to improve communication with their surroundings, perform activities of daily living, increase mobility and walking. CONCLUSIONS: The surgical treatment applied by orthopaedic surgeons in the upper extremities are aimed at achieving an enhanced adaptive functionality rather than morphological normality. Factors to be taken into account include age, voluntary control over muscles and joints, level of severity of the spasticity (Ashworth scale) and stereognostic sensitivity. In general, on soft parts we will use procedures such as dehiscence or lengthening of the flexor muscles of the shoulder and elbow or of the adductor of the thumb; transfer of the pronators in order to adopt the supinating function or of the flexors so as to reinforce the extensors of the forearm, and capsulodesis or tenodesis in the hand. The bony procedures will consist in derotational osteotomies of the humerus and radius and arthrodesis in the wrist or in the metacarpophalangeal joints of the thumb, depending on whether there is greater rigidity or age in the former cases or instability in the latter.

Humans↗
PubMed1992

[Anatomy of the flexor and extensor tendons].

The flexor and extensor tendons of the hand are equipped with special gliding mechanisms. Blood supply is provided via paratenon and in the fibro-osseous tunnel via mesotenon. The tendons show different amplitudes of active excursion which decrease distally. The function of flexors and extensors is coordinated and supplemented by reflexes and by the correlating relay system of lumbricals. Activation of extensor aponeurosis results via the so-called extrinsic and intrinsic system, where the IP joints are additionally linked functionally by the oblique retinacular ligaments of Landsmeer. At the level of the MP joint, the dorsal aponeuroses are furthermore linked by oblique fibrous structures, which lead to functional impairment of the neighboring MP joints in maximal flexion and extension of a finger due to an effect of tenodesis (so-called quadriga phenomenon).

Fasciotomy↗
PubMed2004

[Results of Menon's arthroplasty in basal joint osteoarthritis].

PURPOSE OF THE STUDY: Osteoarthritis of the basal joints is a frequent degenerative disease. The wide range of arthritic lesions of the first carpal metacarpal joint should be treated by targeted surgical techniques. These methods, including arthroplasty, arthrodesis and alloplasty, for use in relevant indications are available in the Department of Orthopedics at the Medical Faculty Teaching Hospital in Hradec Králové. In this study, the results of Menon's arthroplasty modified by the authors are evaluated. MATERIAL AND METHODS: The interpositional arthroplasty, first used and published by Menon in 1955, was introduced in January 2002 by the authors in the treatment of arthritic lesions, classified as stage III disease by the Eaton radiological rating system, in middle-aged, manually working women. The procedure consists of resection of the trapezium articular surface affected by osteoarthritis, tendon interposition, and the reconstruction of the articular capsule soft tissues using tenodesis of the abductor pollicis muscle tendons. Sixteen female patients were treated by our modified technique. The post-operative outcome of arthroplasty was evaluated by comparison of both hands' efficiency, with the use of the Cooney score system. RESULTS: At 2 years of follow-up, in 14 treated hands there was pain relief, improved mobility and an increase in grip strength; excellent and very good outcomes, as evaluated by the Cooney score, were achieved in 80% of the operated hands. In one patient, conversion of Menon's arthroplasty to an alloplasty with a Rubena prosthesis had to be carried out due to persistent complaints. DISCUSSION: The authors evaluate the surgical procedure used and present the reasons for their modification of the Menon's technique with the use of the long palmar muscle tendon. The choice of operative techniques for specific indications, as available in the authors' department, is discussed. The outcomes reported in this study are compared with the results published in the foreign literature. Complications and risks of this treatment are mentioned. The advantage of a partial over a total trapeziectomy is emphasized. CONCLUSIONS: The early outcomes of Menon's arthroplasty, which was indicated in manually working, middle-age female patients with stage III basal-joint osteoarthritis, are satisfactory. This precisely indicated and correctly performed technique has so far fulfilled the authors' expectations.

Adult↗
PubMed1992

[Secondary flexor tendon reconstruction].

Secondary flexor tendon repair has lost its dominant position since Claude Verdan and other pioneers demonstrated, that primary tendon suture within the former "no man's land" is even more successful than secondary tendon grafting. Secondary reconstruction may concern delayed direct tenorrhaphy, one or two staged, short or long tendon grafts, pedicled tendon transplants, pulley reconstruction, tenodesis and tendon transfer. Secondary repair may be indicated for overlooked tendon injuries, for infected wounds, traumatic or septic tendon defects, for rheumatic ruptures and finally for failed primary repair of tenolysis. The indications and techniques of the different procedures are demonstrated and discussed.

Hand Injuries↗
PubMed1992

[Gaining uniform active muscle function by "in situ tendon transplant" in surgical rehabilitation of the upper extremity of tetraplegic patients. A case report].

The results of tendon transfers in the tetraplegic upper limb are encouraging. In contrast to the cases with peripheral nerve injury or polio, the availability of active muscles for transfers is very limited in tetraplegics. In both hands of a tetraplegic patient with Group 4 according to the international classification the brachioradialis was transferred to FPL and ECRL to FDP 2-5. The Zancolli-Lasso-procedure was performed in both hands as well as tenodesis of EPL proximally to the wrist. On the right side stabilisation of the thumb was achieved by CMS-1-fusion and on the left side the thumb got control by an abductor transfer using pronator teres and an interpositional tendon graft of the paralysed FDS 2. The result is described. Grip strength and Sollerman test were measured. Advantages and disadvantages of the two different procedures for thumb control are discussed, and the different abilities of gripping are shown.

Follow-Up Studies↗
PubMed2006

Arthroscopic approach to massive rotator cuff tears.

The treatment of a patient with a painful massive rotator cuff tear can be challenging. Massive tears exceed 5 cm in length and involve partial or complete tearing of three tendons. The arthroscopic approach provides a minimally invasive technique to evaluate the tear, mobilize and repair tendons, and improve symptoms without disruption of the deltoid. The arthroscopic technique can create a low-tension repair. The reduction of postoperative motion provides the best environment for tendon-to-bone reattachment. Procedures that have reduced rates of adhesion formation allow for this protection with a minimal risk of stiffness. Reduction of the boutonniere effect of superior head migration leads to improved arm elevation. Strength deficits are common and relate to muscle and tendon deterioration that may not be reversible, even with successful closure of the tear. Weakness caused by suprascapular neuropathy may improve after the position and length of the posterosuperior cuff tendons are reestablished. Arthroscopic options include rotator cuff repair, partial cuff repairs, xenografts, decompression, débridement, biceps tenotomy, tenodesis, and use in autografting.

Arthroscopy↗
PubMed2006

Multiple-ligament injured knee.

OBJECTIVE: To explore the clinical characteristic of the multiple-ligament injured knee and evaluate the protocol, technique and outcome of treatment for the multiple-ligament injured knee. METHODS: From October 2001 to March 2005, 9 knees with combined anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears in 9 patients were identified with clinical and arthroscopic examinations. Of them, 5 knees were combined with ruptures of posteromedial corner (PMC) and medial collateral ligament (MCL), 4 with disruptions of posterolateral corner (PLC), 2 with popliteal vascular injuries and 1 with peroneal nerve injuries. Six patients were hospitalized in acute phase of trauma, 2 received repairs of popliteal artery and 4 had repairs of PMC and MCL. Reconstructions of ACL and PCL with autografts under arthroscope were performed in all patients at 4 to 10 weeks after trauma, including reconstruction of PLC with the posterior half of biceps femoris tendon tenodesis in 4 patients and reconstructions of PMC and MCL with femoral fascia in 1 patient. RESULTS: No severe complications occurred at early stage after operation in the 9 patients. All of them were followed-up for 10-39 months with an average of 23.00 months+/-9.46 months. Lysholm score was 70-95 with an average of 85.00+/-8.29. International Knee Documentation Committee (IKDC) score was from severely abnormal (Grade D) in 9 knees at initial examination to normal (Grade A) in 2 knees, nearly normal (Grade B) in 6 knees and abnormal in 1 knee at the last follow-up. Of the 9 patients, 7 returned to the same activity level before injury and 2 were under the level. CONCLUSIONS: The multiple-ligament injured knee with severe instability is usually combined with other important structure damages. Therefore, careful assessment and treatment of the combined injuries are essential. Reconstructions of ACL and PCL under arthroscope, combined with repairs or reconstructions of the extraarticular ligaments simultaneously or in stages, have advantage of minimal trauma in surgery and satisfactory outcome.

Adult↗
PubMed1992

The Hitchcock procedure. A cause for failure: a case report.

A 40-year-old man with a tenodesis of the long head of the biceps brachii in the bicipital groove (Hitchcock's operation) for bicipital tendinitis had recurrence of pain seven months after the operation. Roentgenograms of the acromiohumeral interval, taken when the patient tensed the biceps brachii, showed significant upward migration of the humeral head with a decrease in the acromio-humeral interval on the operated side. The authors postulate that resection of the stabilizing, intraarticular segment of the long head of the biceps in the Hitchcock's procedure allowed the short head to draw the humeral head proximally, resulting in a decrease in the acromiohumeral interval and recurrence of impingement. This is one possible explanation for the poor long-term results of the Hitchcock procedure.

Adult↗