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PubMed2004

Arthroscopic debridement of massive rotator cuff tears: negative prognostic factors.

INTRODUCTION: The purpose of this study was to identify the factors that may lead to poor outcomes after arthroscopic debridement in massive rotator cuff tears. MATERIALS AND METHODS: Thirty-three patients (10 women and 23 men) with massive, irreparable rotator cuff tears underwent arthroscopy by a single surgeon. The preoperative diagnosis was based on the clinical examination and MRI. Their mean age was 69 years (range 62-79 years), and the average follow-up was 31 months (range 24-46 months). If indicated, the performed arthroscopic debridement included acromioplasty, debridement of the cuff, resection of the distal part of the clavicle or tenotomy of the long head of the biceps. In 28 cases (85%) acromioplasties and in 6 cases (18%) biceps tenotomies were performed, 2 of which were a single tenotomy without any associated acromioplasty. One patient had been managed with concomitant resection of the distal part of the clavicle. RESULTS: The Constant and Murley Score improved by a mean of 30 points, from a mean of 37 points (range 21-52) preoperatively to a mean of 67 points (range 31-82) at the time of follow-up. Some 82% of the patients were satisfied with the procedure. The result was considered unsatisfactory because of inadequate pain relief in 4 shoulders, because of limited active abduction in 1 and because of limited external rotation in 1. A poor outcome was associated with a complete tear of the subscapularis tendon in 6 patients. The radiological study showed no significant narrowing of the subacromial space. CONCLUSION: Our early results suggest that arthroscopic debridement is an excellent treatment for elderly patients with modest functional demands. However, its long-term consequences remain to be evaluated by studies with lengthy follow-up. Prognostic factors that may lead to a negative outcome are preoperative superior migration of the humeral head, presence of subscapularis tear, presence of glenohumeral arthritis and decreased range of motion.

Acromion↗
PubMed1983

Atrophic effects of proximal tendon transection with and without denervation on mouse soleus muscles.

The response of mouse soleus muscles to transection of the proximal tendon was examined at both gross and microscopic levels. Changes in length and mass of the muscle, and in the dimensions, number, and ATPase staining characteristics of the muscle fibers, were determined at various times to 4 to 6 weeks after tenotomy. Muscles shortened by more than 50% and lost about 60% of their mass. Fiber cross-sectional area increased, and then decreased and stabilized below control after 7 days, and degenerative lesions appeared in some fibers. Fiber numbers decreased by nearly 20% and then remained constant, apparently by regeneration of new fibers replacing atrophied ones. The proportion of muscle fibers of the slow-twitch type was reduced. No structural or functional changes in motor nerve terminals could be detected, except for detachment from severely atrophied fibers. Concurrent denervation decreased both shortening and the loss of mass after tenotomy. Fiber diameter decreased but no significant degenerative lesions or loss of fibers could be detected. Fiber-type composition was unchanged. These experiments provide quantitative information about the degenerative changes in tenotomized muscles without the variable complications arising from tendon reattachment. Comparison of the responses with those that follow transection of the Achilles tendon shows that the degree of atrophy is independent of the extent of active muscle shortening after tenotomy.

Animals↗
PubMed1993

Changes in myosin heavy chain isoform expression of overloaded rat skeletal muscles.

1. The effect of functional overload produced by tenotomy of synergistic gastrocnemius muscle on the expression of myosin heavy chain (MHC) isoforms in the plantaris and soleus muscles of the rat was studied using gradient sodium dodecyl sulfate-acrylamide gel electrophoresis. 2. Five weeks tenotomy, the plantaris and soleus muscle weights induced by tenotomy of the gastrocnemius muscle were 44.3% (P < 0.005) and 37.4% (P < 0.005), respectively, heavier than the contralateral control muscles. 3. Although four types of MHC isoforms were observed in both control and experimental plantaris, the percentage of MHC isoforms in the control and experimental muscles differed; the hypertrophied plantaris muscle contained more HCI (P < 0.05), HCIIa and HCIId (P < 0.05) and less HCIIb (P < 0.05) than the control muscle. 4. The control soleus muscle contained two MHC isoforms, HCI and HCIIa. However, there was only a single HCI isoform in the hypertrophied soleus muscle. 5. These results indicate that overloading a skeletal muscle by removing its synergists produces not only the muscle hypertrophy but also the changes in the expression of MHC isoforms.

Animals↗
PubMed1988

Phosphorylase kinase activities in damaged mouse skeletal muscles.

In the course of work in which the phosphorylase kinase (PhK)-deficient mouse was used as a model of a defined inherited myopathy, we measured the PhK activity in regenerated autografts of normal whole extensor digitorum longus (EDL) muscles. Initially, no PhK activity was found for up to 71 days after grafting. A more sensitive assay technique revealed PhK activity in regenerated normal grafts from 43 days after grafting, but the levels never reached those found in ungrafted normal muscle. PhK activity was also reduced in normal EDL muscles following either: denervation, or tenotomy, or denervation and devascularisation, or denervation, devascularisation and tenotomy, but the reduction was never as great as that observed in grafted muscle of equivalent age. PhK activity was also reduced in the tibialis anterior (TA) muscles of the myopathic C57B1/10 mdx strain of mouse, in which the skeletal muscles undergo persistent bouts of degeneration and regeneration, whilst retaining their vascular and nervous connections. It was concluded that the loss of PhK activity in grafted muscle is due to a combination of the effects of denervation, tenotomy and regeneration which occur on grafting.

Animals↗
PubMed1991

Membrane-bound intracellular collagen fibrils in fibroblasts and myofibroblasts of regenerating rabbit calcaneal tendons.

The ultrastructures of 33 rabbit calcaneal tendons were studied to determine (1) whether vacuolar fibrils are present in three regions of tendons undergoing normal healing after tenotomy and repair, and (2) to stimulate collagen synthesis via functional loading, and hence determine the effect of loading on the presence of vacuolar fibrils in healing tendons. In all the loaded tendons, electron microscopy revealed membrane-bound collagen fibril equivalents in sections of neotendon obtained from the site of tenotomy, and in sections of tendon segments proximal and distal to the site of surgery. Similar vacuolar fibrils were visualized in sections of the proximal and distal segments of the non-loaded regenerating tendons, and also in sections of neotendons formed at the site of tenotomy after 12 and 15 days of healing without functional loading. No such fibrils were visualized in the non-tenotomized normal control tendons. These findings indicate that chemical agents and disease are not necessary to induce the appearance of intracytoplasmic fibrils in vivo and that functional loading augments the presence of fibril-bearing vacuoles in regenerating tendons.

Animals↗
PubMed1987

Changes in protein turnover in hypertrophying plantaris muscles of rats: effect of fenbufen--an inhibitor of prostaglandin synthesis.

Plantaris muscle of the right hind limb of rats was subjected to hypertrophic stimulus by section of the tendons of the right gastrocnemius muscle. The RNA and protein content and the fractional rate of protein synthesis were elevated both 3 and 7 days after operation compared both with the unoperated left limb and with sham-operated control rats. The rate of protein degradation, calculated from the difference between the fractional rates of protein synthesis and protein gain of the muscles, was elevated in the plantaris 3-7 days after tenotomy. Dietary administration of the drug fenbufen reduced the RNA content and the ratio of RNA:protein in muscles from control animals. In one group of tenotomised rats administration of fenbufen commenced 3 days before tenotomy and resulted in a reduction in the ratio RNA:protein of the muscles of the left limb 3 days after the operation. Four days later, i.e. 7 days after tenotomy, both the ratio RNA:protein and the fractional rate of protein synthesis were significantly reduced in the fenbufen treated rats. In spite of these effects, fenbufen did not impair the ability of the plantaris to hypertrophy since the drug also reduced the rate of protein degradation.

Animals↗
PubMed1982

beta-N-acetyl-D-glucosaminidase activity levels in atrophic gastrocnemius muscle of Rana esculenta.

1. The atrophic status induced by long-term sciatectomy or tenotomy is different, since only in the first case have we found an irreversible muscular degeneration. 2. Up to 20 days after denervation or tenotomy the beta-N-acetylglucosaminidase showed increased specific activity. 3. The time-course of the beta-NAG increase is closely correlated with the loss of contractile capacity. 4. beta-NAG increases to 170% and does not fall in 20 days after cutting the nerve; but increases to 150% on day 4 and falls to 130% on day 20 after tenotomy.

Acetylglucosaminidase↗
PubMed1989

Osteopenia in the immobilized rat hind limb is associated with increased bone resorption and decreased bone formation.

The lack of mechanical function (disuse) caused by paralysis, immobilization or weightlessness, leads to osteopenia. This study examines the contribution of bone resorption and bone formation to osteopenia of disuse, during six weeks of limb-immobilization in the growing rat. Male Sprague-Dawley rats of approximately 200 g underwent unilateral hind-limb immobilization by either tenotomy at the knee joint or sciatic neurectomy, while control rats were sham-operated. Animals were sacrificed at 30 and 72 hours, 10, 26 and 42 d postsurgery. Femora were ashed to determine the total mineral content and histomorphometric parameters, static and dynamic, were measured in the secondary spongiosa of the proximal tibial metaphysis. No difference was found in the femoral length of the immobilized legs. Bone loss in the immobilized leg versus the nonimmobilized one, at 10, 26 and 42 d post-surgery was 18.0, 14.0 and 11.2% of femoral mineral content in the tenotomy group, respectively, and 12.4, 16.1 and 15.7% in the neurectomy group. Loss of metaphyseal trabecular bone volume at 10, 26 and 42 days amounted to 67.8, 49.3 and 52.9% in the tenotomy group, respectively, and 70.5, 59.0 and 72.9% in the neurectomy group. The bone loss was caused by: (a) A rapid surge in bone resorption, reflected in a significant increase in the number of osteoclasts per mm bone surface at 30 and 72 h and in the osteoclast surface at 72 h but not at later times, and (b) a sustained decrease in bone mineral apposition rate and bone formation rate (osteoblast-referent) throughout the 42-day immobilization period suggesting osteoblastic hypofunction (reduced activity).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Entrapment of the long head of the biceps tendon: the hourglass biceps--a cause of pain and locking of the shoulder.

We describe an unrecognized mechanical condition affecting the long head of the biceps (LHB) tendon with entrapment of the tendon within the joint and subsequent pain and locking of the shoulder on elevation of the arm. We identified 21 patients with a hypertrophic intraarticular portion of the LHB tendon during open surgery (14 patients) or arthroscopic surgery (7 patients). All cases but one were associated with a rotator cuff rupture. Patients were treated by biceps tenotomy (2 patients) or tenodesis (19 patients) after removal of the hypertrophic intraarticular portion of the tendon and appropriate treatment of concomitant lesions. Minimum follow-up was 1 year. All patients presented with anterior shoulder pain and loss of active and passive elevation averaging 10 degrees to 20 degrees. A dynamic intraoperative test, involving forward elevation with the elbow extended, demonstrated entrapment of the tendon within the joint in each case. This test creates a characteristic buckling of the tendon and squeezing of it between the humeral head and the glenoid (hourglass test). The mean Constant score improved from 38 to 76 points at the final follow-up (P <.05). Complete and symmetric elevation was restored in all cases after resection of the intraarticular portion of the LHB tendon. The hourglass biceps is caused by a hypertrophic intraarticular portion of the tendon that is unable to slide into the bicipital groove during elevation of the arm; it can be compared with the condition of trigger finger in the hand. A loss of 10 degrees to 20 degrees of passive elevation, bicipital groove tenderness, and radiographic findings of a hypertrophied tendon can aid in the diagnosis. A definitive diagnosis is made at surgery with the hourglass test: incarceration and squeezing of the tendon within the joint during forward elevation of the arm with the elbow extended. The hourglass biceps is responsible for a mechanical block, which is similar to a locked knee with a bucket-handle meniscal tear. Simple tenotomy cannot resolve this mechanical block. Excision of the intraarticular portion of the LHB tendon, during bipolar biceps tenotomy or tenodesis, must be performed. The hourglass biceps is an addition to the familiar pathologies of the LHB (tenosynovitis, prerupture, rupture, and instability) and should be considered in cases of shoulder pain associated with a loss of elevation.

Aged↗
PubMed1998

Bilateral recession of superior rectus muscles: its influence on A and V pattern strabismus.

PURPOSE: To determine whether bilateral superior rectus recession modifies A and V pattern strabismus. PATIENTS AND METHODS: Three patients with V patterns and eight patients with A patterns underwent bilateral superior rectus recession with neither oblique muscle surgery nor vertical displacement of the horizontal rectus muscles. Another three patients with A patterns underwent simultaneous superior oblique tenotomy and superior oblique recession. RESULTS: Two of the patients with V patterns demonstrated an increase in the V pattern after surgery; one was unchanged. Five of the patients with A patterns converted to V patterns after surgery. In the remaining three patients the pattern was eliminated. The three patients who underwent superior oblique tenotomy along with superior rectus recession had large shifts toward V pattern (mean shift, 40 delta). CONCLUSION: Bilateral superior rectus recession tends to increase V patterns and reduce A patterns. Superior rectus recession may be synergistic with superior oblique tenotomy in collapsing an A pattern.

Accommodation, Ocular↗
PubMed2000

[Effect of surgical laser on collagen-rich tissue].

The goal of this ex-vivo study was a controlled macroscopical and microscopical comparison of the immediate effects of surgical lasers on dense collagenous tissues. The investigation of the exact denaturizing effects following tissue interaction between lasers and collagenous fibers are of importance for a better understanding of the observed and described healing process. Partial tenotomies were performed ex vivo on sixty tendons of the flexor digitorum profundus muscle of New Zealand White Rabbits using four surgical lasers (Holmium:YAG-, Erbium:YAG-, Neodym:YAG-, and CO2-Laser). The tendons were evaluated macroscopically, histologically and observations were made on the surgical handling of the lasers during the procedure. The choice of lasers allowed the comparison of a wide spectrum of wavelengths (gamma = 1.0 to 10.6 microns). In addition, beam delivery modalities were compared to each other (focus vs. contact). The pulse (frequency and power) was varied within each laser. Other parameters including focus size, absorption, dispersion, and thermal tissue conductivity were maintained constant in this test arrangement in order to allow a later comparison between the observed areas of denaturated collagen. The macroscopical and histological results showed great differences in the effects of the four lasers. Even within each single laser group, the results varied greatly with the choice of variable parameters. Holmium:YAG- and CO2-Laser can produce similar areas of collagen denaturation. When comparing specimens with similar areas of collagen denaturation induced by different laser types, different amounts of charring were observed. Erbium:YAG-Laser tenotomies showed generally inhomogeneous denaturation areas, while tenotomies with Neodym: YAG-Laser used in continuous mode resulted in significant charring and tissue retraction in the area of interaction. These observations help in defining the combination of parameters with which Holmium:YAG-, Erbium:YAG-, and CO2-Lasers can be used for transsection of dense collagenous tissues. In addition, these histological results as well as already published observations on healing patterns following laser surgery allow for the formulation of a hypothesis on the effects of laser in the wound healing process.

Animals↗
PubMed1996

[The contribution of Alfred K. Graefe to surgical treatment of paretic squint in the second half of the 19th century].

Alfred Graefe is one of the three important ophthalmologists of the Graefe family in the nineteenth century, who were engaged scientifically with squint. He dealt with disorders of ocular motility in twenty publications. In: "The indication of operative treatment of paretic eye deviations" Graefe suggested three operative principles: Resection of the paretic muscle, tenotomy of the ipsilateral antagonist and tenotomy of the contralateral synergist. Depending on the amount of the motility disturbance Graefe recommended one or several of these methods. Concerning the vertical muscles Graefe emphasized the importance of parallelism of the retinal meridians. Hence, in the case of superior oblique palsy he favoured a tenotomy of the contralateral inferior rectus.

Germany↗
PubMedDate not supplied

[Effectiveness of intra-articular application of hyaluronic acid on early forms of femoropatellar arthrosis--an experimental study in dogs].

PURPOSE: We investigated the effects of intraarticularly applied hyaluronic acid on the cartilage-integrity with early-forms of retropatellar cartilage degeneration (chondromalacia patellae) in dogs. METHODS: We used the Pond-Nuki model (tenotomy and resection of the anterior cruciate ligament = ACL) in 27 dogs (foxhounds) (3 groups of 9 animals) PILOT STUDY: ACL-tenotomy and resection, no therapy, specimens retrieval after 3, 6, 12 weeks (3 animals each period). VERUM: ACL-tenotomy and resection, hyaluronic acid (start after 3, 6, 12 weeks), 5 injections in 4 weeks, specimens retrieval after 5 weeks following final injection (12, 15, 21 weeks postoperatively, 3 dogs each period). PLACEBO: same procedure as verum, but saline-injections. Specimens were taken from the medial/lateral patellar pole from both, the operated and the normal knee and examined histologically using various staining methods (HE, Azan, Toluidin, Masson-Goldner, Safranin-O). A modified Mankin score was used to grade cartilage degeneration. RESULTS: Our results demonstrate that the Pond-Nuki model is suitable to experimentally induce chondromalacia patellae. There were significantly less degenerative cartilage changes in the knees treated with hyaluronic acid compared to the placebo-group. CONCLUSION: Our results let assume that hyaluronic acid could be indicated i.e. after arthroscopically diagnosed early cartilage-degeneration, the final conclusions concerning the actual mechanisms and therapeutical effectiveness need however further prospective clinical and experimental investigations.

Animals↗
PubMed2001

Experimental induction of ring fibers in regenerating skeletal muscle.

Light microscopy and electron microscopy were used to study the formation of ring fibers induced experimentally in regenerating muscle subjected to tenotomy-induced tension deficiency. Anterior tibial rat muscles were injured by intramuscular injection of mepivacain, tenotomized at varying stages of the regenerative process, and analyzed 30 days after sectioning the tendon. The combination of regeneration and tenotomy led to the appearance of ring fibers at different developmental stages. Ring fibers were not observed in regenerating control muscles and were scarce in tenotomized controls. Our results showed that the regenerative phase in which tension deficiency was established had a significant influence on the number of developing ring fibers; the number increased when tenotomy was performed during subsarcolemmic myofibrillogenesis in regenerating fibers. As a consequence, one might hypothesize that tension deficiency during muscle fiber repair plays a critical role in ring fiber formation.

Animals↗
PubMed2003

Do middle ear muscles trigger attacks of Menière's disease?

OBJECTIVE: Current surgical methods for treating Ménière's disease (MD), e.g. endolymphatic sac surgery, mastoidectomy or insertion of middle ear ventilation tubes, only improve vertigo and fail to influence the hearing threshold. In this retrospective study we examined the long-term effects of tenotomy on the symptoms of MD. MATERIAL AND METHODS: A total of 45 patients suffering from definite MD underwent middle ear muscle tenotomy, a treatment that is very rarely considered nowadays. Of these 45 patients, 20 were observed postoperatively for a period of > 2 years. The disease was scored pre- and postoperatively and the results were evaluated according to the American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy for MD. RESULTS: Sectioning of the tensor tympani and stapedius muscle tendons significantly reduced the frequency and intensity of vertigo and improved both the functional profile and tinnitus. Pure-tone audiometry at frequencies between 500 and 3000 Hz substantiated the improvement in hearing threshold, as did the pure-tone average. The therapeutical outcome was stable in cases where both tendons remained persistently disconnected. Intratympanal inflammatory reactions were observed in most patients during surgery. CONCLUSION: Our results prove that tenotomy is a successful and enduring therapeutic approach for treating the auditory and vestibular symptoms of MD and strongly suggest that it should be reconsidered as a promising surgical treatment for the symptoms of MD.

Adult↗
PubMed2006

Comparative study using 685-nm and 830-nm lasers in the tissue repair of tenotomized tendons in the mouse.

OBJECTIVE: The objective of this study was to evaluate the effects of 685- and 830-nm laser irradiations, at different fluences on the healing process of Achilles tendon (Tendon calcaneo) of mice after tenotomy. BACKGROUND DATA: Some authors have shown that low-level laser therapy (LLLT) is able to accelerate the healing process of tendinuos tissue after an injury, increasing fibroblast cell proliferation and collagen synthesis. However, the mechanism by which LLLT acts on healing process is not fully understood. METHODS: Forty-eight male mice were divided into six experimental groups: group A, tenomized animals, treated with 685 nm laser, at the dosage of 3 J/cm(2); group B, tenomized animals, treated with 685-nm laser, at the dosage of 10 J/cm(2); group C, tenomized animals, treated with 830-nm laser, at dosage of 3 J/cm(2); group D, tenomized animals, treated with 830-nm laser, at the dosage of 10 J/cm(2); group E, injured control (placebo treatment); and group F, non-injured standard control. Animals were killed on day 13 post-tenotomy, and their tendons were surgically removed for a quantitative analysis using polarization microscopy, with the purpose of measuring collagen fibers organization through the birefringence (optical retardation [OR]). RESULTS: All treated groups showed higher values of OR when compared to injured control group. The best organization and aggregation of the collagen bundles were shown by the animals of group A (685 nm, 3 J/cm(2)), followed by the animals of group C and B, and finally, the animals of group D. CONCLUSION: All wavelengths and fluences used in this study were efficient at accelerating the healing process of Achilles tendon post-tenotomy, particularly after the 685-nm laser irradiation, at 3 J/cm(2). It suggests the existence of wavelength tissue specificity and dose dependency. Further studies are required to investigate the physiological mechanisms responsible for the effects of laser on tendinuos repair.

Achilles Tendon↗
PubMed2006

Ponseti management of clubfoot in older infants.

UNLABELLED: Treatment of clubfoot with the Ponseti method is successful when performed immediately after birth. We treated 23 infants (36 feet) who presented to us after casting, applied at other institutions, failed or after 3 months of age. Twenty-two infants had serial casting started during the first 2 months, and one infant who was 6 months old at presentation had not received previous treatment. The original orthopaedists of 18 patients advised posteromedial release. The parameter studied was the need for posteromedial release (ie, failure of Ponseti casting and percutaneous Achilles tenotomy to obtain satisfactory clinical appearance). Only one (2.8%) of 36 feet required open surgical release (posterior only). Thirty-five feet required percutaneous Achilles tenotomy. A mean of six Ponseti casts were applied before tenotomy. Two feet (two infants) required anterior tibialis transfer for mild relapse; three other feet (two infants) required repeat casting for mild relapse. Most pediatric orthopaedists think that successful clubfoot casting depends on treatment started immediately after birth. Our data suggest that older infants with clubfoot can be treated successfully without extensive surgery. Our results in older infants are similar to the results of a previous study we conducted with younger infants. In that study, one (2.9%) of 34 feet required posteromedial release surgery. LEVEL OF EVIDENCE: Therapeutic study, Level IV (Case series). See the Guidelines for Authors for a complete description of levels of evidence.

Achilles Tendon↗
PubMedDate not supplied

A comparative study of different methods of tendon lengthening: an experimental study in rabbits.

Three different techniques of tendon lengthening--Z-lengthening, intramuscular lengthening, and tenotomy--were studied in rabbits. The cut tendon ends were marked with radioopaque sutures. The repair process was similar with all three techniques, with healing being completed by 6 weeks. With intramuscular lengthening, the gap distance remained constant throughout the experiment, whether immobilization was used or not. Thus, immobilization is not necessary with this technique. In contrast, with tenotomy the gap distance increased significantly when immobilization was not used. However, with immobilization the distance remained constant throughout the experiment. Immobilization is necessary after tenotomy to prevent undue lengthening of the tendon.

Animals↗