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PubMed1988

Biomechanics of tendon transfers.

There are just two variables that define the mechanical qualities of each muscle. One is its potential for generating tension, and the other is the distance through which tension can be exerted. Tension capability can be increased in a muscle by exercise. There is no way to increase potential for excursion except by reattaching a muscle at surgery with extra length and tension, at the risk of involuntary contractions during healing that may result in avulsion. Single muscle may control several joints in series but cannot selectively vary the torque delivered at each. Therefore, when working against distal opposing forces, it is necessary to have separate muscles to add torque to proximal joints; or it may be advisable to reduce the number of joints to be controlled by fusing one or more of them, or sometimes by depending on tenodesis or other passive support.

Biomechanical Phenomena↗
PubMed1986

Newly modified Evans operation enables immediate mobilization. Reinforcement band stabilizes ankle, no cast is used.

A new technique for reinforcement using a modified Evans procedure, which enables immediate mobilization of the foot and ankle after surgery, has been developed. The reinforcement band is implanted parallel to the tenodesis of the peroneus brevis, about 1 cm proximal to the tendon, from a hole in the base of the fifth metatarsus to a hole in the lateral malleolus. Postoperative immobilization and its possible adverse sequelae are eliminated by this procedure. The surgical technique described in this paper was used to treat 13 patients with chronically unstable ankles. In all cases, excellent surgical results were obtained and leg immobilization was virtually eliminated. Physical therapy was begun in the immediate postoperative period, and the rehabilitation period was significantly reduced.

Adolescent↗
PubMed1986

Impingement syndrome. A review of late stage II and early stage III lesions.

From 1980 to 1984, 72 patients with impingement syndrome were treated by anterior acromioplasty before they developed rotator cuff tears. Follow-up evaluations averaged 23 months (range, five to 48 months). The average age was 42 years (range, 23-61 years). Preoperatively, 80% of the patients had pain at rest; the other 20% complained of pain during moderate activity. At the time of follow-up examination, 89% showed significant improvement, while 11% remained unchanged. Thirty-seven percent of the patients had varying degrees of muscle weakness preoperatively; of these, 71% were improved, 21% were unchanged, and 8% had a further decrease in the range of motion postoperatively. The results indicate that anterior acromioplasty is an excellent procedure for relief of pain due to impingement. Additionally, beneficial results were obtained in range of motion and muscle strength. In only a few select cases was lateral clavicle excision or tenodesis of the long head of the biceps necessary. Caution is advised in allowing return to strenuous activity unless the patient has recovered adequate strength in the cuff musculature.

Acromion↗
PubMed1985

Combined intra-articular and extra-articular reconstructions for anterior tibial subluxation.

This article describes several procedures that combine intra-articular techniques with extra-articular techniques to stabilize the knee with anterior tibial subluxation. The procedures detailed are reconstruction using the semitendinosus tendon and the iliotibial tract; tenodesis using a strip of iliotibial tract combined with intra-articular reconstruction of the anterior cruciate ligament with the central third of the patellar tendon; "mini-reconstruction"; and a procedure utilizing a vascularized patellar tendon graft plus "dynamic" augmentation.

Humans↗
PubMed1979

Chronic dislocation of the sternoclavicular joint: an operative repair.

Chronic spontaneous dislocation of the sternoclavicular joint occurs more frequently in athletes than nonathletes, causing weakness and sometimes pain during prolonged stress upon the arm. Five such joints were successfully treated in 4 patients by means of a dynamic method of repair--tenodesis of the sternal head of the sternomastoid muscle. The sternal origin of the sternomastoid muscle in continuity with its muscle belly and strip of sternal periosteum is looped under the first rib, back through a drill hole in the clavicle and sutured to itself to replace the damaged costoclavicular ligament. Dislocations of the joint should not be repaired for purely cosmetic reasons as the risk of keloid scar formation in this region is notoriously high. All the patients who were young and athletically inclined, recovered fully within 4 months of the operation and returned to their sporting activities. Follow-up has ranged from 12 to 38 months. There have been no late complications or failures of the technique.

Adolescent↗
PubMed1979

Complete replacement of the peroneus longus muscle by a ganglion with compression of the peroneal nerve: a case report.

In a 38-year-old woman, the entire muscle belly of the peroneus longus was replaced by a ganglion. Signs of peroneal nerve dysfunction resulted from direct pressure of the ganglion. Excision of the ganglion required a tenodesis of the peroneus longus tendon to provide a normal gait pattern which was maintained during a 17 month follow-up period. This entity needs careful, prompt evaluation to avoid neurological damage and to distinguish it from compartment syndrome.

Adult↗
PubMed1981

[Results of a muscle-activated M. peroneus brevis graft [author's transl)].

The article introduces a new method of reconstruction of the lateral ligaments of the ankle. This is a modification of the well-tried tenodesis according to Evans, by which half of the tendon of the short peroneal muscle is retained as a dynamic stabilizer of the ankle. In this method, the tendon of the short peroneal muscle is cut in half about five fingers' breadth above the ankle, the incision being effected as a J-shaped cut behind the fibula; the incision goes distally beyond the proximal retinaculum of the peroneal muscle. A hole of 4.5 mm. is drilled diagonally forwards and downwards at an angle of about 50 degree. The half of the tendon is pushed forwards through this hole in the bone and sutured onto itself below the superior peroneal retinaculum, the foot being held in slightly eversed position. Like many non-anatomical methods of repair, this method is used with good results. 91 reconstructions of the lateral ligaments of the ankle have been performed from 1972 to 1980 in the Medical College Hannover. Of the 76 patients checked in follow-up examinations, 68 showed good results, while the balance of 8 patients was classified as satisfactory.

Adolescent↗
PubMed1983

Dorsal bunions in children.

Iatrogenic dorsal bunions in children, observed mostly after operations for post-poliomyelitic paralysis or club foot, have been successfully treated by an operation in which the tendons of the flexor brevis and the abductor and adductor muscles of the hallux are transferred to the neck of the first metatarsal. This is supplemented by removal of the sesamoids, capsulotomy of the metatarsophalangeal joint, and when necessary by arthrodesis or tenodesis of the metatarsophalangeal joint. In seventeen feet treated in this way only one failure, in a patient with arthrogryposis, was recorded.

Adolescent↗
PubMed1976

[Paralysis of the intrinsic muscles of the hand].

Palliative treatment of intrinsic muscle paralysis aims at correcting the claw deformity and improving prehension. This treatment will vary according to whether the claw can be actively corrected or not, if M. P. hyperextension is blocked. In the first category it suffices to maintain M. P. joint flexion either by capsulodesis or tenodesis so that the long extensors can extend the interphalangeal joints. Tendon transfers are useful only to reinforce the flexion force of the fingers if there is an associated long flexor tendon paralysis. These transfers should be fixed to the proximal part of the proximal phalanx. If the claw is not actively correctable, associated cutaneous, tendinous or joint lesions must co-exist and these will demand priority treatment. Tendon transfers, if possible, aim to extend the distal phalanges and should be fixed distally on the extensor expansion, knowing however that this carries the risk of swan neck deformity.

Hand↗
PubMed1978

Sequential advancing flexion retention attachment: a locking device for the wrist-driven flexor hinge splint.

The Sequential Advancing Flexion Retention Attachment (SAFRA) was developed for cervical spinal cord-injured patients with a muscle grade of poor to fair in the wrist extensors. It is used on a standard wrist-driven flexor hinge hand splint with adjustable tenodesis bar. Through the development of the SAFRA, maintained prehension can be obtained without externally powered devices such as CO2 or electrically powered orthoses. The patient's increased functional abilities are discussed and advantages summarized.

Adult↗
PubMed1982

Lateral ligament injuries of the ankle. Surgical treatment of late cases.

34 ankles with prolonged instability of the lateral ligaments were operated on by the Evans tenodesis procedure. The follow-up period was 24 to 35 months. 33 patients showed subjective improvement, only one had marked postoperative complaints. It was observed that the Evans operation gives good stability of the ankle. As a simple and safe procedure this operation is to be recommended for standard correction of old posttraumatic lateral instability of the ankle joint.

Adolescent↗
PubMed1995

Immediate active short arc motion following extensor tendon repair.

Postoperative management of the extensor tendon injury has been altered over the past 15 years from treatment with 4 to 6 weeks of immobilization to controlled passive motion and, now, to active SAM with minimal tension and wrist tenodesis programs. The concepts of immediate motion are supported biochemically in experimental studies, and biomechanically through excursion studies, mathematical analysis of tendon excursion and force application, and study of repair tensile strengths. The results cited in this article and those reported by others demonstrate that early motion for extensor tendons in zones III, IV, V, VI, VII, T IV, and T V is safe and effective if force application is precise. Early referral to therapy, meticulous care in the control of edema, precise positions of postoperative splinting, and controlled motion programs will greatly improve the results of both simple and complex extensor tendon injuries, both in terms of function achieved and in terms of time and expense.

Adolescent↗
PubMed1995

[Surgical possibilities in spastic paralysis of arm and hand].

OBJECTIVE: To determine the results of surgical correction of spastic paralysis of the hand due to cerebral palsy. DESIGN: Descriptive. SETTING: Academic Medical Centre, Amsterdam, the Netherlands, and rehabilitation centre De Trappenberg. METHOD: From 1-1-1990 until 1-6-1994 twenty patients with spastic upper limb in cerebral palsy were operated in our hospital. They were all seen preoperatively by our multidisciplinary team, and selected according to the Zancolli classification. Seventeen operations were aimed at improving hand function, the other three were performed for contractures or for cosmetic/hygienic reasons. Surgery was aimed at correcting the muscular imbalance, by weakening spastic muscles via tenotomy or lengthening and by reinforcing paralysed muscles via tendon transfer or rerouting. Often stabilisation of joints by tenodesis, capsulodesis or arthrodesis was necessary as well. RESULTS: Eighteen of the twenty patients were (very) happy with the results. In two patients there was no functional gain. Only once was a postoperative complication seen: pseudarthrosis of the first carpometacarpal joint. This was corrected successfully by rearthrodesis. We found we were able to predict the functional outcome fairly accurately. CONCLUSION: With accurate patient selection, surgical intervention in patients with cerebral palsy may restore hand function adequately and predictably.

Activities of Daily Living↗
PubMed1995

Chronic bicipital tenosynovitis in dogs: 29 cases (1985-1992).

Medical records of 23 dogs with unilateral and 3 dogs with bilateral chronic bicipital tenosynovitis were reviewed. Mean age of affected dogs was 4.6 years (SD, 2.0 years), and mean body weight was 32.6 kg (SD, 14.5 kg). Neither a breed nor a gender predilection was detected. All dogs had a history of intermittent or progressive weight-bearing lameness that became worse after exercise. Mean duration of lameness prior to medical or surgical treatment was 6.5 months (range, 0.25 to 24 months). In all dogs, signs of pain were evident during palpation of the biceps tendon within the intertubercular groove. Radiography revealed sclerosis or osteophytosis of the intertubercular groove in all 29 shoulder joints. Mild degenerative joint disease was evident radiographically in 17. Arthrography was performed in 12 joints, and in 11 there were irregularities of or filling defects along the biceps tendon. Arthrocentesis was performed on 17 joints; 14 synovial fluid samples had cytologic abnormalities consistent with degenerative joint disease. Medical treatment, consisting of injection of methylprednisolone acetate into the biceps tendon and its synovial sheath, was attempted in 21 of the 29 affected shoulder joints. Surgery, which consisted of tenodesis of the biceps tendon, was attempted in 14 joints; 8 of these had not been treated medically; the remaining 6 had poor results following medical treatment. Gross and histologic findings consistent with chronic bicipital tenosynovitis were observed in all 14 joints in which surgery was performed. Seventeen of the medically treated shoulders were available for clinical evaluation, and results were excellent or good in 7.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Perimalleolar tendon transfer to the os calcis for triceps surae insufficiency in patients with postpolio syndrome.

Twelve patients (14 feet) with the diagnosis of postpolio syndrome underwent patients-specific transfer of perimalleolar tendons to the os calcis for triceps surae insufficiency. One to 5 tendons were transferred, for a resulting mean muscle strength of Grade 3 at a mean followup of 2.7 years. At final followup, 7 patients were restudied with ankle plantar flexion torque measurements, range of motion, and gait analysis. Patients reported subjective improvements in endurance (86%), pain (90%), and ambulatory distance (50%). No progression of foot deformity was noted. Three of 5 patients became brace free. After tendon transfer, patients recorded increased ankle plantar flexion torque strength (80%) and an increase in 1 grade of muscle strength (29%). There was no significant change in gait velocity, stride length, or heeloff time between pre- and postoperative gait analysis. No tenodesis effect was observed. In conclusion, perimalleolar tendon transfers for triceps surae insufficiency in postpolio patients was effective in decreasing subjective complaints, arresting progressive foot deformity caused by muscle imbalance, and increasing plantar flexion strength, whereas the results of gait analysis failed to show significant improvement.

Adult↗
PubMed1995

[Clinical and roentgenologic 5 year follow-up of modified Evans-plasty in chronic lateral instability of the ankle joint].

Between 1984 and 1989, 108 patients who had chronic lateral instability of the ankle were treated with a modified Evans tenodesis, in which the anterior half of the peroneus brevis tendon was used for reconstruction. Follow up was possible by questionnaire in 75 patients and by clinical examination in 46, after 29-122 months (mean 68 months). Subjectively excellent or good results were achieved in 62 patients (82.6%) while 9 (12%) had fair results and 4 (5.4%) a poor outcome. Pain during physical activity was reported by 27 patients (35%), loss of inversion by 34 (45%) and slight instability by 31 (41%). The X-ray films at follow-up revealed more signs of arthrosis than had been present preoperatively. The stress tests showed an anterior drawer of 7.8 mm preoperatively and 7.0 mm postoperatively (p = 0.03); talar tilt was improved from 7.7 degrees to 4.5 degrees (p < or = 0.01). The outcome reported by the patients and the objective results of the clinical and radiological examinations were at odds. Pain, instability and osteophyte formation after the operation were so frequent because the talus was not fixed when the Evans reconstruction was implemented. Therefore, we suggest that this method should not be used in patients with a high activity level.

Adult↗
PubMed1995

An EMG-controlled grasping system for tetraplegics.

A two-channel, portable, battery operated, functional electrical stimulation (FES) system with surface electrodes to enhance grasping in tetraplegics was developed and tested. This system is meant for tetraplegics capable of grasping by tenodesis. Candidates for this system must retain some wrist extension, and have paralyzed but innervated finger flexors, and nearly normal shoulder and elbow coordination within the working space. The control signal that turns the stimulation of forearm finger and thumb flexors on and off is based on the detection of the threshold of the amplified, rectified, and integrated electromyographic recordings using surface electrodes positioned over the wrist extensors. The voluntary contraction of wrist extensors is suitable for triggering the stimulation, and it is reproducible enough for daily home use. The new device was tested on subjects with tetraplegia, and the general conclusions are: 1) the system increases the strength of the grasp: 2) no side effects or related problems were noticed: 3) the training period is short: 4) the reliability of the operation is good; and, 5) the design of the analog part of the system allows its easy integration into a computerized device. Functional tests of the system showed that some of the study subjects did not benefit from this approach due to disuse and denervation types of muscle atrophy of their finger flexors, lack of controllable wrist extension, curled resting position of distal and proximal interphalangeal (IP) joints, and/or inability to bring the thumb in the opposition of fingers.

Activities of Daily Living↗
PubMed1993

Long-term results of the Steindler flexorplasty.

Seventy-one consecutive patients were treated with a modified Steindler flexorplasty from 1970 to 1987. The mechanisms of injury and etiologies included 45 motor vehicle accidents, 13 birth injuries, and 13 cases of poliomyelitis. Additional operative procedures included shoulder fusion (45 patients), tendon transfer (20 patients), and wrist tenodesis (3). Follow-up averaged 8.2 years. The outcome was excellent in 32%, good in 47%, fair in 13%, and poor in 8%. Postoperatively, the mean arc of active elbow flexion was 114 degrees; the average elbow extension loss, 28 degrees; the mean active pronation, 74 degrees; and supination, 30 degrees. Wire breakage was found in two cases. Additional tendon transfer of flexor carpi ulnaris to extensor carpi radialis brevis improved the outcomes in the patients without active supination. The modified Steindler flexorplasty provided predictable functional improvement in carefully selected patients with paralyzed upper extremities.

Adolescent↗