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At least 469 records · Page 26Linked to original sources
PubMed2004

Tendon-to-bone healing of a quadrupled hamstring tendon graft fixed with biodegradable screws in an immature athlete: a radiologic, arthroscopic, histologic, and electromicroscopic investigation.

Abstract Quadrupled hamstring tendon is one of the most commonly used ligamentous substitutes in anterior cruciate ligament reconstruction. We describe a case of a young athlete who sustained a rerupture of a semitendinosus-gracilis autograft fixed with biodegradable screws 2 years after primary surgery. Radiologic, arthroscopic, histologic, and electromicroscopic investigation showed tendon-to-bone healing of the soft tissue graft and partial degradation of the interference screws.

Adolescent↗
PubMed2005

Reconstruction of the anterior cruciate ligament: meta-analysis of patellar tendon versus hamstring tendon autograft.

PURPOSE: No graft tissue has consistently shown superiority over others for reconstruction of the anterior cruciate ligament (ACL). Bone-patellar tendon-bone (BPTB) and doubled hamstring tendon (semitendinosus and gracilis) (HT) are the most commonly used autologous grafts. We performed a meta-analysis to compare the effectiveness of ACL reconstruction using either BPTB or HT grafts. TYPE OF STUDY: Systematic review and meta-analysis. METHODS: We searched the MEDLINE database (1966 to April 2003) for English-language randomized or prospective studies comparing BPTB and 3- or 4-strand HT grafts used for ACL reconstruction. For inclusion, studies were required to follow identical rehabilitation protocols within each study, and provide subjective or objective outcome data after a minimum average 2-year follow-up. Comparison data between BPTB and HT for each identified outcome measure were combined using a random-effects model meta-analysis. RESULTS: Eleven reports fulfilled the criteria for inclusion. Outcomes favoring BPTB were found in the following outcome measures: normal Lachman examination (relative risk [RR], 0.91; 95% confidence interval [CI], 0.83-0.99; P = .025), normal pivot-shift (RR, 0.94; 95% CI, 0.88-1.0; P = .067), KT-1000 manual-maximum side-to-side difference of < or = 3 mm (RR, 0.75; 95% CI, 0.55-1.01; P = .057), and fewer reconstructions resulting in flexion loss > 5 degrees (RR, 1.41; 95% CI, 1.01-1.96; P = .04). Intermediate level laxity was more common with the HT graft, as shown by higher rates of abnormal Lachman > 0 (RR, 1.22; 95% CI, 0.99-1.5; P = .06), pivot-shift > 0 (RR, 1.3; 95% CI, 0.96-1.75; P = .09), and KT-1000 manual-maximum side-to-side differences > 3 mm (RR, 1.64; 95% CI, 1.13-2.39; P = .01). Outcome measures that favored HT were absence of patellofemoral crepitance (RR, 1.08; 95% CI, 1.01-1.15; P = .03), fewer results with extension loss > 5 degrees (RR, 0.56; 95% CI, 0.3-1.03; P = .06), and kneeling pain. The incidence of instability, as defined by Lachman grade 2, pivot-shift grade 2, or KT-1000 manual-maximum side-to-side difference > 5 mm, was not significantly different between the 2 grafts. All other outcome measures were not significantly different. CONCLUSIONS: The data presented in this meta-analysis show that the incidence of instability is not significantly different between the BPTB and HT grafts. However, BPTB was more likely to result in reconstructions with normal Lachman, normal pivot-shift, KT-1000 manual-maximum side-to-side difference < 3 mm, and fewer results with significant flexion loss. In contrast, HT grafts had a reduced incidence of patellofemoral crepitance, kneeling pain, and extension loss. The choice of graft by the patient and surgeon must be individualized, and the results of this meta-analysis can aid in the decision by clarifying the risks and benefits of each surgical approach. LEVEL OF EVIDENCE: Level I.

Anterior Cruciate Ligament↗
PubMed2005

Anterior cruciate ligament reconstruction with hamstring tendons and cross-pin femoral fixation compared with patellar tendon autografts.

PURPOSE: To investigate the outcome of arthroscopic anterior cruciate ligament (ACL) reconstruction with hamstring autograft using femoral cross-pin fixation compared with patellar tendon autografts. TYPE OF STUDY: Matched retrospective cohort. METHODS: Twenty-one patients who underwent ACL reconstruction with hamstring autograft and femoral cross-pin fixation were evaluated at an average of 16.4 months postoperatively. Subjective data were collected using the International Knee Documentation Committee (IKDC) and the Cincinnati Knee Scale. Objective data included a comprehensive knee examination, plain radiographs, and KT-1000 measurements. The results were compared with 19 matched patients who had previously undergone ACL reconstruction using patellar tendon autograft. RESULTS: The average KT-1000 maximal manual side-to-side difference was 1.63 +/- 0.68 mm. Eighty-six percent of IKDC scores were normal or nearly normal. The average overall Cincinnati Knee Scale subjective symptom rating was 8.7 +/- 1.2. There was no significant difference in subjective or objective data between the 2 groups. CONCLUSIONS: ACL reconstruction using femoral cross-pin fixation is a reliable technique showing outcomes comparable to other established methods of fixation. LEVEL OF EVIDENCE: Level IV, case series.

Adolescent↗
PubMed2006

Evaluation of the anterior cruciate ligament, medial collateral ligament, achilles tendon and patellar tendon as cell sources for tissue-engineered ligament.

This study investigated four different connective tissue cell types to determine which cell type should be the source for seeding a tissue-engineered anterior cruciate ligament (ACL) replacement. Cells derived from the ACL, medial collateral ligament (MCL), achilles tendon (AT), and patellar tendon (PT) of New Zealand White rabbits were isolated and cultured. Each cell type was cultured in vitro after seeding on three-dimensional (3-D) braided polymer scaffolds and on tissue culture polystyrene that served as a control. Samples were evaluated and compared for their morphology, proliferation, and gene expression of fibronectin, type I and type III collagen. Scanning electron microscopy (SEM) photomicrographs verified cell attachment of all four types of connective tissue fibroblasts to the scaffolds. Preliminary results comparing proliferation indicate that cells obtained from the PT and AT have the fastest proliferation. Whereas gene expression of the phenotypic markers measured using real-time reverse transcription polymerase chain reaction (RT-PCR) indicates ACL cells have the highest gene expression for the matrix markers. This leads to the question of which cell type should be the cell source for tissue-engineering of ligament, the highly proliferating cells or the differentiated matrix producing cells. This study would suggest that ACL differentiated matrix producing cells are the most suitable cells for further study and development of a tissue-engineered ligament.

Achilles Tendon↗
PubMed2003

Flexor tendon graft attachment: a review of methods and a newly modified tendon graft attachment.

A review of the described methods of attachment of flexor tendon grafts to the distal phalanx is presented. The authors advocate the previously described method of attachment consisting of passage of the tendon graft through the pulp with anchorage to the nail. A new modification of this technique is presented, facilitating accurate dissection and placement of the graft with minimal trauma.

Fingers↗
PubMed1995

Tendon, tendon sheath, and ligament injuries in the pastern.

The palmar (plantar) aspect of the pastern is an anatomically complex area and an understanding of this is a prerequisite for accurate diagnosis of injuries in this area. The gross and normal ultrasonographic anatomy are described, and injuries of the superficial and deep digital flexor tendons and the digital flexor tendon sheath, the distal sesamoidean ligaments, and the palmar ligaments of the proximal interphalangeal joint are discussed.

Animals↗
PubMed2000

Biomechanical comparison of quadriceps tendon fixation with patellar tendon bone plug interference fixation in cruciate ligament reconstruction.

PURPOSE: The purpose of this study was to use current fixation techniques and compare the stiffness and ultimate tensile failure of the tendinous end of the quadriceps tendon (QT) with the bone plug end of the bone-patellar tendon-bone (BPTB) graft using current techniques of fixation. TYPE OF STUDY: Randomized trial of elderly cadaver knees. MATERIALS AND METHODS: Tibial and femoral biodegradable interference fixation and femoral EndoButton (Smith & Nephew, Acufex, Mansfield, MA) fixation in bone tunnels with the QT and the BPTB graft were compared by using 10 pairs of elderly cadavers and biomechanical testing. Two groups, fixation at time zero (simulating fixation in the operating room) and testing after 1, 000 loading cycles (simulating patient rehabilitation exercises), were used. RESULTS: At time zero fixation, stiffness of the soft tissue QT tibial tunnel interference fixation was 59% less stiff than the stiffness of the interference fixation of a BPTB plug in a femoral tunnel (P =.11). The EndoButton femoral fixation resulted in a decrease in stiffness at time zero compared with femoral tunnel interference fixation of the soft tissue QT (P =.03). All groups improved stiffness with cycling the construct to 1,000 cycles. CONCLUSIONS: Placement of the QT tendinous end of the graft in the femoral bone tunnel when using a interference fixation will approximate the stiffness of a bone plug in the tibial bone tunnel with interference fixation. The EndoButton fixation is not as stiff as either of the femoral interference fixation options. The addition of more than 20 loading cycles could remove laxity from the graft fixation-graft cruciate ligament complex and improve its stiffness.

Anterior Cruciate Ligament↗
PubMed2000

Severe extensor tendon attrition and multiple tendon ruptures resulting from Kienböck's disease.

Kienböck's disease is a rare but recognized cause of chronic wrist pain. Occasionally, complications arise leading to tendon rupture. The authors present the first reported case of attrition to all extensors of the hand, and extensor tendon rupture to the little finger in a patient with a 45-year history of Kienböck's disease. This is also the first reported incidence of this complication in whites. Clinical features, surgical management, and the successful outcome are discussed.

Humans↗
PubMedDate not supplied

Recurrent dislocation of the peroneal tendons. Results of rerouting the tendons under the calcaneofibular ligament.

Nine patients (11 cases) with recurrent dislocation of the peroneal tendons who were treated by surgically rerouting the tendons under the calcaneofibular ligament were reviewed. Mean follow-up time was 30.5 months. An excellent or good result was obtained in all cases. This operative technique was previously described in 1975, by Sarmiento and Wolf, in a case report.

Adult↗
PubMed2004

Morphological study of the Golgi tendon organ in equine superficial digital flexor tendon.

The Golgi tendon organ (GTO) is an encapsulated fusiform mechanoreceptor siding in the musculo-tendinous junction of many animal species. Inhibitory function of afferent nerve fibers distributed from nearby motor units, the organ responds to active tension exerted onto the muscle. The morphological features of the equine GTO have not yet been elucidated. Additionally, there is some controversy regarding to the existence of the GTO in the equine superficial digital flexor tendon (SDFT). Therefore, immunohistochemistry and immunoelectron microscopy using alcian blue (pH 2.5) staining and the silver-enhanced colloidal gold method were carried out to determine both the location and characteristics of the GTO at the musculo-tendinous junction of the SDFT. A GTO with a fusiform structure of approximately 3 mm in length was found in the tendinous part. The lumen of the GTO was divided into compartments by septal cells. Each compartment contained collagen fibrils, nerve fibers and Schwann cells. This is the first report of the equine GTO.

Animals↗
PubMed1983

Experimental tendon grafting within intact tendon sheath.

A chicken toe experimental model was used to study the fate of flexor tendon grafts, introduced into intact tendon sheaths. After perfusion of the limb by India Ink, the vascular pattern of the graft and the synovial sheath could be identified. The grafts showed no or few adhesions to the sheath. With time, there was a conversion from a diffuse superficial vascular pattern towards a concentration of vessels on the dorsal aspect of the graft. In a control group, where the sheath had been resected, adhesions were more apparent, and could be observed still after 16 weeks. These results are in complete agreement with previous experimental findings and further confirm the importance of an intact tube system in the digit.

Animals↗
PubMed2000

Long-term results of anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons with Kennedy ligament augmentation device compared with patellar tendon autografts.

ACL reconstructions were postoperatively evaluated in 102 patients who underwent surgery using an arthroscopically assisted double-incision technique. Augmentation of the distally based semitendinosus and gracilis tendons was done either with the Kennedy ligament augmentation device (LAD) (Group 1 patients, mean follow-up of 108 months) or bone-patellar-tendon-bone graft (Group 2 patients, mean follow-up of 109 months). At follow-up, serial KT-1000 measurements showed < or = 5 mm side-to-side differences in 70% of Group 1 and 90% of Group 2 patients. No differences were found among patients regarding postreconstruction complications such as loss in motion range, patellofemoral crepitus, osteoarthritis, and muscle disfunction.

Activities of Daily Living↗
PubMedDate not supplied

Silastic tendon graft: its role in neglected tendon repair.

A case history is presented of the repair of a neglected traumatic tendon laceration by the use of a permanent Silastic tendon implant, originally manufactured for hand surgery by a staged procedure. Stage I consists of implantation of the Silastic implant and allowance of a 2- to 3-month period for the production of a pseudosheath. Stage II consists of removal of the implant after using it to guide an auto- or allograft, through the newly formed pseudosheath for attachment to the anastomotic sites.

Adolescent↗
PubMed1975

[Ultrastructural changes in human skeletal muscles following tendon and nerve injuries. I. Ultrastructural changes following tendon injuries].

During reconstructive procedures performed 4-16 weeks after the tendon lesion the specimens obtained from the injured muscle have been examined by the authors. It was found that after the tendon injury inactivity atrophy develops and a condition of equilibrium could be observed at this time. The most important changes in the fine structure were seen in the contractile elements: these were atrophied, homogenized, fragmentated and ragged independently from the functional unities. The number of the mitochondria was considerably decreased, the sarcoplasmic reticulum was increased, and the difference between the originally red and white muscular fibres was indistinct. The glycogen content of the musculature was decreased, or it disappeared completely. No pathologic changes have been observed in the sarcolemma, the cell nuclei and the motor nerve end-organs.

Adult↗
PubMed1987

Results of transfer of the flexor digitorum superficialis tendons to the flexor digitorum profundus tendons in adults with acquired spasticity of the hand.

Thirty-one patients who had transfer of the flexor digitorum superficialis tendons to the flexor digitorum profundus tendons en masse in thirty-four non-functional spastic hands were examined at an average of fifty months postoperatively. All of the patients had had a clenched-fist deformity preoperatively, with severe hygienic problems of the palmar skin and no active function of the hand. Postoperatively, all of the hands were in an open position, which allowed for good hygiene of the palmar surface. A minor wound infection developed in three patients. Neurectomy of the motor branch of the ulnar nerve distal to the Guyon canal was needed for control of spasticity of the intrinsic muscles in twenty-five hands. An intrinsic-minus deformity did not develop in any of the hands that had neurectomy of the ulnar nerve, although an intrinsic-plus deformity developed in seven of the nine hands that did not have a neurectomy.

Adult↗