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PubMed2006

Tenotomy does not affect saccadic velocities: support for the "small-signal" gain hypothesis.

We investigated the effects of four-muscle tenotomy on saccadic characteristics in infantile nystagmus syndrome (INS) and acquired pendular nystagmus (APN). Eye movements of 10 subjects with INS and one with APN were recorded using infrared reflection, magnetic search coil, or high-speed digital video. The expanded nystagmus acuity function (NAFX) quantified tenotomy-induced foveation changes in the INS. Saccadic characteristics and peak-to-peak nystagmus amplitudes were measured. Novel statistical tests were performed on the saccadic data. Six out of the 10 INS subjects showed no changes in saccadic duration, peak velocity, acceleration, or trajectory. In the other four, the differences were less than in peak-to-peak amplitudes (from 14.6% to 39.5%) and NAFX (from 22.2% to 162.4%). The APN subject also showed no changes despite a 50% decrease in peak-to-peak amplitude and a 34% increase in NAFX. The "small-signal" changes (peak-to-peak nystagmus amplitude and NAFX) were found to far exceed any "large-signal" changes (saccadic). Tenotomy successfully reduced INS and APN, enabling higher visual acuity without adversely affecting saccadic characteristics. These findings support the peripheral, small-signal gain reduction (via proprioceptive tension control) hypothesis. Current linear plant models, limited to normal steady-state muscle tension levels, cannot explain the effects of the tenotomy.

Acceleration↗
PubMed2005

[Clinical results of arthroscopic tenotomy of the long head of the biceps brachii in full thickness tears of the rotator cuff without repair: 40 cases].

PURPOSE OF THE STUDY: Appropriate treatment of irreparable rotator cuff tears in patients without osteoarthritic shoulder joints remains a subject of debate. Medical treatment, a substitution muscle flap, and palliative arthroscopic treatment have been proposed. Arthroscopic tenotomy of the long head of the biceps brachii is warranted because this tendon is often the cause of part or all of the pain. If there is a full thickness tear of the rotator cuff, the exposed tendon of the long head of the biceps brachii can, because of its anterosuperior position, become impinged against the acromial vault during forward flexion. The purpose of this work was to evaluate the mid-term clinical and radiological results of arthroscopic tenotomy of the long head of the biceps brachii during treatment of full thickness tears of the rotator cuff. MATERIAL AND METHODS: The series included 40 shoulders operated on for tenotomy alone (n=32) or in combination with acromioplasty (n=8). The long head of the biceps brachii was in place in 23 shoulders (58%), displaced in seven and subluxed in five. The position was not determined in five. At last follow-up, the mean rough Constant score was 58 points, giving a gain of 20 points. The gain for pain was +7.1 points, +6.4 points for activity, and +6.6 points for motion. After the operation, muscle force for elbow flexion-supination was decreased 40% compared with an age-, sex- and dominance-matched control group. 86% of the patients were satisfied with the outcome and only two patients were disappointed by the asymmetry of arm muscle volume. Radiographically, at last follow-up there were no signs of superior excentration of the humeral head and the subacromial space, which measured 7.38 mm preoperatively was 7.19 mm postoperatively. Likewise only two shoulders progressed to excentered osteoarthritis at 41 and 72 months. DISCUSSION: Mid-term results of arthroscopic tenotomy of the long head of the biceps brachii are satisfactory. The technique is simple and has limited functional consequences. The procedure has an undeniable impact on pain and has allowed a 34 degree gain in anterior flexion of the shoulder. Complementary acromioplasty was not found to provide a supplementary benefit in this series. Nevertheless, the degradation of the result in one female patient at six years suggests we should be prudent concerning the long-term benefit of this procedure which should be reserved for irreparable tears in patients with minimal functional demands.

Acromion↗
PubMed1992

Myosin heavy-chain composition in striated muscle after tenotomy.

The myosin heavy-chain (MHC) isoform pattern was studied by biochemical methods in the slow-twitch (soleus) and fast-twitch (gastrocnemius) muscles of adult rats during atrophy after tenotomy and recovery after tendon regeneration. The tenotomized slow muscle atrophied more than the tenotomized fast muscle. During the 12 days after tenotomy the total MHC content decreased by about 85% in the slow muscle, and only by about 35% in the fast muscle. In the slow muscle the ratio of MHC-1 to MHC-2A(2S) remained almost unchanged, showing that similar diminution of both isoforms occurs. In the fast muscle the MHC-2A/MHC-2B ratio decreased, showing the loss of MHC-2A mainly. After tendon regeneration, the slow muscle recovered earlier than the fast muscle. Full recovery of the muscles was not observed until up to 4 months later. The embryonic MHC, which seems to be expressed in denervated adult muscle fibres, was not detected by immunoblotting in the tenotomized muscles during either atrophy or recovery after tendon regeneration. The influence of tenotomy and denervation on expression of the MHC isoforms is compared. The results show that: (a) MHC-1 and MHC-2A(2S) are very sensitive to tenotomy, whereas MHC-2B is much less sensitive; (b) expression of the embryonic MHC in adult muscle seems to be inhibited by the intact neuromuscular junction.

Animals↗
PubMedDate not supplied

Bleeding complications following percutaneous tendoachilles tenotomy in the treatment of clubfoot deformity.

Ponseti demonstrated correction of most clubfeet in infants using proper manipulative techniques followed by application of well-molded long-leg plaster casts and a percutaneous tendoachilles tenotomy to correct residual equinus contracture. Medical complications occurring as a result of this technique have not to our knowledge been reported. The authors retrospectively reviewed 134 consecutive infants with 219 idiopathic clubfeet treated with the Ponseti method. A percutaneous tendoachilles tenotomy was performed on 200 clubfeet (91%) at a mean age of 16 weeks (range, 6-77 weeks) when less than 10 degress of ankle dorsiflexion was present after casting. A total of 4 patients had serious bleeding complications following the percutaneous tendoachillis tenotomy--3 due to presumed injury to the peroneal artery and 1 due to injury to the lesser saphenous vein. The authors detail the technique of performing a percutaneous tendoachilles tenotomy and offer guidelines that may help others avoid this same complication.

Achilles Tendon↗
PubMed2002

Management of Achilles tendinopathy by ultrasound-guided percutaneous tenotomy.

PURPOSE: To report the middle to long-term results of ultrasound-guided percutaneous longitudinal tenotomy of the Achilles tendon METHOD: Seventy-five athletes with unilateral Achilles tendinopathy underwent ultrasound-guided percutaneous longitudinal tenotomy under local anesthetic infiltration after failure of conservative management. Sixty-three patients were reviewed at least 36 months after the operation (51 +/- 18.2 months). RESULTS: Thirty-five patients were rated excellent, 12 good, 9 fair, and 7 poor. Nine of the 16 patients with a fair or poor result underwent a formal exploration of the Achilles tendon 7-12 months after the index procedure. The operated tendons remained thickened and the ultrasonographic appearance of operated tendons remained abnormal even 8 yr after the operation, without interfering with physical training. Isometric maximal muscle strength and isometric endurance gradually returned to values similar to their contralateral unoperated tendon. CONCLUSIONS: Percutaneous longitudinal ultrasound-guided internal tenotomy is simple, can be performed on an outpatient basis, requires minimal follow-up care, does not hinder further surgery should it be unsuccessful, and, in our experience, has produced no significant complications. It should be considered in the management of chronic Achilles tendinopathy after failure of conservative management. However, patients should be advised that, if they suffer from diffuse or multinodular tendinopathy or from pantendinopathy, a formal surgical exploration with stripping of the paratenon and multiple longitudinal tenotomies may be preferable.

Achilles Tendon↗
PubMed1999

Correlation of ultrasound and magnetic resonance imaging with clinical outcome after patellar tenotomy: prospective and retrospective studies. Victorian Institute of Sport Tendon Study Group.

OBJECTIVE: To report the appearances of ultrasound (US) and magnetic resonance imaging (MRI) before and after surgery for chronic patellar tendinopathy and to correlate postoperative appearances with clinical outcome. DESIGN: A 12-month prospective longitudinal study and a retrospective study, each part using different patients. Prospective study included clinical assessment, ultrasound, and MRI all performed before and 12 months after surgery. Retrospective study included ultrasound and clinical assessment only (i.e., no MRI) 24 to 67 months after surgery. SETTING: Institutional athlete study group in Australia (Victorian Institute of Sport Tendon Study Group). PATIENTS: In the prospective study, 13 patients (all male; 15 tendons) who underwent patellar tenotomy; in the retrospective study, 17 different patients (18 tendons) who had undergone identical surgery. MAIN OUTCOME MEASURES: Ultrasound and MRI appearances and clinical assessment at baseline and 12 months after surgery (prospective study). Ultrasound appearance and clinical assessment 24 to 67 months after surgery (retrospective study). Dimensions of abnormal regions on imaging were measured. Clinical assessment included categorical rating and numerical Victorian Institute of Sport Assessment (VISA) score. RESULTS: In the prospective study, preoperative ultrasound and MRI appearances confirmed the clinical diagnosis of patellar tendinopathy. Postoperative ultrasound and MRI also revealed abnormalities consistent with patellar tendinopathy. Despite this, 11 of 15 (73%) tendons were rated clinically as either good or excellent. Imaging modalities were unable to distinguish tendons rated as good or excellent from those rated poor at 12 months. In the retrospective study, ultrasound images revealed abnormalities despite full clinical recovery. There was no correlation between dimension of ultrasound abnormality and either VISA score or time since surgery. CONCLUSION: After open patellar tenotomy, MRI and ultrasound findings remain abnormal despite clinical recovery. Thus, clinicians ought to base postoperative management of patients undergoing patellar tenotomy on clinical grounds rather than imaging findings. At present, there appears to be no role for routine postoperative imaging of patients recovering slowly after patellar tenotomy. However, this is not to suggest that imaging cannot play a role in special circumstances.

Adolescent↗
PubMed1986

The effects of tenotomy and overload on the postnatal development of medial gastrocnemius motor units in the cat.

Five-to 7-day-old kittens were subjected to tenotomy of either the medial gastrocnemius muscle (MG) or its synergists within the Achilles tendon. The effects of these operations on the postnatal differentiation of MG motor units were investigated when the cats had reached the adult stage. The MG tenotomy produced a substantial weight loss, while tenotomy of synergists induced only a minor weight gain of the MG muscle. Tenotomy of the MG synergists induced a marked prolongation of motoneuronal AHP durations in the overloaded MG. This prolongation affected equally motoneurones of the S and F types. The twitches of the tenotomized motor unit group showed a relatively slower relaxation than those of the overloaded group. The muscle unit properties of the tenotomized MG muscles showed a less distinct differentiation than those of the overloaded muscles. The basic features of the various motor unit types were, however, normal in both groups, and there was no evidence of a major shift in the proportions of different motor unit types. It is concluded that the postnatal differentiation of all types of MG motor units is largely unaffected by the abnormal situations introduced in the present study.

Achilles Tendon↗
PubMed1998

Correction of lower eyelid retraction in thyroid eye disease: a randomised controlled trial of retractor tenotomy with adjuvant antimetabolite versus scleral graft.

BACKGROUND/AIMS: Lower eyelid retraction in thyroid eye disease contributes to ocular discomfort and an unsightly appearance, especially if asymmetrical. The use of donor scleral grafts is effective in lengthening the lower eyelids but carries a risk of virus transmission. Other techniques, including those which do not use grafts, need to be compared with scleral grafts. Recurrent retraction is a recognised complication of thyroid eyelid surgery; therefore, the authors investigated the use of antimetabolites to reduce postoperative fibrosis. METHODS: In this prospective randomised controlled trial of 25 patients (35 eyelids), the use of donor sclera in 20 lower eyelids (13 patients) was compared with partial tenotomy of the anterior part of the lower eyelid retractors (ALER) with adjuvant peroperative antimetabolite in 15 lower eyelids (12 patients). A 5 minute peroperative application of either 5-fluorouracil (25 mg/ml) in nine lower eyelids (eight patients) or mitomycin C (0.2 mg/ml) in six lower eyelids (four patients) was used to focally inhibit fibroblasts. Follow up ranged from 3 to 18 months (mean 7.8). RESULTS: One month after surgery the results of both groups were similar. However, at 3 months after surgery the results of scleral grafting were better than tenotomy with antimetabolites: 3/12 patients (25%) treated with tenotomy and adjuvant antimetabolite required subsequent surgery using grafts for correction of recurrent retraction. There were no significant complications associated with the use of antimetabolites in the eyelid in the doses used in this study. CONCLUSIONS: This randomised prospective trial shows that donor scleral grafts were more effective in the long term than partial tenotomy with adjuvant antimetabolite in the correction of lower eyelid retraction associated with thyroid eye disease. The use of peroperative antimetabolites in the lower eyelid was safe.

Adult↗
PubMed2004

Tension- and afferent input-associated responses of neuromuscular system of rats to hindlimb unloading and/or tenotomy.

Responses of electromyogram (EMG) in soleus muscle and both afferent and efferent neurograms at the fifth lumbar (L(5)) segmental level of spinal cord were investigated during acute and chronic unloading induced by hindlimb suspension and/or tenotomy in adult rats. The soleus EMG and afferent neurogram decreased 88 and 37%, respectively, relative to those at quadrupedal posture on the floor after acute hindlimb suspension that causes passive shortening of soleus due to ankle plantarflexion. However, the afferent neurogram (P < 0.05) and soleus EMG (P > 0.05) recorded on the floor increased after tenotomy of synergists. Furthermore, the afferent input was inhibited when the soleus EMG disappeared after tenotomy of soleus. The afferent neurogram and EMG of the soleus showed correlated responses to a variety of treatments, suggesting that the afferent neurogram recorded at the L(5) segmental level reflects the neural input associated with the activity level of the soleus predominantly. The level of efferent neurogram decreased after acute hindlimb suspension but was not influenced significantly by tenotomy of synergists and/or soleus itself. The EMG and afferent neurograms remained low up to the 4th day but recovered to the preexperimental levels within 14 days, due to reorganization of sarcomere number and length, as well as the shortening of muscle fiber length and recovery of tension development. It is suggested that the levels of EMG and afferent neurogram associated with antigravity muscle are closely related to the tension development of the muscle.

Animals↗
PubMed2001

Lipoprotein lipase activity in skeletal muscles of the rat: effects of denervation and tenotomy.

The effects of denervation, tenotomy, or tenotomy with simultaneous denervation on the activity of heparin-releasable and intracellular, residual lipoprotein lipase (LPL) and triacylglycerol (TG) content were examined in rat skeletal muscles. An influence of muscle electrostimulation on denervated and tenotomized muscles was also evaluated. Activity of both LPL fractions was decreased in denervated and/or tenotomized soleus and red portion of gastrocnemius muscles. It was accompanied by a slight elevation of the intracellular TG content. Electrostimulation increased activities of both fractions of LPL in red muscles from intact hindlimbs. In stimulated denervated muscles without or with simultaneous tenotomy, activity of two LPL fractions was also enhanced, but control values were reached only in denervated soleus muscle. Electrical stimulation had no pronounced effect on LPL activity in tenotomized muscles. In conclusion, denervation and/or tenotomy decreases LPL activity in red muscles, indicating reduction of the muscle potential to utilize circulating TG. Electrostimulation only partly restores the diminished LPL activity in denervated muscles, without any effect in tenotomized ones. Thus, to maintain LPL activity in resting muscle, intact innervation and tension are needed.

Achilles Tendon↗
PubMed1994

Chevron osteotomy for hallux valgus not improved by additional adductor tenotomy. A prospective, randomized study of 84 patients.

We investigated 106 feet in 84 patients in a prospective randomized series where the clinical and radiographic results of the original chevron osteotomy were compared to the same procedure with the addition of an adductor tenotomy in patients averaging 47 years of age and with a mean follow-up of 3 years. Clinically there was no difference in the satisfaction rate of the two groups, with 58 satisfied and partially satisfied in the 62 operated by chevron osteotomy alone, and 42 of 44 in the group where adductor tenotomy was added. The hallux valgus angle decreased by 7.5 degrees in the group operated with chevron osteotomy and by 9.8 degrees (P 0.04) when an adductor tenotomy was added. The major objective factor affecting satisfaction was the attainment of a decreased ball circumference, shown by the fact that dissatisfied patients had a greater postoperative ball circumference than both satisfied and partially satisfied patients, whereas there were no radiographic correlations to satisfaction. We cannot recommend adding adductor tenotomy to the chevron osteotomy.

Adolescent↗
PubMedDate not supplied

The effect of bilateral superior oblique tenotomy on horizontal deviation in A-pattern strabismus.

In order to determine the horizontal effects of bilateral superior oblique tenotomy, all cases of superior oblique tenotomy performed at the Children's Hospital Medical Center and also in a private practice setting over the past ten years were analyzed retrospectively. A total of 18 patients underwent isolated bilateral oblique tenotomy. An average primary position exo-shift of 2 prism diopters was found; in upgaze a significant exo-shift of 11 prism diopters and in downgaze a significant eso-shift of 21 prism diopters were noted. Analysis of data in the literature on the effects of superior oblique tenotomy suggests that the results of others have, in fact, been consistent with our findings, despite the common misconception that an eso-shift in the primary position was to be expected.

Esotropia↗
PubMedDate not supplied

Superior oblique recession versus tenotomy: a comparison of surgical results.

Past experience with weakening the superior oblique muscle by tenotomy has been complicated by unpredictable results. Superior oblique recession has been advocated as a more controlled and reliable procedure. We retrospectively studied 20 cases of superior oblique tendon recession and tenotomy from the Bascom Palmer Eye Institute over the last ten years. All cases were compared with respect to the amount of deviation corrected, ability to eliminate "A" pattern strabismus, preservation of muscle function, and complications. Both procedures were equally effective in eliminating "A" pattern strabismus regardless of the initial size of the pattern. Unilateral superior oblique recessions were less erratic than tenotomies but tended to result in a slight undercorrection. The complications were similiar for each procedure. We could not demonstrate a clear advantage of bilateral superior oblique recession over tenotomy. Unilateral recession needs further investigation and may have prove useful when combined with the adjustable suture technique.

Adolescent↗
PubMedDate not supplied

Superior oblique tenotomy in the treatment of isolated inferior oblique paresis.

Both tenotomy and tenectomy of the homolateral superior oblique muscle have been advocated as surgical treatment for isolated paresis of the inferior oblique muscle. An iatrogenic superior oblique palsy has been reported to be a frequent complication of superior oblique tenectomy. This complication appears to be less frequent following superior oblique tenotomy. Of 16 consecutive patients with isolated inferior oblique paresis treated by homolateral superior oblique tenotomy and followed an average of 5.0 years (range six months to 11.6 years), only two patients demonstrated a superior oblique palsy postoperatively. Large vertical deviations with spread of comitance, however, required a superior rectus recession of the fellow eye in addition to superior oblique tenotomy.

Adolescent↗
PubMed1999

Deep digital flexor tenotomy as a treatment for chronic laminitis in horses: 35 cases (1988-1997)

OBJECTIVE: To determine long-term prognosis for horses with laminitis treated by deep digital flexor (DDF) tenotomy and to identify factors affecting success of the surgical procedure. DESIGN: Retrospective study. ANIMALS: 35 horses with laminitis treated by DDF tenotomy between 1988 and 1997. PROCEDURE: Information was obtained from individual medical records and follow-up telephone interviews with owners and referring veterinarians. Cumulative proportions of horses that survived 6 months and 2 years after tenotomy were determined. Effect of Obel grade of lameness on 6-month and 2-year survival and effect of distal phalangeal rotation on survival and future performance were evaluated by chi 2 analysis. Body weights of horses that survived > or = 2 years were compared with those of horses that survived < 2 years by ANOVA. RESULTS: 27 of the 35 (77%) horses survived > or = 6 months, and 19 of 32 (59%) survived > 2 years. Obel grade of lameness and body weight at time of surgery had no effect on 6-month or 2-year survival. Degree of distal phalangeal rotation had no effect on 2-year survival or the ability of horses to be used for light riding. Twenty-two of the 30 (73%) owners interviewed indicated they would have the procedure repeated on their horses given similar circumstances. CLINICAL IMPLICATIONS: DDF tenotomy is a viable alternative for horses with laminitis refractory to conventional medical treatment. In some instances, the procedure may be effective in returning horses to light athletic use.

Analysis of Variance↗
PubMed1999

The immediate effect of bilateral superior obliuqe tenotomy on primary position horizontal binocular alignment.

PURPOSE: To evaluate the effect on primary position horizontal binocular alignment of superior oblique tenotomy for A-pattern exotropia with bilateral superior oblique overaction using new surgical and anesthesia techniques. SUBJECTS AND METHODS: We performed intraoperatively adjustable horizontal strabismus surgery under topical anesthesia in 6 cases of A-pattern exotropia. After adjusting the horizontal deviation nearly to orthotropia in primary position, we measured the angle of horizontal deviation in up-, primary, and downgaze positions. This was followed by bilateral superior oblique tenotomy and remeasurement of the horizontal deviation in the same 3 positions. Postoperatively we remeasured the deviation at one day, one month and three months. RESULTS: There was no immediate change in the horizontal deviation in primary position in 2 of the 6 patients, and 3-8 delta of immediate esotropic shift in 4 of the 6 patients (average 3.3 delta) after bilateral superior oblique tenotomy. At 3 months postop' the small esotropia noted at the immediate postop' measurement became orthotropic. There was a tendency of increased exotropic shift or becoming exotropic in those patients with slight exotropia or orthotropia at the immediate postop' measurement. But these shifts were minimal. CONCLUSION: When combined surgery of superior oblique and horizontal muscle is planned for A-pattern exotropia, the effect of bilateral superior oblique tenotomy on the primary position horizontal binocular alignment can be disregarded.

Adult↗
PubMed1975

Synergistic tenotomy: effect on chronically denervated slow and fast muscles of rat.

A study was conducted with chronically denervated adult female Wistar rats to test the hypothesis that synergistic tenotomy of denervated skeletal muscles does not just retard atrophy but produces an increase in muscle weight. The animals were categorized in three groups-denervated exercised (DE), denervated tenotomized (DT), and denervated-tenotomized-exercised (DTE). Mechanical stretch was induced in the DE group by forcing the animals to stand on their hind legs to reach for food and water. In the DT group, mechanical stretch was induced by tenotomy of two synergists in the gastrocnemius-plantaris-soleus complex of each leg of the rat so that either the soleus or the plantaris was left as the only plantar-flexor of the ankle joint in each leg. Mechanical stretch was induced in the DTE group by forcing the animals to stand after the tenotomy of synergists at eight weeks postdenervation. All animals in the three experimental groups, and in the sedentary control group (D) were sacrificed at nine weeks postdenervation; the soleus and plantaris muscles were removed and evaluated for MW, DW and percent of hydration. The slow muscle (soleus) increased in muscle mass in DT (53%), DE (26%), and DTE (17%). The fast muscle (plantaris) increased in weight in DE (18%) and in DTE (24%), but showed no significant changes in DT. Study results confirm the hypothesis that synergistic tenotomy stimulates an increase in muscle weight rather than merely retarding atrophy, and that this phenomenon can take place in the absence of neuronal influences. It is suggested that the increase in denervated muscle mass stimulated by muscle elongation is not a true work hypertrophy associated with significant changes in protein concentrations but only an adaptation to a new muscle length. The purpose of the adaptational changes is to optimize the overlap of actomyosin bridges in anticipation of forceful muscle contraction.

Animals↗
PubMed2002

[Percutaneous extensor tenotomy in patients with lateral epicondylitis resistant to conservative treatment].

OBJECTIVES: We evaluated the results and advantages of percutaneous extensor tenotomy performed in patients with lateral epicondylitis resistant to conservative treatment. METHODS: Percutaneous extensor tenotomy was performed in nine patients (7 females, 2 males; mean age 44 years; range 32 to 54 years) with lateral epicondylitis unresponsive to conservative treatment. The mean duration of the complaints was 25 months (range 9 months to 4 years), during which a mean of 2.7 (range 2 to 4) local corticosteroid injections was administered. The patients were operated under local anesthesia in an outpatient setting. The procedure lasted approximately 4.5 minutes. The remaining portion of the tendon was removed by manipulation. The results were evaluated according to the criteria by Verhaar et al. The mean follow-up period was nine months (range 4 to 15 months). RESULTS: The patients were able to use their affected arms after a mean of nine days (range 6 to 14 days). Hematoma that developed in the lateral epicondyle distally in two patients resolved spontaneously. All patients' complaints of pain decreased by more than 50% within six to eight weeks. The results were excellent or good in eight patients and fair in one patient. All patients but one were satisfied with the result of tenotomy. CONCLUSION: Percutaneous extensor tenotomy is a simple procedure; it can be performed under outpatient settings, and yields favorable results in patients with lateral epicondylitis resistant to conservative treatment.

Adult↗