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PubMed2004

Outcome of a surgical treatment protocol for late consecutive exotropia following bilateral medial rectus recession for esotropia.

PURPOSE: To describe a specific protocol for the surgical treatment of Late Consecutive Exotropia (LCXT) following bilateral medial rectus (MR) recessions, and to report the results of surgery, performed according to this protocol, in a series of 119 children followed 6 months to 15 years after surgery for consecutive exotropia. METHOD: The senior author (JLM) performed a retrospective chart review of 15 years of his experience following a specific protocol for the surgical treatment of LCXT. In individual cases, following this protocol led to recessions of the overacting inferior oblique (IO) with anterior transposition if dissociated vertical deviation (DVD) was also present, weakening of the overacting superior oblique (SO) with simultaneous 10 mm recessions of the superior rectus (SR) with 3 mm of nasal transposition (to ameliorate DVD which might be aggravated by SO tenotomies), graded recessions of one lateral rectus (LR) 7.0 to 8.5 mm if the distance deviation was equal to or less than 23 prism diopters (PD) of XT, and advancement of one previously recessed MR to the insertion if the distance deviation was equal to or greater than 24 PD XT. RESULTS: "Success" was defined as 8 PD ET to 6 PD XT, with both distance and near fixation. Among 14 patients receiving SR recessions, SO tenotomies, and recession of one LR, 12 of the 14 were "successes" at 6 months postop' and 10 of 14 at an average of 3 years postop'. Among 26 receiving advancement of one MR, "successes" were 23 of 26 at 6 months postop' and 20/26 at two years after surgery. Among 22 receiving IO recession with anterior transposition if DVD was present, "successes" were 18 of 22 at 6 months and 12 of 22 at 3.6 years. Among 57 receiving only recession of one LR, 53 of 57 were "successes" at 6 months postop' and 45 of 57 at 4 years postop'. The overall "success" rate for this protocol for these 119 patients was 89% at 6 months and 74% at 2 to 4 years postop'. Treatment of simultaneous IO overaction and LCXT was associated with the highest long term "failure" rate in this protocol. CONCLUSION: This specific surgical protocol for treatment of late consecutive exotropia is reasonably safe and effective and comparable to the few other reported protocols of various surgical treatments for consecutive exotropia.

Adolescent↗
PubMed2006

[Two surgical methods to modify upper eyelid retraction with thyroid associated-ophthalmopathy].

OBJECTIVE: To evaluate the treatment effect of the two surgical methods for upper eyelid retraction with thyroid associated-ophthalmopathy. METHODS: Twenty-two patients (32 eyes) with inactive thyroid associated-ophthalmopathy were divided into 2 groups (11 for each group) randomly. 11 patients (18 eyes) in the group A were treated by central tenotomy of levator aponeurosis. Another 11 patients (14 eyes) in the group B were treated by lengthening of Mullers' muscle combined with levator muscle. The treatment effect was investigated in 6-month follow-up study. RESULTS: All of the patients were improved with the two surgical methods, which there was very significant difference before and after the treatments (P < 0.01), but not between the two surgical methods (P > 0.05) by statistical analysis. There was recurrent retracting in 4 patients (6 eyes) of group A and in 1 patient (1 eye) of group B, which there was significant difference between the two groups (P < 0.05) by Chi-square test. None of the patients was overcorrected. CONCLUSIONS: The two methods are both effective and safe in correcting upper eyelid retraction. The rate of recurrent retracting is lower in lengthening of Mullers' muscle combined with levator muscle than that in central tenotomy of levator aponeurosis.

Blepharoplasty↗
PubMed1991

Surgical treatment of the hip in cerebral palsy.

Hips are affected generally in CP but in favourable cases we can prevent dislocation by adductor tenotomy performed in time (530 cases). Posterior transposition of the origins of the adductor muscles is performed if the patient walks with inwood rotated inferior extremities (105 cases). In the treatment of real subluxation and valgus deformity the open tenotomy of adductor muscles and femur osteotomy with derotation and varisation were used (180 cases). We accomplish open reduction in frank dislocation (35 cases). In such cases it is often necessary to shorten the femur. Also normal acetabulum is found in elder children.

Cerebral Palsy↗
PubMedDate not supplied

[Evaluation of treatment of the hip in arthrogryposis multiplex congenita].

In a retrospective review of 77 patients with arthrogryposis multiplex congenita, 21 showed involvement of the hip (28%). The authors studied 18 cases with hip dislocation (11 bilateral and seven unilateral) and three with hip contracture. There were 12 female and nine male patients ranging their age from one month to 14 years. The follow-up in this series lasted from two to 23 years. The treatment was conservative or surgical. The contractures were treated by manipulation and abduction orthosis in one patient and surgically by multiple hip tenotomy in two. The dislocation was treated by abduction orthosis (two cases), closed reduction (two cases) and open reduction (one case) in the 11 cases with bilateral involvement; for the seven unilateral dislocations the treatment was: closed reduction and abduction orthosis (one case), closed reduction with abductor tenotomy and hip spica cast (four cases) and open reduction followed by hip spica and abduction orthosis (one case); one case remained without treatment of the hip involvement because of severity of deformities in knee and foot. Ten patients of this groups were not treated because they were confined to wheelchairs. The overall result was good in six patients, regular in four and poor in two in the dislocation group; for the three cases of hip contracture the result of treatment was good. In conclusion the authors recommend such treatment for the independent ambulatory patients and emphasize the necessity of treatment of patients with unilateral hip involvement.

Adolescent↗
PubMed1991

[An experimental study of the effect of severed ocular recti on anterior segment circulation].

The effect of recti tenotomy on the blood flow in iris-ciliary body was studied in 30 anaesthetized dogs with 51Cr labelled RBC of the frog as biological microspheres. The quantitative determinations showed that the blood flow in eyes with 2, 3, and 4 recti detached were 4.47%, 20.80%, and 26.15% less respectively than that of the sham-operation controls, indicating that tenotomy of more than 3 recti compromised the anterior segment circulation seriously. The development of ischemia depended on the number of vertical recti severed when the regional circulation was in a critical situation with the detachment of 2 recti.

Animals↗
PubMed1990

[Experimental hip dysplasia in the rabbit].

Neglected cases of congenital dislocation of the hip (CDH) always present with profoundly interesting X rays and pathoanatomical changes. Because of progressive dysplastic change, it is difficult to determine clinically at what stage a patient can not have reconstructive surgery. We used an animal model to induce hip dysplasia in order to understand the mechanism of dislocation and to demonstrate the dysplastic changes at various ages of dislocation. We used a plastic tube to immobilize the left knee of one week old New Zealand white rabbits in the extension position. Fifty-five rabbits in a natural history group were examined physically, radiographically and pathologically every month, until five months old. Ten rabbits were also studied by computed tomography before sacrifice. Forty-two rabbits which had been immobilized for more than 2 months were selected to determine the changes in their left hips. Tenotomy of the hamstrings of the left knee was performed in another 20 rabbits, which were then immobilized in the same way until 2 months old. The changes in their left hips were also determined and compared with the changes of former group. In our study, immobilization of the left knee of rabbits can induce dislocation, subluxation or no change. Tenotomy of the hamstrings can decrease the incidence of dislocation and subluxation, but cannot avoid their occurrence. In long-term observation of rabbits with dislocation and subluxation, we found that there are more dysplastic and degenerative changes in older rabbits. Computed tomography proved to be an effective evaluation tool of the size of dysplastic acetabulum and femoral head.

Animals↗
PubMed1990

[Ultrastructural alterations of Golgi tendon organs in disuse atrophy induced by muscle immobilization in rats].

In order to investigate changes in the ultrastructure of Golgi tendon organs (GTOs), the leg muscles of Wistar strain rats were immobilized over various periods. The immobilized triceps surae muscles were divided into three categories: a stretched-position group, a relaxed-position group, and Achilles tendon tenotomy group. After 1, 2, 3, 4, 6 and 8 weeks the muscle preparations dissected from the muscle belly and from the muscle-tendon junction were processed for classification of the fiber type histochemically and to find GTOs in plastic embedded-preparations. In the Achilles tenotomy group, an early fiber transformation from type I to type II fiber was observed, but in the other two groups a low rate of transition of fiber type occurred. At the end of 8 weeks, similar tendencies were observed in all groups. The ultrastructures of GTOs were not significantly different among three groups in basic and general structure when compared with the control group. However, swollen mitochondria in axons and axon terminals and damage in the lamina structure of the myelin sheath were seen in the capsule, axon terminal, and myelinated nerve fiber of GTOs. Although some differences were observed with shorter periods of immobilization, several structural changes were observed over longer periods, indicating the more profound effect of the length of the period rather than the type of immobilization.

Animals↗
PubMed1990

[Tendon surgery in equinovarus deformity of the foot in children and adolescents with cerebral palsy].

Fifty-eight children or adolescents with cerebral palsy who presented an equino varus deformity of the foot were operated on between the age of 4 to 21 by tibialis posterior tenotomy (23 cases), tibialis posterior transposition (18 cases), tibialis posterior (10 cases) or anterior (6 cases) transfer on the cuboid, with triceps lengthening (37 cases). 56 adolescents were reviewed, 45 had achieved their growth. The foot was painless and weight bearing improved. 15 failures were caused by overcorrection in valgus (7 cases, in 5 of which the tendon was transferred on the cuboid) or under correction and recurrence of the deformity (8 cases). A. walking E.M.G. was not made but a clinical examination of voluntary and automatic activity pre and post operatively in 30 cases, which showed that even after tibialis posterior tenotomy a new muscular activity can appear. We recommend this procedure in the varus deformity of the fore foot associated with triceps lengthening in equino varus deformity when the foot is flexible. When the foot is stiff or in cases of under correction and after 10 years, triple arthrodesis is recommended.

Achilles Tendon↗
PubMed1989

Torticollis.

Torticollis can be an isolated deformity or a sign of other neuromuscular disease. Underlying central nervous system or infectious disorders need to be considered and treated. In most patients, an improvement in the aesthetic disability is the primary objective. In general, an operation is indicated for the classical "congenital" muscular torticollis that does not respond to physiotherapy and forceful stretching of the restricting neck band. The mass or "tumor" of "congenital" torticollis requires no specific treatment. Operation may be delayed until age 1, but should probably be completed prior to school age. Reversal of craniofacial asymmetry is best achieved at an early age when there is maximum growth potential. Principles of surgery are (1) identification and release of all restricting bands involving the sternocleidomastoid muscle and other neck structures, (2) moving of the head and neck through a full range of motion prior to the completion of the procedure, and (3) resumption of physical therapy within 2 weeks of operation to prevent recurrent scar contracture. Various operations have been recommended, the most popular and reliable being inferior open tenotomy of the sternal and clavicular heads of the sternocleidomastoid muscle. Incisions should be placed low in the neck along skin lines and not over the clavicle in order to avoid hypertrophic scarring. Other procedures discussed are superior open sternocleidomastoid tenotomy (mastoid release), muscle lengthening procedures, and sternocleidomastoid excision. Only modest results should be anticipated in older children or adults with long-standing disease or advanced craniofacial asymmetry.

Humans↗
PubMed1988

Historical vignette #9. Little big man: the life and genius of William John Little (1810-1894).

William John Little had in many respects a unique career. He suffered childhood poliomyelitis with residual left lower extremity paraparesis, complicated by severe talipes. As a youth he was an apothecary's apprentice, surrendering his indentures at the age of 18 and entering medical school at the London Hospital. He was admitted to the Royal College of Surgeons in 1832. He later travelled to Germany to study the technique of subcutaneous tenotomy with its originator, Louis Stromeyer, who subsequently corrected Little's deformed foot by this method. His doctoral dissertation (1837) was the first monograph on tenotomy ever published, and he became the apostle of this operation for the correction of skeletal deformity secondary to neuromuscular disease. Little founded the Royal Orthopaedic Hospital of London. Among his many publications was "On the Deformities of the Human Frame" (1853) in which he first described pseudohypertrophic muscular dystrophy (antedating Duchenne's paper by eight years), as well as cerebral spastic palsy (Little's Disease). The techniques originated by Stromeyer and applied by Little are used today in the surgical management of muscular dystrophy. William Little was one of the first to bridge the gap between neurology and orthopaedics and his important work continues to impact on both these fields.

England↗
PubMed1986

Overwork effect on partially denervated rat soleus muscle.

The purpose of this study was to assess the effect of overwork induced by synergistic tenotomy on the muscle weight (MW) and isometric tetanic tension (Po) of the partially denervated rat soleus muscle. Forty-nine young adult male Sprague-Dawley rats were divided into six groups (n = 5 to 9): normal control (N), normal synergistically tenotomized (N-ST), L4 denervated control (L4), L4 denervated synergistically tenotomized (L4-ST), L5 denervated control (L5), and L5 denervated synergistically tenotomized (L5-ST). Bilateral L4 or L5 root transections produced partial denervation. To yield soleus muscle overwork the gastrocnemius and plantaris muscles were bilaterally tenotomized in all ST groups at the time of denervation. The soleus MW and Po were examined seven days following denervation and tenotomy. Compared to their respective controls, there was increased MW in the N-ST (43.5%, p less than 0.01) and the L4-ST (38.6% p less than 0.01) groups. The L5-ST group showed no significant change in MW compared to the L5 group. Tetanic tension was increased only in the N-ST group. The L4-ST and L5-ST groups did not show any change in Po compared to their respective controls. Despite marked denervation, the L5 group did not show any atrophy as compared to the N group, suggesting passive stretch of the denervated muscle fibers, hypertrophy of the innervated muscle fibers and peripheral sprouting prevented the loss of MW due to denervation. Overwork in this markedly denervated group could not produce any increase in the MW or Po.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

Surgical management of chronic laminitis in horses: 13 cases (1983-1985).

Thirteen horses with chronic refractory laminitis were evaluated and treated. In each horse, deep digital flexor tenotomy was performed on all affected limbs at the level of the midpastern. Five horses returned to limited athletic endeavors, 6 horses improved and were comfortable on pasture, 1 horse improved clinically, but was euthanatized for economic reasons, and 1 horse improved, but deteriorated 9 months after surgery and was euthanatized. Results of this study indicated that deep digital flexor tenotomy at the level of the midpastern can be used effectively as a salvage procedure in horses with chronic refractory laminitis.

Animals↗
PubMed1977

Paralysis of the trapezius associated with myogenic torticollis. A report of 6 cases.

The authors report the follow-up results of forty-three patients operated on for myogenic torticollis between 1965 and 1975. The surgical treatment consisted of distal tenotomy in eight cases, distal and proximal tenotomy in twenty-three cases, tenomyomectomy in eight cases. The results were subdivided into three groups: excellent twenty-two, (57 per cent); good , fourteen (38 per cent); poor, two (five per cent). The most interesting finding that emerged was the association of paralysis of the trapezius muscle with myogenic torticollis: this was observed in six cases, three after and three before operation. Preoperative investigations, including an EMG test and confirmation at operation, appeared to show that the paralysis was secondary to compression of the accessory nerve in its passage through the sternocleidomastoid muscle. Neurolysis, performed in three cases, led to recovery of the paralysis. Compression of the accessory nerve is slowly progressive, and paralysis or paresis of the trapezius muscle therefore occurred late. In fact, the patients who presented with both lesions were well beyond infancy. The authors emphasize the importance of being aware of the association of this lesion with myogenic torticollis so that operation for the latter may complemented by neurolysis of the accessory nerve.

Accessory Nerve↗
PubMed1983

[Surgical treatment of dislocated hips after 5 years of age].

Fifty dislocated hips after the age of 5 were treated between 1975 and 1980. The surgical procedures performed combined tenotomy of the iliopsoas and adductor muscles, shortening of the femur, capsulorraphy and a pelvic osteotomy usually for re-orientation (Salter procedure) and rarely for widening of the acetabulum (Chiari procedure). It is thought that tenotomies and femoral shortening were more efficient than pre-operative traction which produced osteoporosis. However post-operative traction was used. In some cases plaster cast immobilisation was not used. The advantages of this technique were an acceleration of the surgical programme, better articular stability and early mobilisation. Osteochondritis and post operative stiffness were rare. The average range of movement included 90 degrees of flexion and lumbar balance was the most significantly improved factor. This type of surgical procedure aims to slow the development of coxarthrosis but it cannot diminish the risk. The limit of age for such treatment appears to be 10 years. After that, the indications need to be assessed carefully.

Age Factors↗
PubMed1980

[Experimental studies on the usefulness of Dexon (polyglycolic acid) and our own modified suture method for suturing after tendon severing].

The author had observed in experimental investigations the healing process that achillo-tenotomy in rabbits and a following suture with catgut or silk or DEXON. The suture after tenotomy was carried out with a circular suture of an own modification. Microscopic and macroscopic investigations showed a distinct bigger reaction of the connective tissue and more adhesions around the tenorrhaphy after catgut suture than after silk or DEXON suture. The mechanic investigations showed a clearly smaller tensile strength after a catgut suture than after silk or DEXON suture. Since DEXON sutures will completely resorb they are superior to the non-absorbable sutures.

Achilles Tendon↗
PubMed1984

Role of the nervous system in regulation of the sarcoplasmic membrane function in different muscle fibres.

The influence of the nervous system on the Ca2+ uptake of sarcoplasmic reticulum (SR) of the slow-twitch and fast-twitch muscle was investigated by the application of denervation, immobilization and tenotomy. Denervation and immobilization produced an increase of Ca2+ uptake in SR of the slow-twitch muscle. No significant change could be observed in fast-twitch muscle. Inactivity atrophy induced by tenotomy had no effect on the Ca2+ uptake in SR of the slow muscle. The results suggest that the nervous system has a greater effect on SR function in the slow than in the fast-twitch muscle. The continuous effect of the nervous system characteristic of slow-twitch muscle fibres with tonic function plays a role in preservation of the low Ca2+ uptake capacity, in contrast to the fast-twitch muscle fibres with phasic function, which have a high Ca2+ uptake capacity.

Animals↗
PubMed1983

[Effect of motor function disorder on the properties of the muscle fiber membrane].

Experiments on frogs with the use of the microelectrode techniques were made to study the effect of tenotomy and immobilization of a limb with a metal cast in the extension position on the properties of the membrane of muscle fibers. Two weeks after tenotomy there were no changes in the magnitude of the membrane rest potential, input resistance and time constant of the membrane of muscle fibers or in the pattern of its sensitivity to acetylcholine. Two and three weeks after the limb immobilization no changes in the membrane rest potential and passive electrical properties of the muscle membrane were recorded either. However, if the time elapsed after immobilization was 2 and 3 weeks, the zone of the sensitivity of muscle fibers to acetylcholine was slightly greater than in the control. It is suggested that the motor activity in the frog per se is not the determinant of the muscle fiber differentiation preset by the nervous system.

Acetylcholine↗
PubMed1983

Muscle capillaries in tenotomized human muscles.

The capillaries were studied in tenotonized human muscles after tenotomy or spontaneous rupture of the tendon. The mean capillary area was not significantly different in the patients with tenotomy, or with spontaneous rupture of the tendon, as compared to intact muscles. The mean basement membrane area as a percentage of total capillary area was significantly larger and the size capillary lumen significantly smaller in the injured than in the intact muscles. The alterations of the capillaries were time-dependent.

Adult↗