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PubMed1978

[The A and V phenomenon and squint operations (author's transl)].

In 140 cases with strabismus of early onset the change of a A or V pattern was examined after a weakening procedure of the oblique muscles or a vertical transposition of the horizontal rectus muscles of one eye was done. The horizontal incomitance was measured between up and down gaze of 20 degrees. In cases with pronounced overaction of the oblique muscles we performed a recession of the inferior oblique or a tenotomy of the superior oblique respectively. If there was no significant vertical deviation we combined the recession- resection procedure with a vertical transposition of 4 to 50 mm. 75% of all cases showed a reduction of the incomitance (3 degrees or more). In average the preoperative pattern was reduced 70%. The most effective procedure was the bilateral superior oblique tenotomy, and the weakest the vertical transposition against the A- pattern.--In 95 cases with a A or V pattern only a horizontal recession-resection procedure was done. 38% showed a change of the preoperative incomitance but the average reduction was under 2%.

Humans↗
PubMed1980

[Variations in the resting membrane potential of denervated and tenotomized-denervated rat skeletal muscles].

Resting membrane potential (RMP) was studied in denervated (D), tenotomized (T) and tenotomized-denervated (TD) Soleus (S) and Tibialis Anterior (TA) muscles of the rat. In TD muscles, denervation was performed 1 week after tenotomy. The measurements were performed "in vitro" at 20 degrees C, 1-7 days after denervation in D and TD muscles, and 7 days after tenotomy in T muscles. In T muscles there were not differences in comparison with the controls. In D muscles RMP decreased earlier in S than in TA. The time course of membrane depolarization was similar in TD and D muscles until the 2nd day after denervation. At the 3rd day, RMP showed a further, significant reduction in TD muscles, both in S and TA, but not in D muscles. In D muscles, the depolarization increased very slowly up to the 7th day.

Animals↗
PubMed1994

[Management of the A-pattern deviation with overacting superior oblique muscle].

The overacting superior oblique muscle is usually associated with A-pattern ocular deviation. 10 such cases (14 eyes), 9 exotropic and 1 esotropic, were performed superior oblique tenotomy with horizontal and vertical corrective surgery; they all attained postoperative normal ocular alignment in the primary position. The A-pattern deviation was corrected and overaction of the superior oblique improved. The authors point out that in the absence of binocular vision and abnormal retinal correspondence, superior oblique tenotomy is a safe and useful procedure for patients with 20 delta and over of A-pattern deviation.

Adolescent↗
PubMed1995

[Results of orthopedic and surgical treatment of mallet finger by subcutaneous rupture of the extensor tendon. Apropos of a series of 216 cases].

PURPOSE OF THE STUDY: To assess the late results of orthopaedic and surgical treatment for mallet finger, two groups of patients were reviewed in a retrospective study. MATERIAL AND METHODS: 156 fingers (Group I) had conservative treatment and 60 fingers (Group II) some form of surgical treatment. RESULTS: In Group I, a dorsal custom-made perforated splint maintained the distal interphalangeal joint (DIP) in extension for an average of 54 days (st13). The mean delay of presentation was 22 days (st36). Initial lack of extension was 35 degrees (st13). After an average follow-up of 154 days (st240), the lack of extension was only 7 degrees with an active range of flexion of 61 degrees (st11). 68 of these patients were reviewed for a long-term assessment (61 months). At this time, lack of extension and range of flexion were not different (respectively 5 degrees- st10 and 61 degrees- st16). In Group II, 45 per cent of patients had initially some form of orthopaedic treatment. Delay between injury and consultation was 118 days (st250). Review with a mean follow-up of 5.6 years demonstrated a lack of extension and a DIP joint flexion of 12 degrees and 53 degrees for tenodermodesis (14 cases), 2 degrees and 59 degrees for the Thompson and Littler procedures (14 cases), 1 degree and 55 degrees for the Fowler tenotomy (10 cases). DISCUSSION AND CONCLUSION: Orthopaedic treatment gave good functional results even in cases with delay of presentation. Surgery is only indicated in failure of conservative treatment. In absence of swan-neck deformity, tenodermodesis is a simple and effective technique. When a swan-neck is present, if the DIP deformity is corrected by PIP stabilization, the Fowler tenotomy is used. Otherwise, the Thompson and Littler operation allows to fully correct the deformity.

Adult↗
PubMed1997

Hamstring release for fixed knee flexion contracture in hemophilia.

Sixteen hamstring tenotomies and posterior capsulotomies were assessed retrospectively in 10 patients with hemophilia. The average age of the patients was 17 years (range, 16-24 years). The main indication for surgery was a fixed knee flexion contracture of 30 degrees to 45 degrees, associated with repeated hemarthroses, and failure of conservative treatment after 6 months. A posterior transverse capsulotomy and a Z shaped hamstring tenotomy were performed. The postoperative treatment consisted of repeated stretching exercises for a 6-month period. An average decrease of 25 degrees in the amount of fixed knee flexion contracture was obtained (range, 10 degrees-40 degrees). Followup for an average of 9.5 years showed 11 good, four fair, and one poor result regarding their joint scores. It is concluded that hamstring release is an effective surgical procedure for fixed knee flexion contracture in hemophilia. It seems to reduce the incidence of hemarthrosis relating to such a deformity.

Adolescent↗
PubMedDate not supplied

[Results of surgical treatment of congenital muscle torticollis].

The article present results of the operative treatment of congenital muscular torticollis at the Department of Orthopaedics, Clinical Hospital Split from 1950 to 1995. 197 patients were operated and in 1995 50 patients responded for the follow-up. Our results confirm that the best results are obtained by open distal tenotomy of the sternocleidomastoid muscle after the first year of life. Children older than six years need bipolar tenotomy, and the results are poorer than in those operated in the first six years of life.

Adolescent↗
PubMed1998

Effect of standard total knee arthroplasty surgical dissection on human patellar blood flow in vivo: an investigation using laser Doppler flowmetry.

We examined the in vivo alterations of human patellar bone blood flow that occur with surgical dissection of the extensor mechanism during total knee arthroplasty. A laser doppler probe was used to measure central patellar blood flow at baseline after quadriceps tenotomy, after partial fat pad excision, after lateral release, and after completion of the lateral release with superolateral geniculate sacrifice. The initial quadriceps tenotomy and medial arthrotomy decreased patellar vascularity to 60.4% of baseline. Fat pad resection initiated another 10.4% decline. The lateral release resulted in a patellar vascularity that was 43.6% of baseline. Finally, the loss of superolateral geniculate inflow reduced the patellar flow to 30.61% of baseline.

Adipose Tissue↗
PubMed1977

Isolated inferior oblique paresis.

The clinical features of eight patients with inferior oblique palsy are described and the differential diagnosis discussed. Six of the eight patients were treated by unilateral superior oblique tenotomy; the conditions of all six improved postoperatively.

Adolescent↗
PubMed1988

Modified optic nerve sheath decompression provides long-term visual improvement for pseudotumor cerebri.

Twenty-three patients with chronic papilledema associated with pseudotumor cerebri underwent "modified" optic nerve sheath decompression for treatment of visual acuity and visual field loss. Instead of removing a single, rectangular section of optic nerve meninges, the operation was modified by making at least three longitudinal incisions in the sheath and then lysing arachnoid adhesions with a tenotomy hook. Twenty-one of the 23 patients demonstrated improved visual function after the initial surgery for a mean (+/- SD) follow-up of 21.5 +/- 12.3 months (median, 25 months; range, three to 45 months) without reoperation or reinstitution or oral corticosteroid and diuretic therapies. The two patients failing to improve after the first surgical procedure initially had a single meningeal window created and subsequently improved following reoperation with the modified procedure. Twelve of 21 patients with bilateral visual loss had improved visual function bilaterally after unilateral surgery. Six of the 21 patients needed bilateral surgery, and the other three had minor visual field defects in the second eye not severe enough to warrant surgery. Preoperative optic disc pallor did not predict a poor postoperative result. Optic nerve surgery improved the visual function in six patients who had failed to recover vision after one or more lumbar-peritoneal shunts.

Adolescent↗
PubMed1998

Laser photostimulation of collagen production in healing rabbit Achilles tendons.

BACKGROUND AND OBJECTIVE: Low energy laser photostimulation at certain wavelengths can enhance tissue repair by releasing growth factors from fibroblasts and stimulate the healing process. This study was designed to evaluate the influence of laser photostimulation on collagen production in experimentally tenotomized and repaired rabbit Achilles tendons. STUDY DESIGN/MATERIALS AND METHODS: A total of 24 male New Zealand rabbits, ages 10-12 weeks, were used. Following tenotomy and repair, the surgical hind limbs of the rabbits were immobilized in customized polyurethane casts. The experimental animals were treated with a 632.8 nm He:Ne laser daily at 1.0 J cm(-2) for 14 days. Control animals were sham treated with the laser head. On the fifth day after repair, the casts were removed to allow the animals to bear weight on the lower extremity. The animals were euthanized on the 15th postoperative day, then, the Achilles tendons were excised, processed and analyzed. RESULTS: Biochemical analyses of the tendons revealed a 26% increase in collagen concentration with laser photostimulation indicating a more rapid healing process in treated tendons compared to controls. Sequential extractions of collagen from regenerating tissues revealed that the laser photostimulated tendons had 32% and 33% greater concentrations of neutral salt soluble collagen and insoluble collagen, respectively, than control tendons suggesting an accelerated production of collagen with laser photostimulation. A significant decrease (9%) in pepsin soluble collagen was observed in laser-treated tendons compared to controls. There were no statistically significant differences recorded in the concentrations of hydroxypyridinium crosslinks and acid soluble collagen between treated and control tendons. CONCLUSION: This study of laser photostimulation on tendon healing in rabbits suggests that such therapy facilitates collagen production in a manner that enhances tendon healing.

Achilles Tendon↗
PubMed1998

Effects of denervation and muscle inactivity on the organization of F-actin.

To discriminate between the influences of a motoneuron and muscle activity on the conformation of actin filaments, the extrinsic polarized fluorescence [of rhodamine-phalloidin and N-(iodoacetylamine)-1-naphthylamine-5-sulfonic acid attached to F-actin] was measured in "ghost" fibers from intact rat soleus muscles and atrophying muscles after denervation, immobilization, or tenotomy. The results show that the conformation of F-actin changed in all the atrophying muscles, but differently. In the denervated muscle, the flexibility of the actin filaments decreased, whereas in the other experimental muscles it remained as in the intact muscle. In the denervated muscle, the mobility of the C-terminus of the actin polypeptide increased. Attachment of myosin subfragment-1 influenced the F-actin conformation differently in the denervated muscle than in the other muscles studied. These results suggest that changes in the conformation of the actin filament are induced by the lack of connection with the motoneuron rather than by muscle inactivity.

Actins↗
PubMed1999

1H double-quantum-filtered MR imaging as a new tool for assessment of healing of the ruptured Achilles tendon.

1H double-quantum-filtered magnetic resonance imaging (DQF MRI) was applied to monitor the healing process of the Achilles tendons in rabbits after tenotomy. DQF MRI provides a new contrast, which is based on the non-zero average of the dipolar interaction caused by anisotropic motion of water molecules, determined mainly by their interaction with the ordered collagen fibers. Tissues are characterized by the dependence of their DQF signal on the DQ creation time, tau. With the use of DQF MRI, higher tissue contrast is obtained between tendon, bone, skin, and muscle. The tendons, which give weak signals in standard MRI techniques, are highlighted in the (1)H DQF image. The image changed dramatically during the healing process of the injured Achilles tendon. These changes matched the phases of the healing process. By using a tau-weighted contrast, the DQF images indicate the part of tendon that has not completely healed, even after the conventional MRI appeared normal. Magn Reson Med 42:884-889, 1999.

Achilles Tendon↗
PubMed1976

Quantitative analysis of muscle cell changes in compensatory hypertrophy and work-induced hypertrophy.

The cytological characteristics of two modes of muscle hypertrophy were studied in the extensor digitorum longus muscle of the rat. Comprensatory hypertrophy (CH) was produced by tenotomy of the tibialis anterior muscle and work-induced hypertrophy (WIH) was produced by forced swimming of the animal. While both methods produced an increase in muscle weight and cell size, these two parameters did not correlate. Morphometric analyses of the hypertrophied muscle cells demonstrated that in CH-muscle there was an increase in mitochondrial volume density, a decrease in myofibrillar volume density and no change in sarcotubular or nuclear volume density. WIH-muscle demonstrated an increase in sarcotubular volume density but no change in mitochondrial, myofibrillar or nuclear volume density. It is concluded that in CH-muscle, the cell volume increase is attributable to mitochondrial volume increase and that there is no increase in the contratile myofibrillar component of the cell. WIH-muscle, on the other hand, has a cell volume increase which is attributable to a proportional increase in these organelles.

Animals↗
PubMed1995

MyoD protein accumulates in satellite cells and is neurally regulated in regenerating myotubes and skeletal muscle fibers.

MyoD belongs to a family of helix-loop-helix proteins that control myogenic differentiation. Transfection of various non-myogenic cell lines with MyoD transforms them into myogenic cells. In normal embryonic development MyoD is upregulated at the time when the hypaxial musculature begins to form, but its role in the function of adult muscle remains to be elucidated. In this study we examined the cellular locations of MyoD protein in normal and abnormal muscles to see whether the presence of MyoD protein is correlated with a particular cellular behaviour and to assess the usefulness of MyoD as a marker for satellite cells. Adult rats were anaesthetised and their tibialis anterior or soleus muscles either denervated, tenotomised, freeze lesioned, lesioned and denervated, or lesioned and tenotomised. At various intervals after the operations the rats were killed and their muscles removed, snap frozen, and sectioned with a cryostat along with muscles from unoperated neonatal and adult rats. The sections were processed for immunohistochemistry using a rabbit affinity-purified antibody to recombinant MyoD. MyoD proved to be an excellent marker for active satellite cells; satellite cells in neonatal and regenerating muscles contained high levels of MyoD protein. MyoD positive cells were not observed in the muscles of old adults, in which the satellite cells are fully quiescent. MyoD immunoreactivity was rapidly lost from satellite cell nuclei after they fused into myotubes and was not detected in either sub-synaptic or non-synaptic nuclei of mature fibers. Denervation, and to a lesser extent tenotomy, of lesioned muscles induced expression of MyoD in myotubal nuclei. Denervation of normal muscles also upregulated MyoD in muscle fiber nuclei, an effect which was maximal after 3 days. We conclude that MyoD protein is neurally regulated in both myotubes and muscle fibers.

Age Factors↗
PubMed1981

Morphological changes in the mechanically unloaded myocardial cell.

The role of stretch and/or tension in maintaining the structural integrity of the myocardial cell was investigated in 16 cats. Right ventricular papillary muscles were studied 1-28 days after transection of the chordae tendinae and compared to adjacent intact papillary muscles. A progressive atrophy, as shown by decreased mean cell cross-sectional area, occurred; by the 28th day mean cardiocyte area was only 28% of the control value. The earliest ultrastructural changes (one day after surgery) were primarily focal and included disorientation of contractile filaments and loss of Z-line substance. During the first week, vacuolation, loss of contractile filaments and infiltration of macrophages and fibroblasts were characteristic. By the second week a massive loss of contractile substance, disappearance of the sarcoplasmic reticulum, and a marked increase in connective tissue occurred. Leptomere structures, membrane alterations, and phagocytosis were the most typical changes between the second and fourth week. Hydroxyproline assays on papillary muscles unloaded for three days showed a 38% increase in connective tissue, indicating an early increase in connective tissue/muscle mass associated with mechanical unloading. It is concluded that the cardiocyte is extremely dependent upon mechanical loading, i.e., stretch and/or tension. Mechanical unloading (tenotomy) results in rapid and marked cellular degeneration which exceeds that observed in skeletal muscle following either disuse or denervation.

Animals↗
PubMed1990

A biomechanical study of tendon adhesion reduction using a biodegradable barrier in a rabbit model.

Adhesion formation associated with tendon surgery is a widespread problem in which a healing tendon becomes adherent via scar tissue to surrounding structures such as bone, muscle, skin, tendon sheath, or other tendons. A model is described in which adhesions were generated reproducibly between the plantaris and Achilles tendons of the rabbit using a partial tenotomy, a Bunnel suture, and immobilization. Using this model, the effect of an absorbable barrier, INTERCEED (TC7), on adhesion formation was investigated. This material, which is a fabric comprised of oxidized regenerated cellulose, was found to diminish significantly the extent and severity of intertendinous adhesions, assessed both mechanically and histologically. No evidence of a foreign body reaction was observed.

Animals↗
PubMed1992

Does immobilization influence the systemic acceleratory phenomenon that accompanies local bone repair?

The rate of remodeling in the region of a bone defect exceeds normal tissue activity. It was Frost who described this reaction as the regional acceleratory phenomenon (RAP). We previously showed that restoration of a local bone defect in the rat leads not only to RAP but also leads to a systemic acceleration of osteogenesis (systemic acceleratory phenomenon, SAP) in distant sites of the skeleton. In this study we investigated the impact of immobilization of the defect-bearing extremity on the development of SAP. A hole 1.2 mm in diameter was drilled in the diaphysis of the left tibia of female rats. In the experimental group (n = 15), a knee tenotomy was performed in the defect-bearing left hind leg. We examined both femora, both tibiae, and the fourth lumbar vertebra by computed x-ray densitometry on day 7 postoperatively. Immobilization of the defect-bearing limb led to a decrease in x-ray density not only of the immobilized (p < 0.0001) but also of the contralateral tibia (p < 0.0001). Both femora (p < 0.001) and the fourth lumbar vertebra (p < 0.025) of the experimental group also showed a significant decrease in x-ray density. We previously showed that SAP leads to an increase in x-ray density of both femora. This increase is no longer detectable in animals after immobilization of the defect-bearing limb. Thus we conclude that immobilization interferes with SAP. This suggests the possible dependence of SAP on mechanical load. Furthermore, these data suggest a possible impact of local immobilization on the rest of the skeleton.

Absorptiometry, Photon↗
PubMed1989

Nerve regulation of class I and class II-asymmetric forms of acetylcholinesterase in rat skeletal muscles.

Two classes of collagen-tailed, asymmetric forms (A-forms) of acetylcholinesterase (AChE) have been described in skeletal muscles of vertebrates. They are distinguished by their different solubilization requirements: class I A-forms are solubilized in the presence of high salt, whereas class II A-forms require in addition a chelating agent for solubilization. We report here that class II A-forms are less sensitive to nerve section than are class I A-forms. The latter form decreases faster and to a lower level of activity after denervation. The decay of both AChE classes is more rapidly in short-stump nerves than in long ones. The effect of nerve section on class II A-forms appears to be dependent on the particular muscle group being studied. Both classes of A-forms reappear after muscle reinnervation, but the class I A-forms recovered earlier. More interestingly, both classes of A-forms increase in normally innervated skeletal muscles after contralateral nerve injury. In this case, however, the class II A-forms change first. Muscular disuse induced by contralateral tenotomy is also followed by a rise in class II A-forms. Our results, showing differences in response and flexibility in the changes of the two classes of A-forms in several experimental conditions, represent a relevant contribution to the understanding of the regulation and functional role of the asymmetric forms of AChE in vertebrate skeletal muscles.

Acetylcholinesterase↗