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At least 685 records · Page 38Linked to original sources
PubMed2002

Endoscopic surgery in chronic achilles tendinopathies: A preliminary report.

PURPOSE: The objective of this prospective study was to evaluate preliminary results of an endoscopic-assisted surgical technique for patients suffering from chronic Achilles tendinopathies. TYPE OF STUDY: Case series. METHODS: Endoscopic operations were performed on 7 consecutive patients involved in recreational sports suffering from chronic Achilles tendon (AT) lesions in whom conservative treatment had failed. Diagnoses included 2 patients with pure peritendinitis, 4 with peritendinitis and degenerative tendinosis, and 1 with a chronic partial tear. Patients were preoperatively and postoperatively evaluated at a mean follow-up period of 16 months (range, 6 to 27 months) with a 0-100 points rating system. All patients were studied preoperatively with magnetic resonance imaging (MRI) and 6 were re-evaluated with the same procedure after surgery. All surgical interventions were performed on an ambulatory basis and 5 under local anesthesia. The surgical endoscopic technique consisted of peritenon release and debridement in cases with pure peritendinitis. In addition, 2 longitudinal tenotomies were performed in cases with degenerative tendinosis or partial tears. RESULTS: According to the scoring system used, all 7 patients had improved final outcome after surgery from a mean of 39 points preoperatively to 88 points postoperatively. The patient with an AT partial tear achieved the lowest score. The only complications were a minor hematoma and edema that resolved spontaneously. Postoperative MRI in patients with tendinosis failed to show evidence of degenerative areas. CONCLUSIONS: Endoscopic surgery may be a valid alternative to treat Achilles tendinopathies unresponsive to conservative treatment because of potential lower morbidity.

Achilles Tendon↗
PubMedDate not supplied

Arthroscopic biceps tenodesis.

Surgical treatment of symptomatic pathology of the long head of the biceps tendon generally consists of either biceps tenotomy or tenodesis. Biceps tenodesis is generally recommended for younger patients and has been well described using open techniques. With advancements in arthroscopic ability and equipment, new arthroscopic techniques have recently been reported. These techniques can be especially useful when used in conjunction with other arthroscopic procedures such as distal clavicle resection, rotator cuff repair, and subacromial decompression. We present a modification of the techniques suggested by other researchers. In this technique, a bone anchor is used as a pulley at the bottom of the tunnel to pull the tendon into position. This is followed by interference screw fixation. To our knowledge, this technique has not been previously described.

Arthroscopy↗
PubMed2003

The early surface cell response to flexor tendon injury.

PURPOSE: The migratory response of surface fibroblasts to flexor tendon injury was studied by their selective labeling with a vital dye. METHOD: The surfaces of 30 rat deep flexor tendons were bathed in 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine percholate (DiI), a vital dye for 5 minutes. The residual dye was removed by thorough irrigation. A partial tenotomy was made in the stained section by cutting out a central window. Semiquantitative cell counts and position of stained fibroblasts were noted by examination under fluorescent light at 0, 1, 3, 5, and 7 days. RESULTS: The surface fibroblasts readily took up the vital dye at day 0. By day 1 dyed cells had moved into the cut. By day 3 they had migrated laterally into the core substance of the tendon. Core dyed cell counts at days 1, 3, 5, and 7 were significantly different compared with day 0 core dyed cell counts. CONCLUSIONS: This cell migration from the surface of the cut to the tendon core is likely to be vital in the early stages of tendon healing.

Animals↗
PubMedDate not supplied

An evaluation of two autologous tendon grafting techniques in ponies.

OBJECTIVE: To compare the healing and mechanical strength of a multiple split autologous tendon graft (MG) to a whole autologous tendon graft (WG) in the deep digital flexor tendon of ponies. STUDY DESIGN: In vitro evaluation of two different tendon-grafting techniques. ANIMALS OR SAMPLE POPULATION: Six ponies of mixed gender and age. METHODS: Tenotomies performed in forelimb deep digital flexor tendons (DDFT) distal to the insertion of the accessory ligament (AL-DDFT) were repaired with free autologous grafts from the hindlimb lateral digital extensor tendon (LDET). Grafts were either whole (WG) or split into three longitudinal strips (multiple graft, MG). Tendons and graft sites were collected and loaded (2.54 cm/s) to failure at either 4 or 8 weeks after surgery. Cross-sectional area was determined by both impression cast (IC) and an inkblot (IB) method. Tissue maturity and inflammation were evaluated by microscopy. RESULTS: Gap formation was a consistent finding in all repair sites. No statistical differences were found in healing or mechanical variables between MG and WG techniques. The failure stress for the 8-week repairs (15.51 +/- 3.1 MPa IB and 11.73 +/- .77 MPa IC, 16.13 +/- 2.2 MPa IB and 10.22 +/- .76 MPa IC for MG and WG, respectively) were significantly greater (P <.0005) than for 4-week repairs (3.71 +/- 1.7 MPa IB and 2.68 +/- 1.44 MPa IC, 2.81 +/- 1.46 MPa IB and 2.3 +/- 1.7 MPa IC for MG and WG, respectively). The repair tissue was more mature (P <.05) at 8 weeks than at 4 weeks, but there was no significant difference in inflammatory responses at 4 and 8 weeks. CONCLUSIONS: There was a sixfold increase in strength between 4 and 8 weeks of healing, but no significant difference in healing or strength between the MG and WG techniques. CLINICAL RELEVANCE: In ponies, autologous tendon grafting contributes to a strong repair during the early convalescent period, but splitting a tendon graft seemingly offers no appreciable advantage over use of a whole graft.

Animals↗
PubMed2000

[Ischemic contractures of the forearm and hand].

This article gives an overview of anatomy, pathophysiology, aetiology, and diagnosis of the compartment syndrome and the resulting ischaemic necrosis of the upper extremity. The relation between compartment syndrome and infection is pointed out. Whereas the therapy of a manifest compartment syndrome is rather uniform consisting in decompression of the involved fascial compartment, the treatment of the ischaemic muscle necrosis is manifold. It depends upon severity and location of the disease. Only the mildest involvement can be treated by nonoperative measures. Surgically, neurolysis, excision of necrotic musculature and scar, muscular slide, elongating tenotomy, tendon transposition and free vascularized muscle transplantation have to be considered. Only the availability of all treatment options gives the surgeon the choice of treatment that fits the demands of the individual patient best.

Compartment Syndromes↗
PubMed2004

The effect of mechanical loading on the MyHC synthesis rate and composition in rat plantaris muscle.

The aim of this study was to investigate the response of protein synthesis rate, particularly myosin heavy chain (MyHC) isoforms synthesis and the magnitude of its isoform transformation in fast-twitch plantaris muscle, to different modes of prolonged mechanical loading. Different protocols of mechanical loading were used: resistance training (RT), compensatory hypertrophy (CH) of m. plantaris after tenotomy of m. gastrocnemius and a combination of the two previous loadings (RT + CH). During the different modes of loading, plantaris muscle hypertrophy in RT group was approximately 10 %, CH approximately 40 % and CH + RT approximately 44 %. MyHC I and IID isoform synthesis rate increased in all experimental groups, as well as their relative content. MyHC IIA relative content decreased during RT and RT + CH and increased during CH. MHC IIB isoform relative content decreased in all experimental groups, but compared with CH in CH + RT MyHC IIB isoform content increased in plantaris muscle. These results demonstrate that different modes of mechanical loading resulted in the selective up- and down-regulation of MyHC isoforms in fast-twitch skeletal muscle. The synthesis rate and relative content of the two fastest isoforms of MyHC IIB and IID are regulated to different directions during mechanical loading.

Animals↗
PubMedDate not supplied

[Early results of the Ponseti method for the treatment of idiopathic clubfoot].

AIM: The Ponseti method for the treatment of congenital clubfeet has been propagated due to the sometimes disappointing functional results after surgical treatment. The aim of our study was to evaluate our early results and experiences with the Ponseti method. METHOD: Between December 2002 and December 2004 a total of 87 clubfeet in 59 patients were treated using the Ponseti method at our department. Only patients in whom treatment was initiated within the first three weeks of life were included in this study. Rate of successful correction without open release surgery, radiological findings, classification according to Pirani at the time of the last follow up, recurrence rate and duration of treatment were defined as outcome measures for this prospective study. RESULTS: Fifty-nine cases in 37 patients met the inclusion criteria. Ninety-three percent of all cases (55 feet) were corrected without open surgery. The mean duration of active treatment was 11.4 weeks (8-20 weeks). The mean tibiocalcaneal angle 3-4 weeks after the percutaneous tenotomy of the Achilles tendon was 69 degrees, the mean a.-p.-talocalcaneal angle measured 33 degrees and the lateral talocalcaneal angle 36 degrees. A recurrence was seen in one patient with bilateral clubfeet (3.6 %). CONCLUSION: Open release surgery can be averted in most cases of idiopathic clubfoot using the Ponseti method. Scarring of the soft tissue and especially of the joint capsule can thereby be avoided.

Achilles Tendon↗
PubMed1992

Morphologic characteristics of muscles grafted in rabbits with neurovascular repair.

In 34 female white rabbits, rectus femoris (RFM) muscles were grafted with immediate anastomoses of the vasculature (VA) and with nerves either left intact (NI-VA) or with nerves repaired (NR-VA). The purpose of the study was to compare the morphologic changes that occur in NI-VA grafts and NR-VA grafts from 8 to 120 days after grafting. After 8 days, nearly complete survival of all muscle fibers was found. The muscle mass and single fiber cross-sectional area (CSA) of the NI-VA group remained near control values for the first 30 days and then declined to 82 percent and 62 percent of the control values, respectively. Little evidence of morphologic disruption was observed. The NR-VA grafts displayed a significant denervation atrophy within the first 15 days, with relative values 67 percent of the control value for mean mass and 53 percent for single fiber CSA. By 120 days, mass and CSA recovered to 80 percent and 62 percent of control values. Although the similarity of the deficits in the nerve-intact and nerve-repaired grafts suggest that tenotomy and repair, rather than innervation, were the major limitations, the mechanism was not resolved.

Adipose Tissue↗
PubMed1995

Clinical results of early orthopaedic management in Duchenne muscular dystrophy.

Although the primary defect of Duchenne muscular dystrophy has been found, there is no causal treatment to alter the natural course of this disease. Based on the recommendations by Glorion and Rideau with early treatment of contractures of the hips and the lower limbs we performed a modified release of the spina muscles, resection of tensor fasciae latae muscle and a lengthening of the tendo calcaneus in 32 patients. The mean age of DMD patients at time of operation was 6.1 years. The mean follow-up was 3.4 years. All children underwent mobilisation the day after surgery. Complete correction of all contractures was immediately achieved after operation and kept in all but two cases up to the follow-up examination after 3.4 years. No loss of ambulation was observed. Our results demonstrate that early selective surgery in DMD patients just at or better before the onset of contractures without performing an additional aponeurectomy of the iliotibial band and percutaneous tenotomy of the hamstrings according to the original Glorion-Rideau technique safely prevents severe contractures and thereby delays the progression of scoliosis.

Child↗
PubMed1997

[Results of surgical treatment of radio-humeral epicondylopathy].

We examined extent and affection of an assumed neuromuscular transmission disorder by performing a prospective clinical study on 75 patients with therapy-resistant radiohumeral epicondylopathy. Before operation, we electromyographically diagnosed an increased rate of polyphasic potentials of the long wrist extensors as well as a prolonged motor latency of the respective muscles. Corresponding to a hereby implied damage to the distal part of the motor neuron, disordered neuromuscular recruitment combined with a reduced maximum strength and -elasticity could be proven. Both effects were significantly reversible (p < 0.001) through operative intervention. We found a significant correlation (corr < 0.90) between the normalization of the motor latency and increased strength. Subgroups were formed depending on different pre-operative diagnostic efforts and differing redicality regarding the performed soft-tissue operation, thus the clinical validity of the findings diagnosed in the anatomic and neurophysiologic part of the study was additionally examined. It was proven that the failure rate varies between 10% and 30%, depending on the radicality of tenotomy, which could be interpreted as a general indication for complete extensor carpi radialis brevis tendon release. In this connection it is remarkable that the clinical result of an electromyographically localized damage in the area between epicondyle and arcade of Frohse could not be improved through open neurolysis. Dealing with strictures located on the proximal side of the epicondyle on the other hand, this technique seems to play an important role for recurrence prophylaxis.

Adult↗
PubMedDate not supplied

[Surgical correction of clubfoot in patients with myelomeningocele].

Between 1974 and 1991, 100 equinovarus deformities in 65 patients with myelomeningocele have been primary operated at the authors clinic. Aim of our treatment was a plantigrade position of the foot, to give the possibility of an orthetic supply. 75% of our patients reached this result after the first operation, 25% had to be operated once more. The incision was done in the way of Cincinnati. According to the level and type of paralysis the operative treatment had to be adapted. We could reach good results of treatment in group 1 (thoracal to L2) with 64% of plantigrade feed as well as in group 3 (L5 to sacral) with 61%. Group 2 (L4 to L5) was worse with 32%. Within all types of paralysis there was a better result while doing a tenotomy. Paralysed muscles should be cut, innervated muscles should be extended to keep the function. Important is the reconstruction of a balance of the muscles. While you have a forefoot varus, a plentiful medial release is necessary. After the operation a cast was given for 8 to 12 weeks, followed by special shoes and nightly storage in stales. Corresponding to the treatment of idiopathic equinovarus deformity the beginning of therapy should be started after birth and should be completed while the child begins to verticalize.

Adolescent↗
PubMedDate not supplied

[Treatment results of modified Glorion-Rideau release in Duchenne muscular dystrophy].

Although the cause of Duchenne muscular dystrophy has been recently found, there is no causal treatment to alter the natural course of this disease. Based on the recommendations by Glorion and Rideau with early treatment of contractures of the hips and the lower limbs we performed a modified release of the spina muscles, resection of tensor fasciae latae and a lengthening of the tendo calcaneus in 32 patients. The mean ae of DMD patients at time of operation was 6.1 yrs. The mean follow-up was 3.4 yrs. All children underwent mobilization the day after surgery. Complete correction of all contractures was immediately achieved after operation and kept in all but two cases up to the follow-up examination. No loss of ambulation was observed. Our results demonstrate that early selective surgery in DMD patients before or just at the onset of contractures without performing an additional aponeurectomy of the iliotibial band and percutaneous tenotomy of the hamstrings according to the original Glorion-Rideau-technique safely prevents severe contractures and should prolong ambulation.

Achilles Tendon↗
PubMedDate not supplied

[Long-term follow-up of 166 surgically treated patients with congenital hip dislocation].

UNLABELLED: 166 patients with congenital dislocation of the hip, ranging from 10 months to 5 years old, were operated between 1958 and 1971. 140 patients were women (84%) and 26 patients were men (16%). 96 patients had unilateral and 70 patients had bilateral dislocation; that makes a total of 236 dislocated hips. 61 patients with bilateral hip dislocation were operated simultaneously on both hips. All the patients were treated with adductor tenotomy and open reduction through Smith Petersen incision with section or elongation of the psoas tendon. The postoperative immobilization consisted in a period of one month pelvic toecast followed by 2 plaster casts with abduction rod during 3 to 5 months. The postoperatory follow-up ranged from 9 years to 26 years, 2 months; average 14 years, 5 months. The clinical evaluation comprises pain, hip mobility, gait and muscle power. RESULTS: excellent 138 (59%); good 66 (28%); fair 29 (12%); and poor 3 (1%). The radiological evaluation considered: Mose; acetabular femoral head index; Wiberg's CD-angle; cervico-diaphysiary angle and radial quotient. RESULTS: normal 5 (2%); excellent 44 (19%); good 78 (33%); subtotal 54%; fair 90 (38%), and poor 19 (8%). Complications (hips); infections 12 (5%); 3 of them deep ones (1%); residual subluxation 19 (8%); reluxation 1 (0.5%). Isquemic necrosis Grade II of Tönnis 31 (13%); Grade III 2 (1%) and Grade IV 1 (0.5%).

Adolescent↗
PubMedDate not supplied

[Joint saving operation procedures in idiopathic femur head necrosis].

At first, this report deals with the characteristics of the idiopathic necrosis of the femoral head and the possibilities of operative treatment specially in the sense of saving the hip-joint. Beside old techniques of sanitation of the focus, nowadays the femoral osteotomy, mainly in the sense of a flexion-osteotomy is well to the fore. Hereby, the necrotic area can be turned out of the main loaded part of the hip-joint. We recommend a combination of femoral osteotomy with a ventral capsulotomy and tenotomy. Furthermore, there should be a sanitation of the focus, above all by drilling. Then we report about our experience with this operative treatment. 37 cases out of 52 were controlled clinically and roentgenologically. The subjective results were very good to fair in about 85%, the functional improvement of the hip-joint was mostly good. On the other hand, there was a difference between clinical and roentgenological results, we found an improvement of the necrotic destruction of the femoral head only in 28%. We mainly noticed poor subjective and objective results in cases of too extended necrotic areas, of too advanced stage of necrosis and of secondary coxarthrosis. In those cases we refer to the differential indication of the total hip-arthroplasty.

Adolescent↗
PubMed1994

[Combined oblique muscle operation with transposition of the insertion in strabismus sursoadductorius].

BACKGROUND: The combined superior oblique tendon tuck and inferior oblique recession is the method of choice for the treatment of congenital and acquired superior oblique muscle palsies with large vertical and cyclodeviations. An additional transposition of the insertions is indicated if the vertical deviation differs greatly from the excyclodeviation. PATIENTS AND METHODS: 38 patients who underwent combined oblique muscle surgery for congenital superior oblique muscle palsy were divided into 3 groups. Group A: 14 patients with small excyclodeviations in spite of large vertical deviations, even after diagnostic occlusion of 3 days. A superior oblique tendon tuck of 5 or 6 mm with transposition of the new insertion to the posterior margin of the original insertion was performed combined with a recession of the inferior oblique muscle of 5 or 6 mm with anterior displacement of 4-6 mm. Group B: 15 patients without a discrepancy between the vertical deviation and the cyclodeviation. They were treated with a conventional superior oblique tendon tuck of 5 or 6 mm combined with a recession of the inferior oblique muscle. Group C: 9 patients without a discrepancy between the vertical deviation and the cyclodeviation, but deviations smaller than in group B. A conventional superior oblique tendon tuck of 6 mm combined with a posterior tenotomy of the inferior oblique muscle was performed. The surgical effect was calculated as the difference between the preoperative deviation after diagnostic occlusion of 3 days and the postoperative deviations (1 week and 3 to 6 months). All angles of deviation were measured subjectively after dissociation of the binocular vision with a dark red filter in front of the fixating, not affected eye at 2.5 m distance using the Harms tangent screen. RESULTS: 3 months postoperatively, the vertical deviation was diminished in primary position by 12.1 degrees/6.8 degrees/6.8 degrees in groups A/B/C, in 25 degrees adduction of the affected eye by 18.4 degrees/13.8 degrees/9.5 degrees. The reduction of the cyclodeviation in primary position was 6.4 degrees/8.0 degrees/5.6 degrees. As a side effect a clinically insignificant, consecutive Brown syndrome occurred in each group. In each group a significant positive correlation between the preoperative deviation and the surgical effect was found. CONCLUSIONS: The combined superior oblique tendon tuck and inferior oblique recession with transposition of the insertions is a suitable method for a selective treatment of the vertical deviation and the cyclodeviation in congenital superior oblique palsy.

Convergence, Ocular↗
PubMed2002

Strabismus surgery for large-angle cyclotorsion after macular translocation surgery.

PURPOSE: We report the results of a new strabismus surgical procedure to address the large-angle cyclotorsion induced by macular translocation surgery for severe age-related macular degeneration. METHODS: The strabismus surgery described is a modification of earlier-described surgery(1) and was performed for symptomatic incyclotorsion measuring 20 degrees or more (by Maddox rod testing) after macular translocation. Surgery included superior oblique tenotomy and inferior oblique advancement, with transposition of the lateral and medial recti to the insertions of the superior and inferior recti, respectively, in the affected eyes. Minimum follow-up time was 6 weeks. RESULTS: Fifteen patients (15 eyes) had macular translocation surgery with incyclotorsion of 20 degrees or more. Mean incyclotorsion after macular translocation (36.1 +/- 9.4 degrees; range, 20-55) was reduced to 1.5 +/- 6.4 degrees after strabismus surgery (P <.0001), with 2 overcorrections and no surgical complications. Mean follow-up time was 24.8 +/- 13.4 weeks. All patients showed a hypertropia of the fellow eye. The mean pre-op hypertropia of 22 +/- 8 PD was reduced to 3 +/- 9 PD after strabismus surgery (P <.0001). The mean exotropia was minimally altered by strabismus surgery (21 +/- 10 PD pre vs 17 +/- 8 PD postop). All patients were symptomatic prior to strabismus surgery: 4 of 15 patients with "tilt" (objects appearing subjectively rotated with respect to their true orientation); 2 of 15 patients with diplopia; and 9 of 15 patients with both. Postoperatively, 7 patients had residual milder symptoms: tilt, 2 patients; diplopia, 3 patients; and both, 2 patients. Two patients required additional muscle surgery (on the fellow eye) for persistent symptoms. No patient showed binocular function (stereopsis or motor fusion) after macular translocation, either before or following strabismus surgery for cyclotorsion. CONCLUSION: The strabismus surgery described is effective at reducing the large degree of cyclotorsion (>or= 20 degrees) often resulting from macular translocation surgery, but does not allow reestablishment of binocular function.

Aged↗
PubMed1999

Muscular force transmission: a unified, dual or multiple system? A review and some explorative experimental results.

Structures contributing to force transmission in muscle are reviewed combining some historical and relatively recently published experimental data. Also, effects of aponeurotomy and tenotomy are reviewed shortly as well as some new experimental results regarding these interventions that reinforce the concept of myofascial force transmission. The review is also illustrated by some new images of single muscle fibres from Xenopus Laevis indicative of such transmission and some data about locations of insertion of human gluteus maximus muscle. From this review and the new material, emerges a line of thought indicating that mechanical connections between muscle fibres and intramuscular connective tissue play an important role in force transmission. New experimental observations are presented for non-spanning muscle (i.c., rat biceps femoris muscle), regarding the great variety of types of intramuscular connections that exist i n addition to myo-tendinous junctions at the perimuscular ends of muscle fibres. Such connections are classified as (1) tapered end connections, (2) Myo-myonal junctions, (3) myo-epimysial junctions and (3) Myo-endomysial junctions. This line of thought is followed up by consideration of a possible role of connections of intra- and extramuscular connective tissue in force transmission out of the muscle. Experimental results of an explorative nature, regarding the interactions of extensor digitorum longus (EDL), tibialis anterior (TA) and hallucis longus (HAL) muscles within a relatively intact dorsal flexor compartment of the rat hind leg, indicate that: (1) length force properties of EDL are influenced by TA activity in a length dependent fashion. Depending on TA length, force exerted by EDL, kept at constant origin insertion distance, is variable and the effect is influenced by EDL length itself as well; (2) Force is transmitted from muscle to extramuscular connective tissue and vice versa. As a consequence force exerted at proximal and distal tendons of a muscle are not always equal. The difference being transmitted by extramuscular connective tissue and may appear at the tendons of other muscles or may be transmitted via connective tissue directly to bone. It is concluded that the system of force transmission from skeletal muscle should be considered as a multiple system.

Animals↗