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PubMed2005

[Video-assisted tenotomy of the triceps muscle of the calf in cerebral palsy patients].

PURPOSE OF THE STUDY: The aim of the study was to demonstrate the outcomes of video-assisted tenotomy of the gastrocnemius and soleus muscles in children with the spastic form of cerebral palsy. MATERIAL: In the period from September 2003 to March 2004, 18 lower extremities in 14 patients were operated on.A set for endoscopic plastic surgery with a 4-mm trocar was used. Aponeurotomy was carried out with a scalpel no. 11 or arthroscopic scissors. The treated limb was immobilized in plaster cast for 6 weeks. METHODS The inclusion criteria were: an equinus gait free from a valgus or a varus deviation, preferably unilateral, and the age range between 4 and 10 years. The patients were examined before surgery and followed up at 3-month intervals. RESULTS: In 16 out of 18 treated extremities, simple aponeurotomy of the gastrocnemius and soleus muscles was sufficient to achieve 20 degrees dorsiflexion. In two cases it was necessary to complete the procedure at the same stage by video-assisted sliding double-point tenotomy of the Achilles tendon. The short-term follow-up did not reveal complications such as failure of wound healing or neurological or vascular disturbance. DISCUSSION: The international literature data show that this method has largely been developed on cadavers. Much attention has been given to potential injury to the sural nerve. However, the ultimate goal of this operation, i. e., sufficient correction, should be regarded as a much more important factor. In older children, simple aponeurotomy may not achieve this objective and therefore the authors developed a procedure combining video-assisted aponeurotomy with sliding double-point tenotomy of the Achilles tendon. CONCLUSIONS: Video-assisted tenotomy of the gastrocnemius and soleus muscles proved a fully effective method in our group evaluated at short-term follow-up.

Cerebral Palsy↗
PubMed1979

Effects of tenotomy on the motor end plates of fast and slow twitch muscles of the rabbit.

The projection areas of vitally stained motor end plates in normal and tenotomized fast and slow twitch muscles of the rabbit hind limb were measured. There was a significant reduction in the mean projection area of the motor end plates of the slow muscle after tenotomy. There was no significant change in the projection area of the FDL or gastrocnemius motor end plates after tenotomy. After tenotomy the deep (slow) component of the tibialis anterior showed an increase in the mean projection area of its end plates and so approached the faster superficial component in this respect. It appears therefore, that the altered pattern of activity of the slow motoneurons (which is known to occur after tenotomy) is associated with a change in the end plate size towards that normally found in muscles innervated by phasic motoneurons.

Animals↗
PubMed2000

Skeletal muscle recovery after tenotomy and 7-day delayed muscle length restoration.

Rabbit extensor digitorum longus (EDL) tendons were cut with the muscle active (active tenotomy, AT) or with the EDL at rest (passive tenotomy, PT). One, 7, and 21 days after tenotomy, contractile testing was performed. A second experiment was performed in which EDL tendons underwent PT and, after a 7-day delay, muscle-tendon units were restored to their original length. Maximum isometric tension dropped precipitously 1 day after either AT or PT to approximately 50% of normal and continued to decline by day 7. In contrast to PT, where peak tension (P(0)) decreased further by 21 days, after AT, P(0) partially recovered. Differences in muscle mass, cross-sectional area, fiber type, and sarcomere number did not explain the differential response. One day after length restoration of muscles, P(0) rapidly increased by approximately 40%. These observations have implications for understanding the outcome of muscle-tendon unit injury and surgical repair.

Animals↗
PubMed2000

Skeletal muscle response to tenotomy.

Tenotomy is a commonly encountered clinical entity, whether traumatic or iatrogenic. This article reviews the response of skeletal muscle to tenotomy. The changes are subdivided into molecular, architectural, and functional categories. Architectural disruption of the muscle includes myofiber disorganization, central core necrosis, Z-line streaming, fibrosis of fibers and Golgi tendon organs, changes in sarcomere number, and alterations in the number of membrane particles. Molecular changes include transient changes in myosin heavy chain composition and expression of neural cell adhesion molecule (NCAM). Functionally, tenotomized muscle produces decreased maximum tetanic and twitch tension. Alterations in normal skeletal muscle structure and function are clinically applicable to the understanding of pathological states that follow tendon rupture and iatrogenic tenotomy.

Animals↗
PubMed1983

Ultrastructural and biochemical changes in rat soleus muscle following tenotomy.

This study was designed to correlate changes in the rate-limiting enzymes of glycogen synthesis (glycogen synthase) and glycogen breakdown (glycogen phosphorylase) with the ultrastructural changes which occur in the soleus muscle following tenotomy. Soleus muscles were removed at 1, 2, 3, 7, 14, 21, and 63 days after tenotomy and were prepared for electron microscopy or frozen for enzyme analysis. In the first 7 days posttenotomy, soleus muscle fibers underwent a series of degenerative changes, while both synthase and phosphorylase activities decreased. Over the next 8 weeks the histological appearance of the soleus muscle eventually returned to normal while synthase and phosphorylase activities increased. We suggest that recovery from tenotomy involves an increase in the energy demands of the muscle, resulting in the increased activity of the key rate-limiting enzymes of muscle glycogen metabolism from the drastically reduced levels observed in the period before recovery begins.

Animals↗
PubMed1990

Tenotomy-induced motor endplate alterations in rat soleus muscle.

The effects of tenotomy on the ultrastructure of rat soleus muscle motor endplates were examined both qualitatively and quantitatively. Rat soleus muscle was studied 2 weeks following tenotomy and compared with normal littermates. The motor endplates from the tenotomized muscles were found to exhibit both degenerative and regenerative changes. Degeneration consisted of postjunctional fold breakdown, exposed junctional folds, myelin-like bodies within the sub-junctional sarcoplasm, and dense bodies within the Schwann cell cytoplasm. The regenerative changes consisted of several small nerve terminals occurring within the same primary synaptic cleft and several axons wrapped by the same Schwann cell. The results demonstrate that tenotomy induces denervation-like changes at endplates that lead to terminal sprouting within the neuromuscular junctional area and remodelling.

Animals↗
PubMed1989

WR-2721 reduces bone loss after hindlimb tenotomy in rats.

WR-2721 is a thiophosphate analog of cysteamine that produces hypocalcemia in vivo. Previous studies suggest that WR-2721 produces hypocalcemia by independent inhibitory effects on parathyroid hormone (PTH) secretion, osteoclastic bone resorption, and tubular reabsorption of calcium. We sought to determine if WR-2721 would decrease bone loss in an animal model of disuse osteoporosis produced by unilateral knee tenotomy in the rat. Tenotomy significantly increased osteoclast number in tibias on the side of the procedure compared with tibias on the opposite side which had not undergone the procedure at 3 and 14 days. Femoral weight of tenotomized limbs were also reduced significantly compared with the contralateral limb at 3 and 14 days. WR-2721 treatment (240 mg/kg daily) prevented 26% of the loss of femoral dry weight and 29% of the loss of femoral ashed weight produced 14 days after tenotomy. In addition, WR-2721 treated (240 mg/kg daily) animals had fewer osteoclasts in tenotomized tibias than control animals at 3 days (6.6 +/- 0.7/mm versus 10.3 +/- 0.9/mm, p less than 0.02) and at 14 days (5.8 +/- 0.3/mm versus 8.7 +/- 0.4/mm, p less than 0.02). These data suggest that WR-2721 decreases bone loss in this model by decreasing osteoclastic bone resorption.

Amifostine↗
PubMed1977

The target phenomenon in rat muscle following tenotomy and neurotomy. A comparative light microscopic and histochemical study.

Target fibers were checked at regular intervals in two groups of rat gastrocnemius muscle namely after tenotomy and neurotomy. The highest amount of target fibres was observed during the first week following tenotomy and around the seventh week, when the muscle became again functional by spontaneous union of the tendon. The target phenomenon was restricted to the type II fibres. It appeared also in the early stage of re-innervation, 5 weeks following neurotomy and remained present subsequently in a transitional zone between denervated and re-innervated muscle fibres and was restricted to the type I muscle fibres. The target phenomenon was not the only histochemical alteration observed following tenotomy and neurotomy. This experimental study allowed to determinate more precisely the causal factors of the target phenomenon.

Adenosine Triphosphatases↗
PubMed1988

The effect of infrahyoid-muscle tenotomy on orofacial motor activity in the rat.

The effects of disturbed proprioceptive feedback from the infrahyoid muscles on the control of chewing and drinking were studied in the unrestrained rat. Rats were trained to lick and to eat in a fixed body position in front of a video camera. After training, the left and right sternohyoid, omohyoid and sternothyroid muscles were cut close to the hyoid bone. EMG-wire electrodes were inserted into the superficial masseter, the anterior and posterior digastic and sternhyoid muscles. EMG-recordings were made at the third, the tenth and the eighteenth day after tenotomy. After about a week the cut ends of the muscles became encapsulated in connective tissue and began to reattach to the hyoid bone; in some animals the sternohyoid muscle reattached to the trachea. In the period before reattachment the mean cycle duration for chewing (but not for drinking) increased. After reattachment the mean cycle duration returned to control values. The contraction patterns after tenotomy were similar to those of the controls during chewing and drinking. The mean burst duration of the sternohyoid increased after tenotomy during chewing but not drinking; it decreased in the digastric muscles and did not change in the masseter.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Electrophysiological study of conditioning lesion effects on rat sciatic nerve regeneration following either prior section or freeze. II. Blocking by prior tenotomy.

The conditioning lesion effects refer to the earlier formation and the accelerated regeneration of axonal sprouts following two successive axotomies. In a previous study, we observed that a prior freeze or a prior cut of rat sciatic nerve resulted in differences in the enhancement of the regeneration rate and the reduction of the initial delay. These differences were interpreted as a possible non-neuronal cells influence on the intrinsic regulation of the conditioning lesion phenomenon. In the present study, we attempted to modify the status of the muscles using tenotomy before the prior nerve injury to determine the respective influence of the muscular cells on conditioning lesion effects. Thus, the conditioning lesion, which was either a cut or a freeze of the tibial nerve at the ankle, was performed 14 days after foot sole muscles were tenotomized, close to their insertion into the calcaneus bone. The test lesion was always a freeze of the sciatic nerve at midthigh performed 7 days following the prior lesion. The elongation of the regenerating sprouts was electrophysiologically evaluated and the regeneration rate as well as the initial delay were calculated by means of regression analysis. Tenotomy did not influence the regeneration as was demonstrated in a group with a single sciatic nerve lesion. In contrast, when prior lesion was performed, the tenotomy prevented both the enhancement of the rate of regeneration and the reduction of the initial delay, whatever was the type of the conditioning lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2003

Effects of tenotomy surgery on congenital nystagmus waveforms in adult patients. Part I. Wavelet spectral analysis.

Congenital nystagmus (CN) is an aperiodic oscillatory eye movement disorder. Horizontal rectus tenotomy with simple re-attachment has been proposed as a therapy for CN. This therapy might affect vision and/or eye movements. Another paper deals with improvements in visual acuity. This and the companion paper examine changes in eye movements. In this study, we examined the effect of tenotomy on nystagmus waveforms using wavelet spectral analysis. No common effect was found across the patients on the wavelet spectra of the CN beat, suggesting that tenotomy surgery has no effect, or only a quite small effect, on the waveform structure of CN.

Adult↗
PubMed2003

Effects of tenotomy surgery on congenital nystagmus waveforms in adult patients. Part II. Dynamical systems analysis.

Congenital nystagmus (CN) is an aperiodic oscillatory eye movement disorder of unknown etiology. We examined the effect of horizontal rectus tenotomy with simple re-attachment on the dimensionality of the dynamical mechanism underlying CN. The correlation dimensions (CDs) were calculated from eight patients who had tenotomy surgery. We found no significant differences in the CDs that could be associated with the surgery. The change in dimensionality was less than 5% on average. The results suggest that the tenotomy has no effect, or only a quite small effect, on the underlying mechanism of the CN beats.

Adult↗
PubMed1987

Simultaneous superior oblique tenotomy and inferior oblique recession in Brown's syndrome.

The technique and results of simultaneous superior oblique tenotomy and 14-mm inferior oblique recession for true Brown's syndrome are presented for 16 eyes of 13 patients. A good or excellent result was achieved in 15 of 16 eyes (94%). Reoperation for overcorrection was not necessary; however, repeat tenotomy was required in two cases. Inferior oblique underaction was present in 12 of 16 eyes (75%) in the early postoperative period; however, elevation in adduction improved over time. At most recent examination, 92% of eyes demonstrated greater than 25 degrees elevation in adduction. Underaction of the superior oblique occurred in 3 of 16 eyes (19%). A simultaneous superior oblique tenotomy and inferior oblique recession is recommended in all patients selected to undergo surgery for true Brown's syndrome to prevent reoperation for iatrogenic superior oblique palsy.

Adolescent↗
PubMed1998

Results of superior oblique posterior tenotomy.

PURPOSE: The purpose of the study was to evaluate the results obtained by the superior oblique posterior tenotomy close to its insertion in patients with A-pattern strabismus and vertical strabismus who had bilateral or unilateral superior oblique overaction. METHODS: We retrospectively analyzed the results of superior oblique posterior tenotomy close to its insertion performed bilaterally in 13 consecutive patients with A-pattern strabismus and unilaterally in 14 consecutive patients with hypotropia performed between March 1989 and October 1996. RESULTS: The mean preoperative A-pattern deviation was 25.31 PD and the mean postoperative A-pattern deviation was 3.23 PD with a mean reduction of 22.08 PD. The mean follow-up for the above group was months (range 3 to 58 months). In the hypotropia group the mean preoperative vertical deviation was 11.07 PD and the mean postoperative vertical deviation was 4.28 PD with a mean reduction of 6.78 PD. The mean follow-up for this group was 16.21 months (range 3 to 72 months). CONCLUSIONS: Superior oblique posterior tenotomy selectively weakens its vertical action. Bilateral weakening showed marked and consistent improvement in A-pattern deviation and unilateral weakening showed definite but less consistent reduction in deviation in cases of hypotropia with superior oblique overaction.

Adolescent↗
PubMed1999

A new surgery for congenital nystagmus: effects of tenotomy on an achiasmatic canine and the role of extraocular proprioception.

PURPOSE: Human eye-movement recordings have documented that surgical treatment of congenital nystagmus (CN) also produces a broadening of the null zone and changes in foveation that allow increased acuity. We used the achiasmatic Belgian sheepdog, a spontaneously occurring animal model of human CN and see-saw nystagmus (SSN), to test the hypothesis that changes induced by surgical interruption of the extraocular muscle afference without a change in muscle-length tension could damp both oscillations. METHODS: An achiasmatic dog with CN and SSN underwent videotaping and infrared oculography in a sling apparatus and head restraints before and after all extraocular muscles (stage 1: 4 horizontal rectus muscles and stage 2 [4 months later]: 4 vertical rectus muscles and 4 oblique muscles) were surgically tenotomized and immediately reattached at their original insertions. RESULTS: The dog had immediate and persistent visible, behavioral, and oculographic changes after each stage of this new procedure. These included damped CN and SSN, increased ability to maintain fixation, and increased periods of maintaining the target image on the area centralis over a broad range of gaze angles. CONCLUSIONS: Severing and reattaching the tendons of the extraocular muscles affect some as-yet-unknown combination of central nervous system processes producing the above results. This new procedure may prove effective in patients with CN with either no null, a null at primary position, or a time-varying null (due to asymmetric, (a)periodic, alternating nystagmus). We infer from our results in an achiasmatic dog that tenotomy is the probable cause of the damping documented in human CN after Anderson-Kestenbaum procedures and should also damp CN and SSN in achiasma in humans. It may also prove useful in acquired nystagmus to reduce oscillopsia. The success of tenotomy in damping nystagmus in this animal suggests that the proprioceptive feedback loop has a more important role in ocular-motor control than has been appreciated. Finally, we propose a modified bimedial recession procedure, on the basis of the damping effects of tenotomy.

Animals↗
PubMed2003

Laser tenotomy and vocal process resection for bilateral midline vocal fold fixation.

BACKGROUND: The present retrospective study presents the outcomes of a group of 21 patients with laryngeal obstruction caused by bilateral vocal fold fixation. All of these patients were treated by laser assisted muscle tenotomy and vocal process resection - a modification of the technique described by Michael and Eugene Rontal in 1994.1 METHODS: Between January 1997 and March 2002 the senior author performed muscle tenotomy and vocal process resection for bilateral vocal fold fixation on 21 patients. RESULTS: The mean follow-up time was 2.3 years. The technique was successful in achieving an adequate airway and good voice with no aspiration in every case. CONCLUSIONS: Laser assisted muscle tenotomy and vocal process resection is a proven treatment for bilateral medial vocal fold fixation with the provision of a good airway, good voice and the avoidance of aspiration.

Adolescent↗
PubMedDate not supplied

Complete biceps brachii tenotomy to facilitate internal fixation of supraglenoid tubercle fractures in three horses.

OBJECTIVE: To describe a method for internal fixation of supraglenoid tubercle fractures in conjunction with complete tenotomy of the biceps brachii tendon. ANIMALS: Three horses, ranging in age from 8 months to 2 years and weighing from 300 to 400 kg. METHODS: Fractures were repaired by open reduction-internal fixation using bone screws placed in lag fashion and complete tenotomy of the biceps brachii tendon. OUTCOME: All three horses were sound for their intended use with a good cosmetic result 6 months after surgery. CONCLUSIONS: Complete transection of the biceps brachii tendon facilitates supraglenoid tubercle fracture repair by reducing tensile forces exerted on the supraglenoid tubercle. Complete tenotomy does not appear to preclude return to a successful athletic career.

Animals↗
PubMed2005

Adductor tenotomy in spastic cerebral palsy. A long-term follow-up study of 78 patients.

BACKGROUND: There is a risk of hip dislocation in children with spastic cerebral palsy. We evaluated the prophylactic effect of adductor tenotomy in patients with long-term follow-up. PATIENTS AND METHODS: Our material comprised 78 patients (46 boys) with a mean age of 8 (2-17) years who underwent adductor tenotomy during the period 1986-1991. 40 patients had spastic diplegia and 38 had quadriplegia. For patients who had further hip surgery, follow-up was until the next hip operation. Those who had not undergone further surgery were invited to a follow-up examination. The migration percentage (MP) was measured on the preoperative and follow-up radiographs. The radiographic result was termed good if MP at follow-up was reduced or had increased less than 10%. The follow-up period was 10 (1.6-16) years, with a mean of 6 years for patients with later hip surgery and 13 years without such surgery. RESULTS: The clinical outcome was good in 51 cases, poor in 12, and uncertain in 15. The radiographic result was good in 39 of the 53 patients with radiographs available both preoperatively and at follow-up. The patients with good radiographic results had lower preoperative MP than those with poor results (MP 34% versus 49%) and lower preoperative acetabular index. The mean increase in MP (worst hip in each patient) was 1.9% per year, which is considerably less than that in nonoperated patients. Further hip surgery was necessary in 27 patients, because of increasing MP in 14 cases and for clinical reasons in 13. INTERPRETATION: Adductor tenotomy reduced the trend towards lateral displacement of the hip joints. The operation had a favorable outcome in approximately two-thirds of the patients. The operation should be performed before the MP reaches 50%.

Adolescent↗