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PubMedDate not supplied

Downgaze restriction after placement of superior oblique tendon spacer for Brown syndrome.

Diplopia in the reading position developed in two patients with unilateral Brown syndrome after a 7-millimeter section of #240 silicone retinal band was sewn between the cut ends of the superior oblique tendon at tenotomy. In both cases, forced ductions were positive, indicating a restrictive downgaze deficit. Surgical exploration revealed adhesions that prevented the normal sliding of the superior oblique tendon beneath the superior rectus muscle. Forced ductions became normal and downgaze improved after removal of the silicone band. Secondary superior oblique muscle paresis was also evident at the time of reoperation, requiring recession of the contralateral inferior rectus muscle (cases 1 and 2) and recession of the ipsilateral inferior oblique muscle (case 1). A restrictive downgaze deficit and a paretic overcorrection must be recognized as possible complications of the superior oblique tendon silicone "expander" operation.

Adult↗
PubMedDate not supplied

Arthroscopic biceps tenodesis: technique and results in six dogs.

Biceps tenodesis was performed using an arthroscopic-assisted technique on six dogs diagnosed with chronic bicipital tendon pathology. The technique was performed using two different fixation methods (i.e., cannulated interference screw, cannulated screw and tissue washer). All six dogs had successful outcomes in terms of return to full function at a mean follow-up time of 11.7 months after surgery. Arthroscopic biceps tenodesis is a feasible option for surgical management of biceps tendon pathology, and it may have advantages over open tenodesis and open or arthroscopic tenotomy. Further study is needed before definitive recommendations regarding indications, complications, and prognosis associated with arthroscopic biceps tenodesis can be made.

Animals↗
PubMed1976

Oerative treatment of the plantar-flexed inverted foot in adult hemiplegia.

From a population of 902 adult patients with acquired hemiplegia, thirty-two patients with extensor synergy were chosen for a reconstructive procedure designed to eliminate the need for an orthosis. Three additional patients underwent the procedure to eliminate severe spasticity which precluded orthotic fitting. The operative technique, first described by Mooney and associates, involved lengthening of the tendo achillis and tibialis posterior tendon, multiple toe-flexor tenotomies, and a split transfer of the tibialis anterior tendon. Satisfactory results were recorded for thirty-two patients. The three failures were ascribed to inappropriate selection of patients for surgery.

Achilles Tendon↗
PubMed1998

[A case of psoriatic arthritis associated with ankylosing spondylitis treated with bilateral total hip arthroplasty].

We report a case of a 40-year-old male with psoriatic arthritis associated with ankylosing spondylitis. At the age of 34, the patient suffered pain in his hips, knees, ankles, neck and low back 3 years after the onset of psoriasis vulgaris. The hip pain gradually became severe despite the medical treatment and physical therapy. On admission, the skin lesion of diffuse erythematous plaques with scales was observed on the trunk and extremities. Motion of the spine was markedly limited. We also noted limitation of motion in the bilateral hips and remarkable gait disturbance. In laboratory findings, rheumatoid factor and HLA-B 27 antigen were negative. Radiographs of the cervical spine showed typical bamboo spine as seen in ankylosing spondylitis. Obliteration of the sacroiliac joints and joint space narrowing in the hips with reactive sclerosis were revealed on the pelvic film. Bilateral cementless total hip arthroplasty with adductor tenotomy resulted in complete pain relief and a marked improvement in gait function 18 months after surgery. The appropriate reconstructive surgery was extremely helpful to increase daily activities of the patient in this case.

Adult↗
PubMed1999

[A common symptom among athletes and persons who exercise. Correct treatment of groin pain requires a meticulous diagnosis].

Groin pain is common among athletes. In its acute form the pain is usually overuse-related and is treated conservatively, whereas in chronic groin pain the clinical picture is often more complex. Successful treatment is dependent on correct diagnosis, as there are multiple differential diagnosis. Surgery has been associated with good results in chronic cases, the most common interventions being adductor tenotomy, abdominal wall repair, and neurotomy of the ilioinguinal and/or iliohypogastric nerve. Which surgical approach should be adopted is dependent on the results of investigation to identify the causative factor.

Adult↗
PubMed1999

[Orthopedic surgery in adults with low intellectual quotients].

PURPOSE OF THE STUDY: The object of this study was to define the requirements for successful management of polyhandicapped adults with low mental level. The goal of surgery was to improve motion performances, suppress pain, improve sitting position, and facilitate handicapped adults life. MATERIAL: Thirty-five adults operated during a period of 20 years with a follow-up between 6 months and 20 years were studied. Three of them died within 2 months postoperatively due to causes unrelated to surgery. METHOD: Surgical procedures performed were adductor tenotomies, femoral or pelvic osteotomies, femoral resections, triple arthrodeses of the foot, spine arthrodesis, lengthening of Achilles tendon, and 2 cases of femoral fractures. RESULTS: The functional goal was achieved in all cases. In 3 cases, we observed postoperative psychic regression. DISCUSSION: The surgeon must make every effort to achieve successful outcome in such cases without creating or exacerbating a behavioral impairment. Team discussions, choice of operative procedures, quality of resuscitation, and rapid return to usual life were the main factors required for successful outcome. CONCLUSION: Functional results obtained regularly in this series justifies using surgery in such cases. Cost is lower, patient's quality of life is improved, the handicapped adults relationships with others are better, and caretaker's tasks are facilitated.

Activities of Daily Living↗
PubMed1999

[Treatment of spastic equinovarus foot in the hemiplegic adult by retrograde fixation of the peroneus brevis tendon onto the anterior tibialis tendon].

PURPOSE OF THE STUDY: The purpose of the present study was to assess the Bardot procedure in the treatment of equinovarus deformities of the foot in spastic hemiplegia. This procedure associates the fixation of the peroneus brevis distal tendon onto the tibialis anterior, heel-cord lengthening, and tenotomies of the flexores digitorum. MATERIAL AND METHODS: Fifty-six patients underwent this procedure between 1989 and 1996. The indication for surgery was equinovarus deformity in adult spastic hemiplegia. Preoperatively all the patients had an instability and 80.5 per cent of them had to wear an ankle and foot orthesis. Postoperatively forty-one patients with a mean follow up of 3.5 years (range: one to 9 years), were available for examination including 24 females and 17 males with a mean age of 46 years at time of surgery (range: 27 to 76). RESULTS: All the patients were objectively improved. Seven of them had a discreet residual varus deformity, but none felt unstable. They all were able to walk barefooted, only one patient still required an adapted shoe. The gait and the quality of live were subjectively improved for 92.7 per cent of the patients. None of the patients has been worsened. DISCUSSION: When spastic equinovarus disturbs significantly quality of live, tendon re-balancement of the hemiplegic foot should be proposed. The fixation of the distal tendon of the peroneus brevis onto the tibialis anterior is effectively performed only if this latter is efficient in the swing phase of gait. If there is no fixed contracture, neurosurgery or chemotherapy are preferable. In case of irreducible articular deformities arthrodesis could be indicated. CONCLUSION: Tendon re-balancement in hemiplegic foot using a peroneus tendon fixation onto the tibialis anterior should be carried out after examination by a team of specialists (surgeon, neurosurgeon, rehabilitation team). In such conditions it offers constantly an improvement to the patients.

Adult↗
PubMed1999

Orthopedic management in autosomal recessive spastic ataxia of Charlevoix-Saguenay.

OBJECTIVE: To review the orthopedic management of choice in patients having autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS). DESIGN: A retrospective study from April 1978 to April 1997. SETTING: Centre hospitalier de la Sagamie, Chicoutimi, Que. PATIENTS: A review of the records of patients having ARSACS who were identified in the registry of the Neuromuscular Diseases Clinic at the Centre hospitalier de la Sagamie revealed 26 patients who received surgical orthopedic treatment. Initially, the patients were offered conservative treatment, which consisted of physiotherapy sessions, the wearing of an ankle-foot orthosis or serial casting. When this was unsuccessful, foot surgery was considered. RESULTS: During the study period, 49 orthopedic procedures were done, including 24 triple arthrodeses; of these, 9 were combined with lengthening of the Achilles tendon. Most triple arthrodeses were done in patients between the ages of 30 and 49 years. The surgical options evolved during the study from Lambrinudi arthrodesis through arthrodesis of the ankle to triple arthrodesis with lengthening of the Achilles tendon. CONCLUSIONS: As a complement to conservative treatment, surgery has a place in the care of patients with ARSACS. Clinically, the most effective surgical procedures are triple arthrodesis with percutaneous lengthening of the Achilles tendon and adductor and psoas tenotomies combined with neurectomy of the obturator nerve for perineal hygiene.

Achilles Tendon↗
PubMed1999

[Evaluation of morphologic changes of the rabbit supraspinal muscle].

The aim of this study was to evaluate morphologic changes within rabbit supraspinatus after detachment of its tendon from the greater tubercle along with infraspinatus and subscapularis tenotomy. Stained with hematoxylin and eosin muscle sample has been examined after 6 weeks (group A), 3 months (group B) and 6 months (group C). There were 10 rabbits in each group. The muscle atrophy was accompanied by statistically significant increase of the interstitium volume in group B (24.5%) and C (26.3%) as opposed to A (15.4%). Statistically significant differences were also found in interstitium volume of tenotomized and contralateral supraspinatus muscle.

Animals↗
PubMed1975

Surgical treatment of the boutonniere deformity in rheumatoid arthritis.

The rheumatoid boutonniere deformity does not limit hand function significantly until it becomes severe. For this reason the surgical procedures used should not risk or sacrifice existing function. For the mild cases one can improve the digital balance by a simple extensor tenotomy combined with dynamic splinting. In more advanced stages with passive correction possible, the deformity can be improved by reconstruction of the extensor mechanism. With fixed deformities one can choose between proximal interphalangeal joint fusion and arthroplasty. The decision is influenced by several factors, including the digit involved and the status of adjacent joints. After a careful evaluation of the patient's capabilities and needs, it is possible to improve these deformities by the methods discussed.

Arthritis, Rheumatoid↗
PubMed2000

Results of the superior oblique tendon elongation procedure for severe Brown's syndrome.

PURPOSE: To evaluate the outcomes of the silicone tendon expander for the treatment of Brown's syndrome. METHODS: This paper consists of 2 parts: a chart review of patients who have under gone the silicone tendon elongation procedure for Brown's syndrome and a survey of the surgical experience of the members of the American Association of Pediatric Ophthalmology and Strabismus. Charts of 15 consecutive Brown's syndrome patients who underwent the superior oblique tendon expander were reviewed by the author from 1987 to 1997. An additional patient referred to the author for management of complications of the silicone tendon expander procedure after surgery elsewhere for Brown's syndrome is reported. The second aspect of the study is a fax survey sent to all 450 members of the American Association of Pediatric Ophthalmology and Strabismus listed in the 1997-1998 directory. Pediatric ophthalmologists were asked to answer questions regarding their experience using the silicone tendon expander for Brown's syndrome. RESULTS: Of 15 patients operated on by the author, preoperative limitation of elevation in adduction measured -4 in 14 patients and -3 in 1 patient preoperatively. Postoperatively, 14 of the 15 patients showed improved motility, with essentially normal versions in 10 patients (no more than +/- 1 oblique dysfunction); 3 patients were undercorrected (2 mild and 1 severely); and 2 had a consecutive superior oblique paresis (1 mild and 1 requiring an inferior oblique weakening procedure). The 1 patient with a severe undercorrection that did not improve after the silicone tendon elongation procedure showed continued restriction by intraoperative forced ductions after superior oblique tenotomy. Superior oblique tendon was not the cause of Brown's syndrome in this patient. The average final result graded on a scale of 1 to 10 (10 being best) was 8.3. Thirteen of 15 patients (87%) achieved a final result score of 7 or better with a single surgery, and an additional patient was corrected with a second surgery providing an overall success rate of 93%. Ten of the 15 patients had at least 11 months' follow-up, and 6 of the 10 patients showed a delayed improvement over a 4- to 6-month period. Five patients had more than 5 years of follow-up, and 4 (80%) had an excellent long-term outcome (final result, 9 to 10) with a single operations; all 5 had a good final outcome (final result, 7 to 10, mean 9.2) with 1 patient requiring a second surgery. There were no long-term complications, including no extrusions, no restriction of ocular rotations, and no infections. The patient who underwent the procedure elsewhere demonstrated limited movement of the eye to adduction elevation, and there was underaction of the ipsilateral superior oblique muscle. A reoperation performed by the author revealed positive forced ductions up and nasal ward. There were scars and adhesions in the area of the silicone implant, including scar to superior nasal sclera and superior rectus muscle. The silicone implant was removed and scar excised until forced ductions improved. This resulted in improved motility. Thirty-nine AAPOS members reported on 140 patients who had undergone the silicone tendon elongation procedure for Brown's syndrome. Judged by the surgeon on a scale of 1 to 10 (10 being best), 26 surgeons rated 91 patients (65%) as good with a score of 8 to 10, and 14 surgeons rated 18 patients (13%) poor with scores of 1 to 3. Complications were recorded for 9 patients and included scarring and restriction with removal of silicone implant in 4 and spontaneous extrusion in 5. Three of the 5 spontaneous extrusions came from the same surgeon, and in another case a surgeon used a 10 mm length of silicone. CONCLUSIONS: A novel procedure, the silicone tendon expander, is an effective option for correcting Brown's syndrome caused by a stiff or inelastic superior oblique tendon; long-term outcomes are excellent. Proper technique with maintenance of the tendon capsule is critical to the successful outcome of the procedure.

Eye Movements↗
PubMed1975

[Results of surgical correction of flexion contractures of the knee joint in CP children (author's transl)].

Follow-up of 78 CP children with elongation of the tendons of knee flexors. In addition further operations were done in a large number of cases, frequently shortening of the patellar ligament, lengthening of hip flexors and correction of pes equinus. The further motor development shows worsening in 8, no improvement in 28 and improvement in 42 children. Analysis according to age showed better results in children under 9 years: Of the 48 younger children 33 showed progress, 13 free walking. Of the 30 older children only 9 showed progress and only 2 learned to walk freely. This difference was significant. Investigation of the causes for not walking showed the importance of motor preconditioning. Only children who had knee-standing before operation learned free walking. Major lack of motor development was most frequently preventing walking. Further causes were mental retardation, athetosis, pes calcaneus and general flexion patterns. While results in gaining extension at the knee were quite good, outward rotation at the hip averaged an improvement of 9.7 degrees. A favorable influence of combined elongation of knee flexors and adductor tenotomy at the hip in the CE angle was also clear. It diminished on average by 6.9 degrees. Special pre-operative conditions and the technique of examination are discussed in detail.

Adolescent↗
PubMedDate not supplied

A minimally invasive vasectomy with the no suture, inline method for vas occlusion.

OBJECTIVE: The current vasectomy methods, including the no scalpel vasectomy (NSV), have received considerable attention in recent years, because they are minimally invasive and utilize special instruments to expose the vas. However, at least 28 different methods for vas occlusion have been utilized with these procedures, and some postoperative complications have been attributed to the method of vas occlusion. Therefore, in this report we will critique the existing methods for vas occlusion and introduce a new and rapid method. PATIENTS AND METHODS: The NSV instruments were used to expose the vas, but, in addition, a fine skin hook, a short-bladed tenotomy scissors, and a hand-held, hotwire cautery were used for the new no suture, inline method of vas occlusion. No ligatures were placed around the vas, no portion of the vas was removed, and the mesentery behind the vas was not disturbed. The vas sheath was disrupted, there was luminal cautery on both the abdominal and testicular sides, a section of vas was detubularized and trimmed, and its epithelium was destroyed by cautery. This technique has been performed in 158 consecutive cases. RESULTS: All patients have demonstrated complete azoospermia on two follow-up semen analyses, with no pregnancies reported. CONCLUSION: This new method of vas occlusion seems to be rapid and compatible with the NSV instruments.

Evaluation Studies as Topic↗
PubMed2001

Altered expression of alternatively spliced isoforms of the mRNA NMDAR1 receptor in the visual cortex of strabismic cats.

PURPOSE: Although much has been written about the role of the NMDA receptor's role in experience dependent visual plasticity, the function of the NMDAR1 receptor subunit in the post-plasticity stage of development is still not well understood. However, in the well studied model of strabismic amblyopia where binocularity is reduced, but where most primary visual cortex neurons can be driven by one or other eye, the density of expression of NMDAR1 receptor protein is significantly reduced, compared to normals. This study aims to identify which of eight isoforms of the spliced heterogeneous variants of the NMDAR1 mRNA receptor gene are associated with this decrease in expression as a means of elucidating possible function. METHODS: A series of digoxygenin-labelled oligonucleotide probes based on the human gene sequence have been used for in situ hybridization (ISH) of sections from the striate cortex of four adult cats. The probes were used to uniquely detect the expression of alternatively spliced mRNA variants in 66,487 cells from sections from the area centralis projection of two normal cats and two cats made esotropic as kittens by tenotomy at two weeks of age. RESULTS: As expected, total NMDAR1 mRNA isoform expression was significantly lower in the striate cortex of strabismic compared to normal cats. The proportion of cortical cells expressing the R1-a, R1-b, and R1-1 isoforms in strabismic animals was decreased while the proportion expressing R1-3 was increased, especially in layers V and VI. No significant difference in expression of the R1-2 and R1-4 isoforms was seen comparing strabismic and normal cats. CONCLUSIONS: These results confirm our previous findings and suggest that transcriptional inhibition of specific isoforms of NMDAR1 mRNA may underlie the change in receptor expression. This preferential reduction in the proportion of neurons bearing particular NMDAR1 isoforms, i.e. isoforms R1-a and b, and R1-1 with partial compensation through the expression of the R1-3 isoform, is more likely related to lowered proportion of binocularly activated neurons in the strabismic cat than to changes in eye dominance or the presence of amblyopia in one eye.

Alternative Splicing↗
PubMed1975

Rationale and indications for the "hanging hip" procudure: a clinical and experimental study.

A series of 71 patients treated by "hanging hip" procedures was followed for up to 12 years. The procedure provided a satisfactory result in patients even with severe hip joint degeneration as long as the congruity of the joint is preserved and there was no concentration of stress. When these conditions are not fulfilled the results are poor. An experimental study was carried out to try and ascertain the physiological rationale for the "healing" seen in patients with good preoperative indications. The articular cartilage of one hip in cats was denuded with a curette. This was accompanied in half the animals with a "hanging hip" procedure. The hips of the animals with "hanging hip" went onto fibrocartilaginous and chondroid healing of their articular surfaces and clinically did well. The hips of the animals who did not have multiple tenotomies developed osteoarthrosis. Full thickness cartilage defects in weight-bearing areas in adult animals are capable of functional healing if the mechanical stress on the joint is sufficiently decreased. The "hanging hip" operation should no longer be considered a salvage procedure. A physiological rationale exists for it in properly selected patients and represents a reasonable alternative to total hip replacement.

Adolescent↗
PubMedDate not supplied

Surgical prevention of foot deformity in patients with Duchenne muscular dystrophy.

The purpose of this study was to evaluate the results of a modification of the posterior tibial tendon transfer in Duchenne muscular dystrophy patients with regard to foot deformity and ambulation. The records of 57 patients with Duchenne muscular dystrophy were retrospectively reviewed. Three treatment groups were studied: group 1, those who had surgery to maintain ambulation; group 2, those who had surgery to correct and maintain foot position; and group 3, those who had no surgery. All surgical patients had posterior tibial tendon transfer and Achilles tendon lengthening as part of their procedure. Thirty-four patients returned for interviews and examinations to assess outcomes and foot position. The mean age at cessation of ambulation for those who had surgery was 11.2 years versus 10.3 years for those who did not have surgery. Of 48 feet in 24 patients who underwent lower extremity surgery to correct and maintain foot position, 94% were clinically satisfactory at a mean of 8.5 years after surgery. Regardless of the desire to continue ambulation, all patients should have posterior tibial tendon transfer, Achilles tendon lengthening, and toe flexor tenotomies to maintain plantigrade feet.

Achilles Tendon↗
PubMed2002

[Spasticity treated with selective posterior rhizotomy].

BACKGROUND: Spasticity is often seen in patients with central nervous lesions. Some patients with severe spasticity are not optimally treated with physiotherapy and medication. MATERIAL AND METHODS: We present a case history of a 41-year-old woman with multiple sclerosis and severe painful spasticity in her lower limbs. Her spasticity did not respond to treatment with physiotherapy, spasmolytic medication, botulinum toxin A, intrathecal baclofen or epidural spinal cord stimulation. RESULT: The patient was treated with selective posterior rhizotomy S1-L1. Section of 60% of the rootlets on the right side and 40% on left the side resulted in a good outcome with less spasticity and pain. Finally her contractures were treated with tenotomy and myotomy, also with good functional result. INTERPRETATION: Patients suffering from severe painful spasticity and who do not respond to physiotherapy in combination with other spasmolytic medication should be considered for surgical treatment. In some patients posterior rhizotomy is the treatment of choice.

Adult↗
PubMedDate not supplied

Ponseti versus traditional methods of casting for idiopathic clubfoot.

Serial casting is successful in avoiding extensive posteromedial release (PMR) in only 11% to 58% of patients with idiopathic congenital clubfoot. Extensive open surgery is commonly associated with long-term stiffness and weakness. Ponseti claims to avoid PMR in 89% of cases by using his specific technique of manipulation, casting, and limited surgery. The authors report their first 27 patients undergoing the Ponseti technique (34 feet) with a group of 27 matched control patients (34 feet). All patients underwent serial casting, begun within the first 3 months of life. The parameter studied was the need to perform PMR within the first year of life. In the Ponseti group, only 1 (3%) of 34 feet required PMR. In 31 (91%) of 34 feet, percutaneous Achilles tenotomy was performed at age 2 to 3 months. The average duration of casting was 2 months. In the control group, 32 (94%) of 34 feet required PMR within the first year of life, despite a longer casting period. Based on the authors' initial success with the Ponseti method, they no longer believe that PMR is required for most cases of idiopathic clubfoot. Foot abduction splints are crucial to avoid recurrence. Longer follow-up will determine whether the authors can continue to match Ponseti's reported outcomes.

Case-Control Studies↗