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PubMed2004

[Reconstruction of shoulder abduction and external rotation in obstetric brachial plexus palsy].

OBJECTIVES: We evaluated the results of the subscapularis and pectoralis major muscle releases and the transfer of the latissimus dorsi/teres major muscles to the rotator cuff in patients with internal rotation contractures due to obstetric brachial plexus palsy. METHODS: Seventy patients (44 boys, 26 girls; mean age 7.6 years; range 2 to 16 years) underwent transfer of the latissimus dorsi/teres major muscles to the rotator cuff. Spinal root involvement was at C5-C6 in 19 patients, at C5-C7 in 16 patients, and at C5-T1 in 35 patients. In 46 patients, the subscapularis muscle was released from the anterior surface of the scapula, and in 55 patients, the pectoralis major muscle was released by fractional tenotomy. The glenohumeral joint was evaluated by anteroposterior direct graphies and axial magnetic resonance scans. According to the Waters-Peljovich grading system, all the patients had type I or type II deformities. Pre- and postoperative range of motion values and Mallet scores were compared. The mean follow-up period was 37.9 months (range 24 to 64 months). RESULTS: The mean shoulder abduction increased to 132.6 degrees (range 90 degrees to 170 degrees; mean gain 60.3 degrees) and external rotation increased to 81.1 degrees (range 30 degrees to 100 degrees; mean gain 58.7 degrees). The mean postoperative Mallet scores for global abduction and external rotation were 3.9; hand-to-head, to-mouth, and to-back scores were 3.7, 3.4, and 2.5, respectively. No serious complications were seen during the follow-up period. CONCLUSION: The results of reconstruction techniques employed in our study show satisfactory increases in shoulder abduction and external rotation in patients with a minimal glenohumeral deformity.

Adolescent↗
PubMed2005

Early experience with the Ponseti method for the treatment of congenital idiopathic clubfoot.

BACKGROUND: The preferred conservative treatment for congenital idiopathic clubfoot deformity remains a controversial issue. OBJECTIVES: To compare the outcomes of two groups of CICF patients who underwent two different treatment protocols. METHODS: The study cohort included 72 infants treated in our hospital from August 1998 to December 2002. Group 1 comprised 40 infants (61 clubfeet) who were treated by a traditional method (a modification of the Kite and Lovell technique), and group 2 consisted of 32 infants (48 clubfeet) treated with the Ponseti technique. Both groups were similar in age, gender and severity of the deformity (Dimeglio scoring system). RESULTS: After an average follow-up of 54.9 months (range 44-68), 35 (57%) clubfeet in group 1 required surgical intervention and 27 (44%) clubfeet had a residual deformity at last follow-up. In the Ponseti group, 45 (94%) clubfeet were fully corrected at last follow-up (average 29.2 months, range 16-45) while 3 (6%) clubfeet had residual deformity and required surgery. Achilles tendon tenotomy was performed with no complications in 47 clubfeet (in group 2) at an average age of 2.4 months (range 2-4 months). CONCLUSIONS: Even after a relatively short follow-up period, our success rate with the Ponseti approach already appears to be significantly higher and to bear fewer complications than the traditional treatment, in agreement with the results published by other medical centers. We now endorse the Ponseti technique of conservative manipulative treatment for congenital idiopathic clubfoot in our department.

Achilles Tendon↗
PubMed2005

[Arthroscopic-assisted mini-open repair of rotator cuff tears].

OBJECTIVES: We retrospectively evaluated the results of patients who underwent arthroscopic-assisted mini-open repair of rotator cuff tears. METHODS: Twenty-three patients (7 males, 16 females; mean age 56 years; range 41 to 75 years) underwent arthroscopic-assisted mini-open repair for nonretracted rotator cuff tears. The right shoulder was involved in 15 patients and the left in eight patients; 83% being on the dominant side. The range of motion was measured with a goniometer, and muscle strength by manual examination. The patients were assessed by physical examination, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the UCLA scale, and magnetic resonance imaging (MRI). The mean follow-up was 32 months (range 12 to 61 months). RESULTS: All the patients had medium-sized ruptures. Biceps tenotomy was performed in three patients for tears affecting more than 50% of the biceps tendon. The mean preoperative active forward flexion increased from 99 degrees to 161 degrees , and active external rotation from 28 degrees to 50 degrees postoperatively (p<0.05); the strength of the supraspinatus and infraspinatus muscles increased significantly (p<0.05). The mean UCLA score was found as 31.6, showing an excellent result in nine patients (39.1%), good in 12 patients (52.2%), moderate in one (4.4%), and poor in one patient. The mean preoperative ASES score increased from 23.7 to 92.4 (p<0.05). The mean healing time was 1.7 months (range 1.5 to 12 months). Twenty-one patients (91.3%) were satisfied with the outcome. Of 16 patients with postoperative MRI scans, three (18.8%) exhibited recurrent ruptures. CONCLUSION: In selective cases, the clinical and functional results are successful following arthroscopic-assisted mini-open repair for rotator cuff tears.

Adult↗
PubMed1992

Heterotopic ossification in children after iliopsoas release.

Heterotopic calcification or ossification of the soft tissues adjacent to the lesser trochanter was observed in the radiographs of 4 patients during a retrospective review of the records of 68 patients with Perthes' disease. This abnormality has since been seen in one other patient with Perthes' disease and in five with spastic quadriplegia. All 10 patients are known to have undergone iliopsoas release as part of adductor tenotomy. The authors believe that the heterotopic ossification is related to the surgery.

Adolescent↗
PubMed2005

An unusual case of congenital convergent convergent strabismus fixus.

BACKGROUND: Convergent strabismus fixus is classified into congenital and acquired types; however, there are only a few detailed case reports of congenital convergent strabismus fixus. Here, we report a rare case of this condition in which the eyeball was shown by imaging diagnosis to be fixed with a hard cord-like material in the orbit. To our knowledge, there have been no previous reports of congenital convergent strabismus fixus caused by an abnormal cord-like material that was clearly identifiable by imaging. CASE REPORT: The patient was a 16 year old female who visited our department for consultation regarding restoration of normal appearance of her strabismus. She had undergone strabismus surgery at the age of 3 years, but a forced duction test was strongly positive in all directions, and the eyeball was not mobile at the time. The initial surgery performed was a tenotomy of the medial rectus muscle and inferior rectus muscle and resection of the lateral rectus muscle of the right eye. The eye position and eye movement remained unchanged after surgery. At this time, MRI of the orbital region was performed, and an abnormal cord-like material connecting the posterior eyeball to the orbital wall was detected in the orbit. The cord-like material was pulling strongly on the posterior eyeball, congenitally fixing the eye position internally. CONCLUSION: We experienced a rare case in which a hard cord-like material in the orbit congenitally fixed the position of the eyeball. On MRI, the intensity of the cord-like material was clearly different from those of the muscle and nerve tissues. Considering the linearity of the cord-like material and the results of a forced duction test, the cord-like material probably consisted of fairly hard tissue, similar to bone.

Adolescent↗
PubMed2005

[Contralateral neuro-motor apparatus under unilateral restriction of motor activity in rat].

Electromyographic recordings of contralateral m. gastrocnemius of the rat after unilateral section of Achilles' tendon (tenotomy) were studied. Motor reflex, Hoffman reflex and firing of motor units of contralateral m. gastrocnemius were recorded in control and in 10 days after tendotomy. Motor units changed their firing in the background and in reaction to sciatic nerve stimulation. The results of study showed that unilateral section of Achilles' tendon increased the excitability of single motoneurons of contralateral spinal senters.

Achilles Tendon↗
PubMed1979

[Is treatment of C.D.H. by progressive reduction by traction still advisable? (author's transl)].

The authors analyse the results that they have obtained in the treatment of C.D.H. either by conservative or surgical methods. The prevention of osteochondritis remains the main worry. However traction leads to long-lasting immobilization and sometimes it is not sufficient. The authors think that osteochondritis may be related to hyper-pressure on the femoral head or to lesions of the vascular pedicle and that in some cases shortening of the femur or tenotomies may allow a decrease of the plaster cast period. The indications on capculotomy, rotation osteotomy, salter osteotomy are discussed. It is concluded that the periods of traction and plaster cast immobilization should be lessened as much as possible.

Age Factors↗
PubMed2005

Acetabular dysplasia following closed reduction of developmental dislocation of the hip.

The purpose of this study was to determine the incidence of acetabular dysplasia following closed reduction of developmental dislocation of the hip, particularly as it relates to the age at reduction and the presence of the ossific nucleus. Thirty-five children with unilateral developmental dislocation of the hip underwent closed reduction. Medical records were reviewed for gender, side, age at reduction, use of Pavlik harness, prereduction traction, presence/absence of the ossific nucleus, and whether adductor longus tenotomy was performed. Acetabular index was measured. The mean age at reduction was 10 months. The mean length of follow-up was 91 months. Following closed reduction, the incidence of acetabular dysplasia was 69% (24 hips). No statistically significant relationship between acetabular dysplasia and age at reduction or presence of the ossific nucleus was demonstrated.

Acetabulum↗
PubMed1991

[Are patellar tension band reconstructions with absorbable materials possible? An animal experiment].

Different biodegradable tension band reconstructions of transverse osteotomies of sheep patella were tested in an experimental pilot study. Without postoperative immobilization, 4 metallic fixations in the control group dislocated secondarily 3 +/- 2 days after the operation. After tenotomy of the gastrocnemius muscle tendon, 6 other metallic fixations showed good bone healing after 12 weeks. Therefore all other fixations were immobilized postoperatively. In 5 of 6 tension band fixations with pure polydioxanone cords (PDS) ventral callus distraction started after 18 +/- 7 days, but total consolidation had taken place after 14 weeks. One PDS fixation failed for technical reasons. The combination of two axial polyglycolide rods (BIOFIX) with two ventral PDS cords showed different results: when rods 4.5 mm in diameter were used 1 fixation dislocated because the fragments were burst by the oversized rods. With rods 3.2 mm in diameter 3 other fixations were followed by complete consolidation with no dislocation after 12 weeks. Other tested combined fixation systems made up of polyglycolide and polylactide composites (cords, screws) failed secondarily, either because the fragments were burst by the oversized implants or because of the fragility of the polylactide cords. It was impossible to use polylactide screws as lag screws, because the screw heads gave way to torque. In an additional study we observed a decrease in tissue pH after implantation of polyglycolide rods in the medullary space of the tibia. Compared with the control medullary space without implants, the pH decreased from 7.38 to 6.92 at the point of greatest implant mass.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

[Vertical talus].

Authors differentiate four etiological groups of vertical talus. In their material the congenital and symptomatic rocker bottom foot was rarer than the paralytic one. Good result can be expected mainly from the operative treatment. From 69 cases good clinical and radiological result was reached in 58, whereas in 6 cases the treatment had no result. It was their experience that a reduction of the talus and of the navicular bone can be reached by tenotomies and capsulotomies and by these a normal form of the foot can be secured. In the conservation of the operative results the significance of the organized care is stressed.

Follow-Up Studies↗
PubMed2006

Pre- and post-critical period induced reduction of Cat-301 immunoreactivity in the lateral geniculate nucleus and visual cortex of cats Y-blocked as adults or made strabismic as kittens.

PURPOSE: To test the post-critical period stability of perineuronal nets by comparing the expression of antigens on aggrecan (a chondroitin sulfate proteoglycan (CSPG) recognized by the monoclonal antibody Cat-301) in the lateral geniculate nucleus (LGN) and striate cortex (A17) of adult Y-blocked cats and cats made strabismic and amblyopic as kittens. The comparison tested the idea that pre- and post-critical period loss of synchronous activity would differentially affect the perineuronal net of Y-type neurons in LGN and A17. METHODS: Seven adult cats, two normal, three convergent strabismic amblyopic, and two monocularly Y-blocked cats, were used in this study. The strabismic amblyopic cats had been made monocularly esotropic (by tenotomy) at 14 days of age. The Y-block was created acutely by a pressure cuff placed on the optic nerve behind the left eye in adult cats. The efficacy of both procedures was tested electrophysiologically. Frontal frozen sections were incubated with the Cat-301 antibody and the labeling visualized using a DAB kit. The sections were counterstained with cresyl violet. In each section, Cat-301-stained cells with well-defined nucleoli were counted under a 20x objective with a computer-based quantitative microscope image analysis system. RESULTS: The percentage of positively labeled cells was reduced in LGN laminae that received input from the deviated eye in amblyopic cats and from the pressure-blocked eye in Y-blocked cats compared with normal cats. Surprisingly, the non-blocked laminae of the Y-blocked cats also showed a significant reduction in positively labeled neurons when compared to normals or to strabismic cats. In the visual cortex of both hemispheres of strabismic and Y-blocked cats, the density of immunopositive neurons was significantly reduced compared with normal. The effect was most pronounced in layers IV-VI for Y-blocked cats and in layer IV for strabismic amblyopic cats. CONCLUSIONS: The results demonstrate that surface expression of aggrecan in adult cat LGN and A17 of adult cat is reduced both by chronic developmental loss of synchronous input from the two eyes and by acute changes in synchronous input in adulthood. Thus both pre- and post-critical plasticity in the expression of epitopes of aggrecan can be demonstrated. The uniform distribution of Cat-301 labeling tangentially within cortical layers of strabismic amblyopic cats indicates that the reduction in immunoreactivity observed with strabismus induced early in life is not simply eye-specific. Indeed, comparison of the immunopositivity of Y-blocked and strabismic animals, both in LGN and cortex, suggests that even after the critical period is ended, the physical removal of monocular Y-type afferent activity and weakening of binocular feedback connections between cortex and thalamus can alter the stability of the perineuronal nets surrounding the affected neurons.

Aggrecans↗
PubMed2006

Arthroscopic approach to massive rotator cuff tears.

The treatment of a patient with a painful massive rotator cuff tear can be challenging. Massive tears exceed 5 cm in length and involve partial or complete tearing of three tendons. The arthroscopic approach provides a minimally invasive technique to evaluate the tear, mobilize and repair tendons, and improve symptoms without disruption of the deltoid. The arthroscopic technique can create a low-tension repair. The reduction of postoperative motion provides the best environment for tendon-to-bone reattachment. Procedures that have reduced rates of adhesion formation allow for this protection with a minimal risk of stiffness. Reduction of the boutonniere effect of superior head migration leads to improved arm elevation. Strength deficits are common and relate to muscle and tendon deterioration that may not be reversible, even with successful closure of the tear. Weakness caused by suprascapular neuropathy may improve after the position and length of the posterosuperior cuff tendons are reestablished. Arthroscopic options include rotator cuff repair, partial cuff repairs, xenografts, decompression, débridement, biceps tenotomy, tenodesis, and use in autografting.

Arthroscopy↗
PubMed2006

Deep digital flexor tendon shortening as a treatment for distal interphalangeal joint hyperextension in a 2-year-old mare.

Shortening of the deep digital flexor tendon was performed by tenotomy, overlapping and anastomosis. The procedure was performed on a two-year-old Quarter Horse Mare with distal interphalangeal joint hyperextension with subluxation and metatarsophalangeal joint hyperextension. These problems originated from damage to the digital flexor tendons, presumably due to previous distal limb trauma. The procedure markedly improved the mare's level of comfort, degree of ambulation and limb conformation. Two years following surgery the mare was comfortable at pasture.

Animals↗
PubMed1991

[Tennis elbow].

Tennis elbow is most often due to a tendinitis of the extensor carpi radialis brevis, and occasionally of the extensor digitorum. Pain felt at the outer aspect of the elbow, is elicited by grasping. Passive movements are painless, and of full range, excepted for extension, and varus strain tested in slight flexion. Isometric contraction of all the muscles controlling the joint are painless, excepted resisted extension of the wrist. The most usual painful spots lay on the lateral epicondyle, or lower on the common tendon. Diagnosis is confirmed when signs disappear immediately after a correct injection of lignocaine, and persist at least 3 Weeks if a corticoïd is added. The two outstanding differential diagnoses are internal derangement of the humero-radial joint, and entrapment of the sensory branch of the radial nerve. Many treatments are indicated. In a series of 58 cases, cervical manipulations give in most cases only a temporary relief; deep transverse massage applied on the tendon below the epicondyle, gives in a series of 131 cases good and excellent results in 63% of the cases. In a series of 257 cases, injections of corticoïds gives full relief in all cases, but the rate of recurrences is 66.7%, although 67% of those recur only once or twice. Percutaneous tenotomy performed only in patients recurring after temporary cure, drops the rate of recurrences to 13%. The last alternative is open surgery, releasing the common tendon.

Humans↗
PubMed1991

Postoperative heterotopic ossification in children: a comparison of children with spina bifida and with cerebral palsy.

The authors reviewed 250 consecutive myotomies and tenotomies performed on the hips of 186 children. Two groups were studied: 162 children with cerebral palsy and 24 children with spina bifida. In total 19 children were found to have heterotopic ossification postoperatively. The incidence of heterotopic ossification was 21% in the spina bifida group and 8.6% in the cerebral palsy group. The most severe cases were in children with thoracic myelomeningocele. Only one child with lumbar myelomeningocele had ossification, and it was mild. This difference was statistically significant. Two children with thoracic spina bifida had severe ossification and abduction contractures requiring resection of the bony mass. Recurrence was successfully prevented by a course of radiotherapy.

Cerebral Palsy↗
PubMed1991

Shelf arthroplasty in patients who have Legg-Calvé-Perthes disease. A study of long-term results.

We reviewed the long-term functional and roentgenographic outcomes of severe Legg-Calvé-Perthes disease in two similar groups of patients, one of which was managed with a shelf arthroplasty and the other, by a variety of non-operative means. Twenty hips in nineteen patients were treated with traction and, when necessary, adductor tenotomy to attempt reduction of the subluxation; this was followed by a shelf arthroplasty to increase the arc of the acetabulum and result in coverage of the femoral head. The average duration of follow-up was nineteen years (range, two to forty-seven years). The initial center-edge angle and the anteroposterior Mose sphericity measurement were significantly improved at the most recent follow-up (p greater than or equal to 0.05), and the average Iowa hip score was 91 points. Hinge abduction, which was producing incongruity, was eliminated in eleven of fourteen hips after the operation. The outcomes for the second group, consisting of eighteen hips in seventeen patients who were managed non-operatively, were also reviewed, at an average duration of follow-up of twenty-eight years (range, seven to forty-five years). No significant improvement in the center-edge angle or the anteroposterior Mose sphericity measurement was observed at the most recent follow-up, and the average Iowa hip score was 81 points. There was no significant difference in the range of motion of the hip between the groups. We believe that shelf arthroplasty is a favorable option in the treatment of Legg-Calvé-Perthes disease when additional bone is needed at the lateral aspect of the acetabulum to cover the extruded portion of the femoral head, to prevent additional incongruity and thereby delay the early onset of degenerative changes.

Adolescent↗
PubMed1991

The Sequoia circular fixator for limb lengthening.

With the Sequoia fixator, lengthenings can be achieved based on the clinical facts of the case. The device is a modular apparatus that can perform corrections in several planes, and, if necessary, in a septic environment. In our opinion, a "lengthener surgeon" is one who can foresee problems and take appropriate steps to prevent them. Likewise, the surgeon must act as the coordinator of an entire team. A successful lengthening is 5% surgery and 95% postoperative nursing and physiotherapy care. In the future, a number of changes will simplify postoperative management: 1. Composite carbon rings will make the frames radiolucent and one third lighter than those made of stainless steel. Automatic tensioners will help maintain steady tension on the wires. 2. Digital analysis of the callus will provide norms of consolidation, allowing faster fixator removal and conversion to an orthosis. 3. Incorporating the foot in the frame to overcome equinus will eliminate the need for tenotomy. We believe that monolateral and ring fixators can work together in certain locations. That is why we proposed, at the 18th Societé Internationale de Chirurgie Orthopédique et Traumatologique meeting, a combined monolateral-ring construct that can be used for lengthening throughout the proximal femoral metaphysis.

Adolescent↗
PubMed1991

Posterior transfer of the adductors in children who have cerebral palsy. A long-term study.

Seventy-eight posterior transfers of the adductors of the hip in forty-two children who has spastic cerebral palsy were reviewed an average of 5.7 years after the operation (range, two to 14.6 years). The results were assessed on the basis of the patient's ability to walk, the range of motion of the affected hip or hips, and the radiographic measurements. In 88 per cent of the patients, the transfer was successful in improving or maintaining abduction, extension, functional walking, and stability of the hip. The failures were all in patients who were unable to walk and who had spastic quadriplegia. Tenotomy of the iliopsoas tendon at the time of the transfer procedure resulted in an improved range of motion of the hip.

Adolescent↗