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At least 163 records · Page 9Linked to original sources
PubMed1995

[Ultrasonographic study of the patellar tendon following bone-tendon-bone anterior cruciate ligament reconstruction arthroscopy].

The arthroscopic reconstruction of the anterior cruciate ligament requires the partial removal of the patellar tendon. US potentials in the assessment of residual patellar tendon after bone-tendon-bone removal were compared with those of CT and clinics. Mechanical resistance reduction of the residual tendon may be caused by removal modalities and size. This work was aimed at investigating the morphologic US patterns indicating "stability" of the operated tendon, which is mandatory for a risk-free functional recovery. Twenty patients were submitted to US of the operated tendon with contralateral comparison. In each patient tendon thickness and structure in the site of removal were studied, especially aiming at demonstrating diffuse or focal alterations of echogenicity. Middle third thickness and new tissue echostructure are fundamental US variables to define residual tendon "stability". The authors describe some US patterns of the surgical tendon to be considered as normal and not abnormal findings, provided that US be performed at least two months after surgery.

Adolescent↗
PubMed1996

Effects of tendon grip technique (frozen versus unfrozen) on in vitro surface strain measurements of the equine deep digital flexor tendon.

OBJECTIVE: To determine effects of tendon grip technique on in vitro surface strain measurements of equine deep digital flexor tendon (DDFT) when loaded in tension. SAMPLE POPULATION: 12 hind limb DDFT from 8 adult horses (mean age, 9.8 years [range, 4.5 to 17 years]; mean body weight, 472 kg [range, 450 to 509 kg]), with no clinical evidence of hind limb lameness. DESIGN AND PROCEDURE: After calibration, liquid mercury strain gauges were sutured to plantar surfaces of the tendons at distal (position 1), middle (position 2), and proximal (position 3) metatarsal regions. Each tendon was affixed to a materials testing machine (distally by the distal phalanx, and proximally by a metal clamp), and loaded once in tension, at a strain rate of 2.8 to 3.0%/s, to 3% clamp displacement. Liquid nitrogen was used to freeze the proximal ends of 6 tendons before placement in the clamp. Proximal ends of the remaining 6 tendons were left unfrozen. Surface strains were determined with the aid of low-resistance bridge circuits. Data were analyzed at time points corresponding to 1, 2, and 3% clamp displacement. RESULTS: Mean surface strains of tendons with frozen ends were significantly greater than those for tendons with unfrozen ends, and closer to strain measured by clamp displacement, at 1 and 2% clamp displacement. This difference was present but not significant at 3% clamp displacement. Mean local surface strain was not significantly different between the 3 gauge positions. CONCLUSIONS: Freezing tendon ends is a useful technique to increase measured surface strains in equine DDFT, thereby making them closer to universal strain as measured by clamp displacement, and, thus, more likely to represent true surface strain.

Animals↗
PubMed1996

Gene transfer to the rabbit patellar tendon: potential for genetic enhancement of tendon and ligament healing.

Injuries to ligaments and tendons occur very commonly, but often heal very poorly. A number of growth factors show promise as biological agents with which to augment the reparative responses of these tissues, but they are extremely difficult to deliver clinically. We have suggested the use of gene transfer as a possible way to obviate this limitation. Here we have used the lacZ marker gene to evaluate methods for gene delivery to ligaments and tendons. Cell cultures were established from the following tissues of the New Zealand white rabbit: anterior and posterior cruciate ligaments, medial collateral ligament, patellar tendon and semitendionsus. In vitro experiments confirmed that these cells were very efficiently transduced by an E1- E3- adenoviral vector carrying the lacZ gene. Cells derived from ligaments and tendons also proved readily susceptible to retroviral transduction and, following transfer of the ned gene, selection in G418. To determine whether these cells could be genetically altered in situ, gene transfer to the patellar tendons of rabbits' knee joints was attempted using an adenovirus for in vivo delivery and a retrovirus for ex vivo delivery. Direct, percutaneous injection of the adenovirus resulted in high levels of lacZ expression, but this was limited to the area of tendon immediately adjacent to the injection site, and preferentially labeled cells in the epitenon sheath. An unexpected finding of these studies was the in vivo adenoviral transduction of bone cells in areas where the tendon insertion site had been accidentally injected. Allotransplantation of tendon fibroblasts into which the lacZ gene had been retrovirally introduced led to lacZ expression throughout the body of the tendon itself. The genetically altered cells appeared able to migrate from the site of injection and to integrate themselves into the crimp pattern of the tissue. Both in vivo and ex vivo methods led to gene expression for at least 6 weeks, which may be long enough for clinical purposes.

Adenoviridae↗
PubMedDate not supplied

Reconstruction of skin and tendon defects from wound complications after Achilles tendon rupture.

Four patients who developed combined tendon and overlying skin defects following operative repair of ruptured Achilles tendon were presented. Three patients had an infected wound. The average interval from the first operation for repairing the ruptured Achilles tendon and the reconstructive procedure was 46.2 days (range, 5-65 days). All patients were treated with a one-stage operation including radical debridement, reconstruction of the Achilles tendon defects using vascularized or nonvascularized tendon grafts, transfer of peroneus brevis for augmentation, and skin coverage with a free flap. The patients recovered uneventfully. The average follow-up period was 39.2 months (range, 18-79 months). In all patients, an evaluation of the clinical outcome, the performance of the calf muscles using a computerized dynamometer, and structural changes of the reconstructed Achilles tendon using magnetic resonance (MR) imaging were made. The clinical outcome was excellent in three patients and good in one. In isokinetic testing (Cybex-Norm), strength was found to be normal in one patient and abnormal in three patients. MR images revealed an intratendinous area of homogenous and normal intensity signal, and a significant increase in thickness and width in all levels of the reconstructed Achilles tendon. The authors conclude that it is possible to obtain satisfactory function in patients with complex wounds in the region of the Achilles tendon.

Achilles Tendon↗
PubMed2006

Is the chronic painful tendinosis tendon a strong tendon?: a case study involving an Olympic weightlifter with chronic painful Jumper's knee.

The chronic painful tendinosis tendon is generally considered a degenerated and weak tendon. However, this has not been scientifically verified, and is to be considered a hypothesis. We present here a case study involving a high-level Olympic weightlifter with chronic painful patellar tendinosis who started heavy-weight training very early after successful treatment with sclerosing injections. A 25-year-old super heavy-weight (+105 kg) Olympic weightlifter with 9 months duration of severe pain (prohibiting full training) in the proximal patellar tendon, where ultrasound and Doppler showed a widened tendon with structural changes and neovascularisation, was given one treatment with ultrasound and Doppler-guided injections of the sclerosing agent polidocanol. The injections targeted the neovessels posterior to the tendon. The patient was pain-free after the treatment, and already after 2-weeks he started with heavy-weight training (240 kg in deep squats) to try to qualify for the Olympics. Additional very heavy training on training camps, most often without having any discomfort or pain in the patellar tendon, resulted in Swedish records and ninth place at the European Championships 17 weeks after the treatment. Despite beating the national records, he did not qualify for the Olympics. Ultrasound and Doppler follow-ups have shown only a few remaining neovessels, and little structural tendon changes. This case questions previous theories about the weak tendinosis tendon, and stresses the importance of studies evaluating tendon strength.

Adult↗
PubMed1999

Effects of increased in vivo excursion on digital range of motion and tendon strength following flexor tendon repair.

Postoperative rehabilitation is an important factor in determining functional outcome following intrasynovial flexor tendon repair. We hypothesized that a rehabilitation protocol that produced increased in vivo excursion would lead to increased digital range of motion and tendon strength and decreased adhesion formation in a canine model. Ninety-six flexor digitorum profundus tendons from 48 dogs were cut transversely and repaired by a multistrand suture technique. Postoperative rehabilitation was performed daily with a low excursion-low force (1.7-mm average excursion; < 10 N force) or a high excursion-low force (3.6 mm excursion; < 10 N force) protocol. After death of the dogs at 10, 21, or 42 days, specimens were evaluated for digital range of motion, tensile mechanical properties, elongation of the repair site, and adhesion formation. Our data indicate that the range of motion of digits whose tendons were at low or high excursion was similar to that of controls. Increased in vivo tendon excursion due to synergistic wrist motion did not significantly affect ex vivo flexion of the distal and proximal interphalangeal joints or tendon displacement (p > 0.05). Similarly, tensile properties (ultimate load, repair site rigidity, and repair site strain at 20 N and at failure) and length of the gap at the repair site were not significantly affected by increased excursion (p > 0.05). Severity of adhesion formation was reduced slightly by increased excursion (p = 0.04). Our findings indicate that 1.7 mm of tendon excursion is sufficient to prevent adhesion formation following sharp transection of the canine flexor tendon and that additional excursion provides little added benefit.

Animals↗
PubMed2001

Gliding characteristics of tendon repair in canine flexor digitorum profundus tendons.

The gliding resistance between the flexor digitorum profundus (FDP) tendon and the proximal pulley system was measured using the method of S. Uchiyama, J.H. Coert, L. Berglund, P.C. Amadio, K.N. An (J. Orthop. Res. 13 (1995) 83) in 108 adult dog digits in vitro. The FDP tendons were then lacerated to 80% of their transverse section. Each tendon was repaired with one of the following six suture techniques: Kessler, modified Kessler, Savage, Lee, Becker and simple running suture alone. Each repaired tendon was then tested again using the same method. The Student-Newman-Keuls test for multiple comparisons was performed for statistical analysis. The average gliding resistances of the Kessler, Savage, and Becker repairs were significantly greater than the resistances of the Lee, modified Kessler, and running suture alone repairs (P < 0.05). The Lee suture technique had a significantly greater resistance than the modified Kessler repair and the running suture (P < 0.05). The results of the peak gliding resistance followed the same trends, except that the modified Kessler repair was significantly higher than the running suture alone (P < 0.05). Suture techniques with a multi-strand core suture, with knots located outside the tendon surface, and with multiple-loops on the tendon surface may result in increased gliding resistance between the tendon and pulley system after tendon repair.

Animals↗
PubMed2000

Conservative management of zone II partial flexor tendon lacerations greater than half the width of the tendon.

Over a 5-year-period 15 patients with zone II partial flexor tendon lacerations that were larger than half the width of the tendon were treated conservatively without tendon suturing. Surgical exploration was done with a digital block and the flexor tendons were observed as the patient fully extended and flexed the finger. If present, the cause of triggering was determined and eliminated by trimming any beveled tendon edge, resection of the involved pulleys, and repair of the flexor sheath. Early protected mobilization was started the first day after injury using a dorsal splint. At 4 weeks after injury the splint was removed and exercises against resistance were started. None of the patients had triggering or rupture of the flexor tendons. Using the Strickland-Glogovac evaluation method, results were excellent in 93% of cases and good in the remaining 7%. It was concluded that conservative management of zone II partial flexor tendon lacerations larger than half the width of the tendon is safe as long as certain guidelines regarding the prevention of triggering and protected mobilization are applied.

Adult↗
PubMed2001

Flexor tendon wound healing in vitro: the effect of lactate on tendon cell proliferation and collagen production.

Flexor tendon repair in zone II is complicated by adhesions to the surrounding fibro-osseous sheath. Lactate is an early mediator of wound healing known to play an important role in stimulation of collagen production after cellular injury. Little attention has been paid to the role of lactate in flexor tendon wound healing. In this study tendon and tendon sheath were excised from rabbit forepaws. We examined proliferation of tendon sheath fibroblasts, epitenon tenocytes, and endotenon tenocytes; collagen production by each of these 3 cell types; and effects of lactate on cell proliferation and collagen production. Three cell lines, tendon sheath, epitenon, and endotenon, were isolated and cultured. Tendon sheath fibroblasts showed the greatest proliferation. All 3 cell lines produced collagen I, II, and III. Lactate significantly increased collagen production by all 3 cell lines. We show that cells of the tendon sheath, epitenon, and endotenon produce collagen in vitro. Modulation of lactate levels may provide a means to modulate collagen production.

Animals↗
PubMedDate not supplied

[Surgical shortening of the Achilles tendon for correction of elongation following healed conservatively treated Achilles tendon rupture].

INTRODUCTION: Is operative shortening of the achilles tendon an adequate therapy in cases of elongation following conservative treatment of achilles tendon rupture? METHODS: From 11/89 to 12/97, 12 patients underwent achilles tendon shortening (9 male, 3 female, average age 43 years). All patients had an elongated tendon following conservative treatment of achilles tendon rupture. We were able to examine 8 patients (67%) after the operation. The average follow-up period was 35 (7-103) months with an average span between the primary trauma and surgery of 22 (8-45) months. RESULTS: Prior to surgery, all patients complained of weakness, gait disturbance and limitation of activity. At follow-up a subjective weakness of the plantar flexion remained in five and an objective weakness in all patients. We found a decrease of the isometric plantar flexion strength to 52% of the non-operated lower extremity while the maximum calf circumference was only 5% decreased. Only two patients reported of a gait disturbance and activity limitation whereas three patients were free of complaints. Using a modified Trillat score (1,967), 7 patients rated good or very good (1 poor). CONCLUSIONS: Achilles tendon shortening in case of elongation following conservative treatment of achilles tendon rupture helps to decrease gait disturbance and limitation of activity whereas a lack of the isometric plantar flexion strength persists. In our opinion an early decision for achilles tendon shortening might prevent this deficit.

Achilles Tendon↗
PubMed1997

Tendonitis of the branches of insertion of the superficial digital flexor tendon in horses.

OBJECTIVE: To describe clinical findings, ultrasonographic features and outcome of injury to the branches of insertion of the superficial digital flexor (SDF) tendon in horses. DESIGN: Retrospective study of 14 cases. PROCEDURE: Fourteen Thoroughbred horses with tendonitis affecting the branches of insertion of the SDF tendon were examined for lameness, location and amount of swelling, and the presence of other musculoskeletal abnormalities. The flexor tendons were assessed by ultrasonographic examination, and recommendations were made for management of the cases. Outcome was assessed by re-examination of some horses, direct communication with the owner or trainer, and examination of race records. RESULTS: The lateral SDF branch was affected in 10 horses; the medial branch in three, and both branches in one horse. Two horses had concurrent injuries to the SDF tendon in the metacarpal region of the contralateral limb. Ultrasonographic findings included swelling of the affected SDF branch, peritendinous fluid accumulation, disruption of normal fibre alignment on sagittal scan, and variable loss of echogenicity. As healing occurred, there was return of normal echogenicity, but normal fibre alignment did not return completely and apparent adhesions formed between the affected SDF branch and adjacent structures. Seven of 10 horses which returned to their previous use were able to compete without further tendon injury. Recurrence of injury occurred in one case, and another two horses developed tendonitis in the metacarpal region. One horse was retired from racing but was able to compete at dressage without recurrence of injury. Two horses were retired for breeding without returning to training, and one horse was sold and lost to follow up but did not race. CONCLUSION: The prognosis is fair for return to previous use following injury to the branches of insertion of the SDF tendon in athletic horses.

Animals↗
PubMed2005

High reproducibility of patellar tendon vascularity assessed by colour Doppler ultrasonography: a reliable measurement tool for quantifying tendon pathology.

BACKGROUND: This study examined whether patellar tendon vascularity could be quantified accurately in the clinical setting using colour Doppler ultrasonography. METHODS: A sonographer and two radiologists visually estimated tendon vascularity in millimetres in 74 tendons during ultrasound (US) examination and from hard copy films. These estimates were then compared to the length of vessels measured from the digital image in millimetres and the correlation between them was determined. A subset of 16 tendons was used to compare the estimates of vascularity by two examiners at US examination. RESULTS: The estimation of vascular length at US examination correlated highly with the measured vascular length (r = 0.92; 95% confidence interval (CI) 0.87 to 0.94), as did the length estimated from the films (r = 0.94; 95% CI 0.9 to 0.96). The correlation between examiners was 0.84 (95% CI 0.51 to 0.94) for the estimates made during US examination and 0.85 (95% CI 0.59 to 0.95) for the vessel lengths measured from the digital images. CONCLUSIONS: These excellent correlations indicate that tendon vascularity can be reliably estimated using colour Doppler ultrasonography and tendon vascularity could therefore be used by clinicians to rate clinical change. This method of quantifying tendon vascularity could also be used in research to investigate the effects of tendon treatments on vascularity.

Humans↗
PubMed2005

An outcome study of chronic Achilles tendinosis after excision of the Achilles tendon and flexor hallucis longus tendon transfer.

BACKGROUND: A number of operative techniques, including decompression with debridement and flexor hallucis longus (FHL) tendon augmentation, have been described for chronic degenerative Achilles tendinosis. Decompression with debridement has been shown to be effective; however, pain and functional limitation can persist in individuals with more severe tendon involvement. Augmentation with the FHL tendon can add mechanical support; however, difficulty in achieving proper tendon tensioning and the potential to leave behind painful diseased tendon are disadvantages of the technique. The purpose of this study was to present the results of a modified technique in which the Achilles tendon is completely excised and the FHL tendon is transferred. METHODS: Fifty-six surgeries using this modified technique were done between October, 1994, and March, 2002, for patients with chronic degenerative Achilles tendinosis. Forty-four patients with and average age of 58.2 (SD 10.1) years and an average time of followup of 3.4 (SD 1.9) years were available for testing. All subjects were mailed a packet of standardized questionnaire information that included the Self-Reported Health Related Quality of Life measures Short Form (SF-36) and the subjective component of the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot Score. Nineteen patients returned to the clinic for objective assessment. Statistical analysis tested for a difference in the SF-36 scores between our subjects and the general United States population and for a difference in strength and range of motion between the involved and uninvolved lower extremities. RESULTS: Pain decreased in 95.5% (n = 42) patients, and 86.4% (n = 38) patients were satisfied with the result. There was no significant difference (p > .05) between the SF-36 scores obtained by our sample compared to the general United States population. The average AOFAS score for the 19 patients was 91.6 (SD 7.7). Dorsiflexion range of motion was not significantly different (p = 0.17); however, significant deficits were found in plantarflexion range of motion (p = 0.001) and plantarflexion strength (p < 0.025). Strength deficits were 30% on average; however, all but one patient could do a heel raise. CONCLUSION: Complete Achilles tendon excision reduces pain while preserving functional status. Although strength deficits persisted, these deficits did not seem to affect the functional status in this sample of patients.

Achilles Tendon↗