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PubMedDate not supplied

[Percutaneous tenodesis of the Achilles tendon. A new surgical method for treatment of acute Achilles tendon rupture using percutaneous tenodesis].

APPROACH TO THE PROBLEM: Various studies (3, 6, 9, 14, 22, 28, 30, 33) have shown that, on average (26), the surgical treatment of a freshly ruptured Achilles tendon can be considered a more appropriate and better treatment than a conservative immobilisation therapy. On the other hand the rate of complications in openly executed reconstructions is quite considerable at 11-29% (13, 19, 20, 31). It therefore seems reasonable to develop a process which, by using minimal invasive measures on the tendon, reduces the risk of complications arising from surgery and simultaneously makes an early post operative treatment encouraging maximum mobility possible. METHOD: We have developed a percutaneous tenodesis of the Achilles tendon using two Lengemann extension wires and fibrin bonding at the point of rupture (8, 18). This process has been applied to 21 patients since 1995. Check-up period for further examination: 1 year. RESULTS: Exclusively male patients have been treated, average age 42 years. The Achilles tendon ruptures occurred in sporting activities and were handled with operations in an average time span of 22 hours. In one case there was a re-rupture resulting from traumatic conditions. All other results were good to very good and free of complications. CONCLUSIONS: The percutaneous tenodesis of the Achilles tendon using Lengemann extension wires and fibrin bonding provides a simple, good value and reliable process which should be used for freshly occurred Achilles tendon ruptures. CLINICAL RELEVANCE: Particularly worthy of mention are the problem-free treatment, the good results and the broad acceptance by the patients. These advantages make the demonstrated process ideal for routine clinical application.

Achilles Tendon↗
PubMed1999

Percutaneous tenodesis of the Achilles tendon. A new surgical method for the treatment of acute Achilles tendon rupture through percutaneous tenodesis.

Various studies have shown that the operative treatment of a freshly ruptured Achilles tendon is generally considered to be more appropriate than a nonoperative regimen. However, complications in open reconstructions are reported to occur between 11-29%. We intended to develop a method which reduces the risk of complications arising from operation but simultaneously allows early postoperative mobilization and functional treatment. We developed a percutaneous tenodesis of the Achilles tendon, using two Lengemann extension wires for adaptation of the ruptured tendon. This method of treatment has been applied in 20 patients. The postoperative observation period was one year. All patients were male, their average age was 42 years. The Achilles tendon ruptures occurred during sporting activities and were treated by operation within 22 h on average. The outcome was very good in 95%. One patient (5%) suffered a rerupture due to trauma. There was no other complication.

Achilles Tendon↗
PubMed2006

Outcomes of dorsal capsulodesis and tenodesis for treatment of scapholunate instability.

PURPOSE: The ideal treatment for scapholunate (SL) instability has not yet been established. This study examined the results of 2 procedures for the primary treatment for chronic SL dissociation of dorsal capsulodesis and flexor carpi radialis tenodesis. METHODS: A retrospective analysis was conducted that examined dorsal capsulodesis and tenodesis procedures performed for chronic SL instability between January 1995 and February of 2003. Twenty-nine patients were identified with isolated chronic SL instability. Of the 29 patients, 14 had a dorsal capsulodesis procedure and 15 had a tenodesis procedure. The follow-up period averaged 38 months in the capsulodesis group and 36 months in the tenodesis group. Results were reviewed clinically and radiographically. Groups were compared with a Student t test. RESULTS: Postoperative wrist motion decreased in both groups after surgery. Final wrist range of motion was 64% of the unaffected side in the capsulodesis group and 63% of the unaffected side in the tenodesis group. Postoperative grip strength remained unchanged in both groups; grip strength measured 91% of the unaffected side in the capsulodesis group and 87% of the unaffected side in the tenodesis group. The average Mayo wrist scores were 77 in the capsulodesis group and 74 in the tenodesis group. One frank failure occurred in the tenodesis group resulting in a wrist fusion. There was no statistical difference in the overall wrist motion, grip strength, or wrist scores between the capsulodesis and tenodesis groups. CONCLUSIONS: Dorsal capsulodesis and tenodesis provided improvement in symptoms for patients with chronic SL instability. Both procedures appear to provide similar results in the treatment of this difficult problem.

Adult↗
PubMed2005

Long head biceps tenotomy versus tenodesis: a cadaveric biomechanical analysis.

PURPOSE: Treatment of pathology of the long head biceps (LHB) tendon has become an area of renewed interest among orthopaedic surgeons in recent years. Numerous authors have recommended tenotomy, whereas others have recommended tenodesis to avoid distal migration of the LHB tendon stump and the associated cosmetic deformity that may develop. The purpose of the present study was to determine the likelihood of distal migration from the bicipital groove of the long head biceps tendon after tenotomy under physiologic loading conditions and the ultimate load to failure for tenotomized LHB tendons, and to compare these values with those present after tenodesis with an interference screw in a cadaveric model. TYPE OF STUDY: Anatomic cadaveric biomechanical study. METHODS: Cyclic loading was performed on 10 cadaveric shoulders through the LHB tendon on an MTS machine (Materials Testing System; MTS Systems Corp, Minneapolis, MN) at a peak force of 50 N (loading rate of 100 N/second) for 200 cycles. After cyclic loading, the specimens were tested to failure at a loading rate of 100 N/second. Failure was defined as migration of the biceps stump distal to the bicipital groove on the proximal humerus. The LHB tendon was then passed back up the bicipital groove and tenodesis was performed in the groove with a bioabsorbable interference screw according to a previously described technique (Arthrex, Naples, FL). Cyclic and load to failure testing were then repeated in similar fashion and the values were recorded and compared with those of the tenotomized subjects (n = 10 in each group). RESULTS: Four of 10 tenotomized specimens (40%) failed during cyclic loading, with the average number of cycles to failure being 35. The other 6 specimens passed the cyclic test. The average ultimate load to failure in these specimens was 110.7 N. After biceps tenodesis, all specimens passed the cyclic loading test. The average ultimate load to failure in these 10 specimens was 310.8 N. Compared with the 6 tenotomized specimens that passed the cyclic test, the specimens that underwent tenodesis had a significantly higher pullout strength (ultimate strength) with P = .001. CONCLUSIONS: These results show that, compared with tenodesis, biceps tenotomy results in a significant risk of distal LHB tendon migration and significantly lower load to failure. Cyclic loads similar to those produced by gentle active range of motion without resistance resulted in failure in 40% of specimens tested after an average of 35 cycles. Based on these results, the authors recommend that LHB tenodesis be considered in any patient who may object to the cosmetic deformity and associated dysfunction produced by distal LHB tendon migration after tenotomy. CLINICAL RELEVANCE: The findings of this study help determine whether to perform long head biceps tenotomy or tenodesis when dealing with long head biceps tendon pathology.

Adult↗
PubMed2005

The biomechanical evaluation of four fixation techniques for proximal biceps tenodesis.

PURPOSE: The purpose of this study was to compare the cyclic displacement and ultimate failure strength of 4 proximal biceps tendon tenodesis fixation methods: the open subpectoral bone tunnel (SBT) biceps tenodesis, the arthroscopic suture anchor (SA) tenodesis, the open subpectoral interference screw (SIS) fixation technique, and the arthroscopic interference screw (AIS) technique. TYPE OF STUDY: Biomechanical experimental control. METHODS: Twenty fresh-frozen cadaver shoulders were dissected free of soft tissues, leaving the proximal humerus and the proximal biceps tendon as a free graft. Specimens were randomized to 1 of 4 groups with 5 total specimens in each group. A proximal biceps tenodesis was performed according to the techniques listed above. The specimens were mounted for an axial pull of the biceps tendon on a servohydraulic materials testing system with a 100-N load cycled at 1 Hz for 5,000 cycles, followed by an axial load to failure test. Cyclic displacement, ultimate load to failure, and site of failure were recorded for each specimen. RESULTS: The mean cyclic displacement recorded for each experimental group was as follows: SBT group, 9.39 +/- 2.82 mm; AIS group, 5.26 +/- 2.60 mm; SIS group, 1.53 +/- 0.60 mm; and SA group, 3.87 +/- 2.11 mm. The mean ultimate failure loads after 5,000 cycles were as follows: SBT group, 242.4 +/- 51.33 N; AIS group, 237.6 +/- 27.58 N; SIS group, 252.4 +/- 68.63 N; and SA group, 164.8 +/- 37.47 N. Each specimen failed at the tenodesis site. CONCLUSIONS: The SBT group showed statistically significant greater displacement than the other tenodesis methods. There were no statistically significant differences in ultimate failure strength between any of the biceps tenodesis methods tested. CLINICAL RELEVANCE: The data serve as a guide to the surgeon performing a proximal biceps tenodesis in choosing a fixation method.

Aged↗
PubMed1987

Classification of the main tenodesis techniques used in hand surgery.

The authors put forward a simple classification of the main types of tenodesis used in hand surgery. This classification is based on the theoretical mechanical effects of different tenodesis techniques. It separates simple tenodesis, which overrides only one joint, from dynamic tenodesis, which crosses two or more joints, and further subdivides "direct" and "crossed" dynamic tenodesis. Direct tenodesis is situated on the same side as the rotation axis of the joints, whereas crossed tenodesis crosses those rotation axes. The concept of "reciprocal" tenodesis effect is also introduced. Many different examples are used to illustrate this classification, with appropriate illustrations.

Hand↗
PubMed2005

Time-dependent changes in failure loads of 3 biceps tenodesis techniques: in vivo study in a sheep model.

BACKGROUND: Failure load of the tendon-fixation material-bone unit has a crucial importance for the rehabilitation protocol after tenodesis procedures. PURPOSE: To investigate and compare the time-dependent changes in fixation strengths of 3 proximal biceps tenodesis techniques. STUDY DESIGN: Controlled laboratory study. METHODS: Two intraosseous techniques (suture sling and tenodesis screw) and 1 extraosseous technique (2 suture anchors) were investigated. Biceps tenodesis was performed on 45 shoulders of 26 sheep, 15 shoulders for each technique. Twelve similar cadaveric sheep shoulders (4 for each technique) provided the day 0 results. Sheep were sacrificed at 3, 6, and 9 weeks, and specimens were tested for the failure load of the tenodeses. RESULTS: All 3 tenodesis techniques were found to have similar failure loads at all time intervals tested. All 3 curves remained below the failure load of the intact tendon (862 +/- 96 N) and above their day 0 results for the study period; similarly, at each time interval, results tended to be better compared to the previous test. The tenodesis screw group exhibited significantly higher failure loads at week 3 (419 +/- 53 N) compared to day 0 values (164 +/- 45 N) (P = .009). The same level of significance was observed at week 6 in the remaining 2 groups. CONCLUSION: Tenodesis of the biceps tendon on the proximal humerus at an extra-articular site does not weaken after surgery. The tenodesis screw group had a significantly higher increase in the fixation strength within the first 3 weeks. CLINICAL RELEVANCE: No significant differences could be found between the failure loads of all 3 investigated tenodeses for the first 9 weeks.

Absorbable Implants↗
PubMedDate not supplied

The effect of an iliotibial tenodesis on intraarticular graft forces and knee joint motion.

Lateral extraarticular reconstructions are used as isolated procedures in knees with moderate rotatory instability and as "backups" in knees requiring primary repair or intraarticular reconstruction for major rotatory instability. We used an experimental knee testing system to analyze the immediate postoperative mechanical effect of an iliotibial band tenodesis on an intraarticular reconstruction of the ACL in fresh cadaver knees using a composite graft consisting of a bone-patellar tendonbone segment augmented with the Kennedy Ligament Augmentation Device (LAD, 3M Co., St. Paul, MN). The intraarticular graft was standardized by using a forcesetting technique. Ligament and graft forces were measured using buckle transducers, and joint motion was measured using an instrumented spatial linkage as 90 N anteriorly directed tibial loads were applied to seven fresh knee specimens at 0 degrees, 30 degrees, 60 degrees, and 90 degrees of flexion. The following knee states were tested in each specimen: intact ACL, excised ACL, intraarticular reconstruction, intraarticular reconstruction with the tenodesis added, and tenodesis with the intraarticular reconstruction added. Adding the iliotibial band tenodesis to an existing standardized intraarticular reconstruction significantly decreased the force in the ACL composite graft by an average of 43%. When the standardized intraarticular reconstruction was added to an existing tenodesis, the graft forces were an average of 15% below the level of when the reconstruction was performed alone. The force in the tenodesis was significantly less than the composite graft force at extension; however, the differences between the tenodesis and total graft force were not significant from 30 degrees to 90 degrees of flexion.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena↗
PubMed2006

To detach the long head of the biceps tendon after tenodesis or not: outcome analysis at the 4-year follow-up of two different techniques.

The aim of this study was to determine whether or not detaching the biceps tendon from the glenoid after tenodesis performed with the inclusion of the biceps in the rotator cuff suture results in an improved outcome. From 1999 to 2001, 22 patients had an arthroscopic rotator cuff repair and associated biceps tendon lesions that were repaired with two new arthroscopic techniques of tenodesis incorporating the biceps tendon in the rotator cuff suture. Patients were randomised into one of two groups: tenodesis without tenotomy (group 1) and tenodesis with tenotomy (group 2). Preoperative and postoperative functions were assessed by means of a modified UCLA rating scale and shoulder ROM. The mean follow-up period was 47.2 months (range 36- 59). In group 1 (tenodesis without tenotomy), eight patients had an excellent postoperative score and three a good postoperative score. The UCLA rating system used for evaluation showed a statistically significant improvement from the preoperative average rating of 10.5 (5-15) to the postoperative average score of 33 (29-35) (P<0.05). In group 2 (tenodesis with tenotomy), the UCLA rating system used for evaluation showed a statistically significant improvement from the preoperative rating of 11.1 to the postoperative score of 32.9 (P<0.05). No statistically significant difference in the total UCLA scores was found when comparing the repairs performed with or without tenotomy. Follow-up results with regard to ROM were not different between the two groups, and the range of motion was improved in all measured directions. In this series, every patient qualified as having good to excellent results according to the UCLA score. This study suggests that there is no difference between detaching and not detaching the biceps after including it in the repair.

Adult↗
PubMed2005

A biomechanical analysis of two biceps tenodesis fixation techniques.

PURPOSE: To assess and compare the biomechanical properties and load-to-failure of 2 biceps tenodesis fixation techniques, interference screw fixation and double suture anchor fixation. TYPE OF STUDY: Biomechanical study. METHODS: Eleven fresh-frozen human cadaveric specimens were used in this study. A biceps tenodesis was performed using 1 of 2 techniques, interference screw fixation or double suture anchor fixation. A 7-mm interference screw was used in 5 cadaveric trials. A double suture anchor technique was performed in 6 cadaveric specimens. The tenodesis construct in each specimen was loaded to failure using a Servohydraulic materials test system (MTS Model 858; Bionix, MTS Corp, Minneapolis, MN). Each specimen was loaded at 5 mm/second with a preload of 5 N with the vector of pull distally in line with the long axis of the humerus. Each specimen was then loaded until failure of the repair occurred. Statistical analysis of the interference screw group compared with the suture anchor group was performed using a Student t test. RESULTS: The mode of failure of the interference screw group was variable, but the suture anchor group consistently failed at the anchor or anchor eyelet. The average pullout strength of the suture anchor group was 135.5 +/- 37.8 N whereas the failure load in the interference group was 233.5 +/- 55.5 N. The interference group had a significantly greater resistance to pullout than the suture anchor group (P = .007). CONCLUSIONS: Based on these results, a biceps tenodesis using an interference screw will provide greater fixation strength than a biceps tenodesis performed with a double suture anchor technique. CLINICAL RELEVANCE: The surgeon treating biceps tenodesis may wish to choose a fixation technique with higher initial strength (interference screw instead of double suture anchor) to lessen the chance of early failure, particularly if the patient begins early active elbow flexion.

Adult↗
PubMedDate not supplied

The cosmetic appearance of the biceps muscle after long-head tenotomy versus tenodesis.

PURPOSE: This study evaluates the cosmetic appearance of the biceps muscle after arthroscopic, intra-articular biceps tenotomy versus tenodesis by presenting subjective outcome results in patients with refractive bicipital pain. TYPE OF STUDY: Retrospective study evaluating clinical follow-up of patients with refractive and chronic bicipital pain. METHODS: Five consecutive years of patients receiving biceps tenotomy (80 patients; 40 males, 40 females; average age, 58 years) or tenodesis (80 patients; 51 males, 29 females; average age, 54 years) procedures were retrospectively followed-up by grading anterior shoulder pain, muscle spasms in the biceps, and cosmetic deformity of the biceps muscle. Statistics were done by chi(2) analysis. RESULTS: When assessing the follow-up questions, no statistical significance was found between the biceps tenotomy and biceps tenodesis groups. There was also no statistical significance when comparing the biceps tenotomy and biceps tenodesis groups when evaluating only the men, women, and men versus women with respect to the questions assessed. CONCLUSIONS: In the majority of patients in which a biceps tenotomy is performed, we note that the cosmetic appearance of the biceps muscle, the grade of muscle spasms of the biceps, and the level of anterior shoulder pain would present with little difference than if a tenodesis had been performed. Therefore, a biceps tenotomy may be a reasonable alternative to a biceps tenodesis in patients with refractive and chronic bicipital pain.

Adult↗
PubMed2004

Tendon graft fixation in ACL reconstruction: in vitro evaluation of bioabsorbable tenodesis screw.

BACKGROUND: Conventional ACL reconstruction requires sufficient tibial bone quality for secure graft fixation. We evaluated the mechanical characteristics of a supplemental tenodesis screw in cadaveric specimens. MATERIAL AND METHODS: One group of 7 specimens from 7-paired tibiae was randomly assigned to undergo tibialis anterior tendon graft-bone tunnel fixation with a bioabsorbable interference screw, using conventional ACL reconstruction techniques. The other group of 7 specimens underwent the same procedure supplemented with a bioabsorbable tenodesis screw. All specimens were subjected to pullout testing on a servo hydraulic device. RESULTS: Specimens in the supplemental fixation group had double the load to failure (tenodesis = 467 (SD 184) N, control group = 223 (SD 66) N, p = 0.02) and were also one-third stiffer (tenodesis = 31 (SD 13) N/mm, control group = 21 (SD 6) N/mm, p = 0.03) than the specimens in the conventional fixation group. INTERPRETATION: Supplemental bioabsorbable tenodesis screw fixation may be advantageous for primary reconstruction in patients with low tibial bone mineral density or during revision procedures. By providing secure soft tissue graft-tibia fixation during the early phase after ACL reconstruction, supplemental tenodesis fixation may enable patients to participate safely in more intense, early rehabilitation.

Absorbable Implants↗
PubMedDate not supplied

An in vitro study of the Müller anterolateral femorotibial ligament tenodesis in the anterior cruciate ligament deficient knee.

The biomechanical effectiveness of the Müller anterolateral femorotibial ligament (ALFTL) iliotibial band tenodesis on anterior stability and internal rotational stability of the ACL deficient knee was investigated in six cadaver knees. Anterior drawer and internal rotation of the tibia were measured at 15 degrees increments from 0 degrees to 90 degrees in response to 50 N of anteriorly applied tibial force and 3 Nm of internally applied internal torque, respectively, in the intact knee, the ACL excised knee, and following the ALFTL reconstruction. A strain gage was used to measure the resting graft tension and to measure strain in the graft during the load-displacement tests. The Müller ALFTL tenodesis failed to return normal anterior stability to the ACL deficient knee (P less than 0.05). The tenodesis did, however, reduce the anterior laxity of the ACL deficient knee from 30 degrees to 90 degrees of knee flexion (P less than 0.05). The tenodesis overconstrained internal tibial rotation of the ACL excised knee from 30 degrees to 90 degrees (P less than 0.05). Measurements of strain in the tenodesis supported the load-displacement findings that the tenodesis was most effective in constraining anterior drawer and internal tibial rotation from 30 degrees to 90 degrees of knee flexion.

Adult↗
PubMedDate not supplied

Biceps tendon tenodesis for posterolateral instability of the knee. An in vitro study.

The effects of biceps tendon tenodesis on internal-external and varus-valgus laxity were measured using fresh-frozen cadaveric specimens that had undergone sequential sectioning of the posterolateral structures and of the fibular collateral ligament. Tenodesis (using 89 N graft tension and a fixation point located 1 cm anterior to the fibular collateral ligament's insertion on the femur) was effective in restoring external rotation and varus laxity; the procedure actually overconstrained external tibial rotation at all flexion positions and varus angulation at 60 degrees and 90 degrees of flexion. Internal rotation and valgus laxity were unaffected by the tenodesis procedure. The anterior fixation point was more effective in reducing laxity than a fixation point located 1 cm proximal to the fibular collateral ligament insertion. Tenodesis using the proximal fixation point, which was nonisometric, did not restore external rotation and varus laxities to intact values at 60 degrees and 90 degrees of knee flexion. Graft tension (45 or 89 N) had no measurable effect on the results of the tenodesis. This study has demonstrated that the biceps tenodesis procedure is effective for reducing static laxity in the knee with posterolateral instability.

Biomechanical Phenomena↗
PubMedDate not supplied

Iliotibial band tenodesis: a new strategy for attachment.

We investigated the changes in distance between Gerdy's tubercle on the tibia and points on the posterior two thirds of the lateral surface of the lateral femoral condyle and adjacent lateral femoral shaft in 15 cadaveric knees. A three-dimensional digitizer was used to quantify motion of the knee during flexion ranging from full extension to 120 degrees of flexion. Four load states were applied: internal, external, and neutral rotation, and quadriceps muscles loads based on one third of values in the literature for maximal isometric quadriceps muscles moments. The femoral location most isometric to Gerdy's tubercle was found to be strongly influenced by the load state. A 1.0 cm wide iliotibial band tenodesis was modelled by five straight lines arising from Gerdy's tubercle and attaching to a simulated washer at the junction of the lateral femoral condyle and shaft. Using this model and the motion data obtained from the cadavers, we investigated the effects of quadriceps muscles loading and external rotation of the knee on changes in the distances between these tibial and femoral attachments for each of the five lines. A 180 degrees twist modelled into the tenodesis significantly reduced the range of changes in distance (difference between the largest and smallest changes in distance among the lines for a given angle of flexion) for both of these load states. Therefore, a 180 degrees twist in the tenodesis can enhance isometry among the fibers of the tenodesis. This implies that a 180 degrees twist can enhance load sharing among the fibers of the tenodesis and, therefore, enhance the overall strength of the tenodesis.

Adult↗
PubMed2004

Arthroscopic-assisted biceps tenodesis for ruptures of the long head of biceps brachii: The cobra procedure.

A number of open procedures have been presented in the literature that described the repair of the ruptured long head of biceps brachii (LHBB). Although arthroscopic biceps tenodesis techniques have been used to address partial tears or subluxation of the biceps, no arthroscopic technique to assist in the treatment of complete retracted ruptures of the LHBB has been described. This article describes an arthroscopic-assisted biceps tenodesis, using interference screw fixation, in the treatment of acute or chronic LHBB ruptures. An arthroscopic-assisted biceps tenodesis with interference screw fixation provides an alternative to open LHBB tenodesis. The ability to tenodese the retracted LHBB arthroscopically is a technologic advance that could reduce morbidity in comparison to open tenodesis, thus resulting in a better functional outcome.

Absorbable Implants↗
PubMedDate not supplied

Biceps tenodesis associated with arthroscopic repair of rotator cuff tears.

Associated lesions of the biceps tendon are commonly found during arthroscopic repair of rotator cuff tears. These lesions are treated with tenodesis, classically performed through an open approach. However, it seems reasonable to seek a single approach to correct both lesions; therefore, we have proposed a new arthroscopic technique that allows an exclusive arthroscopic tenodesis by including the biceps tendon in the rotator cuff suture, a surgical technique with a single suture of the rotator cuff that includes the biceps tendon. We treated 97 shoulders in 96 patients arthroscopically for complete rotator cuff tears. Of these shoulders, 15 required tenodesis for treatment of biceps tendon lesions. Through an arthroscopic approach, a subacromial decompression followed by a rotator cuff repair was carried out in association with a biceps tenodesis. In this technique, one limb of the suture was passed through the biceps tendon, and the other was passed through the rotator cuff tear, bringing both tissues together in the final suture. Of the patients, 9 were men and 5 were women. Their mean age was 71 years (range, 41-80 years). The dominant arm was affected in all patients. Postoperative evaluation, by use of the UCLA score, after a mean follow-up period of 32.4 months showed satisfactory results in 93.4% of patients: 11 had excellent results, 3 had good results, and only 1 had an unsatisfactory result. In this case a postoperative magnetic resonance imaging scan showed an intact rotator cuff and biceps tenodesis. The suture involving the rotator cuff and the biceps tendon proved effective to correct both lesions, with the main advantage being that an additional approach was not required.

Aged↗
PubMed1996

Tenodesis versus carbon fiber repair of ankle ligaments: a clinical comparison.

To compare the clinical and functional outcomes after using different reconstruction methods for chronic ankle instability, the authors followed 2 groups of patients after 69 and 72 months, respectively. Thirty patients (mean age, 28; range, 23-39 years) were treated with modified Evans tenodesis. Twenty-three patients (mean age, 32.2; range, 22-39 years) underwent total replacement of the lateral ankle ligaments by carbon fibers. The protocol of the retrospective study included a questionnaire, clinical examination, radiographic stress diagnostics, and gait analysis with use of the EMED-SF system. Dorsiflexion and inversion were significantly restricted after tenodesis in contrast to the carbon fiber replacement. Although radiographic stability was improved after surgery for both groups, progress of the arthrosis could not be stopped. After tenodesis, the measurement of plantar pressure distribution revealed a 20% increase of midfoot loading as compared with the opposite foot, whereas symmetrical loading of both feet was found after carbon fiber replacement. Additionally, the tenodesis feet had a significantly increased loading of the medial side of the foot. It was concluded that tenodesis and anatomic reconstruction of ankle ligaments lead to subjectively similar results. Foot function and range of motion, however, were less influenced after anatomic repair.

Adult↗