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Sample records for flexor tendon injuries

  1. Flexor Tendon Injuries

    Science.gov (United States)

    ... Media Find a Hand Surgeon Home Anatomy Flexor Tendon Injuries Email to a friend * required fields From * ... move the fingers through cord-like extensions called tendons, which connect the muscles to bone. The flexor ...

  2. Flexor tendon pulley injury in a bowler

    OpenAIRE

    Patel, Purvak; Schucany, William Gregory; Toye, Leon; Ortinau, Eric

    2012-01-01

    Closed traumatic flexor injuries of the hand involving the pulley mechanism are a relatively common injury seen in rock climbers but are very rare in nonclimbers, including bowlers. The injury was first described in 1990. Since then, several studies have shed more light on the diagnostic and therapeutic considerations. Early diagnosis of pulley injuries is crucial since delayed diagnosis can lead to limited range of motion, particularly at the proximal interphalangeal joint. Flexion contractu...

  3. [Rehabilitation after flexor tendon injuries of the hand].

    Science.gov (United States)

    Asmus, A; Kim, S; Millrose, M; Jodkowski, J; Ekkernkamp, A; Eisenschenk, A

    2015-10-01

    Advances in basic research evaluating suture material, techniques, and maximum tendon load with regard to repair site failure help to decide between rehabilitation protocols after the repair of flexor tendon injuries. The presentation and choice of rehabilitation protocols depending on the mechanism of injury and knowledge of the influencing factors concerning tendon load. Expected outcome after flexor tendon repair. Evaluating recent literature and basic research investigations, and presenting expert opinions. Based on the mechanism of injury, the suture technique, the compliance of the patient, and the latest knowledge on tendon capacity help to choose from the basic principles of rehabilitation protocols: passive or early motion protocols, such as those described by Duran-Houser and Kleinert, in the majority of cases lead to good and fair results according to the Hand Functional Score of the American Society for Surgery of the Hand. A larger number of excellent functional results are seen after the rehabilitation of flexor tendon injuries using combined passive/active or completely active motion protocols, e.g., according to Small. In addition to choosing a specific protocol and considering different zones of injury, it is essential to thoroughly supervise therapy and to monitor the adjustment of splints. It is widely recommended that patients should be provided with additional scar treatment and physical therapy throughout their entire rehabilitation. Flexor tendon injuries, especially in zone 2, are still a challenge with regard to operative treatment and rehabilitation, with an unpredictable outcome. Further knowledge and advances in suture techniques and material will support the use of active motion protocols and improve functional results in the future.

  4. History of flexor tendon repair.

    Science.gov (United States)

    Manske, Paul R

    2005-05-01

    The first issue of Hand Clinics published 20 years ago was devoted to flexor tendon injuries. This was most appropriate, because no subject in hand surgery has sparked more interest or discussion. That inaugural issue included excellent presentations on the basic science of tendon injuries (anatomy, biomechanics, nutrition, healing, adhesions) and the clinical practice of tendon repair. Of interest, there was no presentation on the fascinating history of flexor tendon surgery. It is most appropriate, therefore, that this current update of the flexor tendon begins with a historical review of the evolution of flexor tendon repair.

  5. [MR imaging of flexor tendon and pulley system of the fingers: normal anatomy and injury].

    Science.gov (United States)

    Bai, R J; Zhan, H L; Liu, Y; Zhang, H; Qian, Z H; Ye, W; Li, Y X

    2017-09-05

    Objective: To explore the magnetic resonance imaging (MRI) features of the anatomy and injuries of flexor tendon and pulley system of the fingers. Methods: Clinical and imaging data of 20 healthy volunteers without injuries and 36 patients from Beijing Jishuitan Hospital with flexor tendon and pulley system injuries in the fingers between March 2013 and March 2016 were retrospectively analyzed. All subjects underwent magnetic resonance imaging (MRI) examination. The MRI findings of patients were compared with healthy volunteers. In addition, imaging findings of patients were compared with the surgical results and confirmed by double-blinded method. Results: Twenty volunteers without flexor tendon and pulley system injures showed homogeneous hypointensity on both T1-weighted and Proton Density-weighted images with fat saturation (PD-FS). There were 36 patients with finger injures, including 21 cases of flexor tendon injury, 10 cases of pulley system injury, 5 cases of compound injury, which demonstrated unclear signal, discontinuity on T1-weighted images and heterogeneously increased signal intensity of the involved structures on PD-FS images. Edema was detected in the soft tissues surrounding the injured sites. Conclusions: MRI is an accurate method for evaluation of the anatomy and pathologic conditions of flexor tendon and pulley system of the fingers and a useful tool for diagnosis and treatment of flexor tendon and pulley system injuries.

  6. Biomechanical and Macroscopic Evaluations of the Effects of 5-Fluorouracil on Partially Divided Flexor Tendon Injuries in Rabbits

    OpenAIRE

    Duci, Shkelzen B; Arifi, Hysni M; Ahmeti, Hasan R; Manxhuka-Kerliu, Suzana; Neziri, Burim; Mekaj, Agon Y; Lajqi, Shpetim; Shahini, Labinot

    2015-01-01

    Background: The main goals of flexor tendon surgery are to restore digital motion by providing tendon healing and to preserve tendon gliding. Our purpose was to investigate the effects of 5-fluorouracil (5-FU) on tendon adhesions in partially divided profundus flexor tendons (flexor digitorum profundus [FDPs]) following surgical repair and in partially divided FDPs without surgical repair, and to compare the results of the repair versus the nonrepair of zone two injuries via macroscopic and b...

  7. Flexor tendon nutrition.

    Science.gov (United States)

    Manske, P R; Lesker, P A

    1985-02-01

    The concepts regarding nutrient pathways to flexor tendons within the digital sheath are reviewed. Historically, both diffusion and perfusion have been considered significant pathways to the flexor tendon. Theories of tendon healing and adhesion formation, as well as techniques employed by the surgeon in the repair of tendons, are based on these concepts.

  8. Flexor tendon physiology: tendon nutrition and cellular activity in injury and repair.

    Science.gov (United States)

    Gelberman, R H

    1985-01-01

    Scientific studies of the past 20 years have done much to redefine the mechanisms by which flexor tendons heal. Several points have become increasingly clear: Flexor tendons are nourished to a greater extent by synovial fluid diffusion than vascular perfusion. Tendon cells are capable of proliferating, producing collagen, and reconstructing their own gliding surface in the absence of adhesion ingrowth. The key to a successful outcome after flexor tendon repair appears to be an early restoration of tendon continuity, reconstruction of the sheath, if possible, and early passive mobilization. This complex stimulates the tendon's intrinsic repair potential, which is contained within the cells of the tendon itself but appears to be expressed only under ideal experimental and clinical situations.

  9. Extrusion of bone anchor suture following flexor digitorum profundus tendon avulsion injury repair.

    LENUS (Irish Health Repository)

    Tiong, William H C

    2011-09-01

    Flexor digitorum profundus (FDP) zone I tendon avulsion injury is traditionally repaired with a pullout suture technique. More recently, bone anchor sutures have been used as a viable alternative and have largely replaced areas in hand surgery where pullout suture technique was once required. To date, there have been very few complications reported related to bone anchor suture use in FDP tendon reattachment to the bone. We report a very unusual case of extrusion of bone anchor through the nailbed, 6 years after zone I FDP tendon avulsion injury repair and a brief review of literature.

  10. Biomechanical and Macroscopic Evaluations of the Effects of 5-Fluorouracil on Partially Divided Flexor Tendon Injuries in Rabbits

    Directory of Open Access Journals (Sweden)

    Shkelzen B Duci

    2015-01-01

    Full Text Available Background: The main goals of flexor tendon surgery are to restore digital motion by providing tendon healing and to preserve tendon gliding. Our purpose was to investigate the effects of 5-fluorouracil (5-FU on tendon adhesions in partially divided profundus flexor tendons (flexor digitorum profundus [FDPs] following surgical repair and in partially divided FDPs without surgical repair, and to compare the results of the repair versus the nonrepair of zone two injuries via macroscopic and biomechanical evaluations of tendon adhesions. Methods: We used 32 adult male European rabbits (Oryctolagus cunniculus weighing from 2.5 to 3.5 kg. The study was performed on the deep flexor tendons of the second and third digits of the right hind paws of the rabbits; thus, a total of 64 tendons were examined in this study. Results: Based on the results achieved in our experimental study, the load (N significantly increased in subgroup 1a in which the tendons were surgically repaired and were not treated with 5-FU compared with subgroup 2a in which tendons were surgically repaired and treated with 5-FU. Conclusions: The load (N significantly increased in subgroup 1a in which the tendons were surgically repaired and were not treated with 5-FU compared to subgroup 2a in which the tendons were surgically repaired and treated with 5-FU. Therefore, these results revealed a decrease in adhesion formation in the subgroup that was treated with 5-FU due to increased resistance to tendon adhesions during their excursion through the tendon sheath, which in this case required greater traction force.

  11. Biomechanical and Macroscopic Evaluations of the Effects of 5-Fluorouracil on Partially Divided Flexor Tendon Injuries in Rabbits

    Science.gov (United States)

    Duci, Shkelzen B; Arifi, Hysni M; Ahmeti, Hasan R; Manxhuka-Kerliu, Suzana; Neziri, Burim; Mekaj, Agon Y; Lajqi, Shpetim; Shahini, Labinot

    2015-01-01

    Background: The main goals of flexor tendon surgery are to restore digital motion by providing tendon healing and to preserve tendon gliding. Our purpose was to investigate the effects of 5-fluorouracil (5-FU) on tendon adhesions in partially divided profundus flexor tendons (flexor digitorum profundus [FDPs]) following surgical repair and in partially divided FDPs without surgical repair, and to compare the results of the repair versus the nonrepair of zone two injuries via macroscopic and biomechanical evaluations of tendon adhesions. Methods: We used 32 adult male European rabbits (Oryctolagus cunniculus) weighing from 2.5 to 3.5 kg. The study was performed on the deep flexor tendons of the second and third digits of the right hind paws of the rabbits; thus, a total of 64 tendons were examined in this study. Results: Based on the results achieved in our experimental study, the load (N) significantly increased in subgroup 1a in which the tendons were surgically repaired and were not treated with 5-FU compared with subgroup 2a in which tendons were surgically repaired and treated with 5-FU. Conclusions: The load (N) significantly increased in subgroup 1a in which the tendons were surgically repaired and were not treated with 5-FU compared to subgroup 2a in which the tendons were surgically repaired and treated with 5-FU. Therefore, these results revealed a decrease in adhesion formation in the subgroup that was treated with 5-FU due to increased resistance to tendon adhesions during their excursion through the tendon sheath, which in this case required greater traction force. PMID:26063369

  12. Biomechanical and Macroscopic Evaluations of the Effects of 5-Fluorouracil on Partially Divided Flexor Tendon Injuries in Rabbits.

    Science.gov (United States)

    Duci, Shkelzen B; Arifi, Hysni M; Ahmeti, Hasan R; Manxhuka-Kerliu, Suzana; Neziri, Burim; Mekaj, Agon Y; Lajqi, Shpetim; Shahini, Labinot

    2015-06-20

    The main goals of flexor tendon surgery are to restore digital motion by providing tendon healing and to preserve tendon gliding. Our purpose was to investigate the effects of 5-fluorouracil (5-FU) on tendon adhesions in partially divided profundus flexor tendons (flexor digitorum profundus [FDPs]) following surgical repair and in partially divided FDPs without surgical repair, and to compare the results of the repair versus the nonrepair of zone two injuries via macroscopic and biomechanical evaluations of tendon adhesions. We used 32 adult male European rabbits (Oryctolagus cunniculus) weighing from 2.5 to 3.5 kg. The study was performed on the deep flexor tendons of the second and third digits of the right hind paws of the rabbits; thus, a total of 64 tendons were examined in this study. Based on the results achieved in our experimental study, the load (N) significantly increased in subgroup 1a in which the tendons were surgically repaired and were not treated with 5-FU compared with subgroup 2a in which tendons were surgically repaired and treated with 5-FU. The load (N) significantly increased in subgroup 1a in which the tendons were surgically repaired and were not treated with 5-FU compared to subgroup 2a in which the tendons were surgically repaired and treated with 5-FU. Therefore, these results revealed a decrease in adhesion formation in the subgroup that was treated with 5-FU due to increased resistance to tendon adhesions during their excursion through the tendon sheath, which in this case required greater traction force.

  13. [Comparative study of primary and secondary management of flexor tendon injuries].

    Science.gov (United States)

    Deutinger, M; Frey, M; Mandl, H; Holle, J; Freilinger, G

    1987-09-01

    In 1974 a replantation service started at the authors' department. Before that time the treatment of flexor tendon injuries was mainly performed secondarily. Therefore, the authors had the opportunity to compare patients after primary and secondary surgery. In 52 primarily and 22 secondarily treated patients the technique of Kleinert was used. Following issues were investigated: functional results, decrease of grip strength, influence of early mobilization on sensibility restoration in cases of nerve injury, relation between sensitivity to cold and vessel and nerve injuries, duration of physiotherapy and disability. The damage of only one finger might lead to decrease of grip strength. Primary surgery was superior to secondary surgery. Early mobilization in cases of additional nerve injuries did not affect sensibility restoration. Poor sensibility increased the chance of cold sensitivity. The duration of physiotherapy and of disability depended on the need for second procedures such as tenolysis which was more common in the group of secondarily treated patients.

  14. Using of Tendinous Plasty in Treatment of Patients with Flexor Tendons of 2–5 Fingers Injury in “Critical” Zone

    Directory of Open Access Journals (Sweden)

    S.I. Kireev

    2009-06-01

    Full Text Available Injury of both superficial and deep tendons of fingers flexors needs to carry out tendinous plasty with excision of distal part of superficial flexor muscle tendon. Use of length measuring method for tendinous transplant allows us to avoid the flexion contracture in future and appearance of functional insufficiency of flexion during postoperative period and rehabilitation of patient.

  15. Rehabilitation after surgery repair of flexor tendon injuries of the hand with Kleinert early passive mobilization protocol.

    Science.gov (United States)

    Hundozi, Hajrie; Murtezani, Ardiana; Hysenaj, Vale; Hysenaj, Vlore; Mustafa, Aziz

    2013-01-01

    Rehabilitation after surgery repair of flexor tendon injuries of the hand remains challenging and requires experienced professionals and interdisciplinary approaches. The aim of this study was to evaluate rehabilitation results after surgery repair of flexor tendon injuries in the hand with the early passive mobilization--Kleinert protocol. In this retrospective case-series study rehabilitation results of flexor tendon injuries in the hand with the early passive mobilization--Kleinert protocol were evaluated in 35 patients, treated in the Orthopaedic Clinic University Clinical Centre of Kosovo between December 2007 and November 2008. Patients had unilateral injuries on right hand without associated injuries. Patients were divided in three groups: patient with injury of FPL (n = 15), patient with injury of FDP and FDS dig. I-V (n = 10) and patient with injury of FDP and FDS dig.II (n = 10). Patients were included in a rehabilitation program using the Kleinert-early passive mobilization protocol. Functional evaluation was made using the mean improvement on MCP, PIP and DIP joints motion, mean functional are of motion (FAM) and total active motion (TAM) scoring system of The American Society of Surgery of Hand. The functional outcomes were analyzed by Paired t-test, and One way Analysis of Variance, while the mean TAM score were compared using the Wilcoxon Matched-Pairs Signed-Ranks test with significance set at p hand.

  16. Rare causes of closed rupture of the flexor tendon

    NARCIS (Netherlands)

    Stenekes, Martin W.; Ruttermann, Mike; Werker, Paul M. N.

    Closed injuries to the flexor tendon are relatively rare. We present three rare causes of closed injury to the flexor tendon. Early recognition and adequate treatment by a specialised hand surgeon are crucial for the prognosis of such cases. Delayed diagnosis and treatment often require secondary

  17. [The history of flexor tendon surgery].

    Science.gov (United States)

    Chamay, A

    1997-01-01

    Flexor tendon injuries were already treated in antiquity by Hippocrates, Galien and Avicenne. Since the Renaissance, other surgeons have attempted to repair flexor tendon injuries, but without success due to problems related to unsuitable materials and ignorance of the basic rules of asepsis and the absence of antiseptics until the second half of the 19th century. The first successful flexor tendon grafts in man were performed by K. Biesalski in 1910, E. Lexer in 1912 and L. Mayer in 1916. These three authors published their series of grafts and described in detail the anatomical, physiological and technical principles to be respected. St. Bunnell, in 1918, developed various pull-out direct suture procedures, but faced with the problems of adhesions, he abandoned this technique and proposed not to repair flexors in the digital tunnels but to graft them. He defined the famous zone which he called No man's land, which subsequently became Claude Verdan's zone II, in 1959. In 1960, C. Verdan published his first series of sutures maintained by 2 pins in zone II with comparable results to those obtained after grafting. In 1967, H. Kleinert, with his mobile suture, became the leader of direct tendon repair in zone II. 2-stage grafts were introduced in 1965 under the impetus of J. Hunter, who revised and popularized the studies conducted by A. Bassett and R.E. Caroll in 1950.

  18. The flexor tendon pulley system and rock climbing.

    Science.gov (United States)

    Crowley, Timothy P

    2012-06-01

    Rock climbing has increased in popularity over the past two decades. Closed traumatic rupture of the finger flexor tendon pulleys is rare among the general population but is seen much more commonly in rock climbers. This article reviews the anatomy and biomechanics of the finger flexor tendon pulleys, how they may be injured in rock climbing and how these injuries are best diagnosed and managed.

  19. Nutrition of flexor tendons in monkeys.

    Science.gov (United States)

    Manske, P R; Bridwell, K; Whiteside, L A; Lesker, P A

    1978-10-01

    The hydrogen washout technique was used to investigate the role of synovial diffusion versus vascular perfusion in the nutrition of monkey flexor tendons within the digital sheath. There was no significant difference in the uptake and washout of hydrogen tracer by tendons in contact with synovium but detached from the surrounding vasculature, compared to control tendons. However, there was insignificant uptake of tracer by tendons with intact vasculature, but separated from synovium. Synovial diffusion is a primary nutrient pathway of monkey flexor tendons within the digital sheath.

  20. Effects of motor imagery on hand function during immobilization after flexor tendon repair

    NARCIS (Netherlands)

    Stenekes, Martin W.; Geertzen, Jan H.; Nicolai, Jean-Philippe A.; de Jong, Bauke M.; Mulder, Theo

    OBJECTIVE: To determine whether motor imagery during the immobilization period after flexor tendon injury results in a faster recovery of central mechanisms of hand function. DESIGN: Randomized controlled trial. SETTING: Tertiary referral hospital. PARTICIPANTS: Patients (N=28) after surgical flexor

  1. Nutrient pathways of flexor tendons in primates.

    Science.gov (United States)

    Manske, P R; Lesker, P A

    1982-09-01

    The perfusion and diffusion pathways to the flexor profundus tendons of 40 monkeys were investigated by measuring the uptake of tritiated proline by various tendon segments. In the absence of all vascular connections, the process of diffusion provides nutrients to all areas of flexor tendon and in this study the process of diffusion was greater. The distal segment of tendon was observed to be profused most rapidly. The proximal tendon segment is perfused from both the muscular-tendinous junction and the vinculum longus; vincular segment perfusion is via the vinculum longus vessels alone; central segment perfusion is shared by the vinculum longus and vinculum brevis vasculature. The distal segment uptake is by both the process of diffusion or vinculum brevis perfusion. The osseous attachment at the distal phalanx contributes little to tendon nutrition.

  2. Nutrient pathways of flexor tendons in primates

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    Manske, P.R.; Lesker, P.A.

    1982-09-01

    The perfusion and diffusion pathways to the flexor profundus tendons of 40 monkeys were investigated by measuring the uptake of tritiated proline by various tendon segments. In the absence of all vascular connections, the process of diffusion provides nutrients to all areas of flexor tendon and in this study the process of diffusion was greater. The distal segment of tendon was observed to be profused most rapidly. The proximal tendon segment is perfused from both the muscular-tendinous junction and the vinculum longus; vincular segment perfusion is via the vinculum longus vessels alone; central segment perfusion is shared by the vinculum longus and vinculum brevis vasculature. The distal segment uptake is by both the process of diffusion or vinculum brevis perfusion. The osseous attachment at the distal phalanx contributes little to tendon nutrition.

  3. A Review of Current Concepts in Flexor Tendon Repair: Physiology, Biomechanics, Surgical Technique and Rehabilitation

    OpenAIRE

    Singh, Rohit; Rymer, Ben; Theobald, Peter; Thomas, Peter B.M.

    2015-01-01

    Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man’s land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into world-wide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilita...

  4. Turkey model for flexor tendon research: in vitro comparison of human, canine, turkey, and chicken tendons.

    Science.gov (United States)

    Kadar, Assaf; Thoreson, Andrew R; Reisdorf, Ramona L; Amadio, Peter C; Moran, Steven L; Zhao, Chunfeng

    2017-08-01

    Flexor tendon injuries are one of the most common hand injuries and remain clinically challenging for functional restoration. Canine and chicken have been the most commonly used animal models for flexor tendon-related research but possess several disadvantages. The purpose of this study was to explore a potential turkey model for flexor tendon research. The third digit from human cadaveric hands, canine forepaws, turkey foot, and chicken foot were used for this study. Six digits in each of four species were studied in detail, comparing anatomy of the flexor apparatus, joint range of motioņ tendon excursion, tendon cross-sectional area, work of flexion, gliding resistance at the level of the A2 pulley, modulus of elasticity, suture retention strength, and histology across species. Anatomically, the third digit in the four species displayed structural similarities; however, the tendon cross-sectional area of the turkey and human were similar and larger than canine and chicken. Furthermore, the turkey digit resembles the human's finger with the lack of webbing between digits, similar vascularization, tendon excursion, work of flexion, gliding resistance, mechanical properties, and suture holding strength. More importantly, human and turkey tendons were most similar in histological appearance. Turkey flexor tendons have many properties that are comparable to human flexor tendons which would provide a clinically relevant, economical, nonhuman companion large animal model for flexor tendon research. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. A Review of Current Concepts in Flexor Tendon Repair: Physiology, Biomechanics, Surgical Technique and Rehabilitation.

    Science.gov (United States)

    Singh, Rohit; Rymer, Ben; Theobald, Peter; Thomas, Peter B M

    2015-12-28

    Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man's land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into worldwide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biome-chanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs.

  6. Human flexor tendon tissue engineering: decellularization of human flexor tendons reduces immunogenicity in vivo.

    Science.gov (United States)

    Raghavan, Shyam S; Woon, Colin Y L; Kraus, Armin; Megerle, Kai; Choi, Matthew S S; Pridgen, Brian C; Pham, Hung; Chang, James

    2012-04-01

    In mutilating hand injuries, tissue engineered tendon grafts may provide a reconstructive solution. We have previously described a method to decellularize cadaveric human flexor tendons while preserving mechanical properties and biocompatibility. The purpose of this study is to evaluate the immunogenicity and strength of these grafts when implanted into an immunocompetent rat model. Cadaveric human flexor tendons were divided into two groups. Group 1 was untreated, and Group 2 was decellularized by treatment with sodium dodecyl sulfate (SDS), ethylenediaminetetraacetic acid (EDTA), and peracetic acid (PAA). Both groups were then analyzed for the presence of major histocompatibility complexes by immunohistochemistry (IHC). Pair-matched tendons from each group were then placed into the dorsal subcutaneous tissue and anchored to the spinal ligaments of Wistar rats for 2 or 4 weeks, and harvested. The infiltration of B-cells and macrophages was determined using IHC. The explants where then subjected to mechanical testing to determine the ultimate tensile stress (UTS) and elastic modulus (EM). Statistical analysis was performed using a paired Student's t-test. The decellularization protocol successfully removed cells and MHC-1 complexes. At 2 weeks after implantation, there was increased infiltration of B-cells in Group 1 (untreated) compared with Group 2 (acellular), both in the capsule and tendon substance. There was improved ultimate tensile stress (UTS, 42.7 ± 8.3 vs. 22.8 ± 7.8 MPa, ptendons that were decellularized. At 4 weeks, there was continued B-cell infiltration in Group 1 (untreated) compared with Group 2 (acellular). There was no appreciable difference in macrophage infiltration at both time points. At 4 weeks Group 2 (acellular) demonstrated persistently greater UTS (40.5 ± 9.1 vs. 14.6 ± 4.2 MPa, ptendons that were decellularized with SDS, EDTA, and PAA resulted in removal of cellular antigens and a decreased immune response when placed into Wistar

  7. Unilateral Dislocation of the Posterior Tibialis Tendon (PTT) and Flexor Digitorum Longus Tendon With Contralateral PTT Subluxation in a Patient With Congenitally Shallow Flexor Groove.

    Science.gov (United States)

    Waldron, Jacob E; Bernhardson, Andrew S; Fellars, Todd A

    2017-10-01

    Flexor tendon dislocation from the flexor tendon groove posterior of the medial malleolus has been previously described, and may be difficult to diagnose initially, but is amendable to surgical treatment with good outcomes. We present a unique case of unilateral dislocation of the posterior tibialis and flexor digitorum longus tendons with contralateral flexor digitorum longus subluxation that was treated surgically with a good outcome. A 37-year-old active duty male sustained a dislocation and subluxation of the flexor tendons bilaterally after a forced dorsiflexion injury. Bilateral ankle magnetic resonance imaging revealed the injuries that this patient sustained and aided in surgical planning. Surgical Treatment. Bilateral flexor tendon groove deepening with periosteal flap elevation and retinacular repair. This injury has not been previously described in the literature after a forced dorsiflexion mechanism. Advanced imaging is helpful as this injury may be initially misdiagnosed. This case shows that delayed bilateral reconstruction of the flexor tendon grooves and retinacula are reliable methods for pain relief to allow a patient to return to a physically demanding level of function. Level V.

  8. [Flexor tendon pulley system: anatomy, pathology, treatment].

    Science.gov (United States)

    Moutet, F

    2003-02-01

    Flexor tendon pulley has been very early noticed and described. Terminology usually accepted recognizes 6 arcifom pulleys (A0 to A5) and 3 cruciform pulleys (C1 to C3). Anatomy and physiology of this flexor tendon gliding and reflection system at the level of the digital sheet are exposed. The integrity necessity of this system became obvious regarding the flexor tendons repair. Four main pathologies may be concerned: the trigger finger congenital or progressive, due to a chondroid metaplasia of the A1 pulley; tenosynovial ganglions arising at the weak point between A1 and A2 pulley; lesions of the flexor tendon sheet during traumatic lacerations or surgical repairs; quite experimental lesions creating isolated ruptures of one or several pulleys which occur during sport practice, especially high level rock climbing. The repair techniques are exposed to allow to graduate and hierarchy the reparation technique regarding the pathology. A2 and A4 repair is always indicated. The best reconstruction material is an extensor retinaculum graft. But its poor surface available often draws to use conventional palmaris longus free graft.

  9. CLINICAL IMPLICATIONS OF CEREBRAL REORGANISATION AFTER PRIMARY DIGITAL FLEXOR TENDON REPAIR

    NARCIS (Netherlands)

    Coert, J. H.; Stenekes, M. W.; Paans, A. M. J.; Nicolai, J. -P. A.; De Jong, B. M.

    After flexor tendon injury, most attention is given to the quality of the tendon repair and postoperative early passive dynamic mobilisation. Schemes for active mobilisation have been developed to prevent tendon adhesions and joint stiffness. This paper describes five patients to demonstrate the

  10. Serial superficial digital flexor tendon biopsies for diagnosing and monitoring collagenase-induced tendonitis in horses

    Directory of Open Access Journals (Sweden)

    José C. de Lacerda Neto

    2013-06-01

    Full Text Available The purpose of this investigation was to demonstrate the feasibility of a biopsy technique by performing serial evaluations of tissue samples of the forelimb superficial digital flexor tendon (SDFT in healthy horses and in horses subjected to superficial digital flexor tendonitis induction. Eight adult horses were evaluated in two different phases (P, control (P1 and tendonitis-induced (P2. At P1, the horses were subjected to five SDFT biopsies of the left forelimb, with 24 hours (h of interval. Clinical and ultrasonographic (US examinations were performed immediately before the tendonitis induction, 24 and 48 h after the procedure. The biopsied tendon tissues were analyzed through histology. P2 evaluations were carried out three months later, when the same horses were subjected to tendonitis induction by injection of bacterial collagenase into the right forelimb SDFT. P2 clinical and US evaluations, and SDFT biopsies were performed before, and after injury induction at the following time intervals: after 24, 48, 72 and 96 h, and after 15, 30, 60, 90, 120 and 150 days. The biopsy technique has proven to be easy and quick to perform and yielded good tendon samples for histological evaluation. At P1 the horses did not show signs of localised inflammation, pain or lameness, neither SDFT US alterations after biopsies, showing that the biopsy procedure per se did not risk tendon integrity. Therefore, this procedure is feasible for routine tendon histological evaluations. The P2 findings demonstrate a relation between the US and histology evaluations concerning induced tendonitis evolution. However, the clinical signs of tendonitis poorly reflected the microscopic tissue condition, indicating that clinical presentation is not a reliable parameter for monitoring injury development. The presented method of biopsying SDFT tissue in horses enables the serial collection of material for histological analysis causing no clinical signs and tendon damage seen

  11. Flexor tendon specimens in organ cultures.

    Science.gov (United States)

    Rank, F; Eiken, O; Bergenholtz, A; Lundborg, G; Erkel, L J

    1980-01-01

    The healing process of sectioned and subsequently sutured rabbit tendon segments was studied over a period of 3 weeks, using an organ culture technique. In one series, the tendon specimens were exposed to a chemically defined culture medium for nutrition. In two control series, the specimens were kept in the synovial cavity of the knee joint for varying periods of time, before being transferred to the culture medium. The tendons remained viable in the medium. The superficial tendon cells demonstrated the morphological characteristics of fibroblasts, but cellular fibroplasia could not be detected. The two control series subjected to synovia prior to transfer into the culture medium showed superficial repair similar to the findings in previous studies on healing capacity of tendon nourished by synovia. The investigation supports the hypothesis that superficial tendon cells are fibroblasts with a potential for repair and that synovia is an efficient nutrient medium. Thus, the beneficial effects on repair exercised by the tendon sheath function should be utilized in flexor tendon surgery.

  12. Closed traumatic rupture of the ring finger flexor tendon pulley.

    Science.gov (United States)

    Tropet, Y; Menez, D; Balmat, P; Pem, R; Vichard, P

    1990-09-01

    We report an unusual case of closed traumatic rupture of the ring finger flexor tendon pulley not previously reported in the literature. This injury occurred in a 21-year-old athlete during rockclimbing. Lack of flexion of the distal interphalangeal joint was accompanied by a palpable subcutaneous cord on the palmar side of the proximal phalanx. A simple repair of the pulley was done. The postoperative functional result was satisfactory.

  13. Acute Isolated Flexor Tendon Laceration Associated With a Distal Radius Fracture.

    Science.gov (United States)

    Hill, J Ryan; Alluri, Ram K; Ghiassi, Alidad

    2017-05-01

    Subacute rupture of the flexor tendons secondary to distal radius fractures is well documented. Recently, accounts of flexor tendon rupture following open reduction internal fixation have been associated with volar plate fixation. However, discovery of an occult traumatic flexor tendon laceration during fixation of an acute distal radius fracture is not well described. This case indicates the importance of careful preoperative and intraoperative examination of the flexor tendons in the setting of comminuted distal radius fractures. A forty-seven-year-old male sustained a comminuted, dorsally displaced distal radius fracture. Initial and post-reduction examinations revealed no gross functional abnormalities. Upon operative fixation of the fracture, laceration of the flexor digitorum profundus (FDP) tendon to the index finger was incidentally noted at the level of the fracture site. Due to extensive dorsal comminution, shortening, and the presence of a lunate facet fragment, we performed volar fragment-specific and dorsal spanning bridge plate fixation. The proximal and distal ends of the FDP tendon were marked, but repair was deferred until implant removal. This allowed for proper informed consent and avoided potential compromise of the repair given the presence of a volar implant. Acute flexor tendon rupture secondary to closed distal radius fractures may go unnoticed if a high index of suspicion is not maintained. Delayed diagnosis of these ruptures convolutes the mechanism of injury and disrupts the recovery process. Hand surgeons should be vigilant in examining flexor tendon function during the preoperative evaluation, especially in the setting of acute high-energy injury.

  14. Flexor tendon tissue engineering: acellularization of human flexor tendons with preservation of biomechanical properties and biocompatibility.

    Science.gov (United States)

    Pridgen, Brian C; Woon, Colin Y L; Kim, Maxwell; Thorfinn, Johan; Lindsey, Derek; Pham, Hung; Chang, James

    2011-08-01

    Acellular human tendons are a candidate scaffold for tissue engineering flexor tendons of the hand. This study compared acellularization methods and their compatibility with allogeneic human cells. Human flexor tendons were pretreated with 0.1% ethylenediaminetetracetic acid (EDTA) for 4  h followed by 24  h treatments of 1% Triton X-100, 1% tri(n-butyl)phosphate, or 0.1% or 1% sodium dodecyl sulfate (SDS) in 0.1% EDTA. Outcomes were assessed histologically by hematoxylin and eosin and SYTO green fluorescent nucleic acid stains and biochemically by a QIAGEN DNeasy kit, Sircol collagen assay, and 1,9 dimethylmethylene blue glycosaminoglycan assay. Mechanical data were collected using a Materials Testing System to pull to failure tendons acellularized with 0.1% SDS. Acellularized tendons were re-seeded in a suspension of human dermal fibroblasts. Attachment of viable cells to acellularized tendon was assessed biochemically by a cell viability assay and histologically by a live/dead stain. Data are reported as mean±standard deviation. Compared with the DNA content of fresh tendons (551±212  ng DNA/mg tendon), only SDS treatments significantly decreased DNA content (1% SDS [202.8±37.4  ng DNA/mg dry weight tendon]; 0.1% SDS [189±104  ng DNA/mg tendon]). These findings were confirmed by histology. There was no decrease in glycosaminoglycans or collagen following acellularization with SDS. There was no difference in the ultimate tensile stress (55.3±19.2 [fresh] vs. 51.5±6.9 [0.1% SDS] MPa). Re-seeded tendons demonstrated attachment of viable cells to the tendon surface using a viability assay and histology. Human flexor tendons were acellularized with 0.1% SDS in 0.1% EDTA for 24  h with preservation of mechanical properties. Preservation of collagen and glycoaminoglycans and re-seeding with human cells suggest that this scaffold is biocompatible. This will provide a promising scaffold for future human flexor tendon tissue engineering studies to

  15. MRI in flexor tendon rupture after collagenase injection

    Energy Technology Data Exchange (ETDEWEB)

    Khurana, Shruti [Lady Hardinge Medical College, New Delhi (India); Wadhwa, Vibhor [University of Arkansas for Medical Sciences, Little Rock, AR (United States); Chhabra, Avneesh [UT Southwestern Medical Center, Dallas, TX (United States); Johns Hopkins University, Baltimore, MD (United States); Amirlak, Bardia [UT Southwestern Medical Center, Dallas, TX (United States)

    2017-02-15

    Flexor tendon rupture is an unusual complication following collagenase injection to relieve contractures. These patients require a close follow-up and in the event of tendon rupture, a decision has to be made whether to repair the tendon or manage the complication conservatively. The authors report the utility of MRI in the prognostication and management of a patient with Dupuytren's contracture, who underwent collagenase injection and subsequently developed flexor digitorum profundus tendon rupture. (orig.)

  16. MRI in flexor tendon rupture after collagenase injection

    International Nuclear Information System (INIS)

    Khurana, Shruti; Wadhwa, Vibhor; Chhabra, Avneesh; Amirlak, Bardia

    2017-01-01

    Flexor tendon rupture is an unusual complication following collagenase injection to relieve contractures. These patients require a close follow-up and in the event of tendon rupture, a decision has to be made whether to repair the tendon or manage the complication conservatively. The authors report the utility of MRI in the prognostication and management of a patient with Dupuytren's contracture, who underwent collagenase injection and subsequently developed flexor digitorum profundus tendon rupture. (orig.)

  17. Ultrasonographic assessment of flexor tendon mobilization: Effect of different protocols on tendon excursion

    NARCIS (Netherlands)

    J.-W.H. Korstanje (Jan-Wiebe); J. Soeters (Johannes); A.R. Schreuders (Ton); P.C. Amadio (Peter ); S.E.R. Hovius (Steven); H.J. Stam (Henk); R.W. Selles (Ruud)

    2012-01-01

    textabstractBackground: Different mobilization protocols have been proposed for rehabilitation after hand flexor tendon repair to provide tendon excursion sufficient to prevent adhesions. Several cadaver studies have shown that the position of the neighboring fingers influences tendon excursions of

  18. Peroneal Tendon Injuries

    Science.gov (United States)

    ... of peroneal tendon injuries are tendonitis, tears and subluxation. Tendonitis is an inflammation of one or both ... An increase in the height of the arch Subluxation means one or both tendons have slipped out ...

  19. Primary flexor tendon repair: surgical techniques based on the anatomy and biology of the flexor tendon system.

    Science.gov (United States)

    Tonkin, M A

    1991-01-01

    The anatomy, biology and bio-mechanics of the flexor tendon system demand a precise approach to flexor tendon repair. Within the fibroosseous canal, the synovial fluid and a complex intratendinous vascular network provide nutrition for intrinsic flexor tendon healing. Retention of the synovial sheath theoretically maintains an enclosed tendon/tendon sheat environment in which the tendon repair is bathed in synovial fluid, and may glide within a smooth tunnel. The preservation of the intricate double tendon inter-relationship and the annular pulley system is vital to the efficiency of finger flexion. This review details surgical and postoperative techniques aimed at restoring the normal anatomy and providing optimal conditions for the return of flexor tendon function.

  20. Flexor pulley system: anatomy, injury, and management.

    Science.gov (United States)

    Zafonte, Brian; Rendulic, Dora; Szabo, Robert M

    2014-12-01

    Flexor pulley injuries are most commonly seen in avid rock climbers; however, reports of pulley ruptures in nonclimbers are increasing. In addition to traumatic disruption, corticosteroid-induced pulley rupture has been reported as a complication of treating stenosing tenosynovitis. Over the last decade, there have been 2 new developments in the way hand surgeons think about the flexor pulley system. First, the thumb pulley system has been shown to have 4 component constituents, in contrast to the classic teaching of 3 pulleys. Second, in cases of zone II flexor tendon injury, the intentional partial A2 and/or A4 pulley excision or venting is emerging as a component for successful treatment. This is challenging the once-held dogma that preserving the integrity of the entire A2 and A4 pulleys is indispensable for normal digit function. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  1. A review of current concepts in flexor tendon repair: physiology, biomechanics, surgical technique and rehabilitation.

    Directory of Open Access Journals (Sweden)

    Rohit Singh

    2015-12-01

    Full Text Available Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man’s land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into world-wide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biomechanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs.

  2. Bilateral spontaneous rupture of flexor digitorum profundus tendons.

    LENUS (Irish Health Repository)

    O'Sullivan, S T

    2012-02-03

    Spontaneous tendon rupture is an unusual condition usually associated with underlying disease processes such as rheumatoid arthritis, chronic renal failure or bony abnormalities of the hand. We report a case of spontaneous, non-concurrent bilateral rupture of flexor profundus tendons in an otherwise healthy individual. Treatment was successful and consisted of a two-stage reconstruction of the ruptured tendon.

  3. Wide-Awake Primary Flexor Tendon Repair, Tenolysis, and Tendon Transfer

    OpenAIRE

    Tang, Jin Bo

    2015-01-01

    Tendon surgery is unique because it should ensure tendon gliding after surgery. Tendon surgery now can be performed under local anesthesia without tourniquet, by injecting epinephrine mixed with lidocaine, to achieve vasoconstriction in the area of surgery. This method allows the tendon to move actively during surgery to test tendon function intraoperatively and to ensure the tendon is properly repaired before leaving the operating table. I applied this method to primary flexor tendon repair ...

  4. Early mobilization compared with immobilization after repair of a flexor tendon injury in children: A retrospective long time follow-up

    Directory of Open Access Journals (Sweden)

    Illugi Birkisson

    2017-12-01

    Conclusions: The long-term outcome after a flexor tendon repair does not differ between early mobilization in older children and immobilization in younger children, implying that an early rehabilitation program is not necessary in young children. [Hand Microsurg 2017; 6(3.000: 130-135

  5. Friction between finger flexor tendons and the pulley system in the crimp grip position.

    Science.gov (United States)

    Moor, Beat K; Nagy, Ladislav; Snedeker, Jess G; Schweizer, Andreas

    2009-01-01

    Disruption of the finger flexor tendon pulleys are the most often occurring injury in rock climbers due to bowstringing of tendons during crimp grip position. The aim of this study was to quantify friction between the flexor tendons and pulleys and the influence of high load and speed of movement as a potential factor of pulley disruption. Friction between the flexor tendons and pulleys of eight human cadaver fingers was indirectly determined using an isokinetic movement device. During flexion and extension movement with rotational speed from 30 to 210 deg/s in the proximal interphalangeal joint and with load from 20 to 100 N to the flexor tendons the flexion force at the tip of the finger was measured. With 40 N loaded flexor tendons the force at the fingertip was 14.5 N (SD1.5) during extension and 12.6N (SD1.3) during flexion movement. Corresponding force difference of 12.9% and 3.77 N (SD0.6) force of friction can be calculated. Friction peaked at 85.8 degrees (SD2.05) of flexion of the proximal interphalangeal joint. Different speed of motion and load to the flexor tendons did not influence force difference other than linear. Considerable friction between flexor tendons and pulleys is apparent and therefore may have an influence on pulley injuries. Particularly during the crimp grip position where the proximal interphalangeal joint is flexed about 90 degrees shows the greatest amount of friction. However there was no change of friction during high speed motion and no other than linear increase during high load.

  6. Flexor Tendon Repair With Looped Suture: 1 Versus 2 Knots.

    Science.gov (United States)

    Gil, Joseph A; Skjong, Christian; Katarincic, Julia A; Got, Christopher

    2016-03-01

    To assess the strength of flexor tendon repair with looped suture. We hypothesized that, after passing the intact looped suture in the desired repair configuration, splitting the loop and tying 2 independent knots would increase the strength of flexor tendon repair. Thirty-two flexor tendons were harvested and were sharply transected in zone II. The tendons were repaired with a 4-strand core suture repair using 3-0 looped nonabsorbable nylon suture. The harvested tendons were randomly assigned and repaired with either a 1- or a 2-knot construct. The repaired flexor tendons were fixed in a servohydraulic material testing system and were loaded to failure either with uniaxial tension or cyclically. The average force at failure was 43 N for the 1-knot repair and 28 N for the 2-knot repair. The mode of failure of 15 of the flexor tendon repairs that were cyclically loaded to failure was suture pull-out. The average number of cycles and force in cyclic testing that caused failure of flexor tendon repairs was 134 cycles and 31 N for tendons repaired with looped 3-0 suture tied with 1 knot and 94 cycles and 33 N for tendons repaired with looped 3-0 suture tied with 2 knots. Our hypothesis was disproved by the results of this study. This study suggests that, when using looped suture, tying 2 independent knots instead of tying a single knot does not increase the strength of the flexor tendon repair. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  7. [Animal experiment study of healing of the sutured flexor tendon].

    Science.gov (United States)

    Martini, A K; Blimke, B

    1992-01-01

    The purpose of the present study was to determine whether tendons contain intrinsic cells capable of repair. To accomplish this, rabbit flexor tendons were exposed microsurgically, cut through, resutured and transferred as free transplant into the knee-joint. Immobilisation of the knee-joint will cause progressive formation of adhesions permitting neovascularisation of the transplant. Both is not observed when sutured flexor tendons were put in a knee articulation with full range of joint motion. Transmission electron micrography revealed up to 8 weeks after implantation vital cells and incidences of collagen neosynthesis independently whether adhesions existed or not. Histologically intrinsic repair was confirmed in mobile transplants and mainly initiated by cells of the visceral synovial sheet which form an anatomic-surgical unity with the tendon. In conclusion the importance of the synovial fluid for the tendon nutrition is underlined by the fact that an intrinsic healing of flexor tendon is possible without formation of adhesions.

  8. The effect of flexor sheath integrity on nutrient uptake by chicken flexor tendons.

    Science.gov (United States)

    Peterson, W W; Manske, P R; Lesker, P A

    1985-12-01

    The effect of varying degrees of flexor sheath integrity (sheath excised, incised, or incised and repaired) on the uptake of 3H-proline by chicken flexor tendons in Zone II was studied. The tendons were either: normal and uninjured, lacerated and repaired, or uninjured except for vinculum longum ligation. Different degrees of sheath integrity did not influence the uptake of 3H-proline by the tendons. The tendon does not appear to be dependent on a synovial environment for nutrients and is capable of obtaining these nutrients by diffusion from the surrounding extracellular tissue fluid. Diffusion is the primary nutrient pathway to the flexor tendon in this area, because removing its major vascular attachment (i.e., the vinculum longum) did not effect proline uptake. Careful closure of the sheath with restoration of a synovial environment does not appear to be necessary for tendon nutrition.

  9. Effect of flexor sheath integrity on nutrient uptake by chicken flexor tendons

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, W.W.; Manske, P.R.; Lesker, P.A.

    1985-12-01

    The effect of varying degrees of flexor sheath integrity (sheath excised, incised, or incised and repaired) on the uptake of /sub 2/H-proline by chicken flexor tendons in Zone II was studied. The tendons were either: normal and uninjured, lacerated and repaired, or uninjured except for vinculum longum ligation. Different degrees of sheath integrity did not influence the uptake of /sub 2/H-proline by the tendons. The tendon does not appear to be dependent on a synovial environment for nutrients and is capable of obtaining these nutrients by diffusion from the surrounding extracellular tissue fluid. Diffusion is the primary nutrient pathway to the flexor tendon in this area, because removing its major vascular attachment (i.e., the vinculum longum) did not effect proline uptake. Careful closure of the sheath with restoration of a synovial environment does not appear to be necessary for tendon nutrition.

  10. Extensor Tendon Injuries

    Science.gov (United States)

    ... Media Find a Hand Surgeon Home Anatomy Extensor Tendon Injuries Email to a friend * required fields From * ... to straighten one or more joints. Common Extensor Tendon Injuries Mallet Finger refers to a drooping end- ...

  11. Proximal phalanx and flexor digitorum longus tendon biomechanics in flexor to extensor tendon transfer.

    Science.gov (United States)

    DiPaolo, Zachary J; Ross, Matthew S; Laughlin, Richard T; Gould, Greg; Flower, Katie; Kiger, Lorrie; Markert, Ronald J

    2015-05-01

    The flexor to extensor transfer of the flexor digitorum longus (FDL) tendon has been a relatively common operative procedure for the treatment of a flexible hammer toe deformity and chronic metatarsophalangeal (MTP) joint dislocation. A possible complication of using the tunnel technique rather than the tendon splitting technique is iatrogenic fracture through the drilled tunnel site. The purpose of this investigation was to study the FDL tendon and proximal phalanx dimensions in the area of the transfer procedure in order to improve preoperative planning and minimize postoperative complications. Additionally, this study investigated the force necessary to create a fracture in a predrilled proximal phalanx and attempted to elucidate a relationship between that force and the percentage of bone remaining after the drilling process. The proximal phalanx and FDL tendon of the second, third, and fourth toes from both the right and the left foot of 14 fresh frozen cadavers were dissected, and the digit was amputated at the MTP joint. A total of 84 toes (42 right, 42 left) were obtained from 14 cadavers. The diameter of the FDL tendon was measured, and the circumference and volume were calculated. Fourteen proximal phalanges of either the right or the left foot were then drilled with a 3.5-mm drill, as is often done in a tendon transfer procedure. The 14 nondrilled bones from the contralateral foot were used as matched controls. Radiographs were then taken of the proximal phalanges, and the dimensions of the drill tunnel and remaining bone were calculated. These measurements were used to calculate the volume of the bone, the volume of the drill tunnel, and the percentage of bone remaining after the drilling process. The bones were then tested for load-to-failure using a biomechanical loading apparatus. The average bone and tendon diameter measurements showed a gradual decrease in size from the second to the fourth digits. The bone removed by drilling the tunnel accounted

  12. Single-stage reconstruction of flexor tendons with vascularized tendon transfers.

    Science.gov (United States)

    Cavadas, P C; Pérez-García, A; Thione, A; Lorca-García, C

    2015-03-01

    The reconstruction of finger flexor tendons with vascularized flexor digitorum superficialis (FDS) tendon grafts (flaps) based on the ulnar vessels as a single stage is not a popular technique. We reviewed 40 flexor tendon reconstructions (four flexor pollicis longus and 36 finger flexors) with vascularized FDS tendon grafts in 38 consecutive patients. The donor tendons were transferred based on the ulnar vessels as a single-stage procedure (37 pedicled flaps, three free flaps). Four patients required composite tendon and skin island transfer. Minimum follow-up was 12 months, and functional results were evaluated using a total active range of motion score. Multiple linear regression analysis was performed to evaluate the factors that could be associated with the postoperative total active range of motion. The average postoperative total active range of motion (excluding the thumbs) was 178.05° (SD 50°). The total active range of motion was significantly lower for patients who were reconstructed with free flaps and for those who required composite tendon and skin island flap. Age, right or left hand, donor/motor tendon and pulley reconstruction had no linear effect on total active range of motion. Overall results were comparable with a published series on staged tendon grafting but with a lower complication rate. Vascularized pedicled tendon grafts/flaps are useful in the reconstruction of defects of finger flexor tendons in a single stage, although its role in the reconstructive armamentarium remains to be clearly established. © The Author(s) 2014.

  13. Retrieval of the retracted flexor tendons for long fingers: New tip.

    Science.gov (United States)

    Ahed, K; Moujtahid, M; Nechad, M

    2014-09-01

    Zone II flexor tendon injuries continue to be a challenge for hand surgeons. During the injury event, the tendon ends may retract towards the palm. Retrieval of these lacerated ends can be problematic because the tendon sheath is unstretchable. This demanding surgery requires a precise repair technique where the tendon stumps are handled in an atraumatic manner. Microtrauma to the tendon sheath must be avoided as this can induce adhesions and lead to poor functional outcomes. Several retrieval methods for retracted tendon ends have been described in published studies. In this technical note, we will describe a technical variation that streamlines the surgical procedure and uses commonly available materials. This simple trick makes the procedure easier and avoids having to suture the tendon to the tubing. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  14. Quantification of regional blood flow to canine flexor tendons

    Energy Technology Data Exchange (ETDEWEB)

    Weidman, K.A.; Simonet, W.T.; Wood, M.B.; Cooney, W.P.; Ilstrup, D.M.

    1984-01-01

    Although the blood supply and the microcirculation of flexor tendons have been studied and defined extensively using qualitative methods, the quantitative assessment of blood flow has been lacking because of the limitations of the available experimental techniques. The authors studied the regional blood supply to the flexor tendons of dogs by the technique of radionuclide-labeled microspheres. Seven adult mongrel dogs were used. Microsphere injection and tissue-counting techniques previously used for other tissues were applied. Samples of proximal, isthmus, and distal portions of the profundus and superficialis flexor tendons were harvested from each digital unit of available limbs from each dog. Mean (+/- SE) flows (ml/100 g dry tissue/min) were proximal profundus 1.78 +/- 0.60 and superficialis 7.10 +/- 1.50. The differences were significant. The study suggests that regional variation in blood flow to canine digital flexor tendons exists, so that a single value for blood flow to these tendons is not relevant. Furthermore, the study supports the concept of dual (vascular and synovial) nutrition to the digital flexor tendons in dogs. These observations may have implications regarding tendon repair techniques.

  15. Quantification of regional blood flow to canine flexor tendons.

    Science.gov (United States)

    Weidman, K A; Simonet, W T; Wood, M B; Cooney, W P; Ilstrup, D M

    1984-01-01

    Although the blood supply and the microcirculation of flexor tendons have been studied and defined extensively using qualitative methods, the quantitative assessment of blood flow has been lacking because of the limitations of the available experimental techniques. We studied the regional blood supply to the flexor tendons of dogs by the technique of radionuclide-labeled microspheres. Seven adult mongrel dogs were used. Microsphere injection and tissue-counting techniques previously used for other tissues were applied. Samples of proximal, isthmus, and distal portions of the profundus and superficialis flexor tendons were harvested from each digital unit of available limbs from each dog. Mean (+/- SE) flows (ml/100 g dry tissue/min) were proximal profundus 1.78 +/- 0.60 and superficialis 7.10 +/- 1.50. The differences were significant (p less than 0.01). The study suggests that regional variation in blood flow to canine digital flexor tendons exists, so that a single value for blood flow to these tendons is not relevant. Furthermore, the study supports the concept of dual (vascular and synovial) nutrition to the digital flexor tendons in dogs. These observations may have implications regarding tendon repair techniques.

  16. The effect of flexor sheath integrity on nutrient uptake by primate flexor tendons.

    Science.gov (United States)

    Peterson, W W; Manske, P R; Lesker, P A

    1986-05-01

    The effect of flexor sheath excision versus sheath incision and repair on the uptake of 3H-proline by profundus tendons in zone II was examined. Proline uptake was measured at 7 days in eight monkeys with intact flexor tendons (group I) and at either 3 or 7 days in eight monkeys with the tendons transected and repaired (group II). In both groups, the flexor sheaths of the digits of the right hand were excised, whereas those of the left hand were incised and repaired. For both the intact and the transected and repaired flexor tendons, it was found that 3H-proline uptake was not improved with sheath closure. The extracellular tissue fluid appeared to be capable of providing nutrients to the tendon in amounts equal to that of the synovial fluid. Therefore, closure of the sheath after primary flexor tendon repair does not appear to be necessary for tendon nutrition, according to the data obtained from experimental studies on the nonhuman primate.

  17. Systemic EP4 Inhibition Increases Adhesion Formation in a Murine Model of Flexor Tendon Repair.

    Directory of Open Access Journals (Sweden)

    Michael B Geary

    Full Text Available Flexor tendon injuries are a common clinical problem, and repairs are frequently complicated by post-operative adhesions forming between the tendon and surrounding soft tissue. Prostaglandin E2 and the EP4 receptor have been implicated in this process following tendon injury; thus, we hypothesized that inhibiting EP4 after tendon injury would attenuate adhesion formation. A model of flexor tendon laceration and repair was utilized in C57BL/6J female mice to evaluate the effects of EP4 inhibition on adhesion formation and matrix deposition during flexor tendon repair. Systemic EP4 antagonist or vehicle control was given by intraperitoneal injection during the late proliferative phase of healing, and outcomes were analyzed for range of motion, biomechanics, histology, and genetic changes. Repairs treated with an EP4 antagonist demonstrated significant decreases in range of motion with increased resistance to gliding within the first three weeks after injury, suggesting greater adhesion formation. Histologic analysis of the repair site revealed a more robust granulation zone in the EP4 antagonist treated repairs, with early polarization for type III collagen by picrosirius red staining, findings consistent with functional outcomes. RT-PCR analysis demonstrated accelerated peaks in F4/80 and type III collagen (Col3a1 expression in the antagonist group, along with decreases in type I collagen (Col1a1. Mmp9 expression was significantly increased after discontinuing the antagonist, consistent with its role in mediating adhesion formation. Mmp2, which contributes to repair site remodeling, increases steadily between 10 and 28 days post-repair in the EP4 antagonist group, consistent with the increased matrix and granulation zones requiring remodeling in these repairs. These findings suggest that systemic EP4 antagonism leads to increased adhesion formation and matrix deposition during flexor tendon healing. Counter to our hypothesis that EP4 antagonism

  18. Evidence Supporting Intralesional Stem Cell Therapy to Improve Equine Flexor Tendon Healing

    Directory of Open Access Journals (Sweden)

    Sushmitha Durgam

    2017-01-01

    Full Text Available Clinical bottom lineCurrent experimental evidence suggests that intralesional stem cell administration improves the histological characteristics and matrix organisation of healing equine superficial digital flexor tendons (SDFT; however, the clinical relevance of these findings are not clear. Current case-based evidence suggests that cell-based therapies improve the quality of tendon healing and reduce the recurrence rates of SDFT injuries but the lack of any randomised, controlled prospective studies with function-based outcomes is still concerning, given the widespread advocacy for and use of ‘stem cell’ therapies for the treatment of equine tendon injuries

  19. Cerebral consequences of dynamic immobilisation after primary digital flexor tendon repair

    NARCIS (Netherlands)

    Stenekes, M W; Coert, J H; Nicolai, J-P A; Mulder, Th; Geertzen, J H B; Paans, A M; de Jong, BM

    2010-01-01

    Current treatment protocols for flexor tendon injuries of the hand generally result in an acceptable function, which can be quantified by objective parameters such as range of motion. The latter does not always match the patients' subjective experiences of persisting dysfunction. This raises the

  20. Danger zones for flexor tendons in volar plating of distal radius fractures.

    Science.gov (United States)

    Agnew, Sonya P; Ljungquist, Karin L; Huang, Jerry I

    2015-06-01

    To define a danger zone for volar plates using magnetic resonance imaging by analyzing the position of the flexor tendons at risk around the watershed line. We analyzed 40 wrist magnetic resonance images. The location of the flexor pollicus longus (FPL) and index flexor digitorum profundus (FDPi) tendons was recorded at 3 and 6 mm proximal to the watershed line of the distal radius. We measured the distance between the volar margin of the distal radius and the FPL and FDPi tendons, and the coronal position of the tendons. At a point 3 mm proximal to the watershed line, FPL and FDPi were located on average 2.6 and 2.2 mm anterior to the volar margin of the distal radius. This distance increased to 4.7 and 5.3 mm at a point 6 mm proximal to the watershed line. The FPL and FDPi were located at 57% and 42% of the total width of the distal radius from the sigmoid notch at 3 mm from the watershed, and at 66% and 46% at 6 mm from the watershed. Surgeons should be aware of the close proximity of the flexor tendons to the volar cortex of the distal radius proximal to the watershed line and their radial to ulnar position. Three millimeters proximal to the watershed line, plate placement more than 2 mm anterior to the volar cortex or the use of plates thicker than 2 mm poses a high risk for directly contacting flexor tendons. This article may prove to be helpful in avoiding flexor tendon injury during volar plate fixation. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  1. In Vitro Comparison of Two Barbed Suture Configurations for Flexor Tendon Repair.

    Science.gov (United States)

    Engel, Jamie L; Gabra, Joseph N; Esterle, Andrew R; Lanzinger, William D; Elias, John J

    2017-12-01

    Purpose  The current study compares the strength of a previously studied technique for flexor tendon repair with barbed sutures to an experimental approach that aligns all the barbs to oppose distraction. Methods  Twelve flexor tendons from cadaveric specimens were mechanically tested following repair of simulated zone II tendon injuries. Two repair techniques utilizing barbed sutures were studied: the Marrero-Amadeo four-core barbed suture approach and the experimental configuration with all barbs on four cores opposing distraction. Maximum applied load at failure, that is, ultimate load, and 2-mm gap force were compared between the two repair techniques, both as raw values and after normalization to cross-sectional area of the intact tendon. Statistical testing was performed using t -tests and Mann-Whitney U -tests, where appropriate, with a significance level of 0.05. Results  The ultimate loads, raw (58.2 N) and normalized (4.8 N/mm 2 ), were significantly larger for the Marrero-Amadeo repair than the proposed experimental approach (35.6 N and 2.7 N/mm 2 ; p  barbs to oppose distraction does not improve strength of the repaired tendon. The Marrero-Amadeo technique was found to have superior strength for use in traumatic zone II flexor tendon injuries.

  2. [Operative treatment of flexor pollicis longus tendon with Krackow suture, functional results--preliminary results].

    Science.gov (United States)

    Bumbasirević, Marko Z; Andjelković, Sladjana; Lesić, Aleksandar R; Sudjić, Vojo S; Palibrk, Tomislav; Tulić, Goran Dz; Radenković, Dejan V; Bajec, Djordje D

    2010-01-01

    Surgical treatment of the injuried flexor tensons is the important part of hand surgery. Tendon adhesions, ruptures, joint contcatures-stifness are only one part of the problem one is faced during the tendon treatment. In spite of improvement in surgical technique and suture material, the end result of sutured flexor tendons still represent a serious problem. To present of operative treatment of flexor pollicis longus injury with Krakow suture technique. All patients are treated in the first 48 hours after the accident. The regional anesthesia was performed with use of turniquet. Beside spare debridement, the reconstruction of digital nerves was done. All patients started with active and pasive movements-excercises on the first postoperative day. Follow-up was from 6 to 24 months. In evaluation of functional recovery the grip strenght, pinch strenght, range of movements of interphalangeal and metacarpophalangeal joiht and DASH score were used. In the last two years there were 30 patients, 25 males (83.33%) and 5 females (16.66%). Mean age was 39.8 years, ranged from 17 to 65 years. According to mechanism of injury the patients were divided in two groups: one with sharp and other with wider zone of injury. Concomitant digital nerve lesions was noticed in 15 patients (50%). the Krackow sutrue allowed early rehabilitation, which prevent tendon adhesions, enabled faster and better functional recovery.

  3. The pathology of flexor tendon repair.

    Science.gov (United States)

    Matthews, P

    1979-10-01

    This paper discusses the problems of failure after tendon repair. For a long time the subject has been dominated by the problem of adhesion formation. Recent work has shown that this is not inevitable, and consideration of other factors, particularly the nutrition of tendon tissue is leading to the possibilities of other methods of treatment.

  4. Clinical Results of Flexor Tendon Repair in Zone II Using a six Strand Double Loop Technique.

    Science.gov (United States)

    Savvidou, Christiana; Tsai, Tsu-Min

    2015-06-01

    The purpose of this study is to report the clinical results after repair of flexor tendon zone II injuries utilizing a 6-strand double-loop technique and early post-operative active rehabilitation. We retrospectively reviewed 22 patients involving 51 cases with zone II flexor tendon repair using a six strand double loop technique from September 1996 to December 2012. Most common mechanism of injuries was sharp lacerations (86.5 %). Tendon injuries occurred equally in manual and non-manual workers and were work-related in 33 % of the cases. The Strickland score for active range of motion (ROM) postoperatively was excellent and good in the majority of the cases (81 %). The rupture rate was 1.9 %. The six strand double loop technique for Zone II flexor tendon repair leads to good and excellent motion in the majority of patients and low re- rupture rate. It is clinically effective and allows for early postoperative active rehabilitation.

  5. Evaluation of the equine digital flexor tendon sheath using diagnostic ultrasound and contrast radiography

    International Nuclear Information System (INIS)

    Redding, W.R.

    1994-01-01

    This study was designed to evaluate the normal anatomy of the digital flexor tendon sheath using contrast radiography and diagnostic ultrasound. Iodinated contrast medium was injected into eight cadaver limbs and the limbs immediately frozen. Lateromedial and dorsopalmar/plantar radiographs were made. These limps were then cut transversely and proximal to distal radiographs of each slab were made. This cross sectional contrast methodology allowed the visualization of the relative size and shape of the superficial and deep digital flexor tendons as well as the potential space taken by effusions of the digital flexor tendon sheath. The second part of the study used twelve live animals with normal digital flexor tendon sheaths. Ultrasonographic measurement of the structures of the digital flexor tendon sheath at each level were compiled. This documented the ability of diagnostic ultrasound to image: 1) the superficial and deep digital flexor tendons, 2) the proximal and distal ring of the manica flexoria, 3) the straight and oblique sesamoidean ligaments, and 4) the mesotendinous attachments to the superficial and deep flexor tendons. Iodinated contrast medium was then injected into the digital flexor tendon sheath and the ultrasonography repeated. These images were compared with those obtained from contrast radiography and prosections of twenty normal limbs. The iodinated contrast medium enhanced sonographic imaging of the structures of the digital tendon sheath, particularly the abaxial borders of the superficial digital flexor tendon branches and the mesotendinous attachments to the superficial and deep digital flexor tendons

  6. Effects of Non-Steroidal Anti-Inflammatory Drugs onFlexor Tendon Rehabilitation after Repair

    Directory of Open Access Journals (Sweden)

    Alireza Rouhani

    2013-09-01

    Full Text Available   Background: Peritendinous adhesions after repairing an injury to the digital flexor tendons are a major problem in hand surgery. Non-steroidal anti-inflammatory drug therapy may affect tendon healing and the development of peritendinous adhesions. The aim of this study was to evaluate ibuprofen effect in patients function after flexor tendon surgical repair.   Method: Thirty-five patients, who had sharp-edge lacerations of hand-zone II requiring flexor tendons repair, participated in this randomized double-blind clinical trial study. The patients were randomly classified into two parallel and matched groups (21 patients in the intervention group and 14 patients in the control group. The groups were matched considering age, gender, and laceration size. The control group received a placebo with the same appearance and dosage. In the intervention group, ibuprofen was prescribed at a high dosage (2400 mg/day. The range of motion improvement rate of the involved fingers and the patients’ performance after their follow-up period were compared. Results: There was a statistically significant difference between the two groups for range of motion of the involved finger joints (P=0.03. According to the DASH score, there was a statistically significant difference between the final performance of the patients, such that it was 11±2.4 and 18.4±6.3 in the intervention and control groups, respectively (P=0.01. There was not any case of re-tear or need to re-operate in the intervention and control groups. Conclusion: Our findings reveal that ibuprofen with an anti-inflammatory dose was effective in improving the range of motion of the involved fingers joints after flexor tendon injury.

  7. A technique for introducing looped sutures in flexor tendon repair

    Directory of Open Access Journals (Sweden)

    Kamath B

    2006-01-01

    Full Text Available Stronger flexor tendon repairs facilitate early active motion therapy protocols. Core sutures using looped suture material provide 1 ½ to twice the strength of Kessler′s technique (with four strand and six strand Tsuge technique respectively. The technique is well-described and uses preformed looped sutures (supramid. This is not available in many countries and we describe a technique whereby looped sutures can be introduced in flexor tendon repair by the use of 23 G hypodermic needle and conventional 4.0 or 5.0 sutures. This is an alternative when the custom made preformed sutures are not available. This can be practiced in zone 3 to zone 5 repairs. Technical difficulties limit its use in zone 2 repairs.

  8. Intrinsic flexor-tendon repair. A morphological study in vitro.

    Science.gov (United States)

    Manske, P R; Gelberman, R H; Vande Berg, J S; Lesker, P A

    1984-03-01

    Rabbit flexor tendons with a 90 per cent mid-section transverse laceration demonstrated the intrinsic capacity to participate in the repair process in the absence of extrinsic cell sources and without the benefit of nutrition from a circulating blood supply or the influence of synovial fluid. Two cellular processes were involved in the in vitro repair process: (1) phagocytosis occurred by differentiation of fibroblasts from the epitenon--the cells migrated into the repair site and removed cellular debris and collagen fragments, and (2) collagen synthesis occurred primarily within the endotenon cells. The results of this experimental study support the concept that flexor tendons have the intrinsic capacity to phagocytize old collagen and synthesize new collagen fibrils. Consequently, clinical attempts to prevent or control the peripheral adhesions appear valid, since these adhesions do not appear to be an essential component of the repair process.

  9. Amputation of finger by horse bite with complete avulsion of both flexor tendons.

    Science.gov (United States)

    Koren, Lior; Stahl, Shalom; Rovitsky, Alexey; Peled, Eli

    2011-08-08

    Amputation of fingers with tendon avulsion occurs through a traction injury, and most occur through a ring avulsion mechanism. Usually the flexor digitorum profundus is torn out with the amputated finger. Replantation usually is recommended only when the amputation is distal to the flexor digitorum superficialis insertion. Animal bites are relatively common, with a decreasing order of frequency of dogs, cats, and humans. Horse bites are relatively infrequent but are associated with crush injuries and tissue loss when they occur. This article describes a 23-year-old man with amputation of his middle finger at the level of the proximal phalanx after being bitten by a horse. The amputated stump was avulsed with the middle finger flexor digitorum profundus and flexor digitorum superficialis torn from the muscle-tendon junction from approximately the middle of the forearm. The patient had no other injuries, and he was able to move his other 4 fingers with only mild pain. As the amputated digit was not suitable for replantation, the wound was irrigated and debrided. The edges of the phalanx were trimmed, and the edges of the wound were sutured. Tetanus toxoid and rabies vaccine were administered, along with intravenous amoxicillin and clavulanic acid. The patient was discharged from the hospital 2 days later, with no sign of infection of the wound or compartment syndrome of the forearm. This case demonstrates the weakest point in the myotendinous junction and emphasizes the importance of a careful physical examination in patients with a traumatic amputation. Copyright 2011, SLACK Incorporated.

  10. Flexor digitorum profundus tendon anatomy in the forearm

    Directory of Open Access Journals (Sweden)

    Teoman Dogan

    2012-04-01

    Methods: We used 11 forearms belonging to cadavers and fixed with formaldehyde. The forearms numbered 1, 2, 8, 9, 10, 11 were the left and right arms of the same cadavers. Those numbered 3, 4, 5, 6, 7 belonged to different cadavers. Dissections were made by using the atraumatic surgical technique. The tendons were studied to identify the structure and number of the fibers forming them. Results: The presence of a large common tendon was found in 10 of the 11 forearms. In 4 of these, the common tendon included the tendons of all four fingers. While the common tendon included 3 fingers in four forearms, it only included tendons belonging to 2 fingers in two forearms. It was not possible in one forearm to separate the common tendon into its fibers. In another forearm, tendons belonging to each digit were separate and independent starting at the muscle-tendon junction to the attachment points. Conclusion: The majority of the cadaver forearms used in the study displayed a single large FDP tendon in the zone between the muscle-tendon joint to the carpal tunnel entry prior to being distributed into each index. This anatomical feature should be considered in choosing materials and surgical technique for Zone V FDP tendon injuries, as well as in planning the rehabilitation process. [Hand Microsurg 2012; 1(1.000: 25-29

  11. Outcome of early active mobilization after flexor tendons repair in zones II-V in hand

    Directory of Open Access Journals (Sweden)

    Saini Narender

    2010-01-01

    Full Text Available Background: The functional outcome of a flexor tendon injury after repair depends on multiple factors. The postoperative management of tendon injuries has paved a sea through many mobilization protocols. The improved understanding of splinting techniques has promoted the understanding and implication of these mobilization protocols. We conducted a study to observe and record the results of early active mobilization of repaired flexor tendons in zones II-V. Materials and Methods: 25 cases with 75 digits involving 129 flexor tendons including 8 flexor pollicis longus (FPL tendons in zones II-V of thumb were subjected to the early active mobilization protocol. Eighteen (72% patients were below 30 years of age. Twenty-four cases (96% sustained injury by sharp instrument either accidentally or by assault. Ring and little finger were involved in 50% instances. In all digits, either a primary repair (n=26 or a delayed primary repair (n=49 was done. The repair was done with the modified Kessler core suture technique with locking epitendinous sutures with a knot inside the repair site, using polypropylene 3-0/4-0 sutures. An end-to-end repair of the cut nerves was done under loupe magnification using a 6-0/8-0 polyamide suture. The rehabilitation program adopted was a modification of Kleinert′s regimen, and Silfverskiold regimen. The final assessment was done at 14 weeks post repair using the Louisville system of Lister et al. Results: Eighteen of excellent results were attributed to ring and little fingers where there was a flexion lag of < 1 cm and an extension lag of < 15o. FPL showed 75% (n=6 excellent flexion. 63% (n=47 digits showed excellent results whereas good results were seen in 19% (n=14 digits. Nine percent (n=7 digits showed fair and the same number showed poor results. The cases where the median (n=4 or ulnar nerve (n=6 or both (n=3 were involved led to some deformity (clawing/ape thumb at 6 months postoperatively. The cases with digital

  12. Reparación aguda de los tendones flexores

    Directory of Open Access Journals (Sweden)

    Ricardo C. Pacheco-López

    Full Text Available Para la correcta ejecución de la Cirugía de Mano es necesario conocer su anatomía, fisiología, biomecánica, así como las diferentes técnicas quirúrgicas. La función principal del tendón es la transmisión de fuerza desde el vientre muscular de origen hacia el hueso final donde se inserta; en el caso de los tendones flexores, la fuerza muscular da como resultado la flexión de los dedos. El objetivo del presente trabajo es conocer la anatomía de los tendones flexores de la mano, el diagnóstico de sus principales lesiones y repasar las principales técnicas quirúrgicas para su tratamiento. El autor lleva a cabo una revisión de los principios básicos de cicatrización tendinosa, de la identificación de las zonas de lesión de los tendones flexores de la mano, de los métodos para su diagnóstico, de las técnicas quirúrgicas para su tratamiento y de su manejo postoperatorio, basándose en los hechos históricos más importantes relativos a todos estos conocimientos y a sus propias aportaciones y experiencia.

  13. Efficacy of Low Level Laser Therapy After Hand Flexor Tendon Repair

    Science.gov (United States)

    Ayad, K. E.; El Gohary, H. M.; Abd Elrahman, M.; Abd El Mejeed, S. F.; Bekheet, A. B.

    2009-09-01

    Flexor tendon injury is a common problem requiring suturing repair followed by early postoperative mobilization. Muscle atrophy, joint stiffness, osteoarthritis, infection, skin necrosis, ulceration of joint cartilage and tendocutaneous adhesion are familiar complications produced by prolonged immobilization of surgically repaired tendon ruptures. The purpose of this study was to clarify the importance of low level laser therapy after hand flexor tendon repair in zone II. Thirty patients aging between 20 and 40 years were divided into two groups. Patients in group A (n = 15) received a conventional therapeutic exercise program while patients in group B (n = 15) received low level laser therapy combined with the same therapeutic exercise program. The results showed a statistically significant increase in total active motion of the proximal and distal interphalangeal joints as well as maximum hand grip strength at three weeks and three months postoperative, but improvement was more significant in group B. It was concluded that the combination of low level laser therapy and early therapeutic exercises was more effective than therapeutic exercises alone in improving total active motion of proximal and distal interphalangeal joints and hand grip strength after hand flexor tendon repair.

  14. Elastographic characteristics of the metacarpal tendons in horses without clinical evidence of tendon injury.

    Science.gov (United States)

    Lustgarten, Meghann; Redding, W Rich; Labens, Raphael; Morgan, Michel; Davis, Weston; Seiler, Gabriela S

    2014-01-01

    Tendon and ligament injuries are common causes of impaired performance in equine athletes. Gray-scale ultrasonography is the current standard method for diagnosing and monitoring these injuries, however this modality only provides morphologic information. Elastography is an ultrasound technique that allows detection and measurement of tissue strain, and may provide valuable mechanical information about equine tendon and ligament injuries. The purpose of this study was to determine the feasibility, reproducibility, and repeatability of elastography; and to describe elastographic characteristics of metacarpal tendons in sound horses. Nineteen legs for 17 clinically sound horses without evidence of musculoskeletal pathology were included. Elastographic images of the superficial and deep digital flexor tendons and the branches of the suspensory ligament (tendon of the interosseous muscle) were described quantitatively and qualitatively. There was no statistically significant difference between operators (P = 0.86) nor within operators (P = 0.93). For qualitative assessments, reproducibility (0.46) was moderate and repeatability (0.78) was good. Similar to human Achilles tendons, equine tendons were classified as predominantly hard using elastography. There was no statistically significant difference in stiffness of the flexor tendons (P = 0.96). No significant difference in stiffness was found with altered leg position during standing (P = 0.84) and while nonweight bearing (P = 0.61). The flexor tendons were softer when imaged in longitudinal versus transverse planes (P tendons and ligaments of the distal forelimb in horses. © 2013 American College of Veterinary Radiology.

  15. Strong Digital Flexor Tendon Repair, Extension-Flexion Test, and Early Active Flexion: Experience in 300 Tendons.

    Science.gov (United States)

    Tang, Jin Bo; Zhou, Xiang; Pan, Zhang Jun; Qing, Jun; Gong, Ke Tong; Chen, Jing

    2017-08-01

    Over the past 2 decades, repair and rehabilitation methods of primary repair of the digital flexor tendon have changed. In this article, we outline interim results from ongoing investigations in several units. Surgeons in these units now perform digital flexor tendon repairs according to a treatment protocol. Before adopting the protocol, they had no history of tendon-related research; they had not used any of the repair and rehabilitation methods described in the protocol. The surgeons involved are junior or midlevel attending surgeons. At the end of this article, we outline current practice of digital flexor tendon repair in Asian countries. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. A new barbed device for repair of flexor tendons.

    LENUS (Irish Health Repository)

    Hirpara, K M

    2012-02-01

    We split 100 porcine flexor tendons into five groups of 20 tendons for repair. Three groups were repaired using the Pennington modified Kessler technique, the cruciate or the Savage technique, one using one new device per tendon and the other with two new devices per tendon. Half of the tendons received supplemental circumferential Silfverskiold type B cross-stitch. The repairs were loaded to failure and a record made of their bulk, the force required to produce a 3 mm gap, the maximum force applied before failure and the stiffness. When only one device was used repairs were equivalent to the Pennington modified Kessler for all parameters except the force to produce a 3 mm gap when supplemented with a circumferential repair, which was equivalent to the cruciate. When two devices were used the repair strength was equivalent to the cruciate repair, and when the two-device repair was supplemented with a circumferential suture the force to produce a 3 mm gap was equivalent to that of the Savage six-strand technique.

  17. From collagen to tenocyte : How the equine superficial digital flexor tendon responds to physiologic challenges and physical therapy

    NARCIS (Netherlands)

    Lin, Yi-Lo

    2005-01-01

    Introduction Injuries to the equine superficial digital flexor tendon (SDFT) play a prominent role in the orthopaedic disorders and form an important threat to both the equine athletic potential and welfare. Therefore this thesis aims at in-depth understanding the development of ECM composition in

  18. The impact of different peripheral suture techniques on the biomechanical stability in flexor tendon repair.

    Science.gov (United States)

    Wieskötter, B; Herbort, M; Langer, M; Raschke, M J; Wähnert, D

    2018-01-01

    Flexor tendon repair consists of circumferential peripheral sutures in combination with core sutures to avoid fraying and reduces the exposure of suture material on tendon surface. The peripheral suture adds up to a tenfold increase of the biomechanical stability compared to the core suture alone. The purpose of our study was to determine the most favourable peripheral repair technique for tendon repair. Seventy-two porcine flexor tendons underwent standardized tenotomy and repair using one of the following six methods (n = 12): simple-running (SR), simple-locking (SL), Halsted-mattress (HM), lin-locking (LL), Lembert-mattress (LM), and Silfverskiöld cross-stich (SCS) suture technique. The SL- suture was placed 2 mm; the HM, LM, SC, and LL suture were placed 5 mm from the tendon gap. The SR suture was placed 1, 2, and 3 mm from tendon ends; no additional core suture was applied. For cyclic testing (1000 cycles), elongation was calculated; for load to failure construct stiffness, yield load and maximum load were determined. The mean cyclic elongation for all tested suture techniques was less than 2 mm; there was no significant difference between the groups regarding elongation as well as yield load. The HM, LM, SCS, and LL suture techniques presented significantly higher maximum loads compared to the SR- and SL-sutures. The 3 mm SR showed significantly higher maximum loads compared to the 2 and 1 mm SR. Beside the distance from tendon gap, the type of linkage of the suture material across and beneath the epitendineum is important for biomechanical stability. Simple-running suture is easy to use, even with a slight increase of the distance from tendon gap significantly increases biomechanical strength. For future repairs of flexor tendon injuries, 3 mm stitch length is highly recommended for simple peripheral suture, while the Halsted-mattress suture unites the most important qualities: biomechanically strong, most part of suture material placed

  19. Asymptomatic Flexor Tendon Damages after Volar Locking Plate Fixation of Distal Radius Fractures.

    Science.gov (United States)

    Tokunaga, Susumu; Abe, Yoshihiro

    2017-03-01

    To investigate asymptomatic flexor tendon damages after volar locking plate fixation of distal radius fractures in 32 wrists of 32 patients with distal radius fractures fixed using two plate types. Sixteen patients received the Acu-Loc volar distal radius plate, and the remaining 16 patients received the Aptus distal radius correction plate. The flexor pollicis longus (FPL) tendon and flexor digitorum profundus were evaluated according to intraoperative findings at plate removal. Ultrasonography was used to measure the distance between the FPL tendon and distal edge of the plates (FPL plate distance) before plate removal, the distance between the FPL tendon and distal edge of the radius (FPL radius distance) after plate removal, in the contralateral wrist, and the angle between an extension line of a volar surface line on the proximal FPL tendon and a second volar surface line on the distal FPL tendon (FPL angles). Erosion of the FPL tendon was identified in four wrists, and erosion of the flexor digitorum profundus of the index finger was identified in one wrist. All five cases of wrists with flexor tendon damage had Acu-Loc plates installed. The average FPL angle before plate removal was 15.4° in the wrists with tendon damage, which was statistically significantly larger than the average FPL angle in the wrists without erosion. The type of plate and larger FPL angle on ultrasonography may be the risk factors for flexor tendon damage.

  20. Neglected ruptured flexor carpi ulnaris tendon mimics a soft tissue tumor in the wrist.

    Science.gov (United States)

    Rau, Chi-Lun; Yen, Tze-Hsun; Wu, Lien-Chen; Huang, Yi-You; Jaw, Fu-Shan; Liou, Tsan-Hon

    2014-04-01

    A wrist mass is rarely caused by a ruptured tendon in the forearm. The common pathologies are ganglia, tendon tenosynovitis, and giant cell tumors of tendon sheaths. Less common causes are nerve sheath tumors, vascular lesions, or an accessory muscle belly. The authors investigated a case of neglected ruptured flexor carpi ulnaris tendon that mimics a mass in the wrist. To the authors' knowledge, this is the first case report in relevant literature. During investigation, the high-resolution musculoskeletal ultrasound suggested a soft tissue tumor or a ruptured flexor carpi ulnaris tendon. The magnetic resonance imaging scan indicated an accessory flexor carpi ulnaris muscle belly. The diagnosis of ruptured flexor carpi ulnaris tendon was confirmed by surgical exploration. This case indicates that ultrasound may be better suited than magnetic resonance imaging in evaluating a wrist mass for its accuracy, availability, and portability.

  1. Molecular Biology of Flexor Tendon Healing in Relation to Reduction of Tendon Adhesions.

    Science.gov (United States)

    Legrand, Anais; Kaufman, Yoav; Long, Chao; Fox, Paige M

    2017-09-01

    Tendon injuries are encountered after major and minor hand trauma. Despite meticulous repair technique, adhesion formation can occur, limiting recovery. Although a great deal of progress has been made toward understanding the mechanism of tendon healing and adhesions, clinically applicable solutions to prevent adhesions remain elusive. The goal of this paper is to review the most recent literature relating to the tendon healing and adhesion prevention. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  2. Achilles tendon injuries in athletes.

    Science.gov (United States)

    Kvist, M

    1994-09-01

    Two-thirds of Achilles tendon injuries in competitive athletes are paratenonitis and one-fifth are insertional complaints (bursitis and insertion tendinitis). The remaining afflictions consist of pain syndromes of the myotendineal junction and tendinopathies. The majority of Achilles tendon injuries from sport occur in males, mainly because of their higher rates of participation in sport, but also with tendinopathies a gender difference is probably indicated. Athletes in running sports have a high incidence of Achilles tendon overuse injuries. About 75% of total and the majority of partial tendon ruptures are related to sports activities usually involving abrupt repetitive jumping and sprinting movements. Mechanical factors and a sedentary lifestyle play a role in the pathology of these injuries. Achilles tendon overuse injuries occur at a higher rate in older athletes than most other typical overuse injuries. Recreational athletes with a complete Achilles tendon rupture are about 15 years younger than those with other spontaneous tendon ruptures. Following surgery, about 70 to 90% of athletes have a successful comeback after Achilles tendon injury. Surgery is required in about 25% of athletes with Achilles tendon overuse injuries and the frequency of surgery increases with patient age and duration of symptoms as well as occurrence of tendinopathic changes. However, about 20% of injured athletes require a re-operation for Achilles tendon overuse injuries, and about 3 to 5% are compelled to abandon their sports career because of these injuries. Myotendineal junction pain should be treated conservatively. Partial Achilles tendon ruptures are primarily treated conservatively, although the best treatment method of chronic partial rupture seems to be surgery. Complete Achilles tendon ruptures of athletes are treated surgically, because this increases the likelihood of athletes reaching preinjury activity levels and minimises the risk of re-ruptures. Marked forefoot

  3. Mechanical properties of the equine superficial digital flexor tendon relate to specific collagen cross-link levels.

    Science.gov (United States)

    Thorpe, C T; Stark, R J F; Goodship, A E; Birch, H L

    2010-11-01

    Damage to the flexor tendons, particularly the superficial digital flexor tendon (SDFT), is one of the most common musculoskeletal injuries sustained by horses competing in all disciplines. Our previous work has shown that SDFTs from different individuals show a wide variation in mechanical strengths; this is important clinically as it may relate to predisposition to injury. The high mechanical strength of tendon relies on the correct orientation of collagen molecules within fibrils and stabilisation by the formation of chemical cross-links between collagen molecules. It is not known whether the variation in SDFT mechanical properties between individuals relates to differences in collagen cross-link levels. Enzyme-derived, intermolecular cross-linking of tendon collagen correlates with mechanical properties of the SDFT. SDFTs were collected from 38 horses and mechanically tested to failure. Structural and material properties were calculated from the load/deformation plot and cross-sectional area for each tendon. Following mechanical testing, pyrrolic cross-link levels were measured using a spectrophotometric assay for Ehrlich's reactivity and pyridinoline levels were quantified by HPLC. Cross-link levels were correlated with mechanical properties and statistical significance tested using a Pearson's correlation test. Pyrrole cross-link levels showed a significant positive correlation with ultimate stress (P = 0.004), yield stress (P = 0.003) and elastic modulus (P = 0.018) of the tendons, despite being a minor cross-link in these tendons. There was no significant correlation of mechanical properties with either hydroxylysyl- or lysyl-pyridinoline levels. Given the low absolute levels of pyrrole, we suggest that the correlation with high mechanical strength is through an indirect mechanism. Understanding the nature of the relationships between pyrrole cross-links, other matrix characteristics and tendon material properties may allow development of strategies to

  4. Ganglion of the Flexor Tendon Sheath at the A2 Pulley - Case Report

    Directory of Open Access Journals (Sweden)

    P Gunaseelan

    2015-03-01

    Full Text Available There are few reported cases of flexor tendon sheath ganglion arising from the A2 pulley. We report a case of a flexor tendon sheath ganglion in a 17-year old female who presented with pain, triggering and a swelling at the base of her right ring finger. During the excision biopsy, a ganglion measuring 0.5×0.8×0.4 cm in size was removed from the A2 pulley area.

  5. [Pathophysiology of overuse tendon injury].

    Science.gov (United States)

    Kannus, P; Paavola, M; Paakkala, T; Parkkari, J; Järvinen, T; Järvinen, M

    2002-10-01

    Overuse tendon injury is one of the most common injuries in sports. The etiology as well as the pathophysiological mechanisms leading to tendinopathy are of crucial medical importance. At the moment intrinsic and extrinsic factors are assumed as mechanisms of overuse tendon injury. Except for the acute, extrinsic trauma, the chronic overuse tendon injury is a multifactorial process. There are many other factors, such as local hypoxia, less of nutrition, impaired metabolism and local inflammatory that may also contribute to the development of tissue damage. The exact interaction of these factors cannot be explained entirely at the moment. Further studies will be necessary in order to get more information.

  6. Treatment of unfavourable results of flexor tendon surgery: Ruptured repairs, tethered repairs and pulley incompetence.

    Science.gov (United States)

    Elliot, David; Giesen, Thomas

    2013-09-01

    As primary repair of divided flexor tendons becomes more common, secondary tendon surgery becomes largely that of the complications of primary repair, namely ruptured and adherent repairs. These occur with an incidence of each in most reported series world-wide of around 5%, with these problems having changed little in the last two decades, despite strengthening our suture repairs. Where the primary referral service is less well-developed, and as a more occasional occurrence where primary treatment is the routine, the surgeon faces different problems. Patients arrive at a hand unit variable, but longer, times after the primary insult, having had no, or bad, previous treatment. Sometimes the situation is the same, viz. an extended finger with no active flexion, but now no longer amenable to primary repair. Frequently, it is much more complex as a result of injuries to the other tissues of the digit and, also, as a result of the unaided healing process within the digit in the presence of an inactive flexor system. We present our experience in dealing with ruptured repairs, tethered repairs and pulley incompetence.

  7. Treatment of unfavourable results of flexor tendon surgery: Ruptured repairs, tethered repairs and pulley incompetence

    Directory of Open Access Journals (Sweden)

    David Elliot

    2013-01-01

    Full Text Available As primary repair of divided flexor tendons becomes more common, secondary tendon surgery becomes largely that of the complications of primary repair, namely ruptured and adherent repairs. These occur with an incidence of each in most reported series world-wide of around 5%, with these problems having changed little in the last two decades, despite strengthening our suture repairs. Where the primary referral service is less well-developed, and as a more occasional occurrence where primary treatment is the routine, the surgeon faces different problems. Patients arrive at a hand unit variable, but longer, times after the primary insult, having had no, or bad, previous treatment. Sometimes the situation is the same, viz. an extended finger with no active flexion, but now no longer amenable to primary repair. Frequently, it is much more complex as a result of injuries to the other tissues of the digit and, also, as a result of the unaided healing process within the digit in the presence of an inactive flexor system. We present our experience in dealing with ruptured repairs, tethered repairs and pulley incompetence.

  8. Investigating tendon mineralisation in the avian hindlimb: a model for tendon ageing, injury and disease

    Science.gov (United States)

    Agabalyan, Natacha A; Evans, Darrell J R; Stanley, Rachael L

    2013-01-01

    Mineralisation of the tendon tissue has been described in various models of injury, ageing and disease. Often resulting in painful and debilitating conditions, the processes underlying this mechanism are poorly understood. To elucidate the progression from healthy tendon to mineralised tendon, an appropriate model is required. In this study, we describe the spontaneous and non-pathological ossification and calcification of tendons of the hindlimb of the domestic chicken (Gallus gallus domesticus). The appearance of the ossified avian tendon has been described previously, although there have been no studies investigating the developmental processes and underlying mechanisms leading to the ossified avian tendon. The tissue and cells from three tendons – the ossifying extensor and flexor digitorum longus tendons and the non-ossifying Achilles tendon – were analysed for markers of ageing and mineralisation using histology, immunohistochemistry, cytochemistry and molecular analysis. Histologically, the adult tissue showed a loss of healthy tendon crimp morphology as well as markers of calcium deposits and mineralisation. The tissue showed a lowered expression of collagens inherent to the tendon extracellular matrix and presented proteins expressed by bone. The cells from the ossified tendons showed a chondrogenic and osteogenic phenotype as well as tenogenic phenotype and expressed the same markers of ossification and calcification as the tissue. A molecular analysis of the gene expression of the cells confirmed these results. Tendon ossification within the ossified avian tendon seems to be the result of an endochondral process driven by its cells, although the roles of the different cell populations have yet to be elucidated. Understanding the role of the tenocyte within this tissue and the process behind tendon ossification may help us prevent or treat ossification that occurs in injured, ageing or diseased tendon. PMID:23826786

  9. Animal Models for Tendon Repair Experiments: A Comparison of Pig, Sheep and Human Deep Flexor Tendons in Zone II.

    Science.gov (United States)

    Peltz, Tim Sebastian; Hoffman, Stuart William; Scougall, Peter James; Gianoutsos, Mark Peter; Savage, Robert; Oliver, Rema Antoinette; Walsh, William Robert

    2017-09-01

    This laboratory study compared pig, sheep and human deep flexor tendons in regards to their biomechanical comparability. To investigate the relevant biomechanical properties for tendon repair experiments, the tendons resistance to cheese-wiring (suture drag/splitting) was assessed. Cheese-wiring of a suture through a tendon is an essential factor for repair gapping and failure in a tendon repair. Biomechanical testing showed that forces required to pulling a uniform suture loop through sheep or pig tendons in Zone II were higher than in human tendons. At time point zero of testing these differences did not reach statistical significance, but differences became more pronounced when forces were measured beyond initial cheese-wiring (2 mm, 5 mm and 10 mm). The stronger resistance to cheese-wiring was more pronounced in the pig tendons. Also regarding size and histology, sheep tendons were more comparable to human tendons than pig tendons. Differences in tendon bio-properties should be kept in mind when comparing and interpreting the results of laboratory tendon experiments.

  10. Lateral luxation of the superficial digital flexor tendon from the calcaneal tuber in two horses

    International Nuclear Information System (INIS)

    Meagher, D.M.; Aldrete, A.V.

    1989-01-01

    Lateral luxation of the superficial digital flexor tendon from the calcaneal tuber occurs in horses as a result of tearing or rupture of the medial retinaculum of the tendon. This report describes the repair of this condition in 2 Thoroughbred race horses, using a surgical technique in which 2 cancellous bone screws were placed in the calcaneus lateral to the tendon, along with suturing the medial retinaculum

  11. [Functional reeducation of flexor tendons with associated lesions in zone II--comparative study].

    Science.gov (United States)

    Topa, I; Tamaş, Camelia; Perţea, Mihaela; Stamate, T

    2011-01-01

    Regaining satisfactory digital function after flexor tendon laceration and repair has long been one of the most important problems in hand surgery. But optimal therapy is often difficult to ascertain, given the plethora of immediat postoperative protocols published in the scientific literature. The purpose of this study is to compare the functional results between Kleinert, Silfverkiöld, Gratton and Strickland protocol towards evaluate them by interconnection and with the literature. The prospective study enorolled 75 patients who presented in our cabinet consecutives during 1.05.2008-1.12.2010. The subjects were evaluated regarding Total active motion test and Grip strenght test at 12 weeks postoperative. We found the best results to Gratton group, followed by Strickland, Silfverkiöld-May and Kleinert groups. We conclude that, for the tendinous lessions with associated injury (nervs and vessels) in zone II, our first therapeutical indication is to use the Gratton protocol.

  12. The high variability of the chiasma plantare and the long flexor tendons: Anatomical aspects of tendon transfer in foot surgery.

    Science.gov (United States)

    Pretterklieber, Bettina

    2017-05-01

    As tendon transfer of the flexor hallucis longus (FHL) and the flexor digitorum longus (FDL) is an established procedure, exact knowledge of the formation of the chiasma plantare is of great interest. Although the quadratus plantae (QP) appears to play a major role, it has been rarely addressed in previous studies. The aim of the present study was to reinvestigate the formation of the chiasma plantare and the composition of the long flexor tendons in order to clarify the inexact and partly contradictory descriptions published from 1865 onward. The chiasma plantare and the long flexor tendons in both feet of 50 formalin-fixed specimens of body donors (25 men and women) were analyzed by gross anatomical dissection. It was composed of one (3%), two (69%) or three layers (28%) which were variably established by the tendinous and muscular fibers of the FHL, the FDL and the QP. In 61% the FHL gave one or more slips to the FDL, and in 39% there was a bidirectional interconnection between the two tendons. The slip from the FHL to the FDL largely reinforces the second (45%), or the second and third tendon (46%). Thus, the FHL is involved in the first tendon in all cases, in the second one in 97% of cases, and in the third tendon in about one half of cases (53%). In all instances, the FDL contributes to the third to fourth, in 98% the second, and in at least 39% to the first tendon. The QP reinforces the second to fourth tendon in nearly all cases, the fifth in about one half of cases, and even the first tendon in 14% of cases. In addition, the individual composition of the five long flexor tendons arising from the chiasma plantare was analyzed in detail. Special emphasis was placed on the evaluation of side and sex differences as well as individual symmetry. Furthermore, biomechanical, developmental and phylogenetic aspects were outlined. In terms of the outcome of this study, the FHL appears to be the better donor for tendon transfer to restore lost function, but

  13. Blood supply of the flexor digital tendon in the hand and its clinical significance.

    Science.gov (United States)

    Zhang, Z Z; Zhong, S Z; Sun, B; Ho, G T

    1990-01-01

    An anatomical study on the blood sources and vascularity of the flexor digital tendon was conducted in the upper extremities of fresh cadavers by means of arterial injection and meticulous dissection of the transparent tendon under the microscope. According to whether or not synovial membrane surrounded the tendon, the flexor digital tendon can be divided into 2 regions: non-synovial and synovial. The major intrinsic blood supply of the digital tendon was in the form of longitudinal vascular bundles, while the transverse anastomotic branches were short and sparse. The non-synovial region of the tendon was covered by paratenon and the vascular distribution of this region was uniform. In the synovial sheath, the blood vessels distributed only on the dorsal side, while the volar side was devoid of vessels. The profundus and superficialis tendons had an avascular zone at the proximal interphalangeal and metacarpophalangeal joints respectively. It was considered that the difference of the vascular architecture might be related to the mechanical force to which the tendon was subjected. The nutrition of tendon was discussed and the selection of tendon graft at operation was suggested.

  14. The vascularization of human flexor tendons within the digital synovial sheath region--structureal and functional aspects.

    Science.gov (United States)

    Lundborg, G; Myrhage, R; Rydevik, B

    1977-11-01

    The intrinsic vascularization of human flexor tendons within the digital sheath region was studied on fresh amputation specimens with the aid of angiographic and histochemical techniques. In the flexor digitorum profundus tendon, three separate vascular systems of various origin and with no or very little communication could be verified. In the flexor digitorum superficialis tendon, two such systems were observed. The volar surface of both tendons is more or less devoid of vessels. Moreover, at the proximal interphalangeal joint level, the flexor digitorum profundus tendon has a volar avascular zone, constituting about 1 mm, i.e., about one-third to one-fourth of the thickness of the tendon. It is assumed that the synovial fluid is of importance for the nutrition of the tendons and that therefore the synovial sheath should be preserved as much as possible.

  15. Primary repair of flexor tendons in the hand without immobilisation-preliminary report.

    Science.gov (United States)

    Becker, H

    1978-02-01

    A new approach to the problem of flexor tendon repair within the fibro-osseous canal is presented. Using a technique of bevelling the tendon ends and suturing with a fine suture material, under magnificaiton, a sufficiently strong junction is obtained, which enables immediate active mobilisation without strangulation of the blood supply. The junction can resist gap formation up to tensions of 4 Kg. It is postulated that under these conditions tendon nutrition is minimally interfered with, adhesions do not form, and the tendon heals by its own intrinsic healing ability.

  16. Mobilidade articular dos dedos não lesados pós-reparo em lesão dos tendões flexores da mão Joint range of motion of uninjured fingers after repairs to flexor tendon injuries of the hand

    Directory of Open Access Journals (Sweden)

    RB Rabelo

    2007-10-01

    Full Text Available OBJETIVO: Verificar a amplitude de movimento (ADM em mãos que sofreram reparo tendinoso dos músculos flexores superficial e profundo dos dedos, comparando os dados de cada dedo na mão lesada e entre mãos lesadas e não lesadas. MÉTODOS: Foi realizada a goniometria ativa em 15 pacientes e 120 dedos, 60 dedos de mãos lesadas e 60 de mãos controle não lesadas. Os sujeitos foram avaliados no momento da retirada da tala gessada, tendo sido realizada a movimentação precoce pelo método de Duran modificado. A partir dos dados goniométricos, foram registrados os valores do índice TAM (Total Active Motion dos dedos nas mãos lesadas e controle. Para análise dos dados, foi acessada a fórmula de índices funcionais proposta pela American Society for Surgery of the Hand (ASSH e para cálculo estatístico, foi escolhido o Modelo de Efeitos Mistos. RESULTADOS: A fórmula da ASSH para os dedos lesados mostrou que 18,33% tiveram a classificação do movimento "bom", 18,33%, "regular" e 63,34%, "pobre". Foram comparadas as médias das medidas em graus de todos os dedos entre si dentro de cada grupo, controle ou lesado, e as médias das medidas entre os grupos, encontrando-se um p-valor significante apenas entre os grupos controle e lesado. Não houve diferença estatística entre o TAM de cada dedo na mão lesada. CONCLUSÃO: Independente de quantos dedos tenham sofrido lesão tendinosa em uma mão, os dedos não lesados também terão suas ADMs ativas diminuídas no período logo após a retirada da imobilização.OBJECTIVE: To assess the range of motion (ROM in hands that underwent tendon repair in the flexor digitorum superficialis and flexor digitorum profundus muscles of the fingers, comparing the data between the fingers on the injured hand, and between the injured and uninjured hands. METHOD: Active goniometry was performed on 15 patients, making a total of 120 fingers (60 on injured hands and 60 on noninjured control hands. The patients

  17. Pathophysiology of overuse tendon injury

    International Nuclear Information System (INIS)

    Kannus, P.; Paavola, M.; Paakkala, T.; Parkkari, J.; Jaervinen, T.; Jaervinen, M.

    2002-01-01

    Overuse tendon injury is one of the most common injuries in sports.The etiology as well as the pathophysilogical mechanisms leading to tendinopathy are of crucial medical importance.At the moment intrinsic and extrinsic factors are assumed as mechanisms of overuse tendon injury. Except for the acute, extrinsic trauma, the chronic overuse tendon injury is a multifactorial process. There are many other factors, such as local hypoxia, less of nutrition, impaired metabolism and local inflammatory that may also contribute to the development of tissue damage.The exact interaction of these factors cannot be explained entirely at the moment.Further studies will be necessary in order to get more information. (orig.) [de

  18. Histogenesis and morphology of the flexor tendon pulley system in the human embryonic hand.

    Science.gov (United States)

    Sbernardori, M C; Fenu, G; Pirino, A; Fabbriciani, C; Montella, A

    2000-04-01

    The number, position, structural and ultrastructural features of the flexor tendon pulley system in six human embryonic hands, aged from 6 to 12 weeks, were studied by light and electron microscope. The pulley system can be recognized from the ninth week; later, at 12 weeks, the structures are easily identified around the flexor tendon in positions closely correlated to those found during post-natal growth and in the adult hand. Structurally and ultrastructurally the pulleys are not simply thickened portions of the sheath. They are formed by three layers: an inner layer, one or two cells thick, probably representing a parietal synovial tendon sheath; a middle layer formed by collagen bundles and fibroblasts whose direction is mainly perpendicular to the underlying phalanx; and an outermost layer consisting of mesenchymal tissue with numerous vessels which extends dorsally in an identical layer, forming a ring that includes flexor and extensor tendons and the cartilaginous model of the phalanx. The pulley does not have a semicircular shape but a much more complicated one, owing to the middle layer which in part runs dorsally and in part ventrally, under the flexor tendons. Copyright 2000 The British Society for Surgery of the Hand.

  19. Repopulation of Intrasynovial Flexor Tendon Allograft with Bone Marrow Stromal Cells: An Ex Vivo Model

    Science.gov (United States)

    Amadio, Peter C.; Thoreson, Andrew R.; An, Kai-Nan

    2014-01-01

    Purpose: Delayed healing is a common problem whenever tendon allografts are used for tendon or ligament reconstruction. Repopulating the allograft with host cells may accelerate tendon regeneration, but cell penetration into the allograft tendon is limited. Processing the tendon surface with slits that guide cells into the allograft substrate may improve healing. The purpose of this study was to describe a surface modification of allograft tendon that includes slits to aid cell repopulation and lubrication to enhance tendon gliding. Methods: Canine flexor digitorum profundus tendons were used for this study. Cyclic gliding resistance was measured over 1000 cycles. Tensile stiffness was assessed for normal tendon, tendon decellularized with trypsin and Triton X-100 (decellularized group), tendon decellularized and perforated with multiple slits (MS group) and tendon decellularized, perforated with slits and treated with a carbodiimide-derivatized hyaluronic acid and gelatin (cd-HA-gelatin) surface modification (MS-SM group). To assess tendon repopulation, bone marrow stromal cells (BMSCs) were used in the decellularized and MS groups. DNA concentration and histology were evaluated and compared to normal tendons and nonseeded decellularized tendons. Results: The gliding resistance of the decellularized and MS groups was significantly higher compared with the normal group. There was no significant difference in gliding resistance between the decellularized and MS group. Gliding resistance of the normal group and MS-SM group was not significantly different. The Young's modulus was not significantly different among the four groups. The DNA concentration in the MS group was significantly lower than in normal tendons, but significantly higher than in decellularized tendons, with or without BMSCs. Viable BMSCs were found in the slits after 2 weeks in tissue culture. Conclusions: Tendon slits can successfully harbor BMSCs without compromising their survival and without

  20. Acute Hemorrhagic Flexor Tenosynovitis due to Vincula Injury

    Science.gov (United States)

    Maher, Rory

    2015-01-01

    Summary: A 20-year-old previously well woman presented to the emergency department with classical signs of acute flexor tenosynovitis, 4 hours after a minor puncture wound over the volar aspect of her right middle finger distal interphalangeal joint. Exploration of the flexor sheath in theatre revealed frank blood within the sheath and extension of the puncture wound through the profundus tendon into the short vincula beneath. The blood was irrigated from the sheath, and the patient made a complete recovery by 2 weeks postoperatively. Although rare, irritation and distension of the flexor sheath caused by vincular hemorrhage can be an alternative mechanism for the development of acute flexor tenosynovitis, and as with pyogenic flexor tenosynovitis, prompt surgical treatment can minimize the risk of long-term functional impairment. PMID:26301147

  1. Patient compliance with a rehabilitation program after flexor tendon repair in zone II of the hand

    NARCIS (Netherlands)

    Dobbe, J. G. G.; van Trommel, N. E.; Ritt, M. J. P. F.

    2002-01-01

    The use of early mobilization during rehabilitation of a finger after flexor tendon repair in zone II has achieved worldwide acceptance. Different exercise instructions are given to patients in different clinics, however. When using Kleinert dynamic splinting, some hand therapists instruct patients

  2. Injuries to the finger flexor pulley system in rock climbers: current concepts.

    Science.gov (United States)

    Schöffl, Volker Rainer; Schöffl, Isabelle

    2006-04-01

    Closed traumatic ruptures of finger flexor tendon pulleys began to be recognized specifically over the past several decades. This injury, although rare in the general population, is seen more commonly in rock climbers. This article analyzes this type of injury and the current diagnostic and therapeutic criteria. Ultrasound and magnetic resonance imaging are used to differentiate between a pulley strain, partial rupture, complete rupture, or multiple ruptures. Grade I to III injuries (strains, partial rupture, single ruptures) are treated conservatively with initial immobilization and early functional therapy under pulley protection. Grade IV injuries (multiple ruptures) require surgical repair.

  3. The contents of macromolecule solutes in flexor tendon sheath fluid and their relation to synovial fluid. A quantitative analysis.

    Science.gov (United States)

    Hagberg, L; Heinegård, D; Ohlsson, K

    1992-04-01

    The importance of synovial environment for minimal adhesion formation in flexor tendon healing has recently gained attention. Various techniques have been used to restore an injured synovial tendon sheath. Therefore a quantitative analysis of flexor tendon sheath fluid is of interest to increase our knowledge about the specific synovial milieu and to evaluate the success of different types of sheath reconstructions from a biochemical point of view. Samples of tendon sheath fluid from trigger digits and tendon sheaths containing ganglions have been assayed for contents of hyaluronic acid and proteins of different molecular weights. The results show concentrations of hyaluronate and several proteins similar to those in normal joint fluid. These results indicate that flexor tendon sheath fluid has a character similar to synovial fluid of joints and apparently has specific functions such as soft tissue lubrication and nutrition of avascular tendon tissue.

  4. Evaluating adhesion reduction efficacy of type I/III collagen membrane and collagen-GAG resorbable matrix in primary flexor tendon repair in a chicken model.

    Science.gov (United States)

    Turner, John B; Corazzini, Rubina L; Butler, Timothy J; Garlick, David S; Rinker, Brian D

    2015-09-01

    Reduction of peritendinous adhesions after injury and repair has been the subject of extensive prior investigation. The application of a circumferential barrier at the repair site may limit the quantity of peritendinous adhesions while preserving the tendon's innate ability to heal. The authors compare the effectiveness of a type I/III collagen membrane and a collagen-glycosaminoglycan (GAG) resorbable matrix in reducing tendon adhesions in an experimental chicken model of a "zone II" tendon laceration and repair. In Leghorn chickens, flexor tendons were sharply divided using a scalpel and underwent repair in a standard fashion (54 total repairs). The sites were treated with a type I/III collagen membrane, collagen-GAG resorbable matrix, or saline in a randomized fashion. After 3 weeks, qualitative and semiquantitative histological analysis was performed to evaluate the "extent of peritendinous adhesions" and "nature of tendon healing." The data was evaluated with chi-square analysis and unpaired Student's t test. For both collagen materials, there was a statistically significant improvement in the degree of both extent of peritendinous adhesions and nature of tendon healing relative to the control group. There was no significant difference seen between the two materials. There was one tendon rupture observed in each treatment group. Surgical handling characteristics were subjectively favored for type I/III collagen membrane over the collagen-GAG resorbable matrix. The ideal method of reducing clinically significant tendon adhesions after injury remains elusive. Both materials in this study demonstrate promise in reducing tendon adhesions after flexor tendon repair without impeding tendon healing in this model.

  5. Resurfacing with Chemically Modified Hyaluronic Acid and Lubricin for Flexor Tendon Reconstruction

    Science.gov (United States)

    Zhao, Chunfeng; Hashimoto, Takahiro; Kirk, Ramona L.; Thoreson, Andrew R.; Jay, Gregory D.; Moran, Steven L.; An, Kai-Nan; Amadio, Peter C.

    2013-01-01

    We assessed surface coating with carbodiimide derivatized hyaluronic acid combined with lubricin (cd-HA-Lubricin) as a way to improve extrasynovial tendon surface quality and, consequently, the functional results in flexor tendon reconstruction, using a canine in vivo model. The second and fifth flexor digitorum profundus tendons from 14 dogs were reconstructed with autologs peroneus longus (PL) tendons 6 weeks after a failed primary repair. One digit was treated with cd-HA-Lubricin, and the other was treated with saline as the control. Six weeks following grafting, the digits and graft tendons were functionally and histologically evaluated. Adhesion score, normalized work of flexion, graft friction in zone II, and adhesion breaking strength at the proximal repair site in zone III were all lower in the cd-HA-Lubricin treated group compared to the control group. The strength at the distal tendon/bone interface was decreased in the cd-HA-Lubricin treated grafts compared to the control grafts. Histology showed inferior healing in the cd-HA-Lubricin group at both proximal and distal repair sites. However, cd-HA-Lubricin treatment did not result in any gap or rupture at either the proximal or distal repair sites. These results demonstrate that cd-HA-Lubricin can eliminate graft adhesions and improve digit function, but that treatment may have an adverse effect on tendon healing. PMID:23335124

  6. Comparative biomechanic study of flexor tendon repair using FiberWire.

    Science.gov (United States)

    Waitayawinyu, Thanapong; Martineau, Paul A; Luria, Shai; Hanel, Douglas P; Trumble, Thomas E

    2008-01-01

    FiberWire, an increasingly popular suture material, allows for strong flexor tendon repair that may allow early mobilization. This study was designed to evaluate the mechanical characteristics of FiberWire for flexor tendon repair and to identify the most effective repair technique using this material. Forty-nine human cadaver flexor tendons were randomized and tested biomechanically using one of the following techniques of flexor tendon repair performed with 3-0 FiberWire: (1) modified Kessler, (2) modified Pennington, (3) 2-strand multiple grasping, (4) 2-strand multiple locking, (5) 2-strand double cross-locks, (6) Massachusetts General Hospital, and (7) 4-strand locked cruciate. The ultimate tensile strength, 2-mm gap resistance, and failure mode of the repairs were evaluated. Knot unraveling was the most common failure mode of FiberWire repair in 4 of the 7 techniques. Four-strand repairs and locking repairs provided significantly more strength than 2-strand repairs and grasping repairs. Multiple grasping and multiple locking repairs with 2 knots were significantly weaker than single grasping and locking repairs with a single knot. Four-strand locked cruciate repairs were significantly stronger than the other techniques (mean ultimate tensile strength 107 N, 2-mm gap force 96 N). Two-strand double cross-locks repairs were stronger than the other 2-strand repairs (mean ultimate tensile strength 69 N, 2-mm gap force 53 N). The strength of the FiberWire repairs increased with locking repair and with increased number of strands but was not influenced by increased number of locking and grasping stitches. Four-strand locked cruciate and 2-strand double cross-locks provided the greatest strength and likely are appropriate for future clinical use in, respectively, 4-strand and 2-strand repairs. However, the poor knot-holding characteristics of FiberWire with the need of a greater number of knot throws may be of concern for surgeons using this product for flexor tendon

  7. Passive stiffness of the ankle and plantar flexor muscle performance after Achilles tendon repair: a cross-sectional study.

    Science.gov (United States)

    Borges, Pollyana R T; Santos, Thiago R T; Procópio, Paula R S; Chelidonopoulos, Jessica H D; Zambelli, Roberto; Ocarino, Juliana M

    Deficits in ankle muscle strength and ankle stiffness may be present in those subjects who underwent surgical treatment for an Achilles tendon rupture. The presence of these long-term deficits may contribute to a lower performance during daily activities and may be linked to future injuries. To compare the ankle passive stiffness and the plantar flexor muscle performance in patients who underwent unilateral surgical treatment of Achilles tendon rupture with nonsurgical subjects. Twenty patients who underwent unilateral surgical treatment of Achilles tendon rupture [surgical (SU) group], and twenty nonsurgical subjects [non-surgical (NS) group] participated in this study. The ankle passive stiffness was evaluated using a clinical test. The concentric and eccentric plantar flexors performance (i.e. peak torque and work) was evaluated using an isokinetic dynamometer at 30°/s. The surgical ankle of the surgical group presented lower stiffness compared to the non-surgical ankle (mean difference=3.790; 95%CI=1.23-6.35) and to the non-dominant ankle of the non-surgical group (mean difference=-3.860; 95%CI=-7.38 to -0.33). The surgical group had greater absolute asymmetry of ankle stiffness (mean difference=-2.630; 95%CI=-4.61 to -0.65) and greater absolute asymmetry of concentric (mean difference=-8.3%; 95%CI=-13.79 to -2.81) and eccentric (mean difference=-6.9%; 95%CI=-12.1 to -1.7) plantar flexor work compared to non-surgical group. There was no other difference in stiffness and plantar flexor performance. Patients who underwent surgical repair of the Achilles tendon presented with long-term (1 year or more) deficits of ankle stiffness and asymmetries of ankle stiffness and plantar flexor work in the affected ankle compared to the uninjured side in the surgical group and both sides on the nonsurgical group. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

  8. Digital flexor tendon contracture treated by tenectomy: different clinical presentations in three cats

    Directory of Open Access Journals (Sweden)

    Quentin Cabon

    2015-07-01

    Full Text Available Case series summary Three cats, Siamese or Siamese cross, were presented with a chronic thoracic limb weightbearing lameness. Previous anti-inflammatory administrations were unable to improve lameness consistently in the three cats. Two of the three cats had undergone onychectomy several years before presentation. A permanent flexion of the proximal interphalangeal joint of one or more digits, associated with a difficult and painful extension of the proximal interphalangeal joint, was noticed during orthopedic examination. A digital flexor tendon contracture was suspected and confirmed with radiographic examination. Surgical exploration was then performed. For all cats, treatment consisted of a tenectomy or tenotomy of the superficial and deep digital flexor tendons in order to release the contracture. The three cats responded well to the surgical treatment and became sound around 2–4 weeks after surgery. Relevance and novel information Digital flexor tendon contracture is rarely reported as a cause of lameness in cats. It should be considered in a differential diagnosis of feline lameness whenever onychectomy has been performed in the past. The precise etiology that explains this tendon contracture is unknown, but trauma or breed predisposition could represent potential causes.

  9. Delayed rupture of flexor tendons in zone V complicated by neuritis 18 years following Galeazzi fracture-dislocation.

    Science.gov (United States)

    Nagy, Mathias Thomas; Ghosh, Sabyasachi; Shah, Bhavik; Sankar, Thangasamy

    2014-04-16

    We report a rare case of an 84-year-old woman who presented with delayed, complete rupture of superficial (flexor digitorum superficialis) and deep flexor tendons (flexor digitorum profundus) of the third, fourth and fifth digits of the right hand in zone V of the flexor tendons. The patient, who was otherwise healthy, active and independent, incurred a closed fracture of her right wrist 18 years ago, which was treated conservatively. Current X-rays and operative findings confirmed a malunited Galeazzi fracture-dislocation with volar dislocation of the ulna from the distal radioulnar joint. She underwent surgical treatment to improve her hand function and agonising neuritis symptoms, as she was unable to use her middle, ring and little fingers and had developed severe neuritis of the ulnar nerve. Exploration and repair of the flexor tendons, nerve decompressions and Darrach procedure were performed. On follow-up, the patient showed improvement in hand function with the neuritis completely resolved.

  10. Development of a kinematic model to predict finger flexor tendon and subsynovial connective tissue displacement in the carpal tunnel.

    Science.gov (United States)

    Kociolek, Aaron M; Keir, Peter J

    2015-01-01

    Finger flexor tendinopathies and carpal tunnel syndrome are histologically characterised by non-inflammatory fibrosis of the subsynovial connective tissue (SSCT) in the carpal tunnel, which is indicative of excessive and repetitive shear forces between the finger flexor tendons and SSCT. We assessed flexor digitorum superficialis (FDS) tendon and adjacent SSCT displacements with colour Doppler ultrasound as 16 healthy participants completed long finger flexion/extension movements captured by a motion capture system. FDS tendon displacements fit a second-order regression model based on metacarpophalangeal and proximal interphalangeal joint flexion angles (R(2) = 0.92 ± 0.01). SSCT displacements were 33.6 ± 1.7% smaller than FDS tendon displacements and also fit a second-order regression model (R(2) = 0.89 ± 0.01). FDS tendon and SSCT displacement both correlated with finger joint thickness, enabling participant-specific anthropometric scaling. We propose the current regression models as an ergonomic method to determine relative displacements between the finger flexor tendons and SSCT. Relative displacements between the finger flexor tendons and SSCT provide insight into gliding and friction in the carpal tunnel. Our regression models represent a move towards mechanistic-based ergonomic risk assessment of the wrist/hand. This is a natural evolution of ergonomic methods based on tendon-joint interaction.

  11. Experimental intrinsic healing of flexor tendons based upon synovial fluid nutrition.

    Science.gov (United States)

    Lundborg, G; Rank, F

    1978-01-01

    The healing process of totally cut and subsequently resutured rabbit flexor tendons kept isolated in the knee joint cavity and free in the synovial fluid was studied by histological and ultrastructural techniques. This experimental model represents a "tissue culture in situ," where the tendon is nourished by diffusion from the synovial fluid only and where no adhesions are formed. Under these conditions there is a proliferation of tendon cells and deposition of collagen resulting in bridging of the suture line. On the basis of these findings, it is assumed that the tendon cells possess an intrinsic potential of repair, provided they obtain a sufficient nutritional supply. In the present experimental model, this nutrition was provided by way of diffusional pathways from the synovial fluid.

  12. Changes in the distal phalanx in foals with deep digital flexor tendon contraction

    International Nuclear Information System (INIS)

    Arnbjerg, J.

    1988-01-01

    Nine foals, aged 4–7 months, suffering from contracted deep digital flexor tendon were radiographed for changes in the distal phalanx. Varying degrees of osteolysis in the distal part of the distal phalanx were observed. The foals with the most pronounced clinical signs also displayed the most prominent radiologic changes. Tenotomy of the check ligament of the deep digital flexor tendon was performed. In severely affected foals, a shoe with a long toepart was used after surgery. Programmed exercise on hard ground was started 1 week after surgery. Control radiography was performed on three of the foals 1–1½years after treatment. At that time, the colts had normal distal phalanges and their function and mobility were normal. Of the remaining six animals, three had been sold as being healthy and were not available for examination. The remaining three had been examined for the first time within the last 3 months, and long-term evaluation was not possible

  13. The range of excursion of flexor tendons in Zone V: a comparison of active vs passive flexion mobilisation regimes.

    LENUS (Irish Health Repository)

    Panchal, J

    1997-10-01

    A number of early postoperative mobilisation regimes have been developed in an attempt to increase tendon excursion and gliding and thereby reduce formation of adhesions following repair of flexor tendons. Early active flexion mobilisation regimes are becoming more popular, and have replaced early passive flexion regimes in many centres. The aim of the present study was: (a) to determine the range of excursion of flexor tendons in Zone V, and (b) to compare the excursion ranges between active (Belfast) and passive (modified Duran) flexion mobilisation regimes postoperatively. This was done (a) in two cadavers, and (b) in two patients intraoperatively, and postoperatively at 10 days, 3 weeks and 6 weeks. With passive flexion, the mean tendon excursion in Zone V in cadavers was 1 mm for flexor digitorum superficialis (FDS), flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) tendons respectively. With simulated active flexion, the mean tendon excursion was 14 mm, 10 mm and 11 mm respectively. The mean tendon excursion in clinical cases intraoperatively following passive flexion was 2 mm for FDS, FDP and FPL respectively; following simulated active flexion it was 10 mm, 11 mm and 11 mm for FDS, FDP and FPL respectively. On the tenth day following repair, the mean excursions of FDS, FDP and FPL were 1 mm, 4 mm and 4 mm on passive flexion as compared to 3 mm, 10 mm and 12 mm on active flexion respectively. Three weeks postoperatively, the mean excursions of FDS, FDP and FPL tendons were 1 mm, 2 mm and 1 mm on passive flexion as compared to 5 mm, 15 mm on active flexion respectively. Six weeks postoperatively, the mean excursions of FDS, FDP and FPL tendons were 9 mm, 7 mm and 4 mm on passive flexion as compared to 12 mm, 33 mm and 20 mm on active flexion respectively. These results demonstrate an increased excursion of repaired flexor tendons in Zone V following an active flexion mobilisation regime as compared to a passive flexion mobilisation regime.

  14. Tendon properties and muscle architecture for knee extensors and plantar flexors in boys and men.

    Science.gov (United States)

    Kubo, Keitaro; Teshima, Takanori; Ikebukuro, Toshihiro; Hirose, Norikazu; Tsunoda, Naoya

    2014-05-01

    The purpose of this study was to compare the elastic properties and size of tendinous structures and muscle architecture for knee extensors and plantar flexors in boys and men. Twenty-two early pubescent boys (9.6-12.7yrs) and 23 young adult men (19.8-26.2yrs) participated in this study. The maximal strain and thickness of tendinous structures for knee extensors and plantar flexors were measured using ultrasonography. In addition, the fascicle lengths of vastus lateralis and medial gastrocnemius muscles were measured. The maximal strain of tendinous structures for plantar flexors was significantly greater in boys than in men, while there was no difference in the maximal strain for knee extensors between the two groups. The relative thickness (to body mass(1/3)) of Achilles tendon was significantly greater in boys than in men, although there was no difference in that of patellar tendon between the two groups. The relative fascicle length (to limb length) of vastus lateralis muscle was significantly lower in boys than in men, although there was no difference in that of medial gastrocnemius muscle between the two groups. These results suggest that the amount of changes in the elastic properties and sizes of tendinous structures and in the fascicle lengths from early pubescence to maturity is different for different muscle groups (in particular, the knee extensors and the plantar flexors). Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Development of an Acute Care Plastic Surgery Service in the Saskatoon Health Region: Effects on flexor tendon management.

    Science.gov (United States)

    Wilgenbusch, Chelsea S; Dust, Peter W; Sunderland, Ian R

    2015-01-01

    The acute care surgery model has gained favour in general surgery, but has yet to be widely adopted in other specialties. An Acute Care Plastic Surgery (ACS) Service was recently implemented in the Saskatoon Health Region in an effort to improve trauma care. To evaluate the impact of ACS on the management of flexor tendon lacerations. The authors hypothesize that ACS has resulted in more timely intervention, improved outcomes and decreased 'after hours' surgery. A retrospective review of patients treated for flexor tendon lacerations from 2007 to 2013 was performed. Patients were stratified into two groups based on whether they received treatment before (group A) or after (group B) ACS implementation. Variables included dates and times of patient referral, consultation and tendon repair; postoperative complications; and admissions. A surgeon survey was administered on the perceived impact of ACS. Group A was more likely to have surgery performed after hours (P=0.0019) and be admitted to hospital (P=0.0211) compared with group B. Time from referral to consultation and injury-to-surgery interval were slightly increased post-ACS (Group B). Surgeons were highly satisfied with the new system, citing benefits to patients and surgeons. ACS was designed to improve trauma care, while favourably impacting surgeon workload. Surprisingly, the injury-to-surgery interval was slightly increased. However, this was not clinically significant and did not lead to increased postoperative complications. This finding was likely due to a favourable change in practice patterns observed after ACS implementation. ACS has resulted in fewer hospital admissions, decreased after-hours surgeries and improved surgeon satisfaction.

  16. Tissue engineering of flexor tendons: the effect of a tissue bioreactor on adipoderived stem cell-seeded and fibroblast-seeded tendon constructs.

    Science.gov (United States)

    Angelidis, Ioannis K; Thorfinn, Johan; Connolly, Ian D; Lindsey, Derek; Pham, Hung M; Chang, James

    2010-09-01

    Tissue-engineered flexor tendons could eventually be used for reconstruction of large tendon defects. The goal of this project was to examine the effect of a tissue bioreactor on the biomechanical properties of tendon constructs seeded with adipoderived stem cells (ASCs) and fibroblasts (Fs). Rabbit rear paw flexor tendons were acellularized and seeded with ASCs or Fs. A custom bioreactor applied a cyclic mechanical load of 1.25 N at 1 cycle/minute for 5 days onto the tendon constructs. Three additional groups were used as controls: fresh tendons and tendons reseeded with either ASCs or Fs that were not exposed to the bioreactor treatment and were left in stationary incubation for 5 days. We compared the ultimate tensile stress (UTS) and elastic modulus (EM) of bioreactor-treated tendons with the unloaded control tendons and fresh tendons. Comparison across groups was assessed using one-way analysis of variance with the significance level set at ptendons that were exposed to cyclic load were significantly higher than those of unloaded control tendons. Acellularized tendon constructs that were reseeded with ASCs and exposed to a cyclic load had a UTS of 66.76 MPa and an EM of 906.68 MPa; their unloaded equivalents had a UTS of 47.90 MPa and an EM of 715.57 MPa. Similar trends were found in the fibroblast-seeded tendon constructs that were exposed to the bioreactor treatment. The bioreactor-treated tendons approached the UTS and EM values of fresh tendons. Histologically, we found that cells reoriented themselves parallel to the direction of strain in response to cyclic strain. The application of cyclic strain on seeded tendon constructs that were treated with the bioreactor helped achieve a UTS and an EM comparable with those of fresh tendons. Bioreactor pretreatment and alternative cell lines, such as ASCs and Fs, might therefore contribute to the in vitro production of strong tendon material. Copyright 2010. Published by Elsevier Inc.

  17. Experimental flexor tendon healing without adhesion formation--a new concept of tendon nutrition and intrinsic healing mechanisms. A preliminary report.

    Science.gov (United States)

    Lundborg, G

    1976-10-01

    An experimental model is presented enabling an analysis of the healing process of completely cut and re-sutured free segments of rabbit flexor tendons, kept avascular in a synovial milieu and completely isolated from adhesion formation. Under these conditions the cut tendons heal within a few weeks. It can be shown that this healing process is a result of intrinsic tendon cell activity only.

  18. The role of the synovial fluid and tendon sheath for flexor tendon nutrition. An experimental tracer study on diffusional pathways in dogs.

    Science.gov (United States)

    Lundborg, G; Holm, S; Myrhage, R

    1980-01-01

    Radioactive tracers were used to analyse nutritional mechanisms of flexor tendons of dogs during various experimental conditions. The transport and distribution of methyl glucose in the tendon was analysed 15 min after intravenous injection during the following experimental conditions: (1) normal state--rest; (2) passive mobilization of the tendon; (3) active mobilization of the tendon; (4) exclusion of exposure to synovial fluid-preservation of vascular supply; (5) exclusion of vascular supply--preservation of exposure to synovial fluid. The results indicate that active mobilization gives a significant increase in tracer concentration in the volar part of the tendon, while passive mobilization has no such effect. Diffusional pathways from the synovial fluid plays a major role for transport of tracer into the tendon, while the intrinsic vascular system apparently is of no or minor importance in this respect. The main mechanism for solute transport within the tendon is passive diffusion. Transport of sulphate in the volar part follows a similar pattern as in other avascular tissues and the incorporation of sulphate by the cells is low and comparable to that in articular cartilage. The results support our previous hypothesis that the flexor tendon system physiologically corresponds to a joint, and that the synovial fluid plays an important role for flexor tendon nutrition.

  19. Comparing Biomechanical Properties, Repair Times, and Value of Common Core Flexor Tendon Repairs.

    Science.gov (United States)

    Chauhan, Aakash; Schimoler, Patrick; Miller, Mark C; Kharlamov, Alexander; Merrell, Gregory A; Palmer, Bradley A

    2018-05-01

    The aim of the study was to compare biomechanical strength, repair times, and repair values for zone II core flexor tendon repairs. A total of 75 fresh-frozen human cadaveric flexor tendons were harvested from the index through small finger and randomized into one of 5 repair groups: 4-stranded cross-stitch cruciate (4-0 polyester and 4-0 braided suture), 4-stranded double Pennington (2-0 knotless barbed suture), 4-stranded Pennington (4-0 double-stranded braided suture), and 6-stranded modified Lim-Tsai (4-0 looped braided suture). Repairs were measured in situ and their repair times were measured. Tendons were linearly loaded to failure and multiple biomechanical values were measured. The repair value was calculated based on operating room costs, repair times, and suture costs. Analysis of variance (ANOVA) and Tukey post hoc statistical analysis were used to compare repair data. The braided cruciate was the strongest repair ( P > .05) but the slowest ( P > .05), and the 4-stranded Pennington using double-stranded suture was the fastest ( P > .05) to perform. The total repair value was the highest for braided cruciate ( P > .05) compared with all other repairs. Barbed suture did not outperform any repairs in any categories. The braided cruciate was the strongest of the tested flexor tendon repairs. The 2-mm gapping and maximum load to failure for this repair approached similar historical strength of other 6- and 8-stranded repairs. In this study, suture cost was negligible in the overall repair cost and should be not a determining factor in choosing a repair.

  20. Home-based rehabilitation in the postoperative treatment of flexor tendon repair.

    Science.gov (United States)

    Sanmartín-Fernández, M; Fernández-Bran, B; Couceiro-Otero, J

    To evaluate the results and complications of flexor tendon repair in which a home-based rehabilitation program was utilized without the assistance of a hand therapist during the first 4postoperative weeks. Between July 2009 and July 2014, a total of 21 digits in 15 patients were treated in our institution for complete laceration of the flexor tendons within the flexor pulley system (zone 1 and 2). Passive and active exercises performed by the patients themselves were started the morning after the operation. Data, as range-of-motion and complications, were collected 6months after the surgery. Fifteen digits had full recovery of flexion. One patient suffered a rupture in the fifth postoperative week. Ten of the 21 digits developed a flexion contracture of the proximal interphalangeal joint; in 5 the contracture was less or equal to 10° without impairment of function or aesthetics. Over recent decades, specialized hand therapy has been of great importance in the postoperative treatment of hand diseases. Unfortunately, these professionals are not always available in our area in the first days after surgery. With this protocol, the patient is in charge of carrying out the postoperative exercises, which could lead to a worse final result and a higher rate of complications. The home-based rehabilitation program yielded complete recovery of joint mobility in most cases with a low complication rate. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. [Correction of flexible lesser toe deformity : Transfer of the flexor digitorum longus tendon].

    Science.gov (United States)

    Arbab, D; Frank, D; Bouillon, B; Lüring, C

    2017-07-04

    Realignment and pain relief of toes 2-5 by flexor-to-extensor tendon transfer of the flexor digitorum longus (FDL) muscle. As an isolated procedure in flexible proximal interphalangeal (PIP) joint flexion and/or flexible metatarsophalangeal (MTP) joint extension (hammer toe). In combination with a metatarsal osteotomy or PIP joint arthrodesis in case of flexible MTP joint extension. General medical contraindications to surgical interventions. Stiffness of the PIP or MTP joint. Plantar stab incision in the distal interphalangeal (DIP) flexion crease and tenotomy of the FDL tendon. More proximally transverse incision on the plantar aspect of the proximal phalanx and isolation of the FDL tendon. The tendon is split longitudinally along the raphe and the two limbs are transferred from plantar to the dorsal aspect of the proximal phalanx adjacent to the bone. The crossed limbs are sutured to each other under appropriate tension and corrected position of the toe. Postoperative dressings for 3 weeks in corrected position. Subsequently tape dressing in plantar position for 6-12 weeks. Full weight bearing. A total of 24 toes with flexible PIP and/or MTP joint deformity were treated with a FDL tendon transfer. In 14 toes an isolated procedure was performed, in 10 cases an additional metatarsal osteotomy. Patients with operative treatment of the first ray, revision or reoperation were excluded. Mean follow-up was 8.4 (4-14) months. After 6 weeks 22 toes (92%) showed physiological alignment of the PIP and MTP joint. At the last follow-up, 4 (16%) toes had recurrent or persistent extension deformity of the MTP joint. There were no infections, overcorrections, impaired wound healing or transversal malalignment.

  2. Comparison of Post Operative Early Active and Passive Mobilization of Flexor Tendon in Zone 2

    Directory of Open Access Journals (Sweden)

    Fereydoun Layeghi

    2012-10-01

    Full Text Available Objectives: Despite numerous studies, having the best outcome is challenging after flexor tendon repairs in zone 2. This study were done to test the hypothesis that immediate postoperative active mobilization will achieve similar outcomes to passive mobilization. Methods: Fifty fingers in 38 patients with flexor tendon repair in zone 2 were enrolled in this trial. The patients randomly assigned in two groups: Early active mobilization and Passive mobilization. They were assessed eight week post operating. Outcomes were defined using “Strickland” and “Buck-Gramko” criteria. The analysis was done according to intention-to-treat principles and with use of mean imputation for missing data. Results: There were significant difference between groups (P<0.001. The result were 80% excellent and good, 20% fair and no poor in early active motion group, and 40% excellent and good, 44% fair and 16% poor due to Strickland criteria in controlled passive motion group. Mean of total active motion was significantly greater in early active motion group. Discussion: Actively mobilized tendon underwent intrinsic healing without large gap formation. Increased ultimate range of motion confirmed that early active mobilization can be used after strong repair in zone two.

  3. Effect of proprioceptive neuromuscular facilitation stretching on the plantar flexor muscle-tendon tissue properties.

    Science.gov (United States)

    Mahieu, N N; Cools, A; De Wilde, B; Boon, M; Witvrouw, E

    2009-08-01

    Proprioceptive neuromuscular facilitation (PNF) stretching programs have been shown to be the most effective stretching technique to increase the range of motion (ROM). The objective of this study was to examine the mechanism of effect of PNF stretching on changes in the ROM. Sixty-two healthy subjects were randomized into two groups: a PNF stretching group and a control group. The PNF group performed a 6-week stretching program for the calf muscles. Before and after this period, all subjects were evaluated for dorsiflexion ROM, passive resistive torque (PRT) of the plantar flexors and stiffness of the Achilles tendon. The results of the study revealed that the dorsiflexion ROM was significantly increased in the PNF group (DeltaROMext: 5.97+/-0.671 degrees ; DeltaROMflex: 5.697+/-0.788 degrees ). The PRT of the plantar flexors and the stiffness of the Achilles tendon did not change significantly after 6 weeks of PNF stretching. These findings provide evidence that PNF stretching results in an increased ankle dorsiflexion. However, this increase in ROM could not be explained by a decrease of the PRT or by a change in stiffness of the Achilles tendon, and therefore can be explained by an increase in stretch tolerance.

  4. Mechanical muscle and tendon properties of the plantar flexors are altered even in highly functional children with spastic cerebral palsy.

    Science.gov (United States)

    Kruse, Annika; Schranz, Christian; Svehlik, Martin; Tilp, Markus

    2017-12-01

    Recent ultrasound studies found increased passive muscle stiffness and no difference in tendon stiffness in highly impaired children and young adults with cerebral palsy. However, it is not known if muscle and tendon mechanical properties are already altered in highly functional children with cerebral palsy. Therefore, the purpose of this study was to compare the mechanical and material properties of the plantar flexors in highly functional children with cerebral palsy and typically developing children. Besides strength measurements, ultrasonography was used to assess gastrocnemius medialis and Achilles tendon elongation and stiffness, Achilles tendon stress, strain, and Young's modulus in twelve children with cerebral palsy (GMFCS levels I and II) and twelve typically developing peers during passive dorsiflexion rotations as well as maximum voluntary contractions. Despite no difference in ankle joint stiffness (P>0.05) between groups, passive but not active Achilles tendon stiffness was significantly decreased (-39%) and a tendency of increased passive muscle stiffness was observed even in highly functional children with cerebral palsy. However, material properties of the tendon were not altered. Maximum voluntary contraction showed reduced plantar flexor strength (-48%) in the cerebral palsy group. Even in children with mild spastic cerebral palsy, muscle and tendon mechanical properties are altered. However, it appears that the Achilles tendon stiffness is different only when low forces act on the tendon during passive movements. Although maximum voluntary force is already decreased, forces acting on the Achilles tendon during activity appear to be sufficient to maintain typical material properties. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Flexor hallucis longus and extensor digitorum longus tendon transfers for balancing the foot following transmetatarsal amputation.

    Science.gov (United States)

    Roukis, Thomas S

    2009-01-01

    Transmetatarsal amputation is a useful surgical procedure that is applicable to the treatment of the dysvascular, neuropathic, and/or traumatized forefoot. Because of the loss of the insertions of some of the extrinsic pedal musculature, transmetatarsal amputation is known to be associated with imbalance of the residual foot, and this can lead to complications related to cutaneous compromise, as well as difficulties with bracing and shoe fit. In this techniques report, we describe a combination of tendon transfers that use flexor hallucis longus and extensor digitorum longus, which can be useful in preventing pedal imbalance following transmetatarsal amputation.

  6. A barbed suture repair for flexor tendons: a novel technique with no exposed barbs.

    Science.gov (United States)

    Joyce, Cormac W; Sugrue, Conor; Chan, Jeffrey C; Delgado, Luis; Zeugolis, Dimitrios; Carroll, Seam M; Kelly, Jack L

    2014-10-01

    Barbed suture technology has shown promise in flexor tendon repairs, as there is an even distribution of load and the need for a knot is eliminated. We propose that a quick and simple, novel, barbed technique without any exposed barbs on the tendon surface has comparable strength and a smaller cross-sectional area at the repair site than traditional methods of repair. Forty porcine flexor tendons were randomized to polybutester 4-strand barbed repair or to 4-strand Adelaide monofilament repair. The cross-sectional area was measured before and after repair. Biomechanical testing was carried out and 2-mm gap formation force, ultimate strength of repair, and method of failure were recorded. The mean ultimate strength of the barbed repairs was 54.51 ± 17.9 while that of the Adelaide repairs was 53.17 ± 16.35. The mean 2-mm gap formation force for the barbed group was 44.71 ± 17.86 whereas that of the Adelaide group was 20.25 ± 4.99. The postrepair percentage change in cross-sectional area at the repair site for the Adelaide group and barbed group was 12.0 ± 2.3 and 4.6 ± 2.8, respectively. We demonstrated that a 4-strand knotless, barbed method attained comparable strength to that of the traditional Adelaide repair technique. The barbed method had a significantly reduced cross-sectional area at the repair site compared with the Adelaide group. The 2-mm gap formation force was less in the barbed group than the Adelaide group. Barbed repairs show promise for tendon repairs; this simple method warrants further study in an animal model.

  7. Congenital dislocation of the deep digital flexor tendon associated with hypoplasia of the sustentaculum tali in a Thoroughbred colt

    International Nuclear Information System (INIS)

    Lepage, O.M.; Leveille, R.; Breton, L.; Marcoux, M.

    1995-01-01

    An 11-month-old Thoroughbred colt was presented with a hard swelling at the proximal third of the right 4th metatarsal bone. A medial dislocation of the deep digital flexor tendon (flexor digitorum profundus) was also observed on the same leg. On the plantaroproximal-plantarodistal projection of the calcaneus, there was flattening and shortening of the sustentaculum tali. The smooth bony proliferation at the proximal third of the right 4th metatarus was compatible with a chronic splint bone fracture. This report describes a medial deep digital flexor dislocation associated with hypoplasia of the sustentaculum tali

  8. Nonoperative, dynamic treatment of acute achilles tendon rupture

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner; Bencke, Jesper; Lauridsen, Hanne Bloch

    2015-01-01

    Acute Achilles tendon rupture alters the biomechanical properties of the plantar flexor muscle-tendon complex that can affect functional performance and the risk of repeat injury. The purpose of the present study was to compare the biomechanical properties of the plantar flexor muscle-tendon comp......Acute Achilles tendon rupture alters the biomechanical properties of the plantar flexor muscle-tendon complex that can affect functional performance and the risk of repeat injury. The purpose of the present study was to compare the biomechanical properties of the plantar flexor muscle...

  9. Zone II flexor tendon repair: effects of vitamins A, E, beta-carotene.

    Science.gov (United States)

    Greenwald, D P; Sharzer, L A; Padawer, J; Levenson, S M; Seifter, E

    1990-07-01

    Ninety-six adult Leghorn chickens each had the flexor profundus tendon in each middle toe sharply divided in Zone II with immediate repair (pentobarbital, ketamine anesthesia). Animals were then randomly assigned to receive unsupplemented standard chick chow or the chow supplemented with vitamin A (150,000 IU/kg chow), Vitamin E (1000 IU/kg chow), or beta-carotene (90 mg/kg chow). Eight animals from each of the four groups were examined at 7, 30, or 45 days post repair. After sacrifice, in situ composite wound breaking strength was measured in the amputated toe by constant speed tensiometry. Vitamin A-supplemented animals demonstrated breaking strength more than double that of control at each postoperative test day, while those animals receiving supplemental Vitamin E had breaking strength less than half that of control at Day 7 and Day 45. These results are statistically significant. Tensiometry curves differed markedly at all time points among the groups: Vitamin A curves being broader, higher, and having more spikes. These differences in the tensiometry curves, both qualitative and quantitative, may be due to differences in intrinsic tendon healing or to differences in adhesion formation or a combination of both. beta-Carotene supplementation had modest effect. We conclude that supplemental dietary vitamin A increases the breaking strength of composite tendon wounds and that supplemental dietary vitamin E decreases it.

  10. Frontal plane fractures of the accessory carpal bone and implications for the carpal sheath of the digital flexor tendons.

    Science.gov (United States)

    Minshall, G J; Wright, I M

    2014-09-01

    Accurate radiological and ultrasonographic descriptions of frontal plane fractures of the accessory carpal bone (ACB) are lacking, and implications of these fractures for the carpal sheath and its contents have not previously been reported. Aims were as follows: 1) to describe the location and radiological features of frontal plane fractures of the ACB; 2) to document communication of displaced fractures with the carpal sheath and consequent injury to the deep digital flexor tendon (DDFT); 3) to describe ultrasonographic identification of lesions; and 4) to report tenoscopic evaluation and treatment. Retrospective case series. Analysis of frontal plane fractures of the ACB referred to a single hospital between 2006 and 2012, including review of radiographic, ultrasonographic and tenoscopic images. Nine fractures were identified, of which 8 displaced fractures all communicated with the carpal sheath. Comminuted fragments and/or protruding fracture margins lacerated the lateral margin of the enclosed DDFT. This was identifiable ultrasonographically and confirmed at tenoscopy in 7 cases. Treatment in these horses consisted of removal of torn tendon tissue together with fragmentation and protuberant fracture edges, and 7 of 7 cases returned to work. One horse with a nondisplaced fracture was managed with immobilisation; the fracture healed, and the horse returned to work. One horse with a displaced fracture was retired to stud. Frontal plane fractures of the ACB occur palmar to the groove in its lateral margin for the tendon of insertion of ulnaris lateralis. Comminuted fragments can displace distally within the carpal sheath to a mid-metacarpal level or abaxially to lie extrathecally, lateral to the parent bone. Displaced fractures communicate with the carpal sheath and traumatise the DDFT. © 2013 EVJ Ltd.

  11. Flexor hallucis longus tendon rupture in RA-patients is associated with MTP 1 damage and pes planus

    NARCIS (Netherlands)

    Baan, H.; Baan, Henriette; Drossaers-Bakker, K.W.; Dubbeldam, Rosemary; Dubbeldam, Rosemary; Buurke, Jaap J.; Nene, A.V.; van de Laar, Mart A F J

    2007-01-01

    Background: To assess the prevalence of and relation between rupture or tenosynovitis of the Flexor Hallucis Longus (FHL) tendon and range of motion, deformities and joint damage of the forefoot in RA patients with foot complaints. Methods: Thirty RA patients with painful feet were analysed, their

  12. A Biomechanical Analysis of Interference Screw Versus Bone Tunnel Fixation of Flexor Hallucis Longus Tendon Transfers to the Calcaneus.

    Science.gov (United States)

    Liu, George T; Balldin, B Christian; Zide, Jacob R; Chen, Christopher T

    The flexor hallucis longus tendon transfer is commonly used to restore function in chronic Achilles tendon ruptures and chronic Achilles tendinopathy. The tendon is often secured to the calcaneus either through a bone tunnel or by an interference screw. We hypothesized that tenodesis using the bone tunnel method would be mechanically superior to interference screw fixation for flexor hallucis longus transfers. Eight matched pairs of cadaveric specimens were assigned randomly to the bone tunnel or interference screw technique and were loaded to failure. Biomechanical analysis was performed to evaluate the ultimate strength, peak stress, Young's modulus, failure strain, and strain energy. Unpaired comparison, paired comparison, and linear regression analyses were used to determine statistical significance. A slight 22% ± 9% decrease in Young's modulus and a 52% ± 18% increase of strain energy were found in the interference screw group. However, no differences in ultimate strength, peak stress, or failure strain were seen between the 2 groups on paired comparison. Our findings suggest that interference screw fixation provides similar spontaneous biomechanical properties to the use of a bone tunnel for flexor hallucis longus transfer to the calcaneus. The interference screw is a practical option for fixation of the flexor hallucis longus tendon to the calcaneus and can be performed through a single incision approach. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  13. The Effect of Surface Modification on Gliding Ability of Decellularized Flexor Tendon in a Canine Model In Vitro

    Science.gov (United States)

    Ozasa, Yasuhiro; Amadio, Peter C.; Thoreson, Andrew R.; An, Kai-Nan; Zhao, Chunfeng

    2013-01-01

    Purpose To investigate the gliding ability and mechanical properties of decellularized intrasynovial tendons without and with surface modification designed to reduce gliding resistance. Methods Thirty-three canine flexor digitorum profundus tendons were randomly assigned to one of 3 groups: untreated fresh tendons, to serve as a control; tendons decellularized with trypsin and Triton X-100; and tendons decellularized as in group 2 with surface modification using carbodiimide-derivatized hyaluronic acid and gelatin (cd- HA-gelatin). Tendons were subjected to cyclic friction testing for 1000 cycles with subsequent tensile stiffness testing. The surface roughness after 1000 cycles was qualitatively evaluated using scanning electron microscopy. Results The gliding resistance of the decellularized group was significantly higher than that of both the control and cd-HA-gelatin tendons (0.20N, 0.09N and 0.11N after the first cycle, 0.41N, 0.09N and 0.14N after 1000 cycles, respectively).Gliding resistance between the control and cd-HA-gelatin groups was not significantly different. The Young modulus was not significantly different between the 3 groups. The surfaces of the control and cd-HA-gelatin treated tendons appeared smooth after 1000 cycles, while those of the decellularized tendons appeared rougher under scanning electron microscopy observation. Conclusions Decellularization with trypsin and Triton X-100 did not change tendon stiffness. However, this treatment, while effective in removing cells, adversely altered the tendon surface, both in appearance and gliding resistance. Surface modification with cd- HA-gelatin improved the tendon surface smoothness and significantly decreased the gliding resistance. Clinical Relevance The combination of decellularization and surface modification may improve the function of tendon allografts when used clinically. PMID:23849733

  14. Effects of PDGF-BB delivery from heparinized collagen sutures on the healing of lacerated chicken flexor tendon in vivo.

    Science.gov (United States)

    Younesi, Mousa; Knapik, Derrick M; Cumsky, Jameson; Donmez, Baris Ozgur; He, Ping; Islam, Anowarul; Learn, Greg; McClellan, Philip; Bohl, Michael; Gillespie, Robert J; Akkus, Ozan

    2017-11-01

    Flexor tendon lacerations are traditionally repaired by using non-absorbable monofilament sutures. Recent investigations have explored to improve the healing process by growth factor delivery from the sutures. However, it is difficult to conjugate growth factors to nylon or other synthetic sutures. This study explores the performance of a novel electrochemically aligned collagen suture in a flexor tendon repair model with and without platelet derived growth factor following complete tendon laceration in vivo. Collagen suture was fabricated via electrochemical alignment process. Heparin was covalently bound to electrochemically aligned collagen sutures (ELAS) to facilitate affinity bound delivery of platelet-derived growth factor-BB (PDGF-BB). Complete laceration of the flexor digitorum profundus in the third digit of the foot was performed in 36 skeletally mature White Leghorn chickens. The left foot was used as the positive control. Animals were randomly divided into three groups: control specimens treated with standard nylon suture (n=12), specimens repaired with heparinated ELAS suture without PDGF-BB (n=12) and specimens repaired with heparinated ELAS suture with affinity bound PDGF-BB (n=12). Specimens were harvested at either 4weeks or 12weeks following tendon repair. Differences between groups were evaluated by the degree of gross tendon excursion, failure load/stress, stiffness/modulus, absorbed energy at failure, elongation/strain at failure. Quantitative histological scoring was performed to assess cellularity and vascularity. Closed flexion angle measurements demonstrated no significant differences in tendon excursion between the study groups at 4 or 12weeks. Biomechanical testing showed that the group treated with PDGF-BB bound heparinated ELAS suture had significantly higher stiffness and failure load (pBB bound suture had significantly higher ultimate tensile strength and Young's modulus (pBB improved biomechanics and vascularity during tendon healing

  15. Characteristics of acute groin injuries in the hip flexor muscles a detailed MRI study in athletes

    NARCIS (Netherlands)

    Serner, A.; Weir, A.; Tol, J. L.; Thorborg, K.; Roemer, F.; Guermazi, A.; Yamashiro, E.; Hölmich, P.

    2018-01-01

    Hip flexor injuries account for one-third of acute groin injuries; however, little is known about specific injury characteristics. The aims of this study were to describe acute hip flexor injuries using magnetic resonance imaging (MRI) in athletes with acute groin pain and to compare specific muscle

  16. Lesões crônicas de tendões flexores na mão: reconstrução em dois estágios Chronic flexor tendon lesions: reconstruction in two stages

    Directory of Open Access Journals (Sweden)

    Samuel Ribak

    2002-06-01

    Full Text Available Os autores apresentam resultados de tratamento de lesões crônicas dos tendões flexores na mão, usando técnica em dois estágios. O primeiro pelo implante de prótese de silicone e o segundo com enxerto de tendão. Dão detalhes de técnica, e analisam seus resultados comparando-os com os da literatura. Chegam a conclusão que a técnica dá resultados satisfatórios na maioria dos casos.The authors present the results of a two-stage treatment of chronic flexor tendon injuries of the hand. In the first stage a silicone prosthesis is implanted and in the second stage a tendon graft. Details of the technique and results of the analysis are presented and compared with the scientific literature. The authors concluded that satisfactory results were achieved in most of the cases.

  17. Stress examination of flexor tendon pulley rupture in the crimp grip position: a 1.5-Tesla MRI cadaver study

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    Bayer, Thomas; Janka, Rolf [University of Erlangen-Nuremberg, Department of Radiology, Erlangen (Germany); Fries, Simon [Cantonal Hospital Lucerne, Orthopaedic Department, Wolhusen (Switzerland); Schweizer, Andreas [University of Zurich, Department of Orthopaedics, Balgrist, Zurich (Switzerland); Schoeffl, Isabelle [Klinikum Bamberg, Department of Pediatrics, Bamberg (Germany); Bongartz, Georg [University Basel, Department of Radiology, Basel (Switzerland)

    2015-01-15

    The objectives of this study were the evaluation of flexor tendon pulley rupture of the fingers in the crimp grip position using magnetic resonance imaging (MRI) and the comparison of the results with MRI in the neutral position in a cadaver study. MRI in the crimp grip position and in the neutral position was performed in 21 cadaver fingers with artificially created flexor tendon pulley tears (combined pulley rupture, n = 14; single pulley rupture, n = 7). Measurement of the distance between the tendon and bone was performed. Images were evaluated by two readers, first independently and in cases of discrepancy in consensus. Sensitivity and specificity for detecting combined pulley ruptures were calculated. Tendon bone distances were significantly higher in the crimp grip position than in the neutral position. Sensitivity and specificity for detecting combined pulley rupture were 92.86 % and 100 % respectively in the crimp grip position and 78.57 % and 85.71 % respectively in the neutral position. Kappa values for interobserver reliability were 0.87 in the crimp grip position and 0.59 in the neutral position. MRI examination in the crimp grip position results in higher tendon bone distances by subjecting the pulleys to a higher strain, which facilitates image evaluation with higher interobserver reliability, higher sensitivity, and higher specificity for combined pulley rupture compared with examination in the neutral position. (orig.)

  18. Stress examination of flexor tendon pulley rupture in the crimp grip position: a 1.5-Tesla MRI cadaver study

    International Nuclear Information System (INIS)

    Bayer, Thomas; Janka, Rolf; Fries, Simon; Schweizer, Andreas; Schoeffl, Isabelle; Bongartz, Georg

    2015-01-01

    The objectives of this study were the evaluation of flexor tendon pulley rupture of the fingers in the crimp grip position using magnetic resonance imaging (MRI) and the comparison of the results with MRI in the neutral position in a cadaver study. MRI in the crimp grip position and in the neutral position was performed in 21 cadaver fingers with artificially created flexor tendon pulley tears (combined pulley rupture, n = 14; single pulley rupture, n = 7). Measurement of the distance between the tendon and bone was performed. Images were evaluated by two readers, first independently and in cases of discrepancy in consensus. Sensitivity and specificity for detecting combined pulley ruptures were calculated. Tendon bone distances were significantly higher in the crimp grip position than in the neutral position. Sensitivity and specificity for detecting combined pulley rupture were 92.86 % and 100 % respectively in the crimp grip position and 78.57 % and 85.71 % respectively in the neutral position. Kappa values for interobserver reliability were 0.87 in the crimp grip position and 0.59 in the neutral position. MRI examination in the crimp grip position results in higher tendon bone distances by subjecting the pulleys to a higher strain, which facilitates image evaluation with higher interobserver reliability, higher sensitivity, and higher specificity for combined pulley rupture compared with examination in the neutral position. (orig.)

  19. The fate of isolated segments of flexor tendons within the digital sheath--a study in synovial nutrition.

    Science.gov (United States)

    Matthews, P

    1976-07-01

    A study has been made of the fate of isolated, devascularised segments of profundus tendon replaced within the synovial flexor sheaths in the front paws of adult rabbits. In all the experiments the segments were found to have survived as viable "loose bodies" and no adhesions developed. Active remodelling processes occurred over the cut ends of the segments and degenerative changes were confined to the most deeply lying tissue. The experiments confirm the existence of a synovial fluid pathway of nutrition, concerned, it is suggested, with nourishing the more superficial layers of the tendon.

  20. MRI findings in Kirner deformity: normal insertion of the flexor digitorum profundus tendon without soft-tissue enhancement

    International Nuclear Information System (INIS)

    Lee, Jaejoon; Ahn, Joong Kyong; Koh, Eun-Mi; Cha, Hoon-Suk; Choi, Sang-Hee

    2010-01-01

    Kirner deformity is characterized by volar and radial incurvature of the distal phalanx of the 5th finger. A proposed causative mechanism includes abnormal distal insertion of the flexor digitorum profundus tendon along the volar surface of the distal phalanx of the 5th finger. A chronic inflammatory process or altered vascularisation of the soft tissues has also been suggested as the underlying causative mechanism based on MRI findings. We present a teenage boy with Kirner deformity, along with supplementary imaging of his father who also has the deformity, to illustrate MRI findings that dispute the above hypotheses. MRI in both son and father show normal insertion of the deep flexor tendon and no signs of inflammation. (orig.)

  1. Reproducibility of a non-invasive ultrasonic technique of tendon force measurement, determined in vitro in equine superficial digital flexor tendons.

    Science.gov (United States)

    Crevier-Denoix, Nathalie; Ravary-Plumioën, Bérangère; Evrard, Delphine; Pourcelot, Philippe

    2009-09-18

    A non-invasive ultrasonic (US) technique of tendon force measurement has been recently developed. It is based on the relationship demonstrated between the speed of sound (SOS) in a tendon and the traction force applied to it. The objectives of the present study were to evaluate the variability of this non-linear relationship among 7 equine superficial digital flexor (SDF) tendons, and the reproducibility of SOS measurements in these tendons over successive loading cycles and tests. Seven SDF tendons were equipped with an US probe (1MHz), secured in contact with the skin overlying the tendon metacarpal part. The tendons were submitted to a traction test consisting in 5 cycles of loading/unloading between 50 and 4050N. Four tendons out of the 7 were submitted to 5 additional cycles up to 5550N. The SOS-tendon force relationships appeared similar in shape, although large differences in SOS levels were observed among the tendons. Reproducibility between cycles was evaluated from the root mean square of the standard deviations (RMS-SD) of SOS values observed every 100N, and of force values every 2m/s. Reproducibility of SOS measurements revealed high between successive cycles: above 500N the RMS-SD was less than 2% of the corresponding traction force. Reproducibility between tests was lower, partly due to the experimental set-up; above 500N the difference between the two tests stayed nevertheless below 15% of the corresponding mean traction force. The reproducibility of the US technique here demonstrated in vitro has now to be confirmed in vivo.

  2. the relationship between functional absence of the flexor digitorum ...

    African Journals Online (AJOL)

    Flexor Digitorum Superficialis (FDS) tendon to the fifth digit. The Pl is used for reconstructive procedures including tendon grafts. Absence of the FDS to the fifth digit has been associated with reduced grip strength (1). Injury to the FDS of the fifth digit may require reconstruction with the PL tendon. There has been controversy ...

  3. Management of open achilles tendon injury: Primary repair and ...

    African Journals Online (AJOL)

    Background: Achilles tendon injuries have progressive increase worldwide in the last few decades. This is attributable to increase in both competitive and recreational sports. In most of the literature written on Achilles tendon injuries there were rarely any information about open Achilles tendon lacerations. In fact, Achilles ...

  4. A Mechanical Evaluation of Zone II Flexor Tendon Repair Using a Knotless Barbed Suture Versus a Traditional Braided Suture.

    Science.gov (United States)

    Nayak, Aniruddh N; Nguyen, Dzi-Viet; Brabender, Robert C; Hiro, Matthew E; Miles, Jeremy J; Smithson, Ian R; Santoni, Brandon G; Stone, Jeffery D; Hess, Alfred V

    2015-07-01

    To determine repair site bulk, gliding resistance, work of flexion, and 1-mm gap formation force in zone II flexor tendon lacerations repaired with knotless barbed or traditional braided suture. Transverse zone II lacerations of the flexor digitorum profundus (FDP) tendon were created in 36 digits from 6 matched human cadaveric pairs. Repair was performed with 2-0 barbed suture (n = 18) or 3-0 polyethylene braided suture (n = 18). Pre- and postrepair cross-sectional area was measured followed by quantification of gliding resistance and work of flexion during cyclic flexion-extension loading at 10 mm/min. Thereafter, the repaired tendons were loaded to failure. The force at 1 mm of gap formation was recorded. Repaired FDP tendon cross-sectional area increased significantly from intact, with no difference noted between suture types. Gliding resistance and work of flexion were significantly higher for both suture repairs; however, we identified no significant differences in either nondestructive biomechanical parameters between repair types. Average 1-mm gap formation force with the knotless barbed suture (52 N) was greater than that of the traditional braided suture (43 N). We identified no significant advantage in using knotless barbed suture for zone II FDP repair in our primary, nondestructive mechanical outcomes in this in vitro study. In vivo studies may be warranted to determine if one suture method has an advantage with respect to the parameters tested at 4, 6, and 12 plus weeks postrepair and the degree of adhesion formation. The combined laboratory and clinical data, in additional to cost considerations, may better define the role of barbed knotless suture for zone II flexor tendon repair. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  5. Computer Aided Quantification of Pathological Features for Flexor Tendon Pulleys on Microscopic Images

    Directory of Open Access Journals (Sweden)

    Yung-Chun Liu

    2013-01-01

    Full Text Available Quantifying the pathological features of flexor tendon pulleys is essential for grading the trigger finger since it provides clinicians with objective evidence derived from microscopic images. Although manual grading is time consuming and dependent on the observer experience, there is a lack of image processing methods for automatically extracting pulley pathological features. In this paper, we design and develop a color-based image segmentation system to extract the color and shape features from pulley microscopic images. Two parameters which are the size ratio of abnormal tissue regions and the number ratio of abnormal nuclei are estimated as the pathological progression indices. The automatic quantification results show clear discrimination among different levels of diseased pulley specimens which are prone to misjudgments for human visual inspection. The proposed system provides a reliable and automatic way to obtain pathological parameters instead of manual evaluation which is with intra- and interoperator variability. Experiments with 290 microscopic images from 29 pulley specimens show good correspondence with pathologist expectations. Hence, the proposed system has great potential for assisting clinical experts in routine histopathological examinations.

  6. The Effect of Hyaluronidase, Phospholipase, Lipid Solvent and Trypsin on the Lubrication of Canine Flexor Digitorum Profundus Tendon

    Science.gov (United States)

    Sun, Yulong; Chen, Meng-Yi; Zhao, Chunfeng; An, Kai-Nan; Amadio, Peter C.

    2014-01-01

    Although the flexor digitorum profundus (FDP) tendon’s gliding resistance is low, the lubrication mechanism that enables this is unclear. The principal lubricants in joints, such as hyaluronic acid, phospholipids, and lubricin, a lubricating glycoprotein, are known to be present in the canine tendon. In this study, we assessed the effect of these lubricants in the tendon by measuring gliding resistance before and after their removal. Canine FDP tendons were treated with hyaluronidase, phospholipase, lipid solvent, and/or trypsin. The gliding resistance of FDP tendons significantly increased after all treatments (p < 0.05). The largest effect on gliding resistance was observed after trypsin digestion. Scanning electron microscopy and immunostaining for hyaluronic acid and lubricin were used to qualitatively assess the tendon surface after treatments. The trypsin digestion produced the most irregular surface, with many exposed collagen fibers. The results of this study suggest that phospholipids, hyaluronic acid, and protein components are all involved in maintaining the low gliding resistance of the FDP tendon. PMID:18404658

  7. Comparison of Post Operative Early Active and Passive Mobillization of Flexor Tendon in Zone 2

    Directory of Open Access Journals (Sweden)

    Fereidoun Layeghi

    2003-12-01

    Full Text Available Objective: Despite numerous advances in our understanding of the anatomy, Biomechanics, nutrition and Healing, the result Following Fiewor Tendon repair Shiow relatively high rate of failure the purpost of this study was to compare the result of 50 digits treated by either ‘‘Early active mobilization’’ or ‘‘controlled passive mobilization’’ re gimen in Ivan hand rehabilitation center. Materials & Mathods: Pationt being matched for gende, age, injuries hand, technique of srgery (all with eqitenon first, four strand in two groups. They were assessed 8 week postoperatibg in respect of total active motion, flexion gap and extension lags. Outcome were defined using ‘‘Strickland’’ and ‘’ Buck – Gramko’’ criteria. Results: The result were 80% excellent and good, 20% fair and no poor in early active motion group and in second group 40% excellent and good, 44% fair and 16% poor due to Strickland criteria. In buck-grancko criteria 52% extension and good, 32% fair and 16% were poor. Mean of total active motion was significantly greater in early active motion group (in E.A.M.150/2, in passive group: 116/41. Conclusion: Actively mobilized tendon underwent intrinsic healing without large gap formation. Active motion generated bith tension and motion and offer several advantage over passive motion: improved tendon nutrition, less adhission, higher rate of healing, increased ultimate rang of motion. So early active motion is the best protocle for treating tendons in zons 2 our result is comparable with theory.

  8. Comparative biomechanic performances of locked cruciate four-strand flexor tendon repairs in an ex vivo porcine model.

    Science.gov (United States)

    Croog, Alexander; Goldstein, Rachel; Nasser, Philip; Lee, Steve K

    2007-02-01

    To investigate the effects of 3 different locking configurations on repair strength when used in a cruciate four-strand repair. Sixty fresh porcine flexor tendons were transected and repaired with cruciate four-strand core suture repairs with 3 different locking configurations: simple locks (a modification of the Pennigton method), circle locks, and cross locks. Half of the repairs in each locking group were reinforced with a peripheral suture. The tendon repairs were subjected to linear load-to-failure testing. Outcome measures were 2-mm gap force and ultimate tensile strength. The cross lock repair had significantly greater 2-mm gap force and ultimate tensile strength than the simple lock repair, both with and without a peripheral suture. The cross lock repair showed significantly greater 2-mm gap force without a peripheral suture and significantly greater ultimate tensile strength with a peripheral suture than the circle lock repair. With peripheral reinforcement, the cross lock cruciate repair had a mean 2-mm gap force of 92 N and ultimate tensile strength of 119 N. The cross lock cruciate repair consistently produced the strongest biomechanic performance in all outcome measures. Locking configuration influences the biomechanic performance of cruciate four-strand flexor tendon repairs. Our results suggest that the cruciate repair with cross locks is stronger than repairs with simple locks or circle locks. Whether the results of this ex vivo porcine linear model can be translated to the clinical arena is unknown, because the factors of tendon/sheath friction, tendon healing, and compromised tendon viability from the lock were not addressed.

  9. The simple transverse intraosseous phalangeal suture for zone 1 flexor digitorum profundus injuries: case series and review of the literature.

    Science.gov (United States)

    Markeson, Daniel Benjamin; Evgeniou, Evgenios; Choa, Robert; Iyer, Srinivasan

    2013-05-01

    Zone 1 flexor digitorum profundus injury often precludes the use of a simple core suture as a result of a distal remnant that is too short. The aim of this study was to assess the senior author's (S.I.) simple technique for reinsertion of the flexor digitorum profundus tendon. The case series consisted of 12 patients who required a primary flexor digitorum profundus repair in zone 1, with all repairs performed by the senior author. A Bruner incision was extended to the pulp to expose the base of the distal phalanx. A two-strand repair was anchored to the distal phalanx using the author's technique, which involved passing a 3-0 polypropylene suture on a straight needle through a hypodermic needle that had been drilled through the base of the distal phalanx. This provided a stable, intraosseous, internal repair, allowing a standard early active mobilization regimen. Two patients had excellent results and 10 had good results in terms of distal interphalangeal joint range of movement (mean, 57 degrees; range, 51 to 80 degrees) and Quick Disabilities of the Arm, Shoulder and Hand questionnaire scores (mean, 12; range, 0 to 31.8). There were no reported tendon ruptures at the time of writing this article (range, 6 to 37 months after surgery). The authors present a technique for the repair of zone 1 flexor digitorum profundus injuries that is simple, can be performed quickly, is easily learned, and has results that compare favorably with other techniques in the literature. Furthermore, there is limited morbidity to surrounding fingertip structures. Therapeutic, IV.

  10. A study of the distribution of color Doppler flows in the superficial digital flexor tendon of young Thoroughbreds during their training periods.

    Science.gov (United States)

    Hatazoe, Takashi; Endo, Yoshiro; Iwamoto, Yohei; Korosue, Kenji; Kuroda, Taisuke; Inoue, Saemi; Murata, Daiki; Hobo, Seiji; Misumi, Kazuhiro

    2015-01-01

    Aim of this study was to evaluate the relationships of exercise and tendon injury with Doppler flows appearing in the superficial digital flexor tendon (SDFT) of young Thoroughbreds during training periods. The forelimb SDFTs of 24 one- to two-year-old Thoroughbreds clinically free of any orthopaedic disorders were evaluated using grey-scale (GS) and color Doppler (CD) images during two training periods between December 2013 to April 2015. Twelve horses per year were examined in December, February, and April in training periods that began in September and ended in April. The SDFT was evaluated in 3 longitudinal images of equal lengths (labelled 1, 2, 3 in order from proximal to distal), and 6 transversal images separated by equal lengths (labelled 1A, 1B, 2A, 2B, 3A and 3B in order from proximal to distal) of the metacarpus using both GS and CD. The running (canter and gallop) distance for 1 month before the date of the ultrasonographic examinations was increased in December, February, and April in both of the two training periods. CD flows defined as rhythmically blinking or pulsatory colored signals were found in 56 of 864 (6.4%) transversal CD images, in 28, 12, 13, and 3 images of 1A, 1B, 2A and 2B, respectively, and in 7, 14, and 35 images captured in December, February, and April, respectively. There were no longitudinal or transversal GS images indicating injury in the SDFTs in either of the two training periods. The increase of CD flows in the proximal regions of the SDFT are possibly related to the increase of the running distance during the training periods of the one- to two-year-old Thoroughbreds. Because no injury was diagnosed in the SDFTs by GS images during the training periods, the increase of CD flows in the proximal parts of SDFT is not necessarily predictive of tendon injury in the near future during the training period of young Thoroughbreds.

  11. Miscellaneous conditions of tendons, tendon sheaths, and ligaments.

    Science.gov (United States)

    Dyson, S J; Dik, K J

    1995-08-01

    The use of diagnostic ultrasonography has greatly enhances our ability to diagnose injuries of tendons and tendon sheaths that were previously either unrecognized or poorly understood. For may of these injuries, there is currently only a small amount of follow-up data. This article considers injuries of the deep digital flexor tendon and its accessory ligament, the carpal tunnel syndrome soft tissue swellings on the dorsal aspect of the carpus, intertubercular (bicipital) bursitis and bicipital tendinitis, injuries of the gastrocnemius tendon, common calcaneal tendinitis, rupture of peroneus (fibularis tertius) and ligaments injuries of the back.

  12. CORR® ORS Richard A. Brand Award for Outstanding Orthopaedic Research: Engineering flexor tendon repair with lubricant, cells, and cytokines in a canine model.

    Science.gov (United States)

    Zhao, Chunfeng; Ozasa, Yasuhiro; Reisdorf, Ramona L; Thoreson, Andrew R; Jay, Gregory D; An, Kai-Nan; Amadio, Peter C

    2014-09-01

    Adhesions and poor healing are complications of flexor tendon repair. The purpose of this study was to investigate a tissue engineering approach to improve functional outcomes after flexor tendon repair in a canine model. Flexor digitorum profundus tendons were lacerated and repaired in 60 dogs that were followed for 10, 21, or 42 days. One randomly selected repair from either the second or fifth digit in one paw in each dog was treated with carbodiimide-derivatized hyaluronic acid, gelatin, and lubricin plus autologous bone marrow stromal cells stimulated with growth and differentiation factor 5; control repair tendons were not treated. Digits were analyzed by adhesion score, work of flexion, tendon-pulley friction, failure force, and histology. In the control group, 35 of 52 control tendons had adhesions, whereas 19 of 49 treated tendons had adhesions. The number of repaired tendons with adhesions in the control group was greater than the number in the treated group at all three times (p = 0.005). The normalized work of flexion in treated tendons was 0.28 (± 0.08), 0.29 (± 0.19), and 0.32 (± 0.22) N/mm/° at Day 10, Day 21, and Day 42 respectively, compared with the untreated tendons of 0.46 (± 0.19) at Day 10 (effect size, 1.5; p = 0.01), 0.77 (± 0.49) at Day 21 (effect size, 1.4; p < 0.001), and 1.17 (± 0.82) N/mm/° at Day 42 (effect size, 1.6; p < 0.001). The friction data were comparable to the work of flexion data at all times. The repaired tendon failure force in the untreated group at 42 days was 70.2 N (± 8.77), which was greater than the treated tendons 44.7 N (± 8.53) (effect size, 1.9; p < 0.001). Histologically, treated repairs had a smooth surface with intrinsic healing, whereas control repairs had surface adhesions and extrinsic healing. Our study provides evidence that tissue engineering coupled with restoration of tendon gliding can improve the quality of tendon healing in a large animal in vivo model. Tissue engineering may enhance

  13. Capacity for sliding between tendon fascicles decreases with ageing in injury prone equine tendons: a possible mechanism for age-related tendinopathy?

    Science.gov (United States)

    Thorpe, C T; Udeze, C P; Birch, H L; Clegg, P D; Screen, H Rc

    2013-01-08

    Age-related tendinopathy is common in both humans and horses; the initiation and progression of which is similar between species. The majority of tendon injuries occur to high-strain energy storing tendons, such as the human Achilles tendon and equine superficial digital flexor (SDFT). By contrast, the low-strain positional human anterior tibialis tendon and equine common digital extensor (CDET) are rarely injured. It has previously been established that greater extension occurs at the fascicular interface in the SDFT than in the CDET; this may facilitate the large strains experienced during locomotion in the SDFT without damage occurring to the fascicles. This study investigated the alterations in whole tendon, fascicle and interfascicular mechanical properties in the SDFT and CDET with increasing age. It was hypothesised that the amount of sliding at the fascicular interface in the SDFT would decrease with increasing horse age, whereas the properties of the interface in the CDET would remain unchanged with ageing. Data support the hypothesis; there were no alterations in the mechanical properties of the whole SDFT or its constituent fascicles with increasing age. However, there was significantly less sliding at the fascicular interface at physiological loads in samples from aged tendons. There was no relationship between fascicle sliding and age in the CDET. The increase in stiffness of the interfascicular matrix in aged SDFT may result in the fascicles being loaded at an earlier point in the stress strain curve, increasing the risk of damage. This may predispose aged tendons to tendinopathy.

  14. Injury patterns and the role of tendons in protecting neurovascular structures in wrist injuries.

    Science.gov (United States)

    Lee, Chul Hyung; Cha, Soo Min; Shin, Hyun Dae

    2016-06-01

    The purpose of this study was to evaluate the anatomical features of injured structures, investigate the protection provided by the specific tendon of each corresponding important neurovascular structure (radial artery, median nerve, and ulnar nerve/artery) and to compare the results among the three categories of wrist injuries. This study included 114 patients who underwent primary repair for damaged wrist structures; 40 patients sustained accidental damage without intention (group 1), 40 had self-inflicted damage (group 2), and 34 patients had a stab or penetrating wound caused by a sharp instrument during a conflict or violent event involving another person (group 3). The basic demographic factors, distribution pattern, area, and depth of the injured structures were investigated and compared. The barrier roles of the flexor carpi radialis (FCR) for the radial artery, palmaris longus (PL) for the median nerve, and flexor carpi ulnaris (FCU) for the ulnar nerve were estimated. In group 1, FCU injury was the most common single-structure injury. In group 2, PL±median nerve injuries were the most common. Multiple-structure injuries involving more than five structures occurred more frequently in group 3 than in the other groups. FCU±ulnar nerve injuries were more common in group 3 than in the other groups. Radial-side structures were injured most frequently in group 3, and central-side injuries occurred most frequently in groups 1 and 2. Superficial- and middle-layer injuries occurred at similar frequencies among the three groups. Particularly, deep-layer injuries were most weakly related to group 2 injuries. The barrier effects of the FCR, PL, and FCU were confirmed, respectively. Wrist soft tissue injuries showed particular patterns of injured structures and depths according to the injury mechanism. These patterns included features such as single-structure injuries and the locations and depths of multiple-structure injuries with or without neurovascular injuries

  15. Tendon mineralization is accelerated bilaterally and creep of contralateral tendons is increased after unilateral needle injury of murine achilles tendons.

    Science.gov (United States)

    O'Brien, Etienne John Ogilvy; Shrive, Nigel G; Rosvold, Joshua M; Thornton, Gail M; Frank, Cyril B; Hart, David A

    2013-10-01

    Heterotopic mineralization may result in tendon weakness, but effects on other biomechanical responses have not been reported. We used a needle injury, which accelerates spontaneous mineralization of murine Achilles tendons, to test two hypotheses: that injured tendons would demonstrate altered biomechanical responses; and that unilateral injury would accelerate mineralization bilaterally. Mice underwent left hind (LH) injury (I; n = 11) and were euthanized after 20 weeks along with non-injured controls (C; n = 9). All hind limbs were examined by micro computed tomography followed by biomechanical testing (I = 7 and C = 6). No differences were found in the biomechanical responses of injured tendons compared with controls. However, the right hind (RH) tendons contralateral to the LH injury exhibited greater static creep strain and total creep strain compared with those LH tendons (p ≤ 0.045) and RH tendons from controls (p ≤ 0.043). RH limb lesions of injured mice were three times larger compared with controls (p = 0.030). Therefore, despite extensive mineralization, changes to the responses we measured were limited or absent 20 weeks postinjury. These results also suggest that bilateral occurrence should be considered where tendon mineralization is identified clinically. This experimental system may be useful to study the mechanisms of bilateral new bone formation in tendinopathy and other conditions. Copyright © 2013 Orthopaedic Research Society.

  16. Case Report:Triceps Tendon Avulsion: A Rare Injury | Sharma ...

    African Journals Online (AJOL)

    Background: Triceps tendon avulsion is one of the rare tendinous injuries. Such injuries can easily be missed, and should be kept as a differential diagnosis in all patients who present with pain and swelling at the back of the elbow after a traumatic event. Case Details: We present a case of triceps tendon avulsion which ...

  17. Drill Penetration Injury to Extensor Tendons: A Biomechanical Analysis.

    Science.gov (United States)

    Mahylis, Jared M; Burwell, Anora K; Bonneau, Laura; Marshall, Lynn M; Mirarchi, Adam J

    2017-05-01

    Little is known about extensor tendon failure following drill injury at the time of volar plate fixation. Our goals were to analyze extensor tendon injury following simulated drill penetration, and change in tendon displacement during cyclic loading following simulated drill penetration injury. Extensor pollicis longus (EPL) and extensor carpi radialis brevis (ECRB) tendons were harvested from 9 fresh frozen cadaveric arms. Eighteen EPL and 18 ECRB samples were created from harvested tendons. Drill penetration injury was performed in either a continuous or an oscillating mode. Injured tendons were subjected to 1200 cycles at 1- to 15-kg cyclic load at a frequency of 1 Hz, and analyzed for failure at drill sites and change in displacement throughout the testing cycle. Ten EPL samples and 16 ECRB samples completed testing without failure. Tendon type (ECRB, EPL), mode of injury (continuous, oscillating), and location (proximal, distal) did not affect tendon displacement during loading. A single EPL tendon failed following continuous drill penetration injury. Extensor carpi radialis brevis samples had a mean change in displacement of 2.8 (standard deviation [SD]: 1.5 mm) and 5.9 mm (SD: 4.7 mm) for oscillating and continuous modes, respectively. Six EPL samples had a mean change in displacement of 4.7 (SD: 2.7 mm) and 4.3 mm (SD: 1.8 mm) for oscillating and continuous modes, respectively. Complete extensor tendon failure due to drill penetration was rare. Drill mode did not affect the degree of elongation. Increasing cyclic loading of extensor tendons after drill injury caused modest extensor tendon elongation.

  18. Flexor Hallucis Longus tendon rupture in RA-patients is associated with MTP 1 damage and pes planus

    Directory of Open Access Journals (Sweden)

    Buurke Jaap J

    2007-11-01

    Full Text Available Abstract Background To assess the prevalence of and relation between rupture or tenosynovitis of the Flexor Hallucis Longus (FHL tendon and range of motion, deformities and joint damage of the forefoot in RA patients with foot complaints. Methods Thirty RA patients with painful feet were analysed, their feet were examined clinically for the presence of pes planus and range of motion (ROM, radiographs were scored looking for the presence of forefoot damage, and ultrasound examination was performed, examining the presence of tenosyovitis or rupture of the FHL at the level of the medial malleolus. The correlation between the presence or absence of the FHL and ROM, forefoot damage and pes planus was calculated. Results In 11/60(18% of the feet, a rupture of the FHL was found. This was associated with a limited motion of the MTP1-joint, measured on the JAM (χ2 = 10.4, p = 0.034, a higher prevalence of pes planus (χ2 = 5.77, p = 0.016 and a higher prevalence of erosions proximal at the MTP-1 joint (χ2 = 12.3, p = 0.016, and joint space narrowing of the MTP1 joint (χ2 = 12.7, p = 0.013. Conclusion Rupture of the flexor hallucis longus tendon in RA-patients is associated with limited range of hallux motion, more erosions and joint space narrowing of the MTP-1-joint, as well as with pes planus.

  19. Flexor tendon repair: a comparative study between a knotless barbed suture repair and a traditional four-strand monofilament suture repair.

    LENUS (Irish Health Repository)

    Joyce, C W

    2014-01-01

    We compared the tensile strength of a novel knotless barbed suture method with a traditional four-strand Adelaide technique for flexor tendon repairs. Forty fresh porcine flexor tendons were transected and randomly assigned to one of the repair groups before repair. Biomechanical testing demonstrated that the tensile strengths between both tendon groups were very similar. However, less force was required to create a 2 mm gap in the four-strand repair method compared with the knotless barbed technique. There was a significant reduction in the cross-sectional area in the barbed suture group after repair compared with the Adelaide group. This would create better gliding within the pulley system in vivo and could decrease gapping and tendon rupture.

  20. Isolated flexor muscles of the little toe in the feet of an individual with atrophied or lacking 4th head of the M. extensor digitorum brevis and lacking the 4th tendon of the M. extensor digitorum longus.

    Science.gov (United States)

    Claassen, Horst; Wree, Andreas

    2003-01-01

    While dissecting the body of a 75-year-old male we observed variations in the Mm. flexor digitorum brevis and longus of both feet. In the left foot, the 4th tendon of the M. flexor digitorum brevis was atrophied and the respective tendon of the M. flexor digitorum longus to the little toe was absent. In the right foot, the 4th tendons of both the Mm. flexor digitorum brevis and longus to the little toe were absent. The lacking deep flexor tendon to the little toe in the left foot was replaced by an isolated flexor muscle originating from the medial and lateral processes of the calcaneal tuberosity, which additionally had connections to the tendinous plate of the M. flexor digitorum longus and the M. quadratus plantae. The absent superficial and deep flexor tendons to the little toe in the right foot were replaced by an isolated flexor muscle arising from the M. quadratus plantae distal from the medial process of the calcaneal tuberosity. The tendon of both isolated flexor muscles inserted in the distal phalanx of the little toe. The left isolated flexor muscle for the little toe had connections to the M. flexor digitorum longus and the M. quadratus plantae. From these results it seems likely that the M. quadratus plantae could be regarded as additional flexor head (caput breve or plantare) of the M. flexor digitorum longus as is described in classic textbooks. In the individual's lifetime the described variation perhaps led to the possibility of an isolated flexion of the little toe.

  1. Silicone infusion tubing instead of Hunter rods for two-stage zone 2 flexor tendon reconstruction in a resource-limited surgical environment.

    Science.gov (United States)

    Kibadi, K; Moutet, F

    2017-10-01

    The authors describe their experience using silicone infusion tubing in place of Hunter rods for two-stage zone 2 flexor tendon reconstruction in a resource-limited surgical environment. This case report features a 47-year-old, right-handed man who had no active PIP and DIP joint flexion in four fingers of the right hand 5 months after an injury. During the first repair stage, the A2 and A4 pulleys were reconstructed using an extensor retinaculum graft. An infusion tube was inserted instead of Hunter rods. During the second stage, formation of a digital neo-canal around the infusion tubing was observed. The infusion tubing was removed and replaced with a palmaris longus tendon graft according to the conventional technique. Physiotherapy and rehabilitation followed surgery. At 6 months, very significant progress had been made with complete recovery of PIP and DIP flexion in the four fingers. Copyright © 2017 SFCM. Published by Elsevier Masson SAS. All rights reserved.

  2. Chiasma crurale: intersection of the tibialis posterior and flexor digitorum longus tendons above the ankle. Magnetic resonance imaging-anatomic correlation in cadavers

    Energy Technology Data Exchange (ETDEWEB)

    Buck, Florian M. [VA San Diego Medical Center, Department of Radiology, San Diego, CA (United States); Institut fuer Diagnostische Radiologie, Zurich (Switzerland); Gheno, Ramon; Nico, Marcelo A.C.; Trudell, Debra J.; Resnick, Donald [VA San Diego Medical Center, Department of Radiology, San Diego, CA (United States); Haghighi, Parviz [VA San Diego Medical Center, Department of Pathology, San Diego, CA (United States)

    2010-06-15

    To determine the precise anatomy and magnetic resonance (MR) imaging appearance of the chiasma crurale in cadavers, paying special attention to degenerative changes Twelve fresh human ankles were harvested from 11 nonembalmed cadavers (mean age at death 77 years) and used according to institutional guidelines. MR imaging and MR tenography were used to investigate the anatomy of the chiasma crurale using proton density-weighted sequences. The gross anatomy of the chiasma crurale was evaluated and compared to the MR imaging findings. Histology was used to elucidate further the structure of the chiasma crurale. Above the chiasma, five specimens had a small amount of fat tissue between the tibialis posterior and flexor digitorum longus tendon. In all specimens both tendons had a sheath below the chiasma but not above it. At the central portion of the chiasma there was no soft tissue between the tendons, except in two specimens that showed an anatomic variant consisting of a thick septum connecting the tibial periosteum and the deep transverse fascia of the leg. In MR images, eight specimens showed what were believed to be degenerative changes in the tendons at the level of the chiasma. However, during gross inspection and histologic analysis of the specimens, there was no tendon degeneration visible. At the central portion of the chiasma, there is no tissue between the tibialis posterior and flexor digitorum longus tendons unless there is an anatomic variant. At the chiasma crurale, areas with irregular tendon surfaces are normal findings and are not associated with tendon degeneration (fraying). (orig.)

  3. Characteristics of acute groin injuries in the hip flexor muscles - a detailed MRI study in athletes

    DEFF Research Database (Denmark)

    Serner, A; Weir, A; Tol, J L

    2018-01-01

    acute hip flexor muscle injury were included. A total of 156 athletes presented with acute groin pain of which 33 athletes were included, median age 26 years (range 18-35). There were 16 rectus femoris, 12 iliacus, 7 psoas major, 4 sartorius, and 1 tensor fascia latae injury. Rectus femoris injuries...

  4. Spontaneous flexor tendon rupture due to an insufficiency fracture of the hamate hook in a patient with systemic lupus erythematosus: A case report

    Directory of Open Access Journals (Sweden)

    Toshihiro Hosokawa

    2016-01-01

    Conclusion: When we encounter a case of spontaneous flexor tendon rupture in a patient with systemic disease such as SLE or long-term steroid use, attention should be paid to the state of the carpal bones and joints as they sometimes accompany unexpected causes.

  5. Freeze-dried allograft-mediated gene or protein delivery of growth and differentiation factor 5 reduces reconstructed murine flexor tendon adhesions

    DEFF Research Database (Denmark)

    Svensson, Sys Hasslund; Dadali, Tulin; Ulrich-Vinther, Michael

    2014-01-01

    Advances in allograft processing have opened new horizons for clinical adaptation of flexor tendon allografts as delivery scaffolds for antifibrotic therapeutics. Recombinant adeno-associated-virus (rAAV) gene delivery of the growth and differentiation factor 5 (GDF-5) has been previously...

  6. The tendon approximator device in traumatic injuries.

    Science.gov (United States)

    Forootan, Kamal S; Karimi, Hamid; Forootan, Nazilla-Sadat S

    2015-01-01

    Precise and tension-free approximation of two tendon endings is the key predictor of outcomes following tendon lacerations and repairs. We evaluate the efficacy of a new tendon approximator device in tendon laceration repairs. In a comparative study, we used our new tendon approximator device in 99 consecutive patients with laceration of 266 tendons who attend a university hospital and evaluated the operative time to repair the tendons, surgeons' satisfaction as well as patient's outcomes in a long-term follow-up. Data were compared with the data of control patients undergoing tendon repair by conventional method. Totally 266 tendons were repaired by approximator device and 199 tendons by conventional technique. 78.7% of patients in first group were male and 21.2% were female. In approximator group 38% of patients had secondary repair of cut tendons and 62% had primary repair. Patients were followed for a mean period of 3years (14-60 months). Time required for repair of each tendon was significantly reduced with the approximator device (2 min vs. 5.5 min, ptendon repair were identical in the two groups and were not significantly different. 1% of tendons in group A and 1.2% in group B had rupture that was not significantly different. The new nerve approximator device is cheap, feasible to use and reduces the time of tendon repair with sustained outcomes comparable to the conventional methods.

  7. Change in knee flexor torque after fatiguing exercise identifies previous hamstring injury in football players.

    Science.gov (United States)

    Lord, C; Ma'ayah, F; Blazevich, A J

    2018-03-01

    Muscular fatigue and interlimb strength asymmetry are factors known to influence hamstring injury risk; however, limb-specific exacerbation of knee flexor (hamstrings) torque production after fatiguing exercise has previously been ignored. To investigate changes in muscular force production before and after sport-specific (repeated-sprint) and non-specific (knee extension-flexion) fatiguing exercise, and explore the sensitivity and specificity of isokinetic endurance (ie, muscle-specific) and single-leg vertical jump (ie, whole limb) tests to identify previous hamstring injury. Twenty Western Australia State League footballers with previous unilateral hamstring injury and 20 players without participated. Peak concentric knee extensor and flexor (180°∙s -1 ) torques were assessed throughout an isokinetic endurance test, which was then repeated alongside a single-leg vertical jump test before and after maximal repeated-sprint exercise. Greater reductions in isokinetic knee flexor torque (-16%) and the concentric hamstring:quadriceps peak torque ratio (-15%) were observed after repeated-sprint running only in the injured (kicking) leg and only in the previously injured subjects. Changes in (1) peak knee flexor torque after repeated-sprint exercise, and (2) the decline in knee flexor torque during the isokinetic endurance test measured after repeated-sprint exercise, correctly identified the injured legs (N = 20) within the cohort (N = 80) with 100% specificity and sensitivity. Decreases in peak knee flexor torque and the knee flexor torque during an isokinetic endurance test after repeated-sprint exercise identified previous hamstring injury with 100% accuracy. Changes in knee flexor torque, but not SLVJ, should be tested to determine its prospective ability to predict hamstring injury in competitive football players. © 2017 The Authors. Scandinavian Journal of Medicine & Science In Sports Published by John Wiley & Sons Ltd.

  8. CT of peroneal tendon injury in patients with calcaneal fractures

    International Nuclear Information System (INIS)

    Rosenberg, Z.S.; Feldman, F.; Singson, R.D.

    1986-01-01

    Injury to the peroneal tendons is a major complication of intraarticular calcaneal fractures. Heretofore, the injury has been difficult to diagnose by routine imaging modalities. However, CT studies of 24 intraarticular calcaneal fractures revealed evidence of peroneal tendon injury in 22 cases. The pathologic conditions included lateral displacement, subluxation, dislocation, and impingement on the tendons by bony fragments, hematomas, and scar tissue. Patients studied 6-12 months after injury had CT evidence consistent with clinical symptoms of peroneal tenosynovitis. Since peroneal tendon injury is surgically correctable, it should be differentiated from other known and more obvious complications, of calcaneal fractures. CT therefore serves as a valuable, noninvasive tool in evaluating these otherwise nonvisualized soft tissue structures in the immediate posttraumatic period as well as during long-term follow up

  9. Magnetic resonance imaging of the pulleys of the flexor tendons of the toes at 11.7 T

    Energy Technology Data Exchange (ETDEWEB)

    Tafur, Monica; Iwasaki, Kenyu; Statum, Sheronda; Szeverenyi, Nikolaus M.; Bydder, Graeme M. [University of California, San Diego, School of Medicine, Department of Radiology, San Diego, CA (United States); Chung, Christine B. [Department of Radiology, Veterans Administration San Diego Healthcare System, San Diego, CA (United States); University of California, San Diego, School of Medicine, Department of Radiology, San Diego, CA (United States)

    2015-01-15

    We obtained high-resolution 11.7-T MR images of the pulleys of the flexor tendons in cadaveric toe specimens. A detailed understanding of toe pulley anatomy as seen with MR is likely to be of benefit in recognizing disease and the effects of trauma. Six cadaveric toes were imaged with an 11.7-T small-bore MR imaging system using optimized coils. Two-dimensional dual-echo SE scans were obtained in three planes (40 x 40 x 400-μm{sup 3} voxel size, TE = 7/14 ms, TR = 3,500 ms, fat saturation). Three-dimensional spoiled gradient echo scans were obtained (90-150 μm{sup 3} isotropic voxel size, TE = 6 ms, TR = 25 ms, with and without fat saturation). Specimen orientation was with the long axis of the toe either parallel or perpendicular to B{sub 0}. All the annular (A) pulleys were demonstrated in the great and lesser toes. The A2 pulley in the great and lesser toes and the A4 pulley in the lesser toes were the most substantial pulleys. The A5 pulley, which has not previously been described in the toes, was demonstrated. The cruciform pulleys were also seen and were smaller and thinner. Three tissue layers were seen, and there was evidence of different fiber directions in annular pulleys producing different magic angle effects. Detailed anatomy of the pulley system of the flexor tendons was seen on the 11.7-T MR images showing new features and providing a basis for image interpretation. Similarities and differences between the pulley systems in the toes and the fingers were identified. (orig.)

  10. Magnetic resonance imaging of the pulleys of the flexor tendons of the toes at 11.7 T.

    Science.gov (United States)

    Tafur, Monica; Iwasaki, Kenyu; Statum, Sheronda; Chung, Christine B; Szeverenyi, Nikolaus M; Bydder, Graeme M

    2015-01-01

    We obtained high-resolution 11.7-T MR images of the pulleys of the flexor tendons in cadaveric toe specimens. A detailed understanding of toe pulley anatomy as seen with MR is likely to be of benefit in recognizing disease and the effects of trauma. Six cadaveric toes were imaged with an 11.7-T small-bore MR imaging system using optimized coils. Two-dimensional dual-echo SE scans were obtained in three planes (40 × 40 × 400-μm(3) voxel size, TE = 7/14 ms, TR = 3,500 ms, fat saturation). Three-dimensional spoiled gradient echo scans were obtained (90-150 μm(3) isotropic voxel size, TE = 6 ms, TR = 25 ms, with and without fat saturation). Specimen orientation was with the long axis of the toe either parallel or perpendicular to B0. All the annular (A) pulleys were demonstrated in the great and lesser toes. The A2 pulley in the great and lesser toes and the A4 pulley in the lesser toes were the most substantial pulleys. The A5 pulley, which has not previously been described in the toes, was demonstrated. The cruciform pulleys were also seen and were smaller and thinner. Three tissue layers were seen, and there was evidence of different fiber directions in annular pulleys producing different magic angle effects. Detailed anatomy of the pulley system of the flexor tendons was seen on the 11.7-T MR images showing new features and providing a basis for image interpretation. Similarities and differences between the pulley systems in the toes and the fingers were identified.

  11. Achilles tendon injuries in elite athletes: lessons in pathophysiology from their equine counterparts.

    Science.gov (United States)

    Patterson-Kane, Janet C; Rich, Tina

    2014-01-01

    Superficial digital flexor tendon (SDFT) injury in equine athletes is one of the most well-accepted, scientifically supported companion animal models of human disease (i.e., exercise-induced Achilles tendon [AT] injury). The SDFT and AT are functionally and clinically equivalent (and important) energy-storing structures for which no equally appropriate rodent, rabbit, or other analogues exist. Access to equine tissues has facilitated significant advances in knowledge of tendon maturation and aging, determination of specific exercise effects (including early life), and definition of some of the earliest stages of subclinical pathology. Access to human surgical biopsies has provided complementary information on more advanced phases of disease. Importantly, equine SDFT injuries are only a model for acute ruptures in athletes, not the entire spectrum of human tendonopathy (including chronic tendon pain). In both, pathology begins with a potentially prolonged phase of accumulation of (subclinical) microdamage. Recent work has revealed remarkably similar genetic risk factors, including further evidence that tenocyte dysfunction plays an active role. Mice are convenient but not necessarily accurate models for multiple diseases, particularly at the cellular level. Mechanistic studies, including tendon cell responses to combinations of exercise-associated stresses, require a more thorough investigation of cross-species conservation of key stress pathway auditors. Molecular evidence has provided some context for the poor performance of mouse models; equines may provide better systems at this level. The use of horses may be additionally justifiable based on comparable species longevity, lifestyle factors, and selection pressure by similar infectious agents (e.g., herpesviruses) on general cell stress pathway evolution. © The Author 2014. Published by Oxford University Press on behalf of the Institute for Laboratory Animal Research. All rights reserved. For permissions

  12. Tendon Injury and Fluoroquinolone Use: A Systematic Review.

    Science.gov (United States)

    Stephenson, Anne L; Wu, Wei; Cortes, Daniel; Rochon, Paula A

    2013-09-01

    Fluoroquinolone antibiotics are commonly used to treat infections and are prescribed by general practitioners, medical specialists and surgeons. Tendon injury has been associated with the use of these medications but the risk associated with newer fluoroquinolones has not been established. The aim of this systematic review was to evaluate the evidence from observational studies to determine the strength of the association between fluoroquinolone use and tendinopathy, and to identify risk factors for this complication. We searched MEDLINE, EMBASE and the Cochrane Collaboration from inception through May 2013 to identify observational studies focused on tendon injury and fluoroquinolones. Studies with original data were selected for inclusion following the PRISMA guidelines. Of the 560 abstracts screened, 16 relevant studies were independently rated by three authors (WW, AS, DC) using the Newcastle-Ottawa Quality Assessment Scale, and assigned a quality score out of 9. High-quality studies (i.e. scored 4.5 or higher) are summarized in detail in this article. Data were independently extracted by two authors (WW, AS). Overall, 16 studies were included in our study. Eight were deemed to be of high quality and five specifically evaluated Achilles tendon rupture. In addition, three studies examined Achilles tendinitis, and three included tendon disorders (including any tendon rupture) as an outcome. Results from these studies suggest that individuals exposed to fluoroquinolones are at increased risk for Achilles tendon rupture, particularly within the first month following exposure to the drug (odds ratios ranged from 1.1 to 7.1). One study showed an increased risk of tendon rupture in those over 60 years of age. Five studies stated that individuals taking fluoroquinolones and oral corticosteroids are at increased risk for tendon injury compared with those taking fluoroquinolones alone. Four studies examined the differential effect of a limited number of fluoroquinolones

  13. Comprehensive evaluation of finger flexor tendon entheseal soft tissue and bone changes by ultrasound can differentiate psoriatic arthritis and rheumatoid arthritis.

    Science.gov (United States)

    Tinazzi, Ilaria; McGonagle, Dennis; Zabotti, Alen; Chessa, Donatella; Marchetta, Antonio; Macchioni, Pierluigi

    2018-02-28

    To determine whether a detailed sonographic evaluation of the hand flexor tendon compartment could help differentiate between psoriatic arthritis (PsA) and rheumatoid arthritis (RA). Thirty-seven patients with PsA, 47 with RA and 10 healthy controls (HC) had flexor tendon (FT) compartment imaging of the dominant hand 2nd to 4th tendons using grey scale (GS) and power Doppler (PD) ultrasound (US) with evaluation for tenosynovitis, peri-tendinous lesions, soft tissue oedema and bony changes at FT insertions. 24/37 PsA and 19/47 RA cases had morning stiffness and 19/37 PsA and 10/47 RA had swollen and/or tender fingers. Tenosynovitis was more common in PsA (25/37) despite higher DAS28 scores in RA (25/37 versus 10/45; pthe insertional site was significantly more common in PsA (p=0.001). Considering a total inflammatory score per patient summing up the three modifications of the flexor tendon (tenosynovitis, peri-tendinous oedema and insertional enthesophytes) the difference between PsA and RA remained statistically significant (pthe growing body of literature that high resolution US of the hand FT compartment may help differentiate between RA and PsA, which needs assessment in the diagnostic setting.

  14. Functional results from reconstruction of the anterior cruciate ligament using the central third of the patellar ligament and flexor tendons

    Directory of Open Access Journals (Sweden)

    Marcos George de Souza Leao

    2015-12-01

    Full Text Available ABSTRACT OBJECTIVES: To evaluate knee function in patients undergoing reconstruction of the anterior cruciate ligament (ACL using the central third of the patellar ligament or the medial flexor tendons of the knee, i.e. quadruple ligaments from the semitendinosus and gracilis (ST-G, by means of the Knee Society Score (KSS and the Lysholm scale. METHODS: This was a randomized prospective longitudinal study on 40 patients who underwent arthroscopic ACL reconstruction between September 2013 and August 2014. They comprised 37 males and three females, with ages ranging from 16 to 52 years. The patients were numbered randomly from 1 to 40: the even numbers underwent surgical correction using the ST-G tendons and the odd numbers, using the patellar tendon. Functional evaluations were made using the KSS and Lysholm scale, applied in the evening before the surgical procedure and six months after the operation. RESULTS: From the statistical analysis, it could be seen that the patients' functional capacity was significantly greater after the operation than before the operation. There was strong evidence that the two forms of therapy had similar results ( p= >0.05, in all the comparisons. CONCLUSIONS: The results from the ACL reconstructions were similar with regard to functional recovery of the knee and improvement of quality of life, independent of the type of graft. It was not possible to identify the best method of surgical treatment. The surgeon's clinical and technical experience and the patient are the factors that determine the choice of graft type for use in ACL surgery.

  15. Surface markers for locating the pulleys and flexor tendon anatomy in the palm and fingers with reference to minimally invasive incisions.

    Science.gov (United States)

    Gordon, Joshua A; Stone, Lindsay; Gordon, Leonard

    2012-05-01

    Palm and finger pulley anatomy has been well described in relation to osseous structures. The goal of this study was to describe skin surface markers that locate the underlying flexor tendon and pulley system. We describe the anatomic detail of these structures and provide a guide for the surgeon for making small incisions. Using this approach, extensile exposure can be avoided, and the integrity of the complex pulley system is maintained. We dissected 12 palms and 48 fingers in 12 cadaver hands. We marked the palm and finger creases with methylene blue before dissection. We removed palm skin, finger skin, and subcutaneous tissue over the flexor tendon sheath and retained a 2-mm strip of each skin crease in its native position. We divided the palm and palmar surface of the fingers into 4 distinct zones and measured the location of the proximal and distal extent of each pulley and the tendon anatomy relative to the proximal and distal skin crease. We documented the location of the proximal and distal extent of the annular and cruciate pulleys as well as the decussation of the flexor digitorum superficialis (FDS) tendon and Camper chiasm. The results allow us to establish a relationship between the skin creases and underlying anatomy by dividing the palm and finger into 4 zones. In zone A, in the palm, the A2 pulley is located in the distal third and the FDS decussation is at the proximal extent of the A2 pulley. Zone B is in the proximal phalanx and A2 lies in the proximal third of this zone, whereas the Camper chiasm lies in the middle third. Zone C is in the middle phalanx and A4 and the insertion of FDS lie in the middle third of this zone. Zone D lies in the distal phalanx and the flexor digitorum profundus tendon inserts into the middle third of this zone. Skin creases can be used as surface markers to accurately locate the underlying pulley and tendon system and plan for limited incisions. These anatomic descriptions can aid surgeons in preoperative planning

  16. The effects of 5-fluorouracil on flexor tendon healing by using a biodegradable gelatin, slow releasing system: experimental study in a hen model.

    Science.gov (United States)

    Karaaltin, M V; Ozalp, B; Dadaci, M; Kayikcioglu, A; Kecik, A; Oner, F

    2013-07-01

    This study investigated the effects of 5-fluorouracil in a slow-release biodegradable gelatin system on tendon healing. Gelatin blocks prepared in a size of 10 × 20 × 1 mm were loaded with 10, 20, and 30 mg of 5-fluorouracil, and 30 adult white Leghorn chickens were used. The tendons to the third and fourth toes were severed and repaired. The extremities were casted for three weeks. After sacrifice, the tendons were examined histologically and biomechanically for adhesion formation. The 10 mg-loaded gelatin group showed a decrease in adhesion formation when compared with the operative control group; the 20 and 30 mg groups showed signs of severe inflammation. Low doses of 5-fluorouracil applied via a slow-release gelatin system reduced adhesion formation in flexor tendon healing.

  17. A Barbed Suture Repair For Flexor Tendons: A Novel Technique With No Exposed Barbs

    Directory of Open Access Journals (Sweden)

    Cormac W. Joyce, MB BCh

    2014-10-01

    Conclusions: We demonstrated that a 4-strand knotless, barbed method attained comparable strength to that of the traditional Adelaide repair technique. The barbed method had a significantly reduced cross-sectional area at the repair site compared with the Adelaide group. The 2-mm gap formation force was less in the barbed group than the Adelaide group. Barbed repairs show promise for tendon repairs; this simple method warrants further study in an animal model.

  18. Knee flexor strength recovery following hamstring tendon harvest for anterior cruciate ligament reconstruction: a systematic review

    Directory of Open Access Journals (Sweden)

    Clare Ardern

    2009-07-01

    Full Text Available The hamstring tendons are an increasingly popular graft choice for anterior cruciate ligament reconstruction due to preservation of quadriceps function and the absence of anterior knee pain post-operatively. Two commonly used hamstring grafts are a quadruple strand semitendinosus graft (4ST and a double strand semitendinosus-double strand gracilis graft (2ST-2G. It has been suggested that concurrent harvest of the semitendinsous and gracilis tendons may result in sub-optimal hamstring strength recovery as the gracilis may play a role in reinforcing the semitendinosus particularly in deep knee flexion angles. The objective of this systematic review was to synthesize the findings of available literature and determine whether semitendinosus and gracilis harvest lead to post-operative hamstring strength deficits when compared to semitendinosus harvest alone. Seven studies were identified which compared hamstring strength outcomes between the common hamstring graft types. The methodological quality of each paper was assessed, and where possible effect sizes were calculated to allow comparison of results across studies. No differences were reported between the groups in isokinetic hamstring strength. Deficits in hamstring strength were reported in the 2ST-2G groups when compared to the 4ST groups in isometric strength testing at knee flexion angles ≥70°, and in the standing knee flexion angle. Preliminary evidence exists to support the hypothesis that harvesting the semitendinosus tendon alone is preferable to harvesting in combination with the gracilis tendon for minimizing post-operative hamstring strength deficits at knee flexion angles greater than 70°. However, due to the paucity of research comparing strength outcomes between the common hamstring graft types, further investigation is warranted to fully elucidate the implications for graft harvest.

  19. Stenosing Tenosynovitis of the Flexor Hallucis Longus Tendon Associated with the Plantar Capsular Accessory Ossicle at the Interphalangeal Joint of the Great Toe

    Directory of Open Access Journals (Sweden)

    Song Ho Chang

    2017-01-01

    Full Text Available This report presents a case of stenosing tenosynovitis of the flexor hallucis longus tendon associated with the plantar capsular accessory ossicle at the interphalangeal joint of the great toe, which was confirmed by intraoperative observation and was successfully treated with surgical resection of the ossicle. As the plantar capsular accessory ossicle was not visible radiographically due to the lack of ossification, ultrasonography was helpful for diagnosing this disorder.

  20. Tendon Mineralization Is Progressive and Associated with Deterioration of Tendon Biomechanical Properties, and Requires BMP-Smad Signaling in the Mouse Achilles Tendon Injury Model

    Science.gov (United States)

    Zhang, Kairui; Asai, Shuji; Hast, Michael W.; Liu, Min; Usami, Yu; Iwamoto, Masahiro; Soslowsky, Louis J.; Enomoto-Iwamoto, Motomi

    2016-01-01

    Ectopic tendon mineralization can develop following tendon rupture or trauma surgery. The pathogenesis of ectopic tendon mineralization and its clinical impact have not been fully elucidated yet. In this study, we utilized a mouse Achilles tendon injury model to determine whether ectopic tendon mineralization alters the biomechanical properties of the tendon and whether BMP signaling is involved in this condition. A complete transverse incision was made at the midpoint of the right Achilles tendon in 8-week-old CD1 mice and the gap was left open. Ectopic cartilaginous mass formation was found in the injured tendon by 4 weeks post-surgery and ectopic mineralization was detected at 8–10 weeks post-surgery. Ectopic mineralization grew over time and volume of the mineralized materials of 25-weeks samples was about 2.5 fold bigger than that of 10-weeks samples, indicating that injury-induced ectopic tendon mineralization is progressive. In vitro mechanical testing showed that max force, max stress and mid-substance modulus in the 25-weeks samples were significantly lower than the 10-weeks samples. We observed substantial increases in expression of bone morphogenetic protein family genes in injured tendons 1 week post-surgery. Immunohistochemical analysis showed that phosphorylation of both Smad1 and Smad3 were highly increased in injured tendons as early as 1 week post-injury and remained high in ectopic chondrogenic lesions 4 weeks post-injury. Treatment with the BMP receptor kinase inhibitor (LDN193189) significantly inhibited injury-induced tendon mineralization. These findings indicate that injury-induced ectopic tendon mineralization is progressive, involves BMP signaling and associated with deterioration of tendon biomechanical properties. PMID:26825318

  1. Can a Clinical Examination Demonstrate Intramuscular Tendon Involvement in Acute Hamstring Injuries?

    NARCIS (Netherlands)

    Crema, Michel D.; Guermazi, Ali; Reurink, Gustaaf; Roemer, Frank W.; Maas, Mario; Weir, Adam; Moen, Maarten H.; Goudswaard, Gert J.; Tol, Johannes L.

    2017-01-01

    Involvement of the intramuscular (central) tendon in acute hamstring injuries, as detected on magnetic resonance imaging (MRI), may prolong recovery times. To date, it is unclear whether hamstring injuries exhibiting intramuscular tendon involvement can be identified though routine clinical

  2. Can a clinical examination demonstrate intramuscular tendon involvement in acute hamstring injuries?

    NARCIS (Netherlands)

    Crema, M.D. (Michel D.); A. Guermazi (Ali); G. Reurink (Gustaaf); Roemer, F.W. (Frank W.); M. Maas (Mario); A. Weir (Adam); M.H. Moen (Maaike); G.J. Goudswaard (Gert Jan); J.L. Tol (Johannes)

    2017-01-01

    textabstractBackground: Involvement of the intramuscular (central) tendon in acute hamstring injuries, as detected on magnetic resonance imaging (MRI), may prolong recovery times. To date, it is unclear whether hamstring injuries exhibiting intramuscular tendon involvement can be identified though

  3. The role of human ankle plantar flexor muscle-tendon interaction and architecture in maximal vertical jumping examined in vivo.

    Science.gov (United States)

    Farris, Dominic James; Lichtwark, Glen A; Brown, Nicholas A T; Cresswell, Andrew G

    2016-02-01

    Humans utilise elastic tendons of lower limb muscles to store and return energy during walking, running and jumping. Anuran and insect species use skeletal structures and/or dynamics in conjunction with similarly compliant structures to amplify muscle power output during jumping. We sought to examine whether human jumpers use similar mechanisms to aid elastic energy usage in the plantar flexor muscles during maximal vertical jumping. Ten male athletes performed maximal vertical squat jumps. Three-dimensional motion capture and a musculoskeletal model were used to determine lower limb kinematics that were combined with ground reaction force data in an inverse dynamics analysis. B-mode ultrasound imaging of the lateral gastrocnemius (GAS) and soleus (SOL) muscles was used to measure muscle fascicle lengths and pennation angles during jumping. Our results highlighted that both GAS and SOL utilised stretch and recoil of their series elastic elements (SEEs) in a catapult-like fashion, which likely serves to maximise ankle joint power. The resistance of supporting of body weight allowed initial stretch of both GAS and SOL SEEs. A proximal-to-distal sequence of joint moments and decreasing effective mechanical advantage early in the extension phase of the jumping movement were observed. This facilitated a further stretch of the SEE of the biarticular GAS and delayed recoil of the SOL SEE. However, effective mechanical advantage did not increase late in the jump to aid recoil of elastic tissues. © 2016. Published by The Company of Biologists Ltd.

  4. Anti-inflammatory management for tendon injuries - friends or foes?

    Directory of Open Access Journals (Sweden)

    Chan Kai-Ming

    2009-10-01

    Full Text Available Abstract Acute and chronic tendon injuries are very common among athletes and in sedentary population. Most physicians prescribe anti-inflammatory managements to relieve the worst symptoms of swelling and pain, including non-steroidal anti-inflammatory drugs, corticosteroids and physical therapies. However, experimental research shows that pro-inflammatory mediators such as prostaglandins may play important regulatory roles in tendon healing. Noticeably nearly all cases of chronic tendon injuries we treat as specialists have received non-steroidal anti-inflammatory drugs by their physician, suggesting that there might be a potential interaction in some of these cases turning a mild inflammatory tendon injury into chronic tendinopathy in predisposed individuals. We are aware of the fact that non-steroidal anti-inflammatory drugs and corticosteroids may well have a positive effect on the pain control in the clinical situation whilst negatively affect the structural healing. It follows that a comprehensive evaluation of anti-inflammatory management for tendon injuries is needed and any such data would have profound clinical and health economic importance.

  5. Arthroscopic Release of Flexor Hallucis Longus Tendon Sheath in Female Ballet Dancers: Dynamic Pathology, Surgical Technique, and Return to Dancing Performance.

    Science.gov (United States)

    Funasaki, Hiroki; Hayashi, Hiroteru; Sakamoto, Kanako; Tsuruga, Rei; Marumo, Keishi

    2015-12-01

    Stenosing tenosynovitis of the flexor hallucis longus (FHL) tendon is known as a major overuse lesion in female dancers. We describe arthroscopic surgical techniques in relation to the dynamic pathology of the disease. Crepitus and pain on moving the great toe with the ankle in plantar flexion on preoperative examination confirm the diagnosis of FHL stenosing tenosynovitis even if the os trigonum is not evident. The ankle is approached through standard posterolateral and posteromedial portals. A 4.0-mm-diameter 30° arthroscope is used. Soft tissues around the talus are cleared with a motorized shaver and a radiofrequency device. The posterior aspects of the talus, os trigonum, and FHL tendon surrounded by the tendon sheath are visualized. The dynamic pathology of the FHL tendon is well observed on passive motion of the great toe. The prominent bone fragment of the talus is removed and the tendon sheath is cut with a retrograde knife and a motorized shaver from the superior border down to the entrance of the fibro-osseous tunnel. Arthroscopic release of the FHL tendon sheath is a useful and easy method to directly approach the dynamic pathology of FHL tenosynovitis in female ballet dancers.

  6. Diagnosing Achilles tendon injuries in the emergency department.

    LENUS (Irish Health Repository)

    Gibbons, Lynda

    2013-09-01

    Achilles tendon (AT) injury is an overuse injury often seen in professional and recreational athletes. It tends to affect men, particularly those in their thirties and forties, more than women, and is typically seen in people who are intermittently active. To ensure AT ruptures are identified and treated effectively, early intervention in emergency departments (EDs) is crucial. This article discusses how advanced nurse practitioners can use their comprehensive problem-solving, clinical decision-making and clinical judgement skills to manage patients who present with suspected AT injury. It also describes the anatomy of tendon rupture, the aetiology and mechanism of injuries, and the importance of assessment and diagnostic tools, therapeutic techniques and management strategies. Finally, it considers the psychological effect this injury can have on patients, while in the ED and after discharge. A case study is included as an example of ED management.

  7. BIOMECHANICS AND HISTOLOGICAL ANALYSIS IN RABBIT FLEXOR TENDONS REPAIRED USING THREE SUTURE TECHNIQUES (FOUR AND SIX STRANDS) WITH EARLY ACTIVE MOBILIZATION.

    Science.gov (United States)

    Severo, Antônio Lourenço; Arenhart, Rodrigo; Silveira, Daniela; Ávila, Aluísio Otávio Vargas; Berral, Francisco José; Lemos, Marcelo Barreto; Piluski, Paulo César Faiad; Lech, Osvandré Luís Canfield; Fukushima, Walter Yoshinori

    2012-01-01

    Analyzing suture time, biomechanics (deformity between the stumps) and the histology of three groups of tendinous surgical repair: Brazil-2 (4-strands) which the end knot (core) is located outside the tendon, Indiana (4-strands) and Tsai (6-strands) with sutures technique which the end knot (core) is inner of the tendon, associated with early active mobilization. The right calcaneal tendons (plantar flexor of the hind paw) of 36 rabbits of the New Zealand breed (Oryctolagus cuniculus) were used in the analysis. This sample presents similar size to human flexor tendon that has approximately 4.5 mm (varying from 2mm). The selected sample showed the same mass (2.5 to 3kg) and were male or female adults (from 8 ½ months). For the flexor tendons of the hind paws, sterile and driven techniques were used in accordance to the Committee on Animal Research and Ethics (CETEA) of the University of the State of Santa Catarina (UDESC), municipality of Lages, in Brazil (protocol # 1.33.09). In the biomechanical analysis (deformity) carried out between tendinous stumps, there was no statistically significant difference (p>0.01). There was no statistical difference in relation to surgical time in all three suture techniques with a mean of 6.0 minutes for Tsai (6- strands), 5.7 minutes for Indiana (4-strands) and 5.6 minutes for Brazil (4-strands) (p>0.01). With the early active mobility, there was qualitative and quantitative evidence of thickening of collagen in 38.9% on the 15(th) day and in 66.7% on the 30(th) day, making the biological tissue stronger and more resistant (p=0.095). This study demonstrated that there was no histological difference between the results achieved with an inside or outside end knot with respect to the repaired tendon and the number of strands did not affect healing, vascularization or sliding of the tendon in the osteofibrous tunnel, which are associated with early active mobility, with the repair techniques applied.

  8. Eccentric Knee Flexor Strength and Risk of Hamstring Injuries in Rugby Union: A Prospective Study.

    Science.gov (United States)

    Bourne, Matthew N; Opar, David A; Williams, Morgan D; Shield, Anthony J

    2015-11-01

    Hamstring strain injuries (HSIs) represent the most common cause of lost playing time in rugby union. Eccentric knee flexor weakness and between-limb imbalance in eccentric knee flexor strength are associated with a heightened risk of HSIs in other sports; however, these variables have not been explored in rugby union. To determine if lower levels of eccentric knee flexor strength or greater between-limb imbalance in this parameter during the Nordic hamstring exercise are risk factors for HSIs in rugby union. Cohort study; Level of evidence, 2. This prospective study was conducted over the 2014 Super Rugby and Queensland Rugby Union seasons. In total, 178 rugby union players (mean age, 22.6 ± 3.8 years; mean height, 185.0 ± 6.8 cm; mean weight, 96.5 ± 13.1 kg) had their eccentric knee flexor strength assessed using a custom-made device during the preseason. Reports of previous hamstring, quadriceps, groin, calf, and anterior cruciate ligament injuries were also obtained. The main outcome measure was the prospective occurrence of HSIs. Twenty players suffered at least 1 HSI during the study period. Players with a history of HSIs had a 4.1-fold (95% CI, 1.9-8.9; P = .001) greater risk of subsequent HSIs than players without such a history. Between-limb imbalance in eccentric knee flexor strength of ≥15% and ≥20% increased the risk of HSIs by 2.4-fold (95% CI, 1.1-5.5; P = .033) and 3.4-fold (95% CI, 1.5-7.6; P = .003), respectively. Lower eccentric knee flexor strength and other prior injuries were not associated with an increased risk of future HSIs. Multivariate logistic regression revealed that the risk of reinjuries was augmented in players with strength imbalances. Previous HSIs and between-limb imbalance in eccentric knee flexor strength were associated with an increased risk of future HSIs in rugby union. These results support the rationale for reducing imbalance, particularly in players who have suffered a prior HSI, to mitigate the risk of future

  9. MANAGEMENT OF OPEN ACHILLES TENDON INJURY: PRIMARY ...

    African Journals Online (AJOL)

    Teaching Hospital, Edo State, Nigeria over a period of 5 years. There were 52 cases of open Achilles tendon ... Postoperatively, below knee Plaster of. Paris cast were applied, with the ankle in Plantigrade position .... contracture and a below knee boot cast is applied in a plantigrade position in order to facilitate mobilization.

  10. Acute effects of static stretching on muscle-tendon mechanics of quadriceps and plantar flexor muscles.

    Science.gov (United States)

    Bouvier, Tom; Opplert, Jules; Cometti, Carole; Babault, Nicolas

    2017-07-01

    This study aimed to determine the acute effects of static stretching on stiffness indexes of two muscle groups with a contrasting difference in muscle-tendon proportion. Eleven active males were tested on an isokinetic dynamometer during four sessions randomly presented. Two sessions were dedicated to quadriceps and the two others to triceps surae muscles. Before and immediately after the stretching procedure (5 × 30 s), gastrocnemius medialis and rectus femoris fascicle length and myotendinous junction elongation were determined using ultrasonography. Passive and maximal voluntary torques were measured. Fascicle and myotendinous junction stiffness indexes were calculated. After stretching, maximal voluntary torque similarly decreased for both muscle groups. Passive torque significantly decreased on triceps surae and remained unchanged on quadriceps muscles. Fascicle length increased similarly for both muscles. However, myotendinous junction elongation remained unchanged for gastrocnemius medialis and increased significantly for rectus femoris muscle. Fascicle stiffness index significantly decreased on medial gastrocnemius and remained unchanged on rectus femoris muscle. In contrast, myotendinous junction stiffness index similarly decreased on both muscles. Depending on the muscle considered, the present results revealed different acute stretching effects. This muscle dependency appeared to affect primarily fascicle stiffness index rather than the myotendinous junction.

  11. Revascularisation pattern of ruptured flexor tendon grafts in anterior cruciate ligament reconstruction: A histological study.

    Science.gov (United States)

    Figueroa, D; Martínez, R; Calvo, R; Scheu, M; Gallegos, M; Vaisman, A; Martínez, C; González, A

    For successful anterior cruciate ligament (ACL) reconstruction, revascularisation and histological maturation are necessary, as their failure can cause graft rupture. The purpose of this study was to describe differences in the histological maturation of early failed plasty (less than 12 months after surgery) and late failed plasty (more than 12 months after surgery) in patients with re-rupture after ACL reconstruction with hamstring tendons. A descriptive observational study was conducted on a consecutive series of 20 patients whose ACL reconstruction had failed. Graft biopsy samples were obtained during the revision surgery from the proximal, medial, and distal graft remnants. The samples were evaluated by light microscopy, and the vascularity and maturation of the samples were established by histological scoring. The most common aetiology of reconstruction failure (86.6%) was a specific event with non-contact mechanism. The patients with re-rupture of their ACL plasty less than 12 months after surgery had substance vessels that were less deep. The distal segment of the graft in those patients showed a delay in histological maturation with fewer collagen fibres. In patients whose ACL grafts failed less than 12 months after surgery, a lower distribution of blood vessels and collagen fibres was found that were less ordered in the distal graft. These results indicate a delay in maturation, which leads to a higher risk of graft failure. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Results of zone II flexor tendon repair in children younger than age 6 years: botulinum toxin type A administration eased cooperation during the rehabilitation and improved outcome.

    Science.gov (United States)

    Tüzüner, Serdar; Balci, Nilüfer; Ozkaynak, Sibel

    2004-01-01

    The inability of young children with a zone II flexor tendon repair to cooperate in postoperative care and rehabilitation may represent a high risk for medical and surgical complications. To forestall that risk, botulinum toxin type A (2.5 U/kg, 7 U/kg) injection was used during surgery to induce forearm flexor muscle relaxation in seven children under 6 years old with zone 2 flexor tendon repairs. Patients received a controlled passive motion regimen after surgery. Results were evaluated on the basis of the acquisition of muscle tone and active finger movements, total range of motion of affected joints, postoperative grip strength, muscle atrophy, and phalangeal length. In this prospective clinical study, the mean follow-up was 18 months. All the children had good and excellent results based on the Strickland criteria. As for postoperative complications, one patient had bowstring and another had poor finger sensibility and first web space contracture that required Z-plasty. The selective use of botulinum toxin type A to weaken the targeted muscles generated a sufficient reduction in spontaneous activity of the fingers, permitting an improved rehabilitation program. Botulinum toxin type A administration could be an effective form of therapy, serving as an alternative or adjunct to conventional rehabilitation modalities in these children.

  13. Importance of anatomically locating the infrapatellar branch of the saphenous nerve in reconstructing the anterior cruciate ligament using flexor tendons,

    Directory of Open Access Journals (Sweden)

    Julio Cesar Gali

    2014-12-01

    Full Text Available Objective:To describe the path of the infrapatellar branch of the saphenous nerve (IBSN using the medial joint line, anterior tibial tuberosity (ATT, tibial collateral ligament and a horizontal line parallel to the medial joint line that passes over the ATT, as reference points, in order to help surgeons to diminish the likelihood of injuring this nerve branch during reconstruction of the anterior cruciate ligament (ACL using flexor tendons.Methods:Ten frozen knees that originated from amputations were examined. Through anatomical dissection performed with the specimens flexed, we sought to find the IBSN, from its most medial and proximal portion to its most lateral and distal portion. Following this, the anatomical specimens were photographed and, using the ImageJ software, we determined the distance from the IBSN to the medial joint line and to a lower horizontal line going through the ATT and parallel to the first line. We also measured the angle of the direction of the path of the nerve branch in relation to this lower line.Results:The mean angle of the path of the nerve branch in relation to the lower horizontal line was 17.50 ±6.17°. The mean distance from the IBSN to the medial joint line was 2.61 ± 0.59 cm and from the IBSN to the lower horizontal line, 1.44 ±0.51 cm.Conclusion:The IBSN was found in all the knees studied. In three knees, we found a second branch proximal to the first one. The direction of its path was always from proximal and medial to distal and lateral. The IBSN was always proximal and medial to the ATT and distal to the medial joint line. The medial angle between its direction and a horizontal line going through the ATT was 17.50 ± 6.17°.

  14. Systematics of injuries of the rotator cuff and biceps tendon

    International Nuclear Information System (INIS)

    Breitenseher, M.J.; Pones, M.; Breitenseher, J.B.

    2015-01-01

    Injuries of the rotator cuff and the biceps tendon demonstrate different patterns, which can be recognized clinically and radiologically. These patterns are impingement syndrome with additional trauma, isolated trauma of the rotator cuff and shoulder dislocation causing rotator cuff tears. Furthermore, it is clinically crucial to evaluate the extent of a rotator cuff injury. Magnetic resonance imaging (MRI) is the modality of choice to differentiate these patterns. (orig.) [de

  15. The early effects of sustained platelet-derived growth factor administration on the functional and structural properties of repaired intrasynovial flexor tendons: an in vivo biomechanic study at 3 weeks in canines.

    Science.gov (United States)

    Gelberman, Richard H; Thomopoulos, Stavros; Sakiyama-Elbert, Shelly E; Das, Rosalina; Silva, Matthew J

    2007-03-01

    A bioactive fibrin-based delivery system was used to provide sustained administration of platelet-derived growth factor (PDGF-BB) in a clinically relevant model of intrasynovial flexor tendon repair. We hypothesized that PDGF-BB administered in this manner would improve the sutured tendon's functional and structural properties 3 weeks after repair. A delivery system consisting of 30 microL of fibrin matrix, peptide, heparin, and 100 ng of PDGF-BB was incorporated into the repair sites of randomly selected medial or lateral forepaw flexor digitorum profundus tendons of 8 adult mongrel dogs. The remaining forepaw flexor digitorum profundus tendons were repaired without the growth-factor and fibrin-based delivery system and served as controls. The surgically treated forelimbs were treated with controlled passive motion rehabilitation. The animals were killed at 3 weeks, at which time the tendons were tested for range of motion with a motion analysis system and for tensile properties with a materials testing machine. Proximal interphalangeal joint and distal interphalangeal joint rotation values were significantly higher for the PDGF-BB-treated tendons compared with the repair-alone tendons. Excursion values were also significantly higher in the PDGF-BB-treated tendons. There were no significant differences in tensile properties when comparing PDGF-BB-treated with repair-alone tendons. The functional properties of repaired intrasynovial flexor tendons were significantly improved with the sustained administration of PDGF-BB. The failure to achieve improvements in ultimate load, stiffness, and strain in the experimental group may have been due to suboptimal PDGF-BB dosage or suboptimal release kinetics.

  16. Comparison of autologous bone marrow and adipose tissue derived mesenchymal stem cells, and platelet rich plasma, for treating surgically induced lesions of the equine superficial digital flexor tendon.

    Science.gov (United States)

    Romero, A; Barrachina, L; Ranera, B; Remacha, A R; Moreno, B; de Blas, I; Sanz, A; Vázquez, F J; Vitoria, A; Junquera, C; Zaragoza, P; Rodellar, C

    2017-06-01

    Several therapies have been investigated for equine tendinopathies, but satisfactory long term results have not been achieved consistently and a better understanding of the healing mechanism elicited by regenerative therapies is needed. The aim of this study was to assess the separate effects of autologous bone marrow (BM) and adipose tissue (AT) derived mesenchymal stem cells (MSCs), and platelet rich plasma (PRP), for treating lesions induced in the superficial digital flexor tendon (SDFT) of horses. Lesions were created surgically in both SDFTs of the forelimbs of 12 horses and were treated with BM-MSCs (six tendons), AT-MSCs (six tendons) or PRP (six tendons). The remaining six tendons received lactated Ringer's solution as control. Serial ultrasound assessment was performed prior to treatment and at 2, 6, 10, 20 and 45 weeks post-treatment. At 45 weeks, histopathology and gene expression analyses were performed. At week 6, the ultrasound echogenicity score in tendons treated with BM-MSCs suggested earlier improvement, whilst all treatment groups reached the same level at week 10, which was superior to the control group. Collagen orientation scores on histological examination suggested a better outcome in treated tendons. Gene expression was indicative of better tissue regeneration after all treatments, especially for BM-MSCs, as suggested by upregulation of collagen type I, decorin, tenascin and matrix metalloproteinase III mRNA. Considering all findings, a clear beneficial effect was elicited by all treatments compared with the control group. Although differences between treatments were relatively small, BM-MSCs resulted in a better outcome than PRP and AT-MSCs. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Relevância da ultra-sonografia dos tendões flexores em cavalos Puro Sangue de corrida na adaptação ao treinamento Significance of flexor tendon ultrasonography in training thoroughbred horses

    Directory of Open Access Journals (Sweden)

    Carolina Roxana Greig

    2005-08-01

    Full Text Available Vinte e quatro potros Puro Sangue de Corrida (PSC, com dois anos de idade foram avaliados ultra-sonograficamente, durante o período final da doma e início de treinamento, através da imagem transversal dos tendões flexor digital superficial (TFDS e profundo (TFDP. As avaliações foram realizadas com intervalos de 15 dias. A área transversal (AT, a textura dos ecos e a ecogenicidade dos tendões foram avaliadas nas sete zonas da região metacarpiana através de um programa de mensuração de imagens do próprio aparelho de ultra-sonografia. Durante a doma e treinamento, houve diminuição da AT na zona IA e IIIA (PThe cross-sectional area (CSA of the superficial digital flexor tendon (SDFT and deep digital flexor tendon (DDFT of twenty four thoroughbreds was ultrasonographically evaluated before and during their initial training to determine the effect of exercise on the tendon CSA, texture and echogenicity to characterize the response to training. Ultrasonographic transverse images of the left forelimb were obtained every fifteen days. The SDFT CSA of zones IA and IIIA showed a decrease (P<0.05, f=0.010 e f=0.023 res. during the breaking and training period and an increase (P< 0.05 of zone IIIC (f=0.039. Evaluating just the training period, SDFT CSA results of zones IA, IIIA and IIIC were similar. The DDFT showed no variation during the breaking phase but when the training phase was evaluated there was a decrease (P<0.05 in zones IA (f=0.006 and IIIA (f=0.006. Evaluating both breaking and training periods the DDFT showed a decrease (P<0.05 in zones IA (f=0.027, IIIA (f=0.0001 and IIIB (f=0.0031. Fiber texture and tendon echogenicity showed no significant difference between breaking and last reading during training. This study provides evidence of variation of adaptation among the ultrasonographic zones of both SDFT and DDFT to exercise during training of thoroughbred horses. Ultra-sonography is not the most indicated method to evaluate the

  18. A biomechanical analysis of posterior tibial tendon dysfunction, medial displacement calcaneal osteotomy and flexor digitorum longus transfer in adult acquired flat foot.

    Science.gov (United States)

    Arangio, George A; Salathe, Eric P

    2009-05-01

    Biomechanical models have been used to study stress in the metatarsals, subtalar motion, lateral column lengthening and subtalar arthroereisis. Posterior tibial tendon dysfunction has been associated with increased loads in the arch of the acquired flat foot. We examine whether a 10 millimeter (mm) medial displacement calcaneal osteotomy and flexor digitorum longus transfer to the navicular reduces these increased loads in the flat foot. The response of a normal foot, a foot with posterior tibial tendon dysfunction, and a flat foot to an applied load of 683Newton was analyzed using a multi-segment biomechanical model. The distribution of load on the metatarsals, the moment about each joint, the force on each of the plantar ligaments and the muscle forces were computed. Posterior tibial tendon dysfunction results in increased load on the medial arch, which may cause the foot to flatten. A 10mm medial displacement calcaneal osteotomy substantially decreases the load on the first metatarsal and the moment at the talo-navicular joint and increases the load on the fifth metatarsal and the calcaneal-cuboid joint. Adding the flexor digitorum longus transfer to the medial displacement calcaneal osteotomy has only a small effect on the flattened foot. Our biomechanical analysis illustrates that when the foot becomes flat, the force on the talo-navicular joint increases substantially from its value for the normal foot, and that medial displacement calcaneal osteotomy can reduce this increased force back toward the value occurring in the normal foot. This study provides a biomechanical rationale for medial displacement calcaneal osteotomy treatments for posterior tibial tendon dysfunction.

  19. Pathophysiology of overuse tendon injury; Pathophysiologie des Sehnenueberlastungsschadens

    Energy Technology Data Exchange (ETDEWEB)

    Kannus, P. [Accident and Trauma Research Center and Tampere Research Center of Sports Medicine, President Urho Keleva Kekkonen Institute for Health Promotion Research, Tampere (Finland); Department of Surgery and Institute of Medical Technology, Tampere University Medical School and University Hospital, Tampere (Finland); Paavola, M. [Department of Surgery and Institute of Medical Technology, Tampere University Medical School and University Hospital, Tampere (Finland); Paakkala, T. [Department of Radiology, Tampere University Medical School and University Hospital, Tampere (Finland); Parkkari, J.; Jaervinen, T.; Jaervinen, M. [Accident and Trauma Research Center and Tampere Research Center of Sports Medicine, President Urho Keleva Kekkonen Institute for Health Promotion Research, Tampere (Finland)

    2002-10-01

    Overuse tendon injury is one of the most common injuries in sports.The etiology as well as the pathophysilogical mechanisms leading to tendinopathy are of crucial medical importance.At the moment intrinsic and extrinsic factors are assumed as mechanisms of overuse tendon injury. Except for the acute, extrinsic trauma, the chronic overuse tendon injury is a multifactorial process. There are many other factors, such as local hypoxia, less of nutrition, impaired metabolism and local inflammatory that may also contribute to the development of tissue damage.The exact interaction of these factors cannot be explained entirely at the moment.Further studies will be necessary in order to get more information. (orig.) [German] Der Sehnenueberlastungsschaden ist eine der haeufigsten Ursachen fuer Verletzungen im Spitzen- und Breitensport. Die Aetiologie sowie die pathophysiologischen Mechanismen, die zu dieser Sehnenverletzung fuehren, sind fuer das Verstaendnis von grosser medizinischer Bedeutung.Grundsaetzlich werden intrinsische (individuelle) und extrinsische (von aussen einwirkende) Faktoren als Mechanismen fuer Sehnenueberlastung angenommen, wobei bis auf das akute, extrinsisch einwirkende Trauma der chronische Ueberlastungsschaden multifaktoriell hervorgerufen wird. Viele andere Faktoren, wie lokale Hypoxie, zu geringe Naehrstoffzufuhr und herabgesetzter Metabolismus sowie eine lokale Entzuendung spielen in der Entstehung eines manifesten Gewebeschadens ebenfalls eine entscheidende Rolle. Das genaue Zusammenspiel der einzelnen Faktoren mit der jeweiligen individuellen Physis laesst noch eine ganze Reihe von Fragen offen. Weitere Studien sind notwendig, um genauere Aufschluesse zu gewinnen. (orig.)

  20. Histological and Immunohistochemical Evaluation of Autologous Cultured Bone Marrow Mesenchymal Stem Cells and Bone Marrow Mononucleated Cells in Collagenase-Induced Tendinitis of Equine Superficial Digital Flexor Tendon

    Science.gov (United States)

    Crovace, Antonio; Lacitignola, Luca; Rossi, Giacomo; Francioso, Edda

    2010-01-01

    The aim of this study was to compare treatment with cultured bone marrow stromal cells (cBMSCs), bone marrow Mononucleated Cells (BMMNCs), and placebo to repair collagenase-induced tendinitis in horses. In six adult Standardbred horses, 4000 IU of collagenase were injected in the superficial digital flexor tendon (SDFT). Three weeks after collagenase treatment, an average of either 5.5 × 106 cBMSCs or 1.2 × 108 BMMNCs, fibrin glue, and saline solution was injected intralesionally in random order. In cBMSC- and BMMNCS-treated tendons, a high expression of cartilage oligomeric matrix protein (COMP) and type I collagen, but low levels of type III collagen were revealed by immunohistochemistry, with a normal longitudinally oriented fiber pattern. Placebo-treated tendons expressed very low quantities of COMP and type I collagen but large numbers of randomly oriented type III collagen fibers. Both cBMSC and BMMNCS grafts resulted in a qualitatively similar heling improvement of tendon extracellular matrix, in terms of the type I/III collagen ratio, fiber orientation, and COMP expression. PMID:20445779

  1. [Questions concerning two-stage reconstruction of injured flexor tendons. III. Ultrastructure of the tenosynovium in the pseudo-tendon sheath created by using a silicone rod].

    Science.gov (United States)

    Salamon, A; Bíró, V; Vámhidy, L; Trombitás, K; Józsa, L

    1993-01-01

    Authors have investigated the ultrastructure of the pseudo tendon sheath, formed with silicon rod and man. They have observed a superficial structure, resembling the normal tendon sheath in scanning electron microscopic examination. With transmission electron microscopy phagocyte "A" type and secretion "B" type synovial cells were found. Authors state that the newly formed tenosynovium has an important role in the nutrition of the tendon graft and the prevention of adhesions.

  2. The Usefulness of Ultrasonography as a Guide for the Treatment of Delayed Diagnosed Tendon Injury in a 2-Year-Old Child

    Directory of Open Access Journals (Sweden)

    Issei Nagura

    2013-01-01

    Full Text Available In children, flexor pollicis longus (FPL tendon injuries are uncommon. In delayed diagnosed cases, CT and MRI are hard to perform, even though to confirm the location of the lacerated proximal tendon end is preferable for the planning of operation procedure. In such condition, ultrasonography is suitable because of its characteristic feature of easy-to-perform procedure even in children. In this report, preoperative ultrasonography was practical in the delayed diagnosis of FPL tendon in a 2-year-old child to schedule the primary repair because the precise location of both FPL proximal and distal ends was identified. In addition, routine postoperative ultrasonography was also useful to track its healing process without concern about mutual communication due to the patient’s age, which helped to promote active motion.

  3. Quadriceps tendon injuries in national football league players.

    Science.gov (United States)

    Boublik, Martin; Schlegel, Theodore F; Koonce, Ryan C; Genuario, James W; Kinkartz, Jason D

    2013-08-01

    Distal quadriceps tendon tears are uncommon injuries that typically occur in patients older than 40 years of age, and they have a guarded prognosis. Predisposing factors, prodromal findings, mechanisms of injury, treatment guidelines, and recovery expectations are not well described in high-level athletes. Professional American football players with an isolated tear of the quadriceps tendon treated with timely surgical repair will return to their sport. Case series; Level of evidence, 4. Fourteen unilateral distal quadriceps tendon tears were identified in National Football League (NFL) players from 1994 to 2004. Team physicians retrospectively reviewed training room and clinic records, operative notes, and imaging studies for each of these players. Data on each player were analyzed to identify variables predicting return to play. A successful outcome was defined as returning to play in regular-season NFL games. Eccentric contraction of the quadriceps was the most common mechanism of injury, occurring in 10 players. Only 1 player had antecedent ipsilateral extensor mechanism symptoms. Eleven players had a complete rupture of the quadriceps tendon, and 3 had partial tears. There were no associated knee injuries. All ruptures were treated with surgical repair, 1 of which was delayed after failure of nonoperative treatment. Fifty percent of players returned to play in regular-season NFL games. There was a trend toward earlier draft status for those who returned to play compared with those who did not (draft round, 3.1 ± 2.5 vs. 6.0 ± 2.9, respectively; P = .073). For those who returned to play, the average number of games after injury was 40.9 (range, 12-92). Quadriceps tendon tears are rare in professional American football players, and they usually occur from eccentric load on the extensor mechanism. Prodromal symptoms and predisposing factors are usually absent. Even with timely surgical repair, there is a low rate of return to play in regular-season games. There

  4. Microangiographic Comparison of the Effects of 3 Loop Pulley and 6 Strand Savage Tenorrhaphy Techniques on Equine Superficial Digital Flexor Tendon.

    Science.gov (United States)

    Freeman, Kendra D; Barrett, Jennifer G; Youngstrom, Daniel W; White, Nathaniel A

    2015-08-01

    The 6-strand Savage (SSS) tenorrhaphy pattern is biomechanically superior to the commonly employed 3-loop pulley (3LP); however, its effects on intrinsic tendon vasculature remain unknown. The objective of this study was to compare perfusion of intrinsic vasculature of the equine superficial digital flexor tendon (SDFT) after 3LP and SSS tenorrhaphies. We hypothesized that the SSS technique would significantly decrease vascular perfusion compared to the 3LP technique. Ex vivo, randomized, paired design. Horses (n = 9) METHODS: Under general anesthesia, 9 pairs of forelimb SDFT were transected. Two tendons served as baseline control, the remainder had either SSS or 3LP tenorrhaphy performed. Horses were heparinized, euthanatized, and forelimbs perfused with barium sulfate solution were then fixed with formalin under tension. Tendons were transected every 5 mm and microangiographic images obtained. Microvascular analysis of sections proximal to, throughout, and distal to the tenorrhaphy was completed using a custom macro. Differences in vascular count were assessed using MANOVA. A significant reduction in the number of perfused vessels was seen for SSS compared with 3LP at 2 locations within the tenorrhaphy (P = .039 and P = .009). The SSS technique took on average 4.7 ± 0.9 times longer to place. The SSS technique causes an acute reduction in tendon perfusion compared to the 3LP, which may limit its clinical use. Further research is required to elucidate the clinical significance of this difference. © Copyright 2015 by The American College of Veterinary Surgeons.

  5. Magnetic resonance imaging of ankle ligaments and tendon injuries

    International Nuclear Information System (INIS)

    Breitenseher, M.; Trattnig, S.; Kukla, C.; Daebler, C.; Helbich, T.; Haller, J.; Imhof, H.

    1995-01-01

    Today MRI allows evaluation of the integrity of injured ankle ligaments. The major difficulty in MRI is inconsistency in visualization by inadequate appreciation of the three-dimensional orientation of each ankle ligament. Using this technique, 52 patients with sprained ankles underwent MRI. The integrity of rupture of the collateral lateral ligaments was obtained in all 52 ankles. Full-lenght visualization is essential for evaluation of the ankle ligaments with MRI. In these 52 patients the angle of tilt on the stress X-ray was compared with the rate of MRI findings showing an injury affecting two ligaments. We found that none of the patients in whom the angle of lateral tilt was less than 5 had rupture of two laterial ligaments, while 32% of patients with angles of tilt of 6-14 and 42% of those with angles of tilt over 15 on stress X-ray had two ruptured lateral ligaments. The advantages of MRI are that it offers the best visualization of the extent of the tendon lesion. MRI, however, seems to be superior to US in detecting and quantifying lesions of the Achilles tendon. Therefore, MRI may be indicated in particularly difficult cases of tendons injuries in the foot. (orig.) [de

  6. Central Tendon Injuries of Hamstring Muscles: Case Series of Operative Treatment.

    Science.gov (United States)

    Lempainen, Lasse; Kosola, Jussi; Pruna, Ricard; Puigdellivol, Jordi; Sarimo, Janne; Niemi, Pekka; Orava, Sakari

    2018-02-01

    As compared with injuries involving muscle only, those involving the central hamstring tendon have a worse prognosis. Limited information is available regarding the surgical treatment of central tendon injuries of the hamstrings. To describe the operative treatment and outcomes of central tendon injuries of the hamstrings among athletes. Case series; Level of evidence, 4. Eight athletes (6 top level, 2 recreational) with central hamstring tendon injuries underwent magnetic resonance imaging and surgical treatment. The indication for surgery was recurrent (n = 6) or acute (n = 2) central hamstring tendon injury. All patients followed the same postoperative rehabilitation protocol, and return to play was monitored. Magnetic resonance imaging found a central tendon injury in all 3 hamstring muscles (long head of the biceps femoris, semimembranosus, and semitendinosus) with disrupted tendon ends. In acute and recurrent central tendon injuries, full return to play was achieved at 2.5 to 4 months. There were no adverse events during follow-up. Central tendon injuries of the hamstrings can be successfully repaired surgically after acute and recurrent ruptures.

  7. Evaluation and treatment of jersey finger and pulley injuries in athletes.

    Science.gov (United States)

    Freilich, Aaron M

    2015-01-01

    The flexor tendon system in the finger is complex and can be difficult to treat. Closed injuries to the flexor tendon or pulley system are not uncommon in high-level athletes. Their treatment can be complicated by in-season play, position, and the number of people involved in the patient's care. Injuries can be misdiagnosed as "sprains" or unreported by some athletes at the time of injury. Some of these injuries, especially flexor tendon avulsions, require prompt recognition and appropriate treatment to prevent permanent disability to the hand and finger. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. A leucine-rich diet and exercise affect the biomechanical characteristics of the digital flexor tendon in rats after nutritional recovery.

    Science.gov (United States)

    Barbosa, Alexandre Wesley Carvalho; Benevides, Gustavo Pereira; Alferes, Leda Maria Totti; Salomão, Emilianne Miguel; Gomes-Marcondes, Maria Cristina Cintra; Gomes, Laurecir

    2012-01-01

    An increase in the capacity of athletic performance depends on adequate nutrition, which ensures optimal function of the musculoskeletal system, including tendon stability. However, little is known about the status of tendons and extracellular matrix modifications during malnutrition and nutritional recovery when leucine is used in response to exercise conditioning. The purpose of this study was to evaluate the collagen content and biomechanical aspects of the deep digital flexor tendon (DDFT) in malnourished rats submitted to nutritional recovery (control diet or leucine-rich diet) and aerobic physical activity. After 60 days of undernourishment (6% protein diet), the malnourished rats were subsequently nutritionally recovered with a control diet or leucine-rich diet and trained or not (swimming, without overload) for 5 weeks. The biomechanical analysis and quantification of hydroxyproline were assessed in the DDFT in all experimental groups. The leucine-rich diet increased hydroxyproline content in the tension region, independently of the training. In the compression region, hydroxyproline content was higher in the malnourished and leucine-trained groups. Biomechanical analysis showed a lower load in the malnourished and all-trained groups. The lowest stress was observed with control-trained animals. The nutritional-recovered groups showed higher strain values corresponding to control group, while the lowest values were observed in malnourished and trained groups. The results suggest that a leucine-rich diet stimulates collagen synthesis of the DDFT, especially when in combination with physical exercise, and seems to determine the increase of resistance and the biomechanical characteristics of tendons.

  9. Use of the Taguchi method for biomechanical comparison of flexor-tendon-repair techniques to allow immediate active flexion. A new method of analysis and optimization of technique to improve the quality of the repair.

    Science.gov (United States)

    Singer, G; Ebramzadeh, E; Jones, N F; Meals, R

    1998-10-01

    The current trend toward early active flexion after repair of the flexor tendons necessitates a stronger repair than that provided by a modified Kessler technique with use of 4-0 nylon suture. The purpose of the current study was to determine, with use of the Taguchi method of analysis, the strongest and most consistent repair of the flexor tendons. Flexor tendons were obtained from fresh-frozen hands of human cadavera. Eight flexor tendons initially were repaired with the modified Kessler technique with use of 4-0 nylon core suture and 6-0 nylon epitenon suture. A test matrix was used to analyze a total of twenty variables in sixty-four tests. These variables included eight techniques for core-suture repair, four types of core suture, two sizes of core suture, four techniques for suture of the epitenon, and two distances from the repair site for placement of the core suture. After each repair, the specimens were mounted in a servohydraulic mechanical testing machine for tension-testing to failure. The optimum combination of variables was determined, with the Taguchi method, to be an augmented Becker technique with use of 3-0 Mersilene core suture, placed 0.75 centimeter from the cut edge with volar epitenon suture. The four-strand, double modified Kessler technique provided the second strongest repair. Five tendons that had been repaired with use of the optimum combination then were tested and compared with tendons that had been repaired with the standard modified Kessler technique. With the optimum combination of variables, the strength of the repair improved from a mean (and standard deviation) of 17.2 +/- 2.9 to 128 +/- 5.6 newtons, and the stiffness improved from a mean of 4.6 to 16.2 newtons per millimeter.

  10. Multiple extensor tendons reconstruction with hamstring tendon grafts and flap coverage for severe dorsal hand injuries.

    Science.gov (United States)

    Ozbaydar, M; Orman, O; Ozel, O; Altan, E

    2017-12-01

    Treatment of patients with traumatic loss of skin and multiple extensor tendons on the dorsum of the hand is a challenge. The aim of this study was to assess the outcome after reconstruction of soft tissues and multiple extensor tendons in patients who suffered traumatic loss of skin and multiple extensor tendons. Ten patients were enrolled in the study. These patients underwent single-stage reconstruction with autogenous hamstring tendon grafts for multiple extensor tendon defects and fasciocutaneous flaps for coverage of dorsal hand defects. In total, 25 tendons (2 tendons in 5 patients and 3 tendons in 5 patients) were reconstructed. The semitendinosus tendon was used in all patients and the gracilis tendon was added in five patients for tendon reconstruction. Total tendon length requiring reconstruction was between 9cm and 31cm. Free anterolateral thigh flaps were used in six patients and reverse pedicled forearm flaps were used in four patients. According to Miller's scoring system, 8 fingers had excellent results, 12 fingers had good results and 5 fingers had fair results at the final follow-up. Hamstring tendons can be used satisfactorily for primary reconstruction of multiple digital extensor tendons due to their availability and compatibility, with a fasciocutaneous flap. IV. Copyright © 2017 SFCM. Published by Elsevier Masson SAS. All rights reserved.

  11. Progressive retraction of a fractured os peroneum suggesting repetitive injury to the peroneus longus tendon.

    Science.gov (United States)

    Favinger, Jennifer L; Richardson, Michael L; Chew, Felix S

    2018-02-01

    The os peroneum is an accessory ossicle within the peroneus longus tendon. Prior reports have discussed fracture of the os peroneum with associated tears of the peroneus longus tendon. When the ossicle fractures, there can be varying degrees of retraction of the tendon, which can be diagnosed by malposition of the ossicle or the ossicle fragments. We report a case of a man with recurrent eversion ankle injuries with progressive retraction of a fractured os peroneum, implying injuries to the superior and inferior peroneal retinacula and the peroneus longus tendon.

  12. [The Omega "Omega" pulley plasty. A new technique to increase the diameter of the annular flexor digital pulleys].

    Science.gov (United States)

    Bakhach, J; Sentucq-Rigal, J; Mouton, P; Boileau, R; Panconi, B; Guimberteau, J C

    2005-12-01

    The authors report a new technique of pulley plasty of the flexor digital system. It is not an operative procedure to reconstruct a damaged pulley but an original way to expand the volume of an intact pulley in order to adapt its volume to the diameter of the repaired flexor tendon. The flexor tendons ruptures in Verdan zone II and particularly in Tang zones IIA and IIB are often accompanied by an osteofibrous tunnel injury. Initially, the tendon sheath closure was advised after tendons repair. This sheath recovery had to have an effect on tendons nutrition by establishing the synovial cavity continuity and particularly to protect the tendons from adhesions formation. The closure of the digital tube was rapidly shown to be unnecessary creating an obstacle to the tendons movements without any effect on tendons healing. In primary tendon management, the tendon repair is associated with an increase of the tendon diameter. An incongruence appears with the surrounding digital tube with gliding resistance complicating the tendon injury recovery. In secondary tendon injury management, the flexor digital tube is subject to healing and inflammatory process. This situation with the absence of the flexor tendon generates a retraction with a collapse of the digital tunnel over the injured area. This incongruence between the repaired flexor tendons and the narrowed digital tube required a release of the retracted zone to restore an adequate volume. The only way reported is the "Venting" of a part or the total length of the pulley. This procedure even if it resolves the tendon gliding resistance, is still unacceptable. Indeed it destroys an important anatomical structure of the flexor tendon dynamic system. The flexor pulley Omega plasty "Omega" consists in releasing the lateral palmar attachment of the pulley enhancing its internal volume and increasing the flexor tendon gliding area. The digital tube is composed by the succession of five annular and three cruciform pulleys

  13. Genetic Factors in Tendon Injury: A Systematic Review of the Literature.

    Science.gov (United States)

    Vaughn, Natalie H; Stepanyan, Hayk; Gallo, Robert A; Dhawan, Aman

    2017-08-01

    Tendon injury such as tendinopathy or rupture is common and has multiple etiologies, including both intrinsic and extrinsic factors. The genetic influence on susceptibility to tendon injury is not well understood. To analyze the published literature regarding genetic factors associated with tendon injury. Systematic review; Level of evidence, 3. A systematic review of published literature was performed in concordance with the Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) guidelines to identify current evidence for genetic predisposition to tendon injury. PubMed, Ovid, and ScienceDirect databases were searched. Studies were included for review if they specifically addressed genetic factors and tendon injuries in humans. Reviews, animal studies, or studies evaluating the influence of posttranscription factors and modifications (eg, proteins) were excluded. Overall, 460 studies were available for initial review. After application of inclusion and exclusion criteria, 11 articles were ultimately included for qualitative synthesis. Upon screening of references of these 11 articles, an additional 15 studies were included in the final review, for a total of 26 studies. The genetic factors with the strongest evidence of association with tendon injury were those involving type V collagen A1, tenascin-C, matrix metalloproteinase-3, and estrogen-related receptor beta. The published literature is limited to relatively homogenous populations, with only level 3 and level 4 data. Additional research is needed to make further conclusions about the genetic factors involved in tendon injury.

  14. Lacerations to Zones VIII and IX: It Is Not Just a Tendon Injury

    Directory of Open Access Journals (Sweden)

    Charla R. Fischer

    2011-01-01

    Full Text Available Extensor tendon injuries are widely believed to be straightforward problems that are relatively simple to manage. However, these injuries can be complex and demand a thorough understanding of anatomy to achieve the best functional outcomes. When lacerations occur in the forearm as in Zones VIII and IX injury, the repair of the extensor tendon and muscle, and posterior interosseous nerve (PIN is often challenging. A review of the literature shows little guidance and attention for these injuries. We present four patients with injuries to Zones VIII and IX as well as a review of surgical technique, postoperative rehabilitation, and pearls that may be of benefit to those managing these injuries.

  15. Abduction in Proximal Hamstring Tendon Avulsion Injury Mechanism-A Report on 3 Athletes

    NARCIS (Netherlands)

    van der Made, Anne D.; Peters, Rolf W.; Verheul, Claire; Maas, Mario; Kerkhoffs, Gino M.

    2017-01-01

    Proximal hamstring tendon avulsions are typically sustained during forced hip hyperflexion combined with knee extension. We present 3 cases of athletes with a proximal hamstring tendon avulsion caused by an alternative injury mechanism that also involves a considerable hip abduction component

  16. Extensor Tendon Instability Due to Sagittal Band Injury in a Martial Arts Athlete: A Case Report.

    Science.gov (United States)

    Kochevar, Andrew; Rayan, Ghazi

    2017-03-01

    A Taekwondo participant sustained a hand injury from punching an opponent that resulted in painful instability of the ring finger extensor digitorum communis tendon due to sagittal band damage. His symptoms resolved after reconstructive surgery on the sagittal band (SB) with stabilization of the extensor tendon over the metacarpophalangeal joint.

  17. Repair of acute extensor hallucis longus tendon injuries: a retrospective review.

    Science.gov (United States)

    Wong, Justin C; Daniel, Joseph N; Raikin, Steven M

    2014-02-01

    Extensor hallucis longus (EHL) tendon injuries may occur with lacerations sustained over the dorsum of the foot and lead to hallux dysfunction. Primary repair is performed when tendon edges are opposable; however, if a gap exists between tendon edges, then reconstruction with tendon graft or tendon transfer may be necessary to restore hallux alignment and dorsiflexion. We describe the surgical technique and report the results on a large series of patients having undergone primary repair or reconstruction of EHL tendon lacerations. We retrospectively reviewed all patients undergoing EHL tendon repair or reconstruction between January 2005 and May 2012. Information on patient demographics, mechanism of injury, time to surgery, intraoperative findings, surgical repair or reconstruction technique, and postoperative function were collected. Patients were contacted by telephone for administration of the Foot and Ankle Ability Measure (FAAM) and American Orthopaedic Foot and Ankle Society Hallux questionnaires. Twenty of 23 patients undergoing EHL tendon repair or reconstruction were available for review at an average clinical follow-up of 12 months (range 3-89 months) and an average telephone follow-up of 5.1 years (range 1-10.4 years). Primary EHL repair was performed in 80% of cases, with the remaining patients undergoing reconstruction with deep tendon transfer of the extensor digitorum longus tendon from the second toe. At final follow-up, 19 of 20 patients had active hallux dorsiflexion. The average FAAM Activities of Daily Living score was 94.2% (range 58.3% to 100%) and the average FAAM Sports score was 94.2% (range 65.6% to 100%). Primary repair or reconstruction of EHL tendon lacerations is a reliable procedure that restores hallux alignment and function in most patients as measured by the validated FAAM questionnaire. Deep tendon transfer from the extensor digitorum longus may be performed if EHL tendon edges are not opposable thus eliminating the need for

  18. High-resolution US and MR imaging of peroneal tendon injuries.

    Science.gov (United States)

    Taljanovic, Mihra S; Alcala, Jennifer N; Gimber, Lana H; Rieke, Joshua D; Chilvers, Margaret M; Latt, L Daniel

    2015-01-01

    Injuries of the peroneal tendon complex are common and should be considered in every patient who presents with chronic lateral ankle pain. These injuries occur as a result of trauma (including ankle sprains), in tendons with preexisting tendonopathy, and with repetitive microtrauma due to instability. The peroneus brevis and peroneus longus tendons are rarely torn simultaneously. Several anatomic variants, including a flat or convex fibular retromalleolar groove, hypertrophy of the peroneal tubercle at the lateral aspect of the calcaneus, an accessory peroneus quartus muscle, a low-lying peroneus brevis muscle belly, and an os peroneum, may predispose to peroneal tendon injuries. High-resolution 1.5-T and 3-T magnetic resonance (MR) imaging with use of dedicated extremity coils and high-resolution ultrasonography (US) with high-frequency linear transducers and dynamic imaging are proved to adequately depict the peroneal tendons for evaluation and can aid the orthopedic surgeon in injury management. An understanding of current treatment approaches for partial- and full-thickness peroneal tendon tears, subluxation and dislocation of these tendons with superior peroneal retinaculum (SPR) injuries, intrasheath subluxations, and peroneal tendonopathy and tenosynovitis can help physicians achieve a favorable outcome. Patients with low functional demands do well with conservative treatment, while those with high functional demands may benefit from surgery if nonsurgical treatment is unsuccessful. Radiologists should recognize the normal anatomy and specific pathologic conditions of the peroneal tendons at US and MR imaging and understand the various treatment options for peroneal tendon and SPR superior peroneal retinaculum injuries. Online supplemental material is available for this article. RSNA, 2015

  19. [Injuries of ligaments and tendons of foot and ankle : What every radiologist should know].

    Science.gov (United States)

    Thierfelder, K M; Gemescu, I N; Weber, M-A; Meier, R

    2018-04-13

    Injuries of the ligaments and tendons of the ankle and foot are among the most common musculoskeletal injuries. A correct and precise description of the pathology and possible accompanying injuries is essential for treatment planning by trauma and orthopedic surgeons. While X‑ray is used to exclude fractures, ultrasound is a very useful tool to assess the ligaments and tendons. For the radiologist, magnetic resonance imaging (MRI) is invaluable regarding the correct assessment of (partial) ruptures, as well as for evaluating accompanying injuries. The aim of the present overview is to provide the most relevant facts for radiologists regarding injuries of ligaments and tendons of the ankle and foot. A description of expected MRI findings and possible pitfalls are presented. For each ligament complex or tendon, we review the anatomy, followed by relevant facts on biomechanics and typical findings in case of injury. The lateral and medial ligament complex, syndesmosis, spring ligament complex, and the Lisfranc ligament are shown in detail. The Achilles tendon and the peroneal tendons are also discussed.

  20. Achilles tendon rupture: a review of etiology, population, anatomy, risk factors, and injury prevention.

    Science.gov (United States)

    Hess, Gregory William

    2010-02-01

    Sports participation has undergone an increase in recent decades. Injury due to sporting activity has also recently risen. The Achilles tendon has been one of the most common sports-related injuries. A 2 in 100,000 individual Achilles tendon injury rate increased to a 12 in 100,000 individual injury rate in less than 10 years. The injury is typically observed in men in the fourth to fifth decades of life. Male to female injury ratios range from 2:1 to 12:1. Running, jumping, and agility activities involving eccentric loading and explosive plyometric contractions are usual mechanisms. Natural aging allows predisposing chronic degeneration of the tendon. Blood flow decreases and stiffness increases with aging to decrease the ability to withstand stress. Noninflammatory tendinosis and chronic tendinopathy are 2 separate processes proposed for tendon degeneration and subsequent rupture. Rupture typically occurs 2 to 6 cm proximal to the calcaneal insertion. Predisposing factors are grouped into 2 categories: intrinsic and extrinsic risk factors. Avoidance of degenerative changes within the tendon is the primary method to prevent rupture. Regular physical activity as athletes age also promotes tendon hypertrophy, increases nutrient delivery, and reduces collagen fiber fatigue.

  1. Flexor Digitorum Accessorius Longus: Importance of Posterior Ankle Endoscopy

    Science.gov (United States)

    Batista, Jorge Pablo; del Vecchio, Jorge Javier; Golanó, Pau; Vega, Jordi

    2015-01-01

    Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of the flexor hallucis longus (FHL) travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talus. Chronic inflammation of this tendon may lead to painful stenosing tenosynovitis. The aim of this report is to describe two cases depicting an accessory tendon which is an anatomical variation of the flexor hallucis longus in patients with posterior friction syndrome due to posterior ankle impingement and associated with a posteromedial osteochondral lesion of the talus. The anatomical variation (FDAL) described was a finding during an endoscopy of the posterior region of the ankle, and we have spared it by sectioning the superior flexor retinaculum only. The accessory flexor digitorum longus is an anatomical variation and should be taken into account when performing an arthroscopy of the posterior region of the ankle. We recommend this treatment on this type of injury although we admit this does not make a definite conclusion. PMID:26060592

  2. Flexor Digitorum Accessorius Longus: Importance of Posterior Ankle Endoscopy

    Directory of Open Access Journals (Sweden)

    Jorge Pablo Batista

    2015-01-01

    Full Text Available Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of the flexor hallucis longus (FHL travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talus. Chronic inflammation of this tendon may lead to painful stenosing tenosynovitis. The aim of this report is to describe two cases depicting an accessory tendon which is an anatomical variation of the flexor hallucis longus in patients with posterior friction syndrome due to posterior ankle impingement and associated with a posteromedial osteochondral lesion of the talus. The anatomical variation (FDAL described was a finding during an endoscopy of the posterior region of the ankle, and we have spared it by sectioning the superior flexor retinaculum only. The accessory flexor digitorum longus is an anatomical variation and should be taken into account when performing an arthroscopy of the posterior region of the ankle. We recommend this treatment on this type of injury although we admit this does not make a definite conclusion.

  3. Tendinography for diagnosing injuries to tendons and ligaments

    International Nuclear Information System (INIS)

    Grevsten, S.; Eriksson, K.

    1979-01-01

    A radiographic method of tendinography is described. In rabbits no inflammatory reaction in the Achilles tendon was observed 12 to 15 days after injection of contrast medium. Effects of examination of two healthy subjects and a patient with a traumatic condition are described. Suitable amounts and concentrations of contrast medium for examinations of Achilies tendon and cruciate ligaments are discussed. (Auth.)

  4. Diseases of the tendons and tendon sheaths.

    Science.gov (United States)

    Steiner, Adrian; Anderson, David E; Desrochers, André

    2014-03-01

    Contracted flexor tendon leading to flexural deformity is a common congenital defect in cattle. Arthrogryposis is a congenital syndrome of persistent joint contracture that occurs frequently in Europe as a consequence of Schmallenberg virus infection of the dam. Spastic paresis has a hereditary component, and affected cattle should not be used for breeding purposes. The most common tendon avulsion involves the deep digital flexor tendon. Tendon disruptions may be successfully managed by tenorrhaphy and external coaptation or by external coaptation alone. Medical management alone is unlikely to be effective for purulent tenosynovitis. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Protocol for an investigator-blinded, randomised, 3-month, parallel-group study to compare the efficacy of intraoperative tendon sheath irrigation only with both intraoperative and postoperative irrigation in the treatment of purulent flexor tenosynovitis.

    Science.gov (United States)

    Leppänen, Olli V; Jokihaara, Jarkko; Kaivorinne, Antti; Havulinna, Jouni; Göransson, Harry

    2015-12-15

    The management of purulent flexor tenosynovitis of the hand consists of surgical debridement followed by antibiotic treatment. Usually, the debridement is carried out by irrigating the tendon sheath in a proximal to distal direction facilitated by two small incisions. It is unclear whether intraoperative irrigation by itself is adequate for healing or if it should be combined with postoperative irrigation in the ward. The hypothesis of this prospective randomised trial is that intraoperative catheter irrigation alone is as effective as a combination of intraoperative and postoperative intermittent catheter irrigation in the treatment of purulent flexor tenosynovitis. In this investigator-blinded, prospective randomised trial, 48 patients suffering from purulent flexor tenosynovitis are randomised in two groups. Intraoperative catheter irrigation of the flexor tendon sheath and antibiotic treatment is identical in both groups, whereas only the patients in one group are subjected to intermittent postoperative catheter irrigation three times a day for 3 days. The primary outcome measure is total active range of movement of the affected finger after 3 months of surgery. The secondary outcome is the need for reoperation. The research ethics committee of Pirkanmaa Hospital District has approved the study protocol. The protocol has been registered with ClinicalTrials.gov registry (#NCT02320929). All participants will give written informed consent. The study results will elucidate the role of postoperative irrigation, which can be criticised as being labour consuming and unpleasant to the patient. The results of the study will be disseminated as a published article in a peer-reviewed journal. NCT02320929; pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  6. A rare knee extensor mechanism injury: Vastus intermedius tendon rupture

    Directory of Open Access Journals (Sweden)

    Engin Cetinkaya

    2015-01-01

    Conclusion: We report the first case of isolated rupture of the vastus intermedius tendon in the literature and we claim that disorder may be succesfully treated with conservative treatment and adequate physiotheraphy.

  7. Sonoelastography can be used to monitor the restoration of Achilles tendon elasticity after injury.

    Science.gov (United States)

    Gehmert, S; Jung, E M; Kügler, T; Klein, S; Gehmert, S; Zeitler, K; Loibl, M; Prantl, L

    2012-12-01

    The aim of the current study was to evaluate an ultrasound approach for depicting elastic recovery after stem cell application on injured Achilles tendons. A rabbit Achilles tendon injury model was used and randomized hind limbs received an extracellular matrix either with autologous mesenchymal stem cells (group 2, n = 6) or without (group 3, n = 6). The cells were harvested from the rabbits' nuchal fat body. Untreated Achilles tendons (group 1, n = 6) served as controls. Specimens were harvested after 8 weeks and analyzed longitudinally for elasticity using a high resolution 6-15 MHz matrix linear probe. For each tendon, real-time color-coded sonoelastography sequences were recorded for 20 seconds and 10 color histogram frames were obtained. Defined regions of interest (ROIs) were placed on the injury (n = 3) and on the adjacent uninjured tendon tissue (n = 3). In total, 180 measurements were obtained for semi-quantitative analysis. Repeated measures ANOVA demonstrated a higher elasticity for the stem cell-seeded matrix (group 2) in comparison to the unseeded matrix (group 3) (p tendon tissue treated with stem cell-seeded matrix (group 2) and the uninjured Achilles tendons (group 1) (p > 0.05). Moreover, no differences were found between the measurements at different points in time (p > 0.05). Our results indicate that autologous mesenchymal stem cell application successfully restores the mechanical properties of injured tendon tissue. Furthermore, sonoelastography makes it possible to monitor the elasticity of injured Achilles tendons. © Georg Thieme Verlag KG Stuttgart · New York.

  8. Reconstrution of the posterior cruciate ligament using knee flexing tendons for the autograft Reconstrução do ligamento cruzado posterior com os enxertos dos tendões dos músculos flexores do joelho

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Cury Faustino

    2003-04-01

    Full Text Available The author describes his experience in the treatment of chronic posterior instability of the knee with hamstring tendon autografts. Thirteen patients were operated on using the same surgical technique. Followed after a period of 18 to 47 months.O autor descreve a experiência no tratamento da instabilidade posterior crônica do joelho com os enxertos dos tendões dos músculos flexores. Utilizando a mesma técnica cirúrgica foram operados 13 pacientes e acompanhados por um período de 18 a 47 meses.

  9. Moderate treadmill running exercise prior to tendon injury enhances wound healing in aging rats.

    Science.gov (United States)

    Zhang, Jianying; Yuan, Ting; Wang, James H-C

    2016-02-23

    The effect of exercise on wound healing in aging tendon was tested using a rat moderate treadmill running (MTR) model. The rats were divided into an MTR group that ran on a treadmill for 4 weeks and a control group that remained in cages. After MTR, a window defect was created in the patellar tendons of all rats and wound healing was analyzed. We found that MTR accelerated wound healing by promoting quicker closure of wounds, improving the organization of collagen fibers, and decreasing senescent cells in the wounded tendons when compared to the cage control. MTR also lowered vascularization, increased the numbers of tendon stem/progenitor cells (TSCs) and TSC proliferation than the control. Besides, MTR significantly increased the expression of stem cell markers, OCT-4 and Nanog, and tenocyte genes, Collagen I, Collagen III and tenomodulin, and down-regulated PPAR-γ, Collagen II and Runx-2 (non-tenocyte genes). These findings indicated that moderate exercise enhances healing of injuries in aging tendons through TSC based mechanisms, through which exercise regulates beneficial effects in tendons. This study reveals that appropriate exercise may be used in clinics to enhance tendon healing in aging patients.

  10. O ultra-som terapêutico não aumentou as propriedades mecânicas de tendões flexores após reparo Therapeutic ultrasound did not increase the mechanical properties of flexor tendons after their repair

    Directory of Open Access Journals (Sweden)

    Cristiane Vitaliano Graminha Romano

    2010-01-01

    Full Text Available OBJETIVO: Estudo experimental idealizado para investigar as propriedades mecânicas de tendões flexores profundos de coelhos submetidos à tenotomia seguida de tenorrafia e aplicação precoce de ultra-som terapêutico com diferentes intensidades, em comparação com tendões submetidos somente à tenorrafia. MATERIAL E MÉTODOS: Quarenta e quatro coelhos foram divididos em quatro grupos experimentais de acordo com a aplicação do ultra-som. Todos foram submetidos a uma secção do tendão flexor profundo na zona 2 e imobilizados com uma órtese mantida durante todo o experimento. O grupo A recebeu tratamento ultra-sônico com uma intensidade de 1,4 W/cm², o grupo B com 0,6 W/cm², ambos no modo contínuo, o grupo C com 0,6 W/cm² SATA, no modo pulsado à 50% e o grupo D não recebeu tratamento ultra-sônico algum. A frequência ultra-sônica empregada foi de 1 MHz. Após a eutanásia os tendões foram dissecados e submetidos ao ensaio mecânico de tração e análise histológica qualitativa. As propriedades mecânicas avaliadas foram: força máxima, deformação na força máxima e rigidez. RESULTADO: Não houve diferença estatisticamente significante entre os grupos experimentais. CONCLUSÃO: O ultra-som terapêutico não melhorou as propriedades mecânicas dos tendões flexores após reparo.OBJECTIVE: Experimental study idealized to investigate the mechanical properties of deep flexor tendons of rabbits that underwent the tenotomy followed by tenorrhaphy and early application of therapeutic ultrasound with different intensities, in comparison to tendons submitted to tenorrhaphy only. MATERIAL AND METHOD: Forty-four rabbits were divided into four experimental groups according to the ultrasound application. They were all submitted to a section of deep flexor tendon in zone 2 and immobilized with an orthosis maintained throughout the experiment. Group A received ultrasonic treatment with an intensity of 1.4 W/cm², group B with 0.6 W

  11. Pyogenic Flexor Tenosynovitis in an Infant

    Directory of Open Access Journals (Sweden)

    James I. Gragg

    2017-03-01

    Full Text Available Pyogenic flexor tenosynovitis is a rare, though well known infectious process of the flexor tendon sheath of the hand. This condition is generally diagnosed in adults by the observance of the four Kanavel signs. Application of the Kanavel signs to diagnosis in the pediatric population, however, is of unknown utility. We present the case of a 13-month-old male with pyogenic flexor tenosynovitis who presented with all four of the Kanavel signs.

  12. Towards a staged evidence-based approach for the treatment of tendon injuries in the horse

    NARCIS (Netherlands)

    Bosch, G.

    2009-01-01

    Healing of tendon lesions, a common disorder in the equine species, is slow and often inadequate because the resulting scar tissue cannot meet the functional demands posed by the everyday athletic activity of many horses, making re-injury the most common and often fatal complication after initial

  13. Therapeutic potential of mesenchymal stem cells to treat Achilles tendon injuries.

    Science.gov (United States)

    Vieira, M H C; Oliveira, R J; Eça, L P M; Pereira, I S O; Hermeto, L C; Matuo, R; Fernandes, W S; Silva, R A; Antoniolli, A C M B

    2014-12-12

    Rupture of the Achilles tendon diminishes quality of life. The gold-standard therapy is a surgical suture, but this presents complications, including wound formation and inflammation. These complications spurred evaluation of the therapeutic potential of mesenchymal stem cells (MSCs) from adipose tissue. New Zealand rabbits were divided into 6 groups (three treatments with two time points each) evaluated at either 14 or 28 days after surgery: cross section of the Achilles tendon (CSAT); CSAT + Suture; and CSAT + MSC. A comparison between all groups at both time points showed a statistically significant increase in capillaries and in the structural organization of collagen in the healed tendon in the CSAT + Suture and CSAT + MSC groups at the 14-day assessment. Comparison between the two time points within the same group showed a statistically significant decrease in the inflammatory process and an increase in the structural organization of collagen in the CSAT and CSAT + MSC groups. A study of the genomic integrity of the cells suggested a linear correlation between an increase of injuries and culture time. Thus, MSC transplantation is a good alternative for treatment of Achilles tendon ruptures because it may be conducted without surgery and tendon suture and, therefore, has no risk of adverse effects resulting from the surgical wound or inflammation caused by nonabsorbable sutures. Furthermore, this alternative treatment exhibits a better capacity for wound healing and maintaining the original tendon architecture, depending on the arrangement of the collagen fibers, and has important therapeutic potential.

  14. Flexor pollicis longus repair in a patient with Linburg-Comstock anomaly: A case report

    Directory of Open Access Journals (Sweden)

    Mehmet Unal

    2016-08-01

    Results: At the end of the rehabilitation program, the thumb recovered full range of motion, and physical examination revealed synchronous flexion movement (synkinesis of the thumb and index finger. Conclusion: Flexor pollicis longus tendon lacerations are common in the clinical practice of hand surgeons. Making a separate proximal wrist incision is a very useful technique to reach a proximal tendon stump. Otherwise, aggressive maneuvers may cause additional damage to the tendons involved and result in unpredicted outcomes. The attempts to retrieve the tendon at the injury site resulted in failure and gave a tethering sensation to the surgeon who recalled the Linburg-Comstock anomaly. [Hand Microsurg 2016; 5(2.000: 88-91

  15. Contrast-enhanced computed tomographic evaluation of the deep digital flexor tendon in the equine foot compared to macroscopic and histological findings in 23 limbs

    NARCIS (Netherlands)

    van Hamel, S E; Bergman, H J; Puchalski, S M; Groot, M.W.|info:eu-repo/dai/nl/304833150; van Weeren, P R|info:eu-repo/dai/nl/074628550

    2014-01-01

    REASONS FOR PERFORMING THE STUDY: Distal deep digital flexor tendinopathy is an important cause of foot lameness in horses that is difficult to diagnose with radiography and ultrasonography. Magnetic resonance imaging is a well-accepted and validated technique for the identification of deep digital

  16. Avaliação do resultado da reconstrução artroscópica do ligamento cruzado anterior do joelho com enxerto dos tendões flexores Evaluation of the results of arthroscopic ACL reconstruction with autogenous flexor tendons

    Directory of Open Access Journals (Sweden)

    Alexandre Almeida

    2010-01-01

    Full Text Available OBJETIVO: Avaliar o resultado da reconstrução do ligamento cruzado anterior (LCA com o autoenxerto dos tendões flexores da coxa. Serão analisados os dados com relação ao sexo, ao índice de massa corporal (IMC e a associação com fratura no membro inferior (MI. MÉTODOS: Foi analisado um grupo de 265 pacientes submetidos à artroscopia do joelho para fins de reconstrução do LCA com enxerto ipsilateral dos tendões flexores da coxa no período de 6 de julho de 2000 a 19 de novembro de 2007. RESULTADOS: 176 pacientes foram avaliados com média de 34,95 ± 18,8 meses (mediana 31 meses (IIQ: 20-48 meses. A avaliação mínima foi aos 12 meses e a máxima aos 87 meses. Obtivemos 138 (78,4% pacientes com resultado excelente, 22 (12,5% com resultado bom, oito (4,5% com resultado regular e oito (4,5% pacientes apresentaram resultado ruim. Não foi considerada significativa a maior incidência de bons e excelentes resultados para o sexo masculino (p = 0,128, para os pacientes com IMC OBJETIVE: To evaluate the results of single band arthroscopic anterior cruciate ligament (ACL reconstruction with flexor tendon autografts. We analyzed data about sex, body mass index (BMI and lower limb fracture associated with the initial trauma. METHODS: Two hundred and sixty-five patients who underwent arthroscopic anterior cruciate ligament (ACL reconstruction with ipsilateral thigh flexor tendon autografts from July 6, 2000, to November 19, 2007, were evaluated. RESULTS: One hundred and seventy-six patients were evaluated at an average follow up time of 34.95 ± 18.8 months (Median 31 months (IIQ: 20 - 48 months. The minimum evaluation time was 12 months and the maximum 87 months. One hundred and thirty-eight (78.4% patients had excellent results, 22 (12.5% patients good, 8 (4.5% patients fair, and 8 (4.5% poor results. No statistical significance was found for the better results for males (p = 0.128, for patients with a BMI < 25 (p = 0.848, or for patients

  17. Rare Giant Cell Tumor of the Distal Flexor Digitorum Longus Tendon Sheath and Early Diagnosis with Use of Magnetic Resonance Imaging.

    Science.gov (United States)

    Levi, Michael; Crafton, Jordan

    2017-07-01

    Giant-cell tumor of the tendon sheath (GCT-TS) is an uncommon occurrence for a foot and ankle surgeon. However, there is a need to recognize the symptoms of typical and atypical presentations of this pathology. These benign neoplasms are recognized clinically as a soft-tissue mass that is usually painless and palpable. The foot and ankle account for only 3% to 5% of all GCT-TS in the body, with most being located in the hand. Giant cell tumor in the tendon sheath occurring in the foot and ankle is usually encountered on the lateral ankle and dorsum of the foot, occupying the extensor tendons. Additionally, it is commonly misdiagnosed clinically. This case study illustrates how early use of magnetic resonance imaging decreased patient morbidity with early recognition and excision of GCT-TS.

  18. Floating knee injury associated with patellar tendon rupture: a case report and review of literature.

    Science.gov (United States)

    Vaidyanathan, Singaravadivelu; Panchanathan Ganesan, Jagannath; Moongilpatti Sengodan, Mugundhan

    2012-01-01

    Floating knee injuries are frequently associated with other concomitant injuries to the ipsilateral limb or other parts of body of which injury to the ipsilateral knee ligaments carries significance for various reasons. A middle-aged man sustained a floating knee injury following RTA. DCS fixation by bridge plating technique for the distal femur and lateral buttress plating by MIPO technique for proximal tibia were planned and executed under spinal anesthesia with image intensifier. In addition, there were patellar tendon rupture along with avulsion of VMO from the medial border of patella and torn MPFL, which we have missed initially. To the best of our knowledge no similar case has been reported in English literature so far. We have reviewed the literature and proposed a different interpretation of Blake and McBride classification.

  19. Floating Knee Injury Associated with Patellar Tendon Rupture: A Case Report and Review of Literature

    Directory of Open Access Journals (Sweden)

    Singaravadivelu Vaidyanathan

    2012-01-01

    Full Text Available Floating knee injuries are frequently associated with other concomitant injuries to the ipsilateral limb or other parts of body of which injury to the ipsilateral knee ligaments carries significance for various reasons. A middle-aged man sustained a floating knee injury following RTA. DCS fixation by bridge plating technique for the distal femur and lateral buttress plating by MIPO technique for proximal tibia were planned and executed under spinal anesthesia with image intensifier. In addition, there were patellar tendon rupture along with avulsion of VMO from the medial border of patella and torn MPFL, which we have missed initially. To the best of our knowledge no similar case has been reported in English literature so far. We have reviewed the literature and proposed a different interpretation of Blake and McBride classification.

  20. Direct Radiofrequency Application Improves Pain and Gait in Collagenase-Induced Acute Achilles Tendon Injury

    Directory of Open Access Journals (Sweden)

    Yun-Pu Tsai

    2013-01-01

    Full Text Available Radiofrequency (RF is often used as a supplementary and alternative method to alleviate pain for chronic tendinopathy. Whether or how it would work for acute tendon injury is not addressed in the literatures. Through detailed pain and gait monitoring, we hypothesized that collagenase-induce acute tendinopathy model may be able to answer these questions. Gait parameters, including time, distance, and range of motion, were recorded and analyzed using a walking track equipped with a video-based system. Expression of substance P (SP, calcitonin gene related peptide (CGRP, and galanin were used as pain markers. Beta-III tubulin and Masson trichrome staining were used as to evaluate nerve sprouting, matrix tension, and degeneration in the tendon. Of fourteen analyzed parameters, RF significantly improved stance phase, step length, preswing, and intermediary toe-spread of gait. Improved gait related to the expression of substance P, CGRP, and reduced nerve fiber sprouting and matrix tension, but not galanin. The study indicates that direct RF application may be a valuable approach to improve gait and pain in acute tendon injury. Altered gait parameters may be used as references to evaluate therapeutic outcomes of RF or other treatment plan for tendinopathy.

  1. Nerve and tendon injury with percutaneous fibular pinning: a cadaveric study.

    Science.gov (United States)

    Iorio, Justin; Criner, Katharine; Rehman, Saqib; Meizinger, Casey; Haydel, Christopher

    2014-12-01

    The purposes of this study were to measure the average distance from a percutaneous pin in each quadrant of the distal fibula to the sural nerve and nearest peroneal tendon, and define the safe zone for percutaneous pin placement as would be used during surgery. Ten fresh-frozen cadavers underwent percutaneous pin fixation into four quadrants of the distal fibula. The sural nerve and peroneal tendon were identified as they coursed around the lateral ankle. Distances from the K-wire in each quadrant to the anatomic structure of interest were measured. Average distances (mm) from the K-wire to the sural nerve in the anterolateral, anteromedial, posterolateral, and posteromedial quadrants were 19.1±8.9 (range, 5.1-35.5), 12.8±8.2 (range, 0.3-27.8), 12.6±6.8 (range, 3.0-27.8), and 5.9±5.5 (range, 0.1-19.9), respectively. Average distances from the K-wire to the nearest peroneal tendon in the anterolateral, anteromedial, posterolateral, and posteromedial quadrants were 15.7±4.4 (range, 9.5-23.1), 11.9±5.2 (range, 3.2-21.7), 6.3±3.9 (range, 0.1-14.4), and 1.0±1.6 (range, 0-5.6), respectively. Percutaneous pinning of distal fibula fractures is a successful treatment option with minimal complications. Our anatomical study found the safe zone of percutaneous pin placement to be in the anterolateral quadrant. The sural nerve can be as close as 5.1mm and the peroneal tendons as near as 15.7mm. In contrast, the posteromedial quadrant was associated with the greatest risk of injury to both the sural nerve and peroneal tendons. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Effect of single intralesional treatment of surgically induced equine superficial digital flexor tendon core lesions with adipose-derived mesenchymal stromal cells : a controlled experimental trial

    NARCIS (Netherlands)

    Geburek, Florian; Roggel, Florian; van Schie, Hans T M; Beineke, Andreas; Estrada, Roberto; Weber, Kathrin; Hellige, Maren; Rohn, Karl; Jagodzinski, Michael; Welke, Bastian; Hurschler, Christof; Conrad, Sabine; Skutella, Thomas; van de Lest, Chris; van Weeren, René; Stadler, Peter M

    2017-01-01

    BACKGROUND: Adipose tissue is a promising source of mesenchymal stromal cells (MSCs) for the treatment of tendon disease. The goal of this study was to assess the effect of a single intralesional implantation of adipose tissue-derived mesenchymal stromal cells (AT-MSCs) on artificial lesions in

  3. Atraumatic patellar prosthesis dislocation with patellar tendon injury following a total knee arthroplasty: a case report

    Directory of Open Access Journals (Sweden)

    Singh Alka

    2010-01-01

    Full Text Available Abstract Introduction Total knee arthroplasty is a well-established procedure with gratifying results. There is no consensus in the literature whether to routinely resurface the patella while performing total knee arthroplasty or not. Although an extremely rare occurrence in clinical practice, patellar prosthesis dislocation is a possible complication resulting from total knee arthroplasty. Case presentation We report a rare case of atraumatic spontaneous dislocation of patellar prosthesis in a 63-year-old Caucasian man of British origin with patellar tendon injury. The patient was treated successfully through a revision of the patellar component and tendon repair. In two years follow-up the patient is asymptomatic with no sign of loosening of his patellar prosthesis. Conclusions A thorough understanding of knee biomechanics is imperative in performing total knee arthroplasty in order to achieve a better functional outcome and to prevent early prosthetic failure.

  4. Transplantation of tendon-derived stem cells pre-treated with connective tissue growth factor and ascorbic acid in vitro promoted better tendon repair in a patellar tendon window injury rat model.

    Science.gov (United States)

    Lui, Pauline Po Yee; Wong, On Tik; Lee, Yuk Wa

    2016-01-01

    Treatment of tendon-derived stem cells (TDSCs) with connective tissue growth factor (CTGF) and ascorbic acid promoted their tenogenic differentiation. We investigated the effects of TDSCs pre-treated with CTGF and ascorbic acid on tendon repair in a patellar tendon window injury rat model. Green fluorescent protein-TDSCs (GFP-TDSCs) were pre-treated with or without CTGF and ascorbic acid for 2 weeks before transplantation. The patellar tendons of rats were injured and divided into three groups: fibrin glue-only group (control group), untreated and treated TDSC group. The rats were followed up until week 16. The treated TDSCs accelerated and enhanced the quality of tendon repair compared with untreated TDSCs up to week 8, which was better than that in the controls up to week 16 as shown by histology, ultrasound imaging and biomechanical test. The fibrils in the treated TDSC group showed better alignment and larger size compared with those in the control group at week 8 (P = 0.004). There was lower risk of ectopic mineralization after transplantation of treated or untreated TDSCs (all P ≤ 0.050). The transplanted cells proliferated and could be detected in the window wound up to weeks 2 to 4 and week 8 for the untreated and treated TDSC groups, respectively. The transplantation of TDSCs promoted tendon repair up to week 16, with CTGF and ascorbic acid pre-treatment showing the best results up to week 8. Pre-treatment of TDSCs with CTGF and ascorbic acid may be used to further enhance the rate and quality of tendon repair after injury. Copyright © 2015 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

  5. Intramuscular tendon involvement on MRI has limited value for predicting time to return to play following acute hamstring injury

    NARCIS (Netherlands)

    van der Made, Anne D.; Almusa, Emad; Whiteley, Rod; Hamilton, Bruce; Eirale, Cristiano; van Hellemondt, Frank; Tol, Johannes L.

    2018-01-01

    Background Hamstring injury with intramuscular tendon involvement is regarded as a serious injury with a delay in return to play (RTP) of more than 50 days and reinjury rates up to 63%. However, this reputation is based on retrospective case series with high risk of bias. Objective Determine whether

  6. The prevalence of Achilles and patellar tendon injuries in Australian football players beyond a time-loss definition.

    Science.gov (United States)

    Docking, S I; Rio, E; Cook, J; Orchard, J W; Fortington, L V

    2018-03-23

    Little is known about the prevalence and associated of morbidity of tendon problems. With only severe cases of tendon problems missing games, players that have their training and performance impacted are not captured by traditional injury surveillance. The aim of this study was to report the prevalence of Achilles and patellar tendon problems in elite male Australian football players using the Oslo Sports Trauma Research Centre (OSTRC) overuse questionnaire, compared to a time-loss definition. Male athletes from 12 professional Australian football teams were invited to complete a monthly questionnaire over a 9-month period in the 2016 pre- and competitive season. The OSTRC overuse injury questionnaire was used to measure the prevalence and severity of Achilles and patellar tendon symptoms and was compared to traditional match-loss statistics. A total of 441 participants were included. Of all participants, 21.5% (95% CI: 17.9-25.6) and 25.2% (95% CI 21.3-29.4) reported Achilles or patellar tendon problems during the season, respectively. Based on the traditional match-loss definition, a combined 4.1% of participants missed games due to either Achilles or patellar tendon injury. A greater average monthly prevalence was observed during the pre-season compared to the competitive season. Achilles and patellar tendon problems are prevalent in elite male Australian football players. These injuries are not adequately captured using a traditional match-loss definition. Prevention of these injuries may be best targeted during the off- and pre-season due to higher prevalence of symptoms during the pre-season compared to during the competitive season. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. The role of aqueous extract of pineapple fruit parts on the healing of acute crush tendon injury.

    Science.gov (United States)

    Aiyegbusi, A I; Duru, F I O; Awelimobor, D; Noronha, C C; Okanlawon, A O

    2010-01-01

    The Pineapple plant contains the enzyme bromelain which has been acclaimed to reduce pain and swellings following acute muscle injuries as well as carotenoids and polyphenols which are powerful antioxidants. It is yet to be determined if these constituents are distributed throughout the plant and what effect they have on the healing of acute tendon injuries. This study therefore investigated the effects of the aqueous extract of different parts of the pineapple plant on tenoblast proliferation and the tendon Malondialdehyde (MDA) level in the early stage of healing in a crush injury to the achilles tendon of Sprague-Dawley rats. Forty male rats were divided randomly into five groups; all had induced crush injury to the left Achilles tendon. Group 1; injury and nil treatment, Group 2; leaves extract, Group 3; fruit flesh extract, Group 4; bark extract, Group 5; core extract. The extract was given at a dosage of 30 mg/kg body weight daily over the first 14 days post-injury. On the 15th day post injury, the animals were sacrificed and the tendons excised and processed for histological study and MDA assay. The flesh and bark extract induced a proliferation of tenoblasts which however was not significantly different from that of the untreated tendon while the leaves and core extracts reduced the population of the tenocytes. The flesh extract significantly (p leaves and core extract significantly (p pineapple plant are concentrated in the flesh while the bark and flesh extracts have the potential to promote healing by stimulating tenoblast proliferation.

  8. Trapezius tendon transfer according to Saha after neglected complete axillary nerve injury.

    Science.gov (United States)

    Selim, Naser M

    2012-08-01

    Traumatic axillary nerve injury represents less than 1% of all nerve injuries.It is often subclinical because it is masked by the pain due to a shoulder fracture or dislocation, so that treatment is neglected for a long period. When nerve repair and physiotherapy are unsuccessful, trapezius tendon transfer may be considered. Between March 2008 and May 2009, 10 patients with neglected deltoid paralysis were treated by trapezius tendon transfer at Mansoura University hospital and in a private hospital. All patients were males. Their mean age was 27.8 years (range: 17-35). The mean follow-up period was 30 months (range: 24 to 36 months). The operations were performed according to the method described by Saha in 1967, involving transfer of the lateral extremity of the clavicle, the acromioclavicular joint and the acromion, with the insertion of the trapezius, to the proximal humerus. The authors retrospectively assessed the results according to the 5 items (a-e) of the Rowe and Zarins score: all 10 patients had (a) improved shoulder function with (e) a more stable shoulder. The mean active abduction (b) was 76 degrees (range: 50-100 degrees) and the mean active flexion (c) 78 degrees (range: 45-110 degrees). However, most authors report lower values: from 34 to 76 degrees of abduction, and from 30 to 78 degrees of flexion. Arthrodesis results in 59 to 71.43 degrees of abduction. The abduction power (d) was improved: it reached grade 3 in 7 cases and grade 4 in 3 cases. In this study, trapezius tendon transfer provided satisfactory functional improvement for paralysis of shoulder abduction after neglected complete axillary nerve injury, with improvement in shoulder stability, power and range of motion.

  9. Hamstring tendons insertion - an anatomical study

    OpenAIRE

    Cristiano Antonio Grassi; Vagner Messias Fruheling; Joao Caetano Abdo; Marcio Fernando Aparecido de Moura; Mario Namba; Joao Luiz Vieira da Silva; Luiz Antonio Munhoz da Cunha; Ana Paula Gebert de Oliveira Franco; Isabel Ziesemer Costa; Edmar Stieven Filho

    2013-01-01

    OBJECTIVE: To study the anatomy of the hamstring tendons insertion and anatomical rela-tionships. METHODS: Ten cadaver knees with medial and anterior intact structures were selected. The dissection was performed from anteromedial access to exposure of the insertion of the flexor tendons (FT), tibial plateau (TP) and tibial tuberosity (TT). A needle of 40 × 12 and a caliper were used to measure the distance of the tibial plateau of the knee flexor tendons insertion at 15 mm from the ...

  10. Staged tendon grafts and soft tissue coverage

    Directory of Open Access Journals (Sweden)

    David Elliot

    2011-01-01

    Full Text Available The objective of the two-staged flexor tendon method is to improve the predictability of final results in difficult problems dealing with tendon reconstruction. This article reviews the evolution and benefits of this procedure. It also considers the use of the technique to help deal with problems requiring pulley and skin reconstruction simultaneously with re-constituting the flexor tendon system.

  11. Biceps brachii tendon ruptures: a review of diagnosis and treatment of proximal and distal biceps tendon ruptures.

    Science.gov (United States)

    Geaney, Lauren E; Mazzocca, Augustus D

    2010-06-01

    The biceps brachii is a unique muscle with 2 proximal tendons and a single distal tendon. Although these tendons are part of the same muscle, they have significantly different functions. It is hypothesized that the long head of the biceps acts as a pain generator in the shoulder, though the biomechanical function is still under debate. Conversely, the distal biceps tendon is the major supinator of the forearm and serves a secondary flexor. As such, injuries to these tendons must be evaluated independently. Biceps brachii ruptures most often occur in middle-aged men following a traumatic event. Injuries to the long head of the biceps are primarily treated nonoperatively with adequate results. Injuries of distal tendon occur less often, but are receiving significant attention in the literature in regard to treatment options. Surgical repair of distal biceps ruptures is indicated in patients who want to restore supination strength and endurance. It is unclear which operative technique is superior, although the most recent data suggest increased strength of the cortical button repair. This article provides a comprehensive review of both proximal and distal biceps brachii ruptures in addition to our treatment algorithm.

  12. Hand tendon involvement in rheumatoid arthritis: an ultrasound study.

    Science.gov (United States)

    Filippucci, Emilio; Gabba, Alessandra; Di Geso, Luca; Girolimetti, Rita; Salaffi, Fausto; Grassi, Walter

    2012-06-01

    To assess the prevalence and the distribution of tendon involvement in the hands and wrists of patients with rheumatoid arthritis (RA) describing in detail the ultrasound (US) morphostructural and vascular tendon abnormalities. Ninety consecutive RA patients were included in the study. The following tendons were scanned bilaterally: flexor pollicis longus tendon, flexor digitorum superficialis, and profundus tendons of the II to the V fingers (at both finger and carpal tunnel levels), flexor carpi radialis tendon, and extensor tendons of the 6 compartments on the dorsal aspect of the wrist. The presence of US findings indicative of tenosynovitis and tendon damage was investigated. Tenosynovitis was found in at least 1 anatomic site of 44 (48.8%) of 90 patients. Tendon damage was found in at least 1 anatomic site of 39 (43.3%) of 90 patients. The focal tendon echotexture derangement was found in 294 of 5400 (5.4%) tendons, the partial and complete tears in 14 (0.3%), and in 3 (0.06%) tendons, respectively. The most frequently involved tendons were the flexor tendons of the II, III, and IV fingers and the extensor carpi ulnaris tendon. The present study provides evidence in favor of the ability of US to reveal a relatively high frequency of tendon involvement at the hand and wrist level in RA patients. These data can both facilitate US examinations in daily clinical practice and direct further investigations in the US assessment of tendon involvement in RA. Copyright © 2012 Elsevier Inc. All rights reserved.

  13. The effect of butyric acid with autogenous omental graft on healing of experimental Achilles tendon injury in rabbits.

    Science.gov (United States)

    Jahani, S; Moslemi, H R; Dehghan, M M; Sedaghat, R; Mazaheri Nezhad, R; Rezaee Moghaddam, D

    2015-01-01

    In this study, the role of local injection of butyric acid (BA) with autogenous omental graft was evaluated in healing of experimental Achilles tendon injury in rabbits. Nine adult male New Zealand rabbits were anesthetized and a partial thickness tenotomy was created on both hindlimbs. In treated group, omental graft was secured in place using BA soaked polygalactin 910 suture. In control group, the graft was sutured without BA. Butyric acid and normal saline were injected daily to treatment and control groups for three days, respectively. Based on the findings, on day 15 after injury, the tendon sections showed that healing rate in BA treated group was higher than that in control group. Furthermore, at days 28 and 45, comparison between BA treated and control groups demonstrated that BA increased the healing rate but with no significance. In summary, results of this study show that application of BA with autogenous omental graft can improve healing process of damaged Achilles tendon.

  14. Examination of Spasticity of the Knee Flexors and Knee Extensors Using Isokinetic Dynamometry With Electromyography and Clinical Scales in Children With Spinal Cord Injury

    Science.gov (United States)

    Pierce, Samuel R; Johnston, Therese E; Shewokis, Patricia A; Lauer, Richard T

    2008-01-01

    Background/Objective: To examine the role of reflex activity in spasticity and the relationship between peak passive torque, Ashworth Scale (AS), and Spasm Frequency Scale (SFS) of the knee flexors and extensors during the measurement of spasticity using an isokinetic dynamometer in children with spinal cord injury (SCI). Methods: Eighteen children with chronic SCI and 10 children of typical development (TD) participated. One set of 10 passive movements was completed using an isokinetic dynamometer at 15, 90, and 180 degrees per second (deg/s) while surface electromyographic data were collected from the vastus lateralis (VL) and medial hamstrings (MH). Spasticity was clinically assessed using the AS and SFS. Results: There were no significant differences in peak passive torque of the knee flexors and extensors at any velocity for children with SCI compared to children with TD. Children with TD demonstrated significantly more reflex activity of the MH during the assessment of knee flexor spasticity at all movement velocities than did children with SCI. Children with TD demonstrated significantly more reflex activity of the VL during the assessment of knee-extensor spasticity with movements at 180 deg/s. The relationship between peak passive torque, AS, and SFS was significant during movements at a velocity of 90 deg/s only. Conclusions: The role of increased reflexes in spasticity needs further examination. Isokinetic dynamometry may be measuring a different aspect of spasticity than the AS and SFS do in children with SCI. PMID:18581670

  15. Tendon Gradient Mineralization for Tendon to Bone Interface Integration

    Science.gov (United States)

    Qu, Jin; Thoreson, Andrew R.; Chen, Qingshan; An, Kai-Nan; Amadio, Peter C.; Zhao, Chunfeng

    2014-01-01

    Tendon-to-bone integration is a great challenge for tendon or ligament reconstruction regardless of use of autograft or allograft tendons. We mineralized the tendon, thus transforming the tendon-to-bone into a “bone-to-bone” interface for healing. Sixty dog flexor digitorum profundus (FDP) tendons were divided randomly into 5 groups: 1) normal FDP tendon, 2) CaP (Non-extraction and mineralization without fetuin), 3) CaPEXT (Extraction by Na2HPO4 and mineralization without fetuin), 4) CaPFetuin (Non-extraction and mineralization with fetuin), and 5) CaPEXTFetuin (Extraction and mineralization with fetuin). The calcium and phosphate content significantly increased in tendons treated with combination of extraction and fetuin compared to the other treatments. Histology also revealed a dense mineral deposition throughout the tendon outer layers and penetrated into the tendon to a depth of 200 μm in a graded manner. Compressive moduli were significantly lower in the four mineralized groups compared with normal control group. No significant differences in maximum failure strength or stiffness were found in the suture pull-out test among all groups. Mineralization of tendon alters the interface from tendon to bone into mineralized tendon to bone, which may facilitate tendon-to-bone junction healing following tendon or ligament reconstruction. PMID:23939935

  16. Análise biomecânica e histológica de tendões flexores reparados em coelhos usando três técnicas de sutura (quatro e seis passadas com mobilização ativa precoce Biomechanics and histological analysis in rabbit flexor tendons repaired using three suture techniques (four and six strands with early active mobilization

    Directory of Open Access Journals (Sweden)

    Antônio Lourenço Severo

    2012-02-01

    Full Text Available OBJETIVO: Analisar o tempo das suturas, a biomecânica (deformidade entre os cotos tendíneos e a histologia dos três grupos de reparo cirúrgico tendíneo: Brasil-2 (quatro passadas, com técnica de sutura central em que o nó final se encontra fora do tendão; Indiana (quatro passadas; e Tsai (seis passadas, com técnicas de sutura central em que o nó final se encontra no interior do tendão reparado, associados de mobilização ativa precoce. MÉTODOS: O tendão calcâneo direito de 36 coelhos da raça New Zealand foi escolhido para a análise. Este apresenta calibre semelhante ao tendão flexor humano, o qual tem aproximadamente 4,5mm (variando 2mm para mais ou menos. A amostra selecionada apresentava a mesma massa (2,5 a 3kg e eram adultos machos ou fêmeas (a partir de 8½ meses de idade. RESULTADOS: Na análise biomecânica, não houve diferença estatisticamente significativa (p > 0,01. Não houve diferença estatística com relação ao tempo cirúrgico na realização das três técnicas de suturas (p > 0,01. Evidenciou-se, qualitativamente e quantitativamente, com a mobilidade ativa precoce, um espessamento da fibra de colágeno em 38,9% dentro do 15º dia e de 66,7% dentro do período do 30º dia (p = 0,095. CONCLUSÃO: Esta investigação serviu para demonstrar que não houve diferença histológica do nó final da sutura central dentro ou fora do tendão reparado, bem como o número de passadas, no que diz respeito à cicatrização, vascularização ou deformidade do tendão no túnel osteofibroso com as técnicas de reparo aplicadas, associados de mobilização ativa precoce.OBJECTIVE: analyzing suture time, biomechanics (deformity between the stumps and the histology of three groups of tendinous surgical repair: Brazil-2 (4-strands which the end knot (core is located outside the tendon, Indiana (4-strands and Tsai (6-strands with sutures technique which the end knot (core is inner of the tendon, associated with early active

  17. Illusion of arm movement evoked by tendon vibration in patients with spinal cord injury.

    Science.gov (United States)

    Fusco, Gabriele; Tidoni, Emmanuele; Barone, Nicola; Pilati, Claudio; Aglioti, Salvatore Maria

    2016-09-21

    Studies in healthy people show that stimulation of muscle spindles through frequency-specific tendon vibration (TV) induces the illusory perception of movement. Following spinal cord injury (SCI), motor and sensory connections between the brain and parts of the body below-the-lesion level are partially or totally impaired. The present investigation is a descriptive study aimed to investigate whether people living with SCI may experience movement illusions comparable to a control group. Healthy and people with SCI were asked to report on three illusion-related features (Vividness, Duration, Illusory Extension) after receiving 70 Hz TV on the biceps brachii tendon of both arms. Two different forces of stimulation were applied: 2.4 N and 4.2 N. Both patients and controls were susceptible to the kinesthetic illusion. However patients presented lower sensitivity to TV than healthy subjects. Participants rated stronger illusions of movement after 4.2 N than 2.4 N stimulation in all the three illusion-related features. Further, patients reported atypical illusory experiences of movement (e.g. as if the arm wanted to extend, or a sensation of pushing against something) that may reflect different reorganization processes following spinal cord injury. The study provides a preliminary evidence of the possible use of the proprioceptive stimulation in the upper limbs of people living with SCI. Results are discussed in the light of recent advancements of brain-computer applications based on motor imagery for the control of neuroprosthetic and robotic devices in patients with severe sensorimotor deficits.

  18. The cross-sectional area of the superficial digital flexor tendon of trained and untrained Thoroughbred racehorses Área transversal do tendão flexor digital superficial de cavalos Puro Sangue Inglês de corrida em treinamento e sem treinamento

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    Ana Guiomar Matos Santiago Reis

    2010-08-01

    Full Text Available Twenty Thoroughbred racehorses were ultrasonographically evaluated to determine the relation between normal values of the cross-sectional area (CSA of the right and left forelimbs superficial digital flexor tendons (SDFT in the metacarpal region for trained and untrained Thoroughbreds racehorses. Ultrasonography revealed that CSA at 26cm distal to the accessory carpal bone is larger than other proximal levels, for either left or right forelimbs. In addition, the CSA at 2, 4, 6, 8, 10, 12 and 14cm distal to the accessory carpal bone of the left forelimb are larger (P0.05 between left and right forelimb for CSA of the SDFT, at any level, for either trained or untrained horses, and there was no significant difference between untrained or trained horses for the CSA of right forelimb. In conclusion, the CSA of the left forelimb SDFT for horses that had been in continuous race training remains larger when they were trained anticlockwise, contrary to horses that had not been training for more than one year.Vinte cavalos da raça Puro Sangue Inglês de corrida foram submetidos a exame ultrassonográfico, com o intuito de determinar a relação entre os valores normais da área do tendão flexor digital superficial (TFDS na região metacarpiana dos membros torácicos direito e esquerdo, em cavalos com e sem treinamento. O exame ultrassonográfico revelou que a área do tendão 26cm distal ao osso acessório do carpo é maior em comparação com as alturas proximais, tanto nos membros torácicos esquerdos, como nos membros torácicos direitos. Além disso, a área do TFDS nas alturas 2, 4, 6, 8, 10, 12 e 14cm, no membro torácico esquerdo, é maior (P0,05 nas áreas do TFDS entre os membros torácicos direito e esquerdo, tanto para os animais em treinamento, como para os animais sem treinamento. Também não foi encontrada diferença significativa em comparação com o membro direito dos cavalos em treinamento e sem treinamento. Conclui-se que os cavalos

  19. Estudo comparativo da reconstrução do LCA com o posicionamento anatômico dos túneis entre o tendão patelar e os tendões flexores Comparative study of ACL reconstruction with anatomical positioning of the tunnels using the patellar tendon versus hamstring tendon

    Directory of Open Access Journals (Sweden)

    Vitor Barion Castro de Pádua

    2012-02-01

    Full Text Available OBJETIVO: Comparar a reconstrução do LCA com posicionamento anatômico dos túneis entre os tendões flexores e o tendão patelar. MÉTODOS: Foram avaliados 52 pacientes prospectivamente submetidos à reconstrução do LCA segundo a técnica de Chambat, com o posicionamento anatômico dos túneis realizados de fora para dentro. Foram divididos em grupo A, 27 pacientes, utilizando-se o tendão patelar como enxerto, e grupo B, 25 pacientes, utilizando-se os tendões flexores. RESULTADOS: No grupo A, 26 pacientes estavam muito satisfeitos ou satisfeitos, e um insatisfeito; no grupo B, 25 pacientes estavam muito satisfeitos ou satisfeitos (p = 0,990. Segundo a escala de Lysholm, o grupo A atingiu a média de 96,11 e o grupo B, 95,32 (p = 0,594. Quanto ao IKDC pré-operatório, 100% dos pacientes do grupo A e 92% do grupo B eram IKDC C ou D (p = 0,221; na avaliação com mínimo de dois anos de seguimento, 96% do grupo A e 92% do grupo B eram IKDC A ou B (p = 0,256. O teste de Lachman, pivot shift, o retorno às atividades esportivas e o diferencial comparativo da translação anterior (RolimeterTM também não apresentaram diferença estatisticamente significante. No grupo A, 5 pacientes (18,5% não conseguiam ajoelhar em superfície rígida; nenhum paciente do grupo B apresentou essa queixa. CONCLUSÃO: A reconstrução do LCA apresenta resultados semelhantes utilizando-se os tendões flexores ou tendão patelar com o posicionamento anatômico dos túneis. A perfuração de fora para dentro do túnel femoral é uma opção reprodutível e precisa no posicionamento correto do túnel femoral.OBJECTIVE: To compare ACL reconstruction with anatomical positioning of the tunnels using the hamstring or patellar tendons. METHODS: We prospectively evaluated 52 patients who underwent ACL reconstruction using the Chambat's technique, with anatomical positioning of the tunnels drilled outside in. They were divided into group A, with 27 patients, using the

  20. Inter-rater reliability of modified modified Ashworth scale in the assessment of plantar flexor muscle spasticity in patients with spinal cord injury.

    Science.gov (United States)

    Mishra, Chittaranjan; Ganesh, G Shankar

    2014-12-01

    Spasticity occurs in disorders of the central nervous system such as stroke, spinal cord injury (SCI), multiple sclerosis and traumatic brain injury. The recently developed clinical measurement for the measurement of spasticity is the Modified Modified Ashworth Scale (MMAS) PURPOSE OF STUDY: The purpose of this study is to determine the inter-rater reliability of the MMAS in the assessment of plantar flexor spasticity in patients with SCI. Thirty-eight subjects (32 males and six females, mean age 31.9 ± 12.6 years) were recruited for the study. Excluded from the study were patients with contracture in the lower limb and where passive movements were contraindicated. Each patient was assessed by two raters in a single session. After the performance of the procedure by the first assessor and rating of the patient's muscle tone with the MMAS, the same procedure was repeated by the second assessor after 1 hour. The evaluation was carried out in side-lying position. The extent of agreement was analysed by non-weighted Cohen kappa. The agreement between the raters was good (soleus - ĸ: 0.75, SE = 0 .084, p < 0.0001, gastrocnemius - ĸ:0.70, SE = 0.105, p < 0.0001). The MMAS has good inter-rater reliability in the assessment of plantar flexor muscle spasticity in patients with SCI. Copyright © 2014 John Wiley & Sons, Ltd.

  1. Superparamagnetic iron oxide nanoparticles as a means to track mesenchymal stem cells in a large animal model of tendon injury.

    Science.gov (United States)

    Scharf, Alexandra; Holmes, Shannon; Thoresen, Merrilee; Mumaw, Jennifer; Stumpf, Alaina; Peroni, John

    2015-01-01

    The goal of this study was to establish an SPIO-based cell-tracking method in an ovine model of tendonitis and to determine if this method may be useful for further study of cellular therapies in tendonitis in vivo. Functional assays were performed on labeled and unlabeled cells to ensure that no significant changes were induced by intracellular SPIOs. Following biosafety validation, tendon lesions were mechanically (n = 4) or chemically (n = 4) induced in four sheep and scanned ex vivo at 7 and 14 days to determine the presence and distribution of intralesional cells. Ovine MSCs labeled with 50 µg SPIOs/mL remained viable, proliferate, and undergo tri-lineage differentiation (p cell numbers as low as 10 000 and in volumetric distributions as low as 100 000 cells/mL. Cells remained detectable by MRI at 7 days, as confirmed by correlative histology for dually labeled SPIO+/GFP+ cells. Histological evidence at 14 days suggested that SPIO particles remained embedded in tissue, providing MRI signal, although cells were no longer present. SPIO labeling has proven to be an effective method for cell tracking for a large animal model of tendon injury for up to 7 days post-injection. The data obtained in this study justify further investigation into the effects of MSC survival and migration on overall tendon healing and tissue regeneration. Copyright © 2015 John Wiley & Sons, Ltd.

  2. Redefining Zone II: Anatomy of the Flexor Digitorum Superficialis Insertion.

    Science.gov (United States)

    Nicholson, Luke T; Hill, Jeffrey R; McKnight, Braden; Heckmann, Nathanael; Stevanovic, Milan; Ghiassi, Alidad

    2017-10-01

    Flexor zone II is defined as the region spanning the proximal aspect of the A1 pulley to the insertion of the flexor digitorum superficialis (FDS) tendon. Descriptions of the FDS insertion are inconsistent in the literature, but zones of injury are frequently determined with reference to superficial landmarks. The purpose of this study was to describe the footprint of the FDS insertion and define its relationship to the proximal interphalangeal (PIP) skin crease. The FDS insertion on the index, middle, ring, and small fingers was dissected in 6 matched pairs of fresh-frozen cadaveric hands. A Kirschner wire was used to mark the level of the PIP skin crease on bone before measurements of the FDS footprint and its position relative to the PIP skin crease were made using digital calipers. The radial and ulnar FDS slips inserted a mean distance of 3.22 mm from the distal aspect of the PIP skin crease and varied by digit. The mean distal extent of the FDS insertion was 8.29 mm. The mean length of the insertion of each FDS slip was 5.15 mm and the mean width was 1.9 mm. The radial and ulnar FDS slips insert on average 3.22 mm distal to the PIP skin crease and vary by digit. Knowledge of the FDS insertion is clinically relevant when differentiating between flexor zone I and zone II injuries, planning surgical approaches to the finger, and in guiding patient expectations for surgery given the variability in outcome based on zone of injury.

  3. Calcaneal tendon: imaging findings

    International Nuclear Information System (INIS)

    Montandon, Cristiano; Fonseca, Cristiano Rezio; Montandon Junior, Marcelo Eustaquio; Lobo, Leonardo Valadares; Ribeiro, Flavia Aparecida de Souza; Teixeira, Kim-Ir-Sen Santos

    2003-01-01

    We reviewed the radiological and clinical features of 23 patients with calcaneal tendon diseases, who were submitted to ultrasound or magnetic resonance imaging. The objective of this study was to characterize the lesions for a precise diagnosis of calcaneal tendon injuries. A wide range of calcaneal tendon diseases include degenerative lesions, inflammation of the peritendinous tissue such as peritendinitis and bursitis, and rupture. Imaging methods are essential in the diagnosis, treatment and follow-up of calcaneal tendon diseases. (author)

  4. Tensile strength of a weave tendon suture using tendons of different sizes.

    Science.gov (United States)

    Mazurek, Tomasz; Strankowski, Michał; Ceynowa, Marcin; Rocławski, Marek

    2011-05-01

    This study compared the maximum load, stress, elongation at failure and the mode of failure of three kinds of tendons most frequently used for tendon grafting and tendon transfers, using the Pulvertaft weave suture. Sixty tendons were used from fresh human cadaver upper and lower extremities. The performed repairs included: 9 specimens of flexor digitorum superficialis or profundus tendon with flexor digitorum superficialis or profundus tendon (thick-thick suture), 10 specimens of flexor digitorum superficialis or profundus tendon with palmaris longus tendon (thick-medium thin suture), and 10 specimens of flexor digitorum superficialis or profundus tendon with plantaris tendon (thick-thin suture). Material testing machine was used to test repairs to failure. The mean maximum load at failure increased with the thickness of donor tendon. For the thick-thick specimen, the maximum load at failure was 125 newtons (N), for the thick-medium thin specimen it was 86,8N, and for the thick-thin it was 65,2N. These differences were all statistically significant. The active rehabilitation protocol is possible only with thick-thick connections used, the strength of the thick-medium thin connection is on the border of indications for the active rehabilitation protocol, and the thick-thin connection strength is sufficient only for the passive rehabilitation protocol. Copyright © 2010. Published by Elsevier Ltd.

  5. Achillodynia. Radiological imaging of acute and chronic overuse injuries of the Achilles tendon

    International Nuclear Information System (INIS)

    Syha, R.; Springer, F.; Grosse, U.; Tuebingen Univ.; Ketelsen, D.; Kramer, U.; Horger, M.; Ipach, I.; Schick, F.

    2013-01-01

    In the past decades the incidence of acute and chronic disorders of the Achilles tendon associated with sport-induced overuse has steadily increased. Besides acute complete or partial ruptures, achillodynia (Achilles tendon pain syndrome), which is often associated with tendon degeneration, represents the most challenging entity regarding clinical diagnostics and therapy. Therefore, the use of imaging techniques to differentiate tendon disorders and even characterize structure alterations is of growing interest. This review article discusses the potential of different imaging techniques with respect to the diagnosis of acute and chronic tendon disorders. In this context, the most commonly used imaging techniques are magnetic resonance imaging (MRI), B-mode ultrasound, and color-coded Doppler ultrasound (US). These modalities allow the detection of acute tendon ruptures and advanced chronic tendon disorders. However, the main disadvantages are still the low capabilities in the detection of early-stage degeneration and difficulties in the assessment of treatment responses during follow-up examinations. Furthermore, differentiation between chronic partial ruptures and degeneration remains challenging. The automatic contour detection and texture analysis may allow a more objective and quantitative interpretation, which might be helpful in the monitoring of tendon diseases during follow-up examinations. Other techniques to quantify tendon-specific MR properties, e.g. based on ultrashort echo time (UTE) sequences, also seem to have great potential with respect to the precise detection of degenerative tendon disorders and their differentiation at a very early stage. (orig.)

  6. Distinguishing active from passive components of ankle plantar flexor stiffness in stroke, spinal cord injury and multiple sclerosis

    DEFF Research Database (Denmark)

    Lorentzen, Jakob; Grey, Michael James; Crone, Clarissa

    2010-01-01

    to distinguish the contribution of active reflex mechanisms from passive muscle properties to ankle joint stiffness in 31 healthy, 10 stroke, 30 multiple sclerosis and 16 spinal cord injured participants. The results were compared to routine clinical evaluation of spasticity. METHODS: A computer......-controlled robotic device applied stretches to the ankle plantar flexor muscles at different velocities (8-200deg/s; amplitude 6 degrees ). The reflex threshold was determined by soleus EMG. Torque and EMG data were normalized to the maximal torque and EMG evoked by supramaximal stimulation of the tibial nerve...

  7. A Rare Case of Deep Digital Flexor Tendinopathy following Centesis of the Navicular Bursa

    Directory of Open Access Journals (Sweden)

    Tim J. Froydenlund

    2017-10-01

    Full Text Available Navicular bursa (NB centesis is a common diagnostic and therapeutic procedure in equine practice. This case report documents the clinical, diagnostic imaging and histological findings in a horse with a suspected iatrogenic deep digital flexor tendon (DDFT injury following centesis of the NB via a modified distal plantar approach (placement of two needles in a weight bearing position. Although it cannot be proven with absolute certainty, the authors believe that this is the first reported case where NB centesis is the likely cause of a DDFT lesion, and with magnetic resonance imaging performed both pre- and post-centesis. With this potential, though rare, complication of the procedure, alternative tendon sparing injection techniques should be considered prior to NB centesis in certain cases.

  8. Biologics for tendon repair☆

    Science.gov (United States)

    Docheva, Denitsa; Müller, Sebastian A.; Majewski, Martin; Evans, Christopher H.

    2015-01-01

    Tendon injuries are common and present a clinical challenge to orthopedic surgery mainly because these injuries often respond poorly to treatment and require prolonged rehabilitation. Therapeutic options used to repair ruptured tendons have consisted of suture, autografts, allografts, and synthetic prostheses. To date, none of these alternatives has provided a successful long-term solution, and often the restored tendons do not recover their complete strength and functionality. Unfortunately, our understanding of tendon biology lags far behind that of other musculoskeletal tissues, thus impeding the development of new treatment options for tendon conditions. Hence, in this review, after introducing the clinical significance of tendon diseases and the present understanding of tendon biology, we describe and critically assess the current strategies for enhancing tendon repair by biological means. These consist mainly of applying growth factors, stem cells, natural biomaterials and genes, alone or in combination, to the site of tendon damage. A deeper understanding of how tendon tissue and cells operate, combined with practical applications of modern molecular and cellular tools could provide the long awaited breakthrough in designing effective tendon-specific therapeutics and overall improvement of tendon disease management. PMID:25446135

  9. Hamstring tendons insertion - an anatomical study

    Directory of Open Access Journals (Sweden)

    Cristiano Antonio Grassi

    2013-09-01

    Full Text Available OBJECTIVE: To study the anatomy of the hamstring tendons insertion and anatomical rela-tionships. METHODS: Ten cadaver knees with medial and anterior intact structures were selected. The dissection was performed from anteromedial access to exposure of the insertion of the flexor tendons (FT, tibial plateau (TP and tibial tuberosity (TT. A needle of 40 × 12 and a caliper were used to measure the distance of the tibial plateau of the knee flexor tendons insertion at 15 mm from the medial border of the patellar tendon and tibial tuberosity to the insertion of the flexor tendons of the knee. The angle between tibial plateau and the insertion of the flexor tendons of the knee (A-TP-FT was calculated using Image Pro Plus software. RESULTS: The mean distance TP-FT was 41 ± 4.6 mm. The distance between the TT-FT was 6.88 ± 1 mm. The (A-TP-FT was 20.3 ± 4.9°. CONCLUSION: In the anterior tibial flexor tendons are about 40 mm from the plateau with an average of 20°.

  10. Clinical evaluation of bone- patellar tendon- bone grafts for anterior cruciate ligament injury

    International Nuclear Information System (INIS)

    Nakamura, Yasuhiro

    2011-01-01

    One thousand and thirty-eight cases of Anterior Cruciate Ligament (ACL) rupture were treated between January 2002 and November 2010. Eight hundred sixty-six cases (83.9%) were observed for at least six months. All cases were reconstructed with a bone to tendon to bone (BTB) graft from the patella. Much effort was made to return the patient to a competitive sports activity level within one year. The age at suffering from the initial injury ranged from 9 to 74 years old with a mean of 24.7 years old. There were 493 female (50.7%) and 427 male (49.3%) cases. The injured side was right in 408 cases and left in 458 cases. The mean postoperative observation period was 449.2 days. The number of patients who felt 80% or more certain that they could return to competitive sports activities was 538 (61.9%). From the MRI findings, continuity of the reconstructed graft was observed in 793 cases (98.5%). Arthroscopy after reconstruction was performed in 775 cases (89.5%). The reconstructed ACL was observed to be covered with an adequate synovium in 629 cases (81.2%). The medial meniscus and lateral meniscus showed no changes in 657 cases (84.8%) and 666 cases (85.9%) respectively. Reconstructions performed less than two weeks after injury showed no significant differences in terms of Range Of Motion (ROM), arthroscopic findings, or the number of patients who could return to competitive sports activities. Statistically significantly more patients who underwent their reconstruction at an age over forty experienced a loss motion of five degree in extension or ten degree in flexion and resumed a lower level of sports activities. Patients who underwent the reconstruction could return to exercises for muscle strengthening and ROMs within 2 weeks. Patients over forty years old who underwent their reconstruction could prevent their menisci from fraying, tearing, or undergoing osteoarthritic changes. (author)

  11. Risk of iatrogenic injury to the infrapatellar branch of the saphenous nerve during hamstring tendon harvesting: A meta-analysis.

    Science.gov (United States)

    Pękala, Przemysław A; Tomaszewski, Krzysztof A; Henry, Brandon Michael; Ramakrishnan, Piravin Kumar; Roy, Joyeeta; Mizia, Ewa; Walocha, Jerzy A

    2017-11-01

    Our goal was to conduct a comprehensive analysis of studies reporting data on the rate of injury to the infrapatellar branch of the saphenous nerve following hamstring tendon graft harvesting with respect to the type of incision over the pes anserinus. A broad search through all major electronic databases was conducted to identify articles eligible for inclusion. All available data were extracted and pooled into the analysis. Eleven studies (n = 1,050 patients) were included in the meta-analysis. The study revealed that a vertical incision during hamstring tendon harvesting over the pes anserinus was associated with the highest rate of injury with a pooled rate of 51.4% (95% confidence interval [CI], 34.6-67.2%). This was followed by oblique and horizontal incisions with pooled rates of 26.0% (95% CI,1.3-61.3%) and 22.4% (95% CI, 5.4-45.5%), respectively. We highly recommend the use of the shortest possible oblique incision during hamstring tendon harvesting over the pes anserinus. Muscle Nerve 56: 930-937, 2017. © 2017 Wiley Periodicals, Inc.

  12. Sex Hormones and Tendon

    DEFF Research Database (Denmark)

    Hansen, Mette; Kjaer, Michael

    2016-01-01

    The risk of overuse and traumatic tendon and ligament injuries differ between women and men. Part of this gender difference in injury risk is probably explained by sex hormonal differences which are specifically distinct during the sexual maturation in the teenage years and during young adulthood....... The effects of the separate sex hormones are not fully elucidated. However, in women, the presence of estrogen in contrast to very low estrogen levels may be beneficial during regular loading of the tissue or during recovering after an injury, as estrogen can enhance tendon collagen synthesis rate. Yet...... has also been linked to a reduced responsiveness to relaxin. The present chapter will focus on sex difference in tendon injury risk, tendon morphology and tendon collagen turnover, but also on the specific effects of estrogen and androgens....

  13. The Use of Hyaluronic Acid after Tendon Surgery and in Tendinopathies

    Directory of Open Access Journals (Sweden)

    Michele Abate

    2014-01-01

    Full Text Available Viscosupplementation with hyaluronic acid is safe and effective in the management of osteoarthritis, but its use in the treatment of tendon disorders has received less attention. The aim of this review is to summarize the current knowledge on this topic, evaluating experimental and clinical trials. A search of English-language articles was performed using the key search terms “hyaluronic acid” or “viscosupplementation” combined with “tendon,” “tendinopathy,“ “adhesions,“ or “gliding,“ independently. In quite all the experimental studies, performed after surgical procedures for tendon injuries or in the treatment of chronic tendinopathies, using different hyaluronic acid compounds, positive results (reduced formation of scars and granulation tissue after tendon repair, less adhesions and gliding resistance, and improved tissue healing were observed. In a limited number of cases, hyaluronic acid has been employed in clinical practice. After flexor tendon surgery, a greater total active motion and fingers function, with an earlier return to work and daily activities, were observed. Similarly, in patients suffering from elbow, patellar, and shoulder tendons disorders, pain was reduced, and function improved. The positive effect of hyaluronic acid can be attributed to the anti-inflammatory activity, enhanced cell proliferation, and collagen deposition, besides the lubricating action on the sliding surface of the tendon.

  14. Effects of flunixin meglumine on experimental tendon wound healing: A histopathological and mechanical study in rabbits

    Directory of Open Access Journals (Sweden)

    Mehdi Behfar

    2014-12-01

    Full Text Available Tendons are frequently targets of injury in sports and work. Whether nonsteroidal anti-inflammatory drugs (NSAIDs have beneficial effects on tendon healing is still a matter of debate. This study was conducted to evaluate effects of flunixin meglumine (FM on tendon healing after experimentally induced acute trauma. Twenty eight adult male New Zealand White rabbits were subjected to complete transection of deep digital flexor tendons followed by suture placement. Treatment group received intramuscular injection of FM for three days, and controls received placebo. Subsequently, cast immobilization was continued for two weeks. Animals were sacrificed four weeks after surgery and tissue samples were taken. The histological evaluations revealed improved structural characteristics of neotendon formation including fibrillar linearity, fibrillar continuity and neovascularization in treatment group compared to those of controls (p 0.05. Mechanical evaluation revealed significant increase in load-related material properties including ultimate load, yield load, energy absorption and ultimate stress in treatment group compared to those of control group (p 0.05. The present study showed that intramuscular injection of FM resulted in improved structural and mechanical properties of tendon repairs and it could be an effective treatment for acute tendon injuries like severance and laceration.

  15. Point-of-Care Ultrasound in the Evaluation of Pyogenic Flexor Tenosynovitis.

    Science.gov (United States)

    Cohen, Stephanie G; Beck, Sierra C

    2015-11-01

    A 4-year-old girl presented to the emergency department for evaluation of finger swelling after a dog bite. Point-of-care ultrasound was used to diagnose pyogenic flexor tenosynovitis of the digit after visualizing a fluid collection within the flexor tendon sheath. The patient underwent emergent incision and drainage of the digit with good outcome.

  16. Eccentric knee flexor strength profiles of 341 elite male academy and senior Gaelic football players: Do body mass and previous hamstring injury impact performance?

    Science.gov (United States)

    Roe, Mark; Malone, Shane; Delahunt, Eamonn; Collins, Kieran; Gissane, Conor; Persson, Ulrik McCarthy; Murphy, John C; Blake, Catherine

    2018-03-01

    Report eccentric knee flexor strength values of elite Gaelic football players from underage to adult level whilst examining the influence of body mass and previous hamstring injury. Cross-sectional study. Team's training facility. Elite Gaelic football players (n = 341) from under 14 years to senior age-grades were recruited from twelve teams. Absolute (N) and relative (N·kg -1 ) eccentric hamstring strength as well as corresponding between-limb imbalances (%) were calculated for all players. Mean maximum force was 329.4N (95% CI 319.5-340.2) per limb. No statistically significant differences were observed in relative force values (4.4 N ·kg -1 , 95% CI 4.2-4.5) between age-groups. Body mass had moderate-to-large and weak associations with maximum force in youth (r = 0.597) and adult (r =0 .159) players, respectively. Overall 40% (95 CI 31.4-48.7) presented with a maximum strength between-limb imbalance >10%. Players with a hamstring injury had greater relative maximum force (9.3%, 95% CI 7.0-11.8; p > 0.05) and a 28% (95% CI 10.0-38.0) higher prevalence of between-limb imbalances ≥15% compared to their uninjured counterparts. Overlapping strength profiles across age-groups, combined with greater strength in previously injured players, suggests difficulties for establishing cut-off thresholds associated with hamstring injury risk. Copyright © 2018 Elsevier Ltd. All rights reserved.

  17. Association of polymorphisms rs1800012 in COL1A1 with sports-related tendon and ligament injuries: a meta-analysis

    Science.gov (United States)

    Wang, Chunguang; Li, Hao; Chen, Kang; Wu, Bing; Liu, Haifeng

    2017-01-01

    It has been reported that the single nucleotide polymorphism (SNP) rs1800012 in COL1A1 might be associated with the susceptibility to sports-related tendon and ligament injuries such as ACL injuries, Achilles tendon injuries, shoulder dislocations and tennis elbow. But the data from different studies have been conflicting. Here we attempted to systematically summarize and clarify the association between the SNP and sports-related tendon and ligament injuries risk. Six eligible studies including 933 cases and 1,381 controls were acquired from PubMed, Web Of Science and Cochrane library databases. Significant association was identified in homozygote model (TT versus GG: OR=0.17, 95%CI 0.08-0.35, PH=0.00) and recessive model (TT versus GT/GG: OR=0.21, 95%CI 0.10-0.44, PH=0.00). Our results indicated that COL1A1 rs1800012 polymorphism may be associated with the reduced risk of sports-related tendon or ligament injuries, especially in ACL injuries, and that rare TT may played as a protective role. PMID:28206959

  18. Common Peroneal Nerve Palsy with Multiple-Ligament Knee Injury and Distal Avulsion of the Biceps Femoris Tendon

    Directory of Open Access Journals (Sweden)

    Takeshi Oshima

    2015-01-01

    Full Text Available A multiple-ligament knee injury that includes posterolateral corner (PLC disruption often causes palsy of the common peroneal nerve (CPN, which occurs in 44% of cases with PLC injury and biceps femoris tendon rupture or avulsion of the fibular head. Approximately half of these cases do not show functional recovery. This case report aims to present a criteria-based approach to the operation and postoperative management of CPN palsy that resulted from a multiple-ligament knee injury in a 22-year-old man that occurred during judo. We performed a two-staged surgery. The first stage was to repair the injuries to the PLC and biceps femoris. The second stage involved anterior cruciate ligament reconstruction. The outcomes were excellent, with a stable knee, excellent range of motion, and improvement in the palsy. The patient was able to return to judo competition 27 weeks after the injury. To the best of our knowledge, this is the first case report describing a return to sports following CPN palsy with multiple-ligament knee injury.

  19. Using chemical-shift MR imaging to quantify fatty degeneration within supraspinatus muscle due to supraspinatus tendon injuries

    Energy Technology Data Exchange (ETDEWEB)

    Gokalp, Gokhan; Yildirim, Nalan; Yazici, Zeynep [Uludag University Medical Faculty, Department of Radiology, Gorukle, Bursa (Turkey); Ercan, Ilker [Uludag University Medical Faculty, Department of Biostatistics, Gorukle, Bursa (Turkey)

    2010-12-15

    The objective of this study was to prospectively quantify the fatty degeneration of supraspinatus (SSP) muscle due to SSP tendon injuries by using chemical-shift magnetic resonance imaging (CS-MRI). Forty-one patients with suspected rotator cuff tear or impingement examined with MR arthrography were included in the study. The following images were obtained after injection of diluted gadolinium chelate into glenohumeral joint: fat-saturated T1-weighted spin echo in the coronal, axial, and sagittal-oblique plane; fat-saturated T2-weighted and intermediate-weighted fast spin-echo in the coronal-oblique plane; and T1-weighted spin echo in the sagittal-oblique plane. CS-MRI was performed in the coronal plane using a double-echo fast low-angle shot (FLASH) sequence. SSP tendon changes were classified as normal, tendinosis, and partial and complete tear according to MR arthrography findings. Fatty degeneration was quantified after measurement of signal intensity values within the region of interest (ROI) placed over SSP muscle. Signal intensity (SI) suppression ratio and SI index were calculated with the values obtained. Degrees of fatty degeneration depicted in normal subjects and subjects with rotator cuff injuries were compared. Median (min:max) was used as descriptive values. SI suppression ratio was -3.5% (-15.5:3.03) in normal subjects, whereas it was -13.5% (-28.55:-6.60), -30.7% (-41.5:-20.35), and -43.75% (-62:-24.90) in tendinosis, partial and complete tears, respectively. SI index was 0.75% (-6:11.5) in normal subjects. It was 10% (4.50:27), 26.5% (19.15:35.5), and 41% (23.9:57) in tendinosis, partial and complete tears, respectively. The increase in degree of fatty degeneration parallels the seriousness of tendon pathology. CS-MRI is a useful method for grading fat accumulation within SSP muscle. (orig.)

  20. Systematics of injuries of the rotator cuff and biceps tendon; Systematik der Verletzungen von Rotatorenmanschette und Bizepssehne

    Energy Technology Data Exchange (ETDEWEB)

    Breitenseher, M.J. [Landesklinikum Horn, Institut fuer Radiologie und interventionelle Radiologie, Horn (Austria); Pones, M.; Breitenseher, J.B. [Medizinische Universitaet Wien, Univ.-Klinik fuer Radiodiagnostik, Wien (Austria)

    2015-03-01

    Injuries of the rotator cuff and the biceps tendon demonstrate different patterns, which can be recognized clinically and radiologically. These patterns are impingement syndrome with additional trauma, isolated trauma of the rotator cuff and shoulder dislocation causing rotator cuff tears. Furthermore, it is clinically crucial to evaluate the extent of a rotator cuff injury. Magnetic resonance imaging (MRI) is the modality of choice to differentiate these patterns. (orig.) [German] Bei der Verletzung von Rotatorenmanschette und Bizepssehne koennen verschiedene Muster klinisch und radiologisch erkannt werden. Diese Muster sind das Impingementsyndrom mit einem zusaetzlichen Trauma, das isolierte Trauma und die Verletzung der Rotatorenmanschette im Rahmen einer Schulterluxation. Darueber hinaus ist die Beurteilung des Ausmasses einer Verletzung von zentraler klinischer Relevanz. Die MRT kann die Differenzierung dieser Muster bestmoeglich durchfuehren. (orig.)

  1. Tendon and ligament imaging

    Science.gov (United States)

    Hodgson, R J; O'Connor, P J; Grainger, A J

    2012-01-01

    MRI and ultrasound are now widely used for the assessment of tendon and ligament abnormalities. Healthy tendons and ligaments contain high levels of collagen with a structured orientation, which gives rise to their characteristic normal imaging appearances as well as causing particular imaging artefacts. Changes to ligaments and tendons as a result of disease and injury can be demonstrated using both ultrasound and MRI. These have been validated against surgical and histological findings. Novel imaging techniques are being developed that may improve the ability of MRI and ultrasound to assess tendon and ligament disease. PMID:22553301

  2. Tendon functional extracellular matrix.

    Science.gov (United States)

    Screen, Hazel R C; Berk, David E; Kadler, Karl E; Ramirez, Francesco; Young, Marian F

    2015-06-01

    This article is one of a series, summarizing views expressed at the Orthopaedic Research Society New Frontiers in Tendon Research Conference. This particular article reviews the three workshops held under the "Functional Extracellular Matrix" stream. The workshops focused on the roles of the tendon extracellular matrix, such as performing the mechanical functions of tendon, creating the local cell environment, and providing cellular cues. Tendon is a complex network of matrix and cells, and its biological functions are influenced by widely varying extrinsic and intrinsic factors such as age, nutrition, exercise levels, and biomechanics. Consequently, tendon adapts dynamically during development, aging, and injury. The workshop discussions identified research directions associated with understanding cell-matrix interactions to be of prime importance for developing novel strategies to target tendon healing or repair. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  3. Human multipotent mesenchymal stem cells improve healing after collagenase tendon injury in the rat

    Czech Academy of Sciences Publication Activity Database

    Machová-Urdzíková, Lucia; Sedláček, R.; Suchý, T.; Amemori, Takashi; Růžička, Jiří; Lesný, P.; Havlas, V.; Syková, Eva; Jendelová, Pavla

    2014-01-01

    Roč. 13, č. 42 (2014) ISSN 1475-925X R&D Projects: GA ČR GAP304/10/0326; GA MŠk(CZ) ED1.1.00/02.0109 Institutional support: RVO:68378041 Keywords : Achilles tendon * mesenchymal stromal cells * osteogenesis Subject RIV: FI - Traumatology, Orthopedics Impact factor: 1.427, year: 2014

  4. The epidemiology of reoperation after flexor pulley reconstruction.

    Science.gov (United States)

    Dy, Christopher J; Lyman, Stephen; Schreiber, Joseph J; Do, Huong T; Daluiski, Aaron

    2013-09-01

    We used a statewide database to determine the incidence of pulley reconstruction and to evaluate the influence of demographics on reoperation. We hypothesized that age, insurance status, and concomitant nerve or tendon procedure would influence the likelihood of reoperation. We used the Statewide Planning and Research Cooperative System ambulatory surgery database from New York, which represents all outpatient surgery in the state. Patients who had flexor pulley reconstruction from 1998 to 2009 were identified using Current Procedural Terminology 4 codes. Subsequent surgery records for these patients were identified through 2010, allowing at least 1 year follow-up. Concomitant nerve procedure and flexor tendon repair/reconstruction were identified. The type and timing of subsequent procedures, including tenolysis and repeat pulley reconstruction, were recorded. Univariate statistics were calculated to compare age, sex, and payer type between patients with and without reoperation. A multivariable, logistic regression model was used to evaluate the association of the demographics with the chances of having reoperation. There were 623 patients who had flexor pulley reconstruction from 1998 to 2009. The incidence of pulley reconstruction was 0.27 per 100,000 persons, with an annual frequency of 52 procedures. There were 39 (6%) reoperations. There was no difference in age, concomitant nerve or tendon repair, or workers' compensation between patients with and without reoperation. Regression modeling showed a higher likelihood among men of having reoperation. Flexor pulley reconstructions are rare. One-quarter of surgeons performed only one flexor pulley reconstruction over a 12-year period. The 6% reoperation rate is similar to our previous findings for flexor tendon repair using similar methodology. Our report provides information that may be useful in counseling patients. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights

  5. Incidence of tendon entrapment and dislocation with calcaneus and pilon fractures on CT examination

    Energy Technology Data Exchange (ETDEWEB)

    Tresley, Jonathan [Jackson Memorial Hospital, Department of Diagnostic Radiology, Miami, FL (United States); University of Wisconsin-Madison, Department of Radiology, Madison, WI (United States); Subhawong, Ty K.; Singer, Adam D.; Clifford, Paul D. [Jackson Memorial Hospital, Department of Diagnostic Radiology, Miami, FL (United States)

    2016-07-15

    To examine the association between tibial pilon and calcaneal fracture classification and tendon entrapment or dislocation. After institutional review board approval, we retrospectively reviewed consecutive CT scans with calcaneal or pilon fractures from 5 years at a level 1 trauma center. We categorized calcaneal fractures according to the Sanders classification, and pilon fractures according to the Ruedi and Allgower and the Arbeitsgemeinschaft fuer Osteosynthesefragen-Orthopaedic Trauma Association (AO-OTA) classifications. Ankle tendons were assessed for dislocation or entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. A total of 312 fractures (91 pilon only, 193 calcaneal only, and 14 ankles with ipsilateral pilon and calcaneal fractures) were identified in 273 patients. Twenty-two pilon, 42 calcaneal, and nine combination fractures were associated with 99 occurrences of tendon entrapment or superior peroneal retinacular injury. Such findings were associated with multiple fractures (p = 0.002). Multifragmentary pilon fractures were associated with posterior tibial and flexor digitorum longus tendon entrapment (p < 0.0001 and p = 0.0003 for Ruedi/Allgower and AO-OTA, respectively), and multifragmentary Sanders type 3 or 4 calcaneal fractures were associated with superior peroneal retinacular injury (p = 0.0473) compared to simple fracture patterns. Thirty-nine percent of tendon entrapments or retinacular injuries were prospectively identified, 85 % by musculoskeletal radiologists (p < 0.0001). Approximately 25 % of calcaneal and pilon fractures were retrospectively identified to contain posteromedial tendon entrapment or superior peroneal retinacular injury. Radiologists should meticulously search for such injuries, particularly when analyzing multifragmentary and multiple fractures. (orig.)

  6. Incidence of tendon entrapment and dislocation with calcaneus and pilon fractures on CT examination

    International Nuclear Information System (INIS)

    Tresley, Jonathan; Subhawong, Ty K.; Singer, Adam D.; Clifford, Paul D.

    2016-01-01

    To examine the association between tibial pilon and calcaneal fracture classification and tendon entrapment or dislocation. After institutional review board approval, we retrospectively reviewed consecutive CT scans with calcaneal or pilon fractures from 5 years at a level 1 trauma center. We categorized calcaneal fractures according to the Sanders classification, and pilon fractures according to the Ruedi and Allgower and the Arbeitsgemeinschaft fuer Osteosynthesefragen-Orthopaedic Trauma Association (AO-OTA) classifications. Ankle tendons were assessed for dislocation or entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. A total of 312 fractures (91 pilon only, 193 calcaneal only, and 14 ankles with ipsilateral pilon and calcaneal fractures) were identified in 273 patients. Twenty-two pilon, 42 calcaneal, and nine combination fractures were associated with 99 occurrences of tendon entrapment or superior peroneal retinacular injury. Such findings were associated with multiple fractures (p = 0.002). Multifragmentary pilon fractures were associated with posterior tibial and flexor digitorum longus tendon entrapment (p < 0.0001 and p = 0.0003 for Ruedi/Allgower and AO-OTA, respectively), and multifragmentary Sanders type 3 or 4 calcaneal fractures were associated with superior peroneal retinacular injury (p = 0.0473) compared to simple fracture patterns. Thirty-nine percent of tendon entrapments or retinacular injuries were prospectively identified, 85 % by musculoskeletal radiologists (p < 0.0001). Approximately 25 % of calcaneal and pilon fractures were retrospectively identified to contain posteromedial tendon entrapment or superior peroneal retinacular injury. Radiologists should meticulously search for such injuries, particularly when analyzing multifragmentary and multiple fractures. (orig.)

  7. Microstructural stress relaxation mechanics in functionally different tendons.

    Science.gov (United States)

    Screen, H R C; Toorani, S; Shelton, J C

    2013-01-01

    Tendons experience widely varying loading conditions in vivo. They may be categorised by their function as either positional tendons, which are used for intricate movements and experience lower stress, or as energy storage tendons which act as highly stressed springs during locomotion. Structural and compositional differences between tendons are thought to enable an optimisation of their properties to suit their functional environment. However, little is known about structure-function relationships in tendon. This study adopts porcine flexor and extensor tendon fascicles as examples of high stress and low stress tendons, comparing their mechanical behaviour at the micro-level in order to understand their stress relaxation response. Stress-relaxation was shown to occur predominantly through sliding between collagen fibres. However, in the more highly stressed flexor tendon fascicles, more fibre reorganisation was evident when the tissue was exposed to low strains. By contrast, the low load extensor tendon fascicles appears to have less capacity for fibre reorganisation or shearing than the energy storage tendon, relying more heavily on fibril level relaxation. The extensor fascicles were also unable to sustain loads without rapid and complete stress relaxation. These findings highlight the need to optimise tendon repair solutions for specific tendons, and match tendon properties when using grafts in tendon repairs. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.

  8. Impact of combinatory growth factor application on rabbit Achilles tendon injury with operative versus conservative treatment: a pilot study.

    Science.gov (United States)

    Konerding, Moritz A; Arlt, Friederike; Wellmann, Axel; Li, Vincent; Li, William

    2010-02-01

    Acute Achilles tendon (AT) rupture is a common injury with a comparatively high complication rate. Presently, surgical treatments compete with nonoperative treatment modalities. The aim of this study was to elucidate the possible beneficial effects of short-term combinatory application of growth factors on tendon healing during operative or conservative treatment. In this controlled laboratory study, the left ATs of 40 adult New Zealand White rabbits were transected and either sutured or treated conservatively. Half of the animals from each treatment modality group repetitively received a mixture of VEGF165, bFGF, and rPDGF which was administered peritendineally. The left legs were immobilized with external fixateurs for 6 weeks. The ATs were harvested 3 months after intervention. Tensile strength tests revealed no significant differences between operative and conservative treatments. Compared to the normal right ATs, 60% of the average breaking strength was reached 3 months after surgery. Growth factor application did not result in significant improvements. Only a tendency towards higher blood vessel densities was noted in the groups treated with the factors. Collagen type I/III ratios also displayed no significant differences. This study indicates that there is no difference in the biomechanical outcome of conservative versus operative AT rupture treatment and only a marginal impact of short-term combinatory growth and angiogenesis factor application.

  9. Macrophage Sub-Populations and the Lipoxin A4 Receptor Implicate Active Inflammation during Equine Tendon Repair

    Science.gov (United States)

    Dakin, Stephanie Georgina; Werling, Dirk; Hibbert, Andrew; Abayasekara, Dilkush Robert Ephrem; Young, Natalie Jayne; Smith, Roger Kenneth Whealands; Dudhia, Jayesh

    2012-01-01

    Macrophages (Mϕ) orchestrate inflammatory and reparatory processes in injured connective tissues but their role during different phases of tendon healing is not known. We investigated the contribution of different Mϕ subsets in an equine model of naturally occurring tendon injury. Post mortem tissues were harvested from normal (uninjured), sub-acute (3–6 weeks post injury) and chronically injured (>3 months post injury) superficial digital flexor tendons. To determine if inflammation was present in injured tendons, Mϕ sub-populations were quantified based on surface antigen expression of CD172a (pan Mϕ), CD14highCD206low (pro-inflammatory M1Mϕ), and CD206high (anti-inflammatory M2Mϕ) to assess potential polarised phenotypes. In addition, the Lipoxin A4 receptor (FPR2/ALX) was used as marker for resolving inflammation. Normal tendons were negative for both Mϕ and FPR2/ALX. In contrast, M1Mϕ predominated in sub-acute injury, whereas a potential phenotype-switch to M2Mϕ polarity was seen in chronic injury. Furthermore, FPR2/ALX expression by tenocytes was significantly upregulated in sub-acute but not chronic injury. Expression of the FPR2/ALX ligand Annexin A1 was also significantly increased in sub-acute and chronic injuries in contrast to low level expression in normal tendons. The combination of reduced FPR2/ALX expression and persistence of the M2Mϕ phenotype in chronic injury suggests a potential mechanism for incomplete resolution of inflammation after tendon injury. To investigate the effect of pro-inflammatory mediators on lipoxin A4 (LXA4) production and FPR2/ALX expression in vitro, normal tendon explants were stimulated with interleukin-1 beta and prostaglandin E2. Stimulation with either mediator induced LXA4 release and maximal upregulation of FPR2/ALX expression after 72 hours. Taken together, our data suggests that although tenocytes are capable of mounting a protective mechanism to counteract inflammatory stimuli, this appears to be of

  10. Macrophage sub-populations and the lipoxin A4 receptor implicate active inflammation during equine tendon repair.

    Directory of Open Access Journals (Sweden)

    Stephanie Georgina Dakin

    Full Text Available Macrophages (Mφ orchestrate inflammatory and reparatory processes in injured connective tissues but their role during different phases of tendon healing is not known. We investigated the contribution of different Mφ subsets in an equine model of naturally occurring tendon injury. Post mortem tissues were harvested from normal (uninjured, sub-acute (3-6 weeks post injury and chronically injured (>3 months post injury superficial digital flexor tendons. To determine if inflammation was present in injured tendons, Mφ sub-populations were quantified based on surface antigen expression of CD172a (pan Mφ, CD14(highCD206(low (pro-inflammatory M1Mφ, and CD206(high (anti-inflammatory M2Mφ to assess potential polarised phenotypes. In addition, the Lipoxin A(4 receptor (FPR2/ALX was used as marker for resolving inflammation. Normal tendons were negative for both Mφ and FPR2/ALX. In contrast, M1Mφ predominated in sub-acute injury, whereas a potential phenotype-switch to M2Mφ polarity was seen in chronic injury. Furthermore, FPR2/ALX expression by tenocytes was significantly upregulated in sub-acute but not chronic injury. Expression of the FPR2/ALX ligand Annexin A1 was also significantly increased in sub-acute and chronic injuries in contrast to low level expression in normal tendons. The combination of reduced FPR2/ALX expression and persistence of the M2Mφ phenotype in chronic injury suggests a potential mechanism for incomplete resolution of inflammation after tendon injury. To investigate the effect of pro-inflammatory mediators on lipoxin A(4 (LXA(4 production and FPR2/ALX expression in vitro, normal tendon explants were stimulated with interleukin-1 beta and prostaglandin E(2. Stimulation with either mediator induced LXA(4 release and maximal upregulation of FPR2/ALX expression after 72 hours. Taken together, our data suggests that although tenocytes are capable of mounting a protective mechanism to counteract inflammatory stimuli, this

  11. Mechanical properties of the human Achilles tendon, in vivo

    DEFF Research Database (Denmark)

    Kongsgaard, M; Nielsen, C H; Hegnsvad, S

    2011-01-01

    Ultrasonography has been widely applied for in vivo measurements of tendon mechanical properties. Assessments of human Achilles tendon mechanical properties have received great interest. Achilles tendon injuries predominantly occur in the tendon region between the Achilles-soleus myotendinous...... Achilles tendon in vivo by the use of ultrasonography and 2) assess the between-day reproducibility of these measurements....

  12. Rerouting extensor pollicis longus tendon transfer.

    Science.gov (United States)

    Colantoni Woodside, Julie; Bindra, Randip R

    2015-04-01

    Following radial nerve palsy, loss of the extensor pollicis longus (EPL), abductor pollicis longus and extensor pollicis brevis tendons results in loss of thumb extension and radial abduction. Multiple tendon transfers are described to address the loss of thumb extension following radial palsy utilizing the palmaris longus or flexor digitorum sublimis transferred to the EPL tendon. Owing to its ulnar vector of pull, the EPL tendon is a secondary adductor of the thumb, and in order to mitigate the tendency for thumb adduction, the EPL tendon is divided at the wrist and brought subcutaneously to the radial side of the wrist for repair to the donor tendon to improve the line of pull for the donor tendon. We describe the use of a technique to reroute the EPL tendon through the first compartment in a retrograde fashion prior to repair with the donor tendon on the radial side of the wrist. The use of the first dorsal compartment provides a pulley to maintain the position of the transfer and to prevent potential bowstringing of the tendon as wrist flexion and thumb extension are attempted. because the repair is performed proximal to the extensor retinaculum, the donor tendon length is not compromised. Because the tendon is redirected through the first dorsal compartment and inserts into the distal phalanx, a single transfer attempts to restores both thumb extension and radial abduction. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  13. Flexor accessorius longus: A rare variation of the deep extrinsic digital flexors of the leg and its phylogenetic significance

    Directory of Open Access Journals (Sweden)

    Jaijesh P

    2006-01-01

    Full Text Available Anomalies of the calf muscles are rare. One such anomalous muscle, known as the Muscle Flexor accessorius longus (also named accessorius ad accessorium, accessorius secondus, accessory flexor digitorum longus or pronator pedis is of morphological significance. When present, this originates in the deep fascia of the tibia or fibula and inserts in the foot either into the flexor digitorum accessorius or into the tendons of the flexor digitorum longus. In this report we present a discussion of the morphological significance and phylogenetic history of one such muscle observed. In this case report we describe an anomalous calf muscle which extends from the popliteal region, runs along the posterior compartment of the leg, reaches the sole and is inserted to the flexor digitorum longus muscle. This kind of muscle variations are considered to be the higher origin of the flexor digitorum accessorius muscle of the sole. Here we discuss the phylogenetic history of this muscle as this muscle variant is present in some primitive mammals, absent in apes and in this particular case appeared as one of the muscles of the flexor compartment of the leg.

  14. Transosseous-Equivalent Repair for Distal Patellar Tendon Avulsion

    OpenAIRE

    Galos, David K.; Konda, Sanjit R.; Kaplan, Daniel J.; Ryan, William E.; Alaia, Michael J.

    2016-01-01

    Extensor mechanism disruptions are relatively uncommon injuries involving injury to the quadriceps tendon, patella, or patellar tendon. Patellar tendon avulsions from the tibial tubercle in adults are rare; as such, little technical information has been written regarding surgical management of this injury in the adult. Transosseous-equivalent repairs have been described in the management of several types of tendon ruptures, including rotator cuff and distal triceps tendon ruptures, but not pr...

  15. Changes in hip joint muscle-tendon lengths with mode of locomotion.

    Science.gov (United States)

    Riley, Patrick O; Franz, Jason; Dicharry, Jay; Kerrigan, D Casey

    2010-02-01

    We have reported that peak hip extension is nearly identical in walking and running, suggesting that anatomical constraints, such as flexor muscle tightness may limit the range of hip extension. To obtain a more mechanistic insight into mobility at the hip and pelvis we examined the lengths of the muscle-tendons units crossing the hip joint. Data defining the three-dimensional kinematics of 26 healthy runners at self-selected walking and running speeds were obtained. These data were used to scale and drive musculoskeletal models using OpenSIM. Muscle-tendon unit (MTU) lengths were calculated for the trailing limb illiacus, rectus femoris, gluteus maximus, and biceps femoris long head and the advancing limb biceps femoris and gluteus maximus. The magnitude and timing of MTU length peaks were each compared between walking and running. The peak length of the right (trailing limb) illiacus MTU, a pure hip flexor, was nearly identical between walking and running, while the maximum length of the rectus femoris MTU, a hip flexor and knee extensor, increased during running. The maximum length of the left (leading limb) biceps femoris was also unchanged between walking and running. Further, the timing of peak illiacus MTU length and peak contralateral biceps femoris MTU length occurred essentially simultaneously during running, at a time during gait when the hamstrings are most vulnerable to stretch injury. This latter finding suggests exploring the role for hip flexor stretching in combination with hamstring stretching to treat and/or prevent running related hamstring injury. Copyright 2009 Elsevier B.V. All rights reserved.

  16. [Experimental study of allogenic tendon with sheath grafting in chicken].

    Science.gov (United States)

    Zhang, Y L; Wang, S L; Gao, X S

    2001-03-01

    To investigate availability of deep freeze stored allogenic tendon with sheath grafting in repairing the tendon and sheath defect in the II area of flexor digitorum tendon. Sixty chickens with tendon and sheath defect were divided into 2 groups randomly, group A was treated with allogenic grafting and group B was treated with autogenic grafting, these two groups were divided into two subgroups respectively, they were, group A1 allogenic tendon with whole sheath grafting, group A2 allogenic tendon with partial sheath grafting, group B1 autogenic tendon with whole sheath grafting and group B2 autogenic tendon with whole sheath grafting. All the allogenic grafts were treated by deep freeze. Histomorphological study, histoimmunological study and slipping function of the grafts were measured after operation. In group A1 and B1, the local reaction was sever, the nutrition of tendon graft was barricaded by the whole sheath resulting in adhesion, degeneration and necrosis. In group A2 and B2, the tendon graft healed well and little adhesion existed between tendon and sheath. The results showed that there were significant differences between tendon grafting with whole sheath and tendon grafting with partial sheath. Deep freeze store can reduce the immunogenicity of allogenic tendon with sheath. Allogenic tendon with partial sheath grafting can be used as a new biological material for repairing the tendon and sheath defect.

  17. Localized type Volkmann's contracture treated with tendon transfer and tension-reduced early mobilization

    Science.gov (United States)

    Kaji, Yoshio; Nakamura, Osamu; Yamaguchi, Konosuke; Tobiume, Sachiko; Yamamoto, Tetsuji

    2017-01-01

    Abstract Rationale: For localized type Volkmann's contracture, in which degeneration of the flexor digitorum profundus (FDP) muscle to one or two fingers and restriction of finger extension occur, dissection or excision of the affected muscle is usually recommended. However, these surgical procedures need relatively wide exposure of the muscle, because the FDP muscle is in the deep portion of the forearm. Patient concerns: In this report, the case of a 35-year-old woman with localized type Volkmann's contracture is presented. Her left forearm had been compressed with an industrial roller 4 months earlier, and severe flexion contracture of the long finger and mild flexion contracture of the ring finger developed gradually. Diagnoses: localized type Volkmann's contracture. Intervention: Five months after the injury, transection of the FDP tendon to the long finger and transfer of the transected tendon to the FDP tendon to the index finger was performed after adjusting the tonus of these two tendons using a small skin incision. This procedure was followed by a tension-reduced early mobilization technique in which a tension-reduced position of the tendon suture site was maintained by taping the long finger to the volar side of the index finger, and then immediate active range of motion (ROM) exercise was started. Outcomes: Within 9 weeks after surgery, full ROM had been regained. Lessons: Using the treatment procedure presented in this case report, a good clinical result was obtained in a minimally invasive manner. PMID:28072735

  18. Tendon balancing in hallux valgus surgery.

    Science.gov (United States)

    Van Elst, C; Van Riet, A; Vandeputte, G

    2016-09-01

    Recurrent valgus of the hallux after hallux valgus surgery is an unpleasant complication. A possible cause is the imbalance and maltracking of particularly the extensor hallucis longus (EHL) and less frequently the flexor hallucis longus (FHL) or extensor hallucis brevis (EHB) tendon of the hallux. In patients with a tight achilles tendon, the EHL tendon can be recruited to aid dorsiflexion of the foot, creating imbalance. The literature on this subject is very scarce. In 10 patients with severe hallux valgus, a perioperative evaluation after performing the osteotomies and capsular closure showed tight extensor or flexor tendons of the hallux with residual valgus maltracking. A balancing of the tendons was performed with a -realignment -lengthening procedure. A good clinical result was obtained in all patients. No adverse effects were seen after tendon balancing. Strength in all tendons was at least 3+, except in one patient with multiple sclerosis. No weaknesses or -difficulties during walking were reported. Tendon balancing could play a role in prevention of hallux valgus recurrences and can be performed without loss of strength or compromising of walking ability.

  19. Tendon Transfers for Tetraplegia.

    Science.gov (United States)

    Bednar, Michael S

    2016-08-01

    It is estimated that 65% to 75% of patients with cervical spinal cord injuries could benefit from upper extremity tendon transfer surgery. The goals of surgery are to restore elbow extension, as well as hand pinch, grasp, and release. Patients who have defined goals, actively participate in therapy, and understand expected outcomes, appear to have the highest satisfaction following tendon transfer procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Distal biceps tendon rupture.

    Science.gov (United States)

    Savvidou, Olga D; Papagelopoulos, Panayiotis J; Mavrogenis, Andreas F; Partsinevelos, Antonios A; Karadimas, Evangelos J; Korres, Demetrios S

    2004-09-01

    The authors report a rupture of the distal tendon of biceps brachii in a 42-year-old athlete. Magnetic resonance imaging confirmed the injury. Early surgical repair was performed by reinsertion of the tendon on the radial tuberosity according to modified Boyd-Anderson technique. Indomethacin was administered prophylactically. No complications were noted. At the latest follow-up, the patient had full elbow range of motion and participated successfully in athletic activities and job.

  1. Brachial biceps tendon injuries in young female high-level tennis players.

    Science.gov (United States)

    Tsur, A; Gillson, S

    2000-06-01

    To evaluate brachial biceps tendon lesions in four young female tennis players who complained about anterior shoulder pain on their dominant side. Medical and sport's activity history, palpation of the painful zone, Ghilchrist (palm-up) test, and brachial biceps contraction against resistance were performed. The two girls who suffered from mild tenderness in the bicipital groove and over the anterior aspect of the upper arm and the shoulder joint, had tendinitis of the long biceps head. The two girls who suffered from severe tenderness just under the groove, had a partial tear in the long head of the biceps. Ghilchrist test was positive in all girls. Tennis players can have shoulder pain without clear history of trauma. Pain occurred probably as a result of technical errors or use of inadequate equipment.

  2. Achilles tendon Total Rupture Score at 3 months can predict patients' ability to return to sport 1 year after injury

    DEFF Research Database (Denmark)

    Hansen, Maria Swennergren; Christensen, Marianne; Budolfsen, T

    2016-01-01

    PURPOSE: To investigate how the Achilles tendon Total Rupture Score (ATRS) at 3 months and 1 year after injury is associated with a patient's ability to return to work and sports as well as to investigate whether sex and age influence ATRS after 3 months and 1 year. METHOD: This is a retrospective...... study analysing the data from the Danish Achilles tendon Database. A total of 366 patients were included. Logistic regression was conducted to describe the effect of ATRS on return to work and sports. The effect of age and sex on ATRS was analysed by linear regression. RESULTS: Three months after injury...... patients had a significantly increased chance of return to sport after 1 year with an increased ATRS (OR 1.06, p = 0.001) but a non-significant effect on return to work. After 1 year, patients had a significantly increased probability of having returned to sport (OR 1.11, p

  3. Comparative anatomy of rabbit and human achilles tendons with magnetic resonance and ultrasound imaging.

    Science.gov (United States)

    Doherty, Geoffrey P; Koike, Yoichi; Uhthoff, Hans K; Lecompte, Martin; Trudel, Guy

    2006-02-01

    We sought to describe the comparative anatomy of the Achilles tendon in rabbits and humans by using macroscopic observation, magnetic resonance imaging, and ultrasonography. The calcaneus-Achilles tendon-gastrocnemius-soleus complexes from 18 New Zealand white rabbits underwent ultrasound (US) and magnetic resonance (MR) imaging and gross anatomic sectioning; these results were compared with those from a cadaveric gastrocnemius-soleus-Achilles tendon-calcaneus specimen from a 68-y-old human male. The medial and lateral gastrocnemius muscle tendons merged 5.2 +/- 0.6 mm proximal to the calcaneal insertion macroscopically, at 93% of their course, different from the gastrocnemius human tendons, which merged at 23% of their overall course. The rabbit flexor digitorum superficialis tendon, corresponding to the flexor digitorum longus tendon in human and comparable in size with the gastrocnemius tendons, was located medial and anterior to the medial gastrocnemius tendon proximally and rotated dorsally and laterally to run posterior to the Achilles tendon-calcaneus insertion. In humans, the flexor digitorum longus tendon tracks posteriorly to the medial malleolus. The soleus muscle and tendon are negligible in the rabbit; these particular comparative anatomic features in the rabbit were confirmed on the MR images. Therefore the rabbit Achilles tendon shows distinctive gross anatomical and MR imaging features that must be considered when using the rabbit as a research model, especially for mechanical testing, or when generalizing results from rabbits to humans.

  4. Reconstrução do LCA com o uso dos tendões dos músculos flexores mediais do joelho e fixação femoral com o sistema de Rigidifix®: relato preliminar Anterior cruciate ligament reconstruction using double hamstrings tendon graft and the femoral fixation by Rigidifix®: preliminary Study

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Cury Faustino

    2004-12-01

    Full Text Available O autor descreve a técnica de reconstrução do LCA no tratamento das instabilidades anterior do joelho, utilizando os tendões dos músculos flexores mediais do joelho (semitendíneo e grácil, fixados no fêmur pelo sistema de Rigidfix®; e na tíbia, com parafuso de interferência absorvível, através de um estudo preliminar de 54 joelhos operados. Na avaliação final pela escala de Lysholm os pacientes evoluíram de 46 pontos no pré-operatório para 92 pontos no pós-operatório.The author describes the reconstruction technique of the anterior cruciate ligament reconstruction using the hamstrings tendon (semitendinosus and gracilis in the management of anterior instabilities of the knee joint. Rigidfix® system is used to fix the graft on the femur and an absorbable interference screw was used for tibial fixation in a preliminary study in 54 knees. The final evaluation based on Lysholm score showed an improvement from 46 (preoperative to 92 (postoperative.

  5. Converting round tendons to flat tendon constructs: Does the preparation process have an influence on the structural properties?

    Science.gov (United States)

    Domnick, C; Herbort, M; Raschke, M J; Schliemann, B; Siebold, R; Śmigielski, R; Fink, C

    2017-05-01

    The structural properties of hamstring tendon grafts were evaluated in a porcine model, after processing it to a flat shape, to better replace or augment anatomic flat structures (e.g. ACL, MPFL or MCL). In this biomechanical study, porcine flexor tendons were used which have a comparable shape to semitendinosus and gracilis tendons. One part of the tendon was prepared to a flat tendon construct by splitting the tendon longitudinally with a knife to half of the diameter of the tendon. The semi-split tendon was scratched out to a flat shape. The other matched part was tested in its original round shape. The tendons (n = 40) have been fixed in a uniaxial testing machine (Zwick/Roell) by cryo-clamps after preparing the fixed ends by 2-0 polyester sutures (2-0 Ethibond ® EXCEL, Ethicon, Somerville, NJ). In every specimen, there was a free 60-mm tendon part between both clamps. The tendons have been loaded to failure to evaluate typical biomechanical parameters such as stiffness, yield load and maximum load. No statistically significant differences (n.s.) regarding stiffness, yield load and maximum load between natively round and processed flat tendons could be detected. A prepared flat-shaped tendon does not show any different structural properties compared with an original round tendon. Therefore, a flat tendon seems to be a biomechanical stable graft option for anatomic reconstruction or augmentation of injured natively flat-shaped structures such as MCL, MPFL or ACL.

  6. Modified Pectoralis Major Tendon Transfer for Reanimation of Elbow Flexion as a Salvage Procedure in Complete Brachial Plexus Injury: A Case Report

    Directory of Open Access Journals (Sweden)

    S Taran

    2013-03-01

    Full Text Available Traumatic brachial plexus injuries rarely recover spontaneously and if the window period for neurotisation has elapsed, the only option for restoration of function lies in a salvage procedure. Many such salvage procedures have been described in the literature with variable functional results. We report the case of a 16-year-old boy who presented after unsuccessful treatment for a complete brachial plexus injury; we performed a pectoralis major tendon transfer to attain elbow flexion. Postoperatively, the elbow was splinted with flexion at 100°. After 4 weeks of immobilization the splint was removed and the patient could actively flex his elbow from 30° to 100°.

  7. Expression of Bone Morphogenetic Protein-2 in the Chondrogenic and Ossifying Sites of Calcific Tendinopathy and Traumatic Tendon Injury Rat Models

    Directory of Open Access Journals (Sweden)

    Chan Lai

    2009-07-01

    Full Text Available Abstract Background Ectopic chondrogenesis and ossification were observed in a degenerative collagenase-induced calcific tendinopathy model and to a lesser extent, in a patellar tendon traumatic injury model. We hypothesized that expression of bone morphogenetic protein-2 (BMP-2 contributed to ectopic chondrogenesis and ossification. This study aimed to study the spatial and temporal expression of BMP-2 in our animal models. Methods Seventy-two rats were used, with 36 rats each subjected to central one-third patellar tendon window injury (C1/3 group and collagenase-induced tendon injury (CI group, respectively. The contralateral limb served as controls. At week 2, 4 and 12, 12 rats in each group were sacrificed for immunohistochemistry and RT-PCR of BMP-2. Results For CI group, weak signal was observed at the tendon matrix at week 2. At week 4, matrix around chondrocyte-like cells was also stained in some samples. In one sample, calcification was observed and the BMP-2 signal was observed both in the calcific matrix and the embedded chondrocyte-like cells. At week 12, the staining was observed mainly in the calcific matrix. Similar result was observed in C1/3 group though the immunopositive staining of BMP-2 was generally weaker. There was significant increase in BMP-2 mRNA compared to that in the contralateral side at week 2 and the level became insignificantly different at week 12 in CI group. No significant increase in BMP-2 mRNA was observed in C1/3 group at all time points. Conclusion Ectopic expression of BMP-2 might induce tissue transformation into ectopic bone/cartilage and promoted structural degeneration in calcific tendinopathy.

  8. Tendon healing in vivo. An experimental model.

    Science.gov (United States)

    Abrahamsson, S O; Lundborg, G; Lohmander, L S

    1989-01-01

    Flexor tendon segments were incubated in a diffusion chamber in the subcutis of rabbits. Tendons incubated up to 6 weeks in the diffusion chamber showed proliferating and migrating cells from the epitenon cell layer as well as viable endotenon cells. Explants frozen in liquid nitrogen prior to incubation showed no signs of extrinsic cell contamination and remained non-viable indicating that no cell penetration occurred through the Millipore filter and that cell division seen in non-frozen and incubated tendons was an expression of intrinsic cellular proliferative capacity of the tendon. In tendon segments incubated in chambers for three weeks, collagen synthesis was reduced by 50% and the rate of cell proliferation measured as 3H-thymidine incorporation, was 15 times that of native tendons. Frozen and incubated tendons showed only traces of remaining matrix synthesis or cell proliferation. With this experimental model we have histologically and biochemically shown that tendons may survive and heal while the nutrition exclusively could be based on diffusion and the tendons have an intrinsic capacity of healing. The described model enables further studies on tendon healing and its regulation.

  9. Three-dimensional muscle-tendon geometry after rectus femoris tendon transfer.

    Science.gov (United States)

    Asakawa, Deanna S; Blemker, Silvia S; Rab, George T; Bagley, Anita; Delp, Scott L

    2004-02-01

    Rectus femoris tendon transfer is performed in patients with cerebral palsy to improve knee flexion during walking. This procedure involves detachment of the muscle from its insertion into the quadriceps tendon and reattachment to one of the knee flexor muscles. The purpose of the present study was to evaluate the muscle-tendon geometry and to assess the formation of scar tissue between the rectus femoris and adjacent structures. Magnetic resonance images of the lower extremities were acquired from five subjects after bilateral rectus femoris tendon transfer. A three-dimensional computer model of the musculoskeletal geometry of each of the ten limbs was created from these images. The three-dimensional paths of the rectus femoris muscles after transfer demonstrated that the muscle does not follow a straight course from its origin to its new insertion. The typical muscle-tendon path included an angular deviation; this deviation was sharp (>35 degrees ) in seven extremities. In addition, scar tissue between the transferred rectus femoris and the underlying muscles was visible on the magnetic resonance images. The angular deviations in the rectus femoris muscle-tendon path and the presence of scar tissue between the rectus femoris and the underlying muscles suggest that the beneficial effects of rectus femoris tendon transfer are derived from reducing the effects of the rectus femoris muscle as a knee extensor rather than from converting the muscle to a knee flexor. These findings clarify our understanding of the mechanism by which rectus femoris tendon transfer improves knee flexion.

  10. Clinical follow-up of horses treated with allogeneic equine mesenchymal stem cells derived from umbilical cord blood for different tendon and ligament disorders.

    Science.gov (United States)

    Van Loon, Vic J F; Scheffer, Carmen J W; Genn, Herman J; Hoogendoorn, Arie C; Greve, Jan W

    2014-01-01

    Mesenchymal stem cells (MSCs) offer promise as therapeutic aids in the repair of tendon and ligament disorders in sport horses. Equine allogeneic MSCs derived from umbilical cord blood (eUCB-MSCs) can be obtained in a minimally invasive fashion with successful propagation of MSCs. The objective of this study was to determine the applicability and therapeutic effect of eUCB-MSCs on tendinitis of the superficial digital flexor tendon, desmitis of the suspensory ligament, tendinitis of the deep digital flexor tendon, and desmitis of the inferior check ligament in clinical cases. A retrospective clinical study was performed. At two equine clinics, 52 warmblood horses were treated with cultured eUCB-MSCs between 2009 and 2012. About 2-10 × 10(6) cells per lesion were administered. When a lesion was treated twice, the total amount could run up to 20 × 10(6) cells. Pearson's chi-squared test was used to compare the effect of the injured structure on the success rate, as well as the effect of the age of the horse. Based on repeated examinations, 40 horses (77%) returned to work on the same or a higher level based on information provided by the owner. Neither the injured structure nor the age of the horse had a statistically significant influence on the result. Overall, the results of treatment of some tendon and ligament injuries with eUCB-MSCs in clinical cases are promising.

  11. THE EFFECTS OF AN EARLY RETURN TO TRAINING ON THE BONE-TENDON JUNCTION POST-ACUTE MICRO-INJURY HEALING

    Directory of Open Access Journals (Sweden)

    Lin Wang

    2012-06-01

    Full Text Available Bone-tendon junction (BTJ overuse injuries are common athletic and occupational problems. BTJ injuries may sometimes be caused by resuming training too early after injury. To study the effects of post-injury resuming training within 48 hours on the acute injury healing process, as it is often the case for athletes. Twelve mature female rabbits were assigned to one of the following groups: acute injury (AI, n = 6, post-injury early return to training (PIERT, n = 6 and normal control (CON, n = 6. Tissue specimens were harvested at week 4. The radiological and histological characteristics of the AI and PIERT groups were compared among the groups. The trabecular thickness of the PIERT group was significantly different from those of the AI and CON group. A histological evaluation revealed poor collagen fibre alignment, extensive scar tissue and lowered cell density in the AI and PIERT groups compared with the CON group, but no significant differences were observed between the AI group and the PIERT group. The fibrocartilage zone and proteoglycan area in the PIERT group were significantly different from those in AI group. No differences were observed in the Total VOI volume (TV, Object volume (OBV, Percent object volume (BV/TV and trabecular number (Tb.N among the AI, PIERT and CON groups. In conclusion, a repeatable animal model of bone-tendon junction acute micro-damage by puncture was established. Resuming training in 48 hours did not significantly deteriorate the BTJ injury healing, but improved bone remodelling and increased fibrocartilage zone thickness

  12. Comparative Gene Approach to the Investigation of SNPs within the Tenascin-C Gene in Achilles Tendon Injury in the Canine Patient

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    Nina R Kieves

    2016-08-01

    Full Text Available Objective: To evaluate for single nucleotide polymorphisms (SNPs within the tenascin-C (TNC gene in a population of dogs with atraumatic Achilles tendon rupture.Background: In humans, Achilles tendinopathy has been extensively studied for numerous polymorphisms within several genes and has been associated with polymorphisms in collagen (COL5A1 and the TNC genes.Evidentiary value: This study serves as a starting point for evaluating a genetic component of Achilles tendinopathy in the dog.Methods: Whole blood from twenty dogs with atraumatic Achilles tendon rupture and 14 matched control samples were used. DNA was extracted from whole blood run with primers designed around two SNPs previously identified to be related to Achilles tendinopathy in humans. One SNP was located in exon 29, and one exon 17 of the canine TNC gene. Polymerase chain reaction (PCR was run on the samples and they were sequenced. Sequences of the affected canine population were compared to the control sample sequences.Results: There were no significant differences in genotype or allele frequency of the SNPs rs13321 and rs2104772 between any of the affected and control subjects with a p-value of 1.0.Conclusion: This study evaluated a population of canines with atraumatic Achilles tendon rupture for SNPs in the TNC gene. We found no difference in gene sequence for the study population compared to age, sex, and breed matched controls.Application: Though the data from this study did not show a correlation between the specific polymorphisms investigated, it is possible that other SNPs within the TNC gene or other genes involved in tendon composition and repair such as collagen may be associated with atraumatic Achilles tendon injury in the dog. 

  13. Venous thromboembolism rates in patients with lower limb immobilization after Achilles tendon injury are unchanged after the introduction of prophylactic aspirin: audit.

    Science.gov (United States)

    Braithwaite, I; Dunbar, L; Eathorne, A; Weatherall, M; Beasley, R

    2016-02-01

    ESSENTIALS: We audited venous thromboembolism (VTE) in Achilles injuries after the use of prophylactic aspirin. We audited 218 patients with Achilles injury requiring lower limb immobilization for ≥ 1 week. Fourteen patients (6.4%, 95% CI 3.6% to 10.5%) developed symptomatic and confirmed VTE. The incidence was similar to the 6.3% identified in the same patient group prior to the use of aspirin. We report a follow-up audit of the incidence of venous thromboembolism (VTE) in patients requiring lower limb immobilization because of Achilles tendon injury, since the introduction of a policy to routinely prescribe 100 mg of aspirin daily. We studied 218 patients aged 18-65 years who attended the Orthopaedic Assessment Unit at Wellington Hospital between January 2013 and December 2014 with Achilles tendon injury requiring lower limb immobilization for ≥ 1 week. Information on assessment of VTE risk, prescription of aspirin and symptomatic VTE occurring within 70 days of immobilization was obtained and compared with the same information collected with the same method in the same patient group between January 2006 and December 2007, before the policy to routinely prescribe aspirin was introduced. A total of 189 of 218 (93%) patients were prescribed aspirin, as compared with 0.5% previously. Fourteen patients (6.4%, 95% confidence interval 3.6-10.5%) developed symptomatic radiologically confirmed VTE (10 distal deep vein thromboses [DVTs], two proximal DVTs, one pulmonary embolism [PE], and one PE with distal DVT). Aspirin was prescribed to all patients who subsequently developed a VTE; in one of 14, a recognized risk factor was documented. The VTE incidence was similar to the 6.3% identified in the previous audit. Lower limb immobilization following Achilles tendon injury confers a high risk of VTE even with aspirin prophylaxis. Consideration should be given to prophylaxis with low molecular weight heparin during lower limb immobilization following Achilles tendon

  14. Tendon and Ligament Regeneration and Repair: Clinical Relevance and Developmental Paradigm

    Science.gov (United States)

    Tuan, Rocky S.

    2014-01-01

    Tendon and ligament (T/L) are dense connective tissues connecting bone to muscle and bone to bone, respectively. Similar to other musculoskeletal tissues, T/L arise from the somitic mesoderm, but they are derived from a recently discovered somitic compartment, the syndetome. The adjacent sclerotome and myotome provide inductive signals to the interposing syndetome, thereby upregulating the expression of the transcription factor Scleraxis, which in turn leads to further tenogenic and ligamentogenic differentiation. These advances in the understanding of T/L development have been sought to provide a knowledge base for improving the healing of T/L injuries, a common clinical challenge due to the intrinsically poor natural healing response. Specifically, the three most common tendon injuries involve tearing of the rotator cuff of the shoulder, the flexor tendon of the hand, and the Achilles tendon. At present, injuries to these tissues are treated by surgical repair and/or conservative approaches, including biophysical modalities such as physical rehabilitation and cryotherapy. Unfortunately, the healing tissue forms fibrovascular scar and possesses inferior mechanical and biochemical properties as compared to native T/L. Therefore, tissue engineers have sought to improve upon the natural healing response by augmenting the injured tissue with cells, scaffolds, bioactive agents, and mechanical stimulation. These strategies show promise, both in vitro and in vivo, for improving T/L healing. However, several challenges remain in restoring full T/L function following injury, including uncertainties over the optimal combination of these biological agents as well how to best deliver tissue engineered elements to the injury site. A greater understanding of the molecular mechanisms involved in T/L development and natural healing, coupled with the capability of producing complex biomaterials to deliver multiple growth factors with high spatiotemporal resolution and specificity

  15. [Evaluation of early physiotherapy in patients after surgical treatment of cruciate ligament injury by bone-tendon-bone method].

    Science.gov (United States)

    Klupiński, Kamil; Krekora, Katarzyna; Woldańska-Okońska, Marta

    2014-01-01

    Anterior cruciate ligament (ACL) is one of the most important structures of the knee joint. It has a stabilizing function and causes sliding movement between the articular surfaces. Most frequently there comes to the anterior cruciate ligament injury during practicing sports such as skiing, football, sports which require sudden turns and those which are associated with jumps for height like basketball and volleyball. The aim of study was to evaluate of the outcomes of complex physiotherapy after reconstruction of anterior cruciate ligament by bone -tendon-bone (BTB) method. The study involved 41 patients, 8 women and 33 men, aged 20 to 45 years, body height 1.60-1.90 cm and body weight 50-100 kg. The patients were divided into two groups. Group I included 26 patients (3 women and 23 men) after arthroscopic ACL reconstruction. Group II--control-group included 15 patients (5 women and 10 men) after ACL injury but not subjected to the ligament reconstruction. The patients from both groups underwent rehabilitation according to the same rehabilitation program suggested by the Medical Magnus Clinic in Lodz, which consisted in performing daily exercises in open and closed kinetic chains. All group I and II patients were examined three times: after surgery (before the start of the rehabilitation), in the sixth week of rehabilitation and 12 weeks afterwards. The clinical examination included: measurement of the range of movement in the knee joint, the measurement of musculoskeletal strength with Lovett scale, knee pain assessment using Visual Analog Scale (VAS), transpatellar anthropometric measurement of the knee joint, linear measurements of the thigh and shin (at two points: 5 and 10 cm above the patellar apex and at two points: 5 and 10 cm below the patellar base). Introduction of early highly specialized physiotherapy has been demonstrated to contribute to the improvement of the rehabilitation outcomes and to the shortening of the therapy. A statistically significant

  16. Proximal tendon-prosthesis junction for active tendon implants of the hand: a biomechanical comparison of 2 techniques.

    Science.gov (United States)

    Thompson, Matthew J; Owen, John R; McDowell, Charles L; Wayne, Jennifer S

    2015-01-01

    To study the biomechanical characteristics (percent stretch, stiffness, and ultimate load) of 2 tendon-prosthesis techniques used to connect the proximal tendon stump to silicone active tendon implants used in reconstruction of flexor tendons. We evaluated percent stretch following cyclic loading and at failure, stiffness during load to failure, and ultimate load of 16 tendon-prosthesis junctions using cadaveric canine flexor digitorum profundus tendons to re-create 2 junction techniques: the tendon loop (TL) and the polyester weave (PW). The TL junction showed greater percent stretch at a static load of 2 N, following 500 cycles of loading between 2 N and 50 N, and at peak load. The PW junction displayed greater stiffness from 50 to 150 N during load to failure. Both junctions failed at a mean ultimate load greater than 220 N. The described proximal junction techniques for active tendon implants were strong enough to resist early active motion in the immediate postoperative period without significant elongation. The PW technique displayed greater stiffness and ultimate load compared with the TL. Data on tendon-prosthesis characteristics of these 2 methods may aid the surgeon in choosing which junction technique to use, during surgical tensioning decisions, and in considering activity protocols after surgery. These data may also serve as a baseline for further investigations regarding active tendon implants. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  17. The Effect of Sodium Hyaluronate on Ligamentation and Biomechanical Property of Tendon in Repair of Achilles Tendon Defect with Polyethylene Terephthalate Artificial Ligament: A Rabbit Tendon Repair Model

    OpenAIRE

    Li, Shengkun; Ma, Kui; Li, Hong; Jiang, Jia; Chen, Shiyi

    2016-01-01

    The Achilles tendon is the most common ruptured tendon of human body. Reconstruction with polyethylene terephthalate (PET) artificial ligament is recommended in some serious cases. Sodium hyaluronate (HA) is beneficial for the healing of tendon injuries. We aimed to determine the effect of sodium hyaluronate in repair of Achilles tendon defect with PET artificial ligament in an animal tendon repair model. Sixteen New Zealand White rabbits were divided into two groups. Eight rabbits repaired w...

  18. Desequilíbrios musculares entre flexores dorsais e plantares do tornozelo após tratamento conservador e acelerado da ruptura do tendão calcâneo Muscle imbalance between ankle dorsiflexors and plantarflexors after conservative and accelerated treatment of Achilles tendon rupture

    Directory of Open Access Journals (Sweden)

    Alexandre Mayer

    2010-06-01

    Full Text Available A ruptura do tendão calcâneo (TC reduz a sobrecarga mecânica dos flexores plantares (FP do tornozelo. Essa alteração muda o equilíbrio natural entre os FP e flexores dorsais (FD do tornozelo. O objetivo do estudo foi avaliar as razões isocinéticas concêntricas convencionais de torque de pacientes submetidos a tratamento cirúrgico de ruptura aguda do TC após dois protocolos diferentes de reabilitação. Após procedimento cirúrgico para reconstrução do TC, a amostra foi dividida de forma intencional em dois grupos: conservador (GC, 11 homens, 41,3±7,9 anos e grupo acelerado (GA, 13 homens, 43,5±13,7 anos. O GC permaneceu com imobilização gessada no tornozelo por seis semanas (tratamento tradicional, enquanto o GA usou uma órtese robofoot em posição neutra e, após duas semanas, iniciou mobilização e apoio precoce do tornozelo, com reabilitação por seis semanas. Após 3 meses de pós-operatório, a razão do torque concêntrico máximo dos FD pelos FP do tornozelo foi avaliada por dinamômetro isocinético. As razões de torque do lado operado se mantiveram superiores às do lado saudável mesmo após 3 meses de pós-operatório (pAchilles tendon rupture reduces ankle plantarflexor (PF muscles mechanical overload. This change in the ankle joint mechanics changes the natural muscle balance between dorsiflexor (DF and PF muscles. The purpose of this study was to assess such imbalance by concentric conventional isokinetic torque ratios of patients who underwent different rehabilitation protocols after surgical repair of the Achilles tendon. After surgery, subjects were assigned to either a conservative or to an accelerated rehabilitation group. The conservative group (11 men, 41.3±7.9 years old remained with a plaster cast for 6 weeks after surgery. The accelerated group (13 men, 43.5±13,7 years old used a"robofoot" cast for 2 weeks and underwent ankle mobilization and early weight bearing for a period of 6 weeks post

  19. Transcription factor EGR1 directs tendon differentiation and promotes tendon repair

    Science.gov (United States)

    Guerquin, Marie-Justine; Charvet, Benjamin; Nourissat, Geoffroy; Havis, Emmanuelle; Ronsin, Olivier; Bonnin, Marie-Ange; Ruggiu, Mathilde; Olivera-Martinez, Isabel; Robert, Nicolas; Lu, Yinhui; Kadler, Karl E.; Baumberger, Tristan; Doursounian, Levon; Berenbaum, Francis; Duprez, Delphine

    2013-01-01

    Tendon formation and repair rely on specific combinations of transcription factors, growth factors, and mechanical parameters that regulate the production and spatial organization of type I collagen. Here, we investigated the function of the zinc finger transcription factor EGR1 in tendon formation, healing, and repair using rodent animal models and mesenchymal stem cells (MSCs). Adult tendons of Egr1–/– mice displayed a deficiency in the expression of tendon genes, including Scx, Col1a1, and Col1a2, and were mechanically weaker compared with their WT littermates. EGR1 was recruited to the Col1a1 and Col2a1 promoters in postnatal mouse tendons in vivo. Egr1 was required for the normal gene response following tendon injury in a mouse model of Achilles tendon healing. Forced Egr1 expression programmed MSCs toward the tendon lineage and promoted the formation of in vitro–engineered tendons from MSCs. The application of EGR1-producing MSCs increased the formation of tendon-like tissues in a rat model of Achilles tendon injury. We provide evidence that the ability of EGR1 to promote tendon differentiation is partially mediated by TGF-β2. This study demonstrates EGR1 involvement in adult tendon formation, healing, and repair and identifies Egr1 as a putative target in tendon repair strategies. PMID:23863709

  20. Histopathological findings in chronic tendon disorders.

    Science.gov (United States)

    Järvinen, M; Józsa, L; Kannus, P; Järvinen, T L; Kvist, M; Leadbetter, W

    1997-04-01

    Tendon injuries and other tendon disorders represent a common diagnostic and therapeutic challenge in sports medicine, resulting in chronic and long-lasting problems. Tissue degeneration is a common finding in many sports-related tendon complaints. In the great majority of spontaneous tendon ruptures, chronic degenerative changes are seen at the rupture site of the tendon (1). Systemic diseases and diseases specifically deteriorating the normal structure of the tendon (i.e. foreign bodies, and metabolic, inherited and infectious tendon diseases) are only rarely the cause of tendon pathology. Inherited diseases, such as various hereditary diseases with disturbed collagen metabolism and characteristic pathological structural alterations (Ehlers-Danlos syndrome, Marfani syndrome, homocystinuria (ochronosis)), represent approximately 1% of the causes of chronic tendon complaints (2), whereas foreign bodies are somewhat more common and are found in less than 10% of all chronic tendon problems (1). Rheumatoid arthritis and sarcoidosis are typical systemic diseases that cause chronic inflammation in tendon and peritendinous tissues. Altogether, these 'specific' disorders represented less than 2% of the pathological alterations found in the histological analysis of more than 1000 spontaneously ruptured tendons (1, 3, 4). In this material, degenerative changes were seen in a great majority of the tendons, indicating that a spontaneous tendon rupture is a typical clinical end-state manifestation of a degenerative process in the tendon tissue. The role of overuse in the pathogenesis of chronic tendon injuries and disorders is not completely understood. It has been speculated that when tendon is overused it becomes fatigued and loses its basal reparative ability, the repetitive microtraumatic processes thus overwhelming the ability of the tendon cells to repair the fiber damage. The intensive repetitive activity, which often is eccentric by nature, may lead to cumulative

  1. The prevalence of tenosynovitis of the interosseous tendons of the hand in patients with rheumatoid arthritis

    International Nuclear Information System (INIS)

    Rowbotham, Emma L.; Freeston, Jane E.; Emery, Paul; Grainger, Andrew J.

    2016-01-01

    The aim of this study was to establish the prevalence of tenosynovitis affecting the interosseous tendons of the hand in a rheumatoid arthritis (RA) population and to assess for association with metacarpophalangeal (MCP) joint synovitis, flexor tendon tenosynovitis or ulnar drift. Forty-four patients with RA underwent hand MRI along with 20 normal controls. Coronal 3D T1 VIBE sequences pre- and post-contrast were performed and reconstructed. The presence of interosseous tendon tenosynovitis was recorded alongside MCP joint synovitis, flexor tendon tenosynovitis and ulnar drift. Twenty-one (47.7 %) patients with RA showed interosseous tendon tenosynovitis. Fifty-two (14.8 %) interosseous tendons showed tenosynovitis amongst the RA patients. Interosseous tendon tenosynovitis was more commonly seen in association with adjacent MCP joint synovitis (p < 0.001), but nine MCP joints (5.1 %) showed adjacent interosseous tenosynovitis in the absence of joint synovitis. Interosseous tendon tenosynovitis was more frequently seen in fingers which also showed flexor tendon tenosynovitis (p < 0.001) and in patients with ulnar drift of the fingers (p = 0.01). Tenosynovitis of the hand interosseous tendons was found in 47.7 % of patients with RA. In the majority of cases this was adjacent to MCP joint synovitis; however, interosseous tendon tenosynovitis was also seen in isolation. (orig.)

  2. The prevalence of tenosynovitis of the interosseous tendons of the hand in patients with rheumatoid arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Rowbotham, Emma L. [Leeds Teaching Hospitals NHS Trust, Musculoskeletal Radiology Department, Leeds (United Kingdom); Freeston, Jane E. [Department of Rheumatology, Leeds Teaching Hospitals NHS Trust, Leeds (United Kingdom); Emery, Paul [University of Leeds, Arthritis Research UK, Leeds Musculoskeletal Biomedical Research Unit, LTHT Leeds Institute of Rheumatic Musculoskeletal Medicine, Leeds (United Kingdom); Grainger, Andrew J. [Leeds Teaching Hospitals NHS Trust, Musculoskeletal Radiology Department, Leeds (United Kingdom); Chapel Allerton Hospital, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds (United Kingdom)

    2016-02-15

    The aim of this study was to establish the prevalence of tenosynovitis affecting the interosseous tendons of the hand in a rheumatoid arthritis (RA) population and to assess for association with metacarpophalangeal (MCP) joint synovitis, flexor tendon tenosynovitis or ulnar drift. Forty-four patients with RA underwent hand MRI along with 20 normal controls. Coronal 3D T1 VIBE sequences pre- and post-contrast were performed and reconstructed. The presence of interosseous tendon tenosynovitis was recorded alongside MCP joint synovitis, flexor tendon tenosynovitis and ulnar drift. Twenty-one (47.7 %) patients with RA showed interosseous tendon tenosynovitis. Fifty-two (14.8 %) interosseous tendons showed tenosynovitis amongst the RA patients. Interosseous tendon tenosynovitis was more commonly seen in association with adjacent MCP joint synovitis (p < 0.001), but nine MCP joints (5.1 %) showed adjacent interosseous tenosynovitis in the absence of joint synovitis. Interosseous tendon tenosynovitis was more frequently seen in fingers which also showed flexor tendon tenosynovitis (p < 0.001) and in patients with ulnar drift of the fingers (p = 0.01). Tenosynovitis of the hand interosseous tendons was found in 47.7 % of patients with RA. In the majority of cases this was adjacent to MCP joint synovitis; however, interosseous tendon tenosynovitis was also seen in isolation. (orig.)

  3. A portable device for finger tendon rehabilitation that provides an isotonic training force and records exercise behaviour after finger tendon surgery

    NARCIS (Netherlands)

    Dobbe, J. G.; van Trommel, N. E.; de Freitas Baptista, J. E.; Ritt, M. J.; Steenbeek, A.; Molenaar, H. A.

    1999-01-01

    For most hand surgeons, flexor tendon repairs in zone 2 of the hand still present a clinical problem. The surgeon is placed in a dilemma: on the one hand, if repair is achieved and the finger is kept immobile during the healing phase, dense adhesions may bind the tendons within the sheath and limit

  4. Repair of chronic distal biceps brachii tendon rupture using free autogenous semitendinosus tendon.

    Science.gov (United States)

    Hang, D W; Bach, B R; Bojchuk, J

    1996-02-01

    Distal biceps brachii tendon ruptures occur much less frequently than do their proximal counterparts. Distal tendon ruptures usually are associated with considerable function deficits and may require surgical treatment. Repair of chronic distal biceps brachii ruptures are extremely unusual. A free autogenous semitendinosus tendon graft was used to reconstruct the distal biceps tendon by reattaching the graft to the radial tuberosity via a 2-incision technique in a patient with symptoms and a chronic injury.

  5. Flexor carpi ulnaris tenotomy alone does not eliminate its contribution to wrist torque

    NARCIS (Netherlands)

    de Bruin, Marije; Smeulders, Mark J. C.; Kreulen, Michiel

    2011-01-01

    Flexor carpi ulnaris muscle tenotomy and transfer to the extensor side of the wrist are common procedures used to improve wrist position and dexterity in patients with cerebral palsy. Our aim was to determine whether this muscle still influences wrist torque even after tenotomy of its distal tendon.

  6. Tendon tissue engineering: adipose-derived stem cell and GDF-5 mediated regeneration using electrospun matrix systems

    Energy Technology Data Exchange (ETDEWEB)

    James, R [Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908 (United States); Kumbar, S G; Laurencin, C T [Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06030 (United States); Balian, G; Chhabra, A B, E-mail: ac2h@hscmail.mcc.virginia.edu [Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22908 (United States)

    2011-04-15

    Tendon tissue engineering with a biomaterial scaffold that mimics the tendon extracellular matrix (ECM) and is biomechanically suitable, and when combined with readily available autologous cells, may provide successful regeneration of defects in tendon. Current repair strategies using suitable autografts and freeze-dried allografts lead to a slow repair process that is sub-optimal and fails to restore function, particularly in difficult clinical situations such as zone II flexor tendon injuries of the hand. We have investigated the effect of GDF-5 on cell proliferation and gene expression by primary rat adipose-derived stem cells (ADSCs) that were cultured on a poly(dl-lactide-co-glycolide) PLAGA fiber scaffold and compared to a PLAGA 2D film scaffold. The electrospun scaffold mimics the collagen fiber bundles present in native tendon tissue, and supports the adhesion and proliferation of multipotent ADSCs. Gene expression of scleraxis, the neotendon marker, was upregulated seven- to eightfold at 1 week with GDF-5 treatment when cultured on a 3D electrospun scaffold, and was significantly higher at 2 weeks compared to 2D films with or without GDF-5 treatment. Expression of the genes that encode the major tendon ECM protein, collagen type I, was increased by fourfold starting at 1 week on treatment with 100 ng mL{sup -1} GDF-5, and at all time points the expression was significantly higher compared to 2D films irrespective of GDF-5 treatment. Thus stimulation with GDF-5 can modulate primary ADSCs on a PLAGA fiber scaffold to produce a soft, collagenous musculoskeletal tissue that fulfills the need for tendon regeneration.

  7. [Achilles tendon rupture].

    Science.gov (United States)

    Thermann, H; Hüfner, T; Tscherne, H

    2000-03-01

    The treatment of acute of Achilles tendon rupture experienced a dynamic development in the last ten years. Decisive for this development was the application of MRI and above all the ultrasonography in the diagnostics of the pathological changes and injuries of tendons. The question of rupture morphology as well as different courses of healing could be now evaluated objectively. These advances led consequently to new modalities in treatment concepts and rehabilitation protocols. The decisive input for improvements of the outcome results and particularly the shortening of the rehabilitation period came with introduction of the early functional treatment in contrast to immobilizing plaster treatment. In a prospective randomized study (1987-1989) at the Trauma Dept. of the Hannover Medical School could show no statistical differences comparing functional non-operative with functional operative therapy with a special therapy boot (Variostabil/Adidas). The crucial criteria for therapy selection results from the sonographically measured position of the tendon stumps in plantar flexion (20 degrees). With complete adaptation of the tendons' ends surgical treatment does not achieve better results than non-operative functional treatment in term of tendon healing and functional outcome. Regarding the current therapeutic standards each method has is advantages and disadvantages. Both, the operative and non-operative functional treatment enable a stable tendon healing with a low risk of re-rupture (1-2%). Meanwhile there is consensus for early functional after-treatment of the operated Achilles' tendons. There seems to be a trend towards non-operative functional treatment in cases of adequate sonographical findings, or to minimal invasive surgical techniques.

  8. Bilateral osteoarthritis of the trapeziometacarpal joint treated by bilateral tendon interposition arthroplasty

    NARCIS (Netherlands)

    Damen, A; vanderLei, B; Robinson, PH

    Twenty-four flexor carpi radialis (FCR) tendon interposition arthroplasties of the trapezium for bilateral trapeziometacarpal osteoarthritis were reviewed. Pain was reduced in all cases. Function was improved in all right hands and in 92% of the left hands. FCR tendon interposition arthroplasty for

  9. The clinical effect of tendon repair for tendon spontaneous rupture after corticosteroid injection in hands

    Science.gov (United States)

    Lu, Hui; Yang, Hu; Shen, Hui; Ye, Ganmin; Lin, Xiang-Jin

    2016-01-01

    Abstract Corticosteroid injections for hand tendinitis can lead to a rare significant complication of tendon spontaneous rupture. However, only sporadic cases were reported in the literature before. This study was designed to gauge the clinical effect of tendon repair in patients of tendon spontaneous rupture after corticosteroid injection and analyze our experience. This was a retrospective observational study of 13 patients (8 women and 5 men) operated between July 2011 and December 2015 for tendon spontaneous rupture after corticosteroid injection. Demographic data, clinical features, imaging data, and surgical treatments were carefully reviewed. The average age was 52.308 ± 15.381 years (range 29–71). The average injection times were 2.538 ± 1.664 times (range 1–6). The average rupture time (after last injection) was 10.923 ± 9.500 weeks (range 3–32). Nine patients were treated by tendon suture (69% of cases), and 4 patients were treated by tendon grafting (31% of cases). All patients received follow-up in our outpatient clinic. The sites of the tendon rupture (15 tendons of 13 patients had involved) include extensor pollicis longus (6 tendons, 40% of cases), extensor digiti quinti and extensor digiti minimi (4 tendons, 27% of cases), ring finger of extensor digitorum communis (3 tendons, 20% of cases), and middle finger of extensor digitorum communis (2 tendons, 13% of cases). Two patients who had tendon adhesion (15% of cases) were treated by tendon release. One patient who had tendon rerupture (8% of cases) was treated by tendon grafting. No patient had complications of infections, vascular, or nerve injury. Tendon spontaneous rupture is a serious complication after corticosteroid injection for tendinitis. Rigid standard of corticosteroid injection is very important. Magnetic resonance imaging was contributory to preoperative assess tendon defect and can be used to monitor healing quality of tendons during the follow-up. PMID:27741145

  10. Tendon overuse syndrome: imaging diagnosis

    International Nuclear Information System (INIS)

    Huber, W.; Nehrer, S.; Muellner, T.; Kainberger, F.; Ulreich, N.; Bernhard, C.; Imhof, H.

    2001-01-01

    Injuries of muscles and tendons occur commonly during various sporting activities and in most cases the athletes feel such an accident to be sudden and unavoidable. The rupture of a tendon, however, has to be considered in many cases as the final stage of a long-standing progressive degeneration of collagen fibers. This process con be described as 'tendon overuse syndrome (TOS)'. Diagnostic imaging modalities, especially sonography and MRI, are suitable to detect and analyse the different stages of this syndrome and the degree of morphological abnormalities. The first stage is painful functional derangement, followed by tendovaginitis, peritendinitis, or bursitis. The third stage is tendinosis resulting from biomechanical or ischaemic injury of tendon fibers which may eventually be followed by partial or complete rupture. Regional or individual specifications of these four stages may occur at anatomically predisposing sites, so-called critical zones, or during periods of specific proneness, the vulnerable phases. (author)

  11. Clinical and morphological evaluation of snake venom derived fibrin glue on the tendon healing in dogs

    Directory of Open Access Journals (Sweden)

    G. C. Ferraro

    2005-12-01

    Full Text Available The aim of this study was to evaluate the effect of snake venom derived fibrin glue on the healing of the deep digital flexor tendon, during three periods. The tendon of the 2nd digit of 30 thoracic limbs of dogs was partially sectioned for glue application. Biopsies were performed 7, 15, and 30 days post surgery for the clinical and morphological study of tendons. Analysis of the results showed that 73.3% of the tendons showed stump retraction and 16.6% moderate to excessive adherence, which affected sliding. There was a significant difference in the number of inflammatory cells among the three studied periods, being the highest on day 15. The morphological analysis revealed a typical tendon healing process with a lower level of inflammation in the acute phase, facilitating the cicatricial maturation phase. Snake venom derived fibrin glue promotes the healing in dog flexor tendon.

  12. Os trigonum syndrome with flexor hallucis longus tenosynovitis in a professional football referee.

    Science.gov (United States)

    Cooper, M E; Wolin, P M

    1999-07-01

    The presentation of posterior ankle pain in any patient poses a diagnostic dilemma. The os trigonum syndrome and flexor hallucis longus stenosing tenosynovitis have been reported to occur in professional and amateur ballet dancers. It is important to consider these diagnoses in a patient who is not a dancer, as is shown in the case presented here. The patient in this case is a professional referee who injured his ankle while working on artificial turf. The treatment for os trigonum syndrome and flexor hallucis longus tenosynovitis is initially conservative, but in refractory cases, surgical removal of the os and release of the flexor hallucis longus tendon can be successfully performed. This is the first reported case of os trigonum syndrome and flexor hallucis longus tenosynovitis presenting simultaneously in a patient who is not a dancer.

  13. The prevalence of tenosynovitis of the interosseous tendons of the hand in patients with rheumatoid arthritis.

    OpenAIRE

    Rowbotham, EL; Freeston, JE; Emery, P; Grainger, AJ

    2015-01-01

    AIM: The aim of this study was to establish the prevalence of tenosynovitis affecting the interosseous tendons of the hand in a rheumatoid arthritis (RA) population and to assess for association with metacarpophalangeal (MCP) joint synovitis, flexor tendon tenosynovitis or ulnar drift. METHODS: Forty-four patients with RA underwent hand MRI along with 20 normal controls. Coronal 3D T1 VIBE sequences pre- and post-contrast were performed and reconstructed. The presence of interosseous tendon t...

  14. Achilles Tendonitis

    Science.gov (United States)

    ... that you use crutches or wear a walking boot to keep weight off your foot. I ce: ... 2014 More on this topic for: Teens Jumper's Knee Proximal Biceps Tendonitis Safety Tips: Basketball Safety Tips: ...

  15. Effect of laceration and trimming of a tendon on the coefficient of friction along the A2 pulley: an in vitro study on turkey tendon.

    Science.gov (United States)

    Hajipour, L; Gulihar, A; Dias, J

    2010-08-01

    We carried out lacerations of 50%, followed by trimming, in ten turkey flexor tendons in vitro and measured the coefficient of friction at the tendon-pulley interface with loads of 200 g and 400 g and in 10 degrees , 30 degrees, 50 degrees and 70 degrees of flexion. Laceration increased the coefficient of friction from 0.12 for the intact tendon to 0.3 at both the test loads. Trimming the laceration reduced the coefficient of friction to 0.2. An exponential increase in the gliding resistance was found at 50 degrees and 70 degrees of flexion (p = 0.02 and p = 0.003, respectively) following trimming compared to that of the intact tendon. We concluded that trimming partially lacerated flexor tendons will reduce the gliding resistance at the tendon-pulley interface, but will lead to fragmentation and triggering of the tendon at higher degrees of flexion and loading. We recommend that higher degrees of flexion be avoided during early post-operative rehabilitation following trimming of a flexor tendon.

  16. Tendons in the plantar aspect of the foot: MR imaging and anatomic correlation in cadavers

    Energy Technology Data Exchange (ETDEWEB)

    Fernandes, Rodrigo [University of California San Diego, Radiology, San Diego, CA (United States); Fleury Medical Center, Radiology, Sao Paulo, SP (Brazil); Aguiar, Rodrigo; Trudell, Debra; Resnick, Donald [University of California San Diego, Radiology, San Diego, CA (United States)

    2007-02-15

    The purpose of this anatomic imaging study was to illustrate the normal complex anatomy of tendons of the plantar aspect of the ankle and foot using magnetic resonance (MR) imaging with anatomic correlation in cadavers. Seven fresh cadaveric feet (obtained and used according to institutional guidelines, with informed consent from relatives of the deceased) were studied with intermediate-weighted fast-spin-echo MR imaging. For anatomic analysis, cadaveric specimens were sectioned in 3-mm-thick slices in the coronal and axial planes that approximated the sections acquired at MR imaging. The entire courses of the tendons into the plantar aspect of the foot were analyzed. The tibialis posterior tendon has a complex distal insertion. The insertions in the navicular, second, and third cuneiforms bones were identify in all cases using axial and coronal planes. A tendinous connection between the flexor hallucis longus and the flexor digitorum longus tendons was identified in five of our specimens (71%). The coronal plane provided the best evaluation. The peroneus longus tendon changes its direction at three points then obliquely crosses the sole and inserts in the base of the first metatarsal bone and the plantar aspect of the first cuneiform. MR imaging provides detailed information about the anatomy of tendons in the plantar aspect of the ankle and foot. It allows analysis of their insertions and the intertendinous connection between the flexor hallucis longus and the flexor digitorum longus tendons. (orig.)

  17. Cellular and Molecular Factors Influencing Tendon Repair.

    Science.gov (United States)

    Durgam, Sushmitha; Stewart, Matthew

    2017-08-01

    Tendons are complex connective tissues that transmit tensile forces between muscles and tendons. Tendon injuries are among the most common orthopedic problems with long-term disability as a frequent consequence due to prolonged healing time. Furthermore, the repair tissue is of inferior quality, predisposing patients to high rates of recurrence following initial injury. Coordinated cellular processes and biological factors under the influence of mechanical loading are involved in tendon healing and our understanding of these events lags behind other musculoskeletal tissues. Tendons are relatively hypocellular and hypovascular, with little or no intrinsic regenerative capacity. Studies have documented fatty degeneration, chondrogenic dysplasia, and ectopic ossification within tendon repair tissue. The underlying pathogenesis for these metaplastic changes that compromise the quality of tendon repair tissue is poorly understood. The purpose of this review is to compile literature reporting molecular processes that regulate/control the phenotype of cells responsible for abnormal matrix deposition at repair site. In addition, recent studies reporting the interplay of mechanotransduction and cellular responses during tendon repair are summarized. Identifying the links between cellular, biological, and mechanical parameters involved in tendon repair is paramount to develop successful therapies for tendon healing.

  18. Effect of tendon vibration during wide-pulse neuromuscular electrical stimulation (NMES) on muscle force production in people with spinal cord injury (SCI).

    Science.gov (United States)

    Bochkezanian, Vanesa; Newton, Robert U; Trajano, Gabriel S; Vieira, Amilton; Pulverenti, Timothy S; Blazevich, Anthony J

    2018-02-13

    Neuromuscular electrical stimulation (NMES) is commonly used in skeletal muscles in people with spinal cord injury (SCI) with the aim of increasing muscle recruitment and thus muscle force production. NMES has been conventionally used in clinical practice as functional electrical stimulation (FES), using low levels of evoked force that cannot optimally stimulate muscular strength and mass improvements, and thus trigger musculoskeletal changes in paralysed muscles. The use of high intensity intermittent NMES training using wide-pulse width and moderate-intensity as a strength training tool could be a promising method to increase muscle force production in people with SCI. However, this type of protocol has not been clinically adopted because it may generate rapid muscle fatigue and thus prevent the performance of repeated high-intensity muscular contractions in paralysed muscles. Moreover, superimposing patellar tendon vibration onto the wide-pulse width NMES has been shown to elicit further increases in impulse or, at least, reduce the rate of fatigue in repeated contractions in able-bodied populations, but there is a lack of evidence to support this argument in people with SCI. Nine people with SCI received two NMES protocols with and without superimposing patellar tendon vibration on different days (i.e. STIM and STIM+vib), which consisted of repeated 30 Hz trains of 58 wide-pulse width (1000 μs) symmetric biphasic pulses (0.033-s inter-pulse interval; 2 s stimulation train; 2-s inter-train interval) being delivered to the dominant quadriceps femoris. Starting torque was 20% of maximal doublet-twitch torque and stimulations continued until torque declined to 50% of the starting torque. Total knee extensor impulse was calculated as the primary outcome variable. Total knee extensor impulse increased in four subjects when patellar tendon vibration was imposed (59.2 ± 15.8%) but decreased in five subjects (- 31.3 ± 25.7%). However, there were no

  19. Considerations in the surgical use of the flexor sheath and pulley system.

    Science.gov (United States)

    Lowrie, A G; Lees, V C

    2014-01-01

    The use of the digital flexor sheath to reconstruct damaged structures in the fingers is an intriguing but under-investigated subject. The sheath is anchored firmly to the phalanges and palmar plates and has well-vascularized outer and synovial inner layers. The middle layer is strong and fibrous and not all of it is required for its main biomechanical function of maintaining the moment arm of the flexor tendons. These characteristics have led to several descriptions of different reconstructive uses. In sheath reconstruction, flaps can be used to repair damaged A2 and A4 pulleys. As an anchor, the sheath is useful for tenodeses and tendon transfers. It has been used in the correction of ulnar claw and swan neck deformities. In ligament reconstruction, the A1 pulley has been used to reconstruct the transverse intermetacarpal ligament in cleft hand and ray amputations. The sheath has also been used to cover tendon repairs and periosteal defects with the aim of decreasing adhesions. There is potential for further use of the flexor sheath in reconstructive surgery. The digital flexor sheath can be used to restore various finger functions providing its physiological roles are recognized and preserved. This review considers the different techniques described and their potential uses.

  20. Effects of tendon and muscle belly dissection on muscular force transmission following tendon transfer in the rat

    NARCIS (Netherlands)

    Maas, H.; Huijing, P.A.J.B.M.

    2012-01-01

    The aim of the present study was to quantify to what extent the scar tissue formation following the transfer of flexor carpi ulnaris (FCU) to the distal tendon of extensor carpi radialis (ECR) affects the force transmission from transferred FCU in the rat. Five weeks after recovery from surgery

  1. Successful return to play following adductor longus proximal tendon rupture in professional soccer without re-injury at 12 months: A case report.

    Science.gov (United States)

    Gözübüyük, Ömer B; Moen, Maarten H; Akman, Mehmet; Ipseftel, Ioakim; Karakuzu, Agah

    2017-09-08

    Treatment of total ruptures of adductor longus is challenging in professional sports. Time for return to pre-injury level as well as re-injury rates are of concern and surgical and conservative treatment approaches are debated; yet no consensus approach described for professional athletes. We present a case of a professional soccer player who experienced a rupture in his left adductor longus proximal tendon during a game and was treated conservatively. This case was followed-up during clinical assessment, imaging and strength testing until and after return to play. Primary outcome measure was the return to standard play condition at his pre-injury level without any functional deficits, measured by isokinetic testing. Second outcome measure was the recurrence. No recurrence was observed during the first year of follow-up. Total ruptures are very challenging for both the physician and the player to make a quick decision due to minimal or lack of pain. Functional outcomes are almost identical although operative treatments need longer time to return to play. This case report adds another example to the literature of a successful return to play after non-operative treatment of adductor longus rupture at elite level soccer.

  2. Tendon Cell Behavior and Matrix Remodeling in Degenerative Tendinopathy

    NARCIS (Netherlands)

    M. de Mos (Marieke)

    2009-01-01

    textabstractTendon injuries are common in human athletes [1-4]. Furthermore, such injuries are also prevalent in the ageing sedentary population [5-7]. In recent decades, the incidence of tendon injuries has risen due to both an increase in an elderly population and a rise in participation

  3. Flexor tendon tenosynovitis with rice body formation in rheumatoid arthritis

    OpenAIRE

    Groote, J De; Ovreeide, P; Mermuys, K; Casselman, J

    2014-01-01

    A 69-year-old man, known with rheumatoid arthritis was admitted to the orthopaedic surgery department with swelling of the right wrist. Physical examination confirmed the swelling located at the palmar side of the wrist. There was a slightly decreased range of motion of the wrist. The patient was not aware of a recent trauma.The patient is known with an erosive destruction of the wrist in the context of rheumatoid arthritis.The initial X-ray of the wrist confirmed an erosive destruction of th...

  4. Calcaneal tendon: imaging findings; Tendao calcaneo: avaliacao por imagem

    Energy Technology Data Exchange (ETDEWEB)

    Montandon, Cristiano; Fonseca, Cristiano Rezio; Montandon Junior, Marcelo Eustaquio [Colegio Brasileiro de Radiologia e Diagnostico por Imagem, Sao Paulo, SP (Brazil)]. E-mail: crismontandon@hotmail.com; Lobo, Leonardo Valadares; Ribeiro, Flavia Aparecida de Souza; Teixeira, Kim-Ir-Sen Santos [Goias Univ., Goiania, GO (Brazil). Hospital de Clinicas. Dept. de Diagnostico por Imagem e Anatomia Patologica

    2003-12-01

    We reviewed the radiological and clinical features of 23 patients with calcaneal tendon diseases, who were submitted to ultrasound or magnetic resonance imaging. The objective of this study was to characterize the lesions for a precise diagnosis of calcaneal tendon injuries. A wide range of calcaneal tendon diseases include degenerative lesions, inflammation of the peritendinous tissue such as peritendinitis and bursitis, and rupture. Imaging methods are essential in the diagnosis, treatment and follow-up of calcaneal tendon diseases. (author)

  5. Histological Changes in the Proximal and Distal Tendon Stumps Following Transection of Achilles Tendon in the Rabbits.

    Science.gov (United States)

    Al-Qattan, Mohammad M; Mawlana, Ola Helmi; Mohammed Ahmed, Raeesa Abdel-Twab; Hawary, Khalid

    2016-05-01

    To determine tendon stump changes following unrepaired Achilles tendon lacerations in an animal model. An experimental study. King Saud University, Riyadh, Saudi Arabia, from October 2013 to January 2014. Arabbit model was developed and studied tendon retraction and histological changes in the proximal and distal stumps following transection of the Achilles tendon. Over a period of 12 weeks, retraction of the distal tendon stump was minimal (2 - 3 mm). In contrast, retraction of the proximal tendon stump peaked to reach 6 mm at 4 weeks post-injury and plateaued to reach 7 - 8 mm at the 12-week interval. Following complete transection of the Achilles tendon, tendon retraction correlated with the density of myofibroblast expression within the tendon stump. Further research is needed to investigate the pathophysiology of these findings.

  6. Histological Changes in the Proximal and Distal Tendon Stumps Following Transection of Achilles Tendon in the Rabbits

    International Nuclear Information System (INIS)

    Al-Qattan, M. M.; Hawary, K.; Mawlana, O. H.; Ahmed, R. A. M.

    2016-01-01

    Objective: To determine tendon stump changes following unrepaired Achilles tendon lacerations in an animal model. Study Design: An experimental study. Place and Duration of Study: King Saud University, Riyadh, Saudi Arabia, from October 2013 to January 2014. Methodology: Arabbit model was developed and studied tendon retraction and histological changes in the proximal and distal stumps following transection of the Achilles tendon. Result: Over a period of 12 weeks, retraction of the distal tendon stump was minimal (2 - 3 mm). In contrast, retraction of the proximal tendon stump peaked to reach 6 mm at 4 weeks post-injury and plateaued to reach 7 - 8 mm at the 12-week interval. Conclusion: Following complete transection of the Achilles tendon, tendon retraction correlated with the density of myofibroblast expression within the tendon stump. Further research is needed to investigate the pathophysiology of these findings. (author)

  7. Reconstruction of the digital flexor pulley system: a retrospective comparison of two methods of treatment.

    Science.gov (United States)

    Arora, R; Fritz, D; Zimmermann, R; Lutz, M; Kamelger, F; Klauser, A S; Gabl, M

    2007-02-01

    The rare injury of closed rupture of the A2 and A3 flexor pulleys was treated using two non-encircling techniques of pulley reconstruction. Thirteen patients were treated with an extensor retinaculum graft (Group A). At a mean follow-up time of 48 months, the average PIP flexion was 97%, the power grip strength 96%, the pinch grip strength 100% and the thickening 94% of the uninjured side. Ten patients were treated with a free palmaris longus tendon grafts (Group B). At a mean follow-up time of 57 months, the average PIP flexion was 94%, the power grip strength 98%, the pinch grip strength 100% and the thickening 95% of the uninjured side. In both groups, finger extension was unrestricted. The Buck Gramcko score included 10 excellent, two good and one fair result in Group A and seven excellent, two good and one fair result in Group B. Both techniques proved beneficial. All climbers returned to their previous standard and all non-climbers regained full finger dexterity in their previous job.

  8. MRI-Based Assessment of Intralesional Delivery of Bone Marrow-Derived Mesenchymal Stem Cells in a Model of Equine Tendonitis

    Directory of Open Access Journals (Sweden)

    Alexandra Scharf

    2016-01-01

    Full Text Available Ultrasound-guided intralesional injection of mesenchymal stem cells (MSCs is held as the benchmark for cell delivery in tendonitis. The primary objective of this study was to investigate the immediate cell distribution following intralesional injection of MSCs. Unilateral superficial digital flexor tendon (SDFT lesions were created in the forelimb of six horses and injected with 10 × 106 MSCs labeled with superparamagnetic iron oxide nanoparticles (SPIOs under ultrasound guidance. Assays were performed to confirm that there were no significant changes in cell viability, proliferation, migration, or trilineage differentiation due to the presence of SPIOs. Limbs were imaged on a 1.5-tesla clinical MRI scanner postmortem before and after injection to determine the extent of tendonitis and detect SPIO MSCs. Clusters of labeled cells were visible as signal voids in 6/6 subjects. Coalescing regions of signal void were diffusely present in the peritendinous tissues. Although previous reports have determined that local injury retains cells within a small radius of the site of injection, our study shows greater than expected delocalization and relatively few cells retained within collagenous tendon compared to surrounding fascia. Further work is needed if this is a reality in vivo and to determine if directed intralesional delivery of MSCs is as critical as presently thought.

  9. Achillodynia. Radiological imaging of acute and chronic overuse injuries of the Achilles tendon; Achillodynie. Radiologische Bildgebung bei akuten und chronischen Ueberlastungsschaeden der Achillessehne

    Energy Technology Data Exchange (ETDEWEB)

    Syha, R.; Springer, F.; Grosse, U. [Tuebingen Univ. (Germany). Diagnostic and Interventional Radiology; Tuebingen Univ. (Germany). Section on Experimental Radiology; Ketelsen, D.; Kramer, U.; Horger, M. [Tuebingen Univ. (Germany). Diagnostic and Interventional Radiology; Ipach, I. [University Hospital Tuebingen (Germany). Orthopaedic Surgery; Schick, F. [Tuebingen Univ. (Germany). Section on Experimental Radiology

    2013-11-15

    In the past decades the incidence of acute and chronic disorders of the Achilles tendon associated with sport-induced overuse has steadily increased. Besides acute complete or partial ruptures, achillodynia (Achilles tendon pain syndrome), which is often associated with tendon degeneration, represents the most challenging entity regarding clinical diagnostics and therapy. Therefore, the use of imaging techniques to differentiate tendon disorders and even characterize structure alterations is of growing interest. This review article discusses the potential of different imaging techniques with respect to the diagnosis of acute and chronic tendon disorders. In this context, the most commonly used imaging techniques are magnetic resonance imaging (MRI), B-mode ultrasound, and color-coded Doppler ultrasound (US). These modalities allow the detection of acute tendon ruptures and advanced chronic tendon disorders. However, the main disadvantages are still the low capabilities in the detection of early-stage degeneration and difficulties in the assessment of treatment responses during follow-up examinations. Furthermore, differentiation between chronic partial ruptures and degeneration remains challenging. The automatic contour detection and texture analysis may allow a more objective and quantitative interpretation, which might be helpful in the monitoring of tendon diseases during follow-up examinations. Other techniques to quantify tendon-specific MR properties, e.g. based on ultrashort echo time (UTE) sequences, also seem to have great potential with respect to the precise detection of degenerative tendon disorders and their differentiation at a very early stage. (orig.)

  10. Flexor Digitorum Superficialis Tenodesis for Traumatic Digit Amputation at the Level of the Proximal Phalanx.

    Science.gov (United States)

    O'Shaughnessy, Maureen A; Kakar, Sanjeev

    2017-09-01

    Traumatic amputation of the digit requiring revision amputation at the level of the proximal phalanx provides the opportunity to improve flexor function via tenodesis of the remaining flexor digitorum superficialis (FDS) tendon. Salvage of the remaining FDS and performing flexor tenodesis to the proximal phalanx allows increased flexion at the metacarpophalangeal (MCP) joint. This series reviews FDS tenodesis, outlining its surgical technique with clinical and functional outcomes. Institutional review board-approved retrospective study was performed. Twelve digits in 8 patients were included. Average flexion-extension arc of affected MCP joint was 82°, and average grip strength was 70% of unaffected extremity. No patients required revision surgery or revision amputation. One patient had a minor wound infection treated successfully with oral antibiotics. FDS tenodesis is a reliable motion-preserving procedure for patients with amputations at the level of the proximal phalanx to maintain flexion at the MCP joint.

  11. Blood circulation of patellar and achilles tendons during contractions and heating.

    Science.gov (United States)

    Kubo, Keitaro; Ikebukuro, Toshihiro

    2012-11-01

    Recent studies using ultrasonography have demonstrated that training-induced changes in the mechanical properties of tendons in plantar flexors (i.e., Achilles tendon) are lower than those in knee extensors (i.e., patellar tendon). However, the mechanisms for these phenomena are unknown. The purpose of this study was to compare changes in blood circulation of patellar and Achilles tendons by repeated muscle contractions and heating. Eleven healthy males participated in this study. During and after repeated muscle contractions (50 repetitions at 50% of the isometric maximum voluntary contraction for 3 s with 3-s relaxations) and heating (20 min), blood volume (total hemoglobin (THb)) and oxygen saturation (StO2) of the patellar and Achilles tendons were measured using red laser lights. During repeated muscle contractions, StO2 of the patellar tendon decreased significantly, but that of the Achilles tendon did not. During heating, THb and StO2 increased significantly for both tendons. Increases in THb and StO2 of the patellar tendon were significantly higher than those of the Achilles tendon (both P heating were higher than those of the Achilles tendon. This result appears to be related to the differences in the plasticity of the mechanical properties of the patellar and Achilles tendons.

  12. Elbow, forearm, wrist, and hand injuries among sport rock climbers.

    Science.gov (United States)

    Holtzhausen, L M; Noakes, T D

    1996-07-01

    Sport rock climbing with its repetitive high-torque movements in gaining the ascent of a rock face or wall, often in steep overhanging positions, is associated with a unique distribution and form of upper limb injuries. In this article, we review the biomechanical aspects of sport rock climbing and the types of injuries commonly encountered in the forearm, wrist, and hand regions of elite sport rock climbers. Because elbow, forearm, wrist, and hand injuries predominate, representing 62% of the total injuries encountered, these anatomical areas have been selected for review. The predominant source of data are the published work of Bollen et al. The remaining sources were obtained through electronic search of the Medline and Current Contents Databases (last searched May 1995). German and French articles were included in the search criteria. Only studies dealing with acute soft tissue and overuse injuries amongst sport rock climbers were selected. Data were extracted directly from the sourced articles. The following injuries have been described in detail with regard to their presentation, diagnosis, treatment, and prevention amongst sport rock climbers: medial epicondylitis, brachialis tendonitis, biceps brachii tendonitis, ulnar collateral ligament sprain of the elbow, carpal tunnel syndrome, digital flexor tendon pulley sheath tears, interphalangeal joint effusions, fixed flexion deformities of the interphalangeal joints, and collateral ligament tears of the interphalangeal joints. Many of the injuries are specific to the handhold types used by the rock climber. Accurate diagnosis and effective treatment of these unique injuries will be facilitated by a wider understanding of the biomechanical aspects of rock climbing and an awareness of the patterns and incidence of injuries in this sport.

  13. Imaging the infrapatellar tendon in the elite athlete

    International Nuclear Information System (INIS)

    Peace, K.A.L.; Lee, J.C.; Healy, J.

    2006-01-01

    Extensor mechanism injuries constitute a major cause of anterior knee pain in the elite athlete. Sonography and magnetic resonance imaging (MRI) are the imaging methods of choice when assessing the infrapatellar tendon. A comprehensive imaging review of infrapatellar tendon normal anatomy, tendinopathy, and partial/full-thickness tendon tears is provided. The value of imaging the infrapatellar tendon in clinical practice, including whether sonography can predict symptoms in asymptomatic athletes, is discussed. Acute avulsion fractures, including periosteal sleeve avulsion, and chronic avulsion injuries, including Sinding-Larsen-Johansson and Osgood-Schlatter syndromes, are shown. Mimics of infrapatellar tendon pathology, including infrapatellar plica injury, patellar tendon-lateral femoral condyle friction syndrome, and Hoffa's syndrome, are illustrated

  14. Imaging the infrapatellar tendon in the elite athlete

    Energy Technology Data Exchange (ETDEWEB)

    Peace, K.A.L. [Department of Radiology, Chelsea and Westminster Hospital, London (United Kingdom)]. E-mail: kalpeace@hotmail.com; Lee, J.C. [Department of Radiology, Chelsea and Westminster Hospital, London (United Kingdom); Healy, J. [Department of Radiology, Chelsea and Westminster Hospital, London (United Kingdom)

    2006-07-15

    Extensor mechanism injuries constitute a major cause of anterior knee pain in the elite athlete. Sonography and magnetic resonance imaging (MRI) are the imaging methods of choice when assessing the infrapatellar tendon. A comprehensive imaging review of infrapatellar tendon normal anatomy, tendinopathy, and partial/full-thickness tendon tears is provided. The value of imaging the infrapatellar tendon in clinical practice, including whether sonography can predict symptoms in asymptomatic athletes, is discussed. Acute avulsion fractures, including periosteal sleeve avulsion, and chronic avulsion injuries, including Sinding-Larsen-Johansson and Osgood-Schlatter syndromes, are shown. Mimics of infrapatellar tendon pathology, including infrapatellar plica injury, patellar tendon-lateral femoral condyle friction syndrome, and Hoffa's syndrome, are illustrated.

  15. MRI of normal achilles tendon

    Energy Technology Data Exchange (ETDEWEB)

    Rollandi, G.A. [Institute of Radiology, Univ. of Genoa (Italy); Bertolotto, M. [Institute of Radiology, Univ. of Genoa (Italy); Perrone, R. [Institute of Radiology, Univ. of Genoa (Italy); Garlaschi, G. [Institute of Radiology, Univ. of Genoa (Italy); Derchi, L.E. [Institute of Radiology, Univ. of Genoa (Italy)

    1995-12-01

    To investigate the normal internal structure of tendons 11 volunteers without clinical evidence of tendinopathy were examined using conventional spin-echo T1-, T2- and proton-density weighted sequences. The Achilles tendon was chosen because of its high frequency of injury in athletic activity, large size, superficial position and because it is oriented nearly parallel to the static magnetic field, therefore minimizing the ``magic angle phenomenon``. The tendons exhibited areas of slighly increased signal in four T1-weighted and in all but one proton-density-weighted scans. No intratendinous signal was detected in T2-weighted images. The possible origin of these findings is discussed. We conclude that the knowledge of these normal signals may be useful to avoid incorrectly diagnosing as pathological. (orig.). With 2 figs.

  16. Giant cell tumor of the tendon sheath of the hand - magnetic resonance image and orthopaedic treatment

    International Nuclear Information System (INIS)

    Kirova, G.; Monovska, T.; Jablanski, V.; Alexieva, K.; Velev, M.

    2009-01-01

    Giant cell tumour of the tendon sheath (GCT-TS), also known as localized nodular tenosynovitis, is a benign neoplasm that occurs dominantly on the digits. These tumours most commonly occur in patients aged 30-50 years and are associated with degenerative joint disease. GCT-TS usually arises from the synovium of tendon sheets, affecting interfalangeal joints of the hand, feet, ankle and knees. Magnetic Resonance Imaging is able to depict characteristic signal intensities and can accurately assess the tumor size and degree of extent around the phalanx. We present a case of a 36 years-old male patient with GCT-TS in the flexor tendon of his left second finger, diagnosed with Magnetic Resonance imaging. The mass was excised widely with preservation of the flexor tendon without recurrence. (authors)

  17. The adaptability of tendon to loading differs in men and women

    DEFF Research Database (Denmark)

    Magnusson, S Peter; Hansen, Mette; Langberg, Henning

    2007-01-01

    The reason why women sustain more soft tissue injury than men during physical activity is unknown. Connective tissue properties and extracellular matrix adaptability in human tendon were investigated in models that addressed biochemical, physiological and biomechanical aspects of tendon connective...

  18. Tendon Vasculature in Health and Disease

    Science.gov (United States)

    Tempfer, Herbert; Traweger, Andreas

    2015-01-01

    Tendons represent a bradytrophic tissue which is poorly vascularized and, compared to bone or skin, heal poorly. Usually, a vascularized connective scar tissue with inferior functional properties forms at the injury site. Whether the increased vascularization is the root cause of tissue impairments such as loss of collagen fiber orientation, ectopic formation of bone, fat or cartilage, or is a consequence of these pathological changes remains unclear. This review provides an overview of the role of tendon vasculature in healthy and chronically diseased tendon tissue as well as its relevance for tendon repair. Further, the nature and the role of perivascular tendon stem/progenitor cells residing in the vascular niche will be discussed and compared to multipotent stromal cells in other tissues. PMID:26635616

  19. Simultaneous bilateral patellar tendon rupture without

    Directory of Open Access Journals (Sweden)

    LU Hua-ding

    2012-04-01

    Full Text Available 【Abstract】There is a dearth of case reports de-scribing simultaneous bilateral patellar tendon ruptures in the medical literature. These ruptures are often associated with systemic disorders such as lupus erythematosus or chronic steroid use. The author describes a case of a 24-year-old man who sustained traumatic bilateral patellar ten-don ruptures without any history of systemic disease or steroidal medication. We repaired and reattached the rup-tured tendons to the patella and augmented our procedure with allogeneic tendon followed by wire loop reinforcement. One year after operation, the patient regained a satisfactory range of motion of both knees with good quadriceps strength and no extensor lag. The recurrent microtrauma from a history of intense sports activity and a high body mass index may have played an important role in this trauma event. Key words: Patella; Patellar ligament; Rupture; Ten-don injuries; Knee

  20. Subclinical Partial Attritional Rupture of the Flexor Digitorum Profundus as an Etiology of Atraumatic Trigger Finger

    Directory of Open Access Journals (Sweden)

    D. Anthony Bastian

    2017-01-01

    Full Text Available Background. Trigger finger is a relatively common clinical entity. The etiology is most often attributable to stenosing tenosynovitis though traumatic cases have been described. When trigger finger is associated with an underlying flexor tendon rupture, previous cases have reported a clear association with overt laceration or previous trauma. Methods. We present the case of a 23-year-old male active duty military service member who presented with a characteristic history and clinical exam consistent with trigger finger. The symptomatic onset was gradual, with no history of inciting trauma. Results. Given symptomatic persistent triggering following failure of conservative management to include cortisone injections, the patient was taken for open A1 pulley release. Intraoperatively, the triggering was found to be attributable to a partial attritional rupture of the small finger flexor digitorum profundus tendon. Tendon debridement, tubularization, and A1 and partial A2 pulley releases were performed with subsequent resolution of triggering. Conclusion. We present the rare case of subclinical atraumatic attritional rupture of the FDP tendon to the small finger as a cause of clinically apparent trigger finger. This is an important consideration as the hand surgeon must be prepared to address more atypical pathologies.

  1. Tendon displacements during voluntary and involuntary finger movements.

    Science.gov (United States)

    van Beek, Nathalie; Gijsbertse, Kaj; Selles, Ruud W; de Korte, Chris L; Veeger, DirkJan H E J; Stegeman, Dick F; Maas, Huub

    2018-01-23

    In the human hand, independent movement control of individual fingers is limited. One potential cause for this is mechanical connections between the tendons and muscle bellies corresponding to the different fingers. The aim of this study was to determine the tendon displacement of the flexor digitorum superficialis (FDS) of both the instructed and the neighboring, non-instructed fingers during single finger flexion movements. In nine healthy subjects (age 22-29 years), instructed and non-instructed FDS finger tendon displacement of the index, middle and ring finger was measured using 2D ultrasound analyzed with speckle tracking software in two conditions: active flexion of all finger joints with all fingers free to move and active flexion while the non-instructed fingers were restricted. Our results of the free movement protocol showed an average tendon displacement of 27 mm for index finger flexion, 21 mm for middle finger flexion and 17 mm for ring finger flexion. Displacements of the non-instructed finger tendons (≈12 mm) were higher than expected based of the amount of non-instructed finger movement. In the restricted protocol, we found that, despite minimal joint movements, substantial non-instructed finger tendon displacement (≈9 mm) was still observed, which was interpreted as a result of tendon strain. When this strain component was subtracted from the tendon displacement of the non-instructed fingers during the free movement condition, the relationship between finger movement and tendon displacement of the instructed and non-instructed finger became comparable. Thus, when studying non-instructed finger tendon displacement it is important to take tendon strain into consideration. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Musculoskeletal modelling deconstructs the paradoxical effects of elastic ankle exoskeletons on plantar-flexor mechanics and energetics during hopping.

    Science.gov (United States)

    Farris, Dominic James; Hicks, Jennifer L; Delp, Scott L; Sawicki, Gregory S

    2014-11-15

    Experiments have shown that elastic ankle exoskeletons can be used to reduce ankle joint and plantar-flexor muscle loading when hopping in place and, in turn, reduce metabolic energy consumption. However, recent experimental work has shown that such exoskeletons cause less favourable soleus (SO) muscle-tendon mechanics than is observed during normal hopping, which might limit the capacity of the exoskeleton to reduce energy consumption. To directly link plantar-flexor mechanics and energy consumption when hopping in exoskeletons, we used a musculoskeletal model of the human leg and a model of muscle energetics in simulations of muscle-tendon dynamics during hopping with and without elastic ankle exoskeletons. Simulations were driven by experimental electromyograms, joint kinematics and exoskeleton torque taken from previously published data. The data were from seven males who hopped at 2.5 Hz with and without elastic ankle exoskeletons. The energetics model showed that the total rate of metabolic energy consumption by ankle muscles was not significantly reduced by an ankle exoskeleton. This was despite large reductions in plantar-flexor force production (40-50%). The lack of larger metabolic reductions with exoskeletons was attributed to increases in plantar-flexor muscle fibre velocities and a shift to less favourable muscle fibre lengths during active force production. This limited the capacity for plantar-flexors to reduce activation and energy consumption when hopping with exoskeleton assistance. © 2014. Published by The Company of Biologists Ltd.

  3. MRI of the Achilles tendon: A comprehensive review of the anatomy, biomechanics, and imaging of overuse tendinopathies

    Energy Technology Data Exchange (ETDEWEB)

    Pierre-Jerome, Claude; Moncayo, Valeria; Terk, Michael R. (Dept. of Radiology, Emory Univ. Orthopedics and Spine Center, Atlanta, GA (United States)), e-mail: cpierr3@emory.edu

    2010-05-15

    The Achilles tendon is the largest tendon in the body; it plays an important role in the biomechanics of the lower extremity. It can withstand great forces, especially during sporting exercises and pivoting. The pathologies related to the Achilles tendon are diverse and many carry undesirable consequences. We retrospectively analyzed the images of patients who underwent examinations of the ankle/foot region to review the anatomy of the Achilles tendon and its surroundings and to search for pathologies consistent with overuse injuries. The anatomy of the tendon is described from origin to insertion. The imaging characteristics of the Achilles tendon including pitfalls are reviewed. We also describe the Achilles overuse injuries: paratenonitis, tendinosis, tendon tear, atypical tear, tendon re-tear, retrocalcaneal bursitis, retro-Achilles bursitis, Haglund's deformity, and tendon calcification. We present other entities like tendon ossification and failed transplanted Achilles tendon, with emphasis on MRI

  4. MRI of the Achilles tendon: A comprehensive review of the anatomy, biomechanics, and imaging of overuse tendinopathies

    International Nuclear Information System (INIS)

    Pierre-Jerome, Claude; Moncayo, Valeria; Terk, Michael R.

    2010-01-01

    The Achilles tendon is the largest tendon in the body; it plays an important role in the biomechanics of the lower extremity. It can withstand great forces, especially during sporting exercises and pivoting. The pathologies related to the Achilles tendon are diverse and many carry undesirable consequences. We retrospectively analyzed the images of patients who underwent examinations of the ankle/foot region to review the anatomy of the Achilles tendon and its surroundings and to search for pathologies consistent with overuse injuries. The anatomy of the tendon is described from origin to insertion. The imaging characteristics of the Achilles tendon including pitfalls are reviewed. We also describe the Achilles overuse injuries: paratenonitis, tendinosis, tendon tear, atypical tear, tendon re-tear, retrocalcaneal bursitis, retro-Achilles bursitis, Haglund's deformity, and tendon calcification. We present other entities like tendon ossification and failed transplanted Achilles tendon, with emphasis on MRI

  5. Anatomical reference point for harvesting a flexor graft during arthroscopic reconstruction of the anterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Clécio de Lima Lopes

    2015-04-01

    Full Text Available OBJECTIVES: To evaluate the prevalence of a vascular network adjacent to the insertion of the pes anserinus, so that it could be used as an anatomical reference point to facilitate harvesting flexor grafts for arthroscopic reconstruction of the anterior cruciate ligament (ACL.METHODS: Thirty patients with ACL tears who were going to undergo ACL reconstruction using the tendons of the semitendinosus and gracilis muscles as grafts were selected randomly. During the harvesting of these tendons, the presence or absence of this anatomical reference point was noted.RESULTS: All the patients presented a vascular network of greater or lesser diameter.CONCLUSION: The vascular network seems to be a good reference point during harvesting of the tendons of the semitendinosus and gracilis muscles, for facilitating graft harvesting.

  6. Lack of effect of moderate-duration static stretching on plantar flexor force production and series compliance.

    Science.gov (United States)

    Cannavan, Dale; Coleman, David R; Blazevich, Anthony J

    2012-03-01

    The effects of an acute bout of moderate-duration static stretching on plantar flexor force production, series compliance of the muscle-tendon unit, and levels of neuromuscular activation were examined. Eighteen active individuals (9 men and 9 women) performed four 45-s static plantar flexor stretches and a time-matched control of no stretch (where subjects remained seated in the dynamometer for 4 min with no stretch being performed). Measures of peak isometric moment, rate of force development, neuromuscular activation (interpolated twitch technique and electromyography), twitch force characteristics, passive moment during stretch, and tendon elongation during maximal voluntary contractions were taken before and after the stretching. Despite a significant stress-relaxation response during stretch (9.3%, Pforce development (P=0.93; effect size 0.01), neuromuscular activation (interpolated twitch: P=0.86; electromyography: P=0.09; effect size 0.02), or tendon elongation (P=0.61; effect size 0.07) after stretching. Twitch characteristics were also unchanged after stretching, although there was a reduction in the rate of twitch torque relaxation (RR(t); Pstatic stretching did not impair the force generating capacity of the plantar flexors or negatively affect muscle-tendon mechanical properties. Static stretching may not always have detrimental consequences for force production. Thus, clinicians may be able to apply moderate-duration stretches to patients without risk of reducing muscular performance. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. Iliopsoas Tendon Reformation after Psoas Tendon Release

    Directory of Open Access Journals (Sweden)

    K. Garala

    2013-01-01

    Full Text Available Internal snapping hip syndrome, or psoas tendonitis, is a recognised cause of nonarthritic hip pain. The majority of patients are treated conservatively; however, occasionally patients require surgical intervention. The two surgical options for iliopsoas tendinopathy are step lengthening of the iliopsoas tendon or releasing the tendon at the lesser trochanter. Although unusual, refractory snapping usually occurs soon after tenotomy. We report a case of a 47-year-old active female with internal snapping and pain following an open psoas tenotomy. Postoperatively she was symptom free for 13 years. An MRI arthrogram revealed reformation of a pseudo iliopsoas tendon reinserting into the lesser trochanter. The pain and snapping resolved after repeat iliopsoas tendon release. Reformation of tendons is an uncommon sequela of tenotomies. However the lack of long-term studies makes it difficult to calculate prevalence rates. Tendon reformation should be included in the differential diagnosis of failed tenotomy procedures after a period of symptom relief.

  8. Endoscopic adhesiolysis for extensive tibialis posterior tendon and Achilles tendon adhesions following compound tendon rupture

    OpenAIRE

    Lui, Tun Hing

    2013-01-01

    Tendon adhesion is one of the most common causes of disability following tendon surgery. A case of extensive peritendinous adhesions of the Achilles tendon and tibialis posterior tendon after compound rupture of the tendons was reported. This was managed by endoscopic adhesiolysis of both tendons. The endoscopic approach allows early postoperative mobilisation which can relieve the tendon adhesion.

  9. Effects of different extents of pulley release on tendon excursion efficiency and tendon moment arms.

    Science.gov (United States)

    Lu, Szu-Ching; Yang, Tai-Hua; Kuo, Li-Chieh; Jou, I-Ming; Sun, Yung-Nien; Su, Fong-Chin

    2015-02-01

    To compare the excursion efficiency and moment arms of flexor digitorum superficialis (FDS) and profundus (FDP) among different conditions of pulley integrity related to trigger finger treatment, cadaveric fingers were first tested with an intact pulley system, and then the first (A1) and second (A2) annular pulleys were released gradually from the proximal to distal part. Linear position sensors and a motion capture system were used to measure the tendon excursion and joint rotation simultaneously. The tendon excursion efficiency was defined as the range of motion of the involved joints per unit of tendon excursion, and the tendon moment arm was determined by the slope of the linear fitting result of tendon excursion versus metacarpophalangeal (MCP) joint rotation. No significant differences were found between the release of the A1 pulley and the release extending to half the proximal part of the A2 pulley in the FDP excursion efficiency and the moment arms of FDS and FDP with respect to the MCP joint. These results imply that the release could extend to half the proximal A2 pulley, if necessary, without significantly decreasing the FDP excursion efficiency and increasing the moment arms of FDS and FDP with respect to the MCP joint. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  10. Magic angle effect in MR imaging of ankle tendons: influence of foot positioning on prevalence and site in asymptomatic subjects and cadaveric tendons

    International Nuclear Information System (INIS)

    Mengiardi, Bernard; Pfirrmann, Christian W.A.; Hodler, Juerg; Zanetti, Marco; Schoettle, Philip B.; Vienne, Patrick; Bode, Beata

    2006-01-01

    The influence of foot positioning on prevalence of the magic angle effect (MAE) in ankle tendons was investigated. In 30 asymptomatic volunteers and five cadaveric feet, MR imaging of the ankle was performed in the supine (neutral position of the foot) and prone (plantar-flexed foot) position. MAE was considered if increased T1-weighted signal at a certain site was seen in one position only. Histological correlation was obtained at 25 sites of the cadaveric posterior tibialis tendons (PTT). MAE occurred in 6/30 vs 1/30 (supine vs prone) anterior tibialis tendons (ATT), 30/30 vs 0/30 extensor hallucis longus and 27/30 vs 0/30 extensor digitorum longus tendons, 29/30 vs 0/30 PTTs, 30/30 vs 0/30 flexor digitorum and flexor hallucis longus tendons, 30/30 vs 1/30 peroneus brevis and 23/30 vs 1/30 peroneus longus tendons. At 12/25 cadaveric PTT sites where MAE was exclusively responsible for the increased signal, histology revealed normal tissue (11/12) or minimal degeneration (1/12). In conclusion, the supine body position with neutral position of the foot, a high prevalence (77-100%) of MAE in ankle tendons except for the ATT (20%) is seen. MAE is almost absent in the prone body position with plantar flexion of the foot. (orig.)

  11. Magic angle effect in MR imaging of ankle tendons: influence of foot positioning on prevalence and site in asymptomatic subjects and cadaveric tendons

    Energy Technology Data Exchange (ETDEWEB)

    Mengiardi, Bernard; Pfirrmann, Christian W.A.; Hodler, Juerg; Zanetti, Marco [Orthopedic University Hospital Balgrist, Department of Radiology, Zurich (Switzerland); Schoettle, Philip B.; Vienne, Patrick [Orthopedic University Hospital Balgrist, Department of Orthopedic Surgery, Zurich (Switzerland); Bode, Beata [Zurich University Hospital, Department of Pathology, Zurich (Switzerland)

    2006-10-15

    The influence of foot positioning on prevalence of the magic angle effect (MAE) in ankle tendons was investigated. In 30 asymptomatic volunteers and five cadaveric feet, MR imaging of the ankle was performed in the supine (neutral position of the foot) and prone (plantar-flexed foot) position. MAE was considered if increased T1-weighted signal at a certain site was seen in one position only. Histological correlation was obtained at 25 sites of the cadaveric posterior tibialis tendons (PTT). MAE occurred in 6/30 vs 1/30 (supine vs prone) anterior tibialis tendons (ATT), 30/30 vs 0/30 extensor hallucis longus and 27/30 vs 0/30 extensor digitorum longus tendons, 29/30 vs 0/30 PTTs, 30/30 vs 0/30 flexor digitorum and flexor hallucis longus tendons, 30/30 vs 1/30 peroneus brevis and 23/30 vs 1/30 peroneus longus tendons. At 12/25 cadaveric PTT sites where MAE was exclusively responsible for the increased signal, histology revealed normal tissue (11/12) or minimal degeneration (1/12). In conclusion, the supine body position with neutral position of the foot, a high prevalence (77-100%) of MAE in ankle tendons except for the ATT (20%) is seen. MAE is almost absent in the prone body position with plantar flexion of the foot. (orig.)

  12. Digital flexor musculotendinous contracture in two Devon Rex cats.

    Science.gov (United States)

    Thom, Leonie K; Pool, Roy R; Malik, Richard

    2017-03-01

    Clinical summary: A 13-year-old, spayed Devon Rex with unilateral digital flexor musculotendinous contracture of the forelimb was treated by surgical tenotomy. The condition improved transiently, but recurred rapidly and became bilateral. Histopathologic analysis of necropsy tissues resulted in a morphologic diagnosis of fibromyositis of the antebrachial muscles causing contracture and flexural deformity of the carpi and phalanges of both thoracic limbs. A search for similar cases yielded the clinical notes of a second cat, a 10-year-old, spayed Devon Rex, also with bilateral disease. This second case responded well to surgical tenotomy but tissue biopsies were not obtained to permit microscopic assessment of the underlying pathologic process. Relevance and novel information: Acquired and permanent contracture of the digital flexor muscles and/or tendons of the forelimbs is a rare and poorly described condition of cats. The very limited number of documented cases describing disease affecting one or more digits (but not the carpus) infers a causal link with onychectomy, but reported histopathologic changes have been limited to the tendons. The two cases described in this report suffered contracture of the carpus and all digits bilaterally, one without previous onychectomy and the other 9 years after onychectomy. There were novel histopathologic findings in the muscles of the one case for which biopsy material was available. Information gained from these two cases provides a new perspective for the investigation and treatment of future cases. Specifically, consideration should be given to an underlying immune-mediated myopathic process and a possible genetic predisposition in the Devon Rex breed. Currently, the poorly understood etiopathogenesis hinders our ability to definitively recommend treatment options, which might include corticosteroids and other forms of immunosuppressive therapy.

  13. Tendon shift in hallux valgus: observations at MR imaging

    International Nuclear Information System (INIS)

    Eustace, S.; Williamson, D.; Wilson, M.; O'Byrne, J.; Bussolari, L.; Thomas, M.; Stephens, M.; Stack, J.; Weissman, B.

    1996-01-01

    Objective. This study was undertaken to demonstrate a shift in tendon alignment at the first metatarsophalangeal joint in patients with hallux valgus by means of magnetic resonance imaging. Design. Ten normal feet and 20 feet with the hallux valgus deformity conforming to conventional clinical and radiographic criteria were prospectively studied using magnetic resonance imaging. Correlation was made between tendon position at the first metatarsophalangeal joint and the severity of the hallux valgus deformity. Results. There is a significant shift in tendon position at the first metatarsophalangeal joint of patients with hallux valgus. The insertion of the abductor hallucis tendon is markedly plantarward and the flexor and extensor tendons bowstring at the first metatarsophalangeal joint compared with patients without the deformity. The severity of the tendon shift correlates with the hallux valgus angle and clinical severity of the hallux valgus deformity in each case. Conclusion. Patients with hallux valgus have a significant tendon shift at the first metatarsophalangeal joint which appears to contribute to development of the deformity. (orig.). With 4 figs., 1 tab

  14. Tendon shift in hallux valgus: observations at MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Eustace, S. [Department of Radiology, Boston University Medical Center Hospital, 88 East Newton Street, Atrium - 2, Boston, MA 02118 (United States); Williamson, D. [Department of Radiology, Brigham and Womens Hospital, Boston, Massachusetts (United States); Wilson, M. [Department of Orthopedics, Brigham and Womens Hospital, Boston, Massachusetts (United States); O`Byrne, J. [Department of Radiology, Boston University Medical Center Hospital, 88 East Newton Street, Atrium - 2, Boston, MA 02118 (United States); Bussolari, L. [Department of Radiology, Brigham and Womens Hospital, Boston, Massachusetts (United States); Thomas, M. [Department of Radiology, Brigham and Womens Hospital, Boston, Massachusetts (United States); Stephens, M. [Department of Radiology, Boston University Medical Center Hospital, 88 East Newton Street, Atrium - 2, Boston, MA 02118 (United States); Stack, J. [Department of Radiology, Boston University Medical Center Hospital, 88 East Newton Street, Atrium - 2, Boston, MA 02118 (United States); Weissman, B. [Department of Radiology, Brigham and Womens Hospital, Boston, Massachusetts (United States)

    1996-08-01

    Objective. This study was undertaken to demonstrate a shift in tendon alignment at the first metatarsophalangeal joint in patients with hallux valgus by means of magnetic resonance imaging. Design. Ten normal feet and 20 feet with the hallux valgus deformity conforming to conventional clinical and radiographic criteria were prospectively studied using magnetic resonance imaging. Correlation was made between tendon position at the first metatarsophalangeal joint and the severity of the hallux valgus deformity. Results. There is a significant shift in tendon position at the first metatarsophalangeal joint of patients with hallux valgus. The insertion of the abductor hallucis tendon is markedly plantarward and the flexor and extensor tendons bowstring at the first metatarsophalangeal joint compared with patients without the deformity. The severity of the tendon shift correlates with the hallux valgus angle and clinical severity of the hallux valgus deformity in each case. Conclusion. Patients with hallux valgus have a significant tendon shift at the first metatarsophalangeal joint which appears to contribute to development of the deformity. (orig.). With 4 figs., 1 tab.

  15. Effect of adipose-derived nucleated cell fractions on tendon repair in horses with collagenase-induced tendinitis.

    Science.gov (United States)

    Nixon, Alan J; Dahlgren, Linda A; Haupt, Jennifer L; Yeager, Amy E; Ward, Daniel L

    2008-07-01

    To assess the potential of adipose-derived nucleated cell (ADNC) fractions to improve tendon repair in horses with collagenase-induced tendinitis. 8 horses. Collagenase was used to induce tendinitis in the superficial digital flexor tendon of 1 forelimb in each horse. Four horses were treated by injection of autogenous ADNC fractions, and 4 control horses were injected with PBS solution. Healing was compared by weekly ultrasonographic evaluation. Horses were euthanatized at 6 weeks. Gross and histologic evaluation of tendon structure, fiber alignment, and collagen typing were used to define tendon architecture. Biochemical and molecular analyses of collagen, DNA, and proteoglycan and gene expression of collagen type I and type III, decorin, cartilage oligomeric matrix protein (COMP), and insulin-like growth factor-I were performed. Ultrasonography revealed no difference in rate or quality of repair between groups. Histologic evaluation revealed a significant improvement in tendon fiber architecture; reductions in vascularity, inflammatory cell infiltrate, and collagen type III formation; and improvements in tendon fiber density and alignment in ADNC-treated tendons. Repair sites did not differ in DNA, proteoglycan, or total collagen content. Gene expression of collagen type I and type III in treated and control tendons were similar. Gene expression of COMP was significantly increased in ADNC-injected tendons. ADNC injection improved tendon organization in treated tendons. Although biochemical and molecular differences were less profound, tendons appeared architecturally improved after ADNC injection, which was corroborated by improved tendon COMP expression. Use of ADNC in horses with tendinitis appears warranted.

  16. Medline Plus

    Full Text Available ... 14/2013) Wounds and Injuries Repair of Flexor Tendon and Nerve (Wake Forest Baptist Medical Center, Winston- ... Safety Issues Wounds and Injuries Repair of Flexor Tendon and Nerve (Wake Forest Baptist Medical Center, Winston- ...

  17. Repair and rehabilitation of extensor hallucis longus and brevis tendon lacerations in a professional dancer.

    Science.gov (United States)

    Bronner, Shaw; Ojofeitimi, Sheyi; Rose, Donald

    2008-06-01

    Case report. Tendon lacerations of the hallux are potentially devastating to a dancer. Strength of the hallux musculature is necessary to attain and maintain balance, push-off in multiple turns, and decelerate in jumps and hops. The purpose of this paper is to report on the repair and rehabilitation of extensor hallucis longus and extensor hallucis brevis tendon lacerations in a professional dancer. A 30-year-old dancer sustained complete laceration of her extensor hallucis longus and extensor hallucis brevis tendons, and partial laceration of the dorsal aspect of the hallux metatarsophalangeal (MTP) joint capsule. Following primary repair, at 9 weeks postsurgery, hallux MTP joint active dorsiflexion was limited to 5 degrees and passive dorsiflexion to 70 degrees . First toe dorsiflexion and plantar flexion strength was 4/5 at the MTP and 3+/5 at the interphalangeal joint. Rehabilitation included functional electrical stimulation to address considerable calf atrophy, strengthening exercises, functional retraining, and progressive return to dance. The dancer returned to her previous level of dancing in 18 weeks, with 73 degrees and 85 degrees of hallux MTP joint active and passive dorsiflexion, and 30 degrees and 35 degrees of active and passive plantar flexion, respectively. Hallux MTP and interphalangeal joint muscle strength were 5/5 and 4+/5, respectively. Improvement, manifested in her SF-36 and Dance Functional Outcome System scores, accompanied her full functional recovery. Hallux stability provided by coactivation of the great toe extensors and flexors is crucial to accomplish the demands of bipedal and unipedal balances and activities in dance. This report demonstrates the success of primary surgical repair and rehabilitation in a dancer/athlete experiencing this injury.

  18. Sex differences in tendon structure and function.

    Science.gov (United States)

    Sarver, Dylan C; Kharaz, Yalda Ashraf; Sugg, Kristoffer B; Gumucio, Jonathan P; Comerford, Eithne; Mendias, Christopher L

    2017-10-01

    Tendons play a critical role in the transmission of forces between muscles and bones, and chronic tendon injuries and diseases are among the leading causes of musculoskeletal disability. Little is known about sex-based differences in tendon structure and function. Our objective was to evaluate the mechanical properties, biochemical composition, transcriptome, and cellular activity of plantarflexor tendons from 4 month old male and female C57BL/6 mice using in vitro biomechanics, mass spectrometry-based proteomics, genome-wide expression profiling, and cell culture techniques. While the Achilles tendons of male mice were approximately 6% larger than female mice (p  0.05) of plantaris tendons were observed. Mass spectrometry proteomics analysis revealed no significant difference between sexes in the abundance of major extracellular matrix (ECM) proteins such as collagen types I (p = 0.30) and III (p = 0.68), but female mice had approximately twofold elevations (p tendons differed by only 1%. In vitro, neither the sex of the serum that fibroblasts were cultured in, nor the sex of the ECM in which they were embedded, had profound effects on the expression of collagen and cell proliferation genes. Our results indicate that while male mice expectedly had larger tendons, male and female tendons have very similar mechanical properties and biochemical composition, with small increases in some ECM proteins and proteoglycans evident in female tendons. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2117-2126, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  19. THE ROLE OF DETRAINING IN TENDON MECHANOBIOLOGY

    Directory of Open Access Journals (Sweden)

    Antonio eFrizziero

    2016-02-01

    Full Text Available Introduction: Several conditions such as training, aging, estrogen deficiency and drugs could affect the biological and anatomo-physiological characteristics of the tendon. Additionally, recent preclinical and clinical studies examined the effect of detraining on tendon, showing alterations in its structure and morphology and in tenocyte mechanobiology. However, there is a paucity of data examining the impact that cessation of training may have on tendon. In practice, we do not fully understand how tendons respond to a period of training followed by sudden detraining. Therefore, within this review, we summarize the studies where tendon detraining was examined.Materials and methods: A descriptive systematic literature review was conducted by searching three databases (PubMed, Scopus and Web of Knowledge on tendon detraining. Original articles in English from 2000 to 2015 were included. In addition, the search was extended to the reference lists of the selected articles. A public reference manager (www.mendeley.com was used to delete duplicate articles.Results: An initial literature search yielded 134 references (www.pubmed.org: 53; www.scopus.com: 11; www.webofknowledge.com: 70. 15 publications were extracted based on the title for further analysis by two independent reviewers. Abstracts and whole articles were then reviewed to detect if they met inclusion criteria.Conclusions: The revised literature comprised 4 clinical studies and an in vitro and three in vivo reports. Overall, the results showed that tendon structure and properties after detraining are compromised, with an alteration in the tissue structural organization and mechanical properties. Clinical studies usually showed a lesser extent of tendon alterations, probably because preclinical studies permit an in-depth evaluation of tendon modifications, which is hard to perform in human subjects. In conclusion, after a period of sudden detraining (e.g. after an injury, physical activity

  20. The Role of Detraining in Tendon Mechanobiology.

    Science.gov (United States)

    Frizziero, Antonio; Salamanna, Francesca; Della Bella, Elena; Vittadini, Filippo; Gasparre, Giuseppe; Nicoli Aldini, Nicolò; Masiero, Stefano; Fini, Milena

    2016-01-01

    Several conditions such as training, aging, estrogen deficiency and drugs could affect the biological and anatomo-physiological characteristics of the tendon. Additionally, recent preclinical and clinical studies examined the effect of detraining on tendon, showing alterations in its structure and morphology and in tenocyte mechanobiology. However, few data evaluated the importance that cessation of training might have on tendon. Basically, we do not fully understand how tendons react to a phase of training followed by sudden detraining. Therefore, within this review, we summarize the studies where tendon detraining was examined. A descriptive systematic literature review was carried out by searching three databases (PubMed, Scopus and Web of Knowledge) on tendon detraining. Original articles in English from 2000 to 2015 were included. In addition, the search was extended to the reference lists of the selected articles. A public reference manager (www.mendeley.com) was adopted to remove duplicate articles. An initial literature search yielded 134 references (www.pubmed.org: 53; www.scopus.com: 11; www.webofknowledge.com: 70). Fifteen publications were extracted based on the title for further analysis by two independent reviewers. Abstracts and complete articles were after that reviewed to evaluate if they met inclusion criteria. The revised literature comprised four clinical studies and an in vitro and three in vivo reports. Overall, the results showed that tendon structure and properties after detraining are compromised, with an alteration in the tissue structural organization and mechanical properties. Clinical studies usually showed a lesser extent of tendon alterations, probably because preclinical studies permit an in-depth evaluation of tendon modifications, which is hard to perform in human subjects. In conclusion, after a period of sudden detraining (e.g., after an injury), physical activity should be taken with caution, following a targeted rehabilitation

  1. Three-dimensional Doppler ultrasound findings in healthy wrist and finger tendon sheaths

    DEFF Research Database (Denmark)

    Ammitzboll-Danielsen, Mads; Janta, Iustina; Torp-Pedersen, Søren

    2016-01-01

    interpretation of Doppler signals when diagnosing tenosynovitis. Method Forty healthy participants (20 women and 20 men age 23-67 years) without prior history of arthritis, tendon diseases or present pain in their hands were included. Twenty participants had 3D Doppler US of the second and third finger...... participant. No significant difference in feeding vessels was seen between the radial and carpal level in the wrist (p = 0.06) or between the second and third flexor tendon sheath (p = 0.84). Conclusion Doppler findings in or in close proximity to the tendon sheaths were common in wrists and fingers...

  2. Quadriceps Tendon Rupture in an Adolescent Athlete

    Directory of Open Access Journals (Sweden)

    William A. Zuke

    2017-01-01

    Full Text Available Quadriceps tendon rupture is an uncommon injury that usually occurs in middle-aged and elderly men with a history of chronic illnesses. We report the case of a 17-year-old healthy adolescent male baseball player who sustained this injury as a result of sudden deceleration in his left knee. He initially reported to the emergency department and then presented to our practice, where he was diagnosed with a quadriceps tendon tear. Preoperatively, he was unable to perform a single straight-leg raise. During surgical repair, the free edge of the quadriceps tendon was mobilized and anchored into the superior pole of the patella, followed by sutures to ensure reinforcement of the quadriceps footprint. His postoperative course progressed normally, demonstrating full range of motion at 3 months and return to team training at 5 months. Unlike previously reported quadriceps tendon ruptures in adolescents, to our knowledge, this is the first report of a patient who sustained such an injury without previous trauma to his knee or quadriceps mechanism. It is possible that weakened tendon integrity from repeated microtrauma during training combined with the sudden weight change distribution may have resulted in the injury. As urgent surgical intervention is necessary to ensure efficient recovery and return to sport, the sports medicine practitioner must remain educated and vigilant on caring for these patients.

  3. Plantar tendons of the foot: MR imaging and US.

    Science.gov (United States)

    Donovan, Andrea; Rosenberg, Zehava Sadka; Bencardino, Jenny T; Velez, Zoraida Restrepo; Blonder, David B; Ciavarra, Gina A; Adler, Ronald Steven

    2013-01-01

    Tendon disorders along the plantar aspect of the foot may lead to significant symptoms but are often clinically misdiagnosed. Familiarity with the normal anatomy of the plantar tendons and its appearance at magnetic resonance (MR) imaging and ultrasonography (US) is essential for recognizing plantar tendon disorders. At MR imaging, the course of the plantar tendons is optimally visualized with dedicated imaging of the midfoot and forefoot. This imaging should include short-axis images obtained perpendicular to the long axis of the metatarsal shafts, which allows true cross-sectional evaluation of the plantar tendons. Normal plantar tendons appear as low-signal-intensity structures with all MR sequences. At US, accurate evaluation of the tendons requires that the ultrasound beam be perpendicular to the tendon. The normal tendon appears as a compact linear band of echogenic tissue that contains a fine, mixed hypoechoic and hyperechoic internal fibrillar pattern. Tendon injuries can be grouped into six major categories: tendinosis, peritendinosis, tenosynovitis, entrapment, rupture, and instability (subluxation or dislocation) and can be well assessed with both MR imaging and US. The radiologist plays an important role in the diagnosis of plantar tendon disorders, and recognizing their imaging appearances at MR imaging and US is essential.

  4. Can we improve tendon healing in the horse? A multi-angle study of a multi-facet problem

    NARCIS (Netherlands)

    Cadby, J.A.

    2013-01-01

    Tendon problems are frequent among horses and humans as both species face athletic challenges. Repetitive exercise often leads to overuse injuries in tendons and the number of reported cases of tendon injuries has increased enormously during the last decades, due to changes in demographics and

  5. Difficulty in Clinical Evaluation of Radial Nerve Injury due to Multiple Trauma to the Humerus, Wrist, and Hand

    Directory of Open Access Journals (Sweden)

    Balik Mehmet Sabri

    2014-01-01

    Full Text Available Radial nerve damage is frequently encountered in humeral fractures. The radial nerve is primarily damaged when the humerus gets fractured, while secondary damage maybe due to post-traumatic manipulations and surgical exploration. High impact traumatic nerve injury, serious neuropathic pain, lack of response to therapeutic interventions, and indifference to the Tinel test are indications for surgical intervention. Since most humeral fracture-induced low impact radial nerve injuries resolve spontaneously, conservative therapy is preferred. We present a patient with humeral fracture-associated radial nerve injury, accompanied with digital amputation and flexor tendon avulsion on the same arm. These injuries required immediate surgery, thus rendering the clinical evaluation of the radial nerve impossible. We would like to highlight and discuss the inherent difficulties associated with multiple trauma of the upper arm.

  6. The Effect of Sodium Hyaluronate on Ligamentation and Biomechanical Property of Tendon in Repair of Achilles Tendon Defect with Polyethylene Terephthalate Artificial Ligament: A Rabbit Tendon Repair Model.

    Science.gov (United States)

    Li, Shengkun; Ma, Kui; Li, Hong; Jiang, Jia; Chen, Shiyi

    2016-01-01

    The Achilles tendon is the most common ruptured tendon of human body. Reconstruction with polyethylene terephthalate (PET) artificial ligament is recommended in some serious cases. Sodium hyaluronate (HA) is beneficial for the healing of tendon injuries. We aimed to determine the effect of sodium hyaluronate in repair of Achilles tendon defect with PET artificial ligament in an animal tendon repair model. Sixteen New Zealand White rabbits were divided into two groups. Eight rabbits repaired with PET were assigned to PET group; the other eight rabbits repaired with PET along with injection of HE were assigned to HA-PET group. All rabbits were sacrificed at 4 and 8 weeks postoperatively for biomechanical and histological examination. The HA-PET group revealed higher biomechanical property compared with the PET group. Histologically, more collagen tissues grew into the HA-PET group compared with PET group. In conclusion, application of sodium hyaluronate can improve the healing of Achilles tendon reconstruction with polyethylene terephthalate artificial ligament.

  7. Obesity/Type II diabetes alters macrophage polarization resulting in a fibrotic tendon healing response.

    Directory of Open Access Journals (Sweden)

    Jessica E Ackerman

    Full Text Available Type II Diabetes (T2DM dramatically impairs the tendon healing response, resulting in decreased collagen organization and mechanics relative to non-diabetic tendons. Despite this burden, there remains a paucity of information regarding the mechanisms that govern impaired healing of diabetic tendons. Mice were placed on either a high fat diet (T2DM or low fat diet (lean and underwent flexor tendon transection and repair surgery. Healing was assessed via mechanical testing, histology and changes in gene expression associated with collagen synthesis, matrix remodeling, and macrophage polarization. Obese/diabetic tendons healed with increased scar formation and impaired mechanical properties. Consistent with this, prolonged and excess expression of extracellular matrix (ECM components were observed in obese/T2DM tendons. Macrophages are involved in both inflammatory and matrix deposition processes during healing. Obese/T2DM tendons healed with increased expression of markers of pro-inflammatory M1 macrophages, and elevated and prolonged expression of M2 macrophages markers that are involved in ECM deposition. Here we demonstrate that tendons from obese/diabetic mice heal with increased scar formation and increased M2 polarization, identifying excess M2 macrophage activity and matrix synthesis as a potential mechanism of the fibrotic healing phenotype observed in T2DM tendons, and as such a potential target to improve tendon healing in T2DM.

  8. Tendon rupture associated with excessive smartphone gaming.

    Science.gov (United States)

    Gilman, Luke; Cage, Dori N; Horn, Adam; Bishop, Frank; Klam, Warren P; Doan, Andrew P

    2015-06-01

    Excessive use of smartphones has been associated with injuries. A 29-year-old, right hand-dominant man presented with chronic left thumb pain and loss of active motion from playing a Match-3 puzzle video game on his smartphone all day for 6 to 8 weeks. On physical examination, the left extensor pollicis longus tendon was not palpable, and no tendon motion was noted with wrist tenodesis. The thumb metacarpophalangeal range of motion was 10° to 80°, and thumb interphalangeal range of motion was 30° to 70°. The clinical diagnosis was rupture of the left extensor pollicis longus tendon. The patient subsequently underwent an extensor indicis proprius (1 of 2 tendons that extend the index finger) to extensor pollicis longus tendon transfer. During surgery, rupture of the extensor pollicis longus tendon was seen between the metacarpophalangeal and wrist joints. The potential for video games to reduce pain perception raises clinical and social considerations about excessive use, abuse, and addiction. Future research should consider whether pain reduction is a reason some individuals play video games excessively, manifest addiction, or sustain injuries associated with video gaming.

  9. Complications of Supine Surgical Achilles Tendon Repair.

    Science.gov (United States)

    Marcel, John J; Sage, Katherine; Guyton, Gregory P

    2018-02-01

    Open Achilles tendon surgery with the patient in the supine position potentially avoids the complications of the prone position, but the safety and viability of the supine position for this procedure are not known. The aim of this study was to test the hypothesis that supine positioning for open repair of acute Achilles tendon ruptures would be safe, with low wound and neurologic complication rates. Supine position safety in acute Achilles tendon repair was investigated. Consecutive cases of supine Achilles tendon surgical repair performed by one surgeon from 2010 to 2015 were retrospectively reviewed. Patients were included if they were surgically treated with primary repair in the supine position within 15 days of injury and did not undergo concomitant surgery. A paramedian incision 1 cm medial to the Achilles sheath was used. Initial chart review identified 161 patients who underwent any type of Achilles tendon surgery in the supine position, of whom 45 patients met the inclusion criteria. This group included 39 men and 6 women with an average age of 41 years (range, 20-66 years). Median length of follow-up was 116 days (range, 25-1,589 days). Average body mass index was 29 kg/m 2 (range, 23-36 kg/m 2 ). There were no infections, sural nerve injuries, or reruptures. The supine position was safe for primary open Achilles tendon repair, with no wound or neurologic complications. Level IV, Case Series.

  10. Arthroscopic quadriceps tendon repair: two case reports.

    Science.gov (United States)

    Saito, Hidetomo; Shimada, Yoichi; Yamamura, Toshiaki; Yamada, Shin; Sato, Takahiro; Nozaka, Koji; Kijima, Hiroaki; Saito, Kimio

    2015-01-01

    Recently, although some studies of open repair of the tendon of the quadriceps femoris have been published, there have been no reports in the literature on primary arthroscopic repair. In our present study, we present two cases of quadriceps tendon injury arthroscopically repaired with excellent results. Case 1 involved a 68-year-old man who was injured while shifting his weight to prevent a fall. MRI showed complete rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using both suture anchor and pull-out suture fixation methods via bone tunnels (hereafter, pull-out fixation). Two years after surgery, retearing was not observed on MRI and both Japan Orthopedic Association (JOA) Knee and Lysholm scores had recovered to 100. Case 2 involved a 50-year-old man who was also injured when shifting his weight to prevent a fall. MRI showed incomplete superficial rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using pull-out fixation of six strand sutures. One year after surgery, MRI revealed a healed tendon and his JOA and Lysholm scores were 95 and 100, respectively. Thus, arthroscopic repair may be a useful surgical method for repairing quadriceps tendon injury.

  11. Arthroscopic Quadriceps Tendon Repair: Two Case Reports

    Directory of Open Access Journals (Sweden)

    Hidetomo Saito

    2015-01-01

    Full Text Available Recently, although some studies of open repair of the tendon of the quadriceps femoris have been published, there have been no reports in the literature on primary arthroscopic repair. In our present study, we present two cases of quadriceps tendon injury arthroscopically repaired with excellent results. Case 1 involved a 68-year-old man who was injured while shifting his weight to prevent a fall. MRI showed complete rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using both suture anchor and pull-out suture fixation methods via bone tunnels (hereafter, pull-out fixation. Two years after surgery, retearing was not observed on MRI and both Japan Orthopedic Association (JOA Knee and Lysholm scores had recovered to 100. Case 2 involved a 50-year-old man who was also injured when shifting his weight to prevent a fall. MRI showed incomplete superficial rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using pull-out fixation of six strand sutures. One year after surgery, MRI revealed a healed tendon and his JOA and Lysholm scores were 95 and 100, respectively. Thus, arthroscopic repair may be a useful surgical method for repairing quadriceps tendon injury.

  12. Bilateral simultaneous spontaneous rupture of the quadriceps tendons

    African Journals Online (AJOL)

    simultaneous rupture of the quadriceps tendons. The injury occurs most often in elderly people and delay in the diagnosis is not uncommon. Early operative repair is recommended. By using a metal wire passing through a transverse hole in the superior pole of the patella and through the tendon proximal to the repair site, ...

  13. Ultrasound evaluation of stress injuries and physiological adaptations in the fingers of adolescent competitive rock climbers.

    Science.gov (United States)

    Garcia, Kathryn; Jaramillo, Diego; Rubesova, Erika

    2018-03-01

    The impact of high-intensity, repetitive training on the fingers of adolescent climbers is relatively unknown. To evaluate this effect by ultrasound (US) and to confirm some findings by magnetic resonance imaging (MRI). The US study was performed in 20 adolescent rock climbers (ages 10-17 years) and 6 non-climbing controls (ages 11-15 years). US was used to examine the third digit of the right hand for differences in thickness of soft tissue, flexor and extensor tendon, volar plate and bony and growth plate adaptations. In four climbers with finger deformity or pain, 3-T MR images were compared with US findings. Number of hours/week and years of climbing were used to group climbers in three levels (3=most intense training). Mann-Whitney test was used for statistical analysis. Compared with non-climbing controls, climbers demonstrated significantly thicker flexor tendons, volar plates and soft tissues. Joint effusions were found in 13/19 (68%) climbers. Significant phalangeal malalignment was seen in 10/19 (53%) climbers. Growth plate deformities were identified in three level 3 climbers. US findings correlated with MRI for effusions, phalangeal growth plate injury, malalignment and adaptive changes. MRI additional showed capsule rupture (n=1), stress fracture (n=1) and phalangeal physeal stress injury (n=1). Competitive rock climbing results in physiological adaptations in the fingers, an example being significant soft-tissue hypertrophy of the flexor. US demonstrated several non-physiological changes in response to repetitive stress in half of the climbers. MRI showed additional stress injuries to the growth plate, joints and bone.

  14. Percutaneous Achilles Tendon Lengthening

    Science.gov (United States)

    ... All Site Content AOFAS / FootCareMD / Treatments Percutaneous Achilles Tendon Lengthening Page Content ​ Pre-operative incision markings along ... What is the goal of a percutaneous Achilles tendon lengthening? The goal of this procedure is to ...

  15. Biomechanical effects of steroid injections used to treat pyogenic flexor tenosynovitis

    Directory of Open Access Journals (Sweden)

    Turvey Blake R

    2012-10-01

    Full Text Available Abstract Background A recent study from our laboratory has demonstrated improved range of motion in the toes of broiler chickens afflicted with pyogenic flexor tenosynovitis when treated with local antibiotic and corticosteroid injections, without surgical drainage. However, the use of corticosteroids as an adjunct treatment raised peer concern, as steroids are thought to have deleterious effects on tendon strength. The purpose of this study was to compare the tensile strength of the aforementioned steroid treated tendons, to a group of tendons administered with the current standard treatment: systemic antibiotics, surgical drainage and no corticosteroids. Methods Twenty-three tendons’ structural and material properties were investigated (fifteen receiving the standard treatment, eight receiving the steroid treatment. The measurements from each group were interpreted via Student’s unpaired t-test and a post-hoc power analysis. Results The steroid treated tendons did demonstrate a trend toward decreased mechanical properties when compared with the standard treatment group, but the results were not statistically significant. Conclusions Treatment of septic tenosynovitis with local corticosteroid and local antibiotic injections resulted in better digital motion, without a significant loss of tendon strength, over a twenty-eight day recovery period.

  16. Metabolic activity and collagen turnover in human tendon in response to physical activity

    DEFF Research Database (Denmark)

    Kjaer, M; Langberg, H; Miller, B F

    2005-01-01

    Connective tissue of the human tendon plays an important role in force transmission. The extracellular matrix turnover of tendon is influenced by physical activity. Blood flow, oxygen demand, and the level of collagen synthesis and matrix metalloproteinases increase with mechanical loading. Gene...... of overuse tendon injuries occurring during sport, work or leisure-related activities....

  17. Achilles tendon rupture; assessment of nonoperative treatment

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner

    2014-01-01

    BACKGROUND: Acute Achilles tendon rupture is a frequent and potentially disabling injury. Over the past decade a change in treatment of acute Achilles tendon rupture away from operative towards non-operative treatment has taken place. However, the optimal non-operative treatment protocol remains...... to be clarified, particularly the role of weight-bearing during early rehabilitation. Also, there is a need for a clinically applicable and accurate measurement to detect patients in risk of developing Achilles tendon elongation. PURPOSE: The aim of this PhD thesis was to evaluate non-operative treatment of acute...... Achilles tendon rupture. METHODS: In study I, a cross-sectional survey was performed investigating the chosen treatment protocols across Scandinavia. In study II, the effect of immediate weight-bearing on patient reported and functional outcomes was investigated in a randomized controlled trial (RCT...

  18. Achilles tendon rupture; assessment of nonoperative treatment

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner

    2014-01-01

    BACKGROUND: Acute Achilles tendon rupture is a frequent and potentially disabling injury. Over the past decade a change in treatment ofacute Achilles tendon rupture away from operative towards non-operative treatment has taken place. However, the optimal non-operative treatment protocol remains...... to be clarified, particularly the role of weight-bearing during early rehabilitation. Also, there is a need for a clinically applicable and accurate measurement to detect patients in risk of developing Achilles tendon elongation. PURPOSE: The aim of this PhD thesis was to evaluate non-operative treatment of acute...... Achilles tendon rupture. METHODS: In study I, a cross-sectional survey was performed investigating the chosen treatment protocols across Scandinavia. In study II, the effect of immediate weight-bearing on patient reported and functional outcomes was investigated in a randomized controlled trial (RCT...

  19. Asymmetrical Achilles tendon ossification and rare rear heel pain

    Directory of Open Access Journals (Sweden)

    Md Abu Bakar Siddiq

    2017-03-01

    Full Text Available Achilles tendon ossification is not a frequent association of posterior heel pain in pain physicians’ daily practice. The condition has been reportedly common following rear heel trauma (repetitive heel stress injury, surgery (club foot surgery; however, some endocrino-metabolic, haematological disorders can also contribute to Achilles tendon ossification. Shape of ossified tendon mass varies from discrete (single/multiple to extensive variety; and as per literature review, in bilateral cases they are alike. To be intriguing, here in this write-up, we demonstrate asymmetrical (in terms of clinical features and radioimaging findings, bilateral Achilles tendon ossification in a 70-year-old retired farmer, first time in literature.

  20. Nanoparticles for tendon healing and regeneration: literature review.

    Directory of Open Access Journals (Sweden)

    Paolo Domenico Parchi

    2016-08-01

    Full Text Available Tendon injuries are commonly met in the emergency department. Unfortunately, tendon tissue has limited regeneration potential and usually the consequent formation of scar tissue causes inferior mechanical properties Nanoparticles could be used in different way to improve tendon healing and regeneration, ranging from scaffolds manufacturing (increasing the strength and endurance or anti-adhesions, anti-microbial and anti-inflammatory properties to gene therapy. This paper aims to summarize the most relevant studies showing the potential application of nanoparticles for tendon tissue regeneration

  1. [The acquired flatfoot: mid-term results of the medial displacement calcaneal-osteotomy with flexor digitorum longus transfer].

    Science.gov (United States)

    Ivanic, G M; Hofstaetter, S G; Trnka, H J

    2006-01-01

    The present retrospective study investigates the mid-term results after medial displacement calcaneal osteotomy combined with flexor digitorum longus transfer for the treatment of acquired flatfoot deformity due to posterior tibial tendon insufficiency at stage II (Johnson and Strom Classification). 30 feet in 29 patients (6 male, 23 female) with an average age of 58 years (from 43 to 68 years) had surgery between 1995 and 2001. All feet were examined at an average follow-up of 58.5 months (range 35-97 months) and were evaluated with the American-Orthopaedic-Foot and Ankle Society (AOFAS) Hindfoot-Score. The average AOFAS-Score was 88.8+/-10.7 points (range 48 to 100) at final follow-up. The AOFAS-pain-subscale score was 34+/-6.2 points. At the latest follow-up were 14 feet (47%) painfree, 14 feet (47%) noted mild pain and 2 feet (6%) had daily pain. One foot (3%) had pain due to subluxation of the musculus flexor digitorum longus tendon, in another one pain was caused by a contract Chopart joint (3%). Further complications were painful prominent hardware (17%) and neuralgia of the sural nerve (7%). The authors conclude that the combination of the medial calcaneal displacement osteotomy with flexor digitorum longus transfer may provide optimal results in patients with adult acquired flatfoot deformity and posterior tibialis tendon dysfunction.

  2. Range of motion, neuromechanical and architectural daptations to plantar flexor stretch training in humans

    DEFF Research Database (Denmark)

    Blazevich, Anthony John; Cannavan, Dale; Waugh, Charlie M

    2014-01-01

    flexor stretches after 3 wk of twice-daily stretch training (4×30-s). No changes were observed in a non-exercising control group (N=9), however stretch training elicited a 19.9% increase in dorsiflexion range of motion (ROM) and 28% increase in passive joint moment at end ROM (N=12). Only a trend toward......The neuromuscular adaptations in response to muscle stretch training have not been clearly described. In the present study, changes in muscle (at fascicular and whole muscle levels) and tendon mechanics, muscle activity and spinal motoneuron excitability were examined during standardized plantar...... a decrease in passive plantar flexor moment during stretch (-9.9%, p=0.15) was observed and no changes in EMG amplitudes during or at end ROM were detected. Decreases in Hmax:Mmax (tibial nerve stimulation) were observed at plantar flexed (gastrocnemius medialis and soleus) and neutral (soleus only) joint...

  3. Tendon biomechanics and mechanobiology - a mini-review of basic concepts and recent advancements

    Science.gov (United States)

    Wang, James H-C.; Guo, Qianping; Li, Bin

    2011-01-01

    Due to their unique hierarchical structure and composition, tendons possess characteristic biomechanical properties, including high mechanical strength and viscoelasticity, which enable them to carry and transmit mechanical loads (muscular forces) effectively. Tendons are also mechano-responsive by adaptively changing their structure and function in response to altered mechanical loading conditions. In general, mechanical loading at physiological levels is beneficial to tendons, but excessive loading or disuse of tendons is detrimental. This mechano-adaptability is due to the cells present in tendons. Tendon fibroblasts (tenocytes) are the dominant tendon cells responsible for tendon homeostasis and repair. Tendon stem cells (TSCs), which were recently discovered, also play a vital role in tendon maintenance and repair by virtue of their ability to self-renew and differentiate into tenocytes. TSCs may also be responsible for chronic tendon injury, or tendinopathy, by undergoing aberrant differentiation into non-tenocytes in response to excessive mechanical loading. Thus, it is necessary to devise optimal rehabilitation protocols in order to enhance tendon healing while reducing scar tissue formation and tendon adhesions. Moreover, along with scaffolds that can mimic tendon matrix environments and platelet-rich plasma (PRP), which serves as a source of growth factors, TSCs may be the optimal cell type for enhancing repair of injured tendons. PMID:21925835

  4. An anatomical study of the watershed line on the volar, distal aspect of the radius: implications for plate placement and avoidance of tendon ruptures.

    Science.gov (United States)

    Imatani, Junya; Akita, Keiichi; Yamaguchi, Kumiko; Shimizu, Hirotaka; Kondou, Hidenori; Ozaki, Toshifumi

    2012-08-01

    The watershed line is a useful surgical landmark for positioning a volar locking plate. Implants placed on or distal to it can impinge on flexor tendons and cause injury. However, the details of the anatomy of this line are unclear. We studied macroscopically and histologically the structures of the volar aspect of the distal radius. We studied 20 distal forearm regions of 10 cadavers (5 males and 5 females; mean age, 79 y [range, 56-88 y]) to clarify the details of the watershed line. In 16 specimens, we investigated the macroscopic appearance of the volar aspect of the radius and the relationships among the bone, the volarradiocarpal ligaments, and the pronator quadratus. Histological analyses were performed in 4 specimens of 2 cadavers to examine the morphology of the margin of the bony structures. In the medial half of the distal volar radius, 2 lines were identified by direct macroscopic visualization; one was the proximal line that corresponded to the distal ridge of the pronator fossa, and the other was the distal line, which was more prominent. A medial bony prominence was situated on the distal line. In the lateral half, the distal and proximal lines of the medial half merged to form a single line. A lateral prominence was situated on this line. The watershed line might not be a distinct line, and it corresponds to the distal margin of the pronator fossa in the lateral half of the volar radius and to a hypothetical line between the distal and proximal lines in the medial half. The medial and lateral bony prominences on the volar radius should be key structures for accurate plate placement to avoid flexor tendon injury. The present study suggests bony landmarks for positioning a volar locking plate. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  5. Heel-Rise Height Deficit 1 Year After Achilles Tendon Rupture Relates to Changes in Ankle Biomechanics 6 Years After Injury.

    Science.gov (United States)

    Brorsson, Annelie; Willy, Richard W; Tranberg, Roy; Grävare Silbernagel, Karin

    2017-11-01

    It is unknown whether the height of a heel-rise performed in the single-leg standing heel-rise test 1 year after an Achilles tendon rupture (ATR) correlates with ankle biomechanics during walking, jogging, and jumping in the long-term. To explore the differences in ankle biomechanics, tendon length, calf muscle recovery, and patient-reported outcomes at a mean of 6 years after ATR between 2 groups that, at 1-year follow-up, had less than 15% versus greater than 30% differences in heel-rise height. Cohort study; Level of evidence, 3. Seventeen patients with less than 15% (30% group) side-to-side difference in heel-rise height at 1 year after ATR were evaluated at a mean (SD) 6.1 (2.0) years after their ATR. Ankle kinematics and kinetics were sampled via standard motion capture procedures during walking, jogging, and jumping. Patient-reported outcome was evaluated with Achilles tendon Total Rupture Score (ATRS), Physical Activity Scale (PAS), and Foot and Ankle Outcome Score (FAOS). Tendon length was evaluated by ultrasonography. The Limb Symmetry Index (LSI = [Injured Side ÷ Healthy Side] × 100) was calculated for side differences. The >30% group had significantly more deficits in ankle kinetics during all activities compared with patients in the 30% group, compared with the <15% group, also had significantly lower values in heel-rise height (LSI, 72% and 95%, respectively; P < .001) and heel-rise work (LSI, 58% and 91%, respectively; P < .001) and significantly larger side-to-side difference in tendon length (114% and 106%, respectively; P = .012). Achilles tendon length correlated with ankle kinematic variables ( r = 0.38-0.44; P = .015-.027) whereas heel-rise work correlated with kinetic variables ( r = -0.57 to 0.56; P = .001-.047). LSI tendon length correlated negatively with LSI heel-rise height ( r = -0.41; P = .018). No differences were found between groups in patient-reported outcome ( P = .143-.852). Height obtained during the single-leg standing heel

  6. An investigation into the depth of penetration of low level laser therapy through the equine tendon in vivo

    Directory of Open Access Journals (Sweden)

    Ryan Teresa

    2007-05-01

    Full Text Available Abstract Low level laser therapy (LLLT is frequently used in the treatment of wounds, soft tissue injury and in pain management. The exact penetration depth of LLLT in human tissue remains unspecified. Similar uncertainty regarding penetration depth arises in treating animals. This study was designed to test the hypothesis that transmission of LLLT in horses is increased by clipping the hair and/or by cleaning the area to be treated with alcohol, but is unaffected by coat colour. A LLLT probe (810 nm, 500 mW was applied to the medial aspect of the superficial flexor tendon of seventeen equine forelimbs in vivo. A light sensor was applied to the lateral aspect, directly opposite the laser probe to measure the amount of light transmitted. Light transmission was not affected by individual horse, coat colour or leg. However, it was associated with leg condition (F = 4.42, p = 0.0032. Tendons clipped dry and clipped and cleaned with alcohol, were both associated with greater transmission of light than the unprepared state. Use of alcohol without clipping was not associated with an increase in light transmission. These results suggest that, when applying laser to a subcutaneous structure in the horse, the area should be clipped and cleaned beforehand.

  7. Aging contributes to inflammation in upper extremity tendons and declines in forelimb agility in a rat model of upper extremity overuse.

    Directory of Open Access Journals (Sweden)

    David M Kietrys

    Full Text Available We sought to determine if tendon inflammatory and histopathological responses increase in aged rats compared to young rats performing a voluntary upper extremity repetitive task, and if these changes are associated with motor declines. Ninety-six female Sprague-Dawley rats were used in the rat model of upper extremity overuse: 67 aged and 29 young adult rats. After a training period of 4 weeks, task rats performed a voluntary high repetition low force (HRLF handle-pulling task for 2 hrs/day, 3 days/wk for up to 12 weeks. Upper extremity motor function was assessed, as were inflammatory and histomorphological changes in flexor digitorum and supraspinatus tendons. The percentage of successful reaches improved in young adult HRLF rats, but not in aged HRLF rats. Forelimb agility decreased transiently in young adult HRLF rats, but persistently in aged HRLF rats. HRLF task performance for 12 weeks lead to increased IL-1beta and IL-6 in flexor digitorum tendons of aged HRLF rats, compared to aged normal control (NC as well as young adult HRLF rats. In contrast, TNF-alpha increased more in flexor digitorum tendons of young adult 12-week HRLF rats than in aged HRLF rats. Vascularity and collagen fibril organization were not affected by task performance in flexor digitorum tendons of either age group, although cellularity increased in both. By week 12 of HRLF task performance, vascularity and cellularity increased in the supraspinatus tendons of only aged rats. The increased cellularity was due to increased macrophages and connective tissue growth factor (CTGF-immunoreactive fibroblasts in the peritendon. In conclusion, aged rat tendons were overall more affected by the HRLF task than young adult tendons, particularly supraspinatus tendons. Greater inflammatory changes in aged HRLF rat tendons were observed, increases associated temporally with decreased forelimb agility and lack of improvement in task success.

  8. Critically evaluate techniques for the in situ testing of steel tendon grouting effectiveness as a basis for reducing fall of ground injuries and fatalities

    CSIR Research Space (South Africa)

    Kelly, AM

    1996-10-01

    Full Text Available is used, and over the past 20 years a number of research efforts have been made, both in south Africa and overseas to develop a non-destructive test method for assessing grouted tendon effectiveness in situ-with partial success in one case and no success...

  9. FIBRILLINS IN TENDON

    Directory of Open Access Journals (Sweden)

    Betti Giusti

    2016-10-01

    Full Text Available Tendons among connective tissue, mainly collagen, contain also elastic fibres made of fibrillin 1, fibrillin 2 and elastin that are broadly distributed in tendons and represent 1-2% of the dried mass of the tendon. Only in the last years, studies on structure and function of elastic fibres in tendons have been performed. Aim of this review is to revise data on the organization of elastic fibres in tendons, in particular fibrillin structure and function, and on the clinical manifestations associated to alterations of elastic fibres in tendons. Indeed, microfibrils may contribute to tendon mechanics; therefore, their alterations may cause joint hypermobility and contractures which have been found to be clinical features in patients with Marfan syndrome and Beals syndrome. The two diseases are caused by mutations in genes FBN1 and FBN2 encoding fibrillin 1 and fibrillin 2, respectively.

  10. The Supination-Pronation Test for Distal Biceps Tendon Rupture.

    Science.gov (United States)

    Metzman, Louis S; Tivener, Kristin A

    2015-10-01

    Prompt diagnosis of a distal biceps tendon complete rupture increases the ability to perform a primary repair and to restore motion and strength. When examining an acute injury, it is important to isolate the biceps brachii tendon from the lacertus fibrosus and the brachialis because the examiner may mistakenly miss a distal tendon rupture by not isolating supination and pronation. The supination-pronation test can be performed easily in the acute setting and confirms attachment of the biceps tendon distally to the bicipital tuberosity of the radius. If the distal biceps tendon is intact, there is substantial change in the shape of the biceps as the arm is supinated (the biceps moves proximally), then pronated (the biceps moves distally). Clinically, the supination-pronation test has been found to be a reliable, pain-free test that should be incorporated in the physical examination to evaluate patients for distal biceps injury.

  11. Ultrasound Diagnosis of Bilateral Quadriceps Tendon Rupture After Statin Use

    Directory of Open Access Journals (Sweden)

    Nesselroade, Ryan D

    2010-09-01

    Full Text Available Simultaneous bilateral quadriceps tendon rupture is a rare injury. We report the case of bilateral quadriceps tendon rupture sustained with minimal force while refereeing a football game. The injury was suspected to be associated with statin use as the patient had no other identifiable risk factors.The diagnosis was confirmed using bedside ultrasound. [West J Emerg Med. 2010; 11(4:306-309.

  12. Biceps Tendon Rupture

    Directory of Open Access Journals (Sweden)

    Daniel M Polvino

    2018-01-01

    Full Text Available History of present illness: A 55-year-old male presented to the emergency department with a chief complaint of right arm pain. Five days prior to arrival, he attempted to lift himself up on his van and experienced what he described as a “rubber band snapping” in his right arm. He reported severe pain at the time that persisted but lessened in severity. Additionally, he reported increasing bruising over the proximal right arm. He had no history of prior right arm or shoulder injury. Significant findings: Physical exam was significant for ecchymosis and mild swelling of the right bicep. When the right arm was flexed at the elbow, a prominent mass was visible and palpable over the right bicep. Right upper extremity strength was 4/5 with flexion at the elbow. Discussion: The biceps brachii muscle is comprised of a long and short head, which share a common attachment at the bicipital tuberosity on the radius. The short head originates from the coracoid process of the scapula and the long head originates from the supraglenoid tubercle.1 Biceps tendon rupture has been found to occur at a rate of 0.53/100,000 over five years, and is three times more likely to occur in men than women.2 Risk factors for biceps tendon rupture include male sex, old age, increased body mass index, smoking, and pre-existing shoulder pathology.3,4 Diagnosis of biceps tendon rupture is typically a clinical diagnosis utilizing inspection and palpation as well as special testing such as the Speed’s and/or Yergason’s tests. Ultrasound may be used to aid in diagnosis; in full-thickness tears, ultrasound was found to have a sensitivity of 88% and a specificity of 98%. However, in partial thickness tears ultrasound has a sensitivity of 27% and a specificity of 100%.5 Often considered the gold standard in diagnosis, MRI has been found to have a sensitivity of only 67% and specificity of 98% in detecting complete tears6. Treatment initially consists of rest, ice, compression

  13. Effects of trypsinization and mineralization on intrasynovial tendon allograft healing to bone.

    Science.gov (United States)

    Qu, Jin; van Alphen, Nick A; Thoreson, Andrew R; Chen, Qingshan; An, Kai-Nan; Amadio, Peter C; Schmid, Thomas M; Zhao, Chunfeng

    2015-04-01

    The purpose of the current study was to develop a novel technology to enhance tendon-to-bone interface healing by trypsinizing and mineralizing (TM) an intrasynovial tendon allograft in a rabbit bone tunnel model. Eight rabbit flexor digitorum profundus (FDP) tendons were used to optimize the trypsinization process. An additional 24 FDP tendons were stratified into control and TM groups; in each group, 4 tendons were used for in vitro evaluation of TM and 8 were transplanted into proximal tibial bone tunnels in rabbits. The samples were evaluated histologically and with mechanical testing at postoperative week 8. Maximum failure strength and linear stiffness were not significantly different between the control and TM tendons. A thin fibrous band of scar tissue formed at the graft-to-bone interface in the control group. However, only the TM group showed obvious new bone formation inside the tendon graft and a visible fibrocartilage layer at the bone tunnel entrance. This study is the first to explore effects of TM on the intrasynovial allograft healing to a bone tunnel. TM showed beneficial effects on chondrogenesis, osteogenesis, and integration of the intrasynovial tendon graft, but mechanical strength was the same as the control tendons in this short-term in vivo study. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  14. Tavşanlarda zon II fleksör tendon kesilerinin tamiri sonrası yapışıklık oluşumu üzerine politetrafloroetilen cerrahi membran’ın etkisi

    OpenAIRE

    Tomak, Yilmaz; Karaismailoglu, T.N.; Dabak, Nevzat; Tilki, Koksal; Tepe, Selcuk

    2004-01-01

    Adhesions which develop following Zone II flexor tendon repair is a problem still awaiting solution. In this experimental study PTFE SM (Polytetrafluoroethylene Surgical Membrane) use for the primary tendon repair and sheath reconstruction is macroscopically, histopathologically and functionally evaluated in rabbit animal models. FDP tendons of the 3rd and 4th fingers of the both forefoot of 30 New Zealand albino rabbits were bisected at Zone II and repaired. With 8 fingers in either group, o...

  15. Tuberculous flexor tenosynovitis of the hand

    OpenAIRE

    Mohamed Ali Sbai; Sofien Benzarti; Monia Boussen; Riadh Maalla

    2015-01-01

    Tuberculosis is a major public health problem in developing countries. Flexor tenosynovitis of the fingers constitutes an exceptional tuberculosis localization (Gabl et al., 1997; Senda et al., 2011) [1],[2]. Unusual presentations, such as tuberculous tenosynovitis, often go undetected and are associated with a diagnostic and therapeutic delay, especially when bacteriological research proves to be negative. Here, we report a case of tuberculous flexor tenosynovitis of the hand.

  16. A Rare Case of Simultaneous Acute Bilateral Quadriceps Tendon Rupture and Unilateral Achilles Tendon Rupture

    Directory of Open Access Journals (Sweden)

    Wei Yee Leong

    2013-07-01

    Full Text Available Introduction: There have been multiple reported cases of bilateral quadriceps tendon ruptures (QTR in the literature. These injuries frequently associated with delayed diagnosis, which results in delayed surgical treatment. In very unusual cases, bilateral QTRs can be associated with other simultaneous tendon ruptures. Case Report: We present a rare case of bilateral QTR with a simultaneous Achilles Tendon Rupture involving a 31 years old Caucasian man who is a semi-professional body builder taking anabolic steroids. To date bilateral QTR with additional TA rupture has only been reported once in the literature and to our knowledge this is the first reported case of bilateral QTR and simultaneous TA rupture in a young, fit and healthy individual. Conclusion: The diagnosis of bilateral QTR alone can sometimes be challenging and the possibility of even further tendon injuries should be carefully assessed. A delay in diagnosis could result in delay in treatment and potentially worse outcome for the patient. Keywords: Quadriceps tendon rupture; Achilles tendon rupture; Bilateral.

  17. [Role of MRI in the study of the Achilles tendon and patellar tendon].

    Science.gov (United States)

    Frocrain, L; Rochcongar, P; Gouriff, Y; Husson, J L; Gagey, N; De Korvin, B; Duvauferrier, R

    1988-12-01

    The possibilities of MRI and radiography with mammogram to diagnose mechanical tendinitis have been prospectively evaluated in thirty sportsmen. Sixteen had Achilles tendon lesion, fourteen had patellar ligament lesion. Each patient included in the study was programmed for radiography with mammogram and MRI of the pathologic tendon and the controlateral tendon. These examinations were separately interpreted by two reviewers who had no knowledge of pain location. The number of tendinitis diagnosis based on X-ray and MRI was approximatively the same. But the microtearings were more often diagnosed on MRI data than on X-ray data (10/1). Eight patients underwent an operation. The surgery findings always confirmed the MRI diagnoses. MRI seems to be the examination of choice to evaluate the tendon injuries and particularly microtearings before surgery.

  18. Sport-Specific Capacity to Use Elastic Energy in the Patellar and Achilles Tendons of Elite Athletes.

    Science.gov (United States)

    Wiesinger, Hans-Peter; Rieder, Florian; Kösters, Alexander; Müller, Erich; Seynnes, Olivier R

    2017-01-01

    Introduction: During running and jumping activities, elastic energy is utilized to enhance muscle mechanical output and efficiency. However, training-induced variations in tendon spring-like properties remain under-investigated. The present work extends earlier findings on sport-specific profiles of tendon stiffness and cross-sectional area to examine whether years of distinct loading patterns are reflected by tendons' ability to store and return energy. Methods: Ultrasound scans were performed to examine the morphological features of knee extensor and plantar flexor muscle-tendon units in elite ski jumpers, distance runners, water polo players, and sedentary controls. Tendon strain energy and hysteresis were measured with combined motion capture, ultrasonography, and dynamometry. Results: Apart from the fractional muscle-to-tendon cross-sectional area ratio being lower in the knee extensors of ski jumpers (-31%) and runners (-33%) than in water polo players, no difference in the considered muscle-tendon unit morphological features was observed between groups. Similarly, no significant difference in tendon energy storage or energy return was detected between groups. In contrast, hysteresis was lower in the patellar tendon of ski jumpers (-33%) and runners (-30%) compared to controls, with a similar trend for the Achilles tendon (significant interaction effect and large effect sizes η 2 = 0.2). Normalized to body mass, the recovered strain energy of the patellar tendon was ~50% higher in ski jumpers than in water polo players and controls. For the Achilles tendon, recovered strain energy was ~40% higher in ski jumpers and runners than in controls. Discussion: Advantageous mechanical properties related to tendon spring-like function are observed in elite athletes whose sport require effective utilization of elastic energy. However, the mechanisms underpinning the better tendon capacity of some athletes to retain elastic energy could not be ascribed to intrinsic or

  19. Achilles tendon and sports

    International Nuclear Information System (INIS)

    Ulreich, N.; Kainberger, F.; Huber, W.; Nehrer, S.

    2002-01-01

    Because of the rising popularity of recreational sports activities achillodynia is an often associated symptom with running, soccer and athletics. Therefore radiologist are frequently asked to image this tendon. The origin of the damage of the Achilles tendon is explained by numerous hypothesis, mainly a decreased perfusion and a mechanical irritation that lead to degeneration of the tendon. High-resolution technics such as sonography and magnetic resonance imaging show alterations in the structure of the tendon which can be graduated and classified. Manifestations like tendinosis, achillobursitis, rupture and Haglunds disease can summarized as the tendon overuse syndrom. A rupture of a tendon is mostly the result of a degeneration of the collagenfibres. The task of the radiologist is to acquire the intrinsic factors for a potential rupture. (orig.) [de

  20. Evaluation of the clinical-functional results from repairing extensive rotator cuff injury with inclusion of the tendon of the long head of the biceps

    Directory of Open Access Journals (Sweden)

    Roberto Yukio Ikemoto

    2013-04-01

    Full Text Available OBJECTIVES: To assess the outcomes of the arthroscopic margin convergence of the posterior cuff to the biceps tendon. METHODS: From October 2003 to December 2007, 20 patients with massive rotator cuff tear which include the rotator interval were treated with arthroscopic margin convergence of the posterior cuff to biceps tendon. Sixteen patients were female and four were male. The mean age was 58.95 years old. The dominant side was affected in 16 cases (80%. The outcomes were analysed according to the UCLA Score with a minimum follow-up period of two years. RESULTS: The UCLA score improved, on average, 14 points (p < 0.001. Six patients had excellent results; nine good; three fair and two poor results. The mean improvement of forward flexion was 33º (p < 0.001, 3º of external rotation (p < 0.396 and two vertebral levels for internal rotation (p < 0.025. CONCLUSION: The arthroscopic margin convergence of the posterior cuff to the biceps tendon leads to satisfactory results.

  1. Comparison of transforming growth factor beta expression in healthy and diseased human tendon.

    Science.gov (United States)

    Goodier, Henry C J; Carr, Andrew J; Snelling, Sarah J B; Roche, Lucy; Wheway, Kim; Watkins, Bridget; Dakin, Stephanie G

    2016-02-17

    Diseased tendons are characterised by fibrotic scar tissue, which adversely affects tendon structure and function and increases the likelihood of re-injury. The mechanisms and expression profiles of fibrosis in diseased tendon is understudied compared to pulmonary and renal tissues, where transforming growth factor (TGF)β and its associated superfamily are known to be key drivers of fibrosis and modulate extracellular matrix homeostasis. We hypothesised that differential expression of TGFβ superfamily members would exist between samples of human rotator cuff tendons with established disease compared to healthy control tendons. Healthy and diseased rotator cuff tendons were collected from patients presenting to an orthopaedic referral centre. Diseased tendinopathic (intact) and healthy rotator cuff tendons were collected via ultrasound-guided biopsy and torn tendons were collected during routine surgical debridement. Immunohistochemistry and quantitative real-time polymerase chain reaction were used to investigate the protein and gene expression profiles of TGFβ superfamily members in these healthy and diseased tendons. TGFβ superfamily members were dysregulated in diseased compared to healthy tendons. Specifically, TGFβ-1, TGFβ receptor (R)1 and TGFβ R2 proteins were reduced (p tendons. At the mRNA level, TGFβ R1 was significantly reduced in samples of diseased tendons, whereas TGFβ R2 was increased (p tendon disease. We propose that downregulation of TGFβ pathways in established tendon disease may be a protective response to limit disease-associated fibrosis. The disruption of the TGFβ axis with disease suggests associated downstream pathways may be important for maintaining healthy tendon homeostasis. The findings from our study suggest that patients with established tendon disease would be unlikely to benefit from therapeutic TGFβ blockade, which has been investigated as a treatment strategy in several animal models. Future studies should investigate

  2. Knee Injuries and Disorders

    Science.gov (United States)

    ... cartilage in the knee gradually wears away, causing pain and swelling. Injuries to ligaments and tendons also cause knee problems. A common injury is to the anterior cruciate ligament (ACL). You usually injure your ACL ...

  3. Prevalence of triceps tendon tears on MRI of the elbow and clinical correlation

    Energy Technology Data Exchange (ETDEWEB)

    Koplas, Monica C. [University of Mississippi Medical Center, Section of Musculoskeletal Radiology, Department of Radiology, Jackson, MS (United States); Schneider, Erika [Cleveland Clinic, Imaging Institute, Cleveland, OH (United States); Sundaram, Murali [Cleveland Clinic, Section of Musculoskeletal Radiology, Imaging Institute, Cleveland, OH (United States)

    2011-05-15

    Triceps tendon injuries are reported to be very rare. To our knowledge, there have been no studies describing its prevalence or injury patterns on MR imaging. The purpose of this retrospective study was to determine the prevalence and patterns of triceps injuries based on a large series of consecutive MR examinations. Clinical correlation was obtained. From 801 consecutive elbow MR examinations over a 15-year period, 28 patients with 30 triceps tendon injuries were identified and graded as partial tendon tear and complete tendon tear. The patients' medical records were reviewed to determine age, gender, cause of tears, and management. The prevalence of triceps tendon injuries was 3.8%. There were 5 women and 23 men with partial or complete tears (mean age: 46.6 years; range: 2.7 to 75.1 years). The most common injury was partial tear, found in 18 patients. There were 10 patients with 12 complete tears (2 had re-torn following surgical repair). A tear was suspected in 12 out 28 (43%) patients prior to the MRI. The most common presenting symptom was pain. The most common cause was athletic injury (8 patients [29%], including weightlifting [2 patients]). Tendon tear was found to be a complication of infection in 6 patients, and in 3 patients the tears were a complication of steroid use. Thirteen tendon tears were surgically repaired (8 of these were complete tears). Triceps tendon injury is not as rare as commonly reported and may often be clinically underdiagnosed. (orig.)

  4. Distal biceps brachii tendon anatomy revisited from a surgical perspective.

    Science.gov (United States)

    Fogg, Quentin A; Hess, Benjamin R; Rodgers, K Gary; Ashwood, Neil

    2009-04-01

    The distal biceps brachii tendon is commonly susceptible to traumatic injury. This study aimed to describe the morphology of the distal biceps brachii tendon in relation to the commonly used endobutton repair of tendon rupture. The results suggested that the distal tendon is a series of distinct bands of variable number. These bands are obscured surgically by the tendon sheath. Upon opening this sheath, blunt dissection of the tendon released fibrous connections between the tendon bands. Adjacent bands were variably connected via small oblique bands. The separations between bands were continuous onto the radius. They were therefore considered as separate force-conducting units. This notion is of high relevance to endobutton repairs, as the sutures are typically only passed through the margins of the tendon. Where few connections exist between tendinous bands, this represents a potential weakness, as central bands are therefore free to be pulled proximally. This is of primary concern in the early rehabilitative stages of postoperative care. It may be suggested that sutures that cross the width of the tendon will eliminate the give of central bands, improving postoperative results, reducing revision numbers, and potentially reducing rehabilitation time. (c) 2009 Wiley-Liss, Inc.

  5. Posterior Ankle Structure Injury During Total Ankle Replacement.

    Science.gov (United States)

    Reb, Christopher W; McAlister, Jeffrey E; Hyer, Christopher F; Berlet, Gregory C

    2016-01-01

    Total ankle replacement studies have focused on reporting complications that are directly observed clinically or radiographically, including wound problems, technical errors, implant loosening, subsidence, infection, bone fractures, and heterotopic ossification. However, patients can still experience unresolved pain even when these problems have been ruled out. We initiated a study to more clearly define the relative risk of injury to the anatomic structures in the posterior ankle during total ankle replacement using a third-generation implant system. Ten fresh-frozen adult cadaveric below-the-knee specimens were positioned in the intraoperative positioning frame of an approved total ankle replacement system and adjusted to achieve proper foot alignment using fluoroscopic imaging. The relationship between the tibial cutting guide pins and the posterior neurovascular and tendon structures was measured using digital calipers. High rates of posterior structural injury were found. Nearly all proximal-medial pins encountered a posteromedial neurovascular structure, most commonly the tibial nerve. The distal-medial pins mainly encountered posteromedial tendinous structures, in particular, the flexor digitorum longus tendon. The proximal lateral pins were highly likely to encounter the Achilles tendon and the sural nerve. Our results support our hypothesis that the tibial neurovascular structures are at the greatest risk when preparing for and completing the bony resection, particularly with the medial and proximal cuts. Posterior ankle soft tissue structure injuries can occur during implantation but currently with unknown frequency and undetermined significance. Further study of posterior structural injuries could result in a more informed approach to post-total ankle replacement complications and management. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Comparison of Return to Pre-Injury Sport After 10 mm Size Bone-Patellar Tendon-Bone (BPTB) versus 8 mm Hamstring Anterior Cruciate Ligament Reconstruction: A Retrospective Study with a Two-Year Follow-Up.

    Science.gov (United States)

    Gudas, Rimtautas; Jurkonis, Rokas; Smailys, Alfredas

    2018-02-17

    BACKGROUND The aim of this study was to evaluate the reconstruction of a torn anterior cruciate ligament (ACL) with 10 mm diameter BPTB (bone-patellar tendon-bone) autograft versus 8 mm HT (hamstring tendon) autografts, to compare the ability to restore pre-injury sports activities and reduce revision risk after these procedures. MATERIAL AND METHODS A prospective clinical review was performed to compare results of patients who underwent primary anatomical ACLR with 10 mm BPTB autografts with patients who underwent 8 mm diameter HT autografts, between January 2011 and January 2014. RESULTS There were 183 patients evaluated: the 8 mm HT group showed statistically significant higher knee laxity values compared to the 10 mm BPTB group (p=0.042), and significant difference were detected in subjective International Knee Documentation Committee (IKDC) evaluation scores; the average subjective IKDC evaluations after two-year follow-up in the HT group was 88.45±2.8 versus 89.24±2.5 in BPTB group (p=0.047). In the evaluation of the IKDC objective protocol, results were excellent and good in 83 patients (94.3%) after BPTB and in 78 patients (82%) after HT ACLR (p<0.05). The average score on the Tegner activity scale in the HT group decreased from 6.5 at pre-injury to 5.8 at two-year follow-up (p<0.001) and from 6.7 at pre-injury to 6.5 at two-year follow-up in the BPTB group (p=0.4). The ability to restore pre-injury sports activities was higher in the BPTB group (6.5) versus the HT group (5.8) (p<0.001). Revision was required for two patients (2.2%) in the BPTB group compared with 14 patients (14.7%) in the HT group (p<0.05). CONCLUSIONS Smaller HT graft size was a predictor of higher knee laxity and greater revision risk at two-year post primary ACL reconstruction. Larger diameter BPTB ACL grafts had a better ability to restore knee stability and greater ability to restore pre-injury sports activities.

  7. The vasculature and its role in the damaged and healing tendon.

    Science.gov (United States)

    Fenwick, Steven A; Hazleman, Brian L; Riley, Graham P

    2002-01-01

    Tendon pathology has many manifestations, from spontaneous rupture to chronic tendinitis or tendinosis; the etiology and pathology of each are very different, and poorly understood. Tendon is a comparatively poorly vascularised tissue that relies heavily upon synovial fluid diffusion to provide nutrition. During tendon injury, as with damage to any tissue, there is a requirement for cell infiltration from the blood system to provide the necessary reparative factors for tissue healing. We describe in this review the response of the vasculature to tendon damage in a number of forms, and how and when the revascularisation or neovascularisation process occurs. We also include a section on the revascularisation of tendon during its use as a tendon graft in both ligament reconstruction and tendon-tendon grafting.

  8. Unusual Complete Proximal Biceps Tendon Rupture

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    Abdullah F. Raizah

    2013-12-01

    Full Text Available Proximal biceps brachii tendon rupture is an unusual presentation in young individuals. This report is an extremely rare case of a complete rupture of the proximal biceps brachii tendon in a young patient as a result of a high-energy water-skiing injury. It was associated with displacement of the biceps muscle into the forearm with skin necrosis. The patient was treated successfully by débridement of the skin and complete resection of the biceps brachii muscle.

  9. ACHILLES TENDON RUPTURE AND PLATELET RICH PLASMA

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    Pietro Zedde

    2012-03-01

    Full Text Available Achilles tendon rupture is currently one of the most frequent injuries in athletes. Such rupture may be caused by a sudden dorsiflexion of the ankle, pushing off with the weight bearing forefoot while extending the knee or violent dorsiflexion of a plantar flexed foot. The treatment goal consists of restoring the normal tendon length and tension, as well as the function and strength of the gastrocnemius-soleus complex. The biological repair process can be enhanced in all stages of recovery with the use of PRP (Platelet Rich Plasma without any side effects.

  10. [Development of Achilles tendon rupture in skiing].

    Science.gov (United States)

    Suckert, K; Benedetto, K P; Vogel, A

    1983-06-01

    This is an analysis of decline of rupture of the Achilles tendon in skiing while there is a steady increase of skiing injuries. Three groups, equipped with three different types of ski boots were observed once on a plane slope on the other hand on a bump track. The simultaneous size of angle of knee and ankle was measured by telemetry. The high plastic ski boot, which obstructs the ankle forward and lateral is apart from the rise of heel in the boot, the safety binding and the new skiing style the main reason for decline of rupture of the Achilles tendon in skiing.

  11. ARTHROSCOPIC CORRECTION OF THE INJURIES OF THE COMPLEX «TENDON OF THE BICEPS LONG HEAD - THE ARTICULAR LIP» IN TREATMENT OF PATIENTS WITH FULL-LAYER RUPTURES OF THE ROTATOR CUFF

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    S. Y. Dokolin

    2013-01-01

    Full Text Available Damage of the long head of the biceps at the place of attachment to the articular tubercle supraglenoidal lip of shoulder, to the entrance and throughout intertubercle furrows are common causes of pain and dysfunction of the shoulder joint. At the same clinical manifestations of the morphology of such lesions may be different. The current literature discusses various options of surgical correction of the biceps injury. Variety of methods of surgical treatment and the lack of consensus in support of their application in different patients in different types of injuries were the basis for the present study. A prospective analysis of the functional results of surgical treatment of the 34 - year’s patients with associated rotator cuff (SSP+ISP+SSC+ and the tendon of the biceps muscle in age from 34 to 75 years. Options for surgical correction of the damaged part of the biceps were: biceps tenotomy, biceps tenotomy with intraarticular tenodez of the shoulder to the head before entering intertubercle furrow, biceps tenotomy and extraarticular subpectorialtenodez to the proximal humerus is intertubercle interferrent screw groove, as well as its attachment to the tendon suture large pectoral muscle. Choice of surgical approach depended on the patient's age, level of daily physical activity, morphology and localization of lesions. The best results were obtained when the extra-articular subpectorialtenodez of long head of the biceps to the proximal humerus interferrent screw and suture fixation to the pectoralis major muscle, the average follow-up was 16,6 ± 4,7 months.

  12. Giant Cell Tumour of Tendon Sheath Masquerading As Trigger Finger

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    N Rahimawati

    2010-11-01

    Full Text Available We report a case of a 59-year-old female who presented in the general orthopaedic clinic with triggering of her right middle finger. She did not respond to conventional treatment methods; subsequently she underwent surgical open release under local anaesthesia. Five months postoperatively, the patient presented with signs and symptoms of acute flexor tenosynovitis, and was thought to have a postoperative infection. Re-examination by a hand surgeon raised the possibility of a different aetiology. Based on clinical findings and response to initial treatment, giant cell tumour of the flexor tendon sheath was suspected and later confirmed following surgical biopsy. A high index of suspicion and knowledge of the variegated presentations of giant cell tumour in the hand are beneficial in these types of cases.

  13. Actin cytoskeleton contributes to the elastic modulus of embryonic tendon during early development.

    Science.gov (United States)

    Schiele, Nathan R; von Flotow, Friedrich; Tochka, Zachary L; Hockaday, Laura A; Marturano, Joseph E; Thibodeau, Jeffrey J; Kuo, Catherine K

    2015-06-01

    Tendon injuries are common and heal poorly. Strategies to regenerate or replace injured tendons are challenged by an incomplete understanding of normal tendon development. Our previous study showed that embryonic tendon elastic modulus increases as a function of developmental stage. Inhibition of enzymatic collagen crosslink formation abrogated increases in tendon elastic modulus at late developmental stages, but did not affect increases in elastic modulus of early stage embryonic tendons. Here, we aimed to identify potential contributors to the mechanical properties of these early stage embryonic tendons. We characterized tendon progenitor cells in early stage embryonic tendons, and the influence of actin cytoskeleton disruption on tissue elastic modulus. Cells were closely packed in embryonic tendons, and did not change in density during early development. We observed an organized network of actin filaments that seemed contiguous between adjacent cells. The actin filaments exhibited a crimp pattern with a period and amplitude that matched the crimp of collagen fibers at each developmental stage. Chemical disruption of the actin cytoskeleton decreased tendon tissue elastic modulus, measured by atomic force microscopy. Our results demonstrate that early developmental stage embryonic tendons possess a well organized actin cytoskeleton network that contributes significantly to tendon tissue mechanical properties. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  14. Isolated flexor pollicis longus nerve fascicle lesion – a rare differential diagnosis of thumb flexion deficiency

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    Glauser, Eva

    2016-12-01

    Full Text Available A rare differential diagnosis of thumb flexion deficiency is an isolated flexor pollicis longus (FPL nerve fascicle lesion. We present a 42-year-old otherwise healthy female patient who developed a weak thumb-to-index pinch and deficient right thumb flexion following the removal of osteosynthesis plates after a forearm fracture. Clinically,the flexor pollicis longus function was absent, yet index flexion and sensibility were unimpaired. Tendon rupture was excluded using a tenodesis test and the electro-physiological result of isolated interosseus nerve fascicle lesion was confirmed intraoperatively by inspection and electrostimulation. Tendon transfer using the extensor carpi radialis longus reconstruct strong thumb flexion during pinch. In summary, due to its specific location and anatomy, the FPL branch is more prone to isolated neuropathy, e.g. by injections or operations, than to other fascicles of the anterior interosseus nerve. When confronted with sudden and isolated thumb flexion deficiency, specialists should be aware of this rare phenomenon.

  15. Percutaneous & Mini Invasive Achilles tendon repair

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    Carmont Michael R

    2011-11-01

    Full Text Available Abstract Rupture of the Achilles tendon is a considerable cause of morbidity with reduced function following injury. Recent studies have shown little difference in outcome between the techniques of open and non-operative treatment using an early active rehabilitation programme. Meta-analyses have shown that non-operative management has increased risk of re-rupture whereas surgical intervention has risks of complications related to the wound and iatrogenic nerve injury. Minimally invasive surgery has been adopted as a way of reducing infections rates and wound breakdown however avoiding iatrogenic nerve injury must be considered. We discuss the techniques and outcomes of percutaneous and minimally invasive repairs of the Achilles tendon.

  16. Tendon progenitor cells in injured tendons have strong chondrogenic potential: the CD105-negative subpopulation induces chondrogenic degeneration.

    Science.gov (United States)

    Asai, Shuji; Otsuru, Satoru; Candela, Maria Elena; Cantley, Leslie; Uchibe, Kenta; Hofmann, Ted J; Zhang, Kairui; Wapner, Keith L; Soslowsky, Louis J; Horwitz, Edwin M; Enomoto-Iwamoto, Motomi

    2014-12-01

    To study the cellular mechanism of the tendon repair process, we used a mouse Achilles tendon injury model to focus on the cells recruited to the injured site. The cells isolated from injured tendon 1 week after the surgery and uninjured tendons contained the connective tissue progenitor populations as determined by colony-forming capacity, cell surface markers, and multipotency. When the injured tendon-derived progenitor cells (inTPCs) were transplanted into injured Achilles tendons, they were not only integrated in the regenerating area expressing tenogenic phenotype but also trans-differentiated into chondrogenic cells in the degenerative lesion that underwent ectopic endochondral ossification. Surprisingly, the micromass culture of the inTPCs rapidly underwent chondrogenic differentiation even in the absence of exogenous bone morphogenetic proteins or TGFβs. The cells isolated from human ruptured tendon tissues also showed connective tissue progenitor properties and exhibited stronger chondrogenic ability than bone marrow stromal cells. The mouse inTPCs contained two subpopulations one positive and one negative for CD105, a coreceptor of the TGFβ superfamily. The CD105-negative cells showed superior chondrogenic potential in vitro and induced larger chondroid degenerative lesions in mice as compared to the CD105-positive cells. These findings indicate that tendon progenitor cells are recruited to the injured site of tendons and have a strong chondrogenic potential and that the CD105-negative population of these cells would be the cause for chondroid degeneration in injured tendons. The newly identified cells recruited to the injured tendon may provide novel targets to develop therapeutic strategies to facilitate tendon repair. © 2014 AlphaMed Press.

  17. Triple Achilles Tendon Rupture: Case Report.

    Science.gov (United States)

    Saxena, Amol; Hofer, Deann

    We present a case report with 1-year follow-up data of a 57-year-old male soccer referee who had sustained an acute triple Achilles tendon rupture injury during a game. His triple Achilles tendon rupture consisted of a rupture of the proximal watershed region, a rupture of the main body (mid-watershed area), and an avulsion-type rupture of insertional calcific tendinosis. The patient was treated surgically with primary repair of the tendon, including tenodesis with anchors. Postoperative treatment included non-weightbearing for 4 weeks and protected weightbearing until 10 weeks postoperative, followed by formal physical therapy, which incorporated an "antigravity" treadmill. The patient was able to return to full activity after 26 weeks, including running and refereeing, without limitations. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Achilles tendon repair

    Science.gov (United States)

    To fix your torn Achilles tendon, the surgeon will: Make a cut down the back of your heel Make several small cuts rather than one large cut After that, the surgeon will: Bring the ends of your tendon together Sew the ends together Stitch the wound closed

  19. Patellar tendon ossification after partial patellectomy: a case report

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    Guven Melih

    2010-02-01

    Full Text Available Abstract Introduction Patellar tendon ossification is a rare pathology that may be seen as a complication after sleeve fractures of the tibial tuberosity, total patellectomy during arthroplasty, intramedullary nailing of tibial fractures, anterior cruciate ligament reconstruction with patellar tendon autograft and knee injury without fracture. However, its occurrence after partial patellectomy surgery has never been reported in the literature. Case presentation We present the case of a 35-year-old Turkish man with a comminuted inferior patellar pole fracture that was treated with partial patellectomy. During the follow-up period, his patellar tendon healed with ossification and then ruptured from the inferior attachment to the tibial tubercle. The ossification was excised and the tendon was subsequently repaired. Conclusion To the best of our knowledge, this is the first report of patellar tendon ossification occurring after partial patellectomy. Orthopaedic surgeons are thus cautioned to be conscious of this rare complication after partial patellectomy.

  20. Biomechanic comparison of the Teno Fix tendon repair device with the cruciate and modified Kessler techniques.

    Science.gov (United States)

    Wolfe, Scott W; Willis, Andrew A; Campbell, Deidre; Clabeaux, Jonathan; Wright, Timothy M

    2007-03-01

    To compare the mechanical behavior of a novel internal tendon repair device with commonly used 2-strand and 4-strand repair techniques for zone II flexor tendon lacerations. Thirty cadaveric flexor digitorum profundus tendons were randomized to 1 of 3 core sutures: (1) cruciate locked 4-strand technique, (2) modified Kessler 2-strand core suture technique, or (3) Teno Fix multifilament wire tendon repair device. Each repair was tested in the load control setting on a Instron controller coupled to an MTS materials testing machine load frame by using an incremental cyclic linear loading protocol. A differential variable reluctance transducer was used to record displacement across the repair site. Cyclic force (n-cycles) to 1-mm gap and repair failure was recorded using serial digital photography. There was no significant difference in differential variable reluctance transducer displacement between the cruciate, modified Kessler, and Teno Fix repairs. The cruciate repair had greater resistance to visual 1-mm repair-site gap formation and repair-site failure when compared with the Kessler and Teno Fix repairs. No significant difference was found between the modified Kessler repair and the Teno Fix repair. In all specimens, the epitenon suture failed before the core suture. Repair failure occurred by suture rupture in the 7 cruciate specimens that failed, with evidence of gap formation before failure. Seven of 10 modified Kessler repairs failed by suture rupture. All of the Teno Fix repairs failed by pullout of the metal anchor. The Teno Fix repair system did not confer a mechanical advantage over the locked cruciate or modified Kessler suture techniques for zone II lacerations in cadaveric flexor tendons during cyclic loading in a linear testing model. This information may help to define safe boundaries for postoperative rehabilitation when using this internal tendon repair device.

  1. Effects of celecoxib on proliferation and tenocytic differentiation of tendon-derived stem cells

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    Zhang, Kairui; Zhang, Sheng [Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515 (China); Li, Qianqian [Cancer Research Institute, Southern Medical University, Guangzhou 510515 (China); Yang, Jun [Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515 (China); Department of Orthopaedics, 421 Hospital of PLA, Guangzhou 510318 (China); Dong, Weiqiang [Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515 (China); Department of Orthopaedics, The First Affiliated Hospital to Guangzhou Medical University, Guangzhou 510120 (China); Wang, Shengnan; Cheng, Yirong; Al-Qwbani, Mohammed [Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515 (China); Wang, Qiang, E-mail: 1780468505@qq.com [Department of Orthopaedics, Subei People’s Hospital of Jiangsu Province (Clinical Medical College of Yangzhou University), Yangzhou, Jiangsu Province 225001 (China); Yu, Bin, E-mail: carryzhang1985@live.com [Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515 (China)

    2014-07-18

    Highlights: • Celecoxib has no effects on TDSCs cell proliferation in various concentrations. • Celecoxib reduced mRNAs levels of tendon associated transcription factor. • Celecoxib reduced mRNAs levels of main tendon associated collagen. • Celecoxib reduced mRNAs levels of tendon associated molecules. - Abstract: NSAIDs are often ingested to reduce the pain and improve regeneration of tendon after tendon injury. Although the effects of NSAIDs in tendon healing have been reported, the data and conclusions are not consistent. Recently, tendon-derived stem cells (TDSCs) have been isolated from tendon tissues and has been suggested involved in tendon repair. Our study aims to determine the effects of COX-2 inhibitor (celecoxib) on the proliferation and tenocytic differentiation of TDSCs. TDSCs were isolated from mice Achilles tendon and exposed to celecoxib. Cell proliferation rate was investigated at various concentrations (0.1, 1, 10 and 100 μg/ml) of celecoxib by using hemocytometer. The mRNA expression of tendon associated transcription factors, tendon associated collagens and tendon associated molecules were determined by reverse transcription-polymerase chain reaction. The protein expression of Collagen I, Collagen III, Scleraxis and Tenomodulin were determined by Western blotting. The results showed that celecoxib has no effects on TDSCs cell proliferation in various concentrations (p > 0.05). The levels of most tendon associated transcription factors, tendon associated collagens and tendon associated molecules genes expression were significantly decreased in celecoxib (10 μg/ml) treated group (p < 0.05). Collagen I, Collagen III, Scleraxis and Tenomodulin protein expression were also significantly decreased in celecoxib (10 μg/ml) treated group (p < 0.05). In conclusion, celecoxib inhibits tenocytic differentiation of tendon-derived stem cells but has no effects on cell proliferation.

  2. Effects of celecoxib on proliferation and tenocytic differentiation of tendon-derived stem cells

    International Nuclear Information System (INIS)

    Zhang, Kairui; Zhang, Sheng; Li, Qianqian; Yang, Jun; Dong, Weiqiang; Wang, Shengnan; Cheng, Yirong; Al-Qwbani, Mohammed; Wang, Qiang; Yu, Bin

    2014-01-01

    Highlights: • Celecoxib has no effects on TDSCs cell proliferation in various concentrations. • Celecoxib reduced mRNAs levels of tendon associated transcription factor. • Celecoxib reduced mRNAs levels of main tendon associated collagen. • Celecoxib reduced mRNAs levels of tendon associated molecules. - Abstract: NSAIDs are often ingested to reduce the pain and improve regeneration of tendon after tendon injury. Although the effects of NSAIDs in tendon healing have been reported, the data and conclusions are not consistent. Recently, tendon-derived stem cells (TDSCs) have been isolated from tendon tissues and has been suggested involved in tendon repair. Our study aims to determine the effects of COX-2 inhibitor (celecoxib) on the proliferation and tenocytic differentiation of TDSCs. TDSCs were isolated from mice Achilles tendon and exposed to celecoxib. Cell proliferation rate was investigated at various concentrations (0.1, 1, 10 and 100 μg/ml) of celecoxib by using hemocytometer. The mRNA expression of tendon associated transcription factors, tendon associated collagens and tendon associated molecules were determined by reverse transcription-polymerase chain reaction. The protein expression of Collagen I, Collagen III, Scleraxis and Tenomodulin were determined by Western blotting. The results showed that celecoxib has no effects on TDSCs cell proliferation in various concentrations (p > 0.05). The levels of most tendon associated transcription factors, tendon associated collagens and tendon associated molecules genes expression were significantly decreased in celecoxib (10 μg/ml) treated group (p < 0.05). Collagen I, Collagen III, Scleraxis and Tenomodulin protein expression were also significantly decreased in celecoxib (10 μg/ml) treated group (p < 0.05). In conclusion, celecoxib inhibits tenocytic differentiation of tendon-derived stem cells but has no effects on cell proliferation

  3. Comparisons of eccentric knee flexor strength and asymmetries across elite, sub-elite and school level cricket players

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    Wade J. Chalker

    2016-02-01

    Full Text Available Background. There has been a continual increase in injury rates in cricket, with hamstring strain injuries (HSIs being the most prominent. Eccentric knee flexor weakness and bilateral asymmetries are major modifiable risk factors for future HSIs. However, there is a lack of data relating to eccentric hamstring strength in cricket at any skill level. The objective of this study was to compare eccentric knee flexor strength and bilateral asymmetries in elite, sub-elite and school level cricket players; and to determine if playing position and limb role influenced these eccentric knee flexor strength indices. Methods. Seventy four male cricket players of three distinct skill levels performed three repetitions of the Nordic hamstring exercise on the experimental device. Strength was assessed as the absolute and relative mean peak force output for both limbs, with bilateral asymmetries. Differences in mean peak force outputs between skill level and playing positions were measured. Results. There were no significant differences between elite, sub-elite and school level athletes for mean peak force and bilateral asymmetries of the knee flexors. There were no significant differences observed between bowler’s and batter’s mean peak force and bilateral asymmetries. There were no significant differences between front and back limb mean peak force outputs. Discussion. Skill level, playing position and limb role appeared to have no significant effect on eccentric knee flexor strength and bilateral asymmetries. Future research should seek to determine whether eccentric knee flexor strength thresholds are predictive of HSIs in cricket and if specific eccentric knee flexor strengthening can reduce these injuries.

  4. Early stage fatigue damage occurs in bovine tendon fascicles in the absence of changes in mechanics at either the gross or micro-structural level.

    Science.gov (United States)

    Shepherd, Jennifer H; Riley, Graham P; Screen, Hazel R C

    2014-10-01

    Many tendon injuries are believed to result from repetitive motion or overuse, leading to the accumulation of micro-damage over time. In vitro fatigue loading can be used to characterise damage during repeated use and investigate how this may relate to the aetiology of tendinopathy. This study considered the effect of fatigue loading on fascicles from two functionally distinct bovine tendons: the digital extensor and deep digital flexor. Micro-scale extension mechanisms were investigated in fascicles before or after a period of cyclic creep loading, comparing two different measurement techniques - the displacement of a photo-bleached grid and the use of nuclei as fiducial markers. Whilst visual damage was clearly identified after only 300 cycles of creep loading, these visual changes did not affect either gross fascicle mechanics or fascicle microstructural extension mechanisms over the 900 fatigue cycles investigated. However, significantly greater fibre sliding was measured when observing grid deformation rather than the analysis of nuclei movement. Measurement of microstructural extension with both techniques was localised and this may explain the absence of change in microstructural deformation in response to fatigue loading. Alternatively, the data may demonstrate that fascicles can withstand a degree of matrix disruption with no impact on mechanics. Whilst use of a photo-bleached grid to directly measure the collagen is the best indicator of matrix deformation, nuclei tracking may provide a better measure of the strain perceived directly by the cells. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  5. Multicenter Survey of the Effects of Rehabilitation Practices on Pinch Force Strength After Tendon Transfer to Restore Pinch in Tetraplegia.

    Science.gov (United States)

    Johanson, M Elise; Jaramillo, Jeffrey P; Dairaghi, Christine A; Murray, Wendy M; Hentz, Vincent R

    2016-06-01

    To identify key components of conventional therapy after brachioradialis (BR) to flexor pollicis longus (FPL) transfer, a common procedure to restore pinch strength, and evaluate whether any of the key components of therapy were associated with pinch strength outcomes. Rehabilitation protocols were surveyed in 7 spinal cord injury (SCI) centers after BR to FPL tendon transfer. Key components of therapy, including duration of immobilization, participation, and date of initiating therapy activities (mobilization, strengthening, muscle reeducation, functional activities, and home exercise), were recorded by the patient's therapist. Pinch outcomes were recorded with identical equipment at 1-year follow-up. Seven SCI rehabilitation centers where the BR to FPL surgery is performed on a routine basis. Thirty-eight arms from individuals with C5-7 level SCI injury who underwent BR to FPL transfer surgery (N=34). Conventional therapy according to established protocol in each center. The frequency of specific activities and their time of initiation (relative to surgery) were expressed as means and 95% confidence intervals. Outcome measures included pinch strength and the Canadian Occupational Performance Measure (COPM). Spearman rank-order correlations determined significant relations between pinch strength and components of therapy. There was similarity in the key components of therapy and in the progression of activities. Early cast removal was associated with pinch force (Spearman ρ=-.40, P=.0269). Pinch force was associated with improved COPM performance (Spearman ρ=.48, P=.0048) and satisfaction (Spearman ρ=.45, P=.0083) scores. Initiating therapy early after surgery is beneficial after BR to FPL surgery. Postoperative therapy protocols have the potential to significantly influence the outcome of tendon transfers after tetraplegia. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  6. Elastic ankle muscle-tendon interactions are adjusted to produce acceleration during walking in humans.

    Science.gov (United States)

    Farris, Dominic James; Raiteri, Brent James

    2017-11-15

    Humans and other cursorial mammals have distal leg muscles with high in-series compliance that aid locomotor economy. This muscle-tendon design is considered sub-optimal for injecting net positive mechanical work. However, humans change speed frequently when walking and any acceleration requires net positive ankle work. The present study unveiled how the muscle-tendon interaction of human ankle plantar flexors are adjusted and integrated with body mechanics to provide net positive work during accelerative walking. We found that for accelerative walking, a greater amount of active plantar flexor fascicle shortening early in the stance phase occurred and was transitioned through series elastic tissue stretch and recoil. Reorientation of the leg during early stance for acceleration allowed the ankle and whole soleus muscle-tendon complex to remain isometric while its fascicles actively shortened, stretching in-series elastic tissues for subsequent recoil and net positive joint work. This muscle-tendon behaviour is fundamentally different from constant-speed walking, where the ankle and soleus muscle-tendon complex undergo a period of negative work to store energy in series elastic tissues before subsequent recoil, minimizing net joint work. Muscles with high in-series compliance can therefore contribute to net positive work for accelerative walking and here we show a mechanism for how in human ankle muscles. © 2017. Published by The Company of Biologists Ltd.

  7. Stem cell technology for tendon regeneration: current status, challenges, and future research directions

    Directory of Open Access Journals (Sweden)

    Lui PP

    2015-12-01

    Full Text Available Pauline Po Yee Lui Headquarter, Hospital Authority, Hong Kong SAR, People's Republic of China Abstract: Tendon injuries are a common cause of physical disability. They present a clinical challenge to orthopedic surgeons because injured tendons respond poorly to current treatments without tissue regeneration and the time required for rehabilitation is long. New treatment options are required. Stem cell-based therapies offer great potential to promote tendon regeneration due to their high proliferative, synthetic, and immunomodulatory activities as well as their potential to differentiate to the target cell types and undergo genetic modification. In this review, I first recapped the challenges of tendon repair by reviewing the anatomy of tendon. Next, I discussed the advantages and limitations of using different types of stem cells compared to terminally differentiated cells for tendon tissue engineering. The safety and efficacy of application of stem cells and their modified counterparts for tendon tissue engineering were then summarized after a systematic literature search in PubMed. The challenges and future research directions to enhance, optimize, and standardize stem cell-based therapies for augmenting tendon repair were then discussed. Keywords: stem cells, tendon repair, tendon tissue engineering, tendon injuries

  8. Insertional footprint anatomy of the pectoralis major tendon.

    Science.gov (United States)

    Carey, Paul; Owens, Brett D

    2010-01-01

    Correct anatomical repair of pectoralis major tendon injuries requires accurate identification of the humeral insertion site. In the absence of residual fibers at the insertion, proper placement requires knowledge of the anatomic relationships in the proximal humerus. This anatomic study attempts to measure these relationships and the dimensions of the insertional footprint to assist in surgical repair and reconstruction. Six matched pairs of cadaver proximal humeri were examined. All specimens were found to be in good condition and none were excluded. The proximal to distal length and maximum width of the pectoralis major tendon were measured at the humeral insertion with a digital caliper. The distance from the superomedial corner of the greater tuberosity to the superior aspect of the tendon insertion was also measured. The mean proximal to distal dimension of the pectoralis major insertion was 72.3+/-12.3 mm. The mean maximal thickness at the humeral insertion was 1.4+/-.2 mm. The distance from the superomedial corner of the greater tuberosity to the bony tendon insertion was 42.2+/-8.5 mm. The anatomic location of the humeral insertion of the pectoralis major tendon can be located in repair of pectoralis tendon injuries by referencing the superomedial corner of the greater tuberosity and the lateral lip of the bicipital groove. Findings in the present study will improve knowledge of the surgical anatomy relevant to repair and reconstruction of the pectoralis major tendon. Copyright 2010, SLACK Incorporated.

  9. Bevacizumab Improves Achilles Tendon Repair in a Rat Model

    Directory of Open Access Journals (Sweden)

    Herbert Tempfer

    2018-04-01

    Full Text Available Background/Aims: Effective wound-healing generally requires efficient re-vascularization after injury, ensuring sufficient supply with oxygen, nutrients, and various cell populations. While this applies to most tissues, tendons are mostly avascular in nature and harbor relatively few cells, probably contributing to their poor regenerative capacity. Considering the minimal vascularization of healthy tendons, we hypothesize that controlling angiogenesis in early tendon healing is beneficial for repair tissue quality and function. Methods: To address this hypothesis, Bevacizumab, a monoclonal antibody blocking VEGF-A signaling, was locally injected into the defect area of a complete tenotomy in rat Achilles tendon. At 28 days post-surgery, the defect region was investigated using immunohistochemistry against vascular and lymphatic epitopes. Polarization microscopy and biomechanical testing was used to determine tendon integrity and gait analysis for functional testing in treated vs non-treated animals. Results: Angiogenesis was found to be significantly reduced in the Bevacizumab treated repair tissue, accompanied by significantly reduced cross sectional area, improved matrix organization, increased stiffness and Young’s modulus, maximum load and stress. Further, we observed an improved gait pattern when compared to the vehicle injected control group. Conclusion: Based on the results of this study we propose that reducing angiogenesis after tendon injury can improve tendon repair, potentially representing a novel treatment-option.

  10. Tendinopathy alters ultrasound transmission in the patellar tendon during squatting.

    Science.gov (United States)

    Wearing, S C; Hooper, S L; Smeathers, J E; Pourcelot, P; Crevier-Denoix, N; Brauner, T

    2016-12-01

    Measurement of loading patterns of the patellar tendon during activity is important in understanding tendon injury. We used transmission-mode ultrasonography to investigate patellar tendon loading during squatting in adults with and without tendinopathy. It was hypothesized that axial ultrasonic velocity, a surrogate measure of the elastic modulus of tendon, would be lower in tendinopathy. Ultrasound velocity was measured in both patellar tendons of adults with unilateral patellar tendinopathy (n = 9) and in healthy controls (n = 16) during a bilateral squat maneuver. Sagittal knee movement was measured simultaneously with an electrogoniometer. Statistical comparisons between healthy and injured tendons were made using two-way mixed-design ANOVAs. Axial ultrasound velocity in both symptomatic and asymptomatic patellar tendons in tendinopathy was approximately 15% higher than in healthy tendons at the commencement (F 1,23  = 5.2, P tendinopathy and highlight fresh avenues for its clinical management. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Desmotomia do acessório do tendão flexor digital superficial no tratamento das tendinites recidivantes em equinos: relato de três casos

    OpenAIRE

    Escodro, Pierre Barnabé; Hussni, Carlos Alberto [UNESP

    2014-01-01

    Three adult equine athletes, two Thoroughbred in practice of polo and a Standadbred had recurrence of superficial digital flexor tendonitis confirmed by physical examination and ultrasound, with involvement of the regions 1A to 2A. In the initial phase were treated with anti-inflammatory systemic, cryotherapy and other conservative therapeutics procedures. By presenting the recurrence and chronicity of the process, these were submitted to superior check desmotomy. Four days after the surgery ...

  12. Experimental study of the effects of helium-neon laser radiation on repair of injured tendon

    Science.gov (United States)

    Xu, Yong-Qing; Li, Zhu-Yi; Weng, Long-Jiang; An, Mei; Li, Kai-Yun; Chen, Shao-Rong; Wang, Jian-Xin; Lu, Yu

    1993-03-01

    Despite extensive research into the biology of tendon healing, predictably restoring normal function to a digit after a flexor tendon laceration remains one of the most difficult problems facing the hand surgeon. The challenge of simultaneously achieving tendon healing while minimizing the peritendinous scar formation, which limits tendon gliding, has captured the attention of investigators for many years. It has been said that low-power density helium-neon laser radiation had effects on anti-inflammation, detumescence, progressive wound healing, and reducing intestinal adhesions. This experimental study aims at whether helium-neon laser can reduce injured tendon adhesions and improve functional recovery of the injured tendon. Fifty white Leghorn hens were used. Ten were randomly assigned as a normal control group, the other forty were used in the operation. After anesthetizing them with Amytal, a half of the profundus tendons of the second and third foretoes on both sides of the feet were cut. Postoperatively, the hens moved freely in the cages. One side of the toes operated on were randomly chosen as a treatment group, the other side served as an untreated control group. The injured tendon toes in the treatment group were irradiated for twenty minutes daily with a fiber light needle of helium-neon laser therapeutic apparatus (wavelength, 6328 angstroms) at a constant power density of 12.74 mW/cm2, the first exposure taking place 24 hours after the operation. The longest course of treatment was 3 weeks. The control group was not irradiated. At 3 days, 1, 2, 3, and 5 weeks after surgery, 8 hens were sacrificed and their tendons were examined. The experimental results: (1) active, passive flexion and tendon gliding functional recovery were significantly better in the treatment group (p < 0.01); (2) width and thickness of the tendon at the cut site were significantly smaller in the treatment group (p < 0.01); (3) degrees of tendon adhesions were significantly lighter

  13. Analysis of 344 Hand Injuries in a Pediatric Population

    Directory of Open Access Journals (Sweden)

    Byung-Joon Jeon

    2016-01-01

    Full Text Available BackgroundThe purpose of this study was to identify comprehensive hand injury patterns in different pediatric age groups and to assess their risk factors.MethodsThis retrospective study was conducted among patients younger than 16-year-old who presented to the emergency room of a general hospital located in Gyeonggi-do, Republic of Korea, and were treated for an injury of the finger or hand from January 2010 to December 2014. The authors analyzed the medical records of 344 patients. Age was categorized according to five groups.ResultsA total of 391 injury sites of 344 patients were evaluated for this study. Overall and in each group, male patients were in the majority. With regard to dominant or non-dominant hand involvement, there were no significant differences. Door-related injuries were the most common cause in the age groups of 0 to 3, 4 to 6, and 7 to 9 years. Sport/recreational activities or physical conflict injuries were the most common cause in those aged 10 to 12 and 13 to 15. Amputation and crushing injury was the most common type in those aged 0 to 3 and 4 to 6 years. However, in those aged 10 to 12 and 13 to 15, deep laceration and closed fracture was the most common type. With increasing age, closed injuries tended to increase more sharply than open injuries, extensor tendon rupture more than flexor injuries, and the level of injury moved proximally.ConclusionsThis study provides a comprehensive overview of the epidemiology of hand injuries in the pediatric population.

  14. THEORETICAL AND EXPERIMENTAL STUDY ON DURABILITY OF THE CALCANEAL TENDON AND THE PATHOMECHANISM OF ITS ATRAUMATIC, SUBCUTANEOUS BREAK

    Directory of Open Access Journals (Sweden)

    K. Skiba

    2011-11-01

    Full Text Available The pathology of the calcaneal tendon (Achilles presents a serious medical and social problem. This tendon is the strongest plantar flexor of the foot that plays a fundamental role in the accomplishment of human gait. Although this role has long been recognized, neither in medical nor in biomechanical literature can one find a clear description of subcutaneous break of the Achilles tendon. Its pathomechanism and the causes have not been fully accounted for. Many authors concentrate mainly on medical and biological aspects of the damage of the Achilles tendon.They often claim that the vasculature of the tendon itself plays a significant role in the pathogenesis, because the blood supply to the tendon changes with human age, decreasing substantially after the age of 30, leading both to regressive changes in the tendon as well as to a reduction of the tendon’s mechanical strength. The refore a comprehensive description and explanation of this phenomenon needs an interdisciplinary approach, taking into account not only the medical and biological aspects, but also the mechanics sensu largo. The aim of the paper is to put forward a complete description of the pathomechanism of the Achilles tendon spontaneous break, within the framework of its mechanics. The conclusions are based upon a kinematical analysis of the knee joint, a trajectory determination of the point of origin of the gastrocnemius from the initial position of 90 degrees bent up to the full knee extension, and an experimental examination of uniaxial stretching of the Achilles tendon.

  15. Quadriceps Tendon Rupture and Contralateral Patella Tendon Avulsion Post Primary Bilateral Total Knee Arthroplasty: A Case Report

    Directory of Open Access Journals (Sweden)

    Gaurav Sharma

    2016-07-01

    Full Text Available Background: Extensor mechanism failure secondary to knee replacement could be due to tibial tubercle avulsion, Patellar tendon rupture, patellar fracture or quadriceps tendon rupture. An incidence of Patella tendon rupture of 0.17% and Quadriceps tendon rupture of around 0.1% has been reported after Total knee arthroplasty. These are considered a devastating complication that substantially affects the clinical results and are challenging situations to treat with surgery being the mainstay of the treatment. Case Description: We report here an interesting case of a patellar tendon rupture of one knee and Quadriceps tendon rupture of the contralateral knee following simultaneous bilateral knee replacement in a case of inflammatory arthritis patient. End to end repair for Quadriceps tear and augmentation with Autologous Hamstring tendon graft was done for Patella tendon rupture. OUTCOME: Patient was followed up for a period of 1 year and there was no Extension lag with a flexion of 100 degrees in both the knees. DISCUSSION: The key learning points and important aspects of diagnosing these injuries early and the management techniques are described in this unique case of bilateral extensor mechanism disruption following knee replacements.

  16. Comparison of plantar flexor musculotendinous stiffness, geometry, and architecture in male runners with and without a history of tibial stress fracture.

    Science.gov (United States)

    Pamukoff, Derek N; Blackburn, J Troy

    2015-02-01

    Greater lower extremity joint stiffness may be related to the development of tibial stress fractures in runners. Musculotendinous stiffness is the largest contributor to joint stiffness, but it is unclear what factors contribute to musculotendinous stiffness. The purpose of this study was to compare plantar flexor musculotendinous stiffness, architecture, geometry, and Achilles tendon stiffness between male runners with and without a history of tibial stress fracture. Nineteen healthy runners (age = 21 ± 2.7 years; mass = 68.2 ± 9.3 kg; height = 177.3 ± 6.0 cm) and 19 runners with a history of tibial stress fracture (age = 21 ± 2.9 years; mass = 65.3 ± 6.0 kg; height = 177.2 ± 5.2 cm) were recruited from community running groups and the university's varsity and club cross-country teams. Plantar flexor musculotendinous stiffness was estimated from the damped frequency of oscillatory motion about the ankle follow perturbation. Ultrasound imaging was used to measure architecture and geometry of the medial gastrocnemius. Dependent variables were compared between groups via one-way ANOVAs. Previously injured runners had greater plantar flexor musculotendinous stiffness (P < .001), greater Achilles tendon stiffness (P = .004), and lesser Achilles tendon elongation (P = .003) during maximal isometric contraction compared with healthy runners. No differences were found in muscle thickness, pennation angle, or fascicle length.

  17. Extensor and flexor digit synovial sheath, sac and synovial capsule in the distal part of the limbs in buffalos and camels and its relation of surgical interference

    Directory of Open Access Journals (Sweden)

    S. AL-sadi

    2010-01-01

    Full Text Available Sixty one samples of the distal parts of limbs were obtained from different ages of buffalo and camels of both sex to study the synovial structures to determine the suitable sites for injection of surgical interference. The result showed that extensor digit synovial sheath was extend between middle or distal part of metacarpal (metatarsal to the extensor processes and this formed with synovial capsule dorsal pouches which serve in surgical interference. The flexor digit synovial sheath extended to palmar (planter between distal extremity of metacarpal (metatarsal to the middle of second phalanx in buffalo while in camel it extended to the proximal extremity of second phalanx, that sheath was formed with suspensory ligament and sessamoid bone palmar or planter pouches which were serve the surgical interference. Fourth synovial bursa observed situated dorsally between the extensor digit laterals tendon and capsule of fetlock joint, forms site of injection during surgical interference, while the other two synovial bursa were located to palmer (planter between deep flexor tendon and distal sessamoid bone in buffalo while in camel these bursa were located between deep flexor tendon and cartilage of the second phalanx, these bursa were served for surgical interference. The synovial capsule which serve the surgical interference through digit cushion these were shown extended from the claw capsule. The result show that surgical interference was form six pouches in buffalo and eight pouches in camel, which formed by synovial structures and the tissue associated with them.

  18. Anatomy of the distal biceps brachii tendon and its clinical relevance.

    Science.gov (United States)

    Kulshreshtha, Rajiv; Singh, Raminder; Sinha, Joydeep; Hall, Susan

    2007-03-01

    Rupture of the distal biceps tendon is a relatively uncommon injury. Different methods have been described for its surgical repair. According to published reports, current surgical techniques result in decreased strength and endurance of upper extremity functions requiring supination and flexion. In our anatomic study of 74 cadaveric elbows, we observed that the distal biceps tendon spirals in a predictable manner and has a complex fiber arrangement. Successful surgical repair of a ruptured distal biceps tendon should be predicated on an understanding of the tendon anatomy, but current surgical techniques do not take into account the salient anatomic features of the distal biceps tendon. To our knowledge, there is no description in the surgical literature of the fiber arrangement of the distal biceps tendon. We provide a basis for developing an anatomically accurate protocol for repairing a distal biceps tendon rupture.

  19. A Simulation Model for Extensor Tendon Repair

    Directory of Open Access Journals (Sweden)

    Elizabeth Aronstam

    2017-07-01

    Full Text Available Audience: This simulation model is designed for use by emergency medicine residents. Although we have instituted this at the PGY-2 level of our residency curriculum, it is appropriate for any level of emergency medicine residency training. It might also be adapted for use for a variety of other learners, such as practicing emergency physicians, orthopedic surgery residents, or hand surgery trainees. Introduction: Tendon injuries commonly present to the emergency department, so it is essential that emergency physicians be competent in evaluating such injuries. Indeed, extensor tendon repair is included as an ACGME Emergency Medicine Milestone (Milestone 13, Wound Management, Level 5 – “Performs advanced wound repairs, such as tendon repairs…”.1 However, emergency medicine residents may have limited opportunity to develop these skills due to a lack of patients, competition from other trainees, or preexisting referral patterns. Simulation may provide an alternative means to effectively teach these skills in such settings. Previously described tendon repair simulation models that were designed for surgical trainees have used rubber worms4, licorice5, feeding tubes, catheters6,7, drinking straws8, microfoam tape9, sheep forelimbs10 and cadavers.11 These models all suffer a variety of limitations, including high cost, lack of ready availability, or lack of realism. Objectives: We sought to develop an extensor tendon repair simulation model for emergency medicine residents, designed to meet ACGME Emergency Medicine Milestone 13, Level 5. We wished this model to be simple, inexpensive, and realistic. Methods: The learner responsible content/educational handout component of our innovation teaches residents about emergency department extensor tendon repair, and includes: 1 relevant anatomy 2 indications and contraindications for emergency department extensor tendon repair 3 physical exam findings 4 tendon suture techniques and 5 aftercare. During

  20. Enthesiopathy of the flexor carpi ulnaris at the pisiform: Findings of high-frequency sonography

    International Nuclear Information System (INIS)

    Wick, Marius C.; Weiss, Ruediger J.; Arora, Rohit; Gabl, Markus; Gruber, Johann; Jaschke, Werner; Klauser, Andrea S.

    2011-01-01

    Objectives: Acute or chronic pain at the pisiform may be due to tendinopathy of the flexor carpi ulnaris tendon (FCU) insertion, mechanical overuse, bony fractures, and osteoarthritis of the pisiform-triquetral joint. Enthesiopathy of the FCU at the pisiform might exhibit abnormalities assessable for sonographic characterization. This study aimed to determine the most relevant sonographic features of tendinopathy of the FCU insertion at the pisiform. Materials and methods: We retrospectively analyzed radiological findings of 9 patients admitted for high-frequency sonographic evaluation of a painful pisiform FCU insertion. The FCU insertion was assessed for active enthesiopathy in terms of tendon thickening and hyperemia, peritendinous effusion, peritendinous hyperemia, peritendinous soft tissue thickening, cystic fluid collections, erosive cortical irregularities, and osteoproliferative alterations at the pisiform. Results: Of all patients, 5 had inflammatory rheumatic disorders and the remainder had a painful pisiform FCU insertion related to overuse. While peritendinous effusion, pisiform erosive cortical irregularities, and peritendinous soft tissue thickening at the FCU insertion were exclusively found in rheumatic patients, active enthesiopathy of the FCU tendon, pisiform osteoproliferative alterations, and hyperemia of the peritendinous soft tissue were inconsistent and found in both groups. Cystic fluid collections from the pisiform-triquetral joint were only seen in patients with overuse. Conclusions: In this small case series of patients with pain at the pisiform FCU insertion, we could reveal several typical sonographic features for insertion tendinopathy. Further studies should prove if these sonographic features could impact on the management of patients with pain at the pisiform.

  1. Enthesiopathy of the flexor carpi ulnaris at the pisiform: Findings of high-frequency sonography

    Energy Technology Data Exchange (ETDEWEB)

    Wick, Marius C., E-mail: marius.wick@i-med.ac.at [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck (Austria); Weiss, Ruediger J., E-mail: rudiger.weiss@karolinska.se [Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska University Hospital (Solna), Karolinska Institutet, S-17176 Stockholm (Sweden); Arora, Rohit, E-mail: rohit.arora@uki.at [Department for Trauma Surgery and Sports Medicine, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck (Austria); Gabl, Markus, E-mail: markus.gabl@uki.at [Department for Trauma Surgery and Sports Medicine, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck (Austria); Gruber, Johann, E-mail: johann.gruber@uki.at [Department of Internal Medicine I, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck (Austria); Jaschke, Werner, E-mail: werner.jaschke@i-med.ac.at [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck (Austria); Klauser, Andrea S., E-mail: andrea.klauser@i-med.ac.at [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck (Austria)

    2011-02-15

    Objectives: Acute or chronic pain at the pisiform may be due to tendinopathy of the flexor carpi ulnaris tendon (FCU) insertion, mechanical overuse, bony fractures, and osteoarthritis of the pisiform-triquetral joint. Enthesiopathy of the FCU at the pisiform might exhibit abnormalities assessable for sonographic characterization. This study aimed to determine the most relevant sonographic features of tendinopathy of the FCU insertion at the pisiform. Materials and methods: We retrospectively analyzed radiological findings of 9 patients admitted for high-frequency sonographic evaluation of a painful pisiform FCU insertion. The FCU insertion was assessed for active enthesiopathy in terms of tendon thickening and hyperemia, peritendinous effusion, peritendinous hyperemia, peritendinous soft tissue thickening, cystic fluid collections, erosive cortical irregularities, and osteoproliferative alterations at the pisiform. Results: Of all patients, 5 had inflammatory rheumatic disorders and the remainder had a painful pisiform FCU insertion related to overuse. While peritendinous effusion, pisiform erosive cortical irregularities, and peritendinous soft tissue thickening at the FCU insertion were exclusively found in rheumatic patients, active enthesiopathy of the FCU tendon, pisiform osteoproliferative alterations, and hyperemia of the peritendinous soft tissue were inconsistent and found in both groups. Cystic fluid collections from the pisiform-triquetral joint were only seen in patients with overuse. Conclusions: In this small case series of patients with pain at the pisiform FCU insertion, we could reveal several typical sonographic features for insertion tendinopathy. Further studies should prove if these sonographic features could impact on the management of patients with pain at the pisiform.

  2. Adequacy of palmaris longus and plantaris tendons for tendon grafting.

    Science.gov (United States)

    Jakubietz, Michael G; Jakubietz, Danni F; Gruenert, Joerg G; Zahn, Robert; Meffert, Rainer H; Jakubietz, Rafael G

    2011-04-01

    The reconstruction of tendon defects is challenging. The palmaris longus and plantaris tendon are generally considered best for tendon grafting. Only a few studies have examined whether these tendons, when present, meet criteria for successful grafting. The purpose of this study was to evaluate these tendons in regard to adequacy as tendon grafts. To evaluate adequacy for grafting, the palmaris longus and plantaris tendons were harvested from 92 arms and legs of 46 cadavers. Macroscopic evaluation and measurements concerning presence, length, and diameter of the tendons were obtained. Criteria for adequacy were a minimum length of 15 cm with diameter of 3 mm or, alternatively, 30 cm with a diameter of 1.5 mm. The palmaris longus tendon was present bilaterally in 36 cases and was absent bilaterally in 4 cases. The plantaris tendon was present bilaterally in 38 cases and absent bilaterally in 4 cases. In 29 cadavers, the palmaris longus tendon did not meet the criteria to be used as a tendon graft. Only in 8 cases were the tendons satisfactory for grafting bilaterally. The plantaris tendon met criteria for grafting in 20 cases bilaterally. In 17 cases, the tendons were considered inadequate bilaterally. Despite their presence, the palmaris longus and plantaris tendons are adequate for grafting less often than previously thought. In less than 50%, the tendons, although present, would serve as useful grafts. Our findings underscore the importance of choosing a second donor site before surgery in case the primarily selected tendon is not found to be suitable. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. Epidemiology of Hip Flexor and Hip Adductor Strains in National Collegiate Athletic Association Athletes, 2009/2010-2014/2015

    DEFF Research Database (Denmark)

    Eckard, Timothy G; Padua, Darin A; Dompier, Thomas P

    2017-01-01

    restriction time were examined. Injury rate ratios (IRRs) and proportion ratios were calculated to compare rates within and between sports by event type, sex, mechanism, recurrence, and participation restriction time. RESULTS: A total of 770 hip flexor and 621 hip adductor strains were reported, resulting...... in overall injury rates of 1.60 and 1.29 per 10,000 athlete-exposures (AEs), respectively. In men, the rate of hip flexor strains was 1.81 per 10,000 AEs, and that for hip adductor strains was 1.71 per 10,000 AEs. In women, the rate of hip flexor strains was 1.59 per 10,000 AEs, and the rate of hip adductor...... strains was 1.15 per 10,000 AEs. The highest rates of strains were found in men's soccer and men's ice hockey (range, 2.47-3.77 per 10,000 AEs). Most hip flexor and hip adductor strains occurred in practice, but both had higher rates in competition. In sex-comparable sports, hip flexor strain rates did...

  4. Knee extension and flexion muscle power after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendons graft: a cross-sectional comparison 3 years post surgery.

    Science.gov (United States)

    Ageberg, Eva; Roos, Harald P; Silbernagel, Karin Grävare; Thomeé, Roland; Roos, Ewa M

    2009-02-01

    Hamstring muscles play a major role in knee-joint stabilization after anterior cruciate ligament (ACL) injury. Weakness of the knee extensors after ACL reconstruction with patellar tendon (PT) graft, and in the knee flexors after reconstruction with hamstring tendons (HT) graft has been observed up to 2 years post surgery, but not later. In these studies, isokinetic muscle torque was used. However, muscle power has been suggested to be a more sensitive and sport-specific measures of strength. The aim was to study quadriceps and hamstring muscle power in patients with ACL injury treated with surgical reconstruction with PT or HT grafts at a mean of 3 years after surgery. Twenty subjects with PT and 16 subjects with HT grafts (mean age at follow up 30 years, range 20-39, 25% women), who were all included in a prospective study and followed the same goal-based rehabilitation protocol for at least 4 months, were assessed with reliable, valid, and responsive tests of quadriceps and hamstring muscle power at 3 years (SD 0.9, range 2-5) after surgery. The mean difference between legs (injured minus uninjured), the hamstring to quadriceps (H:Q, hamstring divided by quadriceps) ratio, and the limb symmetry index (LSI, injured leg divided by uninjured and multiplied by 100) value, were used for comparisons between the groups (analysis of variance). The mean difference between the injured and uninjured legs was greater in the HT than in the PT group for knee flexion power (-21.3 vs. 7.7 W, p = 0.001). Patients with HT graft had lower H:Q ratio in the injured leg than the patients with PT graft (0.63 vs. 0.77, p = 0.012). They also had lower LSI for knee flexion power than those in the PT group (88 vs. 106%, p hamstring muscle power, and the lower hamstring to quadriceps ratio in the HT graft group than in the PT graft group 3 years (range 2-5) after ACL reconstruction, reflect imbalance of knee muscles after reconstruction with HT graft that may have a negative effect on

  5. Ultrasound of the elbow with emphasis on detailed assessment of ligaments, tendons, and nerves

    Energy Technology Data Exchange (ETDEWEB)

    De Maeseneer, Michel, E-mail: Michel.demaeseneer@uzbrussel.be [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium); Brigido, Monica Kalume, E-mail: Mbrigido@med.umich.edu [Department of Radiology, University of Michigan, Ann Arbor, MI (United States); Antic, Marijana, E-mail: Misscroa@gmail.com [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium); Lenchik, Leon, E-mail: Llenchik@wakehealth.edu [Department of Radiology, Wake Forest University, Winston-Salem, NC (United States); Milants, Annemieke, E-mail: Annemieke.Milants@gmail.com [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium); Vereecke, Evie, E-mail: Evie.Vereecke@kuleuven-kulak.be [Department of Anatomy, KULAK, Katholieke Universiteit Leuven, Campus Kortrijk, Kortrijk (Belgium); Jager, Tjeerd [Aalsters Stedelijk Ziekenhuis, Aalst (Belgium); Shahabpour, Maryam, E-mail: Maryam.Shahabpour@uzbrussel.be [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium)

    2015-04-15

    Highlights: •Medial and lateral tendons: the different muscles forming these tendons can be followed up to the insertion. The imaging anatomy is reviewed. •Medial and lateral ligaments: the anatomy is complex and specialized imaging planes and arm positions are necessary for accurate assessment. •Biceps tendon: the anatomy of the distal biceps and lacertus fibrosus are discussed and illustrated with cadaveric correlation. •US imaging of the nerves about the elbow and visualization of the possible compression points is discussed. -- Abstract: The high resolution and dynamic capability of ultrasound make it an excellent tool for assessment of superficial structures. The ligaments, tendons, and nerves about the elbow can be fully evaluated with ultrasound. The medial collateral ligament consists of an anterior and posterior band that can easily be identified. The lateral ligament complex consists of the radial collateral ligament, ulnar insertion of the annular ligament, and lateral ulnar collateral ligament, easily identified with specialized probe positioning. The lateral ulnar collateral ligament can best be seen in the cobra position. On ultrasound medial elbow tendons can be followed nearly up to their common insertion. The pronator teres, flexor carpi radialis, palmaris longus, and flexor digitorum superficialis can be identified. The laterally located brachioradialis and extensor carpi radialis longus insert on the supracondylar ridge. The other lateral tendons can be followed up to their common insertion on the lateral epicondyle. The extensor digitorum, extensor carpi radialis brevis, extensor digiti minimi, and extensor carpi ulnaris can be differentiated. The distal biceps tendon is commonly bifid. For a complete assessment of the distal biceps tendon specialized views are necessary. These include an anterior axial approach, medial and lateral approach, and cobra position. In the cubital tunnel the ulnar nerve is covered by the ligament of Osborne

  6. Ultrasound of the elbow with emphasis on detailed assessment of ligaments, tendons, and nerves

    International Nuclear Information System (INIS)

    De Maeseneer, Michel; Brigido, Monica Kalume; Antic, Marijana; Lenchik, Leon; Milants, Annemieke; Vereecke, Evie; Jager, Tjeerd; Shahabpour, Maryam

    2015-01-01

    Highlights: •Medial and lateral tendons: the different muscles forming these tendons can be followed up to the insertion. The imaging anatomy is reviewed. •Medial and lateral ligaments: the anatomy is complex and specialized imaging planes and arm positions are necessary for accurate assessment. •Biceps tendon: the anatomy of the distal biceps and lacertus fibrosus are discussed and illustrated with cadaveric correlation. •US imaging of the nerves about the elbow and visualization of the possible compression points is discussed. -- Abstract: The high resolution and dynamic capability of ultrasound make it an excellent tool for assessment of superficial structures. The ligaments, tendons, and nerves about the elbow can be fully evaluated with ultrasound. The medial collateral ligament consists of an anterior and posterior band that can easily be identified. The lateral ligament complex consists of the radial collateral ligament, ulnar insertion of the annular ligament, and lateral ulnar collateral ligament, easily identified with specialized probe positioning. The lateral ulnar collateral ligament can best be seen in the cobra position. On ultrasound medial elbow tendons can be followed nearly up to their common insertion. The pronator teres, flexor carpi radialis, palmaris longus, and flexor digitorum superficialis can be identified. The laterally located brachioradialis and extensor carpi radialis longus insert on the supracondylar ridge. The other lateral tendons can be followed up to their common insertion on the lateral epicondyle. The extensor digitorum, extensor carpi radialis brevis, extensor digiti minimi, and extensor carpi ulnaris can be differentiated. The distal biceps tendon is commonly bifid. For a complete assessment of the distal biceps tendon specialized views are necessary. These include an anterior axial approach, medial and lateral approach, and cobra position. In the cubital tunnel the ulnar nerve is covered by the ligament of Osborne

  7. MRI of the hand and wrist joint of climbers. Imaging of lesions and overstrain injury

    International Nuclear Information System (INIS)

    Heuck, A.; Hochholzer, T.; Keinath, C.

    1992-01-01

    The hands and wrists of 20 top-level rock climbers with sports injuries and overstress abnormalities were compared with the hands and wrists of 10 normal volunteers. They were all studied with MR imaging at 1.5 T. The imaging protocol included spin-echo and gradient-echo sequences with 1- to 5-mm-thick contiguous slices in the axial, coronal and/or sagittal planes, depending on the location and nature of the suspected injury. Typical hand and wrist lesions depicted with MRI in climbers consisted of annular ligament tears, lesions of the flexor tendons, tenosynovitis, ganglion cysts, joint effusion and functional carpal tunnel syndrome. The MRI findings on these abnormalities were compared to normal findings and those with ultrasound and plain films. In addition, hypertrophic changes in the muscles, tendons, ligaments, and bones of top-level rock climbers were assessed morphometrically. MRI proved to be the superior imaging modality in the diagnosis of sports injuries and overstress abnormalities of the hand the wrist in rock-climbing athletes. (orig.) [de

  8. Terminal bifurcation of the biceps brachii muscle and tendon: anatomic considerations and clinical implications.

    Science.gov (United States)

    Dirim, Berna; Brouha, Sharon Sudarshan; Pretterklieber, Michael L; Wolff, Klaus S; Frank, Andreas; Pathria, Mini N; Chung, Christine B

    2008-12-01

    The objective of our study was to describe the anatomic variation of a bifurcated distal biceps tendon with MRI, histology, and dissection in cadavers and to report the MR appearance of superimposed lesions in a patient population with this anatomic variant. Visual and histologic examinations of the distal biceps brachii tendon in eight sectioned fresh-frozen elbow specimens were performed. Dissection of 17 elbow specimens was performed to describe the distal biceps brachii tendon. In addition, all elbow MRI reports over a 3-year period (n = 411) were retrospectively reviewed to determine the presence of bifurcation of the distal biceps brachii tendon. The distal biceps brachii tendon appeared bifurcated in 25% of the sectioned specimens, and these findings were confirmed histologically. The distal biceps brachii tendon was completely separable into two components-that is, a short head and long head- throughout their proximal to distal extent in 41.2% of the dissected specimens. The distal biceps brachii tendon appeared bifurcated in 11.8% of 68 clinical cases that showed distal biceps brachii tendon abnormalities or injuries. The following patterns of injury were noted: complete rupture of both tendons (n = 1), complete rupture of the short head and normal insertion of the long head (n = 2), complete rupture of the short head and partial tear of the long head (n = 2), partial tear of both tendons (n = 2), and complete rupture of the short head and tendinosis in the long head (n = 1). A bifurcated distal biceps brachii tendon is an anatomic variant that arises from persistent division between the short head and long head of the distal biceps brachii tendon and can be characterized with MRI. Knowledge of a bifurcated distal biceps brachii tendon is important to characterize injury to the components and to avoid pitfalls in imaging diagnosis.

  9. Equine induced pluripotent stem cells have a reduced tendon differentiation capacity compared to embryonic stem cells

    Directory of Open Access Journals (Sweden)

    Emma Patricia Bavin

    2015-11-01

    Full Text Available Tendon injuries occur commonly in horses and their repair through scar tissue formation predisposes horses to a high rate of re-injury. Pluripotent stem cells may provide a cell replacement therapy to improve tendon tissue regeneration and lower the frequency of re-injury. We have previously demonstrated that equine embryonic stem cells (ESCs differentiate into the tendon cell lineage upon injection into the damaged horse tendon and can differentiate into functional tendon cells in vitro to generate artificial tendons. Induced pluripotent stem cells (iPSCs have now been derived from horses but, to date, there are no reports on their ability to differentiate into tendon cells. As iPSCs can be produced from adult cell types, they provide a more accessible source of cells than ESCs, which require the use of horse embryos. The aim of this study was to compare tendon differentiation by ESCs and iPSCs produced through two independent methods. In 2-dimensional differentiation assays the iPSCs expressed tendon associated genes and proteins, which were enhanced by the presence of transforming growth factor-β3. However, in 3-dimensional differentiation assays the iPSCs failed to differentiate into functional tendon cells and generate artificial tendons. These results demonstrate the utility of the 3-dimensional in vitro tendon assay for measuring tendon differentiation and the need for more detailed studies to be performed on equine iPSCs to identify and understand their epigenetic differences from pluripotent ESCs prior to their clinical application.

  10. [Therapy of injuries of the pulley system in sport climbers].

    Science.gov (United States)

    Schöffl, V; Hochholzer, T; Winkelmann, H-P; Strecker, W

    2004-08-01

    Closed traumatic ruptures of finger flexor tendon pulleys are frequent in rock climbing. The objectives of this study were to characterise this injury and to formulate diagnostic and therapeutic guidelines. An algorithm and a grading system are analysed for validation. 122 pulley injuries were prospectively evaluated. After standard radiographs, a dynamic ultrasound examination was performed in all climbers. In ten cases an additional MRI was necessary. All patients were classified according to the pulley injury score. Grade I-III injuries received conservative and grade IV injuries received operative therapy. 88 patients were re-evaluated, including all grade IV patients. 48 climbers had pulley strains, and 74 had ruptures (a single rupture in 90.5 % of the cases and multiple ruptures in 9.5 %). According to the pulley-injury-score, 39 % were grade I, 25 % were grade II, 30 % were grade III and 6 % were grade IV injuries. 115 patients underwent conservative therapy, of which 81 were re-evaluated. 8/81 complained three months after the injury about consistent pain, mostly caused by tendinitis. All grade IV injuries underwent surgical reconstruction, in two cases through Weilby's repair, in three cases through the "loop and a half" technique and in two further cases with a combination of the two. Accord