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Sample records for quadriceps tendon lengthening

  1. Percutaneous Achilles Tendon Lengthening

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    ... 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 ...

  2. [Quadriceps and patellar tendon ruptures].

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    Grim, C; Lorbach, O; Engelhardt, M

    2010-12-01

    Ruptures of the quadriceps or patellar tendon are uncommon but extremely relevant injuries. Early diagnosis and surgical treatment with a stable suture construction are mandatory for a good postoperative clinical outcome. The standard methods of repair for quadriceps and patellar tendon injuries include the placement of suture loops through transpatellar tunnels. Reinforcement with either a wire cerclage or a PDS cord is used in patellar tendon repair. The PDS cord can also be applied as augmentation in quadriceps tendon repair. In secondary patellar tendon repair an autologous semitendinosus graft can be used. For chronic quadriceps tendon defects a V-shaped tendon flap with a distal footing is recommended. The different methods of repair should lead to early functional postoperative treatment. The clinical outcome after surgical treatment of patellar and quadriceps tendon ruptures is mainly good.

  3. Quadriceps tendon injuries

    Directory of Open Access Journals (Sweden)

    Ristić Vladimir

    2013-01-01

    Full Text Available Introduction. The aim of study was to analyze risk factors, mechanisms of injury, symptoms and time that elapsed from injury until operation of complete quadriceps tendon ruptures. Material and Methods. This retrospective multicenter study included 30 patients operated for this injury, of whom 28 (93.3% were men. The average age was 53.7 years (18-73. Twenty-six patients had reconstruction of unilateral rupture and four of bilateral one. Results. Eighty percent of them had some risk factors for rupture of the tendon with degenerative changes. Eight patients had diabetes, seven patients were on renal dialysis, two patients had secondary hyperparathyroidism, five patients were obese and two patients had former knee operations. These injuries occurred in 80% following minor trauma caused by falls on stairs, on flat surfaces and squatting. The most frequent symptoms were: pain, swelling, lack of extension of knee and defect above patella, and three cases were initially misdiagnosed. During the first 10 days after injury, acute and chronic ruptures were reconstructed in 22 (73.3% and 8 patients, respectively. Conclusion. Quadriceps tendon injuries most often happen to male patients with predisposing conditions in their fifth and sixth decade of life due to trivial trauma. Patients on renal dialysis are the most vulnerable population group.

  4. Spontaneous bilateral quadriceps tendon rupture.

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    Vigneswaran, N; Lee, K; Yegappan, M

    2007-11-01

    Spontaneous bilateral quadriceps tendon ruptures are uncommon. We present a 30-year-old man with end-stage renal failure, who sustained this injury, and subsequently had surgical repair of both tendons on separate occasions. He has since regained full range of movement of both knees.

  5. Atraumatic quadriceps tendon tear associated with calcific tendonitis.

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    Abram, Simon G F; Sharma, Akash D; Arvind, Chinnakonda

    2012-11-27

    Calcific tendonitis of the quadriceps tendon is an uncommon condition. We present the first case of a quadriceps tendon tear associated with calcific tendonitis. In this case, the patient presented with symptoms mimicking a rupture of the quadriceps tendon. This case illustrates that although calcific tendonitis of the quadriceps is a rare condition it is not benign and should be considered when investigating acute symptoms associated with the extensor mechanism of the knee.

  6. Quadriceps and patellar tendon rupture.

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    Ramseier, L E; Werner, C M L; Heinzelmann, M

    2006-06-01

    Ruptures of the patellar and/or quadriceps tendon are rare injuries that require immediate repair to re-establish knee extensor continuity and to allow early motion. We evaluated 36 consecutive patients with quadriceps or patellar tendon rupture between 1993 and 2000. There were 37 primary ruptures, 3 reruptures, 21 quadriceps and 19 patellar tendon ruptures. Follow up examination (>24 months postoperatively) included the patient's history, assessment of risk factors, clinical examination of both knees, isometric muscle strength measurements and three specific knee scores, Hospital for Special Surgery Score, Knee Society Score and Turba Score, and a short form SF-36. We evaluated 29 patients (26 men) with 33 ruptures (16 patellar tendon, 17 quadriceps tendon). Seven patients were lost to follow up. We found no difference between the range of motion and muscle strength when the injured leg was compared to the non-injured leg. Risk factors did not influence the four scores, patient satisfaction, pain, muscle strength or range of motion. Multiple injured patients had a significant reduction in muscle strength and circumference, however patient satisfaction did not differ to the non-multiple injured patient group.

  7. Outcome of quadriceps tendon repair.

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    Puranik, Gururaj S; Faraj, Adnan

    2006-04-01

    Complete rupture of the quadriceps tendon is a well-described injury. There is a scarcity of literature relating to the outcome of patients with this injury after surgery. We undertook a retrospective analysis of patients who had surgical repair of their quadriceps tendon at our institution over a 13-year period, totalling 21 patients. Males were more commonly affected, with a male/female ratio of 4:1. The peak incidence was in the sixth decade of life. Assessment consisted of the completion of a functional knee questionnaire and a clinical examination. Symptomatic outcome following surgical repair was good with a mean symptom score generated of 19.16 out of a maximum of 25 using the Rougraff et al scoring system. Most of the patients returned to their pre-injury level of activity. Five degrees deficit and extension lag was present in three patients; these patients had the quadriceps repaired using transosseous sutures. Patients who had direct repair of the tendon using the Bunnell technique had lower Rougraff scores than the rest.

  8. Quadriceps tendon rupture - treatment results

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    Popov Iva

    2013-01-01

    Full Text Available Introduction. Quadriceps tendon rupture is a rare but rather serious injury. If this injury is not promptly recognized and early operated, it may lead to disability. This research was aimed at pointing out the results and complications of the quadriceps tendon rupture surgical treatment. Material and Methods. This retrospective multicentric study was conducted in a group of 29 patients (mostly elderly men. Lysholm knee scoring scale was used to evaluate the surgical results. The post-operative results were compared in relation to the type of tendon rupture reconstructions (acute or chronic, various surgical techniques, type of injuries (unilateral or bilateral as well as the presence or absence of comorbid risk factors in the patients. Results. The average value of a Lysholm score was 87.6. Excellent and satisfactory Lysholm score results dominated in our sample of patients. Better post-operative results were recorded in the group of patients without risk factors, in case of a bilateral injury, and in case of an acute injury. The best result was obtained after performing the reconstruction using anchors, and the worst result came after using Codivilla technique. Discussion and Conclusion. Early diagnosis and surgical treatment are an absolute imperative in management of this injury. We have not proven that a certain surgical technique has an advantage over the others. A comorbid risk factor is related to a lower Lysholm score. Despite a few cases of complications, we can conclude that the surgical treatment yields satisfactory results.

  9. Quadriceps and patellar tendon ruptures.

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    Lee, Dennis; Stinner, Daniel; Mir, Hassan

    2013-10-01

    The diagnosis of quadriceps and patellar tendon ruptures requires a high index of suspicion and thorough history-taking to assess for medical comorbidities that may predispose patients to tendon degeneration. Radiographic assessment with plain films supplemented by ultrasound and magnetic resonance imaging when the work-up is equivocal further aids diagnosis; however, advanced imaging is often unnecessary in patients with functional extensor mechanism deficits. Acute repair is preferred, and transpatellar bone tunnels serve as the primary form of fixation when the tendon rupture occurs at the patellar insertion, with or without augmentation depending on surgeon preference. Chronic tears and disruptions following total knee arthroplasty are special cases requiring reconstructions with allograft, synthetic mesh, or autograft. Rehabilitation protocols generally allow immediate weight-bearing with the knee locked in extension and crutch support. Limited arc motion is started early with active flexion and passive extension and then advanced progressively, followed by full active range of motion and strengthening. Complications are few but include quadriceps atrophy, knee stiffness, and rerupture. Outcomes are excellent if repair is done acutely, with poorer outcomes associated with delayed repair.

  10. Histologic analysis of ruptured quadriceps tendons.

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    Trobisch, Per David; Bauman, Matthias; Weise, Kuno; Stuby, Fabian; Hak, David J

    2010-01-01

    Quadriceps tendon ruptures are uncommon injuries. Degenerative changes in the tendon are felt to be an important precondition for rupture. We retrospectively reviewed 45 quadriceps tendon ruptures in 42 patients. Quadriceps tendon ruptures occurred most often in the sixth and seventh decade of life. Men were affected six times as often as women. A tissue sample from the rupture-zone was obtained in 22 cases and histologic analysis was performed. Degenerative changes were present in only 14 (64%) of the 22 samples. We observed an increasing ratio of degenerative to nondegenerative tendons with increasing patient age. Our data suggests that quadriceps tendon rupture, especially in younger patients, can occur in the absence of pathologic tendon degeneration.

  11. Simultaneous and spontaneous bilateral quadriceps tendons rupture.

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    Celik, Evrim Coşkun; Ozbaydar, Mehmet; Ofluoglu, Demet; Demircay, Emre

    2012-07-01

    Simultaneous and spontaneous bilateral quadriceps tendon rupture is an uncommon injury that is usually seen in association with multiple medical conditions and some medications. We report a case of simultaneous and spontaneous bilateral quadriceps tendon rupture that may be related to the long-term use of a statin.

  12. [Simultaneous rupture of a patellar tendon and contralateral quadriceps tendon].

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    Horas, U; Ernst, S; Meyer, C; Halbsguth, A; Herbst, U

    2006-09-01

    The simultaneous bilateral rupture of the quadriceps tendon is a rare injury; only occasional reports exist about the bilateral simultaneous rupture of the patellar tendon. Degenerative changes of the tendon due to drugs or diseases lead to the rupture. We describe two cases of simultaneous rupture of the patellar and contralateral quadriceps tendons; only one patient had special risks. We report the management of therapy and the functional results using the Lysholm score and Knee Rating Scale.

  13. Bilateral synchronous rupture of the quadriceps tendon.

    LENUS (Irish Health Repository)

    Ellanti, P

    2012-09-01

    Bilateral simultaneous rupture of the quadriceps tendon is a rare entity. They are often associated with degenerative changes of the tendons and predisposing conditions such as diabetes or excessive steroid use. They most commonly tend to occur in patients of 40 years of age or older.

  14. Light microscopic histology of quadriceps tendon ruptures.

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    Maffulli, Nicola; Del Buono, Angelo; Spiezia, Filippo; Longo, Umile Giuseppe; Denaro, Vincenzo

    2012-11-01

    To assess histological changes and possible differences in the quadriceps of patients undergoing open repair of the tendon after spontaneous rupture, and subjects with no history of tendon pathology. Biopsies were harvested from the quadriceps tendon of 46 patients (34 men, 12 women) who had reported unilateral atraumatic quadriceps tendon rupture and had undergone surgical repair of the tendon. Samples were also harvested from both the tendons in 11 (N = 11 × 2) patients, nine males and two females, dying from cardiovascular disorders. For each tendon, three slides were randomly selected and examined under light microscopy, and assessed using a semiquantitative grading scale (range 0-21) which considers fibre structure, fibre arrangement, rounding of the nuclei, regional variations in cellularity, increased vascularity, decreased collagen stainability, and hyalinisation. The pathological sum-score averaged 19.2 ± 3.7 in ruptured tendons and 5.6 ± 2.0 in controls, and all variables considered were significantly different between the two groups, showing an association between tendon abnormalities and rupture (0.05 tendons increases the risk of rupture.

  15. Arthroscopic Quadriceps Tendon Repair: Two Case Reports

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    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.

  16. 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.

  17. [Damage to large tendons: Achilles, patellar and quadriceps tendons].

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    Amlang, M H; Zwipp, H

    2006-07-01

    The etiology and mechanisms of Achilles, patellar and quadriceps tendon ruptures are very similar. Age dependent changes in tendon structure and disorders such gout, diabetes, rheumatic diseases and chronic renal failure are associated causes. The main mechanism of rupture is indirect trauma. Although clinical diagnosis is easy, ruptures are still frequently missed. Sonography is the main standard diagnostic tool. MRI is indicated only in special cases. Open operative repair is the most common treatment for quadriceps and patellar tendon ruptures. Treatment of Achilles tendon ruptures is moving towards an individualized choice of therapy. Percutaneous and other "minimally invasive" techniques will play an increasingly important role.

  18. Delayed reconstruction of a quadriceps tendon.

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    Pocock, C A J; Trikha, S P; Bell, J S P

    2008-01-01

    Rupture of the quadriceps tendon is an uncommon injury and rapid diagnosis is important because delay in surgical repair generally is believed to adversely affect outcome. One study of 20 patients suggests repair should be done during the first 48 to 72 hours postinjury to achieve a successful outcome and late repair led to unsatisfactory recovery. Cases of delayed tendon repair have been reported, the longest to our knowledge being 11 months before surgical intervention. We present a case of successful outcome of a quadriceps tendon rupture reconstructed at least 8 years after occurrence and a review of the literature of delayed reconstructions. We show that successful restoration of extensor mechanism function can be achieved several years after tendon rupture.

  19. Quadriceps tendon rupture through a superolateral bipartite patella.

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    Woods, G William; O'Connor, Daniel P; Elkousy, Hussein A

    2007-10-01

    We report a case of a quadriceps tendon rupture through a bipartite patella. Although quadriceps tendon ruptures and patella fractures are common, rupture through a bipartite patella fragment is rare. This case was managed similar to a quadriceps rupture with an excellent result.

  20. Partial tear of the quadriceps tendon in a child

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    Khanna, Geetika; El-Khoury, George [University of Iowa Hospitals and Clinics, Department of Radiology, Iowa City, IA (United States)

    2008-06-15

    We present a case of partial rupture of the quadriceps tendon in an 8-year-old girl. This is one of the youngest patients reported with a quadriceps tendon rupture, an entity seen predominantly in middle-aged people. The strength of the muscle tendon unit in a child makes tendon injuries extremely unusual as compared to apophyseal avulsions. The MR imaging findings of this unusual pediatric injury are illustrated. (orig.)

  1. Partial tear of the quadriceps tendon in a child.

    Science.gov (United States)

    Khanna, Geetika; El-Khoury, George

    2008-06-01

    We present a case of partial rupture of the quadriceps tendon in an 8-year-old girl. This is one of the youngest patients reported with a quadriceps tendon rupture, an entity seen predominantly in middle-aged people. The strength of the muscle tendon unit in a child makes tendon injuries extremely unusual as compared to apophyseal avulsions. The MR imaging findings of this unusual pediatric injury are illustrated.

  2. Reconstruction of neglected patellar tendon ruptures using the quadriceps graft.

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    Gomes, João Luiz Ellera; de Oliveira Alves, Jairo André; Zimmermann, José Mauro

    2014-08-01

    Several techniques using different grafts have been described for reconstruction of the patellar tendon after a neglected rupture. Retraction of the quadriceps tendon may compromise repair integrity due to progressive stretching of the graft. The authors present a surgical technique using the central one-third of the quadriceps tendon. This is supported by the fact that the resistance to traction of this segment of the quadriceps tendon equals that of a double-looped semitendinosus graft and that the harvesting of this specific graft promotes muscle inhibition, thus protecting the reconstruction during the recovery period.

  3. Late quadriceps tendon rupture at the donor site following cruciate ligament reconstruction using central quadriceps tendon graft.

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    Pandey, Vivek; Madi, Sandesh; Joseph, Amy; Acharya, Kiran

    2015-10-16

    Central quadriceps tendon (CQT) graft has been successfully used as a viable autograft option in cruciate ligament reconstruction of the knee. The prime emphasis in the majority of the literature is given to surgical details of quadriceps graft harvesting and outcome of cruciate ligament reconstruction. There is less discussion about donor site morbidity in CQT graft, and it is less frequent as compared to that in bone patellar tendon bone graft. We report an extremely unusual case of late quadriceps tendon rupture at the donor site following anterior cruciate ligament reconstruction using CQT graft.

  4. Complications in Brief: Quadriceps and Patellar Tendon Tears

    National Research Council Canada - National Science Library

    Volk, W Robert; Yagnik, Gautam P; Uribe, John W

    2014-01-01

    .... In particular, inappropriate surgical timing (especially late surgery), misplaced patellar drill holes, and failure to address concomitant injuries can result in complications seen when repairing a patellar or quadriceps tendon tear...

  5. Ultrasound Diagnosis of Bilateral Quadriceps Tendon Rupture After Statin Use

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    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.

  6. Quadriceps tendon allografts as an alternative to Achilles tendon allografts: a biomechanical comparison.

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    Mabe, Isaac; Hunter, Shawn

    2014-12-01

    Quadriceps tendon with a patellar bone block may be a viable alternative to Achilles tendon for anterior cruciate ligament reconstruction (ACL-R) if it is, at a minimum, a biomechanically equivalent graft. The objective of this study was to directly compare the biomechanical properties of quadriceps tendon and Achilles tendon allografts. Quadriceps and Achilles tendon pairs from nine research-consented donors were tested. All specimens were processed to reduce bioburden and terminally sterilized by gamma irradiation. Specimens were subjected to a three phase uniaxial tension test performed in a custom environmental chamber to maintain the specimens at a physiologic temperature (37 ± 2 °C) and misted with a 0.9 % NaCl solution. There were no statistical differences in seven of eight structural and mechanical between the two tendon types. Quadriceps tendons exhibited a significantly higher displacement at maximum load and significantly lower stiffness than Achilles tendons. The results of this study indicated a biomechanical equivalence of aseptically processed, terminally sterilized quadriceps tendon grafts with bone block to Achilles tendon grafts with bone block. The significantly higher displacement at maximum load, and lower stiffness observed for quadriceps tendons may be related to the failure mode. Achilles tendons had a higher bone avulsion rate than quadriceps tendons (86 % compared to 12 %, respectively). This was likely due to observed differences in bone block density between the two tendon types. This research supports the use of quadriceps tendon allografts in lieu of Achilles tendon allografts for ACL-R.

  7. [Neglected ipsilateral simultaneous ruptures of patellar and quadriceps tendon].

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    Karahasanoğlu, İlker; Yoloğlu, Osman; Kerimoğlu, Servet; Turhan, Ahmet Uğur

    2015-01-01

    Neglected patellar and quadriceps tendon rupture is a rare injury, but ipsilateral simultaneous patellar and quadriceps tendon rupture was not described in the literature to our knowledge. In this article, we report a 40-year-old healthy male patient with neglected ipsilateral patellar and quadriceps tendon ruptures treated by peroneus longus tendon autograft. Patient had received some conservative and surgical treatments for patellar fracture before applying to our clinic. After our treatment using peroneus longus autograft and interference nails, patient was immobilized for six weeks in cylindrical cast. Flexion exercises and full weight bearing were started after cast removal. Patient had no complaint at postoperative second year. Patient was a neglected case. Surgical repair and early rehabilitation enabled us to achieve a satisfactory outcome.

  8. Percutaneous quadriceps tendon pie-crusting release of extension contracture of the knee

    National Research Council Canada - National Science Library

    Liu, H X; Wen, H; Hu, Y Z; Yu, H C; Pan, X Y

    2014-01-01

    ...: percutaneous quadriceps tendon pie-crusting release. Percutaneous pie-crusting release was performed using an 18-gauge needle to puncture the stiff fibrous band of the distal and lateral quadriceps tendon under maximum knee flexion...

  9. Chronic quadriceps rupture: treatment with lengthening and early mobilization without cerclage augmentation and a report of three cases.

    Science.gov (United States)

    Rizio, Louis; Jarmon, Nicholas

    2008-01-01

    In this study, 3 patients with chronic quadriceps tears and gaps tendon, repair of the tendon through drill holes in the patella without cerclage augmentation, and early mobilization. The gap was quadriceps tendon. Results of this technique are presented with a minimum of 1-year follow-up.

  10. Quadriceps tendon injuries in national football league players.

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    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

  11. Quadriceps and patellar tendon pie-crusting as a treatment for limited flexion in total knee arthroplasty.

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    Burge, J Ross; Sanchez, Hugo B; Wagner, Russell A

    2014-04-01

    The pie-crusting method of ligament and tendon lengthening has been used successfully in various tissues but is not reported in the literature as an option for patellar or quadriceps tendons to address flexion limitation. Our case report discusses a patient with longstanding flexion limitation who underwent primary total knee arthroplasty. The report reviews the literature on intraoperative treatments, which primarily pertains to the condition of patella baja, and demonstrates that the pie-crusting technique should be included as a treatment option for a tight extensor mechanism while having some advantages over tibial tubercle osteotomy or Z-plasty.

  12. The use of suture anchors to repair the ruptured quadriceps tendon.

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    Bushnell, Brandon D; Whitener, George B; Rubright, James H; Creighton, R Alexander; Logel, Kevin J; Wood, Mark L

    2007-07-01

    Quadriceps tendon rupture is an incapacitating injury that usually requires surgical repair. Traditional repair methods involve transpatellar suture tunnels, but recent reports have introduced the idea of using suture anchors to repair the ruptured tendon. We present 5 cases of our technique of using suture anchors to repair the ruptured quadriceps tendon.

  13. Neglected rupture of the quadriceps tendon in a patient with chronic renal failure (case report and review of the literature).

    Science.gov (United States)

    Hassani, Zouhir Ameziane; Boufettal, Moncef; Mahfoud, Moustapha; Elyaacoubi, Moradh

    2014-01-01

    Spontaneous ruptures of the quadriceps tendon are infrequent injuries, it is seen primarily in patients with predisposing diseases such as gout, rheumatoid arthritis and chronic renal failure. A 32-year-old man had a history of end stage renal disease and received regular hemodialysis treatment for more than 5 years. He was admitted in our service for total functional impotence of the right lower limb with knee pain after a common fall two months ago. The radiogram showed a ''patella baja" with suprapatellar calcifications. The ultrasound and MRI showed an aspect of rupture of the quadriceps tendon in its proximal end with retraction of 3 cm. Quadriceps tendon repair was performed with a lengthening plasty, and the result was satisfactory after a serial rehabilitation program. The diagnosis of quadriceps tendon ruptures needs more attention in patients with predisposing diseases. They should not be unknown because the treatment of neglected lesions is more difficult. We insist on the early surgical repair associated with early rehabilitation that can guarantee recovery of good active extension.

  14. Synthetic Mesh Augmentation of Acute and Subacute Quadriceps Tendon Repair.

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    Morrey, Matthew C; Barlow, Jonathan D; Abdel, Matthew P; Hanssen, Arlen D

    2016-01-01

    Quadriceps tendon rupture is an uncommon injury. To date, surgical results have been less than favorable. A novel repair technique that uses Marlex mesh (C R Bard, Murray Hill, New Jersey) has been developed. Use of this repair may allow earlier range of motion and functional restoration of extension. The authors sought to evaluate the technical feasibility, durability, and postoperative function of this repair. This study retrospectively analyzed 8 knees (7 patients) operated on with this technique from 1990 to 2011. Mean follow-up was 9 years. Average age at the time of injury was 69 years. Mean operative time was 130 minutes. No perioperative complications occurred, no patients had clinical evidence of failure, and no patients required subsequent reoperation. Mean flexion at final follow-up was 100°. Of the 8 knees, 7 knees had no extensor lag at final follow-up. Marlex mesh augmentation for quadriceps tendon ruptures has promising clinical results, despite significant comorbidities. The results showed that the technique was feasible, with low cost and reasonable operative time. The clinical results were durable, with no intraoperative complications, no re-ruptures, rare extension lag, and good range of motion. Therefore, synthetic mesh augmentation is a feasible option in acute quadriceps tendon ruptures.

  15. Novel treatment of a failed quadriceps tendon repair in a diabetic patient using a patella-quadriceps tendon allograft.

    Science.gov (United States)

    Druskin, Sasha C; Rodeo, Scott A

    2013-07-01

    Recurrent quadriceps tendon rupture is a debilitating condition that may be challenging to treat, especially in the presence of systemic disease such as diabetes mellitus (Bedi et al., J Shoulder Elbow Surg 19:978-988, 2010; Chbnou and Frenette, Am J Physiol Regul Integr Comp Physiol 5:R952-R957, 2004; Chen et al., J Shoulder Elbow Surg 5:416-421, 2003). Many surgical treatment protocols have been proposed (Azar, in Canale and Beatty, eds., Campbell's Operative Orthopedics, Mosby/Elsevier, Philadelphia, PA, 2008; Ilan et al., J Am Acad Orthop Surg 3:192-200, 2003; Rodeo and Izawa, in Garrett et al., eds., Principles and Practice of Orthopedic Sports Medicine, Lippincott Williams & Wilkins, Philadelphia, PA, 2000). We report the case of a diabetic male with multiple treatment failures. He ultimately sustained a good outcome following treatment with a novel surgical technique that utilized a patella quadriceps tendon allograft. Tendon allograft-to-native bone healing had previously failed in this patient, so we used a bone-tendon construct allograft to provide an allograft bone-to-native bone healing site. Now, 13 months postoperative, the patient has increased strength, minimal pain, 20 ° of extensor lag and 130 ° of flexion.

  16. Simultaneous bilateral quadriceps tendon rupture in a patient on chronic haemodialysis. (Short-term results of treatment with transpatellar sutures augmented with a quadriceps tendon flap).

    Science.gov (United States)

    Kayali, Cemil; Agus, Haluk; Turgut, Ali; Taskiran, Can

    2008-01-01

    Quadriceps tendon ruptures are rare orthopaedic injuries. Although they are generally seen after the age of 50, they may occur in younger patients with certain underlying conditions, including chronic haemodialysis. Several repair techniques have been proposed but the choice of the best method is still a matter of controversy. This paper presents the case of a renal failure patient with 10 years' history of haemodialysis treatment suffering from bilateral quadriceps tendon rupture. The treatment was with transpatellar sutures augmented with a reverse quadriceps tendon flap. His short-term clinical and radiological results are satisfactory.

  17. Bilateral quadriceps tendon rupture: a rare finding in a healthy man after minimal trauma.

    Science.gov (United States)

    Chiu, Michael; Forman, Edward S

    2010-03-01

    Quadriceps tendon rupture is an uncommon injury; the incidence of simultaneous bilateral quadriceps tendon rupture is extremely rare. Two distinct categories-individuals older than 50 years and between 27 and 54 years-have been described. Bilateral quadriceps tendon rupture is more common in patients older than 50 years and is thought to be the result of tendon weakening due to obesity and arteriosclerosis-induced fibrotic changes, or previous injury.In younger individuals, bilateral simultaneous quadriceps rupture is less frequent and has been associated with anabolic steroid use, but more frequently with underlying comorbid medical conditions such as chronic renal failure, hyperparathyroidism, endocrine disorder, gout, diabetes and obesity, which predispose the patients to tendon rupture. Our case report is unique because we report the simultaneous bilateral quadriceps tendon rupture following minor trauma in an otherwise healthy 43-year-old man with no predisposing comorbidity.

  18. Pain level after ACL reconstruction: A comparative study between free quadriceps tendon and hamstring tendons autografts.

    Science.gov (United States)

    Buescu, Cristian Tudor; Onutu, Adela Hilda; Lucaciu, Dan Osvald; Todor, Adrian

    2017-03-01

    The objective of this study was to compare the pain levels and analgesic consumption after single bundle ACL reconstruction with free quadriceps tendon autograft versus hamstring tendon autograft. A total of 48 patients scheduled for anatomic single-bundle ACL reconstruction were randomized into two groups: the free quadriceps tendon autograft group (24 patients) and the hamstring tendons autograft group (24 patients). A basic multimodal analgesic postoperative program was used for all patients and rescue analgesia was provided with tramadol, at pain scores over 30 on the Visual Analog Scale. The time to the first rescue analgesic, the number of doses of tramadol and pain scores were recorded. The results within the same group were compared with the Wilcoxon signed test. Supplementary analgesic drug administration proved significantly higher in the group of subjects with hamstring grafts, with a median (interquartile range) of 1 (1.3) dose, compared to the group of subjects treated with a quadriceps graft, median = 0.5 (0.1.25) (p = 0.009). A significantly higher number of subjects with a quadriceps graft did not require any supplementary analgesic drug (50%) as compared with subjects with hamstring graft (13%; Z-statistics = 3.01, p = 0.002). The percentage of subjects who required a supplementary analgesic drug was 38% higher in the HT group compared with the FQT group. The use of the free quadriceps tendon autograft for ACL reconstruction leads to less pain and analgesic consumption in the immediate postoperative period compared with the use of hamstrings autograft. Level I Therapeutic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  19. Bilateral simultaneous quadriceps tendon rupture in a patient with secondary hyperparathyroidism: a case report

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    Lee, Yeon Soo; Son, Sang Beom; Han, Chang Whan; Kang, Si Won [Taejon St. Mary' s Hospital, The Catholic Univ. of Korea, Taejon (Korea, Republic of)

    2001-11-01

    Simultaneous bilateral rupture of the quadriceps tendon without a significant history of trauma may occur in association with chronic metabolic disorders such as chronic renal failure and secondary hyperparathyroidism, though has rarely been reported. We describe a case of spontaneous bilateral quadriceps tendon rupture in a 36-year-old female patient with secondary hyperparathyroidism.

  20. Functional results after surgical repair of quadriceps tendon rupture.

    Science.gov (United States)

    De Baere, T; Geulette, B; Manche, E; Barras, L

    2002-04-01

    We present the long-term results of surgical repair of a traumatic rupture of the quadriceps tendon in a group of 24 patients with a mean age of 58 years. There were 21 male and 3 female patients. Fifteen patients were seen for clinical control after a mean follow-up of 75 months and they all presented with some quadriceps muscle atrophy. Twelve patients had normal knee mobility, three had a flexion deformity of 10 degrees and two had less than 120 degrees of knee flexion. Active knee extension was normal in all patients. Three patients experienced some decrease in stability of their knee joint. Subjectively all patients were satisfied with the result. Nine patients underwent a Cybex-test for evaluation of the isokinetic force of knee flexion and extension, with a comparison between the injured and the uninjured side. For concentric force there was a mean deficit at low speed of 36.1% for the quadriceps muscle; at high speed it was 28.2%. For the knee flexors, the deficits were 30.7% and 27.2% respectively. Regarding eccentric force, the mean deficit for knee extensors was 13.8% and 0.25% respectively and for knee flexors 6.5% and 5.5% respectively.

  1. Achilles Tendon Rupture: Avoiding Tendon Lengthening during Surgical Repair and Rehabilitation

    Science.gov (United States)

    Maquirriain, Javier

    2011-01-01

    Achilles tendon rupture is a serious injury for which the best treatment is still controversial. Its primary goal should be to restore normal length and tension, thus obtaining an optimal function. Tendon elongation correlates significantly with clinical outcome; lengthening is an important cause of morbidity and may produce permanent functional impairment. In this article, we review all factors that may influence the repair, including the type of surgical technique, suture material, and rehabilitation program, among many others. PMID:21966048

  2. 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.

  3. Simultaneous reconstruction of quadriceps tendon rupture after TKA and neglected Achilles tendon rupture.

    Science.gov (United States)

    Lee, Yong Seuk; Min, Byoung-Hyun; Han, Kyeong-Jin; Cho, Jae Ho; Han, Seung Hwan; Lee, Doo-Hyung; Oh, Kyung Soo

    2010-05-12

    We report a case of simultaneous reconstruction of a quadriceps tendon rupture after total knee arthroplasty (TKA) and neglected Achilles tendon rupture, which occurred before TKA with an ipsilateral hamstring autograft. A 64-year-old woman presented with persistent right knee pain. She also had right heel pain and had received multiple steroid injections at the knee joint and heel. On examination, she showed osteoarthritis in the medial and lateral compartments of the knee joint and an Achilles tendon rupture in the ipsilateral limb. There was skin dimpling and the proximal portion of tendon was migrated. We performed TKA, and the postoperative course was satisfactory. She returned 3 months postoperatively, however, with skin dimpling around the suprapatellar area and weakness of knee extension. Her ankle symptoms were also aggravated because she could not use the knee joint freely. We performed simultaneous reconstruction of the quadriceps tendon and the Achilles tendon using an ipsilateral hamstring autograft.Hamstring autograft offers a good alternative treatment option for rupture repair, particularly with concommitant ruptures of multiple sites when primary repair is not possible or the viability of repaired tissue is poor.

  4. Surgical management of acute quadriceps tendon rupture (a case report with literature review)

    OpenAIRE

    2015-01-01

    Quadriceps tendon rupture is uncommon and often overlooked in emergency. Tearing affects weakening tendon by systemic diseases or some medications. The mechanism is generally indirect. Inability to actively extend the knee associated to a supra-patellar defect evoke easily the diagnosis without other investigations. Surgical repair is realized in emergency to completely restore the extension. We report a case of a patient who has sustained of complete quadriceps tendon tear after a long perio...

  5. Simultaneous traumatic rupture of the patellar tendon and the contralateral quadriceps tendon in a healthy individual.

    Science.gov (United States)

    Kumar, S; Rachakatla, N; Kerin, C; Kumar, R

    2010-11-05

    A simultaneous traumatic complete rupture of the patellar tendon and the contralateral quadriceps tendon is reported to occur in patients with renal failure and other inflammatory diseases, but is extremely rare in a healthy individual because of the different contributory factors and mechanisms of injury. We present a rare case report of such a combination of injuries in a 48-year-old healthy man. To our knowledge only three such cases have been reported in the English literature. This is an unusual combination and hence there is potential for missed diagnosis leading to suboptimal treatment.

  6. Suture anchor repair of quadriceps tendon rupture after total knee arthroplasty.

    Science.gov (United States)

    Kim, Tae Won B; Kamath, Atul F; Israelite, Craig L

    2011-08-01

    Disruption of the extensor mechanism after total knee arthroplasty (TKA) is a devastating complication, usually requiring surgical repair. Although suture anchor fixation is well described for repair of the ruptured native knee quadriceps tendon, no study has discussed the use of suture anchors in quadriceps repair after TKA. We present an illustrative case of successful suture anchor fixation of the quadriceps mechanism after TKA. The procedure has been performed in a total of 3 patients. A surgical technique and brief review of the literature follows. Suture anchor fixation of the quadriceps tendon is a viable option in the setting of rupture after TKA.

  7. Floating patella: combined quadriceps tendon, retinacula, and patellar tendon ruptures in a high-performance elite athlete.

    Science.gov (United States)

    Langer, Phillip R; Selesnick, F Harlan

    2010-09-01

    Simultaneous quadriceps and patellar tendon rupture is rare. To our knowledge, we present the first known case of simultaneous quadriceps tendon, patella tendon, and retinacula rupture in the ipsilateral knee of a high-performance elite athlete. This disabling injury in the active person results in an inability to actively obtain and maintain full knee extension. When the tendons do not heal properly, at the correct length and tension, knee range of motion and strength can become significantly altered, leading to early fatigue, patellofemoral pain, and possibly instability, preventing return to preinjury status. Immediate surgical repair is recommended for optimal return of knee function and power.

  8. Simultaneous bilateral quadriceps tendon rupture in patient with chronic renal failure.

    Science.gov (United States)

    Lee, Yunseok; Kim, Byounggook; Chung, Ju-Hwan; Dan, Jinmyoung

    2011-12-01

    Simultaneous bilateral spontaneous rupture of the quadriceps tendon is a very rare condition and only a few cases have been reported in the literature. The etiology is not clear yet. But it occurs infrequently in patients with chronic metabolic disorders. A 30-year-old female patient with simultaneous bilateral spontaneous quadriceps tendon rupture visited our hospital. She had chronic renal failure and her parathyroid hormone level was elevated due to parathyroid adenoma. We report a surgical repair of both quadriceps tendons of a patient with chronic renal failure as well as management of hyperparathyroidism.

  9. [Rupture of the quadriceps tendon after lateral retinaculum release by arthroscopy].

    Science.gov (United States)

    Trobisch, P D; Baumann, M; Weise, K; Fischer, R

    2010-06-01

    Complications after arthroscopic surgery of the knee joint are infrequent. Quadriceps tendon ruptures after knee arthroscopy are rarities. Only two cases have been published in the medical literature. This article presents a case of a quadriceps tendon rupture that occurred in a 19-year-old patient 5 weeks after lateral release of the retinaculum by arthroscopy. The late occurrence differentiates this case from the other previously published cases.

  10. 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.

  11. Compensatory muscle activation caused by tendon lengthening post-Achilles tendon rupture.

    Science.gov (United States)

    Suydam, Stephen M; Buchanan, Thomas S; Manal, Kurt; Silbernagel, Karin Gravare

    2015-03-01

    The purpose of this study was to establish a relationship between the lengthening of the Achilles tendon post-rupture and surgical repair to muscle activation patterns during walking in order to serve as a reference for post-surgical assessment. The Achilles tendon lengths were collected from 4 patients with an Achilles tendon rupture 6 and 12 months post-surgery along with 5 healthy controls via ultrasound. EMG was collected from the triceps surae muscles and tibialis anterior during overground walking. Achilles lengths at 6 and 12 months post-surgery were significantly longer (p Achilles tendon rupture; no side-to-side difference was found in the healthy controls. The triceps surae muscles' activations were fair to moderately correlated to the Achilles lengths (0.38 Achilles tendon length and iEMG from the triceps surae muscles indicate that loss of function is primarily caused by anatomical changes in the tendon and the appearance of muscle weakness is due to a lack of force transmission capability. This study indicates that when aiming for full return of function and strength, an important treatment goal appears to be to minimize tendon elongation.

  12. Compensatory muscle activation caused by tendon lengthening post Achilles tendon rupture

    Science.gov (United States)

    Suydam, Stephen M.; Buchanan, Thomas S.; Manal, Kurt; Silbernagel, Karin Gravare

    2013-01-01

    Purpose The purpose of this study was to establish a relationship between the lengthening of the Achilles tendon post rupture and surgical repair to muscle activation patterns during walking in order to serve as a reference for post-surgical assessment. Method The Achilles tendon lengths were collected from 4 patients with an Achilles tendon rupture 6 and 12 month post-surgery along with 5 healthy controls via ultrasound. EMG was collected from the triceps surae muscles and tibialis anterior during over-ground walking. Results Achilles lengths at 6 and 12 months post-surgery were significantly longer (p Achilles tendon rupture; no side to side difference was found in the healthy controls. The triceps surae muscles’ activations were fair to moderately correlated to the Achilles lengths (0.38 Achilles tendon length and iEMG from the triceps surae muscles indicate that loss of function is primarily caused by anatomical changes in the tendon and the appearance of muscle weakness is due to a lack of force transmission capability. This study indicates that when aiming for full return of function and strength an important treatment goal appears to be to minimize tendon elongation. Level of evidence Prognostic prospective case series. Level IV. PMID:23609529

  13. Surgical Treatment of Neglected Traumatic Quadriceps Tendon Rupture with Knee Ankylosis.

    Science.gov (United States)

    Lee, Seung-Hun; Song, Eun-Kyoo; Seon, Jong-Keun; Woo, Seong-Hwan

    2016-06-01

    Quadriceps tendon rupture is an uncommon injury. This disabling condition is the result of direct or indirect trauma. It requires surgical repair to avoid poor outcomes in cases of neglected or chronic rupture. In most acute cases, simple tendon suture or reinsertion is suitable for an extensor mechanism reconstruction of the knee joint. However, chronic lesions often require a tendon graft or flap reconstruction. We report a case of a 15-year-old male who was diagnosed with a chronic quadriceps rupture with a patellar superior pole fracture. We performed quadriceps reconstruction using tibialis anterior allograft tendon and additional screw fixation to reconstruct the extensor mechanism and recover knee joint range of motion to prevent a high-level functional restriction. The treatment was difficult and limited due to neglect for 9-months that led to ankylosis accompanied with nonunion of tibial fracture. Our surgical treatment using allograft tendon resulted in a very good outcome after 30 months of follow-up.

  14. Spontaneous Rupture of the Patellar Tendon and the Contralateral Quadriceps Tendon, Associated with Lupus Erythematosus: Analysis of the Literature

    Directory of Open Access Journals (Sweden)

    Efthimios J. Karadimas

    2011-01-01

    Full Text Available Bilateral rupture of the patellar tendon is a rare injury. A case of a 67-year-old man with systemic lupus erythematosus under corticosteroid treatment for the last 10 years, who sustained spontaneous rupture of the patellar tendon and the contralateral quadriceps tendon, is herein presented. The patient was operated bilaterally, had an optimal outcome considering his age and the comorbidities, and was followed up for 24 months.

  15. Spontaneous and simultaneous bilateral rupture of the quadriceps tendon. A case report.

    Science.gov (United States)

    Alpantaki, Kaliopi; Papadokostakis, George; Katonis, Pavlos; Hadjpavlou, Alexander

    2004-02-01

    Simultaneous bilateral rupture of the quadriceps tendon has rarely been reported; it generally occurs in association with chronic metabolic disorders, such as chronic renal failure, obesity, diabetes mellitus and secondary hyperparathyroidism. The case presented here was in an 85-year-old man with no known risk factors, who sustained simultaneous and spontaneous rupture of both quadriceps tendons. The patient suffered from spinal stenosis and degenerative changes in the knee menisci. These findings suggest that instability of the knee due to meniscal damage, and quadriceps weakness as a result of spinal stenosis, may have played a significant role in the pathogenesis of this injury.

  16. Bilateral quadriceps tendon ruptures in a healthy, active duty soldier: case report and review of the literature.

    Science.gov (United States)

    Johnson, Anthony E; Rose, Stephen D

    2006-12-01

    Unilateral quadriceps tendon ruptures are not uncommon. These injuries have been reported to occur spontaneously and after seemingly trivial trauma in elderly individuals, patients undergoing renal dialysis, and patients with metabolic derangements such as hyperparathyroidism. In young patients, unilateral quadriceps tendon ruptures have been reported as complications of burns, anabolic steroid abuse, and elective orthopedic surgery. Bilateral quadriceps tendon ruptures in young healthy patients are rare injuries. We present the case of a young, healthy, active duty soldier who sustained bilateral quadriceps tendon ruptures after a relatively minor trauma.

  17. Suture anchor versus suture through tunnel fixation for quadriceps tendon rupture: a biomechanical study.

    Science.gov (United States)

    Lighthart, William A; Cohen, David A; Levine, Richard G; Parks, Brent G; Boucher, Henry R

    2008-05-01

    This biomechanical study compared suture anchors versus transosseous sutures for repair of quadriceps tendon ruptures using a force of 150 N at a frequency of 0.5 Hz. No significant difference in displacement was found between the 2 techniques with initial loading or with load or no load after 1000 cycles. Displacement after 1000 cycles for suture anchors and bone tunnels was 4.65 and 4.50 mm, respectively. These findings suggest a possible role for suture anchors in repairing quadriceps tendon ruptures. Suture anchors are relatively expensive but require less dissection over the patella and do not involve suture placement about the patella tendon.

  18. Gender differences in fascicular lengthening during eccentric contractions: the role of the patella tendon stiffness.

    Science.gov (United States)

    Hicks, K M; Onambele-Pearson, G L; Winwood, K; Morse, C I

    2013-11-01

    Elastic tendons have been suggested to attenuate fascicle lengthening during eccentric contractions; however, there is no in vivo evidence to support this hypothesis. Therefore, the aim of this study was to determine whether patella tendon stiffness modulates vastus lateralis (VL) fascicle lengthening during eccentric contractions in males and females. Vastus lateralis and patella tendon properties were measured in males and females owing to previously reported intrinsic gender differences in tendon properties. During maximal voluntary eccentric knee extensions, VL fascicle lengthening and torque were recorded at every 10° (range of motion 20-90°). A significant correlation between maximal patella tendon stiffness and change in fascicle length (r=0.476, P=0.023) was observed. Similarly, there was a significant correlation between maximal Young's modulus and change in fascicle length (r=0.470, P=0.049). As expected, patella tendon stiffness and Young's modulus were significantly higher in males compared with females (Pmuscle-tendon unit elongation was estimated to be significantly greater in males compared with females (5.24 and 4.84 cm respectively). The significant difference in fascicle lengthening during eccentric contractions may be partly explained by the significantly higher patella tendon moment arm, patella tendon stiffness and Young's modulus found in males compared with females. The current study provides in vivo evidence to support the hypothesis that the tendon acts as a 'mechanical buffer' during eccentric contractions. © 2013 Scandinavian Physiological Society. Published by John Wiley & Sons Ltd.

  19. [A simplified technique for repair of quadriceps tendon rupture by transpatellar PDS-cord].

    Science.gov (United States)

    Hosseini, H; Agneskirchner, J D; Lobenhoffer, P

    2005-06-01

    Quadriceps tendon ruptures are relatively unusual injuries caused by direct or more frequently indirect trauma. Since complete ruptures lead to loss of active extension of the knee joint, operative treatment is usually indicated. Several techniques are described in the literature. However, relatively little is known about the functional outcome after operative treatment of acute quadriceps tendon ruptures. We present a new operative technique using a 1.3-mm PDS cord passed through a transverse drill hole in the proximal pole of the patella. We operated ten consecutive cases of complete quadriceps tendon ruptures with the technique described between January 2000 and June 2003. Eight of ten patients were evaluated after a mean follow-up time of 38 months by physical examination, IKDC Subjective score, Lysholm and Tegner score as well as an isokinetic test of the quadriceps strength. No complications were noted in this period. The average postoperative scores were 87 (IKDC), 98 (Lysholm), and 4.5 (Tegner). Isokinetic testing showed an average of 25% quadriceps strength deficit. The operative treatment of complete quadriceps tendon ruptures using a PDS cord through a drill hole in the patella is a safe and effective technique permitting functional postoperative treatment.

  20. Simultaneous rupture of the quadriceps tendon and contralateral patellar tendon in a patient with chronic renal failure.

    Science.gov (United States)

    Muratli, Hasan Hilmi; Celebi, Levent; Hapa, Onur; Biçimoğlu, Ali

    2005-01-01

    Simultaneous quadriceps and patellar tendon rupture is rare. Mechanical factors and coexisting systemic and local factors are taken into consideration in the pathogenesis of these ruptures. In patients with some chronic systemic diseases, simultaneous rupture can occur spontaneously or with minor traumas. We present a case of simultaneous quadriceps and patellar tendon rupture in a 21-year-old man with chronic renal failure in this report. He was treated surgically by osseotendinous repair with suture anchors and supplemental cerclage wire fixation on both sides. He regained his normal knee joint functions 18 months after the operation.

  1. Use of a turndown quadriceps tendon flap for rupture of the patellar tendon after total knee arthroplasty.

    Science.gov (United States)

    Lin, Po-Chun; Wang, Jun-Wen

    2007-09-01

    Patellar tendon rupture is a devastating complication after total knee arthroplasty. The results of surgical treatment of this complication were discouraging in most of the reports. We describe a case of rupture of patellar tendon 7 weeks after total knee arthroplasty treated with a turndown quadriceps flap and circumferential wiring. Two years and 6 months after operation, the patient had no extension lag of the knee and knee flexion to 110 degrees .

  2. Osteotendinous repair of bilateral spontaneous quadriceps tendon ruptures with the Krackow technique in two patients with chronic renal failure.

    Science.gov (United States)

    Kara, Adnan; Sari, Seçkin; Şeker, Ali; Öztürk, Irfan

    2013-01-01

    Although unilateral traumatic quadriceps tendon rupture is a relatively frequent pathology, bilateral non-traumatic spontaneous ruptures are uncommon and are usually associated with chronic renal failure, hyperparathyroidism, gout, and systemic lupus erythematosus. This paper aimed to discuss two patients with chronic renal failure treated with the Krackow suture technique for spontaneous bilateral quadriceps tendon rupture.

  3. Spontaneous and simultaneous bilateral rupture of the quadriceps tendon in a patient with osteogenesis imperfecta: a case report.

    Science.gov (United States)

    Figueroa, David; Calvo, Rafael; Vaisman, Alex

    2006-03-01

    Bilateral rupture of the quadriceps tendon is an uncommon and serious injury that usually occurs in middle aged to elderly patients. It is frequently associated with chronic metabolic disorders like diabetes, hyperparathyroidism, gout, chronic renal failure or the chronic use of steroids. We report a case of spontaneous bilateral rupture of the quadriceps tendon in a patient with osteogenesis imperfecta.

  4. Gastrocnemius myotendinous flap for patellar or quadriceps tendon repair, or both.

    Science.gov (United States)

    Rhomberg, M; Schwabegger, A H; Ninkovic, M; Bauer, T; Ninkovic, M

    2000-08-01

    The authors' experience with simultaneous reconstruction of the quadriceps femoris or patellar tendon or both and soft tissue defect using a musculotendinous unit of the gastrocnemius muscle is presented. Five patients with a partial or complete defect of the quadriceps or patellar tendon or both and additional large soft tissue defects underwent reconstruction applying this technique as a one-stage surgical procedure in different variations. In cases with a partial defect of the tendon or loss of tendon thickness, the thick aponeurosis from the deeper aspect of the gastrocnemius was dissected and transferred as a pedicled tendon flap to reconstruct the tendon defect. In cases with a complete defect of the tendon, the superficial layer of the Achilles tendon together with the deep aponeurotic layer of the gastrocnemius muscle served to reconstruct the tendon. In both procedures the gastrocnemius muscle belly provided soft tissue coverage and was covered with a split thickness skin graft. One patient had a marginal deep necrosis develop that had to be covered with the other gastrocnemius muscle in a second operation. One patient with chronic polyarthritis and infection of his knee prosthesis declined additional reconstruction surgery and had the leg amputated. The average followup was 3.5 years. All patients achieved good results in active extension of the knee with an extension deficit of only 5 degrees to 15 degrees. The range of flexion was at least 90 degrees. The surgical technique described in this report provides functional tendon reconstruction and adequate soft tissue repair simultaneously.

  5. Simultaneous Bilateral Quadriceps Tendon Rupture following Long-Term Low-Dose Nasal Corticosteroid Application

    Directory of Open Access Journals (Sweden)

    Mohamed Omar

    2013-01-01

    Full Text Available Simultaneous bilateral quadriceps tendon rupture is a very rare injury, which was previously only described in slightly more than 100 cases in the English literature. Occurrence after minor trauma is predominantly associated with certain medical conditions including chronic diseases and long-term use of certain drugs. We report the case of a 61-year-old healthy patient who sustained a simultaneous bilateral quadriceps tendon rupture following minor trauma. Medical history was completely clear except of a long-term nasal corticosteroid medication due to allergic rhinitis.

  6. Surgical management of acute quadriceps tendon rupture (a case report with literature review).

    Science.gov (United States)

    Ennaciri, Badr; Montbarbon, Eric; Beaudouin, Emmanuel

    2015-01-01

    Quadriceps tendon rupture is uncommon and often overlooked in emergency. Tearing affects weakening tendon by systemic diseases or some medications. The mechanism is generally indirect. Inability to actively extend the knee associated to a supra-patellar defect evoke easily the diagnosis without other investigations. Surgical repair is realized in emergency to completely restore the extension. We report a case of a patient who has sustained of complete quadriceps tendon tear after a long period of tendon weakening by statin therapy, hypertension and diabetes. The repair has consisted on end-to-end Krackow sutures associated with bone suture to the proximal pole of the patella. Surgeons and emergency physicians must think to this form of extensor apparatus rupture, because early diagnosis leads to early treatment and to best outcomes.

  7. Synchronous quadriceps tendon rupture and unilateral ACL tear in a weightlifter, associated with anabolic steroid use.

    Science.gov (United States)

    Fenelon, Christopher; Dalton, David M; Galbraith, John G; Masterson, Eric L

    2016-05-06

    Synchronous quadriceps tendon rupture is rare. A 29-year-old man, an amateur weight lifter, taking androgenic-anabolic steroids (AAS), developed sudden onset bilateral pain and swelling of his anterior thighs when attempting to squat 280 kg (620 lb). Examination revealed gross swelling superior to the patella and palpable gaps in both quadriceps tendons. He underwent successful operative repair. MRI revealed a partial tear of the anterior cruciate ligament (ACL) of the right knee. This was not reconstructed. Only a few case reports of the association between AAS and quadriceps rupture exist in the literature, with none to the best of our knowledge in the past 10 years. ACL rupture coexisting is very rare, with only two reported cases.

  8. Percutaneous quadriceps tendon pie-crusting release of extension contracture of the knee.

    Science.gov (United States)

    Liu, H X; Wen, H; Hu, Y Z; Yu, H C; Pan, X Y

    2014-05-01

    To release extension contracture of the knee, the authors used a minimally invasive technique: percutaneous quadriceps tendon pie-crusting release. Percutaneous pie-crusting release was performed using an 18-gauge needle to puncture the stiff fibrous band of the distal and lateral quadriceps tendon under maximum knee flexion. Quadriceps contracture was gradually released by multiple needle punctures. A knee brace was prescribed for one week and knee flexion exercises were performed on the first postoperative day. This technique was performed in seven post-traumatic stiff knees and five stiff total knee arthroplasties. Mean maximum flexion increased from 37° preoperatively to 50° after arthrolysis and 107(o) after pie-crusting. At a mean follow-up of eight months, mean maximum flexion was 103°. There were no major complications. The technique of quadriceps tendon pie-crusting release is a simple, minimally invasive and effective treatment for knee extension contracture. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  9. Sequential rupture of triceps and quadriceps tendons in a dialysis patient using hormone supplements.

    Science.gov (United States)

    Soo, I; Christiansen, J; Marion, D; Courtney, M; Luyckx, V A

    2011-02-01

    Spontaneous rupture of tendons is rare, and typically occurs in large weight bearing tendons such as the quadriceps, Achilles and patellar tendon, in the context of various chronic diseases including end-stage renal disease. In general, tendon rupture in dialysis patients is associated with hyperparathyroidism, long duration of dialysis, steroid and quinolone use. We present a case of a young man on chronic dialysis who presented with sequential rupture of triceps and quadriceps tendons requiring surgical repair, several months after initiating use of multiple hormone supplements including human growth hormone and androgens. The supplements were obtained over the internet with the aim of improving his kidney function. Although this patient did have hyperparathyroidism, it is likely his PTH elevation was exacerbated by use of human growth hormone, and tendon rupture risk increased by concurrent use of an androgen supplement. This case highlights the fact that dialysis patients do utilize alternative remedies and that there may be unexpected, dialysis-specific complications associated with their use.

  10. [Bilateral quadriceps tendon rupture and coexistent femoral neck fracture in a patient with chronic renal failure].

    Science.gov (United States)

    Kazimoğlu, Cemal; Yağdi, Serhan; Karapinar, Hasan; Sener, Muhittin

    2007-01-01

    Simultaneous bilateral quadriceps tendon rupture is a very rare injury mostly seen in patients with chronic renal failure or other systemic chronic diseases. Metabolic acidosis in chronic renal failure predisposes these patients to tendon degeneration. A 37-year-old woman who received hemodialysis for chronic renal failure for two years presented with complaints of severe pain in the left hip and inability to walk. She had a history of two consecutive falls in the past two months. On physical examination, there were joint spaces in both suprapatellar areas, active extension of both knees was inhibited, and movements of the left hip were quite painful. Knee ultrasonography and magnetic resonance imaging showed bilateral quadriceps tendon rupture from patellar attachment. At surgery, full-thickness quadriceps tendon tears were repaired with Tycron transpatellar suture anchors. Internal fixation was not considered for hip fracture due to the presence of chronic renal failure, so hemiarthroplasty with bipolar endoprosthesis was performed in the same session for femoral neck fracture. Six months after the operation, the patient was able to walk without support and almost regained her normal knee functions.

  11. Musculo-tendon length and lengthening velocity of rectus femoris in stiff knee gait.

    Science.gov (United States)

    Jonkers, Ilse; Stewart, Caroline; Desloovere, Kaat; Molenaers, Guy; Spaepen, Arthur

    2006-02-01

    Inappropriate activity of M. rectus femoris (RF) during swing is believed to contribute to stiff knee gait in cerebral palsy. This study used musculoskeletal modeling techniques to analyze rectus femoris musculo-tendon (MT) length and lengthening velocity during stiff knee gait in 35 children with diplegic cerebral palsy (CP). Duncan Ely test scores were used to categorize the patients into four groups with increasing levels of rectus femoris spasticity. Knee kinematics confirmed a significant reduction and delay of maximal peak knee flexion during swing in the patient groups compared to reference values. Maximal musculo-tendon length of M. rectus femoris was reduced and occurred prematurely in swing. Musculo-tendon lengthening velocity was significantly reduced and the timing of the maximal lengthening velocity was shifted into stance phase. The present study demonstrates altered dynamic behavior of the M. rectus femoris in stiff knee gait and the results indicate that maximal knee flexion in swing was not a valid reference for the MT length of the M. rectus femoris. Furthermore, in the patient group maximal musculo-tendon lengthening velocity of the muscle related to the stance phase rather than the stance-swing transition.

  12. Rapid recovery from spontaneous and simultaneous bilateral quadriceps tendon rupture in an active, healthy individual.

    Science.gov (United States)

    Gaheer, Rajinder Singh; Hawkins, Amanda

    2010-07-13

    Bilateral spontaneous quadriceps rupture is an uncommon injury that is usually seen in association with multiple medical conditions and is frequently misdiagnosed. It is rarely seen in healthy, active individuals. This article presents a case of bilateral simultaneous and spontaneous rupture of the quadriceps tendon in a healthy, athletic, active and highly motivated patient with rapid recovery from injury and return to full sport activity within a relatively short period of time. A 65-year-old healthy man felt both knees give way while walking down stairs at home and collapsed, unable to bear weight. He was fit and well, not on any medications and basic laboratory screening was within normal limits. He was an active sportsman, horse rider, swimmer, and long-distance cyclist, and had completed a half marathon 1 month before his injury. He was diagnosed with bilateral quadriceps tendon ruptures. An ultrasound of both knees confirmed the diagnosis of full-thickness rupture. Surgical repair of both quadriceps tendons was performed 3 days after the injury. Bilateral locking brace in 10 degrees of flexion was used to immobilize both knees and protect the repair for 6 weeks. The patient remained nonweight bearing for 2 weeks, then gradual weight bearing was commenced, with full weight bearing at 6 weeks. Intensive isometric quadriceps exercises were started on the second postoperative day. Immobilization of both knees was maintained for 6 weeks, after which full active range of motion (ROM) was initiated. At 16 weeks after the injury he had bilateral ROM from 0 degrees to 120 degrees flexion, with no extension lag. He was horse riding, playing golf, swimming, and walking distances up to 2 miles at that time.

  13. Bilateral simultaneous rupture of the quadriceps tendon in a patient with psoriasis: a case report and review of the literature

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    Radha Sarkell

    2011-07-01

    Full Text Available Abstract Introduction Bilateral quadriceps tendon rupture is not common in the absence of systemic disease. Patients with chronic systemic diseases such as uremia and systemic lupus erythematosus and patients who are being treated with systemic steroids or local steroid injections are more prone to tendon rupture. The tendon can rupture spontaneously or as a result of trauma. We report an unusual case of simultaneous bilateral traumatic quadriceps tendon rupture in a patient with psoriasis who was being treated with topical steroid preparations. Case presentation A 57-year-old Caucasian man with a known history of psoriasis, for which he was being treated with topical steroid preparations, presented to our hospital with clinical signs of bilateral quadriceps tendon rupture after he fell while walking down stairs. The diagnosis was confirmed by bilateral ultrasound scans of the thighs. The patient underwent surgery to repair both quadriceps tendons. Post-operatively, the patient was immobilized first in bilateral cylinder casts for six weeks, then in knee braces for the next four weeks. His knees were actively mobilized during physiotherapy. Conclusion Bilateral quadriceps tendon rupture is a rare occurrence in patients with psoriasis who are being treated with topical steroids.

  14. Voluntary activation level and muscle fiber recruitment of human quadriceps during lengthening contractions.

    Science.gov (United States)

    Beltman, J G M; Sargeant, A J; van Mechelen, W; de Haan, A

    2004-08-01

    Voluntary activation levels during lengthening, isometric, and shortening contractions (angular velocity 60 degrees/s) were investigated by using electrical stimulation of the femoral nerve (triplet, 300 Hz) superimposed on maximal efforts. Recruitment of fiber populations was investigated by using the phosphocreatine-to-creatine ratio (PCr/Cr) of single characterized muscle fibers obtained from needle biopsies at rest and immediately after a series of 10 lengthening, isometric, and shortening contractions (1 s on/1 s off). Maximal voluntary torque was significantly higher during lengthening (270 +/- 55 N.m) compared with shortening contractions (199 +/- 47 N.m, P < 0.05) but was not different from isometric contractions (252 +/- 47 N.m). Isometric torque was higher than torque during shortening (P < 0.05). Voluntary activation level during maximal attempted lengthening contractions (79 +/- 8%) was significantly lower compared with isometric (93 +/- 5%) and shortening contractions (92 +/- 3%, P < 0.05). Mean PCr/Cr values of all fibers from all subjects at rest were 2.5 +/- 0.6, 2.0 +/- 0.7, and 2.0 +/- 0.7, respectively, for type I, IIa, and IIax fibers. After 10 contractions, the mean PCr/Cr values for grouped fiber populations (regardless of fiber type) were all significantly different from rest (1.3 +/- 0.2, 0.7 +/- 0.3, and 0.8 +/- 0.6 for lengthening, isometric, and shortening contractions, respectively; P < 0.05). The cumulative distributions of individual fiber populations after either contraction mode were significantly different from rest (P < 0.05). Curves after lengthening contractions were less shifted compared with curves from isometric and shortening contractions (P < 0.05), with a smaller shift for the type IIax compared with type I fibers in the lengthening contractions. The results indicate a reduced voluntary drive during lengthening contractions. PCr/Cr values of single fibers indicated a hierarchical order of recruitment of all fiber

  15. A Study on the Results of Reconstructing Posterior Cruciate Ligament Using Graft from Quadriceps Muscle Tendon

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    K Nazem

    2004-06-01

    Full Text Available Background: Many of the knees affected by rupture of the posterior cruciate ligament (PCL lack their desirable function. Researchers are currently seeking surgical procedures for treating PCL rupture, which can offer a reliable degree of objective and subjective knee stability after surgery. This study assesses the results of anatomical reconstruction of PCL using graft from the tendon of the quadriceps muscle. Methods: This is a descriptive prospective study involving 14 patients with clinical diagnosis of PCL rupture. The patients complained of knee discomfort in spite of conservative treatment and many sessions of physiotherapy. Subjective symptoms of knee instability, i.e. giving way, pain after long walks and pain during climbing, as well as objective knee instability symptoms as assessed by posterior drawer test at 30° and 90° knee flexion, and neutral rotation were recorded and compared prior to and after surgery. The procedure entailed anatomical reconstruction of PCL using grafts taken from the tendon of quadriceps muscle and part of proximal patella. Results: Two patients were excluded from the study due to their failure to refer for follow-up. The patients included 11 men and 1 woman with a mean age of 23 years. The patients displayed statistically significant improvement after surgery as regards subjective symptoms, i.e. giving way, pain after long walks and pain in climbing. Objective knee instability symptoms as evaluated by posterior drawer test at 30° and 90° knee flexion and neutral rotation also showed significant improvement compared to pre-operation findings. Conclusion: Reconstruction of PCL is aimed at achieving normal knee kinematics and stability. The procedure used in this study entailed anatomical reconstruction of PCL. Given the objective and subjective results obtained, the use of this procedure is recommended by authors as the method of choice for reconstructing PCL. Keywords: Posterior Cruciate Ligament, Knee

  16. Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience☆

    Science.gov (United States)

    Hinckel, Betina Bremer; Gobbi, Riccardo Gomes; Bonadio, Marcelo Batista; Demange, Marco Kawamura; Pécora, José Ricardo; Camanho, Gilberto Luis

    2016-01-01

    Objective To describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series. Method The proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo. The following were evaluated before and after the operation: range of motion (ROM), apprehension test, lateral translation test, patellar inclination test, inverted J sign, subluxation upon extension, pain from compression of the patella and pain from contraction of the quadriceps. After the operation, the patients were asked whether any new episode of dislocation had occurred, what their degree of satisfaction with the surgery was (on a scale from 0 to 10) and whether they would be prepared to go through this operation again. Results Seven knees were operated, in seven patients, with a mean follow-up of 5.46 months (±2.07). Four patients who presented apprehension before the operation did not show this after the operation. The lateral translation test became normal for all the patients, while the patellar inclination test remained positive for two patients. The patients with an inverted J sign continued to be positive for this sign. Five patients were positive for subluxation upon extension before the operation, but all patients were negative for this after the operation. None of the patients presented any new episode of dislocation of the patella. All of them stated that they were satisfied: five gave a satisfaction score of 9 and two, a score of 10. All of them said that they would undergo the operation again. Only one patient presented a postoperative complication: dehiscence of the wound. Conclusion Reconstruction of the medial patellofemoral ligament

  17. Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience

    Directory of Open Access Journals (Sweden)

    Betina Bremer Hinckel

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series. METHOD: The proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo. The following were evaluated before and after the operation: range of motion (ROM, apprehension test, lateral translation test, patellar inclination test, inverted J sign, subluxation upon extension, pain from compression of the patella and pain from contraction of the quadriceps. After the operation, the patients were asked whether any new episode of dislocation had occurred, what their degree of satisfaction with the surgery was (on a scale from 0 to 10 and whether they would be prepared to go through this operation again. RESULTS: Seven knees were operated, in seven patients, with a mean follow-up of 5.46 months (±2.07. Four patients who presented apprehension before the operation did not show this after the operation. The lateral translation test became normal for all the patients, while the patellar inclination test remained positive for two patients. The patients with an inverted J sign continued to be positive for this sign. Five patients were positive for subluxation upon extension before the operation, but all patients were negative for this after the operation. None of the patients presented any new episode of dislocation of the patella. All of them stated that they were satisfied: five gave a satisfaction score of 9 and two, a score of 10. All of them said that they would undergo the operation again. Only one patient presented a postoperative complication: dehiscence of the wound. CONCLUSION: Reconstruction of the

  18. [Quadriceps tendon insufficiency and rupture : Treatment options in total knee arthroplasty].

    Science.gov (United States)

    Thiele, K; von Roth, P; Pfitzner, T; Preininger, B; Perka, C

    2016-05-01

    Quadriceps tendon injuries and insufficiencies in total knee arthroplasty are rare, but are followed by a devastating complication that left untreated leads to a complete loss of function of the knee. This review article summarizes the functional anatomy, risk factors, and the prevalence and diagnosis of quadriceps tendon injuries, in addition to the possible management options for partial and complete ruptures. The treatment options are adapted according to the extent of the loss of function (partial, complete) and the duration of the injury (acute vs chronic). Furthermore, the choice of treatment should take into account the quality and availability of primary tissue, the patient's general health, along with their likely functional requirements. Conservative treatment is often justified in partial ruptures with good results. Complete ruptures require surgical intervention and multiple operative techniques are described. Treatment options for acute ruptures include direct primary repair with autogenous or synthetic tissue augmentation. In the case of chronic insufficiency and a lack of soft-tissue surroundings, reconstruction with the aid of a muscle flap or allograft tissue can be considered. All surgical intervention techniques used so far have been fraught with complications and rarely lead to satisfactory results. A new surgical approach to the reconstruction and augmentation of the extensor mechanism consists of the use of a synthetic mesh. The technique is described here in detail.

  19. Clinical outcomes after repair of quadriceps tendon rupture: a systematic review.

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    Ciriello, Vincenzo; Gudipati, Suribabu; Tosounidis, Theodoros; Soucacos, P N; Giannoudis, Peter V

    2012-11-01

    The existing evidence regarding the management of quadriceps tendon rupture remains obscure. The aim of the current review is to investigate the characteristics, the different techniques employed and to analyse the clinical outcomes following surgical repair of quadriceps tendon rupture. An Internet based search of the English literature of the last 25 years was carried out. Case reports and non-clinical studies were excluded. The methodological quality of the included studies was assessed using the Coleman Methodology Score. All data regarding mechanism and site of rupture, type of treatment, time elapsed between diagnosis and repair, patients' satisfaction, clinical outcome, return to pre-injury activities, complications and recurrence rates were extracted and analysed. Out of 474 studies identified, 12 met the inclusion criteria. The average of Coleman Methodology Score was 50.46/100. In total 319 patients were analysed with a mean age of 57 years (16-85). The mean time of follow-up was 47.5 months (3 months to 24 years). The most common mechanism of injury was simple fall (61.5%). Spontaneous ruptures were reported in 3.2% of cases. The most common sites of tear were noted between 1cm and 2 cm of the superior pole of the patella and, in the older people, at the osseotendinous junction. The most frequently used repair technique was patella drill holes (50% of patients). Simple sutures were used in mid-substance ruptures. Several reinforcement techniques were employed in case of poor quality or retraction of the torn ends of tendon. The affected limb was immobilised in a cast for a period of 3-10 weeks. Quadriceps muscular atrophy and muscle strength deficit were present in most of the cases. Worst results were noted in delayed repairs. Reported complications included heterotopic ossifications in 6.9% of patients, deep venous thrombosis or pulmonary embolism in 2.5%, superficial infection in 1.2% and deep infection in 1.1%. It appears that the type of surgical

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

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    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.

  1. Effect of muscle contraction levels on the force-length relationship of the human Achilles tendon during lengthening of the triceps surae muscle-tendon unit.

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    Sugisaki, Norihide; Kawakami, Yasuo; Kanehisa, Hiroaki; Fukunaga, Tetsuo

    2011-07-28

    Findings from animal experiments are sometimes contradictory to the idea that the tendon structure is a simple elastic spring in series with muscle fibers, and suggest influence of muscle contraction on the tendon mechanical properties. The purpose of the present study was to investigate the influence of muscle contraction levels on the force-length relationship of the human Achilles tendon during lengthening of the triceps surae muscle-tendon unit. For seven subjects, ankle dorsiflexion was performed without (passive condition) and with contraction of plantar flexor muscles (eccentric conditions, at 3 contraction levels) on an isokinetic dynamometer. Deformation of the Achilles tendon during each trial was measured using ultrasonography. The Achilles tendon force corresponding to the tendon elongation of 10mm in the passive condition was significantly smaller than those in the eccentric conditions (p<0.05 or p<0.01). Within the eccentric conditions, the Achilles tendon force corresponding to the tendon elongation of 10mm was significantly greater in the maximal contraction level than those in submaximal eccentric conditions (p<0.05 or p<0.01). In addition, the tendon stiffness was greater in higher contraction levels (p<0.05 or p<0.01). Present results suggest that the human tendon structure is not a simple elastic spring in series with muscle fibers.

  2. Quadriceps tendon free graft augmentation for a midsubstance tear of the medial collateral ligament during total knee arthroplasty.

    Science.gov (United States)

    Jung, Kwang Am; Lee, Su Chan; Hwang, Seung Hyun; Jung, Soong Hyun

    2009-12-01

    Primary repair of a disrupted midsubstance MCL during TKA can provide satisfactory stability. However, in cases with poor soft tissue quality or a gap between the ligament ends, primary repair may not be feasible. In these cases, we have used an augmented repair. The purpose of this study is to describe the technique of augmented repair using a quadriceps tendon free graft and present our experience of five patients. A total of five patients underwent augmented repair of a transected MCL substance using a quadriceps tendon free graft. The patients were followed-up for a mean of 16 months. Augmented repair of the transected MCL substance was successful in all five patients, with a mean additional surgery time of 17 min, no coronal instability, a mean Knee Society Score of 87.0+/-2.7 (range, 85 to 90), and a mean function score of 85.0+/-3.5 (range, 80 to 90). There were no complications associated with the extensor mechanism. This data suggests that quadriceps tendon free graft augmentation might be a useful alternative for repairing midsubstance tears of the MCL in special situations, where the quality of the remaining tendon is poor, there is suspicion of stretching, and there is a small gap between both the repaired ligament ends resulting in late laxity.

  3. Simultaneous bilateral quadriceps tendon rupture in a patient with hyperparathyroidism undergoing long-term haemodialysis: a case report and literature review.

    Science.gov (United States)

    Gao, Mao-Feng; Yang, Hui-Lin; Shi, Wei-Dong

    2013-08-01

    Simultaneous bilateral quadriceps tendon rupture is a rare injury that represents quadriceps tendon ruptures. It is generally associated with chronic metabolic disorders and is seen in patients with uraemia undergoing maintenance haemodialysis. The present case was a 46-year-old man who presented with pain and the inability to extend his knees following a minor accident. A physical examination combined with X-radiography and magnetic resonance imaging investigations resulted in a diagnosis of bilateral quadriceps tendon rupture. He had a history of uraemia and had received regular haemodialysis for 7 years. He had high levels of serum parathyroid hormone and he was diagnosed with secondary hyperparathyroidism. Following surgical repair of both quadriceps tendons, in addition to management of the secondary hyperparathyroidism, the patient regained full active mobility of both knee joints and was able to participate in normal activities of daily living.

  4. 'Serious thigh muscle strains': beware the intramuscular tendon which plays an important role in difficult hamstring and quadriceps muscle strains.

    Science.gov (United States)

    Brukner, Peter; Connell, David

    2016-02-01

    Why do some hamstring and quadriceps strains take much longer to repair than others? Which injuries are more prone to recurrence? Intramuscular tendon injuries have received little attention as an element in 'muscle strain'. In thigh muscles, such as rectus femoris and biceps femoris, the attached tendon extends for a significant distance within the muscle belly. While the pathology of most muscle injures occurs at a musculotendinous junction, at first glance the athlete appears to report pain within a muscle belly. In addition to the musculotendinous injury being a site of pathology, the intramuscular tendon itself is occasionally injured. These injuries have a variety of appearances on MRIs. There is some evidence that these injuries require a prolonged rehabilitation time and may have higher recurrence rates. Therefore, it is important to recognise the tendon component of a thigh 'muscle strain'.

  5. Patellar tendon straps decrease pre-landing quadriceps activation in males with patellar tendinopathy.

    Science.gov (United States)

    Rosen, Adam B; Ko, Jupil; Simpson, Kathy J; Brown, Cathleen N

    2017-03-01

    To determine if patellar tendon straps altered quadriceps' muscle activity during a drop-jump landing in males with and without patellar tendinopathy. Case-control. Biomechanics Research Laboratory. Twenty recreationally-active males participated: ten (age = 21.3 ± 2.4 years, height = 182.8 ± 5.3 cm, mass = 81.7 ± 8.6 kg) with patellar tendinopathy; ten (age = 22.0 ± 1.6 years, height = 185.7 ± 4.5 cm, mass = 82.2 ± 9.8 kg) were healthy with no history of tendinopathy. Electromyography (EMG) data for the vastus medialis (VM), rectus femoris (RF), and vastus lateralis (VL) muscles were collected. Five 2-legged 40 cm drop-jumps were performed wearing a patellar tendon strap and 5 with no-strap in a counterbalanced order. Root-mean square EMG (REMG) values of the VM, RF, and VL were averaged for a pre-landing and post-landing interval. Multiple mixed-model two-way ANOVAs were performed to determine the effect of tendinopathy and strapping condition on REMG values for each muscle. For the pre-landing interval, all participants displayed lesser VL EMG activation (0.44 ± 0.19%, 0.53 ± 0.27%, respectively; p = 0.007, d = 0.39) in the no-strap compared with the strap condition. When wearing a strap, all participants demonstrated lower VL activation prior to landing which may be helpful in reducing tensile stress at the tendon. These effects may be clinically important in modulating pain in those with patellar tendinopathy. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Bilateral consecutive rupture of the quadriceps tendon in a man with BstUI polymorphism of the COL5A1 gene.

    Science.gov (United States)

    Longo, Umile Giuseppe; Fazio, Vito; Poeta, Maria Luana; Rabitti, Carla; Franceschi, Francesco; Maffulli, Nicola; Denaro, Vincenzo

    2010-04-01

    A genetic component has been implicated in tendinopathies involving tendon rupture. Type V collagen, a quantitatively minor fibrillar collagen which forms heterotypic fibrils with type I collagen, plays a role in the regulation of the size and configuration of fibrils of the much more abundant component type I collagen. To date, no data on the genetic component of bilateral rupture of the quadriceps tendon have been reported. We describe the presence of BstUI polymorphism of the COL5A1 gene in a man with bilateral rupture of the quadriceps tendon. The COL5A1 (the variant rs12722, BstUI RFLP) can be a candidate gene associated with the development of bilateral quadriceps tendon rupture.

  7. Treatment of knee arthrofibrosis and quadriceps insufficiency after patellar tendon repair: a case report including use of the graston technique.

    Science.gov (United States)

    Black, Douglass W

    2010-06-23

    Arthrofibrosis of the knee is a surgical complication that can limit range of motion, inhibit muscle activity, and decrease patient function. Optimal conservative treatment has not been well established in the literature, leaving a clinician with limited evidence for treatment planning. Described here is part of the rehabilitative course of care for a patient with arthrofibrotic limitations after a mid-substance patellar tendon repair with augmentation. Marked limitations in knee flexion range of motion and quadriceps activity were addressed using the Graston Technique to deal with soft-tissue adhesions; traditional physical therapy care was also provided. Clear improvement in range of motion and quadriceps activity and function was noted over the course of 5 treatments during 1 month. Treatment process and clinical reasoning are offered to promote understanding and to facilitate future inquiry.

  8. [Medial flexor digitorum longus tendon augmentation and lateral foot column lengthening or reorienting triple arthrodesis as surgical therapy of posterior tibial tendon dysfunction].

    Science.gov (United States)

    Speck, M; Klaue, K

    2001-01-01

    The purpose of this study was to evaluate the alignment and functional outcome after surgical augmentation of the tibialis posterior by tendon transfer and lateral column lengthening by osteotomy of the os calcis, calcaneo-cuboidal arthrodesis or reorientating triple arthrodesis. From 1991 to 1999 41 patients with the clinical and radiological diagnosis of dysfunction of the tibialis posterior tendon underwent surgical exploration and repair. These 41 patients (22 women, 19 men) had an average age of 44.3 years (range, 19-69 years) and had been symptomatic for an average of 2.3 years (range, 6 months to 6 years). All patients had the symptoms of a painful flatfoot deformity without dynamic support along the medioplantar aspect. Flexor digitorum longus (FDL) tendon transfer as reconstruction of the tibialis posterior tendon was performed in the cases without major deformity (n = 77). Patients underwent FDL transfer and lengthening osteotomy (n = 15) of the os calcis or calcaneocuboidal (c-c) arthrodesis (n = 12) if passive correction of the foot deformity was still possible and reorientating triple arthrodesis (n = 7) when a fixed flatfoot deformity had developed. AOFAS score and radiological examination were used preoperatively and in the follow-up. The AOFAS score improved for stage 1 patients after a mean follow-up of 43 months with FDL transfer from a preoperative mean of 54 to 84 points, for stage II patients with FDL transfer and lengthening osteotomy (mean follow-up 36 m) from 47 to 92 points, with c-c arthrodesis (follow-up 66 m) from 48 to 86 points, and for stage III patients with triple arthrodesis from 42 to 72 points. In two patients, the deformity failed to improve (stage I) necessitating a revision surgery with a calceneo-cuboidal lengthening arthrodesis for relapsing deformity. In order to correct deformity and provide substantial relief of foot pain and dysfunction, we recommend the transfer of the FDL tendon in flexible flat foot deformity together

  9. Combined Reconstruction of the Medial Collateral Ligament and Anterior Cruciate Ligament Using Ipsilateral Quadriceps Tendon-Bone and Bone-Patellar Tendon-Bone Autografts.

    Science.gov (United States)

    Hetsroni, Iftach; Mann, Gideon

    2016-06-01

    The exclusive autograft choice for medial collateral ligament (MCL) reconstruction that has been described until today is the semitendinosus tendon. However, this has some potential disadvantages in a knee with combined MCL-anterior cruciate ligament (ACL) injury, including weakening of the hamstring's anterior restraining action in an already ACL-injured knee and nonanatomic distal MCL graft insertion when leaving the semitendinosus insertion intact at the pes anserinus during reconstruction. Moreover, because some surgeons prefer to use the hamstring for autologous ACL reconstruction, the contralateral uninjured knee hamstring needs to be harvested as a graft source for the MCL reconstruction if autografts and not allografts are the surgeons' preference. We describe a technique for performing combined reconstruction of the MCL and ACL using ipsilateral quadriceps tendon-bone and bone-patellar tendon-bone autografts. This technique of MCL reconstruction spares the hamstring tendons and benefits from the advantage provided by bone-to-bone healing on the femur with distal and proximal MCL tibial fixation that closely reproduces the native MCL tibia insertion.

  10. Combined Bone Transportation and Lengthening Techniques for the Treatment of Septic Nonunion of the Forearm Followed by Tendon Transfer

    Directory of Open Access Journals (Sweden)

    Konstantinos Ditsios

    2017-01-01

    Full Text Available Infected nonunion of a forearm fracture complicated by a considerable skin-muscle defect poses a great challenge to orthopaedic surgeons. The treatment strategy comprises eradication of the infection, ensuring bony union and soft tissue coverage along with functional restoration. We report a case of a 23-year-old man with an open Gustilo-Anderson IIIb fracture complicated by infected nonunion after internal fixation. After thorough surgical debridement, a considerable soft tissue defect, extensor muscle loss, and posterior interosseous nerve laceration had to be addressed. He was finally treated with bone transportation and bone lengthening followed by tendon transfers.

  11. 微创跟腱延长术联合系统康复治疗跟腱挛缩畸形%Treatment of contracture of achilles tendon with minimally invasive achilles tendon lengthening and system rehabilitation

    Institute of Scientific and Technical Information of China (English)

    彭程; 孙大川; 黄淮; 胡春林

    2012-01-01

    Objective:To investigate the safety and efficacy of minimally invasive achilles tendon lengthening and system rehabilitation for the treatment of contracture of achilles tendon. Methods: From January 2002 to December 2010,27 patients (31 feet) with contracture of achilles tendon were treated with minimally invasive achilles tendon lengthening and system rehabilitation. There were 11 males and 16 females with an average age of 35.5 years (ranged 3 to 65 years). Right foot was in 13 cases, left foot was in 10 cases, both feet were in 4 cases. Course of disease was from 1 to 5 years with an average of 2.3 years. The cause of contracture included postoperative complication of tibia fractures treated with intramedullary nailing in 7 feet, sequelae of lower leg compartment syndrome in 11 feet,congenital talipes equinovarus in 13 feet (both feet in 4). Before operation , all the patients walked with limping, plantar flexion anomaly was from 15° to 50°with an average of 35.5°. The strength of quadriceps muscle of thigh was grade V in 27 feet, grade IV in 4 feet, the strength of musculus triceps surae was grade V in 24 feet,grade Ivin 7 feet. Results:All the patients were followed-up for 6-24 months with an average of 11.3 months. According to standard of Arner-Lindholm to evaluate function of ankle joint, 29 feet obtained excellent results and 2 feet good. No infection, re-rupture or re-contracture was found. Conclusion:Minimally invasive achilles tendon lengthening and system rehabilitation in treating contracture of achilles tendon has advantage such as simple operation,less complication,lower recurrence rate,which is favourable for thoroughly rehabilitation of patients. But,the case in which the strength of quadriceps muscle of thigh or musculus triceps surae still less than grade IE after preoperative rehabilitation care should not choose the method.%目的:分析微创跟腱延长术联合系统康复治疗跟腱挛缩患者的疗效和可行性.方法:2002年1

  12. Isokinetic quadriceps and hamstring muscle strength and knee function 5 years after anterior cruciate ligament reconstruction: comparison between bone-patellar tendon-bone and hamstring tendon autografts.

    Science.gov (United States)

    Lautamies, Riitta; Harilainen, Arsi; Kettunen, Jyrki; Sandelin, Jerker; Kujala, Urho M

    2008-11-01

    Existing clinical studies have not proven which graft is to be preferred in anterior cruciate ligament (ACL) reconstruction. In recent years, bone-patellar tendon-bone and hamstring tendons have been the most frequently used graft types. Muscle strength deficit is one of the consequences after ACL reconstruction. The aim of this study was to evaluate possible differences in hamstring and quadriceps muscle strength and knee function 5 years after ACL reconstruction between the BPTB and the STG groups. The study group consisted of 288 patients (132 women, 156 men) with a unilateral ACL rupture who had received a BPTB (175 patients) or STG (113 patients) ACL reconstruction. Lower extremity concentric isokinetic peak extension and flexion torques were assessed at the angular velocities of 60 degrees /s and 180 degrees /s. The International Knee Documentation Committee (IKDC), the Tegner activity level, the Lysholm knee and the Kujala patellofemoral scores were also collected. Isokinetic quadriceps peak torque (percentage of the contralateral side) was 3.9% higher in the STG group than in the BPTB group at the velocity of 60 degrees /s and 3.2% higher at the velocity of 180 degrees /s and the isokinetic hamstring peak torque 2% higher in the BPTB group than in the STG group at the velocity of 60 degrees /s and 2.5% higher at the velocity of 180 degrees /s. In both groups the subjects had weaker quadriceps and hamstring muscle strength in the injured extremity compared with the uninjured one. In the single-leg hop test (according to the IKDC recommendations) there was a statistically significant difference (P = 0.040) between the groups. In the STG group, 68% of the patients had the single-leg hop ratio (injured vs. uninjured extremity) > or =90%, 31% of the patients 75-89% and 1% of the patients <75%, while in the BPTB group the corresponding percentages were 72, 21 and 7%. However, no statistically significant differences in clinical outcome were found between the

  13. The influence of patellar tendon and muscle-tendon unit stiffness on quadriceps explosive strength in man.

    Science.gov (United States)

    Massey, Garry J; Balshaw, Thomas G; Maden-Wilkinson, Thomas M; Tillin, Neale A; Folland, Jonathan P

    2017-02-15

    The influence of musculotendinous tissue stiffness on contractile rate of torque development (RTD) remains opaque. This study examined the relationships between both patellar tendon (PT) and vastus lateralis (VL) muscle-tendon unit (MTU) stiffness, and voluntary and evoked knee extension RTD. Fifty-two healthy untrained males completed duplicate laboratory sessions. Absolute and relative RTD was measured at 50 Nm/25%MVT increments from onset and sequentially during explosive voluntary and evoked octet (supramaximal stimulation: [8 pulses at 300 Hz]) isometric contractions. Isometric maximum voluntary torque (MVT) was also assessed. PT and MTU stiffness were derived from simultaneous force and ultrasound recordings of the PT and VL aponeurosis during constant RTD ramp contractions. Absolute and relative (to MVT and resting tissue length) stiffness (k) was measured over identical torque increments as RTD. Pearson's correlations tested relationships between stiffness and RTD measurements over matching absolute/relative torque increments. Absolute and relative PT k was unrelated to equivalent voluntary or evoked RTD (r = 0.020.255, P = 0.069-0.891). Absolute MTU k was unrelated to voluntary or evoked RTD (r ≤ 0.191, P ≥ 0.184), however some measures of relative MTU k were related to relative voluntary/evoked RTD (e.g. RTD25-50%MVT r = 0.374/0.353, P = 0.007/0.014). In conclusion, relative MTU k explained a small proportion of the variance in relative voluntary and evoked RTD (both ≤19%), despite no association of absolute MTU k or absolute/relative PT k with equivalent RTD measures. Therefore the muscle-aponeurosis component, but not free tendon was associated with relative RTD, although it seems an overriding influence of MVT negated any relationship of absolute MTU k and absolute RTD. This article is protected by copyright. All rights reserved.

  14. Coordinated collagen and muscle protein synthesis in human patella tendon and quadriceps muscle after exercise

    DEFF Research Database (Denmark)

    Miller, Benjamin F; Olesen, Jens L; Hansen, Mette

    2005-01-01

    We hypothesized that an acute bout of strenuous, non-damaging exercise would increase rates of protein synthesis of collagen in tendon and skeletal muscle but these would be less than those of muscle myofibrillar and sarcoplasmic proteins. Two groups (n = 8 and 6) of healthy young men were studied...... collagen (0.077% h(-1)), muscle collagen (0.054% h(-1)), myofibrillar protein (0.121% h(-1)), and sarcoplasmic protein (0.134% h(-1))). The rates decreased toward basal values by 72 h although rates of tendon collagen and myofibrillar protein synthesis remained elevated. There was no tissue damage...... of muscle visible on histological evaluation. Neither tissue microdialysate nor serum concentrations of IGF-I and IGF binding proteins (IGFBP-3 and IGFBP-4) or procollagen type I N-terminal propeptide changed from resting values. Thus, there is a rapid increase in collagen synthesis after strenuous exercise...

  15. Reconstruction of the medial patellofemoral ligament using autologous graft from quadriceps tendon to treat recurrent patellar dislocation☆

    Science.gov (United States)

    Calapodopulos, Constantino Jorge; Nogueira, Marcelo Corvino; Eustáquio, José Martins Juliano; Calapodopulos Júnior, Constantino Jorge; Rodrigues, Oreston Alves

    2016-01-01

    Objective The objective of this study was to evaluate the efficacy of the surgical technique using the quadriceps tendon as a graft in static reconstruction of the medial patellofemoral ligament. Methods This was a prospective case series study in which the participants were 22 patients with a diagnosis of recurrent patellar dislocation without any other anatomical alterations that required surgical treatment. The functional results from the technique were evaluated using clinical data and the Lysholm questionnaire, one year after the operation. Results It was observed that the patients were predominantly female (86%) and under 21 years of age (73%), just like in the literature. At the first annual return after the surgery, there was no significant pain on medium efforts, no loss of range of motion and a positive apprehension test. According to the questionnaire used, the results were graded as good. The patients who reported having severe pain on greater effort were involved in employment-related legal disputes. Conclusion This technique showed low morbidity and good functional results over the short term. PMID:27069888

  16. Bilateral Simultaneous Quadriceps Tendon Rupture in a 24-Year-Old Obese Patient: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Fahad H. Abduljabbar

    2016-01-01

    Full Text Available Introduction. Simultaneous bilateral quadriceps tendon ruptures (SBQTR are uncommon knee injuries and most frequently occur in male patients, over 50 years of age. It can be associated with one or more predisposing risk factors like obesity, steroids use, and hyperparathyroidism. The main focus of this paper is to review SBQTR in obese patients. Case Report. We are reporting the youngest patient in the literature to date, a 24-year-old obese male patient, who presented to the emergency department complaining of bilateral knee pain and inability to walk after a fall during a basketball game. His clinical examination revealed the presence of a palpable suprapatellar gap and loss of knee extension bilaterally. Magnetic resonance imaging (MRI confirmed that both of his quadriceps tendons were ruptured. A day after his diagnosis, the patient underwent successful operative repair followed by rehabilitation. At the two-year follow-up, the patient had full strength of both quadriceps muscles with no extension lag. Conclusion. The diagnosis of SBQTR can be challenging. Early diagnosis and treatment are associated with better functional outcome compared to delayed treatment. Physicians should have a high index of clinical suspicion in order not to miss such an injury and achieve favourable outcomes.

  17. The effect of an augmentation patella prosthesis versus patelloplasty on revision patellar kinematics and quadriceps tendon force: an ex vivo study.

    Science.gov (United States)

    Mountney, John; Wilson, David R; Paice, Michael; Masri, Bassam A; Greidanus, Nelson V

    2008-12-01

    The purpose of this study was to assess the effect of 2 revision reconstructive interventions on patellofemoral joint mechanics in comparison to control. We flexed 8 cadaver knee specimens from 0 degrees to 60 degrees of flexion in a test rig designed to simulate weight-bearing flexion and extension (Oxford rig). Quadriceps tendon extensor force and patellar kinematics were recorded for control total knee arthroplasty (TKA) (normal primary TKA with patella resurfaced) and then for each of the 2 revision patellar interventions (after patelloplasty of typical revision knee patellar bone defect to leave a simple bony shell, and after TKA with augmentation patella resurfacing). Our results demonstrate that patellar kinematics and quadriceps extensor force are optimized when the patella is reconstructed to normal anteroposterior thickness.

  18. Quantitative analysis of the patella following the harvest of a quadriceps tendon autograft with a bone block.

    Science.gov (United States)

    Ferrer, Gerald A; Miller, R Matthew; Murawski, Christopher D; Tashman, Scott; Irrgang, James J; Musahl, Volker; Fu, Freddie H; Debski, Richard E

    2016-09-01

    The objective of this study was to determine parameters associated with patellar fracture after quadriceps tendon autograft harvest. Thirteen non-fractured and five fractured patella surface models were created based on patient data obtained from a prospective randomized clinical trial in order to assess geometric parameters and bending stress. Measurements that describe the bone block harvest site geometry were used to calculate three normalized parameters. The relative depth parameter describes the thickness of the bone block harvest site with respect to the thickness of the patella at the harvest site. The asymmetry parameter defines the medial-lateral location of the bone bock harvest site. The normalized bending stress parameter assesses the bending stress experienced by the remaining bone beneath the bone block harvest site. The relative depth of the bone block harvest site in the non-fractured patellae was 27 ± 12 % and for the fractured patellae was 42 ± 14 % (p patellae was (1.8 × 10(-3) ± 1.3 × 10(-3)) mm(-3) × M and for the fractured patellae was over three times greater (6.3 × 10(-3) ± 3.7 × 10(-3)) mm(-3) × M (p patella, an emphasis should be made on harvesting a standard percentage of patella thickness rather than a fixed depth. In order to minimize the incidence of a patellar fracture, bone blocks should not be taken laterally and should not exceed 30 % of the total patella thickness at the harvest site.

  19. Lateral column lengthening for acquired adult flatfoot deformity caused by posterior tibial tendon dysfunction stage II: a retrospective comparison of calcaneus osteotomy with calcaneocuboid distraction arthrodesis.

    Science.gov (United States)

    Haeseker, Guus A; Mureau, Marc A; Faber, Frank W M

    2010-01-01

    In this study, clinical and radiological results after lateral column lengthening by calcaneocuboid distraction arthrodesis and calcaneus osteotomy were compared. Thirty-three patients (35 feet) treated with lateral column lengthening by distraction arthrodesis (14 patients, 16 feet; group I) or by calcaneus osteotomy (19 patients, 19 feet; group II) for adult-acquired flatfoot deformity caused by stage II posterior tibial tendon dysfunction were compared retrospectively. Mean follow-up was 42.4 months (range, 6-78 months) for group I and 15.8 months (range, 6-32 months) for group II (P < .001). The American Orthopaedic Foot & Ankle Society ankle-hindfoot score was determined, 4 variables were measured on preoperative and postoperative weight-bearing radiographs, and a number of independent and outcome variables, including patient satisfaction, were recorded. Group 2 had a significantly higher American Orthopaedic Foot & Ankle Society score compared with group I (mean, 85 vs. 72, respectively; P < .02) at time of last follow-up, and there were no dissatisfied patients in group I, whereas 2 patients in group II were dissatisfied with the result of the operation. All radiological results were significantly better at time of follow-up in both groups (except for talocalcaneal angle in group I), although no significant differences were noted in the amount of change in radiographic measurements between the groups. No significant correlation was found between follow-up time and radiographic improvement, indicating stable radiographic measurements over time. In group II, 13 mild calcaneocuboid subluxations were observed. In both groups, 1 nonunion and 1 wound complication occurred. Based on our experience with the patients described in this report, we recommend lateral column lengthening by means of calcaneus osteotomy rather than distraction arthrodesis of the calcaneocuboid joint, for correction of stage II posterior tibial tendon dysfunction.

  20. Quadriceps tendon rupture: a biomechanical comparison of transosseous equivalent double-row suture anchor versus transosseous tunnel repair.

    Science.gov (United States)

    Hart, Nathan D; Wallace, Matthew K; Scovell, J Field; Krupp, Ryan J; Cook, Chad; Wyland, Douglas J

    2012-09-01

    Quadriceps rupture off the patella is traditionally repaired by a transosseous tunnel technique, although a single-row suture anchor repair has recently been described. This study biomechanically tested a new transosseous equivalent (TE) double-row suture anchor technique compared with the transosseous repair for quadriceps repair. After simulated quadriceps-patella avulsion in 10 matched cadaveric knees, repairs were completed by either a three tunnel transosseous (TT = 5) or a TE suture anchor (TE = 5) technique. Double-row repairs were done using two 5.5 Bio-Corkscrew FT (fully threaded) (Arthrex, Inc., Naples, FL, USA) and two 3.5 Bio-PushLock anchors (Arthrex, Inc., Naples, FL, USA) with all 10 repairs done with #2 FiberWire suture (Arthrex, Inc., Naples, FL). Cyclic testing from 50 to 250 N for 250 cycles and pull to failure load (1 mm/s) were undertaken. Gap formation and ultimate tensile load (N) were recorded and stiffness data (N/mm) were calculated. Statistical analysis was performed using a Mann-Whitney U test and survival characteristics examined with Kaplan-Meier test. No significant difference was found between the TE and TT groups in stiffness (TE = 134 +/- 15 N/mm, TT = 132 +/- 26 N/mm, p = 0.28). The TE group had significantly less ultimate tensile load (N) compared with the TT group (TE = 447 +/- 86 N, TT = 591 +/- 84 N, p = 0.04), with all failures occurring at the suture eyelets. Although both quadriceps repairs were sufficiently strong, the transosseous repairs were stronger than the TE suture anchor repairs. The repair stiffness and gap formation were similar between the groups.

  1. Autologous hamstring tendon used for revision of quadiceps tendon tears.

    Science.gov (United States)

    McCormick, Frank; Nwachukwu, Benedict U; Kim, Jaehon; Martin, Scott D

    2013-04-01

    A paucity of literature exists on quadriceps tendon reruptures. Failed quadriceps tendon repair can cause significant morbidity and disability. Surgical management of quadriceps tendon rerupture can be challenging due to tissue degeneration, tendon retraction, muscle atrophy, and poor bone fixation. A lack of guidance in the literature exists on the appropriate surgical techniques for managing quadriceps tendon reruptures.This article describes the case of a male recreational athlete with a failed primary quadriceps tendon repair who presented 10 months after rerupture. Examination was significant for morbid obesity, assisted ambulation, and a significant defect at the superior pole of the patella on the affected side. Intraoperative findings were consistent with a 2.0- to 4.5-cm tendon defect across the extensor mechanism with complete retinaculi tears. The authors performed a novel surgical approach for revision of quadriceps tears using a bilateral hamstring autograft through a quadriceps tendon weave and a transosseous patellar repair. Tendon length was restored, and extensor mechanism tension was reapproximated. Postoperatively, the patient achieved a good outcome and had returned to full, painless, sport participation at 2-year follow-up.This surgical technique is suitable for revision quadriceps tendon repairs of large tendon gap defects, repairs desiring tendon-to-bone in-growth, and repairs requiring large-force transmission across the repair.

  2. Research on low field MRI findings in quadriceps tendon injury%低磁场MRI在股四头肌肌腱损伤的诊断研究

    Institute of Scientific and Technical Information of China (English)

    丁长青; 王文生; 王安震; 许若峰

    2014-01-01

    Objective: To explore the low field MRI application value of quadriceps tendon retrospective analysis of 0.35T MRI data of 26 persons with quadriceps tendon injury confirmed by clinical follow-up. Results:Tendinopathy (quadriceps tendinopathy)in 18 cases, manifesting as the increased signal in the attachment of the patella. Varying degrees of ligament rupture in 8 cases, all were parts of fracture, escort from the retraction in 7 cases. MRI showed better to the concomitant knee injuries or degenerative joint diseases. Conclusion:MRI can accurately evaluate quadriceps tendon injury.%目的:探讨股四头肌肌腱损伤低磁场MRI的应用价值。方法:回顾性分析26例临床随访证实股四头肌肌腱损伤磁场强度为0.35T的MRI影像资料。结果:髌骨附着点肌腱病18例,表现为髌骨附着点附近信号增高;韧带不同程度撕裂8例,均为部分性断裂,伴游离端回缩7例。MRI较好显示了伴发的膝关节其他损伤或退行性骨关节病。结论:MRI易于准确评价股四头肌肌腱损伤。

  3. Quadriceps Contusion

    Science.gov (United States)

    ... are: An intramuscular contusion , which is when a muscle tears within the sheath (lining) that surrounds it. An ... it might be needed if there's a complete muscle tear or if a quadriceps contusion doesn't heal ...

  4. Magnetic resonance imaging in acute tendon ruptures

    Energy Technology Data Exchange (ETDEWEB)

    Daffner, R.H.; Lupetin, A.R.; Dash, N.; Riemer, B.L.

    1986-11-01

    The diagnosis of acute tendon ruptures of the extensor mechanism of the knee or the Achilles tendon of the ankle may usually be made by clinical means. Massive soft tissue swelling accompanying these injuries often obscures the findings, however. Magnetic resonance imaging (MRI) can rapidly demonstrate these tendon ruptures. Examples of the use of MRI for quadriceps tendon, and Achilles tendon rupture are presented.

  5. CROWN LENGTHENING

    OpenAIRE

    2014-01-01

    2014 Latar Belakang: Penampilan jaringan gingiva disekitar gigi memegang peranan penting secara estetis. Abnormalitas dalam simetris dan kontur akan memiliki efek harmonisasi penampilan gigi-geligi. Prosedur yang dapat memberikan solusi untuk masalah estetik, periodontal dan restoratif ini adalah crown lengthening. Crown lengthening adalah prosedur bedah yang bertujuan dalam pengambilan dari jaringan periodontal untuk peningkatan panjang klinis ma...

  6. Muscle strength and knee range of motion after femoral lengthening

    Science.gov (United States)

    Bhave, Anil; Shabtai, Lior; Woelber, Erik; Apelyan, Arman; Paley, Dror; Herzenberg, John E

    2017-01-01

    Background and purpose Femoral lengthening may result in decrease in knee range of motion (ROM) and quadriceps and hamstring muscle weakness. We evaluated preoperative and postoperative knee ROM, hamstring muscle strength, and quadriceps muscle strength in a diverse group of patients undergoing femoral lengthening. We hypothesized that lengthening would not result in a significant change in knee ROM or muscle strength. Patients and methods This prospective study of 48 patients (mean age 27 (9–60) years) compared ROM and muscle strength before and after femoral lengthening. Patient age, amount of lengthening, percent lengthening, level of osteotomy, fixation time, and method of lengthening were also evaluated regarding knee ROM and strength. The average length of follow-up was 2.9 (2.0–4.7) years. Results Mean amount of lengthening was 5.2 (2.4–11.0) cm. The difference between preoperative and final knee flexion ROM was 2° for the overall group. Congenital shortening cases lost an average of 5% or 6° of terminal knee flexion, developmental cases lost an average of 3% or 4°, and posttraumatic cases regained all motion. The difference in quadriceps strength at 45° preoperatively and after lengthening was not statistically or clinically significant (2.7 Nm; p = 0.06). Age, amount of lengthening, percent lengthening, osteotomy level, fixation time, and lengthening method had no statistically significant influence on knee ROM or quadriceps strength at final follow-up. Interpretation Most variables had no effect on ROM or strength, and higher age did not appear to be a limiting factor for femoral lengthening. Patients with congenital causes were most affected in terms of knee flexion. PMID:27892743

  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. Iliopsoas tendon reformation after psoas tendon release.

    Science.gov (United States)

    Garala, K; Power, R A

    2013-01-01

    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.

  9. 缝线锚钉修复肾功能衰竭伴自发性股四头肌腱断裂的临床研究%Clinical Research of Suture Anchor Nail Repair Renal Failure Associated with Spontaneous Femoral Quadriceps Tendon Rupture

    Institute of Scientific and Technical Information of China (English)

    杨瑞; 陈祥云; 颉朝阳; 韩晓军; 刘志鹏; 宋矿朋

    2015-01-01

    目的:评估缝线锚钉修复肾功能衰竭伴自发性股四头肌腱髌骨止点断裂的临床疗效。方法:2007年1月-2012年1月,对本院收治的21例肾功能衰竭伴自发性股四头肌腱断裂患者采用缝线锚钉行股四头肌腱髌骨止点修补缝合。术前常规实验室检查,拍摄患侧膝关节X线片及MRI;术后6周内支具保护,6周后行屈膝练习,术后2年测量患者屈膝角度。结果:21例患者均获得随访。随访结束,均未发生锚钉松动及脱出。术前术后均采用Lysholm和Kujala膝关节评分标准,评分差异有统计学意义(P<0.05)。结论:选择适当的病例,应用缝线锚钉是修复肾功能衰竭伴自发性股四头肌腱髌骨止点断裂的有效方法。%Objective: To assess the clinical efficacy of suture anchor nail repair renal failure associated with spontaneous femoral quadriceps tendon patellar check point of fracture.Method: From January 2007 to January 2012, 21 renal failure patients with spontaneous femoral quadriceps tendon rupture were given the nail line of patella femoral quadriceps tendon suture anchor check point repair suture. Preoperative routine laboratory examination was taken by lateral knee X-ray films and MRI. With a protection within 6 weeks, after 6 weeks bend knees practice was taken, and knees angle was measured 2 years later.Result: 21 patients were all followed up and in the end they were not loose bolts and emergence. The effect was evaluated by Kujala and Lysholm knee scoring standards and showed significant difference before and after operation (P<0.05).Conclusion: Selecting appropriate cases and using suture anchors is renal failure associated with spontaneous femoral quadriceps tendon patellar fracture effective method of check point.

  10. Repair of ruptured quadriceps tendon after total knee arthroplasty:a preliminary report of 12 cases%全关节置换后股四头肌肌腱完全性断裂的修复--12例初步报告

    Institute of Scientific and Technical Information of China (English)

    史少敏; James T. Ninomiya; 史光禹

    2013-01-01

      目的观察改良V-Y翻转肌腱瓣修复膝关节置换术后股四头肌肌腱断裂的临床疗效.方法2005年至2010年,应用改良V-Y翻转肌腱瓣方法修复全膝关节置换术后股四头肌肌腱完全性断裂共12例患者,男4例,女8例;年龄45~77岁,平均62岁.术中通过切取全层肌腱瓣,松解股内、外侧肌远侧1/3,并将两侧肌肉缝合在一起,恢复股四头肌的完整性.术后采用膝关节评分标准评估患者功能恢复情况.结果所有患者均获得随访,随访时间12-54个月,平均24个月.术前所有患者行走需要助行器或轮椅帮助,术后则均可行走,无需协助.10例为优秀,2例良好.末次随访时,美国特种外科医院(The Hospital for Special Surgery,HSS)膝关节评分为75~100分,平均为90分.股四头肌肌力平均为4/5级(3~5/5级),关节活动度为0°~120°.术后无患者发生肌腱二次断裂和感染.结论全膝关节置换后股四头肌肌腱断裂的治疗具有挑战性,改良V-Y翻转肌腱瓣是一种有效、可靠的手术修复方法.%Objective To evaluate the clinical results of a modified V-Y turndown flap reconstruction technique for the treatment of ruptured quadriceps tendon after total knee arthroplasty. Methods From 2005 to 2010, 12 patients who had a quadriceps tendon rupture after total knee arthroplasty were treated with a modified V-Y turndown flap reconstruction at our institution. Among them, there were 4 males and 8 females, whose average age was 62 years old (range; 45-77 years). The modification involved harvesting the quadriceps tendon as a full thickness flap. The vastus medialis and lateralis muscles were released 1/3 distally and then sutured together to reinforce the repair without wires during the surgery. Postoperatively patients were evaluated with the knee joint surgery standard. Results All patients were followed up for a mean period of 24 months (range;12-54 months). Preoperatively all patients needed to use walking aid

  11. Psoas over the brim lengthenings. Anatomic investigation and surgical technique.

    Science.gov (United States)

    Skaggs, D L; Kaminsky, C K; Eskander-Rickards, E; Reynolds, R A; Tolo, V T; Bassett, G S

    1997-06-01

    Lengthening of the psoas tendon commonly is performed for various conditions of the hip including developmental dysplasia and neuromuscular contractures and instability. Anecdotal reports of injury to surrounding neurovascular structures suggest an investigation of the local anatomy is warranted. Using magnetic resonance images from 54 children younger than 10 years, the authors examined the anatomic relationship between major neurovascular structures (femoral artery and vein, external iliac artery and vein, femoral nerve) and the psoas tendon. The mean distance between the neurovascular structures and the psoas tendon in the over the brim position is 1 cm, although it may be as close as 4 mm in a child. The mean distance is 3.1 cm at the tendon's insertion at the lesser trochanter. Surgeons performing psoas over the brim lengthenings should be aware that major neurovascular structures may be only 4 mm from the psoas tendon. The recommended surgical technique is presented.

  12. Traumatic quadriceps rupture in a patient with patellectomy: a case report

    Directory of Open Access Journals (Sweden)

    Shanmugam Chezhiyan

    2007-11-01

    Full Text Available Abstract Introduction Acute traumatic, unilateral, quadriceps rupture after patellectomy is rare. Case presentation We present a 42-year old male who experienced a unilateral left quadriceps tendon rupture following assault by four people. Twenty-seven years before this injury, the patient had suffered ipsilateral femur and comminuted patellar fractures, which were managed by intramedullary nailing and patellectomy respectively. We performed primary end to end repair of the torn tendon. Postoperatively, histology revealed findings consistent with pre-existent degenerative changes. The patient made good recovery, and returned to his former occupation which was reliant on his ability to drive. Conclusion Degenerative changes of the tendon of the extensor mechanism of knee following patellectomy may predispose the quadriceps tendon to traumatic rupture. Early operative intervention and protracted rehabilitation are required to obtain the best functional results.

  13. Crown lengthening revisited.

    Science.gov (United States)

    Rosenberg, E S; Cho, S C; Garber, D A

    1999-06-01

    Over the last 37 years, crown-lengthening procedures have been used predictably to restore teeth broken down from caries, trauma, and extensive wear. With crown lengthening, the dentogingival junction is "re-created" at a more apical level on the root to accommodate the junctional epithelium and the connective tissue attachment. Forced eruption can be used in addition, or as an alternative, to tooth lengthening. The authors discuss the indications for tooth lengthening, forced eruption, and orthodontic extrusion, as well as the treatment planning for these procedures.

  14. Limb lengthening in achondroplasia

    Directory of Open Access Journals (Sweden)

    Sanjay K Chilbule

    2016-01-01

    Full Text Available Background: Stature lengthening in skeletal dysplasia is a contentious issue. Specific guidelines regarding the age and sequence of surgery, methods and extent of lengthening at each stage are not uniform around the world. Despite the need for multiple surgeries, with their attendant complications, parents demanding stature lengthening are not rare, due to the social bias and psychological effects experienced by these patients. This study describes the outcome and complications of extensive stature lengthening performed at our center. Materials and Methods: Eight achondroplasic and one hypochondroplasic patient underwent bilateral transverse lengthening for tibiae, humeri and femora. Tibia lengthening was carried out using a ring fixator and bifocal corticotomy, while a monolateral pediatric limb reconstruction system with unifocal corticotomy was used for the femur and humerus. Lengthening of each bone segment, height gain, healing index and complications were assessed. Subgroup analysis was carried out to assess the effect of age and bone segment on the healing index. Results: Nine patients aged five to 25 years (mean age 10.2 years underwent limb lengthening procedures for 18 tibiae, 10 femora and 8 humeri. Four patients underwent bilateral lengthening of all three segments. The mean length gain for the tibia, femur and humerus was 15.4 cm (100.7%, 9.9 cm (52.8% and 9.6 cm (77.9%, respectively. Healing index was 25.7, 25.6 and 20.6 days/cm, respectively, for the tibia, femur and humerus. An average of 33.3% height gain was attained. Lengthening of both tibia and femur added to projected height achieved as the 3 rd percentile of standard height in three out of four patients. In all, 33 complications were encountered (0.9 complications per segment. Healing index was not affected by age or bone segment. Conclusion: Extensive limb lengthening (more than 50% over initial length carries significant risk and should be undertaken only after due

  15. Orthodontic crown lengthening.

    Science.gov (United States)

    Hohlt, W F

    1992-01-01

    As comprehensive dentistry becomes more complex, procedures must be developed to save teeth once considered unsuitable for crown restoration due to inaccessible finishing lines. Orthodontic crown lengthening is less invasive than a flap procedure and does not result in crestal bone reduction. The crown lengthening procedure is a simple and time-saving remedy for a difficult restorative problem.

  16. Quadriceps muscle contraction protects the anterior cruciate ligament during anterior tibial translation.

    Science.gov (United States)

    Aune, A K; Cawley, P W; Ekeland, A

    1997-01-01

    The proposed skiing injury mechanism that suggests a quadriceps muscle contraction can contribute to anterior cruciate ligament rupture was biomechanically investigated. The effect of quadriceps muscle force on a knee specimen loaded to anterior cruciate ligament failure during anterior tibial translation was studied in a human cadaveric model. In both knees from six donors, average age 41 years (range, 31 to 65), the joint capsule and ligaments, except the anterior cruciate ligament, were cut. The quadriceps tendon, patella, patellar tendon, and menisci were left intact. One knee from each pair was randomly selected to undergo destructive testing of the anterior cruciate ligament by anterior tibial translation at a displacement rate of 30 mm/sec with a simultaneously applied 889 N quadriceps muscle force. The knee flexion during testing was 30 degrees. As a control, the contralateral knee was loaded correspondingly, but only 5 N of quadriceps muscle force was applied. The ultimate load for the knee to anterior cruciate ligament failure when tested with 889 N quadriceps muscle force was 22% +/- 18% higher than that of knees tested with 5 N of force. The linear stiffness increased by 43% +/- 30%. These results did not support the speculation that a quadriceps muscle contraction contributes to anterior cruciate ligament failure. In this model, the quadriceps muscle force protected the anterior cruciate ligament from injury during anterior tibial translation.

  17. Tendon neuroplastic training reduces tendon pain and muscle inhibition in-season: Changing the way we think about exercise

    NARCIS (Netherlands)

    Rio, E.; Kidgell, D.; Van Ark, M.; Zwerver, J; Sheek, I.; Moseley, G.L.; Gaida, J.; Docking, S.; Cook, J.

    2015-01-01

    Introduction: Patellar tendon pain is at its highest in-season but there are no published data of successful management when athletes are playing and training. Furthermore, there are changes to the cortical control of the quadriceps in patellar tendinopathy (including excess quadriceps inhibition) t

  18. Tendon neuroplastic training reduces tendon pain and muscle inhibition in-season: Changing the way we think about exercise

    NARCIS (Netherlands)

    Rio, E.; Kidgell, D.; Van Ark, M.; Zwerver, J; Sheek, I.; Moseley, G.L.; Gaida, J.; Docking, S.; Cook, J.

    2015-01-01

    Introduction: Patellar tendon pain is at its highest in-season but there are no published data of successful management when athletes are playing and training. Furthermore, there are changes to the cortical control of the quadriceps in patellar tendinopathy (including excess quadriceps inhibition)

  19. Tendonitis (image)

    Science.gov (United States)

    Tendonitis is the inflammation, irritation, and swelling of a tendon. It can occur as a result of ... repetitive strain on the forearm muscles can cause tendonitis. The most common symptom of tendonitis is pain, ...

  20. Tendon repair

    Science.gov (United States)

    Repair of tendon ... Tendon repair can be performed using: Local anesthesia (the immediate area of the surgery is pain-free) ... a cut on the skin over the injured tendon. The damaged or torn ends of the tendon ...

  1. Influence of autograft removal on rabbit patellar tendon length.

    Science.gov (United States)

    Monllau, J C; Hinarejos, P; Alvarez, P; Alameda, F; Ballester, J

    2004-02-01

    Twelve adult New Zealand white rabbits were randomly divided into two groups. In group 1, 30% of the central mass of the right patellar tendon was removed. In group 2, 60% was removed. The left knees served as controls. The animals were killed 1 year later. The patella-patellar tendon-tibial tuberosity units of all knees were studied using histological and morphometric analysis. In both groups, the tendons had lengthened. Lengthening average was 2.50 mm in group 1 and 8.17 mm in group 2. In both groups, histology revealed poor alignment of the collagen fibres and high cellularity, although the findings in group 1 were nearer the normal histological pattern. The results suggest that removal of significant portions of the patellar tendon leads to lengthening of the resulting tendon. In clinical practice, it seems prudent to pay attention to the dimensions of the patellar tendon when harvesting a graft.

  2. Brachymetatarsia of the fourth metatarsal, lengthening scarf osteotomy with bone graft

    Directory of Open Access Journals (Sweden)

    Ankit Desai

    2013-09-01

    Full Text Available A 16-year-old girl presented with left fourth metatarsal shortening causing significant psychological distress. She underwent lengthening scarf osteotomy held with an Omnitech® screw (Biotech International, France with the addition of two 1 cm cancellous cubes (RTI Biologics, United States. A lengthening z-plasty of the extensor tendons and skin were also performed. At 6 weeks the patient was fully weight bearing and at one-year follow up, the patient was satisfied and discharged. A modified technique of lengthening scarf osteotomy is described for congenital brachymatatarsia. This technique allows one stage lengthening through a single incision with graft incorporation by 6 weeks.

  3. Curative Effect of Lengthening and Forward of Achilles Tendon on Treating Spastic Equinus of Children with Cerebral Palsy%跟腱延长前移术治疗脑性瘫痪痉挛型马蹄足的疗效

    Institute of Scientific and Technical Information of China (English)

    张天久; 俞松; 杨小红; 胡月光

    2012-01-01

    目的 评价跟腱延长前移术治疗儿童脑性瘫痪痉挛型马蹄足的疗效.方法 收集1998年5月- 2011年6月应用跟腱延长前移术治疗脑性瘫痪痉挛型马蹄足儿童53例85足.男28例45足,女25例40足;年龄2.5 ~14.0岁,平均6.8岁.痉挛程度按Ashworth 5级法评定:3级12足,4级38足,5级35足.患儿均能行走,智力发育及下肢肌力基本正常,伴不同程度肌张力增高,腱反射亢进,踝阵挛和Babinski征阳性,无明显内翻、外翻及平足畸形,X线片未提示明显骨性畸形.合并双髋内收畸形5例,双膝屈曲畸形2例,均在术前或同期行手术矫正.结果 患儿均获随访,随访时间0.5~11.2a,平均2.3a.1例于术后2周出现切口裂开、跟腱断裂,再次行跟腱吻合术,术后恢复良好;患儿术后均未发现小腿三头肌肌力较术前下降.53例85足均获满意疗效,优55足,良30足,优良率达100%.结论 跟腱延长前移术利用生物力学原理,在跟腱延长的基础上将跟腱止点前移至跟距关节后缘,缩短了跟腱至踝关节的力臂,平衡了踝关节背伸与跖屈肌肌力,远期效果良好,是儿童脑性瘫痪痉挛型马蹄足较好的治疗方法.%Objective To evaluate curative effect of lengthening and forward of achilles tendon on treating spastic equinus of children with cerebral palsy. Methods Fifty -three patients (85 feet) with spastic equinus caused by cerebral palsy in children, including 28 male (45 feet)and 25 female (40 feet) .were treated with lengthening and forward of achilles tendon from May 1998 to Jun. 2011. The ages of the patients ranged from 2.5 to 14.0 years. According to the Ashworth method for the evaluation of spastieity:12 feet belonged to level 3,38 feet level 4,and 35 feet level 5. All patients were able to walk,had normal intelligence and muscle strength of lower limbs,varying degrees of muscle tension,tendon reflexes hyperfunction, ankle clonus and Babinski sign positive,had not significant bone

  4. Stretching skeletal muscle: chronic muscle lengthening through sarcomerogenesis.

    Directory of Open Access Journals (Sweden)

    Alexander M Zöllner

    Full Text Available Skeletal muscle responds to passive overstretch through sarcomerogenesis, the creation and serial deposition of new sarcomere units. Sarcomerogenesis is critical to muscle function: It gradually re-positions the muscle back into its optimal operating regime. Animal models of immobilization, limb lengthening, and tendon transfer have provided significant insight into muscle adaptation in vivo. Yet, to date, there is no mathematical model that allows us to predict how skeletal muscle adapts to mechanical stretch in silico. Here we propose a novel mechanistic model for chronic longitudinal muscle growth in response to passive mechanical stretch. We characterize growth through a single scalar-valued internal variable, the serial sarcomere number. Sarcomerogenesis, the evolution of this variable, is driven by the elastic mechanical stretch. To analyze realistic three-dimensional muscle geometries, we embed our model into a nonlinear finite element framework. In a chronic limb lengthening study with a muscle stretch of 1.14, the model predicts an acute sarcomere lengthening from 3.09[Formula: see text]m to 3.51[Formula: see text]m, and a chronic gradual return to the initial sarcomere length within two weeks. Compared to the experiment, the acute model error was 0.00% by design of the model; the chronic model error was 2.13%, which lies within the rage of the experimental standard deviation. Our model explains, from a mechanistic point of view, why gradual multi-step muscle lengthening is less invasive than single-step lengthening. It also explains regional variations in sarcomere length, shorter close to and longer away from the muscle-tendon interface. Once calibrated with a richer data set, our model may help surgeons to prevent muscle overstretch and make informed decisions about optimal stretch increments, stretch timing, and stretch amplitudes. We anticipate our study to open new avenues in orthopedic and reconstructive surgery and enhance

  5. Complete Achilles tendon ruptures.

    Science.gov (United States)

    Landvater, S J; Renström, P A

    1992-10-01

    Achilles tendon ruptures can be treated nonsurgically in the nonathletic or low-end recreational athletic patient, particularly those more than 50 years of age, provided the treating physician does not delay in the diagnosis and treatment (preferably less than 48 hrs and possibly less than 1 week). The patient should be advised of the higher incidence of re-rupture of the tendon when treated nonsurgically. Surgical treatment is recommended for patients who are young and athletic. This is particularly true because the major criticism of surgical treatment has been the complication rate, which has decreased to a low level and to a mild degree, usually not significantly affecting the repair over time. Surgical treatment in these individuals seems to be superior not only in regard to re-rupture but also in assuring the correct apposition of the tendon ends and in placing the necessary tension on the tendon to secure appropriate orientation of the collagen fibers. This in turn allows them to regain full strength, power, endurance, and an early return to sports. Surgery is also recommended for late diagnosed ruptures where there is significant lengthening of the tendon. Surgical technique should involve a medial incision to avoid the sural nerve, absorbable suture, and augmentation with fascia or tendon where there is a gap or late rupture. Postoperatively, the immobilization should be 7 to 10 days in a splint. A walking boot with early motion in plantar flexion or a short leg cast with the tendon under slight tension should thereafter be used for 4 to 5 weeks. An early and well-supervised rehabilitation program should be initiated to restore the patient to the preinjury activity level.

  6. Incidence of Major Tendon Ruptures and Anterior Cruciate Ligament Tears in US Army Soldiers

    Science.gov (United States)

    2007-08-01

    patients who rupture their AT and patients who rupture other ten- dons ( proximal biceps , extensor pollicis longus, quadriceps, and others) was 35.2 and...Interview Survey, 1999. Vital Health Stat 10. 2003;212:1-137. 25. Puranik GS, Faraj A. Outcome of quadriceps tendon repair . Acta Orthop Belg. 2006;72:176

  7. Neural control of lengthening contractions.

    Science.gov (United States)

    Duchateau, Jacques; Enoka, Roger M

    2016-01-01

    A number of studies over the last few decades have established that the control strategy employed by the nervous system during lengthening (eccentric) differs from those used during shortening (concentric) and isometric contractions. The purpose of this review is to summarize current knowledge on the neural control of lengthening contractions. After a brief discussion of methodological issues that can confound the comparison between lengthening and shortening actions, the review provides evidence that untrained individuals are usually unable to fully activate their muscles during a maximal lengthening contraction and that motor unit activity during submaximal lengthening actions differs from that during shortening actions. Contrary to common knowledge, however, more recent studies have found that the recruitment order of motor units is similar during submaximal shortening and lengthening contractions, but that discharge rate is systematically lower during lengthening actions. Subsequently, the review examines the mechanisms responsible for the specific control of maximal and submaximal lengthening contractions as reported by recent studies on the modulation of cortical and spinal excitability. As similar modulation has been observed regardless of contraction intensity, it appears that spinal and corticospinal excitability are reduced during lengthening compared with shortening and isometric contractions. Nonetheless, the modulation observed during lengthening contractions is mainly attributable to inhibition at the spinal level.

  8. The patellar tendon: thickening, internal signal buckling, and other MR variants

    Energy Technology Data Exchange (ETDEWEB)

    Schweitzer, M.E. (Dept. of Radiology, Thomas Jefferson Univ. Hospital, Philadelphia, PA (United States)); Mitchell, D.G. (Dept. of Radiology, Thomas Jefferson Univ. Hospital, Philadelphia, PA (United States)); Ehrlich, S.M. (Dept. of Radiology, Thomas Jefferson Univ. Hospital, Philadelphia, PA (United States))

    1993-08-01

    We studied the range of appearance of asymptomatic patellar tendons and evaluated the effect of age, weight, joint effusions, and anterior cruciate ligament (ACL) tears on this tendon. One hundred and seventythree patellar tendons in asymptomatic patients were studied at 1.5 tesla. Sagittal short and long TE images were evaluated in regard to tendon thickness, ratio of thickness of patellar to quadriceps tendons, frequency, location, and severity of intratendon signal, and frequency and severity of tendon buckling. Results were correlated with patient age, sex, weight, the presence of ACL tears, and relative volumes of joint fluid. The mean thickness of the patellar tendon was 0.52 cm. The patellar to quadriceps tendon ratio was 0.72. The patellar tendon frequently (74%) had focal areas of signal apparently within it. This signal was usually subtle, V-shaped (95%), and seen posteriorly in the proximal end of the tendon (82%). Intratendon signal was also seen commonly in the inferior aspect of the tendon (32%). This signal intensity did not increase with greater T2-weighting (99%). Buckling of the patellar tendon was a frequent asymptomatic variant (71%) but was also associated with joint effusions (p < 0.01) and ACL tears (p = 0.01). Buckling, intratendon signal, and tendon thickness increased with weight and age. Variation of the magnetic resonance appearance of the patellar tendon is frequent. Many of these changes appear to represent subclinical degeneration. Buckling of this tendon also may occur secondary to joint effusions or ACL tears. (orig.)

  9. 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

  10. Humeral lengthening: Case report

    Directory of Open Access Journals (Sweden)

    Gajdobranski Đorđe

    2013-01-01

    Full Text Available Introduction. Difference in length of upper extremities has mainly esthetic significance and is therefore not so often a subject of operative treatment, compared to lower extremities. Case Outline. We are presenting a case of a 16­year­old patient in whom a shortening of 9 cm of the right humerus was determined at the end of growth. This shortening was the result of surgical treatment of solitary bone cyst at the proximal end of the humerus done at the age of 10 years. In order to correct the length of the humerus we applied distraction osteogenesis with a compressive­distracting device according to Mitkovic (Traffix, and we achieved the lengthening of 7.5 cm. During the period of distraction we encountered the following complications: minimal suppuration at the site of the wedges that was successfully resolved with intensive local treatment, while pain and paresthesias along the N. radialis were resolved with a temporarily slowing of the distraction process. Fixation with a plate, i.e. bone grafting was not necessary, and final functional and esthetic result was excellent. Conclusion. Successful lengthening of the shortened humerus can be achieved with a unilateral compressive­distracting device according to Mitkovic as its application up to a complete bone reconstruction does not require additional plate fixation or bone grafting. The patient was capable of performing usual daily activities during application of the device.

  11. In vivo passive mechanical behaviour of muscle fascicles and tendons in human gastrocnemius muscle-tendon units.

    Science.gov (United States)

    Herbert, Robert D; Clarke, Jillian; Kwah, Li Khim; Diong, Joanna; Martin, Josh; Clarke, Elizabeth C; Bilston, Lynne E; Gandevia, Simon C

    2011-11-01

    Ultrasound imaging was used to measure the length of muscle fascicles in human gastrocnemius muscles while the muscle was passively lengthened and shortened by moving the ankle. In some subjects the muscle belly 'buckled' at short lengths. When the gastrocnemius muscle-tendon unit was passively lengthened from its shortest in vivo length by dorsiflexing the ankle, increases in muscle-tendon length were not initially accompanied by increases in muscle fascicle lengths (fascicle length remained constant), indicating muscle fascicles were slack at short muscle-tendon lengths. The muscle-tendon length at which slack is taken up differs among fascicles: some fascicles begin to lengthen at very short muscle-tendon lengths whereas other fascicles remain slack over a large range of muscle-tendon lengths. This suggests muscle fascicles are progressively 'recruited' and contribute sequentially to muscle-tendon stiffness during passive lengthening of the muscle-tendon unit. Even above their slack lengths muscle fascicles contribute only a small part (tendon length. The contribution of muscle fascicles to muscle-tendon length increases with muscle length. The novelty of this work is that it reveals a previously unrecognised phenomenon (buckling at short lengths), posits a new mechanism of passive mechanical properties of muscle (recruitment of muscle fascicles), and confirms with high-resolution measurements that the passive compliance of human gastrocnemius muscle-tendon units is due largely to the tendon. It would be interesting to investigate if adaptations of passive properties of muscles are associated with changes in the distribution of muscle lengths at which fascicles fall slack.

  12. Crown lengthening procedures

    Directory of Open Access Journals (Sweden)

    AA. Khoshkhonejad

    1994-06-01

    Full Text Available Nowadays, due to recent developments and researches in dental science, it is possible to preserve and restore previously extracted cases such as teeth with extensive caries, fractured or less appropriate cases for crown coverage as well as teeth with external perforation caused by restorative pins. In order to restore the teeth with preservation of periodontium, we should know thoroughly physiological aspects of periodontium and protection of Biologic Width which is formed by epithelial and supracrestal connective tissue connections. Considering biologic width is one of the principal rules of teeth restoration, otherwise we may destruct periodontal tissues. Several factors are involved in placing a restoration and one of the most important ones is where the restoration margin is terminated. Many studies have been conducted on the possible effects of restoration margin on the gingiva and due to the results of these studies it was concluded that restoration margin should be finished supragingivally. However, when we have to end the restoration under Gingival Crest, First a healthy gingival sulcus is required. Also, we should not invade the biological width. Since a normal biologic with is reported 2 mm and sound tooth tissue should be placed at least 2 mm coronal to the epithelial tissue, the distance between sound tooth tissue and crown margin should be at least 4mm. Thus, performing crown lengthening is essential to increase the clinical crown length. Basically, two objectives are considered: 1 restorative 2 esthetic (gummy smile Surgical procedure includes gingivectomy and flap procedure. Orthodontic procedure involves orthodontic extrusion or force eruption technique which is controlled vertical movements of teeth into occlusion. Besides, this procedure can also used to extrude teeth defects from the gingival tissue. By crown lengthening, tooth extraction is not required and furthermore, adjacent teeth preparation for placing a fixed

  13. ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: CLINICAL OUTCOMES OF PATELLA TENDON AND HAMSTRING TENDON GRAFTS

    Directory of Open Access Journals (Sweden)

    Dawn T. Gulick

    2002-09-01

    Full Text Available An injury to the ACL can result in significant functional impairment. It has been estimated that more than 100,000 new ACL injuries occur each year. Surgeons employ numerous techniques for reconstruction of the ACL. Of critical importance is the source of the graft to replace the damaged ACL. The graft choices include autografts (the patient's own tissue, allografts (donor tendon, and synthetic/prosthetic ligaments. Tissue harvest sites for autografting include the middle third of the patella tendon, the quadriceps tendon, semitendinosus tendon, gracilis tendon, iliotibial band, tensor fascia lata, and the Achilles tendon. Selection of the type of graft material is predicated upon the tissue's ability to tolerate high levels of stress. Likewise, the clinical presentation and functional outcome is related to the graft material selected. This manuscript specifically examined the patella tendon and hamstring tendon grafts. Numerous manuscripts that studied the outcomes of these graft materials were compiled to help the clinician appreciate the advantages and disadvantages of each of the graft materials. Outcome measures such as thigh circumference, knee range of motion, isokinetic strength, knee stability, pain, and vertical jump/1-leg hop were incorporated. The purpose of this manuscript was to compare and contrast the clinical presentation of patients who underwent an ACL reconstruction using the patella tendon versus the hamstring tendons. This information can be valuable to the clinician when considering the rehabilitation protocol after ACL reconstruction

  14. Bilateral simultaneous complete quadriceps rupture following chronic symptomatic tendinopathy: a case report

    Directory of Open Access Journals (Sweden)

    Arumilli Buchi

    2009-09-01

    Full Text Available Abstract Introduction Quadriceps rupture is a disabling injury mostly seen in men over 40 years of age. Bilateral quadriceps rupture is a rare injury that is often secondary to predisposing medical conditions. Ultrasound is a cheap and reliable tool for diagnosis but is operator dependent. Thus, magnetic resonance imaging is the preferred method of investigation despite its cost and availability. Prompt diagnosis and early surgical repair are needed for an optimal end result. Case presentation We report the case of a healthy 54-year-old Caucasian male farmer who presented with bilateral simultaneous complete quadriceps rupture, which was managed surgically and he was followed up for three years. He was previously under our care for enthesopathy of the quadriceps on both sides. We believe that chronic enthesopathy of the superior pole of patella made his quadriceps susceptible to complete rupture on eccentric loading. Conclusion Only a few cases of bilateral simultaneous complete quadriceps rupture in patients with symptomatic enthesopathy have been previously reported. We stress the importance of warning patients of the risk of developing complete tendon rupture when they present with an enthesopathy around the knee.

  15. Aesthetic Surgical Crown Lengthening Procedure.

    Science.gov (United States)

    de Oliveira, Pablo Santos; Chiarelli, Fabio; Rodrigues, José A; Shibli, Jamil A; Zizzari, Vincenzo Luca; Piattelli, Adriano; Iezzi, Giovanna; Perrotti, Vittoria

    2015-01-01

    The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey), crown lengthening is the most habitual surgical periodontal treatment.

  16. Aesthetic Surgical Crown Lengthening Procedure

    OpenAIRE

    2015-01-01

    The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey), crown lengthening is the most h...

  17. Aesthetic Surgical Crown Lengthening Procedure

    Science.gov (United States)

    de Oliveira, Pablo Santos; Chiarelli, Fabio; Rodrigues, José A.; Shibli, Jamil A.; Zizzari, Vincenzo Luca; Piattelli, Adriano; Iezzi, Giovanna; Perrotti, Vittoria

    2015-01-01

    The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey), crown lengthening is the most habitual surgical periodontal treatment. PMID:26609452

  18. Aesthetic Surgical Crown Lengthening Procedure

    Directory of Open Access Journals (Sweden)

    Pablo Santos de Oliveira

    2015-01-01

    Full Text Available The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey, crown lengthening is the most habitual surgical periodontal treatment.

  19. Recurrent patellar tendon rupture in a patient after intramedullary nailing of the tibia: reconstruction using an Achilles tendon allograft.

    Science.gov (United States)

    Jagow, Devin M; Garcia, Branden J; Yacoubian, Stephan V; Yacoubian, Shahan V

    2015-05-01

    Various complications after intramedullary (IM) nailing of the tibia have been reported, the most common of which are anterior knee pain and symptoms similar to patella tendonitis. Complete rupture of the patellar tendon after IM nailing of the tibia has been reported on 2 occasions, in conjunction with predisposing patient factors, such as systemic disease or a proud tibial nail. Patellar tendon ruptures are disabling injuries that can be technically difficult to repair because of the poor quality of remaining tendon tissue, quadriceps muscle atrophy and/or contracture, and scar-tissue formation. Many methods have described the surgical reconstruction of the knee extensor mechanism, which is most commonly performed after total knee arthroplasty. We report the successful surgical and clinical outcome of patellar tendon reconstruction using an Achilles tendon allograft in a patient subject to late and recurrent ruptures after IM nailing of the tibia through a mid-patellar tendon-splitting approach. Seven months after tendon reconstruction, the patient exhibited full knee flexion, an extension lag of 10º, 4/5 quadriceps strength, and return to her baseline ambulatory status.

  20. Recurrence of Diabetic Pedal Ulcerations Following Tendo-Achilles Lengthening

    Directory of Open Access Journals (Sweden)

    Richard D. Weiner

    2011-05-01

    Full Text Available Foot and ankle surgeons are frequently challenged by the devastating systemic consequences of diabetes mellitus manifested through neuropathy, integumentary and joint breakdown, delayed healing, decreased ability to fight infection, and fragile tendon/ligaments. Diabetic neuropathic pedal ulcerations lead to amputations at an alarming rate and also carry a high mortality rate. This article will discuss causes of diabetic pedal ulcerations that persist or recur after tendo-Achilles lengthening and will highlight areas that need to be addressed by the practitioner such as infection, vascular and nutritional status, glucose control, off-loading, biomechanics, and patient compliance.

  1. Complications in Brief: Quadriceps and Patellar Tendon Tears

    OpenAIRE

    2013-01-01

    Effective treatment of knee extensor mechanism disruptions requires prompt diagnosis and thoughtful decision-making with surgical and nonsurgical approaches. When surgery is chosen, excellent surgical technique can result in excellent outcomes. Complications and failures arise from missed or delayed diagnoses and from technical problems in the operating room. In particular, inappropriate surgical timing (especially late surgery), misplaced patellar drill holes, and failure to address concomit...

  2. Tendon's ultrastructure.

    Science.gov (United States)

    Tresoldi, Ilaria; Oliva, Francesco; Benvenuto, Monica; Fantini, Massimo; Masuelli, Laura; Bei, Roberto; Modesti, Andrea

    2013-01-01

    The structure of a tendon is an important example of complexity of ECM three-dimensional organization. The extracellular matrix (ECM) is a macromolecular network with both structural and regulatory functions. ECM components belong to four major types of macromolecules: the collagens, elastin, proteoglycans, and noncollagenous glycoproteins. Tendons are made by a fibrous, compact connective tissue that connect muscle to bone designed to transmit forces and withstand tension during muscle contraction. Here we show the ultrastructural features of tendon's components.

  3. Peroneal Tendon Injuries

    Science.gov (United States)

    ... page. Please enable Javascript in your browser. Peroneal Tendon Injuries What Are the Peroneal Tendons? A tendon is a band of tissue that ... protect them from sprains. Causes & Symptoms of Peroneal Tendon Injuries Peroneal tendon injuries may be acute (occurring ...

  4. The wrinkled patellar tendon: An indication of abnormality in the extensor mechanism of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Berlin, R.C.; Levinsohn, E.M. (State Univ. of New York, Syracuse, NY (USA). Dept. of Radiology); Chrisman, H. (State Univ. of New York, Syracuse, NY (USA). Coll. of Medicine)

    1991-04-01

    Rupture of the quadriceps tendon is an uncommon condition which requires early diagnosis and treatment to avert prolonged disability. In four patients who had surgically confirmed quadriceps tendon rupture, lateral radiographs of the knee and/or sagittal magnetic resonance (MR) images demonstrated a corrugated appearance to the patellar tendon. Sagittal MR images of the knee following patellectomy in one patient and radiographs of a transverse fracture of the patella in another also demonstrated this appearance. MRI has superb contrast resolution which provides optimal visualization of the contour of the patellar tendon on sagittal images. A retrospective review of 50 consecutive knee MRI examinations was carried out to evaluate the appearance of the normal patellar tendon. In 49 of 50 patients, the sagittal images demonstrated a straight or nearly straight patellar tendon. A corrugated appearance of the patellar tendon on sagittal images indicates a reduction in the normal tensile force applied to it and indicates the need for careful evaluation of the patella and quadriceps tendon mechanism. (orig.).

  5. Clinical outcomes after arthroscopic psoas lengthening: the effect of femoral version.

    Science.gov (United States)

    Fabricant, Peter D; Bedi, Asheesh; De La Torre, Katrina; Kelly, Bryan T

    2012-07-01

    The purpose of this study was to examine the association between femoral anteversion and clinical outcomes after arthroscopic lengthening of a symptomatic, snapping psoas tendon in young patients. Sixty-seven consecutive patients with symptomatic coxa saltans underwent arthroscopic psoas tendon lengthening through a transcapsular approach during a 3-year period by a single arthroscopic hip surgeon. Demographic and clinical variables were collected. Patients were divided into low/normal femoral version and high femoral version groups and analyzed for association of femoral version with clinical outcomes as measured by the modified Harris Hip Score (mHHS) and Hip Outcome Score (HOS) preoperatively and postoperatively with a minimum of 6 months' follow-up (range, 6 to 24 months). Two-sample t tests were used for data analysis, with P 25°) associated with worse HOS sports subscale scores (26.6 v 50.0 for excessive v low/normal anteversion, P = .013) and no difference in mHHS and HOS activities-of-daily living subscale scores. Postoperative mHHS scores were significantly different (76.9 v 86.1 for excessive v low/normal anteversion, P = .031). No association was noted between clinical outcome measures and any other clinical or demographic variable (P > .05). Patients with increased femoral anteversion may be at greater risk for inferior clinical outcomes after arthroscopic lengthening of a symptomatic, snapping psoas tendon. The psoas tendon may be an important passive and dynamic stabilizer of the hip in these patients, and release may result in a greater alteration of kinematics with high-demand activities, particularly terminal extension and external rotation when the tendon is typically at its highest tension. These results may help surgeons identify which patients may be at risk for inferior clinical outcome after psoas lengthening. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  6. Muscle - tendon unit mechanical and morphological properties and sprint performance.

    Science.gov (United States)

    Stafilidis, Savvas; Arampatzis, Adamantios

    2007-07-01

    The objective of this study was to determine whether sprint performance is related to the mechanical (elongation - force relationship of the tendon and aponeurosis, muscle strength) and morphological (fascicle length, pennation angle, muscle thickness) properties of the quadriceps femoris and triceps surae muscle - tendon units. Two groups of sprinters (slow, n = 11; fast, n = 17) performed maximal isometric knee extension and plantar flexion contractions on a dynamometer at 11 different muscle - tendon unit lengths. Elongation of the tendon and aponeurosis of the gastrocnemius medialis and the vastus lateralis was measured using ultrasonography. We observed no significant differences in maximal joint moments at the ankle and knee joints or morphological properties of the gastrocnemius medialis and vastus lateralis between groups (P > 0.05). The fast group exhibited greater elongation of the vastus lateralis tendon and aponeurosis at a given tendon force, and greater maximal elongation of the vastus lateralis tendon and aponeurosis during maximum voluntary contraction (P aponeurosis showed a significant correlation with 100-m sprint times (r = -0.567, P = 0.003). For the elongation - force relationship at the gastrocnemius medialis tendon and aponeurosis, the two groups recorded similar values. It is suggested that the greater elongation of the vastus lateralis tendon and aponeurosis of the fast group benefits energy storage and return as well as the shortening velocity of the muscle - tendon unit.

  7. [Reconstruction of quadriceps femoris muscle function with muscle transfer].

    Science.gov (United States)

    Fansa, H; Meric, C

    2010-08-01

    Femoral nerve palsy, mostly of iatrogen cause, leads to paresis of quadriceps muscle with complete loss of knee extension. Therapeutical options include neurolysis, nerve reconstruction or functional muscle transplantations. Another concept is the transfer of hamstring muscles as described in post polio surgery. We describe our experience of biceps femoris and semitendinosus muscle transfer for reconstruction of knee extension. From 2003 to 2007 seven patients (mean age 43) with complete loss of knee extension after femoral nerve lesion were treated. Nerve palsy was caused by direct lesion, traction, hematoma after collapse, lesion of lumbosacral plexus and an unclear muscle dystrophy. Indication for muscle transfer was due to long standing muscle paresis. All patients received a transfer of biceps femoris and semitendinosus muscle/tendon into the quadriceps tendon. Patients were immobilised in a cast for 6 weeks in extended knee position. Weight bearing started after 8 weeks. Operations went uneventfully. All patients were able to extend the knee postoperatively against gravity and were able to climb stairs without help. 4 Patients had complete knee extension, 2 had a lack of 20 degrees , one of 30 degrees. Daily routine was possible in all cases. No instability of knee joints occurred postoperatively. In a nerve lesion close to the muscle a nerve reconstruction should be aimed. If not performed or with unsuccessful outcome, muscle transfer is a good option to restore function. All recent studies describe good to excellent results with stable knees, allowing the patient to manage daily routine without assistance and to climb stairs up and down. Long term complications such as dislocation of patella or genu recurvatum were not observed in our patients. The latter results as typical complication in polio from weakening knee flexion through biceps femoris transfer, if the gastrocnemius muscle is not forceful enough. However in an isolated femoral nerve lesion this

  8. The evaluation of muscle recovery after anatomical single-bundle ACL reconstruction using a quadriceps autograft.

    Science.gov (United States)

    Iriuchishima, Takanori; Ryu, Keinosuke; Okano, Tatsumasa; Suruga, Makoto; Aizawa, Shin; Fu, Freddie H

    2017-05-01

    The purpose of this study was to reveal the degree of muscle recovery and report the clinical results of anatomical single-bundle ACL reconstruction using a quadriceps autograft. Twenty subjects undergoing anatomical single-bundle ACL reconstruction using a quadriceps autograft were included in this study. A 5-mm-wide, 8-cm-long graft, involving the entire layer of the quadriceps tendon, was harvested without bone block. The average graft diameter was 8.1 ± 1.4 mm. An initial tension of 30 N was applied. The femoral tunnel was created from the far-medial portal. Each femoral and tibial tunnel was created close to the antero-medial bundle insertion site. For the evaluation of muscle recovery (quadriceps and hamstring), a handheld dynamometer was used. The evaluation of muscle recovery was performed pre-operatively, and at 3, 6, 9, and 12 months after surgery. Muscle recovery data were calculated as a percentage of leg strength in the non-operated leg. Anterior tibial translation (ATT), pivot shift test, and IKDC score were evaluated. The average quadriceps strength pre-operatively, and at 3, 6, 9, and 12 months after ACL reconstruction was 90.5 ± 19, 67.8 ± 21.4, 84 ± 17.5, and 85.1 ± 12.6 %, respectively. The average hamstring strength pre-operatively, and at 3, 6, 9, and 12 months after ACL reconstruction was 99.5 ± 13.7, 78.7 ± 11.4, 90.5 ± 19, and 96.7 ± 13.8 %, respectively. ATT pre-operatively and at 12 months after surgery was 5.4 ± 1.3 and 1.0 ± 0.8 mm, respectively. No subjects exhibited positive pivot shift after surgery. Within 6 months following surgery, quadriceps hypotrophy was observed in all subjects. However, the hypotrophy had recovered at 12 months following surgery. No subjects complained of donor site pain after surgery. Anatomical single-bundle ACL reconstruction using a quadriceps autograft resulted in equivalent level of muscle recovery and knee stability when compared with previously reported ACL

  9. Crown lengthening: a clinical review.

    Science.gov (United States)

    Talbot, T R; Briggs, P F; Gibson, M T

    1993-09-01

    The use of crown lengthening surgery as an adjunct to restorative therapy was first suggested by Rosen and Gitnick. This technique is designed to increase the clinical crown heights of teeth requiring restoration following extensive wear through attrition, abrasion and erosion. This loss of tooth tissue and resulting clinical crown height may be localized to a few teeth or affect the entire dentition. This clinical problem is reflected by the increasing number of reports of treatment of the worn dentition.

  10. Sagittal patellar tilt and concomitant quadriceps hypotrophy after tibial nailing.

    Science.gov (United States)

    Aksahin, Ertugrul; Yilmaz, Serdar; Karasoy, Ismail; Duran, Semra; Yuksel, H Yalcin; Dogan, Ozgur; Yildirim, A Ozgur; Bicimoglu, Ali

    2016-09-01

    The aim of the study was to analyse the patellofemoral alignment in the sagittal plane following tibial fracture surgery with intramedullary nailing and its relationship to parapatellar muscle status. The patellofemoral MRI results of 27 patients (15 males and 12 females) treated with locked intramedullary nailing following tibia shaft fracture were reviewed. The mean age of the patients was 41.8 (±15) years. The patella-patellar tendon angle (P-PT) and the distance between the inferior patellar pole and the tibial tubercle (DP-TT) were evaluated for both the operated extremity and the contralateral normal side. MRI assessment of the infrapatellar fat pad, quadriceps, sartorius, gracilis, semi-membranosus muscles and biceps muscles was also carried out. The correlation between the changes in skeletal muscle mass, the volume of the infrapatellar fat pad and the alterations in the DP-TT distances and P-PT angles were analysed. The quadriceps muscle cross-sectional diameter had a mean of 157.2 mm(2) (115.6/319.5) in the operated extremity, and it was 193 mm(2) (77.6/282.2) in the non-operated normal side (p = 0.001). For the Gracilis muscle, the mean was 84.4 mm(2) (19.7/171) at the operated extremity and 75.7 mm(2) (26.9/238.2) on the normal side (p = 0.05). The cross-sectional areas of the semi-membranosus, sartorius and biceps muscles in the operated and non-operated extremity were not noticeably different (n.s). The P-PT angle was 153° (129.7/156.4) in the operated extremity and 145.7° (137.6/163.4) in the non-operated normal extremity (p hypotrophy negatively correlated (r = -0.4, p = 0.02) with the P-PT angle but positively correlated with the increase in gracilis muscle volume (r = 0.4, p = 0.03). This study revealed that patellofemoral joint kinematics in the operated extremity was diminished in the sagittal plane correlating with the quadriceps muscle volume loss and gracilis muscle hypertrophy. The modalities focused on both preventing

  11. Reconstrução do ligamento cruzado anterior com o terço central do tendão do músculo quadríceps: análise de resultados após 10 anos Reconstruction of the anterior cruciate ligament with the central third of the quadriceps muscle tendon: analysis of 10-year results

    Directory of Open Access Journals (Sweden)

    Marcus Valladares Guimarães

    2009-01-01

    articulação femoropatelar.OBJECTIVE: Assess clinical results using two different protocols, 10 years after ACL reconstruction surgery with the central third of quadriceps muscle tendon (QT. METHOD: Between November /1997 and April/1998, 25 patients were submitted to 25 ACL reconstructions with QT by transtibial technique. The bone portion of the graft was fixated on femoral tunnel with interference screw and the tendinous portion of tibial tunnel with screw with washer. Two patients injured the new when playing soccer. Six patients were not available for follow-up (24%. Seventeen patients were evaluated, 15 men and two women, with mean age at surgery time of 28.53 ± 6.64 years. All patients were examined at six months, one year, and ten years after surgery. Clinical evaluation was made by the Lysholm scale, and the knee evaluation, with the Hospital for Special Surgery scale. RESULTS: The patients had their injuries operated after 9.87 ± 14.42 months of the accident. According to Lysholm scale, the results at the end of the first year were 98.71 ± 2.47 and, after 10 years, 97.35 ± 3.12. Using the Hospital for Special Surgery scale, the mean score was 95.07 ± 5.23 in one year, and 94.87 ± 4.16 in 10 years. All patients returned to their professional activities with the same previous status. Fifteen (88.24% patients were able to return to their sports activities, one by modifying the practice, while another one switched to another sport. No patient complained of pain on the donor area in the medium and long term. The sports return rate was excellent, and no changes were found on the femoropatellar joint.

  12. Structure of retracted tendons after staged repair following continuous traction.

    Science.gov (United States)

    Farshad, Mazda; Gerber, Christian; Snedeker, Jess G; Frauenfelder, Thomas; Meyer, Dominik C

    2011-12-01

    The effect of staged repair involving continuous re-lengthening of the retracted musculotendinous unit after rotator cuff tear is not known. We quantified changes in chronically retracted tendons undergoing no repair or a staged repair involving an initial re-lengthening of the musculotendinous unit by traction in a sheep model of massive rotator cuff tear. Infraspinatus tendons of 12 sheep were released and allowed to retract for 4 months. Repair was performed after the retracted musculotendinous unit had been progressively returned to its original length through continuous traction in 8 sheep (group I). In the other 4 sheep (group II) traction was not successful and the tendons remained retracted. Tendon structure was assessed macroscopically, by MRI, histology, and TEM. Normalized to their contralateral controls, at sacrifice, tendon thickness was unchanged in group I (116%, n.s) and increased in group II (129%, P Retracted musculotendinous units have deteriorated tendons, characterized by increased collagen fiber crimp, and ultrastructural collagen fibril atrophy and disorganization. Continuous traction may arrest and partially restore degenerative changes in retracted tendon. The findings of this study might contribute to new approaches for the treatment of chronic "irreparable" rotator cuff tears.

  13. Tendon Graft and Platelet Concentrate for Chronic Achilles Tendon Rupture. A Case Report

    Directory of Open Access Journals (Sweden)

    Yovanny Ferrer Lozano

    2015-12-01

    Full Text Available Achilles tendon is third most common tendon torn, following the rotator cuff and the quadriceps extensor mechanism. Ruptures can be partial or complete and their etiology is multifactorial. We present the case of a 63-year-old woman who attended the Orthopedics service because of discomfort when walking that had been present for several months and persistent pain in his right heel related to an acetonide triamcinolone injection into the back of the calcaneus. The gap in the tendon (hatchet strike defect and a Thompson test confirmed the Achilles tendon rupture. The tendon was repaired using a peroneus brevis tendon graft and the repair was reinforced with gastrocnemius aponeurosis. The skin flap necrosis led to conservative debridement, graft exposure, and daily application of a platelet lysate, which was subsequently alternated due to the successful formation of the scar tissue. Epithelialization was reached in the fourth postoperative week. Twelve weeks after surgery, the patient began to resume her normal life. The use of platelet concentrates as adjuvant therapy is rare in these patients. For this reason, we decided to publish this case.

  14. Region specific patella tendon hypertrophy in humans following resistance training

    DEFF Research Database (Denmark)

    Kongsgaard, M.; Reitelseder, S; Pedersen, T.G.

    2007-01-01

    AIM: To examine if cross-sectional area (CSA) differs along the length of the human patellar tendon (PT), and if there is PT hypertrophy in response to resistance training. METHODS: Twelve healthy young men underwent baseline and post-training assessments. Maximal isometric knee extension strength...... (MVC) was determined unilaterally in both legs. PT CSA was measured at the proximal-, mid- and distal PT level and quadriceps muscle CSA was measured at mid-thigh level using magnetic resonance imaging. Mechanical properties of the patellar tendons were determined using ultrasonography. Subsequently....... CONCLUSIONS: To our knowledge, this study is the first to report tendon hypertrophy following resistance training. Further, the data show that the human PT CSA varies along the length of the tendon....

  15. Iliotibial band Z-lengthening.

    Science.gov (United States)

    Richards, David P; Alan Barber, F; Troop, Randal L

    2003-03-01

    Iliotibial band friction syndrome (ITBFS) is a common overuse injury reported to afflict 1.6% to 12% of runners. It results from an inflammatory response secondary to excessive friction that occurs between the lateral femoral epicondyle and the iliotibial band. Initial treatments include rest, anti-inflammatory medication, modalities (ice or heat), stretching, physical therapy, and possibly a cortisone injection. In recalcitrant cases of ITBFS, surgery has been advocated. This report describes a surgical technique of Z-lengthening of the iliotibial band in patients presenting with lateral knee pain localized to the iliotibial band at the lateral femoral epicondyle and Gerdy's tubercle who failed all nonoperative efforts.

  16. Achilles tendon rupture - aftercare

    Science.gov (United States)

    Heel cord tear; Calcaneal tendon rupture ... MRI scan to see what type of Achilles tendon tear you have. An MRI is a type ... partial tear means at least some of the tendon is still OK. A full tear means your ...

  17. Achilles tendon repair

    Science.gov (United States)

    Achilles tendon rupture-surgery; Percutaneous Achilles tendon rupture repair ... 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 ...

  18. Posterior Tibial Tendon Dysfunction

    Science.gov (United States)

    .org Posterior Tibial Tendon Dysfunction Page ( 1 ) Posterior tibial tendon dysfunction is one of the most common problems of the foot and ankle. It occurs when the posterior tibial tendon becomes inflamed or torn. As a result, the ...

  19. Achilles Tendon Rupture

    Science.gov (United States)

    Achilles tendon rupture Overview By Mayo Clinic Staff Achilles (uh-KILL-eez) tendon rupture is an injury that affects the back ... but it can happen to anyone. The Achilles tendon is a strong fibrous cord that connects the ...

  20. Clinical crown lengthening to improve implant results.

    Science.gov (United States)

    Kohner, J

    1992-01-01

    Clinical crown lengthening is used as an adjunct to implant procedures, and can help provide a better long-term prognosis by establishing proper occlusal planes and aiding in preparation of the abutment teeth. Crown lengthening procedures may be especially useful when caries or a fracture extends below the gingival margin, compromising impression taking and marginal fit.

  1. Crown lengthening: a surgical flap approach.

    Science.gov (United States)

    Lundergan, W; Hughes, W R

    1996-09-01

    In many instances it is not possible to place a restoration margin without encroaching on the periodontal attachment apparatus. A surgical crown-lengthening procedure can provide a good solution to this common clinical problem. This article discusses indication and contraindication for surgical crown-lengthening procedures and presents an appropriate surgical technique.

  2. A completely intramedullary leg lengthening device

    NARCIS (Netherlands)

    Aalsma, A.M.M.; Hekman, E.E.G.; Stapert, J.W.J.L.; Grootenboer, H.J.

    1998-01-01

    The procedure and the external fixator for lengthening long bones was developed by G.A. Ilizarov in the late 1960's. This technique has, despite its proven abilities for leg lengthening and correction of angular deformities, some considerable disadvantages for patients. Discomfort, infections and re

  3. Esthetic crown lengthening for maxillary anterior teeth.

    Science.gov (United States)

    Sonick, M

    1997-08-01

    In the maxillary anterior region, the gingival labial margin position is an important parameter in the achievement of an ideal smile. The relationship between the periodontium and the restoration is critical if gingival health and esthetics are to be achieved. Periodontal therapy is a necessary and useful adjunct when any anterior restoration is undertaken. Anterior surgical crown lengthening may be undertaken to avoid restorative margin impingement on the biologic width. Crown lengthening is also used to alter the gingival labial profiles. This article discusses the esthetic parameters of ideal gingival labial positions and presents a classification of crown-lengthening procedures and the procedure for a two-stage crown-lengthening technique. The two-stage crown-lengthening technique is surgically precise because healing is predictable.

  4. Effects of Quadriceps Muscle Fatigue on Stiff-Knee Gait in Patients with Hemiparesis

    Science.gov (United States)

    Boudarham, Julien; Roche, Nicolas; Pradon, Didier; Delouf, Eric; Bensmail, Djamel; Zory, Raphael

    2014-01-01

    The relationship between neuromuscular fatigue and locomotion has never been investigated in hemiparetic patients despite the fact that, in the clinical context, patients report to be more spastic or stiffer after walking a long distance or after a rehabilitation session. The aim of this study was to evaluate the effects of quadriceps muscle fatigue on the biomechanical gait parameters of patients with a stiff-knee gait (SKG). Thirteen patients and eleven healthy controls performed one gait analysis before a protocol of isokinetic quadriceps fatigue and two after (immediately after and after 10 minutes of rest). Spatiotemporal parameters, sagittal knee and hip kinematics, rectus femoris (RF) and vastus lateralis (VL) kinematics and electromyographic (EMG) activity were analyzed. The results showed that quadriceps muscle weakness, produced by repetitive concentric contractions of the knee extensors, induced an improvement of spatiotemporal parameters for patients and healthy subjects. For the patient group, the increase in gait velocity and step length was associated with i) an increase of sagittal hip and knee flexion during the swing phase, ii) an increase of the maximal normalized length of the RF and VL and of the maximal VL lengthening velocity during the pre-swing and swing phases, and iii) a decrease in EMG activity of the RF muscle during the initial pre-swing phase and during the latter 2/3 of the initial swing phase. These results suggest that quadriceps fatigue did not alter the gait of patients with hemiparesis walking with a SKG and that neuromuscular fatigue may play the same functional role as an anti-spastic treatment such as botulinum toxin-A injection. Strength training of knee extensors, although commonly performed in rehabilitation, does not seem to be a priority to improve gait of these patients. PMID:24718087

  5. Effects of quadriceps muscle fatigue on stiff-knee gait in patients with hemiparesis.

    Directory of Open Access Journals (Sweden)

    Julien Boudarham

    Full Text Available The relationship between neuromuscular fatigue and locomotion has never been investigated in hemiparetic patients despite the fact that, in the clinical context, patients report to be more spastic or stiffer after walking a long distance or after a rehabilitation session. The aim of this study was to evaluate the effects of quadriceps muscle fatigue on the biomechanical gait parameters of patients with a stiff-knee gait (SKG. Thirteen patients and eleven healthy controls performed one gait analysis before a protocol of isokinetic quadriceps fatigue and two after (immediately after and after 10 minutes of rest. Spatiotemporal parameters, sagittal knee and hip kinematics, rectus femoris (RF and vastus lateralis (VL kinematics and electromyographic (EMG activity were analyzed. The results showed that quadriceps muscle weakness, produced by repetitive concentric contractions of the knee extensors, induced an improvement of spatiotemporal parameters for patients and healthy subjects. For the patient group, the increase in gait velocity and step length was associated with i an increase of sagittal hip and knee flexion during the swing phase, ii an increase of the maximal normalized length of the RF and VL and of the maximal VL lengthening velocity during the pre-swing and swing phases, and iii a decrease in EMG activity of the RF muscle during the initial pre-swing phase and during the latter 2/3 of the initial swing phase. These results suggest that quadriceps fatigue did not alter the gait of patients with hemiparesis walking with a SKG and that neuromuscular fatigue may play the same functional role as an anti-spastic treatment such as botulinum toxin-A injection. Strength training of knee extensors, although commonly performed in rehabilitation, does not seem to be a priority to improve gait of these patients.

  6. Effects of quadriceps muscle fatigue on stiff-knee gait in patients with hemiparesis.

    Science.gov (United States)

    Boudarham, Julien; Roche, Nicolas; Pradon, Didier; Delouf, Eric; Bensmail, Djamel; Zory, Raphael

    2014-01-01

    The relationship between neuromuscular fatigue and locomotion has never been investigated in hemiparetic patients despite the fact that, in the clinical context, patients report to be more spastic or stiffer after walking a long distance or after a rehabilitation session. The aim of this study was to evaluate the effects of quadriceps muscle fatigue on the biomechanical gait parameters of patients with a stiff-knee gait (SKG). Thirteen patients and eleven healthy controls performed one gait analysis before a protocol of isokinetic quadriceps fatigue and two after (immediately after and after 10 minutes of rest). Spatiotemporal parameters, sagittal knee and hip kinematics, rectus femoris (RF) and vastus lateralis (VL) kinematics and electromyographic (EMG) activity were analyzed. The results showed that quadriceps muscle weakness, produced by repetitive concentric contractions of the knee extensors, induced an improvement of spatiotemporal parameters for patients and healthy subjects. For the patient group, the increase in gait velocity and step length was associated with i) an increase of sagittal hip and knee flexion during the swing phase, ii) an increase of the maximal normalized length of the RF and VL and of the maximal VL lengthening velocity during the pre-swing and swing phases, and iii) a decrease in EMG activity of the RF muscle during the initial pre-swing phase and during the latter 2/3 of the initial swing phase. These results suggest that quadriceps fatigue did not alter the gait of patients with hemiparesis walking with a SKG and that neuromuscular fatigue may play the same functional role as an anti-spastic treatment such as botulinum toxin-A injection. Strength training of knee extensors, although commonly performed in rehabilitation, does not seem to be a priority to improve gait of these patients.

  7. Crown lengthening: the periodontal-restorative connection.

    Science.gov (United States)

    Becker, W; Ochsenbein, C; Becker, B E

    1998-03-01

    Crown lengthening procedures are based on biologic principles that can be determinants for successful treatment. These procedures are fixed on an understanding of the biologic width. A few of the indications for crown lengthening are caries beneath the gingival margin, fractured teeth with insufficient clinical crown exposure, and teeth with excessive occlusal or incisal wear. This article describes flap designs, the use of a new bur probe for precise measurement of clinical crown exposure, and suturing methods for flap stabilization. Clinical documentation of patients with various clinical situations requiring crown lengthening is presented.

  8. Acquired Brown Syndrome Treated With Traction of Superior Oblique Tendon.

    Science.gov (United States)

    Shin, Kwang Hoon; Paik, Hae Jung; Chi, Mijung

    2016-03-01

    Brown syndrome is a rare strabismic disease characterized by a limited elevation in adduction of the eye. The lengthening/weakening of superior oblique muscle is the main way of surgical intervention for this disease. A 7-year-old boy was diagnosed as having acquired Brown syndrome in his right eye after injury in his face. We experienced successful release of this Brown syndrome through mere pulling outward of superior oblique tendon during surgical exploration. We briefly discuss why this manipulation of superior oblique tendon that we performed was successful.

  9. 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.

  10. 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.

  11. Endoscopic adhesiolysis for extensive tibialis posterior tendon and Achilles tendon adhesions following compound tendon rupture

    Science.gov (United States)

    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. PMID:24045762

  12. Residual bone growth after lengthening procedures

    National Research Council Canada - National Science Library

    Journeau, Pierre; Lascombes, Pierre; Barbier, Dominique; Popkov, Dmitry

    2016-01-01

    .... Using a large cohort of 150 children who had undergone bone lengthening procedures, we describe five patterns of post-intervention growth and identify factors that are favourable for normal residual growth...

  13. Dynamic in vivo 3-dimensional moment arms of the individual quadriceps components.

    Science.gov (United States)

    Wilson, Nicole A; Sheehan, Frances T

    2009-08-25

    The purpose of this study was to provide the first in vivo 3-dimensional (3D) measures of knee extensor moment arms, measured during dynamic volitional activity. The hypothesis was that the vastus lateralis (VL) and vastus medialis (VM) have significant off-axis moment arms compared to the central quadriceps components. After obtaining informed consent, three 3D dynamic cine phase contrast (PC) MRI sets (x,y,z velocity and anatomic images) were acquired from 22 subjects during active knee flexion and extension. Using a sagittal-oblique and two coronal-oblique imaging planes, the origins and insertions of each quadriceps muscle were identified and tracked through each time frame by integrating the cine-PC velocity data. The moment arm (MA) and relative moment (RM, defined as the cross product of the tendon line-of-action and a line connecting the line-of-action with the patellar center of mass) were calculated for each quadriceps component. The tendencies of the VM and VL to produce patellar tilt were evenly balanced. Interestingly, the magnitude of RM-P(Spin) for the VM and VL is approximately four times greater than the magnitude of RM-P(Tilt) for the same muscles suggesting that patellar spin may play a more important role in patellofemoral kinematics than previously thought. Thus, a force imbalance that leads to excessive lateral tilt, such as VM weakness in patellofemoral pain syndrome, would produce excessive negative spin (positive spin: superior patellar pole rotates laterally) and to a much greater degree. This would explain the increased negative spin found in recent studies of patellar maltracking. Assessing the contribution of each quadriceps component in three dimensions provides a more complete understanding of muscle functionality.

  14. Bilateral rectus femoris intramuscular haematoma following simultaneous quadriceps strain in an athlete: a case report

    Directory of Open Access Journals (Sweden)

    Papathanasiou Efthymia

    2010-02-01

    Full Text Available Abstract Introduction Bilateral rectus femoris haematoma following a simultaneous strain of the quadriceps muscles is a very rare condition. Case presentation We report the case of a 21-year-old Greek Caucasian female rowing athlete who was injured on both thighs. She complained of pain and inability to walk. Physical examination revealed tenderness over the thighs and restriction of knee movement. The result of a roentgenogram was normal, and there was no evidence of fracture or patella displacement. Magnetic resonance imaging revealed haematoma formation in both the rectus femoris muscles. The diameters of the left and right haematomas within the muscles were 6 cm and 5 cm, respectively. Therapeutic approaches included compression bandages, ice application, rest, elevation, and administration of muscle relaxant drugs. Active stretching and isometric exercises were performed after three days. The patient was able to walk using crutches two days after the initiation of treatment. On the seventh day, she had regained her full ability to walk without crutches. Non-steroidal anti-inflammatory drugs were administered on the fifth day and continued for one week. Six weeks later, she had pain-free function and the result of magnetic resonance imaging was normal. She was able to resume her training programme and two weeks later, she returned to her previous sport activities and competitions. Conclusion There are references in the literature regarding the occurrence of unilateral quadriceps haematomas following strain and bilateral quadriceps tendon rupture in athletes. Simultaneous bilateral rectus femoris haematomas after a muscle strain is a rare condition. It must be diagnosed early. The three phases of treatment are rest, knee mobilization, and restoration of quadriceps function.

  15. Clinical crown lengthening in the esthetic zone.

    Science.gov (United States)

    Camargo, Paulo M; Melnick, Philip R; Camargo, Luciano M

    2007-07-01

    Periodontal surgical procedures consisting of gingival flaps and osseous recontouring are indicated for crown lengthening of several contiguous teeth in the esthetic zone; both in cases where restorations are required and in cases where no restorations are planned, such as in patients with excessive gingival display due to altered passive eruption. Forced tooth eruption via orthodontic extrusion is the technique of choice when clinical crown lengthening is necessary on isolated teeth in the esthetic zone.

  16. Metacarpal lengthening by distraction histiogenesis in adults

    Directory of Open Access Journals (Sweden)

    Das Sakti

    2009-01-01

    Full Text Available Background: Metacarpal lengthening in the hand is a new application for distraction neo-histiogenesis. Metacarpal lengthening with distraction helps in improvement in pinch function. Thumb lengthening is technically easy in comparison to other metacarpals. We present the operative treatment and post-operative outcome in nine patients with amputations and congenital anomalies. Materials and Methods: Nine patients underwent distraction osteogenesis for the treatment of amputations of the hand and other congenital anomalies. The dominant right hand was operated in eight cases and the left hand in one case. There were six males and three females. Improvement of function was always the aim of surgery. Age range was between 18 and 23 years. Thumb lengthening was performed in five patients and that of the index finger in four patients. Distraction started on the fifth post-operative day at the rate of 0.25 mm/day. Sensory function and bone consolidation was assessed before fixator removal. Results: The mean duration of distraction was 51 days (range, 42-60 days and the distractor was removed at a mean of 150 days (range, 140 and 160 days and the bones were lengthened by a mean of 24 mm (range, 20-28 mm There was improvement of function in all cases. Conclusion: The metacarpal lengthening by distraction histiogenesis in congenital and traumatic amputations is safe and simple method to improve pinch function of hand.

  17. Lengthened temporal integration in schizophrenia.

    Science.gov (United States)

    Parsons, Brent D; Gandhi, Shilpa; Aurbach, Elyse L; Williams, Nina; Williams, Micah; Wassef, Adel; Eagleman, David M

    2013-01-01

    Research in schizophrenia has tended to emphasize deficits in higher cognitive abilities, such as attention, memory, and executive function. Here we provide evidence for dysfunction at a more fundamental level of perceptual processing, temporal integration. On a measure of flicker fusion, patients with schizophrenia exhibited significantly lower thresholds than age and education matched healthy controls. We reasoned that this finding could result from a longer window of temporal integration or could reflect diminished repetition suppression: if every frame of the repeating stimulus were represented as novel, its perceived duration would be accordingly longer. To tease apart these non-exclusive hypotheses, we asked patients to report the number of stimuli perceived on the screen at once (numerosity) as they watched rapidly flashing stimuli that were either repeated or novel. Patients reported significantly higher numerosity than controls in all conditions, again indicating a longer window of temporal integration in schizophrenia. Further, patients showed the largest difference from controls in the repeated condition, suggesting a possible effect of weaker repetition suppression. Finally, we establish that our findings generalize to several different classes of stimuli (letters, pictures, faces, words, and pseudo-words), demonstrating a non-specific effect of a lengthened window of integration. We conclude that the visual system in schizophrenics integrates input over longer periods of time, and that repetition suppression may also be deficient. We suggest that these abnormalities in the processing of temporal information may underlie higher-level deficits in schizophrenia and account for the disturbed sense of continuity and fragmentation of events in time reported by patients.

  18. Tendon material properties vary and are interdependent among turkey hindlimb muscles

    Science.gov (United States)

    Matson, Andrew; Konow, Nicolai; Miller, Samuel; Konow, Pernille P.; Roberts, Thomas J.

    2012-01-01

    SUMMARY The material properties of a tendon affect its ability to store and return elastic energy, resist damage, provide mechanical feedback and amplify or attenuate muscle power. While the structural properties of a tendon are known to respond to a variety of stimuli, the extent to which material properties vary among individual muscles remains unclear. We studied the tendons of six different muscles in the hindlimb of Eastern wild turkeys to determine whether there was variation in elastic modulus, ultimate tensile strength and resilience. A hydraulic testing machine was used to measure tendon force during quasi-static lengthening, and a stress–strain curve was constructed. There was substantial variation in tendon material properties among different muscles. Average elastic modulus differed significantly between some tendons, and values for the six different tendons varied nearly twofold, from 829±140 to 1479±106 MPa. Tendons were stretched to failure, and the stress at failure, or ultimate tensile stress, was taken as a lower-limit estimate of tendon strength. Breaking tests for four of the tendons revealed significant variation in ultimate tensile stress, ranging from 66.83±14.34 to 112.37±9.39 MPa. Resilience, or the fraction of energy returned in cyclic length changes was generally high, and one of the four tendons tested was significantly different in resilience from the other tendons (range: 90.65±0.83 to 94.02±0.71%). An analysis of correlation between material properties revealed a positive relationship between ultimate tensile strength and elastic modulus (r2=0.79). Specifically, stiffer tendons were stronger, and we suggest that this correlation results from a constrained value of breaking strain, which did not vary significantly among tendons. This finding suggests an interdependence of material properties that may have a structural basis and may explain some adaptive responses observed in studies of tendon plasticity. PMID:22771746

  19. Tendon material properties vary and are interdependent among turkey hindlimb muscles.

    Science.gov (United States)

    Matson, Andrew; Konow, Nicolai; Miller, Samuel; Konow, Pernille P; Roberts, Thomas J

    2012-10-15

    The material properties of a tendon affect its ability to store and return elastic energy, resist damage, provide mechanical feedback and amplify or attenuate muscle power. While the structural properties of a tendon are known to respond to a variety of stimuli, the extent to which material properties vary among individual muscles remains unclear. We studied the tendons of six different muscles in the hindlimb of Eastern wild turkeys to determine whether there was variation in elastic modulus, ultimate tensile strength and resilience. A hydraulic testing machine was used to measure tendon force during quasi-static lengthening, and a stress-strain curve was constructed. There was substantial variation in tendon material properties among different muscles. Average elastic modulus differed significantly between some tendons, and values for the six different tendons varied nearly twofold, from 829±140 to 1479±106 MPa. Tendons were stretched to failure, and the stress at failure, or ultimate tensile stress, was taken as a lower-limit estimate of tendon strength. Breaking tests for four of the tendons revealed significant variation in ultimate tensile stress, ranging from 66.83±14.34 to 112.37±9.39 MPa. Resilience, or the fraction of energy returned in cyclic length changes was generally high, and one of the four tendons tested was significantly different in resilience from the other tendons (range: 90.65±0.83 to 94.02±0.71%). An analysis of correlation between material properties revealed a positive relationship between ultimate tensile strength and elastic modulus (r(2)=0.79). Specifically, stiffer tendons were stronger, and we suggest that this correlation results from a constrained value of breaking strain, which did not vary significantly among tendons. This finding suggests an interdependence of material properties that may have a structural basis and may explain some adaptive responses observed in studies of tendon plasticity.

  20. Chronic Achilles Tendon Rupture Reconstructed With Achilles Tendon Allograft and Xenograft Combination.

    Science.gov (United States)

    Hollawell, Shane; Baione, William

    2015-01-01

    More than 20% of acute Achilles tendon injuries are misdiagnosed, leading to chronic or neglected ruptures. Some controversy exists regarding how to best manage an acute Achilles tendon rupture. However, a general consensus has been reached that chronic rupture with ≥3 cm of separation is associated with functional morbidity and, therefore, should be managed operatively. It has been demonstrated that the functional outcomes of surgically treated Achilles ruptures are superior to the nonoperative outcomes in a chronic setting. In the present report, we reviewed 4 patients with chronic Achilles tendon ruptures that were successfully treated with an Achilles tendon interposition allograft and simultaneous augmentation with a xenograft. The median duration of rupture was 11 (range 8 to 16) weeks, the median gap between the proximal and distal segments of the tendon was 4.75 (range 3.5 to 6) cm, and the patients were able to return pain-free to all preinjury activities at a median of 14.5 (range 13.8 to 15.5) weeks, without the need for tendon transfer, lengthening, or additional intervention. The median duration of follow up was 37.25 (range 15.25 to 51.5) months, at which point the mean Foot and Ankle Outcomes Instrument core scale score was 97 ± 1 (mean normative score 53 ± 1), and the Foot and Ankle Outcomes Instrument shoe comfort core scale score was 100 ± 0 (mean normative score 59 ± 0). The combined Achilles allograft plus xenograft augmentation technique appears to be a reasonable option for the surgical treatment of chronic Achilles tendon rupture. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Pitfalls during biomechanical testing - Evaluation of different fixation methods for measuring tendons endurance properties.

    Science.gov (United States)

    Hangody, Gy; Pánics, G; Szebényi, G; Kiss, R; Hangody, L; Pap, K

    2016-03-01

    The goal of the study was to find a proper technique to fix tendon grafts into an INSTRON loading machine. From 8 human cadavers, 40 grafts were collected. We removed the bone-patella tendon-bone grafts, the semitendinosus and gracilis tendons, the quadriceps tendon-bone grafts, the Achilles tendons, and the peroneus longus tendons from each lower extremity. We tested the tendon grafts with five different types of fixation devices: surgical thread (Premicron 3), general mounting clamp, wire mesh, cement fixation, and a modified clamp for an INSTRON loading machine. The mean failure load in case of surgical thread fixation was (381N ± 26N). The results with the general clamp were (527N ± 45N). The wire meshes were more promising (750N ± 21N), but did not reach the outcomes we desired. Easy slippages of the ends of the tendons from the cement encasements were observed (253N ± 18N). We then began to use Shi's clamp that could produce 977N ± 416N peak force. We combined Shi's clamp with freezing of the graft and the rupture of the tendon itself demonstrated an average force of 2198 N ± 773N. We determined that our modified frozen clamp fixed the specimens against high tensile forces.

  2. 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.

  3. Transverse Compression of Tendons.

    Science.gov (United States)

    Salisbury, S T Samuel; Buckley, C Paul; Zavatsky, Amy B

    2016-04-01

    A study was made of the deformation of tendons when compressed transverse to the fiber-aligned axis. Bovine digital extensor tendons were compression tested between flat rigid plates. The methods included: in situ image-based measurement of tendon cross-sectional shapes, after preconditioning but immediately prior to testing; multiple constant-load creep/recovery tests applied to each tendon at increasing loads; and measurements of the resulting tendon displacements in both transverse directions. In these tests, friction resisted axial stretch of the tendon during compression, giving approximately plane-strain conditions. This, together with the assumption of a form of anisotropic hyperelastic constitutive model proposed previously for tendon, justified modeling the isochronal response of tendon as that of an isotropic, slightly compressible, neo-Hookean solid. Inverse analysis, using finite-element (FE) simulations of the experiments and 10 s isochronal creep displacement data, gave values for Young's modulus and Poisson's ratio of this solid of 0.31 MPa and 0.49, respectively, for an idealized tendon shape and averaged data for all the tendons and E = 0.14 and 0.10 MPa for two specific tendons using their actual measured geometry. The compression load versus displacement curves, as measured and as simulated, showed varying degrees of stiffening with increasing load. This can be attributed mostly to geometrical changes in tendon cross section under load, varying according to the initial 3D shape of the tendon.

  4. Altered cell metabolism in tissues of the knee joint in a rabbit model of Botulinum toxin A-induced quadriceps muscle weakness.

    Science.gov (United States)

    Leumann, A; Longino, D; Fortuna, R; Leonard, T; Vaz, M A; Hart, D A; Herzog, W

    2012-12-01

    Quadriceps muscle weakness is frequently associated with knee injuries in sports. The influence of quadriceps weakness on knee joint homeostasis remains undefined. We hypothesized that quadriceps weakness will lead to tissue-specific alterations in the cell metabolism of tissues of the knee. Quadriceps weakness was induced with repetitive injections of Botulinum toxin A in six 1-year-old New Zealand White rabbits for 6 months. Five additional animals served as controls with injections of saline/dextrose. Muscle weakness was assessed by muscle wet mass, isometric knee extensor torque, and histological morphology analysis. Cell metabolism was assessed for patellar tendon, medial and lateral collateral ligament, and medial and lateral meniscus by measuring the total RNA levels and specific mRNA levels for collagen I, collagen III, MMP-1, MMP-3, MMP-13, TGF-β, biglycan, IL-1, and bFGF by reverse transcription and polymerase chain reaction. While the total RNA levels did not change, tissue-specific mRNA levels were lower for relevant anabolic and catabolic molecules, indicating potential changes in tissue mechanical set points. Quadriceps weakness may lead to adaptations in knee joint tissue cell metabolism by altering a subset of anabolic and catabolic mRNA levels corresponding to a new functional and metabolic set point for the knee that may contribute to the high injury rate of athletes with muscle weakness.

  5. The series elastic shock absorber: tendon elasticity modulates energy dissipation by muscle during burst deceleration.

    Science.gov (United States)

    Konow, Nicolai; Roberts, Thomas J

    2015-04-07

    During downhill running, manoeuvring, negotiation of obstacles and landings from a jump, mechanical energy is dissipated via active lengthening of limb muscles. Tendon compliance provides a 'shock-absorber' mechanism that rapidly absorbs mechanical energy and releases it more slowly as the recoil of the tendon does work to stretch muscle fascicles. By lowering the rate of muscular energy dissipation, tendon compliance likely reduces the risk of muscle injury that can result from rapid and forceful muscle lengthening. Here, we examine how muscle-tendon mechanics are modulated in response to changes in demand for energy dissipation. We measured lateral gastrocnemius (LG) muscle activity, force and fascicle length, as well as leg joint kinematics and ground-reaction force, as turkeys performed drop-landings from three heights (0.5-1.5 m centre-of-mass elevation). Negative work by the LG muscle-tendon unit during landing increased with drop height, mainly owing to greater muscle recruitment and force as drop height increased. Although muscle strain did not increase with landing height, ankle flexion increased owing to increased tendon strain at higher muscle forces. Measurements of the length-tension relationship of the muscle indicated that the muscle reached peak force at shorter and likely safer operating lengths as drop height increased. Our results indicate that tendon compliance is important to the modulation of energy dissipation by active muscle with changes in demand and may provide a mechanism for rapid adjustment of function during deceleration tasks of unpredictable intensity.

  6. Achilles tendon: US examination

    Energy Technology Data Exchange (ETDEWEB)

    Fornage, B.D.

    1986-06-01

    Real-time ultrasonography (US) using linear-array probes and a stand-off pad as a ''waterpath'' was performed to evaluate the Achilles tendon in 67 patients (including 24 athletes) believed to have acute or chronic traumatic or inflammatory pathologic conditions. Tendons in 23 patients appeared normal on US scans. The 44 abnormal tendons comprised five complete and four partial ruptures, seven instances of postoperative change, and 28 cases of tendonitis. US depiction of the inner structure of the tendon resulted in the diagnosis of focal abnormalities, including partial ruptures, nodules, and calcifications. Tendonitis was characterized by enlargement and decreased echogenicity of the tendon. The normal US appearance of the Achilles tendon is described.

  7. 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 ...

  8. 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- ...

  9. Proximal Biceps Tendonitis

    Science.gov (United States)

    ... tendons that attach the top of the biceps muscle to the shoulder are the proximal tendons . There are two proximal ... ll want to do exercises that strengthen the muscles of your shoulder and upper arm. Strong muscles will keep the ...

  10. Distal Biceps Tendon Rupture

    Science.gov (United States)

    2010-06-01

    distal tendon . Although these findings overlap with those seen in tendinopathy , the presence of bone marrow edema at the radial tuberosity and fluid in...the bicipitoradial bursa suggests a partial tear rather than tendinopathy .3 When the distal biceps tendon tear is complete, MR imaging shows...Distal Biceps Tendon Rupture Military Medicine Radiology Corner, 2006 Radiology Corner Distal Biceps Tendon Rupture Contributors: CPT Michael

  11. Reconstrução do ligamento cruzado posterior com enxerto autólogo do tendão do músculo semitendinoso duplo e do terço médio do tendão do quadríceps em duplo túnel no fêmur e único na tíbia: resultados clínicos em dois anos de seguimento Posterior cruciate ligament reconstruction with autograft of the double semitendinosus muscles and middle third of the quadriceps tendon with double femoral and single tibial tunnels: clinical results in two years follow up

    Directory of Open Access Journals (Sweden)

    Ricardo de Paula Leite Cury

    2012-02-01

    Full Text Available OBJETIVO: Avaliar os aspectos cirúrgicos que possam oferecer bons resultados anatômicos e funcionais na reconstrução do ligamento cruzado posterior (LCP utilizando enxerto autólogo do tendão do quadríceps e duplo semitendinoso através de um túnel femoral duplo. MÉTODOS: Quatorze pacientes com lesões isoladas do LCP, instabilidade e dor foram operados por artroscopia e avaliados de acordo com as escalas do International Knee Documentation Committee (IKDC e de Lysholm. A lassidão foi examinada com o artrômetro KT 1000. RESULTADOS: Na avaliação pós-operatória, a translação posterior comparando-se com joelho contralateral foi entre 0-2mm em 57,1% dos pacientes e entre 3 e 5mm em 35,7% dos casos. A média da escala de Lysholm foi de 93 pontos na avaliação final. Na avaliação pelo IKDC, três pacientes tiveram grau A, 10 grau B e 1 teve grau C. Conclusões: A reconstrução artroscópica do LCP com feixe duplo baseada no posicionamento anatômico dos túneis, com tendão duplo semitendinoso e único do quadríceps, oferece redução clinicamente evidente dos sintomas e recupera satisfatoriamente a estabilidade, embora diferença significativa não tenha sido encontrada devido ao pequeno tamanho da amostra.OBJECTIVE: To evaluate the surgical aspects that may offer good anatomic and functional results in posterior cruciate ligament (PCL reconstruction using an autologous graft of the quadriceps tendon and double semitendinosus through a double femoral tunnel. METHODS: Fourteen patients with isolated PCL lesions, instability and pain were operated on by arthroscopy and evaluated according to the International Knee Documentation Committee (IKDC and Lysholm scales. Posterior knee laxity was examined with a KT 1000 arthrometer. RESULTS: The mean postoperative posterior side-to-side difference was between 0-2 mm in 57.1% of patients and between 3 and 5 mm in 35.7% of cases. The average Lysholm score was 93 points in the final follow

  12. 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

  13. Biologics for tendon repair.

    Science.gov (United States)

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

    2015-04-01

    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.

  14. Cosmetic arm lengthening with monorail fixator

    Institute of Scientific and Technical Information of China (English)

    Hemendra Kumar Agrawal; Balvinder Singh; Mohit Garg; Vipin Khatkar; Sumit Batra; Vinod Kumar Sharma

    2015-01-01

    Upper limb length discrepancy is a rare occurrence.Humerus shortening may need specialized treatment to restore the functional and cosmetic status of upper limb.We report a case of humerus lengthening of 9 cm with a monorail external fixator and the result was observed during a 2-year follow-up.Humerus lengthening needs specialized focus as it is not only a cosmetic issue but also a functional demand.The monorail unilateral fixator is more functional and cosmetically acceptable,and thus becomes an effective treatment option.

  15. Surgical crown lengthening for function and esthetics.

    Science.gov (United States)

    Allen, E P

    1993-04-01

    Clinical crown lengthening is a useful procedure to provide tooth length for proper restoration of a tooth without compromising the periodontium or the retentive qualities of the restoration. It is also useful for enhancing maxillary anterior esthetics. Crown lengthening may be as simple as a limited removal of soft tissue or as complex as orthodontic extrusion followed by flap with osseous surgery on a tooth requiring endodontic therapy. Total treatment could thus involve endodontic, orthodontic, periodontic, and restorative procedures. Careful evaluation, case selection, treatment planning, and surgical treatment following the principles outlined in this article can achieve results that meet the functional and esthetic challenges of current dental practice.

  16. The telomere lengthening conundrum - artifact or biology?

    DEFF Research Database (Denmark)

    Steenstrup, Troels; Hjelmborg, Jacob V B; Kark, Jeremy D;

    2013-01-01

    Recent longitudinal studies of age-dependent leukocyte telomere length (LTL) attrition have reported that variable proportions of individuals experience LTL lengthening. Often, LTL lengthening has been taken at face value, and authors have speculated about the biological causation of this finding....... Based on empirical data and theoretical considerations, we show that regardless of the method used to measure telomere length (Southern blot or quantitative polymerase chain reaction-based methods), measurement error of telomere length and duration of follow-up explain almost entirely the absence of age...

  17. Percutaneous Repair Technique for Acute Achilles Tendon Rupture with Assistance of Kirschner Wire.

    Science.gov (United States)

    He, Ze-yang; Chai, Ming-xiang; Liu, Yue-ju; Zhang, Xiao-ran; Zhang, Tao; Song, Lian-xin; Ren, Zhi-xin; Wu, Xi-rui

    2015-11-01

    The aim of this study is to introduce a self-designed, minimally invasive technique for repairing an acute Achilles tendon rupture percutaneously. Comparing with the traditional open repair, the new technique provides obvious advantages of minimized operation-related lesions, fewer wound complications as well as a higher healing rate. However, a percutaneous technique without direct vision may be criticized by its insufficient anastomosis of Achilles tendon and may also lead to the lengthening of the Achilles tendon and a reduction in the strength of the gastrocnemius. To address the potential problems, we have improved our technique using a percutaneous Kirschner wire leverage process before suturing, which can effectively recover the length of the Achilles tendon and ensure the broken ends are in tight contact. With this improvement in technique, we have great confidence that it will become the treatment of choice for acute Achilles tendon ruptures. © 2015 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  18. Abdominal muscle and quadriceps strength in chronic obstructive pulmonary disease

    OpenAIRE

    2005-01-01

    Background: Quadriceps muscle weakness is common in chronic obstructive pulmonary disease (COPD) but is not observed in a small hand muscle (adductor pollicis). Although this could be explained by reduced activity in the quadriceps, the observation could also be explained by anatomical location of the muscle or fibre type composition. However, the abdominal muscles are of a similar anatomical and fibre type distribution to the quadriceps, although they remain active in COPD. Cough gastric pre...

  19. Tendon response to pharmaco-mechanical stimulation of the chronically retracted rotator cuff in sheep.

    Science.gov (United States)

    Wieser, Karl; Farshad, Mazda; Meyer, Dominik C; Conze, Philipp; von Rechenberg, Brigitte; Gerber, Christian

    2015-02-01

    Chronic tearing of tendons is associated with molecular and structural alterations causing biomechanical changes, which compromise musculotendinous function and become limiting factors for tendon repair. This study investigated the histological response of chronically retracted sheep rotator cuff tendons to mechanical and pharmacological stimulation in view of tendon repair. Sixteen weeks after experimental release of the infraspinatus tendon in 20 sheep, the retracted musculotendinous unit was subjected to continuous traction either with [anabolic steroids (nandrolone) group/insulin-like growth factor (IGF) group] or without (control group) additional pharmacological treatment during 6 weeks. A new degeneration score for tendinous tissues (DSTT), based on established knowledge on histological changes associated with tendon degeneration, was used for histological analysis at the time of tendon release, at the beginning of continuous re-lengthening and at repair in all animals. The DSTT score (inter-observer correlation: r = 0.83), quantifiably representing tendon degeneration, improved from 15.5 (SD 1.3) points before to 9.8 (SD 3.8) points after re-lengthening. It improved in a qualitatively and quantitatively similar fashion if pharmacological stimulation was added. The nandrolone group improved from 13.7 (SD 1.6) to 9.8 (SD 1.9) and the IGF group from 13.3 (SD 3.6) to 8.8 (SD 1.8) points. Mechanical stimulation significantly reduced tissue degeneration. However, the addition of a pharmacological stimulation with anabolic steroids or IGF had neither a measurable positive nor negative effect on the degenerative process. Therefore, this investigation does neither support the additional pharmacological use of the anabolic steroid nandrolone or of IGF decanoate for restoration of tendon degeneration, nor otherwise provide evidence for additional tendon damage, if those substances are used to alter the muscular metabolism.

  20. Achilles tendon disorders.

    Science.gov (United States)

    Weinfeld, Steven B

    2014-03-01

    Achilles tendon disorders include tendinosis, paratenonitis, insertional tendinitis, retrocalcaneal bursitis, and frank rupture. Patients present with pain and swelling in the posterior aspect of the ankle. Magnetic resonance imaging and ultrasound are helpful in confirming the diagnosis and guiding treatment. Nonsurgical management of Achilles tendon disorders includes nonsteroidal anti-inflammatory drugs, physical therapy, bracing, and footwear modification. Surgical treatment includes debridement of the diseased area of the tendon with direct repair. Tendon transfer may be necessary to augment the strength of the Achilles tendon. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Simultaneous bilateral patellar tendon rupture without predisposing systemic disease or steroid use: a case report

    Institute of Scientific and Technical Information of China (English)

    LU Hua-ding; CAI Dao-zhang; WANG Kun; ZENG Chun

    2012-01-01

    There is a dearth of case reports describing 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 tendon ruptures without any history of systemic disease or steroidal medication.We repaired and reattached the ruptured 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.

  2. 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.

  3. Whole-body vibration training induces hypertrophy of the human patellar tendon.

    Science.gov (United States)

    Rieder, F; Wiesinger, H-P; Kösters, A; Müller, E; Seynnes, O R

    2016-08-01

    Animal studies suggest that regular exposure to whole-body vibration (WBV) induces an anabolic response in bone and tendon. However, the effects of this type of intervention on human tendon properties and its influence on the muscle-tendon unit function have never been investigated. The aim of this study was to investigate the effect of WBV training on the patellar tendon mechanical, material and morphological properties, the quadriceps muscle architecture and the knee extension torque-angle relationship. Fifty-five subjects were randomized into either a vibration, an active control, or an inactive control group. The active control subjects performed isometric squats on a vibration platform without vibration. Muscle and tendon properties were measured using ultrasonography and dynamometry. Vibration training induced an increase in proximal (6.3%) and mean (3.8%) tendon cross-sectional area, without any appreciable change in tendon stiffness and modulus or in muscle architectural parameters. Isometric torque at a knee angle of 90° increased in active controls (6.7%) only and the torque-angle relation remained globally unchanged in all groups. The present protocol did not appreciably alter knee extension torque production or the musculo-tendinous parameters underpinning this function. Nonetheless, this study shows for the first time that WBV elicits tendon hypertrophy in humans.

  4. High-Velocity Quadriceps Exercises Compared to Slow-Velocity Quadriceps Exercises Following Total Knee Arthroplasty: A Randomized Clinical Study.

    Science.gov (United States)

    Doerfler, Deborah; Gurney, Burke; Mermier, Christine; Rauh, Mitchell; Black, Liza; Andrews, Ron

    2016-01-01

    Despite improvement in pain and perceived function in older adults following total knee arthroplasty (TKA), objective outcome measures of muscular impairment and ambulatory function demonstrate significant deficits. Evidence suggests that quadriceps power may play a greater role in ambulatory function than measures of strength alone following TKA. The purpose of this study was to compare the effect of high-velocity (HV) quadriceps exercises with that of slow-velocity (SV) quadriceps exercises on functional outcomes and quadriceps power following TKA. This study was a randomized clinical study conducted in an outpatient physical therapy clinic. Twenty-one participants who were 4 to 6 weeks post unilateral TKA were randomly assigned to an HV or SV group. Participants performed an evidence-based standardized progressive resistance exercise program in addition to HV quadriceps exercises or SV quadriceps exercises. Participants attended 2 sessions per week for 8 weeks. Before and after the 8-week exercise intervention, participants completed a functional questionnaire, health survey, functional testing, and underwent quadriceps strength and power testing. Both groups demonstrated improvements in ambulatory outcome measures, strength, speed, and power. The HV group demonstrated significantly greater improvements in distance walked and quadriceps strength than the SV group. These data should be considered preliminary because of a small sample size. HV quadriceps exercises may be an effective rehabilitation strategy in conjunction with a standardized progressive resistance exercise program beginning 4 to 6 weeks after TKA.

  5. Bilateral quadriceps rupture: results with and without platelet-rich plasma.

    Science.gov (United States)

    Lanzetti, Riccardo Maria; Vadalà, Antonio; Morelli, Federico; Iorio, Raffaele; Ciompi, Alessandro; Vetrano, Mario; Argento, Giuseppe; Vulpiani, Maria Chiara; Di Sanzo, Vincenzo; Ferretti, Andrea

    2013-11-01

    This article presents a 46-year-old man with bilateral atraumatic quadriceps rupture that occurred while he was descending stairs. The patient underwent surgery the day after the accident. In the left knee, quadriceps reinsertion was performed using a conventional technique. In the right knee, platelet-rich plasma (PRP), both in its liquid and semisolid patterns, was added intraoperatively. Ultrasonography and magnetic resonance imaging evaluations were performed 1, 6, and 24 months postoperatively. At 6 and 24 months postoperatively, clinical and functional evaluations also were performed. Clinical examination showed no differences between the knees, and functional scores were the same for both knees. Ultrasonographic evaluation showed bilateral persistent tendon thickening and gross echotexture abnormalities, with no side-to-side differences. Magnetic resonance imaging showed signals of vascularized granulation tissue in both knees, which was more evident in the right (PRP) knee at 1 month postoperatively, along with a better signal of scar tissue in the right knee at 6 and 24 months postoperatively. The use of PRP yielded no better clinical or functional results than the lack of its use. However, a more intense and significant reparative healing process occurred where the PRP was used, thus suggesting a more rapid completion of the healing process, although this effect seems to remain only a radiographic finding with no clinical correlation.

  6. ACL repair might induce further abnormality of gamma loop in the intact side of the quadriceps femoris.

    Science.gov (United States)

    Konishi, Y U

    2011-04-01

    The purpose of this study was to investigate the effect of surgery on the gamma-loop in the quadriceps of patients with ACL injuries. We compared the response to vibration stimulation in subjects with ACL repair, subjects with ACL rupture, and normal subjects, by measuring the maximal strength and integrated electromyography (I-EMG) of the quadriceps. Pre-vibration data were obtained from each subject by measuring the MVC of the knee extension and the I-EMG from the vastus medialis, vastus lateralis, and rectus femoris. Vibration stimulation was applied to the infrapatellar tendon, followed immediately by repeating maximal strength and I-EMG recording. The results of this study indicated that alpha motor neuron activity of the intact side of the vastus lateralis in response to prolonged vibration stimulation was altered by surgery, but no effect was detected in the injured side. The results could suggest that abnormality of the gamma-loop existed even in the quadriceps of patients with ACL rupture since the vibration stimulus failed to elicit changes in ACL-rupture group as compared with those of normal subjects. In comparison, abnormality of the gamma-loop in the intact side of the QF was probably induced by the rupture, and further abnormality of gamma-loop was induced by surgery.

  7. Osteoarthritis of knee joint - role of quadriceps exercises

    Directory of Open Access Journals (Sweden)

    M.A.Q. Ansari

    2014-08-01

    Conclusions: There is relationship between age, sex and quadriceps exercise with osteoarthritis of knee. Moderate quadriceps exercise is a safe and effective prevention and therapy for Osteoarthritis of knee. [Int J Res Med Sci 2014; 2(4.000: 1652-1654

  8. Quadriceps Strength and Executive Functions in Older Women

    NARCIS (Netherlands)

    Scherder, E. J. A.; Eggermont, L. H. P.; Geuze, R. H.; Vis, J.; Verkerke, G. J.

    2010-01-01

    Objective: The aim of this study is to answer the question whether the strength of the knee extensor musculus quadriceps (m. quadriceps), in particular, is related to specific executive functions and whether this relationship is independent of aerobic fitness. The clinical relevance of this question

  9. Crown lengthening: basic principles, indications, techniques and clinical case reports.

    Science.gov (United States)

    Yeh, Simon; Andreana, Sebastiano

    2004-11-01

    Sometimes, in order to properly restore teeth, surgical intervention in the form of a crown-lengthening procedure is required. Crown lengthening is a periodontal resective procedure, aimed at removing supporting periodontal structures to gain sound tooth structure above the alveolar crest level. Periodontal health is of paramount importance for all teeth, both sound and restored. For the restorative dentist to utilize crown lengthening, it is important to understand the concept of biologic width, indications, techniques and other principles. This article reviews these basic concepts of clinical crown lengthening and presents four clinical cases utilizing crown lengthening as an integral part of treatments, to restore teeth and their surrounding tissues to health.

  10. Calcific tendonitis : a model.

    Science.gov (United States)

    Gohr, Claudia M; Fahey, Mark; Rosenthal, Ann K

    2007-01-01

    Calcific tendonitis is a common clinical condition associated with high rates of tendon rupture, prolonged symptoms, and poor response to therapy. Little is known about the pathogenesis of calcifications in tendons and consequently few effective therapies are available. We hypothesized that tendon calcification, like pathologic calcification in other sites, was generated by extracellular organelles known as matrix vesicles and that isolated matrix vesicles would constitute the basis for a useful model of this process. Tendon matrix vesicles were isolated from adult porcine patellar tendons using enzymatic digestion and differential centrifugation. Vesicle morphology was examined with electron microscopy. Levels of calcium, phosphate, pyrophosphate, ATP, and mineralization-associated enzymes were measured and compared with articular cartilage vesicles from porcine articular cartilage. Vesicles were embedded in agarose gels with or without type I collagen or dermatan sulfate and incubated in calcifying salt solution trace labeled with (45)calcium. (45)Calcium in the vesicle fraction was measured after 5-7 days. The type of mineral formed was determined by micro-x-ray diffraction. Matrix vesicles isolated from adult porcine tendon were similar morphologically to those obtained from articular cartilage. They contained mineralization-related enzymes and formed hydroxyapatite mineral in vitro. Mineralization was suppressed by levamisole and modulated by extracellular matrix components. Matrix vesicles isolated from tendons mineralize in vitro. This model may aid in the study of the pathogenesis of calcific tendonitis as well as serve as a means to identify effective therapies for this common disorder.

  11. 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

  12. Camel Tendon Soup

    Institute of Scientific and Technical Information of China (English)

    1995-01-01

    Ingredients: about 400 grams of camel tendon Supplementary ingredients: mushrooms, green beans, winter bamboo shoots, cooking wine, sesame oil, salt, pepper, sugar, vinegar, Chinese onion and ginger. Directions: 1. Soak the tendons in water and take away the bone and hair, and boil the tendons in broth to remove the strong smell. Then cut the tendons, mushrooms and winter bamboo shoots into small cubes. 2. Heat oil in a wok and fry the pepper until it’s aromatic. Add mushrooms, winter bamboo shoots and green beans and stir.

  13. Effect of growth hormone on aging connective tissue in muscle and tendon - gene expression, morphology and function following immobilization and rehabilitation

    DEFF Research Database (Denmark)

    Boesen, Anders Ploug; Dideriksen, Kasper Juel; Couppe, Christian

    2014-01-01

    assigned to daily injections of recombinant GH(rhGH, n=6) or placebo(Plc, n=6). Cross sectional area(CSA), muscle strength(MVC) and biomechanical properties of m. quadriceps and patellar tendon were determined. Muscle and tendon biopsies were analyzed for gene expressions (mRNA) of collagen(COL1A1/3A1......-training. In conclusion, in elderly humans GH seems to have a matrix stabilizing effect during inactivity and rehabilitation by stimulating collagen expression in the musculo-tendinous tissue and increasing tendon CSA and stiffness....

  14. Gene expression responses over 24 h to lengthening and shortening contractions in human muscle: major changes in CSRP3, MUSTN1, SIX1, and FBXO32.

    Science.gov (United States)

    Kostek, Matthew C; Chen, Yi-Wen; Cuthbertson, Daniel J; Shi, Rongye; Fedele, Mark J; Esser, Karyn A; Rennie, Michael J

    2007-09-19

    Resistance training using lengthening (eccentric) contractions induces greater increases in muscle size than shortening (concentric) contractions, but the underlying molecular mechanisms are not clear. Using temporal expression profiling, we compared changes in gene expression within 24 h of an acute bout of each type of contractions conducted simultaneously in the quadriceps of different legs. Five healthy young men performed shortening contractions with one leg while the contralateral leg performed lengthening contractions. Biopsies were taken from both legs before exercise and 3, 6, and 24 h afterwards, in the fed state. Expression profiling (n = 3) was performed using a custom-made Affymetrix MuscleChip containing probe sets of approximately 3,300 known genes and expressed sequence tags expressed in skeletal muscle. We identified 51 transcripts differentially regulated between the two exercise modes. Using unsupervised hierarchical clustering, we identified four distinct clusters, three of which corresponded to unique functional categories (protein synthesis, stress response/early growth, and sarcolemmal structure). Using quantitative RT-PCR (n = 5), we verified expression changes (lengthening/shortening) in SIX1 (3 h, -1.9-fold, P muscle atrophy was differentially expressed: the gene was downregulated after lengthening contractions (3 h, 2.7-fold, P shortening contractions activated distinct molecular pathways as early as 3 h postexercise. The molecular differences might contribute to mechanisms underlying the physiological adaptations seen with training using the two modes of exercise.

  15. Cortical Button Fixation: A Better Patellar Tendon Repair?

    Science.gov (United States)

    Ode, Gabriella E; Piasecki, Dana P; Habet, Nahir A; Peindl, Richard D

    2016-10-01

    Patellar tendon ruptures require surgical repair to optimize outcomes, but no consensus exists regarding the ideal repair technique. Cortical button fixation is a secure method for tendon repair that has not been studied in patellar tendons. Cortical button repair is biomechanically superior to the standard transpatellar repair and biomechanically equivalent to suture anchor repair. Controlled laboratory study. Twenty-three fresh-frozen cadaveric knees were used to compare 3 techniques of patellar tendon repair after a simulated rupture at the inferior pole of the patella. Repairs were performed at 45° of flexion using a standard transpatellar suture repair (n = 7), polyetheretherketone (PEEK) suture anchor repair (n = 8), or cortical button repair (n = 8). All specimens were tested on a custom apparatus to simulate cyclic open kinetic chain quadriceps contraction from extension to 90(o) of flexion. Outcomes of gap formation up to 250 cycles, maximum load to failure, and mode of failure were evaluated. Cortical button repair had significantly less gap formation than anchor repair after 1 cycle (P button repair sustained significantly higher loads to failure than anchor repair and suture repair (P button repairs either failed through the suture (n = 5), secondary failure of the patellar tendon (n = 2), or subsidence of the button through the anterior cortex of the patella (n = 1). Patellar tendon repair using cortical button fixation demonstrated mechanical advantages over suture repair and anchor repair in cadaveric specimens. Cortical button fixation showed less cyclic gap formation and withstood at least twice the load to failure of the construct. The biomechanical superiority of cortical button fixation may impart clinical advantages in accelerating postoperative rehabilitation. © 2016 The Author(s).

  16. Tendon Transfer Surgery

    Science.gov (United States)

    ... Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is ... include: Repair or transfer of nerves Repair of muscle or tendon Splinting or fusion of joints Find a hand surgeon in your area to discuss the best ...

  17. 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....

  18. Guided esthetic crown lengthening: case reports.

    Science.gov (United States)

    Borges, Ivan; Ribas, Tania Rocha Cabral; Duarte, Poliana Mendes

    2009-01-01

    It is well-recognized that excessive gingival display can have a negative impact on a patient's smile. Excessive gingival display due to gingival enlargement or altered passive eruption (dentogingival cause) can be corrected effectively through periodontal surgeries. This article describes two successful esthetic crown-lengthening surgeries that were guided by an acetate template to better predict the outcomes of the surgical procedures in relation to the symmetry and harmony of the gingival contour. This article also highlights the importance of utilizing an interdisciplinary approach to obtain an optimum esthetic result for restorative treatments in the anterior maxilla.

  19. Peripheral nerve lengthening as a regenerative strategy

    Institute of Scientific and Technical Information of China (English)

    Kenneth M.Vaz; Justin M.Brown; Sameer B.Shah

    2014-01-01

    Peripheral nerve injury impairs motor, sensory, and autonomic function, incurring substantial ifnancial costs and diminished quality of life. For large nerve gaps, proximal lesions, or chronic nerve injury, the prognosis for recovery is particularly poor, even with autografts, the current gold standard for treating small to moderate nerve gaps. In vivo elongation of intact proximal stumps towards the injured distal stumps of severed peripheral nerves may offer a promising new strategy to treat nerve injury. This review describes several nerve lengthening strategies, in-cluding a novel internal ifxator device that enables rapid and distal reconnection of proximal and distal nerve stumps.

  20. 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

  1. 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

    2013-11-01

    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 five groups: (1) normal FDP tendon, (2) CaP (non-extraction and mineralization without fetuin), (3) CaPEXT (Extraction by Na2 HPO4 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.

  2. Peroneal tendon disorders

    Science.gov (United States)

    Davda, Kinner; Malhotra, Karan; O’Donnell, Paul; Singh, Dishan; Cullen, Nicholas

    2017-01-01

    Pathological abnormality of the peroneal tendons is an under-appreciated source of lateral hindfoot pain and dysfunction that can be difficult to distinguish from lateral ankle ligament injuries. Enclosed within the lateral compartment of the leg, the peroneal tendons are the primary evertors of the foot and function as lateral ankle stabilisers. Pathology of the tendons falls into three broad categories: tendinitis and tenosynovitis, tendon subluxation and dislocation, and tendon splits and tears. These can be associated with ankle instability, hindfoot deformity and anomalous anatomy such as a low lying peroneus brevis or peroneus quartus. A thorough clinical examination should include an assessment of foot type (cavus or planovalgus), palpation of the peronei in the retromalleolar groove on resisted ankle dorsiflexion and eversion as well as testing of lateral ankle ligaments. Imaging including radiographs, ultrasound and MRI will help determine the diagnosis. Treatment recommendations for these disorders are primarily based on case series and expert opinion. The aim of this review is to summarise the current understanding of the anatomy and diagnostic evaluation of the peroneal tendons, and to present both conservative and operative management options of peroneal tendon lesions. Cite this article: EFORT Open Rev 2017;2:281-292. DOI: 10.1302/2058-5241.2.160047 PMID:28736620

  3. How Obesity Affects Tendons?

    Science.gov (United States)

    Abate, Michele; Salini, Vincenzo; Andia, Isabel

    Several epidemiological and clinical observations have definitely demonstrated that obesity has harmful effects on tendons. The pathogenesis of tendon damage is multi-factorial. In addition to overload, attributable to the increased body weight, which significantly affects load-bearing tendons, systemic factors play a relevant role. Several bioactive peptides (chemerin, leptin, adiponectin and others) are released by adipocytes, and influence tendon structure by means of negative activities on mesenchymal cells. The ensuing systemic state of chronic, sub-clinic, low-grade inflammation can damage tendon structure. Metabolic disorders (diabetes, impaired glucose tolerance, and dislipidemia), frequently associated with visceral adiposity, are concurrent pathogenetic factors. Indeed, high glucose levels increase the formation of Advanced Glycation End-products, which in turn form stable covalent cross-links within collagen fibers, modifying their structure and functionality.Sport activities, so useful for preventing important cardiovascular complications, may be detrimental for tendons if they are submitted to intense acute or chronic overload. Therefore, two caution rules are mandatory: first, to engage in personalized soft training program, and secondly to follow regular check-up for tendon pathology.

  4. Quantum Authentication Based on the Lengthened String Scheme

    Institute of Scientific and Technical Information of China (English)

    GUO Fen-zhuo; WEN Qiao-yan; ZHU Fu-chen

    2004-01-01

    Assuming there is a shared string between the users, we present a novel scheme, the lengthened string scheme (LSS), where the shared string is lengthened firstly by a specially designed algorithm, then some special treatments are applied on the lengthened one before it is used to authenticate. Based on the lengthened string scheme (LSS) we propose a quantum authentication protocol using entanglements. And the robustness of our protocol is discussed. In fact all the quantum key distribution protocols can do identification simultaneously based on the LSS.

  5. Surgical lengthening of the clinical tooth crown.

    Science.gov (United States)

    Planciunas, Liudvikas; Puriene, Alina; Mackeviciene, Grazina

    2006-01-01

    To understand why the crown lengthening may be desirable, a review of periodontal anatomy is in order. The odontologists know, but often underestimate importance of periodontal tissues health to restoration of defected teeth or dental arches. In order to avoid pathological changes, to predict treatment results more precisely, it is necessary to keep gingival biological width unaltered during teeth restoration. If there are less than 2 mm from restoration's margin to marginal bone clinical crown lengthening possibility should be considered in dental treatment plan. The choice depends on relationship of crown-root-alveolar bone and esthetical expectations. In order to keep margins of restoration supragingivally the distance from marginal bone to margins of restoration should not be less than 3 mm. Ideally the margins of restoration should be supragingivally or in the same level as marginal gingiva. When the margins of restoration are prepared subgingivally, the distance from marginal gingiva to margins of restoration should not be more than 0.7 mm. To continue dental treatment in operated area is recommended not earlier than in 4 weeks, and making restorations in esthetical area--not earlier than in 6 weeks.

  6. Identification of electrically stimulated quadriceps - lower leg dynamics - the use of accelerometers for estimating knee joint acceleration and quadriceps torque

    NARCIS (Netherlands)

    Veltink, Peter H.; Tijsmans, Roel; Franken, Henry M.; Boom, Herman B.K.

    1992-01-01

    Knee joiiit acceleration aid quadriceps torque call be estbated from the signals of two tangentially yliiced accelerometers. This euables the ideutificatiou of qundriceps dynamics, loaded with a freely swiugiug lower leg, during electrical stimulation.

  7. Tendinopathy alters cumulative transverse strain in the patellar tendon after exercise.

    Science.gov (United States)

    Wearing, Scott C; Locke, Simon; Smeathers, James E; Hooper, Sue L

    2015-02-01

    This research evaluated the effect of tendinopathy on the cumulative transverse strain response of the patellar tendon to a bout of resistive quadriceps exercise. Nine adults with unilateral patellar tendinopathy (age, 18.2 ± 0.7 yr; height, 1.92 ± 0.06 m; weight, 76.8 ± 6.8 kg) and 10 healthy adults free of knee pain (age, 17.8 ± 0.8 yr; height, 1.83 ± 0.05 m; weight, 73.2 ± 7.6 kg) underwent standardized sagittal sonograms (7.2-14 MHz linear array transducer) of both patellar tendons immediately before and after 45 repetitions of a double-leg decline squat exercise performed against a resistance of 145% body weight. Tendon thickness was determined 5 and 25 mm distal to the patellar pole. Transverse Hencky strain was calculated as the natural log of the ratio of post- to preexercise tendon thickness and expressed as percentage. Measures of tendon echogenicity were calculated within the superficial and deep aspects of each tendon site from grayscale profiles. Intratendinous microvessels were evaluated using power Doppler ultrasound. The cumulative transverse strain response to exercise in symptomatic tendinopathy was significantly lower than that in asymptomatic and healthy tendons (P tendinopathy score. This study is the first to show that patellar tendinopathy is associated with altered morphological and mechanical response of the tendon to exercise, which is manifest by reduction in cumulative transverse strain and microvascularity, when present. Research directed toward identifying factors that influence the acute microvascular and transverse strain response of the patellar tendon to exercise in the various stages of tendinopathy is warranted.

  8. 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.

  9. Clinical thresholds for quadriceps assessment after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Kuenze, Christopher; Hertel, Jay; Saliba, Susan; Diduch, David R; Weltman, Arthur; Hart, Joseph M

    2015-02-01

    Normal, symmetrical quadriceps strength is a common clinical goal after anterior cruciate ligament reconstruction (ACLR). Currently, the clinical thresholds for acceptable unilateral quadriceps function and symmetry associated with positive outcomes after return to activity are unclear. To establish quadriceps-activation and knee-extension-torque cutoffs for clinical assessment after return to activity after ACLR. Descriptive laboratory study. Laboratory. 22 (10 female, 12 male; age = 22.5 ± 5.0 y, height = 172.9 ± 7.1 cm, mass = 74.1 ± 15.5 kg, months since surgery = 31.5 ± 23.5) recreationally active persons with a history of unilateral, primary ACLR at least 6 months prior and 24 (12 female/12 male, age = 21.7 ± 3.6 y, height = 168.0 ± 8.8 cm, mass = 69.3 ± 13.6 kg) recreationally active healthy participants. Patient-reported measures of pain, knee-related function, and physical activity level were recorded for all participants. Normalized knee-extension maximum-voluntary-isometric-contraction (MVIC) torque (Nm/kg) and quadriceps central-activation ratio (CAR, %) were measured bilaterally in all participants. Receiver-operator-characteristic (ROC) curves were used to establish thresholds for unilateral measures of normalized knee-extension MVIC torque and quadriceps CAR, as well as limb-symmetry indices (LSI). ROC curves then established clinical thresholds for normalized knee-extension MVIC torque and quadriceps CAR LSIs associated with healthy knee-related function. Involved-quadriceps CAR above 89.3% was the strongest unilateral indicator of healthy-group membership, while quadriceps CAR LSI above 0.996 and knee-extension MVIC torque above 0.940 were the strongest overall indicators. Unilateral normalized knee-extension MVIC torque above 3.00 Nm/kg and quadriceps CAR LSI above 0.992 were the best indicators of good patient-reported knee-related outcomes. Threshold values established in this study may provide a guide for clinicians when making return

  10. Muscle-Tendon Unit Properties during Eccentric Exercise Correlate with the Creatine Kinase Response

    Directory of Open Access Journals (Sweden)

    Kirsty M. Hicks

    2017-09-01

    Full Text Available Aim: The aim of this paper was to determine whether; (1 patella tendon stiffness, (2 the magnitude of vastus lateralis fascicle lengthening, and (3 eccentric torque correlate with markers of exercise induced muscle damage.Method: Combining dynamometry and ultrasonography, patella tendon properties and vastus lateralis architectural properties were measured pre and during the first of six sets of 12 maximal voluntary eccentric knee extensions. Maximal isometric torque loss and creatine kinase activity were measured pre-damage (−48 h, 48, 96, and 168 h post-damage as markers of exercise-induced muscle damage.Results: A significant increase in creatine kinase (883 ± 667 UL and a significant reduction in maximal isometric torque loss (21% was reported post-eccentric contractions. Change in creatine kinase from pre to peak significantly correlated with the relative change in vastus lateralis fascicle length during eccentric contractions (r = 0.53, p = 0.02 and with eccentric torque (r = 0.50, p = 0.02. Additionally, creatine kinase tended to correlate with estimated patella tendon lengthening during eccentric contractions (p < 0.10. However, creatine kinase did not correlate with resting measures of patella tendon properties or vastus lateralis properties. Similarly, torque loss did not correlate with any patella tendon or vastus lateralis properties at rest or during eccentric contractions.Conclusion: The current study demonstrates that the extent of fascicle strain during eccentric contractions correlates with the magnitude of the creatine kinase response. Although at rest, there is no relationship between patella tendon properties and markers of muscle damage; during eccentric contractions however, the patella tendon may play a role in the creatine kinase response following EIMD.

  11. Tendon transfer or tendon graft for ruptured finger extensor tendons in rheumatoid hands.

    Science.gov (United States)

    Chung, U S; Kim, J H; Seo, W S; Lee, K H

    2010-05-01

    We evaluated the clinical outcome of tendon reconstruction using tendon graft or tendon transfer and the parameters related to clinical outcome in 51 wrists of 46 patients with rheumatoid arthritis with finger extensor tendon ruptures. At a mean follow-up of 5.6 years, the mean metacarpophalangeal (MP) joint extension lag was 8 degrees (range, 0-45) and the mean visual analogue satisfaction scale was 74 (range, 10-100). Clinical outcome did not differ significantly between tendon grafting and tendon transfer. The MP joint extension lag correlated with the patient's satisfaction score, but the pulp-to-palm distance did not correlate with patient satisfaction. We conclude that both tendon grafting and tendon transfer are reliable reconstruction methods for ruptured finger extensor tendons in rheumatoid hands.

  12. Regulation of tendon differentiation by scleraxis distinguishes force-transmitting tendons from muscle-anchoring tendons.

    Science.gov (United States)

    Murchison, Nicholas D; Price, Brian A; Conner, David A; Keene, Douglas R; Olson, Eric N; Tabin, Clifford J; Schweitzer, Ronen

    2007-07-01

    The scleraxis (Scx) gene, encoding a bHLH transcription factor, is expressed in the progenitors and cells of all tendon tissues. To determine Scx function, we produced a mutant null allele. Scx-/- mice were viable, but showed severe tendon defects, which manifested in a drastically limited use of all paws and back muscles and a complete inability to move the tail. Interestingly, although the differentiation of all force-transmitting and intermuscular tendons was disrupted, other categories of tendons, the function of which is mainly to anchor muscles to the skeleton, were less affected and remained functional, enabling the viability of Scx-/- mutants. The force-transmitting tendons of the limbs and tail varied in the severity to which they were affected, ranging from dramatic failure of progenitor differentiation resulting in the loss of segments or complete tendons, to the formation of small and poorly organized tendons. Tendon progenitors appeared normal in Scx-/- embryos and a phenotype resulting from a failure in the condensation of tendon progenitors to give rise to distinct tendons was first detected at embryonic day (E)13.5. In the tendons that persisted in Scx-/- mutants, we found a reduced and less organized tendon matrix and disorganization at the cellular level that led to intermixing of tenocytes and endotenon cells. The phenotype of Scx-/- mutants emphasizes the diversity of tendon tissues and represents the first molecular insight into the important process of tendon differentiation.

  13. Physeal growth arrest after tibial lengthening in achondroplasia

    Science.gov (United States)

    2012-01-01

    Background and purpose Bilateral tibial lengthening has become one of the standard treatments for upper segment-lower segment disproportion and to improve quality of life in achondroplasia. We determined the effect of tibial lengthening on the tibial physis and compared tibial growth that occurred at the physis with that in non-operated patients with acondroplasia. Methods We performed a retrospective analysis of serial radiographs until skeletal maturity in 23 achondroplasia patients who underwent bilateral tibial lengthening before skeletal maturity (lengthening group L) and 12 achondroplasia patients of similar height and age who did not undergo tibial lengthening (control group C). The mean amount of lengthening of tibia in group L was 9.2 cm (lengthening percentage: 60%) and the mean age at the time of lengthening was 8.2 years. The mean duration of follow-up was 9.8 years. Results Skeletal maturity (fusion of physis) occurred at 15.2 years in group L and at 16.0 years in group C. The actual length of tibia (without distraction) at skeletal maturity was 238 mm in group L and 277 mm in group C (p = 0.03). The mean growth rates showed a decrease in group L relative to group C from about 2 years after surgery. Physeal closure was most pronounced on the anterolateral proximal tibial physis, with relative preservation of the distal physis. Interpretation Our findings indicate that physeal growth rate can be disturbed after tibial lengthening in achondroplasia, and a close watch should be kept for such an occurrence—especially when lengthening of more than 50% is attempted. PMID:22489887

  14. Tendon sheath fibroma of the medial canthal tendon.

    Science.gov (United States)

    Andrew, Nicholas; Dodd, Tom; Selva, Dinesh; Davis, Garry

    2013-01-01

    Fibromas of the tendon sheath are slow-growing, benign tumors most commonly found on the hands and wrist. A fibroma of the tendon sheath arising from the medial canthal tendon presented as an enlarging nodule that had been present for 40 years. The fibroma was identified by microscopy and immunohistochemistry, and surgical resection appears to have been curative.

  15. Steroid injections - tendon, bursa, joint

    Science.gov (United States)

    ... medlineplus.gov/ency/article/007678.htm Steroid injections - tendon, bursa, joint To use the sharing features on ... painful. It can be injected into a joint, tendon, or bursa. Description Your health care provider inserts ...

  16. Whey protein hydrolysate augments tendon and muscle hypertrophy independent of resistance exercise contraction mode.

    Science.gov (United States)

    Farup, J; Rahbek, S K; Vendelbo, M H; Matzon, A; Hindhede, J; Bejder, A; Ringgard, S; Vissing, K

    2014-10-01

    In a comparative study, we investigated the effects of maximal eccentric or concentric resistance training combined with whey protein or placebo on muscle and tendon hypertrophy. 22 subjects were allocated into either a high-leucine whey protein hydrolysate + carbohydrate group (WHD) or a carbohydrate group (PLA). Subjects completed 12 weeks maximal knee extensor training with one leg using eccentric contractions and the other using concentric contractions. Before and after training cross-sectional area (CSA) of m. quadriceps and patellar tendon CSA was quantified with magnetic resonance imaging and a isometric strength test was used to assess maximal voluntary contraction (MVC) and rate of force development (RFD). Quadriceps CSA increased by 7.3 ± 1.0% (P contraction mode. MVC and RFD increased by 15.6 ± 3.5% (P contraction mode effects. In conclusion, high-leucine whey protein hydrolysate augments muscle and tendon hypertrophy following 12 weeks of resistance training - irrespective of contraction mode. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Custom Knee Device for Knee Contractures After Internal Femoral Lengthening.

    Science.gov (United States)

    Bhave, Anil; Shabtai, Lior; Ong, Peck-Hoon; Standard, Shawn C; Paley, Dror; Herzenberg, John E

    2015-07-01

    The development of knee flexion contractures is among the most common problems and complications associated with lengthening the femur with an internal device or external fixator. Conservative treatment strategies include physical therapy, serial casting, and low-load prolonged stretching with commercially available splinting systems. The authors developed an individually molded, low-cost custom knee device with polyester synthetic conformable casting material to treat knee flexion contractures. The goal of this study was to evaluate the results of treatment with a custom knee device and specialized physical therapy in patients who had knee flexion contracture during femoral lengthening with an intramedullary lengthening femoral nail. This retrospective study included 23 patients (27 limbs) who underwent femoral lengthening with an internal device for the treatment of limb length discrepancy. All patients had a knee flexion contracture raging from 10° to 90° during the lengthening process and were treated with a custom knee device and specialized physical therapy. The average flexion contracture before treatment was 36°. The mean amount of lengthening was 5.4 cm. After an average of 3.8 weeks of use of the custom knee device, only 2 of 27 limbs (7.5%) had not achieved complete resolution of the flexion contracture. The average final extension was 1.4°. Only 7 of 27 limbs (26%) required additional soft tissue release. The custom knee device is an inexpensive and effective method for treating knee flexion contracture after lengthening with an internal device.

  18. Arthroscopic Treatment of Calcific Tendonitis

    OpenAIRE

    2014-01-01

    Calcific tendonitis, or calcifying tendonitis, is a common disorder characterized by the multifocal accumulation of basic calcium phosphate crystals within the rotator cuff tendons. In most cases, the multifocal calcifications are located 1 to 2 cm from the insertion of the supraspinatus tendon on the greater tuberosity. The initial treatment should be nonoperative including oral anti-inflammatory medication and physical therapy. If this is unsuccessful, arthroscopic debridement of the deposi...

  19. Tendon Driven Finger Actuation System

    Science.gov (United States)

    Ihrke, Chris A. (Inventor); Reich, David M. (Inventor); Bridgwater, Lyndon (Inventor); Linn, Douglas Martin (Inventor); Askew, Scott R. (Inventor); Diftler, Myron A. (Inventor); Platt, Robert (Inventor); Hargrave, Brian (Inventor); Valvo, Michael C. (Inventor); Abdallah, Muhammad E. (Inventor); hide

    2013-01-01

    A humanoid robot includes a robotic hand having at least one finger. An actuation system for the robotic finger includes an actuator assembly which is supported by the robot and is spaced apart from the finger. A tendon extends from the actuator assembly to the at least one finger and ends in a tendon terminator. The actuator assembly is operable to actuate the tendon to move the tendon terminator and, thus, the finger.

  20. The role of variable muscle adaptation to limb lengthening in the development of joint contractures: an experimental study in the goat.

    Science.gov (United States)

    Makarov, Marina; Birch, John; Samchukov, Mikhail

    2009-03-01

    Muscle stiffness and joint contractures are currently regarded as the most common complications of limb lengthening. To better understand the mechanisms of joint contractures, architectural changes of all involved muscles were analyzed in 9 goats after 20% tibial lengthening with standard distraction protocol.All 13 muscles of the goat's tibia were found to be organized into an anterior compartment with 2 longitudinal and 4 pennate muscles and a posterior compartment with 1 longitudinal and 6 pennate muscles. Longitudinal muscles showed better compliance to distraction than pinnate muscles. Although muscle-to-bone lengthening ratio ranged widely (0-1.2), most of the muscles and especially those located in the posterior compartment showed much less lengthening than the bone. Muscular portions of the muscles lengthened more substantially (average, 17%) than their associated tendons (average, 7%). Muscle fiber length changes varied greatly between muscles (range, 0%-88%). Normalization of muscle fiber length revealed considerable elongation of anterior muscles fibers (25%) that was associated with an addition of new sarcomeres in series. Fiber length increase of all posterior muscles but one occurred by stretching of existing sarcomeres, with little addition or even dissolution of sarcomeres in series. This correlated with muscle mass changes showing significant muscle atrophy in the posterior compartment and better mass preservation in the anterior compartment.The study revealed striking difference in response to limb lengthening between individual muscles and muscles from antagonistic compartments in particular. Poor sarcomerogenesis in the posterior muscles leading to their insufficient length increase seems to play major role in the development of joint contractures.

  1. Clinical aspects of tendon healing

    NARCIS (Netherlands)

    J.C.H.M. van der Meulen (Jacques)

    1974-01-01

    textabstractWe know that healing of a tendon wound takes place by an invasion of fibreblasts from the surrounding tissues; the tendon itself has no intrinsic healing capacity. lt was Potenza (1962) who proved that a traumatic suture of the tendons within their sheath is followed by disintegration of

  2. Clinical aspects of tendon healing

    NARCIS (Netherlands)

    J.C.H.M. van der Meulen (Jacques)

    1974-01-01

    textabstractWe know that healing of a tendon wound takes place by an invasion of fibreblasts from the surrounding tissues; the tendon itself has no intrinsic healing capacity. lt was Potenza (1962) who proved that a traumatic suture of the tendons within their sheath is followed by disintegration of

  3. Foam Rolling of Quadriceps Decreases Biceps Femoris Activation.

    Science.gov (United States)

    Cavanaugh, Mark Tyler; Aboodarda, Saied Jalal; Hodgson, Daniel; Behm, David George

    2016-09-06

    Foam rolling has been shown to increase range of motion without subsequent performance impairments of the rolled muscle, however, there are no studies examining rolling effects on antagonist muscles. The objective of this study was to determine whether foam rolling the hamstrings and/or quadriceps would affect hamstrings and quadriceps activation in men and women. Recreationally active men (n=10, 25 ± 4.6 years, 180.1 ± 4.4 cm, 86.5 ± 15.7 kg) and women (n=8, 21.75 ± 3.2 years, 166.4 ± 8.8 cm, 58.9 ± 7.9 kg) had surface electromyographic activity analyzed in the dominant vastus lateralis (VL), vastus medialis (VM), and biceps femoris (BF) muscles upon a single leg landing from a hurdle jump under four conditions. Conditions included rolling of the hamstrings, quadriceps, both muscle groups and a control session. BF activation significantly decreased following quadriceps foam rolling (F(1,16) = 7.45, p = 0.015, -8.9%). There were no significant changes in quadriceps activation following hamstrings foam rolling. This might be attributed to the significantly greater levels of perceived pain with quadriceps rolling applications (F(1,18) = 39.067, p foam rolling for VL (F(6,30) = 1.31, p = 0.283) VM (F(6,30) = 1.203, p = 0.332) or BF (F(6,36) = 1.703, p = 0.199). Antagonist muscle activation may be altered following agonist foam rolling, however, it can be suggested that any changes in activation are likely a result of reciprocal inhibition due to increased agonist pain perception.

  4. Crown lengthening procedure in the management of amelogenesis imperfecta.

    Science.gov (United States)

    Kalaivani, S; Manohar, Jenish; Shakunthala, P; Sujatha, S; Rajasekaran, S A; Karthikeyan, B; Kalaiselvan, S

    2015-08-01

    Full mouth rehabilitation includes a promising treatment planning and execution thus fulfilling esthetic, occlusal, and functional parameters maintaining the harmony of the stomatognathic system. Crown lengthening procedures have become an integral component of the esthetic armamentarium and are utilized with increasing frequency to enhance the appearance of restorations placed in the esthetic zone. Crown lengthening plays a role to create healthy relationship of the gingiva and bone levels so as to gain access to more of the tooth which can be restored, if it is badly worn, decayed or fractured, below the gum line. This paper highlights the full mouth crown lengthening procedure performed on a patient with amelogenesis imperfecta.

  5. Crown lengthening and restorative treatment in mutilated molars.

    Science.gov (United States)

    Parashis, A; Tripodakis, A

    1994-03-01

    Crown lengthening has been advocated as a treatment modality to restore teeth with a clinical crown reduced subsequent to different kinds of trauma. Multirooted teeth, however, present certain anatomic features, such as the furcation area and corresponding interradicular bone, the retromolar area, and the external oblique ridge, that may limit the possibility for soft tissue and bone reduction and minimize the effectiveness of crown-lengthening procedures. This article describes surgical modifications to overcome the anatomic difficulties that multirooted teeth present when crown lengthening is required. Furthermore, root resection is discussed as an alternative to conventional surgery when the latter is not possible.

  6. Crown lengthening procedure in the management of amelogenesis imperfecta

    Science.gov (United States)

    Kalaivani, S.; Manohar, Jenish; Shakunthala, P.; Sujatha, S.; Rajasekaran, S. A.; Karthikeyan, B.; Kalaiselvan, S.

    2015-01-01

    Full mouth rehabilitation includes a promising treatment planning and execution thus fulfilling esthetic, occlusal, and functional parameters maintaining the harmony of the stomatognathic system. Crown lengthening procedures have become an integral component of the esthetic armamentarium and are utilized with increasing frequency to enhance the appearance of restorations placed in the esthetic zone. Crown lengthening plays a role to create healthy relationship of the gingiva and bone levels so as to gain access to more of the tooth which can be restored, if it is badly worn, decayed or fractured, below the gum line. This paper highlights the full mouth crown lengthening procedure performed on a patient with amelogenesis imperfecta. PMID:26538965

  7. ATRX represses alternative lengthening of telomeres.

    Science.gov (United States)

    Napier, Christine E; Huschtscha, Lily I; Harvey, Adam; Bower, Kylie; Noble, Jane R; Hendrickson, Eric A; Reddel, Roger R

    2015-06-30

    The unlimited proliferation of cancer cells requires a mechanism to prevent telomere shortening. Alternative Lengthening of Telomeres (ALT) is an homologous recombination-mediated mechanism of telomere elongation used in tumors, including osteosarcomas, soft tissue sarcoma subtypes, and glial brain tumors. Mutations in the ATRX/DAXX chromatin remodeling complex have been reported in tumors and cell lines that use the ALT mechanism, suggesting that ATRX may be an ALT repressor. We show here that knockout or knockdown of ATRX in mortal cells or immortal telomerase-positive cells is insufficient to activate ALT. Notably, however, in SV40-transformed mortal fibroblasts ATRX loss results in either a significant increase in the proportion of cell lines activating ALT (instead of telomerase) or in a significant decrease in the time prior to ALT activation. These data indicate that loss of ATRX function cooperates with one or more as-yet unidentified genetic or epigenetic alterations to activate ALT. Moreover, transient ATRX expression in ALT-positive/ATRX-negative cells represses ALT activity. These data provide the first direct, functional evidence that ATRX represses ALT.

  8. Surgical crown lengthening: a periodontal and restorative interdisciplinary approach.

    Science.gov (United States)

    Parwani, Simran R; Parwani, Rajkumar N

    2014-01-01

    Surgical crown lengthening helps to provide an adequate retention form for proper tooth preparation, thus enabling dentists to create esthetically pleasing and healthy restorations. Long-term stability requires accurate diagnosis and development of a comprehensive treatment plan in each case. This sequence of events stresses the importance of communication between the restorative dentist and the periodontist. This article presents 2 cases that involve surgical crown lengthening (including mucoperiosteal flap and ostectomy) for the restoration of teeth.

  9. Crown lengthening procedure in the management of amelogenesis imperfecta

    OpenAIRE

    2015-01-01

    Full mouth rehabilitation includes a promising treatment planning and execution thus fulfilling esthetic, occlusal, and functional parameters maintaining the harmony of the stomatognathic system. Crown lengthening procedures have become an integral component of the esthetic armamentarium and are utilized with increasing frequency to enhance the appearance of restorations placed in the esthetic zone. Crown lengthening plays a role to create healthy relationship of the gingiva and bone levels s...

  10. Practical Aspects of Posttrauma Reconstruction With an Intramedullary Lengthening Nail.

    Science.gov (United States)

    Bernstein, Mitchell

    2017-06-01

    Limb equalization using the Ilizarov method has evolved and adapted the use of internal lengthening devices. One of the newest devices, termed "PRECICE," is a magnetically controlled telescoping nail. Complications such as pin site infection and skin irritation are eliminated. Despite trauma surgeons' familiarity with intramedullary nailing, the Ilizarov method requires sound knowledge of deformity analysis and awareness of specific complications associated with distraction osteogenesis. This manuscript discusses some of the practical preoperative and intraoperative components of limb lengthening.

  11. Physeal growth arrest after tibial lengthening in achondroplasia

    OpenAIRE

    Song, Sang-Heon; Agashe, Mandar Vikas; Huh, Young-Jae; Hwang, Soon-Young; Song, Hae-Ryong

    2012-01-01

    Background and purpose Bilateral tibial lengthening has become one of the standard treatments for upper segment-lower segment disproportion and to improve quality of life in achondroplasia. We determined the effect of tibial lengthening on the tibial physis and compared tibial growth that occurred at the physis with that in non-operated patients with acondroplasia. Methods We performed a retrospective analysis of serial radiographs until skeletal maturity in 23 achondroplasia patients who und...

  12. Three different surgical techniques of crown lengthening: A comparative study

    OpenAIRE

    Ramya Nethravathy; Santhana Krishnan Vinoth; Ashwin Varghese Thomas

    2013-01-01

    Introduction: A short clinical crown may lead to poor retention form thereby leading to improper tooth preparation. Surgical crown lengthening procedure is done to increase the clinical crown length without violating the biologic width. Several techniques have been proposed for clinical crown lengthening which includes gingivectomy, apically displaced flap with or without resective osseous surgery, and surgical extrusion using periotome. Objective: The aim of this paper is to compare clinical...

  13. Tendon and skeletal muscle matrix gene expression and functional responses to immobilisation and rehabilitation in young males

    DEFF Research Database (Denmark)

    Boesen, Anders Ploug; Dideriksen, Kasper; Couppé, Christian

    2013-01-01

    We examined the effect of growth hormone (GH) on connective tissue of tendon and skeletal muscle during immobilisation and re-training in humans. Young men (20-30 years; n=20) were randomly assigned to daily recombinant GH (rhGH)(33-50μg/kg/d) or placebo (Plc), and had one leg immobilised for two...... weeks followed by six weeks of strength training. Cross sectional area (CSA), maximal muscle strength (MVC) and biomechanical properties of m.quadriceps and patellar tendon were determined. Muscle and tendon biopsies were analysed for mRNA of collagen (COL-1A1/3A1), insulin-like growth factors (IGF-1Ea....../Ec), lysyloxidase (LOX), matrix metalloproteases (MMP-2 and -9), decorin and tenascin-C. Fibril morphology was analysed by transmission electron microscope (TEM) to detect changes in fibril diameter distribution. In muscle the CSA and MVC declined with immobilisation, and recovered with rehabilitation similar...

  14. Inflamed shoulder tendons (image)

    Science.gov (United States)

    Tearing and inflammation of the tendons of the shoulder muscles can occur in sports which require the arm to be moved over the head repeatedly as in tennis, pitching, swimming, and lifting weights. Most often the shoulder will heal if a break is taken from ...

  15. Do early quadriceps exercises affect the outcome of ACL reconstruction? A randomised controlled trial.

    Science.gov (United States)

    Shaw, Triston; Williams, Marie T; Chipchase, Lucy S

    2005-01-01

    A prospective, blinded, randomised controlled trial investigated the effectiveness of quadriceps exercises following anterior cruciate ligament reconstruction. A treatment group (Quadriceps exercise group) performed straight leg raises and isometric quadriceps contractions throughout the first two postoperative weeks, and a second group (No quadriceps exercise group) did not. A battery of outcome measures assessed subjects postoperatively at day one, two weeks, and one, three and six months. A total of 103 patients (Quadriceps exercise n = 48, No quadriceps exercise n = 55) commenced the study with 91 subjects available at final follow up (Quadriceps exercise n = 47, No quadriceps exercise n = 44). Performance of quadriceps exercises significantly improved a number of knee flexion and extension range of motion measurements (p = 0.01 to 0.04). No significant differences were found between the two groups at any postoperative period for quadriceps lag (p = 0.36), functional hop testing (p = 0.49 to 0.51), isokinetic quadriceps strength (p = 0.70 to 0.72), the majority of numerical analogue scores (p = 0.1 to 0.94) and Cincinnati scores (p = 0.10 to 0.84). Subjects performing quadriceps exercises reported significantly higher pain scores with exercise on the first postoperative day (p = 0.02). At six months postoperatively, the Quadriceps exercise subjects reported significantly more favourable Cincinnati scores for symptoms (p = 0.005) and problems with sport (p = 0.05). While average knee laxity was not significantly different between treatment groups over time (p = 0.27 to 0.94), quadriceps exercise performance was associated with a significantly lower incidence of abnormal knee laxity. Isometric quadriceps exercises and straight leg raises can be safely prescribed during the first two postoperative weeks and confer advantages for faster recovery of knee range of motion and stability. It remains to be proven whether the magnitude of differences between groups is

  16. Experimental quadriceps muscle pain impairs knee joint control during walking

    DEFF Research Database (Denmark)

    Henriksen, Marius; Alkjaer, Tine; Lund, Hans

    2007-01-01

    of the quadriceps muscle, resulting in impaired knee joint control and joint instability during walking. The changes are similar to those observed in patients with knee pain. The loss of joint control during and after pain may leave the knee joint prone to injury and potentially participate in the chronicity...

  17. Adductor Canal Block versus Femoral Nerve Block and Quadriceps Strength

    DEFF Research Database (Denmark)

    Jæger, Pia Therese; Nielsen, Zbigniew Jerzy Koscielniak; Henningsen, Lene Marianne;

    2013-01-01

    : The authors hypothesized that the adductor canal block (ACB), a predominant sensory blockade, reduces quadriceps strength compared with placebo (primary endpoint, area under the curve, 0.5-6 h), but less than the femoral nerve block (FNB; secondary endpoint). Other secondary endpoints were...

  18. Limb lengthening in Africa: tibial lengthening indicated for limb length discrepancy and postosteomyelitis pseudarthrosis

    Directory of Open Access Journals (Sweden)

    Ibrahima F

    2014-05-01

    Full Text Available Farikou Ibrahima,1,2 Pius Fokam,2 Félicien Faustin Mouafo Tambo11Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, 2Department of Surgery, Douala General Hospital, Douala, CameroonBackground: We present a case of lengthening of a tibia to treat postosteomyelitis pseudarthrosis and limb length discrepancy by the Ilizarov device.Objective: The objective was to treat the pseudarthrosis and correct the consequent limb length discrepancy of 50 mm.Materials and methods: The patient was a 5-year-old boy. Osteotomy of the tibia, excision of fibrosis, and decortications were carried out. After a latency period of 5 days, the lengthening started at a rate of 1 mm per day.Results: The pseudarthrosis healed and the gained correction was 21.73%. The index consolidation was 49 days/cm. Minor complications were reported.Discussion: Osteomyelitis of long bones is a common poverty-related disease in Africa. The disease usually is diagnosed at an advanced stage with complications. In these conditions, treatment is much more difficult. Most surgical procedures treating this condition use the Ilizarov device. The most common reported surgical complications are refractures and recurrence of infection.Conclusion: This technique should be popularized in countries with limited resources because it would be an attractive alternative to the amputations that are sometimes performed.Keywords: Limb length discrepancy (LLD, bone gap, Ilizarov device

  19. 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 knee extension power. The lower 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

  20. Functional changes of human quadriceps muscle injured by eccentric exercise

    Directory of Open Access Journals (Sweden)

    F.V. Serrão

    2003-06-01

    Full Text Available The present study evaluated functional changes of quadriceps muscle after injury induced by eccentric exercise. Maximal isometric torque of quadriceps and the surface electromyography (root mean square, RMS, and median frequency, MDF of the vastus medialis oblique (VMO and vastus lateralis (VL muscles were examined before, immediately after and during the first 7 days after injury. Serum creatine kinase (CK levels and magnetic resonance imaging (MRI were used to identify muscle injury. The subject was used as her own control and percent refers to pre-injury data. Experiments were carried out with a sedentary 23-year-old female. Injury was induced by 4 bouts of 15 maximal isokinetic eccentric contractions (angular velocity of 5º/s; range of motion from 40º to 110º of knee flexion. The isometric torque of the quadriceps (knee at 90º flexion decreased 52% immediately after eccentric exercise and recovered on the 5th day. The highest reduction of RMS occurred on the 2nd day after injury in both VL (63% and VMO (66% and only VL recovered to the pre-injury level on the 7th day. Immediately after injury, the MDF decreased by 5 and 3% (VMO and VL, respectively and recovered one day later. Serum CK levels increased by 109% on the 2nd day and were still increased by 32% on the 7th day. MRI showed large areas of injury especially in the deep region of quadriceps. In conclusion, eccentric exercise decreased the isometric torque and electromyographic signals of quadriceps muscle, which were recovered in one week, despite the muscle regeneration signals.

  1. CONTRIBUTION OF HAMSTRING FATIGUE TO QUADRICEPS INHIBITION FOLLOWING LUMBAR EXTENSION EXERCISE

    Directory of Open Access Journals (Sweden)

    Joseph M. Hart

    2006-03-01

    Full Text Available The purpose of this study was to determine the contribution of hamstrings and quadriceps fatigue to quadriceps inhibition following lumbar extension exercise. Regression models were calculated consisting of the outcome variable: quadriceps inhibition and predictor variables: change in EMG median frequency in the quadriceps and hamstrings during lumbar fatiguing exercise. Twenty-five subjects with a history of low back pain were matched by gender, height and mass to 25 healthy controls. Subjects performed two sets of fatiguing isometric lumbar extension exercise until mild (set 1 and moderate (set 2 fatigue of the lumbar paraspinals. Quadriceps and hamstring EMG median frequency were measured while subjects performed fatiguing exercise. A burst of electrical stimuli was superimposed while subjects performed an isometric maximal quadriceps contraction to estimate quadriceps inhibition after each exercise set. Results indicate the change in hamstring median frequency explained variance in quadriceps inhibition following the exercise sets in the history of low back pain group only. Change in quadriceps median frequency explained variance in quadriceps inhibition following the first exercise set in the control group only. In conclusion, persons with a history of low back pain whose quadriceps become inhibited following lumbar paraspinal exercise may be adapting to the fatigue by using their hamstring muscles more than controls

  2. Comparison of quadriceps-sparing minimally invasive and medial parapatellar total knee arthroplasty: A 2-year follow-up study

    Directory of Open Access Journals (Sweden)

    Hongsen Chiang

    2012-12-01

    Conclusions: Patients undergoing quadriceps-sparing and standard medial parapatellar TKA had comparable outcomes for quadriceps muscle strength, hamstring–quadriceps balance, and knee function; however, the quadriceps-sparing TKA was more time consuming surgically and resulted in a less accurate prosthesis position.

  3. A comprehensive approach to long-standing facial paralysis based on lengthening temporalis myoplasty.

    Science.gov (United States)

    Labbè, D; Bussu, F; Iodice, A

    2012-06-01

    Long-standing peripheral monolateral facial paralysis in the adult has challenged otolaryngologists, neurologists and plastic surgeons for centuries. Notwithstanding, the ultimate goal of normality of the paralyzed hemi-face with symmetry at rest, and the achievement of a spontaneous symmetrical smile with corneal protection, has not been fully reached. At the beginning of the 20(th) century, the main options were neural reconstructions including accessory to facial nerve transfer and hypoglossal to facial nerve crossover. In the first half of the 20(th) century, various techniques for static correction with autologous temporalis muscle and fascia grafts were proposed as the techniques of Gillies (1934) and McLaughlin (1949). Cross-facial nerve grafts have been performed since the beginning of the 1970s often with the attempt to transplant free-muscle to restore active movements. However, these transplants were non-vascularized, and further evaluations revealed central fibrosis and minimal return of function. A major step was taken in the second half of the 1970s, with the introduction of microneurovascular muscle transfer in facial reanimation, which, often combined in two steps with a cross-facial nerve graft, has become the most popular option for the comprehensive treatment of long-standing facial paralysis. In the second half of the 1990s in France, a regional muscle transfer technique with the definite advantages of being one-step, technically easier and relatively fast, namely lengthening temporalis myoplasty, acquired popularity and consensus among surgeons treating facial paralysis. A total of 111 patients with facial paralysis were treated in Caen between 1997 and 2005 by a single surgeon who developed 2 variants of the technique (V1, V2), each with its advantages and disadvantages, but both based on the same anatomo-functional background and aim, which is transfer of the temporalis muscle tendon on the coronoid process to the lips. For a comprehensive

  4. MRI of the Achilles tendon

    Energy Technology Data Exchange (ETDEWEB)

    Naegele, M.; Lienemann, A.; Hahn, D.; Lissner, J.; Boehm, P.

    1987-06-01

    The Achilles tendon and preachillar space of 30 patients was studied by MRI. A surface coil (Helmholtz' principle) was applied and all patients were examined with a superconducting magnet operating at 1.0 Tesla field strength. The purpose of the study was to illustrate pathological changes of the tendon and the surrounding soft tissue. In 3 cases MRI diagnosed a total rupture of the Achilles tendon. Furthermore, the strain of the tendon and side effects of an inflammatory process could be demonstrated. The use of a surface coil yields a high resolution of the normal anatomy of the region and of the pathological changes of the tendon and the surrounding soft tissue structures. The advantages of MRI for Achilles tendon diagnostics against competitive modalities are 1) excellent soft tissue contrast, 2) multiplanar imaging, 3) as well as exact delineation and visualisation of the lesion.

  5. Scaffolds in Tendon Tissue Engineering

    Directory of Open Access Journals (Sweden)

    Umile Giuseppe Longo

    2012-01-01

    Full Text Available Tissue engineering techniques using novel scaffold materials offer potential alternatives for managing tendon disorders. Tissue engineering strategies to improve tendon repair healing include the use of scaffolds, growth factors, cell seeding, or a combination of these approaches. Scaffolds have been the most common strategy investigated to date. Available scaffolds for tendon repair include both biological scaffolds, obtained from mammalian tissues, and synthetic scaffolds, manufactured from chemical compounds. Preliminary studies support the idea that scaffolds can provide an alternative for tendon augmentation with an enormous therapeutic potential. However, available data are lacking to allow definitive conclusion on the use of scaffolds for tendon augmentation. We review the current basic science and clinical understanding in the field of scaffolds and tissue engineering for tendon repair.

  6. Biologics for tendon repair ☆

    OpenAIRE

    2014-01-01

    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,...

  7. Fibroma of tendon sheath.

    Science.gov (United States)

    Smith, P S; Pieterse, A S; McClure, J

    1982-01-01

    A series of nine cases of fibroma of tendon sheath is described including details of the ultrastructural features of two cases. The series was composed of lesions from six males and three females with a mean age of 38 yr. The most common site of involvement was the hand (including fingers) and the mean greater diameter was 19 mm. Typically the tumours were lobulated and microscopically there was a collagenous stroma with spindle and stellate cells in a moderate degree of cellularity. One recurrence was noted in the series. The lesion was distinguished from circumscribed fibromatosis, nodular fasciitis, neurofibroma, leiomyoma, scar tissue, giant cell tumour of tendon sheath (localised nodular tenosynovitis) and fibrous histiocytoma. Ultrastructural studies revealed that the large majority of cells present in the two cases studied were myofibroblasts and fibroma of tendon sheath is therefore the third instance of a benign tumour containing these cells (the other two being dermatofibroma and giant cell fibroma of the oral mucosa). Images PMID:7107956

  8. Arthroscopic treatment of calcific tendonitis.

    Science.gov (United States)

    Barber, F Alan; Cowden, Courtney H

    2014-04-01

    Calcific tendonitis, or calcifying tendonitis, is a common disorder characterized by the multifocal accumulation of basic calcium phosphate crystals within the rotator cuff tendons. In most cases, the multifocal calcifications are located 1 to 2 cm from the insertion of the supraspinatus tendon on the greater tuberosity. The initial treatment should be nonoperative including oral anti-inflammatory medication and physical therapy. If this is unsuccessful, arthroscopic debridement of the deposit is effective. The technique used is an arthroscopic localization and debridement without associated subacromial decompression. The rotator cuff should be evaluated for partial- and full-thickness tears before and after the debridement of calcifications. If a partial- or full-thickness rotator cuff tendon tear is identified, it should be treated in a fashion consistent with those without associated calcium deposits. In our hands, tears 5 mm or greater in depth are repaired using a tendon-to-tendon or tendon-to-bone technique. Tears with less depth are debrided and then left alone. Arthroscopic debridement of calcific tendonitis can yield excellent functional results and high patient satisfaction.

  9. Laser-assisted flapless crown lengthening: a case series.

    Science.gov (United States)

    McGuire, Michael K; Scheyer, E Todd

    2011-01-01

    As part of the paradigm shift toward more minimally invasive surgical procedures, increasing numbers of references to laser-mediated flapless crown lengthening are noted in the published literature. The vast majority of these references are noncontrolled case reports or technique-focused articles. Therefore, prospective, randomized controlled studies that objectively examine the safety and efficacy of flapless crown lengthening are lacking. The current case series represents an initial attempt to examine some of the clinical issues posed by this minimally invasive flapless approach. Ultimately, only well-designed controlled clinical trials can yield the type of evidence-based data necessary to categorize this approach to crown lengthening as standard-of-care treatment.

  10. Knee Moment-Angle Characteristics and Semitendinosus Muscle Morphology in Children with Spastic Paresis Selected for Medial Hamstring Lengthening.

    Science.gov (United States)

    Haberfehlner, Helga; Jaspers, Richard T; Rutz, Erich; Becher, Jules G; Harlaar, Jaap; van der Sluijs, Johannes A; Witbreuk, Melinda M; Romkes, Jacqueline; Freslier, Marie; Brunner, Reinald; Maas, Huub; Buizer, Annemieke I

    2016-01-01

    To increase knee range of motion and improve gait in children with spastic paresis (SP), the semitendinosus muscle (ST) amongst other hamstring muscles is frequently lengthened by surgery, but with variable success. Little is known about how the pre-surgical mechanical and morphological characteristics of ST muscle differ between children with SP and typically developing children (TD). The aims of this study were to assess (1) how knee moment-angle characteristics and ST morphology in children with SP selected for medial hamstring lengthening differ from TD children, as well as (2) how knee moment-angle characteristics and ST morphology are related. In nine SP and nine TD children, passive knee moment-angle characteristics and morphology of ST (i.e. fascicle length, muscle belly length, tendon length, physiological cross-sectional area, and volume) were assessed by hand-held dynamometry and freehand 3D ultrasound, respectively. At net knee flexion moments above 0.5 Nm, more flexed knee angles were found for SP compared to TD children. The measured knee angle range between 0 and 4 Nm was 30% smaller in children with SP. Muscle volume, physiological cross-sectional area, and fascicle length normalized to femur length were smaller in SP compared to TD children (62%, 48%, and 18%, respectively). Sixty percent of the variation in knee angles at 4 Nm net knee moment was explained by ST fascicle length. Altered knee moment-angle characteristics indicate an increased ST stiffness in SP children. Morphological observations indicate that in SP children planned for medial hamstring lengthening, the longitudinal and cross-sectional growth of ST muscle fibers is reduced. The reduced fascicle length can partly explain the increased ST stiffness and, hence, a more flexed knee joint in these SP children.

  11. [Treatment of old patellar tendon lesions. Case report and literature review].

    Science.gov (United States)

    Matus-Jiménez, J; Martínez-Arredondo, H

    2010-01-01

    A patellar tendon tear needs a force equivalent to 15 times the weight to overcome the strength of the tendon. It usually occurs in patients from their twenties on, regardless of gender. The diagnosis is made based on the symptoms of pain, impaired ranges of motion, and limitation upon climbing stairs. Pain subsides at two weeks but the limitation of physical activity continues and patients learn to carry out their activities with that disability and therefore they do not get treatment, so the diagnosis is usually made late. Treatment is difficult, as the tendon shortens upon being torn and requires an external reinforcement or an autologous graft; various techniques for repair may be used. The case of a patient with patellar tendon tear is presented herein. She sought treatment 6 months later and was treated with the Ecker, Lotke and modified Glazer technique with a semitendinous and gracilis allograft. She underwent early rehabilitation and quadriceps strengthening. She currently has 110 degrees of flexion, 0 degrees of extension and can carry out activities of daily living and work activities, as she is a laborer.

  12. 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 ...

  13. Gastrocnemius tendon length and strain are different when assessed using straight or curved tendon model

    OpenAIRE

    Stosic, Jelena; Finni Juutinen, Taija

    2011-01-01

    The present study investigated the effects of tendon curvature on measurements of tendon length using 3D-kinematic analysis. Curved and straight tendon models were employed for assessing medial gastrocnemius tendon length and strain during hopping (N = 8). Tendon curvature was identified using small reflective markers placed on the skin surface along the length of the tendon and a sum of vectors between the markers from the calcaneous up to the marker at the origin of tendon was calculated. T...

  14. 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 ...

  15. Gastrocnemius tendon length and strain are different when assessed using straight or curved tendon model

    OpenAIRE

    Stosic, Jelena; Finni Juutinen, Taija

    2011-01-01

    The present study investigated the effects of tendon curvature on measurements of tendon length using 3D-kinematic analysis. Curved and straight tendon models were employed for assessing medial gastrocnemius tendon length and strain during hopping (N = 8). Tendon curvature was identified using small reflective markers placed on the skin surface along the length of the tendon and a sum of vectors between the markers from the calcaneous up to the marker at the origin of tendon was calculated. T...

  16. Partial rupture of the quadriceps muscle in a child

    Directory of Open Access Journals (Sweden)

    Aydemir Gokhan

    2010-09-01

    Full Text Available Abstract Background The quadriceps femoris muscle ruptures usually occur in the middle-aged population. We present a 4-year-old patient with partial rupture of the quadriceps femoris muscle. To our knowledge, this is the youngest patient reported with a quadriceps femoris muscle rupture. Case Presentation A 4-year-old girl admitted to our clinic with left knee pain and limitation in knee movements. Her father reported that she felt pain while jumping on sofa. There was no direct trauma to thigh or knee. We located a palpable soft tissue swelling at distal anterolateral side of thigh. The history revealed that 10 days ago the patient was treated for upper tract respiratory infection with intramuscular Clindamycin for 7 days. When we consulted the patient with her previous doctor and nurse, we learnt that multiple daily injections might be injected to same side of left thigh. MRI showed a partial tear of vastus lateralis muscle matching with the injection sites. The patient treated with long leg half-casting for three weeks. Clinical examination and knee flexion had good results with conservative treatment. Conclusions Multiple intramuscular injections may contribute to damage muscles and make prone to tears with muscle contractions. Doctors and nurses must be cautious to inject from different parts of both thighs.

  17. Biologic width and crown lengthening: case reports and review.

    Science.gov (United States)

    Oh, Se-Lim

    2010-01-01

    The biologic width includes both the connective tissue attachment and the junctional epithelium and has a mean dimension of approximately 2 mm. Invading the biologic width with a restoration can result in localized crestal bone loss, gingival recession, localized gingival hyperplasia, or a combination of these three. When restoring teeth that have subgingival caries or fractures below the gingival attachment, a clinical crown-lengthening procedure is needed to establish the biologic width. This article presents three case reports that utilized crown-lengthening procedures.

  18. On the Effect of Lengthening Circadian Rhythm by Heavy Water

    Directory of Open Access Journals (Sweden)

    Akhmedov T. R.

    2014-01-01

    Full Text Available The problem of time sensor of biological clock (BC attracts interest of many scientists, and a great number of experiments are being conducted to stud y the influence of vari- ous physical and chemical factors on functioning of BC. Special attention is drawn to studying the influence of heavy water (D 2 O on functioning of BC that always leads to lengthening of circadian rhythms (CR. This work presents theoretical consideration of lengthening of CR, when hydrogen (H 2 in water is replaced by deuterium (D 2 , that is based on spacial difference of energy levels with similar principle quantum numbers.

  19. Muscle-tendon interaction and elastic energy usage in human walking

    DEFF Research Database (Denmark)

    Ishikawa, Masaki; Komi, Paavo V.; Grey, Michael James;

    2005-01-01

    The present study was designed to explore how the interaction between the fascicles and tendinous tissues is involved in storage and utilization of elastic energy during human walking. Eight male subjects walked with a natural cadence (1.4 +/- 0.1 m/s) on a 10-m-long force plate system. In vivo...... techniques were employed to record the Achilles tendon force and to scan real-time fascicle lengths for two muscles (medial gastrocnemius and soleus). The results showed that tendinous tissues of both medial gastrocnemius and soleus muscles lengthened slowly throughout the single-stance phase......-stance phase. In contrast, the soleus fascicles were lengthened until the end of the single-stance phase. These findings suggest that the elastic recoil takes place not as a spring-like bouncing but as a catapult action in natural human walking. The interaction between the muscle fascicles and tendinous...

  20. Muscle, tendons, and bone: structural changes during denervation and FES treatment.

    Science.gov (United States)

    Gargiulo, Paolo; Reynisson, Páll Jens; Helgason, Benedikt; Kern, Helmut; Mayr, Winfried; Ingvarsson, Páll; Helgason, Thordur; Carraro, Ugo

    2011-09-01

    , tendons, and bone in SCI patient with LMN injury and to monitor effects and changes in tissue composition due to FES treatment. This work demonstrates improved bone strength in the patella through the FES treatment applied on the quadriceps femur.

  1. The influence of loading intensity on muscle-tendon unit behavior during maximal knee extensor stretch shortening cycle exercise.

    Science.gov (United States)

    Earp, Jacob E; Newton, Robert U; Cormie, Prue; Blazevich, Anthony J

    2014-01-01

    Tendon stiffness increases as the magnitude and rate of loading increases, according to its viscoelastic properties. Thus, under some loading conditions tendons should become exceptionally stiff and act almost as rigid force transducers. Nonetheless, observations of tendon behavior during multi-joint sprinting and jumping tasks have shown that tendon strain increases whilst muscle strain decreases as the loading intensity increases. The purpose of the current study was to examine the influence of external loading intensity on muscle-tendon unit (MTU) behavior during a high-speed single-joint, stretch-shortening cycle (SSC) knee extension task. Eighteen men (n = 9) and women (n = 9) performed single-leg, maximum intensity SSC knee extensions at loads of 20, 60 and 90% of their one repetition maximum. Vastus lateralis fascicle length (L(f)) and velocity (v(f)) as well as MTU (L(MTU)) and tendinous tissue (L(t)) length were measured using high-speed ultrasonography (96 Hz). Patellar tendon force (F(t)) and rate of force development (RFDt) were estimated using inverse dynamics. Results showed that as loading intensity increased, concentric joint velocity and shortening v f decreased whilst F t and RFDt increased, but no significant differences were observed in eccentric joint velocity or peak L(MTU) or L(f). In addition, the tendon lengthened significantly less at the end of the eccentric phase at heavier loads. This is the first observation that tendon strain decreases significantly during a SSC movement as loading intensity increases in vivo, resulting in a shift in the tendon acting as a power amplifier at light loads to a more rigid force transducer at heavy loads.

  2. Progressive fibrosis of the quadriceps muscle FIBROSIS PROGRESIVA DEL CUÁDRICEPS

    Directory of Open Access Journals (Sweden)

    Enrique Vergara-Amador

    2011-06-01

    Full Text Available Background. Fibrosis of the quadriceps in children is a frequently reported pathology which is associated with antibiotics having been injected into the thigh. This study presents a series of patients having a common background of having had a single pentavalent vaccine dose or injectable vitamin K and presenting progressive fibrosis of the quadriceps muscle. Materials and methods. Seven children were found who had progressive unilateral retraction of the knee. Six of them had a background of a single dose of vaccine having been given when they were four months old, suffering muscle contractions/spasms 4 to 8 weeks after the application; one child had been given vitamin K when born. Results. Magnetic resonance revealed alterations in the intermediate vastus medialis obliquus (VMO without intra-articular pathology. Average age when surgery was performed was 18 months (16-20 month range and preoperational flexion was 26° (20°-30°. The quadriceps central tendon was stretched, without quadriceplasy, flexion being improved to 90° in 1 case and 100° to 120° in the remaining ones. Minimum follow-up lasted six months, average post-operational flexion being 109° (90°-120°. Discussion. The intermediate VMO has been used for applying drugs. There is evidence that this muscular portion has poor perfusion in children. The fibrosis's physiopathology is still not exactly known. Many children are given a poor diagnosis, this being confused with articular pathologies so that they wrongly receive other types of surgery.Antecedentes. La fibrosis del cuádriceps en niños es una patología reportada con frecuencia y asociada a la aplicación de antibióticos en el muslo. Este estudio presenta una serie de pacientes que tenían como antecedente común la aplicación de una dosis única de la vacuna pentavalente o de vitamina K y presentaron fibrosis del cuádriceps progresivo. Material y métodos. Se encontraron siete niños con retracción progresiva

  3. Novel methods for tendon investigations

    DEFF Research Database (Denmark)

    Kjær, Michael; Langberg, Henning; Bojsen-Møller, J.

    2008-01-01

    Purpose. Tendon structures have been studied for decades, but over the last decade, methodological development and renewed interest for metabolic, circulatory and tissue protein turnover in tendon tissue has resulted in a rising amount of investigations. Method. This paper will detail the various...

  4. Effects of kinesiology taping on repositioning error of the knee joint after quadriceps muscle fatigue.

    Science.gov (United States)

    Han, Jin Tae; Lee, Jung-Hoon

    2014-06-01

    [Purpose] The purpose of this study was to identify the effects of kinesiology taping on repositioning error of the knee joint after quadriceps muscle fatigue. [Subjects] Thirty healthy adults with no orthopaedic or neurological problems participated in this study. [Methods] The repositioning error of the knee joint was measured using a digital goniometer when the subjects extended their dominant-side knee to a random target angle (30°, 45°, or 60°) with their eyes closed, before and after a quadriceps muscle fatigue protocol, and after application of kinesiology tape. [Results] We found that repositioning errors of the dominant-side knee joint increased after quadriceps fatigue compared with no-fatigue conditions. However, kinesiology taping of the quadriceps muscle and patella after quadriceps fatigue significantly decreased repositioning errors of the knee joint. [Conclusion] These results suggest that quadriceps fatigue increases the repositioning error of the knee joint, whereas application of kinesiology tape decreases fatigue-induced joint repositioning error.

  5. Principles of tendon transfers.

    Science.gov (United States)

    Coulet, B

    2016-04-01

    Tendon transfers are carried out to restore functional deficits by rerouting the remaining intact muscles. Transfers are highly attractive in the context of hand surgery because of the possibility of restoring the patient's ability to grip. In palsy cases, tendon transfers are only used when a neurological procedure is contraindicated or has failed. The strategy used to restore function follows a common set of principles, no matter the nature of the deficit. The first step is to clearly distinguish between deficient muscles and muscles that could be transferred. Next, the type of palsy will dictate the scope of the program and the complexity of the gripping movements that can be restored. Based on this reasoning, a surgical strategy that matches the means (transferable muscles) with the objectives (functions to restore) will be established and clearly explained to the patient. Every paralyzed hand can be described using three parameters. 1) Deficient segments: wrist, thumb and long fingers; 2) mechanical performance of muscles groups being revived: high energy-wrist extension and finger flexion that require strong transfers with long excursion; low energy-wrist flexion and finger extension movements that are less demanding mechanically, because they can be accomplished through gravity alone in some cases; 3) condition of the two primary motors in the hand: extrinsics (flexors and extensors) and intrinsics (facilitator). No matter the type of palsy, the transfer surgery follows the same technical principles: exposure, release, fixation, tensioning and rehabilitation. By performing an in-depth analysis of each case and by following strict technical principles, tendon transfer surgery leads to reproducible results; this allows the surgeon to establish clear objectives for the patient preoperatively.

  6. Knee flexion with quadriceps cocontraction: A new therapeutic exercise for the early stage of ACL rehabilitation.

    Science.gov (United States)

    Biscarini, Andrea; Contemori, Samuele; Busti, Daniele; Botti, Fabio M; Pettorossi, Vito E

    2016-12-08

    Quadriceps strengthening exercises designed for the early phase of anterior cruciate ligament (ACL) rehabilitation should limit the anterior tibial translation developed by quadriceps contraction near full knee extension, in order to avoid excessive strain on the healing tissue. We hypothesize that knee-flexion exercises with simultaneous voluntary contraction of quadriceps (voluntary quadriceps cocontraction) can yield considerable levels of quadriceps activation while preventing the tibia from translating forward relative to the femur. Electromyographic activity in quadriceps and hamstring muscles was measured in 20 healthy males during isometric knee-flexion exercises executed near full knee extension with maximal voluntary effort of quadriceps cocontraction and external resistance (R) ranging from 0% to 60% of the 1-repetition maximum (1RM). Biomechanical modeling was applied to derive the shear (anterior/posterior) tibiofemoral force developed in each exercise condition. Isometric knee-flexion exercises with small external resistance (R=10% 1RM) and maximal voluntary effort of quadriceps cocontraction yielded a net posterior (ACL-unloading) tibial pull (P=0.005) and levels of activation of 32%, 50%, and 45% of maximum voluntary isometric contraction, for the rectus femoris, vastus medialis, and vastus lateralis, respectively. This exercise might potentially rank as one of the most appropriate quadriceps strengthening interventions in the early phase of ACL rehabilitation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Surgical Correction of the Achilles Tendon for Diabetic Foot Ulcerations and Charcot Neuroarthropathy.

    Science.gov (United States)

    Ramanujam, Crystal L; Zgonis, Thomas

    2017-04-01

    Achilles tendon pathologic conditions are implicated in contributing to the development of many diabetic foot complications including diabetic foot ulceration and Charcot neuroarthropathy. Surgical correction of the diabetic equinus deformity has been studied as an isolated or adjunctive treatment when dealing with difficult-to-close diabetic foot ulcerations or when surgically addressing the diabetic Charcot neuroarthropathy foot or ankle. This article reviews the most common indications, complications, and surgical procedures for equinus correction by either a tendo-Achilles lengthening or gastrocnemius recession for the management of diabetic foot conditions.

  8. The role of stretching in tendon injuries.

    Science.gov (United States)

    Witvrouw, E; Mahieu, N; Roosen, P; McNair, P

    2007-04-01

    The function of tendons can be classified into two categories: tensile force transmission, and storage and release of elastic energy during locomotion. The action of tendons in storing and releasing energy is mainly seen in sports activities with stretch-shortening cycles (SSCs). The more intense the SSC movements are (jumping-like activities), the more frequently tendon problems are observed. High SSC movements impose high loads on tendons. Consequently, tendons that frequently deal with high SSC motion require a high energy-absorbing capacity to store and release this large amount of elastic energy. As the elasticity of tendon structures is a leading factor in the amount of stored energy, prevention and rehabilitation programmes for tendon injuries should focus on increasing this tendon elasticity in athletes performing high SSC movements. Recently, it has been shown that ballistic stretching can significantly increase tendon elasticity. These findings have important clinical implications for treatment and prevention of tendon injuries.

  9. Evaluation of the Effect of Surgical Crown Lengthening on Periodontal Parameters

    OpenAIRE

    2015-01-01

    Background: Surgical crown lengthening is needed for teeth with subgingival caries, fractured teeth, insufficient crown length, and deep subgingival margin of failed restorations. Since there is no agreement on the effects of crown lengthening surgery on gingival parameters, the purpose of this study was to evaluate periodontal parameters in patients who needed crown lengthening surgery. Methods: Twenty patients who had healthy periodontium and needed surgical crown lengthening were included ...

  10. Fixator-assisted tibial lengthening over a plate in a patient with sequelae of poliomyelitis.

    Science.gov (United States)

    Tosun, Haci Bayram; Serbest, Sancar; Uludag, Abuzer; Gumustas, Seyitali; Celik, Suat

    2016-11-01

    There are many techniques for limb lengthening. Lengthening over a plate is an alternative choice of fixation in children or when nailing is difficult. We present a new technique for tibial lengthening with using a monolateral external fixator over a lengthening plate.Lengthening over an intramedullary nail is a commonly used method in patients with short stature or limb-length discrepancy. However, in patients with a narrow and excessively sclerotic intramedullary cavity in the pediatric age group where the skeletal system has not yet fully developed, difficulties have been observed in lengthening methods with nailing.Therefore, in these cases, the use of lengthening techniques over a plate is an alternative treatment option. Nevertheless, in lengthening techniques over a plate, if one side of the osteotomy area cannot be fixed, associated mechanical axis problems have been reported.We applied tibia lengthening with external fixator assistance over a custom-made lengthening plate in a patient with sequelae of poliomyelitis. This new lengthening technique applied over a plate could be the solution to the problems observed in other lengthening techniques over a plate.

  11. 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

  12. 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

  13. Simultaneous bilateral patellar tendon rupture

    Directory of Open Access Journals (Sweden)

    Diogo Lino Moura

    Full Text Available ABSTRACT Bilateral patellar tendon rupture is a rare entity, often associated with systemic diseases and patellar tendinopathy. The authors report a rare case of a 34-year-old man with simultaneous bilateral rupture of the patellar tendon caused by minor trauma. The patient is a retired basketball player with no past complaints of chronic knee pain and a history of steroid use. Surgical management consisted in primary end-to-end tendon repair protected temporarily with cerclage wiring, followed by a short immobilization period and intensive rehabilitation program. Five months after surgery, the patient was able to fully participate in sport activities.

  14. Rectus Femoris Tendon Calcification

    Science.gov (United States)

    Zini, Raul; Panascì, Manlio; Papalia, Rocco; Franceschi, Francesco; Vasta, Sebastiano; Denaro, Vincenzo

    2014-01-01

    Background: Since it was developed, hip arthroscopy has become the favored treatment for femoroacetabular impingement. Due to recent considerable improvements, the indications for this technique have been widely extended. Injuries of the rectus femoris tendon origin, after an acute phase, could result in a chronic tendinopathy with calcium hydroxyapatite crystal deposition, leading to pain and loss of function. Traditionally, this condition is addressed by local injection of anesthetic and corticosteroids or, when conservative measures fail, by open excision of the calcific lesion by an anterior approach. Purpose: To assess whether arthroscopic excision of calcification of the proximal rectus is a safe and effective treatment. Study Design: Case series; Level of evidence, 4. Methods: Outcomes were studied from 6 top amateur athletes (age range, 30-43 years; mean, 32.6 years) affected by calcification of the proximal rectus who underwent arthroscopic excision of the calcification. Patients were preoperatively assessed radiographically, and diagnosis was confirmed by a 3-dimensional computed tomography scan. To evaluate the outcome, standardized hip rating scores were used pre- and postoperatively (at 6 and 12 months): the Hip disability and Osteoarthritis Outcome Score, Oxford Hip Score, and Modified Harris Hip Score. Moreover, visual analog scales (VAS) for pain, sport activity level (SAL), and activities of daily living (ADL) were also used. Results: One year after surgery, all patients reported satisfactory outcomes, with 3 of 6 rating their return-to-sport level as high as preinjury level, and the remaining 3 with a percentage higher than 80%. Five patients ranked their ability to carry on daily activities at 100%. Statistical analysis showed significant improvement of the Oxford Hip Score, the Modified Harris Hip Score, and all 3 VAS subscales (pain, SAL, and ADL) from pre- to latest postoperative assessment (P < .05). Conclusion: Arthroscopic excision of

  15. Hamstring transfer for quadriceps paralysis in post polio residual paralysis

    Directory of Open Access Journals (Sweden)

    Jagadish J Patwa

    2012-01-01

    Conclusions: H to Q transfer in the presence of quadriceps paralysis with good power in hamstring is a better alternative than supracondylar osteotomy because it is a dynamic correction and it produces some degree of recurvatum with increasing stability of knee in extension while walking. While inserting hamstring over patella the periosteum is not cut in an I-shaped fashion to create a flap which gives additional strength to new insertion and also patella act as a fulcrum during the extension of knee by producing the bowstring effect.

  16. 高频超声在肌肉、肌腱损伤中的应用%High Frequency Ultrasound in Muscle,Tendon Injury

    Institute of Scientific and Technical Information of China (English)

    庄艳芳; 庄慧芳

    2015-01-01

    目的:探讨超声在肌肉、肌腱损伤诊疗中的应用价值。方法回顾性分析30例外伤性和运动性所致的四肢肌肉、肌腱损伤患者的超声检查结果。结果10例诊断为单纯性肌腱损伤,3例为股四头肌-腱连接损伤,3例为腓肠肌撕裂,6例为股四头肌撕裂,余下8例为肱二头肌肌肉挫伤。结论超声在四肢肌肉、肌腱损伤的诊断中具有较大的优势,可作为临床诊断肌肉、肌腱损伤和愈合情况检查的首选辅助性检查手段之一。%Objective To investigate the value of ultrasonography in the muscle,tendon injury diagnosis and treatment. Methods A retrospective analysis of limbs,muscle,tendon injury ultrasound results of 30 patients with traumatic and movement caused. Results 10 cases diagnosed as simple tendon injury,three cases of the quadriceps - connecting tendon injury,three cases of gastrocnemius tear,six cases of quadriceps tear,and the remaining eight cases of biceps muscle contusion . Conclusion Ultrasound has a large advantage in the muscle,tendon injury in the diagnosis of the limbs can be used as one of the clinical muscle,tendon damage and healing supplementary examination to check the preferred means of diagnosis.

  17. Is the Dresden technique a mechanical design of choice suitable for the repair of middle third Achilles tendon ruptures? A biomechanical study.

    Science.gov (United States)

    de la Fuente, C; Carreño-Zillmann, G; Marambio, H; Henríquez, H

    2016-01-01

    To compare the mechanical failure of the Dresden technique for Achilles tendon repair with the double modified Kessler technique controlled repair technique. The maximum resistance of the two repair techniques are also compared. A total of 30 Achilles tendon ruptures in bovine specimens were repaired with an Ethibond(®) suture to 4.5cm from the calcaneal insertion. Each rupture was randomly distributed into one of two surgical groups. After repair, each specimen was subjected to a maximum traction test. The mechanical failure (tendon, suture, or knot) rates (proportions) were compared using the exact Fisher test (α=.05), and the maximum resistances using the Student t test (α=.05). There was a difference in the proportions of mechanical failures, with the most frequent being a tendon tear in the Dresden technique, and a rupture of the suture in the Kessler technique. The repair using the Dresden technique performed in the open mode, compared to the Kessler technique, has a more suitable mechanical design for the repair of middle third Achilles tendon ruptures on developing a higher tensile resistance in 58.7%. However, its most common mechanical failure was a tendon tear, which due to inappropriate loads could lead to lengthening of the Achilles tendon. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. The effects of dynamic stretching on plantar flexor muscle-tendon tissue properties.

    Science.gov (United States)

    Samukawa, Mina; Hattori, Masaki; Sugama, Naoko; Takeda, Naoki

    2011-12-01

    Dynamic stretching is commonly used in warm-up routines for athletic activities. Even though several positive effects of dynamic stretching on athletic performance have been reported, the effects on the muscle-tendon unit (MTU) itself are still unclear. The objective of this study is to determine the effects of dynamic stretching on the ankle plantar flexor muscle-tendon properties by use of ultrasonography. Twenty healthy male subjects participated in the present study. The subjects were asked to engage in dynamic stretching of plantar flexors for 30 s and to repeat for 5 sets. Ankle dorsiflexion ROM was measured before and after the dynamic stretching. Changes in the displacement of the myotendinous junction (MTJ), pennation angle, and fascicle length were also determined by using ultrasonography. Ankle dorsiflexion ROM increased significantly after the dynamic stretching (p MTJ was observed until the second stretching set (p MTJ was found, indicating some change in the tendon tissues. Therefore, dynamic stretching of the plantar flexors was considered an effective means of lengthening the tendon tissues. Copyright © 2011 Elsevier Ltd. All rights reserved.

  19. Reliability of the Q Force; a mobile instrument for measuring isometric quadriceps muscle strength

    NARCIS (Netherlands)

    Douma, K W; Regterschot, G R H; Krijnen, W P; Slager, G E C; van der Schans, C P; Zijlstra, W

    2016-01-01

    BACKGROUND: The ability to generate muscle strength is a pre-requisite for all human movement. Decreased quadriceps muscle strength is frequently observed in older adults and is associated with a decreased performance and activity limitations. To quantify the quadriceps muscle strength and to monito

  20. Implementation of Open and Closed Kinetic Chain Quadriceps Strengthening Exercises after Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Ross, Michael D.; Denegar, Craig R.; Winzenried, Jay A.

    2001-01-01

    Reviews the effects of open kinetic chain (OKC) and closed kinetic chain (CKC) exercise on anterior cruciate ligament (ACL) strain and patellofemoral joint stress, suggesting a combination of the two for quadriceps strengthening after ACL reconstruction. Both OKC and CKC exercises may be modified and implemented for quadriceps strengthening after…

  1. Reliability of the Q Force; a mobile instrument for measuring isometric quadriceps muscle strength

    NARCIS (Netherlands)

    Douma, K.W.; Regterschot, G.R.H.; Krijnen, W.P.; Slager, G.E.C.; Schans, C.P. van der; Zijlstra, W.

    2016-01-01

    Background: The ability to generate muscle strength is a pre-requisite for all human movement. Decreased quadriceps muscle strength is frequently observed in older adults and is associated with a decreased performance and activity limitations. To quantify the quadriceps muscle strength and to monito

  2. RAPID KNEE-EXTENSIONS TO INCREASE QUADRICEPS MUSCLE ACTIVITY IN PATIENTS WITH TOTAL KNEE ARTHROPLASTY

    DEFF Research Database (Denmark)

    Husted, Rasmus Skov; Wilquin, Lousia; Jakobsen, Thomas Linding

    2017-01-01

    BACKGROUND: Inhibition of the quadriceps muscle and reduced knee-extension strength is common shortly following total knee arthroplasty (weeks to months), due to reduced voluntary activation of the quadriceps muscle. In healthy subjects, strength training with heavy loads is known to increase ago...

  3. Management of Extensor Tendon Injuries

    Science.gov (United States)

    Griffin, M; Hindocha, S; Jordan, D; Saleh, M; Khan, W

    2012-01-01

    Extensor tendon injuries are very common injuries, which inappropriately treated can cause severe lasting impairment for the patient. Assessment and management of flexor tendon injuries has been widely reviewed, unlike extensor injuries. It is clear from the literature that extensor tendon repair should be undertaken immediately but the exact approach depends on the extensor zone. Zone I injuries otherwise known as mallet injuries are often closed and treated with immobilisaton and conservative management where possible. Zone II injuries are again conservatively managed with splinting. Closed Zone III or ‘boutonniere’ injuries are managed conservatively unless there is evidence of displaced avulsion fractures at the base of the middle phalanx, axial and lateral instability of the PIPJ associated with loss of active or passive extension of the joint or failed non-operative treatment. Open zone III injuries are often treated surgically unless splinting enable the tendons to come together. Zone V injuries, are human bites until proven otherwise requires primary tendon repair after irrigation. Zone VI injuries are close to the thin paratendon and thin subcutaneous tissue which strong core type sutures and then splinting should be placed in extension for 4-6 weeks. Complete lacerations to zone IV and VII involve surgical primary repair followed by 6 weeks of splinting in extension. Zone VIII require multiple figure of eight sutures to repair the muscle bellies and static immobilisation of the wrist in 45 degrees of extension. To date there is little literature documenting the quality of repairing extensor tendon injuries however loss of flexion due to extensor tendon shortening, loss of flexion and extension resulting from adhesions and weakened grip can occur after surgery. This review aims to provide a systematic examination method for assessing extensor injuries, presentation and management of all type of extensor tendon injuries as well as guidance on

  4. Distal femoral extension osteotomy and patellar tendon advancement to treat persistent crouch gait in cerebral palsy.

    Science.gov (United States)

    Stout, Jean L; Gage, James R; Schwartz, Michael H; Novacheck, Tom F

    2008-11-01

    Hallmarks of a persistent crouched walking pattern exhibited by individuals with cerebral palsy usually include loss of an adequate plantar flexion/knee extension couple, hamstring and/or psoas tightness, or contracture in conjunction with quadriceps insufficiency. Traditional treatment addresses the muscle-tightness component, but not the contracture or the muscle insufficiency. This study was performed to evaluate the effectiveness of distal femoral extension osteotomy and/or patellar tendon advancement in the treatment of crouch gait in patients with cerebral palsy. A retrospective, nonrandomized, repeated-measures design was used. Individuals with a diagnosis of cerebral palsy were included if they had had (1) a distal femoral extension osteotomy in combination with a distal patellar tendon advancement (thirty-three patients), (2) a distal femoral extension osteotomy without patellar tendon advancement (sixteen), or (3) a distal patellar tendon advancement only (twenty-four). All subjects were evaluated with preoperative and postoperative gait analysis. Gait, radiographic, strength, and functional measures were included in the analysis to assess changes in knee function. Seventy-three individuals met the criteria for inclusion. A single side was chosen for the analysis of each subject. Ninety percent of the subjects had additional, concurrent surgery. Improvements were noted in the index assessing the level of gait pathology and in functional variables across all groups, and pain was consistently decreased. All preoperative stress fractures healed. Strength levels were maintained across all groups. The Koshino index of patellar height improved from 1.4 to -2.3 in the group treated with patellar tendon advancement only and from 1.5 to -2.9 in the group treated with both osteotomy and tendon advancement. The range of knee flexion improved an average of 15 degrees to 20 degrees, and stance-phase knee flexion was restored to the typical range (9 degrees to 10

  5. 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.

  6. Three-Dimensional Gait Analysis Following Achilles Tendon Rupture With Nonsurgical Treatment Reveals Long-Term Deficiencies in Muscle Strength and Function.

    Science.gov (United States)

    Tengman, Tine; Riad, Jacques

    2013-09-01

    Precise long-term assessment of movement and physical function following Achilles tendon rupture is required for the development and evaluation of treatment, including different regimens of physical therapy. To assess intermediate-term (physical function following Achilles tendon rupture treated nonsurgically and to compare these with self-reported measures of physical function. Cross-sectional study; Level of evidence, 3. Two to 5 years after Achilles tendon rupture, 9 women and 43 men (mean age, 49.2 years; range, 26-68 years) were assessed by physical examination, performance of 1-legged jumps, and 3-dimensional gait analysis (including calculation of muscle work). Self-reported scores for foot function (Achilles tendon rupture score) and level of physical activity were collected. Twenty age- and sex-matched controls were assessed in the same manner. Physical examination of patients with the knee extended revealed 11.1° of dorsiflexion on the injured side and 9.2° on the uninjured side (P = .020), indicating gastrocnemius muscle lengthening. The 1-legged jump distance was shorter on the injured side (89.5 vs 96.2 cm; P physical activity were lower in patients than in healthy controls (mean Achilles tendon rupture score, 78.6 and 99.8, respectively). Nonsurgically treated patients with Achilles tendon rupture showed signs of both anatomic and functional lengthening of the tendon. Attenuated muscle strength and function were present during walking as long as 2 to 5 years after rupture, as determined by 3-dimensional gait analysis. More extensive future studies involving patients having both surgical and nonsurgical treatment could provide additional valuable information.

  7. A new flapless technique for crown lengthening after orthodontic extrusion.

    Science.gov (United States)

    Braga, Giovanni; Bocchieri, Anna

    2012-02-01

    Orthodontic extrusion (OE), which is performed in many different clinical situations to move a tooth or its periodontal tissues coronally, is often associated with supracrestal fiberotomy and root planing (OEFRP) or followed by surgical crown lengthening. The OEFRP procedure must be carried out every 2 weeks during the entire extrusive orthodontic phase, and precise control of the technique itself can be quite difficult, especially when this approach is to be performed on a limited portion of the root perimeter in teeth affected by angular defects. The aim of this study was to show a new nonsurgical crown-lengthening technique, performed shortly after the completion of OE, to simultaneously achieve proper hard and soft tissue architecture. Three different illustrative situations (periodontal pocket, root fracture, and root perforation) are described.

  8. Biologic rationale of esthetic crown lengthening using innovative proportion gauges.

    Science.gov (United States)

    Fletcher, Paul

    2011-01-01

    Research shows that practitioners tend to underestimate the amount of tooth structure that must be exposed during a crown lengthening procedure. In the anterior portion of the mouth, this can lead to biologic width problems and subsequent cosmetic issues. This paper presents a biologically based, step-by-step approach to periodontal esthetic crown lengthening. Using a series of innovative measuring gauges, the ideal clinical crown length of a tooth as well as the proper occlusogingival placement of the interproximal papilla will be determined based on established, documented tooth proportion relationships. The biologic crown length of the tooth, defined as the distance from the incisal edge to the bone crest, will subsequently be determined as a function of the clinical crown length, with the ultimate goals being adequate tooth structure for the placement of a restorative margin, establishment of a healthy dentogingival complex, and the placement of an esthetically pleasing definitive restoration.

  9. Femoral lengthening during hip resurfacing arthroplasty: a new surgical procedure.

    Science.gov (United States)

    Vasseur, L; Ayoub, B; Mesnil, P; Pasquier, G; Migaud, H; Girard, J

    2015-04-01

    Correction of leg length discrepancy during hip arthroplasty is a technical challenge. Although resurfacing proposed to young subjects presents a number of advantages (stability, bone stock, etc.), it does not correct leg length discrepancy. We propose an original femoral lengthening technique concomitant to resurfacing performed through the same approach, consisting in a Z-shaped subtrochanteric osteotomy. Resurfacing was performed first and the femoral and acetabular reaming material was used for autografting. The series comprised five cases followed for a mean 42.2 months (range, 33-64 months). The mean surgical time was 100 min (range, 76-124 min). Weightbearing was authorized in all cases at the 8th week. The mean lengthening was 32 mm (range, 25-40 mm). Healing was observed in all cases. This surgical technique, reserved for very young subjects who accept an 8-week postoperative period without weightbearing, can be proposed in cases with substantial preoperative leg length discrepancy.

  10. Inter-limb differences in quadriceps strength and volitional activation.

    Science.gov (United States)

    Pietrosimone, Brian G; Park, Chang M; Gribble, Phillip A; Pfile, Kate R; Tevald, Michael A

    2012-01-01

    In this crossover study, we wished to determine if normalized inter-limb differences in strength differed from inter-limb differences in voluntary activation at 30°, 70°, and 90° of knee flexion. We also assessed the relationship between inter-limb differences in torque with the inter-limb differences in activation. Twenty-five healthy volunteers were used for final data analyses; the order of leg tested, joint angle, and measurement technique (isokinetic strength, voluntary activation) were randomly assigned. Quadriceps strength was measured isokinetically at 1.05 rad · s(-1), while quadriceps voluntary activation was assessed via the central activation ratio. Absolute values of inter-limb differences for both measures were calculated by subtracting the non-dominant leg values from those of the dominant leg. Inter-limb isokinetic strength differences were greater than inter-limb central activation ratio differences at all joint angles (P = 0.003). Interestingly, inter-limb deficits between measures were not strongly correlated, suggesting that these measurements may be evaluating completely different phenomena within the neuromuscular system. These measurement techniques may provide unique information regarding neuromuscular function, suggesting that researchers and clinicians must utilize information from both techniques to determine the true clinical nature of inter-limb deficits.

  11. On the fail-safe design of tendon-driven manipulators with redundant tendons

    Energy Technology Data Exchange (ETDEWEB)

    Sheu, Jinn Biau; Liu, Tyng; Lee, Jyh Jone [National Taiwan University, Taipei (China)

    2012-06-15

    A tendon-driven manipulator having redundant tendons may possess more flexibility in operation, such as optimizing the performance of tendons, reducing the burden of each tendon, and providing fail-safe features. The purpose of this paper is to investigate the design of tendon-driven manipulators with a fail-safe feature, that is, to synthesize a system that may still remain controllable as any of the tendons have broken down or malfunctioned. Characteristics of tendon-driven manipulators are briefly discussed. Criteria for tendon-driven manipulators with redundant tendons and fail-safe feature are then established. Subsequently, constraints for such system are derived from the structure of tendon-driven manipulator. Associated with the criteria, manipulators can remain controllable when any of the tendons fails to function. Finally, a geometric method for determining the structure is developed. Examples of two-DOF and three-DOF tendondriven manipulators are demonstrated.

  12. Surgical crown lengthening: a 12-month study - radiographic results

    Directory of Open Access Journals (Sweden)

    Daniela Eleutério Diniz

    2007-08-01

    Full Text Available OBJECTIVE: The purpose of this study was to perform a radiographic follow-up evaluation after a 12-month healing period, following crown lengthening surgery. MATERIAL AND METHODS: Twenty-three periodontally healthy subjects (mean age 32.5 years that required crown lengthening surgery in premolars were recruited. In a total of 30 premolars, full thickness flaps, osseous resection, and flap suturing were performed. The restorative margin was defined in the pre-surgical phase and maintained unaltered during the healing period, serving as a reference point. Standardized bitewing radiographs were taken before and after osseous reduction, and at 2, 3, 6, and 12-month healing periods. RESULTS: Intact lamina dura was observed at both mesial and distal alveolar crests only from the 3rd month. At 12-months, all alveolar crests presented lamina dura. The overall mean distance from the restorative margin to the alveolar crest achieved after osseous resection was 3.28±0.87 mm at mesial and 2.81±0.51 mm at distal sites. No significant radiographic changes in the bone crest were observed during a 12-month healing period. CONCLUSION: The findings of this study suggest that the radiographic proximal bone level observed on bitewing radiographs following crown lengthening surgery can be used as a reference to predict the future level of the healed alveolar crest.

  13. Three different surgical techniques of crown lengthening: A comparative study

    Directory of Open Access Journals (Sweden)

    Ramya Nethravathy

    2013-01-01

    Full Text Available Introduction: A short clinical crown may lead to poor retention form thereby leading to improper tooth preparation. Surgical crown lengthening procedure is done to increase the clinical crown length without violating the biologic width. Several techniques have been proposed for clinical crown lengthening which includes gingivectomy, apically displaced flap with or without resective osseous surgery, and surgical extrusion using periotome. Objective: The aim of this paper is to compare clinically the three different surgical techniques of crown lengthening procedures. Materials and Methods: Fifteen patients who reported to the department of Periodontology, were included in the study. Patients were randomly divided into three groups, which include patients who underwent gingivectomy (Group A, apically repositioned flap (Group B and surgical extrusion using periotome (Group C. Clinical measurements such as clinical crown length, gingival zenith, interdental papilla height were taken at baseline and at 3 rd month post-operatively. Results: Clinical and radiographic evaluation at 3 rd month suggest that surgical extrusion technique offers several advantages over the other conventional surgical techniques such as preservation of the interproximal papilla, gingival margin position and no marginal bone loss. Conclusions: This technique can be used to successfully treat a grossly damaged crown structure as a result of tooth fracture, dental caries and iatrogenic factors especially in the anterior region, where esthetics is of great concern.

  14. [Surgical crown lengthening procedures. Preparatory step for fixed prosthesis].

    Science.gov (United States)

    Parashis, A O; Tripodakis, A P

    1990-04-01

    Necessary restorative requirements for full coverage are adequate axial wall height of the preparation for retention as well as sufficient vertical width of sound tooth structure cervically for the crown margins. In cases where adequate healthy tooth structure does not exist coronally to the epithelial attachment due to various crown damages, the margins of the crown might traumatize the periodontal attachment and the periodontium will be jeopardized iatrogenically. Teeth with inadequate axial Reight of the clinical crown, subgingival caries, vertical or horizontal fractures will require surgical crown lengthening procedures before prosthetic treatment is performed. These procedures may either involve only the soft tissues or bone remodeling as well. Irrespective of the procedure, crown lengthening must be performed with the objective of at least 3 mm. of healthy tooth structure coronally to the bone. This width will permit the formation of a new dentinogingival junction and the existence of 1-2 m.m. of sound tooth structure coronally to the new attachment line for the construction of a biologically acceptable crown margin. The purpose of this article is to discuss the clinical problem and underline the importance of crown lengthening procedures as a preparatory step for prosthetic treatment in fixed partial dentures.

  15. SURGICAL CROWN LENGTHENING: A 12-MONTH STUDY - RADIOGRAPHIC RESULTS*

    Science.gov (United States)

    Diniz, Daniela Eleutério; Okuda, Kalizia Marcela; Fonseca, Clarissa Ribeiro; Gonzalez, Marly Kimie Sonohara; Greghi, Sebastião Luiz Aguiar; do Valle, Accácio Lins; Lauris, José Roberto Pereira

    2007-01-01

    Objective The purpose of this study was to perform a radiographic follow-up evaluation after a 12-month healing period, following crown lengthening surgery. Material and methods Twenty-three periodontally healthy subjects (mean age 32.5 years) that required crown lengthening surgery in premolars were recruited. In a total of 30 premolars, full thickness flaps, osseous resection, and flap suturing were performed. The restorative margin was defined in the pre-surgical phase and maintained unaltered during the healing period, serving as a reference point. Standardized bitewing radiographs were taken before and after osseous reduction, and at 2, 3, 6, and 12-month healing periods. Results Intact lamina dura was observed at both mesial and distal alveolar crests only from the 3rd month. At 12-months, all alveolar crests presented lamina dura. The overall mean distance from the restorative margin to the alveolar crest achieved after osseous resection was 3.28±0.87 mm at mesial and 2.81±0.51 mm at distal sites. No significant radiographic changes in the bone crest were observed during a 12-month healing period. Conclusion The findings of this study suggest that the radiographic proximal bone level observed on bitewing radiographs following crown lengthening surgery can be used as a reference to predict the future level of the healed alveolar crest. PMID:19089145

  16. Slide crown lengthening procedure using wide surface incisions and cyanoacrylate.

    Science.gov (United States)

    Szymaitis, Dennis W

    2011-01-01

    This article introduces the slide crown lengthening procedure (SCLP), which incorporates surgical design features to overcome present crown lengthening procedure (CLP) shortcomings. The result is a 75% decrease in required surgery on adjacent teeth and a corresponding 75% reduction in surgical time. Other advantages include a reduction in surgical morbidity, improvement in terminal esthetics, and fewer teeth subject to papillae removal and apically repositioned gingiva. The 20 to 30 degree incision forming the slide is the pivotal feature; it allows effortless flap positioning. This incision angle enables wide surface incisions to adhere flaps together by producing stronger fibrin clots, decreasing tissue retraction angles, and reforming disrupted fibrin clots as incision sides slide while maintaining contact. This enhanced fibrin clot eliminates the need for sutures. The slide produced by the 20 to 30 degree incision functions for crown lengthening on all sites (facial, lingual, or palatal). This versatile surgical design introduces a new healing dimension that adapts to and provides benefits for other dental surgeries, such as gingival grafts, endodontic surgery, implants, and extractions.

  17. Demonstration of Achilles tendon on CT

    Energy Technology Data Exchange (ETDEWEB)

    Reiser, M.; Rupp, N.; Lehner, K.; Paar, O.; Gradinger, R.; Karpf, P.M.

    1985-08-01

    Ligaments and tendons, including the Achilles tendon, show the highest density among normal soft tissue structures in the body. Traumatic and degenerative changes of the Achilles tendon are often associated with marked thickening and reduction in density associated with increased opacity of the space in front of the Achilles tendon. These changes are easily demonstrated by CT, whereas conventional radiological techniques only show non-specific changes. Twenty-five patients were examined, including nine with pain, seven following rupture of the Achilles tendon and nine post-operative controls; it was found that CT can add information important for the diagnosis and treatment planning of abnormalities of the Achilles tendon.

  18. Dislocation of a constrained total knee arthroplasty with patellar tendon rupture after trivial trauma

    Institute of Scientific and Technical Information of China (English)

    Raju Vaishya; Vipul Vijay; Abhishek Vaish

    2015-01-01

    Constrained total knee prostheses are used in knees with severe deformities and insufficiency of collaterals to provide stable and mobile knees.Dislocation after constrained knee prosthesis is an extremely rare and dreaded complication.When dislocation is associated with patellar tendon rupture,the management includes restoration of the extensor apparatus along with a stable knee.Repair of the patellar tendon is challenging due to poor soft tissue coverage in the area and a bulky repair can put tension on the wound closure.Ideal method of restoration of the extensor apparatus is a matter of debate.There are various modalities used ranging from primary end-to-end repair,augmentation by medial gastrocnemius flap,semitendinosus and synthetic implants and allograft tendoachilles.We report a rare case of a posterior dislocation of a constrained total knee arthroplasty in association with patellar tendon rupture due to a minor fall after a few weeks of surgery.The first episode was managed by reposition of the dislocation and V-Y plasty of the quadriceps and primary repair.The second episode of dislocation with re-rupture needed augmentation by semitendinosus along with the insertion of the thicker insert.The management of this complex problem along with the review of literature is discussed in this case report.

  19. Effects of low-load resistance training with vascular occlusion on the mechanical properties of muscle and tendon.

    Science.gov (United States)

    Kubo, Keitaro; Komuro, Teruaki; Ishiguro, Noriko; Tsunoda, Naoya; Sato, Yoshiaki; Ishii, Naokata; Kanehisa, Hiroaki; Fukunaga, Tetsuo

    2006-05-01

    The present study aimed to investigate the effects of low-load resistance training with vascular occlusion on the specific tension and tendon properties by comparing with those of high-load training. Nine participants completed 12 weeks (3 days/week) of a unilateral isotonic training program on knee extensors. One leg was trained using low load (20% of 1 RM) with vascular occlusion (LLO) and other leg using high load (80% of 1 RM) without vascular occlusion (HL). Before and after training, maximal isometric knee extension torque (MVC) and muscle volume were measured. Specific tension of vastus lateralis muscle (VL) was calculated from MVC, muscle volume, and muscle architecture measurements. Stiffness of tendon-aponeurosis complex in VL was measured using ultrasonography during isometric knee extension. Both protocols significantly increased MVC and muscle volume of quadriceps femoris muscle. Specific tension of VL increased significantly 5.5% for HL, but not for LLO. The LLO protocol did not alter the stiffness of tendon-aponeurosis complex in knee extensors, while the HL protocol increased it significantly. The present study demonstrated that the specific tension and tendon properties were found to remain following low-load resistance training with vascular occlusion, whereas they increased significantly after high-load training.

  20. Suitable long tendon technologies and practices

    CSIR Research Space (South Africa)

    Altounyan, P

    2001-10-01

    Full Text Available effective long tendon support systems suitable in South African coalmines. Appropriate test procedures for the evaluation of the performance of long tendon systems were also determined and are detailed in this report....

  1. Achilles tendon rupture; assessment of nonoperative treatment

    National Research Council Canada - National Science Library

    Barfod, Kristoffer Weisskirchner

    2014-01-01

    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...

  2. Alternative lengthening of telomeres and loss of ATRX are frequent events in pleomorphic and dedifferentiated liposarcomas.

    Science.gov (United States)

    Lee, Jen-Chieh; Jeng, Yung-Ming; Liau, Jau-Yu; Tsai, Jia-Huei; Hsu, Hung-Han; Yang, Ching-Yao

    2015-08-01

    Telomerase activation and alternative lengthening of telomeres are two major mechanisms of telomere length maintenance. Soft tissue sarcomas appear to use the alternative lengthening of telomeres more frequently. Loss of α-thalassemia/mental retardation syndrome X-linked (ATRX) or death domain-associated protein 6 (DAXX) expression has been implicated in the pathogenesis of alternative telomere lengthening in pancreatic endocrine neoplasm and glioma. The mechanism leading to the alternative lengthening of telomeres in liposarcoma remains unknown. Whereas alternative telomere lengthening was determined to be an indicator of poor prognosis in liposarcomas as a whole, its prognostic power has not been verified in any subtype of liposarcoma. In this study, we characterized the status of alternative telomere lengthening and expression of ATRX and DAXX in 111 liposarcomas (28 well-differentiated, 52 dedifferentiated, 20 myxoid or round cell, and 11 pleomorphic liposarcomas) by telomere fluorescence in situ hybridization and immunohistochemistry, respectively. Alternative lengthening of telomere was observed in 0% (0/16) of well-differentiated, 30% (14/46) of dedifferentiated, 5% (1/19) of myxoid or round cell, and 80% (8/10) of pleomorphic liposarcomas. Eighteen (16%) and one (1%) tumors were negative for ATRX and DAXX immunostaining, respectively. Remarkably, all cases with loss of either ATRX or DAXX expression had alternative lengthening of telomeres, and 83% (19/23) of tumors that had alternative lengthening of telomeres showed loss of either protein. The correlation between loss of either ATRX or DAXX and alternative telomere lengthening was 100% in dedifferentiated liposarcoma. The presence of alternative telomere lengthening in dedifferentiated liposarcoma suggested poor overall survival (hazard ratio=1.954, P=0.077) and was the most significant indicator of short progression-free survival (hazard ratio=3.119, P=0.003). In conclusion, we found that ATRX loss was

  3. EFFECTIVENESS OF DIFFERENT QUADRICEPS STRENGTHENING PROTOCOLS IN IMPROVEMENT OF EXTENSOR LAG IN OSTEOARTHRITIC KNEE JOINT

    Directory of Open Access Journals (Sweden)

    Mayank Shukla

    2010-09-01

    Full Text Available Introduction: Osteoarthritis of knee is a widespread, slowly developing disease with a high prevalence with age, with greater body weight and in post menopausal women. The main causes of functional dysfunction in osteoarthritic knee are pain and quadriceps muscle weakness. Physical rehabilitation usually includes quadriceps exercises i.e. isometric and isotonic exercises for the maintenance of joint range of motion and muscle strength. Biofeedback is a process that can be combined with it to increase the awareness about the extent of muscle work done by quadriceps muscle. The aim of the study was to compare the effectiveness of different quadriceps strengthening protocols with or without biofeedback in improvement of extensor lag in osteoarthritic knee joint. Materials & Methods: Sixty osteoarthritic knee patients with twenty patients each in three groups were randomly selected from Guru Harkrishan Hospital, Sarai Kale khan and Physical rehabilitation clinics in Delhi. Patients were randomly divided into three groups A, B and C. Research Design was Experimental study. Dependent Variables were Quardiceps Lag and Knee ROM .Independent Variables were Biofeedback and Modified Quadriceps Exercise which were introduced to the subjects. ANOVA test was applied to find out the statistical level of significance. Results: There was a great improvement of extensor lag in group C who had received Modified Quadriceps Sets with Biofeedback when compared with group B and group A. The percentage of reduction in pain was more and ROM was more increased in group C when compared with group B and A. Discussion & Conclusion: Modified quadriceps sets with biofeedback are better than the quadriceps sets and quadriceps sets with biofeedback in improvement of extensor lag in osteoarthric knee patients.

  4. Informing tendon tissue engineering with embryonic development

    OpenAIRE

    Glass, Zachary A.; Schiele, Nathan R.; Kuo, Catherine K

    2014-01-01

    Tendon is a strong connective tissue that transduces muscle-generated forces into skeletal motion. In fulfilling this role, tendons are subjected to repeated mechanical loading and high stress, which may result in injury. Tissue engineering with stem cells offers the potential to replace injured/damaged tissue with healthy, new living tissue. Critical to tendon tissue engineering is the induction and guidance of stem cells towards the tendon phenotype. Typical strategies hav...

  5. EFFECT OF ISOMETRIC QUADRICEPS STRENGTHENING EXERCISE AT MULTIPLE ANGLES IN KNEE JOINT AMONG NORMAL ADULTS

    Directory of Open Access Journals (Sweden)

    JibiPaul

    2014-04-01

    Full Text Available Introduction: Strengthening exercises have been routinely used in persons with orthopaedic problems and athletes to increase force production or minimize muscle imbalance and joint injuries.Many studies have reported that isometric contractions can rapidly increases strength in quadriceps muscle. Objective: Objective of the study was to find out the effect of isometric strengthening exercise on strength of quadriceps at 45 and 90 degree of knee joint and also to compare the effect of strengthening exercise on strength of quadriceps at multiple angles of knee joint among control and experimental group. Methodology: This was a ccomparative experimental study with forty female healthy subjects from physiotherapy department of KPJ Healthcare University College, Malaysia. Convenient sampling method used to select the samples. The subjects were selected by inclusion criteria and randomly divided equally in to two with 20 subjects in each group. Isometric strengthening exercise and squatting exercise were given as intervention program for eight weeks respectively for experimental and control group. Pre and post data of quadriceps muscle strength measured were collected separately at 45 and 90 degree of knee joint using goniometry during resisted extension of knee in multi gym. Result: In experimental group Pre –Post statistical analysis found significant effect in increase of quadriceps strength at 45 and 90 degree with P<0.0001.****In control group quadriceps pre-post statistical analysis found no significant effect in increase of quadriceps strength at 45 and 90 degree with P<0.083NS and P<0.055 NS respectively. Comparative study between experimental and control groups for quadriceps strength at 90 degree of knee joint found significant effect in increase of quadriceps strength with P< 0.001.*** Comparative study between experimental and control groups for quadriceps strength at 45 degree of knee joint found significant effect in increase of

  6. High Intensity Neuromuscular Electrical Stimulation to Enhance Quadriceps Strength after Anterior Cruciate Ligament Reconstruction

    Institute of Scientific and Technical Information of China (English)

    Joseph A.Gallo; Christopher Proulx

    2010-01-01

    @@ Despite the implementation of accelerated ACL rehabilitation and improved surgical technique,persistent quadriceps weakness continues to be reported in the literature following ACL reconstruction.[1-4]The literature suggests,that the exclusive use of multijoint CKC exercises may not be selective enough in the recruitment of the quadriceps muscle.[5,6]Ernest et al demonstrated that hip and ankle extensors may compensate for a weak quadriceps during the lateral step-up exercise in subjects status post ACL reconstruction.[3

  7. Midportion Achilles tendinosis and the plantaris tendon.

    Science.gov (United States)

    Alfredson, Håkan

    2011-10-01

    When re-operating patients with midportion Achilles tendinosis, having had a poor effect of ultrasound (US) and Doppler-guided scraping, the author found the involvement of the plantaris tendon to be a likely reason for the poor result. The aim of this study was to investigate the occurrence of a plantaris tendon in close relation to the Achilles tendon in consecutive patients with midportion Achilles tendinosis undergoing treatment with US and Doppler-guided scraping. This study includes 73 consecutive tendons with chronic painful midportion Achilles tendinosis, where US+Doppler examination showed thickening, irregular tendon structure, hypo-echoic regions, and localised high blood flow outside and inside the ventral Achilles midportion. The tendons were treated with US+Doppler-guided scraping, via a medial incision. If there was a plantaris tendon located in close relation to the medial Achilles, it was extirpated. An invaginated, or 'close by located', enlarged plantaris tendon was found in 58 of 73 (80%) tendons. Preliminary clinical results of the combined procedure, US + Doppler-guided surgical scraping and extirpation of the plantaris tendon, are very promising. A thickened plantaris tendon located in close relation to the medial Achilles seems common in patients with chronic painful midportion tendinosis. The role of the plantaris tendon in midportion Achilles tendinosis needs to be further evaluated and should be kept in mind when treating this condition.

  8. Quadriceps Strength, Quadriceps Power, and Gait Speed in Older U.S. Adults with Diabetes: Results from the National Health and Nutrition Examination Survey (NHANES), 1999–2002

    Science.gov (United States)

    Kalyani, Rita Rastogi; Tra, Yolande; Yeh, Hsin-Chieh; Egan, Josephine M.; Ferrucci, Luigi; Brancati, Frederick L.

    2013-01-01

    Objectives To examine the independent association of diabetes (and its duration and severity) with quadriceps strength, quadriceps power, and gait speed in a national population of older adults. Design Cross-sectional nationally representative survey. Setting U.S. Participants We examined 2573 adults ≥50 years of age in the National Health and Nutrition Examination Survey 1999–2002 who had assessment of quadriceps strength. Methods Diabetes was ascertained by questionnaire. Measurement of isokinetic knee extensors (quadriceps) strength was performed at 60 degrees/second. Gait speed was assessed using a 20-foot walk test. Multiple linear regression analyses were used to assess the association between diabetes status and outcomes, adjusting for potential confounders or mediators. Results Among older U.S. adults, those with versus without diabetes had significantly slower gait speed (0.96±0.02 versus 1.08±0.01 m/s; p<0.001). After adjusting for demographics, weight, and height, diabetes was also associated with significantly lower quadriceps strength (−4.6±1.9 Newton-meters; p=0.02), quadriceps power (−4.9±2.0 Watts; p=0.02), in addition to gait speed (−0.05±0.02 m/s; p=0.002). Associations remained significant after adjusting for physical activity and C-reactive protein. After accounting for comorbidities (cardiovascular disease, peripheral neuropathy, amputation, cancer, arthritis, fracture, COPD), diabetes was only independently associated with gait speed (−0.04±0.02 m/s; p=0.02). Diabetes duration in men and women was negatively associated with age-adjusted quadriceps strength (−5.7 and −3.5 Newton-meters/decade of diabetes, respectively) and power (−6.1 and −3.8 Watts/decade of diabetes, respectively) (all p≤0.001, no significant interactions by gender). Hemoglobin A1c was not associated with outcomes accounting for body weight. Conclusion Compared to persons without diabetes, older U.S. adults with diabetes have lower quadriceps

  9. 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.

  10. [Graft reconstruction of flexor tendons].

    Science.gov (United States)

    Pauchard, N; Pedeutour, B; Dautel, G

    2014-12-01

    The improvement of primary flexor tendon repair has limited the indications of secondary repairs to neglected initial wound care and deficiencies in the surgical technique or rehabilitation. The surgical and rehabilitation care is complex and prolonged, requiring full cooperation of the patient. That is why the surgeon must evaluate patient's ability to integrate instructions and to comply with a long and demanding protocol. The functional needs of the patient are important in treatment decisions and the surgeon should not hesitate to use an appropriate surgical alternative (tenodesis, arthrodesis, tendon transfer, etc.). After a brief historical review, the authors discuss the indications, technical procedures and finally the results of one-stage and two-stage flexor tendon graft, which despite mixed results keep a real place in our current armamentarium.

  11. Callus patterns in femur lengthening using a monolateral external fixator

    Energy Technology Data Exchange (ETDEWEB)

    Isaac, Dileep; Fernandez, Harry; Song, Hae-Ryong; Kim, Tae-Young; Kumar Shyam, Ashok [Korea University Medical Centre, Guro Hospital, Department of Orthopaedic Surgery, Rare Diseases Institute, Seoul (Korea); Lee, Seok-Hyun [Dongguk University International Hospital, Department of Orthopaedic Surgery, Ilsan (Korea); Lee, Jong-Chan [Korea University, Department of Statistics, Seoul (Korea)

    2008-04-15

    We studied the callus pattern seen in femoral lengthening using monolateral external fixator to determine whether callus types and shapes can predict the final outcome of the procedure. The radiographs of 41 cases of femoral lengthening (33 unilateral and 8 bilateral) in 33 patients with a mean age 11.9 years (range 4-22 years) were retrospectively analysed by four observers and classified into different shapes and types in concordance with the Ru Li classification. The classification was tested for concurrence and reproducibility by inter-observer studies. An average of 6.2 cm of lengthening (range 3-10.8) was achieved with an external fixator index of 36.5 (range 20.9-55.3). The fusiform type of callus (fixator index 32.04, maturation index 21.6) showed the best result followed by the cylinder type of callus (fixator index 35.7, maturation index 22.3) and the lateral type of callus (fixator index 33.2, maturation index 21.5). However, the concave type of callus showed poor results with a fixator index of 49.4 and a maturation index of 37.1. The homogeneous path showed the best results (fixator index 30.4, maturation index 18.6). The heterogeneous path also showed good results (fixator index 36.4, maturation index 23.9). The mixed path (fixator index 42.5, maturation index 30.8) and the lucent path (fixator index 45.1, maturation index 32.8) showed poor results. Analysis of the callus pattern helps the surgeon to predict the outcome of the procedure and guide him in planning any additional interventions if necessary. (orig.)

  12. Two-strand posterior cruciate ligament reconstruction with a quadriceps tendon-patellar bone autograft: technical considerations and clinical results.

    Science.gov (United States)

    Noyes, Frank R; Barber-Westin, Sue D

    2006-01-01

    In patients with complete posterior cruciate ligament (PCL) ruptures in which 10 mm or more of increased posterior tibial translation is detected, associated knee disorders must be treated at the same time as the PCL injury. Varus malalignment and any abnormal medial or lateral ligament deficiency must be corrected before or with PCL reconstruction to avoid the risk of failure of the PCL graft. Gait retraining is recommended for patients with abnormal knee hyperextension patterns before ligament reconstruction is performed. Advances in PCL reconstruction include the use of a two-strand graft that may be placed using either a tibial inlay or an all-arthroscopic tibial tunnel technique. Biomechanical studies have shown a reduction in graft tension and improved load sharing in these constructs compared with single-strand reconstructions. The tibial inlay method can be used in athletic patients, and it also is required in PCL revisions in which a prior tibial tunnel must be avoided to achieve graft fixation. The tibial tunnel technique is used to treat dislocated knees for which reconstruction of multiple knee ligaments is required or when prior arterial injury or posterior skin or muscle damage limits the indications for a posterior open approach. Postoperative rehabilitation should protect the PCL graft from high forces and repetitive cyclic knee motions during the first 4 weeks postoperatively.

  13. Unpacking a time interval lengthens its perceived temporal distance

    Directory of Open Access Journals (Sweden)

    Yang eLiu

    2014-11-01

    Full Text Available In quantity estimation, people often perceive that the whole is less than the sum of its parts. The current study investigated such an unpacking effect in temporal distance judgment. Our results showed that participants in the unpacked condition judged a given time interval longer than those in the packed condition, even the time interval was kept constant between the two conditions. Furthermore, this unpacking effect persists regardless of the unpacking ways we employed. Results suggest that unpacking a time interval may be a good strategy for lengthening its perceived temporal distance.

  14. Lengthening Temporalis Myoplasty: Virtual Animation-Assisted Technical Video.

    Science.gov (United States)

    Aljudaibi, Nawaf; Bennis, Yasmine; Duquennoy-Martinot, Veronique; Labbé, Daniel; Guerreschi, Pierre

    2016-09-01

    Lengthening temporalis myoplasty is a well-established procedure for dynamic palliative reanimation of the lip in facial palsy sequelae. The particularity of this technique is that the entire temporal muscle is transferred from the coronoid process to the upper half of the lip without interposition of aponeurotic tissue. To date, no video describing the technique was available. This is the first video describing the entire procedure, from preoperative markings through postoperative rehabilitation. In the video presented herein, the authors craft virtual three-dimensional animations in addition to a live operation on a patient performed by Daniel Labbé, who first described this technique 20 years ago.

  15. Achilles tendon lesions in sport.

    Science.gov (United States)

    Williams, J G

    1993-09-01

    Achillodynia (Achilles tendon pain) is a significant source of disability to many people taking part in sports. Papers in the English language published since 1986 are reviewed here, grouped into specific subject areas including biomechanics, pathology, general clinical presentations, experimental treatments, steroids, podiatry and surgery. While there has been no dramatic breakthrough in the field, there have been various interesting advances with particular reference to imaging and conservative management, which will hopefully stimulate further studies. Many problems of Achilles tendon lesions in athletes remain unsolved, however, and much is yet to be done to provide adequate and generally effective methods of prevention and conservative treatment.

  16. Chronic Achilles tendon rupture reconstructed using hamstring tendon autograft.

    Science.gov (United States)

    Ellison, Philip; Mason, Lyndon William; Molloy, Andrew

    2016-03-01

    Chronic rupture of the Achilles tendon (delayed diagnosis of more than 4 weeks) can result in retraction of the tendon and inadequate healing. Direct repair may not be possible and augmentation methods are challenging when the defect exceeds 5-6 cm, especially if the distal stump is grossly tendinopathic. We describe our method of Achilles tendon reconstruction with ipsilateral semitendinosis autograft and interference screw fixation in a patient with chronic rupture, a 9 cm defect and gross distal tendinopathy. Patient reported outcome measures consistently demonstrated improved health status at 12 months post surgery: MOXFQ-Index 38-25, EQ5D-5L 18-9, EQ VAS 70-90 and VISA-A 1-64. The patient was back to full daily function, could single leg heel raise and was gradually returning to sport. No complications or adverse events were recorded. Reconstruction of chronic tears of the Achilles tendon with large defects and gross tendinopathy using an ipsilateral semitendinosis autograft and interference screw fixation can achieve satisfactory improvements in patient reported outcomes up to 1 year post-surgery. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Can PRP effectively treat injured tendons?

    Science.gov (United States)

    Wang, James H-C

    2014-01-01

    PRP is widely used to treat tendon and other tissue injuries in orthopaedics and sports medicine; however, the efficacy of PRP treatment on injured tendons is highly controversial. In this commentary, I reason that there are many PRP- and patient-related factors that influence the outcomes of PRP treatment on injured tendons. Therefore, more basic science studies are needed to understand the mechanism of PRP on injured tendons. Finally, I suggest that better understanding of the PRP action mechanism will lead to better use of PRP for the effective treatment of tendon injuries in clinics.

  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. [Lengthening of residual digit by gradual traction and bone grafting (a report of 143 cases)].

    Science.gov (United States)

    Hou, C L

    1992-06-01

    Since 1985, a device for gradual traction was used for lengthening of 143 residual digits in 75 patients. The average lengthening was 2.2 cm. This method is simple, safe, and effective. The advantages of this method over the previously exercised tubed bone graft and other digital lengthening methods are that the digit reconstructed by the gradual traction-lengthening method has the normal cutaneous structure, good sensation function, and better contour. Multiple digits can be reconstructed simultaneously. Because the periosteum at the osteotomy site is kept intact, the long term results are consistent.

  20. DEVELOPMENTS IN THE USE OF THE HAMSTRING/QUADRICEPS RATIO FOR THE ASSESSMENT OF MUSCLE BALANCE

    Directory of Open Access Journals (Sweden)

    Gerard Garbutt

    2002-09-01

    Full Text Available Isokinetic moment ratios of the hamstrings (H and quadriceps (Q muscle groups, and their implication in muscle imbalance, have been investigated for more than three decades. The conventional concentric H/Q ratio with its normative value of 0.6 has been at the forefront of the discussion. This does not account for the joint angle at which moment occurs and the type of muscle action involved. Advances towards more functional analyses have occurred such that previous protocols are being re-examined raising questions about their ability to demonstrate a relationship between thigh muscle imbalance and increased incidence or risk of knee injury. This article addresses the function of the hamstring-quadriceps ratio in the interpretation of this relationship using the ratios Hecc/Qcon (ratio of eccentric hamstring strength to concentric quadriceps strength, representative of isolated knee extension and Hcon/Qecc (ratio of concentric hamstring strength to eccentric quadriceps strength, representative of isolated knee flexion.

  1. Quadriceps function following ACL reconstruction and rehabilitation : implications for optimisation of current practices

    NARCIS (Netherlands)

    Gokeler, Alli; Bisschop, Marsha; Benjaminse, Anne; Myer, Greg D.; Eppinga, Peter; Otten, Egbert

    To determine the most effective practices for quadriceps strengthening after ACL reconstruction. An electronic search has been performed for the literature appearing from January 1990 to January 2012. Inclusion criteria were articles written in English, German or Dutch with unilateral

  2. A Novel Noninvasive Method for Measuring Fatigability of the Quadriceps Muscle in Noncooperating Healthy Subjects

    National Research Council Canada - National Science Library

    Poulsen, Jesper B; Rose, Martin H; Møller, Kirsten; Perner, Anders; Jensen, Bente R

    2015-01-01

    .... On two occasions, separated by seven days, nonvoluntary isometric contractions (twitch and tetanic) of the quadriceps femoris muscle evoked by transcutaneous electrical muscle stimulation were recorded in twelve healthy adults...

  3. Morphometric analyses of normal pediatric brachial biceps and quadriceps muscle tissue

    National Research Council Canada - National Science Library

    Sallum, Adriana M E; Varsani, Hemlata; Holton, Janice L; Marie, Suely K N; Wedderburn, Lucy R

    2013-01-01

    Pediatric normal brachial biceps (14 specimens) and quadriceps muscles (14 specimens) were studied by immunohistochemistry to quantify fiber-type, diameter and distribution, capillary density, presence of inflammatory cells...

  4. Identification of quadriceps-shank dynamics using randomized interpulse interval stimulation

    NARCIS (Netherlands)

    Franken, Henry M.; Veltink, Peter H.; Tijsmans, Roel; Nijmeijer, Henk; Boom, Herman B.K.

    1995-01-01

    Model structures for artificially stimulated paralyzed muscle-limb system dynamics were developed and experimentally evaluated in paraplegic patients. The examined system consisted of the quadriceps, electrically stimulated using surface electrodes, and a freely swinging shank. The interpulse interv

  5. What understanding tendon cell differentiation can teach us about pathological tendon ossification.

    Science.gov (United States)

    Magne, D; Bougault, C

    2015-08-01

    Tendons are the structures that attach muscles to bones and transmit mechanical forces. Tendon cells are composed of mature tenocytes and a rare population of tendon stem cells. Both cell types ensure homeostasis and repair of tendon extracellular matrix to guarantee its specific mechanical properties. Moreover, tendon cells seem to present a marked potential for trans-differentiation, predominantly into the chondrocyte and osteoblast lineages. In this review article, we first present chronic tendon pathologies associated with abnormal ossification, such as spondyloarthritis and calcifying tendinopathy, and discuss how tendon cell differentiation and trans-differentiation may participate in these diseases. We moreover present the factors known to influence tendon cell differentiation and trans-differentiation, with a particular emphasis on extracellular environment, mechanical stimulation and several soluble factors that can tip the balance toward one or another lineage. A better understanding of the neglected tendon cell biology may be extremely useful to understand the pathological mechanisms of spondyloarthritis and calcifying tendinopathy.

  6. Hamstring tendon harvesting--Effect of harvester on tendon characteristics and soft tissue disruption; cadaver study.

    Science.gov (United States)

    Charalambous, C P; Alvi, F; Phaltankar, P; Gagey, O

    2009-06-01

    The purpose of this study was to determine whether the type of hamstring tendon harvester used can influence harvested tendon characteristics and soft tissue disruption. We compared two different types of tendon harvesters with regard to the length of tendon obtained and soft tissue disruption during hamstring tendon harvesting. Thirty six semitendinosus and gracilis tendons were harvested using either a closed stripper or a blade harvester in 18 paired knees from nine human fresh cadavers. Use of the blade harvester gave longer lengths of usable tendon whilst minimising the stripping of muscle and of any non-usable tendon. Our results suggest that the type of harvester per se can influence the length of tendon harvested as well as soft tissue disruption. Requesting such data from the industry prior to deciding which harvester to use seems desirable.

  7. Bioreactor Design for Tendon/Ligament Engineering

    Science.gov (United States)

    Wang, Tao; Gardiner, Bruce S.; Lin, Zhen; Rubenson, Jonas; Kirk, Thomas B.; Wang, Allan; Xu, Jiake

    2013-01-01

    Tendon and ligament injury is a worldwide health problem, but the treatment options remain limited. Tendon and ligament engineering might provide an alternative tissue source for the surgical replacement of injured tendon. A bioreactor provides a controllable environment enabling the systematic study of specific biological, biochemical, and biomechanical requirements to design and manufacture engineered tendon/ligament tissue. Furthermore, the tendon/ligament bioreactor system can provide a suitable culture environment, which mimics the dynamics of the in vivo environment for tendon/ligament maturation. For clinical settings, bioreactors also have the advantages of less-contamination risk, high reproducibility of cell propagation by minimizing manual operation, and a consistent end product. In this review, we identify the key components, design preferences, and criteria that are required for the development of an ideal bioreactor for engineering tendons and ligaments. PMID:23072472

  8. Functionally Distinct Tendons From Elastin Haploinsufficient Mice Exhibit Mild Stiffening and Tendon-Specific Structural Alteration.

    Science.gov (United States)

    Eekhoff, Jeremy D; Fang, Fei; Kahan, Lindsey G; Espinosa, Gabriela; Cocciolone, Austin J; Wagenseil, Jessica E; Mecham, Robert P; Lake, Spencer P

    2017-11-01

    Elastic fibers are present in low quantities in tendon, where they are located both within fascicles near tenocytes and more broadly in the interfascicular matrix (IFM). While elastic fibers have long been known to be significant in the mechanics of elastin-rich tissue (i.e., vasculature, skin, lungs), recent studies have suggested a mechanical role for elastic fibers in tendons that is dependent on specific tendon function. However, the exact contribution of elastin to properties of different types of tendons (e.g., positional, energy-storing) remains unknown. Therefore, this study purposed to evaluate the role of elastin in the mechanical properties and collagen alignment of functionally distinct supraspinatus tendons (SSTs) and Achilles tendons (ATs) from elastin haploinsufficient (HET) and wild type (WT) mice. Despite the significant decrease in elastin in HET tendons, a slight increase in linear stiffness of both tendons was the only significant mechanical effect of elastin haploinsufficiency. Additionally, there were significant changes in collagen nanostructure and subtle alteration to collagen alignment in the AT but not the SST. Hence, elastin may play only a minor role in tendon mechanical properties. Alternatively, larger changes to tendon mechanics may have been mitigated by developmental compensation of HET tendons and/or the role of elastic fibers may be less prominent in smaller mouse tendons compared to the larger bovine and human tendons evaluated in previous studies. Further research will be necessary to fully elucidate the influence of various elastic fiber components on structure-function relationships in functionally distinct tendons.

  9. 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

  10. Combination of eccentric exercise and neuromuscular electrical stimulation to improve quadriceps function post-ACL reconstruction.

    Science.gov (United States)

    Lepley, Lindsey K; Wojtys, Edward M; Palmieri-Smith, Riann M

    2015-06-01

    Neuromuscular electrical stimulation (NMES) has been shown to reduce quadriceps activation failure (QAF), and eccentric exercise has been shown to lessen muscle atrophy post-ACL reconstruction. Given that these are two critical components of quadriceps strength, intervention combining these therapies may be effective at reinstituting quadriceps function post-reconstruction. Thus, the aim of this study was to evaluate the effectiveness of a combined NMES and eccentric exercise intervention to improve the recovery of quadriceps activation and strength post-reconstruction. Thirty-six individuals post-injury were placed into four treatment groups (N&E, NMES and eccentrics; E-only, eccentrics only; N-only, NMES-only; and STND, standard of care) and ten healthy controls participated. N&E and N-only received the NMES protocol 2× per week for the first 6 weeks post-reconstruction. N&E and E-only received the eccentric exercise protocol 2× per week beginning 6 weeks post-reconstruction. Quadriceps activation was assessed via the superimposed burst technique and quantified via the central activation ratio. Quadriceps strength was assessed via maximal voluntary isomeric contractions (Nm/kg). Data was gathered on three occasions: pre-operative, 12-weeks-post-surgery and at return-to-play. No differences in pre-operative measures existed (P>0.05). E-only recovered quadriceps activation better than N-only or STND (P0.05). Eccentric exercise was capable of restoring levels of quadriceps activation and strength that were similar to those of healthy adults and better than NMES alone. Level 3, Parallel longitudinal study. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. Surface neuromuscular electrical stimulation for quadriceps strengthening pre and post total knee replacement.

    LENUS (Irish Health Repository)

    Monaghan, Brenda

    2010-01-01

    Total knee replacement has been demonstrated to be one of the most successful procedures in the treatment of osteoarthritis. However quadriceps weakness and reductions in function are commonly reported following surgery. Recently Neuromuscular Electrical Stimulation (NMES) has been used as an adjunct to traditional strengthening programmes. This review considers the effectiveness of NMES as a means of increasing quadriceps strength in patients before and after total knee replacement.

  12. Functional and morphological changes in the quadriceps muscle induced by eccentric training after ACL reconstruction

    OpenAIRE

    Brasileiro,Jamilson S.; Pinto,Olga M. S. F.; Mariana A. Ávila; Tania F. Salvini

    2011-01-01

    OBJECTIVES: The purpose of this study was to investigate the contributions of functional and morphological factors in the recovery of the quadriceps muscle after anterior cruciate ligament (ACL) reconstruction. METHODS: Nine subjects (31.3±5.8 years) underwent eccentric exercise sessions twice a week for 12 weeks. Quadriceps muscle function was evaluated using an isokinetic dynamometer (isometric and eccentric peak torque) and electromyography (RMS). Morphological changes were measured using ...

  13. Progressive fibrosis of the quadriceps muscle FIBROSIS PROGRESIVA DEL CUÁDRICEPS

    OpenAIRE

    Enrique Vergara-Amador; Jorge Andrés Largo González

    2011-01-01

    Background. Fibrosis of the quadriceps in children is a frequently reported pathology which is associated with antibiotics having been injected into the thigh. This study presents a series of patients having a common background of having had a single pentavalent vaccine dose or injectable vitamin K and presenting progressive fibrosis of the quadriceps muscle. Materials and methods. Seven children were found who had progressive unilateral retraction of the knee. Six of them had a background of...

  14. Influence of Anterior Cruciate Ligament Tear on Thigh Muscle Strength and Hamstring-to-Quadriceps Ratio: A Meta-Analysis.

    Science.gov (United States)

    Kim, Hyun-Jung; Lee, Jin-Hyuck; Ahn, Sung-Eun; Park, Min-Ji; Lee, Dae-Hee

    2016-01-01

    Theoretical compensation after anterior cruciate ligament (ACL) tear could cause quadriceps weakness and hamstring activation, preventing anterior tibial subluxation and affecting the expected hamstring-to-quadriceps ratio. Although quadriceps weakness often occurs after ACL tears, it remains unclear whether hamstring strength and hamstring-to-quadriceps ratio increase in ACL deficient knees. This meta-analysis compared the isokinetic muscle strength of quadriceps and hamstring muscles, and the hamstring-to-quadriceps ratio, of the injured and injured limbs of patients with ACL tears. This meta-analysis included all studies comparing isokinetic thigh muscle strengths and hamstring-to-quadriceps ratio in the injured and uninjured legs of patients with ACL tear, without or before surgery. Thirteen studies were included in the meta-analysis. Quadriceps and hamstring strengths were 22.3 N∙m (95% CI: 15.2 to 29.3 N∙m; Pmuscles of patients with ACL tear, with the decrease in quadriceps strength being 3-fold greater. These uneven reductions slightly increase the hamstring-to-quadriceps ratio in ACL deficient knees.

  15. Neuromuscular and muscle-tendon system adaptations to isotonic and isokinetic eccentric exercise.

    Science.gov (United States)

    Guilhem, G; Cornu, C; Guével, A

    2010-06-01

    To present the properties of an eccentric contraction and compare neuromuscular and muscle-tendon system adaptations induced by isotonic and isokinetic eccentric trainings. An eccentric muscle contraction is characterized by the production of muscle force associated to a lengthening of the muscle-tendon system. This muscle solicitation can cause micro lesions followed by a regeneration process of the muscle-tendon system. Eccentric exercise is commonly used in functional rehabilitation for its positive effect on collagen synthesis but also for resistance training to increase muscle strength and muscle mass in athletes. Indeed, eccentric training stimulates muscle hypertrophy, increases the fascicle pennation angle, fascicles length and neural activation, thus inducing greater strength gains than concentric or isometric training programs. Eccentric exercise is commonly performed either against a constant external load (isotonic) or at constant velocity (isokinetic), inducing different mechanical constraints. These different mechanical constraints could induce structural and neural adaptive strategies specific to each type of exercise. The literature tends to show that isotonic mode leads to a greater strength gain than isokinetic mode. This observation could be explained by a greater neuromuscular activation after IT training. However, the specific muscle adaptations induced by each mode remain difficult to determine due to the lack of standardized, comparative studies. 2010 Elsevier Masson SAS. All rights reserved.

  16. Smart Tendon Actuated Flexible Actuator

    Directory of Open Access Journals (Sweden)

    Md. Masum Billah

    2015-01-01

    Full Text Available We investigate the kinematic feasibility of a tendon-based flexible parallel platform actuator. Much of the research on tendon-driven Stewart platforms is devoted either to the completely restrained positioning mechanism (CRPM or to one particular type of the incompletely restrained positioning mechanism (IRPM where the external force is provided by the gravitational pull on the platform such as in cable-suspended Stewart platforms. An IRPM-based platform is proposed which uses the external force provided by a compliant member. The compliant central column allows the configuration to achieve n DOFs with n tendons. In particular, this investigation focuses on the angular deflection of the upper platform with respect to the lower platform. The application here is aimed at developing a linkable module that can be connected to one another so as to form a “snake robot” of sorts. Since locomotion takes precedence over positioning in this application, a 3-DOF Stewart platform is adopted. For an arbitrary angular displace of the end-effector, the corresponding length of each tendon can be determined through inverse kinematics. Mathematical singularities are investigated using the traditional analytical method of defining the Jacobian.

  17. Effect of time-dependent cryotherapy on redox balance of quadriceps injuries.

    Science.gov (United States)

    Silva, Marco Aurélio dos Santos; Carvalho, Taiara Ramos de; Cruz, Amanda Cristina Marques Barros da; Jesus, Lennon Rafael Guedine de; Silva Neto, Larissa Alexsandra da; Trajano, Eduardo Tavares Lima; Bezerra, Frank Silva

    2016-02-01

    Muscle trauma represents a high number of injuries in professional sport and recreation and may occur through several mechanisms. This study aims at analyzing time-dependent effects of cryotherapy on the redox balance in lesioned quadriceps muscles in F1 mice. Twenty male F1 mice were divided into five groups: (a) animals were not subjected to muscle lesioning or treatment (CTR); (b) quadriceps muscle was lesioned without treatment (L); (c) quadriceps muscle was lesioned and treated with cryotherapy for 5 min (LC5); (d) quadriceps muscle was lesioned and treated with cryotherapy for 20 min (LC20); and quadriceps muscle was lesioned and treated with cryotherapy for 40 min (LC40). The mice were euthanized; the quadriceps muscles were collected and subjected to analyses for levels of protein, hydroperoxides, nitrite, catalase (CAT) activity, oxidized glutathione (GSSG) and reduced glutathione (GSH). Protein levels were reduced in L (-39%; p cryotherapy does not improve the oxidative stress in lesioned muscles.

  18. Accuracy of predicting maximal quadriceps force from submaximal effort contractions after anterior cruciate ligament injury.

    Science.gov (United States)

    Farquhar, Sara J; Chmielewski, Terese L; Snyder-Mackler, Lynn

    2005-10-01

    Weakness and failure of voluntary activation of the quadriceps femoris muscles often occur after anterior cruciate ligament (ACL) rupture. Side-to-side strength comparisons are used as a measure of progress, and are inaccurate if the quadriceps has activation failure. Burst superimposition testing is commonly used to assess quadriceps strength and activation during a maximal volitional isometric contraction (MVIC), using the central activation ratio (CAR) calculation. A recently developed mathematical model predicts the MVIC from submaximal efforts. The purpose of this study was to compare the CAR calculation to the mathematical model. We hypothesized that the model would be a more accurate predictor of strength than the CAR calculation when voluntary activation failure is present. Data from the involved and uninvolved quadriceps muscles of 100 consecutive subjects with complete, isolated ACL rupture were retrospectively evaluated. Subjects who required multiple trials to produce an MVIC with full activation (true MVIC) were used to compare the CAR calculation, the mathematical model, and this true MVIC. Subjects unable to produce a true MVIC with multiple trials were used to compare the mathematical model to the CAR calculation. Results demonstrate that both methods reliably and accurately estimate the quadriceps weakness associated with ACL rupture. We recommend use of the CAR calculation to provide estimations of true quadriceps strength to facilitate clinical decisions about progress in rehabilitation after ACL rupture.

  19. Serial Changes of Quadriceps and Hamstring Muscle Strength Following Total Knee Arthroplasty: A Meta-Analysis.

    Science.gov (United States)

    Moon, Young-Wan; Kim, Hyun-Jung; Ahn, Hyeong-Sik; Lee, Dae-Hee

    2016-01-01

    This meta-analysis was performed to analyze serial changes in thigh muscles, including quadriceps and hamstring muscles, from before to one year after total knee arthroplasty (TKA). All studies sequentially comparing isokinetic quadriceps and hamstring muscle strengths between the TKA side and the contralateral uninjured limb were included in this meta-analysis. Five studies with 7 cohorts were included in this meta-analysis. The mean differences in the strengths of quadriceps and hamstring muscles between the TKA and uninjured sides were greatest three months after surgery (26.8 N∙m, 12.8 N∙m, Pstrengths relative to preoperative levels were 9.2 N∙m and 4.9 N∙m, respectively, three months postoperatively (P = 0.041), but were no longer significant after six months and one year. During the year after TKA, quadriceps and hamstring muscle strengths were lowest after 3 months, recovering to preoperative level after six months, but not reaching the muscle strength on the contralateral side. Relative to preoperative levels, the difference in muscle strength between the TKA and contralateral knees was only significant at three months. Because decrease of strength of the quadriceps was significantly greater than decrease in hamstring muscle strength at postoperative three months, early rehabilitation after TKA should focus on recovery of quadriceps muscle strength.

  20. The effect of knee injury on the number of muscle fibres in the human quadriceps femoris.

    Science.gov (United States)

    Young, A; Hughes, I; Round, J M; Edwards, R H

    1982-02-01

    By means of ultrasound scanning, bilateral measurements of the cross-sectional area of the quadriceps muscle groups were made in 14 young adults with unilateral thigh muscle wasting after knee injury. Needle biopsy specimens from the lateral mass of the muscle were used to estimate the myofibre cross-sectional area for both quadriceps of each subject. 2. The cross-sectional area of the quadriceps of each patient's injured limb was always smaller than that of the contralateral muscle. The wasting was largely localized to the quadriceps, with relative sparing of the other thigh muscles. 3. None of the biopsies showed any abnormality apart from the reduction in fibre size. In each case, the injured limb's reduced quadriceps cross-sectional area was associated with a reduced mean fibre area. 4. The ratio of the cross-sectional area of a muscle to its mean fibre area is a reduced mean fibre area. 4. The ratio of the cross-sectional area of a muscle to its mean fibre area is a function of the number of fibres it contains. The ratio varied considerably from patient to patient but there was close agreement between the values obtained for the two limbs of each patient. 5. The quadriceps wasting produced by knee injury was due to muscle fibre atrophy. There was no evidence for a change in the number of fibres in the muscle.

  1. Correlation between Quadriceps Endurance and Adduction Moment in Medial Knee Osteoarthritis.

    Directory of Open Access Journals (Sweden)

    Soon-Hyuck Lee

    Full Text Available It is not clear whether the strength or endurance of thigh muscles (quadriceps and hamstring is positively or negatively correlated with the adduction moment of osteoarthritic knees. This study therefore assessed the relationships between the strength and endurance of the quadriceps and hamstring muscles and adduction moment in osteoarthritic knees and evaluated predictors of the adduction moment. The study cohort comprised 35 patients with unilateral medial osteoarthritis and varus deformity who were candidates for open wedge osteotomy. The maximal torque (60°/sec and total work (180°/sec of the quadriceps and hamstring muscles and knee adduction moment were evaluated using an isokinetic testing device and gait analysis system. The total work of the quadriceps (r = 0.429, P = 0.037 and hamstring (r = 0.426, P = 0.045 muscles at 180°/sec each correlated with knee adduction moment. Preoperative varus deformity was positively correlated with adduction moment (r = 0.421, P = 0.041. Multiple linear regression analysis showed that quadriceps endurance at 180°/sec was the only factor independently associated with adduction moment (β = 0.790, P = 0.032. The adduction moment of osteoarthritic knees correlated with the endurance, but not the strength, of the quadriceps muscle. However, knee adduction moment did not correlate with the strength or endurance of the hamstring muscle.

  2. Hyperuricemic PRP in Tendon Cells

    Directory of Open Access Journals (Sweden)

    I. Andia

    2014-01-01

    Full Text Available Platelet-rich plasma (PRP is injected within tendons to stimulate healing. Metabolic alterations such as the metabolic syndrome, diabetes, or hyperuricemia could hinder the therapeutic effect of PRP. We hypothesise that tendon cells sense high levels of uric acid and this could modify their response to PRP. Tendon cells were treated with allogeneic PRPs for 96 hours. Hyperuricemic PRP did not hinder the proliferative actions of PRP. The gene expression pattern of inflammatory molecules in response to PRP showed absence of IL-1b and COX1 and modest expression of IL6, IL8, COX2, and TGF-b1. IL8 and IL6 proteins were secreted by tendon cells treated with PRP. The synthesis of IL6 and IL8 proteins induced by PRP is decreased significantly in the presence of hyperuricemia (P = 0.017 and P = 0.012, resp.. Concerning extracellular matrix, PRP-treated tendon cells displayed high type-1 collagen, moderate type-3 collagen, decorin, and hyaluronan synthase-2 expression and modest expression of scleraxis. Hyperuricemia modified the expression pattern of extracellular matrix proteins, upregulating COL1 (P = 0.036 and COMP (P = 0.012 and downregulating HAS2 (P = 0.012. Positive correlations between TGF-b1 and type-1 collagen (R = 0.905, P = 0.002 and aggrecan (R = 0.833, P = 0.010 and negative correlations between TGF-b1 and IL6 synthesis (R = −0.857, P = 0.007 and COX2 (R = −0.810, P = 0.015 were found.

  3. Comprehensive screening of alternative lengthening of telomeres phenotype and loss of ATRX expression in sarcomas.

    Science.gov (United States)

    Liau, Jau-Yu; Lee, Jen-Chieh; Tsai, Jia-Huei; Yang, Ching-Yao; Liu, Tsung-Lin; Ke, Zhi-Long; Hsu, Hung-Han; Jeng, Yung-Ming

    2015-12-01

    According to cytogenetic aberrations, sarcomas can be categorized as complex or simple karyotype tumors. Alternative lengthening of telomeres is a telomere-maintenance mechanism common in sarcomas. Recently, this mechanism was found to be associated with loss of either α-thalassemia/mental retardation syndrome X-linked (ATRX) or death domain-associated (DAXX) protein. We previously reported that alternative lengthening of telomeres and loss of ATRX expression were common in leiomyosarcoma, angiosarcoma, pleomorphic liposarcoma, and dedifferentiated liposarcoma. In the present study, we screened an additional 245 sarcomas of other types to determine the prevalence of alternative lengthening of telomeres, loss of ATRX/DAXX expression, and their relationship. Undifferentiated pleomorphic sarcomas were frequently alternative lengthening of telomeres positive (65%) and loss of ATRX was seen in approximately half of the alternative lengthening of telomeres-positive tumors. Nineteen of 25 myxofibrosarcomas were alternative lengthening of telomeres-positive, but only one was ATRX deficient. Three of 15 radiation-associated sarcomas were alternative lengthening of telomeres positive, but none of them was ATRX deficient. Alternative lengthening of telomeres and/or loss of ATRX were uncommon in malignant peripheral nerve sheath tumors, gastrointestinal stromal tumors, and embryonal rhabdomyosarcomas. By contrast, none of the 71 gene fusion-associated sarcomas was ATRX deficient or alternative lengthening of telomeres positive. All tumors exhibited preserved DAXX expression. Combining our previous studies and this study, a total of 384 sarcomas with complex karyotypes were examined, 83 of which were ATRX deficient (22%). By telomere-specific fluorescence in situ hybridization, 45% (138/308) were alternative lengthening of telomeres positive, 55% (76/138) of which were ATRX deficient. Loss of ATRX was highly associated with alternative lengthening of telomeres (PATRX is highly

  4. Muscle lengthening surgery causes differential acute mechanical effects in both targeted and non-targeted synergistic muscles.

    Science.gov (United States)

    Ateş, Filiz; Özdeşlik, Rana N; Huijing, Peter A; Yucesoy, Can A

    2013-10-01

    Epimuscular myofascial force transmission (EMFT) is a major determinant of muscle force exerted, as well as length range of force exertion. Therefore, EMFT is of importance in remedial surgery performed, e.g., in spastic paresis. We aimed to test the following hypotheses: (1) muscle lengthening surgery (involving preparatory dissection (PD) and subsequent proximal aponeurotomy (AT)) affects the target muscle force exerted at its distal and proximal tendons differentially, (2) forces of non-operated synergistic muscles are affected as well, (3) PD causes some of these effects. In three conditions (control, post-PD, and post-AT exclusively on m. extensor digitorum longus (EDL)), forces exerted by rat anterior crural muscles were measured simultaneously. Our results confirm hypotheses (1-2), and hypothesis (3) in part: Reduction of EDL maximal force differed by location (i.e. 26.3% when tested distally and 44.5% when tested proximally). EDL length range of active force exertion increased only distally. Force reductions were shown also for non-operated tibialis anterior (by 11.9%), as well as for extensor hallucis longus (by 8.4%) muscles. In tibialis anterior only, part of the force reduction (4.9%) is attributable to PD. Due to EMFT, remedial surgery should be considered to have differential effects for targeted and non-targeted synergistic muscles. Copyright © 2013 Elsevier Ltd. All rights reserved.

  5. Triple extensor digiti minimi tendon: An anatomic variation

    OpenAIRE

    Elif Sari

    2014-01-01

    This case report describes an unusual variation of the extensor digiti minimi tendon discovered during extensor tendon repair in the emergency room. Knowledge of this variation may be helpful for the tendon transfers and tendon surgery that need tendon graft. [Hand Microsurg 2014; 3(2.000): 56-58

  6. Anatomic variance of the iliopsoas tendon.

    Science.gov (United States)

    Philippon, Marc J; Devitt, Brian M; Campbell, Kevin J; Michalski, Max P; Espinoza, Chris; Wijdicks, Coen A; Laprade, Robert F

    2014-04-01

    The iliopsoas tendon has been implicated as a generator of hip pain and a cause of labral injury due to impingement. Arthroscopic release of the iliopsoas tendon has become a preferred treatment for internal snapping hips. Traditionally, the iliopsoas tendon has been considered the conjoint tendon of the psoas major and iliacus muscles, although anatomic variance has been reported. The iliopsoas tendon consists of 2 discrete tendons in the majority of cases, arising from both the psoas major and iliacus muscles. Descriptive laboratory study. Fifty-three nonmatched, fresh-frozen, cadaveric hemipelvis specimens (average age, 62 years; range, 47-70 years; 29 male and 24 female) were used in this study. The iliopsoas muscle was exposed via a Smith-Petersen approach. A transverse incision across the entire iliopsoas musculotendinous unit was made at the level of the hip joint. Each distinctly identifiable tendon was recorded, and the distance from the lesser trochanter was recorded. The prevalence of a single-, double-, and triple-banded iliopsoas tendon was 28.3%, 64.2%, and 7.5%, respectively. The psoas major tendon was consistently the most medial tendinous structure, and the primary iliacus tendon was found immediately lateral to the psoas major tendon within the belly of the iliacus muscle. When present, an accessory iliacus tendon was located adjacent to the primary iliacus tendon, lateral to the primary iliacus tendon. Once considered a rare anatomic variant, the finding of ≥2 distinct tendinous components to the iliacus and psoas major muscle groups is an important discovery. It is essential to be cognizant of the possibility that more than 1 tendon may exist to ensure complete release during endoscopy. Arthroscopic release of the iliopsoas tendon is a well-accepted surgical treatment for iliopsoas impingement. The most widely used site for tendon release is at the level of the anterior hip joint. The findings of this novel cadaveric anatomy study suggest that

  7. Ipsilateral free semitendinosus tendon graft transfer for reconstruction of chronic tears of the Achilles tendon

    Directory of Open Access Journals (Sweden)

    Gougoulias Nikolaos

    2008-07-01

    Full Text Available Abstract Background Many techniques have been developed for the reconstruction of the Achilles tendon in chronic tears. In presence of a large gap (greater than 6 centimetres, tendon augmentation is required. Methods We present our method of minimally invasive semitendinosus reconstruction for the Achilles tendon using one para-midline and one midline incision. Results The first incision is a 5 cm longitudinal incision, made 2 cm proximal and just medial to the palpable end of the residual tendon. The second incision is 3 cm long and is also longitudinal but is 2 cm distal and in the midline to the distal end of the tendon rupture. The distal and proximal Achilles tendon stumps are mobilised. After trying to reduce the gap of the ruptured Achilles tendon, if the gap produced is greater than 6 cm despite maximal plantar flexion of the ankle and traction on the Achilles tendon stumps, the ipsilateral semitendinosus tendon is harvested. The semitendinosus tendon is passed through small incisions in the substance of the proximal stump of the Achilles tendon, and it is sutured to the Achilles tendon. It is then passed beneath the intact skin bridge into the distal incision, and passed from medial to lateral through a transverse tenotomy in the distal stump. With the ankle in maximal plantar flexion, the semitendinosus tendon is sutured to the Achilles tendon at each entry and exit point Conclusion This minimally invasive technique allows reconstruction of the Achilles tendon using the tendon of semitendinosus preserving skin integrity over the site most prone to wound breakdown, and can be especially used to reconstruct the Achilles tendon in the presence of large gap (greater than 6 centimetres.

  8. Facilitation of quadriceps activation is impaired following eccentric exercise.

    Science.gov (United States)

    Hedayatpour, N; Arendt-Nielsen, L; Falla, D

    2014-04-01

    Contracting the knee flexor muscles immediately before a maximum voluntary contraction (MVC) of knee extension increases the maximal force that the extensor muscles can exert. It is hypothesized that this phenomenon can be impaired by muscle fiber damage following eccentric exercise [delayed onset muscle soreness (DOMS)]. This study investigates the effect of eccentric exercise and DOMS on knee extension MVC immediately following a reciprocal-resisted knee flexion contraction. Electromyography (EMG) was recorded from the knee extensors and flexors of 12 healthy men during knee extension MVCs performed in a reciprocal (maximal knee extension preceded by resisted knee flexion), and nonreciprocal condition (preceded by relaxation of the knee flexors). At baseline, knee extension MVC force was greater during the reciprocal condition (P eccentric exercise, the MVC force was not different between conditions. Similarly, at baseline, the EMG amplitude of the quadriceps during the MVC was larger for the reciprocal condition (P eccentric exercise abolished the facilitation of force production for the knee extensors, which normally occurs when maximum knee extension is preceded by activation of the knee flexors.

  9. Interplay between body stabilisation and quadriceps muscle activation capacity.

    Science.gov (United States)

    Bampouras, Theodoros M; Reeves, Neil D; Baltzopoulos, Vasilios; Maganaris, Constantinos N

    2017-03-22

    The study aimed to distinguish the effect of stabilisation and muscle activation on quadriceps maximal isometric voluntary contraction (MVC) torque generation. Nine subjects performed (a) an MVC with restrained leg and pelvis (Typical MVC), (b) a Typical MVC with handgrip (Handgrip MVC), (c) an MVC focusing on contracting the knee extensors only (Isolated knee extension MVC), and (d) an MVC with unrestrained leg and pelvis (Unrestrained MVC). Torque and activation capacity between conditions were compared with repeated measures ANOVA and dependent t-tests. EMG (from eleven remote muscles) was compared using Friedman's and Wilcoxon. Typical MVC (277.2±49.6Nm) and Handgrip MVC (261.0±55.4Nm) were higher than Isolated knee extension MVC (210.2±48.3Nm, pMVC (195.2±49.7Nm, pMVC (83.1±15.9%) activation was higher than Isolated knee extension MVC (68.9±24.3%, pMVC and Handgrip MVC (81.8±17.4%) were higher than Unrestrained MVC (64.9±16.2%, pMVC consistently lower than Typical MVC or Handgrip MVC. Stabilisation of the involved segments is the prime concern allowing fuller activation of the muscle, reinforcing the need for close attention to stabilisation during dynamometry-based knee joint functional assessment.

  10. Neuromuscular adjustments of the quadriceps muscle after repeated cycling sprints.

    Directory of Open Access Journals (Sweden)

    Olivier Girard

    Full Text Available PURPOSE: This study investigated the supraspinal processes of fatigue of the quadriceps muscle in response to repeated cycling sprints. METHODS: Twelve active individuals performed 10 × 6-s "all-out" sprints on a cycle ergometer (recovery = 30 s, followed 6 min later by 5 × 6-s sprints (recovery = 30 s. Transcranial magnetic and electrical femoral nerve stimulations during brief (5-s and sustained (30-s isometric contractions of the knee extensors were performed before and 3 min post-exercise. RESULTS: Maximal strength of the knee extensors decreased during brief and sustained contractions (~11% and 9%, respectively; P0.05. While cortical voluntary activation declined (P 40% reduced (P<0.001 following exercise. CONCLUSION: The capacity of the motor cortex to optimally drive the knee extensors following a repeated-sprint test was shown in sustained, but not brief, maximal isometric contractions. Additionally, peripheral factors were largely involved in the exercise-induced impairment in neuromuscular function, while corticospinal excitability was well-preserved.

  11. Informing tendon tissue engineering with embryonic development

    Science.gov (United States)

    Glass, Zachary A.; Schiele, Nathan R.; Kuo, Catherine K.

    2014-01-01

    Tendon is a strong connective tissue that transduces muscle-generated forces into skeletal motion. In fulfilling this role, tendons are subjected to repeated mechanical loading and high stress, which may result in injury. Tissue engineering with stem cells offers the potential to replace injured/damaged tissue with healthy, new living tissue. Critical to tendon tissue engineering is the induction and guidance of stem cells towards the tendon phenotype. Typical strategies have relied on adult tissue homeostatic and healing factors to influence stem cell differentiation, but have yet to achieve tissue regeneration. A novel paradigm is to use embryonic developmental factors as cues to promote tendon regeneration. Embryonic tendon progenitor cell differentiation in vivo is regulated by a combination of mechanical and chemical factors. We propose that these cues will guide stem cells to recapitulate critical aspects of tenogenesis and effectively direct the cells to differentiate and regenerate new tendon. Here, we review recent efforts to identify mechanical and chemical factors of embryonic tendon development to guide stem/progenitor cell differentiation toward new tendon formation, and discuss the role this work may have in the future of tendon tissue engineering. PMID:24484642

  12. Informing tendon tissue engineering with embryonic development.

    Science.gov (United States)

    Glass, Zachary A; Schiele, Nathan R; Kuo, Catherine K

    2014-06-27

    Tendon is a strong connective tissue that transduces muscle-generated forces into skeletal motion. In fulfilling this role, tendons are subjected to repeated mechanical loading and high stress, which may result in injury. Tissue engineering with stem cells offers the potential to replace injured/damaged tissue with healthy, new living tissue. Critical to tendon tissue engineering is the induction and guidance of stem cells towards the tendon phenotype. Typical strategies have relied on adult tissue homeostatic and healing factors to influence stem cell differentiation, but have yet to achieve tissue regeneration. A novel paradigm is to use embryonic developmental factors as cues to promote tendon regeneration. Embryonic tendon progenitor cell differentiation in vivo is regulated by a combination of mechanical and chemical factors. We propose that these cues will guide stem cells to recapitulate critical aspects of tenogenesis and effectively direct the cells to differentiate and regenerate new tendon. Here, we review recent efforts to identify mechanical and chemical factors of embryonic tendon development to guide stem/progenitor cell differentiation toward new tendon formation, and discuss the role this work may have in the future of tendon tissue engineering.

  13. Tibial lengthening for unilateral Crowe type-IV developmental dysplasia of the hip

    Directory of Open Access Journals (Sweden)

    Jun Wan

    2014-01-01

    Conclusions: Tibial lengthening may effectively correct gait and satisfactorily improve body image in young patients with unilateral Crowe type-IV DDH. Mono-lateral external fixator allows for accelerated postoperative rehabilitation and optimal preservation of ankle movements. Lengthening along with intramedullary nails may significantly reduce the external fixation time and the risk of fixator-related complications.

  14. Design of an intramedullary leg lengthening device with a shape memory actuator

    NARCIS (Netherlands)

    Aalsma, A.M.M.; Hekman, E.E.G.; Stapert, J.; Grootenboer, H.

    1999-01-01

    The procedure and the external fixator for lengthening long bones was developed by G.A. Ilizarov in the late 1960’s. This technique has, despite its proven abilities for leg lengthening and correction of angular deformities, some considerable disadvantages for the patients. Discomfort, infections an

  15. Influence of Anterior Cruciate Ligament Tear on Thigh Muscle Strength and Hamstring-to-Quadriceps Ratio: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Hyun-Jung Kim

    Full Text Available Theoretical compensation after anterior cruciate ligament (ACL tear could cause quadriceps weakness and hamstring activation, preventing anterior tibial subluxation and affecting the expected hamstring-to-quadriceps ratio. Although quadriceps weakness often occurs after ACL tears, it remains unclear whether hamstring strength and hamstring-to-quadriceps ratio increase in ACL deficient knees. This meta-analysis compared the isokinetic muscle strength of quadriceps and hamstring muscles, and the hamstring-to-quadriceps ratio, of the injured and injured limbs of patients with ACL tears. This meta-analysis included all studies comparing isokinetic thigh muscle strengths and hamstring-to-quadriceps ratio in the injured and uninjured legs of patients with ACL tear, without or before surgery. Thirteen studies were included in the meta-analysis. Quadriceps and hamstring strengths were 22.3 N∙m (95% CI: 15.2 to 29.3 N∙m; P<0.001 and 7.4 N∙m (95% CI: 4.3 to 10.5 N∙m; P<0.001 lower, respectively, on the injured than on the uninjured side. The mean hamstring-to-quadriceps ratio was 4% greater in ACL deficient than in uninjured limbs (95% CI: 1.7% to 6.3%; P<0.001. Conclusively, Decreases were observed in both the quadriceps and hamstring muscles of patients with ACL tear, with the decrease in quadriceps strength being 3-fold greater. These uneven reductions slightly increase the hamstring-to-quadriceps ratio in ACL deficient knees.

  16. Alternative lengthening of telomeres: remodeling the telomere architecture.

    Science.gov (United States)

    Conomos, Dimitri; Pickett, Hilda A; Reddel, Roger R

    2013-01-01

    To escape from the normal limits on proliferative potential, cancer cells must employ a means to counteract the gradual telomere attrition that accompanies semi-conservative DNA replication. While the majority of human cancers do this by up-regulating telomerase enzyme activity, most of the remainder use a homologous recombination-mediated mechanism of telomere elongation known as alternative lengthening of telomeres (ALT). Many molecular details of the ALT pathway are unknown, and even less is known regarding the mechanisms by which this pathway is activated. Here, we review current findings about telomere structure in ALT cells, including DNA sequence, shelterin content, and heterochromatic state. We speculate that remodeling of the telomere architecture may contribute to the emergence and maintenance of the ALT phenotype.

  17. Studies of RF Noise Induced Bunch Lengthening at the LHC

    CERN Document Server

    Mastoridis, T; Rivetta, C H; Baudrenghien, P; Butterworth, A C; Molendijk, J C

    2011-01-01

    Radio Frequency noise induced bunch lengthening can strongly affect the Large Hadron Collider performance through luminosity reduction, particle loss, and other effects. Models and theoretical formalisms demonstrating the dependence of the LHC longitudinal bunch length on the RF station noise spectral content have been presented*,**. Initial measurements validated these studies and determined the performance limiting RF components. For the existing LHC LLRF implementation the bunch length increases with a rate of 1 mm/hr, which is higher than the intrabeam scattering diffusion and leads to a 27% bunch length increase over a 20 hour store. This work presents measurements from the LHC that better quantify the relationship between the RF noise and longitudinal emittance blowup. Noise was injected at specific frequency bands and with varying amplitudes at the LHC accelerating cavities. The experiments presented in this paper confirmed the predicted effects on the LHC bunch length due to both the noise around the ...

  18. Radial Forcing and Edgar Allan Poe's Lengthening Pendulum

    CERN Document Server

    McMillan, Matthew; Whitney, Heather M

    2013-01-01

    Inspired by Edgar Allan Poe's The Pit and the Pendulum, we investigate a radially driven, lengthening pendulum. We first show that increasing the length of an undriven pendulum at a uniform rate does not amplify the oscillations in a manner consistent with the behavior of the scythe in Poe's story. We discuss parametric amplification and the transfer of energy (through the parameter of the pendulum's length) to the oscillating part of the system. In this manner radial driving may easily and intuitively be understood, and the fundamental concept applied in many other areas. We propose and show by a numerical model that appropriately timed radial forcing can increase the oscillation amplitude in a manner consistent with Poe's story. Our analysis contributes a computational exploration of the complex harmonic motion that can result from radially driving a pendulum, and sheds light on a mechanism by which oscillations can be amplified parametrically. These insights should prove especially valuable in the undergra...

  19. Surgical repair of acute Achilles tendon rupture with an end-to-end tendon suture and tendon flap.

    Science.gov (United States)

    Corradino, B; Di Lorenzo, S; Calamia, C; Moschella, F

    2015-08-01

    Achilles tendon ruptures are becoming more common. Complications after open or minimally invasive surgery are: recurrent rupture (2-8%), wound breakdown, deep infections, granuloma, and fistulas. The authors expose their experience with a personal technique. In 8 patients with acute rupture of Achilles tendon the surgery was performed at least 25 days after trauma. Clinical exam and MR demonstrated in all case a total lesion of tendon. After a posterolateral skin incision the tendon stumps were debrided and suture in end-to-end fashion. A tendon flap was harvested from the proximal part of the tendon, in order to protect and reinforce the suture itself. A plaster cast was applied for 3 weeks and the patients started the rehabilitation protocol. After 4 months all patients returned to pre-injury daily activities. The mean follow up was 13 months (ranged between 6 and 24 months). No major complications occurred. The posterolateral skin incision, not above the tendon, preserves the vascularity of the soft tissues, allows identifying and not accidentally injuring the sural nerve, and prevents the cutaneous scar is overlapped the tendon. In this way is favoured physiological tendon sliding. The preparation of the flap tendon does not weaken the overall strength of the tendon and protects the tendon suture. The tension on sutured stumps is less than being spread over a larger area. In our sample of 8 patients the absence of short-and long-term complications and the rapid functional recovery after surgery suggest that the technique used is safe and effective. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Distal femoral extension osteotomy and patellar tendon advancement to treat persistent crouch gait in cerebral palsy. Surgical technique.

    Science.gov (United States)

    Novacheck, Tom F; Stout, Jean L; Gage, James R; Schwartz, Michael H

    2009-10-01

    Hallmarks of a persistent crouched walking pattern exhibited by individuals with cerebral palsy usually include loss of an adequate plantar flexion/knee extension couple, hamstring and/or psoas tightness, or contracture in conjunction with quadriceps insufficiency. Traditional treatment addresses the muscle-tightness component, but not the contracture or the muscle insufficiency. This study was performed to evaluate the effectiveness of distal femoral extension osteotomy and/or patellar tendon advancement in the treatment of crouch gait in patients with cerebral palsy. A retrospective, nonrandomized, repeated-measures design was used. Individuals with a diagnosis of cerebral palsy were included if they had had (1) a distal femoral extension osteotomy in combination with a distal patellar tendon advancement (thirty-three patients), (2) a distal femoral extension osteotomy without patellar tendon advancement (sixteen), or (3) a distal patellar tendon advancement only (twenty-four). All subjects were evaluated with preoperative and postoperative gait analysis. Gait, radiographic, strength, and functional measures were included in the analysis to assess changes in knee function. Seventy-three individuals met the criteria for inclusion. A single side was chosen for the analysis of each subject. Ninety percent of the subjects had additional, concurrent surgery. Improvements were noted in the index assessing the level of gait pathology and in functional variables across all groups, and pain was consistently decreased. All preoperative stress fractures healed. Strength levels were maintained across all groups. The Koshino index of patellar height improved from 1.4 to -2.3 in the group treated with patellar tendon advancement only and from 1.5 to -2.9 in the group treated with both osteotomy and tendon advancement. The range of knee flexion improved an average of 15 degrees to 20 degrees , and stance-phase knee flexion was restored to the typical range (9 degrees to 10

  1. Effect of bilateral superior oblique split lengthening on torsion

    Directory of Open Access Journals (Sweden)

    Jitendra Jethani

    2015-01-01

    Full Text Available Introduction: Superior oblique split lengthening (SOSL is done for weakening of superior oblique. It corrects the superior oblique overaction (SOOA and A pattern. Its effect on the torsion of the eye is not known. We present our data on the effect of this particular procedure on torsion. Materials and Methods: We did a study of 16 patients (32 eyes who underwent bilateral SOSL and compared the disc foveal angle (DFA preoperatively and postoperatively. The split lengthening was done from 4 mm to 7 mm depending upon the overaction of superior oblique. Results: The mean age was 15.3 ± 8.4 years. Mean preoperative DFA in the right eye (RE was −3.9° and in the left eye (LE was −2.9°. Mean postoperative DFA in RE was 0.2° and in LE was 0.9°. The mean change in the DFA for RE was 4.1° ± 1.3° and for LE was 3.8° ± 1.2°. All the patients were aligned horizontally within 6 prism diopter and no pattern and no diplopia postoperatively. The A pattern was corrected in all the patient postsurgery. For each mm of surgery, an improvement of 0.8° was seen in the DFA. Conclusion: We report the effect of SOSL on torsion. The SOSL reduces intorsion postsurgery and is, therefore, a valuable procedure in SOOA where both pattern and in torsion needs to be corrected.

  2. Active Achilles tendon kinesitherapy accelerates Achilles tendon repair by promoting neurite regeneration☆

    Science.gov (United States)

    Jielile, Jiasharete; Aibai, Minawa; Sabirhazi, Gulnur; Shawutali, Nuerai; Tangkejie, Wulanbai; Badelhan, Aynaz; Nuerduola, Yeermike; Satewalede, Turde; Buranbai, Darehan; Hunapia, Beicen; Jialihasi, Ayidaer; Bai, Jingping; Kizaibek, Murat

    2012-01-01

    Active Achilles tendon kinesitherapy facilitates the functional recovery of a ruptured Achilles tendon. However, protein expression during the healing process remains a controversial issue. New Zealand rabbits, aged 14 weeks, underwent tenotomy followed immediately by Achilles tendon microsurgery to repair the Achilles tendon rupture. The tendon was then immobilized or subjected to postoperative early motion treatment (kinesitherapy). Mass spectrography results showed that after 14 days of motion treatment, 18 protein spots were differentially expressed, among which, 12 were up-regulated, consisting of gelsolin isoform b and neurite growth-related protein collapsing response mediator protein 2. Western blot analysis showed that gelsolin isoform b was up-regulated at days 7–21 of motion treatment. These findings suggest that active Achilles tendon kinesitherapy promotes the neurite regeneration of a ruptured Achilles tendon and gelsolin isoform b can be used as a biomarker for Achilles tendon healing after kinesitherapy. PMID:25317130

  3. Active Achilles tendon kinesitherapy accelerates Achilles tendon repair by promoting neurite regeneration

    Institute of Scientific and Technical Information of China (English)

    Jiasharete Jielile; Beicen Hunapia; Ayidaer Jialihasi; Jingping Bai; Murat Kizaibek; Minawa Aibai; Gulnur Sabirhazi; Nuerai Shawutali; Wulanbai Tangkejie; Aynaz Badelhan; Yeermike Nuerduola; Turde Satewalede; Darehan Buranbai

    2012-01-01

    Active Achilles tendon kinesitherapy facilitates the functional recovery of a ruptured Achilles tendon. However, protein expression during the healing process remains a controversial issue. New Zealand rabbits, aged 14 weeks, underwent tenotomy followed immediately by Achilles tendon microsurgery to repair the Achilles tendon rupture. The tendon was then immobilized or subjected to postoperative early motion treatment (kinesitherapy). Mass spectrography results showed that after 14 days of motion treatment, 18 protein spots were differentially expressed, among which, 12 were up-regulated, consisting of gelsolin isoform b and neurite growth-related protein collapsing response mediator protein 2. Western blot analysis showed that gelsolin isoform b was up-regulated at days 7–21 of motion treatment. These findings suggest that active Achilles tendon kinesitherapy promotes the neurite regeneration of a ruptured Achilles tendon and gelsolin isoform b can be used as a biomarker for Achilles tendon healing after kinesitherapy.

  4. Serial Changes of Quadriceps and Hamstring Muscle Strength Following Total Knee Arthroplasty: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Young-Wan Moon

    Full Text Available This meta-analysis was performed to analyze serial changes in thigh muscles, including quadriceps and hamstring muscles, from before to one year after total knee arthroplasty (TKA. All studies sequentially comparing isokinetic quadriceps and hamstring muscle strengths between the TKA side and the contralateral uninjured limb were included in this meta-analysis. Five studies with 7 cohorts were included in this meta-analysis. The mean differences in the strengths of quadriceps and hamstring muscles between the TKA and uninjured sides were greatest three months after surgery (26.8 N∙m, 12.8 N∙m, P<0.001, but were similar to preoperative level at six months (18.4 N∙m, 7.4 N∙m P<0.001 and were maintained for up to one year (15.9 N∙m, 4.1 N∙m P<0.001. The pooled mean differences in changes in quadriceps and hamstring strengths relative to preoperative levels were 9.2 N∙m and 4.9 N∙m, respectively, three months postoperatively (P = 0.041, but were no longer significant after six months and one year. During the year after TKA, quadriceps and hamstring muscle strengths were lowest after 3 months, recovering to preoperative level after six months, but not reaching the muscle strength on the contralateral side. Relative to preoperative levels, the difference in muscle strength between the TKA and contralateral knees was only significant at three months. Because decrease of strength of the quadriceps was significantly greater than decrease in hamstring muscle strength at postoperative three months, early rehabilitation after TKA should focus on recovery of quadriceps muscle strength.

  5. Quadriceps strength assessed by magnetic stimulation of femoral nerve in patients with chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    JU Chun-rong; CHEN Rong-chang

    2011-01-01

    Background Skeletal muscle dysfunction is one of important systemic manifestations of chronic obstructive pulmonary disease (COPD) and is associated with mortality in patients with COPD, thus quantifying its strength is of great clinical interest and of particular value. Quadriceps maximal volitional contraction (MVC) is often used for the routine measurements of this muscle's strength; while twitch tension (TwQ) evoked by magnetic stimulation of the femoral nerve has been employed for measurement of quadriceps strength non-volitionally. We aimed to investigate the prevalence and severity of skeletal muscle dysfunction in COPD patients by measurement of quadriceps strength with volitional and non-volitional techniques, and to probe into some methodological issues. Methods We recruited 71 COPD patients and 60 control subjects. Quadriceps strength was measured with both maximality of TwQ and MVC force. The reproducibility for TwQ and MVC was investigated using within-occasion variability from three repeated maneuvers. Results Maximal TwQ was achieved in 121 participants at a mean of 90% of the stimulator's maximum output. The mean maxmality of TwQ was decrease by about 44%-47% in COPD patients as compared with controls (P<0.05), so was MVC. There was a significant correlation between quadriceps TwQ and MVC, and the mean ratio of TwQ/MVC was 0.29 in controls and 0.33 in patients. The coefficient of variation showed that TwQ yielded lower within-occasion variability than MVC in both groups. Conclusions Quadriceps strength is commonly and substantially impaired in patients with COPD, in terms of MVC as well as TwQ. The magnetic stimulation of the femoral nerve presents a higher reproducibility and is a better technique for measurement of quadriceps strength for the general population, especially for those who are too unwell to perform a full MVC; while it may not be applied to subjects who are over-weighted.

  6. Physeal growth arrest after tibial lengthening in achondroplasia: 23 children followed to skeletal maturity.

    Science.gov (United States)

    Song, Sang-Heon; Agashe, Mandar Vikas; Huh, Young-Jae; Hwang, Soon-Young; Song, Hae-Ryong

    2012-06-01

    Bilateral tibial lengthening has become one of the standard treatments for upper segment-lower segment disproportion and to improve quality of life in achondroplasia. We determined the effect of tibial lengthening on the tibial physis and compared tibial growth that occurred at the physis with that in non-operated patients with achondroplasia. We performed a retrospective analysis of serial radiographs until skeletal maturity in 23 achondroplasia patients who underwent bilateral tibial lengthening before skeletal maturity (lengthening group L) and 12 achondroplasia patients of similar height and age who did not undergo tibial lengthening (control group C). The mean amount of lengthening of tibia in group L was 9.2 cm (lengthening percentage: 60%) and the mean age at the time of lengthening was 8.2 years. The mean duration of follow-up was 9.8 years. Skeletal maturity (fusion of physis) occurred at 15.2 years in group L and at 16.0 years in group C. The actual length of tibia (without distraction) at skeletal maturity was 238 mm in group L and 277 mm in group C (p = 0.03). The mean growth rates showed a decrease in group L relative to group C from about 2 years after surgery. Physeal closure was most pronounced on the anterolateral proximal tibial physis, with relative preservation of the distal physis. Our findings indicate that physeal growth rate can be disturbed after tibial lengthening in achondroplasia, and a close watch should be kept for such an occurrence-especially when lengthening of more than 50% is attempted.

  7. Tendon Force Transmission at the Nanoscale

    DEFF Research Database (Denmark)

    Svensson, René

    2013-01-01

    of connective tissue function that are poorly understood. One such aspect is the microscopic mechanisms of force transmission through tendons over macroscopic distances. Force transmission is at the heart of tendon function, but the large range of scales in the hierarchical structure of tendons has made...... it difficult to tackle. The tendon hierarchy ranges from molecules (2 nm) over fibrils (200 nm), fibers (2 μm) and fascicles (200 μm) to tendons (10 mm), and to derive the mechanisms of force transmission it is necessary to know the mechanical behavior at each hierarchical level. The aim of the present work...... was to elucidate the mechanisms of force transmission in tendons primarily by investigating the mechanical behavior at the hierarchical level of collagen fibrils. To do so we have developed an atomic force microscopy (AFM) method for tensile testing of native collagen fibrils. The thesis contains five papers...

  8. Multiple tendons of abductor pollicis longus

    Directory of Open Access Journals (Sweden)

    Mansur DI

    2010-02-01

    Full Text Available Anatomic variations of the tendons of the abductor pollicis longus (APL and its knowledge is important to assess the diseased and traumatized hand and when considering tendons for repair or graft. During routine dissection of a 63-year-old male cadaver, in the Department of Anatomy, Kasturba Medical College, Mangalore, Karnataka, India we came across an unusual APL in the right upper limb. The muscle had altogether 9 tendons and they were inserted to the lateral and anterolateral sides of the base of the 1st metacarpal bone, opponens pollicis (two tendons each, the abductor pollicis brevis, trapezium and thenar fascia (one tendon each. The number of accessory tendons of APL has functional significance in the development of de Quervain’s syndrome.

  9. 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

    2013-09-01

    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. © 2013 Anatomical Society.

  10. 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

  11. Extensor tendon repair an overview

    Directory of Open Access Journals (Sweden)

    Mansoor Bin Fayed

    2015-04-01

    Full Text Available The incidence of extensor injuries is more than that of flexor tendon injuries. This is to a great extent because of the extensors being superficially placed and covered by skin and subcutaneous tissue over the distal part of the upper extremity. Thus they are more vulnerable to blunt and sharp trauma, the proximal and distal forearm present with laceration and cut with sharp weapon. Extensor tendon injuries are often taken lightly by many, repairs being taken-up at the ER. Repair is done in or if the retrieval of tendon ends is difficult or the wound is complicated with associated injuries such as fractures or in cases of tendon retraction. Delayed primary repair can be undertaken from 7-10 days. Assessment of the injured finger has to be very meticulous. Extension of finger is brought about by the interossei and lumbricals which are the short muscles of the hand. They extend the proximal interphalangeal joints and distal interphalangeal joints and flex metacarpophalangeal joint, these intrinsic muscles are innervated by the ulnar and median nerves. The long extensors are innervated by the radial nerve, they primarily extend the metacarpophalangeal joints and also interphalangeal joints. In cases of injury the intrinsic system may compensate for an extensor deficit. Closed injuries of zone I may be managed by splinting of the distal interphalangeal joints and open injuries in the zone I and II can be treated with tenodermodesis. Proximal interphalangeal joints and distal interphalangeal joints are immobilized in zone 3 and 4. Metacarpophalangeal joint is immobilized in full extension and the wrist in 10o extension.

  12. The roentgenographic findings of achilles tendon rupture

    Energy Technology Data Exchange (ETDEWEB)

    Seouk, Kang Hyo; Keun, Rho Yong [Shilla General Hospital, Seoul (Korea, Republic of)

    1999-03-01

    To evaluate the diagnostic value of a lateral view of the ankles in Achilles tendon rupture. We performed a retrospective analysis of the roentgenographic findings of 15 patients with surgically proven Achilles tendon rupture. Four groups of 15 patients(normal, ankle sprain, medial lateral malleolar fracture, and calcaneal fracture) were analysed as reference groups. Plain radiographs were reviewed with regard to Kager's triangle, Arner's sign, Toygar's angle, ill defined radiolucent shadow through the Achilles tendon, sharpness of the anterior margin of Achilles tendon, and meniscoid smooth margin of the posterior skin surface of the ankle. Kager's triangle was deformed and disappeared after rupture of the Achilles tendon in nine patients(60%) with operative verification of the rupture, six patients(40%) had a positive Arner's sign, while none had a diminished Toygars angle. In 13 patients(87%) with a ruptured Achilles tendon, the thickness of this was nonuniform compared with the reference group. The anterior margin of the Achilles tendon became serrated and indistinct in 14 patients(93%) in whom this was ruptured. An abnormal ill defined radiolucent shadow through the Achilles tendon was noted in nine patient(60%), and nonparallelism between the anterior margin of the Achilles tendon and posterior skin surface of the ankle was detected in 11 patients(73%). The posterior skin surface of the ankle had a nodular surface margin in 13 patients(87%). A deformed Kager's triangle and Achilles tendon, and an abnormal ill defined radiolucent shadow through the Achilles tendon in a lateral view of the ankles are important findings for the diagnesis of in diagnosing achilles tendon rupture.

  13. 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...... and Sweden. Immediate weight-bearing was found to be safe and recommendable in non-operative treatment of acute Achilles tendon rupture. The novel ultrasound measurement showed excellent reliability and acceptable validity and agreement....

  14. Achilles tendon rupture; assessment of nonoperative treatment

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner; Troelsen, Anders

    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...... and Sweden. Immediate weight-bearing was found to be safe and recommendable in non-operative treatment of acute Achilles tendon rupture. The novel ultrasound measurement showed excellent reliability and acceptable validity and agreement....

  15. Lubricin Surface Modification Improves Tendon Gliding After Tendon Repair in a Canine Model in Vitro

    Science.gov (United States)

    Taguchi, Manabu; Sun, Yu-Long; Zhao, Chunfeng; Zobitz, Mark E.; Cha, Chung-Ja; Jay, Gregory D.; An, Kai-Nan; Amadio, Peter C.

    2011-01-01

    This study investigated the effects of lubricin on the gliding of repaired flexor digitorum profundus (FDP) tendons in vitro. Canine FDP tendons were completely lacerated, repaired with a modified Pennington technique, and treated with one of the following solutions: saline, carbodiimide derivatized gelatin/hyaluronic acid (cd-HA-gelatin), carbodiimide derivatized gelatin to which lubricin was added in a second step (cd-gelatin + lubricin), or carbodiimide derivatized gelatin/HA + lubricin (cd-HA-gelatin + lubricin). After treatment, gliding resistance was measured up to 1,000 cycles of simulated flexion/extension motion. The increase in average and peak gliding resistance in cd-HA-gelatin, cd-gelatin + lubricin, and cd-HA-gelatin + lubricin tendons was less than the control tendons after 1,000 cycles (p < 0.05). The increase in average gliding resistance of cd-HA-gelatin + lubricin treated tendons was also less than that of the cd-HA-gelatin treated tendons (p < 0.05). The surfaces of the repaired tendons and associated pulleys were assessed qualitatively with scanning electron microscopy and appeared smooth after 1,000 cycles of tendon motion for the cd-HA-gelatin, cd-gelatin + lubricin, and cd-HA-gelatin + lubricin treated tendons, while that of the saline control appeared roughened. These results suggest that tendon surface modification can improve tendon gliding ability, with a trend suggesting that lubricin fixed on the repaired tendon may provide additional improvement over that provided by HA and gelatin alone. PMID:18683890

  16. Press-fit Femoral Fixation in ACL Reconstruction using Bone-Patellar Tendon-Bone Graft

    Directory of Open Access Journals (Sweden)

    Kaseb Mohammad Hasan

    2009-05-01

    Full Text Available Bone-patellar tendon auto graft is probably the most widely used graft for ACL reconstruction. Several methods for graft fixation have been described. To avoid intra-articular hardware we adopt biological fixation with a femoral trapezoidal press-fit fixation. A prospective study was performed on 30 consecutive active people who underwent ACL reconstruction with this technique by two surgeons between september2004 and march2007 (mean follow-up 15.2 months. Results were evaluated by an independent examiner using radiography, subjective and objective evaluation. Assessment using the IKDC knee scoring revealed 92% of the patients with a normal or nearly normal knee joint. Lysholm's score was 63.6(40- 86 preoperatively and 91.88(73-100 at the latest follow up (P < 0.005. No patient complained of instability at latest follow up. The quadriceps muscle showed mild atrophy at 3 and 6 months and at final follow-up. Five Patients complained of anterior knee pain and had a positive kneeling test. We found no graft displacement on follow up radiographs. All cases showed radiological evidence of graft osteointegration at last follow up. Our results show that press-fit fixation of trapezoidal bone graft in femoral tunnel is a simple, reliable, and cost-effective alternative for ACL recon-struction using bone-patellar tendon-bone graft.

  17. Technique for and an anatomic guide to forearm tendon repair.

    Science.gov (United States)

    Burnham, Jeremy M; Hollister, Anne M; Rush, David A; Avallone, Thomas J; Shi, Runhua; Jordan, Jenee' C

    2011-06-01

    Forearm lacerations involving muscle bellies are usually treated by repairing muscle fascia. Repair of tendons themselves is stronger and restores normal muscle anatomy better. Tendon repair requires good knowledge of forearm muscle and tendon anatomy. We have made cadaver measurements to produce graphical maps of locations of individual muscles tendons of origin and insertion, some practical guides for finding tendon ends and a simple grasping stitch for intramuscular tendons.

  18. Early diagnosis of tendon pathologies with sonoelastography

    Directory of Open Access Journals (Sweden)

    Zeynep ilerisoy Yakut

    2015-04-01

    RESULTS: Achilles tendon thicknesses measured at three segments (proximal, middle ,distal. did not show any statistically significant difference in both painless and symptomatic side. Proximal part of achilles tendon's elasticity did not show any difference in both side (p=0.31. In middle and distal segment , the elasticity was statistically different in symptomatic side than normal side p=0.005 and p=0.001 respectively. CONCLUSION: Sonoelastographic examination of Achilles tendons in patients with FMF suffering from talalgia may be useful for determining early dejenerative changes in tendons either in the absence of B-mode ultrasound findings. [TAF Prev Med Bull 2015; 14(2.000: 75-80

  19. Simulation of tendon energy storage in pedaling

    DEFF Research Database (Denmark)

    Rasmussen, John; Damsgaard, Michael; Christensen, Søren Tørholm

    2001-01-01

    The role of elastic energy stored in tendons during pedaling is investigated by means of numerical simulation using the AnyBody body modeling system. The loss of metabolic energy due to tendon elasticity is computed and compared to the mechanical work involved in the process. The AnyBody simulation...... system is based on inverse dynamics, where the redundancy problem is solved by a minimum fatigue criterion guaranteeing maximuminter-muscular collaboration. The tendons are assumed to be linearly elastic. It is concluded that tendon elasticity is responsible for metabolic power loss...

  20. Ultrasonography in traumatic rupture of Schilles tendon

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Kil Ho; Byun, Woo Mok; Lee, Dong Chul; Kim, Se Dong; Park, Bok Hwan [Yeungnam University College of Medicine, Gyeongsan (Korea, Republic of)

    1993-12-15

    Ultrasonography was performed prospectively in 16 patients with suspected rupture of Achilles tendon from March to October 1992 to evaluate the diagnostic value of ultrasonography. Ultrasonography examinations were done according to standard techniques, and then dynamic evaluations were performed during passive plantar flexion of the ankle. We reviewed 10 confirmed cases of ruptured tendons, among which 9 cases were confirmed by operation,and one by ultrasonography and MRI. ultrasonic results were compared with the findings at physical examination and surgery. The normal thickness of the Achilles tendons in healthy sides on ultrasonography ranged from 3 to 5mm.The ruptured tendons were 6-10mm thick at 1-2cm superior to the upper margin of Os Calcis. Rupture sites on ultrasonography were exactly predicted in 7 among the 9 operative cases. In on non-operative case, the rupture site on ultrasonography corresponded to that seen on MRI. Tendon bucking on dynamic ultrasonography was positive in all 4 complete ruptures. In 2 of the 6 partial ruptures which were near complete tears, tendon buckling was also observed. In conclusion, ultrasonography is a valuable diagnostic modality in the diagnosis of Achilles tendon rupture, the differentiation between total and partial rupture, and in determining the rupture site. We consider ultrasonography of tendon as an important diagnostic toot that may guide the treatment plan in the traumatic rupture of the Achilles tendon

  1. Tendon sheath fibroma in the thigh.

    Science.gov (United States)

    Moretti, Vincent M; Ashana, Adedayo O; de la Cruz, Michael; Lackman, Richard D

    2012-04-01

    Tendon sheath fibromas are rare, benign soft tissue tumors that are predominantly found in the fingers, hands, and wrists of young adult men. This article describes a tendon sheath fibroma that developed in the thigh of a 70-year-old man, the only known tendon sheath fibroma to form in this location. Similar to tendon sheath fibromas that develop elsewhere, our patient's lesion presented as a painless, slow-growing soft tissue nodule. Physical examination revealed a firm, nontender mass with no other associated signs or symptoms. Although the imaging appearance of tendon sheath fibromas varies, our patient's lesion appeared dark on T1- and bright on T2-weighted magnetic resonance imaging. It was well marginated and enhanced with contrast.Histologically, tendon sheath fibromas are composed of dense fibrocollagenous stromas with scattered spindle-shaped fibroblasts and narrow slit-like vascular spaces. Most tendon sheath fibromas can be successfully removed by marginal excision, although 24% of lesions recur. No lesions have metastasized. Our patient's tendon sheath fibroma was removed by marginal excision, and the patient remained disease free 35 months postoperatively. Despite its rarity, tendon sheath fibroma should be included in the differential diagnosis of a thigh mass on physical examination or imaging, especially if it is painless, nontender, benign appearing, and present in men.

  2. Patellar hypomobility and the flexibility of the iliotibial band and the femoral quadriceps.

    Science.gov (United States)

    Getka, Aleksandra

    2005-12-30

    Background. The aim of our study was to determine whether or not the flexibility of the iliotibial band and femoral quadriceps have an impact on patellar hypomobility, due to their connections with the patellar stabilizers. Material and methods. We examined 62 patients (44 females, 18 males) with a median age of 15 years (range 9-19). All these patients had patellofemoral dysfunction in the tested knees (101). The medial and distal glide of the patella were tested with a manual test according to Kaltenborn's scale. Ober's test was performed to test the tightness of the iliotibial band. The flexibility of the quadriceps femoris was tested while the patient was lying prone with the tested leg on the couch and the other beside it. Results. Statistical analysis based on the c2 test (P=0.05) found no dependence between the flexibility parameters of the iliotibial band or the femoral quadriceps and the parameters of patellar hypomobility. Of the tested joints, 37.6% showed hypomobile patella and positive Ober's test, while 34.7% had hypomobile patella and a positive test for femoral quadriceps flexibility. Conclusions. The flexibility of the iliotibial band and femoral quadriceps has no direct influence on passive patellar hypomobility, but can affect the biomechanics of the patellofemoral joint and the location of the point of contact on articular surfaces during dynamic knee work. The flexibility of these muscles should be a diagnostic factor in patients with patellofemoral dysfunction.

  3. Reactive oxygen species generation is not different during isometric and lengthening contractions of mouse muscle.

    Science.gov (United States)

    Sloboda, Darcée D; Brooks, Susan V

    2013-10-01

    Skeletal muscles can be injured by lengthening contractions, when the muscles are stretched while activated. Lengthening contractions produce structural damage that leads to the degeneration and regeneration of damaged muscle fibers by mechanisms that have not been fully elucidated. Reactive oxygen species (ROS) generated at the time of injury may initiate degenerative or regenerative processes. In the present study we hypothesized that lengthening contractions that damage the muscle would generate more ROS than isometric contractions that do not cause damage. To test our hypothesis, we subjected muscles of mice to lengthening contractions or isometric contractions and simultaneously monitored intracellular ROS generation with the fluorescent indicator 5-(and-6)-chloromethyl-2',7'-dichlorodihydrofluorescein (CM-DCFH), which is oxidized by ROS to form the fluorescent product CM-DCF. We found that CM-DCF fluorescence was not different during or shortly after lengthening contractions compared with isometric controls, regardless of the amount of stretch and damage that occurred during the lengthening contractions. The only exception was that after severe stretches, the increase in CM-DCF fluorescence was impaired. We conclude that lengthening contractions that damage the muscle do not generate more ROS than isometric contractions that do not cause damage. The implication is that ROS generated at the time of injury are not the initiating signals for subsequent degenerative or regenerative processes.

  4. 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.

  5. Muscle Degeneration Associated With Rotator Cuff Tendon Release and/or Denervation in Sheep.

    Science.gov (United States)

    Gerber, Christian; Meyer, Dominik C; Flück, Martin; Valdivieso, Paola; von Rechenberg, Brigitte; Benn, Mario C; Wieser, Karl

    2017-03-01

    The effect of an additional neurological injury (suprascapular nerve traction injury) to a chronically retracted rotator cuff muscle is incompletely understood and warrants clarification. To investigate the microscopic and macroscopic muscle degeneration patterns caused by tendon release and/or muscle denervation in a sheep rotator cuff model. Controlled laboratory study. Infraspinatus muscle biopsy specimens (for histological analysis) were obtained from 18 Swiss alpine sheep before and 16 weeks after release of the infraspinatus tendon (tenotomy [T] group; n = 6), transection of the suprascapular nerve (neurectomy [N] group; n = 6), or tendon release plus nerve transection (tenotomy + neurectomy [T&N] group; n = 6). Magnetic resonance imaging (MRI) and computed tomography (CT) were used to assess retraction (CT), muscle density (CT), volume (MRI T2), and fat fraction (MRI Dixon). Stiffness of the infraspinatus was measured with a spring scale. At 16 weeks postoperatively, the mean infraspinatus muscle volume had decreased significantly more after neurectomy (to 47% ± 7% of the original volume; P = .001) and tenotomy plus neurectomy (48% ± 13%; P = .005) than after tenotomy alone (78% ± 11%). Conversely, the mean amount of intramuscular fat (CT/MRI Dixon) was not significantly different in the 3 groups (T group: 50% ± 9%; N group: 40% ± 11%; T&N group: 46% ± 10%) after 16 weeks. The mean myotendinous retraction (CT) was not significantly different in the T and T&N groups (5.8 ± 1.0 cm and 6.4 ± 0.4 cm, respectively; P = .26). Stiffness was, however, most increased after additional neurectomy. In contrast to muscle changes after tendon release, denervation of the muscle led to a decrease in the pennation angle of lengthened muscle fibers, with a reduced mean cross-sectional area of pooled muscle fibers, a slow- to fast-type transformation, and an increase in the area percentage of hybrid fibers, leading to overall significantly greater atrophy of the

  6. Split tendon transfers for the correction of spastic varus foot deformity: a case series study

    Directory of Open Access Journals (Sweden)

    Dimitriadis Dimitris

    2010-12-01

    Full Text Available Abstract Background Overactivity of anterior and/or posterior tibial tendon may be a causative factor of spastic varus foot deformity. The prevalence of their dysfunction has been reported with not well defined results. Although gait analysis and dynamic electromyography provide useful information for the assessment of the patients, they are not available in every hospital. The purpose of the current study is to identify the causative muscle producing the deformity and apply the most suitable technique for its correction. Methods We retrospectively evaluated 48 consecutive ambulant patients (52 feet with spastic paralysis due to cerebral palsy. The average age at the time of the operation was 12,4 yrs (9-18 and the mean follow-up 7,8 yrs (4-14. Eigtheen feet presented equinus hind foot deformity due to gastrocnemius and soleus shortening. According to the deformity, the feet were divided in two groups (Group I with forefoot and midfoot inversion and Group II with hindfoot varus. The deformities were flexible in all cases in both groups. Split anterior tibial tendon transfer (SPLATT was performed in Group I (11 feet, while split posterior tibial tendon transfer (SPOTT was performed in Group II (38 feet. In 3 feet both procedures were performed. Achilles tendon sliding lengthening (Hoke procedure was done in 18 feet either preoperatively or concomitantly with the index procedure. Results The results in Group I, were rated according to Hoffer's clinical criteria as excellent in 8 feet and satisfactory in 3, while in Group II according to Kling's clinical criteria were rated as excellent in 20 feet, good in 14 and poor in 4. The feet with poor results presented residual varus deformity due to intraoperative technical errors. Conclusion Overactivity of the anterior tibial tendon produces inversion most prominent in the forefoot and midfoot and similarly overactivity of the posterior tibial tendon produces hindfoot varus. The deformity can be

  7. Impact of leg lengthening on viscoelastic properties of the deep fascia

    Science.gov (United States)

    Wang, Hai-Qiang; Wei, Yi-Yong; Wu, Zi-Xiang; Luo, Zhuo-Jing

    2009-01-01

    Background Despite the morphological alterations of the deep fascia subjected to leg lengthening have been investigated in cellular and extracellular aspects, the impact of leg lengthening on viscoelastic properties of the deep fascia remains largely unknown. This study aimed to address the changes of viscoelastic properties of the deep fascia during leg lengthening using uniaxial tensile test. Methods Animal model of leg lengthening was established in New Zealand white rabbits. Distraction was initiated at a rate of 1 mm/day and 2 mm/day in two steps, and preceded until increases of 10% and 20% in the initial length of tibia had been achieved. The deep fascia specimens of 30 mm × 10 mm were clamped with the Instron 1122 tensile tester at room temperature with a constant tensile rate of 5 mm/min. After 5 load-download tensile tests had been performed, the specimens were elongated until rupture. The load-displacement curves were automatically generated. Results The normal deep fascia showed typical viscoelastic rule of collagenous tissues. Each experimental group of the deep fascia after leg lengthening kept the properties. The curves of the deep fascia at a rate of 1 mm/day with 20% increase in tibia length were the closest to those of normal deep fascia. The ultimate tension strength and the strain at rupture on average of normal deep fascia were 2.69 N (8.97 mN/mm2) and 14.11%, respectively. The increases in ultimate tension strength and strain at rupture of the deep fascia after leg lengthening were statistically significant. Conclusion The deep fascia subjected to leg lengthening exhibits viscoelastic properties as collagenous tissues without lengthening other than increased strain and strength. Notwithstanding different lengthening schemes result in varied viscoelastic properties changes, the most comparable viscoelastic properties to be demonstrated are under the scheme of a distraction rate of 1 mm/day and 20% increase in tibia length. PMID:19698092

  8. Masticatory muscle tendon-aponeurosis hyperplasia exhibits heterotopic calcification in tendons.

    Science.gov (United States)

    Sato, T; Hori, N; Nakamoto, N; Akita, M; Yoda, T

    2014-05-01

    Masticatory muscle tendon-aponeurosis hyperplasia is a new disease entity associated with limited mouth opening. In this study, we analyzed the microstructural characteristics of muscles and tendons in masticatory muscle tendon-aponeurosis hyperplasia by electron microscopy and energy-dispersive X-ray analysis to determine the elemental composition. Histological analysis was performed to detect the calcification. Transmission electron microscopy and scanning electron microscopy were conducted to clarify the microstructural characteristics of muscles and tendons. Energy-dispersive X-ray microanalysis was performed to identify the distribution of elements. Mineralized nodules were observed in tendon tissues of masticatory muscle tendon-aponeurosis hyperplasia as compared with facial deformity. Electron microscopy revealed that the muscle and tendon tissues in masticatory muscle tendon-aponeurosis hyperplasia showed degenerative changes and distinctive histological findings as compared with tissues in facial deformity. We found that Ca, P, and Si were detected only in masticatory muscle tendon-aponeurosis hyperplasia. We demonstrated that masticatory muscle tendon-aponeurosis hyperplasia exhibits heterotopic calcification in tendon tissues. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. 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.

  10. 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.

  11. Rapid knee-extensions to increase quadriceps muscle activity in patients with total knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Rasmus Skov; Wilquin, Lousia; Jakobsen, Thomas Linding

    2017-01-01

    BACKGROUND: Inhibition of the quadriceps muscle and reduced knee-extension strength is common shortly following total knee arthroplasty (weeks to months), due to reduced voluntary activation of the quadriceps muscle. In healthy subjects, strength training with heavy loads is known to increase...... agonist muscle activity, especially if the exercise is conducted using rapid muscle contractions. PURPOSE: The purpose of this study was to examine if patients with total knee arthroplasty could perform rapid knee-extensions using a 10 RM load four to eight weeks after surgery, and the degree to which...... rapid knee-extensions were associated with greater voluntary quadriceps muscle activity during an experimental strength training session, compared to that elicited using slow knee-extensions. STUDY DESIGN: A randomized cross-over study. METHODS: Twenty-four patients (age 66.5) 4-8 weeks post total knee...

  12. Use of adjunctive prednisolone in the management of a cat with bilateral quadriceps contracture following trauma

    Directory of Open Access Journals (Sweden)

    Penelope LC Tisdall

    2017-03-01

    Full Text Available Case summary A 6-month-old cat was successfully treated for bilateral quadriceps contracture. Conventional treatments including surgery, dynamic flexion apparatus and physical therapy along with analgesics and non-steroidal anti-inflammatory drugs resulted in temporary clinical improvement that was relapsing. The initiation of supplementary corticosteroid treatment with prednisolone coincided with an immediate and sustained clinical improvement and long-term resolution. Relevance and novel information Successful treatment of bilateral quadriceps contracture has not previously been reported in a cat. Quadriceps contracture remains a challenging condition to treat with some cases unresponsive to therapy. Systemic prednisolone treatment appeared to be of benefit in the management of this case and may have a role in some cats where muscle contracture appears relapsing in nature. Further prospective investigations in cats with muscle contracture, including muscle biopsies of affected cats, are warranted.

  13. Split tibialis posterior tendon transfer for correction of spastic equinovarus hindfoot deformity.

    Science.gov (United States)

    Vlachou, Maria; Beris, Alex; Dimitriadis, Dimitris

    2010-10-01

    Equinovarus hindfoot deformity is one of the most common deformities in children with spastic paralysis ; it is usually secondary to cerebral palsy. Split tibialis posterior tendon transfer is performed to balance the flexible spastic varus foot and is preferable to tibialis posterior lengthening, as the muscle does not loose its power and therefore the possibility of a valgus or calcaneovalgus deformity is diminished. We retrospectively evaluated 33 consecutive ambulant patients (38 feet) with flexible spastic varus hindfoot deformity. Twenty-eight presented unilateral and five bilateral involvement. The mean age at operation was 10.8 yrs (range 6-17) and the mean follow-up was 10; yrs (4-14). There were 20 hemiplegic feet, 11 diplegic and 7 quadriplegic. Eighteen feet also presented an equinus position of the hindfoot, requiring Achilles tendon lengthening. The surgical technique applied was similar to the one described by Green et al, with four skin incisions, two on either side of the foot and ankle. The evaluation of the results was carried out using Kling and Kaufer's clinical criteria. Results were graded excellent or good for 34 out of 38 feet (89.5%). Twenty feet were graded excellent, indicating that the children managed to walk with a plantigrade foot without fixed or postural deformity and did not have callosities. Fourteen feet were graded good in children who walked with less than 50,varus, valgus or equinus of the hindfoot and had no callosities. Four were graded poor, with recurrent equinovarus deformity. The feet with poor results presented a residual varus deformity due to intraoperative technical errors.

  14. Formation of the biologic width following crown lengthening in nonhuman primates.

    Science.gov (United States)

    Oakley, E; Rhyu, I C; Karatzas, S; Gandini-Santiago, L; Nevins, M; Caton, J

    1999-12-01

    The purpose of this study was to determine if and how the biologic width is reestablished following surgical crown lengthening. Crown-lengthening surgery was performed on the right or left maxillary and mandibular central and lateral incisors of three adult monkeys, with contralateral teeth serving as unoperated controls. Twelve weeks after surgery, tissue blocks were removed for histologic analysis. The results of a histometric evaluation indicate that the biologic width is reestablished following surgical crown lengthening. The junctional epithelium generally migrates to the apical level of root planing. Space for the supracrestal connective tissue fiber groups is created by crestal resorption of alveolar bone.

  15. Restorative Effect of Vitamin D Deficiency on Knee Pain and Quadriceps Muscle Strength in Knee Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Behzad Heidari

    2015-10-01

    Full Text Available Both vitamin D deficiency and quadriceps muscle weakness are associated with kneeosteoarthritis (KOA and pain. The aim of this study was to determine the restorative effect of vitamin Ddeficiency on pain and quadriceps muscle strength in knee osteoarthritis. Patients with KOA aged≥30years, the presence of knee pain for at least one month or longer and serum 25-hydroxyvitamin (25-OHDdeficiencies were recruited in the study. Participants with KOA compatible with Kellgren-Lawrence grade4, joint instability, and effusion, history of surgery or inflammatory arthropathies were excluded. Serum25-OHD was assessed by ELISA method and concentrationsQuadriceps muscle strength was measured by dynamometry method and intensity of knee pain by WesternOntario and McMaster University Osteoarthritis index scored by Likert scale and visual analog scale. Allparticipants received 50.000 IU oral cholecalciferol weekly for at least two months. The influence ofraising serum 25-OHD on quadriceps muscle strength and pain was assessed by calculation of meanchanges from baseline at the end of the treatment period using paired t-test. A total of 67 patients withmean age of 50±6.6 years of age were treated for 2 months. Serum 25-OHD reached to sufficient levels inall except one patient. At the end of the study period, serum 25-OHD and quadriceps muscle strengthincreased significantly as compared with baseline (P=0.007 and P=0.002, respectively, whereas knee paindecreased significantly based on Western Ontario and McMaster University Osteoarthritis index (P=0.001as well as visual analogue scale scores (P=0.001.These findings indicated that correction of vitamin Ddeficiency in patients with KOA exerts a significant favorable effect on quadriceps muscle strength andknee pain.

  16. Adductor Canal Block With 10 mL Versus 30 mL Local Anesthetics and Quadriceps Strength

    DEFF Research Database (Denmark)

    Jæger, Pia; Koscielniak-Nielsen, Zbigniew J; Hilsted, Karen Lisa;

    2015-01-01

    BACKGROUND AND OBJECTIVES: Adductor canal block (ACB) is predominantly a sensory nerve block, but excess volume may spread to the femoral triangle and reduce quadriceps strength. We hypothesized that reducing the local anesthetic volume from 30 to 10 mL may lead to fewer subjects with quadriceps...

  17. Delayed presentation of compartment syndrome of the thigh secondary to quadriceps trauma and vascular injury in a soccer athlete

    Directory of Open Access Journals (Sweden)

    Moo Ing How

    2015-01-01

    Conclusion: A high index of suspicion for compartment syndrome is needed in all severe quadriceps contusion. Vascular injury can cause thigh compartment syndrome in sports trauma. MRI findings of deep thigh muscle swelling and “blow-out” tear of the vastus lateralis are strongly suggestive of severe quadriceps injury, and may be a harbinger of delayed thigh compartment syndrome.

  18. An examination of possible quadriceps force at the time of anterior cruciate ligament injury during landing: A simulation study.

    Science.gov (United States)

    Domire, Zachary J; Boros, Rhonda L; Hashemi, Javad

    2011-05-17

    Anterior cruciate ligament (ACL) rupture is a common and traumatic injury. Although, identifying the mechanism of ACL injury has received considerable research attention, there are still many unanswered questions. One proposed mechanism asserts that the ACL is injured due to an aggressive quadriceps muscle contraction. However, recently it has been questioned if the magnitude of quadriceps force needed to tear the ACL is physiologically realistic under the conditions where injury occurs during landing (e.g. near full knee extension and within 50ms after impact). To answer this question, a simple simulation model was developed to examine the upper bounds of quadriceps force that can be developed under these conditions. The model included force-length, and force-velocity properties as well as activation dynamics. Model parameters were chosen to provide a high estimate for possible quadriceps force in a young healthy man. The effects of varying quadriceps pre-activation levels were also examined. When using realistic pre-activation levels, the simulated quadriceps force was less than half of what has been shown to cause ACL injury. Even when using maximum pre-activation, the quadriceps force still did not reach close to the level shown to cause injury. Therefore, we conclude that quadriceps force alone seems to be an unlikely mechanism for ACL injury.

  19. The associations between quadriceps muscle strength, power, and knee joint mechanics in knee osteoarthritis: A cross-sectional study.

    Science.gov (United States)

    Murray, Amanda M; Thomas, Abbey C; Armstrong, Charles W; Pietrosimone, Brian G; Tevald, Michael A

    2015-12-01

    Abnormal knee joint mechanics have been implicated in the pathogenesis and progression of knee osteoarthritis. Deficits in muscle function (i.e., strength and power) may contribute to abnormal knee joint loading. The associations between quadriceps strength, power and knee joint mechanics remain unclear in knee osteoarthritis. Three-dimensional motion analysis was used to collect peak knee joint angles and moments during the first 50% of stance phase of gait in 33 participants with knee osteoarthritis. Quadriceps strength and power were assessed using a knee extension machine. Strength was quantified as the one repetition maximum. Power was quantified as the peak power produced at 40-90% of the one repetition maximum. Quadriceps strength accounted for 15% of the variance in peak knee flexion angle (P=0.016). Quadriceps power accounted for 20-29% of the variance in peak knee flexion angle (Pknee adduction moment (P=0.05). These data suggest that quadriceps power explains more variance in knee flexion angle and knee adduction moment during gait in knee osteoarthritis than quadriceps strength. Additionally, quadriceps power at multiple loads is associated with knee joint mechanics and therefore should be assessed at a variety of loads. Taken together, these results indicate that quadriceps power may be a potential target for interventions aimed at changing knee joint mechanics in knee osteoarthritis. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. [Amino acid composition of the rat quadriceps femoris muscle after a flight on the Kosmos-936 biosatellite].

    Science.gov (United States)

    Vlasova, T F; Miroshnikova, E B; Poliakov, V V; Murugova, T P

    1982-01-01

    The amino acid composition of the quadriceps muscle of rats flown onboard the biosatellite Cosmos-936 and exposed to the ground-based synchronous control experiment was studied. The weightless rats showed changes in the amino acid concentration in the quadriceps muscle. The centrifuged flight and synchronous rats displayed an accumulation of free amino acids in the above muscle.

  1. Quadriceps and hamstrings morphology is related to walking mechanics and knee cartilage MRI relaxation times in young adults.

    Science.gov (United States)

    Kumar, Deepak; Subburaj, Karupppasamy; Lin, Wilson; Karampinos, Dimitrios C; McCulloch, Charles E; Li, Xiaojuan; Link, Thomas M; Souza, Richard B; Majumdar, Sharmila

    2013-12-01

    Controlled laboratory study using a cross-sectional design. To analyze the relationship of quadriceps-hamstrings and medial-lateral quadriceps anatomical cross-sectional area (ACSA) ratios with knee loads during walking and articular and meniscal cartilage composition in young, healthy subjects. Muscle forces affect knee loading during walking, but it is not known if muscle morphology is associated with walking mechanics and cartilage composition in young subjects. Forty-two knees from 27 young, healthy, active volunteers (age, 20-35 years; body mass index, relaxation times and for quadriceps and hamstrings muscle ACSA. Frontal plane kinetics during the stance phase of walking was calculated. Generalized estimating equation models were used to identify muscle variables that predicted MRI and gait parameters. Quadriceps-hamstrings and medial-lateral quadriceps ACSA ratios were positively related to frontal plane loading (β = .21-.54, P≤.006), global articular cartilage relaxation times (β = .22-.28, P≤.041), and the medial-lateral ratio of meniscus T1rho relaxation time (β = .26-.36, P≤.049). The medial-lateral quadriceps ACSA ratio was positively related to global meniscus T1rho relaxation times (β = .30, P = .046). Higher quadriceps-hamstrings and medial-lateral quadriceps ACSA ratios were associated with higher frontal plane loading during walking and with articular and meniscal cartilage T1rho and T2 relaxation times. These findings highlight the relationships between different knee tissues and knee mechanics in young, healthy individuals.

  2. Structure-mechanics relationships in mineralized tendons.

    Science.gov (United States)

    Spiesz, Ewa M; Zysset, Philippe K

    2015-12-01

    In this paper, we review the hierarchical structure and the resulting elastic properties of mineralized tendons as obtained by various multiscale experimental and computational methods spanning from nano- to macroscale. The mechanical properties of mineralized collagen fibres are important to understand the mechanics of hard tissues constituted by complex arrangements of these fibres, like in human lamellar bone. The uniaxial mineralized collagen fibre array naturally occurring in avian tendons is a well studied model tissue for investigating various stages of tissue mineralization and the corresponding elastic properties. Some avian tendons mineralize with maturation, which results in a graded structure containing two zones of distinct morphology, circumferential and interstitial. These zones exhibit different amounts of mineral, collagen, pores and a different mineral distribution between collagen fibrillar and extrafibrillar space that lead to distinct elastic properties. Mineralized tendon cells have two phenotypes: elongated tenocytes placed between fibres in the circumferential zone and cuboidal cells with lower aspect ratios in the interstitial zone. Interestingly some regions of avian tendons seem to be predestined to mineralization, which is exhibited as specific collagen cross-linking patterns as well as distribution of minor tendon constituents (like proteoglycans) and loss of collagen crimp. Results of investigations in naturally mineralizing avian tendons may be useful in understanding the pathological mineralization occurring in some human tendons. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Recent advances in flexor tendon repair

    NARCIS (Netherlands)

    J.C.H.M. van der Meulen (Jacques)

    1971-01-01

    markdownabstractThe prognosis for restoration of good function after the treatment of a tendon lesion in 'no-man's land' is influenced by a number of factors which may be summarized as follows: - The nature of the injury. - The amplitude of the tendon excursion. - The motility of the

  4. Recent advances in flexor tendon repair

    NARCIS (Netherlands)

    J.C.H.M. van der Meulen (Jacques)

    1971-01-01

    markdownabstractThe prognosis for restoration of good function after the treatment of a tendon lesion in 'no-man's land' is influenced by a number of factors which may be summarized as follows: - The nature of the injury. - The amplitude of the tendon excursion. - The motility of the hand. -

  5. Rupture of Achilles Tendon : Usefulness of Ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Nam Hyeon; Ki, Won Woo; Yoon, Kwon Ha; Kim, Song Mun; Shin, Myeong Jin [Ulsan Medical College, Ulsan (Korea, Republic of); Kwon, Soon Tae [Chungnam University College of Medicine, Daejeon (Korea, Republic of)

    1996-06-15

    To differentiate a complete rupture of Achilles tendon from an incomplete one which is important because its treatment is quite different. And it is necessary to know the exact site of the rupture preoperatively. Fifteen cases of fourteen patients which were diagnosed as Achilles tendon rupture by ultrasonography and surgery were reviewed. We compared sonographic rupture site with surgical findings. Ultrasonographic criteria for differentiation of complete and incomplete rupture was defined as follows : the discreteness, which means the proximal intervening hypoechogenicity to the interface echogenicity of distal margin of ruptured tendon : the slant sign, which represents the interface of ruptured distal margin which was seen over the 3/4 of the thickness of the tendon without intervening low echogeneicity : the invagination sign, which means the echogenic invagination from Kager triangle into posterior aspect of Achilles tendon over the half thickness of the tendon. The sites of complete tendon rupture were exactly corresponded to surgical finding in four cases of ten complete ruptures. And the discrepancy between sonographic and surgical findings in the site of complete rupture was 1.2 {+-} 0.4 cm in six cases. Three of ten complete ruptures showed the discreteness sign, all of ten showed the slant sign and two of ten showed the invagination sign. It is helpful to differentiate a complete from incomplete rupture of the Achilles tendon and to localize the site of the complete rupture with the ultrasonographic evaluation

  6. Measuring Regional Changes in Damaged Tendon

    Science.gov (United States)

    Frisch, Catherine Kayt Vincent

    Mechanical properties of tendon predict tendon health and function, but measuring these properties in vivo is difficult. An ultrasound-based (US) analysis technique called acoustoelastography (AE) uses load-dependent changes in the reflected US signal to estimate tissue stiffness non-invasively. This thesis explores whether AE can provide information about stiffness alteration resulting from tendon tears both ex vivo and in vivo. An ex vivo ovine infraspinatus tendon model suggests that the relative load transmitted by the different tendon layers transmit different fractions of the load and that ultrasound echo intensity change during cyclic loading decreases, becoming less consistent once the tendon is torn. An in vivo human tibialis anterior tendon model using electrically stimulated twitch contractions investigated the feasibility of measuring the effect in vivo. Four of the five subjects showed the expected change and that the muscle contraction times calculated using the average grayscale echo intensity change compared favorably with the times calculated based on the force data. Finally an AE pilot study with patients who had rotator cuff tendon tears found that controlling the applied load and the US view of the system will be crucial to a successful in vivo study.

  7. Instructive materials for tendon and ligament augmentation

    NARCIS (Netherlands)

    Ribeiro Pereira Simões Crispim, João Francisco

    2016-01-01

    Tendons and ligaments (T/L) are the connective tissue that connect muscles to bone and bone to bone, respectively. The main function of tendons is to translate muscle contractions into join motion and consequently generate movement. Ligaments function to stabilize joints and guide them during their

  8. Duplication of the extensor carpi ulnaris tendon.

    Science.gov (United States)

    Barfred, T; Adamsen, S

    1986-05-01

    Three cases are presented, in which an anomalous tendon slip between the extensor carpi ulnaris tendon and the extensor apparatus of the fifth finger was found. One of the patients was a violinist, who had serious impairment of the left wrist joint and the small finger due to the anomaly. The symptoms disappeared after excision.

  9. Radial forcing and Edgar Allan Poe's lengthening pendulum

    Science.gov (United States)

    McMillan, Matthew; Blasing, David; Whitney, Heather M.

    2013-09-01

    Inspired by Edgar Allan Poe's The Pit and the Pendulum, we investigate a radially driven, lengthening pendulum. We first show that increasing the length of an undriven pendulum at a uniform rate does not amplify the oscillations in a manner consistent with the behavior of the scythe in Poe's story. We discuss parametric amplification and the transfer of energy (through the parameter of the pendulum's length) to the oscillating part of the system. In this manner, radial driving can easily and intuitively be understood, and the fundamental concept applied in many other areas. We propose and show by a numerical model that appropriately timed radial forcing can increase the oscillation amplitude in a manner consistent with Poe's story. Our analysis contributes a computational exploration of the complex harmonic motion that can result from radially driving a pendulum and sheds light on a mechanism by which oscillations can be amplified parametrically. These insights should prove especially valuable in the undergraduate physics classroom, where investigations into pendulums and oscillations are commonplace.

  10. The Isolated Effect of Adductor Canal Block on Quadriceps Femoris Muscle Strength After Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Sørensen, Johan Kløvgaard; Jæger, Pia; Dahl, Jørgen Berg

    2016-01-01

    BACKGROUND: Using peripheral nerve block after total knee arthroplasty (TKA), without impeding mobility, is challenging. We hypothesized that the analgesic effect of adductor canal block (ACB) could increase the maximum voluntary isometric contraction (MVIC) of the quadriceps femoris muscle after......, expressed as a percentage of postoperative preblock values. In this manner, the effect of the ACB could be isolated from the detrimental effect on muscle strength caused by the surgery. Secondary end points were differences between groups in mobility and pain scores. We planned a subgroup analysis dividing......: ACB improves quadriceps femoris muscle strength, but whether this translates into enhanced mobility is not clearly supported by this study....

  11. [Bilateral quadriceps rupture in a patient with osteogenesis imperfecta. A case report].

    Science.gov (United States)

    Salcedo-Dueñas, Jesús Alejandro; Torres Castro, Carlos; Estrada Gómez, José Andrés; Algarín Reyes, José Antonio; Bello González, Alejandro

    2009-01-01

    We present the case of a 24-year-old patient with bilateral quadriceps rupture and history of type I congenital osteogenesis imperfecta diagnosed clinically and with ultrasound. Bilateral quadriceps tenoplasty was performed with an anterior approach and without any complications. The patient was discharged with bilateral neoprene knee-guards. The sutures were removed at the 21-day follow-up visit, rehabilitation was started at six weeks and the patient was doing well at the 2- and 3-month follow-up visits. Timely management and early rehabilitation contribute to decrease the risk of sequelae despite the poor functional prognosis.

  12. Impact of quadriceps strengthening on response to fatiguing exercise following ACL reconstruction.

    Science.gov (United States)

    Kuenze, Christopher; Eltoukhy, Moataz; Kelly, Adam; Kim, Chang-Young

    2017-01-01

    Patients commonly experience altered response to fatiguing exercise after ACL reconstruction (ACLR). The objective of this study was to assess the impact of quadriceps strengthening on response to exercise after ACLR. Clinical trial. Ten participants with a history of primary, unilateral ACLR (sex=9F/1M, age=21.0±2.8 years, BMI=23.7±2.7kg/m(2)) and 10 healthy participants (sex=9F/1M, age=22.2±3.2 years, BMI=23.8±3.9kg/m(2)) participated. ACLR participants completed a 2-week quadriceps strengthening intervention including 14 progressive strengthening exercise sessions. Normalized knee extension maximum voluntary isometric contraction (MVIC) torque (Nm/kg) and quadriceps central activation ratio (%, CAR) were measured before and after a 30-minute fatiguing exercise protocol. ACLR participants completed testing before and after the 2-week intervention while control participants completed a single testing session. The intervention significantly improved normalized knee extension MVIC torque (pre-intervention=1.85±0.67Nm/kg, post-intervention=2.09±0.81Nm/kg, p=0.04) and quadriceps CAR in the ACLR involved limb (pre-intervention=86.51±5.03%, post-intervention=92.94±5.99%, p=0.02). Quadriceps CAR (pre-intervention=1.13±9.04%, post-intervention=-3.97±4.59%, p=0.16) and normalized knee extension MVIC torque (pre-intervention=0.26±20.90%, post-intervention=-8.02±12.82%, p=0.30) response to exercise did not significantly change from pre-intervention to post-intervention conditions. Two weeks of quadriceps strengthening reduced this between group difference in the involved limb which may indicate restoration of more optimal quadriceps neuromuscular function and increased demand on the quadriceps during physical activity. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  13. The severe flexible flatfoot: a combined reconstructive procedure with rerouting of the tibialis anterior tendon.

    Science.gov (United States)

    el-Tayeby, H M

    1999-01-01

    A combined procedure is described that addresses all the components at fault in the severely flexible flatfoot deformity in children. The Evans calcaneal distraction wedge osteotomy will lengthen the lateral column, correcting the heel valgus and forefoot abduction. A naviculo--first cuneiform wedge resection (medial and plantar) and fusion will shorten and reshape the collapsed medial arch. This is augmented by reconstruction and plication of the lengthened plantar ligaments, with plantar rerouting of the tibialis anterior tendon to act as a strong plantar ligament. In addition, shifting the tibialis anterior's pull proximally acts as a sling to the talar head. Z plasty of the tight tendo Achillis is always needed. Nineteen feet in 11 patients were the subject of this study. The period of follow-up ranged from 8 to 42 months. The results were assessed according to the relief of foot strain and calf pains, improvement in shoewear, general activity, and foot shape. To evaluate foot shape, reconstruction of the medial arch and heel posture were assessed. The children and parents were satisfied with the final results in 17 feet (89.5%). Improvement of the radiological measurements was evident and was statistically significant.

  14. Tendon vasculature in health and disease.

    Directory of Open Access Journals (Sweden)

    Herbert eTempfer

    2015-11-01

    Full Text Available 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 fibre 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.

  15. 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

  16. Lateral force transmission between human tendon fascicles

    DEFF Research Database (Denmark)

    Haraldsson, Bjarki T; Aagaard, Per; Qvortrup, Klaus

    2008-01-01

    Whether adjacent collagen fascicles transmit force in parallel is unknown. The purpose of the present study was to examine the magnitude of lateral force transmission between adjacent collagen fascicles from the human patellar and Achilles tendon. From each sample two adjacent strands of fascicles...... in the patellar and Achilles tendon fascicles, respectively. A decline in stiffness of 39% and 60% from cycle 1 to cycle 2, and of 93% and 100% from cycle 2 to cycle 3 was observed in the patellar and Achilles tendon fascicles, respectively. The present data demonstrate that lateral force transmission between...... adjacent collagen fascicles in human tendons is small or negligible, suggesting that tendon fascicles largely act as independent structures and that force transmission principally takes place within the individual fascicles....

  17. [Conservative functional treatment of Achilles tendon ruptures].

    Science.gov (United States)

    Hüfner, T; Gaulke, R; Imrecke, J; Krettek, C; Stübig, T

    2010-09-01

    The conservative functional treatment of Achilles tendon ruptures has developed further over the last 20 years and is basically possible for 60-80% of patients. The treatment leads to success if the indications obtained by dynamic sonography are correctly interpreted (adaptation of the tendon ends up to 20 degrees plantar flexion), if the patient presents sufficient compliance and the physiotherapy is increasingly intensified depending on tendon healing. Modern ortheses allow an increased equinus position and therefore improved protection of the healing tendon. If these factors are present a relatively low re-rupture rate of only 7% can be achieved. The decisive advantage of conservative functional therapy is the avoidance of specific operative risks, such as infection and injury to the sural nerve. After removal of the orthesis the tendon should continue to be modeled using shoe insoles and raised heels.

  18. The effect of high-resistance training on the strength and cross-sectional area of the human quadriceps.

    Science.gov (United States)

    Young, A; Stokes, M; Round, J M; Edwards, R H

    1983-10-01

    Seventeen volunteers performed unilateral strength-training of the quadriceps with high-resistance, low-repetition, dynamic exercise, thrice weekly for an average of 5 weeks. Both before and after the training period, bilateral measurements were made of isometric quadriceps strength, quadriceps cross-sectional area (by ultrasound scanning), and thigh circumference. There were no significant changes in the untrained thighs. The trained quadriceps increased their isometric strength by more than they changed their cross-sectional area (mean increments = 15% and 6% respectively). Quadriceps hypertrophy was underestimated by measurements of thigh circumference and could not be predicted from them. We conclude that studies of localized muscle growth require direct measurements of the size of the muscle(s) concerned. Nevertheless, these may still underestimate the improvements in strength produced by high-resistance training.

  19. Mactaquac intake tendons removal and replacement

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, I. [NB Power Generation Corp., Mactaquac Generating Station, Keswick Ridge, NB (Canada); Mee, A. [Hatch Energy, Niagara Falls, ON (Canada)

    2007-07-01

    In 1988 and 1989, multi-strand tendons were installed in the intake structure of the Mactaquac generating station. In order to control displacements caused by alkali aggregate reaction (AAR), they were installed in preparation for a slot cutting program in the intake structure to guard against the possibility of a sliding failure of a section of the structure along a plane coincident with the bottom of the water passage. Unique problems for the designers were present in the expansion affect of AAR that were compounded by field conditions that resulted in further difficulties. For example, concrete expansion required the installation of a thick shim pack under the upper anchor head and the periodic testing of the tendons. Once tested, shims could be gradually removed to maintain the correct load over the life of the tendon. However, during the first round of testing and de-stressing five years after the original installation, it was found that some of the tendons had already failed. Over half of the tendons have been replaced in the 20 years since the installation. This paper discussed the original design considerations and examined the conditions that contributed to the premature failure of the tendons. It outlined the history of tendon testing procedures, tendon failure modes and tendon replacement methods. Specifically, the paper discussed the remedial techniques that were employed and the iterations that lead to the current repair approach, while considering the unique field conditions. The application of various corrosion protection schemes and installation and testing methodologies were discussed. It was concluded that tendons were successfully installed in numerous concrete dams around the world but have needed replacement for a variety of reasons. 1 ref., 10 figs.

  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. Surgical extrusion technique for clinical crown lengthening: report of three cases.

    Science.gov (United States)

    Kim, Chang-Sung; Choi, Seong-Ho; Chai, Jung-Kiu; Kim, Chong-Kwan; Cho, Kyoo-Sung

    2004-10-01

    Although a number of techniques have been proposed for clinical crown lengthening procedures, all have some limitation in terms of function and esthetics. This report presents the clinical and radiographic results of a surgical extrusion technique for clinical crown lengthening. Atraumatic surgical extrusion using a specially designed instrument (Periotome) was performed in three cases in which it was expected that extensive resective osseous surgery would have to be used for crown lengthening. Full-thickness mucoperiosteal flaps were raised both labially and palatally. The tooth was carefully luxated and extruded to the desired position without damaging the marginal bone area or root apex. No rigid splint was applied. Clinical examinations performed for more than 1 year after surgery revealed probing depths crown lengthening; it does not induce functional or esthetic deformities, especially in the anterior region.

  2. Comparing Laser and Scalpel for Soft Tissue Crown Lengthening: A Clinical Study.

    Science.gov (United States)

    Farista, Sana; Kalakonda, Butchibabu; Koppolu, Pradeep; Baroudi, Kusai; Elkhatat, Esam; Dhaifullah, Essam

    2016-10-01

    Crown lengthening procedure is aimed at exposure of sufficient crown structure accomplished by a gingivectomy, an apically positioned flap with osseous resection or the use of lasers. Our present clinical study is aimed to assess the clinical effectiveness of a diode laser for functional crown lengthening procedure and to compare it with the conventional procedure using the scalpel. Fourteen patients including males and females, aged 20- 40 years were recruited and divided into two groups to undergo crown lengthening either with the scalpel or the laser. The data obtained was analyzed for intergroup comparison with an Unpaired t-test and intragroup comparison was determined by ANOVA.Analysis of the intergroup results for pain showcased that there was a significant difference (Pcrown lengthening performed with the scalpel.

  3. A cross-sectional survey of clinicians performing periodontal surgical crown lengthening.

    Science.gov (United States)

    Wyatt, Gillian; Grey, Nick; Deery, Chris

    2004-09-01

    The aim of this study was to conduct a survey of surgical crown lengthening practice performed by dental specialists and general dental practitioners using a cross-sectional questionnaire. One hundred general dental practitioners and 100 specialists from each of the following specialties: prosthodontics, periodontics, restorative dentistry and surgical dentistry. There were fewer surgical dentists performing surgical crown lengthening than the other specialists. The specialists in periodontics were significantly more likely to perform surgical crown lengthening than not. The respondents predominantly considered that periodontal surgical crown lengthening is within the remit of periodontics. 33% of the respondents performing more than 50 PSCL procedures in one year thought that the gingival margin was stable after three months. 33% thought that it was stable after six months and 33% declined to state a post-operative marginal stability time period.

  4. Tibial lengthening over nails in children using modified Ender nails: preliminary results of a new treatment.

    Science.gov (United States)

    Saraph, Vinay; Roposch, Andreas; Zwick, Ernst-Bernhard; Linhart, Wolfgang E

    2004-11-01

    Tibial lengthening over nails, using modified Ender nails, was performed in nine children whose mean age at surgery was 12.8 years. The prerequisite for using this technique was the absence of axial malalignment and an indication for tibial lengthening only. Lengthening was not performed in one case due to the development of a compartment syndrome after the tibial osteotomy. Breakage of one interlocking screw without loss of alignment or length was observed in one case. Superficial pin tract infections were observed in two cases. An average of 4.1 cm (range 3-4.5 cm) lengthening of the tibia was achieved in eight of the nine cases. The modified Ender nails used permitted locking at both ends after achieving the desired distraction and permitted early removal of the external fixator. The advantage of this technique is that it permits early removal of the fixator and thus decreases the incidence of fixator related problems and facilitates early rehabilitation.

  5. 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.

  6. Is higher serum cholesterol associated with altered tendon structure or tendon pain? A systematic review

    Science.gov (United States)

    Tilley, Benjamin J; Cook, Jill L; Docking, Sean I; Gaida, James E

    2015-01-01

    Background Tendon pain occurs in individuals with extreme cholesterol levels (familial hypercholesterolaemia). It is unclear whether the association with tendon pain is strong with less extreme elevations of cholesterol. Objective To determine whether lipid levels are associated with abnormal tendon structure or the presence of tendon pain. Methods We conducted a systematic review and meta-analysis. Relevant articles were found through an electronic search of 6 medical databases—MEDLINE, Cochrane, AMED, EMBASE, Web of Science and Scopus. We included all case–control or cross-sectional studies with data describing (1) lipid levels or use of lipid-lowering drugs and (2) tendon structure or tendon pain. Results 17 studies (2612 participants) were eligible for inclusion in the review. People with altered tendon structure or tendon pain had significantly higher total cholesterol, low-density lipoprotein cholesterol and triglycerides, as well as lower high-density lipoprotein cholesterol; with mean difference values of 0.66, 1.00, 0.33, and −0.19 mmol/L, respectively. Conclusions The results of this review indicate that a relationship exists between an individual’s lipid profile and tendon health. However, further longitudinal studies are required to determine whether a cause and effect relationship exists between tendon structure and lipid levels. This could lead to advancement in the understanding of the pathoaetiology and thus treatment of tendinopathy. PMID:26474596

  7. Micromechanical properties and collagen composition of ruptured human achilles tendon

    DEFF Research Database (Denmark)

    Hansen, Philip; Kovanen, Vuokko; Hölmich, Per

    2013-01-01

    The Achilles tendon is one of the strongest tendons in the human body, and yet it frequently ruptures, which is a substantial clinical problem. However, the cause of ruptures remains elusive.......The Achilles tendon is one of the strongest tendons in the human body, and yet it frequently ruptures, which is a substantial clinical problem. However, the cause of ruptures remains elusive....

  8. Achilles tendon: US diagnosis of pathologic conditions. Work in progress

    Energy Technology Data Exchange (ETDEWEB)

    Blei, C.L.; Nirschl, R.P.; Grant, E.G.

    1986-06-01

    Twenty-three patients were prospectively examined with ultra-sound (US) for acute or recurrent Achilles tendon symptoms. Three types of pathologic conditions of the Achilles tendon were found: tendinitis/tenosynovitis, acute tendon trauma, and postoperative changes. US appears to enable differentiation of these conditions and to contribute to the diagnosis of a broad range of Achilles tendon disorders.

  9. Crown lengthening to facilitate restorative treatment in the presence of incomplete passive eruption.

    Science.gov (United States)

    Hempton, T J; Esrason, F

    2000-04-01

    Crown-lengthening surgery can be utilized to expose subgingival caries. In this clinical case, a patient presented with incomplete passive eruption in the maxillary anterior sextant. This case illustrates that when incomplete passive eruption is present and restorative treatment is necessary in the maxillary anterior sextant, crown-lengthening surgery not only provides exposure of subgingival caries but can also result in a more esthetic therapeutic outcome.

  10. Elimination of a "Gummy Smile" With Crown Lengthening and Lip Repositioning.

    Science.gov (United States)

    Mahn, Douglas H

    2016-01-01

    Excessive gingival display is considered unattractive by many patients. A combination of surgical approaches may be required to correct this problem. Clinical crown lengthening involves recontouring crestal bone levels and moving the gingival margin in an apical direction. Lip repositioning reduces gingival display by limiting upper lip movement when smiling. This article describes a case in which a combination of clinical crown lengthening and lip repositioning was used to correct excessive gingival display when smiling.

  11. Clinical Results and Complications of Lower Limb Lengthening for Fibular Hemimelia: A Report of Eight Cases.

    Science.gov (United States)

    Mishima, Kenichi; Kitoh, Hiroshi; Iwata, Koji; Matsushita, Masaki; Nishida, Yoshihiro; Hattori, Tadashi; Ishiguro, Naoki

    2016-05-01

    Fibular hemimelia is a rare but the most common congenital long bone deficiency, encompassing a broad range of anomalies from isolated fibular hypoplasia up to substantial femoral and tibial shortening with ankle deformity and foot deficiency. Most cases of fibular hemimelia manifest clinically significant leg length discrepancy (LLD) with time that requires adequate correction by bone lengthening for stable walking. Bone lengthening procedures, especially those for pathological bones, are sometimes associated with severe complications, such as delayed consolidation, fractures, and deformities of the lengthened bones, leading to prolonged healing time and residual LLD at skeletal maturity. The purpose of this study was to review our clinical results of lower limb lengthening for fibular hemimelia.This study included 8 Japanese patients who diagnosed with fibular hemimelia from physical and radiological findings characteristic of fibular hemimelia and underwent single or staged femoral and/or tibial lengthening during growth or after skeletal maturity. LLD, state of the lengthened callus, and bone alignment were evaluated with full-length radiographs of the lower limb. Previous interventions, associated congenital anomalies, regenerate fractures were recorded with reference to medical charts and confirmed on appropriate radiographs. Successful lengthening was defined as the healing index <50 days/cm without regenerate fractures.A significant difference was observed in age at surgery between successful and unsuccessful lengthening. The incidence of regenerate fractures was significantly correlated with callus maturity before frame removal. LLD was corrected within 11 mm, whereas mechanical axis deviated laterally.Particular attention should be paid to the status of callus maturation and the mechanical axis deviation during the treatment period in fibular hemimelia.

  12. 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

  13. Peripheral nerve lengthening by controlled isolated distraction: a new animal model.

    Science.gov (United States)

    Kroeber, M W; Diao, E; Hida, S; Liebenberg, E

    2001-01-01

    We have developed a simple and effective animal model to study the distraction neurogenesis utilizing the sciatic nerve-lengthening technique in rats. The model allows macroscopic, physiological, and histological evaluation of the distraction site. Fourteen adult Harlan Sprague Dawley rats (300-350 g) were used in this study. A 10 mm segment of the right sciatic nerve of each animal in the nerve-lengthening group was resected. Gradual nerve lengthening was performed by advancing the proximal nerve stump at a rate of 1 mm/day. The proximal stump neuroma was then resected and a direct nerve anastomosis was performed. On the left side a standard autogenous nerve-grafting procedure was performed with a 10 mm segment of sciatic nerve used as an in situ nerve graft. Three months after the second surgery, the sciatic nerves were exposed and investigated by gross observation and EMG followed by histological processing and tissue analysis. Neomicrovascularization was observed surrounding the sciatic nerve anastomosis in all five specimens of the nerve-lengthening group as compared to the more white-colored scar tissue that was observed in the nerve-grafting group. The EMG results were similar for both groups. Histological studies of the lengthened nerves showed axon morphology equivalent to the grafted nerves. This study demonstrated a clear evidence of the successful nerve regeneration within a segmental nerve gap by nerve lengthening.

  14. Z-plasty lengthening for iliotibial band friction syndrome.

    Science.gov (United States)

    Barber, F Alan; Boothby, Michael H; Troop, Randal L

    2007-10-01

    Iliotibial band friction syndrome presents with lateral knee pain usually in runners. When conservative treatment fails, surgical lengthening, or Z-plasty, can provide symptomatic relief. This retrospective study evaluated the long-term results of iliotibial band Z-plasty for chronic iliotibial band friction syndrome in a consecutive series of patients. Inclusion criteria were failed nonoperative treatment for symptomatic iliotibial band friction syndrome for at least 3 months, minimum age of 17 years, and closed growth plates. Exclusion criteria were history of significant trauma, prior knee surgery, lateral compartment pathology, and anterior or posterior cruciate ligament instability. Postoperative evaluation included annual physical examination consisting of Tegner, Lysholm, Cincinnati, and International Knee Documentation Committee (IKDC) activity scores. Of an initial group of 11 patients, 8 were evaluated an average of 75.6 months postoperatively (range: 59-97 months). Average length of preoperative symptoms was 15.6 months (range: 3-36 months), and average length of nonoperative management was 6.9 months (range: 3-24 months). Postoperatively, mean Cincinnati score was 82.9 (range: 55-95), Tegner score was 4.4 (range: 2-7), Lysholm score was 88.6 (range: 57-100), and IKDC activity score was 2.6 (range: 1-4). No adverse events occurred during surgery. All patients reported complete resolution of lateral knee pain and a full return to preoperative activity levels. Iliotibial Z-plasty was successful for refractory iliotibial band friction syndrome. This improvement was maintained out to 8 years after surgery.

  15. Influence of Gradual Elongation to the Patella Tendon Insertion in Rabbits

    Directory of Open Access Journals (Sweden)

    Hirotaka Mutsuzaki

    2014-08-01

    Full Text Available The purpose of this study was to examine the histological changes at the patella tendon (PT insertion site under gradual elongation in rabbits. Gradual elongation of the PT was performed using external fixation for 4 weeks, with a lengthening speed of 0.5 mm/day (elongation group; n = 24. Rabbits in the sham group underwent the same surgical procedure without gradual elongation (sham group; n = 24. Eight animals were sacrificed 1, 2 and 4 weeks after surgery in each group, respectively. Average thicknesses of stained glycosaminoglycan (GAGs areas by Safranin-O staining in the total cartilage layer and the uncalcified fibrocartilage layer in the elongation group were significantly higher than that in the sham group at 4 weeks (p < 0.05 and that in the intact PT group (n = 6, p < 0.05. In the elongation group, the peak in the average thicknesses of the stained GAGs areas in the total cartilage layer and the uncalcified fibrocartilage layer were observed at 4 weeks. Gradual elongation of PT insertion significantly affected the increase in the average thicknesses of the stained GAGs areas in the cartilage layer especially in the uncalcified fibrocartilage layer at 4 weeks in rabbits. Clinically, insertions of tendon and ligament can extend during gradual elongation using external fixation more than 4 weeks after the operation.

  16. PRP and Metaplasia in repaired tendon

    Institute of Scientific and Technical Information of China (English)

    Kamal Seyed-Forootan; Hamid Karimi; Ahmad-Reza Dayani

    2014-01-01

    Objective:To evaluate effects ofPRP injection in strengthening of repaired tendon.Methods:This study was conducted in animal lab of our hospital on20 rats.The animals were divided into two groups randomly and distal third of leftAchillis tendons were cut and then repaired with Vicryl2/0.The first group was control group and in the second group0.5 cc ofPRP was injected into the repair site.After4 weeks all of the rats were executed and70% of tendons were sent randomly for tensilometry and the force that required to rupture the tendons were measured.In next stage the tendons were sent for pathological exam.Results:The force that was needed to rupture the tendon were not significantly different in the two groups.Neovascularization were more prevalent inPRP group but not statistically significant.There were two cases ofCartilage Metaplasia inPRP group.Conclusion:It seems that usingPRP has no effect on strengthening the tendons repair and may have some adverse effects.It usage needs further studies to evaluate their probable adverse side effects.

  17. 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°.

  18. Identifying Dosage Effect of Light-Emitting Diode Therapy on Muscular Fatigue in Quadriceps.

    Science.gov (United States)

    Hemmings, Thomas J; Kendall, Kristina L; Dobson, John L

    2017-02-01

    Hemmings, TJ, Kendall, KL, and Dobson, JL. Identifying dosage effect of light-emitting diode therapy on muscular fatigue in quadriceps. J Strength Cond Res 31(2): 395-402, 2017-The purpose of this study was to compare the effects of various dosages of light-emitting diode therapy (LEDT) on muscle fatigue while performing a single-leg extension to exhaustion. A total of 34 recreationally resistance-trained athletes between the ages of 18 and 26 participated in 4 trials. Each trial included pre-exercise/postexercise blood lactate measurements and 2 sets of 3 maximal voluntary isometric contractions (MVICs), followed by LEDT on 6 points across the superficial quadriceps. Each randomized trial consisted of a placebo, 30, 60, or 120 seconds on each point on the quadriceps. Three minutes after LEDT, the participants performed an eccentric leg extension with 120% of MVIC until fatigue. There was significant increase in the number of repetitions performed between the placebo treatment and 60 seconds (p = 0.023), as well as placebo and 120 seconds (p = 0.004) of irradiation on each point. There were no significant differences in blood lactate levels between any of the 4 trials. In conclusion, LEDT had a positive effect on performance when irradiating 6 points on the superficial quadriceps for 60 and 120 seconds before an eccentric leg extension.

  19. [Lewis-Sumner syndrome presenting unilateral quadriceps amyotrophy as an initial symptom].

    Science.gov (United States)

    Fujiyama, J; Aita, T; Itoh, K; Hamano, T; Kumano, T; Kinomoto, K; Fujii, A; Yasokawa, T; Kuriyama, M

    2000-11-01

    We report a 55-year-old man with a chief complaint of wasting and weakness of the left quadriceps muscle. At age 54, he noticed difficulty in running and weakness in the left thigh, which gradually progressed. On the first admission to our hospital, based on the nerve conduction studies (NCS), the muscle biopsy findings showing neurologenic changes, and no abnormality of spinal MRI, we diagnosed as unilateral quadriceps amyotrophy, which resulted from an atypical form of spinal progressive muscular atrophy. One year later, he showed the bilateral hand weakness, conduction blocks on the right median and ulnar nerves by NCS, and the presence of serum anti-GM 1 antibody. From these findings, Lewis-Sumner syndrome was diagnosed. The therapy of high-dose intravenous immunoglobulin moderately improved his symptoms. The clinical symptoms of quadriceps amyotrophy is produced by various disorders including spinal progressive muscular atrophy, spinal extradural arachnoid cyst, rimmed vacuole myopathy, Becker dystrophy, limb-girdle dystrophy, and focal myositis. However, there have been no reports of a case of Lewis-Sumner syndrome. It is important to consider Lewis-Sumner syndrome in the differential diagnosis of quadriceps amyotrophy.

  20. Quadriceps function following ACL reconstruction and rehabilitation : implications for optimisation of current practices

    NARCIS (Netherlands)

    Gokeler, Alli; Bisschop, Marsha; Benjaminse, Anne; Myer, Greg D.; Eppinga, Peter; Otten, Egbert

    2014-01-01

    To determine the most effective practices for quadriceps strengthening after ACL reconstruction. An electronic search has been performed for the literature appearing from January 1990 to January 2012. Inclusion criteria were articles written in English, German or Dutch with unilateral ACL-reconstruc

  1. Fatigue of intermittently stimulated quadriceps during imposed cyclical lower leg movements

    NARCIS (Netherlands)

    Franken, Henry M.; Veltink, Peter H.; Fidder, Marc; Boom, Herman B.K.

    1992-01-01

    During prolonged experiments the influence of knee angular velocity, and stimulation parameters (interpulse interval (IPI), duty cycle (DC), number of pulses per cycle (NP)) on fatigue-induced torque decline of paralyzed human quadriceps was studied. Identification of torque-angle and -angular veloc

  2. Artificial-reflex stimulation for FES-induced standing with minimum quadriceps force

    NARCIS (Netherlands)

    Mulder, A.J.; Mulder, A.J.; Boom, H.B.K.; Hermens, Hermanus J.; Zilvold, G.; Zilvold, G.

    1990-01-01

    A control strategy is proposed to decrease quadriceps activity during standing. Modified on/off (or artificial reflex) control is used: a non-numerical or finite-state control scheme based on feedback of knee angle and angular velocity. The control strategy is evaluated in paraplegic patients in an

  3. Quadriceps and hamstrings prelanding myoelectric activity during landing from different heights among male and female athletes.

    Science.gov (United States)

    de Britto, Morgana Alves; Carpes, Felipe P; Koutras, Georgios; Pappas, Evangelos

    2014-08-01

    ACL tear is a major concern among athletes, coaches and sports scientists. More than taking the athlete away from training and competition, ACL tear is a risk factor for early-onset of knee osteoarthritis, and, therefore addressing strategies to avoid such injury is pertinent not only for competitive athletes, but for all physically active subjects. Imbalances in the prelanding myoelectric activity of the hamstrings and quadriceps muscles have been linked to ACL injuries. We investigated the effect of landing from different heights on prelanding myoelectric activity of the hamstrings and quadriceps muscles in recreational athletes. Thirty recreational athletes (15 male and 15 female) performed three bilateral drop jumps from two different heights; 20cm and 40cm while myoelectric activity of the vastus medialis, rectus femoris, biceps femoris and medial hamstrings were collected. When increasing the height of drop landing tasks prelanding normalized myoelectric activity of the quadriceps was increased by 15-20% but no significant changes were found for the hamstrings. Female athletes exhibited higher activity of the medial hamstrings compared to their male counterparts. We concluded that increasing the height of drop landing tasks is associated with increased myoelectric activity of the quadriceps but not the hamstrings in recreational athletes. These differences in muscle activity may be related to increased risk for ACL injury when the height is increased. Female athletes demonstrated higher recruitment of the medial hamstrings. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Contractile properties of the quadriceps muscle in individuals with spinal cord injury

    NARCIS (Netherlands)

    Gerrits, H L; De Haan, A; Hopman, M T; van Der Woude, L H; Jones, D A; Sargeant, A J

    1999-01-01

    Selected contractile properties and fatigability of the quadriceps muscle were studied in seven spinal cord-injured (SCI) and 13 able-bodied control (control) individuals. The SCI muscles demonstrated faster rates of contraction and relaxation than did control muscles and extremely large force oscil

  5. Rapid Hamstrings/Quadriceps strength in ACL-reconstructed elite alpine ski racers

    DEFF Research Database (Denmark)

    Jordan, Matthew J; Aagaard, Per; Herzog, Walter

    2015-01-01

    PURPOSE: Due to the importance of hamstrings (HAM) and quadriceps (QUAD) strength for anterior cruciate ligament (ACL) injury prevention, and the high incidence of ACL injury in ski racing, HAM and QUAD maximal and explosive strength was assessed in ski racers with and without ACL reconstruction...

  6. Reproducibility of contractile properties of the human paralysed and non-paralysed quadriceps muscle.

    NARCIS (Netherlands)

    Gerrits, H.L.; Hopman, M.T.E.; Sargeant, A.J.; Haan, A. de

    2001-01-01

    This study assessed the reproducibility of electrically evoked, isometric quadriceps contractile properties in eight people with spinal cord injury (SCI) and eight able-bodied (AB) individuals. Over all, the pooled coefficients of variation (CVps) in the SCI group were significantly lower (ranging

  7. A novel noninvasive method for measuring fatigability of the quadriceps muscle in noncooperating healthy subjects

    DEFF Research Database (Denmark)

    Poulsen, Jesper Brøndum; Rose, Martin Høyer; Møller, Kirsten;

    2015-01-01

    Background. Critical illness is associated with muscle weakness leading to long-term functional limitations. Objectives. To assess the reliability of a novel method for evaluating fatigability of the quadriceps muscle in noncooperating healthy subjects. Methods. On two occasions, separated by sev...

  8. Oxidative stress participates in quadriceps muscle dysfunction during the initiation of osteoarthritis in rats.

    Science.gov (United States)

    Hsu, Dur-Zong; Chu, Pei-Yi; Wu, Po-Ting; Shen, Po-Chuan; Jou, I-Ming

    2015-01-01

    Osteoarthritis is the most common form of arthritis, affecting approximately 15% of the population. Quadriceps muscle weakness is one of the risk factors of osteoarthritis development. Oxidative stress has been reported to play an important role in the pathogenesis of various muscle dysfunction; however, whether it is involved in osteoarthritis-associated quadriceps muscle weakness has never been investigated. The aim of the present study is to examine the involvement of oxidative stress in quadriceps muscle dysfunction in the initiation of osteoarthritis in rats. Rat osteoarthritis was initiated by conducting meniscectomy (MNX). Quadriceps muscle dysfunction was evaluated by assessing muscular interleukin-6, citrate synthase activity, and myosin heavy chain IIa mRNA expression levels. Muscular oxidative stress was assessed by determining lipid peroxidation, Nrf2 expression, reactive oxygen species, and circulating antioxidants. Increased muscular interleukin-6 production as well as decreased citrate synthase activity and myosin heavy chain IIa mRNA expression were observed at 7 and 14 days after MNX. Biomarkers of oxidative stress were significantly increased after MNX. Muscular free radical counts were increased while glutathione and glutathione peroxidase expression were decreased in MNX-treated rats. We conclude that oxidative stress may be involved in the pathogenesis of muscle dysfunction in MNX-induced osteoarthritis.

  9. Quadriceps Weakness, Patella Alta and Structural Features of Patellofemoral Osteoarthritis: The Multicenter Osteoarthritis Study

    Science.gov (United States)

    Stefanik, Joshua J.; Guermazi, Ali; Zhu, Yanyan; Zumwalt, Ann C.; Gross, K. Douglas; Clancy, Margaret; Lynch, John A.; Segal, Neil A.; Lewis, Cora E.; Roemer, Frank W.; Powers, Christopher M.; Felson, David T.

    2011-01-01

    Objective To determine the relationship between quadriceps weakness and cartilage damage and bone marrow lesions (BMLs) in the patellofemoral joint (PFJ), and if this relationship is modified by patella alta. Methods The Multicenter Osteoarthritis (MOST) Study is a cohort study of persons aged 50–79 years with or at risk for knee OA. Concentric knee extensor strength was measured using an isokinetic dynamometer. Patella alta was measured using the Insall-Salvati ratio (ISR) on the lateral radiograph, and cartilage damage and bone marrow lesions (BMLs) were graded on MRI in the PFJ. We determined the association between quadriceps weakness with cartilage damage and BMLs in the PFJ among those knees with (ISR≥1.2) and without patella alta (ISRpatella alta in the lateral PFJ. Conclusion Quadriceps weakness was associated with PFJ cartilage damage and BMLs. While both patella alta and quadriceps weakness are associated with PFJ damage, the combination of the two was not associated with more damage than either of these factors alone. PMID:21702087

  10. Distal biceps tendon injuries: diagnosis and management.

    Science.gov (United States)

    Ramsey, M L

    1999-01-01

    Rupture of the distal biceps tendon occurs most commonly in the dominant extremity of men between 40 and 60 years of age when an unexpected extension force is applied to the flexed arm. Although previously thought to be an uncommon injury, distal biceps tendon ruptures are being reported with increasing frequency. The rupture typically occurs at the tendon insertion into the radial tuberosity in an area of preexisting tendon degeneration. The diagnosis is made on the basis of a history of a painful, tearing sensation in the antecubital region. Physical examination demonstrates a palpable and visible deformity of the distal biceps muscle belly with weakness in flexion and supination. The ability to palpate the tendon in the antecubital fossa may indicate partial tearing of the biceps tendon. Plain radiographs may show hypertrophic bone formation at the radial tuberosity. Magnetic resonance imaging is generally not required to diagnose a complete rupture but may be useful in the case of a partial rupture. Early surgical reattachment to the radial tuberosity is recommended for optimal results. A modified two-incision technique is the most widely used method of repair, but anterior single-incision techniques may be equally effective provided the radial nerve is protected. The patient with a chronic rupture may benefit from surgical reattachment, but proximal retraction and scarring of the muscle belly can make tendon mobilization difficult, and inadequate length of the distal biceps tendon may necessitate tendon augmentation. Postoperative rehabilitation must emphasize protected return of motion for the first 8 weeks after repair. Formal strengthening may begin as early as 8 weeks, with a return to unrestricted activities, including lifting, by 5 months.

  11. Effect of estrogen on tendon collagen synthesis, tendon structural characteristics, and biomechanical properties in postmenopausal women

    DEFF Research Database (Denmark)

    Hansen, M.; Kongsgaard, M; Holm, Lars

    2009-01-01

    The knowledge about the effect of estradiol on tendon connective tissue is limited. Therefore, we studied the influence of estradiol on tendon synthesis, structure, and biomechanical properties in postmenopausal women. Nonusers (control, n = 10) or habitual users of oral estradiol replacement...... therapy (ERT, n = 10) were studied at rest and in response to one-legged resistance exercise. Synthesis of tendon collagen was determined by stable isotope incorporation [fractional synthesis rate (FSR)] and microdialysis technique (NH(2)-terminal propeptide of type I collagen synthesis). Tendon area...... and fibril characteristics were determined by MRI and transmission electron microscopy, whereas tendon biomechanical properties were measured during isometric maximal voluntary contraction by ultrasound recording. Tendon FSR was markedly higher in ERT users (P

  12. Mechanical properties of human patellar tendon at the hierarchical levels of tendon and fibril

    DEFF Research Database (Denmark)

    Svensson, René B; Hansen, Philip; Hassenkam, Tue

    2012-01-01

    Tendons are strong hierarchical structures, but how tensile forces are transmitted between different levels remains incompletely understood. Collagen fibrils are thought to be primary determinants of whole tendon properties, and therefore we hypothesized that the whole human patellar tendon and its...... distinct collagen fibrils would display similar mechanical properties. Human patellar tendons (n = 5) were mechanically tested in vivo by ultrasonography. Biopsies were obtained from each tendon, and individual collagen fibrils were dissected and tested mechanically by atomic force microscopy. The Young......'s modulus was 2.0 ± 0.5 GPa, and the toe region reached 3.3 ± 1.9% strain in whole patellar tendons. Based on dry cross-sectional area, the Young's modulus of isolated collagen fibrils was 2.8 ± 0.3 GPa, and the toe region reached 0.86 ± 0.08% strain. The measured fibril modulus was insufficient to account...

  13. Local trauma in human patellar tendon leads to widespread changes in the tendon gene expression

    DEFF Research Database (Denmark)

    Heinemeier, Katja Maria; Lorentzen, Marc P; Kildevang Jensen, Jacob

    2016-01-01

    Low cellular activity and slow tissue turnover in human tendon may prolong resolution of tendinopathy. This may be stimulated by moderate localized traumas such as needle penetrations, but whether this results in a widespread cellular response in tendons is unknown. In an initial hypothesis......-generating study, a trauma-induced tendon cell activity (increased total RNA and collagen I mRNA) was observed after repeated patellar tendon biopsies in young men. In a subsequent controlled study, 25 young men were treated with two 0.8 mm diameter needle penetrations (n=13, needle-group (NG)) or one 2.1 mm...... diameter needle biopsy (n=12, biopsy-group (BG)) in one patellar tendon. Four weeks later biopsies were taken from treated (5 mm lateral from trauma site) and contralateral tendons for analyses of RNA content (ribogreen assay), DNA content (PCR based), and gene expression for relevant target genes (Real...

  14. Fibroma of the tendon sheath of the long head of the biceps tendon.

    Science.gov (United States)

    De Maeseneer, Michel; Van Isacker, Tom; Lenchik, Leon; Van Caillie, Marie-Astrid; Shahabpour, Maryam

    2014-03-01

    Fibroma of the tendon sheath is a benign tumor that is less common than giant cell tumor of the tendon sheath. Both tumors may present as a painless, slowly enlarging mass. Radiological findings may be similar for both tumors. Histologically, fibroma of the tendon sheath lacks the hemosiderin-laden macrophages that are typical for giant cell tumor of the tendon sheath. We report on a 49-year-old woman with fibroma of the tendon sheath of the long head of the biceps tendon. In our case, on MR images, we observed band-like hypointense areas centrally in the tumor, mild patchy contrast enhancement, and most importantly, no decrease of signal intensity on gradient echo images. These characteristics reflected histological findings.

  15. Fibroma of the tendon sheath of the long head of the biceps tendon

    Energy Technology Data Exchange (ETDEWEB)

    Maeseneer, Michel de; Shahabpour, Maryam [Universitair Ziekenhuis Brussel, Department of Radiology, Brussels (Belgium); Isacker, Tom van [Sint-Lucas Hospital, Department of Orthopedic Surgery, Brugge (Belgium); Lenchik, Leon [Wake Forest School of Medicine, Department of Radiology, Winston Salem, NC (United States); Caillie, Marie-Astrid van [Sint-Lucas Hospital, Department of Pathology, Brugge (Belgium)

    2014-03-15

    Fibroma of the tendon sheath is a benign tumor that is less common than giant cell tumor of the tendon sheath. Both tumors may present as a painless, slowly enlarging mass. Radiological findings may be similar for both tumors. Histologically, fibroma of the tendon sheath lacks the hemosiderin-laden macrophages that are typical for giant cell tumor of the tendon sheath. We report on a 49-year-old woman with fibroma of the tendon sheath of the long head of the biceps tendon. In our case, on MR images, we observed band-like hypointense areas centrally in the tumor, mild patchy contrast enhancement, and most importantly, no decrease of signal intensity on gradient echo images. These characteristics reflected histological findings. (orig.)

  16. 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.

  17. [Rotator cuff repair with decellularized tendon slices for enhancing tendon-bone healing in rabbits].

    Science.gov (United States)

    Pan, Juan; Liu, Guoming; Ning, Liangju; Luo, Jingcong; Huang, Fuguo; Qin, Tingwu

    2013-09-01

    To investigate the effect of canine decellularized tendon slices (DTSs) on tendon-bone healing in repairing rotator cuff injury of rabbit. Canine DTSs were prepared by repetitive freeze/thaw 5 times combined with nuclease processing for 12 hours from the adult Beagles Achilles tendons. Histological observation and cytocompatibility evaluation for the canine DTSs were performed in vitro. Twenty-four mature male New Zealand white rabbits, weighing 2.5-3.0 kg, were randomly selected. U-shaped defect of more than 50% of normal tendon in width and 8 mm in length was made in infraspinatus tendons of unilateral limb as the experimental group; the canine DTSs were used to repair defect, and the insertion of infraspinatus tendon on greater tuberosity of humerus was reconstructed in the experimental group. No treatment was done on the contralateral limb as the control group. At 4, 8, and 12 weeks after operation, the specimens were harvested for histological observation and biomechanical test. Histological examination showed that collagen fibers of canine DTSs were well preserved, without residual cells. The cytocompatibility examination showed that fibroblasts attached well to canine DTSs. Biomechanical test showed that the maximum load and stiffness increased significantly with time, and the maximum load and stiffness at 12 weeks were significantly higher than those at 4 and 8 weeks (P tendon-bone insertion. In the experimental group at 4 weeks, the tendon-bone interface was filled with granulation tissue, and a small amount of Sharpey's fibers-like connected the tendon to bone; granulation tissue disappeared, and fibroblasts, Sharpey's fiber, new cartilage, and chondrocytes significantly increased with time; tendon-bone interface became mature, but the tide line was not observed between the unmineralized fibrocartilage and mineralized fibrocartilage. Canine DTSs prepared by repetitive freeze/thaw 5 times combined with nuclease processing for 12 hours, can enhance the

  18. Traumatic tibialis anterior tendon rupture: treatment with a two-stage silicone tube and an interposition hamstring tendons graft protocol.

    Science.gov (United States)

    Kontogeorgakos, Vasileios; Koutalos, Antonios; Hantes, Michael; Manoudis, Gregory; Badras, Leonidas; Malizos, Konstantinos

    2015-03-01

    A novel technique for managing ruptured tibialis anterior tendon complicated by infection and tendon substance loss in a young adult is described. A two-stage reconstruction technique with a silicon tube and tendon autograft was performed. At first, after local control of the infection, scar excision and placement of a silicone tube was performed. Ten weeks later, ipsilateral hamstrings tendons were harvested and bridged the 7 cm tendon gap. Eighteen months later, the patient has excellent clinical and functional outcome.

  19. Famotidine suppresses osteogenic differentiation of tendon cells in vitro and pathological calcification of tendon in vivo.

    Science.gov (United States)

    Yamamoto, Kenichi; Hojo, Hironori; Koshima, Isao; Chung, Ung-il; Ohba, Shinsuke

    2012-12-01

    Heterotopic ossification or calcification follows any type of musculoskeletal trauma and is known to occur after arthroplasties of hip, knee, shoulder, or elbow; fractures; joint dislocations; or tendon ruptures. Histamine receptor H2 (Hrh2) has been shown to be effective for reducing pain and decreasing calcification in patients with calcifying tendinitis, which suggested that H2 blockers were effective for the treatment of tendon ossification or calcification. However, the detailed mechanisms of its action on tendon remain to be clarified. We investigated the mechanisms underlying H2 blocker-mediated suppression of tendon calcification, with a focus on the direct action of the drug on tendon cells. Famotidine treatment suppressed the mRNA expressions of Col10a1 and osteocalcin, ossification markers, in a tendon-derived cell line TT-D6, as well as a preosteoblastic one MC3T3-E1. Both of the cell lines expressed Hrh2; histamine treatment induced osteocalcin expression in these cells. Famotidine administration suppressed calcification in the Achilles tendon of ttw mice, a mouse model of ectopic ossification. These data suggest that famotidine inhibits osteogenic differentiation of tendon cells in vitro, and this inhibition may underlie the anti-calcification effects of the drug in vivo. This study points to the use of H2 blockers as a promising strategy for treating heterotopic ossification or calcification in tendon, and provides evidence in support of the clinical use of famotidine. Copyright © 2012 Orthopaedic Research Society.

  20. Multi-Layer Electrospun Membrane Mimicking Tendon Sheath for Prevention of Tendon Adhesions

    Directory of Open Access Journals (Sweden)

    Shichao Jiang

    2015-03-01

    Full Text Available Defect of the tendon sheath after tendon injury is a main reason for tendon adhesions, but it is a daunting challenge for the biomimetic substitute of the tendon sheath after injury due to its multi-layer membrane-like structure and complex biologic functions. In this study, a multi-layer membrane with celecoxib-loaded poly(l-lactic acid-polyethylene glycol (PELA electrospun fibrous membrane as the outer layer, hyaluronic acid (HA gel as middle layer, and PELA electrospun fibrous membrane as the inner layer was designed. The anti-adhesion efficacy of this multi-layer membrane was compared with a single-layer use in rabbit flexor digitorum profundus tendon model. The surface morphology showed that both PELA fibers and celecoxib-loaded PELA fibers in multi-layer membrane were uniform in size, randomly arrayed, very porous, and smooth without beads. Multi-layer membrane group had fewer peritendinous adhesions and better gliding than the PELA membrane group and control group in gross and histological observation. The similar mechanical characteristic and collagen expression of tendon repair site in the three groups indicated that the multi-layer membrane did not impair tendon healing. Taken together, our results demonstrated that such a biomimetic multi-layer sheath could be used as a potential strategy in clinics for promoting tendon gliding and preventing adhesion without poor tendon healing.

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

    National Research Council Canada - National Science Library

    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...

  2. Assessment of Postoperative Tendon Quality in Patients With Achilles Tendon Rupture Using Diffusion Tensor Imaging and Tendon Fiber Tracking.

    Science.gov (United States)

    Sarman, Hakan; Atmaca, Halil; Cakir, Ozgur; Muezzinoglu, Umit Sefa; Anik, Yonca; Memisoglu, Kaya; Baran, Tuncay; Isik, Cengiz

    2015-01-01

    Although pre- and postoperative imaging of Achilles tendon rupture (ATR) has been well documented, radiographic evaluations of postoperative intratendinous healing and microstructure are still lacking. Diffusion tensor imaging (DTI) is an innovative technique that offers a noninvasive method for describing the microstructure characteristics and organization of tissues. DTI was used in the present study for quantitative assessment of fiber continuity postoperatively in patients with acute ATR. The data from 16 patients with ATR from 2005 to 2012 were retrospectively analyzed. The microstructure of ART was evaluated using tendon fiber tracking, tendon continuity, fractional anisotropy, and apparent diffusion coefficient values by way of DTI. The distal and proximal portions were measured separately in both the ruptured and the healthy extremities of each patient. The mean patient age was 41.56 ± 8.49 (range 26 to 56) years. The median duration of follow-up was 21 (range 6 to 80) months. The tendon fractional anisotropy values of the ruptured Achilles tendon were significantly lower statistically than those of the normal side (p = .001). However, none of the differences between the 2 groups with respect to the distal and proximal apparent diffusion coefficient were statistically significant (p = .358 and p = .899, respectively). In addition, the fractional anisotropy and apparent diffusion coefficient measurements were not significantly different in the proximal and distal regions of the ruptured tendons compared with the healthy tendons. The present study used DTI and fiber tracking to demonstrate the radiologic properties of postoperative Achilles tendons with respect to trajectory and tendinous fiber continuity. Quantifying DTI and fiber tractography offers an innovative and effective tool that might be able to detect microstructural abnormalities not appreciable using conventional radiologic techniques. Copyright © 2015 American College of Foot and Ankle

  3. Functional Outcomes of Achilles Tendon Minimally Invasive Repair Using 4- and 6-Strand Nonabsorbable Suture: A Cohort Comparison Study

    Science.gov (United States)

    Carmont, Michael R.; Zellers, Jennifer A.; Brorsson, Annelie; Olsson, Nicklas; Nilsson-Helander, Katarina; Karlsson, Jon; Silbernagel, Karin Grävare

    2017-01-01

    Background: The aim of management of Achilles tendon rupture is to reduce tendon lengthening and maximize function while reducing the rerupture rate and minimizing other complications. Purpose: To determine changes in Achilles tendon resting angle (ATRA), heel-rise height, patient-reported outcomes, return to play, and occurrence of complications after minimally invasive repair of Achilles tendon ruptures using nonabsorbable sutures. Study Design: Cohort study; Level of evidence, 3. Methods: Between March 2013 and August 2015, a total of 70 patients (58 males, 12 females) with a mean age of 42 ± 8 years were included and evaluated at 6 weeks and 3, 6, 9, and 12 months after repair of an Achilles tendon rupture. Surgical repair was performed using either 4-strand or 6-strand nonabsorbable sutures. After surgery, patients were mobilized, fully weightbearing using a functional brace. Early active movement was permitted starting at 2 weeks. Results: There were no significant differences in the ATRA, Achilles Tendon Total Rupture Score (ATRS), and Heel-Rise Height Index (HRHI) between the 4- and 6-strand repairs. The mean (SD) relative ATRA was –13.1° (6.6°) (dorsiflexion) following injury; this was reduced to 7.6° (4.8°) (plantar flexion) directly after surgery. During initial rehabilitation at 6 weeks, the relative ATRA was 0.6° (7.4°) (neutral) and –7.0° (5.3°) (dorsiflexion) at 3 months, after which ATRA improved significantly with time to 12 months (P = .005). At 12 months, the median ATRS was 93 (range, 35-100), and the mean (SD) HRHI and Heel-Rise Repetition Index were 81% (0.22%) and 82.9% (0.17%), respectively. The relative ATRA at 3 and 12 months correlated with HRHI (r = 0.617, P Achilles tendon repair. The use of a nonabsorbable suture during minimally invasive repair when used together with accelerated rehabilitation did not prevent the development of an increased relative ATRA. The ATRA at 3 months after surgery correlated with heel

  4. 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.

  5. Injury to skeletal muscles of mice by forced lengthening during contractions.

    Science.gov (United States)

    Faulkner, J A; Jones, D A; Round, J M

    1989-09-01

    Our purpose was to determine the amount of injury to extensor digitorum longus (EDL) and anterior tibial (ATB) muscles of mice from 1 h to 30 days following passive shortening and lengthening, shortening contractions and lengthening contractions. The shortening-lengthening cycle was of 600 ms duration and was repeated every 5 s for 30 min. Contractions were produced during either the shortening or lengthening phase with stimulation at 100 Hz for 300 ms. The amount of injury was evaluated by the decrease in the number of fibres in a cross-section of the muscle and in the maximum isometric tetanic force (Po). Passively shortened and lengthened and actively shortened EDL and ATB muscles showed no evidence of injury. At 3-5 days after lengthening contractions, EDL and ATB muscles showed an inflammatory response. At 3-5 days, the number of fibres in the cross-section of the injured EDL muscles was 65% of that of the contralateral control EDL muscle, whereas no change was observed in the number of fibres in the injured ATB muscles. By 3 days, the presence of myoblasts, myotubes and central nuclei indicated regeneration of fibres. One hour after shortening contractions, the Po of EDL and ATB muscles decreased to about 75% of the contralateral control value, but recovered completely by 3 days. In contrast, 1 h after lengthening contractions the Po of EDL and ATB muscles decreased to 52 and 40% respectively of the contralateral control value and then both recovered to about 65% within 3 h. For the ATB muscle, the Po showed a secondary decrease to 49% of the contralateral control value at 1 day and for the EDL muscle, to 47% at 3 days. Each muscle recovered gradually and by 30 days the number of fibres and the Po of the injured muscles were not significantly different from values for contralateral control muscles.

  6. The association between submaximal quadriceps force steadiness and the knee adduction moment during walking in patients with knee osteoarthritis

    DEFF Research Database (Denmark)

    Sørensen, Tina Juul; Langberg, Henning; Aaboe, Jens

    2011-01-01

    STUDY DESIGN: Cross-sectional study. OBJECTIVES: To investigate the relationship between quadriceps force steadiness and knee adduction moment during walking in patients with knee osteoarthritis (OA). BACKGROUND: Studies have shown that quadriceps force steadiness is impaired in patients with knee......, and knee pain was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscale and a visual analog scale. RESULTS: Regression analyses showed that quadriceps force steadiness did not predict the peak knee adduction moment (adjusted R2 = 0.05, P = .41). Inclusion of covariates did...

  7. Effects of Kinesio Tape application to quadriceps muscles on isokinetic muscle strength, gait, and functional parameters in patients with stroke.

    Science.gov (United States)

    Ekiz, Timur; Aslan, Meryem Doğan; Özgirgin, Neşe

    2015-01-01

    The aim of this study was to evaluate the effects of Kinesio Tape (KT) application to quadriceps muscles on isokinetic muscle strength, gait, and functional parameters in patients with stroke. Twenty-four patients were allocated into KT and control groups. All patients participated in the same conventional rehabilitation program 5 times/wk for 4 wk. In addition, KT was applied to quadriceps muscles bilaterally to the patients in the KT group. Compared with baseline, peak torque levels increased significantly in both groups (all p 0.05). KT application to quadriceps muscles in addition to conventional exercises for 4 wk is effective on isokinetic but not functional parameters.

  8. [Tendon ruptures of the shoulder].

    Science.gov (United States)

    Habermeyer, P

    1989-08-01

    Common sports, involving raising the arms above the head, i.e., throwing, racquet games and swimming, often result in rotator cuff tendinitis. During the throwing motion, the humeral head and its overlying biceps tendon and rotator cuff must pass rapidly under the coraco-acromial arch. Damage to these structures can occur by several mechanism. First, an increase in the size of the structures passing underneath the arch may lead to impingement. This can occur either by way of hypertrophy of the musculotendinous cuff or by way of inflammation of the cuff. Second, a decreased space available underneath the arch secondary to osteophyte formation of the acromion and fibrosis of the subacromial space may lead to impingement. Third, weakness or incompetence of the rotator cuff allows the humerus to ride up and impinge on the coracoacromial arch with motion of the shoulder. Tendinitis can be combined with increased laxity of the glenohumeral joint and/or acquired instability due to a labral tear. Prevention of overuse injuries is a cornerstone of our treatment concept. The muscle tendon unit requires passive and neuromuscular facilitated streching after warming-up exercises. Muscular imbalance and weakness are prevented by balanced eccentric strenthening with particular attention to the external rotators and scapular muscles. Knowledge of the mechanics of the pitching motion, tennis serve, swimming stroke, etc. is of paramount importance in the prevention of injuries. As the onset of shoulder problems contributes to a particularly fatiguing situation, extreme fatique performance severity should be avoided. Every effort must be made to apply conservative treatment when overuse problems arise in the athlete's shoulder.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. A mini-invasive technique for severe arthrofibrosis of the knee: A technical note.

    Science.gov (United States)

    Shang, Ping; Liu, Hai-Xiao; Zhang, Yu; Xue, En-Xing; Pan, Xiao-Yun

    2016-08-01

    In this article, a mini-invasive technique is described, which consists of arthroscopic adhesiolysis and quadriceps pie-crusting lengthening basing on pre-operative sonographic examination. Sonographic diagnostic value of quadriceps tendon fibrosis is also evaluated. Pre-operative sonographic examination was performed to make an accurate location diagnosis of quadriceps fibrosis. After arthroscopic adhesiolysis, percutaneous pie-crusting release was performed basing on preoperative sonographic examination. An 18-gauge needle was used to puncture the stiff fibrous band of the distal and lateral quadriceps tendon under maximum knee flexion. The contractural quadriceps tendon is gradually released after 60-100 needle punctures. This technique was performed in five post-traumatic stiff knees and three stiff knees after previous infection. The contractural rectus femoris tendon is average 22% thinner than contralateral parts according to sonographic measurement. Mean maximum flexion increased from 35° preoperatively to 80° after arthroscopic adhesiolysis and 120° after pie-crusting. This technique is a simple, effective and mini-invasive method, allowing an immediate, aggressive rehabilitation postoperatively. Pre-operative sonographic location of quadriceps tendon fibrosis could potentially improve the efficacy and accuracy of percutaneous pie-crusting procedures. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. PRP and Metaplasia in repaired tendon

    Directory of Open Access Journals (Sweden)

    Kamal Seyed-Forootan

    2014-01-01

    Conclusion: It seems that using PRP has no effect on strengthening the tendons repair and may have some adverse effects. It usage needs further studies to evaluate their probable adverse side effects.

  11. Position Control of Tendon-Driven Fingers

    Science.gov (United States)

    Abdallah, Muhammad E.; Platt, Robert, Jr.; Hargrave, B.; Pementer, Frank

    2011-01-01

    Conventionally, tendon-driven manipulators implement some force control scheme based on tension feedback. This feedback allows the system to ensure that the tendons are maintained taut with proper levels of tensioning at all times. Occasionally, whether it is due to the lack of tension feedback or the inability to implement sufficiently high stiffnesses, a position control scheme is needed. This work compares three position controllers for tendon-driven manipulators. A new controller is introduced that achieves the best overall performance with regards to speed, accuracy, and transient behavior. To compensate for the lack of tension feedback, the controller nominally maintains the internal tension on the tendons by implementing a two-tier architecture with a range-space constraint. These control laws are validated experimentally on the Robonaut-2 humanoid hand. I

  12. Motor responses to experimental Achilles tendon pain

    DEFF Research Database (Denmark)

    Henriksen, Marius; Aaboe, Jens; Graven-Nielsen, Thomas

    2011-01-01

    of the exercise are affected by Achilles tendon pain. Objective The authors aimed to determine the effects of experimental Achilles tendon pain on motor function during one-legged weight bearing ankle plantar and dorsal flexion exercises. Methods In a crossover study, with 16 healthy subjects tested on two...... before, during and after either experimental Achilles tendon pain or a non-painful control condition. Pain was induced by intratendinous injections of hypertonic saline with isotonic saline injections as control. Joint kinematics, ground reaction force frequency contents and average EMG amplitudes were...... calculated. Results Compared with the control condition experimental Achilles tendon pain reduced the EMG activity in agonistic, synergistic and antagonistic muscles, and increased the ground reaction force frequency content around 10 Hz, during both eccentric and concentric movement phases. Conclusions...

  13. Jumper's Knee (Patellar Tendonitis) (For Parents)

    Science.gov (United States)

    ... Preventing Jumper's Knee en español Rodilla de saltador (tendinitis rotuliana) Jumper's knee — also known as patellar tendonitis or patellar tendinopathy — is an inflammation or injury of the patellar ...

  14. Endoscopic Treatment of Intrasheath Peroneal Tendon Subluxation

    Directory of Open Access Journals (Sweden)

    Frederick Michels

    2013-01-01

    Full Text Available Intrasheath subluxation of the peroneal tendons within the peroneal groove is an uncommon problem. Open exploration combined with a peroneal groove-deepening procedure and retinacular reefing is the recommended treatment. This extensive lateral approach needs incision of the intact superior peroneal retinaculum and repair afterwards. We treated three patients with a painful intrasheath subluxation using an endoscopic approach. During this tendoscopy both tendons were inspected. The distal muscle fibers of the peroneus brevis tendon were resected in two patients. A partial tear was debrided in the third patient. All patients had a good result. No wound-healing problems or other complications occurred. Early return to work and sports was possible. An endoscopic approach was successful in treatment of an intrasheath subluxation of the peroneal tendons.

  15. Biological Augmentation of Rotator Cuff Tendon Repair

    National Research Council Canada - National Science Library

    Kovacevic, David; Rodeo, Scott A

    2008-01-01

    A histologically normal insertion site does not regenerate following rotator cuff tendon-to-bone repair, which is likely due to abnormal or insufficient gene expression and/or cell differentiation at the repair site...

  16. Achilles tendon rupture; assessment of nonoperative treatment.

    Science.gov (United States)

    Barfod, Kristoffer Weisskirchner

    2014-04-01

    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. The aim of this PhD thesis was to evaluate non-operative treatment of acute Achilles tendon rupture. 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). In study III, the effect of immediate weight-bearing on the biomechanical properties of the plantar flexor muscle-tendon complex was investigated in an RCT. In study IV, validity, reliability and agreement of a novel ultrasound measurement of Achilles tendon length and elongation was tested. Study I found surgery to be the preferred treatment in 83% of departments in Denmark, 92% in Norway, 65% in Sweden, and 30% in Finland (p tendon complex. Study IV showed excellent intra-rater reliability (ICC 0.96, SEM 3.7 mm and MDC 10.3 mm), inter-rater reliability (ICC 0.97, SEM 3.3 mm and MDC 9.3 mm) and validity (measurement error 2%). Treatment algorithms across Scandinavia showed considerable variation, though operative treatment and controlled early weight-bearing was the preferred treatment in Denmark, Norway and Sweden. Immediate weight-bearing was found to be safe and recommendable in non-operative treatment of acute Achilles tendon rupture. The novel ultrasound measurement showed excellent reliability and acceptable validity and agreement.

  17. Grasp Assist Device with Shared Tendon Actuator Assembly

    Science.gov (United States)

    Ihrke, Chris A. (Inventor); Bergelin, Bryan J. (Inventor); Bridgwater, Lyndon (Inventor)

    2015-01-01

    A grasp assist device includes a glove with first and second tendon-driven fingers, a tendon, and a sleeve with a shared tendon actuator assembly. Tendon ends are connected to the respective first and second fingers. The actuator assembly includes a drive assembly having a drive axis and a tendon hook. The tendon hook, which defines an arcuate surface slot, is linearly translatable along the drive axis via the drive assembly, e.g., a servo motor thereof. The flexible tendon is routed through the surface slot such that the surface slot divides the flexible tendon into two portions each terminating in a respective one of the first and second ends. The drive assembly may include a ball screw and nut. An end cap of the actuator assembly may define two channels through which the respective tendon portions pass. The servo motor may be positioned off-axis with respect to the drive axis.

  18. Tension Distribution in a Tendon-Driven Robotic Finger

    Science.gov (United States)

    Abdallah, Muhammad E. (Inventor); Platt, Robert (Inventor); Wampler, II, Charles W. (Inventor)

    2013-01-01

    A method is provided for distributing tension among tendons of a tendon-driven finger in a robotic system, wherein the finger characterized by n degrees of freedom and n+1 tendons. The method includes determining a maximum functional tension and a minimum functional tension of each tendon of the finger, and then using a controller to distribute tension among the tendons, such that each tendon is assigned a tension value less than the maximum functional tension and greater than or equal to the minimum functional tension. The method satisfies the minimum functional tension while minimizing the internal tension in the robotic system, and satisfies the maximum functional tension without introducing a coupled disturbance to the joint torques. A robotic system includes a robot having at least one tendon-driven finger characterized by n degrees of freedom and n+1 tendons, and a controller having an algorithm for controlling the tendons as set forth above.

  19. Effect of estrogen on tendon collagen synthesis, tendon structural characteristics, and biomechanical properties in postmenopausal women.

    Science.gov (United States)

    Hansen, Mette; Kongsgaard, Mads; Holm, Lars; Skovgaard, Dorthe; Magnusson, S Peter; Qvortrup, Klaus; Larsen, Jytte O; Aagaard, Per; Dahl, Morten; Serup, Annette; Frystyk, Jan; Flyvbjerg, Allan; Langberg, Henning; Kjaer, Michael

    2009-04-01

    The knowledge about the effect of estradiol on tendon connective tissue is limited. Therefore, we studied the influence of estradiol on tendon synthesis, structure, and biomechanical properties in postmenopausal women. Nonusers (control, n = 10) or habitual users of oral estradiol replacement therapy (ERT, n = 10) were studied at rest and in response to one-legged resistance exercise. Synthesis of tendon collagen was determined by stable isotope incorporation [fractional synthesis rate (FSR)] and microdialysis technique (NH(2)-terminal propeptide of type I collagen synthesis). Tendon area and fibril characteristics were determined by MRI and transmission electron microscopy, whereas tendon biomechanical properties were measured during isometric maximal voluntary contraction by ultrasound recording. Tendon FSR was markedly higher in ERT users (P < 0.001), whereas no group difference was seen in tendon NH(2)-terminal propeptide of type I collagen synthesis (P = 0.32). In ERT users, positive correlations between serum estradiol (s-estradiol) and tendon synthesis were observed, whereas change in tendon synthesis from rest to exercise was negatively correlated to s-estradiol. Tendon area, fibril density, fibril volume fraction, and fibril mean area did not differ between groups. However, the percentage of medium-sized fibrils was higher in ERT users (P < 0.05), whereas the percentage of large fibrils tended to be greater in control (P = 0.10). A lower Young's modulus (GPa/%) was found in ERT users (P < 0.05). In conclusion, estradiol administration was associated with higher tendon FSR and a higher relative number of smaller fibrils. Whereas this indicates stimulated collagen turnover in the resting state, collagen responses to exercise were negatively associated with s-estradiol. These results indicate a pivotal role for estradiol in maintaining homeostasis of female connective tissue.

  20. Erythropoietin stimulates patellar tendon healing in rats.

    Science.gov (United States)

    Uslu, Mustafa; Kaya, Ertuğrul; Yaykaşlı, Kürşat Oğuz; Oktay, Murat; Inanmaz, Mustafa Erkan; Işık, Cengiz; Erdem, Havva; Erkan, Melih Engin; Kandiş, Hayati

    2015-12-01

    Erythropoietin (EPO), regulating erythropoiesis, is used to provide protective and regenerative activity in non-haematopoietic tissues. There is insufficient knowledge about the role of EPO activity in tendon healing. Therefore, we investigated the effect of EPO treatment on healing in rat patellar tendons. One hundred and twenty-six, four-month-old male Sprague-Dawley rats were randomly assigned to three experimental groups: 1, no treatment; 2, treatment with isotonic saline (NaCl) and 3, treatment with EPO. Each group was randomly subdivided into two groups for sacrifice at three (1a, 2a, 3a) or six weeks (1b, 2b, 3b). Complete incision of the left patellar tendon from the distal patellar pole was performed. We applied body casts for 20 days after the incised edges of the patellar tendon were brought together with a surgical technique. Both legs were harvested and specimens from each group underwent histological, biomechanical, and protein mRNA expression analyses. There were statistically significant differences in the ultimate breaking force between the EPO group and others at both weeks three and six (prats compared to the control groups biomechanically, histopathologically and with tissue protein mRNA expression. This is the first experimental study to analyze the relationship between EPO treatment and the patellar tendon repair process by biomechanical, histopathological, and tendon tissue mRNA expression methodologies. Copyright © 2015 Elsevier B.V. All rights reserved.