Extensor Carpi Radialis Brevis Tendon Transfer for Thumb and Finger Flexion Reconstruction after Failed Extensor Carpi Radialis Brevis Motor Branch Transfer in a Tetraplegic Patient.

Distal nerve transfers can restore precise motor control in tetraplegic patients. When nerve transfers are not successful, tendon transfers may be used for subsequent reconstruction. In this case, an extensor carpi radialis brevis (ECRB) tendon transfer was used to restore thumb and finger flexion following an unsuccessful ECRB to anterior interosseous nerve transfer in a young tetraplegic patient. Twelve months following tendon transfer, the patient demonstrated functional grip and pinch strength and was using both hands for daily activities. Level of Evidence: Level V (Therapeutic).

Mid- to long-term outcomes of latissimus dorsi tendon transfer for massive irreparable posterosuperior rotator cuff tears: a systematic review and meta-analysis.

BACKGROUND: This study aims to analyze the mid-to long-term results of the latissimus dorsi tendon for the treatment of massive posterosuperior irreparable rotator cuff tears as reported in high-quality publications and to determine its efficacy and safety. METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, and EMBASE databases were searched until December 2022 to identify studies with a minimum 4 year follow-up. Clinical and radiographic outcomes, complications, and revision surgery data were collected. The publications included were analyzed quantitatively using the DerSimonian Laird random-effects model to estimate the change in outcomes from the preoperative to the postoperative condition. The proportion of complications and revisions were pooled using the Freeman-Tukey double arcsine transformation. RESULTS: Of the 618 publications identified through database search, 11 articles were considered eligible. A total of 421 patients (432 shoulders) were included in this analysis. Their mean age was 59.5 ± 4 years. Of these, 277 patients had mid-term follow-up (4-9 years), and 144 had long-term follow-up (more than 9 years). Postoperative improvements were considered significant for the following outcome parameters: Constant-Murley Score (0-100 scale), with a mean difference (MD) = 28 points (95% confidence interval [CI] 21, 36; I2 = 89%; P < .001); visual analog scale, with a standardized MD = 2.5 (95% CI 1.7, 3.3; P < .001; I2 = 89%; P < .001); forward flexion, with a MD = 43° (95% CI 21°, 65°; I2 = 95% P < .001); abduction, with a MD = 38° (95% CI 20°, 56°; I2 = 85%; P < .01), and external rotation, with a MD = 8° (95% CI 1°, 16°; I2 = 87%; P = .005). The overall reported mean complication rate was 13% (95% CI 9%, 19%; I2 = 0%), while the reported mean revision rate was 6% (95% CI: 3%, 9%; I2 = 0%). CONCLUSIONS: Our pooled estimated results seem to indicate that latissimus dorsi tendon transfer significantly improves patient-reported outcomes, pain relief, range of motion, and strength, with modest rates of complications and revision surgery at mid-to long-term follow-up. In well-selected patients, latissimus dorsi tendon transfer may provide favorable outcomes for irreparable posterosuperior cuff tears.

Allograft-enhanced latissimus dorsi transfer is better than the conventional technique for irreparable posterosuperior rotator cuff tears. A retrospective matched cohort.

PURPOSE: Latissimus dorsi tendon (LDT) transfer (LDTT) to the greater tuberosity to treat irreparable posterosuperior rotator cuff tears (RCTs) in young active patients has been shown to have up to 36% of clinical failures, most of them happening because of either deltoid origin disruption or post-operative transfer rupture from the greater tuberosity. In an attempt to simultaneously prevent both complications, a modified technique includes the following adaptations to the original technique: reinforcement and augmentation of the LDT with a tendinous allograft, enabling the use of a single deltopectoral approach. The aim of this study is to compare mid-term outcomes of the traditional LDTT technique with this modified transfer. METHODS: Retrospective cohort study comparing two groups who underwent either the traditional (group 1; n = 19) or the modified technique (group 2; n = 27). Group homogenization was assured by statistical comparison of 24 baseline independent variables. The outcome variables were the gains to active shoulder range of motions (ROM) and UCLA scores (and all its subscores, independently), at a minimum follow-up of two years. A p value < .05 was considered to be statistically significant. RESULTS: At a mean follow-up of 25 months, both groups have shown improvements to most variables. However, group two (modified technique) achieved greater improvements to UCLA score (p = .009), active external rotation (p = .006) and internal rotation (p = .008). CONCLUSION: At mid-term follow-up, improvements to outcomes of the modified (single approach, allograft-enhanced) latissimus dorsi transfer were greater than those of the original technique.

[Anterior tibialis tendon transfer for the treatment of dynamic supination in patients with clubfoot. Analysis of clinical outcomes and complications]. / Transferencia del tendón tibial anterior para el tratamiento de la supinación dinámica en el pie bot. Análisis de los resultados clínicos y las complicaciones.

INTRODUCTION: our aim was to evaluate the clinical outcomes and complications of anterior tibialis tendon transfer (ATTT) in children with dynamic supination after clubfoot treatment. MATERIAL AND METHODS: children with dynamic supination after initial treatment with Ponseti method or surgery who underwent ATTT between 2008 and 2020 were included for evaluation. Demographic data, previous treatment, associated procedures and fixation method were analyzed. Functional results were evaluated with the grading system described by Thompson. Complications and their treatment were analyzed. RESULTS: a total of 39 patients (57 feet) were analyzed. 70% received previous treatment with Ponseti method, 19.3% underwent surgical posteromedial release, and 10.7% another type of surgical treatment. 88% of cases required associated procedures including Achilles tendon lengthening or tenotomy, plantar fasciotomy, tibial osteotomy, lateral column shortening, posterior release. The predominant type of fixation was the pull-out button method (96.5%). The average follow-up was 31.5 months. According to the Thompson grading system, 52 patients presented good results, two fair and three poor. 98.2% of the feet showed active contraction of the transferred tibialis anterior tendon. There were four complications: plantar irritation, synovial cyst in the dorsum of the foot and deep infection. Two feet required unplanned surgery. CONCLUSION: anterior tibialis tendon transfer is an effective technique to correct residual dynamic supination in patients with clubfoot.

INTRODUCCIÓN: el objetivo de este estudio fue evaluar los resultados clínicos y complicaciones de la transferencia del tendón tibial anterior (TTTA) en niños con pie bot y supinación dinámica. MATERIAL Y MÉTODOS: se incluyeron niños con recurrencia dinámica del pie bot después de tratamiento con método Ponseti o cirugía, que se sometieron a TTTA entre 2008 y 2020. Se analizaron datos demográficos, tratamientos previos, procedimientos asociados y método de fijación. Los resultados funcionales fueron evaluados con el sistema de graduación descrito por Thompson. Se analizaron las complicaciones y su tratamiento. RESULTADOS: se analizaron 39 pacientes (57 pies). Setenta por ciento recibió tratamiento previo con método Ponseti, a 19.3% se le realizó liberación posteromedial y a 10.7% otro tipo de tratamiento quirúrgico. Ochenta y ocho por ciento de los casos requirió procedimientos asociados: tenotomía o alargamiento del tendón de Aquiles, fasciotomía plantar, osteotomía desrotadora de tibia, acortamiento de columna lateral, liberación posterior. El tipo de fijación predominante fue pull-out con botón (96.5%). El seguimiento promedio fue de 31.5 meses. De acuerdo al sistema de Thompson, 52 pacientes presentaron resultados buenos, dos regulares y tres malos. 98.2% de los pies mostraron contracción activa del tendón del tibial anterior transferido. Se presentaron cuatro complicaciones: irritación plantar, quiste sinovial en dorso e infección profunda. Dos pies requirieron cirugía no programada. CONCLUSIÓN: la transferencia del tendón del tibial anterior es una técnica eficaz para corregir la supinación dinámica residual en pacientes con pie bot.

Anterior tibial tendon transfer in idiopathic clubfoot: does the outcome differ with the initial treatment? Proposed classification to surgical indication.

PURPOSE: To establish parameters and propose a radiographic classification for foot adduction/supination deformities to assist the indication of Garceau procedure. Secondly, to investigate whether the outcome of Garceau surgery depends on the initial treatment used, peritalar release, or the Ponseti method, and verify the maintenance of correction until skeletal maturity. METHODS: Prospective cohort study, with follow-up evaluations in 2009 and 2019. Fifty-three consecutive patients (71 feet) with idiopathic congenital clubfoot (ICCF) were divided into two groups according to the initial treatment used: peritalar release (group I) or Ponseti method (group II). All patients underwent Garceau procedure. The patients were evaluated clinically and radiographically using the American Orthopedic Foot Association (AOFAS) score for ankle and hindfoot. A radiographic classification is proposed based on the adduction by talo-first metatarsal angle on dorsoplantar view and supination by the elevation of the head of the first metatarsal on lateral view, both weight-bearing. RESULTS: In the first clinical evaluation, the mean score on the AOFAS was 87 points in group I and 86 points in group II. In the second evaluation, group I had mean AOFAS of 92 points and group II of 94 points. No statistical differences were found between the two groups, neither between the first and the second evaluation. In the radiographic evaluation, the adduction deformity obtained an average correction of 4° in group I and 3.6° in group II; in supination deformity, the average depression of the first metatarsal head in relation to the ground was 6.7 mm in group I and 7.5 mm in group II, with no statistical difference between the two evaluations, indicating the correction was maintained until skeletal maturity. CONCLUSION: Garceau transfer is capable of correcting residual deformities in adduction/supination of mild and moderate degrees, regardless of the initial treatment, and maintaining the correction until skeletal maturity. The proposed radiographic classification might help to objectively indicate the surgical procedure.

Arthroscopic-assisted latissimus dorsi transfer for irreparable posterosuperior cuff tears: Clinical outcome of 15 patients.

OBJECTIVE: We analyzed the clinical and functional results of patients with irreparable posterosuperior rotator cuff tears treated with arthroscopic-assisted latissimus dorsi transfer and the clinical relevance of the addition of partial repair of the remaining cuff to the transfer. METHODS: This was a prospective cohort study that included patients diagnosed with irreparable massive rotator cuff tears treated by arthroscopic-assisted latissimus dorsi transfer between 2015 and 2018. Demographic characteristics, clinical and functional outcomes (Constant-Murley (CS) score and subjective shoulder value (SSV)), and the incidence of complications were evaluated. Clinical outcomes were compared between patients treated with transfer alone and transfer with partial cuff repair. RESULTS: Fifteen patients were included, with an average follow-up of 37 ± 16 months. The median duration of symptoms before surgery was 66 weeks (24-208). A significant increase in forward elevation of 52° (p < 0.003) and abduction of 48° (p < 0.001) was obtained. The CS score increased by 48 points (p < 0.001), and the SSV changed from 29% preoperatively to 70% postoperatively (p < 0.001), with a significant decrease in the visual analog pain score from 7 to 1 (p < 0.001). In 10 patients, partial repair of the rotator cuff was also performed. No statistically significant differences were found in these patients compared with patients treated with transfer alone. Two patients presented complications, including transient sensitive neuropraxia of the axillary nerve and seroma, which were managed conservatively and did not affect the outcomes. CONCLUSION: Arthroscopic-assisted latissimus dorsi transfer is a safe technique that significantly improves clinical and functional outcomes in selected patients. Longer follow-up and comparison with other treatment options are needed to confirm these excellent results in this group of difficult-to-treat patients. LEVEL OF EVIDENCE IV: Nil.

Transferencia de trapecio inferior con injerto autólogo de semitendinoso y recto interno / Transfer of the lower trapezius muscle tendon augmented with semitendinosus and gracillis tendon

Existen múltiples opciones de tratamientos para las rupturas masivas irreparables posterosuperiores del manguito rotador. Describiremos la transferencia del trapecio inferior con aumentación utilizando semitendinoso y recto interno autólogos, bajo asistencia. De esta manera devolvemos el balance muscular y restablecemos las cuplas de fuerza para la correcta movilidad del hombro afectado. Esta técnica se realiza con dos incisiones y tres portales artroscópicos: la primera para la toma del recto interno y semitendinoso en la rodilla del mismo lado del hombro afectado (aumentación), y la segunda en la escápula para la toma del trapecio inferior y para el pasaje de los tendones al espacio subacromial y posterior fijación con anclas sin nudo

In massive irreparable posterosuperior rotator cuff ruptures, there are several options for treatment. We will describe the transfer of the lower trapezius muscle tendon augmented with semitendinosus and gracillis tendons autologous, under arthroscopic assistance. In this way, muscular balance is restored for correct shoulder mobility. This technique is performed with two incisions and three arthroscopic portals, the first for harvest of the gracillis and semitendinosus tendons, in the knee on the same side of the affected shoulder (augmentation) and the second in the scapula for the harvest of the lower trapezius muscle tendon, and for passage to the subacromial, and fixation with knotless anchors

Transferencias tendinosas en hombro. Técnica quirúrgica y revisión de la literatura / Tendon transfers in shoulder. Surgical technique and literature review

En lesiones con criterios de irreparabilidad del manguito rotador en pacientes jóvenes y activos se considera realizar transferencia tendinosa como una opción de tratamiento; transferencia del trapecio inferior en lesiones irreparables posterosuperiores del manguito rotador; transferencia del dorsal ancho vía anterior en lesiones irreparables de supraespinoso y transferencia de dorsal ancho en lesiones irreparables del subescapular. En este trabajo realizamos una revisión narrativa de la técnica quirúrgica. Además, se puede observar el video de la experiencia anatómica de cada técnica descripta

In rotator cuff injuries with irreparable criteria in active and young patients, tendon transfer is considered as a treatment option. We describe our experience in performing lower trapezius transfer in irreparable posterosuperior rotator cuff injuries, anterior latissimus dorsi transfer in supraspinatus injuries, and latissimus dorsi transfer in subscapularis injuries. We carry out a narrative review of the surgical technique with the subsequent video of the anatomical experience of each technique described

Triple transferencia tendinosa en la parálisis radial alta. A propósito de un caso / Triple tendinous transference in high radial paralysis. Apropos of a case

RESUMEN La parálisis del nervio radial producida por lesiones a nivel del brazo es considerada una parálisis alta, y se caracteriza por presentar la muñeca y los dedos flexionados y el pulgar en aducción con imposibilidad para la extensión de los mismos (muñeca y dedos). Todos los autores coinciden en que, para la extensión de la muñeca, el músculo de elección a transferir es el pronador redondo para el segundo radial. Sin embargo, hay diversidad de criterios sobre la utilización del palmar mayor o del cubital anterior para el extensor común de los dedos, y del palmar menor para el extensor largo del pulgar. Se presentó el caso de un paciente de 31 años de edad, con antecedente de accidente de tránsito y diagnóstico de parálisis radial alta de 18 meses de evolución, en el que se decide tratamiento quirúrgico utilizando el músculo cubital anterior después de una rehabilitación exitosa, obteniéndose excelentes resultados (AU).

ABSTRACT The radial nerve paralysis produced by lesions at the level of the arm is considered a high paralysis, and is characterized by presenting the wrist and fingers flexed and the thumb in adduction with impossibility of extending them (wrist and fingers). All consulted authors agree that, for wrist extension, the elective muscle to transfer is the round pronator for the second radial. However, there are different criteria on the use of the palmar major or anterior ulnar for the common finger extender, and the palmar minor for the long thumb extender. We presented the case of a 31-year-old patient, with a history of traffic accident and diagnosis of 18-month high radial paralysis, in which surgical treatment using the anterior ulnar muscle after a successful rehabilitation was decided, obtaining excellent results (AU).

Complicated Traumatic Nerve Injury Treated with Tendon Transfers in a Patient with Myotonic Dystrophy: First Case Report.

CASE: We report a right-handed 37-year-old woman, with myotonic dystrophy type 1 (MD1), presenting with a posterior interosseus nerve injury because of a penetrating trauma in the right forearm. The tendon transfer technique was chosen based on tendon response and functionality of the arms during the surgery. The patient has been able return to her daily life activities with proper fine and gross motor control. CONCLUSION: Despite tendon transfer surgery being a common technique for radial nerve palsy reconstruction, its use has not been extensively described in the literature in patients with muscular dystrophies such as MD1.

Ruptura crónica del tendón de Aquiles reconstruida con el tendón peroneo corto / Chronic Rupture of the Achilles tendon Reconstruction with the Peroneus Brevis Tendon

RESUMEN Introducción: La ruptura espontánea del tendón de Aquiles es una afección frecuente en los pacientes jóvenes que practican deportes. Cuando no se realiza el diagnóstico inicial, pasa a ser una lesión crónica, donde su diagnóstico y tratamiento es aún más complejo. En la mayoría de estos casos son necesarios los injertos tendinosos. Objetivo: Demostrar la eficacia y resultados clínicos funcionales de la reparación quirúrgica de la ruptura crónica del tendón de Aquiles mediante transferencia del tendón peroneo lateral corto. Presentación del caso: Paciente masculino de 38 años de edad con antecedentes de una caída mientras practicaba deportes. Se constató ruptura crónica del tendón de Aquiles. Se realizó una cirugía a cielo abierto, con transferencia tendinosa del tendón peroneo lateral corto hacia el cabo distal del tendón de Aquiles. Se reforzó la plastia con el tendón del plantar delgado. Se colocó una inmovilización tipo bota para el tobillo con 30o de flexión plantar por seis semanas. Pasado este tiempo, se colocó una bota de marcha y comenzó la deambulación, así como la rehabilitación con apoyo parcial hasta cumplir tres meses. A los seis meses se incorporó a su vida normal con adecuada función del pie y el tobillo. Conclusiones: La reparación quirúrgica de la ruptura crónica del tendón de Aquiles mediante transferencia del tendón peroneo lateral corto constituye un método eficaz y ofrece buenos resultados clínicos y funcionales(AU)

ABSTRACT Introduction: Spontaneous rupture of the Achilles tendon is a frequent condition in young patients who practice sports. When the initial diagnosis is not made, it becomes a chronic injury, consequently, diagnosis and treatment is even more complex. In most of these cases, tendon grafts are necessary. Objective: To demonstrate the efficacy and functional clinical results of the surgical repair of the chronic rupture of the Achilles tendon by transferring the short lateral peroneal tendon. Case report: We report the case of a 38-year-old male patient with a history of a fall while playing sports. A chronic rupture of the Achilles tendon was found. Open surgery was performed, the short lateral peroneal tendon was transferred to the distal end of the Achilles tendon. The plasty was reinforced with the thin plantar tendon. Ankle boot-type immobilization was placed with 30° plantar flexion for six weeks. After this time, the patient received a walker boot, ambulation and rehabilitation began. The latter started with partial support during three months. At six months this patient returned to his normal life with adequate foot and ankle function. Conclusions: Surgical repair of chronic Achilles tendon rupture by transferring the short lateral peroneal tendon is an effective method and offers good clinical and functional results(AU)

Surgical treatment of shoulder instability with trans-subscapularis transfer of the biceps long tendon. / Tratamento cirúrgico da instabilidade do ombro através da transferência do tendão longo do bíceps trans-subescapular.

Our objective is to describe the long biceps tendon transfer technique for the treatment of shoulder anterior instability. In this procedure, the long tendon of the biceps brachii is detached from the supraglenoid tubercle and transferred to the anterior edge of the glenoid cavity through a subscapularis tenotomy, reproducing the sling effect and increasing the anterior block. The technique is easy to perform and minimizes the risks of the coracoid process transfer. In conclusion, the transfer of the long tendon of the biceps brachii is an option for the treatment of glenohumeral instability.

O objetivo deste trabalho é descrever, em cadáver, a técnica de transferência do tendão longo do bíceps para o tratamento da instabilidade anterior do ombro. Nesta técnica, o tendão longo do bíceps braquial é desinserido do tubérculo supraglenoidal e transferido para a borda anterior da cavidade glenoidal, através da tenotomia do subescapular, reproduzindo o efeito tirante e aumentando o batente anterior. A técnica é de fácil execução, minimizando os riscos da transferência do processo coracoide e pode ser uma opção para o tratamento da instabilidade glenoumeral.

Calcific Insertional Achilles Tendinopathy-Achilles Repair With Flexor Hallucis Longus Tendon Transfer: Case Series and Surgical Technique.

Calcific insertional Achilles tendinopathy (CIAT) is a relatively common musculoskeletal entity that results in significant pain and disability, as well as posterior muscle group weakness. There is a lack of evidence criteria to support the timing of operative intervention, choice of procedures, or whether equinus requires treatment. The purpose of this study was to retrospectively review 45 patients (48 feet) who have undergone surgical management of CIAT with concomitant posterior muscle group weakness with the single heel rise testing. All patients underwent debridement and repair of the Achilles tendon with reattachment of the Achilles tendon to the calcaneus, ostectomy of the calcaneus, and flexor hallucis longus tendon transfer. Those patients with equinus also underwent gastrocnemius recession. The focus includes patient-reported satisfaction, time to return to normal shoe gear, and the incidence of revision surgery. The overall average of time to weightbearing was 4.3 weeks. After surgery, 73.3% (n = 33) of the 45 patients responded to the following question: "Would you have this surgery done again?" Of these patients, 93.9% (n = 31) responded "Yes" and 6.1% (n = 2) responded "Unsure." Of the same 33 patients, 84.8% (n = 28) responded that they were "Very Satisfied" with the procedure and 15.2% (n = 5) responded that they were "Satisfied." Twelve patients (26.7%) did not respond to either question. One of the 12 patients (8.3%) who did not respond had bilateral procedures. None of the patients experienced tendon rupture, deep vein thrombosis, or the need for revision surgery. Four patients (8%) experienced a superficial infection, whereas 1 patient (2%) had development of a deep infection. No correlations were found when looking at the relationship between body mass index and return to weightbearing/normal shoe gear with Spearman analysis.

Technique tip: EDL-to-EHL double loop transfer for extensor hallucis longus reconstruction.

BACKGROUND: Extensor hallucis longus (EHL) tendon injuries often occur in the setting of lacerations to the dorsum of the foot. End-to-end repair is advocated in acute lacerations, or in chronic cases when the tendon edges are suitable for tension free repair. Reconstruction with allograft or autograft is advocated for cases not amenable to a primary direct repair. This is often seen in cases with tendon retraction and more commonly in the chronic setting. In many countries the use of allograft is very limited or unavailable making reconstruction with autograft and tendon transfers the primary choice of treatment. Tendon diameter mismatch and diminished resistance are common issues in other previously described tendon transfers. METHODS: We present the results of a new technique for reconstruction of non-reparable EHL lacerations in three patients using a dynamic double loop transfer of the extensor digitorum longus (EDL) of the second toe that addresses these issues. RESULTS: At one-year follow up, all patients recovered active/passive hallux extension with good functional (AOFAS Score) and satisfaction results. No reruptures or other complications were reported in this group of patients. No second toe deformities or dysfunction were reported. CONCLUSIONS: Second EDL-to-EHL Double Loop Transfer for Extensor Hallucis Longus reconstruction is a safe, reproducible and low-cost technique to address EHL ruptures when primary repair is not possible. LEVEL OF EVIDENCE: IV (Case Series).

Repair of the Deltoid Ligament Using Posterior Tibial Tendon Autograft:A Novel Technique.

Posterior tibial tendon dysfunction (PTTD) is a progressive disorder secondary to advanced degeneration of the posterior tibial tendon, leading to the abduction of the forefoot, valgus rotation of the hindfoot, and collapse of the medial longitudinal arch. Eventually, the disease becomes so advanced that it begins to affect the deltoid ligament over time. This attenuation and eventual tear of the deltoid ligament leads to valgus deformity of the ankle. Surgical correction of PTTD is performed to protect the ankle joint at all costs. Generally, this is performed using osteotomies of the calcaneus and repair or augmentation of the deltoid ligament. Unfortunately, there has been no universal procedure adapted by foot and ankle surgeons for repair or augmentation of the deltoid ligament. Articles have discussed the use of suture and suture anchors, suture tape, nonanatomic allograft repair, nonanatomic autograft repair with plantaris, peroneal and extensor halluces longus tendons to repair and augment the deltoid ligament. There is very little literature, however, in regard to using the posterior tibial tendon to augment the deltoid ligament in accordance with hindfoot fusion for end-stage PTTD deformity. In general, the posterior tibial tendon in triple and medial double arthrodesis is generally removed because it is thought to be a pain generator. This article presents a case study and novel technique using the posterior tibial tendon to augment and repair the laxity of the deltoid ligament in an advanced flatfoot deformity.

Tratamento cirúrgico da instabilidade do ombro através da transferência do tendão longo do bíceps trans-subescapular / Surgical treatment of shoulder instability with trans-subscapularis transfer of the biceps long tendon

RESUMO O objetivo deste trabalho é descrever, em cadáver, a técnica de transferência do tendão longo do bíceps para o tratamento da instabilidade anterior do ombro. Nesta técnica, o tendão longo do bíceps braquial é desinserido do tubérculo supraglenoidal e transferido para a borda anterior da cavidade glenoidal, através da tenotomia do subescapular, reproduzindo o efeito tirante e aumentando o batente anterior. A técnica é de fácil execução, minimizando os riscos da transferência do processo coracoide e pode ser uma opção para o tratamento da instabilidade glenoumeral.

ABSTRACT Our objective is to describe the long biceps tendon transfer technique for the treatment of shoulder anterior instability. In this procedure, the long tendon of the biceps brachii is detached from the supraglenoid tubercle and transferred to the anterior edge of the glenoid cavity through a subscapularis tenotomy, reproducing the sling effect and increasing the anterior block. The technique is easy to perform and minimizes the risks of the coracoid process transfer. In conclusion, the transfer of the long tendon of the biceps brachii is an option for the treatment of glenohumeral instability.

Description and Clinical Assessment of the Bone Block Tendon Interposition Technique for the Management of Thumb Carpometacarpal Joint Osteoarthritis.

BACKGROUND: Pellegrini's surgical technique is the most useful for thumb carpometacarpal joint osteoarthritis. The purpose of this paper is to describe the technique of a modified version using a bone block in the tunnel through which the flexor carpi radialis tendon is passed (BBTI). METHODS: Case series of patients diagnosed with osteoarthritis of the thumb carpometacarpal joint, in stage II or higher based on Eaton's classification, that were intervened using the BBTI technique for a 2-year period. Grip and pinch strength, range of motion, and 1-2 metacarpal angle were evaluated. Pain and function were measured using the visual analogue scale and the Disabilities of the Arm, Shoulder and Hand (DASH) scale. RESULTS: The study included 16 cases in 14 patients (11 women and 3 men), with an average age of 55.7 ± 7.1 years. Encouraging results were obtained, with an average DASH score of 24.3 ± 17.9 and a minimum VAS pain score. A total of 58% showed a grip strength of over 80% and the postoperative movement was equivalent to the contralateral limb. No cases of infection were reported, and only two minor complications were observed. CONCLUSIONS: The BBTI technique is a surgical option that incorporates an interference screw, offering good functional results for managing osteoarthritis of the thumb carpometacarpal joint, with a similar complication rate to that of the original technique.

Biomechanical Evaluation of Circumtibial and Transmembranous Routes for Posterior Tibial Tendon Transfer for Dropfoot.

BACKGROUND: Tibialis posterior tendon transfer is performed when loss of dorsiflexion has to be compensated. We evaluated the circumtibial (CT), above-retinaculum transmembranous (TMAR), and under-retinaculum transmembranous (TMUR) transfer gliding resistance and foot kinematics in a cadaveric foot model during ankle range of motion (ROM). METHODS: Eight cadaveric foot-ankle distal tibia specimens were dissected free of soft tissues on the proximal end, applying an equivalent force to 50% of the stance phase to every tendon, except for the Achilles tendon. Dorsiflexion was tested with all of the tibialis posterior tendon transfer methods (CT, TMAR, and TMUR) using a tension tensile machine. A 10-repetition cycle of dorsiflexion and plantarflexion was performed for each transfer. Foot motion and the force needed to achieve dorsiflexion were recorded. RESULTS: The CT transfer showed the highest gliding resistance ( P < .01). Regarding kinematics, all transfers decreased ankle ROM, with the CT transfer being the condition with less dorsiflexion compared with the control group (6.8 vs 15 degrees, P < .05). TMUR transfer did perform better than TMAR with regard to ankle dorsiflexion, but no difference was shown in gliding resistance. The CT produced a supination moment on the forefoot. CONCLUSION: The CT transfer had the highest tendon gliding resistance, achieved less dorsiflexion and had a supination moment. Clinical Relevance We suggest that the transmembranous tibialis posterior tendon transfer should be the transfer of choice. The potential bowstringing effect when performing a tibialis posterior tendon transfer subcutaneously (TMAR) could be avoided if the transfer is routed under the retinaculum, without significant compromise of the final function and even with a possible better ankle range of motion.

One-bone forearm osteodesis and biceps re-routing to correct severe supination contracture in a paediatric patient with late obstetric brachial plexus palsy.

PURPOSE: The one-bone forearm arthrodesis has been performed to change the position of the forearm in children with fixed supination deformity due to upper extremity neurologic deficit. In this article, we present a retrospective review of children with late obstetric brachial plexus palsy who underwent palliative surgery to correct severe supination contracture by one-bone forearm osteodesis and biceps re-routing. This technique has not been described previously. MATERIALS AND METHODS: In this retrospective study, four consecutive patients with upper extremity weakness and severe supination contracture who underwent forearm osteodesis in neutral or slight pronation and biceps re-routing. The average age of patients at the time of surgery was 12 years six months (range, 7-14 years). RESULTS: The average follow-up was one year ten months (range, 1 year 6 months to 2 years 7 months). The rotation of the forearm set in neutral (3 patients) and 15° pronation (1 patient). No patients noted adverse effects on the shoulder, elbow or wrist, and none missed having forearm rotation. CONCLUSIONS: One-bone forearm osteodesis and biceps re-routing technique should be considered in some patients with fixed forearm supination deformity and concomitant severe pronation deficit. In this group of patients, repositioning the forearm in a more pronated (or less supinated) position may improve the use of that extremity in activities of daily living. The surgical technique is fairly simple and can be done in a single procedure.