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1.
Arthroscopy ; 36(12): 2982-2983, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33276886

RESUMO

Tenodesis of the long head of the biceps tendon has long been a source of dialogue, discussion, debate, and dogma. In general, the shoulder literature has been exhaustive regarding various biceps tenodesis techniques and outcomes, and studies have shown positive clinical outcomes of tenodesis, regardless of location, along the proximal humerus. Fewer studies have evaluated the outcomes of revision tenodesis; however, those that have looked at this have generally found that a revision to a subpectoral tenodesis site is usually quite successful.


Assuntos
Tenodese , Braço/cirurgia , Humanos , Músculo Esquelético/cirurgia , Ombro/cirurgia , Tendões/cirurgia
2.
Syst Rev ; 9(1): 264, 2020 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-33220705

RESUMO

BACKGROUND: Flexor tendon injuries most commonly occur following a penetrating injury to the hand or wrist. These are challenging injuries and the standard treatment is surgical repair under general or regional anaesthesia. 'Wide-awake' surgery is an emerging technique in hand surgery where a conscious patient is operated on under local anaesthetic. The vasoconstrictive effect of adrenaline (epinephrine) creates a 'bloodless' operating field and a tourniquet is not required. The potential advantages include intra-operative testing of the repair; removal of the risks of general anaesthesia; reduced costs; no aerosol generation from intubation therefore reduced risk of COVID-19 spread to healthcare professionals. The aim of this study will be to systematically evaluate the evidence to determine if wide-awake surgery is superior to general/regional anaesthetic in adults who undergo flexor tendon repair. METHODS: We designed and registered a study protocol for a systematic review and meta-analysis of comparative and non-comparative studies. The primary outcome will be functional active range of motion. Secondary outcomes will be complications, resource use (operative time) and patient-reported outcome measures. A comprehensive literature search will be conducted (from 1946 to present) in MEDLINE, EMBASE, CINAHL, and Cochrane Library. Grey literature will be identified through Open Grey, dissertation databases and clinical trials registers. All studies on wide-awake surgery for flexor tendon repair will be included. The comparator will be general or regional anaesthesia. No limitations will be imposed on peer review status or language of publication. Two investigators will independently screen all citations, full-text articles and abstract data. Potential conflicts will be resolved through discussion or referral to a third author when necessary. The study methodological quality (or bias) will be appraised using an appropriate tool. If feasible, we will conduct a random effects meta-analysis. DISCUSSION: This systematic review will summarise the best available evidence and definitively establish if function, complications, cost, or patient-reported outcomes are improved when flexor tendons are repaired using wide-awake technique. It will determine if this novel approach is superior to general or regional anaesthesia. This knowledge will help guide hand surgeons by continuing to improve outcomes from flexor tendon injuries. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020182196.


Assuntos
Anestesia Local , Anestésicos Locais , Mãos/cirurgia , Controle de Infecções , Traumatismos dos Tendões/cirurgia , Vigília , Adulto , Anestesia por Condução , Anestesia Geral , /virologia , Epinefrina , Humanos , Metanálise como Assunto , Procedimentos Ortopédicos , Pandemias , Amplitude de Movimento Articular , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Tendões/cirurgia , Torniquetes , Resultado do Tratamento
3.
Bone Joint J ; 102-B(12): 1608-1617, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33249900

RESUMO

AIMS: The aim of this systematic review and meta-analysis is to evaluate differences in functional outcomes and complications between single- (SI) and double-incision (DI) techniques for the treatment of distal biceps tendon rupture. METHODS: A comprehensive search on PubMed, MEDLINE, Scopus, and Cochrane Central databases was conducted to identify studies reporting comparative results of the SI versus the DI approach. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for search strategy. Of 606 titles, 13 studies met the inclusion criteria; methodological quality was assessed with the Newcastle-Ottawa scale. Random- and fixed-effects models were used to find differences in outcomes between the two surgical approaches. The range of motion (ROM) and the Disabilities of the Arm, Shoulder and Hand (DASH) scores, as well as neurological and non-neurological complications, were assessed. RESULTS: A total of 2,622 patients were identified. No significant differences in DASH score were detected between the techniques. The SI approach showed significantly greater ROM in flexion (standardized mean difference (SMD) -0.508; 95% confidence interval (CI) -0.904 to -0.112) and pronation (SMD -0.325, 95% CI -0.637 to -0.012). The DI technique was associated with significantly less risk of lateral antebrachial cutaneous nerve damage (odds ratio (OR) 4.239, 95% CI 2.171 to 8.278), but no differences were found for other nerves evaluated. The SI group showed significantly fewer events of heterotopic ossification (OR 0.430, 95% CI 0.226 to 0.816) and a lower reoperation rate (OR 0.503, 95% CI 0.317 to 0.798). CONCLUSION: No significant differences in functional scores can be expected between the SI and DI approaches after distal biceps tendon repair. The SI approach showed greater flexion and pronation ROM and a lower risk of heterotopic ossification and reoperation. The DI approach was favourable in terms of lower risk of neurological complications. Cite this article: Bone Joint J 2020;102-B(12):1608-1617.


Assuntos
Traumatismos do Braço/cirurgia , Traumatismos dos Tendões/cirurgia , Tendões/cirurgia , Humanos , Músculo Esquelético/lesões , Músculo Esquelético/cirurgia , Procedimentos Ortopédicos/métodos , Ferida Cirúrgica
4.
Zhonghua Yan Ke Za Zhi ; 56(11): 853-858, 2020 Nov 11.
Artigo em Chinês | MEDLINE | ID: mdl-33152844

RESUMO

Objective: To investigate the long-term clinical efficacy and safety of the bilateral superior oblique tendon suture spacer in treatment of A-pattern strabismus with superior oblique overaction (SOOA). Methods: Retrospective case series study. Twenty-one A-pattern strabismus patients who received the quantitative bilateral superior oblique tendon suture spacer with a complete follow-up from January 2009 to August 2017 were enrolled. Among these patients, 19 were exotropic and 2 were esotropic, including 11 males and 10 females, aged (14±9) years. Patients with unilateral superior oblique overaction, Broun syndrome or Helveston syndrome were excluded. The A-pattern strabismus, objective torsion, function of the superior oblique muscle and binocular vision were examined pre-and post-operatively. Paired t-test was used for normal distribution data, Wilcoxon rank-sum test was used for non-normal distribution data, Spearman rank correlation test and simple linear regression were used to analyze the correlation between the two variables. Results: The follow-up was 12 to 109 months (mean, 26±17 months). Twenty patients showed good alignment in the primary position with a deviation angle less than 10 prism diopter (PD), and 1 patient with esotropia had an angle greater than 15 PD. All the patients had no A pattern after surgery. The average pre-and post-operative A-patterns were (23.81±9.47) PD and (0.90±3.59) PD (t=11.29, P<0.01), respectively, and the average corrected A pattern was (23.52±9.68) PD.The average pre-and post-operative torsion was 3.18°±3.26° and -4.81°±4.13° (t=8.87, P<0.01), espectively, and the average corrected torsion was 7.95°±3.88°. No patient complained of torsional diplopia after surgery. The average amount of pre-and post-operative SOOA was 3.0 (2.0) and 0.0 (1.0) in 42 eyes (Z=-5.78, P<0.01), respectively. Suture extension of the superior oblique tendon was related with the pre-operative SOOA (r=0.47, P<0.01), but was not related with the pre-operative torsion (r=0.02, P=0.88). The linear regression results was suture extension=2.71× the grade of pre-operative SOOA (t=27.93, P<0.01). Conclusions: The bilateral superior oblique tendon suture spacer can improve the A-pattern, objective torsion and SOOA, with no torsional diplopia or V pattern after the long-term follow-up. It is a safe and effective superior oblique muscle weakening procedure. (Chin J Ophthalmol, 2020, 56: 853-858).


Assuntos
Músculos Oculomotores , Estrabismo , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Estudos Retrospectivos , Estrabismo/cirurgia , Suturas , Tendões/cirurgia , Resultado do Tratamento , Visão Binocular , Adulto Jovem
5.
Am J Vet Res ; 81(9): 714-719, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33112169

RESUMO

OBJECTIVE: To evaluate the effect of suture caliber on the tensile strength of tenorrhaphies performed with a locking-loop technique in cadaveric canine tendons. SAMPLE: 60 superficial digital flexor tendons (SDFTs) from 30 cadaveric adult dogs. PROCEDURES: Transverse tenotomy was performed, and SDFTs were repaired with a locking-loop technique and polypropylene suture of 5 randomly assigned calibers: size-0, 2-0, 3-0, 4-0, or 5-0 (n = 12 SDFTs/suture caliber). Tendon constructs were tested to failure. Yield, peak, and failure forces and causes of failure were compared between groups. RESULTS: Mean ± SD failure force for the constructs was significantly greater with large-caliber suture (size-0: 73.5 ± 3.1 N; size 2-0: 54.4 ± 7.1 N; size 3-0: 28.7 ± 4.9 N; size 4-0: 18.7 ± 3.4 N; and size 5-0: 8.8 ± 2.8 N). The likelihood of construct failure by suture pullout through the tendon substance increased with large-caliber suture (size-0: 12/12), whereas the likelihood of construct failure by suture breakage increased with small-caliber suture (2-0: 10/12; 3-0, 4-0, and 5-0: 12/12 each). CONCLUSIONS AND CLINICAL RELEVANCE: Large-caliber suture had greater tensile strength for tenorrhaphies performed with a locking-loop technique in cadaveric canine tendons. Prior to the use of large-caliber suture in patients requiring tenorrhaphy, however, in vivo studies are required to confirm the results obtained here.


Assuntos
Doenças do Cão , Traumatismos dos Tendões , Animais , Fenômenos Biomecânicos , Cadáver , Cães , Técnicas de Sutura/veterinária , Suturas/veterinária , Traumatismos dos Tendões/cirurgia , Traumatismos dos Tendões/veterinária , Tendões/cirurgia , Resistência à Tração
6.
Zhongguo Gu Shang ; 33(10): 982-5, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33107266

RESUMO

The rate of rotator cuff injury repair and retear is high in elderly patients due to the combination of different degrees of osteoporosis. To solve this problem, many surgeons try to reduce retear rate of rotator cuff injuries in these patients by increasing the initial fixation strength of anchors and changing local bone conditions. The rapid advances of tissue engineering have made it possible to use growth factors as an aid. However, repair of rotator cuff injury with osteoporosis is still a great challenge for clinical workers. How to better increase anchor fixation strength, improve micro-environment of tendon and bone healing, reduce the rotator cuff retear rate have become the research focus in recent years. The paper reviewed literatures on the relationshipbetween osteoporosis and rotator cuff injury, effect of osteoporosis in rotator cuff tendon healing, methods of reducing osteoporosis on rotator cuff tendon healing, in order to guide clinical treatment, improve operative effect and postoperative satisfaction.


Assuntos
Osteoporose , Lesões do Manguito Rotador , Idoso , Artroplastia , Humanos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Tendões/cirurgia
7.
Chirurg ; 91(12): 1083-1092, 2020 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-33089363

RESUMO

The extensor tendon apparatus is a network consisting of two different systems, an intrinsic and an extrinsic system, which are subdivided into eight different zones. Isolated injuries in zones 1 and 2 can be treated nonoperatively, whereas injuries in zones 3-8 usually require surgical treatment. A decision on the suture technique, suture material and postoperative follow-up care is made depending on the zone of the injury. The concomitant injuries of joints, bones, nerves and vessels must be taken into consideration and treated. The outcome of a tendon injury depends on the location and severity of the injury as well as the surgical technique and follow-up care. Exact knowledge of the anatomy with precise diagnostics, atraumatic, zone-dependent surgical and postoperative treatment, adequate rehabilitation and occupational therapy are essential for high quality management and preservation of fine motor skills and coordination of the whole hand.


Assuntos
Traumatismos dos Dedos , Traumatismos da Mão , Traumatismos dos Tendões , Mãos , Traumatismos da Mão/cirurgia , Humanos , Técnicas de Sutura , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/cirurgia , Tendões/cirurgia
8.
Orthopade ; 49(11): 976-984, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33025037

RESUMO

BACKGROUND: Adult acquired flatfoot deformity is characterized by a progressive functional deficit of the foot that leads to an eversion of the subtalar joint complex with heel valgus, abduction of the forefoot and collapse of the medial arch. In the case of a flexible deformity, a joint-preserving operative reconstruction is advisable, which should correct all elements of the deformity. A calcaneal lengthening osteotomy can correct excessive abduction of the forefoot, which can be measured by the amount of talar head uncoverage visible on AP weight-bearing x­rays of the foot. THERAPY: Any calcaneal lengthening osteotomy leads to an incongruence between talar and calcaneal joint surfaces of the subtalar joint, which is a risk factor for secondary degenerative changes. It is, therefore, advisable to limit the amount of lengthening to the necessary minimum. A residual heel valgus can be corrected by an additional medial displacement osteotomy as adjunct to the calcaneal lengthening. Calcaneal osteotomies are usually part of a complex reconstruction of advanced but still flexible adult flatfoot deformities. In addition to the correction of the hindfoot deformity, persistent forefoot supination needs to be corrected. In cases of midfoot instability, which is frequently located in the naviculo-cuneiforme joint line, a corrective arthrodesis is recommended. Without midfoot instability forefoot a Cotton osteotomy is able to reduce forefoot supination and add to reconstruction of the medial arch of the foot. All bony corrections should be combined with soft tissue reconstruction, i.e. spring ligament repair, Flexor tendon transfer and, in cases of gastrocnemius shortening, a gastroc recession.


Assuntos
Calcâneo/cirurgia , Pé Chato/cirurgia , Deformidades Adquiridas do Pé , Ligamentos/cirurgia , Osteotomia/métodos , Adulto , Alongamento Ósseo/métodos , Calcâneo/diagnóstico por imagem , Pé Chato/diagnóstico por imagem , , Deformidades Adquiridas do Pé/diagnóstico por imagem , Deformidades Adquiridas do Pé/cirurgia , Humanos , Complicações Pós-Operatórias , Transferência Tendinosa , Tendões/fisiopatologia , Tendões/cirurgia , Resultado do Tratamento
9.
Medicine (Baltimore) ; 99(39): e22294, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991433

RESUMO

RATIONALE: Kirner's deformity is an uncommon deformity of finger, characterized by palmo-radial curvature of distal phalanx of the fifth finger. The specific mechanism remains unknown yet. This study aims to present a case report to add the knowledge on this type of deformity. PATIENT CONCERNS: A 9-year-old girl presenting with deformity of her fifth finger since she was born was admitted to our hand surgery clinic. MRI findings showed widened epiphyseal plate, L-shaped physis, but normal flexor digitorum profundus tendon insertion, without any significantly enhanced soft issues. DIAGNOSIS: Kirner's deformity of the fifth finger. INTERVENTIONS: We presented 2 surgical choices for the patient: one was wedge osteotomy of the distal phalanx to correct the mechanical line of the distal phalanx and fixation with Kirschner wire and the other one was cut-off of deep flexor tendon insertion with brace immobilization, but her guardians refused either of them. OUTCOMES: Consecutive follow-up was performed for 19 months after the first visit, showing no any change in finger shape and function. LESSONS: The L-shaped epiphyses may be the cause of Kirner's deformity and further attention should be paid on in the clinic. This case report provided a basis for the etiological diagnosis and future treatment of Kirner's deformity.


Assuntos
Falanges dos Dedos da Mão/anormalidades , Deformidades Congênitas da Mão/diagnóstico por imagem , Osteotomia/instrumentação , Assistência ao Convalescente , Fios Ortopédicos/normas , Braquetes/normas , Criança , Feminino , Falanges dos Dedos da Mão/cirurgia , Lâmina de Crescimento/anormalidades , Lâmina de Crescimento/diagnóstico por imagem , Deformidades Congênitas da Mão/cirurgia , Humanos , Imagem por Ressonância Magnética/métodos , Osteotomia/métodos , Tendões/diagnóstico por imagem , Tendões/cirurgia , Recusa do Paciente ao Tratamento
10.
Medicine (Baltimore) ; 99(34): e21837, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846830

RESUMO

RATIONALE: Repair of soft tissue defects on the dorsum of the hand with accompanying tendon defects is a challenging problem in clinical practice. PATIENT CONCERNS: Here, we describe the case of a 3-year-old boy with a 1-week old soft tissue injury with infection due to a soft tissue defect on the dorsum of his right hand, and further describe its treatment. DIAGNOSIS: A diagnosis of a soft tissue defect of the dorsum with extensor tendon defects in the fore, middle, ring, and little fingers of the right hand was made. INTERVENTIONS: The defects were repaired using a dorsal foot flap combined with the extensor digitorum brevis tendon, under spinal anesthesia, and a small dose of the sedative phenobarbital (Lumina) was administered via pump injection after the surgery. OUTCOMES: The patient was followed-up for 6 months. The shape of the dorsal hand flap recovered satisfactorily and the skin color was almost normal. Protective sensation was restored and the tendon graft functioned well in vivo. Satisfactory outcomes were achieved in the flexion and extension of each finger. LESSONS: This case study provides evidence that for soft tissue defects on the dorsum of the hand with tendon defects, 1-stage transfer of a dorsal foot flap with the extensor digitorum brevis tendon can be effective for recovery of appearance and extensor function. In case of infant patients, postoperative use of low-dose sedation can effectively reduce the risk of vascular crisis, thus promoting survival of the flap graft, and ensuring the success of the operation.


Assuntos
Anormalidades Musculoesqueléticas/cirurgia , Retalhos Cirúrgicos/transplante , Transferência Tendinosa/métodos , Tendões/cirurgia , Assistência ao Convalescente , Pré-Escolar , Traumatismos da Mão/complicações , Traumatismos da Mão/cirurgia , Humanos , Masculino , Anormalidades Musculoesqueléticas/etiologia , Infecções dos Tecidos Moles/microbiologia , Lesões dos Tecidos Moles/complicações , Tendões/anormalidades , Resultado do Tratamento
11.
Acta Chir Orthop Traumatol Cech ; 87(3): 210-214, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-32773023

RESUMO

PURPOSE OF THE STUDY Tendon injuries continue to be a highly topical issue. Research and clinical activities in this area aim to achieve an optimal repair of the damaged tendon. Such suture is characterised by maximum tensile strength, resistance to gapping at the repair site, preservation of smooth surface, prevention of adhesions and facilitation of fast rehabilitation and active tendon movement. The suture as such is required to show mechanical resistance in particular. Considered optimal is the use of core suture of the tendon in combination with epitendinous suture. The group of researchers has for several years already been exploring new materials. They can contribute to better balance between adequate mechanical strength of the suture and biological support of healing. MATERIAL AND METHODS The study was carried out as an ex vivo experiment on porcine tendon models. A tendon segment was obtained from slaughtered animals and a total rupture of the tendon was imitated by sharp cutting of its central portion. Subsequently, the tendon was repaired by Adelaide suture using coated braided polyester (Ethibond) and two types of new polyamide 6 based (PA6) sutures. The first suture was designed as an unabsorbable polyester core (PES silk) surrounded by absorbable PA6 nanofibres. The second suture was created by braiding a PES silk yarn and two viscose yarns with PA6 nanofibres into a composite surgical suture. As a part of the study also examined was the tensile strength of suture with the use of other stitches, effect of the shape of the needle s point on the tensile strength of the suture and the effect of secured mattress peritendinous suture. The tensile strength of the suture was tested until failure and the achieved maximum load was monitored. RESULTS The PES core yarn with PA6 nanofibre braiding showed lower tensile strength (28.5 ± 5.2 N) than the yarn braided from one PES yarn and two viscose yarns with PA6 nanofibres (45.7 ± 6.7 N). Both newly developed sutures, however, fail to achieve the tensile strength of Ethibond (100.3 ± 19.1 N). In case of Ethibond suture using various types of stitches, the lowest tensile strength was observed in McLarney 4-strand core suture (68.8 ± 18.7 N). A higher tensile strength was achieved by Adelaide 4-strand core suture (83.6 ± 11.2 N). The highest tensile strength was seen in 6-strand core Savage suture (147.4 ± 22.7 N). When the effect of the type of needle was tested, a statistically significant difference between the taper point needle (72.0 ± 7.0 N) and reverse cutting needle (63.3 ± 9.6 N) was observed. In case of McLarney suture the epitendinous stitch increased the tensile strength by 46.2% and in case of Adelaide suture by 48.3%. CONCLUSIONS For tendon core suture, the use of sutures with multiple longitudinal segments seems more appropriate. The epitendinous suture can considerably reinforce the basic load-bearing core suture. Also observed was not an insignificant effect of the needle profile on the resulting tensile strength of the suture. In materials developed by us, more suitable seems to be the design of braiding of absorbable nanofibers with a load-bearing non-absorbable yarn. While the mechanical tensile strength of new materials is lower, the benefits are expected in the form of biological support of healing. Moreover, the nanofibers can be used as a carrier of biological and therapeutic substances. Further improvement of mechanical properties of the newly developed biomaterial can be foreseen if the material of the load-bearing non-absorbable yarn is changed or the load-bearing yarn and nanofibres ratio modified. This pilot study shall use the findings for further development and modification of new materials in basic research and shall also verify the biological aspects and the course of healing in in vivo studies. Key words: tendon, suture, pig, biomaterials, nanofibres, mechanical testing, healing, polyester, Adelaide.


Assuntos
Materiais Biocompatíveis , Tendões , Animais , Fenômenos Biomecânicos , Humanos , Teste de Materiais , Projetos Piloto , Técnicas de Sutura , Suturas , Suínos , Tendões/cirurgia
12.
N Z Med J ; 133(1519): 55-61, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32777795

RESUMO

AIMS: Hip abductor tendon tears are a common cause of chronic hip pain and a difficult problem to manage. The aim of this survey is to establish the level of recognition by New Zealand orthopaedic surgeons and identify the challenges in treating abductor tendon repairs. METHODS: An online survey was sent to 215 consultant orthopaedic surgeons in New Zealand with a registered interest in hip surgery. The survey consisted of five questions regarding the diagnosis, management and clinical challenges related to hip abductor tendon tears. RESULTS: Eighty-six of 204 eligible surgeons (42.2%) completed the survey. Almost all (90%) of respondents have diagnosed abductor tendon tears and over half (59%) have performed hip abductor tendon tears in their practice. The most common indication for repair was pain (35%), followed by functional weakness (29%), and the most common repair technique involved transosseous repair through the greater trochanter (41%), closely followed by suture anchors (37%). The majority of surgeons identified a need for novel biologics and tissue augments for improving repair. CONCLUSIONS: Hip abductor tendon tears were identified as a pertinent clinical problem in this survey. An improvement in the fundamental pathological understanding of disease and greater availability of proven biologics and tissue augments are required.


Assuntos
Quadril/cirurgia , Cirurgiões Ortopédicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Traumatismos dos Tendões/cirurgia , Artroplastia/estatística & dados numéricos , Humanos , Nova Zelândia , Dor/etiologia , Dor/cirurgia , Inquéritos e Questionários , Traumatismos dos Tendões/complicações , Tendões/cirurgia
13.
Arthroscopy ; 36(8): 2055-2056, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32747054

RESUMO

The long head of biceps tendon (LHB) has been evaluated as one of the most important pain generators of the shoulder. In addition, an unstable LHB can cause cartilage lesions of the humerus. For the treatment of LHB lesions, tenodesis or tenotomy has been shown to be appropriate. A well-performed biceps tenodesis provides a lower rate of Popeye-sign deformities compared with tenotomy but must result in low implant complication rates and costs.


Assuntos
Tenodese , Tenotomia , Cadáver , Humanos , Ombro , Tendões/cirurgia
14.
Am J Sports Med ; 48(10): 2456-2464, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32736504

RESUMO

BACKGROUND: Nonoperative management of injuries to the distal musculotendinous T junction of the biceps femoris is associated with variable periods of rehabilitation and high risk of recurrence. To our knowledge, the efficacy of operative treatment in patients with these acute injuries has not been previously reported. HYPOTHESIS: Surgical repair of injuries to the distal musculotendinous T junction of the biceps femoris would enable return to preinjury level of sport with low risk of recurrence. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: This prospective single-surgeon study included 34 professional athletes (mean age, 26.4 ± 3.1 years; 31 male [91.2%]; 3 female [8.8%]; body mass index, 25 ± 2.0 kg/m2) undergoing primary surgical repair of acute injuries to the distal musculotendinous T junction of the biceps femoris. All study patients underwent a standardized postoperative rehabilitation program. Predefined study outcomes relating to time for return to sporting activity, patient satisfaction, range of motion, hamstring muscle strength, passive range of motion, functional progress, and complications were recorded at regular intervals after surgery. Mean follow-up time was 28.4 months (range, 24.0-36.3 months) from date of surgery. RESULTS: All study patients returned to their preinjury level of sporting activity. Mean time from surgical repair to full sporting activity was 11.7 ± 3.6 weeks. No patients had recurrence of the primary injury. At 1-year follow-up, 18 patients (52.9%) were very satisfied and 16 patients (47.1%) were satisfied with the outcomes of their surgery. At 3 months after surgery, patients had improved mean passive straight leg raise (69.7° ± 11.7° vs 24.1° ± 7.4°; P < .001); increased mean isometric hamstring muscle strength at 0° (93.1% ± 5.4% vs 63.1% ± 7.7%; P < .001), 45° (76.8% ± 9.7% vs 24.8% ± 8.3%; P < .001), and 90° (96.4% ± 3.9% vs 85.6% ± 5.9%; P < .001); higher mean lower extremity functional scores (64.5 ± 4.5 vs 27.2 ± 5.4; P < .001); and improved mean Marx Activity Rating Scale scores (10.7 ± 2.7 vs 2.2 ± 2.1; P < .001) compared with preoperative values. High patient satisfaction and functional outcome scores were maintained at 1 and 2 years after surgery. CONCLUSION: Surgical repair of acute injuries to the distal musculotendinous T junction of the biceps femoris is associated with high patient satisfaction, increased muscle strength, improved functional outcome scores, and high return to preinjury level of sporting activity with low risk of recurrence at short-term follow-up.


Assuntos
Músculos Isquiossurais , Traumatismos dos Tendões/cirurgia , Adulto , Feminino , Músculos Isquiossurais/lesões , Músculos Isquiossurais/cirurgia , Humanos , Masculino , Força Muscular , Satisfação do Paciente , Estudos Prospectivos , Amplitude de Movimento Articular , Ruptura , Tendões/cirurgia , Adulto Jovem
15.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(7): 848-853, 2020 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-32666727

RESUMO

Objective: To investigate the effect of vascularized peroneus longus tendon graft reconstruction on anterior cruciate ligament (ACL) insertion in rabbits. Methods: Eighty healthy New Zealand white rabbits were harvested to prepare ACL injury models and randomly divided into two groups ( n=40). The ACL was reconstructed with vascularized peroneus longus tendon graft in group A and peroneus longus tendon graft without blood supply in group B. The survival of animals and the healing of incision were observed after operation; the grafts were taken for gross and histological observations at 4, 8, and 16 weeks; the biomechanical test of the grafts was carried out to record the maximum tensile strength and incidence of ACL insertion rupture at 8 and 16 weeks. Results: All animals survived until the experiment completed. General observation showed that the tunnel was combined with grafts, the vascular infiltration was abundant, and no obvious boundary between the tunnel and grafts existed at 16 weeks in group A; there was still an obvious boundary between the tunnel and graft in group B. Histological observation showed that the collagen fibers between tendon and bone in group A increased gradually, the dense fiber connection was formed, and the "tidal-line" like structure similar to the normal ACL insertion was formed at 16 weeks; but the"tidal-line" like structure was not obvious in group B. Biomechanical test showed that there was no significant difference in the incidence of ACL insertion rupture at 8 and 16 weeks between group A and group B ( P=0.680; P=0.590), but the maximum tensile strength at 8 and 16 weeks were higher in group A than in group B ( t=18.503, P=0.001; t=25.391, P=0.001). Conclusion: The vascularized peroneus longus tendon graft for ACL reconstruction can obviously promote the outcome of the ACL insertion.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Animais , Ligamento Cruzado Anterior/cirurgia , Pé/cirurgia , Coelhos , Tendões/cirurgia
16.
Arthroscopy ; 36(7): 1843-1844, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32624120

RESUMO

When there is remnant tendon stump on the footprint in rotator cuff tear, preserving the whole insertion structure and reattaching the rotator cuff to the footprint or tendon stump results in a better rotator cuff-greater tuberosity connection.


Assuntos
Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Animais , Artroplastia , Coelhos , Tendões/cirurgia , Cicatrização
17.
Am J Sports Med ; 48(10): 2499-2509, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32628507

RESUMO

BACKGROUND: In recent years, the use of the anterior half of the peroneus longus tendon (AHPLT) as an autograft source for ligament reconstruction has gained popularity. However, no reports are available regarding tendon regeneration after harvesting of the AHPLT. HYPOTHESIS: When half of the tendon is preserved during tendon harvesting, the quality of the regenerated tendon is better than that of the regenerated tendon after full-thickness harvesting. STUDY DESIGN: Case series; Level of evidence, 4; controlled laboratory study. METHODS: A total of 21 patients who underwent AHPLT harvesting for lower extremity ligament reconstruction participated in the magnetic resonance imaging (MRI) study to evaluate tendon regeneration 1 year after the harvesting. An in vivo animal study was performed to compare the quality of the regenerated tendon after partial-thickness and full-thickness tendon harvesting. A total of 30 adult female Sprague-Dawley rats were allocated to 2 groups-15 rats underwent partial-thickness Achilles tendon harvesting (partial-thickness harvesting [PTH] group), and 15 rats underwent full-thickness Achilles tendon harvesting (full-thickness harvesting [FTH] group). The quality of the regenerated tendons was compared 180 days after tendon harvesting. RESULTS: All 21 patients showed regeneration of the peroneus longus tendon (PLT) (homogeneously dark on both T1- and T2-weighted sequences). The cross-sectional area of the regenerated tendon divided by that of the preoperative tendon was 92.6% and 84.5% at 4 cm and 9 cm proximal to the tip of the distal fibula, respectively. In the animal study, the mean histologic score was better for the PTH group compared with the FTH group (9.17 ± 1.35 vs 14.72 ± 0.74; P < .001). The ultimate strength and the stiffness of the regenerated Achilles tendon were significantly higher for the PTH group compared with the FTH group (35.5 ± 8.3 vs 22.4 ± 8.3 N, P = .004; and 31.6 ± 7.7 vs 23.5 ± 4.8 N/mm, P = .016). CONCLUSION: The PLT was found to regenerate after partial-thickness harvesting on MRI. In the animal study, the quality of the regenerated tendon when half of the tendon was preserved during tendon harvesting was better than that after full-thickness tendon harvesting.


Assuntos
, Regeneração , Tendões/crescimento & desenvolvimento , Animais , Feminino , Humanos , Imagem por Ressonância Magnética , Ratos , Ratos Sprague-Dawley , Tendões/diagnóstico por imagem , Tendões/cirurgia
18.
Tokai J Exp Clin Med ; 45(2): 97-101, 2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-32602109

RESUMO

We present an extremely rare case of avulsion injury of the flexor digitorum profundus and the flexor digitorum superficialis tendons associated with fracture of the distal phalanx and bone bruise of the proximal phalangeal base of the small finger. Because of the nondisplaced transverse fracture of the distal phalanx, the early diagnosis of the injury was missed. The patient was treated with two-stage flexor tendon graft and the outcome was acceptable.


Assuntos
Falanges dos Dedos da Mão/lesões , Fraturas Ósseas/cirurgia , Traumatismos dos Tendões/cirurgia , Tendões/cirurgia , Humanos , Transplantes , Resultado do Tratamento
19.
Zhongguo Gu Shang ; 33(7): 684-8, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32700497

RESUMO

Rotator cuff repair is a common treatment for rotator cuff tear, which could effectively relieve shoulder pain and improve shoulder movement, and the incidence of rotator cuff retear after rotator cuff repair is still high. The main reason is poor tendon-bone healing in rotator cuff enthesis after rotator cuff repair and could not recover the original histological structure and biomechanical properties. Therefore, the key to solve the problem is how to effectively improve the healing of tendon bone at the end of rotator cuff. With the in-depth study of rotator cuff enthesis, various treatments have made great progress on improving tendon to bone healing of rotator cuff. Our study will discuss the researchprogress on tendon to bone healing of rotator cuff in recent years from three following aspects to provide some guidance for the clinical treatment of rotator cuff tear:the factors affecting the tendon to bone healing of rotator cuff, the recovery of tendon to bone interface promoting the tendon to bone healing of rotator cuff and the application of tissue engineering in tendon to bone healing.


Assuntos
Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Artroplastia , Humanos , Tendões/cirurgia , Cicatrização
20.
Am J Vet Res ; 81(8): 681-688, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32700993

RESUMO

OBJECTIVE: To compare the biomechanical strength and incidence of gap formation among canine superficial digital flexor tendon (SDFT) constructs that underwent core tenorrhaphy only and those in which the core tenorrhaphy was augmented with skin staples or a continuous Silfverskiold cross-stitch (SXS) suture pattern. SAMPLE: 42 cadaveric forelimb SDFTs from 21 musculoskeletally normal dogs. PROCEDURES: Tendons were randomly assigned to 3 groups (14 SDTFs/group), sharply transected, and repaired with a core locking-loop suture alone (group 1) or augmented with circumferential placement of skin staples (group 2) or a continuous SXS suture pattern (group 3) in the epitenon. All constructs underwent a single load-to-failure test. Yield, peak, and failure loads, incidence of gap formation, and mode of failure were compared among the 3 groups. RESULTS: Mean yield, peak, and failure loads differed significantly among experimental groups and were greatest for group 3 and lowest for group 1 constructs. The incidence of gap formation differed among the tested groups and was lowest for group 3 and highest for group 1. The most common mode of construct failure was the suture pulling through the tendon for group 1, staple deformation for group 2, and epitendinous suture breakage for group 3. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated epitendinous placement of skin staples around a core SDFT tenorrhaphy site improved the biomechanical strength and resistance to gap formation for the repair but was inferior to epitendinous placement of SXS sutures. Further research is necessary before skin staples are used for tenorrhaphy augmentation in clinical patients.


Assuntos
Doenças do Cão , Lacerações/cirurgia , Lacerações/veterinária , Traumatismos dos Tendões/cirurgia , Traumatismos dos Tendões/veterinária , Animais , Fenômenos Biomecânicos , Cadáver , Cães , Técnicas de Sutura/veterinária , Suturas , Tendões/cirurgia , Resistência à Tração
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