Effects of aggressive early rehabilitation on the outcome of anterior cruciate ligament reconstruction with multi-strand semitendinosus tendon.
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To evaluate the effects of aggressive early rehabilitation on the clinical outcome of anterior cruciate ligament reconstruction using semitendinosus (and gracilis) tendon, 103 of 110 consecutive patients who underwent ACL reconstruction using multistrand semitendinosus tendon (ST) or the central one-third of patellar tendon with bony attachments (BTB) were analyzed prospectively. Subjectively, the Lysholm score was not different among the groups. The Lachman test indicated a trend of less negative grade in the ST men's group than that in the BTB men's group. On the patellofemoral grinding test, only women patients of both groups showed pain, with less positive crepitation in the ST group than in the BTB group. KT measurements at manual maximum showed more patients with more than 5 mm differences in the ST group than in the BTB group. The results of this study suggest that aggressive early rehabilitation after the ACL reconstruction using the semitendinosus (and gracilis) tendon has more risk of residual laxity than with the BTB. (+info)
Function after correction of a clawed great toe by a modified Robert Jones transfer.
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We carried out a cross-sectional study in 51 patients (81 feet) with a clawed hallux in association with a cavus foot after a modified Robert Jones tendon transfer. The mean follow-up was 42 months (9 to 88). In all feet, concomitant procedures had been undertaken, such as extension osteotomy of the first metatarsal and transfer of the tendon of the peroneus longus to peroneus brevis, to correct the underlying foot deformity. All patients were evaluated clinically and radiologically. The overall rate of patient satisfaction was 86%. The deformity of the hallux was corrected in 80 feet. Catching of the big toe when walking barefoot, transfer lesions and metatarsalgia, hallux flexus, hallux limitus and asymptomatic nonunion of the interphalangeal joint were the most frequent complications. Hallux limitus was more likely when elevation of the first ray occurred (p = 0.012). Additional transfer of the tendon of peroneus longus to peroneus brevis was a significant risk factor for elevation of the first metatarsal (p < 0.0001). The deforming force of extensor hallucis longus is effectively eliminated by the Jones transfer, but the mechanics of the first metatarsophalangeal joint are altered. The muscle balance and stability of the entire first ray should be taken into consideration in the management of clawed hallux. (+info)
Restoration of elbow flexion by modified Steindler flexorplasty.
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A modified Steindler flexorplasty was used to restore elbow flexion in 8 patients with post-traumatic flail elbow. In 5 patients there was associated loss of wrist and finger extension, which was treated by tendon transfer and in 2 patients an associated flail shoulder was treated by arthrodesis. The results were not compromised in patients whose flexor tendons had been transferred for wrist and finger extension. All patients had a stable and mobile elbow with marked improvement of upper limb function. Modified Steindler flexorplasty is a simple, effective and reliable procedure for the restoration of elbow flexion. (+info)
The Ilizarov method in the management of relapsed club feet.
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We present the results of the management of 17 relapsed club feet in 12 children using the Ilizarov method with gradual distraction and realignment of the joint. Review at a mean of three years after surgery showed maintenance of correction with excellent or good results in 13 feet. Five mobile feet which had been treated by a split transfer of the tibialis anterior tendon two weeks after removal of the frame had an excellent result. (+info)
Posterior psoas transfer and hip instability in lumbar myelomeningocele.
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Seventy-two posterior psoas transfer operations performed in forty-four children with lumbar myelomeningocele were reviewed one to eight years after operation in an attempt to assess its value. Muscle charting, an objective recording of the child's walking ability, and radiographic examination of the hips were done. Hip stability was improved: 49 per cent were stable at the time of psoas transfer and 94 per cent at review. Functional results depend mainly on the level of neurological activity present: 57 per cent of the children had an acceptable functional result. Usually, posterior psoas transfer should be done as soon after the age of nine months as the child's condition will allow. Over the age of two years it should be restricted to children with activity in the third and fourth segments of the lumbar cord. (+info)
Selective release of the flexor origin with transfer of flexor carpi ulnaris in cerebral palsy.
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Transfer of flexor carpi ulnaris combined with selective release of the flexor pronator origin was undertaken in 35 patients with hemiplegic cerebral palsy for a pronation flexion deformity of the forearm, hand and wrist. The patients were divided into four groups depending on the severity of the deformity, the surgical procedure recommended, potential hand function and prognosis. The procedure reduces the power of wrist and finger flexion by release of the flexor pronator origin, and reinforces the strength of extension and supination of the wrist by transfer of flexor carpi ulnaris. After a mean follow-up of four years the appearance of the hand and forearm improved in all patients. None lost movement and all gained improved mobility of the forearm, wrist and hand. There was no overcorrection. (+info)
Tendon transfers to improve grasp in patients with cervical spinal cord injury.
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Patients with cervical spinal cord injury can gain useful hand function from a good rehabilitation programme and non-operative hand care. Effective prehension can usually be achieved by proper positioning, exercises, and splinting but when grasp is poor, tendon transfers are very effective in furthering the goal of independence. These patients have been reviewed extensively and classified into groups according to remaining neurological function. Group I patients have weak elbow flexion and weak shoulder function or less. No tendon transfers were done. Group II patients have shoulder control, elbow flexion and weak wrist extensors. Some of these patients can be improved by transferring the brachioradialis to the radial wrist extensor. Group III patients have the above and good to normal brachioradialis and two radial wrist extensors. Transferring the brachioradialis to restore opposition and the extensor carpi radialis longus to the flexor digitorum profundi provides strong and effective prehension. Group IV patients have the above plus pronator teres and flexor carpi radialis which can be used for transfer. Opposition and finger flexion can be restored by a variety of transfers. In groups III and IV tendon transfers were done only when automatic grasp was poor or absent. If finger grasp was good and thumb function ineffective only opponens transfers were done in order to achieve key pinch. Group V patients have all muscles functioning but with varying degrees of intrinsic weakness. Opponens transfer is useful for these patients. Indications and contraindications to surgery are given. All the patients have improved function and strength following their tendon transfers. No patient has regretted having had surgery. (+info)
Long-term results of tibialis posterior tendon transfer for drop-foot.
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Twelve patients with drop-foot secondary to sciatic or common peroneal nerve palsy treated with transfer of the tibialis posterior tendon were followed-up for a mean of 90 (24-300) months. In 10 patients the results were 'excellent' or 'good'. In 11 patients grade 4 or 5 power of dorsiflexion was achieved, although the torque, as measured with a Cybex II dynamometer, and generated by the transferred tendon, was only about 30% of the normal side. Seven patients were able to dorsiflex their foot to the neutral position and beyond. The results appeared to be better in men under 30 years of age with common peroneal palsies. A painful flatfoot acquired in adulthood does not appear to be a significant long-term complication despite the loss of a functioning tibialis posterior tendon. (+info)