An immunohistological study of the integration at the bone-tendon interface after reconstruction of the anterior cruciate ligament in rabbits.
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We studied bone-tendon healing using immunohistochemical methods in a rabbit model. Reconstruction of the anterior cruciate ligament was undertaken using semitendinosus tendon in 20 rabbits. Immunohistochemical evaluations were performed at one, two, four and eight weeks after the operation. The expression of CD31, RAM-11, VEGF, b-FGF, S-100 protein and collagen I, II and III in the bone-tendon interface was very similar to that in the endochondral ossification. Some of the type-III collagen in the outer layer of the graft, which was deposited at a very early phase after the operation, was believed to have matured into Sharpey-like fibres. However, remodelling of the tendon grafted into the bone tunnel was significantly delayed when compared with this ossification process. To promote healing, we believe that it is necessary to accelerate remodelling of the tendon, simultaneously with the augmentation of the ossification. (+info)
Repair of large supraspinatus rotator-cuff defects by infraspinatus and subscapularis tendon transfers in a cadaver model.
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Transosseous repair of a supraspinatus tendon (SSP) defect (Patte size II) can be difficult if the tendon is retracted and the muscle atrophied. In this situation alternatives are margin convergence techniques, local tendon transfers or distant tendon transfers in massive tears. The object of this study was to compare two local tendon transfers in terms of the feasibility of the shift, the area covered by the shift and the force needed to accomplish the shift. Thirteen fresh-frozen cadaver shoulders were used. First a supraspinatus defect extending to the apex of the humeral head (Patte size II) was created. Transosseous repair was attempted with the infraspintus (ISP) and with the subscapularis (SCP) in all cases; repair was successful in all ISP cases, while use of the SCP resulted in a successful repair in only 8 of the 13 (61.5%). A significantly (P=0.012) larger defect area was covered by the ISP transfer than by the SCP shift: 89.7+/-8.5% versus 31.2+/-31.1% of the original defect, respectively. The tensile force needed to accomplish the shift was significantly (P=0.004) lower when the ISP was used (15+/-11 N) than with the SCP (37.1+/-15 N). In this cadaver model the ISP shift proved more favourable than the SCP shift for covering a Patte size II SSP defect. (+info)
Early and late reconstruction in brachial plexus palsy: a preliminary report.
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OBJECTIVE: To evaluate the most effective surgical procedures in the early and late reconstruction of brachial plexus after its traumatic injury. MATERIAL AND METHODS: A total of 14 consecutive patients with brachial plexus injuries were examined and operated on at the Department of Plastic and Reconstructive Surgery and Burns at Kaunas University of Medicine Hospital. Less than half of them (43%) came for surgery in the early stage of disease--within 12 months after injury--and 57% in the late stage--1-15 years after trauma. Altogether, 23 operations--neurolysis, nerve transfer, tendon transfer, and arthrodesis--were performed. Patients were followed up for an average of 12.5 months (range 4 to 19 months) after surgery. Postoperative motor assessment of hand function was based on the motor classification M0-M6 of Mallet and British Medical Research Council Muscle grading system. Results were considered positive if the range of active movements increased no less than 5-10 degrees odependently from the level of injury and motor strength--no less than 1-2 grades (M0-->M2 or M2-->M3). RESULTS: Of the eight investigated, six patients from early group showed positive results. The most effective surgical procedures were neurolysis and nerve transfer. A significant improvement in the patients of late group was observed after tendon transfer procedure. Nevertheless, the recovery process of motor function was too slow or even minimal in 31% of patients to satisfy the patient and the surgeon. CONCLUSIONS: Neurolysis or nerve transfer in the early stage or tendon transfer in the late stage after brachial plexus injury may result in a significant improvement of motor function of the hand. Sharing the information concerning brachial plexus reconstruction with neonatologists, neuropathologists, traumatologists, and hand therapists would be helpful in operating such patients timely and treating them adequately after surgery. (+info)
Tendon transfers in traumatic foot.
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A clinical review was performed of 11 cases of traumatic foot treated by tendon transfer. Among 11 patients, there were eight males and three females, ranging from four to 36 years of age. The anterior tibial tendon was used in six cases for tendon transfer and among these, split anterior tibial tendon was used in three cases in children. The posterior tibial tenodn was used in two cases and the extensor digitorum longus tendon of the foot was in three cases. In six cases of soft tissue injury where tendon transfer was impossible, microvascular free cutaneous flap transplantation was combined with the tendon transfer. Follow-up results were obtained from 25 months to nine years. Excellent results were obtained in eight cases and satisfactory results in three cases. For the correction of function loss in traumatic foot, tendon transfere were a useful method for the recovery of active motion of the foot. For the restoration of function loss in the traumatic foot, there are several methods of treatment such as tendon transfer, arthrodesis and tenodesis, but for recovery of the active motion of the foot, tendon transer is the only useful method. (+info)
The interaction between the whipstitch sutures of multi-strand ACL grafts and interference screw fixation.
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In a recent experiment examining the effect of interference screw sizing on the fixation stability of multi-strand anterior cruciate ligament grafts, we noticed a large variation in fixation strengths and attributed it to the suturing of the grafts and its interaction with the screw. We performed an experiment using interference screws for fixation of hamstring grafts within a bone tunnel model to compare how the presence of sutures affected graft fixation. We found that having sutures along the region of the graft that contacts the screw within the bone tunnel can increase graft fixation strength 100%. (+info)
Full tendon transposition augmented with posterior intermuscular suture and recession--resection surgery.
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PURPOSE: To report an effect of the full tendon transposition augmented with posterior intermuscular suture and recession-resection surgery, for the patient with monocular elevation deficiency (MED) and large exotropia. METHODS: Interventional case report. Full tendon transposition augmented with posterior intermuscular suture and recession-resection surgery was performed for a 26-year-old male patient had monocular elevation deficiency (MED) and large exotropia. RESULTS: Preoperative angle of deviation was 56 prism diopters (PD) hypotropia and 45 PD right exotropia, compared with 18 PD left hypertropia and 10 PD right esotropia postoperatively. Essotropia persisted after 2.5 years, however, and so the right medial rectus was recessed after removal of the previous posterior intermuscular suture. At a three-year follow-up after the second surgery, alignment was straight in the primary position at near and far distances. CONCLUSIONS: Full tendon transposition augmented with posterior intermuscular suture and recession-resection surgery was effective for a patient with MED associated with significant horizontal deviation, and a second operation was easily performed when overcorrection occurred. (+info)
Model-based improvements in the treatment of patients with strabismus and axial high myopia.
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PURPOSE: Eye motility disorders with axial high myopia and an enlarged globe are often characterized by a hypotropia of the affected eye, usually referred to as heavy-eye syndrome. Based on an intuitive interpretation of magnetic resonance (MR) images, the cause of the hypotropia has typically been assigned to the rectus muscles. In this study, the hypothesis that the oblique muscles play an important role in the underlying biomechanical disorder of this type of strabismus was investigated. METHODS: The hypothesis was tested by (1) a retrospective analysis of surgical results in one patient with unilateral axial high myopia; and (2) MR images of orbital tissues in two further patients with unilateral axial high myopia. RESULTS: MR images demonstrated a pattern of extraocular muscle path displacements similar to those described previously, but also a uniform decrease in the cross-sectional area of the inferior oblique muscles. Computer modeling required decreased inferior oblique contractility in addition to displaced extraocular muscle paths to recreate the observed motility pattern accurately. CONCLUSIONS: Patients with axial high myopia regularly show a reduction in the diameter of the inferior oblique. The resultant reduction in muscle-strength is important for the correct explanation of this complex eye movement disorder. (+info)
Comparison of fixation methods of double-bundle double-tibial tunnel ACL reconstruction and double-bundle single-tunnel technique.
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An experimental study was conducted in order to evaluate biomechanical methods of single-bundle reconstruction in ACL and compare it with a new double-bundle double-tibial tunnel technique. Twenty-four porcine cadaver knees, divided into 4 groups of 6 knees each and 48 proper extensors of the fourth toe tendons, were used for the fixation techniques. In groups A and B, a double-bundle technique with a single femoral and tibial tunnel was used, fixed to a femoral and tibial post with screws and with buttons, respectively. In groups C and D, a double-bundle technique (technique Delta) with two separate tibial tunnels was used, fixed to a femoral and tibial post with screws and with buttons, respectively. A material testing system (Instron) was used for anteriorly translating the tibia until failure. The femoral and tibial post as a fixation method is superior to the conventional buttons technique. The more anatomical double-bundle reconstruction technique provided significantly higher structural properties and smaller loss of fixation compared with the single-bundle reconstruction technique. The comparison of the two techniques gave superior results to the femoral and tibial screws over the buttons. The double-bundle technique attempts to restore the anterior stability of the knee joint. (+info)