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Flexor tendon repair

Hamza Ozer, Yilmaz Ergisi, Gulcan Harput, Mehmet S Senol, Gul Baltaci
Flexor hallucis longus (FHL) tendon transfer to the calcaneus in the repair of delayed or neglected Achilles tendon (AT) injuries is a viable and dynamic option. Nineteen patients (18 males, 1 female; mean age 47.4 ± 12.4, range 24 to 74, years; body mass index 27.5 ± 4.5, range 23.2 to 38.9, kg/m2 ; interval from injury to surgery 40.8 ± 11.6, range 28 to 60, days) with delayed or neglected repair of AT rupture were included in the present study. FHL transfer to the calcaneus through a single incision and repair of the defect with native tendon lengthening or a tendinous turndown flap was performed...
May 18, 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Yoke Rung Wong, Austin Mun Kitt Loke, Shian Chao Tay
BACKGROUND: To propose a new term ('construct efficiency') for the evaluation of multi strands flexor tendon repairs using different suture materials. METHODS: A total of twenty specimens from 4-0 braided polyblend sutures (FiberLoop/FiberWire; Arthrex, Naples, FL) and 4-0 nylon sutures (Supramid Extra II; S. Jackson, Inc., Alexandria, VA) were subjected to tensile testing using Pneumatic Cord-and-Yarn Grips (Instron Corp., Canton MA, USA). The ultimate tensile strengths of the suture materials were measured...
June 2018: Journal of Hand Surgery Asian-Pacific Volume
Renita Sirisena, Amitabha Lahiri, Alphonsus Khin-Sze Chong, Tun-Lin Foo
BACKGROUND: Attaining competency in placement of core suture with adequate distance from juncture is a key skill for learners of tendon repair. Currently, this is most commonly practiced on animal models in wet laboratory environment. To improve accessibility and availability, we developed a tendon repair trainer that aims to guide learners in obtaining this key competency. METHODS: A customized tendon dock was designed and manufactured with additive method that permits insertion of 6mm silicon tendon rods to simulate flexor tendon repair along a digit...
June 2018: Journal of Hand Surgery Asian-Pacific Volume
Takuya Uemura, Tadashi Okano, Ema Onode, Takuya Yokoi, Kosuke Shintani, Mitsuhiro Okada, Hiroaki Nakamura
Flexor pollicis longus (FPL) tendon rupture is a major complication of volar locking plate fixation for distal radius fractures. The tendon rupture is usually caused by friction between the distal edge of the plate and the FPL tendon, and has been well detected recently with ultrasonography. Rarely, the volar locking plate itself entraps the FPL tendon, leading to its rupture. A 63-year-old man was consistently unable to flex his right thumb after previous surgery for a distal radius fracture at another hospital...
April 27, 2018: Journal of Medical Ultrasonics
Jin Bo Tang
This article reviews some recent advancements in repair and rehabilitation of the flexor tendons. These include placing sparse or no peripheral suture when the core suture is strong and sufficiently tensioned, allowing the repair site to be slightly bulky, aggressively releasing the pulleys (including the entire A2 pulley or both the A3 and A4 pulleys when necessary), placing a shorter splint with less restricted wrist positioning, and allowing out-of-splint active motion. The reported outcomes have been favourable with few or no repair ruptures and no function-disturbing tendon bowstringing...
January 1, 2018: Journal of Hand Surgery, European Volume
Jian Yin, Zhaoyang Yin, Ge Gong, Chao Zhu, Chao Sun, Xinhui Liu
PURPOSE: This study was designed to compare the surgical outcomes of a hook plate with double-tunnel coracoclavicular (CC) ligament reconstruction by conjoined tendon transfer versus single hook plate surgery for the repair of acute type of Rockwood type III and V acromioclavicular (AC) joint dislocations. METHODS: The study cohort included 62 patients with acute (within 6 weeks after trauma) Rockwood type III and V AC joint dislocations who underwent surgery from February 2012 to September 2015...
April 18, 2018: International Journal of Surgery
Yuk Wa Lee, Sai Chuen Fu, Tsui Yu Mok, Kai Ming Chan, Leung Kim Hung
Background: Hand flexor tendon injuries are compromised with tendon adhesion. Tendon adhesion forms between flexor tendon and tendon sheath, reduces the range of motion of fingers, and affects their function. Oxidative stress is increased in flexor tendon after injury and might play a role in tendon adhesion formation. Trolox (6-hydroxy-2,5,7,8-tetramethylchroman-2-carboxylic acid), a water-soluble analog of vitamin E, is antioxidative. Trolox reduced oxidative stress and the expression of fibrotic cytokines in the bile gut ligation animal model...
July 2017: Journal of Orthopaedic Translation
Daniel Marsland, Joanna M Stephen, Toby Calder, Andrew A Amis, James D F Calder
PURPOSE: To assess whether early rehabilitation could be safe after flexor digitorum longus (FDL) tendon transfer, the current biomechanical study aimed to measure tendon displacement under cyclic loading and load to failure, comparing a traditional tendon-to-tendon (TT) repair with interference screw fixation (ISF). METHODS: 24 fresh-frozen cadaveric below knee specimens underwent FDL tendon transfer. In 12 specimens a TT repair was performed via a navicular bone tunnel...
April 7, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Zhuang Wei, Ramona L Reisdorf, Andrew R Thoreson, Gregory D Jay, Steven L Moran, Kai-Nan An, Peter C Amadio, Chunfeng Zhao
BACKGROUND: Flexor tendon injury is common, and tendon reconstruction is indicated clinically if the primary repair fails or cannot be performed immediately after tendon injury. The purpose of the current study was to compare clinically standard extrasynovial autologous graft (EAG) tendon and intrasynovial allogeneic graft (IAG) that had both undergone biolubricant surface modification in a canine in vivo model. METHODS: Twenty-four flexor digitorum profundus (FDP) tendons from the second and fifth digits of 12 dogs were used for this study...
April 4, 2018: Journal of Bone and Joint Surgery. American Volume
Assaf Kadar, Haoyu Liu, Alyssa M Vrieze, Thomas R Meier, Andrew R Thoreson, Peter C Amadio, Steven L Moran, Chunfeng Zhao
Flexor tendon injuries are common and pose a clinical challenge for functional restoration. The purpose of our study was to assess the adequacy of the turkey as a large animal model for flexor tendon injuries in vivo. Twenty-four male turkeys underwent surgical flexor tendon cut and repair. Turkeys were allocated to 5 groups postoperatively: 1) foot casted in extension and sacrificed after 3 weeks, 2) foot casted in extension and sacrificed after 6 weeks, 3) foot casted in flexion and sacrificed after 3 weeks, 4) foot casted in flexion and sacrificed after 6 weeks, and 5) foot casted in flexion for 6 weeks and then free roaming allowed for an additional 3 weeks before sacrifice...
March 30, 2018: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Roland S Camenzind, Timo O Tondelli, Tobias Götschi, Claude Holenstein, Jess G Snedeker
BACKGROUND: The suture-tendon interface is often the weakest link in tendon-to-tendon or tendon-to-bone repair. Genipin is an exogenous collagen crosslink agent derived from the gardenia fruit that can enhance suture force to failure of the tendon-suture interface. Viable methods for intraoperative clinical delivery of genipin could be of clinical utility, but to our knowledge have not yet been extensively studied. QUESTIONS/PURPOSES: The purposes of this study were (1) to evaluate whether sutures precoated with genipin can augment the suture-tendon interface to improve force to failure, stiffness, and work to failure in healthy and degenerated tendons; and (2) to determine the effect of genipin on the extent and distribution of crosslinking...
March 28, 2018: Clinical Orthopaedics and related Research
Jin Bo Tang
New developments in primary tendon repair over the past decades include stronger core tendon repair techniques, judicious and adequate venting of critical pulleys, followed by a combination of passive and active digital flexion and extension. During repair, core sutures over the tendon should have sufficient suture purchase (no shorter than 0.7 to 1 cm) in each tendon end and must be sufficiently tensioned to resist loosening, forming gaps. Slight or even modest bulkiness in the tendon substance at the repair site is not harmful, though marked bulkiness should always be avoided...
March 19, 2018: Plastic and Reconstructive Surgery
Tao Zhang, Cheng-Chang Lu, Ramona L Reisdorf, Andrew R Thoreson, Anne Gingery, Steven L Moran, Peter C Amadio, Chunfeng Zhao
This study was to test our hypothesis that flexor tendon reconstruction with an allograft revitalized with bone marrow stromal cells (BMSCs) and synovialized with carbodiimide derivatized autologous synovial fluid (cd-SYN) would result in better digit functional restoration than the conventional allograft tendon. Thirty-two flexor digital profundus tendons from the second and fifth digit of 16 dogs were created a repair failure model first. Then, failed-repaired tendons were reconstructed with either a revitalized-synovialized allograft tendon or a clinical standard autograft tendon (control group)...
March 25, 2018: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Egemen Ayhan, Kadir Çevik, Melih Bağır, Mehmet Çolak, Metin Manouchehr Eskandari
BACKGROUND: Children have a curiosity for climbing walls, stairs, and railings and have an increased risk of falling. Here, we report our experience with railings causing injuries by penetrating the upper extremities, and aim to call attention to spiked railing injuries in children. METHODS: We report on five children with a mean age of 8.8. All of the children were male. The penetrating railing parts were removed in a surgical room. RESULTS: The injured structures repaired immediately were as follows: flexor digitorum profundus tendon, A4 pulley, volar plate of the distal interphalangeal joint, radial digital nerve, ulnar digital artery, and radial digital artery...
March 2018: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
C K Goorens, K Van Royen, S Grijseels, S Provyn, J De Mey, T Scheerlinck, J F Goubau
Flexor tendon injury after volar plating of distal radius fractures is due to friction against the plate. To assess this risk, the distance between the flexor pollicis longus (FPL) and the volar prominence of the plate was measured with ultrasonography under various conditions: a standard plate fixed proximal or distal to the watershed line and a low-profile volar rim plate, with and without transection of the pronator quadratus (PQ). Distance from the FPL to the volar prominence of the plate decreased significantly when the PQ was cut and when a standard plate was placed distal to the watershed line, with the tendon often bulging over the plate...
March 19, 2018: Hand Surgery and Rehabilitation
Lisa Reissner, Nadja Zechmann-Mueller, Holger Jan Klein, Maurizio Calcagni, Thomas Giesen
We report sonographic findings with clinical outcomes after zone 2 flexor digitorum profundus tendon repairs in ten fingers. The tendons underwent a six-strand M-Tang core repair, no circumferential suture, and partial or complete division of the pulleys. Over 12 months after surgery and using ultrasound, we found no gapping at the repair site during finger motion. When the pulleys were divided, there was sonographic evidence of tendon bowstringing, but the bowstringing was minimal. Clinically, we did not find any fingers that displayed tendon bowstringing or had functional loss...
June 2018: Journal of Hand Surgery, European Volume
Thomas Giesen, Lisa Reissner, Inga Besmens, Olga Politikou, Maurizio Calcagni
We report outcomes in 29 patients with flexor tendon repairs in 32 digits (five thumbs and 27 fingers) with our modified protocols. We repaired the lacerated flexor digitorum profundus tendons with core suture repairs using the 6-strand M-Tang method and without circumferential sutures. We divided the pulleys as much as needed to allow excursion of the repaired tendons, including complete division of the A4 or A2 pulleys when necessary. In nine fingers, we repaired one slip of the flexor digitorum superficialis tendon and resected the other half...
January 1, 2018: Journal of Hand Surgery, European Volume
Rebecca Q R Lim, Yoke-Rung Wong, Austin M K Loke, Shian-Chao Tay
This study compared the biomechanical performance of a novel 6-strand asymmetric flexor tendon repair with the modified Lim-Tsai technique using cyclic testing. Two groups of ten porcine tendons each were repaired and tested. Gap formation at every 100 cycles was measured. Survival was defined as maximum gap formation below 2 mm. All the repairs survived Stage I. With increased cyclic load in Stage II, the mean gap formation of modified Lim-Tsai repairs exceeded 2 mm at the 600th cycle and reached 4.2 mm (SD 1...
January 1, 2018: Journal of Hand Surgery, European Volume
Janice C Y Liao, Min He, Aaron W T Gan, Feng Wen, Lay Poh Tan, Alphonsus K S Chong
Progressive tendon adhesion is a major challenge in flexor tendon repair. The authors developed a bifunctional anti-adhesion scaffold and hypothesized that its application would reduce adhesion formation and deliver mesenchymal stem cells (MSCs) to enhance tendon healing. The scaffold was fabricated by an electrospinning machine before surface modification. The flexor tendons of 29 New Zealand rabbits underwent surgical repair and randomized to control, scaffold and scaffold loaded with MSC group. At 3 and 8 weeks post-surgery, range of motion (ROM), biomechanical properties, and histology were examined...
February 9, 2018: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
Michael J Schreck, Hayden S Holbrook, L Andrew Koman
Pseudo-boutonniere deformity is an uncommon complication from long-standing proximal interphalangeal (PIP) joint contracture in Dupuytren disease. Prolonged flexion contracture of the PIP joint can lead to central slip attenuation and resultant imbalances in the extensor mechanism. We present a technique of flexor digitorum superficialis (FDS) tendon transfer to the lateral bands to correct pseudo-boutonniere deformity at the time of palmar fasciectomy for the treatment of Dupuytren disease. The FDS tendon is transferred from volar to dorsal through the lumbrical canal and sutured into the dorsally mobilized lateral bands...
February 2018: Journal of Hand Surgery
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