Prótesis total de rodilla primaria en un paciente con ruptura no reciente del tendón rotuliano, tratado en 2 tiempos quirúrgicos / Total primary knee prosthesis in a patient with non-recent rupture of the patellar tendon, treated in 2 surgical times

Resumen: Introducción: La ruptura de tendón rotuliano en pacientes mayores se relaciona con enfermedades sistémicas como la artritis reumatoide, el lupus eritematoso y aquéllos con tratamiento prolongado con corticoides o antibioticoterapia. Es ocasionado por traumatismo con la rodilla en flexión acompañado de una contracción del cuádriceps o fuerza excéntrica, su diagnóstico puede omitirse hasta en 38% de los casos. El tratamiento en las rupturas no recientes es más complejo ya que después de 45 días de la lesión ocurre retracción del cuádriceps, fibrosis, formación de adherencias e hipotrofia muscular. Las opciones de tratamiento son variadas utilizando desde autoinjertos hasta injertos sintéticos con túneles óseos y anclas de fijación. Reporte de caso: Hombre de 71 años con ruptura del tendón rotuliano de 18 años de evolución tratado en dos tiempos, comenzando por la reparación del aparato extensor con tendones de la pata de ganso preservando la inserción de los mismos y realizando después prótesis total de rodilla en un segundo tiempo quirúrgico y mostramos su evolución.

Abstract: Introduction: Patellar tendon rupture has a higher prevalence in older patients related to systemic diseases such as rheumatoid arthritis, lupus erythematosus and those with prolonged treatment with corticosteroids or antibiotic therapy. It is caused by trauma with the knee in flexion accompanied by a contraction of the quadriceps or eccentric force, the diagnosis can be omitted in up to 38% of cases. Treatment of non-recent tendon ruptures is more difficult with end-to-end techniques are complicated and difficult to perform 45 days after injury due to quadriceps retraction, fibrosis, adhesion formation, and muscle hypotrophy. Treatment options are varied, ranging from autografts to synthetic grafts using bone tunnels and fixation anchors. Case report: Our case is a 71-year-old patient with an 18-year-old patellar tendon rupture treated in two stages, starting with repairing the extensor apparatus with pes anserinus tendons, preserving their insertion and subsequently performing total knee replacement in a second surgical time and we show its evolution.

Gait analysis combined with the expression of TGF-β1, TGF-β3 and CREB during Achilles tendon healing in rat / 中华创伤杂志(英文版)

PURPOSE@#To observe the changes of gait behavior and the expression of wound healing factors of transforming growth factor-β1 (TGF-β1), TGF-β3 and cAMP response element binding protein-1 (CREB-1) during the healing of Achilles tendon in a rat model, and to investigate whether gait analysis can be used to evaluate the tendon healing.@*METHODS@#Achilles tendon of 40 healthy male Sprague-Dawley rats were transected and sutured to establish the Achilles tendon injury (ATI) model. They were randomly divided into 4 groups based on the observational time point at 1, 2, 4 and 6 weeks after injury (n = 10 for each group). Before modeling, 9 rats were randomly selected for CatWalk gait analysis, which contained step cycle, single stance time and average speed. Data were recorded as the normal controls. After then, ATI models were established in the left hind limbs of the all 40 rats (ATI group), while the right hind limbs were only cut and sutured without injury of the Achilles tendon (sham operation group). At 1, 2, 4 and 6 weeks after injury, the gait behavior of the corresponding group of rats (n = 9) as observed and recorded by CatWalk platform. After then, the rats were sacrificed and Achilles tendon of both limbs was harvested. The tendon healing was observed by gross anatomy and histological examination, and the protein and mRNA expression of TGF-β1, TGF-β3, CREB-1 were observed by immunohistochemistry and qPCR. The results of tendon gross grading were analyzed by Wilcoxon rank sum test, and other data were analyzed by one-way analysis of variance among multiple groups.@*RESULTS@#Compared with normal controls, all gait indexes (step cycle, single stance time and average speed) were greatly affected following ATI, which however improved with time. The step cycle was significantly lower at 1, 2 and 4 weeks after ATI (compared with normal controls, all p  0.05). The single stance time of the ATI group was significantly shorter at 1 and 2 weeks after operation ((0.078 ± 0.010) s at 1 week, (0.078 ± 0.020) s at 2 weeks, all p < 0.001) and revealed no significant difference at 4 weeks (p = 0.120). The average speed of ATI group at 1, 2, 4, 6 weeks was significantly lower than that in the normal control group (all p < 0.001). Gross observation showed that the grade of local scar adhesion in ATI group increased significantly at 2, 4 and 6 weeks, compared with the sham operation group (all p < 0.001). Extensive adhesion was formed at 6 weeks after ATI. The results of HE staining showed that the number of fibroblast increased gradually and arranged more orderly in ATI group at 1, 2 and 4 weeks (all p < 0.001), and decreased at 6 weeks, but it was still significantly higher than that of the sham operation group (p < 0.001). Immunohistochemistry showed that the positive expression of TGF-β1, TGF-β3, CREB-1 in ATI group was higher than that in the sham operation group at 4 time points (all p < 0.05), which reached the peak at 2 weeks after operation and decreased at 4 weeks (p = 0.002, p < 0.001, p = 0.041, respectively). The results of qPCR suggested that the mRNA expression of TGF-β1, TGF-β3, CREB-1 in ATI group was higher than that in the sham operation group at all-time points (all p < 0.05), which reached the peak at 2 weeks after operation, decreased at 4 weeks, and significantly decreased at 6 weeks (all p < 0.001).@*CONCLUSION@#Gait behavior indexes are associated with Achilles tendon healing. The study gives an insight of TGF-β1, TGF-β3, CREB-1 changes in the coursing of Achilles tendon healing and these cytokines may be able to be used to regulate the Achilles tendon healing.

Updates in Management of Achilles Tendon Rupture: Simple Literature Review

Background: Achilles tendon rupture (AT) is considered a subversive injury for the young athletes since its fullrecovery takes12 months. In addition to this, there is escalation in the risk of re-injury of the same tendon.Objective: In this review, we aim to assess and evaluate Achilles tendon rupture mechanism of injury, and itsdiagnosis and management published in the current literature. Method: A comprehensive search was done usingbiomedical databases including Medline, and PubMed, for studies concerned with evaluation of Achilles TendonRupture published in English language. Keywords used in our search through the databases were “AchillesTendon Rupture Mechanism and Pathophysiology”, “Achilles Tendon Rupture Management”, and “AchillesTendon Rupture Diagnosis”. Conclusion: The incidence of Achilles tendon rapture among athletes is commonand increasing. Determining the best management option is still controversy among orthopedic surgeons. Opensurgery is associated with the lowest rates of re- rupture incidence, but increase risk of other complications.Percutaneous repair was found to have a low complications rate in comparison to open surgery, but it isassociated with increased risk of sural nerve injury. The recent studies have clearly demonstrated the effectivenessof functional rehabilitation techniques, with biotherapy as potential future for development.

Application of medical biomaterials in prevention and treatment of tendon adhesion / 中国修复重建外科杂志

Objective: To review the research progress of medicine biomaterials in prevention and treatment of adhesion after tendon injury, and to provide reference for clinical treatment. Methods: The literature on the application of medical biomaterials in the prevention and treatment of tendon adhesions in recent years was reviewed, and the biological process, treatment methods, and current status of tendon adhesions were summarized. Results: Tendon adhesion as part of the healing process of the tendon is the biological response of the tendon to the injury and is also a common complication of joint dysfunction. Application of medical biomaterials can achieve better biological function of postoperative tendon by reducing the adhesion of peritendon tissues as far as possible without adversely affecting the tendon healing process. Conclusion: The use of medical biomaterials is conducive to reduce the adhesion of tendon after operation, and the appropriate anti-adhesion material should be selected according to the patients' condition and surgical needs.

Human amniotic membrane, drugs, and growth factors prevent adhesion after repair of tendon injury / 中国组织工程研究

BACKGROUND: Strong evidence exists that tendon adhesion occurs after tendon repair. OBJECTIVE: To review the advance in research on the prevention of tendon adhesion in terms of human amniotic membrane, drugs and growth factor. METHODS: A computer-based online search of Wanfang, CNKI, and Medline databases was performed to search papers regarding prevention of adhesion after tendon injury published between January 2000 and April 2019 with the search terms “tendon injury, tendon adhesions, drug, human amniotic membrane, growth factor” in English and Chinese. Papers recently published in high-impact journals in the same research field were selected. Fifty papers were included in the final analysis. RESULTS AND CONCLUSION: Amniotic membrane and acellular amniotic membrane are effective in preventing tendon adhesion. Drugs can work in many ways to achieve the purpose of preventing adhesion, and drugs exhibit better efficacy after combined application with sustained-release carrier. Most growth factors not only promote tendon healing but also promote adhesion formation. The formation of tendon adhesion can be reduced by adjusting the concentration of growth factors in the lesion site.

Partial tear of the long digital extensor tendon in a dog / Ruptura parcial do tendão extensor digital longo em cão

ABSTRACT: The aim of this paper was to describe the clinical and sonographic findings of partial tear at the musculotendinous junction of the proximal long digital extensor tendon during the acute phase and one year after initial presentation. The dog presented with acute, moderate weight-bearing lameness of the right hind limb. During an orthopedic examination of the stifle, the dog expressed pain on extension and flexion of the right knee. Under general anesthesia, no instability was evident. Radiographic images suggested the presence of joint effusion in the right stifle. Ultrasonography revealed that the long digital extensor tendon was hyperechoic, surrounded by an anechoic effusion, and the muscle fibers were disorganized and interspersed with anechoic fluid. Clinical outcome was considered good after conservative treatment. The dog was re-evaluated approximately one year after treatment and did not present with any clinical signs.

RESUMO: O objetivo deste trabalho é descrever os achados clínicos e ultrassonográficos da ruptura parcial do tendão extensor digital longo em sua porção proximal, na junção musculotendínea, durante a fase aguda e um ano após a apresentação inicial. O cão apresentava claudicação aguda e moderada do membro posterior direito. Durante o exame ortopédico, o animal expressou dor na extensão e flexão do joelho direito. Sob anestesia geral, nenhuma instabilidade foi evidente. Imagens radiográficas sugeriram a presença de efusão articular na articulação do joelho direito. A ultrassonografia revelou que o tendão extensor digital longo estava hiperecóico, circundado por efusão anecóica, e as fibras musculares estavam desorganizadas e entremeadas por líquido anecóico. Após o tratamento conservador, a evolução clínica foi considerada satisfatória. O animal foi reavaliado aproximadamente um ano após o tratamento e não apresentou quaisquer sinais clínicos evidentes.

Flexor Carpi Radialis Tendon Rupture due to Repetitive Golf Swing

Flexor carpi radialis (FCR) muscle is located in the forearm anteriorly that runs through a synovial fibro-osseous tunnel in the forearm. We described a case of FCR tendon rupture due to repetitive overuse injury. A 55-year-old man, right-hand dominant, presented with right forearm pain and swelling which started 3 days ago while playing amateur golf. Focal tenderness and bruising over volo-ulnar region of the right forearm were examined. Plain radiographs showed soft tissue edema around lesion area and no detectable fracture. Ultrasonography showed multiple hypoechoic lesions suspected as hematoma of the flexor muscle group. After done magnetic resonance imaging, he was diagnosed with rupture of FCR tendon at proximal origin and strain of flexor digitorum superficialis and palmaris longus muscle. He received compressive dressing and restriction of wrist range of motion for three weeks. Two months later, remaining traces of lesions were observed at the follow-up ultrasonography and the pain disappeared.

Experiences in the treatment of tendinous mallet finger / 中华整形外科杂志

Objective@#To explore the effect of reconstructing the finger extension function by using partial flexor digitorum profundus tendon transposition.@*Methods@#Twelve patients were treated by using the partial proximal end of the tendon core of flexor digitorum profundus tendon regionⅠand part of region Ⅱ to cut off to the base of the distal digital phalanx, and puncturing at the end of the phalanx with a 2.0 drill. The tendon strips were pierced to the back overlap sutured to the proximal end of the avulsion of the extensor tendon .@*Results@#In 3-18 month follow-up, the average follow-up duration was 10.6 months. According to Dargan function evaluation method, 12 cases were excellent and one case was poor.@*Conclusions@#The method of reconstructing the extensor tendon by partial flexor deep tendon is a reliable method for the treatment of Mallet finger.

Comparison of magnetic resonance and ultrasound in the diagnosisof long head of the biceps tendon injury / 实用放射学杂志

Objective To investigate MR and US diagnotic value of long head of the biceps tendon injury.Methods A total of 80 patients with suspected injury of long head of the biceps tendon underwent arthroscopy surgery.All patients had MR and US examination preoperatively.The preoperative results were compared with the findings during the arthroscopy in order to assess the effectiveness of two methods.Results Among 80 patients, there were completely torn in 19 cases, partly torn in 45 cases, biceps tendon tenosynovitis in 10 cases, biceps tendon slippage in 6 cases.The accuracy of MR and US in the diagnosis of completely torn, partly torn, biceps tendon tenosynovitis, biceps tendon slippage were 98.7%,92.5%,97.5%,100% and 96.2%,85.0%,96.3%,98.7% respectively.There was no statistic difference between MR and US in diagnosing completely torn,biceps tendon tenosynovitis and biceps tendon slippage(P>0.05),but the accuracy of MR in diagnosing partly torn was higer than US(P<0.05).Conclusion MR determination of biceps tendon partial tear is of obvious advantages.US examination can be used as a routine method for the investigation of patients with suspected biceps tendon injury.

The treatment of tendon injury / 医学研究生学报

Multitudinous therapeutic options of tendon damage have been carried out , and in this paper , we will introduce several methods including suture , tendon transplantion , growth factors , stem cells and genes , alone or in combination .The classic su-ture methods, such as MK and K+R methods, have been already mature , and the new suture bridge can also present good strength and biological property.Recent years, the freezing method improves the immunoreaction in tendon transplantion .Furthermore, using the growth factors and stem cells alone or combined can improve the repair of tendon .The genes therapy can upregulate the growth factors to repair the injured tendon by transfecting adenovirus into the tissues of animals .

The effect of finger exercises combined with local physiotherapy on recovery of hand function in postoperative with flexor tendon injury / 中国实用护理杂志

Objective To investigate the effect of finger exercises combined with local physiotherapy on recovery of hand function in postoperative with flexor tendon injury. Methods The data of 286 cases of flexor tendon injury who were received by emergency trauma patients during the period from January 2014 to January 2016.According to the order of admission for single finger exercise function exercise set as the experience group, and routine functional exercise set as control group, to observe the hand function recovery, the satisfaction of patients and the quality of life of patients were compared between the two groups. Results There were no statistical differences of the effective rate of treatment and the daily living ability score between the experimental group and control group in one month after the operation(P>0.05).The effective rate of treatment and the daily living ability score were 95.10% (136/143),(15.32±1.98)points in six months after the operation in the experience group,and 81.12%(116/143),(22.62±1.42)points in the control group,and there were statistical differences between two groups (x2/t=13.35,-14.44,P<0.05).The patient satisfaction score were(88.46±2.20),(96.32±2.64)points in one and six months after the operation in the experimental group and(80.97±3.69),(87.54±2.39)points in the control group(P<0.05),and there were statistical differences between the experimental group and control group (t=20.77, 21.35, all P<0.05). Conclusions The finger exercises combined with local physiotherapy could not only improve the hand function of patients,but also improve the daily life ability of patients,and improve patient satisfaction,it is worth popularizing in clinical practice.

Zona de seguridad para tornillo de bloqueo cefálico posterior-anterior durante enclavijado endomedular retrógrado del húmero: estudio ex vivo en muestras óseas / Safe zone for anterior-posterior cranial blocking screw during retrograde intramedullary nailing of the humerus: ex-vivo study in bone specimens

OBJETIVO: Definir una zona segura, usando como referencia la línea intercondílea anterior (LCA) del codo para realizar los bloqueos anteroposteriores durante el enclavijado endomedular retrógrado humeral (CEMR). MÉTODOS: Estudio experimental ex-vivo. Trece húmeros humanos fueron analizados. Se tomaron fotografías registrando la porción distal de los húmeros paralelos a la LCA, elevando el húmero distal 10cm. Tres evaluadores independientes realizaron las siguientes mediciones: ángulo del surco bicipital (SB) a la altura del cuello quirúrgico humeral (S, formado por las paredes medial y lateral del SB; zona de peligro) y el ángulo complementario lateral (formado por el límite lateral de la tróclea y la pared lateral del SB a la altura del cuello quirúrgico humeral; zona segura). RESULTADOS: Valor promedio de S: 3,1±0,5° (3,3-4), coeficiente de correlación intraclase: 0,057 (p=0,057). Valor promedio del ángulo complementario lateral: 87,5±3,3° (81,3-92,5), coeficiente de correlación intraclase: 0,304 (p=0,217). Considerando 3 desviaciones estándar del promedio de los ángulos medidos (para aumentar los parámetros de seguridad) la zona segura se enmarcó entre los 0° y los 80° con relación a la LCA. CONCLUSIÓN: En este estudio la zona de seguridad del bloqueo cefálico anteroposterior para evitar el daño del tendón bicipital durante el enclavijado endomedular retrógrado humeral se localizó entre los 0° y 80° con relación a la LCA.

OBJECTIVE: To define a safe zone, using the anterior intercondylar line (AIL) of the elbow as a reference to perform anterior-posterior (AP) cranial blocks during retrograde intramedullary humeral nailing (RIHN). METHODS: An ex-vivo experimental study was performed by analysing 13 human humeri. Photographs were taken, recording the distal portion of the humeri parallel to the AIL, elevating the distal humerus 10cm. Three independent evaluators made the following measurements: Bicipital groove (BG) angle at the level of the surgical neck of the humerus (S, formed by the medial and lateral walls of the BG; danger zone) and the Lateral Complementary Angle (LCA, formed by t5he lateral trochlear limit and the lateral wall of the BG at the level of the surgical neck of the humerus; safe zone). RESULTS: The mean value of S: 3.1±0.5° (3.3-4), intraclass correlation coefficient (ICC): 0.057 (P=.057). The mean value of the AIL: 87.5±3.3° (81.3-92.5), ICC: 0.304 (P=.217). Using 3 standard deviations from the mean of the angles measured (in order to increase the safety parameters), the safety zone is located between 0° and 80° in relation to the AIL. CONCLUSION: In this study, the safety zone of the AP cranial block, in order to avoid damage to bicipital tendon during RIHN, is situated between 0° and 80° in relation to the AIL.

Explore the Clinical Effect of Skeletal Muscle Ultrasound in the Diagnosis of Achilles Tendon Injury / 现代医院

Objective Explore the clinical value of ultrasonography in the diagnosis of skeletal muscle injury in the Achilles tendon .Methods Select visit from March 2016 to March 2017 period in orthopedic hospital 56 patients with Achil-les tendon injury , using a random number table group , the experimental group using diagnostic ultrasound skeletal muscles of the control group using diagnostic methods MIR , and ultimately by surgery as a diagnostic criteria between the two groups of patients with the diagnosis .Results Diagnostic accuracy rate of the experimental group were 96.42%.Skeletal muscle ul-trasound display achilles tendon rupture 12 patients , 6 patients with chronic Achilles tendon hyperplasia , swelling of the A-chilles tendon 6 patients, the diagnostic accuracy of the control group were 92.86%.Skeletal muscle ultrasound display A-chilles tendon rupture in 10 patients, 8 patients with chronic Achilles tendon hyperplasia , swelling of the Achilles tendon 3 patients.The results between the two groups of patients was statistically significant , that is P<0.05.Conclusion Ultra-sound in the diagnosis of skeletal muscle tendon injury in a significant clinical effect , but also has an affordable price , easy to operate and less damage to human advantage .It should be introduced .

Multiple Flexor Tendon Ruptures with Compression Neuropathy at Neglected Volar Lunate Dislocation / 대한정형외과학회잡지

Perilunate dislocation represents approximately 3% of all carpal injuries and is diagnosed late in 25% of cases. Neglected perilunate dislocation accompanies many complications. Multiple flexor tendon rupture is a very rare complication of neglected perilunate dislocation. Three cases have been reported in the English literatures. No case has been reported in Korean literature. We report on a case of multiple flexor tendon ruptures with compressive neuropathy of median and ulnar nerve caused by neglected volar perilunate dislocation.

Avulsion Rupture of Flexor Digitorum Profundus in Zone 1, Diagnosed in Early Stage

Avulsion injury of the flexor digitorum profundus (FDP) tendon from the distal phalanx is considered as a rare injury. We report a patient who sustained a FDP tendon rupture insertion on her fifth finger as a result of a closed, hyperextension with no accompanying laceration or predisposing pathologic condition. Preoperative ultrasonography showed complete rupture of FDP and the gap between the tendon ends. According to the classification by Leddy and Pacter, this case is type II. The reconstruction of flexor tendon using pull-out suture and tie-over button. We are reporting a case with brief review of literatures.

Absorbable Barbed Suture for the Repair of Tendo Calcaneus in Rabbits

PURPOSE: A barbed suture used in flexor tenorrhaphy can maintain prolonged strength despite absorption of the suture material and allows knotless repair with tendon-barb adherence along the suture's entire length. The purpose of this study was to evaluate the strength of the tendon and its histologic analysis after tenorrhaphy using barbed sutures. METHODS: Forty-two New Zealand rabbits were used in this study and were divided into experimental and control groups. In the experimental group, knotless repair of the tendons was performed using absorbable barbed sutures. In the control group, a 4-stranded double-modified Kessler tenorrhaphy was performed using non-absorbable monofilament sutures. The force to failure for each tendon was measured immediately after tendon repair and at 1 week, 4 weeks, and 8 weeks after the repair. Microscopic analysis of the tendons was performed at 1 week, 4 weeks, and 8 weeks after their repair. RESULTS: Eight weeks after tendon repair, the force to failure value of the rabbits in the experimental group (144.02+/-10.21 N) was significantly higher than that of the rabbits in the control group (125.26+/-8.75 N) (p=0.032). The difference in the value during the periods was not statistically significant. Histologic findings showed increased foreign body reaction in the tendons of the experimental group and sustained inflammation in those of the control group. CONCLUSION: With respect to load to failure and the degree of inflammation, the use of absorbable barbed suture resulted in better tendon repair than the conventional non-absorbable suture.

Non-Viral gene transfer to the tendon: comparison of two methods / Transferência gênica não viral para tendão: comparação de dois métodos

Tendons are part of the connective tissue that joins muscle to bone. Tendon injuries are a problem, since they have a poor ability to regenerate spontaneously. Alternative treatments involving the injection of local growth factors and gene transfer has been evaluated. Thus, we compared two methods for non-viral gene transfer tendons, using the GFP gene as reporter gene. Methods: Wistar rats had the medial quadriceps tendon exposed and the plasmid was transferred by direct injection or complexed with liposomes. Quantification of GFP in the tendom and in the spleen was evaluated by histological analysis with a fluorescence microscope. Results: gene transfer to the tendon was successfully obtained in both treatments. Lipoplex, as expected, showed the highest efficiency in transducing tenocytes, however we have found GFP expression also in the spleen. Naked DNA also showed fluorescence values above the control group and the signal was limited to the tendom. Discussion: the use of GFP as a reporter gene is a classical approach to evaluate gene transfer efficiency. Non-viral gene transfer methods are safe but show low levels of transduction and transient expression. For tendon repair, however, these characteristics may prove beneficial because a transient expression may be desirable to avoid the risk of adverse effects. GFP distribution in the spleen was probably a result of lipoplexes uptake by cells from the reticular endothelial system. Conclusion: taking into account the distribution of GFP in another tissue when using lipoplex, we believe that naked DNA is a more appropriate way to perform gene transfer to the tendon, ensuring safety, low cost and easy handling

Injúrias no tendão representam um problema, uma vez que estes têm pobre capacidade de regeneração espontânea. Tratamentos envolvendo injeção local de fatores de crescimento e transferência gênica tem sido avaliados. Assim, comparamos dois métodos de transferência gênica não viral para tendões, usando o gene GFP como gene repórter. Métodos: ratos Wistar tiveram a porção medial do tendão quadriciptal exposto e o plasmídeo foi transferido através de injeção direta ou complexado com lipossoma. A quantificação de GFP no tendão e no baço foi avaliada por análise histológica. Resultados: a transferência gênica para o tendão foi obtida com sucesso nos dois tratamentos. Lipoplexo demonstrou maior eficiência na transfecção, porém a presença de GFP foi detectada também no baço. A transfecção com DNA nu demonstrou valores de fluorescência superiores ao grupo controle e o sinal foi limitado ao tendão. Discussão: o uso de GFP como gene repórter é uma abordagem clássica para avaliar a eficiência da transferência de genes. A transferência não-viral é segura embora apresente expressão transiente. Para o reparo do tendão, no entanto, essas características podem ser benéficas, pois uma expressão transiente pode ser desejável para evitar o risco de efeitos adversos. A distribuição de GFP no baço foi provavelmente resultado da absorção dos lipoplexos por células do sistema retículo endotelial. Conclusão: Tendo em conta a distribuição de GFP em outro tecido quando utilizamos lipoplexo, pensamos que o DNA nu é uma forma mais adequada para realizar a transferência de genes para o tendão, garantindo segurança, baixo custo e fácil manuseio

Reconstruction of the Extensor Pollicis Longus Tendon by Tendon Graft or Tendon Transfer

PURPOSE: To compare the clinical results of spontaneous rupture of extensor pollicis longus tendon treated by palmaris longus tendon graft (group I) versus extensor indicis proprius tendon transfer (group II). MATERIALS AND METHODS: Out of twenty-five patients who suffer from spontaneous extensor pollicis longus tendon rupture, twelve patients were treated by palmaris longus tendon graft and thirteen patients were treated by extensor indicis proprius tendon transfer. Postoperatively thumbs were immobilized with thumb spica splint for three weeks. Active and passive movement was allowed subsequently for six weeks. The functions of the thumbs were assessed by the Geldmacher criteria and statistically compared. RESULTS: The overall outcome was excellent in 5(20%) of patients and good in 17(68%) of patients and satisfactory in 3(12%) of patients. The mean scores using the Geldmacher criteria were 18.50 for palmaris longus tendon graft and 19.69 for extensor indicis proprius tendon transfer. No significant difference was noted between two groups. CONCLUSION: Both methods establish equally good clinical results in patient with chronic extensor pollicis longus tendon rupture. Extensor indicis proprius tendon transfer seems more available methods.

Clinical Outcomes of Two-stage Flexor Tendon Reconstruction in the Hand: Experience with Early Postoperative Combined Protocol of Controlled Motion / 대한정형외과학회잡지

PURPOSE: To analyze the final results of a two-stage flexor tendon reconstruction in the hand with the early postoperative combined protocol of controlled motion, and to identify the prognostic factors associated with the final results. MATERIALS AND METHODS: Nine cases of two-stage flexor tendon reconstructions in 9 patients, who had been unable to flex their digits due to old flexor tendon injury, were examined. Using the modified Boyes' injury severity classification, the digits were classified as grades 1, 2 and 3 in 1, 5 and 3 patients, respectively. The average follow-up period was 1 year and 8 months and the final results are expressed using the Buck-Gramcko assessment system. RESULTS: Eight out of nine hands were graded as excellent and one patient whose injury severity had been graded 3 was graded as good. Excellent results were found in patients with a more than 10-year interval between the injury and the stage I procedure. Of the 3 patients who had undergone contracture release two were excellent and one was good. All 5 patients with a pulley reconstruction had excellent results. Complications involved one infection at the distal incision site, one tendon rupture and four flexion contractures. CONCLUSION: A two-stage flexor tendon reconstruction with an early postoperative combined protocol of controlled motion is a useful procedure for restoring the flexor performance in old badly scarred digits. The excellent or good results might be due to following: the early protected rehabilitation incorporating two protocols, a pulley reconstruction and protection, flexion contracture release, an initial injury with less than moderate grade and the young age of the patients.

The long term result of the acute closed rupture of achilles tendon treated by the short incision and tenocutaneous relaxing suture / 中国矫形外科杂志

[Objective]To evaluate the long term effect of the short incision and tenocutaneous relaxing suture to treat the acute closed rupture of the Achilles tendon.[Method]28 cases were treated by short incision and tenocutaneous relaxing suture from 1996-2005,The scar tissue and blood blocks between the ends of ruptured Achilles tendon were first debrided completely,then treated with percutanneous decmpression suture,the duration of follow up ranged from 2 years to 10 years.The treatment outcome were evaluated by Arner-Lindholm evaluation system and the MRI of post operation.2 cases were lost.[Result]According to the Arner-Lindholm evaluation system and the MRI of post operation,the treatment outcome were excellent in 18,and good in 6,with excellent rate of 92%,No complication including nerve injury and infection were found after operation,except 1 rerupture of Achilles tendon was found during the follow up period.The MRI showed the rupture Achilles tendon were repaired and remodeled very well in all cases.[Conclusion]The short incision and tenocutaneous relaxing suture is an ideal surgical technique,with good Clinical result and less Significant complication.