Ruptura traumática aguda del tendón del cuádriceps tratado con sutura de alambre transpatelar / Acute traumatic rupture of the quadriceps tendon treated with transpatellar wire suture

Fundamento: La ruptura traumática aguda del tendón del cuádriceps es una entidad poco frecuente con una incidencia de 1,37/100 000 pacientes por año. Los hombres son los más afectados y la edad media de aparición ronda los 50 años. La cirugía ofrece los mejores resultados. Objetivo: Presentar un paciente con ruptura traumática aguda del tendón del cuádriceps derecho, con evolución favorable luego de una reparación primaria precoz con sutura transpatelar de alambre. Reporte de caso: Paciente masculino de 58 años de edad, con antecedentes de diabetes mellitus tipo II, que sufrió caída de sus pies. Acudió al servicio de urgencias con dolor intenso a nivel de la rodilla derecha, e imposibilidad para la marcha. A la exploración física se encontró impotencia absoluta para la extensión de la pierna derecha y signo del surco en la zona del tendón del cuádriceps. En la ultrasonografía de la rodilla derecha se apreció una solución de continuidad total del tendón del cuádriceps, a nivel del polo superior de la rótula lo que corroboró el diagnóstico de una ruptura traumática aguda del tendón del cuádriceps derecho. Se decidió tratamiento quirúrgico que consistió en perforaciones en la rótula y reinserción del tendón mediante alambres de acero, con buena evolución clínica Conclusiones: La reparación primaria precoz con sutura transpatelar de alambre en la ruptura traumática aguda del tendón del cuádriceps es un proceder quirúrgico efectivo cuando se realiza en los primeros diez días de la lesión.

Background: The acute traumatic rupture of the quadriceps tendon is a rare diseases with an incidence of 1.37 / 100 000 patients per year. Men are the most affected and the average age of appearance is around 50 years old. Surgery offers the best results. Objective: to present a patient with acute traumatic rupture of the right quadriceps tendon, with a favorable evolution after an early primary repair with transpatellar wire suture. Case report: a 58-year-old male patient with a personal history of type II diabetes mellitus, who suffered a fall in his feet. He arrived to the emergency room with severe pain in the right knee and impossibility to walk. At physical examination showed an absolute impotence for the extension of the right leg and a depression sign in the area of ​​the quadriceps tendon. In the right knee ultrasonography, a complete continuity solution of the quadriceps tendon was observed at the level of the superior pole of the patella, which corroborated the diagnosis of an acute traumatic rupture of the right quadriceps tendon. Surgical treatment consisted of perforations in the patella and reinsertion of the tendon through steel wires, with good clinical evolution Conclusions: early primary repair with transpatellar wire suture in acute traumatic rupture of the quadriceps tendon is an effective surgical procedure when it is done in the first ten days of the lesion.

Prediction of the presence of plantaris tendon through examination of palmaris longus tendon: is there a link? / Predicción de la presencia del tendón del músculo plantar mediante el examen del tendón del músculo palmar largo: ¿hay una relación?

The purpose of this study was to investigate the relationship between palmaris longus (PL) and plantaris (P) tendons and test the clinical usefulness of symmetry patterns between these tendons in Turkish population. This prospective study comprised a total of 240 adult patients (120 men and 120 women) who were admitted to our outpatient clinic with bilateral knee complaints that required bilateral knee MR examination during two years. Standard test (Schaefer's test, oppose the thumb to the little finger while flexing the wrist) was used to assess the presence of the PL tendon both with inspection and palpation. Knee MRI was used to determine the presence of P muscle belly on both sides. We have analyzed symmetric distribution pattern using Mc-Nemar test. The PL was absent unilaterally in 34 subjects (14.2%), while it was absent bilaterally in 17 subjects (7.1%). The P was absent unilaterally in 51 subjects (21.3%), while it was absent bilaterally in 10 subjects (4.2%). If PL was absent in one hand, the chance of having an ipsilateral P tendon was 70.6%. If PL was present in one hand, the chance of having an ipsilateral P tendon was 87.6%. The Mc-Nemar test for symmetry yielded a p value of 0.841 for ipsilateral PL and P muscles. A clear-cut link between Palmaris longus and plantaris tendons could not be demonstrated in this study. Both muscles show different variations independent from each other.

El propósito de este estudio fue investigar la relación entre los tendones del músculo palmar largo (MPL ) y músculo plantar (MP) y poner a prueba la utilidad clínica de los patrones de simetría entre estos tendones de la población turca. Estudio prospectivo realizado sobre 240 pacientes adultos (120 hombres y 120 mujeres) que ingresaron en la clínica por síntomas de dolor en la rodilla bilateralmente, quienes requerían un examen de RM de rodilla durante dos años. Se utilizó la prueba estándar (prueba de Schaefer, se oponen el pulgar hasta el dedo mínimo, mientras se flexiona la muñeca) para evaluar la presencia del tendón MPL tanto con la inspección y palpación. La RM de la rodilla se utilizó para determinar la presencia de vientre muscular plantar en ambos lados. Se analizó el patrón de distribución simétrica mediante la prueba de McNemar. El tendón del MPL estuvo ausente de manera unilateral en 34 pacientes (14,2%) y bilateralmente en 17 pacientes (7,1%). El tendón del MP estuvo ausente de manera unilateral en 51 pacientes ( 21,3 %) mientras que bilateralmente no estaba en 10 pacientes (4,2%). Si el tendón del MPL estuvo ausente en un lado, la probabilidad de tener un tendón del MP ipsilateral fue del 70,6 %. Si el tendón del MPL estaba presente en un lado, la probabilidad de tener un tendón del MP ipsilateral fue 87,6%. La prueba de McNemar - simetría produjo un valor p de 0,841 para los músculos PL y P ipsilaterales. Una relación directa claro entre los tendones de los músculos PL y P no se pudo demostrar en este estudio. Ambos músculos muestran diferentes variaciones independiente uno del otro.

Surgical Treatment of Chronic Ankle Lateral Instability: Reconstruction with Tenodesis or Tendon Graft / 대한정형외과학회잡지

Numerous reconstructive procedures have been described for treatment of chronic lateral ankle instability; however, controversy remains regarding the ideal surgical option. Numerous studies of the Brostrom procedure or its modifications have followed, reporting good to excellent results. However they have some limitations regarding the instabilities for over-weight, physically high demanding patients, failed anatomical repair, and particularly for significantly deficient or attenuated ligaments. This may indicate the need for non-anatomical reconstruction using peroneus brevis tendon or anatomical reconstruction using the allo/autograft tendon.

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.

Extensor Pollicis Longus Tendon Rupture Following Local Steroid Injection

Spontaneous extensor pollicis longus tendon rupture is commonly caused by attrition of the tendon from trauma or inflammatory processes. We experienced a patient with extensor pollicis longus tendon rupture after steroid injection, in which the rupture may have been caused by the effects of steroid itself as well as direct damage from the needle. A 51-year-old woman complained of inability to extend her right thumb at the first metacarpophalangal & interphalangeal joint level. The patient had a history of local steroid injection into the dorsal & radial side of wrist on two occations, and had no history of trauma or rheumatologic disease. After a physical examination of the patient, we decided to explore the wrist. The patient agreed with operation. Intraoperatively, an incision was made into the wrist and the proximal and distal ends of the ruptured extensor pollicis longus tendon were identified. The defect between the proximal and the distal end was measured to approach 8cm, and a palmaris longus tendon graft was performed. After three months of rehabilitation, the first metacarpophalangal & interphalangeal joint recovered the normal range of motion. Steroid injection has been widely used in various musculoskeletal disorders such as rheumatoid arthritis and osteoarthritis. However, inadvertent steroid injection into the extra or intra articular spaces may lead to tendon rupture. Steroids reduce tensile strength by decreasing tenocyte activity and collagen synthesis. Also, the physical effect of direct needle-stick injury into the mesotenon and blood vessels around the tendon may cause damage. In addition, hematoma and edema may increase pressure around the tendon and compromise blood supply, leading to tendon degeneration and subsequent rupture. When injecting steroid into an articular area, all physicians should have a complete understanding of the surrounding anatomy and always keep in mind the hazards of such procedures.

Anterior Cruciate Ligament Reconstruction Using a Contralateral Hamstring Tendon Graft in Combined Anterior Cruciate and Medial Collateral Ligament Injury / 대한정형외과학회잡지

PURPOSE: We reviewed the results of a series of patients with combined anterior cruciate ligament and medial collateral ligament injury who received nonoperative management of medial collateral ligament with anterior cruciate ligament reconstruction using a contralateral hamstring tendon graft. MATERIALS AND METHODS: From May 2000 to June 2001, 12 cases (20-46 years; mean, 35 years) were available for follow-up (12-23months; mean, 16.7 months) with combined anterior cruciate ligament and medial collateral ligament injury that underwent anterior cruciate ligament reconstruction alone using a contralateral hamstring tendon graft. Follow-up evaluation involved; KT-2000 arthrometer testing, valgus stress testing and the International Knee Documentation Committee (IKDC) evaluation form. RESULTS: Mean side to side difference of manual maximum anterior displacement using the KT-2000 arthrometer was 1.75 mm. All cases showed a firm end point by the valgus stress test. At the final IKDC evaluation, 2 cases were graded as normal, 8 nearly normal, 1 abnormal and 1 severely abnormal. The donor site result of the IKDC evaluation form showed normal in 8, nearly normal in 3 and abnormal in 1. CONCLUSION: These results demonstrate the effectiveness of ACL reconstruction alone using the contralateral hamstring tendon graft as an autograft in combined ACL and MCL injury, which was found to restore satisfactory stability with minimal complications at both injured and donor sites.

Reconstruction of the Old Flexor Tendon Injury in the Hand / 대한정형외과학회잡지

The old flexor tendon injury in the hand seen after 4 weeks from damage and associated with crushing injury, heavy scarring, fracture and infectious state has the difficulty to deliver the flexor tendon through fibro-osseous sheath and the pulleys. Treatment method depends on the circumstances of the injured flexor tendon and surgeons' judgement. We have treated twenty-three fingers of twenty-three cases, who had old flexor tendon injury, by advancement and tenolysis in 1 each, tendon graft in 5, and staged tendon graft in 16 from March 1989 through February 1994. The result was summarized as follows. 1. The old flexor tendon injury most commonly occurred in the fifth finger(11 cases, 47.8%)and in zone II (16 cases, 69.6%). 2. The most common cause was glass injury(15 cases, 69.6%). 3. 21 of 23 cases(2 thumbs excepted)were evaluated according to the original Strickland system. 14 cases of the staged tendon graft showed excellent(6 cases, 42.9%), good(5 cases, 35.7%)and fair(3 cases, 21.4%). 5 cases of the tendon graft showed excellent(2 cases, 40%), good(1 case, 20%), and fair(2 cases, 40%). 1 case of adhesiolysis and 1 case of advancement showed excellent and good results each. Little difference is observed in the method between the staged graft and tendon graft. 4. The degree of the associated soft tissue injury should be evaluated by the experienced hand surgeon before surgery and the delicate balance between protection and mobilization during the postoperative weeks is important as well as the surgical skill.

Tendon Graft in Old Flexor Tendon Injury / 대한정형외과학회잡지

The flexor tendon injuries of the finger are very difficult to treat satisfactorily. Early treatment is desirable, but not always posaible. In addition, joint stiffness and limitation in gliding of the tendon caused by adhesion, make the problem more complex. From 1978 until 1988, 13 patients (14 eases) underwent operations for free tendon graft, and 10 patients (13 eases) for staged tendon graft at the Department of Orthopaedic Surgery, National Medieal Center. They have been followed up for clinical study, and the result was summarized as follows:1. Old flexor tendon injuries were common in the teen and twenties, especially in male. 2. They occurred in the index (10 Cases, 37.0%) and middle (8 cases, 29.6%) fingers most commony, especially zone II (62.9%). 3. The result was evalusted according to the method designed by Strickland and Glovac. In 19 out of 27 cases, satisfactory result (excellent and good) was yielded. 4. In cause, deep laceration by sharp object was better in the result than crushing injury. 5. The interval between the injury and the operation ranged from 1 month through 11 years, averaging 16 months, and is supposed to have little relation to the result. 6. The preoperative state is supposed to have much relation to postoperative result, judging from 100% of satisfactory result in Grade I compared with 40% in Grade V according to Boyes preoperative classification. 7. Little difference is seen in the result between free tendon graft and staged tendon graft. And 5 cases complicated by adhesion, rupture of grafted tendon and wound infection yielded poor result.

A Clinical Study of Flexor Tendon Grafts for Injured Fingers / 대한정형외과학회잡지

Although the primary repair has been recognized so far, the tendon graft is reported as a primary treatment method for tendon injury in no man's land of Bunnel, judging from the state of injured hand, the ability of operator and the environment of medical operation. The 27 cases of tendon graft that were operated for 11 years from June, 1973 to June, 1984 in the Department of Orthopedic Surgery, Hanyang University College of Medicine have been followed up for clinical study. The results were as follows: 1. The Material of this study was composed of 13 males (21 cases) and 5 females (6 cases) whose age were from 8 to 39 years old. 2. The injured fingers were classified with 3 thumbs, 6 index fingers, 7 middle fingers, 8 ring fingers and and 3 little fingers out of 27 cases and all injured parts of fingers were Zone II except that of thumb which was Zone IV of Bunnel. 6 patients were injured more than 2 fingers. 3. The duration from tendon injury to tendon graft which scattered from 1 month to 9 years and averaged out to 28.2 months is supposed to have little relation to post-operative results. 4. The post-operative results showed up 9 excellent, 7 good and 1 fair out of 17 cases in good gmup, 3 good and 6 fair out of 9 cases in cicatrix group, 1 fair out of 1 case in nerve damage group at pre-operative state. 5. The post-operative results of thumb which show up 2 excellent, 1 good out of 3 cases were most successful among those of all fingers. 6. The pre-operative state is supposed to have great relation to post-operative state judging from 94% satisfactory results of good group at pre-operative state. 7. As multiple injury makes little difference from single injury, the injured state of each hand is supposed to an important effect on post-operative results. 8. As all electric bumed injury show up fair except that of thumb, they are supposed to have unsatisfactory results.

A Preliminary Study on Posterior Cruciate Ligament Reconstruction Using Hamstrings Tendons Knot with Bone Lock-bolt under Arthroscopy / 中国运动医学杂志

Objective To investigate a new method for reconstruction of posterior cruciate ligament(PCL)using hamstrings tendons knot and bone lock-bolt under arthroscopy.Methods Ten cases of PCL lesion were treated arthroscopically. Hamstrings were harvested with a stripper following standard procedure. The hamstring tendons tied a knot at the inter-media part of the tendons and insert a bone lock-bolt on the knot. The tunnel of femur and tibia were prepared. Tunnel diameter of the tibia and the infra 1/3 of femur was 5-7mm and the superior 2/3 of the femur side was 11-12mm,Pulling in the tendon from the lateral side of femur tunnel to the tibia.A hole of 4 5mm was drilled 1cm distal of tibia tunnel exit. Create a bone bridge using curved clamps,passing a tendon under the bone bridge and tying the tendon over the bone bridge in extension.Results All the patients were follow-up.Function and stability of knee during walking and activities improved apparently. All patients were evaluated with the knee functional scales.Patients were clinically rated as excellent in 6,good in 3,and fair in 1. There were no poor results.Conclusion The result of using semitendinosus and gracilis tendons tied a knot and implant a bone lock-bolt to reconstruct PCL is satisfactory. The advantages of the technique included well biological match, exemption from costly materials, promotion of healing of tendons and bone tunnel, decrease in medical cost.

Flexor Tendon Graft / 대한정형외과학회잡지

Flexor tendon grafting is a well-proved procedure for the restoration of tendon defects in the hand. The results are not entirely predictable, it offers a good expectation of successful outcome. Authors have performed the tendon graft in thirteen cases of flexor tendon injury of the hand during the period from September '79 to January '82 and evaluated the results. The followings were the results obtained. 1. Male was eleven, female was two. Age distribution is from 4 to 38 years. 2. Injured fingers were thumb 6, index 2, middle finger 4 and little finger 1 cases. The site of the primary injury was on area of Bunnell's Zone II in all cases. 3. Time interval from tendon injury to flexor tendon graft was 6 weeks to 19 months (average 5.6 months). 4. The results of tendon grafts rated as excellent 2 cases and good 3 cases in preoperative Good group; excellent 1, good 3 and fair 1 in “Scar” group; fair 1 and 1 poor in “Joint” group; fair 1 in “Salvage” group. In the thumbs, the results were better than in the fingers. 5. Degrading the postoperative results were flexion contracture in 3 cases, lack of flexion ROM in 2 cases and bowstringing in 2 cases. 6. Pinch power of the finger where tendon graft was performed was 52% of that of the opposite healthy finger. 7. As complication, bowstringing was observed in 2 cases and recurvatum deformity of the PIP joint in one case.

Clinical Study on the Staged Tendon Graft for Flexor Tendon Injury of the Hand / 대한정형외과학회잡지

The biological characteristic of the silastic rod which in vivo induce the pseudosheath formation has popularized its application in the reconstructive surgery of flexor tendon injury of the digit, especially in the zone I, no-man's-land. We performed staged tendon graft in 14 digits(9 cases) and the following were the results. Clinical results of the 13 digits were good in 10 digists(77%). One case showed the untoward ill effect postoperatively. The above study has also shown that this staged tendon graft operation is applicable even to the higher grade of injury by Boyes. For the prevention of bowstring effect, A2 and A4 pulleys seem to be more essential than A1, A2. and A3.