Decision-Making About Upper Limb Tendon Transfer Surgery by People With Tetraplegia for More Than 10 Years.

OBJECTIVES: To quantify time from spinal cord injury to upper limb reconstructive surgery for individuals with tetraplegia; to explore influences on decision-making about surgery for persons with long-standing (>10y) tetraplegia; and to determine the applicability of our previously developed conceptual framework that described the decision-making processes for people with tetraplegia of <5 years. DESIGN: Quantitative-qualitative mixed-methods study. SETTING: Community based in New Zealand. PARTICIPANTS: People (N=9) living with tetraplegia for >10 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: An audit of time frames between injury, assessment, and surgery for people with tetraplegia was undertaken. Interviews of people with tetraplegia were analyzed using constructivist grounded theory. RESULTS: Sixty-two percent of people with tetraplegia assessed for surgery had upper limb reconstructive surgery. Most were assessed within the first 3 years of spinal cord injury. Over half had surgery within 4 years after injury; however, 20% waited >10 years. Changes in prioritized activities, and the identification of tasks possible with surgery, were influential in the decision-making process. Participants were aware of surgery, but required a reoffer from health professionals before proceeding. The influence of peers was prominent in reinforcing the improvement in prioritized activities possible after surgery. CONCLUSIONS: Findings confirmed that the previously developed conceptual framework for decision-making about upper limb reconstructive surgery was applicable for people with tetraplegia of >10 years. Similarities were seen in the influence of goals and priorities (although the nature of these might change) and information from peers (although this influence was greater for those injured longer). Repeat offers for surgery were required to allow for changes in circumstances over time.

Satisfaction with upper-extremity surgery in individuals with tetraplegia.

OBJECTIVE: To measure the satisfaction of individuals with tetraplegia with their upper-extremity reconstructive surgery. DESIGN: Survey. SETTING: Two Spinal Cord Injury Model Systems centers. PARTICIPANTS: Sixty-seven individuals with spinal cord injury at the C4 through C8 motor level (107 arms). INTERVENTIONS: Participants had upper-extremity surgery to improve function. The surgical procedures included tendon transfers for elbow extension, wrist extension, hand grasp, and pinch or hand grasp neuroprosthesis. MAIN OUTCOME MEASURE: A survey was mailed to participants, who were asked to respond to statements such as, "If I had it to do over, I would have the hand/arm surgery again," using a 5-level Likert scale (ranging from strongly agree to strongly disagree). RESULTS: Seventy percent of the participants were generally satisfied with the results of their upper-extremity surgery, 77% reported a positive impact on their lives, 68% reported improvements in activities of daily living (ADLs), 66% reported improved independence, 69% reported improvement in occupation, 71% reported improved appearance or neutral, 78% reported their hand worked as well (or neutral) as it did when surgery was first performed, and 86% reported postoperative therapy as being beneficial. CONCLUSIONS: Upper-extremity surgery had a positive impact on life, increased ability to perform ADLs and to be independent, and improved quality of life.

The results of reconstruction of the anterior cruciate ligament with semitendinosus and gracilis tendons in chronic laxity of the knee.

The authors report the medium term results (41 months) in 88 patients submitted to surgery for reconstruction of the anterior cruciate ligament according to the method currently in use at our Clinic which uses the semitendinosus and gracilis tendons. The results were evaluated according to a score card method and in 28 patients a KT-1000 arthrometer was also used. The method gives a probability of full success in approximately 85% of cases, with significantly better results in patients not submitted to meniscectomy. A comparison with other methods of autogenous transplant and prosthetic substitution, even on the basis of the data provided by the KT-1000, still places the semitendinosus and gracilis method at the forefront.

[Secondary replacement reconstruction of the anterior cruciate ligament using pediculated gracilis tendons from the proximal musculature (Lindemann)]. / Sekundäre Ersatzplastik des vorderen Kreuzbandes mit der proximal muskulär gestielten Gracilissehne (Lindemann).

Between 1976 and 1987 350 reconstructions of the ACL in accordance to Lindemann have been undergone. 81% were injuries caused by sport accidents. Only 3.5% have had relative acute injuries at the time of operation. 344 patients were followed up. 50% have had good results, in 38% of patients no distinction was possible to the controlateral healthy knee joint. The advantages of the dynamic reconstruction of the ACL seemed to be in easy extraction of autogeneous graft, the dynamic function, the circulation and proprioception of the proximal pediculated gracilis tendon and the good results withoutloosening of the muscular pediculated graft.