Nonoperative Treatment of Psoas Tendon Avulsion in a Professional Athlete: A Case Report and Evidence Based Review.

CASE: A 36-year-old male professional soccer player sustained an acute left hip injury during a tournament game while defending the goal. Magnetic resonance imaging demonstrated a complete avulsion of the iliopsoas tendon from the left trochanter. The patient was treated nonoperatively, and after 10 weeks, he was able to return to full activity. After 1 year of follow-up, the patient was completely asymptomatic, and was still playing professional soccer without flexion strength deficit. CONCLUSION: In this professional soccer athlete, nonoperative treatment of complete psoas avulsion resulted in a good functional outcome and successful return to play.

Tratamento conservativo e modelo de fisioterapia extensora na laceração total do tendão extensor digital longo em equinos: relato de três casos / Conservative treatment and extension physical therapy model in total laceration of long digital extensor tendon in horses: three cases report

A ruptura traumática do tendão extensor digital longo (TEDL) apresenta alta incidência entre as afecções que acometem o aparelho locomotor dos equinos, estando frequentemente associada aos acidentes em cercas de arame liso. O sinal clínico evidente é a perda da capacidade de extensão das falanges e do casco, trazendo déficit de propriocepção e claudicação aparente. Estas lesões tendíneas possuem prognóstico reservado, sendo que em alguns casos podem ser fatais. O objetivo deste artigo é relatar três casos de equinos com ruptura total do TEDL, submetidos a tratamentos de cicatrização de ferida por segunda intenção e modelo de fisioterapia extensora. As cicatrizações e retorno de função extensora ocorreram em média com 52,7± 7,36 dias, com retorno às atividades anteriormente desempenhadas em tempo inferior a 120 dias. Conclui-se que a cicatrização por segunda intenção com aparato de fisioterapia extensora apresenta-se como opção viável em situações que a sutura não é indicada ou nas deiscências relacionadas às lacerações de TEDL.(AU)

The traumatic rupture of the long digital extensor tendon has a high incidence of diseases that affect the locomotor system of horses, and is often associated with accidents in smooth wire fences. The obvious clinical sign is the loss of extensibility of the phalanges and the hull, bringing proprioception deficit and limping apparent. These tendon injuries have a poor prognosis, and in some cases can be fatal. The purpose of this article is to report three cases of horses with total TEDL rupture undergoing healing treatments wound by secondary intention and model extensor physiotherapy. The scarring and extensor function return occurred on average 52.7 ± 7.36 days, with return to activities previously performed in less than 120 days. It was concluded that the healing by secondary intention with extensor physiotherapy apparatus is presented as a viable option in situations where the suture is not indicated or the dehiscence related to lacerations TEDL.(AU)

Tratamento conservativo e modelo de fisioterapia extensora na laceração total do tendão extensor digital longo em equinos: relato de três casos / Conservative treatment and extension physical therapy model in total laceration of long digital extensor tendon in horses: three cases report

A ruptura traumática do tendão extensor digital longo (TEDL) apresenta alta incidência entre as afecções que acometem o aparelho locomotor dos equinos, estando frequentemente associada aos acidentes em cercas de arame liso. O sinal clínico evidente é a perda da capacidade de extensão das falanges e do casco, trazendo déficit de propriocepção e claudicação aparente. Estas lesões tendíneas possuem prognóstico reservado, sendo que em alguns casos podem ser fatais. O objetivo deste artigo é relatar três casos de equinos com ruptura total do TEDL, submetidos a tratamentos de cicatrização de ferida por segunda intenção e modelo de fisioterapia extensora. As cicatrizações e retorno de função extensora ocorreram em média com 52,7± 7,36 dias, com retorno às atividades anteriormente desempenhadas em tempo inferior a 120 dias. Conclui-se que a cicatrização por segunda intenção com aparato de fisioterapia extensora apresenta-se como opção viável em situações que a sutura não é indicada ou nas deiscências relacionadas às lacerações de TEDL.

The traumatic rupture of the long digital extensor tendon has a high incidence of diseases that affect the locomotor system of horses, and is often associated with accidents in smooth wire fences. The obvious clinical sign is the loss of extensibility of the phalanges and the hull, bringing proprioception deficit and limping apparent. These tendon injuries have a poor prognosis, and in some cases can be fatal. The purpose of this article is to report three cases of horses with total TEDL rupture undergoing healing treatments wound by secondary intention and model extensor physiotherapy. The scarring and extensor function return occurred on average 52.7 ± 7.36 days, with return to activities previously performed in less than 120 days. It was concluded that the healing by secondary intention with extensor physiotherapy apparatus is presented as a viable option in situations where the suture is not indicated or the dehiscence related to lacerations TEDL.

Utilização do filme de quitosana na reparação de tendão em coelhos / Use of the film of chitosan in the repair of tendons in rabbits

Com este trabalho objetivou-se avaliar o processo de cicatrização do tendão em coelhos, utilizando-se no grupo tratamento o filme de quitosana, por meio de uma análise clínico-cirúrgica e histológica. Foram utilizados 12 coelhos adultos, separados em grupo controle (GC) e grupo tratamento (GT), nos quais se realizou uma secção parcial do tendão gastrocnêmio de ambos os membros pélvicos. A avaliação clínica baseou-se na presença de reação inflamatória, infecção, dor e deiscência da sutura. Para a avaliação histológica, foi realizado um estudo comparativo do processo cicatricial por meio do tipo de células, da quantidade de tecido conjuntivo e da organização das fibras colágenas entre os grupos e os momentos. Nas feridas cirúrgicas, não foram observadas secreção, dor ou deiscência. Na histologia comparativa entre os grupos, o GC apresentou melhor processo cicatricial em relação ao GT, aos 60 dias. Aos 90 dias, no GT a cicatrização já esboça recuperação do tendão, com reorganização da celularidade e das fibras colágenas no tecido conjuntivo denso modelado. Concluiu-se que a quitosana estimula rápido crescimento celular, mas de forma desorganizada, e que a cicatrização completa só ocorre após 90 dias da sua implantação no tecido.(AU)

This work aimed to evaluate the process of tendon healing in rabbits, using the treatment group in chitosan film through a clinical, surgical and histological analysis. In the experiment, 12 adult rabbits were used, divided into control group (CG) and treatment group (TG), which were held in the partial section of the gastrocnemius tendon of both limbs. Clinical assessment was based on the presence of inflammation, infection, pain and suture dehiscence. For histological evaluation a comparative study of the healing process through the cell type, amount of connective tissue and collagen fiber organization was performed between groups and times. In surgical wounds no secretion, pain or dehiscence were observed. In the comparative histology between groups, the CG showed better healing compared to TG, at 60 days. On day 90 the TG already outlines tendon recovery with reorganization of cellularity and collagen fibers in the dense connective tissue modeled. It was concluded that chitosan stimulates faster cell growth, but it is haphazardly, and that complete healing occurs after 90 days of their implantation in tissue.(AU)

Utilização do filme de quitosana na reparação de tendão em coelhos / Use of the film of chitosan in the repair of tendons in rabbits

Com este trabalho objetivou-se avaliar o processo de cicatrização do tendão em coelhos, utilizando-se no grupo tratamento o filme de quitosana, por meio de uma análise clínico-cirúrgica e histológica. Foram utilizados 12 coelhos adultos, separados em grupo controle (GC) e grupo tratamento (GT), nos quais se realizou uma secção parcial do tendão gastrocnêmio de ambos os membros pélvicos. A avaliação clínica baseou-se na presença de reação inflamatória, infecção, dor e deiscência da sutura. Para a avaliação histológica, foi realizado um estudo comparativo do processo cicatricial por meio do tipo de células, da quantidade de tecido conjuntivo e da organização das fibras colágenas entre os grupos e os momentos. Nas feridas cirúrgicas, não foram observadas secreção, dor ou deiscência. Na histologia comparativa entre os grupos, o GC apresentou melhor processo cicatricial em relação ao GT, aos 60 dias. Aos 90 dias, no GT a cicatrização já esboça recuperação do tendão, com reorganização da celularidade e das fibras colágenas no tecido conjuntivo denso modelado. Concluiu-se que a quitosana estimula rápido crescimento celular, mas de forma desorganizada, e que a cicatrização completa só ocorre após 90 dias da sua implantação no tecido...

This work aimed to evaluate the process of tendon healing in rabbits, using the treatment group in chitosan film through a clinical, surgical and histological analysis. In the experiment, 12 adult rabbits were used, divided into control group (CG) and treatment group (TG), which were held in the partial section of the gastrocnemius tendon of both limbs. Clinical assessment was based on the presence of inflammation, infection, pain and suture dehiscence. For histological evaluation a comparative study of the healing process through the cell type, amount of connective tissue and collagen fiber organization was performed between groups and times. In surgical wounds no secretion, pain or dehiscence were observed. In the comparative histology between groups, the CG showed better healing compared to TG, at 60 days. On day 90 the TG already outlines tendon recovery with reorganization of cellularity and collagen fibers in the dense connective tissue modeled. It was concluded that chitosan stimulates faster cell growth, but it is haphazardly, and that complete healing occurs after 90 days of their implantation in tissue...

Functional results following surgical repair of simultaneous bilateral quadriceps tendon ruptures.

BACKGROUND: Unilateral quadriceps tendon ruptures are common conditions treated by orthopedic surgeons. There is a paucity of information concerning functional outcomes in bilateral tendon ruptures. The aim of this study is to assess a series of 5 cases with simultaneous quadriceps tendon ruptures that underwent acute surgical repair with the purpose of identifying the functional outcomes as compared with unilateral injuries. We hypothesize that patients with bilateral quadriceps tendon ruptures have worse functional outcomes than patients with unilateral ruptures. METHODS: Five cases of bilateral quadriceps tendon ruptures were identified. All patients underwent acute surgical extensor tendon repair employing a 3-patellar hole and a locked, running, nonabsorbable suture technique followed by a 6-week period of immobilization and bracing for 10 to 12 weeks. Mechanism of injury, medical history, social history, operative report, and postoperative exam were recorded with a minimum 1-year follow-up. In addition, each patient completed a subjective International Knee Documentation Committee (IKDC) score at 18 months. Five patients with unilateral injuries and with similar medical history were included as age-matched controls. RESULTS: The mean age for the bilateral group was 54.8 years (range, 44-68 years). Mean postoperative knee flexion was 129 degrees and all patients had active, resisted knee extension. Only 1 patient had a medical comorbidity (diabetes mellitus). The mean IKDC score (mean follow-up, 25.4 months; range, 22-29 months) was 71.9 (range, 34.4 to 91.6), whereas the age-matched control group had a mean IKDC score of 88.3 (P = 0.23). There was no statistical significance between the 2 groups with regard to range of motion (P = 0.24), IKDC score, and return to activity (P = 0.29). CONCLUSION: Patients with early surgical repair of bilateral, simultaneous extensor mechanism ruptures exhibit adequate recovery and return to a high level of function. Our patients were younger than those reported in the literature and had minimal comorbidities. The IKDC scores reflected good outcomes in the bilateral rupture group, albeit lower than in the unilateral group.

Functional restoration of the equine long digital extensor tendon submitted to homologous jugular graft after partial tenectomy / Restabelecimento funcional do tendão extensor digital longo submetido a implante de enxerto jugular homólogo pós-ressecção parcial em equinos

The functional restoration of the equine long digital extensor tendon after partial tenectomy was studied comparing one group submitted to homologous jugular graft (GE) and other group without graft used as control (GC). The animals were submitted to partial resection of the long digital extensor tendon with skin excision, followed by jugular graft suture in the GE. The wounds were treated by second intention and the limbs were supported with a bandage and cast. The horses were stall confined and monitored daily for lameness, wound tendon healing (planimetry and ultrasonography evaluation), limb functional restoration and cast sores. The repair tissue showed initial vascularization and developed granulation tissue. Three horses from GC had exuberant granulation tissue. The tendon functional restoration time from GE was significant less (average time of 28.3 days) than GC (45.9 days). The planimetry was significant different at 10 and 20 days, but it was similar at the final of experiment. Ultrasonographic exams showed the newly formed tendon tissue surrounding the implanted grafts with obvious circulatory activity, however with less organization comparing to the previous tendon before the lesion. Incorporation of a homologous jugular graft improved the quality of the repair tissue in equine extensor tendons avoiding the exuberant granulation tissue development and reduced tendon functional restoration time.(AU)

Em equinos foi estudado o restabelecimento funcional do membro submetido a tenectomia parcial do extensor digital longo. Comparou-se comparando-se um grupo de animais com aplicação de enxerto jugular homólogo fixado em glutaraldeído (GE) com um grupo sem a utilização de enxertos (GC). Os animais foram submetidos à tenectomia segmentar do extensor digital longo, com retirada de pele e de segmento do tendão, seguindo a sutura do enxerto nos animais do GE. As feridas foram tratadas por segunda intenção com curativo, bandagem e tala. Entre os grupos comparou-se as feridas macroscopicamente, o tempo de restabelecimento funcional do membro (dias), planimetria das feridas e aspectos ultrassonográficos do tendão e da região. As feridas mostraram semelhança entre os grupos com sangramento e granulação. Em três animais do GC houve granulação exuberante. Os enxertos aplicados mostraram-se escurecidos e justapostos à granulação sem exuberância nos animais do GE. O tempo de restabelecimento funcional do tendão no GE foi significativamente menor (tempo médio de 28,3 dias) que o GC (45,9 dias) As planimetrias diferiram significativamente (P < 0,05) nos momentos 10 e 20 (dias), sendo semelhantes no momento final. Exames ultrassonográficos no pós-operatório houve a observação do "tecido" neoformado envolvendo o enxerto implantado, sem sobrepô-lo, não ultrapassando as bordas da ferida e não organizado como o tendão pré-existente, e com evidente atividade circulatória visível pela movimentação do sangue na granulação neoformada. O enxerto aplicado na falha de tendão reduziu o tempo de restabelecimento funcional do membro e sugere contribuir na inibição da formação de granulação exuberante.(AU)

Functional restoration of the equine long digital extensor tendon submitted to homologous jugular graft after partial tenectomy / Restabelecimento funcional do tendão extensor digital longo submetido a implante de enxerto jugular homólogo pós-ressecção parcial em equinos

The functional restoration of the equine long digital extensor tendon after partial tenectomy was studied comparing one group submitted to homologous jugular graft (GE) and other group without graft used as control (GC). The animals were submitted to partial resection of the long digital extensor tendon with skin excision, followed by jugular graft suture in the GE. The wounds were treated by second intention and the limbs were supported with a bandage and cast. The horses were stall confined and monitored daily for lameness, wound tendon healing (planimetry and ultrasonography evaluation), limb functional restoration and cast sores. The repair tissue showed initial vascularization and developed granulation tissue. Three horses from GC had exuberant granulation tissue. The tendon functional restoration time from GE was significant less (average time of 28.3 days) than GC (45.9 days). The planimetry was significant different at 10 and 20 days, but it was similar at the final of experiment. Ultrasonographic exams showed the newly formed tendon tissue surrounding the implanted grafts with obvious circulatory activity, however with less organization comparing to the previous tendon before the lesion. Incorporation of a homologous jugular graft improved the quality of the repair tissue in equine extensor tendons avoiding the exuberant granulation tissue development and reduced tendon functional restoration time.

Em equinos foi estudado o restabelecimento funcional do membro submetido a tenectomia parcial do extensor digital longo. Comparou-se comparando-se um grupo de animais com aplicação de enxerto jugular homólogo fixado em glutaraldeído (GE) com um grupo sem a utilização de enxertos (GC). Os animais foram submetidos à tenectomia segmentar do extensor digital longo, com retirada de pele e de segmento do tendão, seguindo a sutura do enxerto nos animais do GE. As feridas foram tratadas por segunda intenção com curativo, bandagem e tala. Entre os grupos comparou-se as feridas macroscopicamente, o tempo de restabelecimento funcional do membro (dias), planimetria das feridas e aspectos ultrassonográficos do tendão e da região. As feridas mostraram semelhança entre os grupos com sangramento e granulação. Em três animais do GC houve granulação exuberante. Os enxertos aplicados mostraram-se escurecidos e justapostos à granulação sem exuberância nos animais do GE. O tempo de restabelecimento funcional do tendão no GE foi significativamente menor (tempo médio de 28,3 dias) que o GC (45,9 dias) As planimetrias diferiram significativamente (P < 0,05) nos momentos 10 e 20 (dias), sendo semelhantes no momento final. Exames ultrassonográficos no pós-operatório houve a observação do "tecido" neoformado envolvendo o enxerto implantado, sem sobrepô-lo, não ultrapassando as bordas da ferida e não organizado como o tendão pré-existente, e com evidente atividade circulatória visível pela movimentação do sangue na granulação neoformada. O enxerto aplicado na falha de tendão reduziu o tempo de restabelecimento funcional do membro e sugere contribuir na inibição da formação de granulação exuberante.

[Effect of early versus late rehabilitation in patients with Achilles tendon tenorrhaphy]. / Efecto de la rehabilitación temprana versus tardía, en pacientes con tenorrafia del tendón de Aquiles.

BACKGROUND: Achilles tendon tear is a prevalent condition in our setting. There is no consensus in the literature regarding the ideal treatment modality or the right immobilization period before starting physiatrics. The harmful effect of prolonged immobilization is widely known, so the functional results of early versus late physical therapy are compared in patients subjected to surgery for Achilles tendon tear. MATERIAL AND METHODS: Ambispective, longitudinal, comparative study in patients over 16 years of age with Achilles tendon rupture treated surgically and referred to rehabilitation; they followed the management protocol established at the service. Retrospective record review was performed for discharged patients and patients admitted after the study initiation date were followed-up prospectively. The evaluation continued by means of a phone interview; results were recorded according to the Achilles Tendon Rupture Score. RESULTS: A total of 115 patients were included; they were classified into two groups according to the time elapsed between the surgery and the onset of physical therapy, as follows: 31 patients in group A, with onset between postoperative days 0 and 21; and 84 patients in group B, with onset after postoperative day 21. Two infectious complications were reported and no re-ruptures. Functional results were 6.52 for group A and 8.18 for group B. CONCLUSIONS: The duration of rehabilitation was similar in all patients, regardless of the protocol. The time elapsed between surgery and discharge was shortest in patients who underwent early physical therapy. The functional score is independent from the onset of physical therapy. Surgery followed by early mobilization is a safe practice that does not increase complications and shortens the total time the patients need to resume their daily activities.

Biomechanical comparison of four methods of repair of the Achilles tendon: a laboratory study with bovine tendons.

We tested four types of surgical repair for load to failure and distraction in a bovine model of Achilles tendon repair. A total of 20 fresh bovine Achilles tendons were divided transversely 4 cm proximal to the calcaneal insertion and randomly repaired using the Dresden technique, a Krackow suture, a triple-strand Dresden technique or a modified oblique Dresden technique, all using a Fiberwire suture. Each tendon was loaded to failure. The force applied when a 5 mm gap was formed, peak load to failure, and mechanism of failure were recorded. The resistance to distraction was significantly greater for the triple technique (mean 246.1 N (205 to 309) to initial gapping) than for the Dresden (mean 180 N (152 to 208); p = 0.012) and the Krackow repairs (mean 101 N (78 to 112; p < 0.001). Peak load to failure was significantly greater for the triple-strand repair (mean 675 N (453 to 749)) than for the Dresden (mean 327.8 N (238 to 406); p < 0.001), Krackow (mean 223.6 N (210 to 252); p < 0.001) and oblique repairs (mean 437.2 N (372 to 526); p < 0.001). Failure of the tendon was the mechanism of failure for all specimens except for the tendons sutured using the Krackow technique, where the failure occurred at the knot. The triple-strand technique significantly increased the tensile strength (p = 0.0001) and gap resistance (p = 0.01) of bovine tendon repairs, and might have advantages in human application for accelerated post-operative rehabilitation.

[Repair of Achilles tendon rupture and early rehabilitation]. / Reparación de ruptura del tendón calcáneo y rehabilitación temprana.

The frequency of Achilles tendon tear has increased worldwide. Several factors have been described that help explain the mechanism of injury. The treatment of choice continues to be surgery; conservative treatment is reserved for patients with a high morbidity and mortality. Surgical treatment consists of an open or percutaneous technique. In both modalities we try to achieve prompt mobilization of the operated tendon to obtain better and quicker healing. This prospective study describes our experience with 35 patients enrolled from February 2004 to August 2010. They were treated with open repair, physical rehabilitation and active ankle mobilization before the second postoperative week, and with colchicine. We obtained satisfactory results. Patients recovered complete mobility approximately at postoperative week 6, and from weeks 8 to 10 they could resume their daily work activities and participate in sports and recreational activities. Patients were assessed according to the ATRS classification to measure their clinical results. We had no infections or other major complications. We conclude that the open surgical repair of Achilles tendon tear, prompt mobility, and colchicine provide good results.

Reparación primaria de los tendones flexores en la zona II con una nueva técnica utilizando sutura reabsorbible y movilización activa temprana / Flexor tendon repair in zone II with a new technique using absorbable suture and early active mobilization

Introducción: El objetivo del presente trabajo es describir una nueva técnica de reparación primaria de los tendones flexores con material reabsorbible combinada con movilización activa y pasiva temprana. Materiales y métodos: Se evaluaron retrospectivamente 19 pacientes (13 dedos, 7 pulgares) con sección del tendón flexor profundo (zona II) o del flexor largo (zona II-III). Edad promedio: 36 años. Tenorrafia: sutura central de cuatro bandas con dos puntos de Kessler en posición vertical y sutura periférica utilizando material de polidioxanona, rehabilitados con movilización precoz activa y pasiva. Se evaluó el arco total de movilidad (ATM) comparativamente y la distancia pulpejo-palma. Los resultados se clasificaron de acuerdo con la fórmula de Strickland-Glogovac en los dedos y el sistema de Buck-Gramcko en los pulgares. Resultados: El tiempo de seguimiento promedio fue de 23 meses (7 a 47 meses). Hubo un caso de rerrotura. El ATM promedio fue de 146° en los dedos y 44° en los pulgares (contralateral 174° y 62°). Resultados funcionales: excelentes en 9 casos, buenos en 10, y malo en 1 caso. Distancia promedio pulpejo-palma: 0,1 cm. Todos los pacientes manifestaron satisfacción con el resultado. Conclusiones: Las potenciales ventajas son que se trata de una técnica relativamente sencilla, que preserva las propiedades biomecánicas de la sutura dorsal, evita los problemas por cuerpo extraño y parece limitar el daño de la irrigación intratendinosa. Los resultados preliminares sugieren que esta nueva técnica con sutura reabsorbible combinada con movilización activa y pasiva precoz representaría un método seguro y eficaz para la reparación primaria de los tendones flexores en la ôzona críticaö de la mano (AU)

Achilles tendon rupture: avoiding tendon lengthening during surgical repair and rehabilitation.

Achilles tendon rupture is a serious injury for which the best treatment is still controversial. Its primary goal should be to restore normal length and tension, thus obtaining an optimal function. Tendon elongation correlates significantly with clinical outcome; lengthening is an important cause of morbidity and may produce permanent functional impairment. In this article, we review all factors that may influence the repair, including the type of surgical technique, suture material, and rehabilitation program, among many others.

Reconstrução coracoclavicular com enxerto tendíneo na luxação acromioclavicular crônica / Coracoclavicular reconstruction using tendinous graft for chronic acromioclavicular joint dislocation

OBJETIVO: Apresentar os resultados radiográficos e funcionais de pacientes submetidos ao tratamento da luxação acromioclavicular crônica com reconstrução dos ligamentos coracoclaviculares com enxerto de tendão semitendíneo. MÉTODO: Quinze pacientes, entre abril de 2007 e junho de 2008, foram submetidos a reconstrução dos ligamentos coracoclaviculares com enxerto tendíneo. Dois pacientes foram excluídos do estudo por seguimento inadequado. Treze pacientes foram seguidos clinicamente e radiograficamente, em média, por 16 meses (12-26 meses). Os pacientes foram submetidos a avaliação clinica pré e pós-operatória, utilizando os escores Constant e UCLA. Radiografias pré e pós-operatórias foram comparadas. RESULTADOS: Neste grupo de 13 pacientes com seguimento mínimo de um ano, o escore Constant variou de 60,9 (26-88) na avaliação pré-operatória para 87 (60-98) na última avaliação no período pós-operatório. O escore UCLA foi de 16,8 (11-27) no pré operatório para 33 (29-35) na avaliação pós-operatória (p=0,001). No controle radiográfico com um ano de pós-operatório, encontramos 12 pacientes (92 por cento) com a distância coracoclavicular igual comparando o ombro operado ao contralateral. Todos os ombros operados apresentavam-se sem translação na direção antero-posterior no perfil axilar. CONCLUSÃO: O resultado funcional e radiográfico foi muito satisfatório nos pacientes submetidos à reconstrução das luxações acromioclaviculares crônicas, com baixo indice de recidiva. Nivel de Evidência IV, série de casos.

OBJECTIVE: The aim of this study is to present the radiographic and functional results of patients undergoing treatment for chronic acromioclavicular dislocation with coracoclavicular ligament reconstruction using tendon graft. METHOD: Between 2007 and 2008, fifteen patients with chronic Rockwood type III through V acromioclavicular joint dislocations underwent reconstruction of the coracoclavicular ligaments using semitendinosus tendon graft. Two patients were excluded due to inadequate follow up. Thirteen patients were followed up clinically and radiographically after a mean of 16 months (range 12-26 months). Clinical evaluation was performed using the UCLA and Constant scores. Preoperative and postoperative radiographs were compared. RESULTS: In this group of 13 patients followed up for at least one year, the Constant score ranged from 60.9 (26-88) in the preoperative evaluation to 87 (60-98) at the last evaluation during the postoperative period (p< .001). The mean UCLA score improved from 16.8 points (11-27) to 33 (29-35) points. (p=0.001). After 1 year of follow-up, the postoperative radiographic control showed twelve patients (92 percent) with equal coracoclavicular distance between the affected and unaffected shoulders. No anteroposterior translation in the axial view was present in any of the shoulders operated on. CONCLUSION: The functional and radiographic results were very satisfactory in patients undergoing reconstruction of chronic acromioclavicular dislocations, with a low recurrence rate. Level of Evidence: Level IV, case series.

Reparación primaria de los tendones flexores en la zona II con una nueva técnica utilizando sutura reabsorbible y movilización activa temprana / Flexor tendon repair in zone II with a new technique using absorbable suture and early active mobilization

Introducción: El objetivo del presente trabajo es describir una nueva técnica de reparación primaria de los tendones flexores con material reabsorbible combinada con movilización activa y pasiva temprana. Materiales y métodos: Se evaluaron retrospectivamente 19 pacientes (13 dedos, 7 pulgares) con sección del tendón flexor profundo (zona II) o del flexor largo (zona II-III). Edad promedio: 36 años. Tenorrafia: sutura central de cuatro bandas con dos puntos de Kessler en posición vertical y sutura periférica utilizando material de polidioxanona, rehabilitados con movilización precoz activa y pasiva. Se evaluó el arco total de movilidad (ATM) comparativamente y la distancia pulpejo-palma. Los resultados se clasificaron de acuerdo con la fórmula de Strickland-Glogovac en los dedos y el sistema de Buck-Gramcko en los pulgares. Resultados: El tiempo de seguimiento promedio fue de 23 meses (7 a 47 meses). Hubo un caso de rerrotura. El ATM promedio fue de 146° en los dedos y 44° en los pulgares (contralateral 174° y 62°). Resultados funcionales: excelentes en 9 casos, buenos en 10, y malo en 1 caso. Distancia promedio pulpejo-palma: 0,1 cm. Todos los pacientes manifestaron satisfacción con el resultado. Conclusiones: Las potenciales ventajas son que se trata de una técnica relativamente sencilla, que preserva las propiedades biomecánicas de la sutura dorsal, evita los problemas por cuerpo extraño y parece limitar el daño de la irrigación intratendinosa. Los resultados preliminares sugieren que esta nueva técnica con sutura reabsorbible combinada con movilización activa y pasiva precoz representaría un método seguro y eficaz para la reparación primaria de los tendones flexores en la “zona crítica” de la mano.

Enfrentamiento quirúrgico de las lesiones del tendón de biceps distal / Surgical approach in distal biceps tendon lesions

Surgical treatment of distal biceps tendon ruptures is indicated in active patients, and its aim is to recover mainly the supination strength, and flexion secondarily, focusing the controversy on its approach and fixation systems. Objective: To present a patients series results operated on for this injury, with different surgical techniques. Methods: Ten patients were evaluated retrospectively analyzing descriptively: age, evolution time, approach and fixation types, grafts use, functional and satisfaction outcome, and complications. Results: It was considered excellent in all patients, despite the use of different types of fixation and approaches, either in acute or chronic, with few complications. Conclusion: According to our results, and the literature review, it can be obtained excellent functional results, with different approaches and fixation systems, allowing an early rehabilitation.

El tratamiento quirúrgico en las roturas del tendón de bíceps distal se indica en pacientes activos, e intenta recuperar principalmente la fuerza de supinación, y secundariamente de flexión, centrando la controversia en su abordaje y sistemas de fijación. Objetivo: Presentar los resultados en una serie de pacientes operados de esta lesión, con diferentes técnicas quirúrgicas. Métodos: Se evalúan retrospectivamente diez pacientes, analizando descriptivamente edad, tiempo de evolución, tipo de abordaje y fijaciones, uso de injertos, resultados funcionales, grado de satisfacción, y complicaciones. Resultados: Fueron considerados excelentes en todos los pacientes, a pesar del uso de distintos tipos de fijación y abordajes, en roturas agudas y crónicas, con escasas complicaciones. Conclusión: De acuerdo a lo presentado, y acorde a la literatura revisada, se pueden obtener excelentes resultados funcionales, con diferentes abordajes y sistemas de fijación, que permitan una rehabilitación precoz.

Restabelecimento funcional do tendão extensor digital longo submetido a ressecção parcial em equinos: observação macroscópica, histopatológica e ultra-sonográfica / Functional restoration of the long digital extensor tendon in horses after parcial tenectomy: gross, histopathologycal and ultrasonographic evaluation

Objetivou-se estudar os aspectos macroscópicos, ultra-sonográficos e histopatológicos do tecido neoformado no local da ressecção parcial do tendão extensor digital longo em 10 eqüinos, no momento do restabelecimento funcional do membro com o animal em locomoção à passo. O exame macroscópico foi realizado a cada 48 horas, o planimétrico das feridas a cada 10 dias, o ultra-sonográfico a cada 15 dias e o histopatológico no final do experimento. As feridas mostraram tecido de granulação em retração e exuberante, sem epitelização total, com aspectos ultra-sonográficos desorganizados diferentes do tendão íntegro e os exames histopatológicos revelaram tecido cicatricial em formação. O restabelecimento funcional médio foi de 45,9 dias, com o tecido neoformado na região da tenectomia permitindo o restabelecimento funcional do membro operado.(AU)

The objective of this work was to study the macroscopic, ultrasonographic and histopathologic aspects from the newly formed cicatricial tissue at the site of the partial resection of the long digital extensor tendon in 10 equines at the moment of functional restoration of the limb with the animal in walk locomotion. The macroscopic exam was performed every 48 hours, the planimetric mensuration every 10 days, the ultrasonographic exam every 15 days and the histopathologyc exam at the end of the study. The wounds showed granulation tissue in retraction, without total lesion epithelization, and the aspects ultrasonographics revealed wound healing with newly formed tissues with variable density and high neovascularization without tendon structural reorganization. The histopathology showed newly formed vascularized tissue, with leukocytic infiltrate and collagenous deposition without full epithelization. The cicatrization tissue formed in the resection region of the tendon, immature and without the structural organization of the normal tendon, showed to be able to functional restoration of the operated limb.(AU)

Restabelecimento funcional do tendão extensor digital longo submetido a ressecção parcial em equinos: observação macroscópica, histopatológica e ultra-sonográfica / Functional restoration of the long digital extensor tendon in horses after partial tenectomy: gross, histopathologycal and ultrasonographic evaluation

Objetivou-se estudar os aspectos macroscópicos, ultra-sonográficos e histopatológicos do tecido neoformado no local da ressecção parcial do tendão extensor digital longo em 10 eqüinos, no momento do restabelecimento funcional do membro com o animal em locomoção à passo. O exame macroscópico foi realizado a cada 48 horas, o planimétrico das feridas a cada 10 dias, o ultra-sonográfico a cada 15 dias e o histopatológico no final do experimento. As feridas mostraram tecido de granulação em retração e exuberante, sem epitelização total, com aspectos ultra-sonográficos desorganizados diferentes do tendão íntegro e os exames histopatológicos revelaram tecido cicatricial em formação. O restabelecimento funcional médio foi de 45,9 dias, com o tecido neoformado na região da tenectomia permitindo o restabelecimento funcional do membro operado.

The objective of this work was to study the macroscopic, ultrasonographic and histopathologic aspects from the newly formed cicatricial tissue at the site of the partial resection of the long digital extensor tendon in 10 equines at the moment of functional restoration of the limb with the animal in walk locomotion. The macroscopic exam was performed every 48 hours, the planimetric mensuration every 10 days, the ultrasonographic exam every 15 days and the histopathologyc exam at the end of the study. The wounds showed granulation tissue in retraction, without total lesion epithelization, and the aspects ultrasonographics revealed wound healing with newly formed tissues with variable density and high neovascularization without tendon structural reorganization. The histopathology showed newly formed vascularized tissue, with leukocytic infiltrate and collagenous deposition without full epithelization. The cicatrization tissue formed in the resection region of the tendon, immature and without the structural organization of the normal tendon, showed to be able to functional restoration of the operated limb.

Propriedades da poliuretana derivada do óleo da mamona associada a fios de poliéster para uso em implante de tendões flexores da mão / Properties of castor-oil derived polyurethane associated to polyester threads in view of its use as hand tendon implants

Com vistas a seu emprego na confecção de implantes de tendões flexores para a mão, foi realizado um estudo das propriedades mecânicas da poliuretana elastomérica derivada do óleo da mamoma, associada a fios de poliéster. Corpos de prova foram recortados de placas de poliuretana.

In view of its use in implants of hand flexor tendons, this study evaluated the mechanical properties of elastomeric polyurethane derived from castor oil associated to polyester threads. Dum-bell shaped specimens were cut out from polyurethane plaques obtained by polymerizarion...

Early active mobilization after flexor tendon repairs in zone two.

INTRODUCTION: This study aims to evaluate an early mobilization regimen after 136 flexor tendon repairs in zone two in 82 patients. METHOD: Postoperatively patients were managed by an early mobilization program, which incorporated immediate active flexion and extension. Results are based on both the International Federation of Societies for Surgery of the Hand (IFSSH) and the Strickland systems of evaluation. The results of long fingers and thumbs were analyzed separately. RESULTS: The results of the long fingers group were excellent (72.2%), good (26.0%) and fair (1.9%) according to Strickland's standards and were good (81.5%), fair (16.6%) and poor (1.9%) according to the IFSSH standards. The results of the thumbs group were excellent (96.4%) and fair (3.6%) according to Strickland's standards and were excellent (82.1%), good (14.3%) and poor (3.6%) according to the IFSSH standards. CONCLUSION: This study corroborates evidence that postoperative programs that incorporate early active flexion can produce good results after flexor tendon repair in zone two.