OBJECTIVETo explore the operative technique of repair and its curative effect of old rupture of the Achilles tendon with flexor digitorum (hallucis)longus tendon transfer.

METHODSFrom Nov 2001 to May 2005, 13 patients who had old rupture of the Achilles tendon were treated with this operative technique. Five of them were treated with flexor digitorum longus tendon transfer and 8 with flexor hallucis longus tendon. All patients had the history of closed injury of Achilles tendon(9 male and 4 female, 8 left feet and 5 right feet). The age ranged from 32 to 69 years(mean 41 years).

OPERATIVE TECHNIQUEflexor digitorum (hallucis)longus tendon was cut down alternatively. The distal end of flexor digitorum longus tendon should be sutured to flexor hallucis longus tendon if the flexor digitorum longus tendon was cut. The distal end of flexor hallucis longus tendon should be sutured to flexor digitorum longus tendon if the flexor hallucis longus tendon was cut. The proximal end of tendon to be cut down was sew up a suture line and pulled out from the incision to reveal the Achilles tendon. A transverse hole was drilled through the anterior aspect of the insertion of the tendon of the calcareous, and then drilled upward perpendicularly. The two holes were cross-connected by towel clamp. The flexor digitorum (hallucis)longus tendon to be transferred was pulled through the first hole from wall outward and upward, and then pulled through superior extremity of the second hole. The end of tendon was sutured firmly with the Achilles tendon.

RESULTSAll patients have no infection or re-rupture during follow-up (average 24 months;range 11 to 54 months). There was no subsequent hammer-toe deformity. Dorsiflexion at least to neutral and normal plantar flexion were obtained in all patients. According to Arner-Lindholm standard,the final results were excellent in 9 patients(6 cases were used flexor hallucis langus tendon, and 3 cases were used flexor digitorum longus tendon),good in 3 patients(2 cases were used flexor hallucis longus tendon and 1 case was used flexor digitorum longus tendon) and poor in 1 patient used with flexor digitorum longus tendon.

CONCLUSIONThe repair of old rupture of the Achilles tendon with flexor digitorum (hallucis) longus tendon transfer is an ideal and effective method. Furthermore, the use of flexor hallucis longus muscle tendon tends to be more reasonable.

Achilles Tendon ; injuries ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Rupture ; Tendon Transfer ; methods

The hand is an organ of both motion and sensibility. Motion is necessary for the highly adaptive functions of pinch, grasp, and hook. When a major muscle is paralyzed, the balance of the hand is disrupted. The objective of reconstructive procedure is to achieve a limited but balanced functional performance by means of redistributing assets rather than creating new motor and sensory units. Among the variable methods of treatment, the tendon transfer is a useful method in restoring the lost functions of the paralyzed hand. Authors reviewed 3 cases of paralyzed hands: the first one had an impairment of the opposition and flexion of the thumb caused by brachial plexus injury; the second one had an adducted thumb and a flexion contracture of the index and middle fingers due to a severe compression injury to forearm; the third one was a quadriplegics due to the C5-6 fracture-dislocation, but fortunately had a function of active flexion in ring and little fingers. They were treated by Omer's technique plus other reconstructive procedures for the paralysis at the Department of Orthopaedics, Catholic Medical Center from 1978 to 1981. By this procedure gratifying results such as restoration of pinching and grasping function were obtained.
Brachial Plexus ; Contracture ; Fingers ; Forearm ; Hand Strength ; Hand ; Methods ; Muscles ; Paralysis ; Tendon Transfer ; Thumb

A clinical review was performed of 11 cases of traumatic foot treated by tendon transfer at Severance Hospital during the period from April 1979 to March 1988 and the results are summarized as follows: l. Among 11 patient, there were 8 males and 3 females, ranging from 4 to 36 years of age. 2. Anterior tibial tendon was used in 6 cases, among these, split anterior tibial tendon was used in 3 cases. Posterior tibial tendon was used in 2 cases and extensor digitorum longus tendon of the foot in 3 cases. 3. In cases of soft tissue injury where tendon transfer was impossible, microvascular free cutaneous flap transplantation was combined with the tendon transfer in 6 cases. 4. Follow-up results of the 11 cases were obtained from 5 months to 9 years. Excellent results were obtained in 8 cases and satisfactory in 3 cases. For the correction of function loss in traumatic foot, tendon transfers were useful method for the recovery of active motion of the foot.
Female ; Follow-Up Studies ; Foot ; Humans ; Male ; Methods ; Soft Tissue Injuries ; Tendon Transfer ; Tendons

PURPOSE: To report an effect of the full tendon transposition augmented with posterior intermuscular suture and recession-resection surgery, for the patient with monocular elevation deficiency (MED) and large exotropia. METHODS: Interventional case report. Full tendon transposition augmented with posterior intermuscular suture and recession-resection surgery was performed for a 26-year-old male patient had monocular elevation deficiency (MED) and large exotropia. RESULTS: Preoperative angle of deviation was 56 prism diopters (PD) hypotropia and 45 PD right exotropia, compared with 18 PD left hypertropia and 10 PD right esotropia postoperatively. Essotropia persisted after 2.5 years, however, and so the right medial rectus was recessed after removal of the previous posterior intermuscular suture. At a three-year follow-up after the second surgery, alignment was straight in the primary position at near and far distances. CONCLUSIONS: Full tendon transposition augmented with posterior intermuscular suture and recession-resection surgery was effective for a patient with MED associated with significant horizontal deviation, and a second operation was easily performed when overcorrection occurred.
Tendon Transfer/*methods ; *Suture Techniques ; Oculomotor Muscles/physiopathology/*surgery ; Male ; Humans ; Follow-Up Studies ; Eye Movements ; Exotropia/physiopathology/*surgery ; Adult

Paralytic hand is the ultimate result of permsnent damage of the central nervous system, failure of the functional repair of peripheral nerve injuries and extensive muscular or tendinous defect resulting in the impairment of hand function. There are a lot of controversies in the side of treatment methods in the paralytic hand, and it is very difficult to formulate the most adequate surgical reconstruction for a given pstient. At Depsrtment of Orthopedic Surgery, Seoul National University Hospital, 66 cases oi paralytic hands in 62 patients have been treated surgically with tendon transfers for 7 years from Jan, 1980 to Dec, 1986. 49 case in 46 patients were followed up for more than one year, and surgical method and its results were anslysed. They consist of CNS lesion (17), peripheral nerve lesion(23) and musulotenidinous defect(9). The methods of surgical reconstruction were opponenesplasty(12), standard set extensor reconstruction(9), Green and Bsnks FCU transfer(11), intrinsic reconstruction(7), pronator rerouting(7), adductorplasty (5) and so on. The mean follow-up was 2.2 years, and in 38 cases good or excellent results were obtained.
Central Nervous System ; Follow-Up Studies ; Hand ; Humans ; Methods ; Orthopedics ; Peripheral Nerve Injuries ; Peripheral Nerves ; Seoul ; Tendon Transfer

Loss of radial nerve function in the hand results in a significant disability and so cannot extend the wrist, thumb & fingers according to the injury levels. Therefore the patient has great difficulty in grasping objects, especially power grip. Tendon transfers to restore function of extension of wrist and fingers are among the the best − most predictable transfers in the upper extremity. We performed 13 cases of tendon transfers for radial nerve palsy and extensive extensor ruptures from 1987 to 1993. The results were evaluated according to Arbitrary Value Method. Among 13 cases 30% of excellent, 46% of good, 24% of fair and no poor result were obtained and the better results were obtatined in low radial nerve lesion.
Fingers ; Hand ; Hand Strength ; Humans ; Methods ; Paralysis ; Radial Nerve ; Radial Neuropathy ; Rupture ; Tendon Transfer ; Tendons ; Thumb ; Upper Extremity ; Wrist

OBJECTIVETo explore the clinical effect of interference screw and flexor hallucis longus tendon as augmentation material in repair of chronic Achilles tendon rupture.

METHODSFrom September 2010 to June 2012,26 patients with chronic Achilles tendon rupture were treated, including 18 males and 8 females with an average age of 44.2 years old (20 to 66 years old). All patients were unilateral damage. MRI showed the Achilles tendon.ends' distance was 6.0 to 9.0 cm. The postoperative complications were observed. The curative effect was assessed by American Orthopedic Foot and Ankle Society and Leppilahti score.

RESULTSAll the 26 patients were followed up for 18 to 68 months (means 30.4 months). No neurological injury and infection of incision occurred, all patients were stage I incision healing. The shape and function of the ankle were recovered well. The average AOFAS score increased from 52.27±12.30 preoperatively to 90.92±6.36 postoperatively. Leppilahti Achilles Tendon Repair score increased from 34.23±12.86 preoperatively to 90.00±5.10 postoperatively.

CONCLUSIONThe flexor hallucis tendon transfer with an interference screw technique for repairing the chronic Achilles tendon rupture of type IV of Kuwada had advantages of simple operation, quick recovery, firm tendon fixation, and less complications.

Achilles Tendon ; injuries ; physiopathology ; surgery ; Adult ; Bone Screws ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Range of Motion, Articular ; Reconstructive Surgical Procedures ; instrumentation ; methods ; Rupture ; physiopathology ; surgery ; Tendon Injuries ; physiopathology ; surgery ; Tendon Transfer ; Treatment Outcome ; Young Adult

Tendon surgery is unique because it should ensure tendon gliding after surgery. Tendon surgery now can be performed under local anesthesia without tourniquet, by injecting epinephrine mixed with lidocaine, to achieve vasoconstriction in the area of surgery. This method allows the tendon to move actively during surgery to test tendon function intraoperatively and to ensure the tendon is properly repaired before leaving the operating table. I applied this method to primary flexor tendon repair in zone 1 or 2, tenolysis, and tendon transfer, and found this approach makes tendon surgery easier and more reliable. This article describes the method that I have used for tendon surgery.
Anesthetics, Local/administration & dosage/therapeutic use ; Epinephrine/administration & dosage/therapeutic use ; Humans ; Range of Motion, Articular ; Suture Techniques ; *Tendon Injuries/rehabilitation/surgery ; Tendon Transfer/*methods ; Tendons/*surgery ; Vasoconstrictor Agents/administration & dosage/therapeutic use

BACKGROUNDRecurrence of hallux valgus is considered to be the most common problem experienced postoperatively. We designed and carried out operations to correct hallux valgus by transferring the extensor hallucis longus (EHL) tendon to reduce the likelihood of recurrence.

METHODSTwenty-five patients (38 feet) with the average age of (46.3 ± 12.3) (range, 22 to 60) years underwent the operation. The American Orthopaedic Foot and Ankle Society score and weight-bearing radiographs of the foot were applied to assess the feet pre- and postoperatively with a mean duration of follow-up of (38.2 ± 3.2) months. The surgical procedure includes the release of the distal soft tissues, excision of the medial eminence, plication of the medial part of the capsule, and transfer of the EHL tendon, and reconstructing its insertion.

RESULTSAt follow-up, 35 feet (23 patients, 85%) were free from pain at the first metatarsophalangeal (MTP) joint. In three feet (two patients), the pain was alleviated but persisted. The mean hallux valgus angle decreased significantly from a preoperative 38.3° ± 8.0° to 7.3° ± 2.0° at the time of the most recent follow-up (P < 0.0001), and the mean intermetatarsal (IM) angle decreased significantly from preoperative 12.5° ± 3.4° to postoperative 6.5° ± 2.4° (P < 0.0001). The mean score according to the American Orthopaedic Foot and Ankle Society had increased from 46.5 to 84.8 points (P < 0.0001).

CONCLUSIONSHallux valgus can be corrected by transferring the EHL tendon medially and reconstructing its insertion. The technique can achieve stress balance of metatarsophalangeal joints and therefore prevent the recurrence of hallux valgus.

Adult ; Female ; Follow-Up Studies ; Hallux Valgus ; etiology ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Tendon Transfer ; methods ; Treatment Outcome ; Young Adult

In this case series study, we assessed the effects of recession-resection surgery augmented with botulinum toxin A chemodenervation for patients with chronic paralytic horizontal strabismus. In addition, we compared these effects with those of full tendon transposition (FTT) augmented with posterior intermuscular suture (PIMS). Ten patients who underwent strabismus surgery due to paralytic horizontal strabismus were retrospectively reviewed. They received a recession-resection surgery augmented with botulinum toxin A chemodenervation (type I surgery) or a FTT augmented with PIMS (type II surgery). The preoperative angle of deviation (AOD) and postoperative improvement in AOD were compared according to the type of procedure. The preoperative AOD was 60.00 +/- 28.50 prism diopters (PD) for type I surgery and 68.00 +/- 27.06 PD for type II (p = 0.421). Improvement in AOD was 53.20 +/- 25.01 PD for type I surgery and 44.20 +/- 18.74 PD for type II (p = 0.548). Recession-resection surgery augmented with botulinum toxin A chemodenervation is a concise and effective procedure for treating paralytic horizontal strabismus.
Adolescent ; Botulinum Toxins, Type A/*therapeutic use ; Humans ; Male ; Middle Aged ; Nerve Block/*methods ; Neuromuscular Agents/*therapeutic use ; Oculomotor Muscles/*transplantation ; Ophthalmologic Surgical Procedures/*methods ; Strabismus/etiology/*therapy ; Suture Techniques ; Tendon Transfer/*methods