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

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

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

BACKGROUNDThe medial plica may be caused by direct trauma or joint degeneration, which also could be iatrogenic. There have been few reports in the literature discussing incidence of the medial plica caused by an operation on the knee joint, specifically after the reconstruction of anterior cruciate ligament (ACL). In this study, we aimed to evaluate and analyze the relationship between the incidence of the medial plica and reconstruction of the ACL.

METHODSA retrospective case series study was conducted to review the findings of 1085 patients between 2003 and 2007, who underwent second-look arthroscopy after reconstruction of the ACL (between 2002 and 2006). The correlation of the incidence of medial plica with the stability of the knee joint, the time from onset of injury to reconstruction surgery, the associated injuries, and the rate of progress during postoperative rehabilitation were analyzed.

RESULTSWe found that 722 patients had the structure of a medial plica. The incidence after reconstruction of the anterior cruciate ligament (66.5%) was significantly higher than usually reported. All these medial plica had avascular fibrotic and thickened edges. An excision of pathologic medial plica and fat pad synovial fringes were done. The incidences were significantly different between the two groups with their reconstruction operation time, from onset of injury to surgery (less than one month or over 2 years), and the progress rate of postoperative rehabilitation (knee flexion could not be over 90 degrees in four weeks). The incidence was not different between the groups with knee stable conditions.

CONCLUSIONSMedial plica is more common in patients after reconstruction of ACL. More associated injuries and more rehabilitation difficulties can increase the medial plica incidence.

Adolescent ; Adult ; Anterior Cruciate Ligament ; surgery ; Female ; Humans ; Joint Diseases ; etiology ; pathology ; Knee Joint ; pathology ; surgery ; Male ; Middle Aged ; Patella ; pathology ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Tendon Transfer ; methods ; Treatment Outcome ; Young Adult

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

PURPOSE: To evaluate the effect of transposition procedures on the vertical rectus muscle (VRM) in the patients who underwent a medial rectus muscle (MR) transection after endoscopic sinus surgery (ESS). METHODS: In 4 patients with exotropia (XT) and a lack of adduction after ESS, orbital CT or MRI revealed a complete transection of the midportion of the MR. Full-tendon VRM transposition was performed within 3 months after injury (early surgery) in 2 patients with 40delta XT. Two patients with 70delta and 85delta XT underwent an X-type augmented Hummelsheim procedure, which involved pulling each half-tendon and crossing it through the undersurface of the severed MR to the other end of the MR insertion, concurrently with an ipsilateral lateral rectus (LR) recession 11 months and 36 months after ESS, respectively. The adduction deficits were divided into -1 through to -8. The patients were followed up for more than than 1.5 years. RESULTS: Postoperatively, 3 patients showed orthophoria and no diplopia in the primary position. The adduction deficits improved to -3.5 or -4. One patient who underwent an X-type augmented Hummelsheim procedure showed a residual XT of 25delta. CONCLUSIONS: VRM transposition is effective in correcting a large XT secondary to a MR transection after ESS. When a longstanding large-angle XT with severe contracture of the ipsilateral LR and massive scarring of the adjacent tissues is present, the X-type augmented Hummelsheim procedure coupled with an ipsilateral LR recession had an augmenting effect.
Adult ; Aged ; Endoscopy/*adverse effects ; Exotropia/diagnosis/etiology/*surgery ; Eye Movements ; Female ; Humans ; *Iatrogenic Disease ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Oculomotor Muscles/injuries/pathology/*surgery ; Paranasal Sinus Diseases/*surgery ; Tendon Transfer/*methods ; Tomography, X-Ray Computed ; Vision, Binocular

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

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

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