Tendon Plasty Research Articles

Optimisation of methods of diagnosis and correction of heel foot in children with cerebral palsy

The main cause of heel foot is muscle imbalance due to dysfunction of the triceps femoris muscle. Literature data indicate the need to study issues related to changes in the anatomy and function of the foot flexor muscles and calcaneus and to determine indications for optimal methods of correction of heel foot. Purpose - to study the anatomical and functional changes in the calf muscle and bones in children with heel foot to determine the optimal methods of diagnosis and correction of deformity. Materials and methods. We analysed the results obtained during the treatment of 14 patients (28 cases) aged 11 to 17 years with cerebral palsy complicated by calcaneal foot formation. Two groups were formed: the main group of 6 patients (12 cases), in which posterior calcaneal osteotomy with Achilles tendon plasty and transposition of the tibialis anterior tendon was performed; the comparison group of 8 patients (16 cases), in which only soft tissue surgery was performed. The comparative group was divided into 2 subgroups, which differed in radiological parameters of Bohler and Kite Danilov angles: the subgroup A - 3 patients (6 cases), the subgroup B - 5 patients (10 cases). Clinical and radiological methods were used to examine patients. Results. The structure and shape of the calcaneus change in the presence of heel foot, which leads to changes in the Danilov angle and the angles between the trabecular lines. Correction of the shape of the calcaneus is a prerequisite for creating optimal biomechanical gait conditions. Transplantation of the tibialis anterior tendon eliminates the pathological effect of its retraction; achilloplasty eliminates the functional deficiency of the triceps tendon. Conclusions. The results of surgical correction on soft tissues showed effectiveness at Bohler, Kite <35⁰, Danilov <40⁰ angles. At higher values, it is necessary to supplement the intervention with a posterior calcaneal osteotomy. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committees of all institutions participating in the study. Informed consent was obtained from the patients. No conflict of interests was declared by the authors.

Emergency reconstruction of extensor terminal slip defect by tendon plasty

IntroductionWe report our experience with a tendon plasty technique to reconstruct extensor terminal slip defect, with results in 11 patients. Material and methodsThe technique was proposed to 11 patients with mean tendon defects of 6 mm. Mean follow-up was 10.6 months. Clinical assessment comprised active distal interphalangeal (DIP) range of motion, active DIP extension and spontaneous DIP extension deficit. ResultsMean range of motion was 50°. Active extension was restored in all cases. There was a mean 11° spontaneous DIP extension deficit. DiscussionThe present results confirmed those in the literature for this type of tendon plasty. As well as these encouraging outcomes, the technique has the advantage of being simple, with low morbidity thanks to remote harvesting.

Posterolateral Rotational Knee Instability: Evolution and Current Trends in Surgical Treatment

Background. Diagnostics and treatment of patients with chronic posterior and posterolateral instability of the knee is one of the most understudied problems of modern orthopedics. This is due to rather low frequency of this pathology, as well as to complex anatomy of tendoligamentous structures of the posterolateral part of the knee joint. Steadily increasing number of foreign publications dedicated to this topic say that there is no common approach to the tactics of surgical treatment of patients of this category at the moment.
 Aim of review to evaluate the main trends of surgical treatment of this pathology according to the stage of involvement of various anatomical structures responsible for posterolateral rotational instability in the pathologic process.
 Results. Despite a large number of methods of surgical treatment of posterolateral corner injuries, when analyzing modern publications, several main trends concerning posterolateral instability of the knee joint can be identified. In case of type 1 posterolateral instability, an isolated arthroscopic posterior cruciate ligament plasty is the most optimal. As for types 3 and 4, today such anatomical techniques as Larson and LaPrade have completely replaced the methods of non-anatomical reconstruction of the posterolateral corner. In addition, a large number of publications have recently appeared concerning arthroscopic techniques of these surgeries. The most important problem concerns the extent and the methods of surgical intervention in case of type 2 instability. Authors of the article consider that an arthroscopic posterior cruciate ligament plasty combined with popliteal tendon plasty is the most optimal for such category of patients.
 Conclusion. The actual problem is the question of the method of surgical treatment in case of type 2 instability. The optimal technique for such patients is arthroscopic posterior cruciate ligament plasty combined with popliteal tendon plasty.

Which Tendon Plasty Has the Best Outcome? A Comparison of Four Tendon Plasty Techniques in a Large Cohort of Patients with Symptomatic Trapeziometacarpal Osteoarthritis.

Trapeziometacarpal osteoarthritis is commonly treated with a trapeziectomy combined with a form of tendon plasty. The type of tendon plasty used is based on the surgeon's preference. The purpose of this observational study was to compare the outcomes of four different tendon plasties combined with trapeziectomy used to treat osteoarthritis of the trapeziometacarpal joint: the Weilby, Burton-Pellegrini, Zancolli, and anchovy plasty procedures. Patients treated with a trapeziectomy followed by a tendon plasty completed patient-reported outcome measures at baseline and 12 months postoperatively. The primary outcome was the Michigan Hand Outcomes Questionnaire pain subscale. Secondary outcomes were the minimal clinically important difference of Michigan Hand Outcomes Questionnaire pain scale score, Michigan Hand Outcomes Questionnaire hand function, satisfaction, and complication rate. Seven hundred ninety-three patients underwent a trapeziectomy with a tendon plasty between November of 2013 and December of 2018. There was no difference in pain score after 12 months between the four tendon plasty techniques. Patients undergoing an anchovy plasty had a higher chance of reaching the minimal clinically important difference for Michigan Hand Outcomes Questionnaire pain score compared to the other techniques (OR, 2.3; 95 percent CI, 1.2 to 4.6). Overall, more than 80 percent of the patients were satisfied with the treatment outcome, independent of which technique was used. Complication rates of the different techniques were similar. Surgical treatment of osteoarthritis of the trapeziometacarpal joint reduced pain after 12 months, independent of which tendon plasty was used. Patients undergoing an anchovy plasty were more likely to experience a clinically relevant improvement in pain while having similar hand function, satisfaction, and complication rates. This suggests that anchovy plasty is the preferred tendon plasty. Therapeutic, III.

Anatomic Reconstruction of the Triangular Fibrocartilage Complex for the Treatment of Chronic Instability of the Distal Radioulnar Joint. A Systematic Review

Abstract Introduction Peripheral injuries of the triangular fibrocartilage complex (TFCC) can produce pain and instability of the distal radioulnar joint (DRUJ). There are several techniques for the reconstruction of the TFCC. The aim of the present paper was to summarize the tendon plasties of the DRUJ ligaments for the anatomic reconstruction of TFCC, to analyze the surgical techniques, and to evaluate their outcomes. Methods In order to perform a systematic review, we searched in the literature the terms DRUJ instability OR chronic distal radioulnar joint instability OR distal radioulnar tendon plasty. Results In total, 11 articles with level of evidence IV (case series) were retrieved. Most studies achieved good results, with recovery of wrist stability, improvement of the pain, and increase in grip strength in the functionality tests. In the historical evolution of the published series, wrist surgeons tried to perform a more anatomical plasty, with a more stable fixation and less invasive techniques. Conclusion The Adams procedure continues to be a valid and reproducible technique for the treatment of chronic DRUJ instability. If wrist arthroscopy and implants are available and surgeons have been technically trained, the authors recommend an arthroscopy-assisted technique, or, if possible, an all-arthroscopic TFCC reconstruction with implant fixation of the plasty in its anatomical points of insertion. Comparative studies between open and arthroscopic TFCC reconstruction techniques are needed.

Revision surgery after resection arthroplasty of the CMC-1 joint using the extensor carpi radialis longus muscle tendon

Resuspension of the first metacarpal bone using the extensor carpi radialis longus muscle tendon. Prevention of contact between the first metacarpal bone and adjacent bones (scaphoid, trapezoideum, second metacarpal bone). Preservation of motion. Pain after preceeding resectional arthroplasty due to proximalisation of the first ray. Radiologically demonstrated contact between the base of the first metacarpal bone and adjacent bones (scaphoid, trapezoideum, second metacarpal bone). Instability of the first ray at the site of the suspension. Proven specific reasons: neuropathical complaints and dysaesthesia in the region supplied by the superficial branch of the radial nerve, tendinitis of the flexor carpi radialis tendon etc. SURGICAL TECHNIQUE: Distalisation of the first ray after mobilisation and debridement at the base of the first metacarpal bone with resection of scar tissue, Resection of the pre-existing tendon plasty and contouring the base of the first metacarpal bone with removal of osteophytes. Interposition of tendon material between the base of the first and second metacarpal bones. Immobilisation in aforearm cast including the thumb metacarpophalangeal joint for 6weeks. Of 21patients treated using this procedure, 15(13women, 2men, average age 59(51-70)years) were evaluated retrospectively on average 4(2-10)years postoperatively. Opposition of the thumb was nearly normal. Grip strength and strength of pinch grip did not differ significantly from the contralateral side. Pain at rest and exercise (evaluated by avisual analogue scale from 0-10) was postoperatively significantly reduced. On plain X‑rays the distance between the base of the first metacarpal bone and the distal scaphoid pole was significantly increased as asign of asuccessful distalisation. Ultimately, 12patients postoperatively returned to work, 10to their original occupation. No patient required additional procedures.

Cervical intervertebral disc denervation during rotator cuff tendon plasty

Objective. To analyze the effect of denervation of intervertebral discs in the cervical spine on the results of surgical treatment of patients with injuries to rotator cuff tendons of the shoulder joint.Material and Methods. Study design: descriptive hypothesis-generating study. The study included patients requiring surgical treatment of rotator cuff tear. Two groups were identified: Group A included 28 patients who underwent plastic repair of rotator cuff tear with additional denervation of intervertebral discs, and Group B – 30 patients who underwent only plastic surgery for rotator cuff tear. The intensity of pain according to the VAS, functional activity due to neck pain (NDI), functionality of the shoulder joint (UCLA), and the degree of intervertebral disc degeneration according to MRI were assessed, and the effectiveness of treatment was determined. Statistical calculations were performed using the RStudio program.Results. In the group of patients with denervation of intervertebral discs, a more pronounced decrease in the intensity of pain syndrome at 3, 6, and 12 months (p < 0.001; p < 0.001; and p = 0.002), a more proportion of effectively treated patients at 3 months (p = 0.003), and significant increase in functional activity according to NDI at 3, 6 and 12 months of follow-up period (p < 0.001; p = 0.010; and p = 0.045) were observed.Conclusions. There is an underestimation of the role of degenerative cervical spine pathology in the occurrence of shoulder joint pain. In the case of rotation cuff plasty the additional denervation reduces the intensity of pain syndrome in the shoulder joint in the postoperative period.

A prospective study of bone-tendon-bone ACL reconstruction with and without lateral extra-articular tenodesis: 19-year clinical and radiological follow-up

ObjectivesAnterior cruciate ligament (ACL) arthroscopic reconstruction with a patellar tendon graft (BTB) is a well-known and reliable surgical option for control of anterior laxity, at short and middle term. Most of those patients are young and practice sports, often at high level. Few studies have evaluated the long term effects of ACL reconstruction, and more specifically lateral tenodesis, on knee function. It has been shown that chronic anterior instability, when left untreated, evolves towards femorotibial osteoarthritis in the 10 to 20 years after ACL rupture. This study aims to compare long-term survival and femorotibial arthritis between ACL reconstruction with and without lateral tenodesis.Methods121 consecutive knees (120 patients) presenting with an ACL rupture between 1998 and 1999 were included in this prospective randomized monocentric study. For the 61 knees in group BTB, an isolated patellar tendon plasty with outside-in technique was performed. For 60 knees in group BTB-T, the intra-articular plasty was associated with a lateral tenodesis with gracilis tendon. Patients were reviewed at 1 year, 6 years and 19 years post-operatively.Results80 patients were contacted with a minimum follow-up of 19 years. 43 patients had a clinical examination and the 37 other patients were evaluated through a telephone questionnaire. We had standard X-rays for 45 patients and laximetry (TELOS™) for 42 patients. 41 patients (34%) were lost to follow-up. 16 knees (20%) had experienced a graft failure, 5 of which had had an iterative ACL plasty. The difference between group BTB (27.5%) and group BTB-T (13.2%) concerning graft failure was not statistically significant (p = 0.38). 32 patients (71%) had femorotibial osteoarthritis (IKDC grade C or D). There was no difference between groups BTB and BTB-T concerning medial femorotibial osteoarthritis. Lateral femorotibial osteoarthritis was significantly increased in groupe BTB-T (59%) compared to group BTB (21%) and to the contralateral knee (5%). 36 patients (45%) had had a lateral or medial meniscectomy. Mean subjective IKDC score was 81.8/100, comparable between groups BTB and BTB-T. 67% still practiced pivot sports.ConclusionAt 19 years follow-up after patellar tendon ACL plasty, lateral tenodesis did not significantly improve graft survival in our study. Lateral femorotibial osteoarthritis was significantly increased in patients with a lateral tenodesis. However, a follow-up bias may be that lesions of the lateral meniscus were more frequent in BTB-T patients for whom we obtained X-rays. Functional scores were stable at over 80/100 and two thirds of patients still practiced pivot sports. ACL graft survival was 80% at 20 years follow-up.

All-Arthroscopic Triangular Fibrocartilage Complex Ligamentoplasty for Chronic DRUJ Instability.

Peripheral injuries of the triangular fibrocartilage complex can produce pain and instability of the distal radioulnar joint (DRUJ). There are several techniques for the repair or reconstruction of these injuries, which vary depending on the location, healing capacity, and viability of the tissues, as described by the classification proposed by Atzei. In irreparable chronic injuries of the triangular fibrocartilage complex in which there are no associated chondral injuries of the DRUJ or in failures in previous repair techniques, ligament reconstruction plasty with tendon grafts, either by open surgery or assisted by arthroscopy, are the treatments of choice. We present a completely arthroscopic reconstruction technique of the triangular fibrocartilage complex by means of tendon graft to provide stability to the DRUJ. This reconstruction technique provides a more stable reconstruction after the integration of the tendon plasty in the bone tunnels, based on the anatomic insertions of the triangular fibrocartilage in the fovea and in the corners of the dorsal and volar sigmoid notch, along with the advantages offered by arthroscopy in terms of recovery time, esthetic result, less mobility loss, and pain.

Mistakes and complications in the surgical treatment of ambulatory equino planovalgus foot deformities in patients with cerebral palsy using extra-articular subtalar arthrodesis

Aim.To evaluate the results of a modified technique for extra-articular arthrodesis of the subtalar joint for patients with cerebral palsy with an ambulatory form of equine-planovalgus deformity of the foot. The mistakes and complications that occurred during treatment with this technique are discussed.Materials and methods.Between 2005 and 2015, this surgical method for performing arthrodesis of the subtalar joint, was performed on 544 patients (989 feet) between 4 and 15 years old. Correction of equinus contracture was performed using Achilles tendon plasty or dissection of the tendon of the gastrocnemius muscle. Abnormal muscle tone was reduced either by administering Dysport® in the calf muscle or by selective neurotomy of the tibial nerve.Results. Good results were achieved for 72% of cases, satisfactory for 23% of cases, and unsatisfactory for 5% of cases. Unsatisfactory results of treatment were associated with overvaluation of the degree of mobility of the deformity and with a number of technical and tactical mistakes.Conclusion.This analysis of mistakes and complications of extra-articular arthrodesis of the subtalar joint will allow surgeons to avoid these issues in the future and improve the quality of treatment for similar patients.

Long-term Results of Chronic Achilles Tendon Ruptures Repaired With V-Y Tendon Plasty and Fascia Turndown.

This study aimed to evaluate the long-term follow-up results of V-Y tendon plasty with fascia turndown, for repairing chronic Achilles tendon ruptures. Seventeen patients (12 males, 5 females), who were diagnosed with chronic Achilles tendon rupture and met the inclusion criteria, were included in the study. These patients received treatment by means of V-Y tendon plasty with fascia turndown from January 1995 to December 2001. Clinical outcomes of the patients were assessed by using isokinetic strength testing, questioning the patient regarding residual discomfort, pain, or swelling and having the ability to perform heel rises and using American Orthopaedic Foot & Ankle Society's (AOFAS's) Ankle-Hind Foot Scale score. Mean follow-up duration was 16 years (13-18 years). Mean time from the injury to operative treatment was 7 months. Mean operative defect of Achilles tendon in neutral position after debridement was 6 cm. During the follow-up, the mean calf atrophy was 3.4 cm. The mean 30 degrees/s plantarflex and 120 degrees/s plantarflex peak torques were 89 and 45 Nm, respectively. The mean 30 degrees/s plantarflex peak torque deficiency was 16%. The mean 120 degrees/s plantarflex peak torque deficiency was 17%. The average peak torque deficiency was 17%. The pre- and postoperative mean AOFAS Ankle-Hindfoot Scale scores were 64 and 95, respectively. No patient had a rerupture. Superficial wound infection was treated with oral antibiotic therapy in 2 patients (11%). The V-Y tendon plasty with fascia turndown for repairing chronic Achilles tendon ruptures yielded results comparable with the literature regarding clinical outcomes. This method did not require synthetic materials for augmentation and was an economic alternative compared to other repair methods. Level III, retrospective comparative study.

Long-term clinical outcomes of combined BPTB ACL reconstruction and popliteus tendon plasty.

A deficiency of posterolateral structures significantly increases the varus load on the ACL, while a chronic ACL lesion, the increased tibial rotation and the repetitive non-physiological knee motion, could affect and damage the integrity of the popliteus tendon. Therefore, the aim of the present study was to report the very long clinical outcomes of a combined single-bundle BPTB ACL reconstruction and popliteus plasty according to Bousquets technique, for the treatment of combined chronic anterior and posterolateral laxities. Fifteen patients that underwent combined ACL reconstruction and popliteal plasty according to Bousquets technique were available at mean 26.8±1.0years (range 25.4-28.0years). All the patients were evaluated clinically and 13 by means of KT-1000 Arthrometer as well. Subjective evaluation was performed with the subjective IKDC, WOMAC and a 0-10 VAS for pain scales. At clinical evaluation, 10 patients (67%) presented a negative anterior drawer test; Lachman test was negative in nine patients (60%); the varus stress test was negative in eight (53%); and the dial test was negative in all but one patient (93%). Only two patients (15%) presented a side-to-side difference >5mm at the instrumented laxity evaluation. The combined single-bundle BPTB ACL reconstruction and popliteal plasty according to Bousquets technique were able to produce very good long-term results, in terms of knee stability, subjective outcomes, functional results and return to sport activity, in case of chronic anterior and posterolateral laxities. Retrospective case series, Level IV.

Medical tactic in hand polydactyly in children

Untimely correction of anomalies of fingers and hands or inefficiently performed reconstructive operations may affect the processes of adaptation of children to life. Objective: To improve outcomes in children with polydactyly by optimizing the methods of surgical correction of congenital hand pathology. Methods: During the period from 2000 to 2012 in 118 patients (70 boys, 48 girls, age to 6 years) with polydactyly there were performed 141 operations on 136 hands. There were 68 children with radial form of polydactyly, 17 with ulnar form, and 3 with central one. For establishment of the nature of the pathology examination with using of radiological, CT, and ultrasound dopplerography mapping was done. Results: In the case of the main finger deformity after removal of additional finger we performed corrective osteotomies, modeling resections of articular surfaces, and restored capsular-ligamentous apparatus. In cases of ulnar polydactyly with thickening of V metacarpal bone on the wide head of which there are two claw like little fingers we removed less developed one, cut off the abductor digiti minimi, restored lateral metacarpophalangeal ligament, fixed the muscle to the proximal phalanx, angular deformity of the V finger we eliminated by wedge osteotomy with K-wire fixation. In cases of central polydactyly after removal of extra finger we used created from a remote segment reserve of skin for closing the skin defect on lateral surfaces of the fingers with simultaneous correction of axial deformities. Long-term outcomes were followed up during the period of 1 to 10 years in 78 children: good results were obtained in 44 cases, satisfactory — in 27, and unsatisfactory — in 7 cases. Errors and complications: deviation of the main finger, nonunion of bone surfaces, scar deformities, limitation of movement. Conclusions: While choosing the method of surgery and duration of its execution one should establish the primary and the secondary fingers in cases of radial polydactyly. Zigzag incisions, rational skin, bone and tendon plasty allow to prevent the formation of scar contractures and secondary deformities of fingers and contribute to the restoration of the hand function.

Emergency repair of extensor tendon central slip defects with Oberlin's bypass technique: Feasibility and results in 4 cases with more than 5 years of follow-up

Treatment of soft tissues defects in the central slip of the extensor tendon at the proximal interphalangeal (PIP) joint is challenging because of the potential for stiffness and boutonniere deformity. The bypass procedure proposed by Oberlin for secondary injuries is an attractive solution. This salvage procedure uses a free tendon graft (palmaris longus) that is intercalated between the extensor indicis proprius muscle and the base of the middle phalanx. This study reports on the first cases of acute central slip defect treated in an emergency setting. Four patients with an average age of 37years (range 11–69) were treated by the same surgeon using the bypass procedure. Clinical evaluations consisted of measuring the active range of motion in the PIP joint, QuickDASH, Total Active Motion (TAM) and strength with a Jamar® dynamometer. All patients had reintegrated their injured finger into their body image within three months. At the last follow-up, the average active mobility was 0–5–76.5°. The functional outcomes were similar at nine months, with an average mobility of 0–13–72°. The two patients who were working at the time of injury were able to return to work in the third month. Various procedures such as tendon plasty, transfer or graft have been described in the literature for posttraumatic chronic boutonnière deformity. In cases where significant defects exist not only in the tendon, but the bone and skin, the bypass procedure is an effective approach to achieving satisfactory functional outcomes.

Elastic Stable Intramedullary Nailing (ESIN) of Pediatric Metacarpal Fractures: Experiences with 66 Cases

Elastic stable intramedullary nailing (ESIN) is the first-choice surgical technique for stabilizing various pediatric diaphyseal and selected metaphyseal fractures of the long bones. This technique has increasingly been applied in fractures of the small bones. Here, we report experiences with ESIN in displaced fractures of the metacarpals in children. Retrospective data analysis of metacarpal fractures in children stabilized by ESIN in three pediatric trauma centers between 2003 and 2009. Indication for intervention was total displacement or axial deviation >10 degrees in the frontal plane and/or >30 degrees in the sagittal view. A total of 66 cases of metacarpal fractures (51 right hand and 12 left hand) treated by ESIN were found in 63 children (mean age 13.3 years; range 4.0 to 16.1) over the study period. Of these, 55 fractures affected metacarpal 5, 6 fractures affected metacarpal 4, 3 fractures affected metacarpal 1, and 2 fractures occurred at metacarpal 2. Mean operating time was 21 minutes (range 5 to 54), titanium elastic nails were used with a diameter of 1.5 mm (n = 23), 2.0 mm (n = 42), and 2.5 mm (n = 1). Single ESIN implantation was performed in 63 cases; in 3 cases, two nails were implanted. Eleven patients received additional immobilization due to nondisplaced additional fractures of the phalanx (n = 2) or for analgetic treatment (n = 9). Five complications were registered (7.6%). In two cases recurrent fracture dislocation occurred, one of them requiring revision of the osteosynthesis. In other two cases irritation of the extensor tendons occurred, one of them requiring secondary tendon plasty. One persisting cutaneous hyposensibility after ESIN of a metacarpal 5 fracture was reported. All fractures healed uneventfully and metal removal was performed after a mean of 92 days (range 31 to 104). After a mean follow-up of 26 months (range 2 to 74), all patients had full range of movement and cosmetic results were described as good and satisfactory by all patients. ESIN of the metacarpals is a safe, minimally invasive, and technically easy option in displaced fractures that warrant surgical intervention achieving excellent long-term results. Complications occurred when technical aspects to obtain stability were neglected or tendons and nerves of the hand had been injured. Stabilizing fractures of metacarpal 1 is technically challenging when compared with fractures of metacarpals 2 to 5.

Subtalar Arthroeresis in Posterior Tibial Tendon Dysfunction

The purpose of the study was to evaluate the efficacy of subtalar arthroeresis for II stage tibial tendon dysfunction by Johnson and Storm classification. From November 2007 to August 2009, 18 patients with that pathology were operated on. After implantation of Kalix® II endorthesis the plasty of posterior tibial tendon was performed. The results were assessed by American Orthopaedic Foot and Ankle Society (AOFAS) scores system. After treatment average estimate by AOFAS increased from 47.2 before operation to 79.0 after surgery, pain index from 16.3 to 30.0, foot function from 28.7 to 41.6, foot position from 2.6 to 8.4. According to X-ray data the longitudinal arch angle decreased by 14.3° at an average and talar-calcaneal angle by 8°. Study results showed that technique of subtalar arthrodesis was effective enough for correction of flat foot resulted from II stage posterior tibial tendon dysfunction. Combination of that technique with tendon plasty ensured the full-value reconstruction of the foot.

La voie d’abord postérieure transtricipitale dans les luxations invétérées du coude

Neglected elbow dislocation is a rare injury but is still frequent in our country. Authors report 12 cases of neglected elbow dislocation with stiffness in extension. All patients were treated by open reduction using a posterior approach and plasty of tricipital tendon. Authors describe the interest of the posterior approach for treatment of neglected elbow dislocation with stiffness in extension.

Reconstruction du LCA chez le sportif de compétition. Évaluation, à court terme, après reprise du sport

Background Most studies have observed satisfactory outcome after anterior cruciate ligament (ACL) reconstruction. The best series report 80 to 90% success, irrespective of the type of operation. The purpose of this work was to investigate resumption of sports activities after ACL reconstruction. We studied the impact of the conditions of sports activity after the operation, gender, type of sport, presence of an extra-articular reinforcement and time since surgery. Material and method In order to search for significant differences between the postoperative and follow-up scores, a questionnaire with a subjective IKDC grid was addressed 12 months after their hospitalization to all athletes who had undergone ACL reconstruction at the CERS from 1 st January, 2003 through 31 st October, 2004. Results For the period considered, 2248 athletes were hospitalized at the CERS for ACL reconstruction. The response rate was 43% (969 responses at 12 months). There was no significant difference between the hospitalized population and the responders in terms of type of sports activity or type of graft. There was however a significant female predominance among responders ( p = 0.01). Mean follow-up was 13.9 ± 2.9 months. Reconstruction methods were: hamstring graft 54%, free patellar graft 43%, MacIntosh fascia lata 2%, MacIntosh quadriceps 1%. The main activity was a pivot sport for 74% of the athletes. Male gender predominated: 77%. There was no difference regarding postoperative training, but competition level was achieved more readily by males (65% versus 54%, p = 0.0038), since more females stated resumption of competition was not an objective. It was also noted that resumption of training occurred earlier for gliding sports than for pivot–contact sports (7.32 ± 2.09 months versus 8.23 ± 2.66 months, p = 0.021). The presence of a lateral reinforcement did not have a significant impact on resumption of sports activities which was more frequent in the hamstring group than the patellar group (16% versus 7%, p < 0.0001) and more frequent in the pivot–contact sports ( p = 0.0039). Regarding the role of the surgical technique, resumption of training and competition was better after hamstring plasty compared with patellar tendon plasty for follow-up less than or equal to 12 months ( p = 0.0009 and 0.0001 respectively). The subjective IKDC score was also significantly better in the hamstring group for the period considered ( p = 0.0006). The differences observed early in the follow-up resolved over time and no significant difference was observed at 18 and 22 months. Regarding the MacIntosh fascia lata plasty, resumption of competition was significantly earlier (7.67 ± 1.87 months) compared with hamstring plasty (9.69 ± 2.58 months) and patellar tendon plasty (9.65 ± 3 months). Resumption of training (90%) and competition (76%) was also better with the MacIntosh fascia lata plasty compared with the two other techniques but the difference was not significant. These differences, in favor of the MacIntosh fascia lata plasty, might have been due to a recruitment bias since the level of the sports activities was significantly higher in the MacIntosh population than in the populations of the other two methods. Conclusion This study is of particular interest because of the size of the homogeneous study population resulting from the highly selective recruitment of athletes at the CERS. This study is generally in agreement with prior data in the literature, particularly concerning the rate of resumed training one year after surgery. This study shows that the patellar tendon plasty reaches maturity more slowly than the hamstring plasty although the two techniques yielded comparable results at 18 months for all criteria studied.

Influence d’une ligamentoplastie extra-articulaire latérale sur les résultats de la reconstruction du ligament croisé antérieur avec le ligament patellaire avec 7 ans de recul: Intra-articular reconstruction of the anterior cruciate ligament with and without extra-articular supplementation by quadricipital tendon plasty: seven-year follow-up

Purpose of the study Reconstruction of the anterior cruciate ligament (ACL) is a common procedure, but use of lateral reinforcement is still a subject of debate. The purpose of this study was to compare two randomized series of ACL reconstructions, one using an intra-articular method (patellar tendon autograft) and the other an intra- and extra-articular method (Mac-InJones). Material and methods From January 1995 to March 1998, 63 knees underwent surgery for ACL reconstruction. Inclusion criteria was significant medial differential laxity measured between 7 and 12 mm on passive dynamic x-rays as 20̊ flexion. Group 1 (patellar tendon intra-articular reconstruction) included 34 patients (27.1±7.5 years) and group 2 (intra-articular reconstruction plus extra-articular quadircipital tendon plasty) included 29 patients (28.5±12 years). The IKDC score was determined for 72% of the knees in group 1 and 68% in group 2 at seven years follow-up on average (102 and 93 months respectively). Anterior laxity was measured radiographically and with KT-1000. The position of the tunnels was controlled using the Aglietti method. Results The subjective functional score was 83.6±3.5 in group 1 and 83.5±3.5 in group 2. The overall IKDC knee score classes for group 1 were 0% A, 52.4% B, 28.6% C, and 19% D and for group 2 were 5.5% group A, 50% group B, 33.3% group C, and 11.1% group D. In group 1, the pivot test was negative in 61.9% and noted stage 1 in 28.6% and stage 2 in 9.5%. In group 2, the pivot test was negative in 78.9% and noted stage 1 in 15.8% and stage 2 in 5.3%. The KT-1000 showed no difference in gain in laxity: 31% for group 1 and 27% for group 2. Similarly, radiographically there was no difference with a 43.9% gain in differential laxity for the medial compartment and 45.3% for the lateral compartment in group 1. In group 2 the corresponding values were 51.9% and 41.8%. The position of the tunnels was the same in the two groups. Discussion In a preliminary study with two years follow-up, the results in these two series were not significantly different. It was concluded that there was not clear advantage to adding the extra-articular lateral plasty. At the present 7-year follow-up, pivoting appears to be better controlled in the lateral plasty group (p=0.23), but with no significant difference for laxity for both knee compartments. The inclusion criteria would be different today and would be based on the laxity of the lateral compartment.

Surgical Treatment the Sequelae of High Voltage Electrical Injury of Hand and Forearm

Ten patients with electrical injury (over 3000 V) of the forearm and hand were operated on during the period of 11.6±3.1 months after accident. Soft tissue plasty with free microsurgical flap and simultaneous tendon and nerve plasty with nonvascularized autograft was performed in eight patients. In two patients with extensive soft tissue defects microsurgical flap included musculus latissimus dorsi that was reinnervated using the anastomoses with anterior interosseous nerve. For the restoration of sensation along the palmar surface of the hand, transposition of ulnar nerve segment on a vascular pedicle from the arm to the forearm was performed. Although no severe postoperative complications developed all patients required tendolysis and transposition of tendons for the restoration of tendon function. Those additional interventions provided the restoration of the wrist grip and social rehabilitation of all patients.