Prevent Tendon Rupture Research Articles

Novel surgical management of tibialis anterior tendinosis using an anchor augment

Objective: The objective of this paper was to describe a surgical technique for the management of TA tendinosis: Debridement, repair, and augmentation with a suture anchor without tendon transfer. Methods: This is a retrospective case series including five patients managed surgically for TA tendinosis. If ≥ 30% of healthy tendon remains after debridement, the tendon is augmented with a suture anchor, with the suture incorporating the healthy tendon as acheckrein. Patient outcomes were assessed using the AOFAS midfoot, VAS Pain, and SEFAS score. Results: The mean AOFAS improved preoperatively from 37.0 (range 18–51) to 97.6 (range 95–100), the VAS pain score from 8.0 (range7–9) to 0.8 (range 0–1), and the mean SEFAS score at final follow-up was 43.8 (range 41–48). Conclusions: Tibialis anterior tendinosis is an uncommon degenerative process. Early diagnosis and appropriate management can prevent tendon rupture. This case series of debridement, repair, and augmentation with a suture anchor showed high patient satisfactionand good clinical outcomes without needing a tendon transfer. Level of Evidence III; Therapeutic Studies - Investigating the Results of Treatment; Retrospective Comparative Study

Spontaneous tendon rupture in a patient with systemic sclerosis: a case report

BackgroundSystemic sclerosis (SSc) is an incurable autoimmune disease characterized by progressive skin fibrosis and organ failure. Tenosynovitis is a common musculoskeletal manifestation, but tendon rupture has seldom reported in SSc.Case presentationWe present a rare case of a 49-year-old female with SSc who has suffered from bilateral tendon rupture of the fourth and fifth digits with positive antinuclear antibody (ANA) and anti-centromere B antibody, but negative rheumatoid factor in serum. In the extensor tendons of the patient’s hands, inflammation, edema, hypertrophy and tendon interruption were detected with ultrasound and magnetic resonance imaging(MRI). Tendon transfer repair surgery was performed and 10 mg/week methotrexate was then used in this patient. Her hand function was improved well with methotrexate and rehabilitation treatment postoperatively.ConclusionsEarly detection of tenosynovitis is necessary to prevent tendon rupture in SSc patients. Ultrasound and Magnetic Resonance Imaging appear to be useful examinations for evaluating tendon pathology for early detection.

Tension Reducing Muscle Stretch Protocol to Obtain Full Distal Tendon Excursion: A New Rehabilitation Protocol after Flexor Tendon Repair.

Background: Flexor tendon rehabilitation protocols minimize repair tension by limiting range of movement to prevent tendon rupture. The resultant muscle contracture inhibits finger extension, increases resistance in tendon gliding distally, and progress to proximal interphalangeal (PIP) joint flexion contracture. This study describes our new rehabilitation protocol, the Tension Reducing Muscle Stretch (TRMS), designed to prevent flexor muscle contracture and obtain full distal tendon excursion. Methods: We reviewed retrospectively 14 fingers in 13 consecutive patients with primary repair of complete zone I or II flexor digitorum profundus (FDP) tendon rupture were treated with our protocol between 2007 and 2019. Our rehabilitation following FDP 4-strand repairs consisted of three steps. The first step comprised of exercises from traditional protocols such as Duran, Kleinert, Synergistic-wrist-motion, and Place-and-hold. The second step comprised the TRMS exercise to prevent the onset of muscle contracture. Anatomically, FDP tendons arise from the same FDP muscle belly. TRMS involved placing the affected finger in full passive flexion while unaffected fingers were passively extended to full extension. This made the affected FDP muscle stretched. The final step incorporated the early active flexion motion exercise, in which simple fisting was performed, from a fully extended position. Results: The mean total active motion at the final follow up was 235° (range 170-265). Using the Strickland criteria, eight achieved excellent, four had good, two had fair results. The mean angle of passive extension deficit at the PIP joint at four weeks after surgery was -7° (-30-0), and at the final follow up was -3° (-20-0). No tendon repair was ruptured. Conclusions: This protocol reduced tension in the affected tendon muscle and encouraged tendon excursion distal to the repair site without complications. It allows full tendon excursion and prevents PIP joint contractures.

Ultrasound Evaluation of the Protector Role of the Pronator Quadratus Suture in Volar Plating.

The main complication of volar locking plates for distal radius fractures is flexor tendon rupture. The flexor pollicis longus (FPL) is the most commonly ruptured. Repair of the pronator quadratus (PQ) is one of the ways to prevent tendon rupture. The main purpose of this series was to evaluate the role of PQ repair after volar plating to prevent flexor tendon rupture using ultrasound (US). This work was a mono-operator prospective series of 20 consecutive patients with volar locking plates for distal radius fracture between September 2014 and May 2015. The PQ was repaired in all patients. A clinical, ultrasound, and perioperative evaluation of the flexor tendon was performed by this same surgeon. There was no flexor tendon rupture or tenosynovitis. There were no type A cases, which are characterized by contact between the plate and the FPL, and mostly type C cases, which are characterized by no contact between the plate and the FPL on US imaging. The suture of the PQ was sustainable over time when we removed the plate. Pronator quadratus repair is one of the ways to prevent flexor tendon rupture after volar plating. The outward-running suture is an effective technique for repairing the PQ. Ultrasound may be helpful during follow-up to detect asymptomatic flexor tendon irritation.

Gastrocnemius fascia release under local anaesthesia as a treatment for neuropathic foot ulcers in diabetic patients: a short series

Background: Diabetic foot ulceration is the leading cause of major amputation in the developed world. Plantar neuropathic ulcers at the forefoot can be managed conservatively with off-loading, but treatment is not invariably successful. Achilles tendon lengthening procedures aim at increasing dorsiflexion and decreasing forefoot pressure but can be associated with complications and require prolonged postoperative immobilization to prevent tendon rupture. We assessed the feasibility and clinical outcome of a comparative minimal invasive procedure: the gastrocnemius fascia release. This technique targets the same goals but is performed under local anaesthesia and allows immediate postoperative weight bearing and ambulation.Methods: Diabetic patients with plantar neuropathic ulcers Wagner grade 2 or 3 were recruited from our diabetic foot clinic. Patients with infected wounds or untreatable peripheral arterial disease were excluded from the study. Conservative treatment with off-loading and local wound care was attempted for six weeks and surgical procedure only contemplated upon failure. Primary end-points were improved range of dorsiflexion and time to healing. Secondary end-points were local ulcer recurrences, new plantar ulcers, and minor or major amputation. Post-operative follow-up was 12 months.Results: Seven patients were included in the study. An improvement in dorsiflexion of 10.4° (mean) was recorded post-operatively (p < 0.01). After 30 days, complete healing was accomplished in six of the seven patients. Long-term results were excellent as no ulcer recurrence or amputation was noted.Conclusions: Gastrocnemius fascia release under local anaesthesia can be performed safely in diabetic patients with plantar neuropathic ulcers under the metatarsal heads. Clinical outcome is excellent and long-term results promising.

Endoscopic Resection of Gouty Tophus of the Patellar Tendon

Tophaceous deposition of tendon can result in spontaneous patellar tendon rupture. Surgical therapy may be needed to control symptoms and prevent tendon rupture. Open debridement of the lesion requires a lengthy incision over the lesion; this may result in symptomatic scar adhesion of the patellar tendon or an unhealed wound with persistent tophaceous discharge. Moreover, the other part of the patellar tendon cannot be examined through the incision. We describe a technique for endoscopic resection of a gouty tophus of the patellar tendon. It has the advantage of small incisions away from the lesion and tendon and minimizes wound problems. The whole patellar tendon can be examined endoscopically.

Tendinopatías por fluoroquinolonas

Tendinitis and tendon ruptures induced by fluoroquinolones, while uncommon, have been documented in the literature since 1983. We report five cases of tendinitis induced by fluoroquinolones, three caused by levofloxacin and two by ciprofloxacin. We revise actual knowledge of this association and we insist on how important is an early detection to prevent tendon rupture.

Atraumatic hand infection in an infant

We report a rare case of atraumatic infection of the extensor tendon sheaths. Acute medical staff should be aware of the insidious nature of presentation of this condition, as early aggressive treatment is required to prevent tendon rupture. In this instance, an excellent functional outcome was achieved by surgical drainage and early tendon reconstruction.

Spontaneous Rupture of the Patellar and Contralateral Quadriceps Tendons Associated with Secondary Hyperparathyroidism in a Patient Receiving Long-term Dialysis

Although spontaneous rupture of the extensor tendon of the knee is more likely to occur in uremic patients with secondary hyperparathyroidism, simultaneous ruptures of bilateral knee extensor tendons is a rarely reported condition. We describe a 30-year-old man with uremia who underwent subtotal parathyroidectomy because of secondary hyperparathyroidism with very high serum parathyroid hormone (PTH) level (1940.4 pg/mL). Two weeks later, he complained of a sharp pain in both knees without trauma when he walked downstairs with his left knee forward and right knee behind. Spontaneous simultaneous ruptures of the right patellar tendon and the left quadriceps tendon were diagnosed and surgically repaired. The mechanism of spontaneous tendon rupture in uremic patients with secondary hyperparathyroidism seems to be related to high PTH level which results in osteolytic bone resorption at the tendon insertion site. Early surgical repair, control of secondary hyperparathyroidism, early use of vitamin D analogs, and total parathyroidectomy with or without autotransplantation of part of the parathyroid gland, can treat and prevent tendon rupture or re-rupture with satisfactory results.

Interactive Hand Clinic: Dorsoulnar Wrist Pain

The authors present a series of self assessment cases in hand surgery that demonstrate unusual presenting pathologies to our tertiary referral hand unit. The first is a case of dorsoulnar wrist pain and the differential diagnosis, imaging and surgical management are discussed. CASE REPORT A 52 year-old left hand dominant plasterer with rheumatoid arthritis was referred by his GP with dorsoulnar wrist pain and swelling. Figure 1 DESCRIBE THE CLINICAL APPEARANCE? There is a multiloculated swelling at the level of the DRUJ extending under the extensor retinaculum at the level of the IVth and Vth extensor compartments onto the ulnar aspect of the dorsum of the hand. WHERE IS THE SWELLING ARISING FROM? The DRUJ WHAT ARE THE IMPORTANT POINTS IN THE EXAMINATION? Consistency of the swelling. A firm swelling suggests synovitis. Wrist and forearm movements. Pain, crepitus and loss of supination suggest DRUJ arthritis. Extensor tendon function. A loss of ring and small finger extension suggests rupture of the EDM and EDC to these fingers at the level of the DRUJ (Vaughn-Jackson lesion). WHAT ARE THE COMPLICATIONS OF THIS CONDITION? Subluxation of the ulnar head dorsally as the carpus subluxes volarly and ulnarwards. Tendon attrition rupture to the ring and small fingers. WHAT IS THE PATHOPHYSIOLOGY OF TENDON RUPTURE? Synovitis, fibrosis, encasement, ischaemic necrosis, tendon attrition, tendon rupture. Figure 2 Figure 1: Plain wrist radiographs DESCRIBE THE SIGNIFICANT RADIOGRAPHIC FINDINGS Loss of the normal DRUJ alignment with ulnar head cyst. Lateral view shows volar subluxation of the carpus. HOW IS THIS CONDITION MANAGED? Early management is systemic management of the Interactive Hand Clinic: Dorsoulnar Wrist Pain 2 of 3 underlying disease. This patient has Rheumatoid Arthritis and was managed with NSAIDs for joint symptoms together with disease modifying therapy in the form of methotrexate. His synovitis continued to develop despite this. Early referral and surgical synovectomy is necessary to prevent tendon rupture and the synovectomy is performed through a dorso-ulnar incision and division of the extensor retinaculum and the dorsal capsule of the DRUJ. The synovectomy should follow the tendons distally to the hand. The ER can be repaired deep to the tendons to try to prevent rupture (exteriorisation of the extensors). If already ruptured, extensor tenodesis can be performed at the same time. Figure 3 Figure 2: Intra-operative photograph IF THE DRUJ PAIN PERSISTS, WHAT ARE THE TREATMENT OPTIONS? Distal ulnar excision (Darrach) may reduce the pain from the DRUJ. CORRESPONDENCE TO Dominic Power 84 Royal Worcester Crescent Bromsgrove Worcestershire, B60 2TA, UK Email: dominic.power@roh.nhs.uk Telephone: 0044 1527 870 206 Fax: 0044 1527 831 777 References Interactive Hand Clinic: Dorsoulnar Wrist Pain 3 of 3 Author Information D. M. Power Department of Hand Surgery, Royal Orthopaedic Hospital R. J. Potter Department of Hand Surgery, Royal Orthopaedic Hospital

EXTENSOR TENDON PROBLEMS IN RHEUMATOID ARTHRITIS

Extensor tenosynovitis is a common presenting upper extremity problem and, unless it resolves with medical management, preventative tenosynovectomy is indicated to prevent tendon rupture. When a rupture has occurred, tendon reconstruction with either a transfer or a graft has a reasonable chance of restoring function as long as the number of tendons involved is limited. Rupture of a single extensor tendon requires surgical treatment to eliminate the cause and prevent further damage, as well as repairing the injured tendon. It is important to give consideration to associated wrist and MP joint problems before, during, or after treating tendon abnormalities.

Results of extensor carpi ulnaris tenodesis in the rheumatoid wrist undergoing a distal ulnar excision

Distal ulna resections that are done in patients with rheumatoid arthritis to alleviate pain, correct alignment, and prevent tendon rupture may contribute to distal ulnar instability. A distally based slip of the extensor carpi ulnaris tendon has been used to both stabilize the distal ulnar remnant and to prevent recurrent deformity in 26 rheumatoid wrists, with an average follow-up of 3.5 years. In all postoperative cases, the distal ulna was no longer prominent and the wrist was well aligned. The distal ulna was stabilized in 96% of the patients. Subjectively, pain was relieved in 85% and grip strength improved in 77%.

The Distal Radioulnar Joint in Rheumatoid Arthritis

Rheumatoid arthritis commonly affects the distal radioulnar joint (DRUJ). This can result in pain, instability, or tendon rupture. The goals of surgical reconstruction of the DRUJ are to relieve pain, stabilize the joint, and prevent tendon rupture. We review many of the previously described procedures and report our experience with distal ulna excision and soft tissue reconstruction with a distally based slip of extensor carpi ulnaris tendon.