Tendon Repair Research Articles

Endoscopic Hip Abductor Tendon Repair Results in Successful Outcomes With 5- to 10-Year Follow-up

PurposeThe purpose of this study is to report the outcomes of endoscopic repair in a consecutive series of patients with follow-up ranging from five to ten years. MethodsSixty-five consecutive hips in 63 patients (2 bilateral) undergoing endoscopic abductor tendon repair with minimum five-year follow-up were assessed with modified Harris Hip Scores (mHHS). The minimal clinically important difference (MCID) was determined as one half the standard deviation of the amount of improvement. ResultsMean age was 56.6 years (SD 11.3) with 58 females and 5 males. Follow-up was obtained on 64 hips (98.5%) at mean 85 months (SD 15.7). There were 33 full-thickness and 32 partial-thickness tears; 40 gluteus medius tears, 23 medius and minimus tears, and 2 isolated minimus tears. 50 patients (52 hips) underwent concomitant arthroscopy of the hip joint, including 15 with correction of Femoroacetabular Impingement (FAI)). The mean preop mHHS was 48.4 (SD 15.7) and postop 83.4 (SD 15.9); reflecting of 34.9 (95% confidence interval 34.9 ± 4.3) with 92.2% achieving the MCID of 8.7. There were no complications. Three patients underwent further surgery: One underwent total hip replacement at 11 months following abductor repair; one underwent repeat arthroscopy for joint debridement at 12 months following repair; and one underwent revision abductor repair at 6 years postop. ConclusionsCollectively, with 5-10 year follow-up, patients undergoing endoscopic abductor tendon repair can respond exceptionally well, with 92.2% achieving MCID; even among a heterogeneous group of single and two tendon involvement with partial and full thickness tears, undergoing single and double row repair. Level of EvidenceLevel IV, Case Series

A comparison between modified Kessler and modified Tsuge suture techniques in flexor tendon repair

Background and Objective: Severed digital flexor tendon needs to be repaired to restore flexion function of the finger. The aim is to evaluate tendon repair outcomes by using two different suturing techniques modified Kessler and modified Tsuge. Patients and Methods: This is a comparative study performed in Rozhawa Emergency Hospital and Emergency Medical Center in Erbil city, Kurdistan region-Iraq between 1st of December 2019 to 1st of June 2021. The study included (33) patients of both genders who presented with acute flexor tendons laceration in fingers which their number were (44) fingers underwent digital flexor repair by using two different suture techniques modified Tsuge and modified Kessler. Results: This study includes (30) males and (3) females, patients with digital flexor tendon cut the age ranged from 18 years to 58 years, mean age was 30.1 ± (10.5) years SD. The majority of the injuries (90.9%) were in zone 2, and the right hand was injured in 56.8% of the total injuries. The most common injured fingers were the ring (25%) and the little finger (25%). The Flexor digitorum profundus was the most common (79.5%) injured tendon. The proportion of the patients who were satisfied with the operation's outcome is 60.6%. Conclusions: Tendon repair by using modified Tsuge 4 strands suture technique showed significant strength and less complication rate.

Examining the Potential of Vitamin C Supplementation in Tissue-Engineered Equine Superficial Digital Flexor Tendon Constructs.

Because equine tendinopathies are slow to heal and often recur, therapeutic strategies are being considered that aid tendon repair. Given the success of utilizing vitamin C to promote tenogenesis in other species, we hypothesized that vitamin C supplementation would produce dose-dependent improvements in the tenogenic properties of tendon proper (TP) and peritenon (PERI) cells of the equine superficial digital flexor tendon (SDFT). Equine TP- and PERI-progenitor-cell-seeded fibrin three-dimensional constructs were supplemented with four concentrations of vitamin C. The gene expression profiles of the constructs were assessed with 3'-Tag-Seq and real-time quantitative polymerase chain reaction (RT-qPCR); collagen content and fibril ultrastructure were also analyzed. Moreover, cells were challenged with dexamethasone to determine the levels of cytoprotection afforded by vitamin C. Expression profiling demonstrated that vitamin C had an anti-inflammatory effect on TP and PERI cell constructs. Moreover, vitamin C supplementation mitigated the degenerative pathways seen in tendinopathy and increased collagen content in tendon constructs. When challenged with dexamethasone in two-dimensional culture, vitamin C had a cytoprotective effect for TP cells but not necessarily for PERI cells. Future studies will explore the effects of vitamin C on these cells during inflammation and within the tendon niche in vivo.

Relative motion splint versus static splint in extensor tendon repair: comparative study

Relative motion splint versus static splint in extensor tendon repair: comparative study

Multilayer amnion-PCL nanofibrous membrane loaded with celecoxib exerts a therapeutic effect against tendon adhesion by improving the inflammatory microenvironment

Tendon adhesion is a common complication after tendon surgery. The inflammatory phase of tendon healing is characterized by the release of a large number of inflammatory factors, whose mediated excessive inflammatory response is an important cause of tendon adhesion formation. Nonsteroidal anti-inflammatory drugs(NSAIDs) were used to prevent tendon adhesions by reducing the inflammatory response. However, recent studies have shown that the NSAIDs partially impairs tendon healing. Therefore, optimizing the anti-adhesive membrane loaded with NSAIDs to mitigate the effects on tendon healing requires further in-depth study. Amniotic membranes(AM) are natural polymeric semi-permeable membranes from living organisms that are rich in matrix, growth factors, and other active ingredients. In this study, we used electrostatic spinning technology to construct multifunctional nanofiber membranes of the PCL membrane loaded with celecoxib and AM. In vitro cellular assays revealed that celecoxib-loaded PCL membranes significantly inhibited the adhesion and proliferation of fibroblasts with increasing concentrations of celecoxib. In a rabbit tendon repair model, biomechanical tests further confirmed that the PCL membrane loaded with celecoxib had better anti-adhesion effects. Further experimental studies revealed that the PCL/AM membrane improved the inflammatory microenvironment by downregulating the expression of pro-inflammatory factors such as COX-2, IL-1β, and TNF-α proteins; and inhibiting the synthesis of COL I and COL Ⅲ. The PCL/AM membrane can continuously release celecoxib to reduce the inflammatory response and deliver growth factors to the damaged area to build a suitable microenvironment for tendon repair, which provides a new direction to improve the repair efficiency of tendon.

Prevalence and clinical implications of heterotopic ossification after distal biceps tendon repair.

Complete distal biceps tendon ruptures are relatively uncommon. Conservative treatment may result in persistent pain and weakness. Therefore, surgical repair is usually indicated in order to restore strength. Different surgical techniques and fixation methods have been described. The most reported complications after surgery are iatrogenic nerve damage, heterotopic ossification (HO) and re-rupture. Heterotopic ossification can be variable in size. Significant HO can limit range of motion while minor HO often remains asymptomatic. The overall presence of HO is likely underreported in literature, as imaging is reserved for symptomatic patients. The purpose of this study is to report the prevalence and clinical implications of heterotopic ossification after surgical repair of the distal biceps tendon. This retrospective study assessed the prevalence and clinical relevance of postoperative HO after distal biceps tendon repair. CT-scans were used to evaluate size and location of the HO. VAS scores, DASH scores, MEPI, and range of motion (ROM) were assessed to evaluate pain, patient satisfaction and elbow function. HO was observed on CT images of 19 out of 35 patients (54%). The use of interference screws, timing of surgery after rupture and timing of radiographic assessment postoperatively did not influence the prevalence of HO. The presence of HO had no statistically significant impact on the VAS scores, ROM measurements and MEPI and DASH scores. According to our findings, the overall incidence of HO is higher than previously reported but there are no differences in clinical outcomes when compared to patients without HO.

Achilles Tendon Ruptures: Limited Incision Repair

Achilles tendon ruptures are a common injury, and a steadily rising incidence has been noted since the middle of the 20th century. Conservative management is a recognized treatment method, but it bears a higher risk of tendon rerupture compared with surgical treatment. Standard open surgery, however, can lead to complications, such as wound complications and surgical site infection. Hence, efforts have been put into the development of alternative surgical techniques to lower the risk of complications. In the 1970s, Ma and Griffith introduced percutaneous tendon repair by limiting the incision to 6 stab wounds. Subsequently, the open and percutaneous approaches have been merged into limited incision procedures, which include the advantages of both: visual control as well as smaller incisions. The primary limited incision approach consisted in using twisted Kirschner wires as suture guides. They were replaced by specific guiding instruments, such as the Achillon and Percutaneous Achilles Repair System (PARS) device, which rendered the limited incision procedure safer and more standardized. The instruments consist of 4 arms: The outer arms facilitate needle introduction by predetermined holes, the inner arms allow for suture passage exclusively underneath the tendon sheath. The minimally invasive procedures may reduce complication rates, especially regarding wound healing and infection. Limited incision techniques also may reduce sural nerve injury. Level of Evidence: Diagnostic Level V—expert opinion. See Instructions for Authors for a complete description of levels of evidence.

Single-row or Double-row Rotator Cuff Repair.

Rotator cuff tears are potentially a career-ending injury for athletes. The surgeon must identify which patients will benefit from surgical repair. The factors to consider are age, type of sport, time since injury, athlete's level, and the patient's expectations. An essential and independent fact determining the surgical treatment is whether the damage is due to overuse or from a traumatic/collision injury. Some sports are more demanding than others resulting in different return-to-participation (RTP) rates. This RTP return rate can present a real challenge and more so by a desire to reach the pre-injury level of play. The incidence of rotator cuff tearing varies from one sport to another. In football players this can be 12% whereas for tennis players this incidence is 4% to 17%. The RTP rate must be considered when making treatment decisions and is influenced by the level of the athlete: for professional athletes, the rate is 61%, and for recreational 73%. When the surgeon and the patient decide on the surgical treatment, the surgeon must consider whether to perform a double-row or a single-row rotator cuff tendon repair. The decision-making and the surgical technique will be addressed.

Reconstruction of Achilles Tendon Skin Defect Using Single-Stage Reverse Sural Artery Island Flap

Wound complications following open repair of a ruptured Achilles tendon are common and require immediate skin cover. This study analyses the use of a reverse sural artery island flap to cover skin defects over an exposed intact Achilles tendon. Thirteen patients with postoperative wound complications over the tendoachilles were operated upon. All wounds were debrided and reconstructed with a single-stage reverse sural artery island flap. Within 5 weeks of flap cover, 12 wounds healed completely, while 1 flap had superficial necrosis at the margin in a diabetic patient. This eventually healed and did not compromise the final result. None of the flaps had venous congestion. In our hands, reconstructing skin defects following wound complications after Achilles tendon repair with islanded reverse sural artery flap is a reliable and safe option. Level of Evidence: Level IV.

Traditional Open Repair and Reconstruction of Achilles Tendon Rupture

Despite the development of minimally invasive techniques and more effective nonoperative functional rehabilitation protocols, traditional open approaches remain viable options for both acute and chronic Achilles tendon rupture repair and reconstruction. Here, techniques for open Achilles tendon repair and reconstruction are discussed, along with outcomes, possible complications, and brief comparisons to other management options.Level of Evidence:Level V.

The Outcome of the WALANT Technique in Primary Hand Flexor Tendons Repair

IntroductionWide-awake local anesthesia and no tourniquet (WALANT) represents a revolutionary technique for hand surgeons who dismiss tourniquets and sedation. In this study, we present our experience with the WALANT technique in primary flexor tendon injuries of the hand. Patient and methodsThis prospective research was carried out on 30 patients undergoing hand primary, flexor tendon repair surgery. Flexor tendon injury zones 2, 3, 4, and 5 were included. WALANT was prepared and injected. The tendons were surgically managed by a cruciate single cross-stitched locked 4-strand technique. The pain was assessed using a visual analog scale (VAS) score. The range of motion (ROM) of affected fingers was assessed according to the Strickland evaluation system. ResultsThere was a highly significant relationship between the patient's compliance with physiotherapy and obtained ROM of the affected finger with a P value <0.001. During injection of WALANT solution, 4 cases (13.3%) had no pain, 25 cases (83.3%) had mild pain (score 1–4), and 1 case (3.3%) had moderate pain (score 5–7). ConclusionWALANT provides an optimal bloodless and comfortable field with an opportunity to assess the strength of tendon repair, gapping or triggering and managing them intra-operatively.

Histopathological and histomorphometric investigation of the effects of different irrigation solutions on Achilles tendon healing in rats.

This study aimed to examine the effect of irrigation fluids containing povidone-iodine (PVP-I), rifampicin (RF), and chlorhexidine gluconate (CHG) used during surgery on healing on a rat Achilles tendon model. Twenty-eight male Sprague-Dawley rats (range, 300 to 400 g) were used in the experiment carried out between November 2022 and December 2022. The rats were divided into PVP-I, RF, CHG, and control groups, with seven rats in each group. Following the tenotomy and repair of the right Achilles tendon, the surgical site was irrigated using PVP-I, RF, CHG, or normal saline (the control group) for 2 min. All rats were sacrificed on the 21st postoperative day. The samples were evaluated histomorphometrically using the scoring system modified by Svensson, Soslowsky, and Cook and histopathologically using the Bonar and Movin classifications. The RF group gave better results in all three scoring systems compared to the control, PVP-I, and CHG groups (p=0.008, p=0.002, and p=0.006, respectively). Cellularity, rounding, and tenocyte morphology showed a significant difference in favor of the RF group (p=0.004). While the distribution of ground substance glycosaminoglycans showed a significant difference in favor of the RF group, there was no significant difference among the other groups (p=0.22). Irrigation solutions containing PVP-I, RF, or CHG show no negative effect on Achilles tendon healing. Moreover, the findings suggest that RF irrigation can accelerate the healing process.

Galvanic Corrosion of Strands in Re-Grouted, Post-Tensioned Concrete Bridges

Grouted, post-tensioned (PTD) concrete systems are widely used to construct bridges, typically with an anticipated corrosion-free service life of 100+ y. However, the usage of inadequate grout materials and grouting practices in PTD concrete systems have caused unwanted air voids in ducts, leading to strand/grout/air interface, carbonation of exposed grout layer, and localized corrosion of strands (say, within about 10 y to 20 y). Re-grouting of voids as a tendon repair strategy has led to accelerated galvanic corrosion of the portion of strands at the interface between the carbonated base grout and repair grout with different chemistry, raising concerns and reluctance in re-grouting of voids in tendons. This work focused on understanding and quantifying the galvanic corrosion at the interface of carbonated base grout and repair grout in a re-grouted tendon. The theoretical analysis based on mixed potential theory estimated a galvanic current density of approximately 2 µA/cm2 and showed that the galvanic coupling can increase the corrosion current density of the prestressing steel in the base grout by about two-fold. The study on prestressed steel in simulated solutions estimated a galvanic current density of approximately 20 µA/cm2. Then, the study on prestressing steel in grouts and the analytical simulation estimated galvanic current densities around 1.5 µA/cm2 to 2 µA/cm2 at 95% external relative humidity (ERH) and 25°C. A model relating the galvanic current density in grouted systems as a function of ERH was developed, which showed an exponential increase in the galvanic corrosion with an increase in ERH. Also, a case study showed that if the tendon anchorage region experiences 95% ERH for about 20 y, sufficient strand corrosion could happen, and structural behavior can change from ductile to brittle nature, which could be a serious concern for structures in the coastal zone.

Comparison of functional outcomes between inlay and onlay distal biceps tendon repair with cortical button: A retrospective case-control study

Comparison of functional outcomes between inlay and onlay distal biceps tendon repair with cortical button: A retrospective case-control study

The ankle ligament reconstruction-return to sport after injury (ALR-RSI) is a valid and reproductible scale to evaluate psychological readiness after acute Achilles tendon repair

The ankle ligament reconstruction-return to sport after injury (ALR-RSI) is a valid and reproductible scale to evaluate psychological readiness after acute Achilles tendon repair

Using Free Chimeric Anterolateral Thigh Flap For Reconstruction Of Composite Dorsal Hand Defect

Simultaneous repair of the extensor tendons and soft tissues in hand injuries remains challenging. The free chimeric anterolateral thigh (ALT) flap with fascia lata (FL) flap represents an alternative for hand reconstruction. This report describes the reconstruction of the extensor tendon and skin defects using free chimeric ALT flaps with FL. Eight patients (one female and seven male) underwent reconstruction of complex hand defects with free chimeric ALT and FL flaps. The defects were caused by crushing injuries, burns, snakebite scars, and animal bite wounds. The average skin defect was 116 cm2. Perforators were selected for the skin paddle and the FL flap. The thinning procedure was performed microsurgically. The skin paddle size ranged from 12 to 23cm in length and 6 to 11cm in width, and the FL flaps ranged from 3×5 to 12×5cm. The mean pedicle length was 7.88cm. Nine extensor tendons were repaired with FL flaps. The flap thickness after thinning was only 3-6mm. The donor site was closed primarily in six patients, and skin grafts were used in two cases. All flaps survived without complications. The follow-up period lasted from 17 to 80 months. Range of motion was achieved with satisfaction. The chimeric-thinned ALT and FL flap is a valuable material, and it should be considered a reconstructive option for hand soft tissue and extensor tendon reconstruction. This technique allows us to achieve a good appearance and extensor function without donor-site morbidity.

Decellularization-Based Modification Strategy for Bioactive Xenografts Promoting Tendon Repair.

Xenografts have emerged as a promising option for severe tendon defects treatment. However, despite undergoing decellularization, concerns still remain regarding the immunogenicity of xenografts. Because certain components within the extracellular matrix also possess immunogenicity. In this study, a novel strategy of post-decellularization modification aimed at preserving the endogenous capacity of cells on collagen synthesis to mask antigenic epitopes in extracellular matrix is proposed. To implement this strategy, a human-derived rosiglitazone-loaded decellularized extracellular matrix (R-dECM) is developed. R-dECM can release rosiglitazone for over 7 days in vitro. By suppressing M1 macrophage polarization, R-dECM protects the migration and collagen synthesis abilities of tendon-derived stem cells (TDSCs), while also stabilizing the phenotype of M2 macrophages in vitro. RNA sequencing reveals R-dECM can mitigate the detrimental crosstalk between TDSCs and inflammatory cells. When applied to a rat patellar tendon defect model, R-dECM effectively inhibits early inflammation, preventing chronic inflammation. Its duration of function far exceeds the release time of rosiglitazone, implying the establishment of immune evasion, confirming the effectiveness of the proposed strategy. And R-dECM demonstrates superior tendon repair outcomes compared to dECM. Thus, this study provides a novel bioactive scaffold with the potential to enhance the long-term clinical outcomes of xenogeneic tendon grafts.

Subscapularis Repair Augmentation With Bioinductive Implant During Anatomic Total Shoulder Arthroplasty

Subscapularis management and repair are crucial during total shoulder arthroplasty to maximize outcomes. Bioinductive implants have been used to aid in repair of tendons in a variety of surgical techniques. In this surgical technique, we demonstrate our technique of subscapularis repair augmentation with a bioinductive implant during anatomic total shoulder arthroplasty.

Quantitative Assessment of Calf Muscle Volume, Strength, and Quality After Achilles Tendon Rupture Repair: A 1-Year Prospective Follow-up Study

Background: A number of studies have reported that calf muscle atrophy is a common long-term problem after Achilles tendon repair; however, there is still a lack of data concerning early postoperative morphological changes in the calf muscle after surgery. Purpose: To investigate changes over time in calf muscle volume and fatty degeneration during 1 year after Achilles tendon repair. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective 1-year serial magnetic resonance imaging study was carried out with 20 patients who underwent tendon repair for unilateral acute Achilles tendon rupture. The magnetic resonance imaging assessment in addition to clinical and functional evaluations was performed at 1, 3, 6, and 12 months after surgery. The muscle volume of the medial and lateral gastrocnemius, soleus, and flexor hallucis longus (FHL) and fatty degeneration of the medial and lateral gastrocnemius and soleus were measured for the calf muscles, and the relative volume and fatty degeneration changes in the affected leg compared with the healthy contralateral leg were calculated as a percentage ([injured/healthy control] × 100) to assess structural changes over time. Results: Muscle volumes of the medial gastrocnemius, lateral gastrocnemius, soleus, and FHL were 92.3%, 92.8%, 84.6%, and 95.9% at 12 months after surgery, respectively. Medial and lateral gastrocnemius and FHL muscle volumes improved over time and recovered to almost equal to that of the healthy side at 12 months after surgery. The soleus muscle volume did not recover significantly over time and was statistically significantly smaller than that of the healthy side at 12 months (P = .029). Fatty degeneration rates of the medial gastrocnemius, lateral gastrocnemius, and soleus were 118.2%, 113.9% and 121.1% at 12 months after surgery, respectively. Fatty degeneration of the medial and lateral gastrocnemius did not change significantly, but there was a statistically significant increase in fatty degeneration of the soleus over time (P < .001). Conclusion: Within the triceps surae muscle, the soleus was the most negatively affected by injury and repair for both muscle volume and fatty degeneration. Postoperative management to recover the soleus muscle function before a return to sporting activities should be considered in the future.

Anti-Adhesive Resorbable Indomethacin/Bupivacaine-Eluting Nanofibers for Tendon Rupture Repair: In Vitro and In Vivo Studies.

The treatment and surgical repair of torn Achilles tendons seldom return the wounded tendon to its original elasticity and stiffness. This study explored the in vitro and in vivo simultaneous release of indomethacin and bupivacaine from electrospun polylactide-polyglycolide composite membranes for their capacity to repair torn Achilles tendons. These membranes were fabricated by mixing polylactide-polyglycolide/indomethacin, polylactide-polyglycolide/collagen, and polylactide-polyglycolide/bupivacaine with 1,1,1,3,3,3-hexafluoro-2-propanol into sandwich-structured composites. Subsequently, the in vitro pharmaceutic release rates over 30 days were determined, and the in vivo release behavior and effectiveness of the loaded drugs were assessed using an animal surgical model. High concentrations of indomethacin and bupivacaine were released for over four weeks. The released pharmaceutics resulted in complete recovery of rat tendons, and the nanofibrous composite membranes exhibited exceptional mechanical strength. Additionally, the anti-adhesion capacity of the developed membrane was confirmed. Using the electrospinning technique developed in this study, we plan on manufacturing degradable composite membranes for tendon healing, which can deliver sustained pharmaceutical release and provide a collagenous habitat.