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Flexor tendon repair

Jessica H Heyer, Amos Z Dai, Donald J Rose
An os trigonum is a potential source of posterior ankle pain in dancers, often associated with flexor hallucis longus (FHL) pathology. Surgical excision is indicated on failure of nonoperative management. Options for surgical excision include open excision (via a posterolateral or posteromedial approach), subtalar arthroscopy, and posterior endoscopy. Os trigonum excision via an open posteromedial approach with concomitant FHL tenolysis/tenosynovectomy is a safe and effective method for the operative treatment of a symptomatic os trigonum that allows for identification and treatment of associated FHL pathology...
December 26, 2018: JBJS Essential Surgical Techniques
Arda Kucukguven, Hakan Uzun, Fethiye D Menku, Gokhan Sert, Ali E Aksu
BACKGROUND: The repair of retracted flexor tendons is a challenging problem for hand surgeons. The tendon stump should be handled in an atraumatic manner because any microtrauma to the sheath and tendon can lead to poor functional outcomes. METHODS: Twenty-three patients with flexor zone 2 injuries and intraoperative finding of retracted tendons were randomly divided into two groups: endoscopic retrieval group and proximal incision group. A flexible endoscope and a flexible grasping forceps were used for endoscopic retrieval of the retracted flexor tendons...
January 14, 2019: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Min Kai Chang, Sanchalika Acharyya, Zeus Yiwei Lim, Shian Chao Tay
BACKGROUND: The single looped suture modified Lim/Tsai technique is widely used for flexor tendon repairs. It has been shown to possess better biomechanical properties and require less repair time per tendon as compared to the double looped suture original Lim/Tsai technique. However, there is no clinical data on the modified technique. METHODS: The retrospective study included zone 2 flexor tendon repairs made using the modified Lim/Tsai technique from January 2008 to December 2014...
March 2019: Journal of Hand Surgery Asian-Pacific Volume
Zhang Jun Pan, Yun Fei Xu, Lei Pan, Jing Chen
We report the outcomes of zone 2 tendon repairs in 60 fingers using a strong core suture, sparse peripheral stitches and early active motion. From January 2014 to April 2016, we repaired 60 flexor digitorum profundus tendons with a tensioned 4-strand or 6-strand core suture and three to four peripheral stitches. The A2 or A4 pulleys were vented as necessary. Following early active flexion of the repaired tendons, no repairs ruptured and 52/60 (87%) fingers recovered to good or excellent function using the Tang criteria after follow-up of 8-33 months...
February 7, 2019: Journal of Hand Surgery, European Volume
Baozhi Ding, Xin Wang, Min Yao
PURPOSE: We utilized a novel approach of combined photochemical tissue bonding (PTB) and human amniotic membrane (HAM) to improve hand tendon repair and also evaluated its efficacy. METHODS: Subei chickens underwent surgical transection of the flexor digitorum profundus tendons and repair by (1) SR (standard Kessler suture; n = 24; 6-0 prolene) and (2) HAM/PTB (n = 24), where a section of HAM was stained with 0.1% Rose Bengal, wrapped around the ruptured tendon and bonded with 532 nm light (0...
January 30, 2019: Surgical Innovation
Min Kai Chang, Zeus Yiwei Lim, Yoke Rung Wong, Shian Chao Tay
BACKGROUND: Cyclic testing of flexor tendons aims to simulate post-operative rehabilitation and is more rigorous than static testing. However, there are many different protocols, making comparisons difficult. We reviewed these protocols and suggested two protocols that simulate passive and active mobilization. METHODS: Literature search was performed to look for cyclic testing protocols used to evaluate flexor tendon repairs. Preload, cyclic load, number of cycles, frequency and displacement rate were categorised...
December 13, 2018: Clinical Biomechanics
Yukitoshi Kaizawa, Jacinta Leyden, Anthony W Behn, U Serdar Tulu, Austin Franklin, Zhen Wang, Geoffrey Abrams, James Chang, Paige M Fox
PURPOSE: Poor healing of the tendon-bone interface (TBI) after rotator cuff (RTC) tears leads to high rates of recurrent tear following repair. Previously, we demonstrated that an injectable, thermoresponsive, type I collagen-rich, decellularized human tendon-derived hydrogel (tHG) improved healing in an acute rat Achilles tendon injury model. The purpose of this study was to investigate whether tHG enhances the biomechanical properties of the regenerated TBI in a rat model of chronic RTC injury and repair...
January 23, 2019: Journal of Hand Surgery
Stephen J Wallace, Lauren M Mioton, Robert M Havey, Muturi G Muriuki, Jason H Ko
PURPOSE: Conventional suture repairs, when stressed, fail by suture rupture, knot slippage, or suture pull-through, when the suture cuts through the intervening tissue. The purpose of this study was to compare the biomechanical properties of flexor tendon repairs using a novel mesh suture with traditional suture repairs. METHODS: Sixty human cadaveric flexor digitorum profundus tendons were harvested and assigned to 1 of 3 suture repair groups: 3-0 and 4-0 braided poly-blend suture or 1-mm diameter mesh suture...
January 16, 2019: Journal of Hand Surgery
Abdul Malik Mujahid, Muhammad Saleem, Shohreh Ahmadi, Farrukh Aslam Khalid, Muhammad Younas Mehrose, Zain Ul Abidin, Moazzam Nazeer Tarar
BACKGROUND: Hand is unique for the dexterity of its function and flexor tendons have most important function in hand. Its injury is a challenging treatment. Purpose of this study is to compare the success of 1- and 2-knot, flexor tendon repair (good to excellent results) with early active mobilization in terms of total active motion (TAM) of affected hand postoperatively. METHODS: Hundred patients with age range of 5-70 years of age presenting with flexor tendon lacerations of hand were included in the study...
October 2018: Journal of Ayub Medical College, Abbottabad: JAMC
Michael A Howell, Timothy P McConn, Karl R Saltrick, Alan R Catanzariti
Calcific insertional Achilles tendinopathy (CIAT) is a relatively common musculoskeletal entity that results in significant pain and disability, as well as posterior muscle group weakness. There is a lack of evidence criteria to support the timing of operative intervention, choice of procedures, or whether equinus requires treatment. The purpose of this study was to retrospectively review 45 patients (48 feet) who have undergone surgical management of CIAT with concomitant posterior muscle group weakness with the single heel rise testing...
January 3, 2019: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Malrey Lee, Young-Ran Jung, Young-Keun Lee
Secondary trigger finger caused by trauma to the hand, especially associated with partial flexor tendon rupture, is not a common condition. Thus, the clinical manifestations of these patients are not well-known. The aim of this study is to present secondary trigger finger caused by a neglected partial flexor tendon rupture including discussion of the mechanism and treatment.We retrospectively reviewed the records of 6 patients with trigger finger caused by a neglected partial flexor tendon rupture who had been treated with exploration, debridement, and repairing of the ruptured tendon from August 2010 to May 2015...
January 2019: Medicine (Baltimore)
Rebecca L Neiduski, Rhonda K Powell
STUDY DESIGN: Systematic review. INTRODUCTION: The rehabilitation of patients following flexor tendon injury has progressed from immobilization to true active flexion with the addition of wrist motion over the last 75 years. PURPOSE OF THE STUDY: This review specifically intended to determine whether there is evidence to support one type of exercise regimen, early passive, place and hold, or true active, as superior for producing safe and maximal range of motion following flexor tendon repair...
December 10, 2018: Journal of Hand Therapy: Official Journal of the American Society of Hand Therapists
Yuki Fujihara, Hideyuki Ota, Kentaro Watanabe
INTRODUCTION: Flexor tendon injury often occurs with concomitant injuries such as fracture, vascular injury, and extensor tendon injury. These injuries are repaired independently, without a comprehensive strategy. We aimed to identify the effect of concomitant injuries and treatment choice on the outcome of flexor tendon repair. PATIENTS AND METHODS: We evaluated 118 fingers of 102 adult patients with zone 1-3 flexor digitorum profundus (FDP) tendon injuries who underwent primary surgery at our hospital between April 2009 and December 2017...
December 2018: Injury
Andreas Lenich, Christian Pfeifer, Philipp Proier, Roman Fleer, Coen Wijdicks, Martina Roth, Frank Martetschläger, Jonas Pogorzelski
BACKGROUND: Elbow dislocation represents a common injury, especially in the younger population. If treated surgically, the reattached tendons require a high amount of primary stability to allow for an early rehabilitation to avoid postoperative stiffness. The purpose of this study was to assess the biomechanical properties of a single and a double row technique for reattachment of the common extensor and common flexor muscles origin. We hypothesized that the double row technique would provide greater stability in terms of pullout forces than the single row technique...
December 3, 2018: BMC Musculoskeletal Disorders
Özgün Barış Güntürk, Murat Kayalar, İbrahim Kaplan, Abuzer Uludağ, Kemal Özaksar, Beray Keleşoğlu
OBJECTIVE: There has been no consensus in literature for the ideal flexor tendon repair technique. The results of zone 2 flexor tendon lacerations repaired primarily by 4 strand Modified Kessler core suture and epitendinous interlocking suture technique followed by Modified Kleinert protocol were investigated. METHODS: 128 fingers of 89 patients who had flexor tendon laceration in zone 2 built the working group. Functional outcomes were evaluated using the Strickland formula...
September 2018: Acta Orthopaedica et Traumatologica Turcica
Jay R Ebert, Nicholas Gormack, Peter T Annear
PURPOSE: To report outcomes following proximal hamstring reconstruction employing an ipsilateral distal hamstring tendon autograft, in patients with chronic proximal ruptures. METHODS: Six patients presenting with a chronic proximal hamstring avulsion and a medial time from injury of 11.0 months (range 7-18), confirmed via magnetic resonance imaging, underwent proximal hamstring repair using a free graft harvested from the ipsilateral distal hamstrings. Patients were evaluated at 6, 12 and 24 months post-surgery, via the Perth Hamstring Assessment Tool, the Short Form Health Survey, the Lower Extremity Functional Scale, a Patient Satisfaction Questionnaire, the Active Knee Extension and 6 min walk tests, the single and triple hop tests for distance, and isokinetic knee extensor and flexor strength...
November 23, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Sang Hyun Woo, Myung Jae Yoo, Hee Chan Ahn
Wide-awake local anesthesia no tourniquet (WALANT) is a promising development for surgeons and patients through improved operation outcomes in hand and wrist surgery. The authors have mostly used WALANT for flexor and extensor tendon repair, tenolysis, and tendon transfer. Its application at W Hospital in korea has bolstered surgeon confidence in tendon repair integrity, gliding ability, and transfer tension via direct observation and patient feedback. The authors do not use WALANT in complicated tenolysis or in secondary surgeries in previous severe injury situations...
February 2019: Hand Clinics
Donald H Lalonde
Injection of tumescent local anesthesia should no longer be painful. WALANT anesthesia, strong sutures, a slightly bulky repair, intraoperative testing of active movement, and judicious venting of the A2 and A4 pulleys improve results in flexor tendon repair. WALANT K wire finger fracture reduction permits intraoperative testing of K wire stability with active movement to facilitate early protected movement at 3 to 5 days after surgery. WALANT can decrease costs and garbage production while increasing accessibility and affordability...
February 2019: Hand Clinics
Q Q Yang, Y L Zhou
We sought to investigate the strength of two multi-strand tendon repair configurations in a chicken model. Fifty-six chicken flexor tendons were repaired with one to two different four-strand configurations: 1) a four-strand repair consisting of a two-strand core modified Kessler suture with a circle loop repair and 2) a four-strand core Kessler suture repair with three separate peripheral suture points. The strength of the repaired tendons were measured 2, 3 and 4 weeks after the surgical repair and were analyzed statistically...
November 14, 2018: Hand Surgery and Rehabilitation
Yoke-Rung Wong, Ita Suzana Mat Jais, Min-Kai Chang, Beng-Hai Lim, Shian-Chao Tay
BACKGROUND: This study evaluated the feasibility of using a low-profile titanium (Ti) plate implant, also known as the Ti-button, for Zone II flexor tendon repair. We hypothesize that the use of the Ti-button can distribute the tensile force on the digital flexor tendons to achieve better biomechanical performance. METHODS: Twenty lacerated porcine flexor tendons were randomly divided into two groups and repaired using Ti-button or 6-strand modified Lim-Tsai technique...
December 2018: Journal of Hand Surgery Asian-Pacific Volume
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