Tendon and Ligament injuries

Tears on the bursal and articular sides of the rotator cuff tendons are known to behave differently and strain is thought to play a role in this difference. This study investigates the effect of tear location on the changes in three strain measurements (grip-to-grip, insertion, and mid-substance tissue) in a sheep infraspinatus tendon model during axial loading. We introduced a 14 mm wide defect near the insertion from either the articular or bursal side of the tendon to three depths (3 mm, 7 mm & full) progressively. For each condition, tendons were sinusoidally stretched (4% at 0.5 Hz) while insertion and midsubstance strains were tracked with surface markers. For a fixed load, grip-to-grip strain increased significantly compared to intact for both cuts. Insertion strain increased significantly for the bursal-side defect immediately but not for the articular-side until the 66% cut. Mid-substance tissue strain showed no significant change for partial thickness articular-side defect...

To improve of the effectiveness of surgical procedures in the repair of rupture of the Achilles tendon, some surgeons use various augmented techniques. The purpose of this study was to evaluate the value of the use of graft from the fascia lata to add strength to the Bunnell suture in the treatment of subcutaneous tear of the Achilles tendon on the base of clinical and ultrasonographic results. 44 cases of the Achilles tendon lesion in 43 patients were included to the study. The patients were placed quasi-randomly into one of the two groups--group A of 26 tendons, repaired using the Bunnell suture with the reinforcement by a graft of the fascia lata, and group B of 18 tendons, repaired with simple end-to-end Bunnell suture. Results of the treatment were evaluated by the objective 100-point Hannover scale and subjectively by the modified Rupp scale. Results of the static and dynamic ultrasound examination were also analysed. There was no statistically significant difference due to Ha...

Computed tomography has become increasingly popular in the assessment of limbs in the acute trauma setting. Bony anatomic detail is excellent; however, soft tissue detail is typically limited, especially when compared with ultrasound and magnetic resonance imaging. The advent of dual-energy computed tomography has allowed additional information to be gathered regarding the morphology of collagen-based soft tissue structures. We report our initial experiences of 4 cases with imaging and clinical correlation.

Results of treatment of 61 patients with "mallet finger" injuries have been analyzed. After discontinuation of permanent immobilization the patients of the main group (n = 20) underwent "splint dishabituation" consequentially and bit by bit during 8 weeks, according to an original protocol developed with special reference to the stages of biological process of union of the damaged tendon. Following permanent immobilization patients of the group of comparison (n = 35) were recommended to use a removable splint at night during two weeks. The proposed protocol of "splint dishabituation" improved the results of treatment of injuries of the "mallet finger" type.

Volar locking plates have provided surgeons with enhanced capability to reliably repair both simple and complex fractures and avoid the hardware-related complications associated with dorsal plating. However, there have been an increasing number of published reports on the frequency and types of complications and failures associated with volar locked plating of distal radius fractures. An informed, critical assessment of distal radius fracture characteristics will allow surgeons to select an individualized treatment strategy that maximizes the likelihood of a successful outcome. Knowledge of the anatomy, patterns, and characteristics of the diverse types of distal radius fractures and the complications and failures associated with volar locked plating will be helpful to orthopaedic surgeons who treat patients with these injuries.

Absorbable sutures behave favourably in vitro and in an animal model. We report the outcome of flexor tendon injuries in a series of 272 consecutive patients treated over 45 months with a mean follow-up of 4 (range 3–12) months. Five hundred and seventy-six tendons were repaired in 416 digits. The patients were not randomised and all repairs were performed using a Strickland four-strand core technique. In 191 (73%) patients an absorbable core suture was used (Group 1) and in 81 (27%) a non-absorbable material was used (Group 2). There were six ruptures (2%) in Group 1 and two (2%) in Group 2. Using the original Strickland criteria, there were 72% excellent/good and 28% fair/poor results in the absorbable core suture group, and 73% and 27%, respectively, in the non-absorbable core suture group. This study suggests that appropriate absorbable core sutures can be used safely for flexor tendon repair.

Background Overuse tendon injuries are frequent. Corticosteroid injections are commonly used as treatment, although their direct effects on the material properties of the tendon are poorly understood. Purpose To examine the influence of corticosteroids on the tensile strength of isolated collagen fascicles. Study Design Controlled laboratory study. Methods Single strands (300-500 [.mu]m) of rat-tail collagen fascicles were incubated in either high (1 mL of 40 mgmL-1 mixed with 0.5 mL saline 9%) or low (1 mL of 40 mgmL-1 mixed with 2 mL saline 9%) concentration of methylprednisolone acetate (Depomedrol) for 3 or 7 days, while the control segment from the same fascicle was kept in saline (N = 64). After the incubation period, the fascicles underwent displacement to failure in a mechanical test rig at 0.13 mm/s, and thereafter hydroxylysyl pyridinoline and lysyl pyridinoline cross-link content was evaluated in a high-performance liquid chromatography system. Data for each group were an...

Arthroscopic repair of rotator cuff tears has been shown to be effective and safe. The use of suture anchors has increased the ability to perform rotator cuff repairs arthroscopically. However, the use of suture anchors for any surgery around the shoulder can result in complications if the devices are not used and inserted properly. Complications that have been reported with the use of suture anchors for rotator cuff surgery include prominent anchors in the tuberosities, dislodged anchors secondary to pull-out or improper insertion, and osteolysis around the anchors. We report a case of articular cartilage damage secondary to a suture anchor protruding through the humeral head because of improper anchor insertion. Our patient's case reminds surgeons not only to be careful of the depth of insertion of suture anchors when performing rotator cuff surgery but also to obtain radiographs to evaluate the anchor position if patients continue to have symptoms after rotator cuff repair us...

The diagnosis of a torn biceps tendon in athletes who use overhead throwing or swinging motions can be difficult to make because there is no one physical examination finding that will confirm the diagnosis, and because magnetic resonance imaging, although sometimes helpful, does not image the length of the biceps tendon adequately. We report a case of an isolated partial biceps tendon tear in an adolescent female athlete who was diagnosed during arthroscopy after the tendon was pulled into the joint. The tendon was cut and a tenodesis was performed. Two years after the surgical procedure, the patient was without pain and returned to playing tennis at her previous level.