Peroneal retinaculoplasty with anchors for peroneal tendon subluxation

Recurrent subluxation of the peroneal tendons is rare but can produce marked functional impairment in athletes. We describe a technique for the reconstruction of the superior peroneal retinaculum using anchors. This procedure is safe and effective in managing instability.     

Superior retinaculoplasty for recurrent dislocation of peroneal tendons

BACKGROUND: Although dislocation of peroneal tendons is an uncommon injury, if it does occur, daily and sports activities may be restricted because of snapping of the tendons and pain in the posterolateral aspect of the ankle joint. Many operative procedures have been reported for this pathology, including anatomic reattachment of the retinaculum, bone block procedures, tissue-transfer procedures, and groove-deepening. However, no procedure has been established as the "gold standard." Successful results were reported after anatomic reattachment of the detached superior peroneal retinaculum and periosteum of the fibula. We have modified the procedure to reduce operative invasiveness and introduced a method to determine proper tension when suturing the retinaculum to the fibula. METHODS: In our retinaculoplasty, the false pouch was opened through one incision, and the retinaculum was sutured to the fibula while measuring the tension, avoiding too tight or too loose suturing. We performed this procedure in 20 patients with symptomatic dislocation of peroneal tendons in whom conservative treatment had failed. We followed them over 2 years, and clinical results were evaluated. RESULTS: No patient had re-dislocation of the peroneal tendons during the followup period. Fifteen of 18 patients who had been involved in sports activities returned to their previous activities without reducing their activity levels. All patients acquired full range of motion of the ankle joint postoperatively. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores improved significantly (p value < 0.01) postoperatively. CONCLUSIONS: This study demonstrated that the described repair successfully treated patients with symptomatic dislocation of the peroneal tendon and should be considered for this pathology.     

Management of recurrent subluxation of the peroneal tendons

Recurrent peroneal subluxation occurs when an acute injury is misdiagnosed or not adequately managed. The primary pathology is failure of the SPR, the principal restraint to the peroneal tendons. Several surgical techniques have been described. Determining the most effective technique from the small case series and reports in the literature is impossible. If an anatomic approach to treating the pathology is used, reattachment of the SPR, as we have described, seems a most appropriate technique. Rarely, the retinaculum in recurrent cases may not be robust enough to withstand repair, and a different approach to the problem may be required. In the future, there may be an emerging role for minimally invasive SPR repair with the use of endoscopic techniques.     

A modification of the Ellis Jones procedure for chronic peroneal subluxation.

The authors present a modification of the classic Ellis Jones procedure. The modification primarily involves the technique used for tenodesis of the transferred slip of Achilles tendon to the fibula. Advantages and disadvantages are discussed, as well as the results of 31 cases.     

Distal internal carotid exposure: a simplified technique for temporary mandibular subluxation

Distal internal carotid artery exposure can be technically demanding even for experienced vascular surgeons. Although a variety of techniques have been described to facilitate such exposure, temporary mandibular subluxation has emerged as the simplest and least debilitating approach. Current techniques for maintaining temporary mandibular subluxation during distal internal carotid artery procedures, including maxillomandibular arch bar fixation and circummandibular/transnasal wiring, have been time consuming and associated with complications. Over the last 4 years a new simplified technique of temporary mandibular subluxation fixation has been used in 14 patients requiring distal internal carotid exposure. Indications for operation included extended carotid endarterectomy (8), carotid body tumor excision (2), repair of distal internal carotid artery trauma (2), and repair of postendarterectomy pseudoaneurysm (2). Among patients with healthy teeth, unilateral temporary mandibular subluxation was maintained by interdental wiring from the ipsilateral mandibular bicuspids to the contralateral maxillary bicuspids. In edentulous patients or those with chronic periodontal disease, temporary mandibular subluxation was maintained with diagonal wiring between maxillary and mandibular Steinmann pins. No instances of malocclusion, dental injury, or local infection were observed. Transient postoperative cranial nerve dysfunction was observed in three patients. Transient ipsilateral temporomandibular joint pain occurred in three patients. Two patients developed permanent cranial nerve injuries unrelated to temporary mandibular subluxation. These data suggest that temporary mandibular subluxation by diagonal interdental/Steinmann pin wiring is safe, expeditious, and effective in facilitating exposure of the distal internal carotid artery.     

Patellar tilt and subluxation following subvastus and parapatellar approach in total knee arthroplasty: Implication for surgical technique

Eighty-nine posterior-stabilized total knee arthroplasties (TKAs) were studied using a Merchant view to assess patellar tilt or subluxation. Forty TKAs were performed via the subvastus approach (SVA) and 49 via the standard parapatellar approach (PPA). Intraoperative tracking was assessed using a “no thumbs” test, and a lateral release was performed if necessary. Following the SVA, 40.0% of patellas tracked centrally compared to 44.9% for the PPA. With the SVA, a lateral release was necessary in 27.5% of procedures compared to 51.0% for the PPA. The data suggest that the no thumbs test may overestimate the need for lateral release following the PPA. Since there are fewer lateral releases following the SVA, reapproximation of the medial retinaculum to assess intraoperative tracking may result in fewer lateral releases being performed without adversely affecting patellar position. Medial tilting of the patella is also found to be common; 29.7% of the patellas tilted this way, including 40.0% of knees operated via the SVA. Why this occurs is unclear, but the incidence of medial tilting increased after posterior-stabilized TKA.     

Chronic recurrent subluxation of the peroneal tendons in a pediatric patient. Surgical recommendations

Numerous surgical and non-operative approaches have been used to treat chronic recurrent subluxation of the peroneal tendons in adult athletes. There have been no published reports of surgical repair in children. In this report on a skeletally immature patient a modification of the Chrisman-Snook procedure (previously described for lateral ligament reconstruction) is described to correct recurrent subluxation of the peroneal tendons, child.     

Conjunctivochalasis: a surgical technique

Conjunctivochalasis can be surgically corrected when it gives an appearance of a moist eye, produces tearing by mechanical obstruction of the lower punctum, or if it impedes the normal outflow of the lacrimal film. We present a surgical technique that provides a satisfactory anatomical reconstruction, does not leave a deformity, and will not lead to a retraction that could produce a cicatricial ectropion. We stress the importance of a complete ophthalmologic examination to rule out more common causes of tearing.     

Posttraumatic ulnar subluxation of the extensor tendons: a reconstructive technique

Ulnar subluxation of the extensor digitorum communis over the metacarpal head can compromise the function of the extensor mechanism to the affected digit. Extensor displacement can be posttraumatic, developmental, congenital, or caused by arthritis of the metacarpophalangeal joint. A tendon centralizing procedure was performed on five digits in three patients who had posttraumatic ulnar subluxation of the extensors at the metacarpophalangeal joint after conservative management failed. No recurrences of subluxation have been noted in this series, and all patients have regained full range of motion.     

Endoscopic management of recalcitrant retrofibular pain without peroneal tendon subluxation or dislocation

Peroneal tendon pathology is not uncommonly encountered behind the lateral malleolus and presented as retrofibular pain. The three primary categories of peroneal tendon disorders include tendinitis and tenosynovitis, tendon subluxation and dislocation, and tendon tears and ruptures. We described an approach of endoscopic groove deepening and endoscopic assisted repair of longitudinal peroneal tendon tears in management of recalcitrant retrofibular pain without peroneal tendon subluxation or dislocation.     

Posterior surgical stabilization for atlantoaxial subluxation in rheumatoid arthritis

Twelve patients with rheumatoid arthritis involving the cervical spine were treated with posterior surgical stabilization for atlantoaxial instability. There were two occiput C2 fusions with one death and ten C1-2 fusions with nine successful fusions, giving an overall 84% satisfactory results and 90% satisfactory results in the C1-2 fusions alone. It is proposed that careful attention to operative positioning and postoperative management are responsible for the better results reported in this series than recent reports of operative treatment of similar patients. The use of halo traction intraoperatively with careful attention to positioning of the neck and halo cast postoperatively are advocated.     

The Singapore operation for chronic recurrent peroneal tendon subluxation—Short-term follow-up in four patients

BackgroundRecurrent peroneal tendon subluxation is an uncommon condition which is usually the result of sports related trauma. This injury may be misdiagnosed resulting in long-term disability. Most authors would recommend surgical treatment for patients who have a long history or in patients in whom conservative treatment has failed. Surgical treatment can also be considered in the acute phase when managing young athletic individuals.MethodsWe report the outcome in four patients who underwent the Singapore operation for chronic peroneal tendon subluxation. All patients were operated on by the same surgeon and followed up at regular intervals with a minimum follow-up of two years.ResultsIn all four patients a Bankart type lesion was found in association with subluxation solely of the peroneus longus tendon. Following repair all patients returned to pre-injury activity levels within six months.ConclusionIn our experience the Singapore operation is technically easy to perform and offers excellent results with high patient satisfaction levels.     

Superior vena cava stenosis after orthotopic heart transplantation: complication of an alternative surgical technique

Superior vena cava stenosis presented as a postoperative complication of orthotopic heart transplantation in a patient in whom a new surgical technique was used. This alternative technique consists of total excision of the recipient's atria, with donor heart implantation performed using bicaval and pulmonary venous anastomoses. This rare complication required surgical repair 1 month after transplantation. The patient remains well on long-term follow-up. The pathogenesis, surgical management and modifications of the alternative technique to prevent this potentially serious complication are discussed.     

Possibilities for fertility restoration: a new surgical technique

Previously published work concluded that uterine artery microvascular anastomosis in the porcine model was feasible with subsequent normal vascular function in pregnancy. of the anastomosed vessels. The objective of this study was to assess the feasibility of uterine autotransplantation in a porcine model using microvascular anastomoses. Eight large white/landrace sows of proven fertility were used. A supracervical hysterectomy with or without bilateral salpingo-oophorectomy (BSO) was performed. After 1 hour of cold storage in a transplant solution, the specimen was reintroduced and followed by stepwise vascular reanastomosis. Objective perfusion index measurements suggested adequate uterine perfusion after transplantation. Postoperatively, sow 1 survived to 3 months with no signs of oestrus, and sows 2, 6, and 8 were killed on days 6, 33, and 54, respectively, for pelvic infection. Histopathology of the uterine grafts revealed gradual vessel thromboses. Microvascular reanastomosis is feasible, however, unsuccessful in uterine autotransplantation because of gradual vessel thromboses. The porcine model is highly susceptible to postoperative infection.     

Atlantoaxial rotatory subluxation after surgical relocation of Sprengel deformity: a case report

We report a case of atlantoaxial rotatory subluxation developed after scapular relocation for Sprengel deformity in a 5-year-old girl. Scapular relocation descended the scapula by 60%, and achieved a normal shoulder joint motion. However, atlantoaxial rotatory subluxation developed, probably by pulling force of the tightened anterior fibers of upper trapezius muscle. Atlantoaxial joint was reduced easily under general anesthesia and muscle relaxant, along with surgical release of the tight band at the anterior part of trapezius muscle, which was maintained by halovest immobilization.