Peroneus longus tendon transfer; prospective study of treatment outcome of recurrent fixed clubfoot deformities in children after failed surgical treatment

BackgroundIn childhood, for flexible clubfoot deformity, the transfer of the tendon of the tibialis anterior muscle is widely used. In contrast, extensive surgical procedures are required for fixed clubfoot deformities.MethodsWe describe the peroneus longus tendon transfer to the peroneus brevis tendon, additionally to full surgical release, in cases of recurrent fixed clubfoot deformities. The purpose of this surgical technique was to restore and maintain the dynamic balance of foot inversion-eversion during the gait cycle by augmenting the muscular strength of the weak peroneus brevis tendon. We report the prospective study of treatment outcome of twenty recurrent fixed clubfoot deformities in twelve children (20 feet) after failed surgical treatment they had. Anteroposterior and lateral radiographs under full-body weight-bearing and the AOFAS score pre-and postoperatively were used in all patients. For the estimation of the severity of the recurrent clubfoot deformity in each child and to increase the credibility of the AOFAS rating scale, we additionally used a clubfoot sheet score preoperatively and postoperatively (maximum score 100 points for normal foot appearance clinically and radiologically).ResultsThe mean age at surgery was 6,85 (±1,81; 5–11) years. The mean follow-up time was 5,4 (±1,7; 2–8) years. The mean AOFAS ankle-hindfoot rating score increased from 69,85 (±9,51; 53–82) points preoperatively to 94,4 (±2,43; 91–97) points postoperatively. The mean clubfoot sheet rating score increased from 43,00 (±12,18; 15–55) points, preoperatively to 90,0 (±4,58; 80–95) points postoperatively. The two-tailed p-value was < 0,0001.ConclusionsThe transfer of the peroneus longus tendon to the peroneus brevis tendon is a minimal surgical procedure that acts collaboratively in maintaining the correction of foot deformity, achieved by the complete surgical release. Level of Evidence: IV.     

Management of chronic Achilles tendon ruptures—A review

Achilles tendon ruptures are increasingly common yet up to a fifth of them are undiagnosed after medical consultation. Those undiagnosed will become chronic ruptures causing considerable functional morbidity and represent a challenge to the treating doctor.The purpose of this article is to discuss the presentation and management of chronic Achilles tendon ruptures. Due to the paucity of data, evidence-based recommendations are unavailable. A number of different surgical techniques are presented and a working algorithm is described to aid in the treatment of these lesions.     

Trends in digital joint motion following surgical reconstruction of a tendon rupture after distal radius fracture

BackgroundTendon rupture has been recognized as a complication of distal radius fracture (DRF); however, the clinical outcome of reconstructive surgery for this injury remains unclear. We examined prognostic factors for the outcomes of reconstructive surgery in patients with a tendon rupture after DRF.MethodsThis study was a retrospective review of a case series. Seventy-five consecutive patients were treated at our institution for tendon rupture after DRF. The cohort included 14 males and 61 females with a mean age of 67.7 years at the time of tendon reconstruction. Sixty-four and eighteen tendon ruptures occurred after non-operative management for DRF and palmar locking plate fixation, respectively. Seven ruptured tendons received a free tendon graft from the palmaris longus tendon, and the others underwent tendon transfers. All patients were managed postoperatively by our hand therapy unit according to a controlled active mobilization regime.ResultsThe mean follow-up period was 28 weeks (range: 12–80 weeks). Patients with extensor tendon ruptures were significantly younger than those with flexor tendon ruptures regardless of the initial DRF treatment. The mean percentage active range of motion of the injured digits relative to normal active motion (%AROM) at the final follow-up was 70% (range: 30–101%) in all patients. The %AROM after flexor tendon reconstruction for patients after non-operative management was significantly inferior to that of other patients. Multiple regression analysis revealed that aging and non-operative management of DRF are independent risk factors for poor %AROM.ConclusionsThis study confirmed that advanced age and non-operative management of DRF were prognostic factors for digital joint motion following surgical reconstruction for tendon rupture. Our results suggest that it may be difficult to achieve good clinical outcomes in elderly patients with tendon ruptures (particularly flexor tendon ruptures) following non-operative management of DRF.     

超声联合功能锻炼对Ⅱ区指屈肌腱修复术后功能的影响

目的探讨超声治疗对Ⅱ区指屈肌腱损伤修复术后手功能的影响。方法将38例(84指)患者随机分为A、B、C三组。A组12例(28指)进行超声治疗和功能训练;B组11例(28指)给予功能训练(同A组)和假超声治疗;C组15例(28指)仅给予术后常规处理。术后进行TAM评定、手指运动功能损伤及Carroll上肢功能评定。结果第4周末,A组与B组的3项指标的差异均有统计学意义(P<0.05),A组与C组、B组与C组之间差异也有统计学意义(P<0.01)。第12周末时,所测的3项指标,A组、B组和C组之间差异有统计学意义(P<0.01),而A组与B组间差异无统计学意义(P>0.05)。结论Ⅱ区指屈肌腱修复术后,在功能训练的基础上,早期使用超声治疗,对消炎消肿、减轻粘连形成和改善手功能有显著的疗效。     

Anatomical study of Lapidus arthrodesis using two different plantar plate systems

BackgroundFirst tarsometatarsal arthrodesis (modified Lapidus procedure) constitutes a sufficient treatment for moderate to severe hallux valgus deformity and first ray instability. The plantar plate arthrodesis was shown to provide superior mechanical stability and less postoperative complications than screw fixation or dorsal plating. Nevertheless, the in-brought hardware may cause irritation of the tibialis anterior or peroneus longus tendon requiring explantation of the material in some cases.The purpose of this study was to investigate the potential of tendon irritation after plantar first tarsometatarsal joint arthrodesis in a cadaver study.MethodsPlantar plate arthrodesis was performed as in real surgery on twelve pairs of fresh frozen cadaveric feet. Two different plate systems were randomly allocated to each pair of feet. After plate fixation careful dissection of the feet followed to analyze potential tendon irritation and to determine a “safe zone” for plantar plate placement.ResultsA “safe zone” between the insertion sties of tibialis anterior and peroneus longus tendon was found and proven to be sufficiently exposed using a standard medio-plantar approach. Both plates were fixed in this zone without compromising central tendon parts. Peripheral tendon parts were irritated in 42% using Darco Plantar Lapidus Plating System® (Wright Medical, Memphis, TN) and in 8% using the Plantar Lapidus Plate® (Arthrex, Naples, FL). Bending of the anatomically preshaped plates is often necessary to ensure optimal fit on the bone surface.ConclusionsModified Lapidus procedure with plantar plating of the first tarsometatarsal joint can be performed safely without compromising central tendon parts via standard medio-plantar approach.Level of clinical evidence5, Cadaver Study.