Chronic Distal Biceps Tendon Tear Reconstruction With Tibialis Anterior Allograft.
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ABSTRACT:
SUBMITTER: Mirzayan R
PROVIDER: S-EPMC8355415 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Chronic musculotendinous retraction, shortening and fibrosis after distal biceps tendon tears makes a primary reconstruction often difficult or even impossible. Interposition reconstruction with allograft provides a solution, however there is no consensus about appropriate intraoperative graft length adjustment. Therefore, the purpose of this study was to find a practical reference value for distal biceps tendon length adjustment. Three-dimensional surface models of healthy distal biceps tendons were created based on 85 MRI scans. The tendon length was measured from the myotendinous junction to the insertion on the bicipital tuberosity. Inter-epicondylar distance (IED) and radial head diameter (RHD) were measured on antero-posterior radiographs as a surrogate for patient size. Correlations between the tendon length and IED, RHD and patient's height (PH) were calculated. Mean length of the external part of the distal biceps tendon was 69mm (female 64mm, male 71mm). The tendon length in mm was on average 1.1 times of the IED (mm), 3 times of the RHD (mm) and 0.4 times of PH (cm). Herewith, the tendon length could be predicted within a narrow range of +/-1cm in 84% by using IED, 82% by using RHD and 80% by using PH. Intra- and inter-reader reliabililty of IED and RHD was excellent (R2 = 0.938-0.981). The distal biceps tendon length can be best predicted within 1cm with an accuracy of 82-84% using the IED and RHD with an excellent intra- and inter-reader reliability.
| S-EPMC8412371 | biostudies-literature
Project description:In an effort to better restore normal joint function and kinematics, recent emphasis has been placed on surgical techniques that provide a more anatomic reconstruction of the anterior cruciate ligament (ACL). With femoral tunnel placement shown to play a vital role in the biomechanics, stability, and clinical outcomes after ACL reconstruction, approaches that better approximate the ACL's native femoral origin have been adopted. The independent anteromedial portal technique is thought to better position the femoral tunnel within the native ACL footprint and leave the graft more posteroinferior on the wall of the lateral femoral condyle than the more traditional transtibial approach. This article outlines the surgical technique for an anteromedial portal ACL reconstruction with a tibialis anterior allograft fixed with the Mitek Femoral and Tibial Intrafix sheath and screw system (DePuy Synthes, Raynham, MA).
| S-EPMC5368166 | biostudies-literature
Project description:In cases of chronic distal biceps ruptures, the combination of muscle atrophy, distal tendon retraction, and fibrosis makes primary anatomic reattachment of the tendon particularly challenging. To regain tendon length and avoid flexion contractures, reconstruction with graft augmentation has been proposed as an alternative for cases not amenable to primary repair. We describe our technique using an Achilles allograft through a modified Henry approach to reconstruct the distal biceps tendon to regain length as well as restore flexion and supination strength. With proper and detailed exposure, chronic distal biceps injuries can be reconstructed safely and efficaciously using an Achilles allograft.
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Project description:Biceps tenodesis and tenotomy are both effective surgical procedures for management of shoulder pain and dysfunction secondary to SLAP tears, biceps tendinitis, rotator interval pulley lesions, and failed SLAP repairs. These procedures are generally safe with low complication rates. However, failure of a proximal biceps tenodesis or tenotomy can rarely lead to symptomatic Popeye deformity with pain and cramping with repetitive forearm supination and elbow flexion. Surgical revision is indicated in young active patients to restore the length tension relationship of the biceps brachii to improve supination and flexion strength, as well as to provide symptomatic relief and improved endurance. Failed biceps tenodesis can be a challenging surgical scenario, as oftentimes there is limited available proximal biceps tendon tissue, especially in the setting of prior subpectoral biceps tenodesis. We report a technique of revision open subpectoral biceps tenodesis with allograft tendon augmentation for the management of symptomatic Popeye deformity in young active patients with little to no remaining proximal biceps tendon.
| S-EPMC9134021 | biostudies-literature
Project description:Advances in surgical technique and our knowledge of anterior cruciate ligament (ACL) anatomy have resulted in a marked increase in options for ACL reconstruction. Currently, patient age and activity level, surgeon preference and experience, and cost are factors influencing the type of reconstruction recommended to address knee instability. We present a simplified transtibial method of ACL reconstruction using a single-bundle, doubled tibialis anterior allograft. This method uses fixation with a suspensory device on the femur and a bio-composite interference screw on the tibia. We recommend this simplified technique for primary ACL reconstruction because it minimizes total steps, thus limiting variance, maximizing efficiency, and reducing potential technical error.
| S-EPMC5368165 | biostudies-literature
Project description:PurposeTo evaluate the effect of graft donor age on outcomes of anterior cruciate ligament (ACL) reconstruction with nonirradiated, fresh-frozen tibialis tendon allografts.MethodsThis prospective, randomized, double-blind, single surgeon, 2-year follow-up study enrolled 40 patients (28 female, 12 male who underwent ACL reconstruction with tibialis tendon allografts. Results were compared with historical outcomes for allografts from donors aged 18 to 70 years. Analysis was determined by Group A (<50 years) and Group B (>50 years). Objective and subjective International Knee Documentation Committee (IKDC) forms, KT-1000 testing, and Lysholm scores were used for the evaluation.ResultsFollow-up on average of 24 months was completed in 37 patients (92.5%; Group A = 17, Group B = 20). Average patient age at surgery for Group A was 42.1 years (range 27-54) and Group B was 41.7 years (range 24-56). None of the patients required additional surgery during the initial 2-year follow-up. At 2-year follow-up, there were no significant differences in subjective outcomes. IKDC objective ratings for Group A were A-15 and B-2, and Group B were A-19 and B-1 (P = .45). Average IKDC subjective scores for Group A were 86.1 (± 16.2) and Group B were 84.1 (± 15.6) (P = .70). KT-1000 side to side differences for Group A were 0-4, 1-10, and 2-2, and Group B were 0-2, 1-10, 2-6 (P = .28). Average Lysholm scores for Group A were 91.4 (± 16.7) and Group B were 88.1 (± 12.3) (P = .49).ConclusionsDonor age was not associated with clinical outcomes after ACL reconstruction using nonirradiated, fresh-frozen tibialis tendon allografts.Level of evidenceII, prospective prognostic trial.
| S-EPMC9972004 | biostudies-literature
Project description:The importance of the labrum in the biomechanics of the hip joint is well documented. Labral tears are the most common pathology in patients undergoing hip arthroscopy and therefore appropriate labral management is vital. Labral preservation has been advocated as a superior alternative to labral excision in terms of clinical outcomes. While reconstruction of the labrum is recommended for irreparable tears, labral augmentation is a viable alternative for labral function restoration under certain indications. This Technical Note will describe a method for arthroscopic hip labral augmentation using an anterior tibialis tendon allograft and the pull-through technique.
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Project description:Once perceived to be a vestigial structure, the ligamentum teres (LT) is now increasingly understood to be critical to providing stability in the adult hip. Surgical treatment with arthroscopic debridement is usually the procedure of choice to treat LT tears. However, reconstruction is a possible alternative in select cases. The authors of a recent systematic review concluded that LT debridement may provide short-term relief of hip pain in patients with partial-thickness tears in whom conservative management has failed whereas reconstruction may be more beneficial in cases of full-thickness tears. This Technical Note describes a method for arthroscopic LT reconstruction using the tension-slide technique to fixate an anterior tibialis tendon allograft to the acetabulum.
| S-EPMC6948114 | biostudies-literature
Project description:Despite the different treatment options for irreparable and massive rotator cuff tears (RCTs), there is no optimal treatment. Thirty percent of total RCTs can be classified as irreparable because of the massive tear size and severe muscle atrophy. The reported treatment failure rate is approximately 40% for massive RCTs. RCTs may be treated conservatively or surgically depending on pain, disability, and functional demands. The surgical treatment options are many, but decision making is a challenge; the real challenge is to apply the correct procedure for the correct indication in each patient. The long head of the biceps tendon (LHBT) was used for augmentation to bridge the gap in immobile, massive RCTs. An arthroscopic biceps-incorporating technique was used for repair of large and massive RCTs, avoiding undue tension on the rotator cuff (RC). Recently, the LHBT was used for superior capsular reconstruction. This article describes the use of the LHBT for reconstruction of massive and irreparable RCTs through the following steps: (1) open exposure of the RCT, (2) debridement and subacromial decompression, (3) biceps tenotomy at the LHBT's origin on the glenoid, (4) LHBT and RC cuff mobilization, (5) passage of the LHBT through the mobilized RC and reflection onto itself, (6) tuberoplasty, and (7) fixation of the RC complex at the RC footprint.
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Project description:Rotator cuff tears with anterior cable disruption show a more detrimental natural history than tears with an intact cable. Anterior cable reconstruction in the setting of such tears provides a potential avenue to improve tissue quality of the repaired construct and enhance repair longevity. Cadaveric studies investigating anterior cable reconstruction have shown biomechanical advantages. We present an arthroscopic surgical technique for rotator cuff anterior cable reconstruction using long head of the biceps tendon autograft in the setting of repairable large-to-massive rotator cuff tears with poor anterior cable tissue quality.
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