Acute Triceps Tendon Repair: A Technique Utilizing 3 Curved Tunnels and Proximal Knots.
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ABSTRACT:
SUBMITTER: Sarokhan AK
PROVIDER: S-EPMC6713898 | biostudies-other | 2019 Jul
REPOSITORIES: biostudies-other
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Project description:To evaluate the effectiveness of teaching core tendon repairs using a simulation model, ten surgical residents with no prior experience repairing flexor tendons were taught a four-strand cruciate repair. The residents then performed ten repairs each on a simulated tendon (a round synthetic bait worm 10 mm in diameter) while being timed and graded by a hand surgeon using a global rating scale (1 to 5). Six residents also performed a zone IV flexor tendon repair on a fresh frozen cadaver--three residents who had practiced and three other residents who had no practice on the simulated tendon. The mean initial quality score was 2.4/5.0 which improved to 4.8/5.0 by the tenth trial. There was a significant incremental improvement in mean performance from trial 1 to 10 (p < 0.0001). The mean times to complete the first and last repairs were 5.4 and 3.0 min, respectively. In the cadaver trial, there was statistically significant evidence (p = 0.05, one-sided Wilcoxon exact test) that the three residents previously trained with the simulated tendon had a higher median performance (4.4, min = 4.3, max = 4.8) than the three who had not been trained (1.8, min = 1.7, max = 2.1). The mean times to complete the repairs were 4.0 and 5.8 min, respectively. In conclusion, this inexpensive model mimics an in vivo tendon repair experience with sufficient fidelity to justify its use in training residents to perform a tendon repair.
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Project description:Proximal hamstring injuries are common, and open surgical repair with suture anchors has been the gold standard when surgical intervention is warranted. Endoscopic techniques offer the opportunity of surgical repair with smaller incisions to limit complications and expedite rehabilitation. The purpose of this technique guide is to describe a modified endoscopic technique that allows a safe and anatomic repair of proximal hamstring injuries. The patient is positioned prone with the feet at the head of the bed, table in reverse Trendelenburg, and knees flexed to 90°. Four portals are used, 3 in horizontal alignment within the gluteal fold and 1 directly superior to the ischial tuberosity. The sciatic nerve is identified, dissected, and mobilized away from the operative field. Retraction sutures help retract the gluteus maximus and further protect the sciatic nerve. Dissection is within the interval between the conjoint and semimembranosus tendons. The tendons are freed and mobilized, the ischial tuberosity is decorticated, and an anatomic repair is performed via 4 suture anchors, 2 at each tendon footprint. Advancements in arthroscopy have permitted adequate visualization and exposure of the hamstring footprint, thus allowing for an anatomic repair with increased protection of the sciatic nerve and decreased resources and cost.
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Project description:Patellar tendon ruptures may be considerably limiting, especially in younger and highly active patients. These injuries ultimately result in a complete inability to maintain extension of the knee, thereby placing strict impediment on physical activity. As a result, a durable repair construct via surgery is necessary to allow patients to return to their preinjury activity level. Because of the inherent difficulty in maintaining patellar tendon position after repair, and to avoid failure of the tendon healing to the patella, we recommend using an internal brace construct. The construct uses bone tunnels in the patella and also cortical buttons on the tibia with suture tape whipstitched through the tendon. We feel that this provides an enhanced fixation construct. The purpose of this Technical Note is to describe our preferred method for proximal patellar tendon repair via an internal brace construct with unicortical buttons and suture tape.
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Project description:PurposeTo use validated outcome measures to evaluate the clinical results of surgical repair of distal triceps tendon ruptures using transosseous tunnels and high-strength sutures with proximally based knots.MethodsA consecutive series of traumatic distal triceps tendon ruptures at a single institution was studied. All cases were surgically repaired by 1 surgeon using high-strength suture with a bone tunnel-based repair technique. Repair knots were oriented proximally instead of in the traditional distal position. All patients were evaluated at long-term follow-up with a physical examination performed by the orthopaedic surgeon and the following validated outcome measures: Disabilities of the Arm, Shoulder and Hand score; Mayo Elbow Performance Score; and visual analog scale score.ResultsSeven male patients with a mean age of 38 years (range, 19-50 years) and mean follow-up period of 4.1 ± 1.2 years underwent distal triceps tendon repair with bone tunnels and high-strength sutures with proximally positioned knots. Of the repairs, 4 involved the dominant arm. At final follow-up, the mean Disabilities of the Arm, Shoulder and Hand score was 1.3 ± 3.1; the mean Mayo Elbow Performance Score was 99.3 ± 1.9; and the mean visual analog scale score was 0. One additional patient who declined participation in the study had wound dehiscence and infection with an associated partial rerupture.ConclusionsThis case series of triceps tendon repairs using transosseous tunnels and proximally based knots showed favorable postoperative elbow function based on validated outcome measures.Level of evidenceLevel IV, therapeutic case series.
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Project description:Quadriceps tendon rupture is a devastating injury that has traditionally been repaired using bone tunnels and knot tying. Recent innovations seeking to address persistent weakness and gap formation of repairs have used suture anchors and knotless technology. Despite these innovations, the clinical outcomes of these repairs continue to be mixed. We describe a technique that leverages a pre-tied knotted high-tension suture construct to allow for a re-tensionable quadriceps repair. Technique Video Video 1 Re-tensionable quadriceps tendon repair surgical technique using FiberTape cerclage and transosseous tunnels.
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Project description:The aim of this study is to introduce a self-designed, minimally invasive technique for repairing an acute Achilles tendon rupture percutaneously. Comparing with the traditional open repair, the new technique provides obvious advantages of minimized operation-related lesions, fewer wound complications as well as a higher healing rate. However, a percutaneous technique without direct vision may be criticized by its insufficient anastomosis of Achilles tendon and may also lead to the lengthening of the Achilles tendon and a reduction in the strength of the gastrocnemius. To address the potential problems, we have improved our technique using a percutaneous Kirschner wire leverage process before suturing, which can effectively recover the length of the Achilles tendon and ensure the broken ends are in tight contact. With this improvement in technique, we have great confidence that it will become the treatment of choice for acute Achilles tendon ruptures.
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Project description:The fast and steady development of arthroscopy techniques in the last couple of decades led to a drastic increase of arthroscopic rotator cuff repairs over the open procedure. Supraspinatus tears are the most common of all, but the subscapularis tendon tear is a more common injury than expected. Most of the time it presents as a partial tear or is associated with a subsequent rotator cuff tendon injury, especially the supraspinatus. Nowadays, the standard procedure to repair the subscapularis tendon is performed arthroscopically, even though a real superior result over the open repair it is yet to be reported. Ideally less operative time, less scarring, and postoperative pain would be the expected benefits, but no study has compared the long-term outcome of these 2 procedures yet. To maximize possible improvements, we would like to present an arthroscopic technique: a subscapularis tendon repair performed with the aid of an angled suture passer and using a single anterior working portal.
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Project description:Patellar tendon ruptures are severe but uncommon injuries that require surgical treatment. Primary repair for acute patellar tendon ruptures using augmentation techniques has shown good results in terms of biomechanical and clinical outcomes. This Technical Note details patellar tendon repair with suture tape augmentation for proximal patellar tendon rupture. Because this surgical technique does not require harvesting of the hamstring tendon and hardware removal, it is minimally invasive. In addition, it is simple and quick to perform.
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Project description:Proximal hamstring tears are among the most common sports-related injuries. These injuries often occur as strains or partial tears at the proximal muscle belly or the musculotendinous junction, with avulsion injuries of the proximal attachment occurring less frequently. Regardless of the mechanism, they produce functional impairment and negatively affect an athlete's performance. Various classifications for these injuries are reported in the literature. Early surgical treatment is recommended for patients with either a 2-tendon tear/avulsion with more than 2 cm retraction or those with complete 3-tendon tears. Surgery can be performed in the chronic phase but it is technically demanding because of scar formation and tendon retraction. This Technical Note describes a biomechanically validated surgical technique for repair of the proximal hamstring tears.
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