Spätergebnisse der Rückverlagerung des M. tibialis anterior (Operation nach Müller-Niederecker) beim kindlichen Pes planovalgus

Author(s):  
W. Küsswetter ◽  
L. Zwack ◽  
A. Rütt
2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0035
Author(s):  
Daniel Miles ◽  
Tyler W. Fraser ◽  
Neal Huang ◽  
Franklin B. Davis ◽  
Jesse F. Doty

Category: Midfoot/Forefoot; Other Introduction/Purpose: Midfoot arthrodesis is a reliable procedure for deformity correction and pain relief. First tarsometatarsal arthrodesis can be used for correction of hallux valgus deformity with large intermetatarsal angles or first-ray hypermobility. Midfoot arthrodesis is also integral in correction of pes planovalgus deformity with midfoot collapse. First tarsometatarsal arthrodesis has a nonunion rate of 2-15%. Arthrodesis is completed traditionally through a dorsal approach. Due to high nonunion rates, recent studies have investigated plater based plates. These have been shown to have superior strength by creating a tension band construct as the foot is loaded. Tibialis anterior footprint is at risk when accessing first tarsometatarsal joint for arthrodesis. We explore whether the tibialis insertional footprint can be released and repaired with no deleterious effects. Methods: Patients included were undergoing first tarsometatarsal joint or naviculocuneiform joint arthrodesis with a plantar based plate and screw construct for hallux valgus deformity with large intermetatarsal angle or first-ray hypermobility, and those with first TMT joint arthritis, pes planovalgus, Lisfranc injury, or Charcot neuroarthropathy. Medial based surgical approach is centered over the first tarsometatarsal joint. Saphenous neurovascular bundle is retracted dorsally. Release of the capsular structures allowed for complete visualization and distraction of the joint. The distal-most attachment of the tibialis anterior tendon onto the first metatarsal is release in line with the capsulotomy. Primary insertion on the medial cuneiform was preserved. A cuff of released insertional tissue is preserved and reflected distally for repair. Standard tarsometatarsal arthrodesis joint preparation was completed. Plantar plate then fixed and compressed. Deep fascial layers were then closed over the plated were previous tendon release was performed. Results: In 62 patients, none had tibialis anterior tendon rupture, weakness, or irritation, with average follow-up of 36.2 months. Nine wound complications were recognized during the study. Twelve percent of patients experiencing delayed incisional healing that went on to heal with local wound care. Smokers accounted for six of the seven patients (OR 24.62, p<.05), and one of seven patients had Charcot (OR 2.08, p<.05). Deep wound complications, which required return to the operating room for formal irrigation and debridement, were seen in 3% (2 of 62). Both patients were active smokers and had removal of hardware at the time of debridement. Both underwent definitive coverage with split-thickness skin grafts and went on to successful arthrodesis and wound healing. Conclusion: One advantage of applying a plate and screw construct plantarly for midfoot arthrodesis is biomechanical stability. Multiple studies have indicated this plantar construct may be superior. Another benefit may be less hardware prominence due to increased soft-tissue coverage. Subcutaneous positions of dorsal plates have been reported to contribute to incisional irritation and symptomatic hardware. Tibialis anterior tendon damage has been suggested as a limitation of the plantar approach for midfoot arthrodesis, and the tendon insertion must be released to prepare the joint adequately to apply implants. This series shows tendon release can be safely accomplished without any deleterious effects. [Table: see text]


Author(s):  
H.D. Geissinger ◽  
C.K. McDonald-Taylor

A new strain of mice, which had arisen by mutation from a dystrophic mouse colony was designated ‘mdx’, because the genetic defect, which manifests itself in brief periods of muscle destruction followed by episodes of muscle regeneration appears to be X-linked. Further studies of histopathological changes in muscle from ‘mdx’ mice at the light microscopic or electron microscopic levels have been published, but only one preliminary study has been on the tibialis anterior (TA) of ‘mdx’ mice less than four weeks old. Lesions in the ‘mdx’ mice vary between different muscles, and centronucleation of fibers in all muscles studied so far appears to be especially prominent in older mice. Lesions in young ‘mdx’ mice have not been studied extensively, and the results appear to be at variance with one another. The degenerative and regenerative aspects of the lesions in the TA of 23 to 26-day-old ‘mdx’ mice appear to vary quantitatively.


Author(s):  
H. D. Geissinge ◽  
L.D. Rhodes

A recently discovered mouse model (‘mdx’) for muscular dystrophy in man may be of considerable interest, since the disease in ‘mdx’ mice is inherited by the same mode of inheritance (X-linked) as the human Duchenne (DMD) muscular dystrophy. Unlike DMD, which results in a situation in which the continual muscle destruction cannot keep up with abortive regenerative attempts of the musculature, and the sufferers of the disease die early, the disease in ‘mdx’ mice appears to be transient, and the mice do not die as a result of it. In fact, it has been reported that the severely damaged Tibialis anterior (TA) muscles of ‘mdx’ mice seem to display exceptionally good regenerative powers at 4-6 weeks, so much so, that these muscles are able to regenerate spontaneously up to their previous levels of physiological activity.


2020 ◽  
Author(s):  
G Toporowski ◽  
R Rödl ◽  
G Gosheger ◽  
A Frommer ◽  
B Bröking ◽  
...  

2002 ◽  
Vol 87 (4) ◽  
pp. 1763-1771 ◽  
Author(s):  
Antoni Valero-Cabré ◽  
Xavier Navarro

We investigated the changes induced in crossed extensor reflex responses after peripheral nerve injury and repair in the rat. Adults rats were submitted to non repaired sciatic nerve crush (CRH, n = 9), section repaired by either aligned epineurial suture (CS, n = 11) or silicone tube (SIL4, n = 13), and 8 mm resection repaired by tubulization (SIL8, n = 12). To assess reinnervation, the sciatic nerve was stimulated proximal to the injury site, and the evoked compound muscle action potential (M and H waves) from tibialis anterior and plantar muscles and nerve action potential (CNAP) from the tibial nerve and the 4th digital nerve were recorded at monthly intervals for 3 mo postoperation. Nociceptive reinnervation to the hindpaw was also assessed by plantar algesimetry. Crossed extensor reflexes were evoked by stimulation of the tibial nerve at the ankle and recorded from the contralateral tibialis anterior muscle. Reinnervation of the hindpaw increased progressively with time during the 3 mo after lesion. The degree of muscle and sensory target reinnervation was dependent on the severity of the injury and the nerve gap created. The crossed extensor reflex consisted of three bursts of activity (C1, C2, and C3) of gradually longer latency, lower amplitude, and higher threshold in control rats. During follow-up after sciatic nerve injury, all animals in the operated groups showed recovery of components C1 and C2 and of the reflex H wave, whereas component C3 was detected in a significantly lower proportion of animals in groups with tube repair. The maximal amplitude of components C1 and C2 recovered to values higher than preoperative values, reaching final levels between 150 and 245% at the end of the follow-up in groups CRH, CS, and SIL4. When reflex amplitude was normalized by the CNAP amplitude of the regenerated tibial nerve, components C1 (300–400%) and C2 (150–350%) showed highly increased responses, while C3 was similar to baseline levels. In conclusion, reflexes mediated by myelinated sensory afferents showed, after nerve injuries, a higher degree of facilitation than those mediated by unmyelinated fibers. These changes tended to decline toward baseline values with progressive reinnervation but still remained significant 3 mo after injury.


2015 ◽  
Vol 14 ◽  
pp. 125-128 ◽  
Author(s):  
Aysha Rajeev ◽  
Mhairi McDonald ◽  
Mike Newby ◽  
Paul Patterson

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