Excellent functional outcomes after synthetic reconstruction of an isolated chronic distal rectus femoris tendon injury in a professional athlete

Extensor tendon injuries are widely believed to be straightforward problems that are relatively simple to manage. However, these injuries can be complex and demand a thorough understanding of anatomy to achieve the best functional outcomes. When lacerations occur in the forearm as in Zones VIII and IX injury, the repair of the extensor tendon and muscle, and posterior interosseous nerve (PIN) is often challenging. A review of the literature shows little guidance and attention for these injuries. We present four patients with injuries to Zones VIII and IX as well as a review of surgical technique, postoperative rehabilitation, and pearls that may be of benefit to those managing these injuries.

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Central Tendon Injury Impairs Regional Neuromuscular Activation of the Rectus Femoris Muscle

Sports ◽

10.3390/sports9110150 ◽

2021 ◽

Vol 9 (11) ◽

pp. 150

Author(s):

Yoshiaki Kubo ◽

Kohei Watanabe ◽

Koichi Nakazato ◽

Koji Koyama ◽

Kenji Hiranuma

Keyword(s):

Functional Role ◽

Rectus Femoris ◽

Tendon Injury ◽

Proximal Region ◽

Neuromuscular Activation ◽

Injured Region ◽

History Of ◽

Hip Flexion ◽

Rectus Femoris Muscle ◽

Femoris Muscle

We aimed to uncover which rectus femoris strain injury types affect regional activation within the rectus femoris. The rectus femoris has a region-specific functional role; the proximal region of the rectus femoris contributes more than the middle and distal regions during hip flexion. Although a history of strain injury modifies the region-specific functional role within the rectus femoris, it was not obvious which rectus femoris strain injury types affect regional activation within it. We studied 12 soccer players with a history of rectus femoris strain injury. Injury data were obtained from a questionnaire survey and magnetic resonance imaging. To confirm the region-specific functional role of the rectus femoris, surface multichannel electromyographic signals were recorded. Accordingly, eight legs had a history of central tendon injury, four had a history of myofascial junction injury, and four had a healed strain injury. When the injury was limited to the central tendon, the region-specific functional role disappeared. The region-specific functional role was confirmed when the injury was outside the central part. The neuromuscular function was also inhibited when the longitudinal range of the injured region was long. Our findings suggest that a central tendon injury with a long injury length impairs regional neuromuscular activation of the rectus femoris muscle.

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The case of ‘A Rhino Horn’: case report and proposal for modification to the Hetsroni and Kelly classification

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnab020 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. i51-i59

Author(s):

Oliver Marín-Pena ◽

Olufemi R Ayeni ◽

Marc Tey-Pons ◽

Jesús Mas-Martinez ◽

Pedro Dantas ◽

...

Keyword(s):

Rectus Femoris ◽

Impingement Syndrome ◽

Professional Athlete ◽

Type Iii ◽

Trochanteric Region ◽

One Year ◽

The One ◽

Acetabular Rim

Abstract Subspine impingement syndrome by definition involves a prominent antero-inferior iliac spine (AIIS) which can lead to impingement on the femoral neck thereby causing symptoms. We present the case of a 22-year-old semi-professional athlete who presented with a Type III AIIS morphology leading to subspine impingement syndrome and was managed via a mini open anterior approach. Radiological examination revealed a fairly prominent left AIIS resembling the ‘horn of a rhino’ extending to the trochanteric region anteriorly. A mini-anterior surgical approach was utilized for the resection of the ‘rhino horn’ and the rectus femoris was reattached. The patient remained asymptomatic at the one-year follow-up and had resumed weightlifting. Following this case, we propose a new classification of the type III AIIS morphology in view of the clinical presentation. The AIIS type III-Standard represents an extension from the acetabular rim to less than 1 cm (type III-S) and type III-Large, with an extension from the acetabular rim beyond 1 cm (type III-L). The type III-L will further be divided into two groups based on its relation to the ilium, type III-Lr (‘rib shape’) and type III-Lrh (‘rhino horn’).

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Outcomes Following Posterior and Posterolateral Plating of Distal Fibula Fractures

Foot & Ankle Specialist ◽

10.1177/1938640018788433 ◽

2018 ◽

Vol 12 (3) ◽

pp. 246-252 ◽

Cited By ~ 1

Author(s):

Danica D. Vance ◽

Hasani W. Swindell ◽

Justin K. Greisberg ◽

James T. Vosseller

Keyword(s):

Functional Outcomes ◽

Demographic Data ◽

Tendon Injury ◽

Hardware Removal ◽

Peroneal Tendon ◽

Ankle Pain ◽

Distal Fibula ◽

Lateral Posterior ◽

Fibular Fixation

Ankle fractures are common orthopaedic injuries often requiring open reduction and internal fixation. A variety of positions for plate placement exist for surgical fixation of distal fibula fractures, including direct lateral, posterior, or posterolateral. Direct lateral is more common, despite evidence that posterior and posterolateral placement is mechanically superior. However, concern for peroneal tendon injury from posterior plating remains. Our study investigates clinical and functional outcomes of patients who underwent operative fixation of distal fibula fractures with posterior or posterolateral plating over a 3-year period. Analyses were performed on 59 patients with at least 2 years of follow-up. Questionnaires were used to obtain demographic data, in addition to information regarding the presence of ankle pain, subsequent hardware removal, and Foot and Ankle Outcome Scores (FAOS). In patients with at least 2 years of follow-up (average 39.6 ± 10.6 months), 37.2% reported ongoing ankle pain; 11 patients underwent hardware removal (18.6%), with 8 patients undergoing removal because of hardware-related pain (13.6%). FAOS scores (n = 51) were as follows: pain (79.9 ± 22.3), activities of daily living (84.2 ± 22.6), symptoms (75.7 ± 23.5), sports (69.4 ± 31.6), and quality of life (58.3 ± 30.5). Posterior and posterolateral plating achieved good clinical and high functional outcomes across our study population. The percentage of hardware removal in our study was either equivalent to, or less than, historical controls for any type of fibular fixation, and removal may be helpful for those patients whose postoperative ankle pain is subjectively related to the hardware. Levels of Evidence: Therapeutic, Level IV: Retrospective

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Functioning Free Muscle Transfer for Brachial Plexus Injury: A Systematic Review and Pooled Analysis Comparing Functional Outcomes of Intercostal Nerve and Spinal Accessory Nerve Grafts

Journal of Reconstructive Microsurgery ◽

10.1055/s-0040-1713147 ◽

2020 ◽

Vol 36 (08) ◽

pp. 567-571

Author(s):

Jeremie D. Oliver ◽

Chase Beal ◽

Emily M. Graham ◽

Katherine B. Santosa ◽

Michael S. Hu

Keyword(s):

Brachial Plexus ◽

Functional Outcomes ◽

Latissimus Dorsi ◽

Brachial Plexus Injury ◽

Rectus Femoris ◽

Elbow Flexion ◽

Intercostal Nerve ◽

The Mean ◽

Lost To Follow Up

Abstract Background The aim of this study was to compare postoperative elbow flexion outcomes in patients receiving functioning free muscle transplantation (FFMT) innervated by either intercostal nerve (ICN) or spinal accessory nerve (SAN) grafts. Methods A comprehensive systematic review on FFMT for brachial plexus reconstruction was conducted utilizing Medline/PubMed database. Analysis was designed to compare functional outcomes between (1) nerve graft type (ICN vs. SAN) and (2) different free muscle graft types to biceps tendon (gracilis vs. rectus femoris vs. latissimus dorsi). Results A total of 312 FFMTs innervated by ICNs (169) or the SAN (143) are featured in 10 case series. The mean patient age was 28 years. Patients had a mean injury to surgery time of 31.5 months and an average follow-up time of 39.1 months with 18 patients lost to follow-up. Muscles utilized included the gracilis (275), rectus femoris (28), and latissimus dorsi (8). After excluding those lost to follow-up or failures due to vascular compromise, the mean success rates of FFMTs innervated by ICNs and SAN were 64.1 and 65.4%, respectively. Conclusion This analysis did not identify any difference in outcomes between FFMTs via ICN grafts and those innervated by SAN grafts in restoring elbow flexion in traumatic brachial plexus injury patients.

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