Suture constructs for rehabilitation using early active motion after tendon transfer surgery

The purpose of this study was to better define an ideal tendon transfer suture construct to allow for early active range of motion. A side-to-side tendon construct was used to test suture technique (cross stich vs. Krackow stitch), number of suture throws, and calibre of suture. A minimum load to failure of 100 N was used to comfortably allow early motion while minimizing rupture risk. All constructs tested, except the 4-0 Krackow construct, were strong enough to withstand 100 N of load. The choice of suture should be based on surgeon preference, patient compliance, and specific surgery, and 3-0 non-absorbable suture may be more suitable for tendon transfers from a yield force standpoint.

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Radial Nerve Palsy: Nerve Transfer Versus Tendon Transfer to Restore Function

Hand ◽

10.1177/1558944720988126 ◽

2021 ◽

pp. 155894472098812

Author(s):

J. Megan M. Patterson ◽

Stephanie A. Russo ◽

Madi El-Haj ◽

Christine B. Novak ◽

Susan E. Mackinnon

Keyword(s):

Radial Nerve ◽

Tendon Transfer ◽

Nerve Palsy ◽

Nerve Transfer ◽

Pinch Strength ◽

Radial Nerve Palsy ◽

Nerve Injuries ◽

Tendon Transfers ◽

Nerve Transfers ◽

Transfer Group

Background: Radial nerve injuries cause profound disability, and a variety of reconstruction options exist. This study aimed to compare outcomes of tendon transfers versus nerve transfers for the management of isolated radial nerve injuries. Methods: A retrospective chart review of 30 patients with isolated radial nerve injuries treated with tendon transfers and 16 patients managed with nerve transfers was performed. Fifteen of the 16 patients treated with nerve transfer had concomitant pronator teres to extensor carpi radialis brevis tendon transfer for wrist extension. Preoperative and postoperative strength data, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and quality-of-life (QOL) scores were compared before and after surgery and compared between groups. Results: For the nerve transfer group, patients were significantly younger, time from injury to surgery was significantly shorter, and follow-up time was significantly longer. Both groups demonstrated significant improvements in grip and pinch strength after surgery. Postoperative grip strength was significantly higher in the nerve transfer group. Postoperative pinch strength did not differ between groups. Similarly, both groups showed an improvement in DASH and QOL scores after surgery with no significant differences between the 2 groups. Conclusions: The nerve transfer group demonstrated greater grip strength, but both groups had improved pain, function, and satisfaction postoperatively. Patients who present early and can tolerate longer time to functional recovery would be optimal candidates for nerve transfers. Both tendon transfers and nerve transfers are good options for patients with radial nerve palsy.

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Clinical Outcomes After Aggressive Active Early Motion and Modified Kleinert Regimens: Comparison of 2 Consecutive Cohorts

Hand ◽

10.1177/15589447211017222 ◽

2021 ◽

pp. 155894472110172

Author(s):

Kaisa Jokinen ◽

Arja Häkkinen ◽

Toni Luokkala ◽

Teemu Karjalainen

Keyword(s):

Quality Of Life ◽

Range Of Motion ◽

Grip Strength ◽

Clinical Outcomes ◽

Flexor Tendon ◽

Hand Grip Strength ◽

Active Motion ◽

Hand Grip ◽

Active Range Of Motion

Background Modern multistrand repairs can withstand forces present in active flexion exercises, and this may improve the outcomes of flexor tendon repairs. We developed a simple home-based exercise regimen with free wrist and intrinsic minus splint aimed at facilitating the gliding of the flexor tendons and compared the outcomes with the modified Kleinert regimen used previously in the same institution. Methods We searched the hospital database to identify flexor tendon repair performed before and after the new regimen was implemented and invited all patients to participate. The primary outcome was total active range of motion, and secondary outcomes were Disabilities of Arm, Shoulder, and Hand; grip strength; globally perceived function; and the quality of life. Results The active range of motion was comparable between the groups (mean difference = 14; 95% confidence interval [CI], −8 to 36; P = .22). Disabilities of Arm, Shoulder, and Hand; grip strength; global perceived function; and health-related quality of life were also comparable between the groups. There was 1 (5.3%) rupture in the modified Kleinert group and 4 (15.4%) in the early active motion group (relative risk = 0.3; 95% CI, 0.04-2.5; P = .3). Conclusions Increasing active gliding with a free wrist and intrinsic minus splint did not improve the clinical outcomes after flexor tendon injury at a mean of 38-month follow-up.

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Surgical Treatment of the Clasped Thumb

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(89)90020-x ◽

1989 ◽

Vol 14 (1) ◽

pp. 72-79 ◽

Cited By ~ 11

Author(s):

Esther Lipskeir ◽

M. Weizenbluth

Keyword(s):

Surgical Treatment ◽

Tendon Transfer ◽

Pathological Feature ◽

Tendon Transfers ◽

Extensor Tendons ◽

The Third ◽

First Ray ◽

Intrinsic Muscles

We report a series of 12 patients (19 hands) with clasped thumb who underwent surgical treatment. The series is divided into three groups. In the first group, the prominent pathological feature was hypoplasia of the extensor tendons which was treated by tendon transfer. The second group, the arthrogryphotic type, had contracture of the intrinsic muscles of the thumb and shortening of the skin; these needed mainly release operations. In only three hands out of nine was tendon transfer performed. The third group was defined by a combination of skeletal, muscular and tendon hypoplasia. Instability of the M.P. joint and adduction contracture of the first ray were found in all hands of this group. The adduction deformity was corrected by skin-plasty of the first web and the extension was improved by tendon transfers. Only one case needed stabilisation of the M.P. joint. The final results were related to the extent of the contractures and to the age of the patient when treatment started.

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Load to failure of common meniscal repair techniques: Effects of suture technique and suture material

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/s0749-8063(97)90008-6 ◽

1997 ◽

Vol 13 (6) ◽

pp. 731-736 ◽

Cited By ~ 103

Author(s):

William R. Post ◽

Scott R. Akers ◽

Vincent Kish

Keyword(s):

Suture Material ◽

Meniscal Repair ◽

Suture Technique ◽

Load To Failure ◽

Repair Techniques

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Intramedullary Compression Screw Fixation of Proximal Phalangeal Fractures: A Systematic Literature Review

Hand ◽

10.1177/1558944720928503 ◽

2020 ◽

pp. 155894472092850

Author(s):

Brahman S. Sivakumar ◽

Vincent V. G. An ◽

David J. Graham ◽

James Ledgard ◽

Richard D. Lawson ◽

...

Keyword(s):

English Language ◽

Screw Fixation ◽

Adhesion Formation ◽

Major Complication ◽

Original Data ◽

Active Motion ◽

Early Motion ◽

Total Active Motion ◽

Phalangeal Fractures ◽

Intramedullary Screw

Proximal phalangeal fractures have traditionally been fixed via either Kirschner wires or dorsal plating. Concerns regarding lack of compression and potential for infection with wire fixation, and adhesion formation and stiffness with plating, have lead to alternative fixation methods, such as intramedullary screw fixation. However, the literature regarding this modality is limited. Methods: A systematic review was performed to review the literature regarding intramedullary screw fixation for proximal phalangeal fractures. English language studies that reported original data and commented on at least one postoperative measure of function were eligible for inclusion. 4 studies were eligible for inclusion, with a further 3 studies assessing proximal and middle phalanges analysed separately. Total active motion was greater than 240° in all proximal phalangeal studies; mean post-operative DASH was 3.62. 6% of patients sustained a major complication. Intramedullary screw fixation of proximal phalangeal fractures is safe, providing stable fixation to allow early motion.

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A modular tension-adjusting splint for tendon transfer in reconstructive surgeries of extremities

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699156 ◽

2006 ◽

Vol 39 (02) ◽

pp. 185-188

Author(s):

B Kamath Jagannath ◽

Bhardwaj Praveen

Keyword(s):

Tendon Transfer ◽

Age Groups ◽

Final Outcome ◽

Proper Position ◽

Tendon Transfers ◽

User Friendly ◽

Outcome Of Surgery

ABSTRACTOptimal tension during tendon transfer is the most important surgeon-controlled factor, which determines the final outcome of surgery. To attain optimal tension, the joints have to be maintained in proper position during the final attachment of the transferred tendon. Maintaining this desired position requires one extra assistant and is difficult. We herein describe a modular splint designed by us, which can be used for most of the commonly done tendon transfers in practice. It is very versatile as it can be used for all the age groups and for both right and left sides. A single splint, which is autoclavable and can be used for most commonly done tendon transfers, makes it user-friendly

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Outcome of Early Motion Protocol for Total Hand Replantation: 1- and 2-Year Postoperative Results

Journal of Hand and Microsurgery ◽

10.1055/s-0039-1697060 ◽

2019 ◽

Vol 12 (S 01) ◽

pp. S70-S74

Author(s):

Lucas M. Harrison ◽

Spencer R. Anderson ◽

Sunishka M. Wimalawansa

Keyword(s):

External Fixation ◽

Extensor Tendon ◽

Metacarpophalangeal Joint ◽

Postoperative Management ◽

Active Motion ◽

Early Motion ◽

Right Hand ◽

Rehabilitation Protocols ◽

Hand Amputation ◽

Hand Replantation

Abstract Introduction We review the benefits of early motion protocols following replantation of a total right hand amputation at 1 and 2 years after replantation, and provide recommendations for postoperative management. Materials and Methods Replantation of the entire right hand in zone-4 was performed and supported by rigid external fixation spanning the forearm and hand. An early active “place-and-hold” motion protocol was initiated within the first 3 postoperative days. Metacarpophalangeal joint extensors were tethered by the pins, limiting full excursion. This resulted in stiffness and extensor adhesions that required a staged extensor tenolysis; however, all joints remained supple. The early motion protocol prevented the need for significant flexor tenolysis and joint releases. Results Early motion rehabilitation protocols can produce very successful results in complex replantation. The enhanced stability afforded by external fixation of the wrist allowed us to perform aggressive early rehabilitation. Conclusion This case highlights the benefits of early active motion (limiting the need for complex joint and flexor tendon releases) and demonstrates the degree of extensor adhesions caused by even minor extensor tendon tethering. This aggressive rehabilitation approach can produce excellent range of motion, and likely limit the need for secondary tenolysis and joint release procedures.

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Operative Management of Foot and Ankle Equinovarus Associated with Focal Dystonia

Foot & Ankle International ◽

10.1177/107110079801900408 ◽

1998 ◽

Vol 19 (4) ◽

pp. 229-231 ◽

Cited By ~ 8

Author(s):

Thomas J. Moore ◽

William Evans ◽

Douglas Murray

Keyword(s):

Tendon Transfer ◽

Operative Management ◽

Clinical Results ◽

Focal Dystonia ◽

Functional Improvement ◽

Foot And Ankle ◽

Tendon Transfers ◽

Anterior Tibial ◽

Clinically Significant

Six surgical procedures, consisting of tendon transfers and releases, were performed in five patients with idiopathic focal dystonia involving the lower extremity. All patients were female. Surgical management was performed to correct clinically significant foot abnormalities. The goal of each procedure was functional improvement and obtaining a plantigrade foot. The SPLATT (split anterior tibial tendon transfer) procedure was performed in each foot with a flexible equinovarus foot abnormality. Follow up at a mean of 27.2 months (range, 8–40 months) yielded satisfactory clinical results without significant complications. Clinical equinovarus has not recurred after this procedure. All patients remain brace-free ambulators.

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