Biomechanical evaluation of two methods of fixation of a flexor hallucis longus tendon graft

2018 ◽  
Vol 100-B (9) ◽  
pp. 1175-1181 ◽  
Author(s):  
E. Benca ◽  
M. Willegger ◽  
F. Wenzel ◽  
L. Hirtler ◽  
S. Zandieh ◽  
...  
Keyword(s):  
Ultimate Load ◽  
Invasive Procedure ◽  
Tendon Graft ◽  
Flexor Hallucis Longus ◽  
Supporting Evidence ◽  
Mineral Density ◽  
Less Invasive ◽  
Suture Group ◽  
Cyclical Loading ◽  
Screw Group

Aims The traditional transosseus flexor hallucis longus (FHL) tendon transfer for patients with Achilles tendinopathy requires two incisions to harvest a long tendon graft. The use of a bio-tenodesis screw enables a short graft to be used and is less invasive, but lacks supporting evidence about its biomechanical behaviour. We aimed, in this study, to compare the strength of the traditional transosseus tendon-to-tendon fixation with tendon-to-bone fixation using a tenodesis screw, in cyclical loading and ultimate load testing. Materials and Methods Tendon grafts were undertaken in 24 paired lower-leg specimens and randomly assigned in two groups using fixation with a transosseus suture (suture group) or a tenodesis screw (screw group). The biomechanical behaviour was evaluated using cyclical and ultimate loading tests. The Student’s t-test was performed to assess statistically significant differences in bone mineral density (BMD), displacement, the slope of the load-displacement curves, and load to failure. Results The screw group showed less displacement (loosening) during cyclical loading, which was significant during 300, 500, 600, 700, 800, 900, and 1000 cycles (p < 0.05: other cycles: 0.079 < p < 0.402). Compared with the suture group, the screw group had higher mean ultimate load values (133.6 N, sd 73.5 vs 110.1 N, sd 46.2; p = 0.416). Conclusion Fixation of the FHL tendon with a tenodesis screw enables a less invasive procedure to be undertaken and shows similar biomechanical behaviour and primary strength compared with fixation using a transosseus suture. Cite this article: Bone Joint J 2018;100-B:1175–81.

scholarly journals Comparative Study of Flexor Hallicus Longus Tendon Length through Single Incision or Accessory Plantar Medial Incision: A Cadaver Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0018
Author(s):  
Caitlin Curtis Crocker ◽  
Eildar Abyar ◽  
Sean Young ◽  
Fatemah Razaghi ◽  
Gerald McGwin ◽  
...  
Keyword(s):  
Single Incision ◽  
Plantar Flexion ◽  
Cadaver Study ◽  
Tendon Graft ◽  
Interference Screw ◽  
Flexor Hallucis Longus ◽  
Tunnel Length ◽  
Exact Test ◽  
Fresh Frozen ◽  
The Mean

Category: Ankle; Hindfoot Introduction/Purpose: Flexor Hallucis Longus (FHL) tendon transfer to the calcaneus is a common adjuvant procedure in the treatment of Achilles pathology. The FHL tendon can be harvested using a posterior incision where the tendon is dissected along its course into the fibroosseous tunnel. Alternatively, the FHL may be harvested through a separate plantar medial incision as it crosses the flexor digitorium longus at the Knot of Henry. This study aims to quantify FHL tendon lengths achieved through the two common approaches utilizing pair matched cadavers. Methods: Seven pair matched fresh-frozen cadaver legs without signs of musculoskeletal abnormalities were used for this assessment. One leg in each pairing underwent a single incision harvest while the contralateral leg underwent an accessory medial plantar harvest. After dissecting the tendon, a calcaneus tunnel was prepared from dorsal to plantar in both calcanei in standard fashion. Two measurements were obtained. The first measurement was taken from the distal aspect of the muscle belly to the distal end of the tendon. The tendon was then pulled through the calcaneus, and the foot was held in tension at 20 degrees of plantar flexion. The second measurement was taken from site where tendon entered the calcaneous to the distal end of the tendon graft. The measurements were analyzed using Wilcoxon Signed Ranks Test and Fischer Exact Test. Results: Using a posterior incision, the mean tendon measurement from calcaneous tunnel to the distal end of the tendon was 4.0 cm. Using an accessory plantar medial incision, the mean tendon measurement from the calcaneous tunnel to the distal end of the tendon was 7.2 cm. The average tunnel length obtained using an accessory medial incision was significantly greater than the length obtained using the single incision approach (p= 0.0003, p=0.0022, and p=0.0016). The accessory plantar medial incision obtained an FHL tendon tunnel length that was an average of 2.9 cm greater than the posterior incision. Conclusion: The single incision approach provided sufficient length to safely anchor the FHL into the calcaneus which suggests that the accessory plantar medial approach is not necessary for routine FHL transfers to the calcaneus with interference screw fixation. However, if additional length is needed for other applications such as posterior tibialis tendon dysfunction or peritoneal tendon tears, the accessory incision does provide an average of 2.9 cm of additional length.

scholarly journals Continuous-Loop Tape Technique Has Greater Stiffness and Less Elongation Compared With Tied-Suture Fixation of Full-Thickness All–Soft Tissue Quadriceps Tendon Autografts

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110541
Author(s):  
Christopher M. Gibbs ◽  
Philipp W. Winkler ◽  
Robert T. Tisherman ◽  
Calvin K. Chan ◽  
Theresa A. Diermeier ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Ultimate Load ◽  
Quadriceps Tendon ◽  
Tendon Graft ◽  
Suture Technique ◽  
Suture Fixation ◽  
Full Thickness ◽  
Quadriceps Tendon Graft ◽  
Significant Difference ◽  
Permanent Elongation

Background: Many graft fixation techniques are utilized for full-thickness soft tissue quadriceps tendon autografts during anterior cruciate ligament reconstruction (ACLR). Purpose: To determine the tensile properties of all–soft tissue quadriceps tendon graft fixation using a tied-suture versus continuous-loop tape technique. It was hypothesized that the continuous-loop tape technique would have less cyclic elongation and greater ultimate load to failure and stiffness compared with a commonly used tied-suture technique. Study Design: Controlled laboratory study. Methods: Sixteen fresh-frozen human knee specimens were used to harvest a full-thickness all–soft tissue quadriceps tendon graft; half were secured using a Krackow suture technique with 2 braided sutures, and half were secured using a continuous-loop tape suspensory fixation button with a rip-stop stitch. Cyclic and permanent elongation, toe- and linear-region stiffness, and ultimate load were determined. Statistical analysis was performed at P <.05. Results: The tied-suture fixation group demonstrated significantly higher permanent elongation (11.7 ± 3.6 vs 4.2 ± 1.0 mm, P < .001) and cyclic elongation (5.9 ± 1.3 vs 2.0 ± 0.4 mm, P < .001) compared with the continuous-loop tape fixation group. There was a significantly higher linear-region stiffness with continuous-loop tape fixation compared with tied-suture fixation (98.8 ± 12.7 vs 85.5 ± 7.5 N/mm, P = .022). No significant difference in ultimate load between groups (517.1 ± 149.2 vs 465.6 ± 64.6 N) was found. The mode of failure was tendon pull-through for the continuous-loop tape group and suture breakage in the tied-suture group ( P < .001). Conclusion: Continuous-loop tape fixation is superior to tied-suture fixation in regard to elongation and stiffness for all–soft tissue quadriceps tendon grafts, but there was no significant difference in ultimate load. Clinical Relevance: Continuous-loop tape fixation of all–soft tissue quadriceps tendon grafts for ACLR is a valid technique with superior tensile properties.

scholarly journals Image-Derived Input Function for Brain PET Studies: Many Challenges and Few Opportunities

2011 ◽  
Vol 31 (10) ◽  
pp. 1986-1998 ◽  
Author(s):  
Paolo Zanotti-Fregonara ◽  
Kewei Chen ◽  
Jeih-San Liow ◽  
Masahiro Fujita ◽  
Robert B Innis
Keyword(s):  
Invasive Procedure ◽  
Input Function ◽  
Emission Tomography ◽  
Alternative Methods ◽  
Less Invasive ◽  
Brain Pet ◽  
Positron Emission ◽  
Arterial Sampling ◽  
Challenging Technique ◽  
Methodological Problems

Quantitative positron emission tomography (PET) brain studies often require that the input function be measured, typically via arterial cannulation. Image-derived input function (IDIF) is an elegant and attractive noninvasive alternative to arterial sampling. However, IDIF is also a very challenging technique associated with several problems that must be overcome before it can be successfully implemented in clinical practice. As a result, IDIF is rarely used as a tool to reduce invasiveness in patients. The aim of the present review was to identify the methodological problems that hinder widespread use of IDIF in PET brain studies. We conclude that IDIF can be successfully implemented only with a minority of PET tracers. Even in those cases, it only rarely translates into a less-invasive procedure for the patient. Finally, we discuss some possible alternative methods for obtaining less-invasive input function.

Detection of Largyneal Sensory-Evoked Potentials (LSEPs) in the Cat

1993 ◽  
Vol 109 (4) ◽  
pp. 748-752
Author(s):  
Tsuyako Fukuyama ◽  
Toshiro Umezaki ◽  
Takemoto Shin
Keyword(s):  
Evoked Potentials ◽  
Evoked Potential ◽  
Superior Laryngeal Nerve ◽  
Invasive Procedure ◽  
Human Beings ◽  
Less Invasive ◽  
Sensory Evoked Potential ◽  
Laryngeal Mucosa ◽  
Disk Electrodes ◽  
Sensory Evoked

We previously reported on evoked potentials elicited by electrical stimulation of the superior laryngeal nerve at an appropriate site on the dural surface as a reflection of activities in the brain stem and cortex in anesthetized cats. This evoked potential was called the laryngeal sensory evoked potential (LSEP). In this study we attempted to establish a less invasive procedure for measuring LSEP. The procedures were recording on the scalp using chloride-coated silver disk electrodes and stimulation by insertion of a bipolar platinum hooked wire electrode into the laryngeal mucosa. Evoked potentials could be detected using these less invasive procedures. The response morphologies and relative timing of LSEP components were quite similar for each method in a given cat. However, the amplitudes were slightly lower and the latencies were slightly prolonged with the less invasive techniques. These results suggest that this LSEP method might be applicable to human beings as a noninvasive method for evaluating the function of the laryngeal sensory pathway

Closed Complete Rupture of the Flexor Hallucis Longus Tendon at the Groove of the Talus

1997 ◽  
Vol 18 (1) ◽  
pp. 47-49 ◽  
Author(s):  
Suguru Inokuchi ◽  
Norio Usami
Keyword(s):  
Soccer Player ◽  
Metatarsophalangeal Joint ◽  
Tendon Graft ◽  
Soccer Players ◽  
Flexor Hallucis Longus ◽  
Partial Rupture ◽  
Longus Tendon ◽  
Complete Rupture ◽  
Active Flexion ◽  
Classical Ballet

A rare case of closed complete rupture of the flexor hallucis longus tendon at its groove in the posterior process of the talus is reported in a soccer player who developed pseudarthrosis of the posterolateral tubercle of the talus after a Shepherd's fracture. Partial rupture or tenosynovitis of the flexor hallucis longus tendon at this level is well known in classical ballet dancers and soccer players. Three cases of complete rupture of the flexor hallucis longus tendon near the metatarsophalangeal joint and three under the sustentaculum tali have been reported, but there have been no reports at the groove of the talus. Repair was accomplished by tendon graft, and active flexion of the interphalangeal joint is now possible.

scholarly journals A Modified and Less Invasive Procedure in Aortic Arch Replacement

2017 ◽  
Vol 103 (2) ◽  
pp. e203-e206 ◽  
Author(s):  
Feng Gao ◽  
Jing Chen ◽  
Qian Zeng ◽  
Fangming Lin
Keyword(s):  
Aortic Arch ◽  
Invasive Procedure ◽  
Aortic Arch Replacement ◽  
Less Invasive

scholarly journals Genome-Wide Association Study of Bone Mineral Density in Premenopausal European-American Women and Replication in African-American Women

2010 ◽  
Vol 95 (4) ◽  
pp. 1802-1809 ◽  
Author(s):  
Daniel L. Koller ◽  
Shoji Ichikawa ◽  
Dongbing Lai ◽  
Leah R. Padgett ◽  
Kimberly F. Doheny ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
African American ◽  
Femoral Neck ◽  
Bone Mineral ◽  
Premenopausal Women ◽  
Genome Wide Association ◽  
European American ◽  
Supporting Evidence ◽  
Mineral Density ◽  
Genome Wide

Abstract Context: Several genome-wide association studies (GWAS) have been performed to identify genes contributing to bone mineral density (BMD), typically in samples of elderly women and men. Objective: The objective of the study was to identify genes contributing to BMD in premenopausal women. Design: GWAS using the Illumina 610Quad array in premenopausal European-American (EA) women and replication of the top 50 single-nucleotide polymorphisms (SNPs) for two BMD measures in African-American (AA) women. Subjects: Subjects included 1524 premenopausal EA women aged 20–45 yr from 762 sibships and 669 AA premenopausal women aged 20–44 yr from 383 sibships. Interventions: There were no interventions. Main Outcome Measures: BMD was measured at the lumbar spine and femoral neck by dual-energy x-ray absorptiometry. Age- and weight-adjusted BMD values were tested for association with each SNP, with P values determined by permutation. Results: SNPs in CATSPERB on chromosome 14 provided evidence of association with femoral neck BMD (rs1298989, P = 2.7 × 10−5; rs1285635, P = 3.0 × 10−5) in the EA women, and some supporting evidence was also observed with these SNPs in the AA women (rs1285635, P = 0.003). Genes identified in other BMD GWAS studies, including IBSP and ADAMTS18, were also among the most significant findings in our GWAS. Conclusions: Evidence of association to several novel loci was detected in a GWAS of premenopausal EA women, and SNPs in one of these loci also provided supporting evidence in a sample of AA women.

Alcohol Septal Ablation Versus Surgical Myectomy in Hypertrophic Obstructive Cardiomyopathy

2020 ◽  
Author(s):  
Hussein Taqi
Keyword(s):  
Treatment Modality ◽  
Heart Block ◽  
Invasive Procedure ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Major Surgery ◽  
Muscle Area ◽  
Alcohol Septal Ablation ◽  
Invasive Approach ◽  
Less Invasive ◽  
Surgical Myectomy

The surgical myomectomy for hypertrophied myocardium in patients with HOCM is a well-established and evidence-based treatment modality. However, with the drawback of exposing the patient to major surgery and prolonged post-operative periods, cardiologists together with their surgical peers found the advent of a potentially less invasive procedure. This has been accomplished by the installation of alcohol through the coronary arteries in order to shrink the diseased and hypertrophied muscle area with an aim to alleviate the symptoms in the first instance if not completely curing the pathology as an endeavor goal. Nevertheless, with this invention, a few complications have started to emerge. The main drawback was heart block, which could require permanent pacemaker insertion in most of the cases. In the interim, there is no clear pathway or guideline to decide which treatment option would be the best, and there is no certain inclusion or exclusion criteria incorporate patients who can undergo either one of the modalities. In this review, four studies were scrutinized to investigate the major consequences of each route, especially focusing on the proportion of complete heart block. Also, the role of MRI in the delineation of the resected area either surgically or by alcohol administration is studied in detail. After reviewing these articles, it has been concluded that despite alcohol septal ablation being less invasive approach, surgical therapy remains the preferred treatment modality and it is preferred treatment modality and so far, it is the gold standard option in the management of hypertrophic obstructive cardiomyopathy. Nevertheless, it could not be overlooked the lack of strong RCTS in such area which could be one of the main points that future trialists need to consider.

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