scholarly journals Reconstruction of a Neglected, Extensor Hallucis Longus Tendon Rupture Using Interposed Scar Tissue: A Case Report and Literature Review

2021 ◽  
Vol 18 (22) ◽  
pp. 12157
Author(s):  
Woo-Jong Kim ◽  
Ki-Jin Jung ◽  
Hyein Ahn ◽  
Eui-Dong Yeo ◽  
Hong-Seop Lee ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Full Range ◽  
Donor Site ◽  
Extensor Tendon ◽  
Scar Tissue ◽  
Donor Site Morbidity ◽  
Full Weight Bearing ◽  
Short Operative Time ◽  
Tendon Reconstruction ◽  
Extensor Hallucis Longus

Injury of the extensor hallucis longus (EHL) tendon is relatively rare, but surgical repair is necessary to prevent deformity and gait disturbance. Primary suturing is possible if the condition is acute, but not when it is chronic. The scar tissue between the ruptured ends is a proliferative tissue composed of fibroblasts and collagen fibers. Given the histological similarity to normal tendons, several studies have reported tendon reconstruction using scar tissue. Here, we report a reconstruction of a neglected EHL rupture using interposed scar tissue. A 54-year-old female visited our clinic with a weak extension of a big toe. She had dropped a knife on her foot a month prior, but did not go to hospital. The wound had healed, but she noted dysfunctional extension of the toe and increasing pain. Magnetic resonance imaging (MRI) revealed that EHL continuity was lost and that the proximal tendon stump was displaced toward the midfoot. Scar tissue running in the direction of the original ligament was observed between the ruptured ends. In the surgical field, the scar tissue formed a shape similar to the extensor tendon. Therefore, we performed tendon reconstruction using the interposed scar tissue. For the first 2 postoperative weeks, the ankle and foot were immobilized to protect the repair. Six weeks after surgery, the patient commenced full weight-bearing. At the 3-month follow-up, active extension of the hallux was possible, with a full range of motion. The patient did not feel any discomfort during daily life. Postoperative MRI performed at 1 year revealed that the reconstructed EHL exhibited homogeneously low signal intensity, and was continuous. The AOFAS Hallux Metatarsophalangeal-Interphalangeal scale improved from 57 to 90 points and the FAAM scores improved from 74% to 95% (the Activities of Daily Living subscale) and from 64% to 94% (the Sports subscale). Scar tissue reconstruction is as effective as tendon autografting or allografting, eliminates the risk of donor site morbidity and infection, and requires only a small incision and a short operative time.

scholarly journals Screw osteosynthesis of transverse fracture of the patella in children

2019 ◽  
Vol 2 (2) ◽  
pp. e000014
Author(s):  
Simon Oksbjerre Mortensen ◽  
Anne Mette Stausholm ◽  
Rikke Thorninger
Keyword(s):  
Screw Fixation ◽  
Weight Bearing ◽  
Full Range ◽  
Surgical Techniques ◽  
Full Weight Bearing ◽  
Transverse Fracture ◽  
Excellent Outcome ◽  
Fractures In Children ◽  
Patella Fractures ◽  
Special Surgery

ObjectivePatella fractures in children are rare, with an incidence of less than 1% of all pediatric fractures. Literature describes different surgical techniques and outcomes, but there is not a specified superior technique for children. The aim of this study is to assess the functional outcome after screw fixation of transverse patella fractures in children.MethodsTwo boys at 11 years of age were presented with a transverse fracture of the patella within the same week. Open reduction and fixation of the fractured patella with periost sutures and a 4.0 mm titanium screw inserted from the distal fragment. Afterward, the quadriceps expansion was meticulously repaired with sutures.ResultsThe patients could fully weight bear immediately on a fully extended knee in an orthosis. After 4 weeks, radiological healing was obtained. At the 8-week and 6-month follow-up, the modified Hospital of Special Surgery knee score was 100 points in both patients.ConclusionSingle screw fixation provides an excellent outcome after 8 weeks with a full range of motion and full weight bearing, providing a faster recovery.

scholarly journals Synovial Lipomatosis (Lipoma Arborescens) of the Knee

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0026
Author(s):  
Melih Malkoç ◽  
Ozgur Korkmaz ◽  
Ali Seker ◽  
Mehmet Isyar ◽  
Ismail Oltulu ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Knee Society Score ◽  
Weight Bearing ◽  
Full Range ◽  
Daily Activities ◽  
Full Weight Bearing ◽  
Female Group ◽  
Arthroscopic Synovectomy ◽  
Significant Difference ◽  
Synovial Lipomatosis

Objectives: The goals of this retrospective study are to emphasize that the patients who have non surgical treatments for several times due to the massive swelling in their knees should be considered the SL and this pathology is treatable by arthroscopic synovectomy Methods: Seventeen patients (four female and thirteen male), were evaluated retrospectively from May 2009 and April 2013. Mean age for female group was 34,75 (range between 32 to 41) and for male group was 34,23 (range between 26 to 46). Mean follow-up period was 14,76 months (range between 6 months and 38 months). Mean duration of compliance was 26,23 months (range between 9 to 96) months. All patients rated by Knee Society Score preoperatively and postoperatively arthroscopic synovectomy, performed by using radiofrequency ablation and arthroscopic shaver for treatment procedure. Patients were discharged at the end of the one day hospitalization. Postoperatively all patients were allowed to full range of motion and full weight-bearing within one day after surgery. Results: Patients were evaluated preoperatively and postoperatively using the Knee Society Score. The mean Knee Society Score was 67,82 preoperatively and 88,23 was postoperatively. There is significant difference between preoperative and postoperative Knee Society scores.(p <0.05) At the end of the three months, MRI studied and there was no clue of recurrence except two patients. All patients returned to their daily activities with full of range of motion and without swelling of the affected knee joints. At the microscopic histological studies were reported as synovial lipomatosis for all patients Conclusion: Arthroscopic synovectomy is the safe and dramatically effective method of treatment in synovial lipomatosis with less complication, curability and retrieving patients full range of motion with no limitation in their daily activities

scholarly journals Treatment of a Femur Nonunion with Microsurgical Corticoperiosteal Pedicled Flap from the Medial Femoral Condyle

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Matteo Guzzini ◽  
Cosma Calderaro ◽  
Marco Guidi ◽  
Carolina Civitenga ◽  
Germano Ferri ◽  
...  
Keyword(s):  
Distal Femur ◽  
Femoral Condyle ◽  
Weight Bearing ◽  
Donor Site ◽  
Pedicled Flap ◽  
Medial Femoral Condyle ◽  
Full Weight Bearing ◽  
Genicular Artery ◽  
Reconstruction Of Bone Defects

Introduction. The vascularized corticoperiosteal flap is harvested from the medial femoral condyle and it is nourished by the articular branch of the descending genicular artery and the superomedial genicular artery. This flap is usually harvested as a free flap for the reconstruction of bone defects at forearm, distal radius, carpus, hand, and recently at lower limb too.Case Report. A 50-year-old Caucasian man referred to our department for hypertrophic nonunion of the distal femur, refractory to the conservative treatments. The first surgical choice was the revision of the nail and the bone reconstruction with a corticoperiosteal pedicled flap from the medial femoral condyle. We considered union to have occurred 3.5 months after surgery when radiographs showed bridging of at least three of the four bony cortices and clinically the patient was able to walk with full weight bearing without any pain. At the last follow-up (25 months), the patient was completely satisfied with the procedure.Discussion. The corticoperiosteal flap allows a faster healing of fractures with a minimal morbidity at the donor site. We suggest that the corticoperiosteal pedicled flap graft is a reliable and effective treatment for distal femur nonunion.

scholarly journals Sole Reconstruction Using Anterolateral Thigh Free Flap: A Review of 4 Cases

1970 ◽  
Vol 2 (3) ◽  
Author(s):  
Parintosa Atmodiwirjo ◽  
Afriyanti Sandhi
Keyword(s):  
Free Flap ◽  
Weight Bearing ◽  
Donor Site ◽  
Three Dimensional ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Common Procedure ◽  
Anterolateral Thigh ◽  
Protective Sensation ◽  
And Function

Background: The ideal technique for sole reconstruction should meet such requisite as a durable and comfortable weight-bearing surface, solid anchoring to deep tissue for resistance to shear force and adequate protective sensation. The anterolateral thigh (ALT) perforator free flap provides a large, pliable skin island and sufficient bulk, allowing three-dimensional tailoring to complex defects. The present article is about our experience of sole reconstruction ALT perforator free flap. Patient and Method: Total of 4 flaps in the foot defects was performed in February 2009 to December 2012. We reconstructed soft tissue defects in the sole using ALT free flaps, the complications, aesthetic and function results were monitored. Result: ALT perforator free flap provided stable and durable long-term wound cover in all patients, resulting in early rehabilitation and function outcomes were completely achieved. Complications were few and manageable in all cases. Summary: ALT perforator free flap has become common procedure in many centers around the world. The numerous advantages include stable wound coverage; improve aesthetic and functional outcomes, and minimal donor site morbidity. In our experiences, we found that the use of ALT perforator free flap in sole defect reconstruction, to be technically affordable, reliable and have resulted in excellent outcomes.

Quadriceps Tendon Autograft Versus Bone–Patellar Tendon–Bone and Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

2021 ◽  
pp. 036354652110302
Author(s):  
Wenli Dai ◽  
Xi Leng ◽  
Jian Wang ◽  
Jin Cheng ◽  
Xiaoqing Hu ◽  
...  
Keyword(s):  
Observational Studies ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Full Range ◽  
Donor Site ◽  
Quadriceps Tendon ◽  
Hamstring Tendon ◽  
Donor Site Morbidity ◽  
Bone Plug

Background: The best type of autograft for anterior cruciate ligament (ACL) reconstruction remains debatable. Hypothesis: Compared with bone–patellar tendon–bone (BPTB) and hamstring tendon (HT) autografts, the quadriceps tendon (QT) autograft has comparable graft survival as well as clinical function and pain outcomes. Study Design: Meta-analysis; Level of evidence, 4. Methods: A systematic literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Library to July 2020. Randomized controlled trials (RCTs) and observational studies reporting comparisons of QT versus BPTB or HT autografts for ACL reconstruction were included. All analyses were stratified according to study design: RCTs or observational studies. Results: A total of 24 studies were included: 7 RCTs and 17 observational studies. The 7 RCTs included 388 patients, and the 17 observational studies included 19,196 patients. No significant differences in graft failure ( P = .36), the International Knee Documentation Committee (IKDC) subjective score ( P = .39), or the side-to-side difference in stability ( P = .60) were noted between QT and BPTB autografts. However, a significant reduction in donor site morbidity was noted in the QT group compared with the BPTB group (risk ratio [RR], 0.17 [95% CI, 0.09-0.33]; P < .001). No significant differences in graft failure ( P = .57), the IKDC subjective score ( P = .25), or the side-to-side stability difference ( P = .98) were noted between QT and HT autografts. However, the QT autograft was associated with a significantly lower rate of donor site morbidity than the HT autograft (RR, 0.60 [95% CI, 0.39-0.93]; P = .02). A similar graft failure rate between the QT and control groups was observed after both early and late full weightbearing, after early and late full range of motion, and after using the QT autograft with a bone plug and all soft tissue QT grafts. However, a significantly lower rate of donor site morbidity was observed in the QT group compared with the control group after both early and late full weightbearing, after early and late full range of motion, and after using the QT autograft with a bone plug and all soft tissue QT grafts. No difference in effect estimates was seen between RCTs and observational studies. Conclusion: The QT autograft had comparable graft survival, functional outcomes, and stability outcomes compared with BPTB and HT autografts. However, donor site morbidity was significantly lower with the QT autograft than with BPTB and HT autografts.

scholarly journals An Uncemented Spreading Stem for the Fixation in the Metaphyseal Femur: A Preliminary Report

Sarcoma ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Daniel Burger ◽  
Matthias Pumberger ◽  
Bruno Fuchs
Keyword(s):  
Weight Bearing ◽  
Full Range ◽  
Implant Design ◽  
Full Weight Bearing ◽  
Tumour Resection ◽  
Rigid Fixation ◽  
Femoral Bone ◽  
Bone Resection ◽  
Uncemented Fixation

Surgical treatment to restore full range of motion and full weight bearing after extensive femoral bone resection in patients with primary or metastatic femoral tumours is individually challenging. Especially when the remaining distal or proximal bone is very short, a rigid fixation of an implant is difficult to achieve due to the reverse funnel shape of the metaphysis. Herein, we present a novel implant design using a spreading mechanism in the distal part of the prosthesis for rigid, uncemented fixation in the remaining femoral bone after extensive tumour resection of the femur. We present the outcome of 5 female patients who underwent implantation of this spreading stem after extensive proximal or distal femoral bone resection. There was no radiological or clinical loosening or implant-related revision surgery in our follow-up (mean 21.46 months, range 3.5–46 months). This uncemented spreading stem may therefore represent an alternative option for fixation of a prosthetic device in the remaining metaphyseal femur.

scholarly journals Suture Anchors Fixation in MPFL Reconstruction using a Bioactive Synthetic Ligament

Joints ◽  
2017 ◽  
Vol 05 (03) ◽  
pp. 188-190 ◽  
Author(s):  
Massimo Berruto ◽  
Paolo Ferrua ◽  
Daniele Tradati ◽  
Francesco Uboldi ◽  
Eva Usellini ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Donor Site ◽  
Surgical Techniques ◽  
Patellofemoral Instability ◽  
Donor Site Morbidity ◽  
Mpfl Reconstruction ◽  
Suture Anchors ◽  
Partial Weight Bearing ◽  
Partial Weight ◽  
Biosynthetic Graft

AbstractMedial patellofemoral ligament (MPFL) reconstruction has a key role in patellofemoral instability surgery. Many surgical techniques have been described so far using different types of grafts (autologous, heterologous, or synthetic) and fixation techniques. The hereby described technique for MPFL reconstruction relies on the use of a biosynthetic graft (LARS Arc Sur Tille, France). Fixation is obtained by means of suture anchors on the patellar side and a resorbable interference screw on the femoral side locating the insertion point according to Schottle et al. An early passive range of motion (ROM) recovery is fundamental to reduce the risk of postoperative stiffness; a partial weight bearing with crutches is allowed until 6 weeks after the surgery. In our experience, the use of a biosynthetic graft and suture anchors provides stable fixation, minimizing donor site morbidity and reducing the risk of patellar fracture associated with transosseous tunnels. This technique represents a reliable and reproducible alternative for MPFL reconstruction, thereby minimizing the risk of possible complications.

scholarly journals Medial Plantar Flap for Reconstruction of Heel Defect

1970 ◽  
Vol 1 (1) ◽  
Author(s):  
Benny Raymond ◽  
Gentur Sudjatmiko
Keyword(s):  
Weight Bearing ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Full Thickness ◽  
Plantar Surface ◽  
Defect Reconstruction ◽  
Secondary Defect ◽  
Foot Function

Heel is subjected to exceed weight bearing and shearing forces. Full-thickness defects to the plantar surface of the foot present a challenge. Variety of procedures have been described for resurfacing this site, but not all achieve normal foot function. Reporting two cases, defects of the plantar surface of the heel resurfaced with medial plantar flap, an island fasciocutaneus flap and innervated, thus provide a good replacement.One patient show good result within 4 weeks, with minimal raw surface on secondary defect. While other patient didn’t show up after 2 weeks. Medial plantar flap was successfully used for heel defect reconstruction. Donor site morbidity was minimal, and patient could walk post-operatively without special devices for the heel.

scholarly journals Reconstruction of chronic extensor hallucis longus tendon rupture using plantaris tendon graft

2021 ◽  
Vol 15 (2) ◽  
pp. 179-182
Author(s):  
Ricardo Ummen de Almeida Tenório Villar ◽  
Pedro Costa Benevides ◽  
Caio Augusto de Souza Nery ◽  
Marcelo Pires Prado ◽  
José Felipe Marion Alloza ◽  
...  
Keyword(s):  
Tendon Rupture ◽  
Donor Site ◽  
Biomechanical Properties ◽  
Tendon Graft ◽  
Donor Site Morbidity ◽  
Level Of Evidence ◽  
Longus Tendon ◽  
Plantaris Tendon ◽  
Extensor Hallucis Longus ◽  
Safe Technique

Chronic tendon ruptures can be difficult to manage as end-to-end repair can be challenging. In this scenario, reconstruction techniques with tendon grafts may be useful. The ideal tendon graft would be one that has similar biomechanical properties, low donor-site morbidity and length compatible with the tendon gap. We describe a safe technique for the reconstruction of a chronic extensor hallucis longus tendon rupture using a plantaris tendon graft. Level of Evidence V, Therapeutic Studies; Expert Opinion. 

scholarly journals Distal tibial fractures are a poorly recognised complication with fibula free flaps

2015 ◽  
Vol 97 (6) ◽  
pp. 409-413 ◽  
Author(s):  
A Durst ◽  
J Clibbon ◽  
B Davis
Keyword(s):  
Free Flap ◽  
Weight Bearing ◽  
Donor Site ◽  
Free Flaps ◽  
Valgus Deformity ◽  
Donor Site Morbidity ◽  
Leg Pain ◽  
Tibial Stress Fracture ◽  
Fibula Free Flap ◽  
Tibial Plate

The fibula free flap is ideal for complex jaw reconstructions, with low reported donor and flap morbidity. We discuss a distal tibial stress fracture two months following a vascularised fibula free flap procedure. Despite being an unrecognised complication, a literature review produced 13 previous cases; only two were reported in the reconstructive surgery literature, with the most recent claiming to be the first. The majority of these studies treated this fracture non-operatively; none reported their patient follow-up. Each case presented with ipsilateral leg pain, which has been cited as an early donor site morbidity in as many as 40% of fibula free flap cases. It is known that the fibula absorbs at least 15% of leg load on weight bearing. Studies have shown severe valgus deformities in up to 25% of patients with fibulectomies. We treated our patient operatively, first correcting his worsening valgus deformity with an external fixator, then reinforcing his healed fracture with a long distal tibial plate. We believe that this complication is underreported, unexpected and not mentioned during the consenting process. By highlighting the management of our case and the literature, we aim to increase awareness (and thus further reporting and appropriate management) of this debilitating complication.

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