[Incidence of tendon re-rupture and multiple tendon ruptures].
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Biomedical subjects
Publications and source records attributed to B J Bálint.
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The authors examined the regeneration and incorporation of homologous tendon grafts in 25 patients from 10 days to 20 years after tendon grafting. Newly formed collagen fibers in the place of graft are first observed 3 months after transplantation. The reorganization of tendon grafts begins at the end of the first postoperative year and is accomplished within the second year.
The fibre type ratio and the cross sectional areas of fibres were studied in triceps brachial muscle after rupture of tendon of the biceps brachial muscle in man. On the healthy and injured sides of the m. triceps brachii, the mean value of type 1 fibres was 51.9% and 52.4%, respectively. The mean cross sectional area of fibre on the two sides of the triceps muscle varied considerably among individuals without any significant correlation to injury of the biceps tendon.
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50 tendons were examined by electron microscopy. Although they did not demonstrate any signs of inflammation or lipomatosis marked hypoxic changes in the tenocytes were evident on ultrastructural examination. The most frequent alterations were longitudinal splitting, disintegration, angulation and the so-called "kink deformation" of the collagen fibers.
The investigation was under taken to study the long-term effect of tendon suturing on the capillarization of guinea-pig crural muscle after Achilles tenotomy. The results indicate that the capillary density has been greatly decreased by the tenotomy. The recapillarization and the time of restitution of the crural muscle are influenced by the interval between tenotomy and tendon suture.
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The authors, in their experiments on chickens, imitate human "no man's land" flexor tendon injuries of bad prognosis. For reconstruction of gliding surfaces they transplanted composite flexor tendon grafts containing flexor tendons with their sheath, pulleys, and vincula. Autologous grafts were compared with homologous composite tendon grafts preserved in beta-propiolacton. Summarizing the results of macroscopic and light microscopic examinations they state that the tendon sheath of the autologous composite tendon grafts revitalize in two weeks, and their tissue structure remains practically intact. The composite tendon allografts conserved in beta-propiolacton on the contrary rebuild much more slowly, on the average over three months. Regeneration is accompanied by round-cell infiltration. In the case of the autogenous graft generally smaller, and in the case of homologous composite flexor tendon graft more multitudinous adhesions occurred between flexor tendon and tendon sheath. The authors conclude from the literature and their own results that the reconstruction of flexor tendons with autologous composite flexor tendon grafts is a proper method for the restoration of severe flexor tendon injuries. Before clinical use, homologous composite flexor tendon grafts require more experimental investigation.
Fine structural alterations of collagen fibers were analyzed in 29 ruptured tendons. The most frequent alterations were longitudinal splitting, disintegration, angulation, and the so-called "Knickdeformation" of the collagen fibers. All these phenomena were considered to be the consequences of stress fatigue and mechanical injuries of fibers.
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The authors examined 34 tendons under the electron microscope, excised within 48 h after rupture of the tendons. The tendons did not exhibit any signs of inflammation or lipomatosis, but fine-structurally marked hypoxic alterations in the tenocytes could be seen. The degenerative (hypoxic tendinopathy appears in three phases, and the hypoxic lesions of the tendon occur at multiple foci or diffusely, and the various phases can exist simultaneously.
The LDH specific activity and the LDH isoenzyme pattern of eleven pairs of different normal tendons were compared with hypokinetic tendons. The LDH specific activity of hypokinetic tendons was 13--66% of the specific activity of normal tendons. The isoenzyme pattern of hypokinetic tendons altered in such a way that--with one exception--the ratio of LDH-5 and LDH-4 decreased and the ratio of LDH-1, LDH-2, and LDH-3 increased and, as a consequence, the amount of the M subunit decreased.
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