Flexor tendon injuries: a review of results.
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Information for all cattle with a diagnosis of tendon injury entered into the Veterinary Medical Data Base (VMDB) was retrieved and selected medical records reviewed. The proportional morbidity rate for tendon disruption was 0.89 cattle/1,000 cattle admissions and 95 of 99 cattle survived. Female and dairy cattle had a greater risk of tendon disruption than male or beef cattle, respectively. Also, cattle 6 months to 7 years old had a greater risk than cattle younger than 6 months old. Complete medical records were examined for 27 cattle. Affected cattle were 2.5 +/- 1.8 years old and weighed 593.6 +/- 315.6 kg. Injuries were most commonly caused by accidents involving farm machinery (72%). Unilateral superficial digital flexor tendon injury occurred in 8 cattle (30%); multiple tendon injury occurred in the other 19 cattle (70%). A single limb was involved in 25 cattle, a rear limb was involved in 24 cattle, and an open wound was associated with the injury in 26 cattle. Wounds were identified most commonly at the mid (13 cattle) and proximal metatarsus (4 cattle). Treatment of tendon disruption included tenorrhaphy and casting (9 cattle), external coaptation, alone, (14 cattle), stall confinement, alone, (1 cow), and euthanasia or salvage (3 cattle). External coaptation was maintained for 74.4 +/- 34.3 days, and total confinement period was 88.3 +/- 59.5 days. Short-term complications included severe tendon laxity (one cow) and fatal septic peritonitis (one bull). Twenty-two of 24 cattle treated for tendon disruption survived. Follow-up information was available for 16 cattle; 14 cattle (87%) returned to productivity and 11 of 15 cattle with long-term follow-up (73%) were considered productive. Long-term complications included persistent lameness (56%) and persistent hyperextension of the digits (19%).
PURPOSE: The migratory response of surface fibroblasts to flexor tendon injury was studied by their selective labeling with a vital dye. METHOD: The surfaces of 30 rat deep flexor tendons were bathed in 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine percholate (DiI), a vital dye for 5 minutes. The residual dye was removed by thorough irrigation. A partial tenotomy was made in the stained section by cutting out a central window. Semiquantitative cell counts and position of stained fibroblasts were noted by examination under fluorescent light at 0, 1, 3, 5, and 7 days. RESULTS: The surface fibroblasts readily took up the vital dye at day 0. By day 1 dyed cells had moved into the cut. By day 3 they had migrated laterally into the core substance of the tendon. Core dyed cell counts at days 1, 3, 5, and 7 were significantly different compared with day 0 core dyed cell counts. CONCLUSIONS: This cell migration from the surface of the cut to the tendon core is likely to be vital in the early stages of tendon healing.
OBJECTIVES: We evaluated two-staged flexor tendoplasty with tendon prosthesis in patients with flexor tendon injuries in which conventional tendon grafting would fail to yield an acceptable result. METHODS: We performed flexor tendoplasty with tendon prosthesis in 37 hands of 31 patients (24 males, 7 females; mean age 23 years; range 4-46 years). Twenty-six patients had penetrating injuries, four had occupational injuries, and one patient had an electric burn. Preoperatively, all patients were evaluated according to the Boyes' classification. At the first stage, a silicone prosthesis, 4-6 mm in diameter was placed according to the patient's age and the recipient bed; after 3 to 5 months, silicone prosthesis was removed and flexor tendoplasty with a tendon graft was performed. The results were calculated according to the Strickland's formula. The mean follow-up period after the second operation was 37 months (range 12-80 months). RESULTS: The results were excellent in 11 hands (Strickland 75-100%), good in 15 hands (50-74%), moderate in nine hands (25-49%), and poor in two hands (0-24%), with a mean of 58%. Tenolysis was performed in seven patients at least four months after the second stage. Removal of the tendon prosthesis was required in one patient because of infection. CONCLUSION: Satisfactory results can be obtained with two-staged flexor tendoplasty with a tendon prosthesis in patients with joint injuries restricting finger movements, digital nerve injuries causing trophic changes in the finger, and multiple tissue injuries.
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Recent research on chronic painful Achilles tendons in humans using ultrasonography and immunohistochemistry, has demonstrated an association between neurovascular ingrowth and tendon pain. In horses, chronic debilitating tendon conditions are well-known to be very difficult to treat, and the background to impaired function and pain is not scientifically clarified. In a collaborative research project between the Sports Medicine Unit in Umeå and Strömsholm Equine Hospital, grey-scale ultrasonography (US) and colour Doppler (CD) examination were performed in ten horses with chronic tendon injuries (>3 months) and a control group of six healthy and asymptomatic horses. In all symptomatic tendons, but not in any of the tendons in the control group, neovessels were seen in the area with structural tendon changes. The neovessels found in the horse tendons looked similar to what has recently been presented in human Achilles tendons. These findings motivate evaluation of the same treatment, a sclerosing injection that was demonstrated recently to give promising results in the treatment of chronic Achilles tendon injuries (tendinosis) in humans.
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The correct management of partially divided flexor tendon injuries is still in dispute. This study compares the results of repair with non-repair in zone 2 injuries. We conclude that tendons divided by 60% or less in cross-sectional area should not be repaired.
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The keys to the treatment of extensor tendon injuries are knowledge of the anatomic characteristics of the area, the correct position of immobilization of the wrist and fingers, and the timing for institution of active and resistive exercises.
The pediatric athlete with open physeal plates is more susceptible to growth plate injuries and avulsion fractures than to ligament and muscle-tendon injuries that most often occur in adults. Muscle contusions and strains are common injuries in young athletes. Although they are rare in the early and middle stages of childhood, they become quite common during the growth spurt period. Healing of muscle tissues is much more rapid in children than that in adults, but it must be ensured that full motion and full strength are regained before returning to sports activities, because recurrences of injuries may result in more serious complications such as myositis ossificans. On the other hand, acute tendinous injuries are quite rare in children; however, repetitive submaximal stress may lead to overuse syndromes. This article reviews the basic anatomy and function of skeletal muscle and discusses the physiopathology of muscle-tendon injuries, and the methods of treatment and prevention, with particular focus on the growing child.
OBJECTIVES: We evaluated the results of zone II flexor tendon injuries treated by primary repair and early rehabilitation in children under the age of 14 years. METHODS: The study included 25 digits of 23 patients (12 boys, 11 girls; mean age 7 years; range 2 to 14 years) with appropriate follow-up. Sixteen patients underwent surgery within the first 24 hours, while the remaining patients had surgery in a mean of three days (range 2 to 14 days). Digital nerve injuries were detected in 10 digits (40%). Repair of the tendons was performed with the use of a modified Kessler technique followed by an above-elbow stabilization splint. Passive flexion-extension exercises were started on the postoperative first day according to the Duran technique. The results were evaluated according to the Glocovac and Strickland's criteria. The mean follow up period was 49 months (range 12 to 92 months). RESULTS: Functional results were excellent in 18 digits (72%), good in five digits (20%), fair in one digit (4%), and poor in one digit (4%). The mean total active movement was 78.5% (range 0% to 100%). No significant differences were observed in functional results with regard to age groups and the presence or absence of digital nerve injuries (p>0.05). No occurrences of infection were encountered. CONCLUSION: The results show that primary repair and early passive mobilization of zone II flexor tendon injuries in children yield satisfactory results.
This article analyzes the controversial topic of whether or not to repair a lacerated extensor hallucis longus tendon. A literature review of extensor hallucis longus tendon injuries is presented. The authors then provide a treatment protocol for extensor hallucis tendon injuries.
Injury to the peroneal tendons is a frequently overlooked cause of persistent lateral ankle pain after trauma. Peroneal tendon anatomy, biomechanics, diagnostic studies, and traumatic disorders were reviewed.