Biomechanical and Morphometric Properties of the Long Flexor Tendons of the Toes: A Cadaver Study

2019 ◽  
Vol 109 (4) ◽  
pp. 282-290 ◽  
Author(s):  
Orhan Beger ◽  
Gamze Tumentemür ◽  
Coşar Uzun ◽  
Elif Nedret Keskinöz ◽  
Özlem Elvan ◽  
...  
Keyword(s):  
Biomechanical Properties ◽  
Cadaver Study ◽  
Surgical Approaches ◽  
Flexor Hallucis Longus ◽  
Postoperative Function ◽  
Flexor Tendons ◽  
Fresh Frozen ◽  
Fifth Toe ◽  
Tendon Grafts ◽  
Group 2

Background: We sought to show the biomechanical and morphometric properties of flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendon grafts harvested by specific surgical approaches and to assess the contribution of FHL slips to the long flexor tendons of the toes. Methods: Thirteen fresh-frozen amputated feet (average age, 79 years) were dissected. The connections between the FHL and FDL tendons and the contribution of FHL slips to the long flexor tendons were classified. The biomechanical properties of the tendons and slips were measured using a tensile device. Results: The connections between the FHL and FDL tendons were reviewed in two groups. Group 1 had FHL slips (11 cases) and group 2 had cross-slips (two cases). The FHL slips joined the second and third toe long flexor tendon structures. Tendon length decreased significantly from the second to the fifth toe (P < .001). Apart from the second toe tendon being thicker than that of the fourth toe (P = .02) and Young's modulus being relatively smaller in the third versus the fourth toe tendon (P = .01), biomechanical and morphometric properties of second to fourth tendons were similar. Mechanical properties of those tendons were significantly different from fifth toe tendons and FHL slips. Morphometric and biomechanical properties of FHL slips were similar to those of the fifth toe tendon. Conclusions: Herein, FHL slips were shown to have biomechanical properties that might contribute to flexor functions of the toes. During the harvesting of tendon grafts from the FHL by minimally invasive incision techniques from the distal plane of the master knot of Henry, cutting slips between FHL and FDL tendons could be considered a cause of postoperative function loss in toes.

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 Segmental Surface Referencing during Intraoperative Three-dimensional Image-Guided Spine Navigation: An Early Validation with Comparison to Automated Referencing

2016 ◽  
Vol 6 (8) ◽  
pp. 765-770 ◽  
Author(s):  
Amro F. Al-Habib ◽  
Salah Al-Akkad
Keyword(s):  
Image Acquisition ◽  
Three Dimensional ◽  
Pedicle Screws ◽  
Cadaver Study ◽  
Registration Accuracy ◽  
Spine Instrumentation ◽  
Early Validation ◽  
Distant Target ◽  
Fresh Frozen ◽  
Group 2

Study Design Interventional human cadaver study. Objective Intraoperative three-dimensional (3-D)-guided navigation improves spine instrumentation accuracy. However, image acquisition may need to be repeated with segment hypermobility or distant target from reference frame (RF). The current study evaluates the usefulness of internal metal fiducials (IMFs) as surface references in enhancing registration accuracy and avoiding repeating imaging. Methods Six fresh-frozen cadaveric human torsos were utilized. Posterior C1–T2 exposure was done, and three IMFs were inserted per level; intraoperative 3-D images were then acquired. Two registration methods were utilized: autoregistration (AR, group 1) and point registration using IMF (IMFR, group 2). Registration accuracy was checked by identifying IMFs in both groups. Pedicle screws inserted into C2, C4, C5, and C7 based on the two registration methods (three cadavers each) with RF on C7 and then on C2. Results The mean registration error was lower with IMFR compared with AR (0.35 ± 0.5 mm versus 2.02 ± 0.85 mm, p = 0.0001). Overall, 34 pedicle screws were inserted (AR, 18; IMFR, 16). Final screw placement was comparable using both techniques ( p = 0.58). Lateral screws violations were observed in four IMFR screws (1 to 2 mm) as compared with five in AR group (2 to 3 mm). Reregistration after moving RF to C2 was possible using surface screws in IMFR group, thus avoiding new 3-D image acquisition. Conclusion During intraoperative 3-D navigation in spine procedures, surface fiducial registration using IMF provided superior accuracy over automated registration. It allowed repeat registration without repeating radiation during long spine segment instrumentations. More studies are needed to clarify both practical and clinical application of this method.

Endoscopic Flexor Hallucis Longus Decompression: A Cadaver Study

2007 ◽  
Vol 28 (7) ◽  
pp. 810-814 ◽  
Author(s):  
John J. Keeling ◽  
Gregory P. Guyton
Keyword(s):  
Sural Nerve ◽  
Significant Risk ◽  
Cadaver Study ◽  
Flexor Hallucis Longus ◽  
Lateral Plantar Nerve ◽  
Endoscopic Release ◽  
Incision Size ◽  
Large Joint ◽  
Fresh Frozen ◽  
Neurovascular Structures

Background New indications for arthroscopy are being considered because arthroscopy limits incision size and potentially decreases operative morbidity. This cadaver study investigated the utility of performing an all-endoscopic flexor hallucis longus (FHL) decompression. Methods Eight fresh-frozen cadaver legs were used. In the simulated prone position with large joint arthroscopic equipment, posterolateral and posteromedial portals were used to perform posterolateral talar process bony excision and FHL sheath debridement and release. We noted the integrity of the sural nerve, FHL tendon, and medial tibial neurovascular bundle. After open dissection, values for sural nerve distance to the posterolateral portal, the amount of FHL sheath released and the proximity of the arthroscopic instrumentation to the medial tibial neurovascular structures were recorded. Results Three of eight FHL tendons were injured during the attempted FHL release. Furthermore, no FHL sheath was completely released down to the level of the sustentaculum. Although posterolateral portal placement was on average 12.1 mm from the sural nerve, it was only 6.1 mm from the lateral calcaneal branch of the sural nerve. Moreover, in all cases the medial calcaneal nerve and first branch of the lateral plantar nerve were closely juxtaposed and in some cases adherent to the FHL fibro-osseous sheath. Conclusions Although os trigonum or posterolateral talar process excision was performed without difficulty, endoscopic release of the FHL tendon proved technically demanding with significant risk to the local neurovascular structures. Given the reliability and low morbidity of open techniques, this cadaver study calls into question the clinical use of complete endoscopic FHL release to the level of the sustentaculum. Moreover, hindfoot endoscopic surgery should be performed by surgeons familiar with open posterior ankle anatomy and experienced in hindfoot endoscopy.

scholarly journals Posterolateral Plate Fixation with Pantalarlock® is More Stable than Nail Fixation in Tibiotalocalcaneal Arthrodesis in a Biomechanical Cadaver Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0023
Author(s):  
Natalia Gutteck
Keyword(s):  
Plate Fixation ◽  
Pearson Correlation ◽  
Biomechanical Testing ◽  
Treatment Phase ◽  
Biomechanical Properties ◽  
Cadaver Study ◽  
Postoperative Treatment ◽  
Osteoporotic Bone ◽  
Cyclic Testing ◽  
Fresh Frozen

Category: Ankle; Ankle Arthritis Introduction/Purpose: Despite the promising results of ankle joint arthroplasty, the tibiotalocalcaneal (TTC) arthrodesis remains an established procedure in treatment of combined pathology of the ankle and subtalar joint. Despite the promising results in biomechanical investigations, nonunion rates of up to 24% are described in recent studies. The objective of this work was a comparative study of the biomechanical properties of the posterolateral plate fixation with retrograde intramedullary nail fixation. Methods: Twenty four fresh-frozen human lower leg specimens (12 pairs) were used for the comparative biomechanical testing. Every specimen was preconditioned with 100N over 200 cycles. After every 250 cycles the force was increased by 50N from 200 to 600N. This was followed by cyclic loading in dorsi-/plantiflexion with 800N for 3000 cycles. All specimens were subjected to bone densitometry (DXA) and computed tomography. Results: Significantly higher number of spacimens with nails (4) failed during the cycling testing in dorsi-/plantarflexion and futher two during the cyclic testing with 800N. Two specimens with plates failed during the cyclic testing with 800N. Statistical analysis showed that the specimens with the plate were significantly more stable in each test direction. The Pearson correlation demonstrated for the specimens with plate a linear relationship between the stiffness and the determined bone density. Conclusion: We expect a considerable reduction of the pseudarthrosis rate and shorten the postoperative treatment phase in clinical set up and appropriate advantages in the treatment of high risk patients with severe deformity of the ankle, bone defects, neuropathic deformity, poor bone quality and osteoporosis. The choice of most predictable and stable implant is essential for the successful fusion. In conclusion, the posterolateral plate ostesynthesis for TTC arthrodesis is significantly stiffer compared to the nail osteosynthesis in osteoporotic bone model.

Outcomes of three surgical approaches for managing ectopia lentis in Marfan syndrome

2021 ◽  
pp. 112067212199295
Author(s):  
Gurkan Erdogan ◽  
Nilay Kandemir Besek ◽  
Betul Onal Gunay ◽  
Alper Agca
Keyword(s):  
Marfan Syndrome ◽  
Crystalline Lens ◽  
Surgical Approaches ◽  
Posterior Chamber ◽  
Ectopia Lentis ◽  
Iol Implantation ◽  
Capsular Tension Ring ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective: To investigate the clinical outcomes of three surgical approaches for ectopia lentis in Marfan syndrome (MS) patients who had undergone crystalline lens removal with posterior chamber intraocular lens (IOL) implantation techniques comprising the intrascleral fixation of IOL, sutured scleral fixation of IOL, and IOL implantation with the use of a Cionni capsular tension ring (CTR). Methods: This is a retrospective comparative study, including 35 eyes of 21 patients who underwent the intrascleral fixation of IOL (group 1), scleral IOL fixation with the Z-suture (group 2), and IOL implantation with the use of a Cionni CTR (group 3) following crystalline lens removal. The surgical indications were as follows: no improvement in visual function after eyeglasses or contact lens application due to excessive irregular astigmatism and advanced crystalline lens decentration in which the edge of the crystalline lens came up to the optical axis, or dislocation of the crystalline lens resulting in aphakia and secondary glaucoma due to lens dislocation. The surgical outcomes and complications due to surgery were compared between the groups. Results: The mean age of the patients in the study was 12.3 ± 8.7 years (5–32 years). There were 10 eyes in group 1, 13 eyes in group 2, and 12 eyes in group 3. Visual acuity improved significantly in each group after surgery. Ocular residual astigmatism did not differ significantly between the groups ( p = 0.51). Conclusion: There were no significant differences between the three surgical approaches in the current study in terms of the postoperative results and complications.

scholarly journals Influence of peracetic acid-ethanol sterilisation on the biomechanical properties of human meniscus transplants

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Volker Eras ◽  
Josefine Graffunder ◽  
Norus Ahmed ◽  
Jan C. Brune
Keyword(s):  
Peracetic Acid ◽  
Biomechanical Properties ◽  
Bone Block ◽  
Test Device ◽  
Level Of Evidence ◽  
Load To Failure ◽  
Graft Extrusion ◽  
Fresh Frozen ◽  
Failure Loads ◽  
N Loading

Abstract Purpose Meniscus allograft transplantation (MAT) is a possible treatment for patients suffering with pain after meniscectomy. Here, peracetic acid (PAA) sterilised meniscus transplants were investigated on whether they would provide an adequate alternative to fresh-frozen transplants in their viscoelastic and mechanical properties. Methods In this analysis, 31 menisci donors (26 male and 5 female) were included. The average donor age was 49.87 years, ranging from 32 to 65 years. Menisci of matched pairs of knees underwent chemical sterilisation while counterparts were left fresh-frozen. Stiffness and load to failure were determined via suture retention. Further menisci were analysed while attached to the tibial bone block using a novel test device to mimic physiological load distribution. Meniscus relaxation, stiffness and failure loads were determined. Histology and biphasic properties of the menisci were examined and results were analysed using paired t-tests. Results A novel custom built test device allowed the application of physiological loads for suture retention testing and revealed no significant differences between PAA sterilised (14.85 ± 4.46 N/mm, 50.49 ± 17.01 N) and fresh-frozen (18.26 ± 4.46 N/mm, 59.49 ± 21.07 N) regarding stiffness and failure load, respectively. Furthermore, initial 200 N loading showed significantly higher strain in sterilised menisci (18.87 ± 1.56) compared to fresh frozen (13.81 ± 1.04). Load relaxation experiments demonstrated significantly lower relaxation for sterilised menisci (77.71 ± 1.62) compared to fresh-frozen (89.11 ± 1.00, p-value < 0.0001). Conclusion Peracetic acid sterilised human menisci performed equally to fresh-frozen counterparts in a suture retention test and in physiological failure testing providing an adequate alternative. However, meniscus relaxation, biphasic properties and strain were shown to be significantly different between the groups. A common problem of MAT is graft extrusion or shrinkage, therefore the parameters measured here should be considered and may influence meniscus extrusion after transplantation. Level of evidence n/a (experimental study)

scholarly journals Biomechanical properties of the bone during implant placement

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ádám László Nagy ◽  
Zsolt Tóth ◽  
Tamás Tarjányi ◽  
Nándor Tamás Práger ◽  
Zoltán Lajos Baráth
Keyword(s):  
Bone Structure ◽  
Biomechanical Properties ◽  
Control Group ◽  
Dynamic Tests ◽  
Bone Model ◽  
Implant Placement ◽  
Significant Difference ◽  
Before And After ◽  
Group 2 ◽  
Post Hoc

Abstract Background In this research the biomechanical properties of a bone model was examined. Porcine ribs are used as experimental model. The objective of this research was to investigate and compare the biomechanical properties of the bone model before and after implant placement. Methods The bone samples were divided in three groups, Group 1 where ALL-ON-FOUR protocol was used during pre-drilling and placing the implants, Group 2 where ALL-ON-FOUR protocol was used during pre-drilling, and implants were not placed, and Group 3 consisting of intact bones served as a control group. Static and dynamic loading was applied for examining the model samples. Kruskal–Wallis statistical test and as a post-hoc test Mann–Whitney U test was performed to analyze experimental results. Results According to the results of the static loading, there was no significant difference between the implanted and original ribs, however, the toughness values of the bones decreased largely on account of predrilling the bones. The analysis of dynamic fatigue measurements by Kruskal–Wallis test showed significant differences between the intact and predrilled bones. Conclusion The pre-drilled bone was much weaker in both static and dynamic tests than the natural or implanted specimens. According to the results of the dynamic tests and after a certain loading cycle the implanted samples behaved the same way as the control samples, which suggests that implantation have stabilized the skeletal bone structure.

Biomechanical properties of triceps brachii tendon after in vitro simulation of different posterior surgical approaches

2007 ◽  
Vol 16 (6) ◽  
pp. 849-853 ◽  
Author(s):  
Mounir Guerroudj ◽  
Jean-Charles de Longueville ◽  
Marcel Rooze ◽  
Maurice Hinsenkamp ◽  
Véronique Feipel ◽  
...  
Keyword(s):  
Biomechanical Properties ◽  
Surgical Approaches ◽  
Triceps Brachii ◽  
In Vitro Simulation

Single-Stage Repair of Coarctation of the Aorta and Ventricular Septal Defect: A Comparison of Surgical Strategies and Resource Utilization

2017 ◽  
Vol 8 (5) ◽  
pp. 559-563 ◽  
Author(s):  
Connor Callahan ◽  
David Saudek ◽  
Amanda Shillingford ◽  
Sara Creighton ◽  
Garick Hill ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Resource Utilization ◽  
Septal Defect ◽  
Coarctation Of The Aorta ◽  
Retrospective Chart Review ◽  
Single Stage ◽  
Surgical Approaches ◽  
Off Pump ◽  
Group 2 ◽  
Group 1

Background: We sought to compare clinical outcomes and resource utilization for two surgical approaches for single-stage repair of coarctation of the aorta and ventricular septal defect (VSD). Methods: This was a retrospective chart review of 21 consecutive neonates and infants undergoing single-stage repair of coarctation of the aorta and VSD. Group 1 included 13 patients with both arch repair and VSD repair completed via sternotomy. Group 2 included eight patients with off-pump arch repair via left thoracotomy followed by repositioning and VSD repair via sternotomy. Primary clinical outcome was arch reintervention. Secondary outcomes included various measures of resource utilization. Results: Group 1 patients demonstrated younger age at repair (median of 10 days vs 57 days for group 2; P = .05) and lower proximal arch z scores (−4.2 vs −2.3 for group 2; P = .003). Arch reintervention occurred in 0 of 8 patients in group 2 and 1 (7.7%) of 13 patients in group 1 ( P = nonsignificant). Group 2 was associated with lower total charges (US$68,301 vs US$211,723 for group 1; P = .0007), shorter length of stay (8 days vs 23 days for group 1; P = .004), and shorter duration of postoperative mechanical ventilation (0.5 days vs 4.0 days for group 1; P = .0008). Group 2 was also associated with shorter total cardiopulmonary bypass time (86 minutes vs 201 minutes for group 1; P = .0009). Conclusion: Single-stage two-incision repair of coarctation and VSD in appropriately selected patients may be associated with higher value of care. Confirmation of this finding will require further study based on larger numbers of patients.

Application of femtolaser-assisted phacoemulsification in combined pathology of cataract and glaucoma

2021 ◽  
pp. 18-21
Author(s):  
A.P. Voznyuk ◽  
◽  
S.I. Anisimov ◽  
S.Y. Anisimova ◽  
L.L. Arutyunyan ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Biomechanical Properties ◽  
Mean Values ◽  
Long Term Follow Up ◽  
The Mean ◽  
Group 2 ◽  
Observation Period ◽  
Group 1

Purpose. To evaluate the efficacy and safety of femtolaser-assisted phacoemulsification in glaucomatous eyes in the long-term follow-up. Materials and methods. A retrospective analysis of the results of the surgical treatment of patients with combined cataract and glaucoma pathology was analyzed. The patients were divided into groups depending on the method of surgical intervention: 1) phacoemulsification with femtolaser support (26 eyes, 23 patients); 2) phacoemulsification (36 eyes, 30 patients); Results. Before surgery, there were no statistically significant differences in IOP and corneal hysteresis (СН) between groups 1 and 2. The mean values of IOP cc, IOP g and СН of group 1 before surgery were 22.7±6.1 mm Hg, 20.9±6.9 mm Hg, 8.5±1.6 mm Hg; 2 group – 22.9±8.7 mm Hg, 21.6±8.9 mm Hg, 8.9±1.6 mm Hg respectively. Average values of IOP cc, IOP g and CН 5 years after the surgical treatment in group 1 were 15.3±1.2 mm Hg, 14.4±3.4 mm Hg, 9.6±4.2 mm Hg; in group 2 – 18.0±4.2 mm Hg, 16.1±4.2 mm Hg, 8.8±2.2 mm Hg respectively. In both groups, stabilization of IOP and CH indices was noted, which remained throughout the entire observation period, which shows the normalization of the biomechanical properties of the corneoscleral membrane of the eye in the long-term postoperative period. Conclusion. Femtolaser accompaniment of phacoemulsification is an effective and safe method of cataract surgery for combined pathology. Key words: femtolaser, cataract, glaucoma, phacoemulsification.

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