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Hershey Manual > Tendon Stuff > Flashcards

Tendon Stuff Flashcards

1
Q

4 stages of tendon healing

A

Stage 1: The severed ends being joined by a fibroblastic splint. At the end of this stage the repair site is its weakest state consisting of serous material and granulation tissue

Stage II: Shows an increase in paratenon vascularity and collagen proliferation. Immobilization is necessary.

Stage 3: Collagen fibers begin to form longitudinally and give the tendon a moderate degree of strength. At this time controlled passive motion is beneficial to decrease the formation of fibrous adhesions.

Stage 4: Exhibits fiber alignment which imparts increased strength to the tendon. At this point active mobilization can be initiated.

***Each stage takes approximately 1 week

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2
Q

How do tendon lengthenings affect muscle strength?

A

Tendon lengthenings will often result in a loss of muscle strength roughly equal to one grade of manual examination once healed

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3
Q

Suture selections for tendons (5)

A

Surgilon

Stainless steel

Silk

Tevdek/Ticron

Vicryl Dexon

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4
Q

Surgilon in tendon procedures

A

This non-absorbable noninflammatory suture allows for increased strength during the end of stage one when the tendon is at its weakeset

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5
Q

Stainless steel in tendon procedures

A

excellent to anchor tendon to bone and then removed when healing occurs. It is the strongest and least reactive, and bet in contaminated wounds

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6
Q

Silk in tendon procedures

A

Was used for years but has been replaced with less reactive nonabsorbable and absorbables

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7
Q

Tevdek/Ticron

A

nonabsorbable braided polyester that retain greater ability to resist gap producing forces at 3 weeks than either nylon or polypropylene

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8
Q

Vicryl/Dexon

A

Absorbable polygalactic acid and polyglycolic acid usually provide strength long enough for repair

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9
Q

Methods of tendon to tendon suture techniques (8)

A

Bunnell end-to-end

Double right angle

Lateral trap

Chicago

Robertson

Interlace

Herringbone

Bunnell pull-out suture

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10
Q

Bunnell end-to end

A

excellent technique but can cause tissue restriction

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11
Q

Double right angle

A

good for quick repair of small tendons

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12
Q

Lateral trap

A

firmly grips the outside of the tendon without constriction the microcirulation in the center.

Central mattress suture acts as a temporary anchor

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13
Q

Chicago

A

a simple x-stitch described by Mason and Allen

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14
Q

Robertson

A

an excellent method of anastamosing tendons of unequal diameter

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15
Q

Interlace

A

another method for attaching smaller to larger tendons as in tendon grafting

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16
Q

Bunnell pull-out suture

A

A pull out stitch is a non-absorbable suture that anchors a deep stitch to the outside of the skin so it can be removed once healing is complete. Anchored to the outside with a button

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17
Q

Methods for securing tendon to bone: methods (6)

A

Trephine plug

Three hole suture

Buttress and button anchor

Tunnell with sling

Crew and washer

STATAC Device

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18
Q

Trephine plug

A

Using a Michele vertebral trephine a hole is drilled into the bone with the tendon pressed inside and the resultant plug is later tapped into place securing the tendon

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19
Q

Three hole suture

A

Anchoring the transposed tendon with a double armed suture and placing it in a drill hole.

The sutures are then tied into 2 adjacent small drill holes

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20
Q

Buttress and button anchor

A

for tenodesis using a nonabsorbable suture that is removed once the healing is complete

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21
Q

Tunnel with sling

A

Can only be used with a tendon with sufficient length. Made via a tunnel in a bone with the tendon passed through and sutured on itself.

Used with a Jones suspension of the EHL

22
Q

Screw and washer

A

Useful where there is little soft tissue for the transferred tendon can be sutured

23
Q

STATAC device

A

Titanium implant that is drilled into the bone with non-absorbable sutured attached that can be threaded to Keith needles and sewn through a tendon

24
Q

Objectives of tendon transfer (6)

A
  • to improve motor function where weakness and imbalance exist and thereby prevent contractures and further deformity
  • to eliminate deforming forces
  • To provide active motor power
  • to provide better stability
  • to eliminate the need for bracing
  • to improve cosmesis
25
Q

Tendon lengthening and tenotomy indications

A
  • Limited indications when abnormal contracture of a musculotendinous unit compromises normal function.
  • absolute tenotomy has few applications in reconstructive foot surgery (severing the adductor tendon in HAV surgery, the FDL for mallet toe, and tenotomy for lengthening of the Achilles tendon)
26
Q

Common procedures in tendon lengthening and tenotomy (8)

A
  • Strayer technique
  • Silverskiold procedure
  • Fulp and McGlamry tongue- in- groove procedure
  • White tenotomy
  • Hoke’s tenotomy
  • Hibb’s procedure
  • Sliding Z-plasty
  • Abductor hallucis tenotomy
27
Q

Strayer technique

A

distal recession.

-Modification of the Volpius-Stoffel procedure.

Lengthening the gastrocnemius muscle requiring the complete severance of the aponeurosis

Suturing the retracted proximal aponeurosis to the underlying soleus, and casting the foot in neutral to allow for healing at the new length.

28
Q

Silverskiold procedure

A

release muscular heads of the spastic gastrocnemius from the femoral condyles and reinsertion to the proximal tibial area

29
Q

Fulp and McGlamry ton in groove procedure

A

Modified Baker procedure. The tongue- in groove cuts are inverted in the gastroc.

30
Q

White tenotomy

A

Tenotomy of the anterior 2/3 of the distal end of the Achilles tendon and the medial 2/3 of the tendon, performed 5- 7.5cm proximal to the insertion

31
Q

Hoke’s tenotomy

A

triple tenotomy of the Achilles tednon starting 2.5 cm from the insertion and the others at 2.5 cm intervals extending proximally

32
Q

Hibbs procedure

A

Tendo Achilles lengthening via a lateral skin incision with the medial 2/3 of the tendon divided proximally and then split longitudinally in the distal direction at the lateral end of the incision.

Lateral 2/3 of the tendon is then divided near the point insertion and it is split longitudinally in the proximal direction at the medial end of the incision

33
Q

Sliding Z-plasty

A

can be used for the Achilles or tensor tendons

34
Q

Abductor hallucis tenotomy

A

Tenotomy of the abductor hallucis in the treatment of congenital hallux varus and metatarsus adductus.

35
Q

Tendon Transfer procedures (15 types)

A
  • Murphy Modification
  • Peroneus brevis tendon transfer
  • Peroneus Longus tendon transfer
  • Tibialis posterior tendon transfer
  • Tibialis anterior tendon transfer
  • Split tibialis aanterior tendon transfer (STATT)
  • Hibbs tenosuspension
  • Jones Suspension
  • Young procedure
  • Kidner procedure
  • Lowman procedure
  • Heyman Procedure
  • Flexor digitorum longus transfer
  • Peroneal anastomosis
  • Joplin sling procedure
36
Q

Murphy Modification

A

utilized in young patients with CP where the spasticity of the triceps is causing ankle equinus.

Transect and reroute the Achilles tendon into the calcaneus distally just proximal to the subtalar joint

37
Q

Peroneus brevis tendon transfer

A

muscle is transferred to aid in dorsiflexion via rerouting the tendon medially into the 3rd cuneiform

38
Q

Peroneus longus tendon transfer

A

this muscle is transferred when additional dorsiflexory power is needed via rerouting the tendon medially into the 3rd cuneiform.

Can also be rerouted into the posterior calcaneus when paralytic calcaneal deformities are present

39
Q

Tibialis posterior tendon transfer

A

Has the potential to be a good dorsiflexor when replacement is needed by rerouting the tendon laterally into the 3rd cuneiform

40
Q

Tibialis Anterior tendon transfer

A

to reduce the supinatory forces in the foot via detaching the tibialis anterior over the navicular and rerouting it laterally into the 3rd cuneiform

41
Q

Split Tibialis Anterior Tendon Transfer

A

its goal is to increase true dorsiflexion in the foot by balancing its power laterally via splitting the tibialis anterior and suturing the lateral portion to the peroneus tertius

42
Q

Hibbs Tenosuspension

A

performed to release the retrograde buckling a the MPJ’s causing the flexible forefoot equinus

Detach all 4 tendons of the EDL distally enough and fused at the base of the 3rd metatarsal to the corresponding EDB

43
Q

Jones suspension

A

Used for treatment of a cocked-up hallux by transecting the EHL at the IPJ of the hallux

-Reroute it through a medial to lateral drill hole in the head of the 1st met

44
Q

Young procedure

A

a tendon transposition

  • rerouted through a keyhole in the navicular
  • useful in flatfoot deformities
45
Q

Kidner procedure

A

Advancement of the Tibialis posterior either inferior to the navicular bone or modified by attachment to the medial cuneiform to increase its adductory influence on the forefoot

46
Q

Lowman procedure

A

For flatfoot. Reroute medial band of the of Tibialis Anterior tendon the navicular and sutured to the spring ligament and transfer or a section of tendo achilles

47
Q

Heyman Procedure

A

A panmetatarsal suspension for equinus foot via suturing the EDL to their respective met heads

48
Q

Flexor digitorum longus transfer

A

transferring the FDL to the proximal phalanx of the involved digit will convert it to a strong plantarflexor of the MPJ

49
Q

Peroneal anastomosis

A

involves securing the Peroneus longus to the peroneus brevis at the level of the midcalf

50
Q

Joplin Sling procedure

A

to narrow the forefoot

Done via cutting the EDL tendon 5 and passing it through and underneath the 5th MPJ joint capsule to the abductor hallucis and back around and over the EHL suturing it to the 1st MPJ joint capsule.

The EDL tendon 4 is then sutured to the stump of EDL 5

Hershey Manual (2 decks)

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