Growth Factor Expression During Healing in 3 Distinct Tendons.

Purpose: We investigated unique tendon growth-factor expression profiles over time in response to simultaneous, similar injuries. Characterizing these genetic differences lays the foundation for creating targeted, tendon-specific therapies and provides insight into why current growth-factor treatments have success in some applications but not others.

Methods: The left fourth digital flexor, triceps, and supraspinatus tendons in 24 rats were cut to 50% of their transverse width at the midbelly under anesthesia.

Use of high-speed burr and water-based lubricant in the partial removal of surgical plates: A technique Guide.

Implant removal comprises 5% of all orthopaedic surgery procedures performed annually. Surgical indications range from implant failure, infection, non-union, and symptomatic hardware. Intra-operatively, surgeons need to prepare for complications including bony overgrowth, cold-welding, broken screws, and stripped screw heads.

Septic Arthritis of the Shoulder: A Comparison of Treatment Methods.

Introduction: In-hospital outcomes were compared among patients with shoulder septic arthritis treated with arthrocentesis, open irrigation and débridement, or arthroscopic irrigation and débridement.

Methods: The Nationwide Inpatient Sample database was queried for all cases of native shoulder septic arthritis between 2002 and 2011. Patient demographics, comorbidities, and hospitalization complications were compared for the shoulder arthrocentesis (nonsurgical) and open or arthroscopic irrigation and débridement (surgical) groups.

Current flexor and extensor tendon motion regimens: a summary.

This article summarizes select multinational early motion protocols. Included are flexor and extensor protocols for digital tendon repair in many forms. Custom orthosis design, exercise regimens, and advanced techniques are examples of what to expect.

Biomechanical analysis of partial flexor tendon lacerations in zone II of human cadavers.

Purpose: The aims of this study were to examine nonrepaired 90% partial lacerations of human cadaver flexor digitorum profundus (FDP) tendon after simulated active motion, and to assess the residual ultimate tensile strength.

Methods: Partial, transverse zone II flexor tendon lacerations were made in the volar 90% of the tendon substance in 10 FDP tendons from 5 fresh-frozen human cadaver hands. The tendons were cycled in the curvilinear fashion described by Greenwald 500 times to a tension 25% greater than the maximum in vivo active FDP flexion force measured by Schuind and colleagues.

Effects of the deep anterior oblique and dorsoradial ligaments on trapeziometacarpal joint stability.

Purpose: Osteoarthritis of the trapeziometacarpal (TMC) joint of the thumb affects as many as 25% of postmenopausal women and 5% of middle-aged men. This study investigated the relative contribution of the dorsoradial ligament (DRL) and the deep anterior oblique ligament (dAOL) to the stability of the TMC joint. This knowledge will improve our understanding of the pathomechanics of osteoarthritis at the base of the thumb and may help to design novel reconstructive surgical procedures.

Anatomy of the coronoid process.

Purpose: Coronoid injuries are classified according to the size of the coronoid fracture. The purpose of this study was to provide a detailed anatomic description of the coronoid process, with specific focus on the coronoid height, the coronoid width, and the olecranon-coronoid angle.

Methods: Thirty-five cadaveric arms were dissected.

Repair of zone II flexor digitorum profundus lacerations using varying suture sizes: a comparative biomechanical study.

Purpose: To compare the maximum tensile load, change in work of flexion, and gapping at the repair site after zone II flexor digitorum profundus tendon repairs using 2-0, 3-0, and 4-0 braided polyester 4-strand locked cruciate repair technique in fresh-frozen cadaveric hands with standard 6-0 suture epitenon repairs, to determine which suture size is the best for a core repair.

Methods: A randomized study was designed using 41 tendons from 15 fresh-frozen cadaveric hands. We included only the flexor digitorum profundus tendons from the index, middle, and ring fingers to minimize variation between digits.

The future of flexor tendon surgery.

Clinical outcomes following flexor tendon repair have made significant improvements in the last 50 years. In that time standard treatment has evolved from secondary grafting to primary repair with postoperative rehabilitation protocols. Unfortunately, excellent results are not yet attained universally following treatment.

Acute flexor tendon repairs in zone II.

Flexor tendon repair in zone II is still a technically demanding procedure, but the outcomes have become more predictable and satisfying. Of keystone importance for obtaining the goals of normal strength and gliding of repaired flexor tendons are an atraumatic surgical technique, an appropriate suture material, a competent pulley system, and the use of early motion rehabilitation protocols. The overall goal of hand and finger function also implies timely addressing of neurovascular injuries.

Zone I flexor tendon injuries.

Zone I flexor tendon injuries entail injuries to the flexor digitorum profundus (FDP) tendon. These injuries occur distal to the superficialis insertion over the middle phalanx or proximal distal phalanx, and as such are isolated injuries to the FDP. The mechanism most commonly is closed avulsion from the distal phalanx or a laceration, but other mechanisms such as open avulsion or crush injury can occur.

Characterization of adenovirus-mediated gene transfer in rabbit flexor tendons.

Purpose: Adenoviral vector-based gene therapy is a promising technique for the delivery of growth factors to tendons. The objective of this study was to determine whether rabbit flexor tendons could be transduced effectively by adenoviral vectors and whether the introduction of adenoviral vectors would cause a notable local inflammatory response.

Methods: Recombinant adenoviruses expressing green fluorescent protein (AdGFP) or BMP-13 (AdBMP-13) were constructed and 3 different viral titers (1 x 10(7), 1 x 10(8), and 1 x 10(9)) were tested in this study.

Effects of the adductor pollicis and abductor pollicis brevis on thumb metacarpophalangeal joint laxity before and after ulnar collateral ligament reconstruction.

Purpose: The intrinsic muscles and ulnar capsuloligamentous structures (UCLS), which consist of the ulnar collateral ligament (UCL), accessory UCL, dorsal capsule, and volar plate of the thumb metacarpophalangeal (MCP) joint are important for controlling the motion and stability of the MCP joint during pinch. The purpose of this cadaveric study was to determine the effects of the adductor pollicis (AdP) and abductor pollicis brevis (APB) on the 3-dimensional MCP joint laxity before transection of the UCLS and after reconstruction of the UCL and repair of the dorsal capsule.

Methods: Loads were applied to the flexor pollicis longus (FPL) alone, to the AdP and FPL in combination, and to the APB and FPL in combination in 11 cadavers.

The strength of distal fixation of flexor digitorum profundus tendon grafts in human cadavers.

Early active motion limits adhesion formation and thus improves functional performance after tendon grafting. The early strength of distal fixation is critical to successful tendon grafting. We describe a new Y-tunnel technique of distal fixation and compare it with 2 established methods, the Pulvertaft transverse tunnel and the Bunnell button over the fingernail techniques, in a human cadaver model to determine which is the strongest method.

Comparative biomechanical performances of 4-strand core suture repairs for zone II flexor tendon lacerations.

To compare the biomechanical performances of six 4-strand flexor tendon repairs at zone II, we used an in situ testing model in 54 cadaver profundus tendons. The techniques studied were the modified Becker, modified double Tsuge, Lee, locked cruciate, Robertson, and Strickland. Prerepair and postrepair comparisons for work of flexion to a 3.