• Journal of Veterinary Clinics
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• v.25 no.2
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• pp.90-95
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• 2008

One fresh equine cadaver (two forelimbs) and five non-lamed thoroughbreds (ten sound forelimbs) were examined ultrasonographically through 5.0 MHz linear array transducer with a stand-off pad in palmar pastern region. The normal transverse ultrasonographic images of the superficial digital flexor tendon (SDFT), deep digital flexor tendon (DDFT), straight sesamoidean ligament (SSL), oblique sesamoidean ligament (OSL), and medium scutum could be identified at the region. The mean $\pm$ SD (min.$\sim$max. $mm^2$) of SDFT cross-sectional areas at P1A, P1B, P1C in the region were $110.00{\pm}5.38$ ($100{\sim}128$), $100.00{\pm}5.02$ ($90{\sim}111$), $114.00{\pm}3.33$ ($104{\sim}124$), respectively. The mean $\pm$ SD (min.$\sim$max. $mm^2$) of DDFT cross-sectional areas at each phalanx (P1A, P1B, P1C, P2A, P2B) were $136.00{\pm}4.83$ ($125{\sim}147$), $94.00{\pm}5.43$ ($85{\sim}108$), $99.00{\pm}4.87$ ($90{\sim}111$), $115.00{\pm}3.67$ ($108{\sim}124$), $135.00{\pm}3.65$ ($125{\sim}145$), respectively. The mean ratio of SDFT of P1B to DDFT was 0.74, 1.06, 1.01, 0.87, 0.74 at P1A, P1B, P1C, P2A, P2B, respectively.

• Archives of Plastic Surgery
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• v.46 no.3
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• pp.228-234
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• 2019

Background The management of flexor tendon injuries has evolved in recent years through industrial improvements in suture materials, refinements of repair methods, and early rehabilitation protocols. However, there is no consensus on the ideal suture material and technique. This study was conducted to compare the tensile strength, repair time, and characteristics of 4-strand cruciate, modified Kessler, and 4-strand horizontal intrafiber barbed sutures for flexor tenorrhaphy with a 12-mm suture purchase length in an animal model. Methods The right third deep flexors of 60 adult Leghorn chicken feet were isolated and repaired with a 12-mm suture purchase length. The tendons were randomly assigned to three groups of equal number (n=20 each). Groups 1 and 2 received 4-strand cruciate and modified Kessler repair with conventional suture materials, respectively. A 4-strand horizontal intrafiber barbed suture technique was used in group 3. The repaired tendons were biomechanically tested for tensile strength, 2-mm gap resistance, and mode of failure. Repair times were also recorded. Results The maximum tensile strength until failure was $44.6{\pm}4.3N$ in group 1, $35.7{\pm}5.2N$ in group 2, and $56.7{\pm}17.3N$ in group 3. The barbed sutures were superior to the other sutures in terms of the load needed for 2-mm gap formation (P<0.05). Furthermore, the barbed sutures showed the shortest repair time (P<0.05). Conclusions This study found that 4-strand horizontal intrafiber barbed suture repair with a 12-mm purchase length in a chicken flexor tendon injury model showed promising biomechanical properties and took less time to perform than other options.

• Journal of Korean Foot and Ankle Society
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• v.13 no.2
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• pp.133-137
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• 2009

Purpose: The purpose of this study was to evaluate the clinical results of the old Achilles tendon rupture treated with modified flexor hallucis longus (FHL) tendon transfer. Materials and Methods: Seventeen patients with old Achilles tendon rupture treated with modified FHL tendon transfer between March 2004 and February 2008 were enrolled in this study. Technically FHL was pass through the distal portion of the ruptured tendon instead of the drilled hole made on the calcaneus. The mean age of the patients was 37 years (range, 22~67 years), mean follow-up period was 28 months (range, 12~30 months). Patients' subjective satisfaction, calf circumferential diameter, range of motion of ankle and AOFAS ankle-hind foot score and Arner-Lidholm score was evaluated. Results: The average gap between the ruptured tendon was 52 mm (range, 47~56 mm). The AOFAS score improved from 47 pre-operatively to 91 points at the last follow-up. Sixteen patients were satisfied with the result free from discomfort, a patient had mild discomfort who had DM. fourteen patients had decreased range of motion less than 5 degrees while 2 patients had more than 7 degrees decrease compared to the intact side but had no discomfort in daily activities. Nine patients had less than 1 cm calf circumferential diameter difference and 7 patients had 1 to 3 cm diameter difference compared to the intact side. One who had more than 3 cm diameter difference had deteriorated muscle strength. Conclusion: Modified FHL tendon transfer can be a useful technique for the treatment of old Achilles tendon rupture when the gap is with large gap placed too proximal.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.723-728
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• 2008

Purpose: The disinsertion of the phalangeal tendon distal insertion has difficulties in ordinary tenorrhaphy operation for the anatomical features, and still has controversy between non-surgical and surgical management. The purpose of this study is to select treatment for the injury of the phalangeal tendon distal insertion, as we've had a good results from operation treatment with Pull-in suture technique. Methods: We reviewed the hospital records of 12 patients treated with Pull-in suture technique with disinsertion of the phalangeal extensor or flexor tendon distal insertion from June 2006 to June 2007. Eight patients were involved with the tendon disinsertion without bone fracture, and 4 patients were involved with the fracture of the phalangeal tendon distal insertion site. After removal of the K-wire in week 6, active physical exercises were commenced immediately. The mean follow-up period was 12.4 months. Results: All the patients who had tendon disinsertion with bone fracture had IIB, by Wehbe and Schneider's classification 2, and we evaluated the results comparing the same finger of the other hand according to Crawford's evaluation criteria 5. The nine excellent and three good results were obtained and there were no limitation of motor for the patient who had operation for the rupture of flexor tendon as well. There were no particular complications during the follow-up period. Conclusion: The most important thing for the disinsertion of the phalangeal tendon distal insertion is to maintain an accurate and durable reduction state keeping the tension of tendon. At this point, after removal of the K-wire, the Pull-in suture technique allows accurate realignment of the tendon-bone unit without any specific instrumentation under the more stable state. The Pull-in suture technique seems to be a strong alternative for the treatment of disinsertion of the phalangeal tendon distal insertion, with successful treatment outcome(rapid functional recovery and high patient satisfaction).

• Journal of Veterinary Clinics
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• v.33 no.1
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• pp.1-5
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• 2016

Septic tenosynovitis of the digital flexor tendon sheath (DFTS) is a potentially career-ending and life-threatening problem in horses. This study aimed to describe the outcomes of tenoscopy for the treatment of acute septic digital flexor tenosynovitis in horses. Tenoscopy was performed on 13 Thoroughbred horses with acute septic tenosynovitis of the DFTS. Surgical time was 56-148 min (mean 85.6 min, median 84.0 min). In the synovial fluid analysis, mean white blood cell count, mean neutrophil proportion, and mean total protein were $42.9{\times}10^3cells/{\mu}l$ (range, $7.2-109.5cells/{\mu}l$), 89.5% (range, 68-97%), and 4.0 g/dl (range, 2.5-5.2 g/dl), respectively. Microbial growth in the synovial fluid culture was detected in 2 of 11 horses. All horses survived and returned to their intended use without complications. The present study demonstrated that the tenoscopy is useful for treating acute septic tenosynovitis of the DFTS in horses.

• Journal of Korean Foot and Ankle Society
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• v.19 no.1
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• pp.35-38
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• 2015

The checkrein deformity describes tethering of the flexor hallucis longus tendon, which mainly occurs after fracture of the distal tibia. The deformity increases with dorsiflexion of the ankle and decreases or disappears with plantarflexion of the ankle. In some cases, the deformity may occasionally include the second and third toes. In the current study, the authors experienced secondary checkrein deformity of all lesser toes after open reduction and plate fixation for comminuted fracture of the calcaneus. As a treatment, plate and screws were removed, followed by an additional medial incision which showed a partially ruptured flexor digitorum longus tendon with severe adhesion. Resection of the adhesed tendon and tenodesis of its distal portion to the flexor hallucis longus was performed for correction of the checkrein deformity. Then the lessor toe checkrein deformity recovered immediately. The authors report on this rare lessor toe checkrein deformity after calcaneal fracture fixation with a review of literature.

• Journal of Korean Foot and Ankle Society
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• v.9 no.2
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• pp.213-215
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• 2005

Tarsal tunnel syndrome caused by space occupying lesion is unusual but it rarely occur by ganglion which is presented below the flexor retinaculum due to compression neuropathy of posterior tibial nerve and its branches. The object of the current study is to report our experience of surgical treatment about tarsal tunnel syndrome caused by the ganglion of flexor digitorum longus tendon sheath and multifocal myxoid degeneration of medial plantar nerve with a review of the literatures.

• Journal of Korean Foot and Ankle Society
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• v.14 no.2
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• pp.173-176
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• 2010

Synovial chondromatosis is a benign lesion forming multiple round cartilagenous nodules or osseous loose bodies in joint cavity. Predilection sites are known as knee, hip and elbow joints. However, the involvement of ankle joint was rarely reported in the literature. Moreover, extraarticular chondromatosis in synovial sheath or bursa of extremities is extremely rare. We present a case of synovial chondromatosis of the left ankle joint and flexor hallucis longus tendon sheath.

• Korean Journal of Applied Biomechanics
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• v.24 no.1
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• pp.35-42
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• 2014

Tendon elasticity is an important factor affecting muscle function and thus human movements. It has been reported that the mechanical properties of tendon are adaptable to external loading condition. Based on the adaptability of muscle and tendon to external loading conditions, one can assume that there might be an optimum ratio between muscle strength and tendon stiffness. The present study aimed to investigate whether there is correlation between plantar flexor muscle strength and stiffness of the achilles tendon (AT). Twenty two male subjects (age: $23.2{\pm}1.5yrs$, height: $175.5{\pm}6.2cm$, weight: $75.4{\pm}9.8kg$) performed maximum voluntary isometric plantarflexion on a custom-built dynamometer and muscle-tendon junction of the medial gastrocnemius muscle was simultaneously monitored using a real-time ultrasound imaging machine. The averages of muscle force and tendon stiffness were $366.38{\pm}79.37N$, $35.34{\pm}10.42N/mm$, respectively. Significant positive correlation was observed between muscle strength and tendon stiffness (r=0.8507), indicating that the muscle force is proportional to tendon stiffness. The results might have been used in computational modeling and criterion of training progress level in the fields of training and rehabilitation.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.543-547
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• 2009

Purpose: Adhesion is the most common and troublesome complication after repair of flexor tendon injury. Recently, use of sodium hyaluronate derivatives for adhesion prevention is increasing. A commercial product, Guardix$^{(R)}$, sodium hyaluronate(NaHe) combined with carboxymethylcellulose(CMC) has been newly developed as a preventive material for adhesion. We have investigated its effect in rabbits. Methods: Twenty seven male New Zealand white rabbits were operated under ketamine anesthesia. After tendon repair in zone II of the hind paw, Guardix$^{(R)}$(experimental group) or normal saline(control group) was administered. Biomechanical tests were performed to estimate adhesion formation at 2, 4, 8, and 12 weeks after the operation. Maximum tensile load to flex the distal interphalangeal joint 50 degree from its resting state(MTL50) was measured, depicting the amount of adhesion formed. Subsequently, breaking strength was assessed. Results: There were no postoperative complications such as infection, wound dehiscence, or hematoma. MTL50 was significantly lower in the experimental group than in the control group at 4, 8, 12 weeks (p<0.05). Mean value of MTL50 was 6.64N in the experimental group and 28.53N in the control group at 12 weeks after surgery. There were no significant differences in breaking strength. Conclusion: Our results indicate that Guardix$^{(R)}$ is helpful in reducing adhesion formation and does not interfere with normal healing processes of the tendon.