• Clinics in Shoulder and Elbow
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• v.26 no.2
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• pp.131-139
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• 2023

Background: Massive rotator cuff tears (RCTs) are complicated by muscle atrophy, fibrosis, and intramuscular fatty degeneration, which are associated with postoperative tendon-to-bone healing failure and poor clinical outcomes. We evaluated muscle and enthesis changes in large tears with or without suprascapular nerve (SN) injury in a rat model. Methods: Sixty-two adult Sprague-Dawley rats were divided into SN injury (+) and SN injury (-) groups (n=31 each), comprising tendon (supraspinatus [SSP]/infraspinatus [ISP]) and nerve resection and tendon resection only cases, respectively. Muscle weight measurement, histological evaluation, and biomechanical testing were performed 4, 8, and 12 weeks postoperatively. Ultrastructural analysis with block face imaging was performed 8 weeks postoperatively. Results: SSP/ISP muscles in the SN injury (+) group appeared atrophic, with increased fatty tissue and decreased muscle weight, compared to those in the control and SN injury (-) groups. Immunoreactivity was only positive in the SN injury (+) group. Myofibril arrangement irregularity and mitochondrial swelling severity, along with number of fatty cells, were higher in the SN injury (+) group than in the SN injury (-) group. The bone-tendon junction enthesis was firm in the SN injury (-) group; this was atrophic and thinner in the SN injury (+) group, with decreased cell density and immature fibrocartilage. Mechanically, the tendon-bone insertion was significantly weaker in the SN injury (+) group than in the control and SN injury (+) groups. Conclusions: In clinical settings, SN injury may cause severe fatty changes and inhibition of postoperative tendon healing in large RCTs. Level of evidence: Level Basic research, controlled laboratory study.

• Journal of Korean Foot and Ankle Society
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• v.15 no.1
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• pp.36-38
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• 2011

Ankle fracture and Achilles tendon rupture are common as an isolated injury. However, Achilles tendon rupture with ipsilateral ankle fracture is uncommon, and occurs by a different injury mechanism with a risk of negligence. We report a case of Achilles tendon rupture with ipsilateral medial malleolar fracture.

• Journal of Korean Foot and Ankle Society
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• v.26 no.4
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• pp.183-186
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• 2022

Anterior tibialis ruptures are a rare type of injury related to the foot and ankle. Specifically, chronic and non-traumatic ruptures are related to preexisting chronic tendinopathic conditions and anatomical factors. These ruptures may cause persistent pain and functional impairments if neglected. Chronic tibialis anterior ruptures are frequently diagnosed late because the symptoms are not distinct. In cases with chronic or non-traumatic tibialis anterior tendon ruptures, tendons often become irreparable. Hence, various surgical options have been introduced to address this issue. The current surgical treatment options are as follows: free sliding anterior tibialis graft, extensor hallucis longus tendon transfer, and reconstruction with an allograft tendon. To date, there have been few reports about the reconstruction technique using Z-plasty for irreparable tibialis anterior tendon ruptures. In this report, we present a rare case of the application of the tibialis anterior tendon reconstruction technique using Z-plasty and tenodesis for a middle-aged man with an irreparable avulsion injury rupture. We also present the management plan and prognostic outlook, as well as a subsequent review of the relevant literature.

• Journal of Korean Foot and Ankle Society
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• v.6 no.1
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• pp.92-95
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• 2002

Traumatic ruptures of tibialis posterior tendon are much less common and consequently have received little attention. A tibialis posterior tendon rupture associated with a closed medial malleolar fracture occured in a 32 years old man due to slip down. The tendon rupture was not diagnosed before surgery but was recognized at the time of open operation. The treatment was open reduction and internal fixation at the bony fragments with primary repair of the tendon. This tendon injury, although rare, should be considered in the management of ankle fracture because the tendon rupture could easily have been overlooked and failure to recognize this at the time of injury may result in poor long - term ankle function despite a well- healed fracture.

• Archives of Plastic Surgery
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• v.44 no.2
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• pp.144-149
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• 2017

Background The purpose of this study was to identify the epidemiologic characteristics of hand tendon injuries in children and to compare these with those of adults. Methods This retrospective study was conducted on acute traumatic tendon injuries of the hand treated at our institution from 2005 to 2013, based on medical records and X-ray findings. Age, sex, hand injured, mechanism of injury, tendons and zones injured, number of affected digits, and comorbidities and complications were analyzed. Patients were divided into 2 groups: a pediatric group (${\leq}15years$) and an adult group (>15 years). Results Over the 9-year study period, 533 patients were surgically treated for acute traumatic tendon injuries of the hand. In the pediatric group (n=76), being male, the right hand, the extensor tendon, complete rupture, the middle finger, and glass injury predominated in hand tendon injuries. In the adult group (n=457), results were similar, but injury to the index finger and knife injury were the most common. An accompanying fracture was more common in the adult group and complication rates were non-significantly different. Conclusions This comparative analysis revealed no significant epidemiologic intergroup differences. The belief that pediatric tendon injuries tend to be less severe is misplaced, and careful physical examination and exploration should be conducted in pediatric cases of hand injury.

• Korean Journal of Applied Biomechanics
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• v.16 no.4
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• pp.175-187
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• 2006

The purpose of this study was to find the relationship between Achilles tendon angle, angular velocity from 2D cinematography utilized to easily analyze the functions of shoes, ankle joint moment, knee joint moment, and hip joint moment from 3D cinematography utilized to predict the injury. Also, this study was to provide the optimal standard to analyze the injury related to the shoes. Subjects in this study were 30 university male students and 18 conditions (2 types of running speed, 3 of midsole hardness, 3 of midsole height) were measured using cinematography and force platform. The results were as following. 1) Hip joint abduction moment was effected by many variables such as running speed, midsole height, maximum achilles tendon angle, ground reaction force. 2) Knee joint rotational moment in running was approximately 1/10 - 1/4 times of the injury critical value and eversion moment was approximately 1/4 - 1/2 times of the injury critical value. 3) Ankle joint pronation moment in running was 1/3 - 1/2 times of the injury critical value. 4) Knee joint rotational moment was found to be irrelevant with maximum achilles tendon angle or angular velocity. 5) Pronation from running was thought to be relevant to rather eversion moment activity than rotational moment activity of knee joint. 6) Plantar flexion abductor of ankle showed significant relationship with the ground reaction force variable. 7) When the loading rate for ground reaction force in passive region increased, extensor tended to be exposed to the injury. Main variables in biomechanical analysis of shoes were impact absorption and pronation. Among these variables, pronation factor was reported to be relevant with knee injury from long duration exercise. Achilles tendon angle factor was utilized frequently to evaluate this. However, as the results of this study showed, the relationship between these variables and injury relating variable of knee moment was so important. Studies without consideration on this finding should be reconsidered and reconfirmed.

• Journal of the Optical Society of Korea
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• v.19 no.2
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• pp.175-181
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• 2015

Optical coherence tomography (OCT) is a noninvasive technique for microscopic investigation of tissue. We thought that the OCT method could be a potential tool for monitoring the healing process of a tendon. In this study we used two rat models, denervated and non-denervated groups, to observe a variety of healing phases of Achilles tendon (AT) injury. We made samples of AT injury lesions, to take OCT images and to make histopathological samples of serial sectional tissue. In an OCT image the denervated rat showed no specific finding, but the non-denervated rat showed a large defect lesion that was scaffolding tissue. OCT findings combined with pathologic findings showed advantages in visualization of tendon microstructure over other imaging modalities such as MRI and US, and OCT is beneficial to making a treatment plan, especially the timing and intensity of rehabilitation. Therefore a multimodal platform using OCT for evaluation of tendon injury may be potentially useful for many applications.

• Journal of Korean Foot and Ankle Society
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• v.11 no.1
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• pp.120-122
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• 2007

Traumatic dislocation of the peroneal tendon is an infrequent injury. This injury is caused by forceful dorsiflexion of the foot accompanied by a powerful contraction of the peroneal muscles. This mechanism of injury tears the superior peroneal retinaculum and allows the tendons to snap anteriorly. We experienced a case of chronic recurrent dislocation of the peroneal tendon, which was treated by bone block surgery using autograft of lateral fibula and reattachment of the superior peroneal retinaculum. The clinical result was satisfactory.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.729-734
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• 2008

Purpose: The evaluation and management of a completely transected tendon of the hand is relatively clear. In most cases, the integrity is assessed by physical examination(eg, broken normal cascade, motion loss) but occasionally, It happens in troubles. because of pain, limited patient cooperation(eg, child, unconscious patient), and other associated injuries(eg, fractures, foreign bodies). Methods: From september 2006 to August 2007, 28 patients were evaluated with real time ultrasonography preoperatively and postoperatively. Twenty eight patients with injured tendon were evaluated using an HDI 5000 Sono CT(Philips Medical Systems, Bothell, WA) machine with a high resolution, 7.5MHz hockey stick linear probe. Dynamic evaluation was performed in real time. Results: Surgery was performed after the ultrasonographic evaluation. Sonographic diagnosis and intraoperative findings were correlated. Ultrasonographic findings show tendon discontinuity, gaps, and fluid collection. Conclusion: We conclude that ultrasonography is helpful in evaluating and managing acute tendon injury. Especially, in cases of completely lacerated tendon, ultrasonography can identify the location of the proximal tendon stump and partial lacerated tendon, ultrasonographic diagnostic tool can decrease misdiagnosis.

• Archives of Plastic Surgery
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• v.36 no.4
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• pp.516-518
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• 2009

Purpose: To retrieve the retracted flexor tendon, additional incision and wide dissection are conventionally required. We introduce minimal - incision tenorrhaphy using 1 cm - length incision and minimal dissection. Methods: Transverse incision about 1 cm - length is made over the level of retracted tendon. Nelaton's catheter is advanced into tendon sheath from distal primary laceration wound to emerge proximally through the incisional wound. Catheter is sutured to proximal tendon in end - to - end fashion. By gently pulling the catheter, retracted tendon is delivered to distal wound. Tenorrhaphy with core suture and epitendinous suture is then carried out. Results: This retrieving technique provides minimal incision, minimal dissection, minimal bleeding, minimal injury to tendon end, and shorter operation time with preservation of vincula tendinum and pulley system. Conclusion: In case of flexor tendon rupture with retraction, this operative method is believed to allow reliable and effective tenorrhaphy and excellent postoperative outcomes.