Tendoscopic Surgery for Peroneal Tendons Instability: A Literature Review

Introduction: There has been a surge in the use of tendoscopic surgery for treating peroneal tendons instability. The novelty of this approach demanded a literature review of its indications, limitations, and clinical outcomes. Aim: a literature review of the clinical studies reporting on tendoscopic peroneal tendon stabilisation surgery along with its outcomes and complications. Methods: We carried out a comprehensive review of the literature up until September 2022 with an extensive search of the MEDLINE, Embase and Cochrane library databases. Results: Initial search resulted in 66 articles. Four duplicate articles were removed. Further 30 articles were excluded after title and abstract screening. Eight studies satisfied the inclusion criteria and were included in this review. Articles were analysed for outcomes and complications. Conclusion: The tendoscopic technique for peroneal tendon instability is an effective and safe surgical technique with very low failure rate. Levels of Evidence: Level IV.

Morphology and Histology of Lattice-like Ossified Epaxial Tendons in Psittacosaurus(Dinosauria:Ceratopsia)

Epaxial tendons play an important role in the study of the musculoskeletal system and locomotory style of dinosaurs. Although the ossified epaxial tendon lattice is fairly well known in Iguanodontoidea, only recently has knowledge of this complex been extended to ceratopsians. This study concerns the gross morphology and microstructure of the tendon lattice in Psittacosaurus, a basal ceratopsian. As in the neoceratopsian Chasmosaurus, the ossified tendons of Psittacosaurus form a three -layered, lattice-like structure. The microstructure of the tendons in large psittacosaur individuals retains an early stage of ossification, as in juvenile birds and nestling hadrosaurs, suggesting a slow developmental rate of ossification of the tendons in psittacosaur ontogeny. Comparative study indicates that a lattice-like arrangement of three-layered epaxial tendons is widely distributed in Cerapoda. This pattern also extends to Ankylosauria, implying a similar pattern of the epaxial muscles through the ornithischian clade. In addition, comparison with crocodiles implies that the different morphology of ossified tendons in dinosaurs may be associated with adaptive aspects of their paleobiology, not simply a side effect of skeletal ossification. In contrast to the short tendons in quadrupedal Chasmosaurus and Protoceratops, the elongated tendons in Psittacosaurus may be related to the bipedal locomotion characteristic of this taxon.

Catheter ablation of premature ventricular complexes associated with false tendons: A case report

BACKGROUND False tendon is a common intraventricular anatomical variation. It refers to a fibroid or fibromuscular structure that exists in the ventricle besides the normal connection of papillary muscle and mitral or tricuspid valve. A large number of clinical studies have suggested that there is a significant correlation between false tendons and premature ventricular complexes. However, few studies have verified this correlation during radiofrequency catheter ablation of premature ventricular complexes.CASE SUMMARY A 45-year-old male was admitted to receive radiofrequency ablation for symptomatic premature ventricular complexes. A three-dimensional model of the left ventricle was established by intracardiac echocardiography using the CartoSound^TM mapping system. In addition to the left anterior papillary muscle,the posterior papillary muscle was mapped. False tendons were found at the base of the interventricular septum, and the other end was connected to the left ventricular free wall near the apex. An irrigated touch force catheter was advanced into the left ventricle via the retrograde approach. The earliest activation site was marked at the interventricular septum attachment of the false tendons and was successfully ablated.CONCLUSION This case verified that false tendons can cause premature ventricular complexes and may be cured by radiofrequency ablation guided by intracardiac echocardiography with the Carto Sound TM system.

Strut-and-Tie Method as a Basis for Optimization of Hoop Prestressed Tendons in Abnormally Shaped Anchorage Zone of Cable-Stayed Bridge Pylon

Based on full-scale segment model tests of the abnormally shaped anchorage zone of the Maling River cable-stayed bridge pylon and FEM analysis, its mechanical and deformation properties were obtained, and the validity of FEM analysis was verified. An optimal layout of prestressed tendons in the anchorage zone was obtained by using the strut-and-tie method （STM）. The comparison FEM analysis between the full-scale segment model and the optimal prestressed tendons model show that： the optimal model not only saves prestressed tendons, but also achieves the same cracking resistance; STM method is reliable and accurate in the analysis of the abnormally shaped anchorage zone of cable-stayed bridge pylon.

Dynamic Observation on the Effects of Different Suture Techniques on the Biomechanical Properties in the Healing of Tendons

Summary： To identify the best suture techniques for the tendon repair, the biomechanical properties of tendons sutured by different methods were dynamically examined. 140 chickens were divided into 2 groups equally： group A and group B. The tendon of the right side was subjected to injury-repair process, and the tendons of the left sides served as controls in both groups. In group A, ＂figure-of- 8＂ suture, modified Kessler suture and Bunnell suture were used for the 2nd to 4th paws respectively, while in group B, Kleinert suture, Tsuge suture and Ikuta suture were used. On the day 0, 3, 7, 14, 21, 28, 42 after operation, 10 animals were sacrificed and the flexor tendons of both sides were harvested for strength test. The results showed that the initial strength of the repaired tendons and the strength after 6 weeks following tendon cut were far below those of intact tendons, irrespective of suture techniques used. With the 6 techniques, the P of tendons repaired by Tsuge suture was increased continually, reaching the highest value on the 42nd day. The P of tendons sutured by the modified Kessler suture was slightly lower than that by Tsuge suture, but it was increased steadily in healing. The tendons repaired by figure-of-8 suture yielded the lowest P It was concluded that Tsuge suture and modified Kessler suture were the best techniques for tendon repair.

PI force feedback control for large flexible structure vibration with active tendons

Active tendon, consisting of a displacement actuator and a collocated force sensor, was first presented by Preumont and his co-workers to attenuate the vibration of large flexible space structures, and the control algorithm adopted by them was integral force feedback. This paper presents a new proportional-integral （PI） force feedback algorithm to achieve larger damping ratios for the structure without the requirement of structure model. Stability of the control system is shown, and simulations of a structure similar to JPL-MPI demonstrate the effectiveness of the proposed algorithm for vibration control of space structures.

Fracture of ossified Achilles tendons:A review of cases

Fracture of an ossification of the Achilles tendon(OAT)is a rare entity,and its etiology,pathology,and treatment remain unclear.We reviewed and scrutinized 18 cases(16 articles)of the fracture of an OAT.The most common etiologies of the ossifications include previous surgery and trauma.The fractures often occur without any trigger or with minimal trigger.The long,>5 cm,ossification in the body of the Achilles tendon may have a higher risk of fracture.The OAT itself is often asymptomatic;however,its fracture causes severe local pain,swelling,and weakness of plantar flexion,which forces patients to undergo aggressive treatments.Regarding the treatments of the fractures,nonoperative treatment by immobilizing ankle joint could be an option for elderly patients.However,because it often cannot produce satisfactory results in younger patients,surgical treatment is typically recommended.Excision of the fractured mass and repairing the tendon is applicable if the remnant is enough.If there is a defect after the excision,reconstruction with autologous grafts or adjacent tendon transfer is performed.Gastrocnemius fascia turndown flap,hamstring tendon and tensor fascia lata are used as autologous grafts,whereas peroneus brevis and flexor hallucis longus tendons are used for the tendon transfer.If the fracture of an OAT is treated properly,the functional result will be satisfactory.

Healing of subcutaneous tendons: Influence of the mechanical environment at the suture line on the healing process

Tendon ruptures remain a significant musculoskeletal injury. Despite advances in surgical techniques and procedures, traditional repair techniques maintain a high incidence of rerupture or tendon elongation. Mechanical loading and biochemical signaling both control tissue healing. This has led some researchers to consider using a technique based on tension regulation at the suture line for obtaining good healing. However, it is unknown how they interact and to what extent mechanics control biochemistry. This review will open the way for understanding the interplay between mechanical loading and the process of tendon healing.

Simultaneous repair of bilateral pectoralis major tendons: A case report

BACKGROUND Injuries to the pectoralis major are infrequent,with only a few hundred cases currently recorded in the literature.CASE SUMMARY We report a case of a patient who sustained bilateral pectoralis major tendon ruptures.While other cases of bilateral pectoralis major tears have been reported in the literature,the operative management in this report differs.Due to delayed presentation of the patient right and left pectoralis major repairs were performed simultaneously.CONCLUSION Patients with delayed presentation of bilateral pectoralis major tendon ruptures can undergo simultaneous repair of both tendon with a good postoperative outcome and high patient satisfaction.

Abstraction and operator characterization of fractal ladder viscoelastic hyper-cell for ligaments and tendons

This study investigates the viscoelastic behavior of soft bio-fibres in association with their fractal structures. A spring-dashpot fractal network with the self-similar topology, named the -type fractal ladder hyper-cell (FLHC), is abstracted from the micro/nano-structure of ligaments and tendons (LTs). Its constitutive operator is derived by the Heaviside operational calculus, which is of intrinsic fractional order. In terms of this operator, the long-term viscoelastic relaxation of bio-fibres arising from the fractal ladder topology is expounded. In addition, the fractional-order viscoelastic constitutive equation is obtained based on the FLHC of LTs, and its results are consistent with those of available human knee and spinal LT relaxation experiments. Results on the constitutive equation of FLHCs are formulated into two propositions. The multidisciplinary invariance and implications from the fractal ladder pattern of bio-fibres are also discussed.

Late Secondary Rupture of Flexor Tendons in the Palm of the Hand

Normal tendon substance is strong and is unlikely to break before the muscle origin, muscle, musculotendinous junction or the insertion yield. In almost all the cases, closed ruptures of the flexor tendon within the tendinous portion have been described in association with distinct underlying pathologies. We report a case of flexor tendon rupture of the index finger which seems to be associated with previous trauma occurred more than 40 years ago and abnormal healing.

Approach to Determine Corrosion Propensity in Post-Tensioned Tendons with Deficient Grout

After corrosion failure of post-tensioned tendons was identified in a Florida bridge in early 2011, laboratory tests were conducted in this study on extracted sections from the failed tendons to identify the grout properties and makeup leading to the failure and also to elucidate the mechanism of corrosion. The initial steps in identification of PT tendons with a high propensity for corrosion initiation or damaged included a detailed visual inspection and identification of voids in the grout. Voids in tendon can be a result of bleed water formation or construction problems. General characteristics of the deficient grout and corrosion behavior of steel in the affected bridge gave a first approach to assessing grout deficiency and corrosion susceptibility. However, refinements in the understanding of the mechanisms causing grout segregation and the elucidation of the role of sulfates, oxygen content, and pore water pH in corrosion development are required.

Natural,synthetic and commercially-available biopolymers used to regenerate tendons and ligaments

Tendon and ligament(TL)injuries affect millions of people annually.Biopolymers play a significant role in TL tissue repair,whether the treatment relies on tissue engineering strategies or using artificial tendon grafts.The biopolymer governs the mechanical properties,biocompatibility,degradation,and fabrication method of the TL scaffold.Many natural,synthetic and hybrid biopolymers have been studied in TL regeneration,often combined with therapeutic agents and minerals to engineer novel scaffold systems.However,most of the advanced biopolymers have not advanced to clinical use yet.Here,we aim to review recent biopolymers and discuss their features for TL tissue engineering.After introducing the properties of the native tissue,we discuss different types of natural,synthetic and hybrid biopolymers used in TL tissue engineering.Then,we review biopolymers used in commercial absorbable and non-absorbable TL grafts.Finally,we explain the challenges and future directions for the development of novel biopolymers in TL regenerative treatment.

近海三角张力腿平台钢筋束假定失效研究

Offshore triceratops is one of the successful manifestations of the form-dominant design approaches deployable in ultra-deepwater oil and gas exploration.The deck’s geometric shape and partial isolation from the legs counteract lateral loads.Legs are position-restrained to the sea bed by taut-moored tendons,while ball joints partially isolate the deck from the buoyant legs.However,compliance in the horizontal plane imposes large displacements,intuiting the necessity to examine tendon failure.Numerical analysis of triceratops under wave and wind combined action is carried out under the postulated conditions of a tendon failure.10-yr,100-yr,and 1000-yr post-Katrina hurricane conditions are assumed as loading to the platform.Results confirm a marginal increase in the natural periods of stiff degrees of freedom even under postulated failure conditions,ensuring good adaptability to ultra-deep water.Under postulated failure,the tension of adjacent tendons varies significantly,causing a shift to the mean position of the platform.Fatigue life is significantly reduced under the postulated failure of tendons,making the platform free-floating without affecting its stability.Results also show that the pitch response of the deck is a clear manifestation of the postulated failure,which is otherwise absent due to the presence of ball joints.The attempted study deliberates on the fatigue life of tendons,assessing the platform’s suitability to ultra-deep waters and identifying the vulnerable legs for the chosen load combinations.

Ultimate stress increase in unbonded tendons in prestressed concrete beams

Since the assumption of plane sections cannot be applied to the strain of unbonded tendons in prestressed concrete beams subjected to loadings,a moment-curvature nonlinear analysis method is used to develop analytical programs from stress increases in unbonded tendons at the ultimate limit state.Based on the results of model testing and simulation analysis,equations are proposed to predict the stress increase in tendons at the ultimate state in simple or continuous beams of partially prestressed concrete,considering the loading type,non-prestressed reinforcement index βp,prestressing reinforcement index βs,and span-depth ratio L/h as the basic parameters.Results of 380 beams studied here and test results for 35 simple beams obtained by the China Academy of Building Research were compared with those from prediction equations given in codes and other previous studies.The comparison reveals that the values predicted by the proposed equations agree well with experimental results.

Experimental monitoring of the strengthening construction of a segmental box girder bridge and field testing of external prestressing tendons anchorage

Prestressed concrete segmental box girder bridges are composed of short concrete segments that are either precast or cast in situ and then joined together by longitudinally post-tensioning internal,external,or mixed tendons.The objectives of this study are to monitor the construction process of the external prestressing tendons to strengthen the bridge structure and perform a field load test to measure the strain and the deflection of the anchorage devices of the external prestressing tendons to determine the state of these devices after tension forces are applied.The monitoring process of the external prestressing tendons construction includes inspecting the cracks in the diaphragm anchorage and the deviation block devices before the tension forces are applied to the external tendons;measuring the deformation of the steel deviation cross beam during the tension process;measuring the deformation of the box girder after different levels of tension forces are applied;measuring the elongation of the external tendons in each level of the tension;and measuring the natural frequency of the external tendons after the tension process is complete.The results of the monitoring process show that the measured values of the deformation,the elongation,and the natural frequency meet the requirements.Therefore,there is no damage during the construction and the tensioning of the external prestressing tendons.A field load test is performed to the anchorage beam,the steel deviation block devices,and the steel deviation cross beam.The field load test results of the anchorage devices show that the values of the strains,the stresses,and the deflection are less than the respective allowable limit values in the requirements.Therefore,the anchorage devices have sufficient strength,and the working state is good after the tension forces are applied to the external prestressing tendons.

Epidemiology of insertional and midportion Achilles tendinopathy in runners:A prospective cohort study

Background:Achilles tendinopathy(AT)is a common problem among runners.There is only limited evidence for risk factors for AT,and most studies have not defined the AT subcategories.No study has compared the incidence and risk factors between insertional AT and midportion AT,though they are considered distinct.This study aimed to assess incidence and risk factors of AT based on data from a large prospective cohort.The secondary aim was to explore differences in risk factors between insertional and midportion AT.Methods:Participants were recruited from among registered runners at registration for running events.Questionnaires were completed at baseline,1 month before the event,1 week before the event,and 1 month after the event.Information concerning demographics,training load,registered events,and running-related injuries were collected at baseline.The follow-up questionnaires collected information about new injuries.A pain map was used to diagnose midportion and insertional AT.The primary outcome was the incidence of AT.Multivariable logistic regression analysis was applied to identify risk factors for the onset.Results:We included 3379 participants with a mean follow-up of 20.4 weeks.The incidence of AT was 4.2%.The proportion of insertional AT was 27.7%and of midportion AT was 63.8%;the remaining proportion was a combined type of insertional and midportion AT.Men had a significantly higher incidence(5%,95%confidence interval(95%CI):4.1%-6.0%)than women(2.8%,95%CI:2.0%-3.8%).AT in the past12 months was the most predominant risk factor for new-onset AT(odds ratio(OR)=6.47,95%CI:4.27-9.81).This was similar for both subcategories of AT(insertional:OR=5.45,95%CI:2.51-11.81;midportion:OR=6.96,95%CI:4.24-11.40).Participants registering for an event with a distance of 10/10.55 km were less likely to develop a new-onset AT(OR=0.59,95%CI:0.36-0.97)or midportion AT(OR=0.47,95%CI:0.23-0.93).Higher age had a significant negative association with insertional AT(OR=0.97,95%CI:0.94-1.00).Conclusion:The incidence of new-onset AT among recreational runners was 4.2%.The proportion of insertional and midportion AT was 27.7%and 63.8%,respectively.AT in the past 12 months was the predominant risk factor for the onset of AT.Risk factors varied between insertional and midportion AT,but we could not identify clinically relevant differences between the 2 subtypes.

Bipolar hip arthroplasty using conjoined tendon preserving posterior lateral approach in treatment of displaced femoral neck fractures

BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective management option for these patients.Various approaches can be used for the BHA procedure.However,there is a high risk of postoperative dislocation.The conjoined tendon-preserving posterior(CPP)lateral approach was introduced to reduce postoperative dislocation rates.AIM To evaluate the effectiveness and safety of the CPP lateral approach for BHA in elderly patients.METHODS We retrospectively analyzed medical data from 80 patients with displaced femoral neck fractures who underwent BHA.The patients were followed up for at least 1 year.Among the 80 patients,57(71.3%)were female.The time to operation averaged 2.3 d(range:1-5 d).The mean age was 80.5 years(range:67-90 years),and the mean body mass index was 24.9 kg/m^(2)(range:17-36 kg/m^(2)).According to the Garden classification,42.5%of patients were typeⅢand 57.5%of patients were typeⅣ.Uncemented bipolar hip prostheses were used for all patients.Torn conjoined tendons,dislocations,and adverse complications during and after surgery were recorded.RESULTS The mean postoperative follow-up time was 15.3 months(range:12-18 months).The average surgery time was 52 min(range:40-70 min)with an average blood loss of 120 mL(range:80-320 mL).The transfusion rate was 10%(8 of 80 patients).The gemellus inferior was torn in 4 patients(5%),while it was difficult to identify in 2 patients(2.5%)during surgery.The posterior capsule was punctured by the fractured femoral neck in 3 patients,but the conjoined tendon and the piriformis tendon remained intact.No patients had stem varus greater than 3 degrees or femoral fracture.There were no patients with stem subsidence more than 5 mm at the last follow-up.No postoperative dislocations were observed throughout the follow-up period.No significance was found between preoperative and postoperative mean Health Service System scores(87.30±2.98 vs 86.10±6.10,t=1.89,P=0.063).CONCLUSION The CPP lateral approach can effectively reduce the incidence of postoperative dislocation without increasing perioperative complications.For surgeons familiar with the posterior lateral approach,there is no need for additional surgical instruments,and it does not increase surgical difficulty.

Surgeon preferences in the treatment of thumb carpometacarpal osteoarthritis

BACKGROUND Primary thumb carpometacarpal(CMC)osteoarthritis is one of the most common conditions encountered by hand surgeons.Of the vast number of operations that have been proposed,none have demonstrated results significantly superior to trapeziectomy alone.AIM The purpose of our study was to determine why surgeons opt for their technique in treating CMC arthritis.METHODS A cross-sectional survey of active members of the American Society for Surgery of the Hand was conducted to evaluate the reasons behind their preferred technique in the treatment of isolated thumb CMC arthritis.Surgeons were contacted by email once and provided with a link to a de-identified survey consisting of 5 treatment questions and 5 demographic questions.RESULTS Of 950 responses were received.40.5%of surgeons preferred trapeziectomy+ligament reconstruction tendon interposition(LRTI),followed by trapeziectomy+suspensionplasty(28.2%),suture button suspension(5.9%),trapeziectomy alone(4.6%),prosthetic arthroplasty(3.2%),arthrodesis(1.1%),and other(6.6%).Proponents of trapeziectomy+LRTI cited familiarity(73.2%),exposure during fellowship(48.8%)and less proximal migration(60%)to be the main reasons affecting their decision.Surgeons who preferred trapeziectomy+suspensionplasty most reported simplicity(74.9%),fewer complications(45.3%),less proximal migration(43.8%),and avoidance of autogenous tissue harvest(42.7%).Advocates of suture button suspension cited avoidance of autogenous tissue harvest(80.4%),shorter immobilization(76.8%),and quicker recovery(73.2%)with their technique.Advocates of trapeziectomy alone cited simplicity(97.7%),fewer complications(86.4%),and avoidance of autogenous tissue harvest(59.1%).In their comments,45%of surgeons choosing trapeziectomy alone cited evidence as an additional rationale.Advocates of prosthetic arthroplasty cited improved pinch strength(83.3%)and improved range of motion(63.3%),while those preferring arthrodesis cited better pinch strength(90%)and frequently in their comments,durability.Of the surgeons who preferred a technique other than LRTI,41.8%reported they had tried LRTI in the past,citing complexity of the procedure,flexor carpi radialis harvest,and longer operative time as reasons for moving on.CONCLUSION Our study provides an update on current treatment trends and offers new insight into the reasons behind surgeons'decision making in the management of thumb carpometacarpal osteoarthritis.Despite strong Level 1 evidence supporting the use of trapeziectomy alone,our findings demonstrate that most surgeons continue to supplement trapeziectomy with other techniques such as LRTI or suspensionplasty.Several factors including familiarity,personal experience(Level 4 evidence),and comfort may be more influential than Level 1 evidence in determining the techniques in a surgeon's armamentarium.Further prospective studies are needed to determine the optimal technique for surgical management of Eaton stages II-IV CMC arthritis and how these studies will affect surgeons’choice.