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Kawada T, Shinohara Y, Kurihara T, Satake H, Itokawa K, Fukuyoshi M, Hayashi N, Sugimoto K. Anatomical evaluations of the adipose tissue surrounding the flexor hallucis longus tendon. Sci Rep 2024; 14:16903. [PMID: 39043789 PMCID: PMC11266517 DOI: 10.1038/s41598-024-67831-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/16/2024] [Indexed: 07/25/2024] Open
Abstract
This study aimed to evaluate the presence of adipose tissue surrounding the flexor hallucis longus (FHL) tendon through gross dissection and magnetic resonance imaging (MRI). Grossly, we observed the FHL tendon and surrounding tissues in nine cadavers. Using MRI, we quantitatively evaluated each tissue from the horizontal plane in 40 healthy ankles. Macroscopic autopsy revealed the presence of adipose tissue behind the ankle joint between the FHL and fibula, and horizontal cross-sections showed an oval-shaped adipose tissue surrounding the tendon. The cross-sectional area on MRI was 14.4 mm2 (11.7-16.7) for the FHL tendon and 120.5 mm2 (100.3-149.4) for the adipose tissue. Additionally, the volume of the adipose tissue was 963.3 mm3 (896.2-1115.6). There is an adipose tissue around FHL tendon and maybe this close anatomical relationship might influence the function of the tendon and be involved in its pathologies.
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Affiliation(s)
- Tatsuhito Kawada
- Graduate School of Sports and Health Science, Ritsumeikan University, Shiga, Japan
- Department of Rehabilitation, Nagoya Sports Medicine & Orthopedic Clinic, Aichi, Japan
| | - Yasushi Shinohara
- College of Sport and Health Science, Ritsumeikan University, Shiga, Japan.
| | - Toshiyuki Kurihara
- Research Organization of Science and Technology, Ritsumeikan University, Shiga, Japan
| | - Hayato Satake
- Graduate School of Sports and Health Science, Ritsumeikan University, Shiga, Japan
| | - Kana Itokawa
- Graduate School of Sports and Health Science, Ritsumeikan University, Shiga, Japan
| | - Masaki Fukuyoshi
- Department of Rehabilitation, Nagoya Sports Medicine & Orthopedic Clinic, Aichi, Japan
| | - Norio Hayashi
- Musculoskeletal Functional Anatomy Research Institute, Gifu, Japan
| | - Katsumasa Sugimoto
- Department of Orthopedic Surgery, Nagoya Sports Medicine & Orthopedic Clinic, Aichi, Japan
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Tsang CY, Lui TH. Endoscopic Release of the Flexor Hallucis Longus Tendon at Posterior Ankle for Management of Checkrein Deformity of the Great Toe, Second Toe, and Third Toe. Arthrosc Tech 2024; 13:102936. [PMID: 38835445 PMCID: PMC11144810 DOI: 10.1016/j.eats.2024.102936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/15/2024] [Indexed: 06/06/2024] Open
Abstract
Checkrein deformity is rare and involves entrapment or fixed tethering of the flexor hallucis longus (FHL) in the posterior foot, just proximal to the flexor retinaculum of the ankle, and causes the "constant length phenomenon" of FHL. The clinical presentation is a dynamic flexion deformity of the great toe characterized by flexion contracture of the interphalangeal joint with mild extension contracture of the metatarsophalangeal joint, causing difficulty in walking since in the stance phase of gait, the hallux is forced into plantar flexion and impinges onto the ground. Because the FHL tendon has some interconnection to the tendons of the flexor digitorum longus at the master knot of Henry, deformities of the second and third toes are sometimes seen. There is no standard surgical treatment for checkrein deformity. Surgical release of the FHL muscle or release/lengthening of the FHL tendon has been proposed. The purpose of this Technical Note is to report the endoscopic release of the FHL tendon at the posterior ankle for management of checkrein deformity of the great toe, second toe, and third toe.
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Affiliation(s)
- Cho Yin Tsang
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Hong Kong SAR, China
| | - Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong SAR, China
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Mudarra García J, Saus Milán N, Blasco Mollá MC, Forriol Brocal F, Martin-Gorgojo V. Arthroscopic Tenotomy of the Flexor Hallucis Longus to Treat Checkrein Deformity. Foot Ankle Spec 2023:19386400231206279. [PMID: 37881886 DOI: 10.1177/19386400231206279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Checkrein deformity is a rare entity that results in alteration of the normal flexion and extension of the hallux, caused by a retraction or adhesion of the flexor hallucis longus (FHL) in its tendinous or muscular portion. It is usually caused by the sequelae of ankle and tibia fractures, such as adhesions and neuropathies, and often undiagnosed compartment syndromes. Its treatment is mainly surgical, and different techniques of release or lengthening of the FHL have been described. We present the clinical case of a 61-year-old patient treated by a simple arthroscopic tenotomy of the FHL at the retromalleolar level of the ankle, with complete functional recovery and absence of recurrence after 2 years of evolution. We recommend that this procedure should be considered for this pathology due to its technical simplicity, low iatrogenicity, early recovery, and theoretical absence of recurrence.Level of Evidence: Level V: Expert opinion, case report.
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Affiliation(s)
- Jesús Mudarra García
- Department of Orthopedic Surgery and Traumatology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Natalia Saus Milán
- Department of Orthopedic Surgery and Traumatology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - María Carmen Blasco Mollá
- Department of Orthopedic Surgery and Traumatology, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
| | - Francisco Forriol Brocal
- Department of Orthopedic Surgery and Traumatology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Victor Martin-Gorgojo
- Department of Orthopedic Surgery and Traumatology, Hospital Clínico Universitario de Valencia, Valencia, Spain
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Sallent A, Soza D, Duarri G, Busquets R. Checkrein deformity: a case report of two patients with hallux deformity and pain following mandibular reconstruction in oral cancer treatment. Oral Maxillofac Surg 2020; 24:359-362. [PMID: 32500381 DOI: 10.1007/s10006-020-00852-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Checkrein deformity is an uncommon disease with a well-described etiology. It is characterized by a dynamic deformity of the hallux or great toe. We report two cases of checkrein deformity due a fibular graft harvesting in two patients with a mandibular bone defect secondary to an oral cancer treatment. CASE REPORT We report two young patients with mandibular cancers that had been treated several years before our visit and were currently free of disease. The patients had a mandibular bone defect due to the maxillofacial treatment, solved with a free fibular graft. The current complaint was a great toe deformity that caused pain and made them walk with difficulties. Diagnosis was a checkrein deformity, and after a surgical release of the flexor hallucis longus tendon, both cases returned to normal activities with no walking limitations. CONCLUSION Our cases highlight that an accurate patient examination is warranted following these reconstructions as many of them can be misdiagnosed, and a relatively simple surgery can improve the patients' limitations.
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Affiliation(s)
- Andrea Sallent
- Orthopedic Department, Hospital Vall d'Hebron, Paseo Vall d'Hebron, 119-129 08035, Barcelona, Spain.
| | - Diego Soza
- Orthopedic Department, Hospital Vall d'Hebron, Paseo Vall d'Hebron, 119-129 08035, Barcelona, Spain
| | - Gemma Duarri
- Orthopedic Department, Hospital Vall d'Hebron, Paseo Vall d'Hebron, 119-129 08035, Barcelona, Spain
| | - Rosa Busquets
- Orthopedic Department, Hospital Vall d'Hebron, Paseo Vall d'Hebron, 119-129 08035, Barcelona, Spain
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Lui TH, Pan XH, Pan Y. Arthroscopic and Endoscopic Management of Common Complications After Displaced Intra-Articular Calcaneal Fractures. Clin Podiatr Med Surg 2019; 36:279-293. [PMID: 30784537 DOI: 10.1016/j.cpm.2018.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The list of late complications after calcaneal fracture that can be treated through arthroscopic and/or endoscopic approach continues to expand. The late complications of calcaneal fractures can be classified into 3 groups: (1) those causing focal hindfoot or ankle pain, (2) those causing functional deficit, and (3) those present with diffuse and poorly localized pain. Many group 1 and some group 2 complications can be managed arthroscopically and/or endoscopically. There are usually multiple coexisting sources of the pain. Careful evaluation and analysis of a problem and detailed surgical planning with combination of arthroscopic/endoscopic and open procedures are key to success.
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Affiliation(s)
- Tun-Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong, China.
| | - Xiao-Hua Pan
- Guangdong Provincial Engineering Research Center of Wound Repair and Regenerative Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China; Guangdong Provincial Academician Workstation of Wound Repair and Regenerative Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China; Department of Trauma and Orthopedics, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China
| | - Yu Pan
- Guangdong Provincial Engineering Research Center of Wound Repair and Regenerative Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China; Guangdong Provincial Academician Workstation of Wound Repair and Regenerative Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China; Department of Trauma and Orthopedics, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China
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Heyer JH, Dai AZ, Rose DJ. Excision of Os Trigonum in Dancers via an Open Posteromedial Approach. JBJS Essent Surg Tech 2018; 8:e31. [PMID: 30775136 DOI: 10.2106/jbjs.st.18.00015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
An os trigonum is a potential source of posterior ankle pain in dancers, often associated with flexor hallucis longus (FHL) pathology. Surgical excision is indicated on failure of nonoperative management. Options for surgical excision include open excision (via a posterolateral or posteromedial approach), subtalar arthroscopy, and posterior endoscopy. Os trigonum excision via an open posteromedial approach with concomitant FHL tenolysis/tenosynovectomy is a safe and effective method for the operative treatment of a symptomatic os trigonum that allows for identification and treatment of associated FHL pathology. The major steps in the procedure, which are demonstrated in this video article, are: (1) preoperative planning with appropriate imaging; (2) patient is positioned in a supine position with the operative extremity in figure-of-4 position; (3) a 3-cm, slightly curvilinear longitudinal incision is made midway between the posterior aspect of the medial malleolus and the anterior aspect of the Achilles tendon, over the palpated FHL tendon, and the flexor retinaculum is exposed and incised; the neurovascular bundle is retracted anteriorly, exposing the FHL tendon and sheath; (4) FHL tenolysis/tenosynovectomy is performed; (5) the FHL is retracted anteriorly and a capsulotomy is performed over the os trigonum and the os trigonum is excised; (6) the capsule is repaired and closure is performed; and (7) dressings and a CAM (controlled ankle motion) walking boot are applied. The patient begins physical therapy at 2 weeks postoperatively and may return to dance at 4 to 6 weeks postoperatively as tolerated. In our series of 40 cases, 95% of patients who desired to return to dance were able to return to their pre-injury level of dance. There were no major neurovascular complications.
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Affiliation(s)
- Jessica H Heyer
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC
| | - Amos Z Dai
- Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, New York
| | - Donald J Rose
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
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Abstract
Ankle, hindfoot, and toe stiffness can result from hindfoot trauma. It can be due to capsular fibrosis, tendon adhesion, muscle fibrosis, or malunion. For symptomatic stiffness that is resistant to nonoperative treatment, operative treatment should be considered. It is important to tackle the sources of stiffness, and careful preoperative clinical assessment is the key for proper formulation of the surgical plan. Whenever possible, arthroscopic/endoscopic surgery is preferable to open surgery because less extensive dissection and small surgical incisions allow immediate vigorous mobilization of the foot and ankle.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong, China,Address for correspondence: Dr. Tun Hing Lui, Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong, China. E-mail:
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Endoscopic Fasciotomy of the Superficial and Deep Posterior Compartments of the Leg. Arthrosc Tech 2017; 6:e711-e715. [PMID: 28706822 PMCID: PMC5495649 DOI: 10.1016/j.eats.2017.01.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 01/30/2017] [Indexed: 02/03/2023] Open
Abstract
Chronic exertional compartment syndrome is a rare cause of lower leg pain incurred during sports activities and typically affects young athletes who need to return to their activity level as quickly as possible. Nonoperative treatments are often unsuccessful and fasciotomy of the involved compartment is the treatment of choice. Endoscopically assisted release of the anterior and deep compartments is proven to be safe and effective. Endoscopically assisted deep posterior compartment release via an incision 1 to 3 cm behind the medial tibial border has high risk of injury to the great saphenous and perforating veins and the saphenous nerve. The purpose of this Technical Note is to describe the details of endoscopic fasciotomy of the superficial and deep posterior compartments of the leg. The operative field of this approach is away from the saphenous vein and nerve. Moreover, the tibial insertion of the soleus muscle does not need to be released to gain access to the proximal part of the deep posterior compartment.
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Lui TH. Endoscopic Adhesiolysis of Flexor Hallucis Longus Muscle. Arthrosc Tech 2017; 6:e325-e329. [PMID: 28580249 PMCID: PMC5442461 DOI: 10.1016/j.eats.2016.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 10/04/2016] [Indexed: 02/03/2023] Open
Abstract
Adhesion of the flexor hallucis longus (FHL) muscle to the distal tibia can occur after distal tibial fracture, distal fibular fracture, low tibial osteotomy, soft-tissue injury at the posterior ankle, subclinical compartment syndrome of the distal deep posterior compartment of the leg, or Volkmann contracture after deep posterior compartment syndrome of the leg. The purpose of this Technical Note is to report the endoscopic approach of FHL muscle adhesiolysis. It is indicated in patients with symptomatic adhesion of the FHL muscle and contraindicated if there is entrapment of the FHL muscle or tendon in the fracture callus or if there is extensive fibrosis and contracture of the FHL muscle as a result of Volkmann contracture after deep posterior compartment syndrome of the leg.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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Lui TH. Endoscopic Calcaneoplasty and Achilles Tendoscopy With the Patient in Supine Position. Arthrosc Tech 2016; 5:e1475-e1479. [PMID: 28149742 PMCID: PMC5264240 DOI: 10.1016/j.eats.2016.08.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/25/2016] [Indexed: 02/03/2023] Open
Abstract
Insertional and non-insertional Achilles tendinopathy is usually treated conservatively. Surgery is indicated if conservative treatment fails to relieve the pain. Endoscopic surgery has the advantages of less morbidity, a shorter operating time, reduced postoperative pain, and a lower rate of wound and soft-tissue healing problems. Patients will have a short recovery time and quickly resume work and sports because of less soft-tissue disruption. Moreover, the pathology can be better differentiated and precisely treated. Achilles tendoscopy is classically performed with the patient in the prone position, whereas endoscopic calcaneoplasty can be performed with the patient in the prone or supine position. This technical note describes the technique of Achilles tendoscopy and endoscopic calcaneoplasty with the patient in the supine position. This has the advantages of more ergonomic hand motion for the Achilles tendon debridement, easier access to the ventral surface of the Achilles tendon, and better orientation of the inside structures; moreover, concomitant chondral lesions of the ankle can be dealt with arthroscopically.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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Lui TH. Arthroscopic Capsular Release of the Ankle Joint. Arthrosc Tech 2016; 5:e1281-e1286. [PMID: 28149726 PMCID: PMC5263115 DOI: 10.1016/j.eats.2016.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/21/2016] [Indexed: 02/03/2023] Open
Abstract
Adhesive capsulitis of the ankle is also known as frozen ankle and results in marked fibrosis and contracture of the ankle capsule. Arthroscopic capsular release is indicated for symptomatic frozen ankle that is resistant to conservative treatment. It is contraindicated for ankle stiffness due to degenerative joint disease, intra-articular malunion, or adhesion of the extensors of the ankle. The procedure consists of endoscopic posterior ankle capsulectomy and arthroscopic anterior ankle capsulotomy. It has the advantages of being minimally invasive surgery and allowing early postoperative vigorous mobilization of the ankle joint.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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Das steife Sprunggelenk. ARTHROSKOPIE 2016. [DOI: 10.1007/s00142-016-0080-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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