1
|
Ohta S, Ueda Y, Komai O. Postoperative results of arthroscopic superior capsule reconstruction using fascia lata: a retrospective cohort study. J Shoulder Elbow Surg 2024; 33:686-697. [PMID: 37619926 DOI: 10.1016/j.jse.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Superior capsule reconstruction (SCR) was developed to improve shoulder function and alleviate pain in patients with primary irreparable rotator cuff tears. Although suitable clinical results of SCR have been reported, only a few studies have investigated the clinical outcomes of arthroscopic superior capsule reconstruction (ASCR) using tensor fascia at a minimum follow-up period of 2 years after surgery. METHODS Among 100 consecutive patients who underwent ASCR since April 2010, this retrospective cohort study included 49 patients with a Hamada classification of ≤3 who were available for at least 2-year follow-up after surgery. The mean follow-up period was 34.5 (24-74) months. We analyzed preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, University of California at Los Angeles (UCLA) shoulder scores, preoperative and postoperative active elevation angles, external and internal rotations with the arms in the anatomical position, manual muscle test (MMT) scores, preoperative and postoperative acromiohumeral distance (AHD), and cuff integrity on postoperative magnetic resonance imaging using the Hasegawa classification. We compared 27 pseudoparalyzed (elevation of <90°) shoulders with 22 nonpseudoparalyzed shoulders. We also evaluated the treatment of patients with subscapularis tendon tears and compared the outcomes of patients with good graft repair and those with graft retear. RESULTS The JOA score, UCLA score, active elevation angle, internal and external rotation angles, and muscle strength (MMT) significantly improved at the time of investigation preoperatively and 2 years postoperatively. The mean AHD also improved from 5 ± 2.6 mm preoperatively to 9 ± 2.8 mm postoperatively. No significant difference in graft tear rate was observed between pseudoparalyzed shoulder and nonpseudoparalyzed shoulder groups. The subscapularis tendon was torn in 26 of 49 (53%) patients, and all patients underwent repair. The graft repair group showed a significant improvement in JOA scores, UCLA shoulder scores, joint range of motion, MMT, and AHD postoperatively, but not in internal rotation strength. In contrast, the graft tear group did not show any significant improvement. All patients could return to work, except for those performing heavy labor. Complications included graft tear in five patients, postoperative infection in two patients, and progressive postoperative arthropathic changes in one patient. CONCLUSION Good clinical results of ASCR were obtained using tensor fascia lata at 2 years after surgery, with few complications and low graft tear rates.
Collapse
Affiliation(s)
- Satoru Ohta
- Department of Orthopaedic Surgery, Shinseikei Toyama Hospital.
| | - Yoshiyuki Ueda
- Department of Orthopaedic Surgery, Shinseikei Toyama Hospital
| | - Osamu Komai
- Department of Orthopaedic Surgery, Shinseikei Toyama Hospital
| |
Collapse
|
2
|
Selkowitz DM, Beneck GJ, Powers CM. Persons with patellofemoral pain exhibit altered hip abductor muscle recruitment while performing hip abductor exercises. Physiother Theory Pract 2024; 40:11-20. [PMID: 35880404 DOI: 10.1080/09593985.2022.2101167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/09/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Strengthening of the hip abductors has been advocated for persons with patellofemoral pain (PFP). It is not clear if these individuals activate the hip abductor muscles appropriately to achieve the desired therapeutic effects. OBJECTIVE To compare activation of the hip abductor muscles between persons with and without PFP during the performance of hip abductor exercises. METHODS Thirty-two individuals participated (12 with PFP and 20 without PFP). The average age (± standard deviation) was 29.7 ± 5.9 years for the PFP group and 28.1 ± 6.9 for the control group. Electromyographic (EMG) signals from the gluteus medius (GMED), superior gluteus maximus (SUP-GMAX), and tensor fascia lata (TFL) were obtained using fine-wire electrodes while participants performed 11 different exercises. Normalized EMG activity of each muscle was compared between groups across all exercises. RESULTS When averaged across all exercises, persons with PFP exhibited significantly greater EMG activity of TFL (mean = 25.3% MVIC; 95% CI = 19.2, 31.3) compared to those without PFP (mean = 17.6% MVIC; 95% CI = 12.8, 22.4) and significantly lower EMG activity of SUP-GMAX (mean = 16.4% MVIC; 95% CI = 11.0, 22.0) compared to those without PFP (mean = 25.4% MVIC; 95% CI = 21.0, 29.8). Persons with PFP exhibited lower EMG activity of GMED, but only for 3 out of the 11 exercises evaluated (hip abduction, hip hike, step-up). CONCLUSION Compared to persons without PFP, those with PFP exhibited activation differences during the performance of exercises used to target the hip abductors. Our results highlight the need for activation training prior to the initiation of strengthening exercises to achieve desired therapeutic effects.
Collapse
Affiliation(s)
- David M Selkowitz
- Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - George J Beneck
- Department of Physical Therapy, California State University, Long Beach, CA, USA
| | - Christopher M Powers
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
3
|
Korkmaz AC, Gungor Y, Tuncay İ, Bozkurt M, Acar Hİ. Protection of the innervation of the tensor fasciae latae in hip direct anterior and anterolateral approaches: a cadaver study. Hip Int 2023; 33:649-654. [PMID: 35959716 DOI: 10.1177/11207000221118551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aims to reveal the exact course of the superior gluteal nerve (SGN) branch innervating the tensor fascia lata (TFL) and show how it can be protected in the direct anterior approach (DAA) and anterolateral approach (ALA). METHODS The anterolateral regions of 22 thighs from formalin-fixed cadavers were dissected. 3 anatomical points were determined. Point A, B, C indicates where the SGN enters the gluteus minimus (GMin) fibres, the SGN leaves the gluteal muscles, the SGN enters the TFL, respectively. Measurements were made on 3 separate lines. RESULTS On the anterior superior iliac spine (ASIS) and the head of the fibula line (Line 1), the horizontal-vertical distances from point B and C to the ASIS were 7.99 ± 3.65 mm-40.40 ± 11.50 mm and 11.74 ± 6.61 mm-70.35 ± 14.11 mm respectively. The horizontal-vertical distances from point A, B, C to the greater trochanter (GT) were 32.41 ± 9.97 mm-55.28 ± 12.25 mm; 67.70 ± 8.54 mm-17.76 ± 13.57 mm; 63.92 ± 9.96 mm-13.00 ± 7.92 mm on the GT and the head of the fibula line (Line 2), respectively. The horizontal-vertical distances from point A, B, C to the GT were 24.58 ± 9.83 mm-42.54 ± 12.86 mm; 9.45 ± 7.92 mm-36.25 ± 9.06 mm; 26.18 ± 11.12 mm-64.05 ± 11.67 mm on the ASIS and the GT line (Line 3). CONCLUSIONS In the DAA, the increased risk of damaging the branch of the SGN that innervates the TFL must be kept in mind. The protection of this branch can be ensured with easy and applicable rules.
Collapse
Affiliation(s)
- Ali Can Korkmaz
- Gulhane Training and Research Hospital, Ministry of Health University, Ankara, Turkey
| | - Yigit Gungor
- Department of Anatomy, School of Medicine, Ankara University, Ankara, Turkey
| | - İbrahim Tuncay
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | - Murat Bozkurt
- Department of Orthopedics and Traumatology, Acibadem Hospital Ankara, Ankara, Turkey
| | - Halil İbrahim Acar
- Department of Anatomy, School of Medicine, Ankara University, Ankara, Turkey
| |
Collapse
|
4
|
Park TH. The versatility of tensor fascia lata allografts for soft tissue reconstruction. Int Wound J 2022; 20:784-791. [PMID: 36054479 PMCID: PMC9927912 DOI: 10.1111/iwj.13923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/27/2022] Open
Abstract
The purpose of this retrospective study was to introduce our successful use of tensor fascia lata allograft to reconstruct various soft tissue defects. Since May 2021, we have applied tensor fascia lata allografts in eight cases. A frozen type of fascia of 0.6 mm thickness was used in all cases, and allografts were covered by vascularized soft tissue. We used tensor fascia lata allograft in eight cases to cover the infected wounds, donor site closure, and pedicle protections. These were abdominal wall and back reconstructions following rectus muscle and latissimus dorsi muscle harvest, coverage of infected spine wound after posterior fusion, pressure ulcer reconstruction, and pedicle protection of free and pedicle flaps. The follow-up periods were from one to 14 months. None of the cases showed wound problems after initial reconstruction using tensor fascia lata allografts. Tensor fascia lata allograft could be an excellent cost-effective surgical option comparable to autologous tissue grafts. Level of evidence: IV.
Collapse
Affiliation(s)
- Tae Hwan Park
- Department of Plastic and Reconstructive SurgeryDongtan Sacred Heart Hospital, Hallym University College of MedicineHwaseongRepublic of Korea
| |
Collapse
|
5
|
Takayama K, Shiode H, Ito H. Acromial and humeral head osteolysis following superior capsular reconstruction using autologous tensor fascia lata graft. J Shoulder Elbow Surg 2022; 31:1479-1487. [PMID: 35065292 DOI: 10.1016/j.jse.2021.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/05/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Graft tear is a critical complication following superior capsular reconstruction (SCR) as it directly links with clinical outcomes. No previous reports have described acromial and humeral head osteolysis following SCR. Acromial and humeral head osteolysis may incidentally occur after SCR using autologous tensor fascia lata graft. This study aimed to demonstrate the incidence of osteolysis following SCR using autologous tensor fascia lata graft and investigate the factors that affect osteolysis. METHODS This retrospective cohort study included patients who underwent SCR for irreparable rotator cuff tears between June 2014 and June 2019. The patients were divided into 2 groups-those with no osteolysis and those with osteolysis-and were compared. For subanalysis, patients in the osteolysis group were further divided into 3 groups according to the location of the osteolysis-acromial osteolysis, humeral head osteolysis, and acromial and humeral head osteolysis-to clarify the factors determining the location of osteolyses. The shoulder range of motion was evaluated preoperatively and 24 months postoperatively. Additionally, the following items were evaluated: condition of the subscapularis tendon, Hamada classification (grade 2 or 3), critical shoulder angle, acromiohumeral distance measured preoperatively and 24 months postoperatively, graft size, and graft thickness. In addition, the graft condition was evaluated using magnetic resonance imaging 12 months postoperatively. RESULTS In total, 57 patients were enrolled and followed up for a minimum of 2 years (follow-up rate, 92% [57 of 62 cases]). Overall, the incidence of osteolysis following SCR was 35.1% (20 of 57 cases; acromial osteolysis in 7, humeral head osteolysis in 3, and acromial and humeral head osteolysis in 10). Compared with the group with no osteolysis, the osteolysis group had no inferior clinical outcomes or higher graft tear rates. The proportions of Hamada grade 3 (P = .041) and involvement of the subscapularis tendon (P = .020) were significantly higher in the osteolysis group. The relative risks of subscapularis involvement and Hamada grade 3 for osteolysis were 2.9 and 5.1, respectively. In the subanalysis, the factors determining the location of the osteolysis could not be clarified. CONCLUSIONS This study suggested that the progression of the Hamada classification and condition of the subscapularis tendon affect the occurrence of osteolyses. However, these osteolyses were not associated with clinical outcomes, including graft tear rate and shoulder range of motion.
Collapse
Affiliation(s)
- Kazumasa Takayama
- Department of Orthopaedics, Kurashiki Central Hospital, Okayama, Japan.
| | - Hayao Shiode
- Department of Orthopaedics, Kurashiki Central Hospital, Okayama, Japan
| | - Hiromu Ito
- Department of Orthopaedics, Kurashiki Central Hospital, Okayama, Japan
| |
Collapse
|
6
|
Sathyamurthy R, Manjunath KN, Waiker V, Shanthakumar S, Kumaraswamy M. Free tensor fascia lata flap - a reliable and easy to harvest flap for reconstruction. Acta Chir Plast 2021; 63:57-63. [PMID: 34404218 DOI: 10.48095/ccachp202157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Flaps are the essence of reconstructive surgery. The ability to successfully design, execute and manage the flaps makes plastic surgery an outstanding speciality. The choice of flap is mainly guided by the type of the defect. However, certain factors like technique feasibility, duration of the surgery and patient factors do have a role in decision making. The primary type of free flap (whether a muscle or a fasciocutaneous flap) is dictated by the defect or the wound characteristics. However, the choice of flap depends on various factors like the component of flap, pedicle length required, the ease of harvest and donor site morbidity. Tensor fascia lata (TFL) is one myocutaneous flap, which has well developed components other than a muscle. MATERIALS AND METHODS The patients admitted to a tertiary care hospital with the diagnosis of composite tissue defect in any region of the body were enrolled for this study from November 2016 to November 2018. Patients undergoing free TFL flap reconstruction are studied. The duration of flap harvest, the anatomical site of pedicle, flap outcome and the need of secondary surgery were analysed. RESULTS Totally 14 patients were reconstructed with a free TFL flap. The anatomic location of the defect was more frequent on lower limbs - 8 cases (58%), followed by the upper limb and the head and neck area (3 cases, each 21%). The mean flap harvest time was -62.07 (45-80) min. The mean size of pedicle entry was 8.7 cm from the anterior superior iliac spine. Out of the 14 flaps, there were 10 (71%) flaps successful completely and 4 (29%) of them had partial loss. CONCLUSION A free TFL flap harvest time is very short compared to any other flaps and hence makes it the flap of choice in patients who are critical and cannot withstand long operating time.
Collapse
|
7
|
Mittal R, Jain S. Bilateral gluteus maximus contracture due to intra muscular injections. Trop Doct 2021; 51:450-452. [PMID: 33427089 DOI: 10.1177/0049475520984747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gluteus maximus contracture, characterised by contracture of gluteus maximus, iliotibial band and covering fascia, can be caused by repeated intramuscular injections in the gluteal region. It is amenable to open surgical release.
Collapse
Affiliation(s)
- Ravi Mittal
- Professor, Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Jain
- Fellow in Arthroscopy, Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
8
|
Vredenburgh ZD, Prodromo JP, Tibone JE, Dunphy TR, Weber J, McGarry MH, Chae S, Adamson GJ, Lee TQ. Biomechanics of tensor fascia lata allograft for superior capsular reconstruction. J Shoulder Elbow Surg 2021; 30:178-187. [PMID: 32778385 DOI: 10.1016/j.jse.2020.04.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/06/2020] [Accepted: 04/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND We hypothesized that in a cadaveric massive rotator cuff tear (MCT) model, a fascia lata (FL) allograft superior capsular reconstruction (SCR) would restore subacromial contact pressure and humeral head superior translation without limiting range of motion (ROM). Therefore, the objective of this study was to compare these parameters between an intact rotator cuff, MCT, and allograft FL SCR. METHODS Eight fresh cadavers were studied using a custom shoulder testing system. ROM, superior translation, and subacromial contact pressure were measured in each of 3 states: (1) intact rotator cuff, (2) MCT, and (3) MCT with SCR. RESULTS Total ROM was increased in the MCT state at 60° of abduction (P = .037). FL SCR did not restrict internal or external rotational ROM. Increased superior translation was observed in the MCT state at 0° and 30° of humeral abduction, with no significant difference between the intact cuff and FL SCR states. The MCT state significantly increased mean subacromial contact pressure at 0° of abduction with 30° and 60° of external rotation, and FL SCR restored this to intact levels. Peak subacromial contact pressure was increased for the MCT state at 0° of abduction with 30° and 60° of external rotation, as well as 30° of abduction with 30° of external rotation. CONCLUSION This study demonstrates a tensor FL allograft preparation technique for use in SCR. After MCT, FL SCR restores ROM, superior translation, and subacromial contact pressure to the intact state.
Collapse
Affiliation(s)
- Zachary D Vredenburgh
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - James E Tibone
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | | | - Joel Weber
- Evergreen Health Orthopedics & Sports Care, Kirkland, WA, USA
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Seungbum Chae
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA; Department of Orthopaedic Surgery, Daegu Catholic University Hospital School of Medicine, Daegu, Republic of Korea
| | - Gregory J Adamson
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA.
| |
Collapse
|
9
|
Long S, Leahy H, Bush C, Surrey D, Nazarian L. Anterolateral hip pain: Sonographic evaluation of the proximal iliotibial band and tensor fascia lata. J Clin Ultrasound 2020; 48:193-197. [PMID: 32128810 DOI: 10.1002/jcu.22822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 02/12/2020] [Accepted: 02/19/2020] [Indexed: 06/10/2023]
Affiliation(s)
- Suzanne Long
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Hannah Leahy
- Department of Rehabilitation Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Chelsea Bush
- Department of Orthopedics, WellSpan York Hospital, York, Pennsylvania, USA
| | - David Surrey
- Department of Rehabilitation Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Levon Nazarian
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| |
Collapse
|
10
|
Yildiz F, Bilsel K, Pulatkan A, Kapicioglu M, Uzer G, Çetindamar T, Sonmez C, Bozdag E, Sünbüloglu E. Comparison of two different superior capsule reconstruction methods in the treatment of chronic irreparable rotator cuff tears: a biomechanical and histologic study in rabbit models. J Shoulder Elbow Surg 2019; 28:530-538. [PMID: 30466819 DOI: 10.1016/j.jse.2018.08.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/16/2018] [Accepted: 08/19/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND In the treatment of irreparable rotary cuff (RC) tears, the superior capsule of the shoulder is reconstructed using tensor fascia lata (TFL) or several allografts to prevent progressive joint degeneration. This study compared the healing qualities of acellular human dermal graft (HDG) and the TFL autograft in superior capsule reconstruction (SCR) from biomechanical and histologic perspectives. METHODS Chronic retracted RC tear models were created bilaterally in 9 rabbits, and 7 rabbits with intact RC were used as a control group. SCR was performed 8 weeks after the tear using HDG in right shoulders and TFL in left shoulders. At 12 weeks after SCR, 2 shoulders from each experimental group were investigated for histologic healing, and 7 samples from the experimental and control groups were biomechanically tested. RESULTS Complete healing was observed macroscopically in the glenoid and humeral sides of both groups. No difference was observed in the enthesis maturation scores between the experimental groups. Collagen fiber density was higher and the orientation was better in TFL group. Inflammatory cell infiltration was not seen in the TFL group, but inflammatory cell infiltration was pronounced in the HDG group. The mean pullout strengths of the TFL group, HDG group, and intact RC group were 139.7 ± 40.5 N, 123.9 ± 47.9 N, and 105.1 ± 11.8 N (P = .187), respectively. The mean stiffness values (P = .711), yield forces (P = .404), and displacements (P = .135) were also statistically not different between the groups. CONCLUSION In SCR, the healing qualities of HDG and TFL were similar in rabbit models.
Collapse
Affiliation(s)
- Fatih Yildiz
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey.
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Anil Pulatkan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Gokcer Uzer
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Tolga Çetindamar
- Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Cavide Sonmez
- Department of Pathology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Ergun Bozdag
- Biomechanics Laboratory, Department of Mechanical Engineering, Istanbul Technical University, Taksim, Istanbul, Turkey
| | - Emin Sünbüloglu
- Biomechanics Laboratory, Department of Mechanical Engineering, Istanbul Technical University, Taksim, Istanbul, Turkey
| |
Collapse
|
11
|
Wilhelm M, Matthijs O, Browne K, Seeber G, Matthijs A, Sizer PS, Brismée JM, James CR, Gilbert KK. DEFORMATION RESPONSE OF THE ILIOTIBIAL BAND- TENSOR FASCIA LATA COMPLEX TO CLINICAL-GRADE LONGITUDINAL TENSION LOADING IN-VITRO. Int J Sports Phys Ther 2017; 12:16-24. [PMID: 28217413 PMCID: PMC5294943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Iliotibial Band (ITB) syndrome is a troublesome condition with prevalence as high as 12% in runners. Stretching has been utilized as a conservative treatment. However, there is limited evidence supporting ITB elongation in response to a stretching force. PURPOSE/HYPOTHESES The purpose of this study was to describe the iliotibial band tensor fascia lata complex (ITBTFLC) tissue elongation response to a simulated clinical stretch in-vitro. The authors hypothesized that the ITBTFLC would undergo statistically significant elongation when exposed to a clinical-grade stretching regimen, with the majority of the elongation occurring within the proximal ITBTFLC region. STUDY DESIGN Within subjects repeated measures in-vitro design. METHODS The strain response of six un-embalmed ITBTFLCs to a simulated clinical stretch of 2.75% elongation was assessed. Four sets of array marks were placed along the length of the ITBTFLC. Photographic images were taken in resting position (with 1.0% in-situ elongation) and with an additional 2.75% elongation. Tissue elongation was compared between proximal, middle, and distal ITBTFLC regions. RESULTS A paired samples t-test demonstrated a significantly longer ITBTFLC in the "stretched" versus resting condition (p = 0.001). Significant elongation was observed in the proximal (3.96mm (SD = 1.35); p = 0.001), middle (2.12mm (SD = 1.49); p = 0.018) and distal (2.25mm (SD = 1.37); p = 0.01) regions during the "stretched" versus the resting condition. A one-way ANOVA demonstrated a significant main effect for region (p = 0.002). The proximal region exhibited significantly greater elongation versus the middle (p = 0.003) and distal (p = 0.007) regions, with no significant difference between the middle and distal regions (p = 0.932). CONCLUSION The results of this study demonstrate that the ITBTFLC is capable of elongation in response to a clinically simulated stretch. The proximal ITB region underwent significantly greater elongation than the middle and distal regions and may be more likely to respond to "stretching" in clinical situations. Future investigation should assess the ITBTFLC load/deformation properties to determine whether a short-term clinically available stretch translates into permanent tissue elongation. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Mark Wilhelm
- Department of Rehabilitation Sciences, Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Omer Matthijs
- Boma, Physical Therapy Outpatient Clinic, Mariazeller Straße 30, 8605 Kapfenberg, Styria, Austria
| | - Kevin Browne
- Department of Rehabilitation Sciences, Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Gesine Seeber
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Anja Matthijs
- Boma, Physical Therapy Outpatient Clinic, Mariazeller Straße 30, 8605 Kapfenberg, Styria, Austria
| | - Phillip S. Sizer
- Department of Rehabilitation Sciences, Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Jean-Michel Brismée
- Department of Rehabilitation Sciences, Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - C. Roger James
- Department of Rehabilitation Sciences, Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Kerry K. Gilbert
- Department of Rehabilitation Sciences, Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| |
Collapse
|
12
|
Abstract
STUDY DESIGN Controlled laboratory study, repeated-measures design. OBJECTIVES To compare hip abductor muscle activity and hip and knee joint kinematics in the moving limb to the stance limb during resisted side stepping, and to determine whether muscle activity was affected by the posture (upright standing versus squat) used to perform the exercise. BACKGROUND Hip abductor weakness has been associated with a variety of lower extremity injuries. Resisted side stepping is often used as an exercise to increase strength and endurance of the hip abductors. Exercise prescription would benefit from knowing the relative muscle activity level generated in each limb and for different postures during the side-stepping exercise. METHODS Twenty-four healthy adults participated in this study. Kinematics and surface electromyographic data from the gluteus maximus, gluteus medius, and tensor fascia lata were collected as participants performed side stepping with a resistive band around the ankle, while maintaining each of 2 postures: (1) upright standing and (2) squat. RESULTS Mean normalized electromyographic signal amplitude of the gluteus maximus, gluteus medius, and tensor fascia lata was higher in the stance limb than in the moving limb (P≤.001). Gluteal muscle activity was higher, whereas tensor fascia lata muscle activity was lower, in the squat posture compared to the upright standing posture (P<.001). Hip abduction excursion was greater in the stance limb than in the moving limb (P<.001). CONCLUSION The 3 hip abductor muscles respond differently to the posture variations of the side-stepping exercise in healthy individuals. When prescribing resisted side-stepping exercises, therapists should consider the differences in hip abductor activation across limbs and variations in trunk posture.
Collapse
Affiliation(s)
- Justin W. Berry
- Physical Therapist Assistant Program, Northland Community and Technical College, East Grand Forks, Minnesota
| | - Theresa S. Lee
- Department of Physical Therapy and Athletic Training, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts
| | - Hanna D. Foley
- Department of Physical Therapy and Athletic Training, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts
| | - Cara L. Lewis
- Department of Physical Therapy and Athletic Training, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts
| |
Collapse
|
13
|
Schade VL, Harsha W, Rodman C, Roukis TS. Peroneal Tendon Reconstruction and Coverage for Treatment of Septic Peroneal Tenosynovitis: A Devastating Complication of Lateral Ankle Ligament Reconstruction With a Tendon Allograft. J Foot Ankle Surg 2015; 55:406-13. [PMID: 26002675 DOI: 10.1053/j.jfas.2015.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Indexed: 02/03/2023]
Abstract
Septic peroneal tenosynovitis is a rare and significant challenge. A search of peer-reviewed published studies revealed only 5 case reports to guide treatment, none of which resulted in significant loss of both peroneal tendons necessitating reconstruction. No clear guidance is available regarding how to provide reliable reconstruction of both peroneal tendons after a significant loss secondary to septic tenosynovitis. In the present report, we describe the case of a young, active-duty soldier who underwent lateral ankle ligament reconstruction with a tendon allograft whose postoperative course was complicated by septic peroneal tenosynovitis resulting in significant loss of both peroneal tendons. Reconstruction was achieved in a staged fashion with the use of silicone rods and external fixation to maintain physiologic tension and preserve peroneal tendon function, followed by reconstruction of both peroneal tendons and the superior peroneal retinaculum with a tensor fascia lata autograft. Soft tissue coverage was obtained with an anterolateral thigh free tissue transfer and a split-thickness skin graft. The patient returned to full activity as an active-duty soldier with minimal pain and no instability of the right lower extremity. The muscle strength of both peroneal tendons remained at 5 of 5, and no objective findings of ankle instability were seen at 3.5 years postoperatively.
Collapse
Affiliation(s)
| | - Wayne Harsha
- Chief, Otolaryngology Service, Madigan Army Medical Center, Tacoma, WA
| | - Caitlin Rodman
- Staff, Adult Family Nurse Practitioner, South Sound Internal Medicine, Olympia, WA
| | - Thomas S Roukis
- President, American College of Foot and Ankle Surgeons, Chicago, IL; Attending Staff, Department of Orthopedics, Podiatry, and Sports Medicine, Gundersen Health System, La Crosse, WI
| |
Collapse
|
14
|
Contedini F, Negosanti L, Pinto V, Tavaniello B, Fabbri E, Sgarzani R, Tassone D, Cipriani R. Tensor fascia latae perforator flap: An alternative reconstructive choice for anterolateral thigh flap when no sizable skin perforator is available. Indian J Plast Surg 2013; 46:55-8. [PMID: 23960306 PMCID: PMC3745122 DOI: 10.4103/0970-0358.113707] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: The anterolateral thigh flap (ALT) is a versatile flap and very useful for the reconstruction of different anatomical districts. The main disadvantage of this flap is the anatomical variability in number and location of perforators. In general, absence of perforators is extremely rare. In literature, it is reported to be from 0.89% to 5.4%. If no sizable perforators are found, an alternative reconstructive strategy must be considered. Tensor fascia lata (TFL) perforator flap can be a good alternative in these cases: Perforator vessels are always present, the anatomy is more constant and it is possible to harvest it through the same surgical access. The skin island of the flap can be very large and can be thinned removing a large part of the muscle allowing its use for almost the same indications of the ALT flap. Materials and Methods: We report 11 cases of reconstruction firstly planned with the ALT flap, then converted into TFL perforator flap. Results and Conclusion: The result was always satisfactory in terms of the donor site morbidity and reconstructive outcome.
Collapse
Affiliation(s)
- Federico Contedini
- Department of Plastic Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | | | | | | | | | | | | |
Collapse
|