• Archives of Plastic Surgery
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• 제35권6호
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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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• 제36권4호
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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.

• Journal of the Optical Society of Korea
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• 제13권4호
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• pp.472-477
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• 2009

A Stokes polarimetry imaging (SPI) system was developed and utilized to detect tendon tears by constructing the degree of linear polarization (DOLP) image maps after linearly polarized light illumination. The micro and partial-thickness tears of turkey tendons were made and imaged by the SPI system at different incident polarization angles (IPA) with different mechanical loads on the tendon. The micro and partial-thickness tendon tears were detected by the DOLP images due to weak birefringence around the tears. The tendon tears were detected by a highest DOLP contrast at longest visible wavelength (Red, 650 ${\pm}$ 50 nm). All polarized images showed modulated DOLP as the incident polarization angle (IPA) was varied. The varying DOLP allowed the optimal detection of the micro and partial-thickness tendon tears at a certain IPA. The SPI system with variable IPA and spectral information can improve the detection of the tendon tears by higher visibility of fiber orientations, and thereby improve diagnosis and treatment of the tendon related injuries.

• 대한족부족관절학회지
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• 제27권2호
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• pp.39-42
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• 2023

A ruptured Achilles tendon at the calcaneus attachment, which does not include a bone that can be fixed, is called 'sleeve avulsion'. A small amount of tendon in the calcaneal region can be sutured to the proximal portion of the ruptured Achilles tendon or insufficient bone to be fixed. Hence, tendon-bone healing is expected, but the results are not good compared to other parts of the tear. The incidence of Achilles tendon rupture is 7 to 40 per 100,000 patients, and 25% of patients undergo direct suture or reconstruction surgery, and 7.6% of patients with sleeve avulsion injuries undergo surgery. Surgical treatment may be a better choice for Achilles tendon sleeve avulsion because no successful case of conservative treatment has been reported. Distal wounds above the ruptured tendon adjacent to the bony eminence can have wound healing problems because of the thin, soft tissue and hypovascularity. An appropriate surgical method must be selected for each patient.

• 한국운동역학회지
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• 제24권1호
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• pp.35-42
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• 2014

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

• Archives of Plastic Surgery
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• 제33권1호
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• pp.120-123
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• 2006

Spontaneous extensor pollicis longus tendon rupture is commonly caused by attrition of the tendon from trauma or inflammatory processes. We experienced a patient with extensor pollicis longus tendon rupture after steroid injection, in which the rupture may have been caused by the effects of steroid itself as well as direct damage from the needle. A 51-year-old woman complained of inability to extend her right thumb at the first metacarpophalangal & interphalangeal joint level. The patient had a history of local steroid injection into the dorsal & radial side of wrist on two occations, and had no history of trauma or rheumatologic disease. After a physical examination of the patient, we decided to explore the wrist. The patient agreed with operation. Intraoperatively, an incision was made into the wrist and the proximal and distal ends of the ruptured extensor pollicis longus tendon were identified. The defect between the proximal and the distal end was measured to approach 8cm, and a palmaris longus tendon graft was performed. After three months of rehabilitation, the first metacarpophalangal & interphalangeal joint recovered the normal range of motion. Steroid injection has been widely used in various musculoskeletal disorders such as rheumatoid arthritis and osteoarthritis. However, inadvertent steroid injection into the extra or intra articular spaces may lead to tendon rupture. Steroids reduce tensile strength by decreasing tenocyte activity and collagen synthesis. Also, the physical effect of direct needle-stick injury into the mesotenon and blood vessels around the tendon may cause damage. In addition, hematoma and edema may increase pressure around the tendon and compromise blood supply, leading to tendon degeneration and subsequent rupture. When injecting steroid into an articular area, all physicians should have a complete understanding of the surrounding anatomy and always keep in mind the hazards of such procedures.

• 대한한의학회지
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• 제26권1호
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• pp.11-17
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• 2005

This study was carried out to identify the components of the human heart meridian muscle, the regional muscle group being divided into outer, middle, and inner layers. The inner parts of the body surface were opened widely to demonstrate muscles, nerves, blood vessels and to expose the inner structure of the heart meridian muscle in the order of layers. We obtained the following results; $\cdot$ The heart meridian muscle is composed of muscles, nerves and blood vessels. $\cdot$ In human anatomy, the difference between terms is present (that is, between nerves or blood vessels which control the meridian muscle and those which pass near by). $\cdot$ The inner composition of the heart meridian muscle in the human arm is as follows: 1) Muscle H-l: latissimus dorsi muscle tendon, teres major muscle, coracobrachialis muscle H-2: biceps brachialis muscle, triceps brachialis muscle, brachialis muscle H-3: pronator teres muscle and brachialis muscle H-4: palmar carpal ligament and flexor ulnaris tendon H-5: palmar carpal ligament & flexor retinaculum, tissue between flexor carpi ulnaris tendon and flexor digitorum superficialis tendon, flexor digitorum profundus tendon H-6: palmar carpal ligament & flexor retinaculum, flexor carpi ulnaris tendon H-7: palmar carpal ligament & flexor retinaculum, tissue between flexor carpi ulnaris tendon and flexor digitorum superficial is tendon, flexor digitorum profundus tendon H-8: palmar aponeurosis, 4th lumbrical muscle, dorsal & palmar interrosseous muscle H-9: dorsal fascia, radiad of extensor digiti minimi tendon & extensor digitorum tendon 2) Blood vessel H-1: axillary artery, posterior circumflex humeral artery H-2: basilic vein, brachial artery H-3: basilic vein, inferior ulnar collateral artery, brachial artery H-4: ulnar artery H-5: ulnar artery H-6: ulnar artery H-7: ulnar artery H-8: palmar digital artery H-9: dorsal digital vein, the dorsal branch of palmar digital artery 3) Nerve H-1: medial antebrachial cutaneous nerve, median n., ulnar n., radial n., musculocutaneous n., axillary nerve H-2: median nerve, ulnar n., medial antebrachial cutaneous n., the branch of muscular cutaneous nerve H-3: median nerve, medial antebrachial cutaneous nerve H-4: medial antebrachial cutaneous nerve, ulnar nerve H-5: ulnar nerve H-6: ulnar nerve H-7: ulnar nerve H-8: superficial branch of ulnar nerve H-9: dorsal digital branch of ulnar nerve.

• 대한족부족관절학회지
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• 제7권2호
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• pp.223-231
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• 2003

Purpose: Achilles tendon rupture has become more common in the recent years. As suture with foreign material has been blamed for impaired healing, better results should be expected from the use of autogenous material such as plantaris tendon. We have evaluated the surgical results of end-to-end anastomosis using the plantaris tendon as suture material. Materials and Methods: Between Jan 1997 and Jan 2002, the 60 patients were included this study during one year follow-up. We performed the operations with end-to-end suture technique using modified Lynn's method. The plantaris tendon has been used as a autogenous suture material and can be utilized in the end-to-end anastomosis of ruptured Achilles tendon with modifed Bunnel suture technique. We used a clinical scoring system reported by Leppilahti to evaluate the results. Results: The overall results were excellent in thirty eight(63.3%), good in sixteen(26.6%), fair in five(8.3%) cases, and poor in only one (1.6%) case. Fifty four cases(90%) had the score more than good. We had no deep infection, rerupture, deep vein thrombosis, and skin necrosis as major complication. In just 2 cases, although there were superficial skin infection, the wounds did not proceed necrosis due to using antibiotics. Conclusion: End-to-end anastomosis using the plantaris tendon as suture material was good treatment option that had low infection rate and no foreign body reaction because of using autogenous material, and therefore we can get rapid healing of ruptured tendon due to early ragne of motion and accerlerated rehabilitation.

• Clinics in Shoulder and Elbow
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• 제21권1호
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• pp.3-14
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• 2018

Background: Platelet-rich plasma (PRP) stimulates cell proliferation and enhances matrix gene expression and synthesis. However, there have been no comparative study of the PRP effect on the normal and degenerative tenocytes. The purpose of this study was to compare the effect of PRP on tenocytes from normal and degenerative tendon. Methods: Tendon tissues were obtained from patients undergoing arthroscopic repair (n=9) and from healthy donors (n=3). Tenocytes were cultured with 10% (vol/vol) platelet-poor plasma, PRP activated with calcium, and PRP activated with calcium and thrombin. The total cell number was assessed at days 7 and 14. The expressions of type I and III collagen, decorin, tenascin-C, and scleraxis were evaluated by quantitative real-time reverse transcriptase polymerase chain reaction. The total collagen and glycosaminoglycan (GAG) synthesis was evaluated at days 7 and 14. Results: No differences were observed between the groups at day 7, but cell proliferation was remarkably increased in tenocytes from the degenerative tendon at day 14. In both tenocyte groups, the gene expressions of type I and III collagen were up-regulated. GAG synthesis was greater in the normal tendon, whereas the expressions of decorin and tenascin-C were increased in tenocytes from the degenerative tendon. Tenocytes from the degenerative tendon had higher fold-change of GAG synthesis and a lower collagen III/I ratio than normal tenocytes. Conclusions: PRP promoted the cell proliferation and enhanced the synthesis of tendon matrix in both groups. PRP has a greater positive effect on cell proliferation, matrix gene expression and synthesis in tenocytes from degenerative tendon.

• Journal of Microbiology and Biotechnology
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• 제33권3호
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• pp.339-347
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• 2023

Transforming growth factor-β is a key factor in regulating adhesion formation during tendon healing. We investigated the effectiveness of SMAD family members, SMAD7 and SMAD3, in the TGF-β/Smad signaling during flexor tendon repair. Mouse flexor toe deep tendon rupture anastomosis models were made. On days 3, 7, 14, 21, and 28, the expressions of smad7 and smad3 in flexor tendon tissues were detected by RT-qPCR and western blot. Furthermore, postoperative intraperitoneal injections of SMAD7 agonists or SMAD3 antagonists were given. The degree of tendon healing was evaluated by adhesion testing and biomechanical experiments. Hematoxylin and eosin (HE) staining was used to observe the pathological changes. Immunohistochemistry was used to evaluate the expressions of collagen III, SMAD3, and SMAD7. The mRNA levels of matrix metalloproteinases, Mmp2 and Mmp9, and scleraxis (SCX) in flexor tendon tissue were detected by RT-qPCR. Smad3 expression increased and Smad7 expression decreased in flexor tendon tissue after injury. In addition, the SMAD7 agonist blocked SMAD3 phosphorylation. SMAD7 agonist and SMAD3 antagonist both improved adhesion formation during flexor tendon healing, and decreased the expressions of collagen III, Mmp9, and SCX, while increasing Mmp2 expression. This study provides a possible theoretical basis for the SMAD7-SMAD3 signal cascade during flexor tendon adhesion healing.