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The effects of intramuscular tenotomy on the lengthening characteristics of tibialis posterior: high versus low intramuscular tenotomy

BACKGROUND: Lengthening of soft-tissue contractures is frequently required in children with a wide variety of congenital and acquired deformities. However, little is known about the biomechanics of surgical procedures which are commonly used in contracture surgery, or if variations in technique may...

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Autores principales: Altuntas, Altay O., Dagge, Benjamin, Chin, Terence Y. P., Palamara, Joseph E. A., Eizenberg, Norman, Wolfe, Rory, Graham, H. Kerr
Formato: Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3100458/
https://www.ncbi.nlm.nih.gov/pubmed/21779309
http://dx.doi.org/10.1007/s11832-011-0335-5
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author Altuntas, Altay O.
Dagge, Benjamin
Chin, Terence Y. P.
Palamara, Joseph E. A.
Eizenberg, Norman
Wolfe, Rory
Graham, H. Kerr
author_facet Altuntas, Altay O.
Dagge, Benjamin
Chin, Terence Y. P.
Palamara, Joseph E. A.
Eizenberg, Norman
Wolfe, Rory
Graham, H. Kerr
author_sort Altuntas, Altay O.
collection PubMed
description BACKGROUND: Lengthening of soft-tissue contractures is frequently required in children with a wide variety of congenital and acquired deformities. However, little is known about the biomechanics of surgical procedures which are commonly used in contracture surgery, or if variations in technique may have a bearing on surgical outcomes. We investigated the hypothesis that the site of intramuscular tenotomy (IMT) within the muscle–tendon-unit (MTU) of the tibialis posterior (TP) would affect the lengthening characteristics. METHODS: We performed a randomized trial on paired cadaver tibialis posterior muscle–tendon-units (TP-MTUs). By random allocation, one of each pair of formalin-preserved TP-MTUs received a high IMT, and the other a low IMT. These were individually tensile-tested with an Instron(®) machine under controlled conditions. A graph of load (Newtons) versus displacement (millimetres) was generated for each pair of tests. The differences in lengthening and load at failure for each pair of TP-MTUs were noted and compared using paired t tests. RESULTS: We found 48% greater lengthening for low IMT compared to high IMT for a given load (P = 0.004, two tailed t test). Load at failure was also significantly lower for the low IMT. These findings confirm our hypothesis that the site of the tenotomy affects the amount of lengthening achieved. This may contribute to the reported variability in clinical outcome. CONCLUSIONS: Understanding the relationship between tenotomy site and lengthening may allow surgeons to vary the site of the tenotomy in order to achieve pre-determined surgical goals. It may be possible to control the surgical “dose” by altering the position of the intramuscular tenotomy within the muscle–tendon-unit.
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spelling pubmed-31004582011-07-14 The effects of intramuscular tenotomy on the lengthening characteristics of tibialis posterior: high versus low intramuscular tenotomy Altuntas, Altay O. Dagge, Benjamin Chin, Terence Y. P. Palamara, Joseph E. A. Eizenberg, Norman Wolfe, Rory Graham, H. Kerr J Child Orthop Original Clinical Article BACKGROUND: Lengthening of soft-tissue contractures is frequently required in children with a wide variety of congenital and acquired deformities. However, little is known about the biomechanics of surgical procedures which are commonly used in contracture surgery, or if variations in technique may have a bearing on surgical outcomes. We investigated the hypothesis that the site of intramuscular tenotomy (IMT) within the muscle–tendon-unit (MTU) of the tibialis posterior (TP) would affect the lengthening characteristics. METHODS: We performed a randomized trial on paired cadaver tibialis posterior muscle–tendon-units (TP-MTUs). By random allocation, one of each pair of formalin-preserved TP-MTUs received a high IMT, and the other a low IMT. These were individually tensile-tested with an Instron(®) machine under controlled conditions. A graph of load (Newtons) versus displacement (millimetres) was generated for each pair of tests. The differences in lengthening and load at failure for each pair of TP-MTUs were noted and compared using paired t tests. RESULTS: We found 48% greater lengthening for low IMT compared to high IMT for a given load (P = 0.004, two tailed t test). Load at failure was also significantly lower for the low IMT. These findings confirm our hypothesis that the site of the tenotomy affects the amount of lengthening achieved. This may contribute to the reported variability in clinical outcome. CONCLUSIONS: Understanding the relationship between tenotomy site and lengthening may allow surgeons to vary the site of the tenotomy in order to achieve pre-determined surgical goals. It may be possible to control the surgical “dose” by altering the position of the intramuscular tenotomy within the muscle–tendon-unit. Springer Berlin Heidelberg 2011-03-25 2011-06 /pmc/articles/PMC3100458/ /pubmed/21779309 http://dx.doi.org/10.1007/s11832-011-0335-5 Text en © The Author(s) 2011 https://creativecommons.org/licenses/by/4.0/ This article is published under license to BioMed Central Ltd. Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution and reproduction in any medium, provided the original author(s) and source are credited.
spellingShingle Original Clinical Article
Altuntas, Altay O.
Dagge, Benjamin
Chin, Terence Y. P.
Palamara, Joseph E. A.
Eizenberg, Norman
Wolfe, Rory
Graham, H. Kerr
The effects of intramuscular tenotomy on the lengthening characteristics of tibialis posterior: high versus low intramuscular tenotomy
title The effects of intramuscular tenotomy on the lengthening characteristics of tibialis posterior: high versus low intramuscular tenotomy
title_full The effects of intramuscular tenotomy on the lengthening characteristics of tibialis posterior: high versus low intramuscular tenotomy
title_fullStr The effects of intramuscular tenotomy on the lengthening characteristics of tibialis posterior: high versus low intramuscular tenotomy
title_full_unstemmed The effects of intramuscular tenotomy on the lengthening characteristics of tibialis posterior: high versus low intramuscular tenotomy
title_short The effects of intramuscular tenotomy on the lengthening characteristics of tibialis posterior: high versus low intramuscular tenotomy
title_sort effects of intramuscular tenotomy on the lengthening characteristics of tibialis posterior: high versus low intramuscular tenotomy
topic Original Clinical Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3100458/
https://www.ncbi.nlm.nih.gov/pubmed/21779309
http://dx.doi.org/10.1007/s11832-011-0335-5
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