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Concept: Common flexor tendon

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OBJECTIVE: To describe a tenosynoviotomy technique for treatment of sepsis of the digital flexor tendon sheath (DFTS) in horses and report long-term outcome. STUDY DESIGN: Case series. ANIMALS: Horses (n = 9). METHODS: Horses were positioned in lateral recumbency with the affected limb uppermost. A linear incision was made just lateral to the mesotenon beginning 5 cm proximal to the apices of the proximal sesamoid bones, extending 2 cm distal to the bifurcation of the superficial digital flexor tendon (SDFT). The incision was continued through the skin, subcutaneous tissue, palmar/plantar annular ligament, and DFTS. Tenotomy of the distal lateral branch of the SDFT was also performed. The site was thoroughly debrided, lavaged, and packed with gauze and allowed to heal by second intention. Follow-up was obtained via owner telephone interview. RESULTS: Mean surgery time was 32 minutes (range, 10-64 minutes). Systemic antibiotics were administered postoperatively (range, 11-46 days; mean, 23 days). Mean hospitalization was 11 days (range, 0-49 days). Follow-up was available for 7 (70%) horses. One year postoperatively, 5 (71%) horses were serviceable for their intended use, and 2 (29%) had been euthanatized. Of 5 survivors, 3 returned to ridden exercise, 1 was retired as a broodmare, and 1 was a broodmare. All owners were satisfied with the cosmetic appearance of the surgery site. CONCLUSION: Open drainage via tenosynoviotomy, performed as a salvage procedure, represents a feasible treatment for DFTS sepsis.

Concepts: Bacteria, Skin, Dermis, Ligament, Tendon, Subcutaneous tissue, Common flexor tendon, Sesamoid bone

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Solutions containing bacillus Calmette-Guérin (BCG), a live attenuated form of Mycobacterium bovis or Mycobacterium tuberculosis, commonly are injected intravesically to treat tumors of the urinary bladder. We report a case of acute mycobacterial flexor tenosynovitis in a health care worker who inadvertently inoculated her finger via needlestick while preparing BCG solution for intravesicular administration. She was treated successfully with immediate operative intervention followed by 6 months of antimycobacterial antibiotics. Of 3 previous reports of hand infections following self-inoculation with BCG solutions, this case is unique owing to rapid onset of acute mycobacterial flexor tenosynovitis and positive intraoperative mycobacterial cultures. Needlesticks with BCG-containing solutions, especially into the flexor tendon sheath, should be treated with timely surgical debridement and appropriate antimycobacterial management.

Concepts: Health care, Urinary bladder, Tuberculosis, Mycobacterium, Mycobacterium tuberculosis, Mycobacterium bovis, Bacillus Calmette-Guérin, Common flexor tendon

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To evaluate the results and complications of flexor tendon repair in which a home-based rehabilitation program was utilized without the assistance of a hand therapist during the first 4postoperative weeks.

Concepts: Computer program, Interpreter, Common flexor tendon

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Flexor tendon injury is common, and tendon reconstruction is indicated clinically if the primary repair fails or cannot be performed immediately after tendon injury. The purpose of the current study was to compare clinically standard extrasynovial autologous graft (EAG) tendon and intrasynovial allogeneic graft (IAG) that had both undergone biolubricant surface modification in a canine in vivo model.

Concepts: Comparison, In vivo, The Current, Comparisons, Tendon, Common flexor tendon, Allotransplantation

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Injuries to flexor tendons can be complicated by fibrotic adhesions, which severely impair the function of the hand. Adhesions have been associated with TGF-β1, which causes upregulation of PAI-1, a master suppressor of protease activity, including matrix metalloproteinases (MMP). In the present study, the effects of inhibiting PAI-1 in murine zone II flexor tendon injury were evaluated utilizing knockout (KO) mice and local nanoparticle-mediated siRNA delivery. In the PAI-1 KO murine model, reduced adherence of injured tendon to surrounding subcutaneous tissue and accelerated recovery of normal biomechanical properties compared to wild type controls were observed. Furthermore, MMP activity was significantly increased in the injured tendons of the PAI-1 KO mice, which could explain their reduced adhesions and accelerated remodeling. These data demonstrate that PAI-1 mediates fibrotic adhesions in injured flexor tendons by suppressing MMP activity. In vitro siRNA delivery to silence Serpine1 expression after treatment with TGF-β1 increased MMP activity. Nanoparticle-mediated delivery of siRNA targeting Serpine1 in injured flexor tendons significantly reduced target gene expression and subsequently increased MMP activity. Collectively, the data demonstrate that PAI-1 can be a druggable target for treating adhesions and accelerating the remodeling of flexor tendon injuries.

Concepts: Gene, Gene expression, Extracellular matrix, Injury, Tendon, Physical trauma, Concussion, Common flexor tendon

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Corrective shoeing is used to change hoof angulation with the intention to influence the angulation of the digital joints to reduce strain on associated tendons. The objective of this study is to examine how gradual changes in hoof angulation affect the dorsal metacarpophalangeal joint (DMPJ) angulation and cross-sectional areas (CSAs) of the deep digital flexor tendon (DDFT) and superficial digital flexor tendon (SDFT) concerning the individual toe conformation. Forelimbs of 30 horses were examined barefoot and equipped with 5°, 10° and 20° toe wedges (TWs) and heel wedges (HWs). Phalangeal angulation and lengths were measured in lateromedial radiographs of the digit. CSAs of both flexor tendons was calculated in sonographic images. Significant effects on the DMPJ and CSA of the DDFT/SDFT were measured with 10° and 20° HWs or 20° TWs. Both flexor tendons showed increasing CSA after heel elevation. Significant interindividual variations occurred. Phalangeal angulation and length influenced the responsivity of the parameters to a changed hoof angulation. Significant impact of corrective shoeing on the DMPJ and flexor tendons is related to a distinct change in hoof orientation and varies with individual toe conformation. Similar response of the DDFT and SDFT to raised and lowered hoof orientation needs further investigation for a more specific application of therapeutic shoeing.

Concepts: Knee, Change, Joints, Ligament, Tendon, Length, Toe, Common flexor tendon

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Substantial gap formation of a repaired finger flexor tendon is assumed to be harmful for tendon healing. The purpose of this study was to investigate the relationship between gap formation and the failure of the repair during cyclic loading.

Concepts: Collagen, Tendon, Common flexor tendon

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Progressive tendon adhesion is a major challenge in flexor tendon repair. The authors developed a bifunctional anti-adhesion scaffold and hypothesized that its application would reduce adhesion formation and deliver mesenchymal stem cells (MSCs) to enhance tendon healing. The scaffold was fabricated by an electrospinning machine before surface modification. The flexor tendons of 29 New Zealand rabbits underwent surgical repair and randomized to control, scaffold and scaffold loaded with MSC group. At 3 and 8 weeks post-surgery, range of motion (ROM), biomechanical properties, and histology were examined. There was no significant increase in ROM and biomechanical properties between the three groups. The histology showed successful delivery of MSCs but no significant difference in nuclear morphometry. This barrier delivers and retains MSCs within the tendon repair site. However, its sheet form and wrapping around the repair site may not be optimal for tendon healing. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2018.

Concepts: Collagen, Stem cell, Mesenchymal stem cell, Bone marrow, Stem cells, New Zealand, Tendon, Common flexor tendon

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The aim of this study was to evaluate the use of a single-portal endoscopic desmotomy of the PAL with the use of Arthrex - Centerline™. Ten horse distal front limbs from horses free of PAL disease were prepared for tenoscopy of the digital flexor tendon sheath (DFTS). A dual-port endoscopic desmotomy with a hook knife was performed in 5 specimens (Group A) and single port Arthrex-Centerline™ Desmotomy was performed in another 5 specimens (Group B). The performing time, judgments of the surgeon, number of blade passages, and gross anatomy were evaluated. The performing time and surgeon judgments were significantly lower in Group B. No significant differences were assessed in number of passages to achieve a complete PAL resection and a gross anatomy evaluation. The use of Arthrex-Centerline™ is feasible for a PAL desmotomy procedure. It was faster with more handling ease compared with the free-hand double-portal desmotomy and allowed the same results in terms of number of passages to complete the release evaluated at gross anatomy.

Concepts: Performance, Horse, Ligament, Tendon, Music, Group B, Common flexor tendon, Tendon sheath

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Penetrating trauma or lacerations within zone II of the flexor sheath may result in partial tendon injury. The proper management of this injury is controversial; the literature contains differing indications for surgical treatment and post-operative rehabilitation.

Concepts: Surgery, Injuries, Injury, Wound, Tendon, Traumatology, Penetrating trauma, Common flexor tendon