Rev. bras. ortop. vol.49 número5

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r e v b r a s o r t o p . 2014;49(5):528–531

w w w . r b o . o r g . b r

Original

Article

Use

of

the

semitendinosus

tendon

for

foot

and

ankle

tendon

reconstructions

夽

,

夽夽

Frederico

Lutti

Guerra

de

Aguiar

Zink

a,∗

_,

_Danilo

_Glória

_Mendonc¸a

a

_,

_Cintia

_Kelly

_Bittar

a

_,

José

Luís

Amim

Zabeu

a

_,

_Osny

_Salomão

b

_,

_Antonio

_Egydio

_de

_Carvalho

_Junior

c

_,

Marcelo

Tarso

Torquato

d

_,

_Décio

_Cerqueira

_de

_Moraes

_Filho

e

a_Servic¸o_de_Ortopedia_e_{Traumatologia,}_Pontifícia_Universidade_Católica_de_Campinas_{(PUC-Campinas),}_Campinas,_SP,_Brazil

b_Departamento_de_Ortopedia_e_{Traumatologia,}_Universidade_de_São_Paulo_(USP),_São_Paulo,_SP,_Brazil

c_Departamento_de_Ortopedia_e_{Traumatologia,}_Universidade_Estadual_de_Campinas_(UNICAMP),_Campinas,_SP,_Brazil

d_Servic¸o_de_Ortopedia_e_{Traumatologia,}_Hospital_de_Base_de_Bauru,_Bauru,_SP,_Brazil

e_Servic¸o_de_Ortopedia_e_{Traumatologia,}_Faculdade_de_Medicina_de_Marília_(FAMEMA),_Marília,_SP,_Brazil

a

r

t

i

c

l

e

i

n

f

o

Articlehistory:

Received8August2013 Accepted16September2013 Availableonline13August2014

Keywords:

Achillestendon/injuries Achillestendon/surgery Tendons

Foot Ankle

Reconstruction

a

b

s

t

r

a

c

t

Objective:Todemonstratetheresultsobtainedfromfootandankletendonreconstructions usingthetendonofthesemitendinosusmuscle.Theclinicalresults,thepatient’sdegreeof satisfactionandcomplicationsinthegraftdonorandrecipientareaswereevaluated.

Methods:Thiswasaretrospectivestudyinwhichthemedicalfilesof38patientswho under-wentthissurgicalprocedurebetween2006and2010weresurveyed.Thefunctionalresults fromthistechnique,thecomplicationsinthedonorandrecipientareasandthepatients’ degreeofsatisfactionwereevaluated.

Results:Threepatientspresentedcomplicationsintherecipientarea(skinnecrosis);one patientshowedcomplicationsinthedonorarea(painandinsensitivity);andallpatients hadsatisfactoryfunctionalresults,withcompleterangeofmotion.

Conclusion:Thesemitendinosusmuscleisagoodoptionfortreatmentsforfootandankle tendoninjuries.

Uso

do

tendão

semitendíneo

em

reconstruc¸ões

tendíneas

do

pé

e

do

tornozelo

Palavras-chave:

TendãodeAquiles/lesões

r

e

s

u

m

o

Objetivo:Demonstrarosresultadosobtidosnasreconstruc¸õestendíneasdopéedotornozelo comousodotendãodomúsculosemitendíneo.Foramavaliadososresultadosclínicos,

夽

WorkdevelopedattheCelsoPierroHospitalandMaternityHospital,PontificalCatholicUniversity,Campinas,SP,Brazil.

夽夽

Pleasecitethisarticleas:ZinkFLGDA,DGMendonc¸aDG,BittarCK,ZabeuJLA,SalomãoO,deCarvalhoJuniorAE,etal.Usodotendão semitendíneoemreconstruc¸õestendíneasdopéedotornozelo.RevBrasOrtop.2014;49(5):528-31.

∗ _{Corresponding}_author_.

E-mail:[email protected](F.LuttiGuerradeAguiarZink).

http://dx.doi.org/10.1016/j.rboe.2013.09.001

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rev bras ortop.2014;49(5):528–531

529

TendãodeAquiles/cirurgia Tendões

Pé Tornozelo Reconstruc¸ão

ograudesatisfac¸ãodopacienteeascomplicac¸õesdaáreadoadoraereceptoradoenxerto.

Métodos: Estudoretrospectivoem queforamlevantadososprontuáriosde38pacientes submetidosaesseprocedimentocirúrgicoentre2006e2010eavaliadososresultados fun-cionaisdessatécnica,ascomplicac¸õesdasáreasdoadoraereceptoraeograudesatisfac¸ão dospacientes.

Resultados: Três apresentaram complicac¸ões da áreareceptora (necrose de pele),um complicac¸ãodaáreadoadora(doreinsensibilidade)etodostiveramresultadosfuncionais satisfatórioscomarcodemovimentocompleto.

Conclusão:Omúsculosemitendinosoéumaboaopc¸ãodetratamentoparalesõestendinosas dopéetornozelo.

Introduction

Use of the tendon of the semitendinosus muscle in knee ligament reconstruction surgery is well established in the literature.1_It_is_now_also_used_as_a_treatment_option_for surgi-calreconstructionoffootandankletendons.2,3

Footandankletendontearsoccurmostfrequentlybetween the third and fifth decades of life, although they can occuratanyage, withclearpredominanceofcasesamong men. It is believed that the frequency of these injuries is highernowadaysbecauseofbetterphysicalconditioningand increased sports practice among middle-aged and elderly individuals. The etiology and treatment of these injuries continues to be a matter of controversy in the orthope-dic literature. Currently, there isno preferentialtreatment method.

Amongtheoptionsforsurgicaltreatment,methods involv-ingprimarysuturingandreconstructionsusingthefollowing tendonshavebeencited:shortfibularmuscle,4,5_long_fibular muscle,6_gracilis_muscle,_long_flexor_muscle_of_the_hallux7_and semitendinosusmuscle.2,3

Theaimofthe present studywas toevaluatethe func-tionalresultsobtainedfromtreatingpatientswhounderwent tendonreconstructionsurgerywithagraftfromthetendon ofthesemitendinosusmuscle,emphasizingtheincidenceof complicationsinthegraftdonorandrecipientareasandthe patients’degreeofsatisfaction.

Materials

and

methods

Thirty-eightpatientswithadiagnosisofacuteor degenera-tivefootorankletendontearsbetween2006and2010were selected.Age,sex,tendonaffected,typeofinjuryand com-plicationswereanalyzed.Patientswithdiabetesmellitusand vasculardiseaseswereexcluded.Themeanlengthof follow-upwastwoyears.

This study used the questionnaire of the American OrthopaedicFootandAnkleSociety(AOFAS),whichanalyzes dataonpain,limitationofactivities,needforsupport,walking distanceandwalking abnormalities,sagittalmobility, hind-footmobility,anklestability,hindfootstabilityandhindfoot alignment.

Results

Amongthe38patientsselected,27presentedinjuriesofthe calcanealtendonandninepresentedinjuriesoftheanterior tibialtendon.Intwocases,theseinjurieswereassociatedwith thelongextensorofthetoes;inonecase,withthelong exten-sorofthehallux;andinonecase,withboththelongextensor ofthetoesandthelongextensorofthehallux.Onepatient presentedinjurytothefibulartendons(shortandlong)and one,injurytothetendonofthelongextensorofthetoes.

Threepatientswhounderwentreconstructionofthe cal-canealtendonpresentedcomplicationsofthereceptorarea (7.8%):superficialskinnecrosis,deepnecrosisanddehiscence ofthescar.Onlyonepatientpresentedcomplicationsofthe donorarea(2.6%),whichwerereportedaspainand insensitiv-ity.Thereconstructionsoftheothertendonsdidnotpresent complications.

Theclinical–functionalresultsobtainedthroughtheAOFAS scaleaftertheoperationweresimilartothosefoundinthe lit-erature,withameanof90points(variationfrom81to92).8–10

Themeanlengthoffollow-upwastwoyears.

By the end ofthe study period, all ofthe patients had resumed their recreational and professionalactivities with completerangesofmotion,exceptfortwocasesthatevolved unsatisfactorily(5%)(Table1).

Discussion

Thepredominantagegroupinthepresentstudywas concord-antwithdataintheliterature.Therewere28patientsaged between30and50years11_and_trauma_was_the_main_cause oftheinjuries.Thetendonmostaffectedwasthecalcaneal tendon(71%).

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rev bras ortop.2014;49(5):528–531

Table1–Generaldataonthepatientswhounderwenttendonreconstruction.

Patients Age Sex Tendonaffected RAC DAC DS Typeofinjury

1 47 M CT No No S Trauma

3 65 M CT No No S Degenerative

4 62 F CT No No S Trauma

5 47 F CT No No S Trauma

8 38 M CT Yes No S Trauma

9 34 M CT Yes No D Trauma

10 15 M AT No No S Trauma

12 67 M AT No No S Degenerative

13 61 M AT No No S Degenerative

14 26 M LET No No S Trauma

15 28 M AT+LET No No S Trauma

16 26 M AT+LET+LEH No No S Trauma

18 37 M AT+LET No No S Trauma

19 19 M AT+LEH No No S Trauma

25 59 M FC+FL No No S Degenerative

28 48 M CT No Yes S Trauma

29 36 M CT Yes No D Degenerative

CT,calcanealtendon;AT,anteriortibialtendon;LET,longextensorofthetoes;LEH,longextensorofthehallux;FL,fibular;RAC,receptorarea complication;DAC,donorareacomplication;DS,degreeofsatisfaction;S,satisfied;D,dissatisfied.

forexample,anevertorisusedto performplantarflexion. Thistypeoftransferislessfunctional,accordingtothe ten-dontransferrules,andpartiallossofeversionforcecanbe observed.

ItshouldbenotedthatMafullietal.,2,3 _used_transfers_of thetendonofthesemitendinosusmuscletorepairinjuriesof thecalcanealtendonwithadistancebetweenthestumpsof greaterthan6cmandobtainedgoodresults.

Inourstudy,thepercentageofcomplications(10.5%)was lessthanwhatwasdescribedbyKrueger-Franketal.Although thelatterauthorsachievedgoodresultsfromtendon recons-tructions,theyhadahighercomplicationrate(15.1%).12

The importance of the tendon of the semitendinosus muscle for walking, running or jumping is well known. Nonetheless,itsuseinkneeligamentreconstructioniswell established and no functional losses in its absence are observed.1

Mostofthepatientspresentedexcellentresultsandeven those withresultsthat were considered good were able to

returntotheiractivitieswithoutrestrictions.Thelatterwere thusclassifiedonlybecauseofcomplicationsrelatingtothe operativewound.Norepetitionsoftearsinthereconstructed tendonswereobservedduringthefollow-upperiod.

Conclusion

Incasesoffootorankletendontears,functionalrestoration can beachievedbymeansofreconstructionusingthe ten-donofthesemitendinosusmuscle.Thistechniquepresents advantagesinrelationtoothersdescribedpreviouslyinthe literature.Mostofthepatientspresentedexcellentor good results.

Conflicts

of

interest

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