METHODS: Traumatic pediatric Achilles ruptures are rare, and few cases have been reported among patients with a history of Achilles tenotomy. A 17-year-old boy with a history of Achilles tenotomies for congenital clubfoot as an infant presented with acute midsubstance Achilles tendon rupture of the right leg. The gastrocnemius fascia was dissected to allow for approximation of the ruptured Achilles tendon segments. Furthermore, the plantaris tendon was harvested and sutured around the Achilles tendon-rupture site to improve strength.
CONCLUSIONS: Patients with a history of clubfoot and chronic Achilles tendon pain should be alerted to the risk of Achilles tendon rupture.

METHODS: We present a 67-year-old woman with long finger extrinsic extensor tightness and a 56-year-old man with limited index finger flexion due to extrinsic extensor tightness secondary to tendon transfers for radial nerve palsy. Both patients underwent prior surgical procedures that led to limited range of motion (ROM). Subsequently, they elected for central tendon tenotomy (CTT), which demonstrated postoperative ROM improvement and satisfactory patient outcomes.
CONCLUSIONS: Surgical management of extrinsic extensor tendon tightness of the hand is generally addressed by performing tenolysis to improve tendon excursion. We present a novel and simple technique of CTT with pertinent anatomy, descriptive cases, and a cadaveric video.

Traumatic brain injuries have the potential to cause the development of long-term complications. We aim to show that the use of flexor tenotomies in the treatment of flexion contractures following traumatic brain injury is a viable solution.

Adduction and internal rotation of the shoulder is a common presentation in post-stroke patients, and can often be caused by spasticity and musculotendinous retraction causing a contracture of the pectoralis major and minor muscles. A post cerebral arteriovenous malfunction rupture patient with severe refractory left shoulder spasticity with contracture was treated with cryoneurolysis to the medial and lateral pectoral nerves, combined with a percutaneous needle tenotomy to the pectoralis major tendon. There was an improvement in shoulder forward flexion, abduction and external rotation immediately and found sustained at 8 weeks by 50°, 45°, and 15°. The patient noted an immediate cessation of limitation of shoulder abduction, a liberation of range of motion of the shoulder, and looseness in their arm and shoulder. They reported a dramatic improvement in their gait, increased independence, and an improvement in overall quality of life in a structured interview 8 weeks after the procedure. The patient relayed a positive experience with the combined neuro-orthopedic procedure of cryoneurolysis and tenotomy for the treatment of their spastic shoulder. This combined treatment could be considered as a management strategy for patients experiencing shoulder spasticity with contracture.

Aplasia of the inferior rectus and inferior oblique muscles is extremely rare. Failure of the normal embryologic development of the inferior mesodermal complex can lead to agenesis of inferior rectus, inferior oblique, and lower sections of the lateral rectus muscles. This rare condition is usually seen in association with craniofacial syndromes or in conjunction with microcornea, microphthalmos, Axenfeld-Rieger syndrome, and coloboma. The usual treatment for this condition is a reverse Knapp procedure to improve the vertical alignment; however, this procedure can lead to complications, such as anterior segment ischemia, undercorrection, and torsional problems. To our knowledge, unilateral inferior rectus and inferior oblique muscle aplasia has not been described previously in a patient with congenital facial nerve palsy and optic nerve hypoplasia. In the present case, the patient was successfully treated with a modified minimally invasive horizontal rectus muscle transposition procedure.

UNASSIGNED: Congenital muscular torticollis is a benign affection defined as a contracture or fibrosis of the sternocleidomastoid muscle, causing ipsilateral inclination and contralateral rotation of the face and chin. The management is multidisciplinary, usually surgical and should start at very early age in infants to secure better results. Thus, the purpose of our study is to report the outcomes of delayed surgery performed in older children above 5 years old with late diagnosis.
METHODS: We report the cases of 4 patients aged between 5 and 11 years old and followed in our department for congenital torticollis. They were all born by vaginal delivery with vacuum extraction in two cases of breech presentation. Even if the condition is present at birth, most parents were not bothered by the cervical vicious neck position of their children until a later age, delaying the diagnosis. The clinical examination found a flexed head position on the right side in all cases, with contralateral rotation. Regarding the age, we proposed surgical treatment immediately for two of them, while two were sent to our department after multiple ineffective physiotherapy sessions. The surgery consisted on right distal tenotomy and a cervical collar was prescribed next to physiotherapy. They all had successful results with correction of head position and improvement of cervical range motion.
UNASSIGNED: Children treated early with active and well monitored rehabilitation, recover completely and regain normal head position and mobility rapidly. In older children, above 5 years, they are more likely to develop sequels such as asymmetry of facial movement.
CONCLUSIONS: Delayed diagnosis after the age of 5 years old still can be managed successfully with a correction of the head position and rotation motion. However, in these older children, physiotherapy alone cannot be effective and should be associated to surgery. Moreover, once the diagnosis is done, surgical treatment should be performed to avoid wasting more time.

To describe and analyze the surgical outcomes of transcanal endoscopic resection of the stapedial tendon (ST) and tensor tympani tendon (TT) in the management of middle ear myoclonus (MEM).
A retrospective case series.
Tertiary academic center.
Seven consecutive patients (seven ears) with tinnitus were diagnosed with MEM.
Transcanal endoscopic resection of both the ST and TT using either microinstruments or a laser.
The symptom of tinnitus, based on visual analog scale and Tinnitus Handicap Inventory scores, was analyzed preoperatively and postoperatively for each patient. The intraoperative findings and postoperative complications were also evaluated.
Amelioration of objective tinnitus with significant improvement in visual analog scale and Tinnitus Handicap Inventory scores was noted in all seven patients. The ST and TT were easily identified in the same endoscopic field, with minimal or no removal of the scutum. There was no need to perform an anterior tympanotomy to expose the TT. Resection of both the ST and TT and creating a gap between the cut edges were achieved by using either microinstruments or a laser under an endoscopic field. Conversion to or conjunction with the microscopic approach was unnecessary for any of the seven patients. No hearing loss or hyperacusis occurred postoperatively.
Transcanal endoscopic resection of the ST and TT successfully ameliorated the symptom of tinnitus in patients with MEM. A transcanal endoscopic approach provides an alternative method to manage MEM, providing excellent visualization and minimal invasiveness.

Fixed flexion deformity may accompany severe knee osteoarthritis in patients with long-standing pathology. This makes it difficult to achieve complete knee extension intraoperatively during total knee replacement surgery. Various options of treatment are available including preoperative serial knee extension and casting, intraoperative additional distal femoral resection to increase extension gap, and extensive soft tissue releases. We present this technique of on-table percutaneous medial hamstring tenotomy that we found helpful in achieving complete or near-complete knee extension intraoperatively, thereby minimizing the need for extensive bone resection and soft tissue dissection. An M is a 78-year-old man who presented with inability to walk for a 2-year duration due to pain and deformity of both knees. Complete clinical evaluation revealed the diagnosis of bilateral severe knee osteoarthritis with fixed flexion deformities. Ranges of knee motion were 90°-120° on the right and 80°-125° on the left. On-table percutaneous medial hamstring tenotomy + extension exercise under spinal anesthesia was carried out first and subsequently had posterior stabilized semi-constrained knee replacement. Knee extensions of 160° and 180° were achieved preoperatively after tenotomy and exercise and intraoperatively following distal cuts and soft tissue releases, respectively. This technique may be additive to various attempts at achieving adequate knee extension preoperatively for successful knee replacement. May be further evaluated to assess its effectiveness or otherwise to selected patients with severe flexion contractures undergoing primary total knee replacement.
Résumé Une déformation en flexion fixe peut accompagner une arthrose sévère du genou chez les patients présentant une pathologie de longue date. Cela rend difficile deobtenir une extension complète du genou en peropératoire lors d\'une arthroplastie totale du genou. Diverses options de traitement sont disponibles, y compris extension et moulage préopératoires du genou en série, résection fémorale distale supplémentaire peropératoire pour augmenter l\'écart d\'extension et extension douce libérations de tissus. Nous présentons cette technique de ténotomie percutanée des ischio-jambiers médiaux sur table que nous avons trouvée utile pour obtenir une ou une extension quasi-complète du genou en peropératoire, minimisant ainsi le besoin d\'une résection osseuse étendue et d\'une dissection des tissus mous. Un Mest un homme de 78 ans qui s\'est présenté avec une incapacité à marcher pendant une durée de 2 ans en raison de douleurs et d\'une déformation des deux genoux. Clinique complète l\'évaluation a révélé le diagnostic d\'arthrose sévère bilatérale du genou avec déformations fixes en flexion. Les amplitudes de mouvement du genou étaient de 90° à 120° à droite et 80°–125° à gauche. Une ténotomie percutanée des ischio-jambiers médiaux sur table + exercice d\'extension sous rachianesthésie a été réalisée en premier lieu puis a subi une arthroplastie totale du genou semi-contrainte postérieure stabilisée. Extensions du genou de 160° et 180° ont été réalisées en préopératoire après ténotomie et exercice et en peropératoire après des coupes distales et des libérations de tissus mous, respectivement. Cetechnique peut s\'ajouter à diverses tentatives pour obtenir une extension adéquate du genou avant l\'opération pour une arthroplastie réussie du genou. Peut être évalué plus avant pour évaluer son efficacité ou autrement chez des patients sélectionnés présentant des contractures sévères en flexion subissant une chirurgie primaire du genou remplacement. Mots-clés: Contracture en flexion, ténotomie des ischio-jambiers, arthroplastie totale primaire du genou.

暂无摘要。

UNASSIGNED: Pectoralis minor syndrome involves pain, paraesthesia and weakness in the arm due to compression of the brachial plexus passing beneath pectoralis minor; this paper reports the results of a single centre\'s treatment pathway in affected patients.
UNASSIGNED: During a four-year period, patients exhibiting symptoms of pectoralis minor syndrome without significant improvement following physiotherapy proceeded to Botulinum injection. Those with good response to injection but subsequent recurrence of symptoms were offered pectoralis minor tenotomy. Oxford shoulder Scores were collected at baseline and after interventions.
UNASSIGNED: Twenty-one patients received Botulinum injection; at six weeks following injection, mean change in Oxford Shoulder Score was +12.4, with only one patient reporting a worsening of symptoms. Of the 17 patients with clinically significant response to injection, 12 have subsequently undergone tenotomy; three months following tenotomy, mean change in Oxford Shoulder Score from baseline was +22.3. Improvement was maintained in all patients at prolonged follow-up (average 20 months post-tenotomy).
UNASSIGNED: This pathway has shown to be extremely effective in patients not responding to first-line treatment for pectoralis minor syndrome, with 85% of patients post-injection and 100% of patients post-tenotomy showing significant (greater than published minimal clinically important difference value of six points) improvements in Oxford Shoulder Score, maintained at follow-up.