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After carrying out 215 in vivo dissections, 65 of which were video-recorded, the authors propose that the current representation of the notion of the tendon sliding is incorrect. It is suggested that tendon sliding is explained by the existence of a mechanical adaptable multimicrovacuolar and fibrillar tissue. This tissue enables complete sliding without any dynamic influence on the surrounding tissues. The new theory is based on a polyhedric fibrillar framework, apparently chaotic and complex, subtending the microvacuolar gel, a concept that is to be found everywhere in the human body., (Copyright © 2012. Published by Elsevier SAS.)

Purpose of the Study: In clinical practice, it is generally accepted that hamstring tightness results in incomplete knee extension when the hip is in flexion and in smaller conventional and modified popliteal angles. Similarly, a difference between the conventional popliteal angle and the modified popliteal angle (popliteal differential) would be associated with a permanent deficit in knee extension. The purpose of this study was to determine whether these two hypothesis correlate with clinical findings., Material and Methods: The series was composed of 35 walking cerebral palsy children, 16 girls and 19 boys, mean age 11+/-3.6 years with a pathological conventional popliteal angle. These children walked using the jump knee (n=24) or the crouch knee (n=11) pattern. Permanent hip flexion and the conventional and modified popliteal angles were noted. SPSS version 10.1.3 for Window was used to search for a correlation between the popliteal differential and the presence of permanent hip flexion using several values for the popliteal differential (5, 10, 15, 20, and 30 degrees ). Data were adjusted for age and gender., Results: The statistical analyses demonstrated a significant relationship between the presence of permanent hip flexion and a popliteal differential strictly less than 10 degrees and between the absence of permanent hip flexion and a popliteal angle greater or equal to 10 degrees . These statistically significant results, which demonstrated the opposite of what was expected, were independent of age and gender., Discussion: Our findings demonstrate that examination of the knee joint is indispensable but insufficient. The conventional popliteal angle is not a reliable indicator of hamstring tightness. The normal value of the modified popliteal angle has not been established so that it is impossible to determine what a pathological angle is. We do not know whether measurement of this angle is sufficient to establish indications for surgery. In the future, the development of muscle models coupled with gait analysis should enable more reliable prediction of outcome after surgery. At the present time, we recommend repeated physical examination using a standardized protocol, taking into consideration, several parameters including spasticity, selectivity and muscle force and to perform quantified gait analysis before scheduling hamstring lengthening surgery for walking cerebral palsy children.

Tendons are extracellular matrix rich structures allowing the transmission of forces generated by skeletal muscles to bones in order to produce movements. Some intrinsic characteristics of tendons, namely hypovascularity and hypocellularity, may explain their slow rate of healing. A growing body of evidence suggests that the inflammatory process, essential for pathogen clearance and injury scavenging, may play opposite functions in tendon healing. For instance, inflammation can lead to degradation of intact collagen and to viable cell death, thereby increasing the functional deficit and recovery period. Paradoxically, many cellular and subcellular events occurring during the inflammatory response lead to the release of a plethora of growth factors that trigger the healing phase. Prostaglandins are implicated in the inflammatory process and may also contribute to the primary steps of tendon healing. Prolonged administration of non steroidal anti-inflammatory drugs (NSAIDs) is a common practice following musculoskeletal injuries. However, there is no clear consensus on the effect of NSAIDs on tendon healing. This review presents a contemporary vision of the inflammatory process following tendon injury and examines the roles of the constitutive and inducible COX-derived prostaglandins. The effect of COX inhibitors will be addressed and special attention will be taken to describe COX-independent effects of these pharmacological inhibitors. Together, this review is an attempt to guide readers toward a more conscientious use of NSAIDs following tendon injuries.

The mobility of our body structures is so intrinsic and natural to us that we tend to take it for granted. The very fact of being able to pinch your skin and lift it, then let it go and see it return to its initial shape and texture in just a few seconds may seem banal enough until you begin to think of all the elements involved. The same is true when you bend your fingers and think of the movement of the flexor tendon across the palm without external translation. For decades, scientists thought that the skin was simply an elastic structure with loose connective tissue and a more or less virtual space. However, in biomechanical terms, this explanation is very vague. These old concepts developed more than 50 years ago have evolved thanks to the impact of research at the microscopic level, and the global, mesospheric concept has been abandoned. And yet, surgical dissection in vivo demonstrates that there are only tissue connections, simply a histological continuum without any clear separation between skin and hypodermis, the vessels, the aponeurosis and the muscles. In fact, visible everywhere are structures, which ensure a gliding movement between the aponeurosis, the fat structures and the dermis. As they studied this system of gliding between the various organs, in particular at the level of the tendons, the authors noted the existence of a type of system composed of cables and veil-like structures that they term the Multimicrovacuolar Collagen Dynamic Absorption System (MCDAS). This system looks totally chaotic in organization and seems to function in a manner far removed from traditional mechanical structures. The functional unity of this sliding system is dependent upon a polyhedral three-dimensional crisscrossing in space of the microvacuoles, whose collagen envelope is type 1 or type 4 and whose content is made up of proteoglycoaminoglycans. The dynamic of this multimicrovacuolar system allows all of the subtle movements that occur within the body, thanks to its pre-stressed nature and the molecular fusion-scission-dilacerations that it is capable of. In this way, the system is mobile, can move quickly and interdependently, and is able to adapt is plasticity. This notion of microvacuoles is a fascinating one because it provides an explanation for the system's space-filling ability. The matter is composed of elements. However, although they seem to be arranged in a haphazard manner, this is not the case. In fact, they occupy space in an optimal manner. If we accept this notion of microvacuoles, then it becomes possible to explain certain pathologies occurring with age, such as edema, obesity, aging and inflammation. This sliding system is to be found everywhere in the body and would seem to be the basic network of tissue organization. For this reason, it should be thought of in global terms. Since it constitutes the inseparable link and occurs in all living structures and at many levels, could it be that it the basic architectural design of Life?

Tendinopathy and tendon rupture are the adverse effects observed with fluoroquinolone antibiotics in old patients. The aim of this study was to investigate the effect of anethole dithiolethione (5-[p-methoxyphenyl]3H-1,2-dithiole-3-thione) on the oxidative stress induced by three fluoroquinolones (pefloxacin, ofloxacin, ciprofloxacin) incubated with rabbit tenocyte cell line. Anethole dithiolethione is a well known antioxidant and glutathione inducer. Anethole dithiolethione is widely used in human therapy for its choleretic, sialogogic properties and recently proposed as cytoprotective agent in lung precancerous lesions prevention in smokers. In this purpose, protection against oxidative stress induced by fluoroquinolones has been assessed using cytofluorimetric probes to quantify cytotoxicity and reactive oxygen species production. Fluorescence signal was quantified in 96-well microplates, using cold light cytofluorometer. Significant reactive oxygen species production was detected after 45 minutes for all fluoroquinolones tested. Anethole dithiolethione has been evaluated on this parameter. Anethole dithiolethione significantly (*: P<0.05) reduces and normalizes reactive oxygen species induced by fluoroquinolones. So, anethole dithiolethione (Sulfarlem), well known for its antioxidant and glutathione inducing properties, good tissue diffusion and good tolerance in humans, could be beneficially associated to fluoroquinolones, and be proposed as a therapeutic adjuvant to prevent oxidative stress and tendinous adverse effects induced by xenobiotics and more precisely by fluoroquinolones.

Flexor tendon pulley has been very early noticed and described. Terminology usually accepted recognizes 6 arcifom pulleys (A0 to A5) and 3 cruciform pulleys (C1 to C3). Anatomy and physiology of this flexor tendon gliding and reflection system at the level of the digital sheet are exposed. The integrity necessity of this system became obvious regarding the flexor tendons repair. Four main pathologies may be concerned: the trigger finger congenital or progressive, due to a chondroid metaplasia of the A1 pulley; tenosynovial ganglions arising at the weak point between A1 and A2 pulley; lesions of the flexor tendon sheet during traumatic lacerations or surgical repairs; quite experimental lesions creating isolated ruptures of one or several pulleys which occur during sport practice, especially high level rock climbing. The repair techniques are exposed to allow to graduate and hierarchy the reparation technique regarding the pathology. A2 and A4 repair is always indicated. The best reconstruction material is an extensor retinaculum graft. But its poor surface available often draws to use conventional palmaris longus free graft.

This article is concerned with two distinct corporeal logics. In the first, corporeality is founded on joints, tendons, and mobility; in the second, the envelope and its apertures are considered primordial. The first logic is extant in very few works. Although these texts (e.g. The Iliad, Beowulf) clearly share the same, very specific, conception of the body, they belong to different histories. The corporeal logic of the 'jointed body' (corps articulaire) cannot, therefore, be appraised in terms of longue durée. The texts represent, instead, a moment of transition between the psychodynamics of orality and literacy. A problem correlated to this fact is that readers (ancient and modern) no longer think using the same logic as that pertaining to the jointed body. They tend to translate information regarding the logic of the jointed body into data meaningful in their own logic.

Introduction: The extensor tenodesis is a direct dynamic tenodesis which is activated by wrist flexion due either to hand weight or flexor carpi radialis. This tenodesis is usually performed to the distal radius, but it is possible to fix EDC (extensor digitorum communis) to the retinaculum extensorum., Material and Methods: Biomechanical study concerned 12 anatomical subjects (24 wrists). The biometric and radiological analysis of retinaculum displacement distalwards was made under low (1 kg) and moderate (6 kg) pulling. Surgical clips were placed on the proximal and distal limits of the retinaculum in order to study their positions on roentgenograms., Results: Average width of the retinaculum was 19 mm. Average movement under 1 kg drive was 6 mm and 8.6 mm under 6 kg drive. X-rays showed that the proximal border of the retinaculum was always located proximally to the wrist rotate centre, whatever the traction., Discussion: We found the same anatomical features described by different authors, except for the width of the retinaculum. Our study suggests that the retinaculum is strong enough to support a surgical tenodesis.

The main risks in case of extensor tendon laceration are firstly, the possibility of misdiagnosis, and secondly the occurrence of adhesions which can compromise the excursion of the extensor apparatus. Extensor tendon lesions at the dorsum of the wrist and hand have a better prognosis regarding the postoperative results than lesions at the finger level. Protected early mobilisation methods represent a real advance in the postoperative management of extensor tendon lesions.

The most widely used dynamic extension systems, both to straighten the digital flexion retractions as well as to ensure directed mobilization after surgical repair of extensor tendons, are the so-called "Levame" and "Low Profile" splints. This study analysed the application of forces for these two types of extension splints, the directional constraints which they impose and freedom of joint movement which they allow in order to more clearly define the type of motorization to be used as a function of the most frequent indications.

The electric stimulation is widely used in flexor tenolysis rehabilitation by the authors. Since 1983 implantable electrodes were used during the operative procedure. Actually they gave better access to the deep muscles (Flexor Profundus of the index), better specificity, less dysesthesia of the skin. Further more they allowed to tests the quality of the tenolysis without wrist incision. This procedure gave 76% of good or very good results over 25 finders in 20 patients. The results were especially good for the index finger which is usually unable to be stimulated by the surface electrodes and for the fingers badly damaged. In this type of situation prognostic was getting better (70% of good and very good results).

Eleven superficial aponeuroses have been examined in order to study their biomechanical and structural properties. Specimens were taken from 5 fresh cadavers, 3 males, 2 females with a mean age between 40 and 60 years. The study was done by two methods: biomechanical and histological. Aponeuroses can be classified in 2 biomechanical and histological groups that match perfectly. The first group has biomechanical and histological properties similar to those of tendons, and the second group similar to those of tendons, and the second group similar to those of ligaments. Ignoring the biomechanical and histological properties of tendons, ligaments and aponeuroses can be the cause of failure of a number of ligament and tendon plasties. The surgeon has an important role in choosing the transplants according to the histological properties (thickness, length of structures, bundle orientation) and biomechanical properties (solidity and extensibility).

In flexor tendon surgery, the main concern of hand surgeons in the last two decades has been to find an effective and reproducible means to avoid post-operative adhesions. For most authors, these adhesions were responsible for the bad results. Since 1960, a constant progress has been achieved with the progress in operative procedures and the better understanding of tendon healing process. Post-operative rehabilitation, especially Kleinert's and Duran's active and passive methods, have radically transformed the prognosis of fresh tendon lesions. In spite of all this progress, zone II tendon injuries are still a difficult problem. In this clinical study, we wanted to introduce two new orientations in order to improve the overall results, the use of human fibrin sealant instead of the epitendinous running suture and an improvement of Duran's technique, developed by the Bichat rehabilitation team since 1987. Seventy-seven tendon lesions treated according to our technique (55 fingers and 22 thumbs) between 1987 and 1991, were reviewed. All the lesions studied were in zone II and T II. The mean follow-up is 14.4 months. The evaluation is based on the International Federation of Hand Surgery score for fingers, and the Tubiana score for thumbs. 74% of fingers and 86% of thumbs were scored as good and excellent.

Despite the histological knowledge acquired from light and electron microscopy and the deeper studies devoted to the composition of tendons, we are still unable to draw practical conclusions concerning the treatment of tendinitis. Experimental in vivo studies and biochemical studies are still too far from physiological conditions to be useful in the traumatology of tendons. They have, however, the merit to provide better theoretical basis and to persuade doctors specialized in sport not to disregard these date.

Isolated contraction of several motor units can excite a single tendon organ. Although the rate of receptor discharge may be different for each motor unit, it is not related to the tension. During repetitive stimulation of a motor unit at increasing frequency the receptor discharge reaches a maximum at rates below fusion frequency for that motor unit.

Emergency treatment of flexor tendon lesion in 1988: anatomic biomechanical and healing characteristics. Flexor tendon surgery in 1988 must take into account detailed anatomic knowledge as well as healing and biomechanical properties of flexor tendons. Application of standardised surgical technics allows reliable treatment when the surgeon is familiar with these technics and the basic knowledge they suppose. The authors detail the technics and certain details with practical goals.

The author is critical of the usual methods of evaluating the results after suturing of the flexor tendons. The methods in general based on active articular mobility of the finger, do not take into account the condition of the hand examined, and are not precise on taking the measurements. He proposes a method which is simple and more objective for it is based on the measurement of the total function of the finger compared to that of the same finger on the other hand. The results, expressed in percents, are classified into three groups (A, B, C) whose limits vary whether the lesion is an isolated one of the deep flexor tendon or of the both flexors.

The authors present a methodical study concerning traction strength of the ligaments and the periarticular tendons of the knee. The straining potential and the mechanical strength of these elements are made clear. This study permits applications in chronic laxities of the knee by giving the mechanical value of the different kinds of tendon reconstruction.

The mechanical requirements before satisfactory muscular balance in a total wrist prosthesis have been studied in 25 cadavers. The centre of rotation was determined in X-Rays; it was localised in the sagittal plane crossing the axis of the forearm and in the frontal plane situated in front of the axis of the forearm. A graphic model of the wrist was then established. A total prosthesis was then designed, made up of two components with a torus surface. This prosthesis was found to be compatible with the wrist model. Movement required forces only slightly greater than normal muscular activity. One male was operated on using this prosthesis. The result was satisfactory after one year.

The splint proposed here is designed for patients undergoing extensive tenolysis of the long fingers in zone 5. Based on the anatomy, the principle of this splint is to place the flexor tendons of one finger in a short position and its neighbour in a long position and vice versa. This promotes the formation of "long" adhesions allowing independent movement of each finger.

Initial feasibility studies of glutaraldehyde-stabilized bovine pericardium show promise for use in hand surgery. The pericardium exhibits excellent handling characteristics with no obvious biologically adverse reactions. Testing in the experimental models show a decrease in adhesion formation and an increase in tendon gliding. Clinical use of the bovine pericardium in selected cases appears to be confirm the experimental results.

The authors discuss the collagen biomechanical properties. Firstly they recall the technical devices used in biomechanics and the mechanical data usually explored. Next, they review the mechanical properties of the various collagens found in tendons, joints, bone, vascular walls, skin and pulmonary alveoli.

Each fibrous structure of the wrist has been studied by elastometric methods. These lead to a classification superposable to the functional classification. They show up the big mechanical differences between to tendons and but to ligaments. The former are 3 to 5 times as solid, but 3 to times less extensible than the latter. These are divided into 3 groups the more fragile as much as they are stretchable. The aponeuroses have their place between tendons and ligaments, but their properties are very closer to the latter.