1. The normal vascular anatomy of flexor tendons and extensor tendons in the hind limb of the rabbit is outlined. A marked difference between a tendon in a sheath and a tendon with a paratenon is shown, the latter having a much better blood supply.

2. The vascular reaction in flexor tendon divided within a sheath is shown.

3. The revascularisation of free grafts is illustrated and the differences between tendon with sheath and tendon with paratenon are detailed.

4. Experiments are reported to show that the microcirculation within a "vascular" tendon can support a pedicle graft in the rabbit. Such pedicle grafts are shown to be inferior to free grafts of "avascular" tendon, but the vascularity within the pedicle tendon graft may be modified by "blocking" the surface with silastic tubing.

5. The implications of this work on tendon grafting are discussed, together with a review of additional experimental work in related fields.

1 . A case of haemangioma arising in the tendons of the extensor pollicis longus and extensor pollicis brevis muscles of a twenty-seven-year-old woman is described.

2. The etiology of the lesion is discussed, together with a brief review of the literature.

1. Tendon possesses an active potential for repair and remodelling.

2. Large defects made in the flexor tendons of rabbits showed tenoblastic activity and repair without the formation of adhesions.

3. The failure to show this intrinsic ability for repair in previous studies may have been influenced by adverse factors introduced in order to hold the cut tendon ends together.

This experiment demonstrates that infiltration of hydrocortisone into rabbit calcaneal tendons has a direct effect on the tendon, producing necrosis of collagen at the site of injection. The repair of the lesion so produced is incomplete even after eight weeks, and is often complicated by dystrophic calcification. Similar morphological changes may account for spontaneous rupture of tendons in patients receiving steroid infiltration.

1. A case of bilateral spontaneous and simultaneous rupture of the quadriceps tendons is described.

2. The underlying cause was found to be gouty affection of the tendons.

3. So far as is known, a similar case has not previously been recorded.

1. This clinical investigation compares the results with varying periods of immobilisation after the primary repair of extensor tendons over the metacarpo-phalangeal joints of the fingers.

2. One hundred and thirty-seven Bantu mine workers with such injuries were each splinted for either one day, ten days or three weeks, and the results were compared.

3. The results indicate that the optimum period of splintage is ten days.

1. Three patients are described in whom forward dislocation of the peroneal tendons was associated with a chip fracture of the lateral malleolus and forward dislocation of the tendons through the fracture.

2. This injury differs from the more usual simple anterior dislocation of the peroneal tendons in which rupture of the superior peroneal retinaculum allows the dislocation to occur.

3. A simple operation is described which succeeded in holding reduced the dislocated tendons by suturing the fractured small chip of bone back to the lateral malleolus.

The blood supply of the flexor and extensor tendons of the fingers is described. The blood-vascular system consists of main feeding channels which supply a longitudinal network of vessels. These lie in the interfascicular connective tissue.

A variation of the typical intratendinous vascular pattern in relation to the proximal interphalangeal joint is described.

1. The case notes of 140 patients with a total of 297 severed long flexor tendons in the thumb and fingers have been analysed.

2. Fifty-seven patients in whom tendon reconstructive surgery was performed have been examined and the results have been recorded by three methods.

3. Methods of assessing finger and tendon function are reviewed and discussed. Accuracy and precision in tendon repair should be followed by an accurate and precise evaluation of tendon, joint and finger function.

4. A method of assessing the function is described. This is expressed as a percentage of the function of the uninjured contralateral finger.

1 . The principles and technique of flexor-extensor tendon transfers for claw toes are described. The operation is tedious, but it is effective in selected cases.

2. Sixty-eight patients have been operated upon and followed up; good results were obtained in fifty, fair results in eleven, and poor in seven. More careful selection and better operative technique might have avoided some of the failures.

3. The operation restores useful function to the toes at the cost of their prehensile action, diminishes any cavus deformity of the foot, and, by lessening the prominence of the metatarsal heads in the sole, avoids callosities and discomfort.

1. Multiple barbed sutures made from nylon are described and the theoretical advantages with the use of the nylon are outlined.

2. Methods of joining tendon stumps using the multiple barbed sutures are illustrated and in vitro tests show that the anchorage of this suture in cadaveric and canine flexor tendons is of the same order.

3. Preliminary in vivo tests where the flexor digitorum profundus tendon of dogs have been repaired with multiple barbed sutures show that it maintains apposition of the tendon stump as effectively as the Bunnell "buried core" technique using G 40 stainless steel wire.

4. The multiple barbed suture is an experimental suture for certain compact tendons capable of giving a neat and relatively atraumatic junction. It requires further study and development. It does not appear to make tendon repair technically easier, nor does it alter the indications for operation or management.

1. Bony spurs resulting from erosion of the scaphoid bone and trapezium in rheumatoid arthritis can pierce the floor of the carpal tunnel and cause attrition rupture of flexor tendons–most often the flexor pollicis longus tendon.

2. It is difficult to show these spurs on conventional radiographs, but using a special tomographic technique we have been able to explore the floor of the carpal tunnel in three planes. Using this technique we have been able to guard the flexor pollicis longus against attrition rupture by early excision of a spur from the scaphoid bone.

3. Our findings support the recommendation of free division of the flexor retinaculum in rheumatoid arthritis. When doing this the surgeon should always look for a bony spur piercing the floor of the carpal tunnel.

Aims

The traditional transosseus flexor hallucis longus (FHL) tendon transfer for patients with Achilles tendinopathy requires two incisions to harvest a long tendon graft. The use of a bio-tenodesis screw enables a short graft to be used and is less invasive, but lacks supporting evidence about its biomechanical behaviour. We aimed, in this study, to compare the strength of the traditional transosseus tendon-to-tendon fixation with tendon-to-bone fixation using a tenodesis screw, in cyclical loading and ultimate load testing.

Lateral epicondylitis, or ’tennis elbow’, is a common condition that usually affects patients between 35 and 55 years of age. It is generally self-limiting, but in some patients it may continue to cause persistent symptoms, which can be refractory to treatment. This review discusses the mechanism of disease, symptoms and signs, investigations, current management protocols and potential new treatments.

Cite this article: Bone Joint J 2013;95-B:1158–64.