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Over the last 50 years tendon transfer surgery for tetraplegic patients has been improved by various working groups for special hand surgery. This type of surgery is intended to achieve greater independence for seriously disabled patients. The function of the upper extremities including the hands is grouped according to an international classification depending on residual movement patterns and innervated muscles. This classification is essential for planning tendon transfer surgery. Other factors such as spasticity, contractures or the patient’s motivation should be taken into account for decision-making. Success depends on cooperation within the treating team (physician, physiotherapist, occupational therapist). The number of cases we have treated is small, results have been good and the level of patient satisfaction is high. The goal is to extend application of this surgical method in Germany for special cases of tetraplegia with the level of injury from CV4/5–CV6/7 (CV: cervical vertebrae). These patients achieve greater independence with key-grip and elbow extension. [ABSTRACT FROM AUTHOR]

The use of barbed sutures in tendon repair and reconstruction is advantageous because it allows for a knotless suturing technique. In this biomechanical study, we compared barbed sutures with conventional sutures in tendon transfers using the Pulvertaft weave technique in a human cadaveric model. Thirty human cadaveric finger flexor tendons were transected and divided into three groups of ten tendons, which were then reconstructed by the Pulvertaft weave technique using 3-0 Prolene (Ethicon, Inc., Somerville, NJ, USA), 3-0 Ethilon (Ethicon, Inc., Somerville, NJ, USA) or 3-0 V-Loc (Covidien Deutschland GmbH, Neustadt, Germany) sutures. Biomechanical testing showed that repairs in the V-Loc group had significantly greater ultimate tensile strength and stiffness than conventional sutures. The time taken to complete the weave and the length of sutures used were also the least in the V-Loc group. Our study has shown that the barbed suture has a better biomechanical performance than conventional suture types when used in the Pulvertaft weave technique.

Aim: Reconstruction of insufficient anterior cruciate ligament (ACL) has become a standard operative procedure. Still, graft choice and fixation technique are discussed controversially. The objective of this study was to ascertain the current treatment of ACL reconstruction in german orthopedic surgery and trauma centers., Methods: A total of 250 trauma and 220 orthopedic surgery centers were asked for their treatment strategy and postoperative procedure of ACL reconstruction in an anonymous German-wide survey., Results: 230 questionnaires (48.9 %) were returned for evaluation. 90.4 % of the surgeons reconstruct the anterior cruciate ligament. Patellar tendon is used by 73 % of orthopedists and 80.7 % of trauma surgeons. Reconstruction with semitendinosus tendon transplant is performed by 71.6 % of the orthopedists and 41.6 % of trauma surgeons. For tibial fixation the interference screw is as well of the semitendinosus tendon as of the patellar tendon the most common technique. In about 30 % each the femoral fixation results from interference screw and endo-button., Conclusion: There is still no generally accepted intra- and postoperative strategy for reconstruction of ACL. Reconstruction with semitendinosus tendon becomes more common.