Mr Henry Atkinson, Consultant Lower Limb Surgeon, has been lecturing internationally and pioneering the internal bracing technique, and has been expanding its indications to now also include tendon augmentation.
Internal bracing has now been successfully used in many scenarios in both the ankle and knee, including the ankle lateral ligament complex (ATFL), the deltoid and spring ligaments and syndesmosis complex; as well as for all the major knee ligaments including the ACL, PCL, MCL, LCL, anterolateral ligament (ALL), and medial patellofemoral ligament (MPFL).
Internal bracing augments the tissues using a 2mm fibertape which is then docked into the bony attachments using swivelocks. This construct acts as a checkrein and has tensile and torque properties superior to the native tissues, which allow early mobilisation. Fibertape itself is versatile, strong, safe and biocompatible, while at the same time having low rates of tissue cut-through.
Its use in Achilles repair and Quadriceps ruptures has transformed the surgical outcomes, ensuring the restoration of the musculo-tendinous lengths and providing a repair which is at least three times as strong as a conventional repair. This technique allows early weight bearing and mobilisation which in turn accelerates healing, minimises muscle wasting and pain, and restores function. It also reduces the risks of VTE, which are associated with prolonged immobilisation in plaster casts, boots and braces. Henry has found that these patients are hitting their rehabilitation milestones significantly earlier, with reductions in recovery times by as much as 50%, and faster and safer returns to sport.
These are intraoperative and clinical pictures of a 78 year old man with a quadriceps rupture, showing the devastating multiplanar rupture with significant tendon retraction, treated with internal bracing with a return to active 0-90 flexion at 4 weeks post-operatively; and a 32 year old man with a tendoachilles rupture treated with internal bracing demonstrating active single and double stance heel raise at 8 weeks post-operatively (with permission).
Quadriceps tendon rupture
Tendoachilles rupture
For more information please contact Henry’s secretary Suzy at London Sports Orthopaedics on 08445 617121.