Biomechanical Evaluation of a Four-Strand Modification of the Tang Method of Tendon Repair

2005 ◽  
Vol 30 (4) ◽  
pp. 374-378 ◽  
Author(s):  
Y. CAO ◽  
J. B. TANG
Keyword(s):  
Ultimate Strength ◽  
Testing Machine ◽  
Tendon Repair ◽  
Gap Formation ◽  
Single Cycle ◽  
Tensile Testing Machine ◽  
Load To Failure ◽  
Biomechanical Evaluation ◽  
Finger Motion ◽  
Initial Force

We report a four-strand modification of the Tang technique of tendon repair that uses fewer sutures and fewer knots on the tendon surface. This repair consists of four longitudinal and two horizontal strands that form a “U” configuration within the tendon made with a single looped suture. Thirty-four fresh pig flexor tendons were divided into 3 groups and repaired with the four-strand modified Tang method, a double-looped four-strand method or a double Kessler repair (four-strand). The tendons were subjected to a single cycle of load-to-failure test in a tensile testing machine. The initial force, 2-mm gap formation force and ultimate strength of the four-strand modified Tang repair were statistically identical to those of the double looped suture and were superior to those of the double Kessler repair. Ultimate strength was 43.4 ± 4.3 N for the four-strand modified Tang method, 45.2 ± 4.0 N for the double-looped method and 39.1 ± 4.0 N for the double Kessler repair. The four-strand modification of the Tang method appears to have strength sufficient for protected active finger motion. Given our preliminary clinical experience with this method, we recommend this new and simplified technique for clinical flexor tendon repairs.

Repairs of Partial Oblique Tendon Injuries: A Biomechanical Evaluation

2004 ◽  
Vol 29 (4) ◽  
pp. 381-385 ◽  
Author(s):  
J. TAN ◽  
L. MING ◽  
Z.J. JIA ◽  
J.B. TANG
Keyword(s):  
Ultimate Strength ◽  
Cross Section ◽  
Testing Machine ◽  
Transverse Cross Section ◽  
Flexor Digitorum Profundus ◽  
Gap Formation ◽  
Tensile Testing Machine ◽  
Load To Failure ◽  
Biomechanical Evaluation ◽  
Flexor Digitorum

This study evaluated the tensile properties of oblique partial tendon lacerations and the effects of peripheral sutures on their strength. Seventy-four fresh pig flexor digitorum profundus tendons were divided into eight groups and were transected across 90% of their diameter. The lacerations in the tendons of five of the groups were at 0°, 15°, 30°, 45°, and 60° to their transverse cross-section, respectively. In the other three groups the lacerations were 0°, 45°, and 60° to the cross-section and were repaired with running peripheral sutures. The tendons were subjected to load-to-failure tests in a tensile testing machine to determine the initial, 1 and 2 mm gap formation forces, and the ultimate strength. Obliquity of tendon lacerations affected the strength of partially lacerated tendons. The tendons with 45° and 60° oblique lacerations had a significantly lower ultimate strengths than those with transverse (0°), or 15° or 30° oblique lacerations. Running peripheral sutures significantly increased both the gap formation forces and the ultimate strength of the tendons with oblique partial lacerations.

Comparison of Postoperative Early Active Mobilization and Immobilization in Vivo Utilising a Four-Strand Flexor Tendon Repair

2001 ◽  
Vol 26 (4) ◽  
pp. 301-306 ◽  
Author(s):  
A. WADA ◽  
H. KUBOTA ◽  
K. MIYANISHI ◽  
H. HATANAKA ◽  
H. MIURA ◽  
...  
Keyword(s):  
Ultimate Strength ◽  
Flexor Tendon ◽  
Testing Machine ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Gap Formation ◽  
Flexor Tendon Repair ◽  
Tensile Testing Machine ◽  
Active Mobilization

We evaluated a technique of four-strand double-modified locking Kessler flexor tendon repair in healing tendons. Seventy-two canine flexor digitorum profundus tendons in Zone 2 were repaired and evaluated following either active mobilization or immobilization at 0, 7, 14, 28 and 42 days after surgery. Fifty-six tendons were examined for gap and ultimate strength using a tensile testing machine and 16 were evaluated with standard hematoxylin and eosin, and Masson’s trichrome staining. All tendons healed without rupture or gap formation of more than 1 mm, thus demonstrating that this repair technique has enough tensile strength to withstand early active mobilization. The gap and ultimate strength of actively mobilized tendons did not decrease significantly during the first 7 days, and were significantly greater than those of immobilized tendons throughout the 42-day study period. Actively mobilized tendons healed without the extrinsic adhesions and large tendon calluses that were found in immobilized tendons.

Dorsal-Enhanced Sutures Improve Tension Resistance of Tendon Repair

2002 ◽  
Vol 27 (2) ◽  
pp. 161-164 ◽  
Author(s):  
Y. CAO ◽  
R. G. XIE ◽  
J. B. TANG
Keyword(s):  
Ultimate Strength ◽  
Tensile Testing ◽  
Testing Machine ◽  
Tendon Repair ◽  
The Other ◽  
Dorsal Part ◽  
Gap Formation ◽  
Tensile Testing Machine ◽  
Finger Flexion ◽  
Main Components

Thirty-six fresh pig flexor tendons were repaired using either the modified Kessler method or the Tang method. Nine tendons from each group were tested in an Instron tensile testing machine with the tendons passing 90° around a pulley. The other nine tendons from each group were pulled linearly by the testing machine. The 2mm gap formation force of the tendons repaired with the modified Kessler and Tang methods and pulled at 90° were 64%±5% and 79%±9% respectively of those forces recorded during linear testing. The ultimate strengths of tendons repaired by the modified Kessler and Tang methods and pulled at 90° were 76%±6% and 81%±8% respectively of the forces measured during linear testing. The percentage gap formation and ultimate strength of the Tang method was significantly higher than that of the modified Kessler suture when the tendons were pulled around a pulley. This demonstrates that the Tang suture, with its main components in the dorsal part of the repaired tendon, has greater tension resistance capacity than conventional tendon sutures which are placed in the middle of the tendon. This study suggests that dorsally-enhanced multiple tendon sutures are better placed to sustain the tension generated during active finger flexion.

scholarly journals A Biomechanical Comparison of a Limited Open and Standard Open Technique for Achilles Tendon Rupture Repair

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Robert Dekker ◽  
Charles Qin ◽  
Cort Lawton ◽  
Muturi Muriuki ◽  
Robert Havey ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Achilles Tendon ◽  
Open Repair ◽  
Achilles Tendon Rupture ◽  
Testing Machine ◽  
Tendon Repair ◽  
Lower Limbs ◽  
Gap Formation ◽  
Load To Failure ◽  
Biomechanical Comparison

Category: Basic Sciences/Biologics, Sports Introduction/Purpose: The drive to reduce soft tissue complications after Achilles tendon repair has led to increased interest in less invasive techniques. The PARS Achilles Jig System is one option that has gained popularity as an alternative to open repair. For many surgeons, standard open repair consists of a Krackow locking-loop technique. We compared the load to failure of a limited open and open Krackow technique for repair of Achilles tendon ruptures. Methods: Nine pairs of human cadaver lower limbs were randomized to undergo either a Krackow locking loop repair with epitendinous weave or a PARS Achilles Jig System Repair. Specimen were loaded to failure on a servo-hydraulic material testing machine. From load- displacement curves, initial linear stiffness, load to failure, and work to failure were calculated. Results: The average load to failure for Krackow repair (353.8 ± 88.8 N) and PARS repair (313.3 ± 99.9 N) was not statistically different (p = .38). The average work to failure for open repair (6.4 ± 2.3 J) and PARS repair (6.3 ± 3.5 J) was also not statistically different (p = .904). Mean initial linear stiffness of the Krackow repair (17.8 ± 5.4 N/mm) was significantly greater than the PARS repair (11.8 ± 2.5 N/mm) (p = .011). The predominant location of failure for Krackow repair was at the suture itself. In contrast, the PARS repair predominantly failed at the suture-tendon interface. Conclusion: The results suggest no difference between the Krackow and PARS repairs in terms of ultimate strength or work to failure. The Krackow repair demonstrated a higher initial linear stiffness than the PARS, which may imply a greater ability to withstand gap formation. With less devitalization to surrounding soft tissue and equal repair strength, the PARS system should be considered a favourable option for repair of ruptured Achilles tendons.

The consistency and reliability of six-strand and four-strand flexor tendon repairs: a comparative porcine cadaveric study

2022 ◽  
pp. 175319342110665
Author(s):  
Jaakko A. E. Kuronen ◽  
Benjamin Riski ◽  
Olli V. Leppänen ◽  
Teemu Karjalainen ◽  
Lasse Linnanmäki
Keyword(s):  
Flexor Tendon ◽  
Testing Machine ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Gap Formation ◽  
Load To Failure ◽  
Level Of Experience ◽  
Flexor Digitorum ◽  
Material Testing Machine ◽  
Technical Reliability

The aim of this study was to compare the consistency and reliability of the six-strand Gan modification of the Lim-Tsai flexor tendon repair with the four-strand Adelaide repair, both with 3-0 sutures and with eight to ten runs of simple 5-0 running peripheral suture as well as the influence of the surgeons’ level of experience on the strength of the repair in a cadaveric animal setup. Thirty-nine surgeons repaired 78 porcine flexor digitorum profundus tendons with either the Adelaide technique (39 tendons) or the modified Lim-Tsai technique (39 tendons). Each repaired tendon was tested in a material testing machine under a single cycle load-to-failure test. The forces were recorded when the gap between the two tendon stumps reached 1 and 2 mm and when irreversible elongation or total rupture occurred. We found no significant differences in gap formation force and yielding strength of the tendons between the two methods. The surgeon’s previous experience in tendon repairs did not improve the consistency, reliability or tensile strength of the repairs. We conclude that if a strong peripheral suture is added, the modified Lim-Tsai repair has the same technical reliability and consistency as the Adelaide repair in term of ultimate loading strength in this test setup.

Increased Suture Embedment in Tendons: An Effective Method to Improve Repair Strength

2002 ◽  
Vol 27 (4) ◽  
pp. 333-336 ◽  
Author(s):  
B. WANG ◽  
J. B. TANG
Keyword(s):  
Tensile Strength ◽  
Tensile Properties ◽  
Ultimate Strength ◽  
Tensile Testing ◽  
Testing Machine ◽  
Gap Formation ◽  
Tensile Testing Machine ◽  
Flexor Tendons ◽  
Important Contributor ◽  
Complete Failure

We evaluated the effect of length of suture embedment within tendons on the tensile strength of repaired tendons. Thirty fresh pig flexor tendons were divided into three groups and subjected to repairs with the Halsted tendon sutures in which 1/3, 1/2, and 2/3 of the length of the longitudinal sutures was embedded within the tendons. The repaired tendons were pulled to complete failure by an Instron tensile testing machine. The 2 mm gap-formation force, ultimate strength, stiffness, and energy to failure were greatest when 2/3 of the suture length was embedded within the tendon. The results indicate that suture embedment is an important contributor to the tensile properties of the repair, and that increase in length of suture embedment is an effective way to strengthen tendon repairs.

scholarly journals A Biomechanical Comparison of Limited Open Versus Krackow Repair for Achilles Tendon Rupture

2017 ◽  
Vol 2 (4) ◽  
pp. 247301141771543 ◽  
Author(s):  
Robert G. Dekker ◽  
Charles Qin ◽  
Cort Lawton ◽  
Muturi G. Muriuki ◽  
Robert M. Havey ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Tendon Repair ◽  
Lower Limbs ◽  
Gap Formation ◽  
Postoperative Rehabilitation ◽  
Significant Difference ◽  
Load To Failure

Background: Soft tissue complications after Achilles tendon repair has led to increased interest in less invasive techniques. Various limited open techniques have gained popularity as an alternative to open operative repair. The purpose of this study was to biomechanically compare an open Krackow and limited open repair for Achilles tendon rupture. We hypothesized that there would be no statistical difference in load to failure, work to failure, and initial linear stiffness. Methods: A simulated Achilles tendon rupture was created 4 cm proximal to its insertion in 18 fresh-frozen cadaveric below-knee lower limbs. Specimens were randomized to open or limited open PARS Achilles Jig System repair. Repairs were loaded to failure at a rate of 25.4 mm/s to reflect loading during normal ankle range of motion. Load to failure, work to failure, and initial linear stiffness were compared between the 2 repair types. Results: The average load to failure (353.8 ± 88.8 N vs 313.3 ± 99.9 N; P = .38) and work to failure (6.4 ± 2.3 J vs 6.3 ± 3.5 J; P = .904) were not statistically different for Krackow and PARS repair, respectively. Mean initial linear stiffness of the Krackow repair (17.8 ± 5.4 N/mm) was significantly greater than PARS repair (11.8 ± 2.5 N/mm) ( P = .011). Conclusion: No significant difference in repair strength was seen, but higher initial linear stiffness for Krackow repair suggests superior resistance to gap formation, which may occur during postoperative rehabilitation. With equal repair strength, but less soft tissue devitalization, the PARS may be a favorable option for patients with risk factors for soft tissue complications.

Changes in Tendon Strength After Partial Cut and Effects of Running Peripheral Sutures

2003 ◽  
Vol 28 (5) ◽  
pp. 478-482 ◽  
Author(s):  
J. TAN ◽  
B. WANG ◽  
B. TAN ◽  
Y. XU ◽  
J. B. TANG
Keyword(s):  
Tensile Strength ◽  
Tensile Properties ◽  
Ultimate Strength ◽  
The Other ◽  
Flexor Digitorum Profundus ◽  
Gap Formation ◽  
Load To Failure ◽  
Flexor Digitorum ◽  
Lower Tensile Strength

We performed a study to evaluate the tensile properties of partial tendon lacerations and the effects of peripheral sutures on the tendon strength. Seventy-two fresh pig flexor digitorum profundus tendons were divided equally into eight groups. Tendons in four of the groups were subjected to partial lacerations (60%, 70%, 80%, and 90%) and were not repaired. In the other four similar groups partial lacerations were repaired with running peripheral sutures. The tendons were subjected to load-to-failure tests in an Instron tensile machine to determine the initial, 1 mm, 2 mm gap formation forces and the ultimate strength. The tendons with lacerations of 80% and 90% had a remarkably lower tensile strength than those 60% and 70% lacerations. Running peripheral sutures increased the gap formation forces and the ultimate strength of all the tendons, though particularly those with 80% and 90% lacerations.

scholarly journals Biomechanical evaluation of self-cinching stitch techniques in rotator cuff repair: The single-loop and double-loop knot stitches

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 293-298
Author(s):  
Stephan Frosch ◽  
Gottfried Buchhorn ◽  
Fabian Kück ◽  
Tim Alexander Walde ◽  
Wolfgang Lehmann ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Ultimate Load ◽  
Double Loop ◽  
Gap Formation ◽  
Tendon Tissue ◽  
Single Loop ◽  
Load To Failure ◽  
Biomechanical Evaluation ◽  
Cuff Repair

Abstract In rotator cuff repair, strong and reliable suturing is necessary to decrease failure rates. The biomechanics of two self-cinching stitches – the single-loop knot stitch (SLKS) and the double-loop knot stitch (DLKS) – and the modified Mason-Allen stitch (mMAS) were compared. Twenty-seven porcine infraspinatus tendons were randomized among the three stitches. Each was cyclically loaded (10–80–200 N for 50 cycles each) while the gap formation was measured. Next, ultimate load to failure was tested. The gap widths after cyclic loading were 8.72 ± 0.93 mm for the DLKS, 8.65 ± 1.33 mm for the mMAS, and 9.14 ± 0.89 mm for the SLKS, without significant differences. The DLKS showed the highest ultimate load (350.52 ± 38.54 N) compared with the mMAS (320.88 ± 53.29 N; p = 0.304) and the SLKS (290.54 ± 60.51 N; p < 0.05). The DLKS showed similar reliability and better strength compared with the mMAS, while the SLKS showed a slight but not significant decrease in performance. In our experience, the DLKS and SLKS have clinical advantages, as they are easy to perform and the self-cinching loop knot allows the surgeon to grasp degenerative tendon tissue. Initial intraoperative tightening of the suture complex (preloading) before locking is important in order to decrease postoperative elongation.

Flexor tendon pulley V–Y Plasty: an Alternative to Pulley Venting or Resection

2006 ◽  
Vol 31 (2) ◽  
pp. 133-137 ◽  
Author(s):  
E. DONA ◽  
W. R. WALSH
Keyword(s):  
Flexor Tendon ◽  
Testing Machine ◽  
Tendon Repair ◽  
Partial Resection ◽  
Attractive Alternative ◽  
Custom Made ◽  
Load To Failure ◽  
A2 Pulley ◽  
Active Mobilization

Zone 2 flexor tendon repairs can require “venting” or partial resection of the A2 and/or A4 pulleys. We propose and biomechanically assess a technique used by the authors in which the A2 and A4 pulleys are divided and repaired using a V–Y plasty. Two groups of cadaveric fingers were used, one group for assessing the A2 pulley and the second for assessing the A4 pulley. Prepared fingers were mounted onto custom-made jigs, tested using a servohydraulic testing machine and assessed for load to failure. The loads obtained were 75N (SD = 26N) and 234N (SD = 73N) for the A4 and A2 pulleys, respectively. These loads are well in excess of those one would anticipate during a postoperative active mobilization protocol. Tendon pulley V–Y plasty creates a mechanically sound pulley and maintains sufficient cover of the underlying tendon. This technique provides access to perform a tendon repair and/or permits free tendon gliding post-repair, thus providing an attractive alternative to simply “venting”, or resecting, an otherwise troublesome pulley.

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