Providing Quantitative Feedback When Teaching Tendon Repair: A New Tool

Flexor tendon repair remains one of the more difficult technical tasks facing the hand surgeon. A good repair must be both strong and able to glide smoothly through the tendon sheath. The purpose of this study is to present a model that allows surgeons to improve their technique of flexor tendon repair by receiving feedback on these important biomechanical parameters. The set-up requires testing equipment found in most biomechanical laboratories and should be available in many academic medical centres. Preliminary data suggest that receiving feedback about the strength and smoothness of a flexor tendon repair may be a very useful tool in helping surgeons improve the overall quality of their tendon repair technique.

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The Direct Midlateral Approach with Lateral Enlargement of the Pulley System for Repair of Flexor Tendons in Fingers

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(96)80047-7 ◽

1996 ◽

Vol 21 (4) ◽

pp. 463-468 ◽

Cited By ~ 12

Author(s):

A. MESSINA ◽

J. C. MESSINA

Keyword(s):

Flexor Tendon ◽

Skin Flap ◽

Tendon Repair ◽

Tendon Sheath ◽

Flexor Tendon Repair ◽

Anterior Compartment ◽

Pulley System ◽

Neurovascular Pedicle ◽

Anchoring System ◽

Palmar Skin

The direct midlateral approach and the lateral enlarging procedure of the pulley system have been utilized in our service since 1972. The incision runs directly behind the neurovascular pedicle, which is left in the palmar skin flap of the anterior compartment of the finger, in order to ensure its blood supply and sensibility. The transverse digital lamina of Landsmeer’s skin anchoring system and Cleland’s ligament are preserved and are used to perform a lateral enlargement of the pulleys after tendon repair. The technique allows wide surgical exposure of the digital fibro-osseous tunnel, enlargement and reconstruction of the pulley system and tendon sheath, flexor tendon repair (using the technique of choice) and reduces postoperative impingement in zone 2.

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Elbow Common Flexor Tendon Repair Technique

Arthroscopy Techniques ◽

10.1016/j.eats.2019.07.016 ◽

2019 ◽

Vol 8 (11) ◽

pp. e1367-e1371

Author(s):

Rami George Alrabaa ◽

Julian Sonnenfeld ◽

David Trofa ◽

Christopher Ahmad

Keyword(s):

Flexor Tendon ◽

Tendon Repair ◽

Flexor Tendon Repair ◽

Repair Technique

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Efficacy of Adcon-T/N After Primary Flexor Tendon Repair in Zone II: A Controlled Clinical Trial

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(02)00249-8 ◽

2003 ◽

Vol 28 (2) ◽

pp. 113-115 ◽

Cited By ~ 58

Author(s):

A. GOLASH ◽

A. KAY ◽

J. G. WARNER ◽

F. PECK ◽

J. S. WATSON ◽

...

Keyword(s):

Clinical Trial ◽

Flexor Tendon ◽

Tendon Repair ◽

Tendon Sheath ◽

Control Group ◽

Controlled Clinical Trial ◽

Flexor Tendon Repair ◽

Double Blind ◽

Active Motion ◽

Zone Ii

A prospective double-blind, randomized, controlled clinical trial was conducted to assess the use of ADCON-T/N after flexor tendon repair in Zone II. Forty-five patients with 82 flexor tendon repairs in 50 digits completed the study. ADCON-T/N was injected into the tendon sheath after tenorrhaphy in the experimental group while the control group was not treated with ADCON-T/N. ADCON-T/N had no statistically significant effect on total active motion at 3, 6 and 12 months but the time taken to achieve the final range of motion was significantly shorter in treated patients. ADCON-treated patients had a higher rupture rate but this was not significant.

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LENGTHENING THE LOCKING LOOP REPAIR FOR ZONE 2 FLEXOR TENDON LACERATION AND PARTIAL LATERAL RELEASE OF THE TENDON SHEATH

Hand Surgery ◽

10.1142/s0218810409004359 ◽

2009 ◽

Vol 14 (02n03) ◽

pp. 125-129 ◽

Cited By ~ 6

Author(s):

Hithoshi Hatanaka ◽

Tetsuo Kojima ◽

Tomoyuki Miyagi ◽

Tomoyuki Mizoguchi ◽

Yoshifumi Ueshin

Keyword(s):

Clinical Outcomes ◽

Flexor Tendon ◽

Full Range ◽

Tendon Repair ◽

Tendon Sheath ◽

Lateral Release ◽

Flexor Tendon Repair ◽

Loop Technique ◽

Tendon Laceration

The authors present the clinical outcomes of nine zone 2 flexor tendon repairs using a locking loop technique (i.e. the Modified Pennington technique). The locking loops were located approximately 10 mm away from the lacerated tendon ends to "lengthen" the locking loop repair, as experimentally and clinically recommended. The partial lateral release of the tendon sheath, including the A2 and/or A4 pulley, was performed not only to locate the sutures but also to allow a full range of motion of the repair without catching on the tendon sheath, as clinically recommended. All the patients were followed up for six months or more except for one. All digits were evaluated as excellent or good at the final follow-up by the original Strickland criteria. No rupture occurred and no bowstring of the flexor tendon was observed. The clinical outcomes of the current study indicate that "lengthening" the locking loop repair is effective for zone 2 flexor tendon repair and that the partial lateral release of the tendon sheath, including the A2 and/or A4 pulley, does not result in the bowstring of the flexor tendon.

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A Knotless Flexor Tendon Repair Technique Using a Bidirectional Barbed Suture

Plastic & Reconstructive Surgery ◽

10.1097/01.prs.0000388768.94275.66 ◽

2010 ◽

Vol 126 ◽

pp. 46-47 ◽

Cited By ~ 1

Author(s):

W. Thomas McClellan ◽

Matthew J. Schessler ◽

David S. Ruch ◽

L. Scott Levin ◽

Richard D. Goldner

Keyword(s):

Flexor Tendon ◽

Tendon Repair ◽

Barbed Suture ◽

Flexor Tendon Repair ◽

Repair Technique

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A Biomechanical Comparison of 3 Loop Suture Materials in a 6-Strand Flexor Tendon Repair Technique

Yearbook of Hand and Upper Limb Surgery ◽

10.1016/j.yhls.2013.02.035 ◽

2013 ◽

Author(s):

J.B. Tang

Keyword(s):

Flexor Tendon ◽

Tendon Repair ◽

Suture Materials ◽

Flexor Tendon Repair ◽

Repair Technique ◽

Biomechanical Comparison

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Influence of Core Suture Material and Peripheral Repair Technique on the Strength of Kessler Flexor Tendon Repair

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(03)00080-9 ◽

2003 ◽

Vol 28 (4) ◽

pp. 357-362 ◽

Cited By ~ 46

Author(s):

V. MISHRA ◽

J. H. KUIPER ◽

C. P. KELLY

Keyword(s):

Cyclic Loading ◽

Suture Material ◽

Flexor Tendon ◽

Tendon Repair ◽

Flexor Tendon Repair ◽

Flexor Tendons ◽

Repair Technique ◽

Nylon Suture ◽

Load To Failure ◽

The Cross

The purpose of our study was to determine the most favourable combination of core suture material and peripheral repair technique for Kessler tendon repair. Thirty freshly thawed pig flexor tendons were repaired by a Kessler technique, either with braided polyester or monofilament nylon suture. A peripheral augmentation was done using one of the three techniques – running, cross-stitch and Halsted. All repairs were tested by cyclic loading, followed by load-to-failure. During cyclic loading six of the 15 tendons with a nylon core failed, but none with a braided polyester core. Irrespective of peripheral technique, the monofilament nylon core suture allowed early central cyclic gapping, resulting in failure of the repair. During load-to-failure testing, the running stitch proved weakest and the cross-stitch repair toughest.

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A Biomechanical Comparison of 3 Loop Suture Materials in a 6-Strand Flexor Tendon Repair Technique

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2012.06.008 ◽

2012 ◽

Vol 37 (9) ◽

pp. 1830-1834 ◽

Cited By ~ 37

Author(s):

Aaron W.T. Gan ◽

Puay Yong Neo ◽

Min He ◽

Andrew K.T. Yam ◽

Alphonsus K.S. Chong ◽

...

Keyword(s):

Flexor Tendon ◽

Tendon Repair ◽

Suture Materials ◽

Flexor Tendon Repair ◽

Repair Technique ◽

Biomechanical Comparison

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Asymmetric 6-Strand Flexor Tendon Repair – Biomechanical Analysis Using Barbed Suture

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835519500371 ◽

2019 ◽

Vol 24 (03) ◽

pp. 297-302

Author(s):

Jasmin Shimin Lee ◽

Yoke-Rung Wong ◽

Shian-Chao Tay

Keyword(s):

Tensile Strength ◽

Ultimate Tensile Strength ◽

Flexor Tendon ◽

Tendon Repair ◽

Biomechanical Analysis ◽

Barbed Suture ◽

Flexor Tendon Repair ◽

Barbed Sutures ◽

Repair Technique ◽

Nylon Suture

Background: This study investigates the biomechanical performance of the Asymmetric flexor tendon repair technique using barbed suture. The Asymmetric repair technique using monofilament nylon suture was previously reported to have a higher tensile strength than the modified Lim-Tsai repair technique, but its repair stiffness and load to gap force were significantly lower. There is hence an unmet need to improve this technique and the substitution of nylon suture with barbed sutures may be the solution. Methods: Two groups consisting of 10 porcine tendons each were repaired with the six-strand Asymmetric repair technique using V-Loc® 3-0 and Supramid® 4-0 respectively. The repairs were subjected to a mechanical tester for static testing. The ultimate tensile strength, load to 2 mm gap force, repair stiffness, time taken to complete a repair and failure mechanism of the repairs were recorded and analyzed. Results: All the repairs using V-Loc® 3-0 sutures had significantly higher median values of ultimate tensile strength (64.1 N; 56.9 N), load to 2 mm gap force (39.2 N; 19.7 N), repair stiffness (6.4 N/mm; 4.7 N/mm) and time taken to complete a repair (9.4 mins; 7.7 mins). All the repairs using V-Loc® sutures failed by suture breakage while 80% of repairs using Supramid® sutures failed by suture pullout. Conclusions: The use of the barbed sutures in the Asymmetric repair technique, whilst more time consuming, has shown promising improvement to its biomechanical performance (i.e. better ultimate tensile strength, stiffness and resistance to gap formation).

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