Effect of Suture Knots on Tensile Strength of Repaired Canine Flexor Tendons

1995 ◽  
Vol 20 (1) ◽  
pp. 72-75 ◽  
Author(s):  
M. AOKI ◽  
D. L. PRUITT ◽  
H. KUBOTA ◽  
P. R. MANSKE
Keyword(s):  
Tensile Strength ◽  
Ultimate Tensile Strength ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Repair Site ◽  
Flexor Tendons ◽  
The One ◽  
Flexor Digitorum

59 dog cadaver flexor digitorum profundus tendons were repaired with one or two knots inside or outside the tendon, using two, four and six suture strands. The ultimate tensile strength and gap strengths were compared. Locating the knots outside rather than within the tendon repair site showed significantly higher ultimate tensile strength for two, four, and six strand sutures. The strength was greater in one knot than in two knot sutures; the value of the six-strand suture using the one knot outside technique was the greatest. Similarly, increased gap strength was also obtained from the one-knot-outside technique. We concluded that the knots should be located away from the tendon repair site and there should be as few as possible.

An Exploratory Study Using Semi-Tabular Plate in Zone II Flexor Tendon Repair

2018 ◽  
Vol 23 (04) ◽  
pp. 547-553 ◽  
Author(s):  
Yoke-Rung Wong ◽  
Ita Suzana Mat Jais ◽  
Min-Kai Chang ◽  
Beng-Hai Lim ◽  
Shian-Chao Tay
Keyword(s):  
Tensile Strength ◽  
Ultimate Tensile Strength ◽  
Coefficient Of Friction ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Flexor Tendon Repair ◽  
Flexor Tendons ◽  
Custom Made ◽  
Zone Ii

Background: This study evaluated the feasibility of using a low-profile titanium (Ti) plate implant, also known as the Ti-button, for Zone II flexor tendon repair. We hypothesize that the use of the Ti-button can distribute the tensile force on the digital flexor tendons to achieve better biomechanical performance. Methods: Twenty lacerated porcine flexor tendons were randomly divided into two groups and repaired using Ti-button or 6-strand modified Lim-Tsai technique. Ultimate tensile strength, load to 2 mm gap force, and mode of failure were recorded during a single cycle loading test. We also harvested twelve fingers with lacerated flexor digitorum profundus tendons from six fresh-frozen cadaver hands and repaired the tendons using either Ti-button method or modified Lim-Tsai technique. A custom-made bio-friction measurement jig was used to measure the gliding resistance and coefficient of friction of the tendon sheath interface at the A2 pulley. Results: The ultimate tensile strength, load to 2 mm gap force, stiffness, and gliding resistance of the Ti-button repairs were 101.5 N, 25.7 N, 7.8 N/mm, and 2.2 N respectively. Ti-button repairs had significantly higher ultimate tensile strength and stiffness than the modified Lim-Tsai repair. However, Ti-button also increased the gliding resistance and coefficient of friction but there was no significant difference between the two repair techniques. Conclusions: Ti-button repair displayed comparable mechanical properties to the traditional repair in terms of 2-mm gap formation and gliding resistance, but with a stronger repair construct. Thus, this deepened our interest to further investigate the potential of using Ti-button implant in Zone II flexor tendon repair by studying both the mechanical and biochemical (tendon healing) properties in more in-depth.

Biomechanical comparison of the Lim/Tsai tendon repair with a modified method using a single looped suture

2017 ◽  
Vol 42 (9) ◽  
pp. 915-919 ◽  
Author(s):  
Min Kai Chang ◽  
Yoke Rung Wong ◽  
Shian Chao Tay
Keyword(s):  
Tensile Strength ◽  
Ultimate Tensile Strength ◽  
Mechanical Performance ◽  
Tendon Repair ◽  
Original Method ◽  
Flexor Digitorum Profundus ◽  
Loading Test ◽  
Modified Method ◽  
Cycle Loading ◽  
The Difference

The Lim/Tsai tendon repair technique has been modified clinically to achieve a 6-strand repair using a single looped suture with one extratendinous knot. We compared biomechanical performance of the original and modified methods using 20 porcine flexor digitorum profundus tendons. The ultimate tensile strength, load to 2 mm gap force, mode of failure, and time taken to repair each tendon were recorded during a single cycle loading test in 10 tendons with each repair method. We found that despite having the same number of core strands, the single looped suture modified Lim/Tsai technique possessed significantly greater ultimate tensile strength and load to 2 mm gap force. Also, less repair time was required. We conclude that the modified 6-strand repair using a single looped suture has better mechanical performance than the original method. The difference likely was due to the changes in locations of the knots and subsequent load distribution during tendon loading.

Flexor Tendon Repair Using a Stainless Steel Internal Anchor

1998 ◽  
Vol 23 (1) ◽  
pp. 37-40 ◽  
Author(s):  
L. GORDON ◽  
M. TOLAR ◽  
K. T. VENKATESWARA RAO ◽  
R. O. RITCHIE ◽  
S. RABINOWITZ ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Stainless Steel ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Flexor Tendon Repair ◽  
Active Flexion ◽  
Active Range Of Motion ◽  
Flexor Digitorum

We have developed a stainless steel internal tendon anchor that is used to strengthen a tendon repair. This study tested its use in vitro to produce a repair that can withstand the tensile strength demands of early active flexion. Fresh human cadaver flexor digitorum profundus tendons were harvested, divided, and then repaired using four different techniques: Kessler, Becker or Savage stitches, or the internal tendon anchor. The internal splint repairs demonstrated a 99–270% increase in mean maximal linear tensile strength and a 49–240% increase in mean ultimate tensile strength over the other repairs. It is hoped that this newly developed internal anchor will provide a repair that will be strong enough to allow immediate active range of motion.

Sonographic study of repair, gapping and tendon bowstringing after primary flexor digitorum profundus repair in zone 2

2018 ◽  
Vol 43 (5) ◽  
pp. 480-486 ◽  
Author(s):  
Lisa Reissner ◽  
Nadja Zechmann-Mueller ◽  
Holger Jan Klein ◽  
Maurizio Calcagni ◽  
Thomas Giesen
Keyword(s):  
Clinical Outcomes ◽  
Ultrasound Examination ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Level Of Evidence ◽  
Repair Site ◽  
Heterotopic Ossifications ◽  
Finger Motion ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

We report sonographic findings with clinical outcomes after zone 2 flexor digitorum profundus tendon repairs in ten fingers. The tendons underwent a six-strand M-Tang core repair, no circumferential suture, and partial or complete division of the pulleys. Over 12 months after surgery and using ultrasound, we found no gapping at the repair site during finger motion. When the pulleys were divided, there was sonographic evidence of tendon bowstringing, but the bowstringing was minimal. Clinically, we did not find any fingers that displayed tendon bowstringing or had functional loss. With ultrasound examination, the repaired tendons remained enlarged over 12 months. Two patients developed heterotopic ossifications at the repair site without tendon gliding, and these required tenolysis. We conclude that the tendon repair site does not gap when a strong core suture is used in the repair without adding peripheral sutures. There is no notable tendon bowstringing clinically, though the repaired tendons have sonographic evidence of minor bowstringing. Level of evidence: III

Simplifying four-strand flexor tendon repair using double-stranded suture: a comparative ex vivo study on tensile strength and bulking

2012 ◽  
Vol 37 (2) ◽  
pp. 101-108 ◽  
Author(s):  
T. H. Low ◽  
T. S. Ahmad ◽  
E. S. Ng
Keyword(s):  
Tensile Strength ◽  
Flexor Tendon ◽  
Ex Vivo ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Flexor Tendon Repair ◽  
Significant Difference ◽  
Load To Failure ◽  
Fresh Frozen ◽  
Flexor Digitorum

We have compared a simple four-strand flexor tendon repair, the single cross-stitch locked repair using a double-stranded suture (dsSCL) against two other four-strand repairs: the Pennington modified Kessler with double-stranded suture (dsPMK); and the cruciate cross-stitch locked repair with single-stranded suture (Modified Sandow). Thirty fresh frozen cadaveric flexor digitorum profundus tendons were transected and repaired with one of the core repair techniques using identical suture material and reinforced with identical peripheral sutures. Bulking at the repair site and tendon–suture junctions was measured. The tendons were subjected to linear load-to-failure testing. Results showed no significant difference in ultimate tensile strength between the Modified Sandow (36.8 N) and dsSCL (32.6 N) whereas the dsPMK was significantly weaker (26.8 N). There were no significant differences in 2 mm gap force, stiffness or bulk between the three repairs. We concluded that the simpler dsSCL repair is comparable to the modified Sandow repair in tensile strength, stiffness and bulking.

Helical 6-Strand Cruciate Tenorrhaphy: Description of a New Technique and Biomechanical Comparative Analysis With 2 Standard Techniques

Hand ◽  
2020 ◽  
pp. 155894471989713 ◽  
Author(s):  
Carlos Eduardo Torres Fuentes ◽  
Francisco Sebastián Carvajal Flechas ◽  
Julián Andrés Hernández ◽  
Juan Sebastián Abaunza Ubaque ◽  
Dayana Beatriz Carmona García ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Ultimate Tensile Strength ◽  
Ex Vivo ◽  
Tendon Repair ◽  
Early Mobilization ◽  
Standard Technique ◽  
Biomechanical Study ◽  
Flexor Tendons ◽  
Significant Difference ◽  
Standard Techniques

Background: Multiple flexor tendon repair techniques have been developed over the last years. Despite all this, there is no standard technique that has proven to be superior to others, leading to great variability in the use of techniques in surgical practice. We describe a novel tendon repair technique and compare its biomechanical characteristics with 2 conventional techniques. Methods: Comparative experimental biomechanical study in ex vivo animal models. In all, 66 deep flexor tendons of the pig’s front legs were taken and it’s repair was performed by 1 of 3 techniques (helical 6-strand cruciate tendon repair, Adelaide tendon repair, or modified Kessler). These repairs were subjected to biomechanical study, measuring, and registering the ultimate tensile strength, load to 2-mm gap force, and stiffness. Results: The helical 6-strand cruciate tenorrhaphy compared with the Adelaide and modified Kessler techniques carries statistically significant greater ultimate tensile strength before failure (65.5, 46, and 36 N, respectively, P < .001). It also required a greater load to 2-mm gap force and is less stiff, allowing greater strain before failure. This technique does not generate significant changes in the dimensions of the tendons compared to the others, and there was no significant difference in the strength of repair between surgeons. Conclusions: The helical 6-strand cruciate tenorrhaphy is a novel technique, useful for the repair of flexor tendons in the hand that holds up the necessary forces to initiate early mobilization in the postoperative period and has better biomechanical properties than 2 standard techniques.

Comparison of the Mechanical Properties of Polyglycolide-Trimethylene Carbonate (Maxon) and Polydioxanone Sutures (PDS2) used for Flexor Tendon Repair and Active Mobilization

2002 ◽  
Vol 27 (4) ◽  
pp. 329-332 ◽  
Author(s):  
A. WADA ◽  
H. KUBOTA ◽  
M. TAKETA ◽  
H. MIURA ◽  
Y. IWAMOTO
Keyword(s):  
Mechanical Properties ◽  
Tensile Strength ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Trimethylene Carbonate ◽  
Flexor Tendon Repair ◽  
Active Mobilization ◽  
Flexor Digitorum ◽  
Observation Period

Thirty-six canine flexor digitorum profundus tendons were repaired using 5-0 polyglycolide-trimethylene carbonate monofilament (Maxon) or polydioxanone monofilament (PDS2). All the tendons healed without rupture or formation of gaps of more than 2 mm. Mechanically, all tendon repairs had sufficient tensile strength to enable active mobilization. Polyglycolide-trimethylene carbonate (Maxon) repairs were initially superior in gap and ultimate strength to polydioxanone (PDS2) repairs. However, the gap and ultimate tensile strength of polyglycolide-trimethylene carbonate (Maxon) repairs had decreased significantly at day 14, whereas polydioxanone (PDS2) repairs maintained their strength throughout the 28-day observation period.

THE EFFECT OF FREEZE STORAGE ON THE TENSILE PROPERTIES OF TENDONS

2003 ◽  
Vol 03 (03n04) ◽  
pp. 299-308 ◽  
Author(s):  
BOON-HO NG ◽  
SIAW-MENG CHOU
Keyword(s):  
Tensile Strength ◽  
Ultimate Tensile Strength ◽  
Tensile Properties ◽  
Structural Integrity ◽  
Freeze Storage ◽  
Flexor Digitorum Profundus ◽  
Minor Effect ◽  
Fiber Density ◽  
A Minor ◽  
Flexor Digitorum

The objective of the current study is to elucidate the influence of freeze storage on the tensile properties of tendons by testing specimens at numerous adjacent durations to eliminate the influence of biological variation and experimental errors. Chicken flexor digitorum profundus tendons were stored intact in the digits at -20°C and specimens were tensile tested at 33 durations over 360 days. Scanning electron microscopy was done on fresh specimens and specimens freeze-stored for 30, 233 and 427 days to investigate microstructure change after freeze storage. The tensile properties of tendons, as represented by ultimate tensile strength, strained at ultimate tensile strength. The elastic modulus did not deviate significantly (p>0.01) after freeze storage while the collagen fiber density of specimens stored for 233 and 427 days decreased with porosity growth. In contrast, no obvious microstructure difference was observed between fresh tendons and tendons stored for 30 days. These findings suggest that the postmortem degradation incurred a minor effect on the structural integrity of the tendons and therefore did not affect the overall tensile properties. We conclude that freeze storage at -20°C does not alter the tensile properties of tendons for as many as 360 days.

Zone 2 flexor tendon repairs using a tensioned strong core suture, sparse peripheral stitches and early active motion: results in 60 fingers

2019 ◽  
Vol 44 (4) ◽  
pp. 361-366 ◽  
Author(s):  
Zhang Jun Pan ◽  
Yun Fei Xu ◽  
Lei Pan ◽  
Jing Chen
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Level Of Evidence ◽  
Active Motion ◽  
Repair Site ◽  
The Core ◽  
Active Flexion ◽  
Flexor Digitorum

We report the outcomes of zone 2 tendon repairs in 60 fingers using a strong core suture, sparse peripheral stitches and early active motion. From January 2014 to April 2016, we repaired 60 flexor digitorum profundus tendons with a tensioned 4-strand or 6-strand core suture and three to four peripheral stitches. The A2 or A4 pulleys were vented as necessary. Following early active flexion of the repaired tendons, no repairs ruptured and 52/60 (87%) fingers recovered to good or excellent function using the Tang criteria after follow-up of 8–33 months. We conclude that tensioned multi-strand strong core repairs only require sparse peripheral stitches and are safe for early active flexion. Standard peripheral sutures are not necessary. The core sutures should be properly tensioned to prevent gapping at tendon repair site and pulleys should be sufficiently vented to allow tendon motion. Level of evidence: IV

Flexor Tendon Repair Using a Stainless Steel External Splint

1999 ◽  
Vol 24 (6) ◽  
pp. 654-657 ◽  
Author(s):  
L. GORDON ◽  
F. A. DYSARZ ◽  
K. T. VENKATESWARA ◽  
A. P. MOK ◽  
R. O. RITCHIE ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Stainless Steel ◽  
Testing Machine ◽  
Biomechanical Testing ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Tensile Testing Machine ◽  
In Vivo Testing ◽  
Flexor Digitorum

A stainless steel external tendon splint was used in repair of cadaver tendons and compared with standard tendon repairs with suture. The splint was combined with a Kessler repair and tested against the Kessler, Becker, and Savage repairs in fresh human cadaver flexor digitorum profundus tendons. Biomechanical testing was done on a tensile testing machine, and load-displacement curves were generated. The repairs using the external tendon splint demonstrated a range of improvement of 32 to 146% in mean maximal tensile strength and a 20 to 185% improvement of mean ultimate tensile strength compared with all other repairs. The external tendon splint is relatively easy to apply to a tendon. The repair is strengthened and becomes capable of withstanding early active range of motion excercises. In vivo testing will be needed to assess the potential clinical usefulness of such a device.

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