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.

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.

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.

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.

In vivo flexor tendon forces generated during different rehabilitation exercises

2015 ◽  
Vol 40 (7) ◽  
pp. 705-710 ◽  
Author(s):  
S. Edsfeldt ◽  
D. Rempel ◽  
K. Kursa ◽  
E. Diao ◽  
L. Lattanza
Keyword(s):  
Flexor Tendon ◽  
Controlled Trial ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Neutral Position ◽  
Flexor Digitorum Superficialis ◽  
Flexor Tendon Repair ◽  
Finger Flexion ◽  
Flexor Digitorum

We measured in vivo forces in the flexor digitorum profundus and the flexor digitorum superficialis tendons during commonly used rehabilitation manoeuvres after flexor tendon repair by placing a buckle force transducer on the tendons of the index finger in the carpal canal during open carpal tunnel release of 12 patients. We compared peak forces for each manoeuvre with the reported strength of a flexor tendon repair. Median flexor digitorum profundus force (24 N) during isolated flexor digitorum profundus flexion and median flexor digitorum superficialis force (13 N) during isolated flexor digitorum superficialis flexion were significantly higher than during the other manoeuvres. Significantly higher median forces were observed in the flexor digitorum superficialis with the wrist at 30° flexion (6 N) compared with the neutral wrist position (5 N). Median flexor digitorum profundus forces were significantly higher during active finger flexion (6 N) compared with place and hold (3 N). Place and hold and active finger flexion with the wrist in the neutral position or tenodesis generated the lowest forces; isolated flexion of these tendons generated higher forces along the flexor tendons. Level of evidence: III (controlled trial without randomization)

A Novel Flexor Tendon Repair Device: Biomechanical Testing in Cadaver Tendon and In-Vivo Verification Using a Rabbit Model

2013 ◽  
Author(s):  
Shawn P. Reese ◽  
Eric N. Kubiak
Keyword(s):  
Flexor Tendon ◽  
Biomechanical Testing ◽  
Rabbit Model ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Suture Repair ◽  
Flexor Tendon Repair ◽  
Tissue Ischemia ◽  
Flexor Tendons

The digital flexor tendons of the hand, including the flexor digitorum profundus (FDP), are responsible for enabling finger flexion and gripping. Injuries involving a partial or complete laceration to the digital flexor tendons are common and associated with a high incidence of morbidity [1]. The current state of the art for flexor tendon repair is the use of two or more core sutures in combination with an epitendinous circumferential suture. There are inherent limitations to suture based methods, including a high level of skill required to perform the suture repair, increased surgical time and the tendency for sutures to strangulate the tissue (creating local tissue ischemia). Suture based repairs often result in sub-optimal clinical outcomes, with reported failure rates ranging from 4%–10% [2]. In order to address these limitations, a novel non-suture based repair device has been developed. The objectives of this study were twofold. The first objective was to determine the gapping strength of the device in cadaver FDP tendons so that comparisons could be made to values reported in the literature for suture based repairs. The second objective was to determine the in-vivo capability of the device to facilitate tendon repair, relative to a suture control, in a rabbit model at a five week time point.

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.

Biomechanical Analysis of a Step-Cut Technique for Flexor Tendon Repair

1992 ◽  
Vol 17 (3) ◽  
pp. 282-285 ◽  
Author(s):  
L. GORDON ◽  
J. L. GARRISON ◽  
J. C. CHENG ◽  
Y. K. LIU ◽  
R. P. NATHAN ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Ultimate Tensile Strength ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Biomechanical Analysis ◽  
Flexor Digitorum Profundus ◽  
Gap Formation ◽  
Flexor Tendon Repair ◽  
The Core ◽  
Human Cadavers

We compared the strength of a new step-cut technique for flexor tendon repair with that of the widely used Kessler-Tajima technique, giving special attention to the relative contributions of the core and epitendinous sutures. 36 flexor digitorum profundus tendons from human cadavers were used. Corresponding digits from the same donor were paired, and the two tendons of each pair were placed in the Kessler-Tajima and step-cut groups, respectively. Each group had three subcategories of repair: (1) core repair alone; (2) epitendinous repair alone; and (3) full repair. In the Kessler-Tajima repair, the core stitch contributed more to ultimate tensile strength, while the epitendinous stitch contributed more to gap formation resistance. In the step-cut repair, however, the epitendinous stitch contributed more to both measures of strength. The full step-cut repair was 65% stronger in resisting gap formation and had 84% more ultimate tensile strength than the full Kessler-Tajima repair. We attribute the greater strength of the step-cut repair to the additional number of epitendinous loops, which lie perpendicular to the long axis of the tendon.

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.

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.

The Mantero Flexor Tendon Repair in Zone 1

1999 ◽  
Vol 24 (2) ◽  
pp. 148-151 ◽  
Author(s):  
D. GUINARD ◽  
F. MONTANIER ◽  
D. THOMAS ◽  
D. CORCELLA ◽  
F. MOUTET
Keyword(s):  
Functional Assessment ◽  
Functional Outcomes ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Flexor Tendon Repair ◽  
Pull Out ◽  
Active Mobilization ◽  
The Mean ◽  
Flexor Digitorum

Mantero and colleagues have reported a modification of the Bunnell pull-out method for the repair of zone 1 flexor digitorum profundus (FDP) lacerations that allows active postoperative mobilization. We report a series of 24 FDP lesions in 20 adult patients treated with this technique. The mean duration of the rehabilitation regimen, which was followed by all patients, was 4.2 months. Functional assessment using Strickland’s criteria demonstrated 23 excellent to good results and one poor due to a septic rupture. Nineteen of the 20 patients were satisfied with treatment and all but one of the patients returned to work within an average of 2.6 months after operation. In comparison to other zone 1 repair methods with active mobilization regimens, the Mantero technique gives better functional outcomes and appears to be more reliable.

Sign in / Sign up

Export Citation Format

Share Document