scholarly journals Scapholunate Ligament Internal Brace 360 Tenodesis (SLITT) Procedure: A Biomechanical Study

2018 ◽  
Vol 08 (03) ◽  
pp. 250-254
Author(s):  
Sanjeev Kakar ◽  
Ryan M. Greene ◽  
Janet Denbeigh ◽  
Andre Van Wijnen
Keyword(s):  
Surgical Techniques ◽  
Maximum Load ◽  
Difficult Problem ◽  
Biomechanical Study ◽  
Mode Of Failure ◽  
Load To Failure ◽  
Internal Brace ◽  
Fresh Frozen ◽  
Prolonged Immobilization ◽  
Ligament Disruption

Background Twelve paired fresh frozen cadaveric wrists were randomized to a 360-degree tenodesis repair group or the 360-degree tenodesis repair with an internal brace (suture tape) construct. Case Description The specimens were preloaded to 5 N and subsequently biomechanically loaded to failure, at a rate of 0.1 mm/s on a jig that allowed for axial load. The maximum load and mode of failure were recorded. Load to failure in the 360 tenodesis group with internal brace was 283.47 ± 100.25 N, compared with the 360 tenodesis group only, whose yield strength was 143.61 ± 90.54 N. The mode of failure within the internal brace construct was either through knot slippage, graft disruption, or bone separation from strength testing construct. The 360 tenodesis group tended to fail via graft slippage or graft rupture. Literature Review The management of scapholunate instability can be a difficult problem to treat. Traditionally, many of the surgical reconstructions have focused upon dorsal ligament reconstruction with Kirschner (K) wire fixation. This results in prolonged immobilization of the wrist with varied outcomes, in part due to the multiaxial instability that may persist due to concomitant volar ligament disruption. To address this instability, surgical techniques have been devised that address both the volar and dorsal ligament injuries. Clinical Relevance Scapholunate reconstruction with a 360-degree tenodesis and internal brace augmentation (SLITT procedure) provided superior biomechanical stability than tenodesis alone.

scholarly journals Novel implant-free loop Tenodesis vs. simple Tenotomy of the long biceps tendon - a biomechanical investigation

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Maximilian Kerschbaum ◽  
Andreas Voss ◽  
Christian Pfeifer ◽  
Isabella Weiss ◽  
Agnes Mayr ◽  
...  
Keyword(s):  
Biceps Tendon ◽  
Maximum Load ◽  
Study Groups ◽  
Displacement Curve ◽  
The Novel ◽  
Shoulder Joints ◽  
Biomechanical Investigation ◽  
Mode Of Failure ◽  
Load To Failure ◽  
Group A

Abstract Background Simple tenotomy and anchor tenodesis are commonly used in treatment of long biceps tendon (LHB) pathologies. The tenotomy can result in biceps distalization or cosmetic deformities. A novel loop Tenodesis Technique (LTD) could prevent a distalization of the biceps muscle without the risk of implant associated complications. The purpose of this study was to investigate the biomechanical aspects of the novel LTD compared to a standard tenotomy of the LHB. It has been hypothesized that the novel technique will show biomechanical superiority in terms of resistance and distalization. Methods Seven paired adult human cadaveric shoulder joints were assigned to one of the two study groups: Loop tenodesis (LTD); simple tenotomy (STT). In both groups load-to-failure testing was performed. The load-displacement curve was used to determine the maximum load (N), the degree of distalization of the LHB (mm) and the stiffness (N/mm). Additionally, the mode of failure was registered. Results The LTD group achieved a significantly higher ultimate load to failure (LTD: 50.5 ± 12.5 N vs. STT: 6.6 ± 3.9 N; p = 0.001). Significantly less distalization of the tendon could be detected for the LTD group (LTD: 8 ± 2.3 mm vs. STT: 22.4 ± 2.4 mm; p = 0.001). Stiffness was 7.4 ± 3.9 N/mm for the LTD group and 0.23 ± 0.16 N/mm for the STT group (p = 0.001). In all specimens of the LTD group a tendon rupture was found as mode of failure, while the STT group failed because of pulling out the LHB through the bicipital groove. Conclusion The novel loop Tenodesis Technique shows biomechanically higher stability as well as less distalization compared to a simple tenotomy of the long biceps tendon.

scholarly journals Comparing Biomechanical Properties, Repair Times, and Value of Common Core Flexor Tendon Repairs

Hand ◽  
2017 ◽  
Vol 13 (3) ◽  
pp. 313-318 ◽  
Author(s):  
Aakash Chauhan ◽  
Patrick Schimoler ◽  
Mark C. Miller ◽  
Alexander Kharlamov ◽  
Gregory A. Merrell ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Maximum Load ◽  
Biomechanical Properties ◽  
Barbed Suture ◽  
Load To Failure ◽  
Fresh Frozen ◽  
Post Hoc ◽  
Biomechanical Strength ◽  
Determining Factor

Background: The aim of the study was to compare biomechanical strength, repair times, and repair values for zone II core flexor tendon repairs. Methods: A total of 75 fresh-frozen human cadaveric flexor tendons were harvested from the index through small finger and randomized into one of 5 repair groups: 4-stranded cross-stitch cruciate (4-0 polyester and 4-0 braided suture), 4-stranded double Pennington (2-0 knotless barbed suture), 4-stranded Pennington (4-0 double-stranded braided suture), and 6-stranded modified Lim-Tsai (4-0 looped braided suture). Repairs were measured in situ and their repair times were measured. Tendons were linearly loaded to failure and multiple biomechanical values were measured. The repair value was calculated based on operating room costs, repair times, and suture costs. Analysis of variance (ANOVA) and Tukey post hoc statistical analysis were used to compare repair data. Results: The braided cruciate was the strongest repair ( P > .05) but the slowest ( P > .05), and the 4-stranded Pennington using double-stranded suture was the fastest ( P > .05) to perform. The total repair value was the highest for braided cruciate ( P > .05) compared with all other repairs. Barbed suture did not outperform any repairs in any categories. Conclusions: The braided cruciate was the strongest of the tested flexor tendon repairs. The 2-mm gapping and maximum load to failure for this repair approached similar historical strength of other 6- and 8-stranded repairs. In this study, suture cost was negligible in the overall repair cost and should be not a determining factor in choosing a repair.

scholarly journals Longer stitch interval in the Krackow stitch for tendon graft fixation leads to poorer biomechanical property

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901879951 ◽  
Author(s):  
Chih-Kai Hong ◽  
Cheng-Li Lin ◽  
Fa-Chuan Kuan ◽  
Ping-Hui Wang ◽  
Ming-Long Yeh ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Ultimate Load ◽  
Tendon Graft ◽  
Biomechanical Study ◽  
Graft Fixation ◽  
Biomechanical Property ◽  
Cross Sectional ◽  
Mode Of Failure ◽  
Load To Failure ◽  
Post Hoc

Purpose: The purpose of this study was to analyze the effects of different intervals between stitch throws on tendon graft fixation with the Krackow stitch. Methods: Forty-four porcine flexor profundus tendons were randomly divided into four groups of 11 specimens each. The Krackow stitch with various stitch intervals (2.5, 5.0, 7.5, and 10.0 mm) were evaluated, and named the K-2.5, K-5.0, K-7.5, and K-10.0 groups, respectively. A braided nonabsorbable suture was used to complete each suture-tendon construct. All specimens were pretensioned to 100 N for three cycles, cyclically loaded from 50 to 200 N for 200 cycles, and then finally loaded to failure. Elongation after cyclic loading, ultimate load to failure, and the mode of failure were recorded. Results: There were significant differences in elongation after cyclic loading among the K-2.5 (31% ± 5%), K-5.0 (32% ± 4%), K-7.5 (34% ± 5%), and K-10.0 (41% ± 8%) groups ( p = 0.004); the post hoc analysis showed significantly smaller values in the K-2.5 and K-5.0 groups than in the K-10.0 group ( p = 0.002 and 0.003, respectively). The stitch interval was correlated with elongation after cyclic loading ( r = 0.52, p < 0.001). Ultimate loads to failure and cross-sectional area were not significantly different across the four groups. Conclusion: The Krackow stitch with stitch intervals of 2.5 and 5.0 mm had significantly smaller elongation after cyclic loading than with an interval of 10.0 mm in this porcine biomechanical study. The stitch interval was moderately correlated with elongation after cyclic loading.

Tibial Fixation of Anterior Cruciate Ligament Allograft Tendons

2009 ◽  
Vol 37 (8) ◽  
pp. 1531-1538 ◽  
Author(s):  
Daniel K. Park ◽  
Harold A. Fogel ◽  
Sanjeev Bhatia ◽  
Bernard R. Bach ◽  
Aman Gupta ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Maximum Load ◽  
Materials Testing ◽  
Tibial Fixation ◽  
Fixation Devices ◽  
Load To Failure ◽  
Fresh Frozen ◽  
Lower Load ◽  
Anterior Cruciate

Background In sum, 1-, 2-, and 4-stranded allografts are used for soft tissue anterior cruciate ligament reconstruction; however, the fixation properties of fixation devices are not well assessed. Hypothesis There are no differences in the biomechanical characteristics of 1 (Achilles)-, 2 (posterior tibialis)-, and 4 (semitendinosus)-stranded allograft tibial fixation. Study Design Controlled laboratory study. Methods Sixty-three fresh-frozen porcine tibiae were used to evaluate the fixation of 1-, 2-, and 4-stranded human tendon allografts (Achilles, posterior tibialis, and semitendinosus) with 3 fixation devices (Delta, Intrafix, and Calaxo screws). With use of a materials testing system, each graft was subjected to 500 cycles of loading (50-250 N, 0.75 mm/sec) to determine displacement and cyclic stiffness, followed by a monotonic failure test (20 mm/min) to determine maximum load and pullout stiffness. Results For each graft type, there were no significant biomechanical differences between fixation devices. However, the 1-stranded graft (Achilles) construct demonstrated significantly higher mean displacement (3.17 ± 1.62 mm), lower cyclical stiffness (156 ± 25 N/mm), lower load to failure (479 ± 87 N), and lower pullout stiffness (140 ± 28 N/mm). In comparison with the 2-stranded graft (posterior tibialis), the 4-stranded graft (semitendinosus) exhibited lower displacement (0.86 ± 0.44 to 1.12 ± 0.51 mm) and higher ultimate failure load (832 ± 255 to 656 ± 168 N). Numerous differences in fixation properties were noted when comparing a device to each of the 3 grafts. Conclusion The 1-stranded allograft demonstrated inferior biomechanical tibial fixation properties when compared with 2 (posterior tibialis)- and 4 (semitendinosus)-stranded allograft constructs for all fixation devices tested. Clinical Relevance This study demonstrated that not all tibial fixation devices are designed to adequately accommodate different types of anterior cruciate ligament allografts. Biomechanical evidence suggests that caution is warranted when using an Achilles allograft fixated solely with an interference device.

Comparison of the Syndesmotic Staple to the Transsyndesmotic Screw: A Biomechanical Study

2005 ◽  
Vol 26 (3) ◽  
pp. 224-230 ◽  
Author(s):  
Timothy Marqueen ◽  
John Owen ◽  
Gregg Nicandri ◽  
Jennifer Wayne ◽  
James Carr
Keyword(s):  
External Rotation ◽  
Biomechanical Study ◽  
Tibial Rotation ◽  
Intact State ◽  
Cortical Screw ◽  
Torsional Testing ◽  
Load To Failure ◽  
Posterior Translation ◽  
Fresh Frozen ◽  
Torsional Loads

Background: Controversy still exists about treatment of syndesmotic injuries. This study compared the fixation strengths and biomechanical characteristics of two types of ankle fracture syndesmotic fixation devices: the barbed, round staple and the 4.5-mm cortical screw. Methods: Cadaveric testing was done on 21 fresh-frozen knee disarticulation specimens in biaxial servohydraulic Instron testing equipment. Submaximal torsional loads were applied to specimens in intact and Weber C bimalleolar fracture states. The specimens were then fixed with one of two techniques and again subjected to submaximal torsion and torsion to failure. Biomechanical parameters measured included tibiofibular translation and rotation, maximal torque to failure, and degrees of rotation at failure. Results: Compared to the intact state before testing, the staple held the fibula in a more anatomic position than the screw for mediolateral and anterior displacements (p < 0.01). With submaximal torsional testing, the staple restored 85% of the tibiofibular external rotation and all of the posterior translation values as compared to the intact state. The screw resulted in 203% more tibiofibular medial translation and 115% more external rotation than the intact state. The degree of tibial rotation during submaximal torsional loading was restored to within 15% of intact values but was 21% less with the screw. There was no statistical difference between the screw and staple when tested in load to failure. Tibio-talar rotation at failure was statistically different with the staple construct, allowing more rotation as compared to the screw. Conclusion: The staple restored a more physiologic position of the fibula compared to the syndesmotic screw. Both provided similar performance for the load to failure testing, while the screw reduced tibial rotation more after cyclic loading. There was more tibial rotation before failure for the staple, suggesting a more elastic construct. This study provides biomechanical data to support the clinical use of the syndesmotic staple.

Screw Fixation Compared to H-Locking Plate Fixation for First Metatarsocuneiform Arthrodesis: A Biomechanical Study

2005 ◽  
Vol 26 (11) ◽  
pp. 984-989 ◽  
Author(s):  
David A. Cohen ◽  
Brent G. Parks ◽  
Lew C. Schon
Keyword(s):  
Locking Plate ◽  
Mechanical Design ◽  
Screw Fixation ◽  
Plate Fixation ◽  
Biomechanical Study ◽  
Maximal Load ◽  
Load To Failure ◽  
Fresh Frozen ◽  
The Mean ◽  
Eden Prairie

Background: Several different techniques have been used for fixation of first metatarsocuneiform (MTC) joint arthrodesis, a standard treatment for arthritis, instability, and deformity of the MTC joint. Improved plating systems using locking designs are now available, but no studies have yet compared this construct with other methods. We compared load to failure with a locking plate design versus standard crossed-screw fixation. Methods: Ten matched pairs of fresh frozen cadaver feet were used. The bone density of each pair was measured with DEXA scanning. One foot of each pair was randomly assigned to have a dorsomedial Normed H titanium locking plate (Normed Medizin-Technik Vertriebs-GmbH, D-78501 Tuttlingen, Germany) applied to the first MTC joint. On the other foot of the pair, fixation of the first MTC joint was done with crossed ACE DePuy 4.0 (DePuy/Ace, Warsaw, IN) titanium cannulated screws. The first metatarsal and first cuneiform were then isolated and planted in an epoxy resin. The specimens were loaded to failure in a four-point bending configuration using a MTS Mini Bionix test frame (MTS Systems Corp., Eden Prairie, MN). Failure was defined as displacement of more than 3 mm at the arthrodesis site. The Student t-test was used to determine any observed differences, with significance set at p ≤ 0.05. Results: The mean maximal load to failure was 140.08 N (SD ± 77.1) for screw fixation alone and 58.09 N (SD ± 11.86) for the H-locking plate. This difference was statistically significant ( p = 0.008). The mean stiffness of the construct for screw fixation alone was 83.10 N/mm (SD ± 49.8) and 19.96 N/mm for the H-locking plate. This difference also was statistically significant ( p = 0. 004). Conclusion: Screw fixation for first MTC arthrodesis created a stronger and stiffer construct than did the H-locking plate. This was likely due to the mechanical design of the implants. Compression across the MTC joint could be applied with the screws, but the plate relied on a fixed angle design with no compression.

scholarly journals The Loop ’n’ Tack Knot: Biomechanical Analysis of a Novel Suture Technique for Proximal Biceps Tenodesis

2020 ◽  
Vol 8 (9) ◽  
pp. 232596712095231
Author(s):  
Jonathan Acosta ◽  
John M. Rinaldi ◽  
J. Jared Guth ◽  
Sam Akhavan
Keyword(s):  
Biomechanical Testing ◽  
High Strength ◽  
Poor Quality ◽  
Suture Technique ◽  
Biomechanical Analysis ◽  
Suture Techniques ◽  
Longitudinal Splitting ◽  
Mode Of Failure ◽  
Load To Failure ◽  
Fresh Frozen

Background: Secure tendon grasping is critical to the success of any tenodesis procedure. Several techniques currently used for tendon grasping can result in longitudinal splitting of the tendon, causing construct failure and failure of the tenodesis. Purpose: To compare the Loop ’n’ Tack knot as a tendon-grasping technique with other common suture techniques. We investigated the biomechanical strength and mode of failure. Study Design: Controlled laboratory study. Methods: Eleven matched pairs of proximal biceps were harvested from fresh-frozen cadaveric shoulders. One tendon from each pair was stitched using 1 of 4 different techniques. The suture techniques evaluated included the Loop ’n’ Tack with 2 different types of high-strength nonabsorbable suture, a double half-racking stitch, and a Krakow stitch. Samples were cyclically loaded between 5 and 20 N for 100 cycles, followed by a pull to failure at 33 mm/s. Results: The Loop ’n’ Tack techniques were equivalent to the double half-racking and Krakow techniques for load to ultimate failure ( P = .817 and P = .984, respectively). The double half-racking technique was the stiffest construct, which was significantly greater than the second-stiffest group, the Loop ’n’ Tack method with both FiberLink suture ( P = .012) and SutureTape ( P = .002), which had greater stiffness than the Krakow group ( P < .001). The most common failure mode for the Loop ’n’ Tack stitch was suture breakage compared with the Krakow and double half-racking methods, where the most common mode of failure was suture pullout from the tendon ( P < .001). Conclusion: Biomechanical testing found that the Loop 'n’ Tack techniques had similar ultimate load to failure values when compared with the double half-racking and Krakow methods. Mode-of-failure analysis showed that the Loop 'n’ Tack construct typically failed by suture breakage, whereas the other techniques failed by suture pullout. Clinical Relevance: The Loop 'n’ Tack technique allows for secure grasping of tissue without the need for externalization of the tendon. This technique may be beneficial in compromised or poor-quality tissue without reducing overall pullout strength when compared with a standard half-racking or Krakow stitch.

A Comparison of the Mechanical Properties of Two External Fixator Designs for Transarticular Stabilization of the Canine Hock

1997 ◽  
Vol 10 (01) ◽  
pp. 54-59 ◽  
Author(s):  
A. D. Pardo ◽  
M. B. Parrott ◽  
J. F. Wassermann ◽  
K. L. Wells
Keyword(s):  
Mechanical Properties ◽  
Clinical Trials ◽  
Stainless Steel ◽  
External Fixator ◽  
Biomechanical Testing ◽  
Maximum Load ◽  
Mode Of Failure ◽  
Load To Failure ◽  
Biomechanical Parameters ◽  
The Mean

SummaryBiomechanical testing was performed on 20 canine tibiotarsal joints. The conventional transarticular external skeletal fixator (ESF) was applied to one rear limb while the alternative design using acrylic was applied to the contralateral rear limb. The mode of failure for all models was fracture of the phalanges at the point of fixation in the distal grip device.The mean stiffness for the acrylic design was 58.5 N/mm and for the conventional ESF 44.8 N/mm. The mean maximum load to failure for the acrylic design was 490.7 N, compared to 405.1 N for the conventional ESF. The angle of deformation at maximum for the acrylic apparatus was 0.45 degrees compared to 2.36 degrees for the standard ESF. The mean energy absorbed to maximum load was 1.92 N-m for the acrylic design and for the conventional ESF 2.69 N-m. This study indicated that the acrylic design was superior in maintaining immobilization across the tibiotarsal joint, indicated by the angle of deformation (p = 0.002) and was structurally comparable in stiffness (p = 0.295), maximum strength (p = 0.438), and total energy absorbed to failure (p = 0.276).The properties of an acrylic and a stainless steel external transarticular skeletal fixator were biomechanically evaluated. Biomechanical parameters evaluated included: maximum load to failure, stiffness, angle of deformation across the tibiotarsal joint, and energy absorbed to failure. The angle of deformation was less (p = 0.002) for the acrylic device. Based on this study, we conclude that the new acrylic design is structurally comparable to the conventional transarticular ESF and warrants clinical trials.

scholarly journals Assessment of Conduit-Assisted Primary Nerve Repair Strength With Varying Suture Size, Number, and Location

Hand ◽  
2018 ◽  
Vol 14 (6) ◽  
pp. 735-740 ◽  
Author(s):  
Nikola Babovic ◽  
Derek Klaus ◽  
Matthew J. Schessler ◽  
Patrick J. Schimoler ◽  
Alexander Kharlamov ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Failure Load ◽  
Nerve Repair ◽  
Maximum Load ◽  
Nerve Conduit ◽  
Digital Nerve ◽  
Repair Site ◽  
Size Number ◽  
Load To Failure ◽  
Fresh Frozen

Background: Outcomes following digital nerve repair are suboptimal despite much research and various methods of repair. Increased tensile strength of the repair and decreased suture material at the repair site may be 2 methods of improving biologic and biomechanical outcomes, and conduit-assisted repair can aid in achieving both of these goals. Methods: Ninety-nine fresh-frozen digital nerves were equally divided into 11 different groups. Each group uses a different combination of number of sutures at the coaptation site and number of sutures at each end of the nerve-conduit junction, as well as 2 calibers of nylon suture. Nerves were transected, repaired with these various suture configurations using an AxoGuard conduit, and loaded to failure. Results: The 2-way analysis of variance (ANOVA) showed that repairs performed with 8-0 suture have significantly higher maximum failure load compared with 9-0 suture repairs ( P < .01). Increasing the number of sutures in the repair significantly increased the maximum failure load in all groups regardless of suture caliber used ( P < .01). Repairs with 9-0 suture at the coaptation site did not jeopardize repair strength when compared with 8-0 suture. Conclusions: Conduit-assisted primary digital nerve repairs with 8-0 suture increases the maximum load to failure compared with repairs with 9-0 suture, as does increasing the overall number of sutures. Using 9-0 suture at the coaptation site with 8-0 suture at the nerve-conduit junction does not jeopardize tensile strength when compared with similar repairs using all 8-0 suture and may decrease inflammation at the repair site while still achieving sufficient tensile strength.

A Biomechanical Evaluation of the Tibiofibular and Tibiotalar Ligaments of the Ankle

2003 ◽  
Vol 24 (5) ◽  
pp. 426-429 ◽  
Author(s):  
Annechien Beumer ◽  
Wouter L.W. van Hemert ◽  
Bart A. Swierstra ◽  
Louis E. Jasper ◽  
Stephen M. Belkoff
Keyword(s):  
Failure Modes ◽  
Ex Vivo ◽  
Clinical Problem ◽  
Dominant Mode ◽  
Biomechanical Study ◽  
Deltoid Ligament ◽  
Tibiofibular Ligament ◽  
Mode Of Failure ◽  
Fresh Frozen ◽  
Strength And Stiffness

The purpose of this ex vivo biomechanical study was to determine the strength and stiffness of the anterior and posterior syndesmotic tibiofibular ligaments and the posterior tibiotalar component of the deltoid ligament. Injuries to these ligaments are a prevalent clinical problem, yet little is known about their mechanical behavior. Ten fresh-frozen cadaver lower extremities (average age at death, 72 ± 8 years) were harvested. The anterior and posterior tibiofibular ligaments and the posterior tibiotalar component of the deltoid were isolated and prepared as bone–ligament–bone complexes for tensile testing to determine strength, stiffness, and mode of failure. The posterior tibiofibular ligament exhibited greater strength, but not significantly so ( p <.05), than the anterior tibiofibular ligament and the posterior tibiotalar component of the deltoid ligament. There were no significant differences in stiffness between the three ligaments tested. The dominant mode of failure for the anterior tibiofibular ligament was ligament substance rupture, primarily near its fibular insertion, whereas the failure modes of the posterior tibiofibular ligament were evenly split between substance ruptures and fibular avulsions. The posterior tibiotalar component of the deltoid ligament ruptured most often near the talar insertion. The tibiofibular ligaments showed greater strength than the lateral collateral and deltoid ligaments, as mentioned in literature. The greater strength of the tibiofibular ligaments relative to the lateral collateral and deltoid ligaments suggests that these ligaments play an important role in ankle constraint.

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