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.

scholarly journals Flexor tendon repair: a comparative study between a knotless barbed suture repair and a traditional four-strand monofilament suture repair

2013 ◽  
Vol 39 (1) ◽  
pp. 40-45 ◽  
Author(s):  
C. W. Joyce ◽  
K. E. Whately ◽  
J. C. Chan ◽  
M. Murphy ◽  
F. J. O’Brien ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Biomechanical Testing ◽  
Tendon Repair ◽  
Barbed Suture ◽  
Suture Repair ◽  
Flexor Tendon Repair ◽  
Cross Sectional ◽  
Pulley System ◽  
Suture Group

We compared the tensile strength of a novel knotless barbed suture method with a traditional four-strand Adelaide technique for flexor tendon repairs. Forty fresh porcine flexor tendons were transected and randomly assigned to one of the repair groups before repair. Biomechanical testing demonstrated that the tensile strengths between both tendon groups were very similar. However, less force was required to create a 2 mm gap in the four-strand repair method compared with the knotless barbed technique. There was a significant reduction in the cross-sectional area in the barbed suture group after repair compared with the Adelaide group. This would create better gliding within the pulley system in vivo and could decrease gapping and tendon rupture.

scholarly journals Four-Strand Core Suture Improves Flexor Tendon Repair Compared to Two-Strand Technique in a Rabbit Model

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Alice Wichelhaus ◽  
Sascha Tobias Beyersdoerfer ◽  
Brigitte Vollmar ◽  
Thomas Mittlmeier ◽  
Philip Gierer
Keyword(s):  
Suture Material ◽  
Flexor Tendon ◽  
Healing Process ◽  
Adhesion Formation ◽  
Rabbit Model ◽  
Tendon Repair ◽  
Initial Increase ◽  
Suture Repair ◽  
Flexor Tendon Repair ◽  
The Third

Introduction. This study was designed to investigate the influence of the amount of suture material on the formation of peritendinous adhesions of intrasynovial flexor tendon repairs.Materials and Methods. In 14 rabbits, the flexor tendons of the third and the fourth digit of the right hind leg were cut and repaired using a 2- or 4-strand core suture technique. The repaired tendons were harvested after three and eight weeks. The range of motion of the affected toes was measured and the tendons were processed histologically. The distance between the transected tendon ends, the changes in the peritendinous space, and cellular and extracellular inflammatory reaction were quantified by different staining.Results. A 4-strand core suture resulted in significantly less gap formation. The 2-strand core suture showed a tendency to less adhesion formation. Doubling of the intratendinous suture material was accompanied by an initial increase in leukocyte infiltration and showed a greater amount of formation of myofibroblasts. From the third to the eighth week after flexor tendon repair, both the cellular and the extracellular inflammation decreased significantly.Conclusion. A 4-strand core suture repair leads to a significantly better tendon healing process with less diastasis between the sutured tendon ends despite initially pronounced inflammatory response.

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.

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)

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.

Gross and Histological Analysis of Healing After Dog Flexor Tendon Repair with the Teno Fix™ Device

2006 ◽  
Vol 31 (5) ◽  
pp. 524-529 ◽  
Author(s):  
B. W. SU ◽  
F. J. RAIA ◽  
H. M. QUITKIN ◽  
M. PARISIEN ◽  
R. J. STRAUCH ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Weight Bearing ◽  
Tendon Repair ◽  
Tendon Healing ◽  
Full Weight Bearing ◽  
Cast Immobilization ◽  
Flexor Tendon Repair ◽  
The Common ◽  
Flexor Digitorum

The purpose of this study was to examine the in vivo characteristics of the stainless-steel Teno Fix™ device used for flexor tendon repair. The common flexor digitorum superficialis tendon was transected in 16 dogs and repaired with the device. The animals were euthanized at 3, 6, or 12 weeks postoperatively. Difficulties with cast immobilization led nine of 16 animals to be full weight bearing too early, leading to rupture of their repairs. The seven tendons with successful primary repairs (gap <2 mm) underwent histological examination. This in vivo study demonstrates that use of the Teno Fix™ in “suture” of dog flexor tendons did not lead to scarring at the tendon surface, does not cause an inflammatory reaction within the tendon and does not interfere with tendon healing.

Effects of Increased In Vivo Excursion on Digital Range of Motion and Tendon Strength following Flexor Tendon Repair

2000 ◽  
Vol 82 (3) ◽  
pp. 68
Author(s):  
Matthew J. Silva ◽  
Michael D. Brodt ◽  
Martin I. Boyer ◽  
Timothy S. Morris ◽  
Haralambos Dinopoulos ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Tendon Repair

Effects of Increased In Vivo Excursion on Digital Range of Motion and Tendon Strength following Flexor Tendon Repair

2000 ◽  
Vol 82 (8) ◽  
pp. 56
Author(s):  
Matthew J. Silva ◽  
Michael D. Brodt ◽  
Martin I. Boyer ◽  
Timothy S. Morris ◽  
Haralambos Dinopoulos ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Tendon Repair

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.

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