Biomechanical Evaluation of Suture Configurations in Lesser Toe Plantar Plate Repairs

2018 ◽  
Vol 39 (7) ◽  
pp. 836-842 ◽  
Author(s):  
Fred T. Finney ◽  
Simon Lee ◽  
Jaron Scott ◽  
Todd A. Irwin ◽  
James R. Holmes ◽  
...  
Keyword(s):  
Proximal Phalanx ◽  
Peak Load ◽  
Biomechanical Properties ◽  
Biomechanical Analysis ◽  
Plantar Plate ◽  
Significant Difference ◽  
Load To Failure ◽  
Fresh Frozen ◽  
Human Cadavers ◽  
Number Of Cycles

Background: Lesser toe metatarsal-phalangeal (MTP) joint instability can be a major source of pain and dysfunction. Instability occurs when there is incompetence of the plantar plate and/or collateral ligaments. Newer operative treatments focus on performing anatomic repairs of the plantar plate. The goal of this study was to compare the biomechanical properties of 3 suture configurations that may be used for plantar plate repairs. Methods: Biomechanical analysis of 27 lesser toe plantar plates from fresh frozen human cadavers was completed. The plantar plate was detached from the proximal phalanx, and suture was placed in the distal plantar plate in a horizontal mattress, luggage-tag, or Mason-Allen suture configuration. Cyclic loading followed by load-to-failure testing was performed. Results: There was a significant difference in peak load-to-failure force between constructs (mattress: 115.53 ± 15.95 N; luggage-tag 102.42 ± 19.33 N; Mason-Allen: 89.96 ± 15.78 N; P = .015). Post hoc analysis demonstrated that the mattress configuration had significantly higher load-to-failure force compared with the Mason-Allen configuration ( P = .004). There were no significant differences between the mattress and the luggage-tag configurations or the luggage-tag and the Mason-Allen configurations. There were no differences in construct stiffness, axial displacement at the time of failure, or number of cycles required to produce 2 mm of displacement. Conclusion: The mattress configuration demonstrated better peak load-to-failure force compared with the Mason-Allen configuration but was not statistically different from the luggage-tag configuration. Although not significant, the mattress configuration trended toward higher load-to-failure force compared with the luggage-tag. Clinical Relevance: The horizontal mattress stitch may be the biomechanically superior configuration in plantar plate repairs.

scholarly journals Influence of peracetic acid-ethanol sterilisation on the biomechanical properties of human meniscus transplants

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Volker Eras ◽  
Josefine Graffunder ◽  
Norus Ahmed ◽  
Jan C. Brune
Keyword(s):  
Peracetic Acid ◽  
Biomechanical Properties ◽  
Bone Block ◽  
Test Device ◽  
Level Of Evidence ◽  
Load To Failure ◽  
Graft Extrusion ◽  
Fresh Frozen ◽  
Failure Loads ◽  
N Loading

Abstract Purpose Meniscus allograft transplantation (MAT) is a possible treatment for patients suffering with pain after meniscectomy. Here, peracetic acid (PAA) sterilised meniscus transplants were investigated on whether they would provide an adequate alternative to fresh-frozen transplants in their viscoelastic and mechanical properties. Methods In this analysis, 31 menisci donors (26 male and 5 female) were included. The average donor age was 49.87 years, ranging from 32 to 65 years. Menisci of matched pairs of knees underwent chemical sterilisation while counterparts were left fresh-frozen. Stiffness and load to failure were determined via suture retention. Further menisci were analysed while attached to the tibial bone block using a novel test device to mimic physiological load distribution. Meniscus relaxation, stiffness and failure loads were determined. Histology and biphasic properties of the menisci were examined and results were analysed using paired t-tests. Results A novel custom built test device allowed the application of physiological loads for suture retention testing and revealed no significant differences between PAA sterilised (14.85 ± 4.46 N/mm, 50.49 ± 17.01 N) and fresh-frozen (18.26 ± 4.46 N/mm, 59.49 ± 21.07 N) regarding stiffness and failure load, respectively. Furthermore, initial 200 N loading showed significantly higher strain in sterilised menisci (18.87 ± 1.56) compared to fresh frozen (13.81 ± 1.04). Load relaxation experiments demonstrated significantly lower relaxation for sterilised menisci (77.71 ± 1.62) compared to fresh-frozen (89.11 ± 1.00, p-value < 0.0001). Conclusion Peracetic acid sterilised human menisci performed equally to fresh-frozen counterparts in a suture retention test and in physiological failure testing providing an adequate alternative. However, meniscus relaxation, biphasic properties and strain were shown to be significantly different between the groups. A common problem of MAT is graft extrusion or shrinkage, therefore the parameters measured here should be considered and may influence meniscus extrusion after transplantation. Level of evidence n/a (experimental study)

scholarly journals Metacarpal shaft fixation: a biomechanical comparison of dorsal plating, lag screws, and headless compression screws

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Felix G. E. Dyrna ◽  
Daniel M. Avery ◽  
Ryu Yoshida ◽  
David Lam ◽  
Simon Oeckenpöhler ◽  
...  
Keyword(s):  
Peak Load ◽  
Rigid Fixation ◽  
Advantages And Disadvantages ◽  
Shaft Fractures ◽  
Metacarpal Shaft ◽  
Significant Difference ◽  
Load To Failure ◽  
Headless Compression Screws ◽  
Diaphyseal Fractures ◽  
Dorsal Plating

Abstract Background Metacarpal shaft fractures are common and can be treated nonoperatively. Shortening, angulation, and rotational deformity are indications for surgical treatment. Various forms of treatment with advantages and disadvantages have been documented. The purpose of the study was to determine the stability of fracture fixation with intramedullary headless compression screws in two types of metacarpal shaft fractures and compare them to other common forms of rigid fixation: dorsal plating and lag screw fixation. It was hypothesized that headless compression screws would demonstrate a biomechanical stronger construct. Methods Five matched paired hands (age 60.9 ± 4.6 years), utilizing non-thumb metacarpals, were used for comparative fixation in two fracture types created by an osteotomy. In transverse diaphyseal fractures, fixation by headless compression screws (n = 7) and plating (n = 8) were compared. In long oblique diaphyseal fractures, headless compression screws (n = 8) were compared with plating (n = 8) and lag screws (n = 7). Testing was performed using an MTS frame producing an apex dorsal, three point bending force. Peak load to failure and stiffness were calculated from the load-displacement curve generated. Results For transverse fractures, headless compression screws had a significantly higher stiffness and peak load to failure, means 249.4 N/mm and 584.8 N, than plates, means 129.02 N/mm and 303.9 N (both p < 0.001). For long oblique fractures, stiffness and peak load to failure for headless compression screws were means 209 N/mm and 758.4 N, for plates 258.7 N/mm and 518.5 N, and for lag screws 172.18 N/mm and 234.11 N. There was significance in peak load to failure for headless compression screws vs plates (p = 0.023), headless compression screws vs lag screws (p < 0.001), and plates vs lag screws (p = 0.009). There was no significant difference in stiffness between groups. Conclusion Intramedullary fixation of diaphyseal metacarpal fractures with a headless compression screw provides excellent biomechanical stability. Coupled with lower risks for adverse effects, headless compression screws may be a preferable option for those requiring rapid return to sport or work. Level of evidence Basic Science Study, Biomechanics.

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.

The Plantar Plate of the Lesser Toes: An Anatomical Study in Human Cadavers

1994 ◽  
Vol 15 (5) ◽  
pp. 276-282 ◽  
Author(s):  
Richard B. Johnston ◽  
Judith Smith ◽  
Timothy Daniels
Keyword(s):  
Metatarsophalangeal Joint ◽  
Anatomical Study ◽  
Volar Plate ◽  
Anatomic Structure ◽  
Joint Dislocation ◽  
Plantar Plate ◽  
Adjacent Structures ◽  
Fresh Frozen ◽  
Human Cadavers ◽  
Second Toe

The purpose of this study was to evaluate the anatomic structure and biochemical composition of the plantar plate of the lesser toes. Fresh frozen-human cadaveric feet were used to study 20 metatarsophalangeal and proximal interphalangeal plantar plates. The observations of foot dissections were compared with the finger volar plate. The plantar plate of the toe is a rectangular structure with a stout distal insertion and relatively flimsy proximal origin. The anatomic relationships to adjacent structures and composition are similar between the volar plates of the fingers and plantar plates of the toes. The plantar plate is known to experience extension forces that the volar plate does not experience. The weightbearing nature of the foot and forces imposed by toe-off may create chronic hyperextension of the metatarsophalangeal joint and predispose the plantar plate to attenuation or rupture, thus leading to instability of the metatarsophalangeal joint. These findings may explain in part the clinical condition of spontaneous metatarsophalangeal joint dislocation, most commonly found in the second toe.

Cyclic Testing of Flexible All-Inside Meniscus Suture Anchors: Biomechanical Analysis

2005 ◽  
Vol 33 (3) ◽  
pp. 388-394 ◽  
Author(s):  
Thore Zantop ◽  
Ann K. Eggers ◽  
Volker Musahl ◽  
Andre Weimann ◽  
Wolf Petersen
Keyword(s):  
Cyclic Loading ◽  
Biomechanical Properties ◽  
Meniscus Repair ◽  
Biomechanical Analysis ◽  
Suture Techniques ◽  
Suture Anchors ◽  
Pull Out ◽  
Meniscus Suture ◽  
Significant Difference ◽  
Pull Out Strength

Background Flexible meniscus repair devices are designed to combine the benefits of rigid all-inside meniscus anchors with the biomechanical properties of sutures. Hypothesis Stiffness and pull-out strength of flexible all-inside suture anchors and conventional sutures under cyclic loading conditions will be comparable. Study Design Controlled laboratory study Methods In 50 fresh frozen bovine menisci, artificial meniscus lesions were repaired with different meniscus fixation techniques: horizontal and vertical FasT-Fix, RapidLoc, and horizontal and vertical 2-0 Ethibond sutures. The specimens were cycled 1000 times between 5 and 20 N and then loaded to failure. Results All devices survived the cyclic loading protocol. There was no significant difference in the displacement between all repair techniques tested (horizontal FasT-Fix, 6.23 mm; vertical FasT-Fix, 5.34 mm; RapidLoc, 6.84 mm; horizontal 2-0 Ethibond, 6.03 mm; vertical 2-0 Ethibond, 5.61 mm (P >. 05). Vertical and horizontal FasT-Fix suture anchors had a significantly higher stiffness and pull-out strength (94.1 N and 80.8 N, respectively) than did horizontal sutures (50.2 N) and RapidLoc devices (30.3 N) (P >. 05). Conclusions In this study, flexible all-inside meniscus anchors (FasT-Fix) had higher pull-out strength than did conventional vertical suture techniques. Biomechanical characteristics of the flexible RapidLoc are comparable to those of horizontal sutures. Clinical Relevance Flexible all-inside meniscus repair devices are an alternative to conventional suture techniques.

scholarly journals Hip Capsular Closure: A Biomechanical Analysis of Failure Torque

2016 ◽  
Vol 45 (2) ◽  
pp. 434-439 ◽  
Author(s):  
Jorge Chahla ◽  
Jacob D. Mikula ◽  
Jason M. Schon ◽  
Chase S. Dean ◽  
Kimi D. Dahl ◽  
...  
Keyword(s):  
External Rotation ◽  
Arthroscopic Surgery ◽  
Testing Machine ◽  
Biomechanical Analysis ◽  
Biaxial Testing ◽  
Improved Outcomes ◽  
Significant Difference ◽  
Fresh Frozen ◽  
Hip Capsule ◽  
Optimal Quantity

Background: Hip capsulotomy is routinely performed during arthroscopic surgery to achieve adequate exposure of the joint. Iatrogenic instability can result after hip arthroscopic surgery because of capsular insufficiency, which can be avoided with effective closure of the hip capsule. There is currently no consensus in the literature regarding the optimal quantity of sutures upon capsular closure to achieve maximal stability postoperatively. Purpose/Hypothesis: The purpose of this study was to determine the failure torques of 1-, 2-, and 3-suture constructs for hip capsular closure to resist external rotation and extension after standard anterosuperior interportal capsulotomy (12 to 3 o’clock). Additionally, the degree of external rotation at which the suture constructs failed was recorded. The null hypothesis of this study was that no significant differences with respect to the failure torque would be found between the 3 repair constructs. Study Design: Controlled laboratory study. Methods: Nine pairs (n = 18) of fresh-frozen human cadaveric hemipelvises underwent anterosuperior interportal capsulotomy, which were repaired with 1, 2, or 3 side-to-side sutures. Each hip was secured in a dynamic biaxial testing machine and underwent a cyclic external rotation preconditioning protocol, followed by external rotation to failure. Results: The failure torque of the 1-suture hip capsular closure construct was significantly less than that of the 3-suture construct. The median failure torque for the 1-suture construct was 67.4 N·m (range, 47.4-73.6 N·m). The median failure torque was 85.7 N·m (range, 56.9-99.1 N·m) for the 2-suture construct and 91.7 N·m (range, 74.7-99.0 N·m) for the 3-suture construct. All 3 repair constructs exhibited a median 36° (range, 22°-64°) of external rotation at the failure torque. Conclusion: The most important finding of this study was that the 2- and 3-suture constructs resulted in comparable biomechanical failure torques when external rotation forces were applied to conventional hip capsulotomy in a cadaveric model. The 3-suture construct was significantly stronger than the 1-suture construct; however, there was not a significant difference between the 2- and 3-suture constructs. Additionally, all constructs failed at approximately 36° of external rotation. Clinical Relevance: Re-establishing the native anatomy of the hip capsule after hip arthroscopic surgery has been reported to result in improved outcomes and reduce the risk of iatrogenic instability. Therefore, adequate capsular closure is important to restore proper hip biomechanics, and postoperative precautions limiting external rotation should be utilized to protect the repair.

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.

scholarly journals Biomechanical testing of trans-humeral all-suture anchors for rotator cuff repair

2018 ◽  
Vol 11 (1_suppl) ◽  
pp. 77-85
Author(s):  
Mikel Aramberri-Gutiérrez ◽  
Amaia Martínez-Menduiña ◽  
Simon Boyle ◽  
Maria Valencia
Keyword(s):  
Rotator Cuff ◽  
Proximal Humerus ◽  
Biomechanical Testing ◽  
Tensile Load ◽  
Biomechanical Properties ◽  
Rotator Cuff Tears ◽  
Suture Anchors ◽  
Load To Failure ◽  
Insertion Sites ◽  
Number Of Cycles

Background Rotator cuff tears are one of the most common causes of shoulder pain. All-suture anchors are increasingly being used in the arthroscopic repair of rotator cuff tears. The purpose of this experimental study is to evaluate the biomechanical properties of all-suture anchors at different insertion sites in the proximal humerus relevant to rotator cuff repairs and the remplissage procedure. Methods Sixteen cadaveric shoulders were used for the study. Four all-suture anchors were inserted in each proximal humerus at common anchor insertion sites on the rotator cuff footprint and a simulated Hill–Sachs defect. Cyclic loading and load-to-failure tests were undertaken. The number of cycles, load to failure and nature of failure were recorded. Results The all-suture anchors placed in the cuff footprint using a transosseous technique displayed superior biomechanical properties. Sutures sited in this way demonstrated a maximum tensile load to failure of 542 N as well as a highest mean load to failure and the maximum number of cycles before anchor failure. In descending order, all-suture anchors placed in the lateral footprint were significantly superior to those located in the medial row and in a simulated Hill–Sachs defect. Discussion Anchors placed in the rotator cuff footprint exceeded the physiological isometric abduction forces for the supraspinatus and infraspinatus. Data obtained from our study suggest that all-suture anchors are strong enough to be used for the repair of rotator cuff tears.

Comparative Study of Biomechanical Properties between Needled Suture and Needleless Suture in Multi-Strand Tendon Graft Model

2021 ◽  
Vol 104 (9) ◽  
pp. 1447-1451
Keyword(s):  
Testing Machine ◽  
Biomechanical Properties ◽  
Tendon Graft ◽  
Suture Technique ◽  
Biomechanical Study ◽  
Modes Of Failure ◽  
Tendon Elongation ◽  
Significant Difference ◽  
Load To Failure ◽  
Distraction Force

Objective: To compare the biomechanical properties of the Chinese finger (CF) suture, a needleless suture technique, with the baseball stitch (BS) suture, a needled suture technique, in a multi-strand model by using a 4-strand tendon model. Additionally, the BS was compared with the serial rolling hitch (RH), a locking needleless suture technique. Materials and Methods: 4-strand grafts, made from two 20-cm fresh porcine toe extensors, were used in all three groups. After the grafts were sutured, pretension was applied with a load of 100-N distraction force for five minutes. After the tendon elongation was measured before and after the pretension, the distraction force was continued until the constructed graft failed. Stress-strain relationship graphs were recorded by universal testing machine (UTM), distributing to the calculation of percentage on tendon elongation, stiffness, and load-to-failure. Results: The BS had significantly higher load of failure than the CF (p=0.001) but no significant difference when compared with the RH. Comparing between BS, CF, and RH, there were no significant difference in stiffness and percentage of tendon elongation. In modes of failure, there was evidence of knot slipping in CF in six of six cases and graft strangulation in RH in four of six cases. Conclusion: Multi-strand model BS, a needled suture, had a higher load to failure than CF, a needleless suture. Moreover, needleless sutures had serious modes of failure, which were knot slipping and strangulation of graft by the suture material. Therefore, needleless suture technique for multi-strand tendon graft preparation was not recommended. Keywords: Tendon preparation; Multi-Strand; Needled suture; Needleless suture; Chinese finger; Baseball stitch; Rolling Hitch; Biomechanical study; Graft elongation; Load to failure

scholarly journals In vitro Biomechanical Study of Pulvertaft Tendon Weaving Technique

2011 ◽  
Vol 15 (2) ◽  
pp. 62-64 ◽  
Author(s):  
Yuen Chi-Pan ◽  
Yen Chi-Hung ◽  
Leung Hon-Bong ◽  
Tse Wing-Lim ◽  
Ho Pak-Cheong ◽  
...  
Keyword(s):  
Peak Load ◽  
Tendon Repair ◽  
Early Mobilization ◽  
Biomechanical Properties ◽  
Biomechanical Study ◽  
Load To Failure ◽  
Active Mobilization ◽  
Passive Mobilization ◽  
Single Suture

Background/Purposes The outcome of tendon repair depends on the strength, which allows early active mobilization to achieve better function without rupture. The aims of this study are to assess quantitatively the biomechanical properties and relationship between the number of tendon weaving and suture method using Pulvertaft technique. Results We found that the load to failure was increased with increasing number of weaves and sutures. From 1-weave to 4-weave single suture samples, the peak load to failure was 9.5 N, 19.7 N, 37.5 N, and 42.6 N, respectively. Based on previous studies, wrist and finger tendons should withstand 1–8N on passive mobilization. Conclusion On active mobilization, finger tendon repair need to provide 34 N for immediate mobilization. Therefore, irrespective of number of sutures, both 3- and 4-weave repairs could allow early mobilization biomechanically.

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