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.

Morphological and biomechanical studies on the common calcaneal tendon in dogs

2009 ◽  
Vol 22 (02) ◽  
pp. 119-124 ◽  
Author(s):  
S. Reese ◽  
I. Jopp
Keyword(s):  
Flexor Tendon ◽  
Biomechanical Testing ◽  
Tensile Load ◽  
Maximum Load ◽  
Biomechanical Properties ◽  
Tendon Injury ◽  
Calcaneal Tendon ◽  
Superficial Digital Flexor Tendon ◽  
Load To Failure ◽  
The Common

SummarySpontanous rupture at the distal part of the gastrocnemius tendon (GT) is the second most common non-traumatic tendon injury in dogs, whereas the other strands of the common calcaneal tendon do not seem to have a predisposition to rupture. In order to discover why we investigated the common calcaneal tendons of 63 dogs microscopically and biomechanically. Both the gastrocnemius and superficial digital flexor tendon (SFT) had multiple low vascularized fibrocartilaginous areas within their distal course as opposed to regular parallel fibered areas in the proximal tendon areas. Biomechanical testing revealed that the distal sections in both tendons show a 50% and 70% lower tensile strength (Fmax/kg BW) than the proximal sections (p<0.01), respectively. On the contrary, tensile load (Fmax/mm2) only differed minimally between proximal and distal sections in both tendons (8% and 9%, respectively), whereas the tensile load of the distal gastrocnemius tendon is 35% lower than of the distal superficial flexor tendon (p<0.01). To the authors' knowledge, this is the first study to experimentally show that there are different biomechanical properties within the same tendon. The maximum load to failure is lower in the GT compared to the SFT within the same dog which explains its higher incidence of rupture in the field. The avascular fibrocartilaginous structure in the distal gastrocnemius tendon seems to play a further role in the pathogenesis of spontaneous rupture.

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)

Zoledronic Acid Substantially Improves Bone Microarchitecture and Biomechanical Properties After Rotator Cuff Repair in a Rodent Chronic Defect Model

2020 ◽  
Vol 48 (9) ◽  
pp. 2151-2160
Author(s):  
Jakob E. Schanda ◽  
Claudia Keibl ◽  
Patrick Heimel ◽  
Xavier Monforte ◽  
Stefan Tangl ◽  
...  
Keyword(s):  
Zoledronic Acid ◽  
Rotator Cuff ◽  
Humeral Head ◽  
Bone Microarchitecture ◽  
Intervention Group ◽  
Maximum Load ◽  
Biomechanical Properties ◽  
Rotator Cuff Tears ◽  
Mineral Density ◽  
Load To Failure

Background: Bone mineral density at the humeral head is reduced in patients with chronic rotator cuff tears. Bone loss in the humeral head is associated with repair failure after rotator cuff reconstruction. Bisphosphonates (eg, zoledronic acid) increase bone mineral density. Hypothesis: Zoledronic acid improves bone mineral density of the humeral head and biomechanical properties of the enthesis after reconstruction of chronic rotator cuff tears in rats. Study Design: Controlled laboratory study. Methods: A total of 32 male Sprague-Dawley rats underwent unilateral (left) supraspinatus tenotomy with delayed transosseous rotator cuff reconstruction after 3 weeks. All rats were sacrificed 8 weeks after rotator cuff repair. Animals were randomly assigned to 1 of 2 groups. At 1 day after rotator cuff reconstruction, the intervention group was treated with a single subcutaneous dose of zoledronic acid at 100 µg/kg bodyweight, and the control group received 1 mL of subcutaneous saline solution. In 12 animals of each group, micro–computed tomography scans of both shoulders were performed as well as biomechanical testing of the supraspinatus enthesis of both sides. In 4 animals of each group, histological analyses were conducted. Results: In the intervention group, bone volume fraction (bone volume/total volume [BV/TV]) of the operated side was higher at the lateral humeral head ( P = .005) and the medial humeral head ( P = .010) compared with the control group. Trabecular number on the operated side was higher at the lateral humeral head ( P = .004) and the medial humeral head ( P = .001) in the intervention group. Maximum load to failure rates on the operated side were higher in the intervention group ( P < .001). Cortical thickness positively correlated with higher maximum load to failure rates in the intervention group ( r = 0.69; P = .026). Histological assessment revealed increased bone formation in the intervention group. Conclusion: Single-dose therapy of zoledronic acid provided an improvement of bone microarchitecture at the humeral head as well as an increase of maximum load to failure rates after transosseous reconstruction of chronic rotator cuff lesions in rats. Clinical Relevance: Zoledronic acid improves bone microarchitecture as well as biomechanical properties after reconstruction of chronic rotator cuff tears in rodents. These results need to be verified in clinical investigations.

scholarly journals Biomechanical Strength of Scaphoid Partial Unions

2018 ◽  
Vol 07 (05) ◽  
pp. 399-403 ◽  
Author(s):  
Mark Snoddy ◽  
Donald Lee ◽  
Marc Richard ◽  
Mihir Desai ◽  
Adam Brekke
Keyword(s):  
Failure Mechanism ◽  
Clinical Relevance ◽  
Permanent Deformation ◽  
Maximum Load ◽  
Control Group ◽  
Average Maximum ◽  
Significant Difference ◽  
Load To Failure ◽  
Biomechanical Strength ◽  
Inherent Stability

Background It remains unknown how much force a partially united scaphoid can sustain without refracturing. This is critical in determining when to discontinue immobilization in active individuals. Purpose The purpose of this study was to test the biomechanical strength of simulated partially united scaphoids. We hypothesized that no difference would exist in load-to-failure or failure mechanism in scaphoids with 50% or more bone at the waist versus intact scaphoids. Materials and Methods Forty-one cadaver scaphoids were divided into four groups, three experimental osteotomy groups (25, 50, and 75% of the scaphoid waist) and one control group. Each was subjected to a physiologic cantilever force of 80 to 120 N for 4,000 cycles, followed by load to failure. Permanent deformation during physiologic testing and stiffness, max force, work-to-failure, and failure mechanism during load to failure were recorded. Results All scaphoids survived subfailure conditioning with no significant difference in permanent deformation. Intact scaphoids endured an average maximum load to failure of 334 versus 321, 297, and 342 N for 25, 50, and 75% groups, respectively, with no significant variance. There were no significant differences in stiffness or work to failure between intact, 25, 50, and 75% groups. One specimen from each osteotomy group failed by fracturing through the osteotomy; all others failed near the distal pole loading site. Conclusion All groups behaved similarly under physiologic and load-to-failure testing, suggesting that inherent stability is maintained with at least 25% of the scaphoid waist intact. Clinical Relevance The data provide valuable information regarding partial scaphoid union and supports mobilization once 25% union is achieved.

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 comparison of subscapularis peel and lesser tuberosity osteotomy for double-row subscapularis repair technique in a cadaveric arthroplasty model

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Mandeep S. Virk ◽  
Saleh S. Aiyash ◽  
Rachel M. Frank ◽  
Christopher S. Mellano ◽  
Elizabeth F. Shewman ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Maximum Load ◽  
Biomechanical Properties ◽  
Level Of Evidence ◽  
Double Row ◽  
Lesser Tuberosity ◽  
Bone Interface ◽  
Tendon Suture ◽  
Fresh Frozen ◽  
Cadaveric Model

Abstract Introduction Management of the subscapularis during shoulder arthroplasty is controversial. The purpose of this study was to compare the biomechanical performance of subscapularis peel (SP) and lesser tuberosity osteotomy (LTO) in a cadaveric model. Methods The subscapularis and proximal humerus were dissected from all soft tissues in 21 fresh-frozen human cadaveric shoulders and randomized to undergo SP, LTO, or standard subscapularis tenotomy (ST, control). For SP and LTO, six #5 sutures were passed through eyelets in the implant (on lateral border and through drill holes in bicipital groove [2] and under trunion [4]). Double-row repair was performed using two lateral row transosseous sutures and four medial row sutures through the tendon (SP) or osseotendinous junction (LTO). Biomechanical properties and mode of failure were tested. Results There were no significant differences in elongation amplitude, cyclic elongation, or maximum load to failure between the three groups (P > 0.05). Mean stiffness was significantly higher in LTO (P = 0.009 vs. SP and ST). In the ST group, 7/7 specimens failed at the tendon-suture interface. For SP, 4/7 failed at the tendon-suture interface, one at the suture-bone interface, one fractured around the implant stem, and one at the knots. For LTO, 3/7 failed at the tendon-suture interface, two at the suture-bone interface and two fractured around the implant stem. Conclusions In this cadaveric model, subscapularis repair via ST, SP, and LTO techniques was biomechanically equivalent. Additional studies are needed to confirm these findings and determine the influence of biologic healing on healing rates and clinical outcomes. Level of evidence N/a, biomechanical laboratory study

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.

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 Comparing biomechanical strength of unicortical locking plate versus bicortical compression plate for transverse midshaft metacarpal fracture

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901880251
Author(s):  
Rukmanikanthan Shanmugam ◽  
Chong Yin Chyi@ Chong Shyh Jian ◽  
Amber Haseeb ◽  
Saw Aik
Keyword(s):  
Locking Plate ◽  
Flexor Tendon ◽  
Plate Fixation ◽  
Metacarpal Fracture ◽  
Three Point Bending ◽  
Plate Group ◽  
Compression Plate ◽  
Load To Failure ◽  
Cyclical Loading ◽  
Biomechanical Strength

Purpose: Metacarpal bone fractures constitute 10% of all fractures. Unstable metacarpal fractures require surgical intervention, which poses danger to flexor tendon either due to bicortical drilling or construct of the implant. Unicortical locking plate fixation may be the solution to preventing flexor tendon injury. Studies have compared locking and compression plates. However, in these studies, the biomechanical properties were tested using the static loading method. This study looks into cyclical loading that is more representative of in vivo conditions, particularly for early rehabilitation. We compared the biomechanical strength of the unicortical locking plate and bicortical compression plate system in a transverse metacarpal fracture, tested with cyclical loading and torsion. Method: Twenty pieces of fourth-generation, biomechanical testing grade, left third metacarpal composite bones were used. Resin was used to create the holding block at both ends of the bone. An oscillating saw with 0.8 mm thick saw blade was used to osteotomize the metacarpal sawbones to create a midshaft transverse metacarpal fracture model. Ten pieces were fixed with a 2.0 mm titanium locking plate via unicortical screw purchase and 10 were fixed with a 2.0 mm, four holes, titanium dynamic compression plate, bicortical purchase of screws. They were subjected to cyclic load to failure testing three-point bending and torsion. Results: There were no significant difference in stiffness and cyclic three-point bending to failure between the unicortical locking plate group and the bicortical compression plate group. The bicortical compression plate group is stiffer and has a higher cyclic bending load to failure as compared to the unicortical locking plate group. Conclusion: Unicortical locking plate fixation of metacarpal fracture can be reliably applied clinically to produce a strong and stable construct that allows early mobilization of the joints. This will not only reduce the complication rate of metacarpal plating, but also improve the functional outcome of the hand.

scholarly journals Biomechanical Comparison of Modified Suture Bridge Using Rip-Stop versus Traditional Suture Bridge for Rotator Cuff Repair

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
ZiYing Wu ◽  
Chong Zhang ◽  
Peng Zhang ◽  
TianWu Chen ◽  
ShiYi Chen ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Frozen Shoulder ◽  
Biomechanical Properties ◽  
Modified Technique ◽  
Promising Alternative ◽  
Suture Bridge ◽  
Load To Failure ◽  
Fresh Frozen ◽  
Cuff Repair

Purpose. To compare the biomechanical properties of 3 suture-bridge techniques for rotator cuff repair. Methods. Twelve pair-matched fresh-frozen shoulder specimens were randomized to 3 groups of different repair types: the medially Knotted Suture Bridge (KSB), the medially Untied Suture Bridge (USB), and the Modified Suture Bridge (MSB). Cyclic loading and load-to-failure test were performed. Parameters of elongation, stiffness, load at failure, and mode of failure were recorded. Results. The MSB technique had the significantly greatest load to failure (515.6±78.0 N, P=0.04 for KSB group; P<0.001 for USB group), stiffness (58.0±10.7 N/mm, P=0.005 for KSB group; P<0.001 for USB group), and lowest elongation (1.49±0.39 mm, P=0.009 for KSB group; P=0.001 for USB group) among 3 groups. The KSB repair had significantly higher ultimate load (443.5±65.0 N) than USB repair (363.5±52.3 N, P=0.024). However, there was no statistical difference in stiffness and elongation between KSB and USB technique (P=0.396 for stiffness and P=0.242 for elongation, resp.). The failure mode for all specimens was suture pulling through the cuff tendon. Conclusions. Our modified suture bridge technique (MSB) may provide enhanced biomechanical properties when compared with medially knotted or knotless repair. Clinical Relevance. Our modified technique may represent a promising alternative in arthroscopic rotator cuff repair.

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