scholarly journals The effect of core suture flexor tendon repair techniques on gliding resistance during static cycle motion and load to failure: a human cadaver study

2011 ◽  
Vol 37 (4) ◽  
pp. 316-322 ◽  
Author(s):  
T. Moriya ◽  
M. C. Larson ◽  
C. Zhao ◽  
K.-N. An ◽  
P. C. Amadio
Keyword(s):  
General Hospital ◽  
Ultimate Load ◽  
Massachusetts General Hospital ◽  
Tendon Repair ◽  
Cadaver Study ◽  
Flexor Digitorum Profundus ◽  
Significant Difference ◽  
Load To Failure ◽  
Using Data ◽  
Flexor Digitorum

The purpose of this study was to describe a modification of the Massachusetts General Hospital (MMGH) tendon repair and to compare it with three other suture techniques. Twenty human flexor digitorum profundus (FDP) tendons were randomly assigned to the modified Pennington (MP) suture and the MMGH suture. These were compared to the modified Kessler (MK) and Massachusetts General Hospital (MGH) sutures, using data from a previous study. All tendons were repaired with a similar epitendinous stitch and core sutures of 4-0 FiberWire. There was no significant difference in the normalized gliding resistance within the two-strand or four-strand core repair groups. The MP suture had significantly higher 2 mm gap force and ultimate load to failure than the MK suture. The MMGH suture had significantly higher 2 mm gap force and maximum failure ultimate load than the MGH suture. All repairs failed by knot unravelling.

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 Flexor Digitorum Profundus Avulsion Repair

2019 ◽  
Vol 08 (04) ◽  
pp. 312-316 ◽  
Author(s):  
Jill G. Putnam ◽  
Damon Adamany
Keyword(s):  
Suture Anchor ◽  
Tendon Repair ◽  
Maximum Load ◽  
Flexor Digitorum Profundus ◽  
Anchor Group ◽  
Load To Failure ◽  
Group 3 ◽  
Group 2 ◽  
Flexor Digitorum ◽  
Group 1

Purpose Multiple repair techniques have been investigated for flexor digitorum profundus (FDP) tendon avulsions. The purpose of this study is to compare the biomechanical characteristics of a new fully threaded titanium suture anchor with previously examined fixation techniques. Methods Repair of FDP tendon avulsions was performed in 18 fresh-frozen cadavers using one of three implants: Nano Corkscrew FT 1.7 mm suture anchor (Group 1; Arthrex, Inc., Naples, FL; n = 6), Mitek Micro 1.3 mm suture anchor (Group 2; Mitek Surgical Products, Westwood, MA; n = 6), or pullout suture button fixation (Group 3; n = 6). Constructs were preloaded before testing load to failure. For each trial, elongation at 20 N and maximum load, mean load to failure, stiffness, and failure mechanism were recorded. Results Load to failure occurred in all trials. Mean load to failure was significantly greater for Group 1 (61.6 ± 18.9 N) compared to Group 2 (42.5 ± 4.2 N; p < 0.05) and Group 3 (41.6 N ± 8.0 N; p < 0.05). Stiffness was significantly greater in Groups 1 and 2 compared to Group 3 (6.9 ± 2.2 N/mm vs. 6.1 ± 0.8 N/mm vs. 3.1 N/mm ± 0.5 N/mm, respectively, p < 0.01). Mechanism of failure differed between the groups: Group 1 broke at the anchor in two trials and tore through the tendon in three trials, Group 2's suture universally broke at the anchor, and Group 3's trials mainly failed at the button. Conclusions The Nano Corkscrew anchor (Group 1) has a significantly higher load to failure when compared with the other techniques. The higher load to failure of the corkscrew anchor provides a secure method for flexor tendon repair in zone I. Clinical Relevance A fully threaded titanium suture anchor used for FDP tendon avulsion injuries is likely to withstand early active range of motion protocols.

scholarly journals Braided tape is equivalent to modified Mason-Allen multi-strand #2 suture in subscapularis muscle repair: results of a biomechanical study

2016 ◽  
Vol 9 (2) ◽  
pp. 85-91
Author(s):  
Benjamin Léger-St-Jean ◽  
Jérémie Ménard ◽  
Stéphanie Hinse ◽  
Frédéric Balg ◽  
Dominique M Rouleau
Keyword(s):  
Cyclic Loading ◽  
Ultimate Load ◽  
Tendon Repair ◽  
Biomechanical Study ◽  
Fixation Method ◽  
Subscapularis Tendon ◽  
Mineral Density ◽  
Significant Difference ◽  
Load To Failure ◽  
The Mean

Background To help determine the optimal fixation method for subscapularis tendon repair in arthroplasty, the present study compares single-passage transosseous tape (BT) and modified Mason-Allen #2 suture (MA). Methods Eighteen human cadaveric shoulders were randomized to two repair constructs after arthroplasty preparation. Both techniques included two transosseous passages through the bicipital groove and then through the tendon at the level of the anatomical neck. Construct was tested using a traction machine, measuring cyclic loading and ultimate load to failure. Results The mean age of our specimens was 71 years. No significant difference was observed between the repair techniques in both mean ultimate load and cyclic loading. The mean (SD) ultimate load (UL) for BT was 293 (84) N and 342 (117) N for MA, which was not statistically significant ( p = 0.374). The majority of repairs failed in the tendon. Bone cut-out was observed with the MA but not for the BT repair. No correlation was found between bone density and UL for BT ( r = −0.09) but there was strong correlation for MA ( r = 0.63). Conclusions The MA repair appears to be more dependant on bone mineral density for ultimate load, indicating that braided-tape might be better suited for osteoporotic patients to avoid bone cut-out.

scholarly journals Comparison of step-cut and Pulvertaft attachment for flexor tendon graft: a biomechanics evaluation in an in vitro canine model

2012 ◽  
Vol 37 (9) ◽  
pp. 848-854 ◽  
Author(s):  
T. Hashimoto ◽  
A. R. Thoreson ◽  
K.-N. An ◽  
P. C. Amadio ◽  
C. Zhao
Keyword(s):  
Ultimate Load ◽  
Flexor Tendon ◽  
Canine Model ◽  
Tendon Graft ◽  
Flexor Digitorum Profundus ◽  
Load To Failure ◽  
Tendon Grafts ◽  
Flexor Digitorum ◽  
Flexor Tendon Graft

The purpose of this study was to compare two different methods of joining tendons of similar and dissimilar sizes between recipient and donor tendons for flexor tendon grafts. Flexor digitorum profundus (FDP) and peroneus longus (PL) canine tendons were harvested and divided into four groups. The repair technique we compared was a step-cut (SC) suture and a Pulvertaft weave (PW). FDP tendons were significantly larger in diameter than PL tendons ( p < 0.05). The volume of the SC repairs using either FDP or PL tendon as a graft was significantly smaller than PW repairs ( p < 0.05). The ultimate load to failure and repair stiffness in FDP graft tendons significantly increased compared with the PL graft tendons ( p < 0.05). The SC suture can be used as an alternative to the PW, with similar strength and less bulk for repairs using graft tendons of similar diameter. Surgeons should be aware of the effect of graft tendon size and repair method on strength and bulk when performing flexor tendon grafts.

ADHESION FORMATION AFTER FLEXOR TENDON REPAIR: COMPARISON OF TWO- AND FOUR-STRAND REPAIR WITHOUT EPITENDINOUS SUTURE

Hand Surgery ◽  
2005 ◽  
Vol 10 (02n03) ◽  
pp. 193-197 ◽  
Author(s):  
Margaret J. Strick ◽  
Susan L. Filan ◽  
Mark Hile ◽  
Catriona McKenzie ◽  
William R. Walsh ◽  
...  
Keyword(s):  
Broiler Chickens ◽  
Adhesion Formation ◽  
Biomechanical Testing ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Significant Difference ◽  
Histological Data ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon ◽  
Chicken Model

Increased handling, increased bulk at the repair site and an increase in external suture material may affect adhesion formation and gliding after tendon repair. A previous study1 showed no significant difference in biomechanical or histopathological measurement of adhesion formation in two- and four-strand repairs combined with an epitendinous suture in the chicken model. In the present study, the flexor digitorum profundus tendon of the middle toe of 47 broiler chickens was cut and repaired with either a single (two-strand) or double (four-strand) modified Kessler core suture without epitendinous suture and immobilised for four weeks. Adhesion formation was measured by biomechanical testing or quantitative and qualitative histopathology. Biomechanical and histological data showed no differences between two- and four-strand repairs. Results did not differ from the previous study which used an epitendinous suture. Adhesion formation is not necessarily increased when multi-strand techniques are used, nor by the placement of an epitendinous suture if care is taken with surgical technique. Individual healing response introduces more variability than an increase in tendon handling by an experienced surgeon.

Photochemical Tissue Bonding Technique for Improving Healing of Hand Tendon Injury

2019 ◽  
Vol 26 (2) ◽  
pp. 153-161 ◽  
Author(s):  
Baozhi Ding ◽  
Xin Wang ◽  
Min Yao
Keyword(s):  
Adhesion Formation ◽  
Tendon Repair ◽  
Inflammatory Cells ◽  
Tendon Injury ◽  
Biochemical Properties ◽  
Flexor Digitorum Profundus ◽  
Human Amniotic Membrane ◽  
Active Motion ◽  
Significant Difference ◽  
Flexor Digitorum

Purpose. We utilized a novel approach of combined photochemical tissue bonding (PTB) and human amniotic membrane (HAM) to improve hand tendon repair and also evaluated its efficacy. Methods. Subei chickens underwent surgical transection of the flexor digitorum profundus tendons and repair by (1) SR (standard Kessler suture; n = 24; 6-0 prolene) and (2) HAM/PTB (n = 24), where a section of HAM was stained with 0.1% Rose Bengal, wrapped around the ruptured tendon and bonded with 532 nm light (0.5 W/cm2, 200 J/cm2). Total active motion, gross appearance, extent of adhesion formation, biochemical properties, and inflammatory cells of the repaired tendon were evaluated on days 3, 7, 14, and 28 postoperatively. Results. PTB strongly bonded HAM with flexor digitorum profundus tendon surface. No significant difference was observed between the tensile properties of either group on all postoperative time points. The joint activities and the adhesion formation levels were significantly better in the HAM/PTB group compared with those in the SR group on day 14. Histological examination revealed drastically reduced number of inflammatory cells in the HAM/PTB group than in the SR group on days 7 and 14 after surgery. Conclusions. These findings revealed that PTB sealing of HAM around the tendon repair site provided considerable benefits for hand tendon repair by eliminating technical difficulties and obvious contraindications. Thus, this novel procedure has considerable benefits in repairing hand tendon damage.

Biomechanical Evaluation of Suture Anchor versus Transosseous Tunnel Patellar Tendon Repair Techniques

2018 ◽  
Vol 32 (08) ◽  
pp. 825-832 ◽  
Author(s):  
Seth L. Sherman ◽  
Brandee Black ◽  
Matthew A. Mooberry ◽  
Katie L. Freeman ◽  
Trevor R. Gulbrandsen ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Failure Mode ◽  
Bone Quality ◽  
Ultimate Load ◽  
Suture Anchor ◽  
Tendon Repair ◽  
Tensile Load ◽  
Significant Difference ◽  
Load To Failure ◽  
Suture Anchor Repair

AbstractThe objective of this study is to compare the cyclic loading strength and ultimate failure load in suture anchor repair versus transosseous tunnel repair of patellar tendons using a cadaver model. Twelve cadaveric patella specimens were used (six matched pairs). Dual-energy X-ray absorptiometry (DXA) measurements were performed to ensure equal bone quality among groups. All right knees were assigned to the suture anchor repair group (n = 6), whereas all left knees were assigned to the transosseous bone tunnel group (n = 6). Suture type and repair configuration were equivalent. After the respective procedures were performed, each patella was mounted into a gripping jig. Tensile load was applied at a rate of 1 Hz between magnitudes of 50 and 150 N, 50 and 200 N, 50 and 250 N, and tensile load at a rate of 0.1 mm/s until failure. Failure was defined as a sharp deviation in the linear load versus displacement curve, and failure mode was recorded. DXA measurements demonstrated equivalence of bone quality between the two groups (p > 0.05). During cyclic load testing, there was only a statistically significant difference between the groups with regard to cyclic loading at the 50 to 200 N loading cycle (p = 0.010). There was no statistically significant difference between the groups with regard to ultimate load to failure (p = 0.43). Failure mode within the suture anchor cohort occurred through anchor pullout except for one, which failed through the tendon. All specimens within the transosseous cohort failed through the midsubstance of the tendon except for one, which failed through suture breakage. Suture anchor repair demonstrated a similar biomechanical profile regarding cyclic loading and ultimate load to failure when compared with “gold standard” transosseous tunnel patellar tendon repair with a trend toward less gapping in the suture anchor group. Using suture anchors for repair of the patella tendon has similar biomechanical properties to transpatellar tunnels but may provide other clinical advantages.

Reinforcement of the Flexor Tendon Repair Using Human Amniotic Membrane

2016 ◽  
Vol 106 (5) ◽  
pp. 319-322 ◽  
Author(s):  
Yunus Dogramaci ◽  
Ibrahim Gökhan Duman
Keyword(s):  
Amniotic Membrane ◽  
Mechanical Performance ◽  
Testing Machine ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Human Amniotic Membrane ◽  
Load To Failure ◽  
Group A ◽  
Group B ◽  
Flexor Digitorum

Background: Human amniotic membrane is used to prevent peritendinous adhesions after tendon injuries. This study compares the mechanical properties of modified Kessler repairs and modified Kessler repairs strengthened using multiple layers of human amniotic membrane. Methods: Twenty flexor digitorum profundus tendons of sheep forelimbs were sutured by the two-strand modified Kessler technique (group A) and by the two-strand modified Kessler repair reinforced with multiple layers of human amniotic membrane (group B). To assess the mechanical performance of the repairs, tendons were subjected to a linear noncyclic load-to-failure test using a material testing machine. Outcome measures included ultimate forces and the mode of failure. Results: The mean ± SD value of the failure strength was 34.6 ± 1.64 N for group A and 50.6 ± 5.60 N for group B. The reinforced repair provided a significantly higher ultimate load compared with the nonreinforced group (P &lt; .001). All of the specimens failed due to suture breakage at the repair site. Conclusions: The results of this study show that the modified Kessler repair can be reinforced effectively with human amniotic membrane.

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.

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