Asymmetric six-strand core sutures enhance tendon fatigue strength and the optimal asymmetry

2016 ◽  
Vol 41 (8) ◽  
pp. 802-808 ◽  
Author(s):  
N. Kozono ◽  
T. Okada ◽  
N. Takeuchi ◽  
M. Hanada ◽  
T. Shimoto ◽  
...  
Keyword(s):  
Fatigue Strength ◽  
Cyclic Loading ◽  
Tendon Repair ◽  
Longitudinal Axis ◽  
Suture Repair ◽  
Repair Site ◽  
Beneficial Effects ◽  
The Core

Under cyclic loading, we recorded the fatigue strength of a six-strand tendon repair with different symmetry in the lengths of suture purchase in two stumps of 120 dental rolls and in 30 porcine tendons. First, the strengths of the repairs with 1, 2, 3, 4 and 5 mm asymmetry were screened using the dental rolls. The asymmetric core suture repairs were then made with a Kessler repair of equal suture purchase (10 mm) in two tendon stumps, and shifting two other Kessler repairs by 1, 3 or 5 mm, respectively, along the longitudinal axis of the tendon in relation to the first (symmetric) Kessler repair. The core repairs with 3 mm or more asymmetry in suture purchases in two tendon ends showed significantly greater fatigue strength and significantly smaller gaps compared with 1 mm asymmetry in core suture repair. Our results support that asymmetric placement of core sutures in two tendon ends favour resisting gapping at the repair site and 3 mm or more asymmetry is needed to produce such beneficial effects.

Strength enhancement of the interlocking mechanism in cross-stitch peripheral sutures for flexor tendon repair: biomechanical comparisons by cyclic loading

2009 ◽  
Vol 35 (1) ◽  
pp. 46-50 ◽  
Author(s):  
N. Takeuchi ◽  
H. Mitsuyasu ◽  
S. Hotokezaka ◽  
H. Miura ◽  
H. Higaki ◽  
...  
Keyword(s):  
Fatigue Strength ◽  
Cyclic Loading ◽  
Cyclic Load ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Suture Techniques ◽  
Flexor Tendon Repair ◽  
Strength Enhancement ◽  
The Cross ◽  
Dental Roll

The fatigue strength of three peripheral suture techniques for flexor tendon repair was compared by cyclic loading of repairs in a cotton dental roll tendon model. Thirty pairs of dental roll were sutured using only peripheral sutures with 6-0 polypropylene. An initial cyclic load of 5 N for 500 cycles was applied and increased by 5 N for an additional 500 cycles at each new load until rupture. The fatigue strength of an interlocking cross-stitch suture was 113% greater than a running suture and 36% greater than a standard cross-stitch suture. Interlocking the cross-stitch prevented shortening of the transverse portions under load and appears to be a useful technique for increasing the strength of the peripheral suture.

Surgical adhesive BioGlue™ does not benefit tendon repair strength: an ex vivo study

2015 ◽  
Vol 40 (7) ◽  
pp. 700-704 ◽  
Author(s):  
M. C. Jordan ◽  
V. Schmitt ◽  
S. Dannigkeit ◽  
K. Schmidt ◽  
R. H. Meffert ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Ex Vivo ◽  
Tendon Repair ◽  
Suture Repair ◽  
Load Testing ◽  
Flexor Tendon Repair ◽  
Level Of Evidence ◽  
Repair Site ◽  
Surgical Adhesive ◽  
Ex Vivo Study

Surgical adhesives are useful supplements in surgery, but their benefit in tendon repair is uncertain. The purpose of this study was to evaluate the effect of BioGlue™ on strength of flexor tendon repair. A total of 60 porcine flexor tendons were divided into three groups. In group one, a conventional core and peripheral suture repair was used. In group two, a core suture and BioGlue™ were used. In group three, a conventional core and peripheral suture repair and BioGlue™ were used. We performed static and cyclic axial load testing and measured diameter of the repair site. We found that BioGlue™ did not improve the tensile strength when added to a core and peripheral suture and that there was an increase in bulk at the repair site. We conclude that BioGlue™ application cannot replace a peripheral suture as tensile strength significantly decreases without a peripheral suture, and it does not benefit a tendon already repaired with a core and peripheral suture. Level of evidence: n/a

A knotless bidirectional-barbed tendon repair is inferior to conventional 4-strand repairs in cyclic loading

2016 ◽  
Vol 41 (8) ◽  
pp. 809-814 ◽  
Author(s):  
F. P. O’Brien ◽  
B. G. Parks ◽  
M. A. Tsai ◽  
K. R. Means
Keyword(s):  
Cyclic Loading ◽  
Tendon Repair ◽  
Suture Technique ◽  
Flexor Digitorum Profundus ◽  
Barbed Suture ◽  
Suture Repair ◽  
Level Of Evidence ◽  
Active Range Of Motion ◽  
Suture Group ◽  
Flexor Digitorum

We divided 21 flexor digitorum profundus tendons in the index, middle and ring fingers in seven cadaver hands into three groups. The tendons were cut in zone 2 and repaired using a 4-strand cruciate core suture repair with one of the following three materials in each group: (1) a knotless repair with a 2-0 bidirectional-barbed suture, which has similar tensile strength as a 4-0 non-barbed suture used in the other two groups; (2) a knotted locking repair with a non-barbed 4-0 conventional suture; and (3) a non-locking repair with a non-barbed 4-0 knotless suture. The repaired fingers were cyclically loaded through a simulated active range of motion to a 5 N load. We monitored and recorded the gap sizes at regular intervals during the test. The 2-0 bidirectional-barbed suture group and non-barbed suture groups developed gaps of 2.2 mm after 10 cycles and 2.4 mm after 20 cycles, respectively. Over 1000 cycles, the mean gaps were 3.2 mm in the 4-0 conventional suture group and 9.1 mm in the 2-0 bidirectional-barbed group. The tendons in the 2-0 bidirectional-barbed group gapped earlier, with statistically significant differences compared with those in the locking repair with a non-barbed 4-0 knotless suture group. The repair strength of the barbed suture technique was inferior to the cruciate repairs using a conventional 4-0 non-barbed suture tested in this cyclic-loading model. Level of evidence: Level V

Cutting or Round-Bodied Needles for Tendon Repair

2003 ◽  
Vol 28 (5) ◽  
pp. 475-477 ◽  
Author(s):  
W. L. LAM ◽  
A. GARRIDO ◽  
J. VANDERMEULEN ◽  
M. J. FAGAN ◽  
P. R. W. STANLEY
Keyword(s):  
Tensile Strength ◽  
Tendon Repair ◽  
Biomechanical Study ◽  
Suture Repair ◽  
Longitudinal Stress ◽  
The Core ◽  
Group 3 ◽  
Group 2 ◽  
Repair Group ◽  
Group 1

We carried out a biomechanical study comparing tensile strength after using round-bodied or cutting needles for tendon repair. Swine tendons were repaired in three groups: Group 1 core suture repair only; group 2 core and circumferential suture repair; and group 3 isolated circumferential suture repair. The tendons were tested at longitudinal stress to failure at 5 mm/minute. No significant differences were found between the round-bodied and cutting needles in any group. Equal numbers in the core suture repair group failed by suture pullout when comparing cutting and round-bodied needles. We conclude that the choice of needle has no effect on the outcome of tendon repair if there is consistency of surgeon’s skill and experience.

Biomechanical Comparison of Patellar Tendon Repairs in a Cadaver Model: An Evaluation of Gap Formation at the Repair Site with Cyclic Loading

2002 ◽  
Vol 30 (4) ◽  
pp. 469-473 ◽  
Author(s):  
Richard V. Ravalin ◽  
Augustus D. Mazzocca ◽  
John C. Grady-Benson ◽  
Carl W. Nissen ◽  
Doug J. Adams
Keyword(s):  
Patellar Tendon ◽  
Tendon Repair ◽  
Early Mobilization ◽  
Suture Repair ◽  
Gap Formation ◽  
Repair Site ◽  
Fresh Frozen ◽  
Biomechanical Comparison ◽  
Drill Holes ◽  
Repair Techniques

Background Ruptures of the patellar tendon are rare injuries. Surgical treatment for this injury is mandatory. Hypothesis Gap formation does not differ between the three patellar tendon repair techniques. Study Design Controlled laboratory study. Methods Twelve fresh-frozen cadaveric knees were used to compare three techniques of patellar tendon repairs. The standard suture repair used two Krackow sutures placed in the avulsed patellar tendon, passed through transpatellar drill holes, and secured with the knee in 30° of flexion. In the second group, suture repair was augmented with a No. 5 Ethibond suture. In the third group, suture repair was augmented with a 2.0 Dall-Miles cable. Testing was performed with the specimens mounted to a custom knee jig with the tibia free, simulating the knee moment of a 70-kg person. Each knee was then cycled 250 times at 0.25 Hz. Results Gap formation across the standard suture repair averaged 7.3 mm; across the suture augmentation and cable augmentation groups it averaged 4.9 mm and 3.5 mm, respectively. Conclusions Augmentation of patellar tendon avulsions can decrease gap formation at the repair site, allowing early mobilization. Clinical Relevance Gap formation seen in repair without augmentation could lead to clinical failure with resultant patella alta and extensor mechanism lag.

Zone 2 flexor tendon repairs using a tensioned strong core suture, sparse peripheral stitches and early active motion: results in 60 fingers

2019 ◽  
Vol 44 (4) ◽  
pp. 361-366 ◽  
Author(s):  
Zhang Jun Pan ◽  
Yun Fei Xu ◽  
Lei Pan ◽  
Jing Chen
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Level Of Evidence ◽  
Active Motion ◽  
Repair Site ◽  
The Core ◽  
Active Flexion ◽  
Flexor Digitorum

We report the outcomes of zone 2 tendon repairs in 60 fingers using a strong core suture, sparse peripheral stitches and early active motion. From January 2014 to April 2016, we repaired 60 flexor digitorum profundus tendons with a tensioned 4-strand or 6-strand core suture and three to four peripheral stitches. The A2 or A4 pulleys were vented as necessary. Following early active flexion of the repaired tendons, no repairs ruptured and 52/60 (87%) fingers recovered to good or excellent function using the Tang criteria after follow-up of 8–33 months. We conclude that tensioned multi-strand strong core repairs only require sparse peripheral stitches and are safe for early active flexion. Standard peripheral sutures are not necessary. The core sutures should be properly tensioned to prevent gapping at tendon repair site and pulleys should be sufficiently vented to allow tendon motion. Level of evidence: IV

Symmetric Peripheral Running Sutures are Superior to Asymmetric Peripheral Running Sutures for Increasing the Tendon Strength in Flexor Tendon Repair

2017 ◽  
Vol 22 (02) ◽  
pp. 208-213 ◽  
Author(s):  
N. Takeuchi ◽  
T. Okada ◽  
N. Kozono ◽  
T. Shimoto ◽  
H. Higaki ◽  
...  
Keyword(s):  
Fatigue Strength ◽  
Cyclic Loading ◽  
Cyclic Load ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Suture Techniques ◽  
Flexor Tendon Repair ◽  
Flexor Digitorum

Background: The fatigue strength of three peripheral suture techniques for flexor tendon repair was compared by cyclic loading of the repairs in the porcine flexor digitorum tendon. Methods: Thirty-six tendons were sutured using only peripheral sutures with 6-0 Nylon. An initial cyclic load of 10 N for 500 cycles was applied and increased by 10 N for an additional 500 cycles at each new load until rupture. Results: The fatigue strength of the symmetric running peripheral suture was 85.0% and 144.8% greater than that of the two kinds of the asymmetric running peripheral sutures. Conclusions: Symmetric running sutures can enhance the suture strength and appears to be a useful technique for increasing the strength of the peripheral suture.

The impact of transverse components on 4-strand tendon repairs

2021 ◽  
pp. 175319342110183
Author(s):  
Ya Fang Wu ◽  
Wei Feng Mao ◽  
Jin Bo Tang
Keyword(s):  
Cyclic Loading ◽  
Ultimate Strength ◽  
Repair Site ◽  
Flexor Tendons ◽  
The Core ◽  
The Impact

We investigated the effects of the transverse components of a tendon core suture on tensile resistance and strength of 4-strand repairs. Forty-four pig flexor tendons were repaired with one of the following four methods: double Tsuge, U-shaped, 4-strand cross and 4-strand rectangular repairs. We recorded the number of the repaired tendons that formed a 2 mm gap between the tendon ends during cyclic loading for 20 cycles, stiffness of the tendon at the 1st and 20th cycle, gap distance at the repair site and ultimate strength of the repair at the 20th cycle. When transverse components were added to the core suture, a greater number of tendons formed a 2 mm gap during cyclic loading. The stiffness gradually decreased, and the repair site's gap distance after cyclic loading increased with the presence of transverse components of the sutures. We conclude that the core suture's transverse components negatively impact the tensile resistance of 4-strand tendon repairs.

scholarly journals Contextualization of the Bioeconomy Concept through Its Links with Related Concepts and the Challenges Facing Humanity

2021 ◽  
Vol 13 (14) ◽  
pp. 7746
Author(s):  
Leire Barañano ◽  
Naroa Garbisu ◽  
Itziar Alkorta ◽  
Andrés Araujo ◽  
Carlos Garbisu
Keyword(s):  
Environmental Economics ◽  
Green Economy ◽  
Added Value ◽  
Economic Activities ◽  
Biological Resources ◽  
Beneficial Effects ◽  
The Core ◽  
Points Of View ◽  
Broad Interpretation ◽  
Shed Light

The concept of bioeconomy is a topic of debate, confusion, skepticism, and criticism. Paradoxically, this is not necessarily a negative thing as it is encouraging a fruitful exchange of information, ideas, knowledge, and values, with concomitant beneficial effects on the definition and evolution of the bioeconomy paradigm. At the core of the debate, three points of view coexist: (i) those who support a broad interpretation of the term bioeconomy, through the incorporation of all economic activities based on the production and conversion of renewable biological resources (and organic wastes) into products, including agriculture, livestock, fishing, forestry and similar economic activities that have accompanied humankind for millennia; (ii) those who embrace a much narrower interpretation, reserving the use of the term bioeconomy for new, innovative, and technologically-advanced economic initiatives that result in the generation of high-added-value products and services from the conversion of biological resources; and (iii) those who stand between these two viewpoints. Here, to shed light on this debate, a contextualization of the bioeconomy concept through its links with related concepts (biotechnology, bio-based economy, circular economy, green economy, ecological economics, environmental economics, etc.) and challenges facing humanity today is presented.

scholarly journals Effects of thermomechanical history and environment on the fatigue behavior of (β)-Ti-Nb implant alloys

2018 ◽  
Vol 165 ◽  
pp. 06001 ◽  
Author(s):  
André Reck ◽  
Stefan Pilz ◽  
Ulrich Thormann ◽  
Volker Alt ◽  
Annett Gebert ◽  
...  
Keyword(s):  
Fatigue Strength ◽  
Cyclic Loading ◽  
Fatigue Behavior ◽  
Fatigue Tests ◽  
Grain Structure ◽  
Fatigue Properties ◽  
Β Phase ◽  
Α Phase ◽  
Nb Content ◽  
Implant Alloys

This study examined the fatigue properties of a newly developed cast and thermomechanical processed (β)-Ti-40Nb alloy for a possible application as biomedical alloy due to exceptional low Young’s modulus (64-73 GPa), high corrosion resistance and ductility (20-26%). Focusing on the influence of two microstructural states with fully recrystallized β-grain structure as well as an aged condition with nanometer-sized ω-precipitates, tension-compression fatigue tests (R=-1) were carried out under lab-air and showed significant differences depending on the β-phase stability under cyclic loading. Present ω- precipitates stabilized the β-phase against martensitic α’’ phase transformations leading to an increased fatigue limit of 288 MPa compared to the recrystallized state (225 MPa), where mechanical polishing and subsequent cyclic loading led to formation of α’’-phase due to the metastability of the β-phase. Additional studied commercially available (β)-Ti-45Nb alloy revealed slightly higher fatigue strength (300 MPa) and suggest a change in the dominating cyclic deformation mechanisms according to the sensitive dependence on the Nb-content. Further tests in simulated body fluid (SBF) at 37°C showed no decrease in fatigue strength due to the effect of corrosion and prove the excellent corrosion fatigue resistance of this alloy type under given test conditions.

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