Biomechanical comparison of the Lim/Tsai tendon repair with a modified method using a single looped suture

2017 ◽  
Vol 42 (9) ◽  
pp. 915-919 ◽  
Author(s):  
Min Kai Chang ◽  
Yoke Rung Wong ◽  
Shian Chao Tay
Keyword(s):  
Tensile Strength ◽  
Ultimate Tensile Strength ◽  
Mechanical Performance ◽  
Tendon Repair ◽  
Original Method ◽  
Flexor Digitorum Profundus ◽  
Loading Test ◽  
Modified Method ◽  
Cycle Loading ◽  
The Difference

The Lim/Tsai tendon repair technique has been modified clinically to achieve a 6-strand repair using a single looped suture with one extratendinous knot. We compared biomechanical performance of the original and modified methods using 20 porcine flexor digitorum profundus tendons. The ultimate tensile strength, load to 2 mm gap force, mode of failure, and time taken to repair each tendon were recorded during a single cycle loading test in 10 tendons with each repair method. We found that despite having the same number of core strands, the single looped suture modified Lim/Tsai technique possessed significantly greater ultimate tensile strength and load to 2 mm gap force. Also, less repair time was required. We conclude that the modified 6-strand repair using a single looped suture has better mechanical performance than the original method. The difference likely was due to the changes in locations of the knots and subsequent load distribution during tendon loading.

Biomechanical comparison of modified Lim/Tsai tendon repairs with intra- and extra-tendinous knots

2018 ◽  
Vol 43 (9) ◽  
pp. 919-924 ◽  
Author(s):  
Min Kai Chang ◽  
Yoke Rung Wong ◽  
Shian Chao Tay
Keyword(s):  
Tensile Strength ◽  
Ultimate Tensile Strength ◽  
Tendon Repair ◽  
Single Cycle ◽  
Loading Test ◽  
Repair Technique ◽  
Mode Of Failure ◽  
Cycle Loading ◽  
Biomechanical Comparison ◽  
Failure Location

We compared the Lim/Tsai tendon repair technique using an extra-tendinous knot with modification using an intra-tendinous knot. The ultimate tensile strength, load to 2 mm gap force, stiffness, mode of failure, location of failure, and time taken to repair each tendon were recorded during a single cycle loading test in 20 tendons with each repair method. We found that the ultimate tensile strength and 2 mm gap force of the modified Lim/Tsai repair with an extra-tendinous knot (56 SD 5 N and 14 SD 2 N, respectively) were statistically significantly higher than that of the modified Lim/Tsai repair with intra-tendinous knot (51 SD 7 N and 11 SD 2 N, respectively). We conclude that the modified Lim/Tsai repair with extra-tendinous knot is stronger, despite having the same number of core strands.

Effect of Suture Knots on Tensile Strength of Repaired Canine Flexor Tendons

1995 ◽  
Vol 20 (1) ◽  
pp. 72-75 ◽  
Author(s):  
M. AOKI ◽  
D. L. PRUITT ◽  
H. KUBOTA ◽  
P. R. MANSKE
Keyword(s):  
Tensile Strength ◽  
Ultimate Tensile Strength ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Repair Site ◽  
Flexor Tendons ◽  
The One ◽  
Flexor Digitorum

59 dog cadaver flexor digitorum profundus tendons were repaired with one or two knots inside or outside the tendon, using two, four and six suture strands. The ultimate tensile strength and gap strengths were compared. Locating the knots outside rather than within the tendon repair site showed significantly higher ultimate tensile strength for two, four, and six strand sutures. The strength was greater in one knot than in two knot sutures; the value of the six-strand suture using the one knot outside technique was the greatest. Similarly, increased gap strength was also obtained from the one-knot-outside technique. We concluded that the knots should be located away from the tendon repair site and there should be as few as possible.

Biomechanical Analysis of a Step-Cut Technique for Flexor Tendon Repair

1992 ◽  
Vol 17 (3) ◽  
pp. 282-285 ◽  
Author(s):  
L. GORDON ◽  
J. L. GARRISON ◽  
J. C. CHENG ◽  
Y. K. LIU ◽  
R. P. NATHAN ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Ultimate Tensile Strength ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Biomechanical Analysis ◽  
Flexor Digitorum Profundus ◽  
Gap Formation ◽  
Flexor Tendon Repair ◽  
The Core ◽  
Human Cadavers

We compared the strength of a new step-cut technique for flexor tendon repair with that of the widely used Kessler-Tajima technique, giving special attention to the relative contributions of the core and epitendinous sutures. 36 flexor digitorum profundus tendons from human cadavers were used. Corresponding digits from the same donor were paired, and the two tendons of each pair were placed in the Kessler-Tajima and step-cut groups, respectively. Each group had three subcategories of repair: (1) core repair alone; (2) epitendinous repair alone; and (3) full repair. In the Kessler-Tajima repair, the core stitch contributed more to ultimate tensile strength, while the epitendinous stitch contributed more to gap formation resistance. In the step-cut repair, however, the epitendinous stitch contributed more to both measures of strength. The full step-cut repair was 65% stronger in resisting gap formation and had 84% more ultimate tensile strength than the full Kessler-Tajima repair. We attribute the greater strength of the step-cut repair to the additional number of epitendinous loops, which lie perpendicular to the long axis of the tendon.

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.

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.

Effect of Mo and Bi on Mechanical Properties of Zr-Fe-Cr Alloy at Room Temperature

2013 ◽  
Author(s):  
B. F. Luan ◽  
L. Q. Yang ◽  
T. G. Wei ◽  
K. L. Murty ◽  
C. S. Long ◽  
...  
Keyword(s):  
Mechanical Properties ◽  
Tensile Strength ◽  
Electron Microscope ◽  
Ultimate Tensile Strength ◽  
Yield Strength ◽  
Room Temperature ◽  
Mechanical Performance ◽  
Microstructure Observation ◽  
Scanning Electron ◽  
Zr Alloy

To investigate the effects of Mo and Bi on mechanical properties of a Zr-Fe-Cr alloy at room temperature, seven Zr-Fe-Cr-Mo-Bi alloys with different compositions were designed. They were subjected to a series of rolling processes and heat treatments, and then sampled to measure mechanical properties by hardness and tensile test and to characterize microstructures by scanning electron microscope (SEM) and electron channel contrast (ECC) technique. Results indicated that among them two types of Zr-Fe-Cr-Mo-Bi alloys achieve the designed goals on mechanical properties and have the following advantages: (i) the hardness of the alloys, up to 334HV after annealing, is 40% higher than traditional Zr-4. (ii) The yield strength (YS) and ultimate tensile strength (UTS) of the alloys are 526 MP a and 889 MP a after hot rolling and annealing, markedly higher than the traditional Zr alloy. (iii) Good plasticity of the new Zr-Fe-Cr-Mo-Bi alloy is obtained with about 40% elongation, which is greatly higher than the Zr-Fe-Cr-Mo alloy thanks to the addition of Bi offsetting the disadvantage of addition Mo. Furthermore, according to observations of the microstructure observation, the reasons of the effect of the Mo and Bi elements on the mechanical performance of Zr-Fe-Cr alloy were studied and discussed.

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.

Influence of Sintering Parameters on the Mechanical Performance of PM Steels Pre-Alloyed with Chromium

2007 ◽  
Vol 534-536 ◽  
pp. 545-548 ◽  
Author(s):  
Ola Bergman ◽  
Björn Lindqvist ◽  
Sven Bengtsson
Keyword(s):  
Mechanical Properties ◽  
Tensile Strength ◽  
Ultimate Tensile Strength ◽  
High Performance ◽  
Mechanical Performance ◽  
Sintering Temperature ◽  
Oxide Reduction ◽  
Low Oxygen ◽  
Positive Effects ◽  
Partial Pressures

Powder grades pre-alloyed with 1.5-3 wt% chromium are suitable for PM steel components in high performance applications. These materials can be successfully sintered at the conventional temperature 1120 °C, although well-monitored sintering atmospheres with low oxygen partial pressures (<10-17-10-18 atm) are required to avoid oxidation. Mechanical properties of the Cralloyed PM grades are enhanced by a higher sintering temperature in the range 1120-1250 °C, due to positive effects from pore rounding, increased density and more effective oxide reduction. A material consisting of Astaloy CrM, which is pre-alloyed with 3 wt% Cr and 0.5 wt% Mo, and 0.6 wt% graphite obtains an ultimate tensile strength of 1470 MPa combined with an impact strength of 31 J at density 7.1 g/cm3, after sintering at 1250 °C followed by cooling at 2.5 °C/s and tempering.

Collagen Cross-linking and Ultimate Tensile Strength in Dentin

2004 ◽  
Vol 83 (10) ◽  
pp. 807-810 ◽  
Author(s):  
P.A. Miguez ◽  
P.N.R. Pereira ◽  
P. Atsawasuwan ◽  
M. Yamauchi
Keyword(s):  
Tensile Strength ◽  
Ultimate Tensile Strength ◽  
Dental Materials ◽  
Cross Linking ◽  
Anatomical Location ◽  
Dentinal Tubules ◽  
Root Dentin ◽  
Cross Links ◽  
The Difference ◽  
Collagen Cross Linking

Several studies have indicated differences in bond strength of dental materials to crown and root dentin. To investigate the potential differences in matrix properties between these locations, we analyzed upper root and crown dentin in human third molars for ultimate tensile strength and collagen biochemistry. In both locations, tensile strength tested perpendicular to the direction of dentinal tubules (undemineralized crown = 140.4 ± 48.6/root = 95.9 ± 26.1; demineralized crown = 16.6 ± 6.3/root = 29.0 ± 12.4) was greater than that tested parallel to the tubular direction (undemineralized crown = 73.1 ± 21.2/root = 63.2 ± 22.6; demineralized crown = 9.0 ± 3.9/root = 16.2 ± 8.0). The demineralized specimens showed significantly greater tensile strength in root than in crown. Although the collagen content was comparable in both locations, two major collagen cross-links, dehydrodihydroxylysinonorleucine/its ketoamine and pyridinoline, were significantly higher in the root (by ~ 30 and ~ 55%, respectively) when compared with those in the crown. These results indicate that the profile of collagen cross-linking varies as a function of anatomical location in dentin and that the difference may partly explain the site-specific tensile strength.

Helical 6-Strand Cruciate Tenorrhaphy: Description of a New Technique and Biomechanical Comparative Analysis With 2 Standard Techniques

Hand ◽  
2020 ◽  
pp. 155894471989713 ◽  
Author(s):  
Carlos Eduardo Torres Fuentes ◽  
Francisco Sebastián Carvajal Flechas ◽  
Julián Andrés Hernández ◽  
Juan Sebastián Abaunza Ubaque ◽  
Dayana Beatriz Carmona García ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Ultimate Tensile Strength ◽  
Ex Vivo ◽  
Tendon Repair ◽  
Early Mobilization ◽  
Standard Technique ◽  
Biomechanical Study ◽  
Flexor Tendons ◽  
Significant Difference ◽  
Standard Techniques

Background: Multiple flexor tendon repair techniques have been developed over the last years. Despite all this, there is no standard technique that has proven to be superior to others, leading to great variability in the use of techniques in surgical practice. We describe a novel tendon repair technique and compare its biomechanical characteristics with 2 conventional techniques. Methods: Comparative experimental biomechanical study in ex vivo animal models. In all, 66 deep flexor tendons of the pig’s front legs were taken and it’s repair was performed by 1 of 3 techniques (helical 6-strand cruciate tendon repair, Adelaide tendon repair, or modified Kessler). These repairs were subjected to biomechanical study, measuring, and registering the ultimate tensile strength, load to 2-mm gap force, and stiffness. Results: The helical 6-strand cruciate tenorrhaphy compared with the Adelaide and modified Kessler techniques carries statistically significant greater ultimate tensile strength before failure (65.5, 46, and 36 N, respectively, P < .001). It also required a greater load to 2-mm gap force and is less stiff, allowing greater strain before failure. This technique does not generate significant changes in the dimensions of the tendons compared to the others, and there was no significant difference in the strength of repair between surgeons. Conclusions: The helical 6-strand cruciate tenorrhaphy is a novel technique, useful for the repair of flexor tendons in the hand that holds up the necessary forces to initiate early mobilization in the postoperative period and has better biomechanical properties than 2 standard techniques.

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