scholarly journals Anatomical and Biomechanical properties of MPFL reconstruction technique using Adductor Magnus tendon graft

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0031
Author(s):  
Danko Dan Milinkovic ◽  
Christian Fink ◽  
Petri Sillanpää ◽  
Michael J. Raschke ◽  
Christoph Kittl ◽  
...  
Keyword(s):  
Insertion Site ◽  
Biomechanical Properties ◽  
Tendon Graft ◽  
Mpfl Reconstruction ◽  
Reconstruction Technique ◽  
Maximum Elongation ◽  
Load To Failure ◽  
Application Potential ◽  
Length Changes ◽  
The Mean

Aims and Objectives: The main goal of the presented study was to evaluate the anatomical and biomechanical properties of the proposed surgical technique for anatomical Medial Patellofemoral ligament (MPFL) reconstruction using the flat Adductor tendon (AT) graft in order to primarily determine its overall plausibility and application potential, as well as to reveal the main risks and pitfalls of the technique. Materials and Methods: Anatomical descriptive evaluation, followed by biomechanical testing of the proposed AT- MPFL reconstruction was conducted on 12 fresh frozen human cadaveric knees. The morphological and topographical features of the AT and native MPFL were reported. The biomechanical tests were performed in order to determine the strength and resistance to maximum loading force of the reconstruction. The construct was placed in an uniaxial testing machine and cyclically loaded 500 times between 5 and 50N, followed by load to failure, measuring the maximum elongation, stiffness and maximum load respectively. Results: Regarding the anatomical evaluation of the structures in focus, several findings have been reported. The mean length of the tendon was found to be 12,59±1,54cm, the mean distance between the insertion on the Adductor tubercule and Hiatus was measured at 10,83±1,27cm, exceeding the mean desired length of the graft, found at 7,54±0,45cm by 2,43±0,56cm. The desired length of the graft was based on the measured length of the native MPFL with additional ±25-30mm of the tendon that allows for intraoperative length changes and different means of patellar fixation depending on the surgeons preference. The insertion of the Adductor tendon on the Adductor tubercule was found to be superior and posterior to the insertion of the native MPFL. The distal portion of AT was found to be consisted of two distinct parts with varying fiber orientation, the tendinous and the membranous part. After cyclic load, the maximum elongation was reported at 1,9 ± 0,4mm. The mean stiffness and load to failure of the construct were measured at 26,2±7,6N/mm and 148,74±22,01N. The graft failed at the patellar insertion site in two of the tested specimens and at the femoral insertion site in the remaining 10. Conclusion: Due to its advantageous anatomical and topographical aspects, as well as adequate biomechanical properties, the Adductor tendon graft caries a high utilization potential for MPFL reconstruction. Application that allows for primarily soft tissue fixation on the patella, in addition to absence of femoral drill holes with consequently no risk of injury to the physis, makes the AT graft choice a preferable option when considering MPFL reconstruction in patients with open growth plates. Even though it includes graft and methods of fixation alternative to the traditionally used techniques, this reconstruction is not exclusively predetermined for the skeletally immature patients and has a high application potential for the older patient population as well.

Anatomic and Biomechanical Properties of Flat Medial Patellofemoral Ligament Reconstruction Using an Adductor Magnus Tendon Graft: A Human Cadaveric Study

2021 ◽  
pp. 036354652110095
Author(s):  
Danko Dan Milinkovic ◽  
Christian Fink ◽  
Christoph Kittl ◽  
Petri Silanpää ◽  
Elmar Herbst ◽  
...  
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Biomechanical Properties ◽  
Mpfl Reconstruction ◽  
Maximum Elongation ◽  
Skeletally Immature ◽  
Femoral Insertion ◽  
Adductor Tubercle ◽  
Adductor Magnus ◽  
Load To Failure ◽  
The Mean

Background: In contrast to the majority of existing techniques for reconstruction of the medial patellofemoral ligament (MPFL), the technique described in this article uses the adductor magnus muscle tendon to gain a flat, broad graft, leaving its distal femoral insertion intact, and does not require drilling within or near the femoral physis. It also allows for soft tissue patellar fixation and could facilitate anatomic MPFL reconstruction in skeletally immature patients. Purpose: To evaluate the anatomic and structural properties of the native MPFL and the adductor tendon (AT), followed by biomechanical evaluation of the proposed reconstruction. Study Design: Descriptive laboratory study. Methods: The morphological and topographical features of the AT and MPFL were evaluated in 12 fresh-frozen cadaveric knees. The distance between the distal insertion of the AT on the adductor tubercle and the adductor hiatus, as well as the desired length of the graft, was measured to evaluate this graft’s application potential. Load-to-failure tests were performed to determine the biomechanical properties of the proposed reconstruction construct. The construct was placed in a uniaxial testing machine and cyclically loaded 500 times between 5 and 50 N, followed by load to failure, to measure the maximum elongation, stiffness, and maximum load. Results: The mean ± SD length of the AT was 12.6 ± 1.5 cm, and the mean distance between the insertion on the adductor tubercle and adductor hiatus was 10.8 ± 1.3 cm, exceeding the mean desired length of the graft (7.5 ± 0.5 cm) by 3.3 ± 0.7 cm. The distal insertion of the AT was slightly proximal and posterior to the insertion of the MPFL. The maximum elongation after cyclical loading was 1.9 ± 0.4 mm. Ultimately, the mean stiffness and load to failure were 26.2 ± 7.6 N/mm and 169.7 ± 19.2 N, respectively. The AT graft failed at patellar fixation in 2 of the initially tested specimens and at the femoral insertion in the remaining 10. Conclusion: The described reconstruction using the AT has potential for MPFL reconstruction. The AT graft presents a graft of significant volume, beneficial anatomic topography, and adequate tensile properties in comparison with the native MPFL following the data from previously published studies. Clinical Relevance: Given its advantageous anatomic relationship as an application that avoids femoral drilling and osseous patellar fixation, the AT may be considered a graft for MPFL reconstruction in skeletally immature patients.

scholarly journals Interference Screw Versus Suture Anchors for Femoral Fixation in Medial Patellofemoral Ligament Reconstruction: A Biomechanical Study

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712198928
Author(s):  
Heath P. Gould ◽  
Nicholas R. Delaney ◽  
Brent G. Parks ◽  
Roshan T. Melvani ◽  
Richard Y. Hinton
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Interference Screw ◽  
Biomechanical Study ◽  
Graft Fixation ◽  
Mpfl Reconstruction ◽  
Suture Anchors ◽  
Femoral Fixation ◽  
Significant Difference ◽  
Load To Failure ◽  
The Mean

Background: Femoral-sided graft fixation in medial patellofemoral ligament (MPFL) reconstruction is commonly performed using an interference screw (IS). However, the IS method is associated with several clinical disadvantages that may be ameliorated by the use of suture anchors (SAs) for femoral fixation. Purpose: To compare the load to failure and stiffness of SAs versus an IS for the femoral fixation of a semitendinosus autograft in MPFL reconstruction. Study Design: Controlled laboratory study. Methods: Based on a priori power analysis, a total of 6 matched pairs of cadaveric knees were included. Specimens in each pair were randomly assigned to receive either SA or IS fixation. After an appropriate reconstruction procedure, the looped end of the MPFL graft was pulled laterally at a rate of 6 mm/s until construct failure. The best-fit slope of the load-displacement curve was then used to calculate the stiffness (N/mm) in a post hoc fashion. A paired t test was used to compare the mean load to failure and the mean stiffness between groups. Results: No significant difference in load to failure was observed between the IS and the SA fixation groups (294.0 ± 61.1 vs 250.0 ± 55.9; P = .352), although the mean stiffness was significantly higher in IS specimens (34.5 ± 9.6 vs 14.7 ± 1.2; P = .004). All IS reconstructions failed by graft pullout from the femoral tunnel, whereas 5 of the 6 SA reconstructions failed by anchor pullout. Conclusion: In this biomechanical study using a cadaveric model of MPFL reconstruction, SA femoral fixation was not significantly different from IS fixation in terms of load to failure. The mean load-to-failure values for both reconstruction techniques were greater than the literature-reported values for the native MPFL. Clinical Relevance: These results suggest that SAs are a biomechanically viable alternative for femoral-sided graft fixation in MPFL reconstruction.

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 Sternoclavicular Joint Reconstruction Fracture Risk Is Reduced With Straight Drill Tunnels and Optimized With Tendon Graft Suture Augmentation

2019 ◽  
Vol 7 (4) ◽  
pp. 232596711983826 ◽  
Author(s):  
Frank Martetschläger ◽  
Franziska Reifenschneider ◽  
Nicole Fischer ◽  
Coen A. Wijdicks ◽  
Peter J. Millett ◽  
...  
Keyword(s):  
Testing Machine ◽  
Primary Stability ◽  
Biomechanical Properties ◽  
Tendon Graft ◽  
Sternoclavicular Joint ◽  
Graft Material ◽  
Load To Failure ◽  
Posterior Translation ◽  
Drill Holes ◽  
Suture Tape

Background: Despite the rare entity of sternoclavicular joint (SCJ) instability, a variety of different reconstruction techniques for SCJ dislocations have been described. A technique with oblique drilling has been proposed to reduce intraoperative risks. Purpose: To biomechanically investigate different cerclage reconstruction techniques and the benefit of additional reinforcement using suture tape. Study Design: Controlled laboratory study. Methods: Reconstructed artificial bone specimens were mounted on a mechanical testing machine. They were subjected to anterior and posterior translation, analyzing ultimate strength, displacement, stiffness, and elongation. For stage 1, different angulations of the drill tunnels through the sternum and clavicle were compared. Straight drill tunnels from anterior to posterior were compared with 45° oblique drill tunnels. For stage 2, three different materials for cerclage reconstruction were compared: (1) suture tape alone (FT group), (2) tendon graft alone (tendon group), and (3) tendon graft with suture tape augmentation (tendon+FT group). Results: For the FT group, in the anterior and posterior directions, straight drill holes resulted in a significantly higher load to failure (936.9 ± 122.5 N) compared with oblique ones (434.5 ± 20.2 N) ( P < .0001). During cyclic testing, all specimens with straight drill holes survived the 5- to 550-N step, while all specimens with oblique ones failed during the 5- to 450-N step. Analyzing the graft material choice, the mean load to failure was 556.6 ± 174.3 N for the tendon group, 936.9 ± 122.5 N for the FT group, and 767.0 ± 110.7 N for the tendon+FT group ( P = .089). The stiffness of the tendon+FT group was significantly lower than that of the FT group and significantly higher than that of the tendon group. Conclusion: Oblique tunnel placement during SCJ reconstruction, while reducing the intraoperative risk, results in decreased primary stability of the construct. Tendon graft reconstruction with suture tape augmentation leads to enhanced stability and optimizes biomechanical properties of the construct. Clinical Relevance: The surgical technique with straight drill holes has superior initial biomechanical properties and may likewise produce superior clinical outcomes in the treatment of SCJ instability. Suture tape augmentation can provide additional stability to reconstruction procedures.

scholarly journals Biomechanical Analysis of a Novel Acetabulum Reconstruction Technique with Acetabulum Reconstruction Cage and Threaded Rods after Type II Pelvic Resections

Sarcoma ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Vivek Ajit Singh ◽  
Hassan Elbahri ◽  
Rukmanikanthan Shanmugam
Keyword(s):  
Hip Replacement ◽  
Biomechanical Analysis ◽  
Acetabular Reconstruction ◽  
Reconstruction Technique ◽  
Type Ii ◽  
Acetabular Cup ◽  
Viable Option ◽  
Load To Failure ◽  
The Mean ◽  
Biomechanical Strength

Background. Periacetabular resections with reconstruction has high rates of complications due to the complexity of the reconstruction. We have improvised a novel technique of reconstruction for type II and type II + III pelvic resections with the use of a commercially available acetabulum reconstruction cage (gap II, Stryker) and threaded rods.Objectives. The aim of our study is to determine the biomechanical strength of our reconstruction compared to the traditional cemented total hip replacement (THR) designs in normal acetabulum and establish its mode of failure.Methods. Five sets of hemipelvises were biomechanically tested (Instron® 3848, MA, USA). These constructs were subjected to cyclic loading and load to failure.Results. The reconstructed acetabulum was stiffer and required a higher load to failure compared to the intact pelvis with a standard THR. The mean stiffness of the reconstructed pelvis was1738.6±200.3 Nmm−1compared to the intact pelvis, which was911.4±172.7 Nmm−1(Pvalue = 0.01). The mean load to failure for the standard acetabular cup construct was3297.3±117.7 N while that of the reconstructed pelvis with the acetabulum cage and threaded rods was4863.8±7.0 N.Conclusion. Reconstruction of the pelvis with an acetabular reconstruction cage and threaded rods is a biomechanical viable option.

Biomechanical Evaluation of a Single- Versus Double-Tunnel Coracoclavicular Ligament Reconstruction With Acromioclavicular Stabilization for Acromioclavicular Joint Injuries

2018 ◽  
Vol 46 (5) ◽  
pp. 1070-1076 ◽  
Author(s):  
Michael B. Banffy ◽  
Carlos Uquillas ◽  
Julie A. Neumann ◽  
Neal S. ElAttrache
Keyword(s):  
Ligament Reconstruction ◽  
Ultimate Load ◽  
Clavicle Fracture ◽  
Biomechanical Properties ◽  
Reconstruction Technique ◽  
Ac Joint ◽  
Joint Injuries ◽  
Load To Failure ◽  
Clavicle Fractures ◽  
Ac Joint Injuries

Background: An anatomic double-tunnel (DT) reconstruction technique has been widely adopted to reconstruct the ruptured coracoclavicular (CC) ligaments seen with high-grade acromioclavicular (AC) joint injuries. However, the anatomic DT reconstruction has been associated with the risk of clavicle fractures, which may be problematic, particularly for contact athletes. Purpose/Hypothesis: The purpose was to compare a single-tunnel (ST) CC ligament reconstruction for AC joint injuries with the native state as well as with the more established anatomic DT CC ligament reconstruction. The hypothesis was that ST CC ligament reconstruction would demonstrate biomechanical properties similar to those of the native state and the DT CC ligament reconstruction. Study Design: Controlled laboratory study. Methods: Eighteen fresh-frozen human cadaveric shoulders (9 matched pairs) with mean ± SD age of 55.5 ± 8.5 years underwent biomechanical testing. One specimen of each matched pair underwent a ST CC ligament reconstruction and the second, a DT CC ligament reconstruction. The ST and DT CC ligament reconstruction techniques involved a 5-mm distal clavicle excision, avoided coracoid drilling, and utilized a 3.0-mm suture anchor to fix the excess lateral limb to reconstruct the superior AC joint capsule. The ST CC ligament reconstruction technique additionally included a 1.3-mm suture tape to help avoid a sawing effect, as well as a dog-bone button over the clavicular tunnel to increase stability of the construct. All specimens were tested to 70 N in 3 directions (superior, anterior, and posterior) in the intact and reconstructed states. The ultimate load, yield load, stiffness, and mode of failure of the reconstructed specimens were tested. Results: There were no significant differences in translation at 70 N in the superior ( P = .31), anterior ( P = .56), and posterior ( P = .35) directions between the ST CC ligament reconstruction and the intact state. The ultimate load to failure, yield load, and stiffness in the ST and DT groups were also not significantly different. There were no distal clavicle fractures in load-to-failure testing in the ST or DT group. Conclusion: In this biomechanical study, ST CC ligament reconstruction demonstrates biomechanical properties comparable to the intact state. Additionally, use of the ST CC ligament reconstruction shows biomechanical properties similar to the DT CC ligament reconstruction technique while theoretically posing less risk of clavicle fracture. Clinical Relevance: This study suggests that the ST CC ligament reconstruction has biomechanical properties equivalent to the DT CC ligament reconstruction with less theoretical risk of clavicle fracture.

The biomechanical properties of the feline femur

2008 ◽  
Vol 21 (04) ◽  
pp. 312-317 ◽  
Author(s):  
N. M. M. Moens ◽  
R. J. Runciman ◽  
D. L. Holmberg ◽  
G. M. Monteith ◽  
T. W. G. Gibson
Keyword(s):  
Bone Fractures ◽  
Maximum Load ◽  
Biomechanical Properties ◽  
Long Bone ◽  
Three Point Bending ◽  
Pull Out ◽  
Fracture Stabilization ◽  
Surgical Implants ◽  
Load To Failure ◽  
The Mean

SummaryThe purpose of this study was to determine the biomechanical properties of feline long bone by testing cadaver bone from mature cats in compression, threepoint bending, notch sensitivity and screw pull-out strength. The determination of these properties is of clinical relevance with regard to the forces resulting in long bone fractures in cats as well as the behaviour and failure mode of surgical implants utilized for fracture stabilization and repair in the cat. Cadaveric cat femurs were tested in compression, three-point bending and in three-point bending after the addition of a 2.0 mm screw hole. Cortical screws, 2.7 mm in diameter, were inserted in cadaveric cat femur samples for screw pullout testing. The mean maximum load to failure of mid diaphyseal feline femurs tested in compression was 4201 ± 1218 N. Statistical analysis of the parameter of maximum load tested in compression revealed a statistical difference between sides (p=0.02), but not location (p=0.07), or location by side (p=0.12). The maximum strength of mid diaphyseal feline femurs tested in compression was 110.6 ± 26.6 MPa. The modulus of elasticity of mid-diaphyseal cat femurs tested in compression was determined to be 5.004 ± 0.970 GPa. The mean maximum load to failure of feline femurs tested in three-point bending was 443 ± 98 N. The mean maximum load to failure of feline femurs tested in three-point bending after a 2.0 mm diameter hole was drilled in the mid-diaphyseal region of each sample through both cortices was 471 ± 52 N. The mean maximum load required for screw pull-out of 2.7 mm cortical screws placed in feline femurs tested in tension was 886 ± 221 N. This data should be suitable for investigating fracture biomechanics and the testing of orthopaedic constructs commonly used for fracture stabilization in the feline patient.

scholarly journals Does using high-tensile strength tape improve the fixation strength in tendon graft fixation with needleless suture wrapping techniques compared to a suture?

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902097186
Author(s):  
Chih-Kai Hong ◽  
Fa-Chuan Kuan ◽  
Kai-Lan Hsu ◽  
Yueh Chen ◽  
Hao-Chun Chuang ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Cyclic Loading ◽  
High Strength ◽  
Biomechanical Properties ◽  
Tendon Graft ◽  
Graft Fixation ◽  
Fixation Strength ◽  
High Tensile Strength ◽  
Suture Materials ◽  
Load To Failure

Purpose: To compare the biomechanical properties of a high-tensile strength suture and high-tensile strength tape in tendon graft fixation using two needleless suture wrapping techniques, the modified Prusik knot and modified rolling hitch. Methods: Two needleless suture wrapping techniques, the modified rolling hitch (MR) and modified Prusik knot (MP), were utilized. Meanwhile, two kinds of suture materials, a No. 2 braided nonabsorbable high-strength suture (S) and a 1.3 mm high-tensile strength tape (T), were used. A total of 40 porcine tendons were used, which were randomly divided into four groups. Each group was assigned to one of the following groups: MRS, MRT, MPS, and MPT. Each specimen was pretensioned to 100 N for three cycles, cyclically loaded from 50 to 200 N for 200 cycles, and finally loaded to failure. Results: The MRT group (34.1 ± 3.5%) had a significantly higher value compared with the MRS (29.7 ± 2.3%), MPS (27.1 ± 3.6%) and MPT (29.5 ± 4.0%) groups in term of elongation after cyclic loadings ( p = 0.002). In terms of ultimate failure load, there were no significant differences in the MRS (401 ± 27 N), MRT (380 ± 27 N), MPS (398 ± 44 N) and MPT (406 ± 49 N) values ( p = 0.539). All specimens failed due to suture breakage at the knots. Conclusion: Compared with the high-tensile strength suture, using the high-tensile strength tape lead to greater elongation after cyclic loading when the modified rolling hitch was used. No differences in terms of elongation after cyclic loading and load to failure were found between the high-tensile strength suture and tape using the modified Prusik knot.

Augmentation of Distal Biceps Repair With an Acellular Dermal Graft Restores Native Biomechanical Properties in a Tendon-Deficient Model

2017 ◽  
Vol 45 (9) ◽  
pp. 2028-2033 ◽  
Author(s):  
Christine Conroy ◽  
Paul Sethi ◽  
Craig Macken ◽  
David Wei ◽  
Marc Kowalsky ◽  
...  
Keyword(s):  
Biceps Tendon ◽  
Peak Load ◽  
Tendon Repair ◽  
Biomechanical Properties ◽  
Gap Formation ◽  
Dermal Graft ◽  
Distal Biceps ◽  
Load To Failure ◽  
The Mean ◽  
Acellular Dermal

Background: The majority of distal biceps tendon injuries can be repaired in a single procedure. In contrast, complete chronic tears with severe tendon substance deficiency and retraction often require tendon graft augmentation. In cases with extensive partial tears of the distal biceps, a human dermal allograft may be used as an alternative to restore tendon thickness and biomechanical integrity. Hypothesis: Dermal graft augmentation will improve load to failure compared with nonaugmented repair in a tendon-deficient model. Study Design: Controlled laboratory study. Methods: Thirty-six matched specimens were organized into 1 of 4 groups: native tendon, native tendon with dermal graft augmentation, tendon with an attritional defect, and tendon with an attritional defect repaired with a graft. To mimic a chronic attritional biceps lesion, a defect was created by a complete tear, leaving 30% of the tendon’s width intact. The repair technique in all groups consisted of cortical button and interference screw fixation. All specimens underwent cyclical loading for 3000 cycles and were then tested to failure; gap formation and peak load at failure were documented. Results: The mean (±SD) load to failure (320.9 ± 49.1 N vs 348.8 ± 77.6 N, respectively; P = .38) and gap formation (displacement) (1.8 ± 1.4 mm vs 1.6 ± 1.1 mm, respectively; P = .38) did not differ between the native tendon groups with and without graft augmentation. In the tendon-deficient model, the mean load to failure was significantly improved with graft augmentation compared with no graft augmentation (282.1 ± 83.8 N vs 199.7 ± 45.5 N, respectively; P = .04), while the mean gap formation was significantly reduced (1.2 ± 1.0 mm vs 2.7 ± 1.4 mm, respectively; P = .04). The mean load to failure of the deficient tendon with graft augmentation (282.1 N) compared with the native tendon (348.8 N) was not significantly different ( P = .12). This indicates that the native tendon did not perform differently from the grafted deficient tendon. Conclusion: In a tendon-deficient, complete distal biceps rupture model, acellular dermal allograft augmentation restored the native tendon’s biomechanical properties at time zero. The grafted tissue-deficient model demonstrated no significant differences in the load to failure and gap formation compared with the native tendon. As expected, dermal augmentation of attritional tendon repair increased the load to failure and stiffness as well as decreased displacement compared with the ungrafted tissue-deficient model. Tendons with their native width showed no statistical difference or negative biomechanical consequences of dermal augmentation. Clinical Relevance: Dermal augmentation of the distal biceps is a biomechanically feasible option for patients with an attritionally thinned-out tendon.

scholarly journals Knotless Fixation Is Stronger and Less Variable Than Knotted Constructs in Securing a Suture Loop

2018 ◽  
Vol 6 (5) ◽  
pp. 232596711877400 ◽  
Author(s):  
Patrick J. Denard ◽  
Christopher R. Adams ◽  
Nicole C. Fischer ◽  
Marina Piepenbrink ◽  
Coen A. Wijdicks
Keyword(s):  
Laboratory Study ◽  
Biomechanical Properties ◽  
Considerable Variability ◽  
Knot Tying ◽  
Bone Fixation ◽  
Load To Failure ◽  
The Mean ◽  
Cuff Repair ◽  
K2 Group ◽  
Suture Tape

Background: Historically, tendon-to-bone fixation has relied on knot tying. However, considerable variability exists in knot-tying strength among surgeons. Purpose/Hypothesis: The purpose of this study was to compare the biomechanical properties of knotted and knotless fixation and to evaluate variability among surgeons. The hypothesis was that knotless constructs would be stronger and have less variability as compared with knotted constructs. Study Design: Controlled laboratory study. Methods: A total of 34 orthopaedic surgeons participated in a laboratory study to compare knotted and knotless constructs, where 104 knotted constructs were performed with No. 2 suture, 21 knotless constructs with No. 2 suture (K2 group), and 79 knotless constructs with suture tape (KT group). Mechanical testing was performed to compare load at 3 mm of displacement, load to failure, and stiffness of each construct. Results: The mean load at 3 mm of displacement was greatest in the KT group, with significant differences among all 3 groups ( P < .001). Load to failure was significantly greater in the KT group as compared with the K2 group and the knotted group ( P < .001), but there was no difference between the K2 and knotted groups ( P ≥ .999). Stiffness and displacement were also greatest in the KT group. Based on the F test, the variance in load to failure was significantly different between the knotted and knotless constructs, with the knotted group demonstrating greater variability (SD, 94 N) than the KT (SD, 38 N) and K2 (SD, 17 N) groups ( P < .001). Conclusion: Knotless fixation with suture tape had improved biomechanical performance as compared with knots or knotless fixation with No. 2 suture. In addition, knotless fixation had less variability in biomechanical properties among multiple surgeons. Clinical Relevance: This study may be relevant for surgeons choosing between knotted and knotless constructs as well as for considerations in the design of rotator cuff repair constructs.

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