scholarly journals Suturing Achilles tendon and mesh simultaneously in augmented repair resists gap formation foremost: an experimental study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
William McCartney ◽  
Ciprian Ober ◽  
Maria Benito ◽  
Bryan MacDonald
Keyword(s):  
Achilles Tendon ◽  
Polypropylene Mesh ◽  
Tendon Repair ◽  
Biomechanical Properties ◽  
In Vivo Studies ◽  
Control Group ◽  
Gap Formation ◽  
Achilles Tendon Repair ◽  
Mesh Augmentation

Abstract Background The common calcanean tendon (Achilles tendon) is the strongest and largest tendon and is one of the most commonly affected by spontaneous rupture. Different suture techniques are used to repair the tendon rupture. We compare the biomechanical properties of three different modalities of suture pattern in a mechanical experiment in rabbits with the purpose of evaluating the use of polypropylene mesh augmentation for Achilles tendon repair to find out the best surgical option. Methods The study tests single cycle to failure tensile strength characteristics of three different combinations of the 3-loop pulley (3-LP) suture technique with polypropylene mesh, and statistically compares the biomechanical properties as the maximum load at failure for all 3-LP repair. Results The normal Achilles tendon—control group—failed at a mean load of 25.5 + 13.6; the experimental groups failed at a significantly lower load (p < 0.001), with the group of 3-LP suture with polypropylene mesh included in the suture being the more similar to controls, but all the groups exhibited statistically significant differences with regard to normal tendons (p < 0.001). The distance at which each group failed was also significant between control and experimental groups (p < 0.001) with the exception of the suture-only group and the group with the mesh over the suture (p = 0.15). Conclusion Results from this study suggest that incorporating the mesh within the suture provides benefit to the Achilles tendon repair by improving strength and resistance to pull through. However, further in vivo studies will be necessary to confirm these results and incorporate this technique to the routine human and veterinary surgery.

scholarly journals Biomechanical properties of Achilles tendon repair augmented with a bioadhesive-coated scaffold

2011 ◽  
Vol 6 (1) ◽  
pp. 015014 ◽  
Author(s):  
Michael Brodie ◽  
Laura Vollenweider ◽  
John L Murphy ◽  
Fangmin Xu ◽  
Arinne Lyman ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Repair ◽  
Biomechanical Properties ◽  
Achilles Tendon Repair

scholarly journals Effects of plasma rich in growth factors (PRGF) on biomechanical properties of Achilles tendon repair

2015 ◽  
Vol 24 (12) ◽  
pp. 3997-4004 ◽  
Author(s):  
Diego López-Nájera ◽  
Mónica Rubio-Zaragoza ◽  
Joaquín J. Sopena-Juncosa ◽  
Eduard Alentorn-Geli ◽  
Ramón Cugat-Bertomeu ◽  
...  
Keyword(s):  
Growth Factors ◽  
Achilles Tendon ◽  
Tendon Repair ◽  
Biomechanical Properties ◽  
Achilles Tendon Repair

Influence of Interlocking Horizontal Mattress Epitendinous Suture Placement on Tendinous Biomechanical Properties in a Canine Common Calcaneal Laceration Model

2020 ◽  
Vol 33 (03) ◽  
pp. 205-211 ◽  
Author(s):  
Christina J. Cocca ◽  
Daniel J. Duffy ◽  
Mariana E. Kersh ◽  
George E. Moore
Keyword(s):  
Tendon Repair ◽  
Biomechanical Properties ◽  
Gap Formation ◽  
Mode Of Failure ◽  
In Vivo Testing ◽  
Failure Loads ◽  
Pull Through ◽  
Biomechanical Strength ◽  
Suture Placement

Abstract Objective This article evaluates the effect of an interlocking horizontal mattress epitendinous suture (IHMES) in addition to a three-loop pulley (3LP) core suture for canine tendon repair. Study Design Twenty-eight cadaveric common calcaneal tendons were randomized, sharply transected and repaired with either a 3LP or 3LP + IHMES. Tensile loads required to create a 1- and 3-mm gap, yield, peak and failure loads, and mode of failure were analysed. Significance was set at p < 0.05. Results Mean ± standard deviation yield and failure force for 3LP + IHMES was 178.0 ± 45.3 N and 242.1 ± 47.8 N, respectively, which was significantly greater compared with 3LP alone, 97.9 ± 36.2 N and 119.3 ± 35.6 N (p < 0.0001). Occurrence of 3-mm gap formation was significantly less in the 3LP + IHMES group (p < 0.013). Mode of failure was significantly different between the groups (p < 0.001) with 3LP + IMHES patterns failing by suture breakage (13/14) compared with suture pull-through in the 3LP (11/14). Conclusion Addition of an epitendinous suture pattern significantly reduced gap formation between tendon ends and significantly increased loads at yield (1.8 × ), peak (2.0 × ) and failure (2.0 × ) force of repairs. Use of an epitendinous suture should be considered to significantly increase biomechanical strength of repairs; however, further in vivo testing is necessary to evaluate its effect on tendinous blood supply.

scholarly journals Biomechanical Comparison of Panda Rope Bridge Technique and Other Minimally Invasive Achilles Tendon Repair Techniques In Vitro

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110084
Author(s):  
Ting Wang ◽  
Yuan Mu ◽  
Yulei Diao ◽  
Wenke Liu ◽  
Yahong Wu ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Tendon Repair ◽  
Biomechanical Properties ◽  
Repair System ◽  
Postoperative Rehabilitation ◽  
Achilles Tendon Repair ◽  
Repair Techniques

Background: Although nonoperative management of acute Achilles tendon rupture (ATR) is a reasonable option, surgical repair has attracted attention for young and active patients. More reliable Achilles tendon repair techniques are needed to enhance recovery after ATR in this population. Purpose/Hypothesis: To biomechanically analyze the panda rope bridge technique (PRBT) and compare it with other minimally invasive repair techniques over a simulated, progressive rehabilitation program. It was hypothesized that PRBT would result in better biomechanical properties and enhanced recovery after ATR. Study Design: Controlled laboratory study. Methods: An Achilles tendon rupture was created 4 cm from the distal tendon insertion site in 40 bovine lower extremities, and specimens were then randomly allocated to 5 Achilles tendon repair techniques: (1) Achillon, (2) modified Achillon, (3) Percutaneous Achilles Repair System (PARS), (4) modified PARS, and (5) PRBT. Each group was subjected to a cyclic loading protocol that was representative of progressive postoperative rehabilitation for ATR (250 cycles at 1 Hz for each loading stage: 20-100 N, 20-200 N, 20-300 N, and 20-400 N). Results: The PRBT technique demonstrated significantly less elongation (1.62 ± 0.25 mm) than the 4 other repair techniques after the first loading stage of 20 to 100 N ( P < .05). All specimens in the 4 other groups developed a large gap (elongation ≥5 mm) at the 20- to 200-N loading stage. When overall biomechanical performance was examined, the PRBT group exhibited higher strength (20-400 N) and more mean loading cycles (984 ± 10) compared with the 4 other groups ( P < .05). Conclusion: In this bovine model, PRBT biomechanically outperformed the other minimally invasive Achilles tendon repair techniques that were tested and could therefore meet the requirements of accelerated rehabilitation. Clinical Relevance: The reduced tendency for premature rerupture and the overall improved biomechanical properties of PRBT suggest that ATR patients treated with PRBT may more readily complete early and aggressive postoperative rehabilitation protocols. In addition, they may have a lower risk of early irreversible suture failure.

scholarly journals Electrospun Water-Borne Polyurethane Nanofibrous Membrane as a Barrier for Preventing Postoperative Peritendinous Adhesion

2019 ◽  
Vol 20 (7) ◽  
pp. 1625 ◽  
Author(s):  
Shih-Heng Chen ◽  
Pang-Yun Chou ◽  
Zhi-Yu Chen ◽  
Feng-Huei Lin
Keyword(s):  
Tendon Repair ◽  
Major Complication ◽  
Biomechanical Properties ◽  
Tendon Injury ◽  
Electrospinning Process ◽  
In Vivo Studies ◽  
Surrounding Tissue ◽  
Water Borne

Peritendinous adhesion is a major complication after tendon injury and the subsequent repairs or reconstructions. The degree of adhesion can be reduced by the interposition of a membranous barrier between the traumatized tendon and the surrounding tissue. In the present study, electrospun water-borne polyurethane (WPU) nanofibrous membranes (NFMs) were created for use after the reparation or reconstruction of tendons to reduce adhesion. In the electrospinning process, water was employed as the solvent for WPU, and this solvent was ecofriendly and nontoxic. The nanofibrous architecture and pore size of the WPU NFMs were analyzed. Their microporosity (0.78–1.05 µm) blocked the penetration of fibroblasts, which could result in adhesion and scarring around the tendon during healing. The release of WPU mimicked the lubrication effect of the synovial fluid produced by the synovium around the tendon. In vitro cell studies revealed that the WPU NFMs effectively reduced the number of fibroblasts that became attached and that there was no significant cytotoxicity. In vivo studies with the rabbit flexor tendon repair model revealed that WPU NFMs reduced the degree of peritendinous adhesion, as determined using a gross examination; a histological cross section evaluation; and measurements of the range of motion of interphalangeal joints (97.1 ± 14.7 and 79.0 ± 12.4 degrees in proximal and distal interphalangeal joints respectively), of the length of tendon excursion (11.6 ± 1.9 cm), and of the biomechanical properties.

A Biomechanical Study of Achilles Tendon Repair Augmentation Using GraftJacket Matrix

2008 ◽  
Vol 29 (3) ◽  
pp. 329-333 ◽  
Author(s):  
F. Alan Barber ◽  
John E. McGarry ◽  
Morley A. Herbert ◽  
Robert Bentley Anderson
Keyword(s):  
Achilles Tendon ◽  
Primary Repair ◽  
Tendon Repair ◽  
Rehabilitation Program ◽  
Biomechanical Study ◽  
Matched Pair ◽  
Control Group ◽  
Achilles Tendon Repair ◽  
Ultimate Failure ◽  
Strength And Stiffness

Background: Ruptured Achilles tendons benefit from primary repair by decreasing re-rupture rates and allowing earlier range of motion. A stronger repair might allow for more aggressive rehabilitation decreasing postoperative stiffness, calf atrophy, and repair site gapping. The hypothesis of this study was that human dermal allograft augmentation of an Achilles repair would significantly increase repair strength and stiffness. This study evaluated strength and stiffness of an Achilles tendon repair augmented with a human dermal allograft (GraftJacket). Materials and Methods: Eight matched pairs of human cadaver legs were used. Simulated Achilles tendon ruptures were created 4 cm proximal to the calcaneal insertion. All tendons were repaired with a Krackow locking loop stitch. One of each matched pair was augmented with GraftJacket. Each construct was pre-loaded at 10 N and cyclically loaded (20 cycles) from 2 N to 30 N at a rate of 5 N/sec on an Instron machine. This was followed by testing to failure at a displacement rate of 6 mm/sec. Results: The ultimate failure load in the control group was 217 N ± 31 compared to 455 N ± 76.5 in the GraftJacket group ( p < 0.001). The mean stiffness in the control group was 4.3 ± 0.83 N/mm which was significantly less than the 12.99 ± 5.34 N/mm in the GraftJacket group ( p = 0.002). Conclusion: The augmentation of an Achilles tendon repair with GraftJacket significantly increased repair strength and stiffness. Clinical Significance: These findings suggest that a GraftJacket augmented Achilles tendon repair could acutely withstand a more aggressive rehabilitation program, potentially decreasing ankle stiffness and allowing earlier return to full activities.

Effect of knot location on the biomechanical strength and gapping characteristics of ex vivo canine gastrocnemius tenorrhaphy constructs

2021 ◽  
pp. 1-6
Author(s):  
Jessica L. Corrie ◽  
Daniel J. Duffy ◽  
Yi-Jen Chang ◽  
George E. Moore
Keyword(s):  
External Surface ◽  
Ex Vivo ◽  
Tendon Repair ◽  
In Vivo Studies ◽  
Gap Formation ◽  
Mode Of Failure ◽  
Load To Failure ◽  
Suture Patterns ◽  
Biomechanical Strength

Abstract OBJECTIVE To evaluate the effect of knot location on the biomechanical strength and gapping characteristics of ex vivo canine gastrocnemius tenorrhaphy constructs. SAMPLE 36 cadaveric gastrocnemius tendons from 18 adult dogs. PROCEDURES Tendons were randomly assigned to 3 groups (12 tendons/group) and sharply transected and repaired by means of a core locking-loop suture with the knot at 1 of 3 locations (exposed on the external surface of the tendon, buried just underneath the external surface of the tendon, or buried internally between the apposed tendon ends). All repairs were performed with size-0 polypropylene suture. All constructs underwent a single load-to-failure test. Yield, failure, and peak forces, mode of failure, and forces required for 1- and 3-mm gap formation were compared among the 3 knot-location groups. RESULTS Mean yield, failure, and peak forces and mean forces required for 1- and 3-mm gap formation did not differ significantly among the 3 groups. The mode of failure also did not differ significantly among the 3 groups, and the majority (33/36 [92%]) of constructs failed owing to the suture pulling through the tendinous substance. CONCLUSIONS AND CLINICAL RELEVANCE Final knot location did not significantly affect the biomechanical strength and gapping characteristics of canine gastrocnemius tenorrhaphy constructs. Therefore, all 3 evaluated knot locations may be acceptable for tendon repair in dogs. In vivo studies are necessary to further elucidate the effect of knot location in suture patterns commonly used for tenorrhaphy on tendinous healing and collagenous remodeling at the repair site.

scholarly journals Optimizing Manufacturing and Osseointegration of Ti6Al4V Implants through Precision Casting and Calcium and Phosphorus Ion Implantation? In Vivo Results of a Large-Scale Animal Trial

Materials ◽  
2020 ◽  
Vol 13 (7) ◽  
pp. 1670 ◽  
Author(s):  
Wölfle-Roos JV ◽  
Katmer Amet B ◽  
Fiedler J ◽  
Michels H ◽  
Kappelt G ◽  
...  
Keyword(s):  
Ion Implantation ◽  
Large Scale ◽  
In Vivo Studies ◽  
Control Group ◽  
Implant Surface ◽  
Precision Casting ◽  
Pull Out ◽  
Significant Difference ◽  
Calcium And Phosphorus

Background: Uncemented implants are still associated with several major challenges, especially with regard to their manufacturing and their osseointegration. In this study, a novel manufacturing technique—an optimized form of precision casting—and a novel surface modification to promote osseointegration—calcium and phosphorus ion implantation into the implant surface—were tested in vivo. Methods: Cylindrical Ti6Al4V implants were inserted bilaterally into the tibia of 110 rats. We compared two generations of cast Ti6Al4V implants (CAST 1st GEN, n = 22, and CAST 2nd GEN, n = 22) as well as cast 2nd GEN Ti6Al4V implants with calcium (CAST + CA, n = 22) and phosphorus (CAST + P, n = 22) ion implantation to standard machined Ti6Al4V implants (control, n = 22). After 4 and 12 weeks, maximal pull-out force and bone-to-implant contact rate (BIC) were measured and compared between all five groups. Results: There was no significant difference between all five groups after 4 weeks or 12 weeks with regard to pull-out force (p > 0.05, Kruskal Wallis test). Histomorphometric analysis showed no significant difference of BIC after 4 weeks (p > 0.05, Kruskal–Wallis test), whereas there was a trend towards a higher BIC in the CAST + P group (54.8% ± 15.2%), especially compared to the control group (38.6% ± 12.8%) after 12 weeks (p = 0.053, Kruskal–Wallis test). Conclusion: In this study, we found no indication of inferiority of Ti6Al4V implants cast with the optimized centrifugal precision casting technique of the second generation compared to standard Ti6Al4V implants. As the employed manufacturing process holds considerable economic potential, mainly due to a significantly decreased material demand per implant by casting near net-shape instead of milling away most of the starting ingot, its application in manufacturing uncemented implants seems promising. However, no significant advantages of calcium or phosphorus ion implantation could be observed in this study. Due to the promising results of ion implantation in previous in vitro and in vivo studies, further in vivo studies with different ion implantation conditions should be considered.

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