Tibial tuberosity transposition-advancement for lateralization of the tibial tuberosity: An ex vivo canine study

2014 ◽  
Vol 27 (04) ◽  
pp. 271-276 ◽  
Author(s):  
N. Bertollo ◽  
W. Walsh ◽  
K. Voss ◽  
M. Newman
Keyword(s):  
Computed Tomography ◽  
Cyclic Loading ◽  
Tibial Plateau ◽  
Ex Vivo ◽  
Peak Load ◽  
Tibial Tuberosity ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Load To Failure ◽  
Canine Study

SummaryObjectives: To evaluate the degree of lateralization achievable and strength of tibial tuberosity transposition and advancement (TTTA) relative to pin and tension band wiring (PTBW) for lateral tibial tuberosity transposition.Methods: Six pairs of cadaveric tibiae were used. Tibial tuberosity position was determined with computed tomography (CT); bones were then randomly assigned into TTTA and PTBW groups. The PTBW group had a tibial tuberosity osteotomy and fixation with pin and tension band wiring. The TTTA group had a tibial tuberosity advancement performed with lateralization of the tibial tuberosity by 50% of cage depth, using spacers on the cranial cage screw. Postoperative CT images showed lateralization and craniocaudal deviation. Single axial distractive loading was applied to the patella at 90° to the tibial plateau, and peak load, energy, and stiffness were calculated.Results: There were significant differences in lateralization (PTBW: 67.92 ± 5.1 %; TTTA: 88.51 ± 5.5 %) (p = 0.0173) and craniocaudal deviation (PTBW: –8.30 ± 1.4 %; TTTA: 6.83 ± 0.6) (p = 0.0001). There were no significant differences in peak load to failure (N) (PTBW: 1448 ± 121; TTTA: 1597 ± 43) (p = 0.4541), energy to failure (N/mm) (PTBW: 15013 ± 2719; TTTA: 17314 ± 887) (p = 0.646), or stiffness (N/mm)(PTBW: 102.8 ± 4.7; TTTA: 92.9 ± 4.8) (p = 0.2716).Clinical significance: The TTTA was more effective at lateralization of the tibial tuberosity, and of comparable strength to PTBW. Greater support of the osteotomized fragment with TTTA may resist cyclic loading, and requires evaluation.

Mechanical testing of a new osteotomy design for tibial tuberosity advancement using the Modified Maquet Technique

2013 ◽  
Vol 26 (01) ◽  
pp. 47-53 ◽  
Author(s):  
S. Etchepareborde ◽  
N. Barthélémy ◽  
F. Farnir ◽  
M. Balligand ◽  
L. Brunel
Keyword(s):  
Body Weight ◽  
Tibial Plateau ◽  
Ultimate Load ◽  
Ex Vivo ◽  
The Body ◽  
Tibial Tuberosity ◽  
Mechanical Study ◽  
Load To Failure ◽  
Tangent Method ◽  
The Common

SummaryObjectives: To evaluate the mechanical properties of the distal cortical hinge associated with a new osteotomy design for the Modified Maquet Technique (MMT).Study design: Ex vivo mechanical study.Methods: The osteotomy was started 10 mm caudal to the tibial tuberosity and extended over 150% of the length of the tibial crest; it was slightly curved distally to stay at a distance of 2 to 4 mm from the cranial cortex, according to the body weight. Ninety-six tibiae were tested in advancement, and 60 tibiae were axially loaded perpendicular to the tibial plateau, until failure of the crest. Desired advancement was measured using the common tangent method in 60 tibiae. Angle of opening, thickness, and area of the cortical hinge were recorded.Results: Desired advancement of 6 mm, 9 mm, 12 mm and 15 mm was recorded in 16, 12, 18 and 14 tibiae respectively. Mean maximal advancement in these bones was 15.6 ± 6.4 mm, 20.8 ± 5.2 mm, 21.3 ± 5.2 mm and 22.7 ± 5.2 mm respectively. The desired advancement was reached in all but one tibia. Advancement was mainly influenced by the angle of opening and the stiffness of the cortical hinge. Mean ultimate load to failure was 6.12 ± 2.4 times the body weight. It was significantly associated with the body weight, thickness, and area of the cortical hinge.Clinical relevance: Mean maximal advancement was higher than clinically required without occurrence of fissure or fracture. Ultimate load to failure and maximal advancement could be predicted using calculated formulae.

scholarly journals Comparison of tension band wiring and other tibial tuberosity advancement techniques for cranial cruciate ligament repair: an experimental study

2019 ◽  
Vol 61 (1) ◽  
Author(s):  
William McCartney ◽  
Ciprian Ober ◽  
Maria Benito ◽  
Bryan MacDonald
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Tibial Tuberosity ◽  
Tension Band ◽  
Tension Band Wiring ◽  
The Other ◽  
Cranial Cruciate Ligament ◽  
Surgical Methods

Abstract Background Cranial cruciate ligament (CCL) rupture is one of the most common causes of limb lameness in dogs. Surgical techniques based on tibial osteotomies such as tibial plateau leveling osteotomy and tibial tuberosity advancement are used to eliminate dynamic thrust. Tibial tuberosity advancement (TTA) uses an osteotomy fixated by cage, plates, forks and screws to change the relationship of the patellar tendon and tibial plateau angle. Tension band wiring technique is one of the most common surgical methods used to treat a tension fracture and remains the gold standard for the treatment of tibial tuberosity fractures. In this study, we compared experimentally the biomechanical effect of application of tension band wiring compared to other techniques for the fixation of the TTA osteotomy. The techniques compared to are standard commercially available systems for TTA fixation. Results Tension band wiring (TBW) presented the higher resistance to failure compared to all the other surgical procedures, with the highest values found in the TBW group with 1.47 ± 0.07 N and the lowest in the TTA cage (0.82 ± 0.08) and TTA-2 (0.85 ± 0.06) groups with statistically significant differences in all cases (P < 0.001). TTA rapid and TTA plate groups exhibited a similar strength, and same happened between TTA-2 and TTA cage groups. All the other comparisons by pair were significantly different with P < 0.001. Conclusions Results suggest that fixating the osteotomy with tension band wiring increases the strength of the fixation and decrease the risk of implant failure. Further clinical studies are needed to demonstrate in vivo reliability and to test different variables such as size and weight of dogs. These results could have important clinical implications in the treatment of CCL ruptures.

Tibial Tuberosity Transposition Fixation with a Locking Plate during Medial Patellar Luxation Surgery: An Ex Vivo Mechanical Study

2021 ◽  
Author(s):  
Esa V. Eskelinen ◽  
Ari P. Suhonen ◽  
Juha V. Virolainen ◽  
William D. Liska
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Locking Plate ◽  
Ex Vivo ◽  
Tibial Tuberosity ◽  
Tension Band ◽  
Patellar Ligament ◽  
Raccoon Dog ◽  
Tension Band Wire ◽  
Lower Load

Abstract Objectives The purpose of this study was to compare the load at failure, stiffness and mode of failure between three types of tibial tuberosity transposition fixation techniques: (a) pin and figure-8 tension band wire (Pin-TBW), (b) locking plate with pin and a tension band wire (Plate-Pin-TBW) and (c) locking plate with a pin (Plate-Pin). Methods Six pairs of raccoon dog cadaveric tibiae were tested in Phase I Pin-TBW versus Plate-Pin-TBW and seven pairs in Phase II Plate-Pin-TBW versus Plate-Pin. One limb of each pair was randomly assigned to one of two groups for each phase. A tensile force was applied to the patellar ligament until construct failure. Results Pin-TBW (342N ± 54.7N) failed at a lower load than Plate-Pin-TBW (469N ± 77.3N), p = 0.00748, with all Pin-TBW failing by fracture and the majority of Plate-Pin-TBW failing by rupture of patellar ligament. Pin-TBW group Phase I, normalized with Plate-Pin-TBW Phase I, failed at a lower load than Plate-Pin group Phase II, normalized with Plate-Pin-TBW Phase II, p = 0.00467. There was no significant difference in mean load at failure, stiffness or mode at failure between the groups in the Phase II study. Clinical Significance Although ex vivo mechanical testing does not replicate the postoperative live dog or cat, these results demonstrate lower construct strength of the Pin-TBW construct compared with the Plate-Pin construct in the raccoon dog cadaver model.

Avulsion fractures of the tibial tuberosity in adolescents treated by tension band wiring

1993 ◽  
Vol 3 (3) ◽  
pp. 247-250
Author(s):  
P. Nikiforidis ◽  
G. Ch. Babis ◽  
J. Galouzis ◽  
Th. Pantazopoulos
Keyword(s):  
Tibial Tuberosity ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Avulsion Fractures

PEAK LOAD RESISTANCE OF THE JUGGERKNOTXS™ SOFT ANCHOR TECHNIQUE COMPARED WITH OTHER COMMON FIXATION TECHNIQUES FOR LARGE MALLET FINGER FRACTURES

Hand Surgery ◽  
2013 ◽  
Vol 18 (03) ◽  
pp. 381-388
Author(s):  
Jason Pui Yin Cheung ◽  
Boris Fung ◽  
Wing Yuk Ip
Keyword(s):  
Kirschner Wire ◽  
Peak Load ◽  
Load Resistance ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Fixation Method ◽  
Mallet Finger ◽  
Pull Out ◽  
Fixation Techniques ◽  
Anchor Fixation

Introduction: To identify the strongest peak load resistance among four mallet finger fracture fixation methods (Kirschner wire, pull-out wire, tension-band wiring and the JuggerKnot™ (Biomet) soft anchor fixation). Methods: Fixation techniques were assigned among 24 specimens from six cadaveric human hands in a randomized block fashion. Peak load resistance was tested at 30°, 45° and 60° of flexion of the distal interphalangeal joint. Results: The mean peak load of tension-band wiring was 67.8 N at 60° of flexion which was most superior. The JuggerKnot™ fixation had mean peak loads of 13.35 N (30°), 22.51 N (45°) and 32.96 N (60°). No complications of implant failure or fragmentation of the dorsal fragment was noted. Conclusions: Tension-band wiring was the strongest fixation method but was most prominent on the skin surface as seen in three specimens. The JuggerKnot™ soft anchor fixation had similar peak load resistance as k-wire fixation and pull-out wiring.

Tension Band Wiring of Displaced Tibial Tuberosity Fractures in Adolescents

1986 ◽  
Vol &NA; (209) ◽  
pp. 161???165 ◽  
Author(s):  
DONALD R. POLAKOFF ◽  
ROBERT W. BUCHOLZ ◽  
JOHN A. OGDEN
Keyword(s):  
Tibial Tuberosity ◽  
Tension Band ◽  
Tension Band Wiring

scholarly journals Patellar Tendon Avulsion with Tibial Tuberosity Sleeve Fragment

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Akira Isaka ◽  
Satoshi Ichihara ◽  
Yasuhiro Homma ◽  
Tomohiko Hirose ◽  
Hajime Kajihara
Keyword(s):  
Pediatric Patient ◽  
Patellar Tendon ◽  
Suture Anchor ◽  
Optimal Treatment ◽  
Tibial Tuberosity ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Patient Diagnosis ◽  
Tendon Avulsion

Rupture of the patellar tendon is relatively rare. We report a case of patellar tendon avulsion with a tibial tuberosity sleeve fragment in pediatric patient. In pediatric patient, diagnosis is sometimes difficult due to uncompleted ossification. In the present case, which involved the presence of a small fleck of bone from tibia, we were able to attain a diagnosis using the Koshino-Sugimoto index and MRI and easily determine the optimal treatment with the use of the suture anchor and tension band wiring method.

Biomechanical Comparison of Onlay Distal Biceps Tendon Repair: All-Suture Anchors Versus Titanium Suture Anchors

2019 ◽  
Vol 47 (10) ◽  
pp. 2478-2483 ◽  
Author(s):  
Alexander Otto ◽  
Julian Mehl ◽  
Elifho Obopilwe ◽  
Mark Cote ◽  
Lucca Lacheta ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Biceps Tendon ◽  
Peak Load ◽  
Tendon Repair ◽  
Suture Anchors ◽  
Mineral Density ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Load To Failure ◽  
Biceps Tendon Repair

Background: A rupture of the distal biceps tendon is the most common tendon rupture of the elbow and has received increased attention in the past few years. Newly developed all-suture anchors have the potential to minimize surgical trauma and the risk of adverse events because of the use of flexible drills and smaller drill diameters. Purpose/Hypothesis: The purpose was to biomechanically compare all-suture anchors and titanium suture anchors for distal biceps tendon repair in cadaveric specimens. The hypothesis was that all-suture anchors would show no differences in load to failure or displacement under cyclic loading compared with titanium suture anchors. Study Design: Controlled laboratory study. Methods: Sixteen unpaired, fresh-frozen human cadaveric elbows were randomized to 2 groups, which underwent onlay distal biceps tendon repair with 2 anchors. Bone mineral density at the radial tuberosity was evaluated in each specimen. In the first group, distal biceps tendon repair was performed using all-suture anchors. In the second group, titanium suture anchors were applied. After cyclic loading for 3000 cycles, the repair constructs were loaded to failure. The peak load to failure as well as repair construct stiffness and mode of failure were determined. Results: The mean (±SD) peak load was 293.53 ± 122.15 N for all-suture anchors and 280.02 ± 69.34 N for titanium suture anchors ( P = .834); mean stiffness was 19.78 ± 2.95 N/mm and 19.30 ± 4.98 N/mm, respectively ( P = .834). The mode of failure was anchor pullout for all specimens during load to failure. At the proximal position, all-suture anchors showed a displacement of 1.53 ± 0.80 mm, and titanium suture anchors showed a displacement of 0.81 ± 0.50 mm ( P = .021) under cyclic loading. At the distal position, a displacement of 1.86 ± 1.04 mm for all-suture anchors and 1.53 ± 1.15 mm for titanium suture anchors was measured ( P = .345). A positive correlation between bone mineral density and load to failure was observed ( r = 0.605; P = .013). Conclusion: All-suture anchors were biomechanically equivalent at time zero to titanium suture anchors for onlay distal biceps tendon repair. While the proximally placed all-suture anchors demonstrated greater displacement than titanium suture anchors, the comparable displacement at the distal position as well as the similar load and mechanism of failure make this difference unlikely to be clinically significant. Clinical Relevance: All-suture anchors performed similarly to titanium suture anchors for onlay distal biceps tendon repair at time zero and represent a reasonable alternative.

scholarly journals Stress avulsion of the tibial tuberosity after tension band wiring of a patellar fracture: a case report

Cases Journal ◽  
2009 ◽  
Vol 2 (1) ◽  
Author(s):  
Michael T Hirschmann ◽  
Björn Wind ◽  
Christian Mauch ◽  
Gesa Ickler ◽  
Niklaus F Friederich
Keyword(s):  
Case Report ◽  
Tibial Tuberosity ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Patellar Fracture

scholarly journals A biomechanical study comparing the mean load to failure of two different osteosynthesis techniques for the Step-Cut Olecranon Osteotomy

2020 ◽  
Author(s):  
Silvan Hess ◽  
Alexander Bürki ◽  
Beat Kaspar Moor ◽  
Lilianna Bolliger ◽  
Philippe Zysset ◽  
...  
Keyword(s):  
Traction Force ◽  
Biomechanical Study ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Gap Formation ◽  
Compression Screw ◽  
Screw Osteosynthesis ◽  
Load To Failure ◽  
Osteosynthesis Techniques ◽  
The Mean

Abstract Background: A tension band wiring technique is the current gold standard for osteosynthesis of olecranon osteotomies, although the technique has several practical disadvantages and its theoretical advantages have been questioned. The Step-Cut Olecranon osteotomy is an interesting new option for surgeons to access distal intra-articular humerus fractures, but its stability has only been assessed using the tension band wiring osteosynthesis. Therefore, the mean load to failure of this osteotomy with two different osteosynthesis techniques (tension band wiring and compression screws) was assessed. A higher load to failure was hypnotized for the tension-band-wiring osteosynthesis group. Methods: A Step-Cut Olecranon osteotomy was performed on 32 Sawbones. Half were secured by a tension band wiring and the other half by two compression screws. The humero-ulnar joint was simulated using an established test setup, which allows the application of triceps traction force through a tendon model to the ulna model, while the joint is in a fixed position. Eight models of each group were tested at one of two angles (20° and 70° of flexion) by isometrical loading until failure. A failure was defined as either complete fracture or gap formation of more than 2mm between osteotomy and the remaining model. Results: At 20° of flexion, the mean load to failure in the tension band wiring group was 1360 N (SD 238) and 1401 N (SD 261) in the compression screw group. At 70° of flexion, it was 1398 N (SD 215) and 1614 N (SD 427), respectively. Differences did not reach significance (p = 0.88 at 20°, p = 0.28 at 70°).Conclusions: A tension band wiring osteosynthesis does not provide higher stability than a compression screw osteosynthesis for the Step-Cut Olecranon osteotomy. A Step-Cut Olecranon osteotomy with screw osteosynthesis might be an interesting option for surgeons when treating intra-articular distal humeral fractures.

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