Strength of Braided Polyblend Polyethylene Sutures versus Braided Polyester Sutures in Achilles Tendon Repair

2010 ◽  
Vol 100 (3) ◽  
pp. 185-188 ◽  
Author(s):  
Keith D. Cook ◽  
Greg Clark ◽  
Eric Lui ◽  
Gaurav Vajaria ◽  
George F. Wallace
Keyword(s):  
Achilles Tendon ◽  
Suture Material ◽  
Tendon Repair ◽  
Contralateral Side ◽  
Suture Technique ◽  
Materials Testing ◽  
Suture Materials ◽  
Cross Sectional ◽  
The Mean ◽  
The Right

Background: Various techniques may be used to repair Achilles tendon ruptures; however, we contend that using the strongest suture with the least amount of suture material is ideal. Methods: To compare the strength of 2-0 FiberLoop (Arthrex Inc, Naples, Florida) and #2 Ethibond (Ethicon Inc, Somerville, New Jersey) suture materials in Achilles tendon repairs, 12 Achilles tendons were harvested from cadavers aged 18 to 62 years (median age, 42 years). The tendons were transected and repaired using a modified Krackow suture technique. All of the right limbs were repaired with 2-0 FiberLoop, and the contralateral side was repaired with #2 Ethibond. The specimens were mounted to a materials testing system, and the repairs were pulled to failure in an anatomical direction. Results: The mean ± SD yield loads of 2-0 FiberLoop and #2 Ethibond were 233 ± 48 N and 134 ± 34 N, respectively (P = .002). The mean ± SD ultimate load of 2-0 FiberLoop was 282 ± 58 N, and that of #2 Ethibond was 135 ± 33 N (P < .001). The cross-sectional area of one pass of 2-0 FiberLoop was calculated to be 0.21 mm2, and one pass of #2 Ethibond was 0.28 mm2. Conclusions: The smaller-caliber 2-0 FiberLoop was significantly stronger than #2 Ethibond. This study suggests that there is no advantage to using the traditional larger suture material for Achilles tendon repairs; however, further clinical testing is needed to determine the optimal repair technique. (J Am Podiatr Med Assoc 100(3): 185–188, 2010)

Response of the Injured Tendon to Growth Factors in the Presence or Absence of the Paratenon

2018 ◽  
Vol 47 (2) ◽  
pp. 462-467 ◽  
Author(s):  
Sebastian A. Müller ◽  
Nicholas P. Quirk ◽  
Julia A. Müller-Lebschi ◽  
Patricia E. Heisterbach ◽  
Lutz Dürselen ◽  
...  
Keyword(s):  
Growth Factors ◽  
Achilles Tendon ◽  
Platelet Rich Plasma ◽  
Tendon Repair ◽  
Tendon Healing ◽  
Cross Sectional ◽  
Autologous Conditioned Serum ◽  
Injured Tendon ◽  
The Right ◽  
Exogenous Growth Factors

Background: The paratenon is important for Achilles tendon healing. There is much interest in the use of exogenous growth factors (GFs) as potential agents for accelerating the healing of damaged Achilles tendons. Purpose/Hypothesis: The present study used a rat model to study the responses of the injured Achilles tendon to GFs in the presence or absence of the paratenon. The hypothesis was that responses of the injured tendon to GFs would be lower in the absence of a paratenon. Study Design: Controlled laboratory study. Methods: A 4-mm defect was created in the right Achilles tendon of 60 skeletally mature rats, which were treated with a validated combination of GFs (bFGF, BMP-12, and TGF-β1). Animals were randomly assigned to the intact paratenon (IP) group or resected paratenon (RP) group. Healing was studied anatomically, mechanically, and histologically after 1, 2, and 4 weeks. Results: IP tendons showed improved healing compared with RP tendons. IP tendons were significantly stronger (32.2 N and 48.9 N, respectively) than RP tendons (20.1 N and 31.1 N, respectively) after 1 and 2 weeks. IP tendons did not elongate as much as RP tendons and had greater cross-sectional areas (18.0 mm2, 14.4 mm2, and 16.4 mm2, respectively) after 1, 2, and 4 weeks compared with RP tendons (10.5 mm2, 8.4 mm2, and 11.9 mm2, respectively). On histology, earlier collagen deposition and parallel orientation of fibrils were found for IP tendons. Conclusion: The paratenon is essential for efficient Achilles tendon healing. Healing with GFs in this Achilles tendon defect model was superior in the presence of the paratenon. Clinical Relevance: Biological approaches to tendon engineering using GFs are in vogue and have been shown to improve healing of the rat Achilles tendon, most likely by inducing progenitor cells located within the paratenon. Clinically, resection or incision of the paratenon has been proposed for wound closure. Our data demonstrate the fundamental importance of the paratenon, which therefore should be preserved during Achilles tendon repair, especially if augmented with products such as platelet-rich plasma or autologous conditioned serum that are rich in GFs.

scholarly journals Polytetrafluoroethylene (PTFE) suture vs fiberwire and polypropylene in flexor tendon repair

2021 ◽  
Author(s):  
Elias Polykandriotis ◽  
Florian Ruppe ◽  
Miriam Niederkorn ◽  
Ektor Polykandriotis ◽  
Lars Bräuer ◽  
...  
Keyword(s):  
Mechanical Characteristics ◽  
Suture Material ◽  
Tendon Repair ◽  
Suture Technique ◽  
Bonferroni Correction ◽  
Suture Materials ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
Significant Difference ◽  
Repair Techniques

Abstract Background In this study, we evaluate the value of novel suture material based on monofilamentous-extruded polyfluoroethylene (PTFE) compared to polypropylene (PPL) and Fiberwire (FW). Materials and methods 60 flexor tendons were harvested from fresh cadaveric upper extremities. 4–0 sutures strands were used in the PPL, FW and PTFE group. Knotting properties and mechanical characteristics of the suture materials were evaluated. A 4-strand locked cruciate (Adelaide) or a 6-strand (M-Tang) suture technique was applied as core sutures for a tendon repair. Two-way ANOVA tests were performed with the Bonferroni correction. Results Stable knotting was achieved with 5 throws with the PPL material, 7 throws for FW and 9 throws for PTFE. In the PPL group, linear tensile strength was 45.92 ± 12.53 N, in the FW group 80.11 ± 18.34 N and in the PTFE group 76.16 ± 29.10 N. FW and PTFE are significantly stronger than PPL but show no significant difference among each other. Similar results were obtained in the subgroup comparisons for different repair techniques. The Adelaide and the M-Tang knotting technique showed no significant difference. Conclusion Fiberwire showed superior handling and knotting properties in comparison to PTFE. However, PTFE allows easier approximation of the stumps. In both, M-Tang and Adelaide repairs, PTFE was equal to FW in terms of repair strength. Both PTFE and FW provide for a robust tendon repair so that early active motion regimens for rehabilitation can be applied.

scholarly journals TA Rupture Assessment Analysis – are Our "GOLD-Standards“ of Tendon Repair Valid?

2020 ◽  
Author(s):  
Simone Frunz ◽  
Markus Knupp ◽  
Beat Goepfert ◽  
Lukas Iselin
Keyword(s):  
Achilles Tendon ◽  
Failure Mode ◽  
Operative Treatment ◽  
Suture Material ◽  
Testing Machine ◽  
Tendon Repair ◽  
Suture Technique ◽  
Achilles Tendon Repair ◽  
Rupture Pattern

Abstract Background: Current studies showed that operative treatment has advantages in comparison to conservative treatment for acute Achilles tendon ruptures. The gold standard therapy in our clinic is the operative treatment with the four strand Adelaide suture. The goal of this study is to evaluate which suture material (a) B Braun; MonoMax, b) Ethicon; PDS CTX) is more appropriate for Achilles tendon suture.Methods: Ten pairs of fresh frozen Achilles tendons were obtained from human donors aged 41 – 85. The tendons were fixed on a testing machine and loaded until failure. The goal of this setup was to create a natural rupture pattern. The ruptured tendons were sutured either with BB or PDS and again loaded until failure.The failure mode in all sutured tendons was a pullout of the suture material through the tendon fibres.Results: The ruptures occurred on different locations. The maximal forces in the sutured tendons occurring at the rupture were for the BB-suture between 144 N and 232 N (Mean 197 (SD 67) N) and for the PDS-suture between 158 N and 226 N (Mean 194(SD 70) N). The failure mode in all sutured tendons was a pullout of the suture material through the tendon fibres.Conclusion: Due to the failure mode we are not able to evaluate which suture material is better to use for the Achilles tendon repair with the Adelaide suture. Either the Adelaide suture is not an appropriate suture technique for Achilles tendon repair or the natural rupture pattern has in comparison to the in vitro rupture patterns constructed by sharp dissection a bigger influence on the pullout strength of suture techniques than we thought. This would mean that probably the data from most in vitro studies are not applicable for daily life.

Initial Pull-Out Strength of Tendon Sutures: An In Vitro Study in Sheep Achilles Tendon

2002 ◽  
Vol 23 (12) ◽  
pp. 1126-1130 ◽  
Author(s):  
Yakup Yıldırım ◽  
Tanıl Esemenli
Keyword(s):  
Achilles Tendon ◽  
Suture Material ◽  
Achilles Tendon Rupture ◽  
Testing Machine ◽  
In Vitro Study ◽  
Materials Testing ◽  
Suture Materials ◽  
Initial Strength ◽  
Pull Out

Forty-eight fresh frozen sheep achilles tendons were used to compare the pull-out strengths of Kessler, Bunnell and locking loop techniques which are the standard configurations described for Achilles tendon repair. A simulated Achilles tendon rupture was done with a tenotomy made 2 cm proximal to the calcaneal insertion. One of the configurations was placed at the distal end of the proximal portion of the tendon specimens using No. 5 Ticron. The distal ends of the suture materials were left free and were not used to connect the proximal and distal portions of the tendon. Using a servohydraulic materials testing machine, each tendon was tested to failure in tension at a displacement rate of 20 mm/min. All the specimens failed due to pull-out of the suture material. Since the cause of failure was suture material breakage in the previous studies reporting repair strength, they were unable to represent the effect of configuration on the strength. This study is the first to represent the effect of configuration on the initial strength since there is no failure due to suture material breakage.

scholarly journals Transverse versus longitudinal incision for minimally invasive Achilles tendon repair

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0016
Author(s):  
Daniel Bohl ◽  
Eric Barnard ◽  
Kamran Movassaghi ◽  
Kamran Hamid ◽  
Adam Schiff
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Suture Material ◽  
Tendon Repair ◽  
Wound Complications ◽  
Transverse Incision ◽  
Longitudinal Incision ◽  
Achilles Tendon Repair ◽  
Deep Suture ◽  
No Tourniquet

Category: Sports Introduction/Purpose: The rate of wound complications following traditional open Achilles tendon repair is reported at 7-8%. In an effort to reduce the rate of wound complications, orthopaedic surgeons have adopted novel minimally invasive techniques. The purpose of this study is to characterize the rate of wound and other early complications following a minimally invasive Achilles tendon repair, to identify any factors associated with increased risk. Methods: The postoperative courses of 55 patients who underwent minimally invasive Achilles tendon repair by two surgeons at separate academic medical centers were retrospectively reviewed. Repair technique was similar in all cases, making use of the same commercially available suture-guidance jig, silicone-impregnated deep suture material, and locking stitch technique. However, 31 procedures used a longitudinal incision and a tourniquet (one surgeon’s preference), while 24 procedures used a transverse incision and no tourniquet (the second surgeon’s preference). Of the 24 procedures using transverse incisions, 2 had to be converted to L-shaped incisions to achieve better access to the tendon. The rates of early complications within 3 months after surgery were characterized and compared between patients with differing procedural characteristics. Results: Of the 55 patients included in the study, 2 (3.6%) developed wound complications. Both wound complications appeared to be reactions to the deep suture material (see Table 1 for details). There was no statistical difference in the rate of wound complications between patients in the longitudinal incision/tourniquet group and patients in the transverse incision/no tourniquet group (6.5% versus 0.0%; p=0.499). Three patients (5.5%) developed sural neuropraxia, which manifested as mild-to-moderate subjective numbness with sensation remaining intact to light touch. There were no cases of re-rupture. At 3-month follow-up, all 55 patients had intact Thompson tests and well-healed wounds. Conclusion: The rate of wound complications following minimally invasive Achilles repair is low at 3.6%. The present study could not demonstrate a difference in risk for wound complications between patients treated with a longitudinal incision and tourniquet and patients treated with a transverse incision and no tourniquet. The wound complications we observed were primarily attributable to inflammatory reactions to the silicone-impregnated deep suture material. Patients should be counseled that although risk for wound complications may be lower with minimally invasive techniques, such techniques do risk sural neuropraxia and deep suture reaction. Further prospective analysis is warranted.

scholarly journals Patients with Achilles Tendon Rupture Have a Degenerated Contralateral Achilles Tendon: An Elastography Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Qianru Li ◽  
Qi Zhang ◽  
Yehua Cai ◽  
Yinghui Hua
Keyword(s):  
Achilles Tendon ◽  
Axial Strain ◽  
Achilles Tendon Rupture ◽  
Cross Sectional Area ◽  
Control Group ◽  
Computer Assisted ◽  
Study Group ◽  
Sectional Area ◽  
Cross Sectional ◽  
The Mean

Purpose. To evaluate differences of Achilles tendon (AT) hardness and morphology between asymptomatic tendons in patients with acute AT ruptures on the contralateral side and asymptomatic tendons in healthy people by using computer-assisted quantification on axial-strain sonoelastography (ASE). Methods. The study consisted of 33 asymptomatic tendons in 33 patients (study group) and 34 tendons in 19 healthy volunteers (control group). All the tendons were examined by both ASE and conventional ultrasound. Computer-assisted quantification on ASE was applied to extract hardness variables, including the mean (Hmean), 20th percentile (H20), median (H50) and skewness (Hsk) of the hardness within tendon, and the ratio of the mean hardness within tendon to that outside tendon (Hratio) and three morphological variables: the thickness (THK), cross-sectional area, and eccentricity (ECC) of tendons. Results. The Hmean, Hsk, H20, H50, and Hratio in the proximal third of the tendon body in study group were significantly smaller than those in control group (Hmean: 0.43±0.09 vs 0.50±0.07, p=0.001; Hsk: -0.53±0.51 vs -1.09±0.51, p<0.001; H20: 0.31±0.10 vs 0.40±0.10, p=0.001; H50: 0.45±0.10 vs 0.53±0.08, p<0.001; Hratio: 1.01±0.25 vs 1.20±0.23, p=0.003). The THK and cross-sectional area of tendons in the study group were larger than those in the control group (p<0.05). Conclusions. As a quantitative objective method, the computer-assisted ASE reveals that the asymptomatic ATs contralateral to acute rupture are softer than those of healthy control group at the proximal third and the asymptomatic tendons in people with rupture history are thicker, larger, and rounder than those of normal volunteers especially at the middle and distal thirds of AT body.

scholarly journals Evaluation of optic canal anatomy and symmetry using CT

2019 ◽  
Vol 4 (1) ◽  
pp. e000302 ◽  
Author(s):  
Xinxin Zhang ◽  
Yueh Lee ◽  
Daniel Olson ◽  
David Fleischman
Keyword(s):  
North Carolina ◽  
Retrospective Chart Review ◽  
Bilateral Symmetry ◽  
Optic Canal ◽  
Difference Threshold ◽  
Racial Groups ◽  
Cross Sectional ◽  
Minimum Diameter ◽  
The Mean ◽  
The Right

ObjectiveWe aim to describe the anatomy and symmetry patterns of the optic canal in patients having undergone maxillofacial CT imaging.MethodsIn this retrospective chart review, we included all patients who received sinus and maxillofacial CT at the University of North Carolina hospitals between 2008 and 2016, without facial or cranial fractures or other medical conditions that would affect optic canal size. We measured the length of ≥75% enclosed canal, minimum cross-sectional area and minimum diameter bilaterally using iNtuition TeraRecon (Durham, North Carolina) and compared bilateral symmetry using a 20 % difference threshold. Each parameter above was compared among white, black, non-white and non-black patients.ResultsOf 335 patients, the mean canal length was 5.61±2.22 mm. The mean minimum area was 11.84±3.11 mm2. The mean minimum diameter was 3.28±0.55 mm. A total of 39.4% (132/335) of patients had asymmetric canal lengths, 18.8% (63/335) had asymmetric minimum areas, and 12.5% (42/335) had asymmetric minimum diameters. No differences were found between racial groups. The right optic canal was larger than the left (right: 12.12 mm vs left: 11.55 mm, p<0.0001).ConclusionOptic canal asymmetry is not uncommon. It may affect risk of papilloedema severity, explain cases of unilateral or asymmetric papilloedema and possibly asymmetric glaucoma.

scholarly journals The Clinical Outcomes After a Novel Mini-Open Achilles Tendon Repair

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0009
Author(s):  
Craig C. Akoh ◽  
Amanda N. Fletcher ◽  
Selene G. Parekh ◽  
Akhil Sharma
Keyword(s):  
Achilles Tendon ◽  
Clinical Outcomes ◽  
Tendon Repair ◽  
Postoperative Outcomes ◽  
Categorical Variables ◽  
Foot And Ankle ◽  
Achilles Tendon Repair ◽  
Tendon Ruptures ◽  
The Mean ◽  
Mini Open

Category: Sports; Other Introduction/Purpose: Achilles tendon ruptures are a common sporting injury, mostly occurring in men over the age of 40. Operative repair of Achilles tendon can lead to earlier return to activity and improved function in the active population. Mini-open repairs have recently been described for effective treatment of Achilles tendon ruptures. We aim to describe our unique mini- open Achilles tendon repair technique and to report our clinical outcomes. Methods: We retrospectively reviewed charts of patients from January 2010 and July 2019 who underwent a 3cm mini-open Achilles tendon repairs, without additional targeting devices, for closed acute Achilles tendon ruptures. Patients were followed up for a minimum of one year. We recorded pre- and postoperative Foot and Ankle Disability Index (FADI), visual analog scale (VAS), and the Foot and Ankle Outcome Score (FAOS) scores. Subgroup analysis were performed for acute repairs (< 2 weeks) and subacute (2-6 weeks). Two-sided student’s t-test to compare preoperative and postoperative outcomes for continuous variables. Chi-square analyses were used to determine the strength of correlation between categorical variables. A p-value of < .05 was considered significant for all statistical analyses. Results: A total of 33 patients met the inclusion criteria and are included in this study. The mean age of our cohort was 43.8 years old (range 22-78) and 78.8% of patients were male. The mean length of follow-up was 4.4 years (range 1.0-9.8 years). The mean time from injury to surgery was 15.6 days (1-45 days). Patients reported a mean return to their previous level of activity at a mean of 5.6 months (range 1.7-22.1). The mean pre- and postoperative outcomes scores improved significantly for both the acute and subacute repair groups (p < 0.05). There were no significant differences for postoperative outcomes scores between the acute and subacute Achilles repair groups (p > 0.05). There were no reported complications in our patient cohort. Conclusion: Patients showed improvements in postoperative patient-reported outcome scores with minimal complications. There were no significant difference in outcomes for acute versus subacute repairs. Our mini-open Achilles tendon repair, which required no additional targeting instrumentation, has shown favorable mid-term results.

scholarly journals Histomorphometric Study of the Glomeruli of the Kidney in Bangladeshi Population

2015 ◽  
Vol 9 (1) ◽  
pp. 11-16
Author(s):  
Fatema Johora ◽  
Abu Sadat Mohammad Nurunnabi ◽  
Sunjida Shahriah ◽  
Rukshana Ahmed ◽  
Shamim Ara
Keyword(s):  
Left Kidney ◽  
Age Groups ◽  
Population Based ◽  
Cross Sectional ◽  
Medical College ◽  
Histomorphometric Study ◽  
The Mean ◽  
Group 10 ◽  
Bangladeshi Population ◽  
The Right

Background: Controversies still prevail on glomerular changes of kidney whether due to normal aging or its association with diseases Objective: The aim of the present study was to see the variation in number and size of the glomeruli of kidney with increasing age in a Bangladeshi population based on autopsy. Methods: This cross-sectional, descriptive study was done in the Department of Anatomy, Dhaka Medical College, Dhaka, from July 2008 to June 2009, based on collection of 140 post mortem human kidneys collected from 70 unclaimed dead bodies from the morgue. All the samples were divided into three age-groups: 10-19 years, 20-39 years and 40-59 years. Histological slides were prepared by using routine Harris’ Haematoxylin and Eosin (H & E) stain. The number of glomeruli was measured by point counting technique, while the size (diameter) was measured by using ocular and stage micrometer. Results: The mean ± SE number of glomeruli per sq. mm found in the right and left kidney were 8.45±0.52 and 8.67±0.80 in group 10-19 years, 9.90±0.42 and 9.92±0.47 in 20-39 years, and 8.52±0.18 and 8.55±0.16 in 40-59 years respectively. Besides, the size (mean ± SE diameter) of glomeruli was found in the right and left kidney were 43.96±3.01ìm and 143.92±2.90ìm in group 10-19 years, 153.69±5.18ìm and 153.61±5.24ìm in 20-39 years, and 140.48±0.95ìm and 140.78±0.88ìm in 40-59 years respectively. Conclusion: No difference was found in number and size of glomeruli between right and left kidney in any group. Similarly, no difference was also evident among different age groups. DOI: http://dx.doi.org/10.3329/jbsp.v9i1.22788 Bangladesh Soc Physiol. 2014, June; 9(1): 11-16

Mechanical properties and dimensions of the major pulmonary arteries

1960 ◽  
Vol 15 (1) ◽  
pp. 92-96 ◽  
Author(s):  
Dali J. Patel ◽  
Donald P. Schilder ◽  
Alexander J. Mallos
Keyword(s):  
Pulmonary Artery ◽  
Pulse Pressure ◽  
Technical Assistance ◽  
Main Pulmonary Artery ◽  
Pulmonary Arteries ◽  
Cross Sectional ◽  
Measurement Control ◽  
The Mean ◽  
The Right ◽  
The Relationship

The relationship between instantaneous distending pressure and diameter of the pulmonary artery was studied in 18 living thoracotomized dogs. An electrical caliper with adequate recording characteristics was developed for instantaneous diameter measurement. Control observations were made over a range of pressures induced by rapid, right heart dextran-infusion and were compared with those obtained during norepinephrine administration. Results indicate: a) the pulse contours of the pulmonary artery pressure and diameter are essentially identical, indicating negligible inertance and viscous resistance of the vessel wall, b) the mean change in average radius during a cardiac cycle was ±7.8% ± 2.86 S.D. ± .32 S.E.M. (0.48%/cm H2O pulse pressure) under control conditions, c) the ratio of change in radius to pulse pressure, R/P, showed a significant decrease during norepinephrine administration when compared to control values within the same pressure range (P < .01) and d) the cross-sectional area of the main pulmonary artery exceeded that of the right and left combined. Note: (With the Technical Assistance of Alfred G. T. Casper) Submitted on August 25, 1959

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