New autoplastic method of tendon suture

Despite a significant number of special works devoted to the question of the tendon suture, the latter is far from perfect, and the final word in the doctrine of tendon suturing has not yet been said.

The Optimal Surgical Needle for Tendon Suture: Cutting Edge or Reverse Cutting Edge?

Background. Achieving a durable connection between the lacerated tendon ends is difficult. The outcome of treatment depends on many factors. Several authors consider the properties of the surgical needle used for suturing the tendon to be important. The aim of the study— to compare the strength of the tendon suture applied with the conventional cutting edge and reverse cutting edge surgical needles in the experiment.Materials and Methods.We used porcine tendons for the experiment. The tendon fragments were divided into 2 groups of 20 tendons each. On all 40 tendons, the same type of “injury” of the tendon was simulated — using a scalpel. In the first group, the interrupted suture of the tendon was applied with a cutting edge surgical needle, in the second group — reverse cutting edge. Laboratory tests of the tendon sutures strength were performed on the improvised stand.Results.In the first (suture made with a cutting needle edge), diastasis of 2 mm was determined at an average load of 1219.5 g (m = ±76.56, where «m» is the representativeness error). Complete suture failure occurred at an average load of 1770.8 g (m = ±100.02). In this group, the thread rupture was not recorded. In the second group (a suture made with a reverse cutting edge needle), diastasis occurs with an average load of 1754.75 g (m = ±77.32). Complete suture failure occurred at an average load of 2571.25 (at m= ± 103.78). In three cases, the thread ruptured. In the second group (reverse cutting edge needle), the tendon suture strength was statistically significantly higher than in the first group. Conclusion. The tendon suture strength depends on the surgical needle properties. In tendons reconstruction the reverse cutting edge needle use is more preferable compared to the conventional cutting edge needle use.

Editorial Comment on the Article by A.S. Zolotov et al. “The Optimal Surgical Needle for Tendon Suture: Cutting Edge or Reverse Cutting Edge?”

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An experimental study of the mechanical properties of the Achilles tendon in rabbits during its recovery after injury

Background. The problem of treating patients with tendon injuries remains unresolved. Unsatisfactory results after surgical treatment, according to different authors, range from 15 to 62 %. The functional outcome after surgical repair of damaged tendons is difficult to predict because of the high risk of scar block formation, which prevents them from sliding freely. Adhesions compromise the extensibility of the tendons, which in turn affects their strength. The purpose was to experimentally investigate the strength properties of the Achilles tendons after their surgical restoration with the further use of various medications. Materials and methods. The mechanical properties of the Achilles tendons of rabbits were investigated, on which a model of their partial damage was created by crossing by 1/2 the diameter. The injured tendon was sutured with a tendon suture. Within the experiment, 5 groups of preparations of the Achilles tendons of rabbits with a heel bone were studied, 3 preparations in each group. Group 1 was a control one. After performing the tendon suture, the wound was sutured. The rabbits of group 2 were administered Noltrex around the tendon suture. Group 3 included the animals who were injected with a preparation of hyaluronic acid. Group 4 consisted of the animals who were injected with lidase. Group 5 included the animals with the normal values, preparations of non-operated Achilles tendons of intact animals. All animals were withdrawn from the experiment on day 60. According to the test results, the value of the elastic modulus and the ultimate strength of the preparation was calculated. Results. The greatest elongation under a tensile load of 30 N was achieved on preparations of unoperated Achilles tendons of rabbits — 2.96 ± 0.22 mm. The smallest elongation was obtained for the preparations of the control group — 0.83 ± 0.37 mm. The rest of the drug groups showed intermediate values. The Achilles tendon preparations of rabbits from the control group (0.216 ± 0.123 MPa) have the highest value of the elastic modulus. The smallest value of the modulus of elasticity was found in the study of non-injured preparations of the Achilles tendon (0.051 ± 0.004 MPa). The drugs of the control group had the greatest strength (the value of the maximum permissible load was 81.81 ± 0.34 N). The least strength was demonstrated by preparations of non-traumatized Achilles tendons of rabbits (the value of the maximum permissible load was 69.72 ± 0.18 N). Conclusions. Within the recovery of the Achilles tendon in rabbits after injury, an increase in the values of indicators characterizing the strength properties of tissues is observed — elastic modulus, maximum permissible load, and ultimate strength. The values of indicators characterizing the plastic properties of tissues decrease, which can be one of the reasons for the development of post-traumatic contractures. The best indicators in terms of tissue plasticity were observed in the group of preparations of the Achilles tendon of rabbits treated with hyaluronic acid. The worst ones were registered in the control group.

Treatment of the fresh central slip avulsion of the extensor tendon by bone tunnel-tendon suture: a prospective cohort study

Background The current evidence base for the management of central slip avulsions is limited from obtaining a best approach. The purpose of this study was to evaluate the clinical effect and feasibility of repairing the fresh central slip avulsion by bone tunnel-tendon suture. Methods Twenty-four cases of open and closed central slip avulsions were prospectively studied. They were treated by suturing the tendon to the pre-holed bone through two parallel bone tunnels. Follow-up was conducted at 1 month, 3 months, 6 months, 12 months and 18 months after the operation. Symptoms, degree of satisfaction with the appearance, complications, Crawford’s evaluation, DASH scores and the total active movement (TAM) were collected. Results The follow-up period was 6~18 months (mean 13 months). Finger function was assessed using the Crawford’s evaluation criteria: excellent in 12, good in 10, average in 2, with an excellent and good rate of 91.7%. DASH scores ranged from 37 to 47(mean 39). According to the Chinese Medical Association’s trial criteria for assessing the function of upper limbs, excellent, good and average cases were 9, 14 and 1 respectively. The range of motion gradually improved over time. Conclusions Good prognosis can be achieved through bone tunnel-tendon suture for the treatment of fresh central slip avulsion.

The New Approach for Tendon Repair Training: Virtual Reality Simulator (Preprint)

BACKGROUND The use of virtual reality (VR) simulators in medical schools has become widespread to train medical students and residents. The students using VR simulators are provided with a three-dimensional human model to observe human details using multiple senses and can participate in an environment relatively close to the reality. This paper promotes a new approach consisting of a sharing and independent study platform for medical orthopedics students. OBJECTIVE This study compared traditional tendon repair training and VR simulation of tendon repair and evaluated future applications of VR simulation in the medical academic field. METHODS One-hundred twenty-one participants were allocated into the VR and control groups. The participants in the VR group were studying the tendon repair technique via the VR simulator; while the control group followed traditional tendon suture teaching methods. RESULTS A total of 117 participants finished the assessment, and four participants were lost during follow-up. The overall performance (a total 35 score) for the VR group using the “Kessler tendon repair with 2 interrupted tendon repair knots” method was significantly higher score (P <.001) than the control group (24.13 ± 1.71 versus 20.38 ± 1.21). Moreover, for the “Bunnell tendon repair with figure 8 tendon repair” method, the VR group also had a significantly better result (P < .001) than the control group (22.8 ± 1.81 versus 19.9 ± 2.27). The participants using the VR simulator training had a significantly higher score than those using the traditional training method. CONCLUSIONS Use of the VR simulator for learning the tendon suture produced a significant improvement in the time in motion, suture skill, flow of operation, and knowledge of procedure for medical students than using traditional tendon suture method. Therefore, future VR simulator development would likely be beneficial for medical education and clinical practice.