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

Conroy, Christine; Sethi, Paul M.; Macken, Craig; Wei, David H.; Kowalsky, Marc S.; Mirzayan, Raffy; Pauzenberger, Leo; Dyrna, Felix; Obopilwe, Elifho; Mazzocca, Augustus D.

doi:10.1177/0363546517701426

Cited by 18 publications

(25 citation statements)

References 24 publications

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“…However, a dermal allograft may allow for potentially greater incorporation to the AC joint with biomechanical equivalency to allograft tendons. 16,18,20…”

Section: Discussionmentioning

confidence: 99%

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Reconstruction of the Acromioclavicular Ligament Complex Using Dermal Allograft: A Biomechanical Analysis

Morikawa

Mazzocca

Obopilwe

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…However, a dermal allograft may allow for potentially greater incorporation to the AC joint with biomechanical equivalency to allograft tendons. 16,18,20…”

Section: Discussionmentioning

confidence: 99%

“…), for procedures such as rotator cuff repair, superior capsule reconstruction, and distal biceps repair. [18][19][20][21] However, its potential role in augmentation of ACLC reconstruction has yet to be investigated.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of the Acromioclavicular Ligament Complex Using Dermal Allograft: A Biomechanical Analysis

Morikawa

Mazzocca

Obopilwe

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…The biomechanical protocol was based on previously published work. 4,13,20 A servohydraulic mechanical testing system (Bionix 858; MTS Systems) was used for biomechanical testing. Specimens were cut at the midhumerus and distal third of the forearm before being mounted with the humerus in a rigid clamp in line with the actuator.…”

Section: Methodsmentioning

confidence: 99%

“…The applied surgical approach, which is commonly used, preserved the soft tissue surrounding the radius and made optical tracking not feasible in this biomechanical setup. After the preload was applied, the specimens were cycled between maximal extension without supination and 90°of flexion by inferior and superior translation of the material testing system at a rate of 0.25 Hz for 3000 cycles 4,20 (Figure 2A). Displacement indicated elongation of the overall construct.…”

Section: Biomechanical Testingmentioning

confidence: 99%

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

et al. 2019

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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.

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“…Conroy et al [22], investigated an unusual and therefore new augmentation approach by bridging a distal biceps tendon defect with acellular skin graft. Biomechanical testing produced equivalent results compared with the actual distal biceps tendon.…”

Section: Resultsmentioning

confidence: 99%

Surgical Reconstruction Options in Chronic Distal Biceps Tendon Ruptures – Case Report and Literature Review

et al. 2019

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Introduction Chronic distal biceps tendon ruptures are rare and conservative or operative treatment options are suitable. There is a consensus in the literature in case of acute traumatic ruptures the operative refixation should be preferred. Disagreement exists in the best way of care of old ruptures (> 4 weeks) of distal biceps tendon. Several kinds of refixation possibilities up to tendon grafts are described. Aim of this publication is showing an overview of the literature of the approved methods in reconstruction of the distal biceps tendon using autogenous and allogenic grafts, comparing the outcomes and transferring them on an own case. Material and Methods A literature research was carried out using the online medical database “PubMed” with the following keywords “chronic rupture distal biceps tendon, surgical techniques”. 59 citations were found concerning the topic, 37 publications were relevant for this work. Results There is consensus that even in chronic ruptures the operative management of the distal biceps tendon generates the best results. Consistently the experiences and results of only little patient collectives are reported. Numerous techniques of surgery are described without predominance of one method. Reinsertions of the tendon butts are reported in different techniques: with achilles, palmaris longus, fascia lata, triceps, quadriceps and semitendinosus tendon grafts. All together they showed postoperative satisfactory results. Conclusion With surgical treatment of chronic ruptured distal biceps tendons comparable outcomes can be achieved by primary refixation and graft augmentations. In case of graft augmentations several tissue options are available which showed in all cases satisfactory functional results in the end.

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

Abstract: Dermal augmentation of the distal biceps is a biomechanically feasible option for patients with an attritionally thinned-out tendon.

Cited by 18 publications

References 24 publications

Reconstruction of the Acromioclavicular Ligament Complex Using Dermal Allograft: A Biomechanical Analysis

Reconstruction of the Acromioclavicular Ligament Complex Using Dermal Allograft: A Biomechanical Analysis

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

Surgical Reconstruction Options in Chronic Distal Biceps Tendon Ruptures – Case Report and Literature Review

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