Effect of A2 Pulley Release on Repaired Tendon Gliding Resistance and Rupture in a Chicken Model

Tang, Jin Bo; Cao, Yi; Wu, Ya Fang; Wang, Gu Heng

doi:10.1016/j.jhsa.2009.04.010

Cited by 27 publications

(11 citation statements)

References 29 publications

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“…However, these studies were performed in normal functioning tendons undisturbed by laceration and subsequent repair. Further, recent studies in chicken models suggest that partial pulley release, and in some cases completely dividing the pulley, may actually improve tendon gliding and decrease the risk of tendon rupture after repair17–19. Additional studies have shown that partial excision of the A2 and A4 tendon pulleys can be tolerated without a significant change in finger flexion15, 20–21, and clinical reports of Kwai Ben and Elliot and Tang advocate complete A4 pulley excision to prevent tendon catching14, 22.…”

Section: Introductionmentioning

confidence: 99%

Quantification of Partial or Complete A4 Pulley Release With FDP Repair in Cadaveric Tendons

Franko

Lee

Finneran

et al. 2011

The Journal of Hand Surgery

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Purpose Repair of a lacerated flexor digitorum profundus (FDP) tendon underneath or just distal to the A4 pulley can be technically challenging, and success may be confounded by tendon triggering and scarring to the pulley. The purpose of this study was to quantify the effect of partial and complete A4 pulley release in the context of a lacerated and repaired FDP tendon just distal to the A4 pulley. Methods Tendon biomechanics were tested in six cadaveric hands secured to a rigid frame permitting measurement of tendon excursion, tendon force, and finger range of motion. After control testing, each finger underwent laceration and repair of the FDP tendon at the distal margin of the A4 pulley using a six-strand core suture technique and epitendinous repair. Testing was then repeated after the following interventions: 1) Intact A4 pulley 2) Release of the distal half of the A4 pulley, 3) Complete release of the A4 pulley, and 4) Continued proximal release of the sheath to the distal edge of A2 (release of C2, A3, and C1 pulleys). Release of the pulleys was performed by incision; no tissue was removed from the specimens. Results From full extension to full flexion, average profundus tendon excursion for all intact digits was 37.9 ± 1.5 mm, and tendon repair resulted in average tendon shortening of 1.6 ± 0.4 mm. Flexion lag increased from less than 1 mm to over 4 mm with venting of the A4 pulley, complete A4 release, and proximal sheath release, respectively. Compared to the intact state, repair of the tendon with an intact A4 pulley, release of half the A4 pulley, complete A4 release, and proximal sheath release resulted in percent increases in work of flexion (WOF) of 11.5 ± 3.1%, 0.83 ± 2.8%, 2.6 ± 2.4%, and 3.25 ± 2.2%, respectively (p<0.05). Conclusions After FDP laceration and repair in the region of the A4 pulley, WOF did not increase by more than 3% from control conditions after partial or complete A4 pulley release, and WOF was significantly less than performing a repair and leaving the A4 pulley intact.

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Section: Introductionmentioning

confidence: 99%

Quantification of Partial or Complete A4 Pulley Release With FDP Repair in Cadaveric Tendons

Franko

Lee

Finneran

et al. 2011

The Journal of Hand Surgery

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“…Most importantly, this physiologically high loading on bones makes the tendons strong and large. Indeed, the chicken has been used for flexor tendon research; however, the scale size of chicken flexor tendons is far smaller than that of humans, which makes the surgical repair very difficult and variable and thus diminishes its clinical relevance. Turkey flexor tendons are large and have other characteristics that are comparable to those in humans …”

Section: Discussionmentioning

confidence: 99%

Establishment of an in vivo turkey model for the study of flexor tendon repair

Kadar

Liu

Vrieze

et al. 2018

Journal Orthopaedic Research

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Flexor tendon injuries are common and pose a clinical challenge for functional restoration. The purpose of our study was to assess the adequacy of the turkey as a large animal model for flexor tendon injuries in vivo. Twenty-four male turkeys underwent surgical flexor tendon cut and repair. Turkeys were allocated to five groups postoperatively: (1) foot casted in extension and sacrificed after 3 weeks; (2) foot casted in extension and sacrificed after 6 weeks; (3) foot casted in flexion and sacrificed after 3 weeks; (4) foot casted in flexion and sacrificed after 6 weeks; and (5) foot casted in flexion for 6 weeks and then free roaming allowed for an additional 3 weeks before sacrifice. After sacrifice, digits were collected and analyzed for adhesion formation, healing at the macrolevel and histologically, and biomechanical properties-including friction, work of flexion, stiffness, and strength of repair. All turkeys survived anesthesia and surgery. Tendon rupture occurred in all extension casts and in 11% of those casted in flexion. Friction and work of flexion were significantly higher in the repaired digit than the control digit. There was a correlation between duration of immobilization and repair strength. Histologically, the tendon healed with tenocytes migrating into the gap and producing collagen fibers. We have, for the first time, studied flexor tendon injury and repair using turkeys in terms of anesthesia, surgical procedures, postoperative care, and animal husbandry. The findings regarding functional and histological results from this novel avian model were comparable to the most commonly used mammal model. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2497-2505, 2018.

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“…3 The effect of A2 pulley constraint was then studied at 2 and 4 weeks after FDP repair. 4 With the A2 pulley released, 25% of FDP repairs ruptured when loaded to full range flexion at 2 or 4 weeks. With an intact pulley, 75% of repairs loaded to full range flexion ruptured at 2 weeks; 87.5% ruptured at 4 weeks.…”

Section: Animal Studiesmentioning

confidence: 98%

Zone II: Repair or Resect the Flexor Digitorum Superficialis?

Henry

2011

The Journal of Hand Surgery

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Effect of A2 Pulley Release on Repaired Tendon Gliding Resistance and Rupture in a Chicken Model

Cited by 27 publications

References 29 publications

Quantification of Partial or Complete A4 Pulley Release With FDP Repair in Cadaveric Tendons

Quantification of Partial or Complete A4 Pulley Release With FDP Repair in Cadaveric Tendons

Establishment of an in vivo turkey model for the study of flexor tendon repair

Zone II: Repair or Resect the Flexor Digitorum Superficialis?

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