Effects of Tension Across the Tendon Repair Site on Tendon Gap and Ultimate Strength

Wu, Ya Fang; Tang, Jin Bo

doi:10.1016/j.jhsa.2012.01.004

Cited by 65 publications

(42 citation statements)

References 30 publications

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“…In our experimental protocol, we did not over-tension our repairs but instead attempted to obtain neutral tension at the repair site. Some reports have investigated other factors contributing to repair site failure including tensioning of the core suture and resistance to flexor tendon excursion caused by post-operative edema [18, 19, 20]. Our investigation did not examine these factors and future in-vivo studies may benefit from investigation of the effect of these factors on flexor tendon repair characteristics.…”

Section: Discussionmentioning

confidence: 97%

The Effect of Core and Epitendinous Suture Modifications on Repair of Intrasynovial Flexor Tendons in an In Vivo Canine Model

Fufa

Osei

Calfee

et al. 2012

The Journal of Hand Surgery

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Purpose To determine in-vivo effects of modifications to core and epitendinous suture techniques in a canine intrasynovial flexor tendon repair model using clinically relevant rehabilitation. Our null hypothesis was that gap formation and rupture rates would remain consistent across repair techniques. Methods We evaluated gap formation and rupture in 75 adult mongrel dogs that underwent repair of intrasynovial flexor tendon lacerations followed by standardized post-operative therapy. The current suture technique was a 4-0, 8-strand core suture with a purchase of 1.2 cm and a 5-0, epitendinous suture repair with a 2 mm purchase length and depth. Gap and failure were compared by chi-squared analysis to a historical group of in-vivo repairs (n=76) from the same canine model using 8-strand core suture repair with purchase of 0.75 cm and 6-0 epitendinous suture with a 1 mm purchase length and depth. Results Ninety-three percent of tendons (n = 70) demonstrated gapping of <3 mm using the current suture technique. Five percent of tendons (n = 4) had a gap of 3 mm or greater, and there was 1 repair site failure. This was significantly improved over the comparison group of historical 8-strand core repair technique which resulted in 82% (n = 62) and 81% (n=112) of repairs with a gap of <3 mm and 7 failures (9%). Conclusions In an in-vivo model, current modifications of suture techniques for intrasynovial flexor tendon repair demonstrated significant improvements in gap formation and rupture compared to a similar technique using shorter purchase lengths and shallower purchase depth. Clinical Relevance Suggested repair modifications for the treatment of Zone 2 flexor tendon transections demonstrate improvements in gap formation and tendon rupture in-vivo.

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Section: Discussionmentioning

confidence: 97%

The Effect of Core and Epitendinous Suture Modifications on Repair of Intrasynovial Flexor Tendons in an In Vivo Canine Model

Fufa

Osei

Calfee

et al. 2012

The Journal of Hand Surgery

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“…Some studies have isolated the effect of a single variable such as suture caliber(1, 9), suture material (14, 15), repair technique(16–19), suture purchase(7, 8, 20), use of locked stitches(21, 22), degree of tensioning of the core suture repair(10, 11), or number of strands across the repair site(2, 5). Other authors have examined several factors together as a combined operative technique(12, 13).…”

Section: Discussionmentioning

confidence: 99%

“…Prior investigations have demonstrated that the tensile properties of repair are directly related to suture caliber(1), number of strands that extend across the repair site(2–5), core suture depth(6, 7), and peripheral suture depth(8, 9). Further, suture repair techniques incorporating locked stitches, preloading of the core suture(10), and over-tensioning the core suture across the repair site(11) have been associated with improved tensile properties in repaired tendons. While many of the commonly used flexor tendon repair techniques appear to provide sufficient time zero tensile strength for the initiation of passive motion rehabilitation, enhancement of the mechanical properties of flexor tendon repair has been related to decreased risk of gap formation and repair failure (2–4, 6, 11, 12).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Suture Caliber and Number of Core Suture Strands on Zone II Flexor Tendon Repair: A Study in Human Cadavers

Osei

Stepan

Calfee

et al. 2014

The Journal of Hand Surgery

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Purpose To compare the tensile properties of a 3-0, 4-strand flexor tendon repair to a 4-0, 4 strand repair and a 4-0, 8-strand repair. Methods Following evaluation of the intrinsic material properties of the 2 core suture calibers most commonly used in tendon repair (3-0 and 4-0), we tested the mechanical properties of 40 cadaver flexor digitorum profundus tendons after zone II repair with one of 3 techniques: a 3-0, 4-strand core repair, a 4-0, 8-strand repair, or a 4-0, 4-strand repair. We compared results across suture caliber for the 2 sutures and across tendon repair methods. Results Maximum load to failure of 3-0 polyfilament caprolactam suture was 49% greater than that of 4-0 polyfilament caprolactam suture. The cross sectional area of 3-0 Supramid was 42% greater than that of 4-0 Supramid. The 4-0, 8 strand, repair produced greater maximum load to failure when compared to the 2 4-strand techniques. Load at 2 mm gap, stiffness, and work to yield were significantly greater in the 4-0, 8-strand repair when compared to the 3-0, 4-strand repair. Discussion In an ex vivo model, an 8-strand repair using 4-0 suture was 43% stronger than a 4-strand repair using 3-0 suture, despite the finding that 3-0 polyfilament caprolactam was 49% stronger than was 4-0 polyfilament caprolactam. These results suggest that, although larger caliber suture has superior tensile properties, the number of core suture strands across a repair site has an important effect on time zero, ex vivo flexor tendon repair strength. Clinical Relevance Surgeons should consider using techniques that prioritize multi-strand core suture repair over an increase in suture caliber.

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“…The gap can be repaired with a tighter suture to avoid rupture. 6 A series of 102 patients with intraoperative testing of wideawake flexor tendon repairs by our group revealed 7 patients with intraoperative gapping that was repaired intraoperatively and did not rupture postoperatively. None of the 102 patients who followed proper postoperative instructions ruptured after surgery.…”

mentioning

confidence: 96%

Wide-awake Flexor Tendon Repair and Early Tendon Mobilization in Zones 1 and 2

2013

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Effects of Tension Across the Tendon Repair Site on Tendon Gap and Ultimate Strength

Cited by 65 publications

References 30 publications

The Effect of Core and Epitendinous Suture Modifications on Repair of Intrasynovial Flexor Tendons in an In Vivo Canine Model

The Effect of Core and Epitendinous Suture Modifications on Repair of Intrasynovial Flexor Tendons in an In Vivo Canine Model

The Effect of Suture Caliber and Number of Core Suture Strands on Zone II Flexor Tendon Repair: A Study in Human Cadavers

Wide-awake Flexor Tendon Repair and Early Tendon Mobilization in Zones 1 and 2

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