Ex vivo mechanical testing of various suture patterns for use in tendon plating

Abstract

Objective: To determine the influence of suture patterns on resistance to gap formation after tendon plating Study Design: Ex vivo study Sample Population: Suspensory ligament and superficial and deep digital flexor tendons harvested from 16 neonatal cadaver foal limbs. Methods: Each tendon/ligament from a given limb was randomly assigned to one of three treatment groups consisting of a 7-hole veterinary cuttable plate fixed with alternating simple interrupted, figure-8, or hybrid suture patterns. The constructs were distracted at a rate of 1.0 mm/s to failure, as determined by the formation of a 1 mm gap for initial failure and a 3 mm gap for ultimate failure. The mode of failure was also recorded.Results: Constructs prepared with hybrid and figure-8 patterns sustained over 2Â higher (p < .01) forces before gap formation compared to those prepared with a simple interrupted pattern. No difference was identified between tendons whose plate was secured with hybrid or figure-8 suture patterns. Mode of failure between groups did not differ. Conclusion:The figure-8 and hybrid patterns described herein improved the resistance to gap formation of plated tendons compared to an alternating simple interrupted pattern described previously. Clinical Significance: Figure-8 and hybrid patterns should be considered over simple interrupted patterns to improve resistance to gap formation in horses undergoing tendon plating. | INTRODUCTIONTendon injury requiring surgical correction occurs frequently in both dogs and horses and may arise from chronic overstretching of the tendon, acute trauma, or secondary to laceration or penetrating wound. In horses,

Use of a bone‐to‐tendon plate to stabilize a comminuted calcaneus fracture in a dog

“…Plates for tendon repair have been described and are superior regarding their ability to withstand tensile load when compared to suture alone. 7,[13][14][15] In our case a figure-of-8 pattern was chosen to suture the plate to the tendon. In a prior cadaveric study, the figureof-8 pattern was superior to a simple interrupted pattern.…”

“…In a prior cadaveric study, the figureof-8 pattern was superior to a simple interrupted pattern. 7 With the bone-to-tendon plate being at a fixed angle, postoperative tarsal immobilization was required. The plate had the potential to cause injury to the overlaying soft tissues during tarsal flexion.…”

“…In essence, the bone‐to‐tendon plate was also acting in a bridging plate fashion, whereby the tensile loads from the Achilles mechanism were transmitted directly to the calcaneal base, eliminating the loads on the plantar plate. Plates for tendon repair have been described and are superior regarding their ability to withstand tensile load when compared to suture alone 7,13–15 . In our case a figure‐of‐8 pattern was chosen to suture the plate to the tendon.…”

“…Three  2.7 mm locking screws were used to secure the plate to the base of the calcaneus, and 5 sutures with 0-Prolene (Ethicon Inc., Cornelia, Georgia) were used in a figure-of-8 pattern to suture the tendon to the plate through the proximal 5 screw holes. 7 No screws of the bone-to-tendon plate construct engaged the calcaneal tuber. Autogenous cancellous bone graft harvested from the proximal metaphysis of both humeri was mixed with canine corticocancellous allogenic bone graft (Fine OrthoMix, Veterinary Transplant Services, Kent, Washington) and packed into the defect.…”

“…A 2.7 mm 15‐hole locking plate (2.7 mm 15‐hole LCP Plate, DePuy Synthes), shortened to 14 holes by cutting the plate, was contoured to the lateral aspect of the calcaneus and the common calcaneal tendon with the hock at a flexion angle of approximately 135° (Figure 2). Three × 2.7 mm locking screws were used to secure the plate to the base of the calcaneus, and 5 sutures with 0‐Prolene (Ethicon Inc., Cornelia, Georgia) were used in a figure‐of‐8 pattern to suture the tendon to the plate through the proximal 5 screw holes 7 . No screws of the bone‐to‐tendon plate construct engaged the calcaneal tuber.…”