Fibrin Glue Augmentation for Flexor Tendon Repair Increases Friction Compared With Epitendinous Suture

Xu, Neng; Brown, Philip J.; Plate, Johannes F.; Nazir, Omar F.; Gluck, George S.; Stitzel, Joel D.; Li, Zhongyu

doi:10.1016/j.jhsa.2013.09.007

Cited by 8 publications

(4 citation statements)

References 15 publications

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“…A priori power calculation based on a clinically significant difference of 2 mm of shortening and a large effect size (Cohen's d of 0.8) determined that a sample size of 10 for each group yields power of 0.50 which is comparable to other experimental cadaveric studies with similar statistical measures. 35,36 Cadaveric studies control variables better than population studies and often do not require large sample sizes to achieve normal distribution and normal variance for acceptable statistical analysis. One-way analysis of variance (ANOVA) was used to compare differences in tensile force for each incremental shortening.…”

Section: Methodsmentioning

confidence: 99%

Distal Metaphyseal Osteotomy Allows for Greater Ulnar Shortening Compared to Diaphyseal Osteotomy for Ulnar Impaction Syndrome: A Biomechanical Study

et al. 2019

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Purpose To compare the biomechanical characteristics between diaphyseal and metaphyseal ulnar-shortening osteotomy with respect to (1) maximal shortening achieved at each osteotomy site and (2) force required to achieve shortening at each site. Methods Nine fresh frozen cadaveric upper extremities were affixed through the proximal ulna to a wooden surgical board. A metaphyseal 20-mm bone wedge was resected from the distal ulna and sequential shortening was performed. A load cell was attached to a distal post that was clamped to the surgical board and used to measure the force required for each sequential 5-mm of shortening until maximal shortening was achieved. The resected bone was reinserted, and plate fixation was used to restore normal anatomy. A 20-mm diaphyseal osteotomy was performed, and force measurements were recorded in the same manner with (1) interosseous membrane intact, (2) central band released, and (3) extensive interosseous membrane and muscular attachments released. Results Metaphyseal osteotomy allowed greater maximal shortening than diaphyseal osteotomy with the interosseous membrane intact and with central band release but similar shortening when extensive interosseous membrane and muscle release was performed. Force at maximal shortening was similar between metaphyseal and diaphyseal osteotomy. Sequential soft tissue release at the diaphysis allowed for increased shortening with slightly decreased shortening force with sequential release. Conclusion Metaphyseal ulnar osteotomy allows greater maximal shortening but requires similar force compared with diaphyseal osteotomy. Sequential release of the interosseous membrane permits increased shortening at the diaphysis but requires extensive soft tissue release. Clinical Relevance Both sites of osteotomy can achieve sufficient shortening to decompress the ulnocarpal joint for most cases of ulnar impaction syndrome. The greater shortening from metaphyseal ulnar osteotomy may be reserved for severe cases of shortening, especially after distal radius malunion or in the setting of distal radius growth arrest in the pediatric population. Level of Evidence This is a Level V, basic science study.

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Section: Methodsmentioning

confidence: 99%

Distal Metaphyseal Osteotomy Allows for Greater Ulnar Shortening Compared to Diaphyseal Osteotomy for Ulnar Impaction Syndrome: A Biomechanical Study

et al. 2019

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“…In addition, they showed that fibrin glue did not alter the biomechanical healing strength of the repaired tendons. Xu et al (2013) found in cadaveric flexor tendons that the fibrin glue causes higher gliding resistance. In our study, reinforcement with a surgical adhesive BioGlue™ did not increase the tensile strength, but it increased the bulkiness of the repair site.…”

Section: Discussionmentioning

confidence: 93%

“…1993, Jones et al, 2002, Xu et al, 2013. Fibrin glue is one type of surgical adhesive that was evaluated for tendon repair in previous studies, particularly in Achilles tendons (Ambacher et al, 2001, Hohendorff et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

Surgical adhesive BioGlue™ does not benefit tendon repair strength: an ex vivo study

Jordan

Schmitt

Dannigkeit

et al. 2015

J Hand Surg Eur Vol

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“…(2019) found that small finger tendons gapped and failed earlier than tendons from the other three digits, suggesting this was due to difficulty in accurately suturing smaller tendons. In several studies, the small finger was omitted from analysis due to the small size (Marrero-Amadeo et al., 2011; Xu et al., 2013; Zhao et al., 2004). We find this problematic since small finger flexor tendons are commonly lacerated (Gunturk et al., 2018; Su et al., 2005).…”

Section: Discussionmentioning

confidence: 99%

Strength, bulk and surgery time of ex situ versus in situ flexor tendon repair in a cadaveric model

Lindsay

Watson

Yanik

et al. 2022

J Hand Surg Eur Vol

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The purpose of this study was to compare strength, bulk and time of repair of human cadaveric flexor digitorum profundus tendons repaired in situ versus ex situ. Ninety-six human cadaveric flexor digitorum profundus tendons were transected 5 mm distal to the A2-pulley and randomized to 2-strand, 4-strand or 6-strand repairs. We found no significant differences in repair strength between in situ and ex situ repairs, but repair strength increased with increasing number of strands. The cross-sectional area of the repair was not significantly related to the number of strands, but 4- and 6-strand in situ repairs were bulkier than ex situ repairs. In situ repair took longer, and repair time increased with increasing number of strands. We suggest that cadaveric studies of flexor tendon repair should be performed in situ in order to better mimic the clinical reality of tissue handling and repair bulkiness.

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Fibrin Glue Augmentation for Flexor Tendon Repair Increases Friction Compared With Epitendinous Suture

Cited by 8 publications

References 15 publications

Distal Metaphyseal Osteotomy Allows for Greater Ulnar Shortening Compared to Diaphyseal Osteotomy for Ulnar Impaction Syndrome: A Biomechanical Study

Distal Metaphyseal Osteotomy Allows for Greater Ulnar Shortening Compared to Diaphyseal Osteotomy for Ulnar Impaction Syndrome: A Biomechanical Study

Surgical adhesive BioGlue™ does not benefit tendon repair strength: an ex vivo study

Strength, bulk and surgery time of ex situ versus in situ flexor tendon repair in a cadaveric model

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