Flexor Tendon Repairs: The Impact of Fiberwire on Grasping and Locking Core Sutures

Miller, Brian A.; Dodds, Seth D.; deMars, Adam; Zagoreas, Niko; Waitayawinyu, Thanapong; Trumble, Thomas E.

doi:10.1016/j.jhsa.2007.03.003

Cited by 85 publications

(76 citation statements)

References 34 publications

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“…In ex vivo flexor tendon repair the polyblend polyethylene and braided stainless steel repairs reached significantly higher ultimate force and stiffness compared to coated braided polyester and especially nylon and polypropylene repairs. The gap resistance of the polyblend polyethylene repairs did not improve compared to coated braided polyester repairs (24,50).…”

Section: Suture Materialsmentioning

confidence: 75%

“…Also abraided polyblend polyethylene suture(Fiberwire ® )h as been introduced for flexor tendon repair.T he polyblend polyethylene sutureh as significantly higher ultimate force and stiffness compared to coated braided polyester,monofilament nylon, and polypropylene sutures, and as imilar ultimate force but higher stiffnessc ompared to braideds tainless steel (24,50). In ex vivo flexor tendon repair the polyblend polyethylene and braided stainless steel repairs reached significantly higher ultimate force and stiffness compared to coated braided polyester and especially nylon and polypropylene repairs.…”

Section: Suture Materialsmentioning

confidence: 89%

“…Thestrength of the 4-0 suturehas been reported to be less thant he holding capacity of several locking and grasping repair techniques with failureoccurring predominantly by suturer upture ( 13,14,19,23,44,50). With 3-0 suture failure both due to suture rupture and pullout has been reported (9, 13,14,16,23,24). The use of 3-0 suturehas been recommended to offer am argin of safety for the tendon repair through increased material strength (9, 13, 14), but it does not improve the strength of the intact repair composite (23).…”

Section: Suture Calibrementioning

confidence: 99%

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Primary Flexor Tendon Repair Techniques

2008

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Section: Suture Materialsmentioning

confidence: 75%

Section: Suture Materialsmentioning

confidence: 89%

Section: Suture Calibrementioning

confidence: 99%

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Primary Flexor Tendon Repair Techniques

2008

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“…Nearly two thirds of anchor repairs done using Supramid suture failed by suture rupture, indicating that suture strength was often a limiting factor for this type of repair. As the strength of the suture material increased (from Supramid to Ethibond to FiberWire), [13][14][15] ultimate force to failure increased and the mechanism of failure shifted from suture breakage to anchor pullout from bone. Mitek anchors with FiberWire sutures had a similar ultimate force to failure and significantly higher stiffness values compared with that of pull-out suturing using Supramid (p < .01), indicating that this construct had the best combination of properties among the groups that were tested here and may be appropriate for use with early active mobilization.…”

Section: Discussionmentioning

confidence: 99%

Effect of Suture Material and Bone Quality on the Mechanical Properties of Zone I Flexor Tendon–Bone Reattachment With Bone Anchors

Matsuzaki¹,

Zaegel²,

Gelberman³

et al. 2008

The Journal of Hand Surgery

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Purpose-To compare the initial biomechanical properties of zone I flexor tendon to bone repairs performed using pull-out and anchor techniques and to investigate the effect of bone quality and suture materials on the strength of anchor repairs.Methods-Using computed tomography, we measured bone mineral density and cortical thickness of the distal phalanx of 60 cadaver fingers (mean age, 77 years). Flexor digitorum profundus tendons were then transected at their insertion sites and repaired using a 4-strand grasping suture and either pull-out or anchor fixation. For pull-out repair (n = 20), the suture strands (Supramid 3-0; S. Jackson, Inc., Alexandria, VA) were passed through the distal phalanx and tied over a dorsal button. For anchor repair, 2 bone anchors were inserted into the distal phalanx, and tendons were grasped using either Supramid (n = 21), Ethibond (Ethicon, Inc., Somerville, NJ; n = 10), or FiberWire suture (Arthrex Inc., Naples, FL; n = 9) (all 3-0). Mechanical properties of the repaired tendon-bone constructs were determined in linear, load-tofailure loading and correlated with bone characteristics.Results-The FiberWire-anchor repair group had the best combination of mechanical properties, with ultimate force to failure no different from the pull-out repairs but with greater stiffness and reduced displacement. Pull-out suture repairs had significantly higher ultimate force-to-failure values than did Ethibond-anchor and Supramid-anchor repairs (p < .01). However, pull-out repairs had significantly reduced stiffness and greater displacement at 20 N force than did anchor repairs from all groups (p < .05). Both bone mineral density and cortical thickness correlated significantly with ultimate force (p < .01). Almost all anchors pulled out for bone mineral density below 420 mg/cm3 or cortical thickness less than0.31 mm, which occurred only for specimens aged greater than75 years.Conclusions-The mechanical properties of the double Mitek bone anchors were sensitive to both suture material and bone quality. FiberWire-anchor repairs provided the best combination of mechanical properties. Pull-out suture repairs had good strength but poor stiffness. Anchor fixation may be contraindicated in patients greater than 75 years because of poor bone quality.Copyright © 2008 by the American for Surgery of the Hand. All rights Corresponding author: Hironori Matsuzaki, MD, Department of Orthopaedic Surgery, Tsubame Rosai Hospital, 633 Sawatari, Tsubame-shi, Niigata 959-1228 Japan; hiro-mat@fa2.so-net.ne.jp.. The objective of tendon-bone repair is to re-establish direct tendon-bone contact with adequate initial strength to maintain contact during rehabilitation and healing. The initial mechanical properties of tendon-bone repairs performed using anchors are limited by the strength of the anchor fixation or the suture. Fixation strength, particularly for bone anchors, depends, in large part on bone quality and device design. In a recent cadaver study of rotator cuff reattachment to the proximal humerus, Tingar...

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“…A lthough new suture materials [1][2][3] , suture techniques 4,5 , and postoperative rehabilitation protocols 6,7 have improved clinical outcomes, functional restoration following flexor tendon injury and repair in zone II remains a substantial concern for hand surgeons because of the high rate of complications, such as rupture at the repair site and Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work.…”

mentioning

confidence: 99%