Reattachment of the flexor and extensor tendons at the epicondyle in elbow instability: a biomechanical comparison of techniques

Abstract

BackgroundElbow dislocation represents a common injury, especially in the younger population. If treated surgically, the reattached tendons require a high amount of primary stability to allow for an early rehabilitation to avoid postoperative stiffness. The purpose of this study was to assess the biomechanical properties of a single and a double row technique for reattachment of the common extensor and common flexor muscles origin. We hypothesized that the double row technique would provide greater stability in terms of pullout forces than the single row technique.MethodsTwelve cadaveric specimens were randomized into two groups of fixation methods for the common extensor tendon or the common flexor tendon at the elbow (1): a single row technique using two knotted 3.0 mm suture anchors, and (2) a double row technique using an additional knotless 3.5 mm anchor. The repairs were cyclically loaded over 500 cycles at 1 Hz from 10 N to a maximum of 100 N (extensors) or 150 N (flexors), and then pulled to failure. Stiffness and maximum load at failure and mode of failure were recorded and calculated.ResultsNo significant differences in stiffness were observed between the two techniques for both the extensor and flexor reattachment (P = 0.701 and P = 0.306, respectively). The mean maximum load at failure indicated that the double row construct was significantly stronger than the single row construct. This was found to be true for both the extensor and flexor reattachment (213.6; SD 78.7 N versus 384.1; SD 105.6 N, P = 0.010 and 203.7; SD 65.8 N versus 318.0; SD 64.6 N, P = 0.013, respectively).ConclusionsThe double row technique provides significant greater stability to the reattached common flexor or extensor origin to the medial or lateral epicondyle. Thus, it should be considered in the development of improved repair techniques for stabilizers of the elbow.Study designControlled laboratory study.

Bracing with Tape and Extensor Refixation of Elbow with Posterolateral Instability Due to Cubitus Varus

“…necessitating the need for graft usage. The biomechanical study by Lenich et al on 12 cadaveric specimens supports that by using the double-row technique the reattached common extensor origin to the lateral epicondyle is significantly more stable 9 .…”

“…Refixation of the extensor origin was also possible with the use of extra anchors in a double-row fashion and possibly added to the stability and favorable outcomes, without necessitating the need for graft usage. The biomechanical study by Lenich et al on 12 cadaveric specimens supports that by using the double-row technique the reattached common extensor origin to the lateral epicondyle is significantly more stable 9 .…”

Imaging Evaluation of Medial and Lateral Elbow Pain: Acute and Chronic Tendon Injuries of the Humeral Epicondyles

“…26 More commonly, acute injury to the flexor-pronator tendon occurs in the setting of elbow dislocation. 27 Similarly, acute injury to the extensor tendons most commonly occurs in the setting of recent elbow dislocation or other significant trauma. 27 Acute extensor tendon tears are uncommon in athletes.…”

“…27 Similarly, acute injury to the extensor tendons most commonly occurs in the setting of recent elbow dislocation or other significant trauma. 27 Acute extensor tendon tears are uncommon in athletes.…”