Repair of Tendon Disruption Using a Novel Synthetic Fiber Implant in Dogs and Cats: The Surgical Procedure and Three Case Reports

Abstract

<jats:p>Surgical management of tendon rupture is challenging. One concern is to provide adequate tensile strength to prevent distraction during weight-bearing and gap formation following repair, associated with an increased risk of repair failure. Additional challenges may arise from the nature or the chronicity of the lesion. In the event of avulsion, when the tendon is torn off at the bone insertion, its reinsertion on the bone is generally difficult and may even be impossible in the presence of an avulsion fracture, especially when the bone fragment is too small or fragmented. Repair management is also complicated in chronic cases, as degeneration of the tendon may lead to excessive scar tissue formation, tendon retraction, and muscle atrophy, resulting in a large gap and inadequate tissue for reconstruction. The authors describe the surgical procedure for implanting a novel implant, illustrated by three characteristic clinical cases: (1) an acute Achilles tendon avulsion; (2) a chronic patellar tendon rupture; and (3) a chronic avulsion fracture of the triceps tendon. In these three cases, complete recovery of the function was observed at the last clinical evaluation (6 or 8 months), and no complication was noted. A splinted dressing (6 to 8 weeks) was used successfully in two cases. A resin cast (8 weeks) was preferred in case 1, a very active dog. In conclusion, this novel implant represents a simple procedure for the effective repair of chronic tendon rupture, as well as an effective tendon reinsertion on the bone and adequate support for bone tendon healing in the treatment of tendon avulsion, even in cases of fragmented bone fracture. The thinness of the implant facilitates its insertion into the native tendon, while the bone-screw-implant interface provides immediate and lasting mechanical support. This may facilitate the healing process and potentially shorten the period of immobilization.</jats:p>

Long-term outcome following synthetical reconstruction of the tarsal medial collateral ligament in a dog

“…The tunnels were drilled with a larger diameter relatively to the size of the animal and at a smaller distance from each other than in our study. Finally, implant tensioning was performed using Kocher forceps ( Buttin et al ., 2020 ). This method was preferred to the less accurate subjective tensioning described by some authors ( Luescher et al ., 2020 ).…”

Novel Achilles Tendon Repair Technique Utilizing an Allograft and Hybrid External Fixator in Dogs

“…Our subjective impression is that the success rate in this study is at least comparable if not superior to our success rates using simple repairs without any augmentation of the tenorrhaphy. This impression is tentatively supported by previous studies that cite unacceptable outcomes of up to 30% in cases without tenorrhaphy augmentation ( Worth et al ., 2004 ; Nielsen and Pluhar, 2006 ; Corr et al ., 2010 ), as well as the numerous surgeons and reports that document use of tenorrhaphy augmentation ( Nellas et al ., 1996 ; Shani and Shahar, 2000 ; Baltzer and Rist, 2009 ; Alam et al ., 2013 ; Morton et al ., 2015 ; Katayama, 2016 ; Zellner et al ., 2018 ; Schulz et al ., 2019 ; Song and Hua, 2019 ; Buttin et al ., 2020 ; El-Taliawi et al ., 2020 ; Serra et al ., 2020 ). Consequently, we hypothesize that bolstering the Achilles mechanism repairs is beneficial.…”

“…Accordingly, numerous reports detail addition of materials to try and support the tenorrhaphy including the use of an “artificial” tendon ( Morton et al ., 2015 ; Buttin et al ., 2020 ), mesh ( Gall et al ., 2009 ), bone plates ( Zellner et al ., 2018 ), muscle grafts ( Baltzer and Rist, 2009 ), the flexor digitorum lateralis tendon ( Katayama, 2016 ), and tensor fascia lata autografts ( Shani and Shahar, 2000 ). Success has been reported with most of these augmented techniques ( Shani and Shahar, 2000 ; Baltzer and Rist, 2009 ; Gall et al ., 2009 ; Morton et al ., 2015 ; Katayama, 2016 ; Zellner et al ., 2018 ; Buttin et al ., 2020 ), but each has its drawbacks. Repairs with artificial materials pose concern for potential infection and the need for subsequent removal, while autologous tissue harvest potentially creates additional morbidity.…”

“…Reported success rates with such treatment are generally good, but can be as low as 70% ( Worth et al ., 2004 ; Nielsen and Pluhar, 2006 ; Corr et al ., 2010 ; Schulz et al ., 2019 ). Accordingly, numerous reports detail addition of materials to try and support the tenorrhaphy including the use of an “artificial” tendon ( Morton et al ., 2015 ; Buttin et al ., 2020 ), mesh ( Gall et al ., 2009 ), bone plates ( Zellner et al ., 2018 ), muscle grafts ( Baltzer and Rist, 2009 ), the flexor digitorum lateralis tendon ( Katayama, 2016 ), and tensor fascia lata autografts ( Shani and Shahar, 2000 ). Success has been reported with most of these augmented techniques ( Shani and Shahar, 2000 ; Baltzer and Rist, 2009 ; Gall et al ., 2009 ; Morton et al ., 2015 ; Katayama, 2016 ; Zellner et al ., 2018 ; Buttin et al ., 2020 ), but each has its drawbacks.…”

Uso de plasma rico en plaquetas como coadyuvante en el tratamiento quirúrgico de la ruptura del tendón calcáneo común en gatos

“…Durante la exploración clínica es común observar la hiperflexión tarsiana (Corr et al 2010;Hayashi & Schulz, 2018). El paciente no apoya peso sobre la extremidad afectada, si la lesión es provocada por un traumatismo agudo; en el caso de que se encuentre afectado todo el complejo del tendón, el tarso se verá hiperflexionado, adoptando una posición plantígrada (Buttin et al 2020).…”