Effect of partial vs complete circumferential epitendinous suture placement on the biomechanical properties and gap formation of canine cadaveric tendons

2020 ◽  
Vol 49 (8) ◽  
pp. 1571-1579
Author(s):  
Daniel J. Duffy ◽  
Yi‐Jen Chang ◽  
Matthew B. Fisher ◽  
George E. Moore
Keyword(s):  
Biomechanical Properties ◽  
Gap Formation ◽  
Suture Placement

Influence of Interlocking Horizontal Mattress Epitendinous Suture Placement on Tendinous Biomechanical Properties in a Canine Common Calcaneal Laceration Model

2020 ◽  
Vol 33 (03) ◽  
pp. 205-211 ◽  
Author(s):  
Christina J. Cocca ◽  
Daniel J. Duffy ◽  
Mariana E. Kersh ◽  
George E. Moore
Keyword(s):  
Tendon Repair ◽  
Biomechanical Properties ◽  
Gap Formation ◽  
Mode Of Failure ◽  
In Vivo Testing ◽  
Failure Loads ◽  
Pull Through ◽  
Biomechanical Strength ◽  
Suture Placement

Abstract Objective This article evaluates the effect of an interlocking horizontal mattress epitendinous suture (IHMES) in addition to a three-loop pulley (3LP) core suture for canine tendon repair. Study Design Twenty-eight cadaveric common calcaneal tendons were randomized, sharply transected and repaired with either a 3LP or 3LP + IHMES. Tensile loads required to create a 1- and 3-mm gap, yield, peak and failure loads, and mode of failure were analysed. Significance was set at p < 0.05. Results Mean ± standard deviation yield and failure force for 3LP + IHMES was 178.0 ± 45.3 N and 242.1 ± 47.8 N, respectively, which was significantly greater compared with 3LP alone, 97.9 ± 36.2 N and 119.3 ± 35.6 N (p < 0.0001). Occurrence of 3-mm gap formation was significantly less in the 3LP + IHMES group (p < 0.013). Mode of failure was significantly different between the groups (p < 0.001) with 3LP + IMHES patterns failing by suture breakage (13/14) compared with suture pull-through in the 3LP (11/14). Conclusion Addition of an epitendinous suture pattern significantly reduced gap formation between tendon ends and significantly increased loads at yield (1.8 × ), peak (2.0 × ) and failure (2.0 × ) force of repairs. Use of an epitendinous suture should be considered to significantly increase biomechanical strength of repairs; however, further in vivo testing is necessary to evaluate its effect on tendinous blood supply.

scholarly journals Biomechanical evaluation of a novel double rip-stop technique with medial row knots for rotator cuff repair

2020 ◽  
Vol 9 (6) ◽  
pp. 285-292
Author(s):  
Zhanwen Wang ◽  
Hong Li ◽  
Zeling Long ◽  
Subin Lin ◽  
Andrew R. Thoreson ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Failure Modes ◽  
Failure Load ◽  
Biomechanical Properties ◽  
Gap Formation ◽  
Ultimate Failure Load ◽  
Fresh Frozen ◽  
Ultimate Failure ◽  
Cuff Repair

Aims Many biomechanical studies have shown that the weakest biomechanical point of a rotator cuff repair is the suture-tendon interface at the medial row. We developed a novel double rip-stop (DRS) technique to enhance the strength at the medial row for rotator cuff repair. The objective of this study was to evaluate the biomechanical properties of the DRS technique with the conventional suture-bridge (SB) technique and to evaluate the biomechanical performance of the DRS technique with medial row knots. Methods A total of 24 fresh-frozen porcine shoulders were used. The infraspinatus tendons were sharply dissected and randomly repaired by one of three techniques: SB repair (SB group), DRS repair (DRS group), and DRS with medial row knots repair (DRSK group). Specimens were tested to failure. In addition, 3 mm gap formation was measured and ultimate failure load, stiffness, and failure modes were recorded. Results The mean load to create a 3 mm gap formation in the DRSK and DRS groups was significantly higher than in the SB group. The DRSK group had the highest load to failure with a mean ultimate failure load of 395.0 N (SD 56.8) compared to the SB and DRS groups, which recorded 147.1 N (SD 34.3) and 285.9 N (SD 89.8), respectively (p < 0.001 for both). The DRS group showed a significantly higher mean failure load than the SB group (p = 0.006). Both the DRS and DRSK groups showed significantly higher mean stiffness than the SB group. Conclusion The biomechanical properties of the DRS technique were significantly improved compared to the SB technique. The DRS technique with medial row knots showed superior biomechanical performance than the DRS technique alone.

Investigation of the effects of two-, four-, six- and eight-strand suture repairs on the biomechanical properties of canine gastrocnemius tenorrhaphy constructs

2021 ◽  
pp. 1-7
Author(s):  
Yi-Jen Chang ◽  
Daniel J. Duffy ◽  
George E. Moore
Keyword(s):  
Failure Modes ◽  
Clinical Decision Making ◽  
Ex Vivo ◽  
Biomechanical Testing ◽  
Tendon Repair ◽  
Clinical Decision ◽  
Biomechanical Properties ◽  
Suture Technique ◽  
Gap Formation ◽  
Ex Vivo Model

Abstract OBJECTIVE To determine the effects of 2-, 4-, 6- and 8-strand suture repairs on the biomechanical properties of canine gastrocnemius tenorrhaphy constructs in an ex vivo model. SAMPLE 56 cadaveric gastrocnemius musculotendinous units from 28 adult large-breed dogs. PROCEDURES Tendons were randomly assigned to 4 repair groups (2-, 4-, 6- or 8-strand suture technique; n = 14/group). Following tenotomy, repairs were performed with the assigned number of strands of 2-0 polypropylene suture in a simple interrupted pattern. Biomechanical testing was performed. Yield, peak, and failure loads, the incidence of 1- and 3-mm gap formation, forces associated with gap formation, and failure modes were compared among groups. RESULTS Yield, peak, and failure forces differed significantly among groups, with significantly greater force required as the number of suture strands used for tendon repair increased. The force required to create a 1- or 3-mm gap between tendon ends also differed among groups and increased significantly with number of strands used. All constructs failed by mode of suture pull-through. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that increasing the number of suture strands crossing the repair site significantly increases the tensile strength of canine gastrocnemius tendon repair constructs and their resistance to gap formation. Future studies are needed to assess the effects of multistrand suture patterns on tendon glide function, blood supply, healing, and long-term clinical function in dogs to inform clinical decision-making.

scholarly journals Suturing Achilles tendon and mesh simultaneously in augmented repair resists gap formation foremost: an experimental study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
William McCartney ◽  
Ciprian Ober ◽  
Maria Benito ◽  
Bryan MacDonald
Keyword(s):  
Achilles Tendon ◽  
Polypropylene Mesh ◽  
Tendon Repair ◽  
Biomechanical Properties ◽  
In Vivo Studies ◽  
Control Group ◽  
Gap Formation ◽  
Achilles Tendon Repair ◽  
Mesh Augmentation

Abstract Background The common calcanean tendon (Achilles tendon) is the strongest and largest tendon and is one of the most commonly affected by spontaneous rupture. Different suture techniques are used to repair the tendon rupture. We compare the biomechanical properties of three different modalities of suture pattern in a mechanical experiment in rabbits with the purpose of evaluating the use of polypropylene mesh augmentation for Achilles tendon repair to find out the best surgical option. Methods The study tests single cycle to failure tensile strength characteristics of three different combinations of the 3-loop pulley (3-LP) suture technique with polypropylene mesh, and statistically compares the biomechanical properties as the maximum load at failure for all 3-LP repair. Results The normal Achilles tendon—control group—failed at a mean load of 25.5 + 13.6; the experimental groups failed at a significantly lower load (p < 0.001), with the group of 3-LP suture with polypropylene mesh included in the suture being the more similar to controls, but all the groups exhibited statistically significant differences with regard to normal tendons (p < 0.001). The distance at which each group failed was also significant between control and experimental groups (p < 0.001) with the exception of the suture-only group and the group with the mesh over the suture (p = 0.15). Conclusion Results from this study suggest that incorporating the mesh within the suture provides benefit to the Achilles tendon repair by improving strength and resistance to pull through. However, further in vivo studies will be necessary to confirm these results and incorporate this technique to the routine human and veterinary surgery.

scholarly journals Biomechanical comparison of vertical suture techniques for repairing radial meniscus tear

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Guanqi Hang ◽  
Andy Khye Soon Yew ◽  
Siaw Meng Chou ◽  
Yoke Rung Wong ◽  
Shian Chao Tay ◽  
...  
Keyword(s):  
Meniscal Tear ◽  
Biomechanical Properties ◽  
Conventional Technique ◽  
Suture Technique ◽  
Suture Techniques ◽  
Meniscus Tear ◽  
Gap Formation ◽  
Load To Failure ◽  
Fresh Frozen ◽  
Repair Techniques

Abstract Purpose The aim of this study was to (1) develop suture techniques in repairing radial meniscal tear; (2) to compare the biomechanical properties of the proposed repair techniques with the conventional double horizontal technique. Methods Thirty-six fresh-frozen porcine medial menisci were randomly assigned into four groups and a complete tear was made at the midline of each meniscus. The menisci were subsequently repaired using four different repair techniques: double vertical (DV), double vertical cross (DVX), hybrid composing one vertical and one horizontal stitch, and conventional double horizontal (DH) suture technique with suturing parallel to the tibia plateau. The conventional double horizontal group was the control. The repaired menisci were subjected to cyclic loading followed by the load to failure testing. Gap formation and strength were measured, stiffness was calculated, and mode of failure was recorded. Results Group differences in gap formation were not statistically significant at 100 cycles (p = .42), 300 cycles (p = .68), and 500 cycles (p = .70). A trend was found toward higher load to failure in DVX (276.8 N, p < .001), DV (241.5 N, p < .001), and Hybrid (237.6 N, p < .001) compared with DH (148.5 N). Stiffness was also higher in DVX (60.7 N/mm, p < .001), DV (55.3 N/mm, p < .01), and Hybrid (52.1 N/mm, p < .01), than DH group (30.5 N/mm). Tissue failure was the only failure mode observed in all specimens. Conclusion Our two proposed vertical suture techniques, as well as the double vertical technique, had superior biomechanical properties than the conventional technique as demonstrated by higher stiffness and higher strength.

Augmentation of Distal Biceps Repair With an Acellular Dermal Graft Restores Native Biomechanical Properties in a Tendon-Deficient Model

2017 ◽  
Vol 45 (9) ◽  
pp. 2028-2033 ◽  
Author(s):  
Christine Conroy ◽  
Paul Sethi ◽  
Craig Macken ◽  
David Wei ◽  
Marc Kowalsky ◽  
...  
Keyword(s):  
Biceps Tendon ◽  
Peak Load ◽  
Tendon Repair ◽  
Biomechanical Properties ◽  
Gap Formation ◽  
Dermal Graft ◽  
Distal Biceps ◽  
Load To Failure ◽  
The Mean ◽  
Acellular Dermal

Background: The majority of distal biceps tendon injuries can be repaired in a single procedure. In contrast, complete chronic tears with severe tendon substance deficiency and retraction often require tendon graft augmentation. In cases with extensive partial tears of the distal biceps, a human dermal allograft may be used as an alternative to restore tendon thickness and biomechanical integrity. Hypothesis: Dermal graft augmentation will improve load to failure compared with nonaugmented repair in a tendon-deficient model. Study Design: Controlled laboratory study. Methods: Thirty-six matched specimens were organized into 1 of 4 groups: native tendon, native tendon with dermal graft augmentation, tendon with an attritional defect, and tendon with an attritional defect repaired with a graft. To mimic a chronic attritional biceps lesion, a defect was created by a complete tear, leaving 30% of the tendon’s width intact. The repair technique in all groups consisted of cortical button and interference screw fixation. All specimens underwent cyclical loading for 3000 cycles and were then tested to failure; gap formation and peak load at failure were documented. Results: The mean (±SD) load to failure (320.9 ± 49.1 N vs 348.8 ± 77.6 N, respectively; P = .38) and gap formation (displacement) (1.8 ± 1.4 mm vs 1.6 ± 1.1 mm, respectively; P = .38) did not differ between the native tendon groups with and without graft augmentation. In the tendon-deficient model, the mean load to failure was significantly improved with graft augmentation compared with no graft augmentation (282.1 ± 83.8 N vs 199.7 ± 45.5 N, respectively; P = .04), while the mean gap formation was significantly reduced (1.2 ± 1.0 mm vs 2.7 ± 1.4 mm, respectively; P = .04). The mean load to failure of the deficient tendon with graft augmentation (282.1 N) compared with the native tendon (348.8 N) was not significantly different ( P = .12). This indicates that the native tendon did not perform differently from the grafted deficient tendon. Conclusion: In a tendon-deficient, complete distal biceps rupture model, acellular dermal allograft augmentation restored the native tendon’s biomechanical properties at time zero. The grafted tissue-deficient model demonstrated no significant differences in the load to failure and gap formation compared with the native tendon. As expected, dermal augmentation of attritional tendon repair increased the load to failure and stiffness as well as decreased displacement compared with the ungrafted tissue-deficient model. Tendons with their native width showed no statistical difference or negative biomechanical consequences of dermal augmentation. Clinical Relevance: Dermal augmentation of the distal biceps is a biomechanically feasible option for patients with an attritionally thinned-out tendon.

scholarly journals Evaluation of biomechanical properties on partial and complete epitendinous suture in human cadaver flexor tendon repair

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Thepparat Kanchanathepsak ◽  
Wilarat Wairojanakul ◽  
Sorasak Suppaphol ◽  
Ittirat Watcharananan ◽  
Panithan Tuntiyatorn ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Ultimate Tensile Strength ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Biomechanical Properties ◽  
Biomechanical Property ◽  
Human Cadaver ◽  
Gap Formation ◽  
Significant Difference ◽  
Human Cadavers

Abstract Objective This study was designed to compare the ultimate tensile strength and force to 2 mm gap formation among 50% partial, 75% partial, and complete circumferential epitendinous suture with a combination of 4-strand core suture in human cadaver flexor tendon. Materials and methods Forty-five flexor tendons from four soft human cadavers were used to evaluate the biomechanical property among 50% partial, 75% partial, and complete circumferential epitendinous suture with a combination of 4-strand core suture. Results The force to 2 mm gap of complete epitendinous was significantly greater than partial epitendinous suture (P < 0.05); however, there was no difference between 50% partial and 75% partial epitendinous suture (P > 0.05). For the ultimate strength, there was no significant difference between partial and complete epitendinous suture (P > 0.05). The partial epitendinous was approximately 60% of the complete epitendinous suture in force to 2 mm gap and also 70% of complete epitendinous suture in ultimate tensile strength with a combination of core sutures. Conclusions The complete epitendinous suture showed better ultimate tensile strength and force to 2 mm gap compared with a partial 50% and 75% epitendinous suture. However, in some clinical scenario which the complete epitendinous suture is not possible to perform, the authors suggested only partial epitendinous suture with 50% circumference is recommended as the additional epitendinous repair up 75% circumference cannot provide any mechanical benefit to the repaired site.

BIOMECHANICAL PROPERTIES OF EXTENSOR TENDON REPAIR USING THE SIX-STRAND SINGLE-LOOP SUTURE TECHNIQUE: A COMPARATIVE ANALYSIS WITH THREE OTHER TECHNIQUES IN CADAVERIC MODELS

2011 ◽  
Vol 11 (04) ◽  
pp. 845-855 ◽  
Author(s):  
BENG HAI LIM ◽  
LAI HOCK OOI ◽  
SIAW MENG CHOU ◽  
KHENG LIM GOH
Keyword(s):  
Tendon Repair ◽  
Extensor Tendon ◽  
Biomechanical Properties ◽  
Suture Technique ◽  
Maximum Force ◽  
Gap Formation ◽  
Single Loop ◽  
Extensor Tendons ◽  
Pull Out ◽  
Gap Opening

A six-strand single-loop technique has been implemented for repairing extensor tendons. This paper describes an investigation to compare the biomechanical properties of extensor tendons repaired using this technique with three other commonly used techniques, namely the Kessler-Tajima (two-stand) technique, the Tsuge (two-strand) technique, and the modified (four-strand and double-loop) Tsuge technique. Epitendinous stitches were implemented on all techniques. From human cadaveric hands, extensor tendons were harvested, transected, and repaired using these techniques. Tensile test was performed on the repaired tendons to determine the force at the first gap opening, 1-mm and 2-mm gap distances and at the maximum load. We have observed that at the first gap opening, the forces generated in the tendons repaired using the six-strand, Kessler-Tajima, and modified Tsuge techniques are significantly larger than the Tsuge technique. Thereafter, the force generated at gap distances of 1 mm, 2 mm, and the maximum force depend on the number of strands and the epitendinous stitches. In this case, the maximum force (31.80 N ± 4.73 N) from the six-strand technique is significantly higher than that from the Kessler-Tajima technique. In particular, all samples from the six-strand technique failed by suture pull-out. In contrast, suture pull-out is less common for the other techniques; these samples also exhibited suture rupture. This study is important because it reveals that cadaveric tendons repaired using the Kessler-Tajima, modified Tsuge, and six-strand techniques can accommodate higher initial forces (compared to the Tsuge technique) and, thus, are more effective for resisting gap formation. Among these techniques, it is shown that the six-strand configuration is reliable because the strands, rather than breaking, results in pull-out at sufficiently high loads. Thus, the six-strand approach for anchoring the ruptured tissue results in the transfer of large forces to the suture. It is suggested that the six-strand technique may be a viable technique since it requires only a single-loop suture and this may simplify the repair procedure and tendon handling without increasing the bulk of the repaired tendon appreciably.

scholarly journals Biomechanical comparison between single-row with triple-loaded suture anchor and suture-bridge double-row rotator cuff repair

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
He-Bei He ◽  
Yong Hu ◽  
Chuan Li ◽  
Cheng-Guo Li ◽  
Min-Cong Wang ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Suture Anchor ◽  
Biomechanical Properties ◽  
Gap Formation ◽  
Double Row ◽  
Single Row ◽  
Dr Method ◽  
Ultimate Failure ◽  
Cuff Repair

Abstract Background Numerous biomechanical and clinical studies comparing different techniques for rotator cuff repair have been reported, yet universal consensus regarding the superior technique has not achieved. A medially-based single-row with triple-loaded suture anchor (also referred to as the Southern California Orthopedic Institute [SCOI] row) and a suture-bridge double-row (SB-DR) with Push-Locks have been shown to result in comparable improvement in treating rotator cuff tear, yet the biomechanical difference is unknown. The purpose of the current study was to determine whether a SCOI row repair had comparable initial biomechanical properties to a SB-DR repair. Methods Six matched pairs of fresh-frozen cadaveric shoulders with full-thickness supraspinatus tendon tears we created were included. Two different repairs were performed for each pair (SCOI row and SB-DR methods). Specimens were mounted on a material testing machine to undergo cyclic loading, which was cycled from 10 to 100 N at 1 Hz for 500 cycles. Construct gap formation was recorded at an interval of 50 cycles. Samples were then loaded to failure and modes of failure were recorded. Repeated-measures analysis of variance and pair-t test were used for statistical analyses. Results The construct gap formation did not differ between SCOI row and SB-DR repairs (P = 0.056). The last gap displacement was 1.93 ± 0.37 mm for SCOI row repair, and 1.49 ± 0.55 mm for SB-DR repair. The tensile load for 5 mm of elongation and ultimate failure were higher for SCOI row repair compared to SB-DR repair (P = 0.011 and 0.028, respectively). The ultimate failure load was 326.34 ± 11.52 N in the SCOI row group, and 299.82 ± 27.27 N in the SB-DR group. Rotator cuff repair with the SCOI row method failed primarily at the suture- tendon interface, whereas pullout of the lateral row anchors was the primary mechanism of failure for repair with the SB-DR method. Conclusion Rotator cuff repair with the SCOI row method has superior biomechanical properties when compared with the SB-DR method. Therefore, SCOI row repair using a medially-based single-row technique with triple-loaded suture anchor is recommended to improve the initial strength in treating full-thickness rotator cuff tears.

A biomechanical comparison of the modified Bunnell pullout and Teo intraosseous suture techniques for attachment of tendon to bone

2019 ◽  
Vol 44 (8) ◽  
pp. 816-824 ◽  
Author(s):  
Jose Ballesteros-Betancourt ◽  
Roberto S. Rosales ◽  
Raquel García-Tarriño ◽  
Jose Rios ◽  
Andrés Combalia-Aleu ◽  
...  
Keyword(s):  
Bone Repair ◽  
Biomechanical Properties ◽  
Suture Technique ◽  
Suture Techniques ◽  
Cyclic Loads ◽  
Gap Formation ◽  
Control Groups ◽  
Fresh Frozen ◽  
Biomechanical Comparison ◽  
And Control

We compared the biomechanical properties of the Teo intraosseous suture technique with the modified Bunnell pullout technique in a cadaver model after a tendon to bone repair. Thirty-six fresh-frozen cadaveric fingers were assigned randomly to three groups (Teo, Bunnell and control groups). They were loaded cyclically from 2 to 15 N at 25 mm/min, for 500 cycles. Gap formation at the repair site was assessed every 100 cycles and then specimens were tested to failure. The Teo group had an approximately 30% smaller gap every 100 cycles and needed 30% more energy to obtain a 2 mm gap than the modified Bunnell group. Displacement after 500 cyclic loads was significantly lower in the Teo group than in the Bunnell group. For the failure of the Teo suture, it was necessary to apply 31% more load than the Bunnell technique.

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