A Biomechanical Analysis of the Interlock Suture and a Modified Kessler-Loop Lock Flexor Tendon Suture

Yang, Wenfeng; Qiao, Dan; Ren, Yuanfei; Dong, Yvjin; Shang, Yaohua; Zhang, Tiehui

doi:10.6061/clinics/2017(09)10

Cited by 9 publications

(8 citation statements)

References 19 publications

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“…The necessary strength for immediate mobilization is estimated between 35 to 45 N, depending on the study and interpretation. [2][3][4][5] Different suture techniques reach ultimate failure loads of 40-70 N in biomechanical tests [6][7][8][9][10] , which is within the range of the required strength for immediate mobilization. When considering the initial weakening of the tendon during the first weeks after repair, clinical failure with gap formation at lower loads, and possible compliance issues of the patient, there still exists a delicate balance between postoperative mobilization and the strength of the repair.…”

Section: Introductionmentioning

confidence: 85%

Biomechanical Evaluation of a Tubular Braided Construct for Primary Deep Flexor Tendon Surgery

Peeters

Vermeulen

Tongel

et al. 2023

The Journal of Hand Surgery

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Section: Introductionmentioning

confidence: 85%

Biomechanical Evaluation of a Tubular Braided Construct for Primary Deep Flexor Tendon Surgery

Peeters

Vermeulen

Tongel

et al. 2023

The Journal of Hand Surgery

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“…The other side of the bridging patch was sutured to the tendon stump medially using the modified Kessler-loop lock technique (Figure 1). 50 The deltoid muscle and the overlying skin were closed in successive layers with No. 4-0 Vicryl.…”

Section: Methodsmentioning

confidence: 99%

A Synthetic Graft With Multilayered Co-Electrospinning Nanoscaffolds for Bridging Massive Rotator Cuff Tear in a Rat Model

et al. 2020

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Background: Graft bridging is used in massive rotator cuff tear (MRCT); however, the integration of graft-tendon and graft-bone is still a challenge. Hypothesis: A co-electrospinning nanoscaffold of polycaprolactone (PCL) with an “enthesis-mimicking” (EM) structure could bridge MRCT, facilitate tendon regeneration, and improve graft-bone healing. Study Design: Controlled laboratory study. Methods: First, we analyzed the cytocompatibility of the electrospinning nanoscaffolds, including aligned PCL (aPCL), nonaligned PCL (nPCL), aPCL–collagen I, nPCL–collagen II, and nPCL-nanohydroxyapatite (nHA). Second, for the EM condition, nPCL–collagen II and nPCL-nHA were electrospun layer by layer at one end of the aPCL–collagen I; for the control condition, the nPCL was electrospun on the aPCL. In 40 mature male rats, resection of both the supraspinatus and infraspinatus tendons was performed to create MRCT, and the animals were divided randomly into EM and control groups. In both groups, one end of the layered structure was fixed on the footprint of the rotator cuff, whereas the other end of the layered structure was sutured with the tendon stump. The animals were euthanized for harvesting of tissues for histologic and biomechanical analysis at 4 weeks or 8 weeks postoperatively. Results: All scaffolds showed good cytocompatibility in vitro. The graft-tendon tissue in the EM group had more regularly arranged cells, denser tissue, a significantly higher tendon maturing score, and more birefringence compared with the control group at 8 weeks after operation. Newly formed fibrocartilage could be observed at the graft-bone interface in both groups by 8 weeks, but the EM group had a higher graft-bone healing score and significantly more newly formed fibrocartilage than the control group. An enthesis-like structure with transitional layers was observed in the EM group at 8 weeks. Biomechanically, the values for maximum failure load and stiffness of the tendon-graft-bone complex were significantly higher in the EM group than in the control group at 8 weeks. Conclusion: The co-electrospinning nanoscaffold of aPCL–collagen I could be used as a bridging graft to improve early graft-tendon healing for MRCT in a rat model and enhance early enthesis reconstruction in combination with a multilayered structure of nPCL–collagen II and nPCL-nHA. Clinical Relevance: We constructed a graft to bridge MRCT, enhance graft-tendon healing and graft-bone healing, and reconstruct the enthesis structure.

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“…A total of 1000 cycles were performed and the samples loaded from 5 to 20 N in each cycle ( Fig 3 ). The displacement rate and the cyclic loading regime are based on previous studies and appear to be in physiological range [ 14 , 19 , 24 – 28 ]. The displacement was recorded at 100, 500, 750, and 1000 cycles.…”

Section: Methodsmentioning

confidence: 99%

Comparison of the double loop knot stitch and Kessler stitch for Achilles tendon repair: A biomechanical cadaver study

et al. 2020

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Tendon elongation after Achilles tendon (AT) repair is associated with the clinical outcome. Reliable suture techniques are essential to reduce gap formations and to allow early mobilization. Cyclic loading conditions represent the repetitive loading in rehabilitation. The aim of this study was to compare the Kessler stitch and double loop knot stitch (DLKS) in a cyclic loading program focussing on gap formation. Sixteen human cadaveric ATs were transected and sutured using either the Kessler stitch or DLKS (eight matched pairs). The suture-tendon configurations were subjected to cyclic loading and additional ultimate load to failure testing using the Zwick 1446 universal testing machine. Each AT survived cyclic loading, with a mean gap formation less than 5 mm after 1000 cycles. The mechanical properties of the Kessler stitch and DLKS were not significantly different after cyclic loading with a mean displacement of 4.57 mm (± 1.16) for the Kessler stitch and 4.85 mm (± 1.14) for the DLKS (P = .76). There were no significant differences in the ultimate load testing (P = .85). Both bioprotective techniques prevent excessive gaping in cyclic testing when tendon loading is moderate. Our data and those from literature of gap formation in cyclic and ultimate loading allow the conclusion, that early aggressive AT loading after repair (e.g. full weightbearing) overstrain simple as well as complex suture configurations. Initial intraoperative tightening of the knots (preloading) before locking is important to decrease postoperative elongation.

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A Biomechanical Analysis of the Interlock Suture and a Modified Kessler-Loop Lock Flexor Tendon Suture

Cited by 9 publications

References 19 publications

Biomechanical Evaluation of a Tubular Braided Construct for Primary Deep Flexor Tendon Surgery

Biomechanical Evaluation of a Tubular Braided Construct for Primary Deep Flexor Tendon Surgery

A Synthetic Graft With Multilayered Co-Electrospinning Nanoscaffolds for Bridging Massive Rotator Cuff Tear in a Rat Model

Comparison of the double loop knot stitch and Kessler stitch for Achilles tendon repair: A biomechanical cadaver study

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