A review of cyclic testing protocols for flexor tendon repairs

Chang, Min Kai; Lim, Zeus Yiwei; Wong, Yiik Diew; Tay, Shian Chao

doi:10.1016/j.clinbiomech.2018.12.007

Cited by 11 publications

(8 citation statements)

References 56 publications

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“…Of note, some authors have recently claimed that a force of 2 kg is needed to simulate finger motion, however, we did not find it necessary for our study [ 12 ]. Each repair was cycled for 2,000 cycles of flexion–extension at a rate of 0.3 Hz, simulating active rehabilitation motion protocol [ 13 ] (Fig. 4 ).…”

Section: Methodsmentioning

confidence: 99%

Dynamic Tendon Grip (DTG™) novel knot array compared to traditional sutures for zone two flexor tendon injury – a biomechanical feasibility study

Kadar

Fainzack

Vigler

2022

BMC Musculoskelet Disord

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Background Flexor tendon injuries pose many challenges for the treating surgeon, the principal of which is creating a strong enough repair to allow early active motion, preserving a low-profile of the repair to prevent buckling and subsequent pulley venting. A main concern is that a low-profile repair is prone to gap formation and repair failure. The Dynamic Tendon Grip (DTG™) all suture staple device claims to allow a strong and low-profile repair of the flexor tendon. The purpose of this study is to test the effects of the DTG™ device in early active motion simulation on range of motion, load to failure and gap formation and to compare it to traditional suturing technique. Methods Twelve fresh-frozen cadaveric fingers were assigned to two groups: DTG™ device (n = 9) and traditional suturing (double Kessler 4-core suture and a peripheral suture, n = 3). The deep flexor was incised and repaired in zone 2, and active motion simulation was carried out with a cyclic flexion–extension machine. Finger range of motion and gap formation were measured, as well as load to failure and method of repair failure. Results Following motion simulation, ROM decreased from 244.0 ± 9.9° to 234.5 ± 5.8° for the DTG™ device compared to 234.67 ± 6.51° to 211.67 ± 10.50° for traditional suturing. The DTG™ repair demonstrated gap formation of 0.93 ± 0.18 mm in 3 of 8 specimens after applying 1 kg load, which negated after load removal. Load to failure averaged 76.51 ± 23.15 N for DTG™ and 66.31 ± 40.22 N for the traditional repair. Repair failure occurred as the suture material broke for the DTG™ array and at the knot level for the traditional repair. Conclusions The DTG™ all-suture stapling concept achieved a strong low-profile repair in zone 2 flexor tendon injury after active motion simulation. Further clinical studies will be needed to determine the effectiveness of this device compared to traditional techniques.

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Section: Methodsmentioning

confidence: 99%

Dynamic Tendon Grip (DTG™) novel knot array compared to traditional sutures for zone two flexor tendon injury – a biomechanical feasibility study

Kadar

Fainzack

Vigler

2022

BMC Musculoskelet Disord

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show abstract

“…The deep exors were attached to an actuator in order to produce full exion, and the extensors tendons were attached to a 1 kg weight through a pulley to allow for static load and nger extension. Each repair was cycled for 2,000 cycles of exion-extension at a rate of 0.3 Hz, simulating active rehabilitation motion protocol [10] (Fig. 4).…”

Section: Biomechanical Studymentioning

confidence: 99%

Dynamic Tendon Grip (DTG™) Novel Knot Array Compared to Traditional Sutures for Zone Two Flexor Tendon Injury – A Biomechanical Study

Kadar

Fainzack

Vigler

2021

Preprint

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BackgroundFlexor tendon injuries pose many challenges for the treating surgeon, the principal of which is creating a strong enough repair to allow early active motion, preserving a low-profile of the repair to prevent buckling and subsequent pulley venting. A main concern is that a low-profile repair is prone to gap formation and repair failure. The Dynamic Tendon Grip (DTG™) all suture staple device claims to allow a strong and low-profile repair of the flexor tendon. The purpose of this study is to test the effects of the DTG™ device in early active motion simulation on range of motion, load to failure and gap formation and to compare it to traditional suturing technique. MethodsTwelve fresh-frozen cadaveric fingers were assigned to two groups: DTG™ device (n=9) and traditional suturing (double Kessler 4-core suture and a peripheral suture, n=3). The deep flexor was incised and repaired in zone 2, and active motion simulation was carried out with a cyclic flexion-extension machine. Finger range of motion and gap formation were measured, as well as load to failure and method of repair failure. ResultsFollowing motion simulation, ROM decreased from 244.0 ± 9.9° to 234.5 ± 5.8° for the DTG™ device compared to 234.67 ± 6.51° to 211.67 ± 10.50° for traditional suturing. The DTG™ repair demonstrated gap formation of 0.93 ± 0.18 mm in 3 of 8 specimens after applying 1 kg load, which negated after load removal. Load to failure averaged 7.8 ± 2.36 kg for DTG™ and 6.76 ± 4.10 kg for the traditional repair. Repair failure occurred as the suture material broke for the DTG™ array and at the knot level for the traditional repair.ConclusionsThe DTG™ all-suture stapling concept achieved a strong low-profile repair in zone 2 flexor tendon injury after active motion simulation. Further clinical studies will be needed to determine the effectiveness of this device compared to traditional techniques.

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“…Otro aspecto por considerar es que, durante las primeras tres semanas, la fuerza de reparación de los tendones flexores disminuye entre un 10% y un 50%. 15 Sobre la base del tipo de reparación, se decidirá cuál es el programa de rehabilitación más adecuado. Una reparación de dos hebras solo permite protocolos de movilización pasiva, mientras que, para un protocolo de movilización activa, se necesita un mínimo de cuatro hebras.…”

Section: ¿De Qúe Manera Comenzamos a Movilizar El Tendón?unclassified

Rehabilitación de los tendones flexores en la zona II. ¿Qué aspectos debemos tener en cuenta a la hora de abordar a los pacientes? Revisión bibliográfica

Ortiz

2021

Rev. Asoc. Arg. Ort. y Traumatol

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El tratamiento de los tendones flexores es un tema de interés y genera un desafío constante tanto para los cirujanos como para los rehabilitadores. Se han descrito numerosas técnicas quirúrgicas y tratamientos con la finalidad de mejorar el resultado funcional, aunque hoy en día no existe un protocolo ideal. El objetivo de este artículo es analizar la información relevante a los efectos de planificar la rehabilitación de los pacientes con lesiones de tendones flexores en la zona II. Entre otros aspectos tendremos en cuenta la solidez de la sutura, el edema, la cicatriz, el tipo de inmovilización utilizada y el deslizamiento tendinoso. Es necesariocontar con un buen equipo de trabajo formado por el cirujano, el terapista de mano y el paciente a fin de planificar la rehabilitación más adecuada para cada caso.

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A review of cyclic testing protocols for flexor tendon repairs

Cited by 11 publications

References 56 publications

Dynamic Tendon Grip (DTG™) novel knot array compared to traditional sutures for zone two flexor tendon injury – a biomechanical feasibility study

Dynamic Tendon Grip (DTG™) novel knot array compared to traditional sutures for zone two flexor tendon injury – a biomechanical feasibility study

Dynamic Tendon Grip (DTG™) Novel Knot Array Compared to Traditional Sutures for Zone Two Flexor Tendon Injury – A Biomechanical Study

Rehabilitación de los tendones flexores en la zona II. ¿Qué aspectos debemos tener en cuenta a la hora de abordar a los pacientes? Revisión bibliográfica

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