Comparing Biomechanical Properties, Repair Times, and Value of Common Core Flexor Tendon Repairs

Chauhan, Aakash; Schimoler, Patrick J.; Miller, Mark Carl; Kharlamov, Alexander; Merrell, Gregory A.; Palmer, Bradley A.

doi:10.1177/1558944717701238

Cited by 9 publications

(15 citation statements)

References 20 publications

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“…36 Although several epitendinous suture patterns have been used for flexor tendon repairs in human patients, the most common consist of continuous and interlocking horizontal mattress patterns because of their ease of placement after primary core suture repair. 17 Therefore, this pattern was adapted for canine tendon repair in our study. The primary mode of failure in this study was suture pull through, which occurred in 59.7% of constructs.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11][12][13][14][15] The patterns most commonly used for primary tendinous repair in dogs are the 3LP or LL. 16 In publications on human flexor tendon repair, it has been reported that the strength of the repair site is directly proportional to the number of suture strands crossing the repair site, 17 with sutures placed in the epitenon increasing the strength of the repair by 10% to 50% compared with core suture placement alone. 18 Epitendinous, or circumferential, tendon repair was first introduced in man in the 1960s and later refined.…”

Section: Introductionmentioning

confidence: 99%

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Effect of a continuous epitendinous suture as adjunct to three‐loop pulley and locking‐loop patterns for flexor tendon repair in a canine model

et al. 2019

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Objective To evaluate the effect of combining a continuous epitendinous suture with three‐loop pulley (3LP) and locking‐loop (LL) core patterns for flexor tendon repair. Study design Ex vivo biomechanical study. Sample population Seventy‐two cadaveric superficial digital flexor musculotendon (SDFT) units. Methods Tendons were divided into four groups (n = 18/group). After sharp transection, SDFT were repaired with 3LP, LL, 3LP + epitendinous (E), or LL + E suture patterns. After preloading, repaired constructs were tested to failure. Video data acquisition allowed evaluation of failure mode and quantitation of gap formation. Yield, peak, and failure force were measured from force‐displacement data. Significance was set at P < .05. Results Mode of failure did not differ between repairs with or without an epitendinous suture (P = .255). Gap formation was best prevented with 3LP compared with LL when used alone (P = .001). Mean yield force for 3LP, LL, 3LP + E, and LL + E were 91.4 N ± 25.4, 61.3 N ± 18.4, 195.2 N ± 66.0, 165.3 N ± 46.8, respectively. Tenorrhaphies combined with an epitendinous suture achieved higher yield (P < .0001), peak (P < .0001), and failure forces (P < .0001), without gapping between tendon ends. Conclusion Addition of an epitendinous suture eliminated gapping between tendon ends until failure and increased resistance to loads tolerated at the repair site. Clinical significance The addition of an epitendinous suture may increase the strength of tendon repairs and resistance to gap formation over core suture use alone. The influence of epitendinous suture placement on tendinous healing and blood supply warrants in‐vivo testing.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of a continuous epitendinous suture as adjunct to three‐loop pulley and locking‐loop patterns for flexor tendon repair in a canine model

et al. 2019

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“…Although TDABC may be an accurate measurement of cost analysis, the use of institutional cost and minutes of operating time and cost of major materials to estimate the total procedure cost remains a cost analysis that remains popular in the literature. 5 As hospitals move toward a value-based care model, with value defined as outcomes divided by costs, accurate and standardized tracking of procedural costs must be better defined as these figures will continue to grow in importance. 12 PSI also significantly decreased the tourniquet time in our study.…”

Section: Discussionmentioning

confidence: 99%

“…7 Other cost analysis methods used to measure effectiveness have been based on operating room (OR) charges, billing costs, cost of materials, and out-of-pocket cost paid by payers. 5,16 Similarly, estimates of OR time per minute and other input variables used in cost analysis vary widely. 6 We are not aware of any other studies comparing TDABC to other cost analysis methodologies in TAA.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Time and Cost Savings Using Different Cost Methodologies for Patient-Specific Instrumentation vs Standard Referencing in Total Ankle Arthroplasty

Savage-Elliott

et al. 2019

Foot & Ankle Orthopaedics

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Background: Patient-specific 3-D printing cutting blocks (PSI) have been used instead of traditional intramedullary cutting guides. We hypothesized that PSI would lead to significantly decreased operating room (OR) time and significant cost savings to our institution with noninferior radiographic outcomes and no difference in expected vs actual implant size when compared with standard referencing (SR). Methods: Patients who had undergone total ankle replacements at our institution from 2013 through 2016 were included in the study. Associations between demographic variables and postoperative alignment in the SR vs PSI group were calculated using the Wilcoxon rank-sum test and the intraclass correlation coefficient. The cost of the operation was calculated using both an institutionally based fixed cost of OR time and using Time Driven Activity Based Cost (TDABC) accounting. A total of 43 patients were included in the study, 13 in the SR group and 30 in the PSI group. Results: Operative time (168 vs 137 minutes) and tourniquet time (123 vs 113 minutes) were significantly lower in the PSI vs the SR group. PSI predictions were accurate 100% of the time for tibial components and 83% of the time for talar components. Average costs of TAA using PSI were significantly reduced by $7597.00 when using traditional OR accounting, whereas PSI was $836.00 more expensive on average using TDABC accounting. Conclusion: Further research is needed to determine the cost-effectiveness of PSI vs SR in TAA; however, it does appear to save time intraoperatively. The long-term effect on clinical outcomes requires further study. Level of Evidence: Level III, case-control study.

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“…Passing bidirectional barbed suture through the tendon to maximize passes with one suture aligns portions of the barbs to resist tendon distraction, that is, separation of the repaired tendon with tensioning, with other suture portions not providing resistance to distraction. [12][13][14][15][16] The previous biomechanical studies investigating barbed suture have shown that the ultimate load and 2-mm gap force were comparable but not superior to standard knotted sutures, 12,13 possibly due to underutilization of the barbs to prevent distraction.…”

Section: Introductionmentioning

confidence: 99%

In Vitro Comparison of Two Barbed Suture Configurations for Flexor Tendon Repair

et al. 2017

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The current study compares the strength of a previously studied technique for flexor tendon repair with barbed sutures to an experimental approach that aligns all the barbs to oppose distraction. Twelve flexor tendons from cadaveric specimens were mechanically tested following repair of simulated zone II tendon injuries. Two repair techniques utilizing barbed sutures were studied: the Marrero-Amadeo four-core barbed suture approach and the experimental configuration with all barbs on four cores opposing distraction. Maximum applied load at failure, that is, ultimate load, and 2-mm gap force were compared between the two repair techniques, both as raw values and after normalization to cross-sectional area of the intact tendon. Statistical testing was performed using -tests and Mann-Whitney -tests, where appropriate, with a significance level of 0.05. The ultimate loads, raw (58.2 N) and normalized (4.8 N/mm ), were significantly larger for the Marrero-Amadeo repair than the proposed experimental approach (35.6 N and 2.7 N/mm ; < 0.05). No significant differences were identified for 2-mm gap force. The innovation of suturing to align all barbs to oppose distraction does not improve strength of the repaired tendon. The Marrero-Amadeo technique was found to have superior strength for use in traumatic zone II flexor tendon injuries.

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Comparing Biomechanical Properties, Repair Times, and Value of Common Core Flexor Tendon Repairs

Cited by 9 publications

References 20 publications

Effect of a continuous epitendinous suture as adjunct to three‐loop pulley and locking‐loop patterns for flexor tendon repair in a canine model

Effect of a continuous epitendinous suture as adjunct to three‐loop pulley and locking‐loop patterns for flexor tendon repair in a canine model

Comparison of Time and Cost Savings Using Different Cost Methodologies for Patient-Specific Instrumentation vs Standard Referencing in Total Ankle Arthroplasty

In Vitro Comparison of Two Barbed Suture Configurations for Flexor Tendon Repair

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