Eliminating the Gap in Flexor Tendon Surgery

Becker, Hilton; Davidoff, Michael

doi:10.1016/s0072-968x(77)80122-8

Cited by 54 publications

(22 citation statements)

References 8 publications

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“…Due to its locking configuration, the suture tightens around the collagen fibers when tensile forces are applied, thus providing approximation under tension, greater ultimate tensile strength, and resistance to gapping. 25,26 The suture configuration resembled three X's and for ease it was designated as triple X analogous to multiple U-loops (Fig. 1).…”

Section: Locking Suture Techniquementioning

confidence: 99%

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment

Nguyen

Geel

Schulze

et al. 2013

Tissue Engineering Part A

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Primary suture repair of the anterior cruciate ligament (ACL) has been used clinically in an attempt to heal the ruptured ACL. The results, however, were not satisfactory, which in retrospect can be attributed to the used suturing technique and the suboptimal healing conditions. These constraining conditions can be improved by introducing a new suturing technique and by using small intestinal submucosa (SIS) as a bioscaffold. It is hypothesized that the suturing technique keep the torn ends together and that SIS enhance and promote the healing of the ACL. The goat was used as the study model. In the Suture group, the left ACL was transected and suture repaired with a new locking suture repair technique (n = 5) allowing approximation and fixation under tension. The Suture-SIS group underwent the same procedure with the addition of SIS (n = 5). The right ACL served as control. After 12 weeks of healing, anterior-posterior translation and in situ force of the healing ACL were measured, followed by the measurement of the cross-sectional area and structural stiffness. Routine histology was performed on tissue samples. Gross morphology showed that the healing ACL was continuous with collagenous tissue in both groups. The cross-sectional area of the Suture and the Suture-SIS group was 35% and 50% of the intact control, respectively. The anterior-posterior translations at different flexion angles were statistically not different between the Suture group and the Suture-SIS group. Only the in situ force at 30°in the Suture-SIS group was higher than in the Suture group. Tensile tests showed that the stiffness for the Suture group was not different from the Suture-SIS group (31.1 -8.1 N/mm vs. 41.9 -18.0 N/mm [p > 0.05]). Histology showed longitudinally aligned collagen fibers from origo to insertion. More fibroblasts were present in the healing tissue than in the control intact tissue. The study demonstrated the proof of concept of ACL repair in a goat model with a new suture technique and SIS. The mechanical outcome is not worse than previously reported for ACL reconstruction. In conclusion, the approach of using a new suture technique, with or without a bioscaffold to heal the ACL is promising.

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Section: Locking Suture Techniquementioning

confidence: 99%

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment

Nguyen

Geel

Schulze

et al. 2013

Tissue Engineering Part A

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show abstract

“…Active motion, however, places additional biomechanical requirements on the tendon repair to resist gap formation and rupture (Seradge, 1983;Small et al, 1989). New core suture techniques have been developed to meet these needs and have modified suture configurations, increased the numbers of strands or used larger sutures (Aslam and Afoke, 2000;Becker, 1978;Becker and Davidoff, 1977;Kubota et al, 1998;Kusano et al, 1999;Lee, 1990a;McLarney et al, 1999;Robertson and Al-Qattan, 1992;Savage, 1985;Smith and Evans, 2001;Winters et al, 1998). The ultimate force of repairs increased with these techniques.…”

Section: Introductionmentioning

confidence: 99%

A Comparative Analysis of the Biomechanical Behaviour of Five Flexor Tendon Core Sutures

Viinikainen

Göransson

Huovinen

et al. 2004

Journal of Hand Surgery

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Five core suture techniques were compared by static tensile testing in vitro. Fifty porcine tendons were used. The core sutures were performed with 3-0 or 4-0 braided polyester suture (Ticron) and the over-and-over running peripheral sutures with 6-0 monofilament polypropylene (Prolene). The core sutures were: (1) Pennington modified Kessler (3-0), (2) Double Pennington modified Kessler (3-0), (3) 4-strand Savage (3-0), (4) 4-strand Savage (4-0), and (5) 6-strand Savage (4-0). Repairs were compared as paired in regard to one variable: the number of core suture strands, the suture calibre, or the suture configuration. Biomechanical differences between the repair groups started during the linear region, with the yield force and stiffness increasing along with the number of core suture strands. All three variables influenced the strain at the yield point. Thus, the strength of the intact repair can be improved by modifying the core suture. In all repairs gap formation started near the yield point after failure of the peripheral suture. The yield force represents the strength of the intact repair composite and should be considered the strength of the tendon repair.

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“…D, Cross-lock configuration (embedded). 10,11,21 There was no difference between the remaining repairs (Fig. 5).…”

Section: Stiffnessmentioning

confidence: 90%

Biomechanical Analysis of the Modified Kessler, Lahey, Adelaide, and Becker Sutures for Flexor Tendon Repair

Jordan

Schmitt

Jansen

et al. 2015

The Journal of Hand Surgery

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Eliminating the Gap in Flexor Tendon Surgery

Abstract: A new method of tendon suture has been designed to eliminate the development of a gap when tension is applied to the repair. It has been demonstrated to resist distraction at relatively high tensions on cadaveric tendon. The possible advantages of the technique are discussed.

Cited by 54 publications

References 8 publications

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment

A Comparative Analysis of the Biomechanical Behaviour of Five Flexor Tendon Core Sutures

Biomechanical Analysis of the Modified Kessler, Lahey, Adelaide, and Becker Sutures for Flexor Tendon Repair

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