Four-Strand Core Suture Improves Flexor Tendon Repair Compared to Two-Strand Technique in a Rabbit Model

Wichelhaus, Alice; Beyersdoerfer, Sascha Tobias; Vollmar, Brigitte; Mittlmeier, Thomas; Gierer, Philip

doi:10.1155/2016/4063137

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…1 Other studies suggest that additional epitendinous suture may lead to greater bulk at the repair site along with an increased inflammatory response increasing the risk of adhesion formation. 13,14 However, these findings are not consistent among all studies. 15 Our clinical data are in line with studies supporting epitendinous suture, as greater IP motion implies fewer adhesions.…”

Section: Discussionmentioning

confidence: 81%

Zone II Flexor Pollicis Longus Repair: Thumb Flexion and Complications

Bruin

Lans

Eberlin

et al. 2020

Hand (New York, N,Y.)

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Background: The aim of flexor pollicis longus (FPL) repair is to create a construct that is strong enough to withstand forces encountered during rehabilitation and to achieve an optimal active range of motion. The aim of this study was to: (1) assess factors influencing active thumb interphalangeal (IP) joint flexion; and (2) assess the factors associated with reoperation. Methods: Retrospectively, 104 patients with primary repair of a Zone II FPL laceration from 2000 to 2016 were identified. A medical chart review was performed to collect patient-, injury-, and surgery characteristics as well as the degree of postoperative active IP-flexion and occurrence of reoperation. Bivariate analyses were performed to identify factors influencing active IP-flexion and factors associated with reoperation. Results: The reoperation rate was 17% (n = 18) at a median of 3.4 months (range: 2.3-4.4). Indications for reoperation mainly included adhesion formation (n = 10, 56%) and re-rupture (n = 5, 28%). The median range of active IP-flexion was 30° (interquartile range [IQR]: 20-45) at a median of 12.4 weeks (IQR: 8.1-16.7). Solitary injury to the thumb (β = 17.9, P = .022) and the use of epitendinous suture (β = 10.0, P = .031) were associated with increased active IP-joint flexion. No factors were statistically associated with reoperation. Conclusions: About 1 in 5 patients undergo reoperation following primary repair of a Zone II FPL laceration, mostly within 6 months of initial surgery. The use of epitendinous suture is associated with greater active IP-flexion. Patients with multiple digits injured accompanying a Zone II FPL laceration have inferior IP-joint motion.

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Section: Discussionmentioning

confidence: 81%

Zone II Flexor Pollicis Longus Repair: Thumb Flexion and Complications

Bruin

Lans

Eberlin

et al. 2020

Hand (New York, N,Y.)

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“…Besides, FiberWire (Arthrex, Naples, FL) was found to be a superior suture material in a study [ 30 ]. In addition, four-strand core sutures lead to less gapping but caused more inflammatory response within the tendon [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Tamoxifen Prevents Peritendinous Adhesions: A Preliminary Report

Kayiran

Tunc²,

Ozcan³

et al. 2022

BioMed Research International

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Background. Scarless healing comprises the ultimate goal after an injury. Since tendon healing results in a fibrotic scar, an injured tendon can never regain the mechanical potential and strength of its uninjured form. A wide variety of studies focus on the tendon healing with an absent or minimal peritendinous adhesions. However, no simple method has managed it at all. Possible complex actions and peritendinous environmental events take place during the tendon healing process. Tamoxifen (TAM), besides its breast cancer-related usage, is a potent antifibrotic drug. Here, we aimed to reduce the peritendinous adhesion with TAM administration. Methods. Achilles tendons of 44 Wistar albino rats were randomly distributed in 4 groups. In group 1, bilateral lower extremities were used as control and sham. Groups 2 and 3 were comprised of low-dose (1 mg/kg) and high-dose (40 mg/kg) systemic administration of TAM, respectively. Group 4 included local administration (1 mg/kg) of TAM. Biomechanical, macroscopical, and histopathological analyses were done and compared statistically. Biomechanically, the maximum force that led to tendon rupture was determined, and tensile force data were recorded via tensile testing device. Macroscopical and histopathological analysis were composed of the quantity, quality, and grade of peritendinous adhesions. Results. Macroscopic and histopathologic findings revealed that groups 2 and 3 had a variety of values ranging between slight to severe adhesions. In group 2, almost half of the animals had moderate adhesions, whereas in group 3, the majority of the animals had moderate adhesions. There were no animals with moderate or severe adhesions in group 4. Statistically significant values were calculated between sham and control groups. Biomechanically, group 2 showed the most significant result. The tendons in group 2 had the highest stiffness when maximal force was applied to rupture the tendons. Henceforth, all these consequences were proven statistically. Conclusion. We achieved less peritendinous adhesion with the local administration of TAM when compared to systemic administration of TAM. A better understanding of the peritendinous environmental process will reveal to develop new therapies in the prevention of peritendinous adhesions.

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“…In agreement with our hypothesis, results of this study show that increasing the number of suture strands crossing the repair and increasing the level of suture purchase from the transection site are positively correlated with repair site strength while reducing the occurrence of gap formation in a cadaveric gastrocnemius model. While multiple sources in both the veterinary and human literature report variations of multi-strand repairs, 19,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] the authors of the current study sought to modify existing patterns to Fig. 4 Box and whisker plot showing failure loads of tenorrhaphies repaired with a two-strand (Group 1), four-strand (Group 2) and sixstrand locking repair (Group 3) using 2-0 USP polypropylene.…”

Section: Discussionmentioning

confidence: 99%

“…18,[24][25][26][27] Within the human literature, it has been demonstrated that increasing the number of strands traversing the repair site increases the overall strength of tendon repair. 19,[28][29][30][31][32][33][34][35][36][37][38] In the veterinary literature, the 3LP has been demonstrated to be biomechanically superior, compared with the LL pattern, 39 likely as it relies on multiple divergent passes and utilizes six strands that cross the repair site. 25,39 The LL has previously been demonstrated to be inferior to 3LP regarding loads tolerable prior to failure and ultimate tensile strength.…”

Section: Introductionmentioning

confidence: 99%

Ex Vivo Biomechanical Assessment of a Novel Multi-Strand Repair of Canine Tendon Lacerations

Curcillo

Duffy

Chang

et al. 2021

Vet Comp Orthop Traumatol

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Objective This study aimed to evaluate the effect of increasing the number of suture strands traversing the transection site, level of suture purchase and depth of suture penetrance on the biomechanical properties of repaired gastrocnemius tendons. Study Design Thirty-eight adult cadaveric gastrocnemius tendons were randomized, transected and repaired with either two-, four- or six-strand locking multi-level repair. Tensile loads required to create a 1 and 3 mm gap, yield, peak and failure loads and failure mode were analysed. Significance was set at p < 0.05. Results Mean ± standard deviation yield, peak and failure force for six-strand repairs was 90.6 ± 22.1 N, 111.4 ± 15.2 N and 110.3 ± 15.1 N respectively. This was significantly greater compared with both four-strand (55.0 ± 8.9 N, 72.9 ± 7.8 N and 72.1 ± 8.2 N) and two-strand repairs (24.7 ± 8.3 N, 36.5 ± 6.0 N and 36.1 ± 6.3 N) respectively (p < 0.001). Occurrence of 3 mm gap formation was significantly less using six-strand repairs (p < 0.001). Mode of failure did not differ between groups with all repairs (36/36; 100%) failing by suture pull-through. Conclusion Pattern modification by increasing the number of suture strands crossing the repair site, increasing points of suture purchase from the transection site and depth of suture penetrance is positively correlated with repair site strength while significantly reducing the occurrence of gap formation in a canine cadaveric model. Additional studies in vivo are recommended to evaluate their effect on tendinous healing, blood supply and glide resistance prior to clinical implementation.

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Four-Strand Core Suture Improves Flexor Tendon Repair Compared to Two-Strand Technique in a Rabbit Model

Cited by 7 publications

References 21 publications

Zone II Flexor Pollicis Longus Repair: Thumb Flexion and Complications

Zone II Flexor Pollicis Longus Repair: Thumb Flexion and Complications

Tamoxifen Prevents Peritendinous Adhesions: A Preliminary Report

Ex Vivo Biomechanical Assessment of a Novel Multi-Strand Repair of Canine Tendon Lacerations

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