The Mantero Flexor Tendon Repair in Zone 1

Guinard, D.; Montanier, F.; Thomas, D.; Corcella, D.; Moutet, F.

doi:10.1054/jhsb.1998.0173

Cited by 34 publications

(18 citation statements)

References 17 publications

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“…Although Baer et al (2003) used the Mantero technique with 3/0 sutures, the original Mantero technique used a 2/0 suture. Both the technique and this suture size are still used routinely in many parts of South Europe, including in Mantero's own unit (Brunelli and Monini, 1982;Brunelli et al, 1983;Emery, 1977;Grandis and Rossello, 1988;Guinard et al, 1999;Mantero et al, 1974/5;Mantero and Bertolotti, 1976;Wulle, 1992). This technique is applicable to primary repair of zone 1 and 2 divisions of the FPL, so provides an alternative means of adding strength while simplifying the FPL suture.…”

Section: %mentioning

confidence: 99%

Early Active Mobilization of Primary Repairs of the Flexor Pollicis Longus Tendon with Two Kessler Two-Strand Core Sutures and a Strengthened Circumferential Suture

Sirotakova

Elliot

2004

Journal of Hand Surgery

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This study reports our treatment of divided flexor pollicis longus (FPL) tendons by primary repair from 1999 to 2002. Forty-eight FPL repairs were performed using two Kessler two-strand repairs with a cross-linked Silfverskiold circumferential suture. All were rehabilitated by early active mobilization. Excellent or good results were observed in 73/77% of cases (White/Buck-Gramcko assessments, respectively). No patients (0%) ruptured their repair as a result of early active mobilization. Two patients (4%) developed post-operative infections with wound and tendon dehiscence. This combination of repairs addresses the problem of rupture of FPL during early mobilization which we experienced in previous studies. Its problems and alternatives are discussed.

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Section: %mentioning

confidence: 99%

Early Active Mobilization of Primary Repairs of the Flexor Pollicis Longus Tendon with Two Kessler Two-Strand Core Sutures and a Strengthened Circumferential Suture

Sirotakova

Elliot

2004

Journal of Hand Surgery

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“…1 However, this technique is complicated and carries the risk of infection secondary to the transcutaneous course of the sutures. 2 A newer alternative is to use a bone anchor technique, which makes it possible to reattach tendon to bone relatively easily without the need to have an exposed tie-down mechanism.…”

Section: Introductionmentioning

confidence: 99%

Effect of Suture Material and Bone Quality on the Mechanical Properties of Zone I Flexor Tendon–Bone Reattachment With Bone Anchors

Matsuzaki¹,

Zaegel²,

Gelberman³

et al. 2008

The Journal of Hand Surgery

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Purpose-To compare the initial biomechanical properties of zone I flexor tendon to bone repairs performed using pull-out and anchor techniques and to investigate the effect of bone quality and suture materials on the strength of anchor repairs.Methods-Using computed tomography, we measured bone mineral density and cortical thickness of the distal phalanx of 60 cadaver fingers (mean age, 77 years). Flexor digitorum profundus tendons were then transected at their insertion sites and repaired using a 4-strand grasping suture and either pull-out or anchor fixation. For pull-out repair (n = 20), the suture strands (Supramid 3-0; S. Jackson, Inc., Alexandria, VA) were passed through the distal phalanx and tied over a dorsal button. For anchor repair, 2 bone anchors were inserted into the distal phalanx, and tendons were grasped using either Supramid (n = 21), Ethibond (Ethicon, Inc., Somerville, NJ; n = 10), or FiberWire suture (Arthrex Inc., Naples, FL; n = 9) (all 3-0). Mechanical properties of the repaired tendon-bone constructs were determined in linear, load-tofailure loading and correlated with bone characteristics.Results-The FiberWire-anchor repair group had the best combination of mechanical properties, with ultimate force to failure no different from the pull-out repairs but with greater stiffness and reduced displacement. Pull-out suture repairs had significantly higher ultimate force-to-failure values than did Ethibond-anchor and Supramid-anchor repairs (p < .01). However, pull-out repairs had significantly reduced stiffness and greater displacement at 20 N force than did anchor repairs from all groups (p < .05). Both bone mineral density and cortical thickness correlated significantly with ultimate force (p < .01). Almost all anchors pulled out for bone mineral density below 420 mg/cm3 or cortical thickness less than0.31 mm, which occurred only for specimens aged greater than75 years.Conclusions-The mechanical properties of the double Mitek bone anchors were sensitive to both suture material and bone quality. FiberWire-anchor repairs provided the best combination of mechanical properties. Pull-out suture repairs had good strength but poor stiffness. Anchor fixation may be contraindicated in patients greater than 75 years because of poor bone quality.Copyright © 2008 by the American for Surgery of the Hand. All rights Corresponding author: Hironori Matsuzaki, MD, Department of Orthopaedic Surgery, Tsubame Rosai Hospital, 633 Sawatari, Tsubame-shi, Niigata 959-1228 Japan; hiro-mat@fa2.so-net.ne.jp.. The objective of tendon-bone repair is to re-establish direct tendon-bone contact with adequate initial strength to maintain contact during rehabilitation and healing. The initial mechanical properties of tendon-bone repairs performed using anchors are limited by the strength of the anchor fixation or the suture. Fixation strength, particularly for bone anchors, depends, in large part on bone quality and device design. In a recent cadaver study of rotator cuff reattachment to the proximal humerus, Tingar...

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“…Clinical complications include nail deformities and prolonged hypersensitivity (10). Also, due to its external location, the button may be pulled and result in failure of the tendon reattachment or cause infection (3, 10). …”

Section: Discussionmentioning

confidence: 99%

“…This suture is advanced through the nail and tied over a button. Problems with this technique include patient tolerance and concerns about infection (3). Suture anchor repairs are another described repair method.…”

Section: Introductionmentioning

confidence: 99%

Comparison of an All-Inside Suture Technique With Traditional Pull-Out Suture and Suture Anchor Repair Techniques for Flexor Digitorum Profundus Attachment to Bone

Chu

Chen

Awad

et al. 2013

The Journal of Hand Surgery

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Purpose One goal in repairing Zone 1 flexor digitorum profundus (FDP) injuries is to create a tendon-bone construct strong enough to allow early rehabilitation while minimizing morbidity. This study introduces an alternative all-inside suture repair technique and compares it biomechanically with pull-out suture and double suture anchor repairs. Methods Repairs were performed on thirty cadaver fingers. In all-inside suture repairs (n=8), the FDP tendon was attached to bone with two 3-0 Ethibond sutures and tied over the dorsal aspect of distal phalanx. Pull-out suture repairs (n=8) were performed with 2-0 Prolene suture and tied over a dorsal button. There were two suture anchor repair groups: Arthrex Micro Corkscrew anchors preloaded with 2-0 FiberWire suture (n=7) and Depuy Micro Mitek anchors preloaded with 3-0 Orthocord suture (n=7). Repair constructs were tested using a servohydraulic materials testing system and loaded until the repair lost 75% of its strength. Results There were no statistically significant differences in tensile stiffness, ultimate load, or work to failure between the repairs. Failure mode was suture stretch and gap formation >2mm at the repair site for all pull-out suture repairs and 7 of 8 all-inside suture repairs. Two of the Arthrex Micro Corkscrew repairs and five of the Depuy Micro Mitek repairs failed by anchor pull out. Conclusions This cadaveric biomechanical study showed no difference in tensile stiffness, ultimate load, and work to failures between an all-inside suture repair technique for zone 1 FDP repairs and previously described pull-out suture and suture anchor repair techniques. The all-inside suture technique also has the advantages of avoiding an external button and the cost of anchors. Therefore, it should be considered as an alternative to other techniques. Clinical Relevance This study introduces a new FDP reattachment technique that avoids some of the complications of current techniques.

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The Mantero Flexor Tendon Repair in Zone 1

Cited by 34 publications

References 17 publications

Early Active Mobilization of Primary Repairs of the Flexor Pollicis Longus Tendon with Two Kessler Two-Strand Core Sutures and a Strengthened Circumferential Suture

Early Active Mobilization of Primary Repairs of the Flexor Pollicis Longus Tendon with Two Kessler Two-Strand Core Sutures and a Strengthened Circumferential Suture

Effect of Suture Material and Bone Quality on the Mechanical Properties of Zone I Flexor Tendon–Bone Reattachment With Bone Anchors

Comparison of an All-Inside Suture Technique With Traditional Pull-Out Suture and Suture Anchor Repair Techniques for Flexor Digitorum Profundus Attachment to Bone

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