Viscoelastic adaptation of tendon graft material to compression: biomechanical quantification of graft preconditioning

Meyer, Dominik C.; Snedeker, Jess G.; Weinert-Aplin, Robert A; Farshad, Mazda

doi:10.1007/s00402-012-1553-0

Cited by 8 publications

(8 citation statements)

References 17 publications

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“…Creep deformation most likely accounted for the elongation of the grafted tendon (Brand et al, 1999). Meyer et al (2012) have shown that the tendon length is elongated by approximately 10% when a tensile force of 6000 N is applied to the fresh flexor digitorum tendons of the calf and adult sheep extensor digitorum tendons. On the other hand, Martin et al (2011) demonstrated that the length of the palmaris longus tendon of a fresh frozen cadaver only increased by 0.3% when a tension of 57 N was applied.…”

Section: Discussionmentioning

confidence: 99%

Changes in tendon length and excursion following extensor tendon grafting at the distal radioulnar joint

Hashimoto

Kato

Uchiyama³

et al. 2022

J Hand Surg Eur Vol

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We evaluated the tendon length and excursion after extensor tendon grafting following ruptures at the distal radioulnar joint in eight patients. The mean patient age was 70.8 years (range 58 to 84), and the mean follow-up period was 63 months (range 12 to 129). Radiographic markers were placed on ends of the grafted tendon to assess changes in length and passive excursion. The mean length of the grafted tendon and mean passive excursion were 68.2 mm and 4.4 mm immediately after tendon grafting, 76.1 mm and 7.1 mm at 1 year postoperatively, and 76.3 mm and 7.3 mm at final follow-up, respectively. The mean elongation of the grafted tendon was 12% and mean increase of excursion was 2.9 mm. We recommend that tension set during extensor tendon grafting should be with the metacarpophalangeal joint of the affected finger in a slightly extended position as compared with adjacent fingers. Level of evidence IV

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Section: Discussionmentioning

confidence: 99%

Changes in tendon length and excursion following extensor tendon grafting at the distal radioulnar joint

Hashimoto

Kato

Uchiyama³

et al. 2022

J Hand Surg Eur Vol

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“… 12 As such, strategies to place larger soft tissue grafts with less bone loss may be important. Meyer et al 15 have shown that applying circumferential compression on a graft can reduce the graft diameter by extrusion of water without decreasing the structural properties of the graft. These data suggest that circumferential preconditioning allows for implantation of a graft with greater structural content in smaller bony tunnels.…”

Section: Discussionmentioning

confidence: 99%

“…This explains why taller patients, with larger harvested grafts, may need fewer folds to achieve an appropriate graft diameter before implantation. While graft compression has been shown to remove water from the grafts, 15 it likely also decreases dead space within the grafts. Multistrand grafts may have more dead space, explaining why shorter patients with thinner autografts would have an increased strand number and exhibit a more substantial decrease in graft size after circumferential preconditioning.…”

Section: Discussionmentioning

confidence: 99%

Reduction in Diameter of Hamstring Autograft With Additional Circumferential Preconditioning During ACL Reconstruction in a Pediatric Population

Weltsch

Chan

Dale

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Over 130,000 anterior cruciate ligament (ACL) reconstructions (ACLRs) are performed annually in the United States. Previous studies have shown that circumferential preconditioning reduces the diameter of fresh-frozen allografts, but no studies have described the effect in ACL autografts used during ACLR. Purpose: To characterize the changes in the hamstring autograft diameter as a result of preparatory circumferential preconditioning. Study Design: Case series; Level of evidence, 4. Methods: A total of 135 patients with ACLR, with a median age of 15 years (interquartile range, 14-16 years; 50.4% boys), were identified in 2 pediatric hospitals. Three orthopaedic surgeons recorded hamstring autograft diameters at 2 time points during graft preparation. Hamstring tendons were prepared using a standardized procedure, tensioned to 15 to 20 lbs, and measured using cylindrical sizing guides. The graft was left with passive compression in the smallest initial rigid sizing guide for 10 minutes on both the tibial and femoral sides and then measured again immediately before implantation. Tunnels were drilled based on the second measurement of graft size. Comparisons were made between the graft diameter before and after circumferential preconditioning. A random-effects regression model and a linear regression model were performed to capture any unexplained variance on the linear predictor scale and determine correlations between demographics and graft characteristics. Results: The median initial diameter for both femoral and tibial sides was 9.5 mm. After longitudinal tension and circumferential preconditioning, the median autograft diameter of both sides decreased by 1 mm ( P < .001) to 8.5 mm. In the random-effects model, decreased patient height was a significant predictor of greater reduction in graft diameter. Increased height was a significant predictor for greater initial graft diameter (average beta coefficient = 3.08; P < .01). No intraoperative complications were noted with implantation of the preconditioned grafts in smaller diameter tunnels. Conclusion: The median diameter of hamstring ACL autografts decreases by 1 mm after circumferential preconditioning within standard cylindrical sizing guides. This allowed for drilling of tunnels that were an average of 1 mm smaller without any noted intraoperative complications with graft insertion.

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“…After reconstruction, tendon grafts are at risk to slowly lose tension and volume due to viscoelastic relaxation and loss of water content. 13 This concern may be more pronounced for patients with general ligamentous laxity such as hypermobility. To address the problem with residual laxity, techniques have been described to incorporate suture augmentation to reinforce the tendon graft during healing and ligamentization.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of the Distal Oblique Bundle for DRUJ Instability

Thomsen

Björkman

2021

J Wrist Surg

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Background Treatment algorithm for disruption of the triangular fibrocartilage complex (TFCC) from the ulnar fovea includes direct TFCC repair, tendon reconstruction of the radioulnar ligaments, or a salvage procedure in cases with painful distal radioulnar joint (DRUJ) degeneration. Case Description We describe our surgical technique for reconstruction of the distal oblique bundle (DOB), to attain DRUJ stability in a young man, after failed attempts of direct TFCC reinsertion and radioulnar ligament reconstruction with the Adams procedure. Literature Review Reconstruction of the central band of the interosseous membrane is well recognized for Essex-Lopresti injuries that demonstrate longitudinal forearm instability. The role for reconstruction/reinforcement of the DOB to restore DRUJ stability after TFCC injury has not gained the same recognition and needs further clarification. Clinical Relevance DOB reconstruction technique described is extra-articular and technically straightforward. We believe that the procedure could be considered for patients with an irreparable TFCC injury as a part of the treatment algorithm for younger patients, who otherwise would face a more extensive salvage procedure.

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Viscoelastic adaptation of tendon graft material to compression: biomechanical quantification of graft preconditioning

Cited by 8 publications

References 17 publications

Changes in tendon length and excursion following extensor tendon grafting at the distal radioulnar joint

Changes in tendon length and excursion following extensor tendon grafting at the distal radioulnar joint

Reduction in Diameter of Hamstring Autograft With Additional Circumferential Preconditioning During ACL Reconstruction in a Pediatric Population

Reconstruction of the Distal Oblique Bundle for DRUJ Instability

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