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Pinto I, Kostretzis L, Katakalos K, Kazakos G, Cheva A, Chatzisotiriou A, Papadopoulos P, Ditsios K. Repair of chronic and large rotator cuff tears using extra-synovial autografts: An experimental study in rabbits. J Exp Orthop 2024; 11:e12010. [PMID: 38455456 PMCID: PMC10900185 DOI: 10.1002/jeo2.12010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 03/09/2024] Open
Abstract
Purpose To investigate whether and how extra-synovial autografts can enhance the reconstruction of chronic and large rotator cuff tears in a rabbit subscapularis model. Methods Twenty rabbits were used to create a large subscapularis tear bilaterally. Six weeks later, the right shoulder of each rabbit was operated to repair the tear with an extra-synovial autograft, whereas the left shoulder did not undergo any surgery. At 6 and 12 weeks after the second procedure, the specimens underwent biomechanical and histological evaluation. Six more rabbits were used only as a normal reference. Results Biomechanical evaluation demonstrated that the ultimate load to failure of the Graft group (184.1 ± 35.7 N) was significantly higher (p = 0.04) than that of the Defect group (144.5 ± 32.2 N) at 12 weeks after repair, rising to 76% of the normal subscapularis tendon tensile strength. Histological analysis revealed an enhanced healing environment with neoangiogenesis and decreased inflammatory response at the repair site. Moreover, the tendon maturing score of the Graft group increased substantially from 6 (15.8 ± 0.9) to 12 (23.1 ± 0.6) weeks after repair (p = 0.01). Conclusion In vivo data support the efficacy of extra-synovial autograft interposition in repairing chronic and large rotator cuff tears in a rabbit subscapularis model. The autografts were capable of enhancing the biomechanical properties of the repaired tendons, as evidenced by increased tensile strength, and forming new connective tissue simulating a fibrocartilage zone, as revealed by histological evaluation. Level of Evidence N/A.
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Affiliation(s)
- Iosafat Pinto
- 2nd Orthopaedic Department, Aristotle University of ThessalonikiGeneral Hospital of Thessaloniki “G.Gennimatas”ThessalonikiGreece
| | - Lazaros Kostretzis
- 2nd Orthopaedic Department, Aristotle University of ThessalonikiGeneral Hospital of Thessaloniki “G.Gennimatas”ThessalonikiGreece
| | - Konstantinos Katakalos
- Laboratory for Strength of Materials and Structures, Civil Engineering DepartmentAristotle University of ThessalonikiThessalonikiGreece
| | - George Kazakos
- School of Veterinary MedicineAristotle University of ThessalonikiThessalonikiGreece
| | - Angeliki Cheva
- Pathology Department, School of MedicineAristotle University of ThessalonikiThessalonikiGreece
| | | | - Pericles Papadopoulos
- 2nd Orthopaedic Department, Aristotle University of ThessalonikiGeneral Hospital of Thessaloniki “G.Gennimatas”ThessalonikiGreece
| | - Konstantinos Ditsios
- 2nd Orthopaedic Department, Aristotle University of ThessalonikiGeneral Hospital of Thessaloniki “G.Gennimatas”ThessalonikiGreece
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Bi C, Thoreson AR, Zhao C. Improving Mechanical Properties of Tendon Allograft through Rehydration Strategies: An In Vitro Study. Bioengineering (Basel) 2023; 10:641. [PMID: 37370572 PMCID: PMC10295036 DOI: 10.3390/bioengineering10060641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Allogenic tendons grafts sourced from intrasynovial tendons are often used for tendon reconstruction. Processing is achieved through repetitive freeze-thaw cycles followed by lyophilization. Soaking the lyophilized tendon in saline (0.9%) for 24 h is the standard practice for rehydration. However, data supporting saline rehydration over the use of other hydrating solutions are scant. The purpose of the current study was to compare the effects of different rehydration solutions on biomechanical properties of lyophilized tendon allograft. A total of 36 canine flexor digitorum profundus tendons were collected, five freeze-thaw cycles followed by lyophilization were performed for processing, and then divided into three groups rehydrated with either saline solution (0.9%), phosphate-buffered saline (PBS), or minimum essential medium (MEM). Flexural stiffness, tensile stiffness, and gliding friction were evaluated before and after allograft processing. The flexural moduli in both fibrous and fibrocartilaginous regions of the tendons were measured. After lyophilization and reconstitution, the flexural moduli of both the fibrocartilaginous and non-fibrocartilaginous regions of the tendons increase significantly in the saline and MEM groups (p < 0.05). Compared to the saline and MEM groups, the flexural moduli of the fibrocartilaginous and non-fibrocartilaginous regions of tendons rehydrated with PBS are significantly lower (p < 0.05). Tensile moduli of rehydrated tendons are significantly lower than those of fresh tendons for all groups (p < 0.05). The gliding friction of rehydrated tendons is significantly higher than that of fresh tendons in all groups (p < 0.05). There is no significant difference in either tensile moduli or gliding friction between tendons treated with different rehydration solutions. These results demonstrate that allograft reconstitution can be optimized through careful selection of hydrating solution and that PBS could be a better choice as the impact on flexural properties is lower.
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Affiliation(s)
- Chun Bi
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA;
- Orthopaedic Traumatology, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 650 Xin Songjiang Road, Shanghai 201620, China
| | - Andrew R. Thoreson
- Materials and Structural Testing Core Laboratory, Mayo Clinic, 200 First ST SW, Rochester, MN 55905, USA
| | - Chunfeng Zhao
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA;
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di Vico G, Simonetta R, Correra G, Corona K, Proietti L, Morris BJ, Cerciello S. Popliteomeniscal fascicles tears with lateral meniscus instability: outcomes of arthroscopic surgical technique at mid-term follow-up. Arch Orthop Trauma Surg 2022; 143:2573-2579. [PMID: 35927338 DOI: 10.1007/s00402-022-04486-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 05/16/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE The popliteomeniscal fascicles (PMFs) are a crucial part of the posterolateral corner of the knee. They provide stability to the lateral meniscus and stabilize the joint during tibial internal rotation. The clinical diagnosis of a torn PMFs is difficult, and magnetic resonance imaging (MRI) may be inconclusive as well. The aim of the present study was to report the outcomes of a continuous series of patients affected by PMF lesions and treated with an arthroscopic repair. METHODS Seventeen patients (average age of 22 ± 3.6 years) with PMF lesions and lateral meniscus instability were prospectively enrolled. All patients were evaluated with clinical examination, International Knee Documentation Committee (IKDC), Lysholm and Tegner scores and 1.5 T MRI. All patients had the same arthroscopic procedure consisting of meniscal repair with an all-inside meniscal repair system (mean 2.2 ± 0.77 anchors) and followed with the same postoperative protocol. RESULTS All patients were available at a mean follow-up of 68 ± 24 months (range 49-84 months). Mean IKDC increased from 60.2 ± 13.5 to 83.1 ± 12, mean Lysholm score improved from 56.7 ± 8.2 to 89.8 ± 3.2, and mean Tegner score improved from 2.9 ± 1.3 to 6.5 ± 2. No intraoperative or postoperative complications were reported. MRI evaluation at 6-month follow-up showed successful healing of the menisco-popliteal fascicles in all cases. CONCLUSIONS The diagnosis and treatment of tears of the PMFs is still debated. Diagnostic confirmation of tearing of the PMFs is usually determined at the time of arthroscopy. Meniscal repair with an all-inside meniscal repair system appears to be an excellent treatment option, since it yields good functional results at mid-term follow-up, no local complications, and complete radiographic healing at 6-month follow-up MRI. Further studies are needed to confirm these promising early results. LEVEL OF EVIDENCE Case series, 4.
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Affiliation(s)
- G di Vico
- Department of Orthopaedics and Trauma Surgery, Clinica San Michele, Caserta, Maddaloni, Italy
| | - R Simonetta
- Cure Ortopediche Traumatologiche Messina, Messina, Italy
| | - G Correra
- Ospedale Cardarelli Napoli, Naples, Italy
| | - K Corona
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
| | | | - B J Morris
- Baptist Health Medical Group Orthopedics and Sports Medicine, Lexington, USA
| | - S Cerciello
- Casa Di Cura Villa Betania, Rome, Italy.,Marrelli Hospital, Crotone, Italy.,Department of Orthopaedics, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
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Bao R, Cheng S, Zhu J, Hai F, Mi W, Liu S. A Simplified Murine Model to Imitate Flexor Tendon Adhesion Formation without Suture. Biomimetics (Basel) 2022; 7:biomimetics7030092. [PMID: 35892362 PMCID: PMC9326731 DOI: 10.3390/biomimetics7030092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/25/2022] [Accepted: 07/02/2022] [Indexed: 02/01/2023] Open
Abstract
Peritendinous adhesion (PA) around tendons are daunting challenges for hand surgeons. Tenotomy with various sutures are considered classical tendon repair models (TRM) of tendon adhesion as well as tendon healing. However, potential biomimetic therapies such as anti-adhesion barriers and artificial tendon sheaths to avoid recurrence of PA are sometimes tested in these models without considering tendon healing. Thus, our aim is to create a simplified model without sutures in this study by using three 6 mm longitudinal and parallel incisions called the longitudinal incision model (LCM) in the murine flexor tendon. We found that the adhesion score of LCM has no significant difference to that in TRM. The range of motion (ROM) reveals similar adhesion formation in both TRM and LCM groups. Moreover, mRNA expression levels of collagen I and III in LCM shows no significant difference to that in TRM. The breaking force and stiffness of LCM were significantly higher than that of TRM. Therefore, LCM can imitate flexor tendon adhesion formation without sutures compared to TRM, without significant side effects on biomechanics with an easy operation.
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Affiliation(s)
- Rong Bao
- Department of Orthopaedics, Sixth People’s Hospital, Jiao Tong University, 600 Yishan Rd, Shanghai 200233, China;
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Science, Institutes of Integrative Medicine, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Shanghai Medical College, Fudan University, Shanghai 200032, China; (S.C.); (J.Z.); (F.H.)
| | - Shi Cheng
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Science, Institutes of Integrative Medicine, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Shanghai Medical College, Fudan University, Shanghai 200032, China; (S.C.); (J.Z.); (F.H.)
| | - Jianyu Zhu
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Science, Institutes of Integrative Medicine, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Shanghai Medical College, Fudan University, Shanghai 200032, China; (S.C.); (J.Z.); (F.H.)
| | - Feng Hai
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Science, Institutes of Integrative Medicine, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Shanghai Medical College, Fudan University, Shanghai 200032, China; (S.C.); (J.Z.); (F.H.)
| | - Wenli Mi
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Science, Institutes of Integrative Medicine, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Shanghai Medical College, Fudan University, Shanghai 200032, China; (S.C.); (J.Z.); (F.H.)
- Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Fudan University, Shanghai 200032, China
- Correspondence: (W.M.); (S.L.)
| | - Shen Liu
- Department of Orthopaedics, Sixth People’s Hospital, Jiao Tong University, 600 Yishan Rd, Shanghai 200233, China;
- Correspondence: (W.M.); (S.L.)
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Lindsay TA, Myers HR, Tham S. Ligamentization and Remnant Integration: Review and Analysis of Current Evidence and Implications for Scapholunate Reconstruction. J Wrist Surg 2021; 10:476-483. [PMID: 34877079 PMCID: PMC8635821 DOI: 10.1055/s-0040-1716863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
Background Scapholunate interosseous ligament injuries are common but remain a therapeutic challenge. Current treatment modalities prioritize restoration of normal anatomy with reconstruction where appropriate. To date no reconstructive technique has been described that discusses the potential benefit of preservation of the scapholunate ligament remnant. Little is known about the "ligamentization" of grafts within the wrist. However, a growing body of knee literature suggests that remnant sparing may confer some benefit. In the absence of wrist specific studies, this literature must guide areas for potential augmentation of current surgical practices. Objective The purpose of this study was to perform a review of the process of ligamentization and a systematic review of the current literature on the possible role of ligament sparring and its effect on ligamentization. Methods A systematic search of the literature was performed to identify all the studies related to remnant sparing and the ligamentization of reconstructed tendons, regardless of graft type or joint involved from MEDLINE, EMBASE, and PubMed until February 1, 2016 using the following keywords: ligamentization, graft, remodelling, reconstruction, biomechan*, histolo∗, scapholunate ligament. Each selected study was evaluated for methodological quality and risk of bias according to a modified Systematic Review Center for Laboratory Animal Experimentation criteria. Conclusions The available literature suggests that ligament sparring demonstrated a trend toward improvements in vascularity, mechanoreceptors, and biomechanics that lessens in significance over time. Clinical Relevance This review suggests that remnant sparing may be one way to improve outcomes of scapholunate ligament reconstructive surgery. Level of Evidence This is a level I/II, review study.
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Affiliation(s)
- Tim A.J. Lindsay
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Harley R. Myers
- Department of Plastic, Hand and Faciomaxillary Surgery, The Alfred, Melbourne, Victoria, Australia
| | - Stephen Tham
- Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia
- St. Vincent's Hand Surgery Unit, St. Vincent's Hospital, Fitzroy, Victoria, Australia
- Hand and Wrist Biomechanics Laboratory, O'Brien Institute, St Vincents Hospital, Fitzroy, Victoria, Australia
- Hand Unit, Dandenong Hospital, Dandenong, Victoria, Australia
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D'Addona A, Izzo A, Di Vico G, Rosa D, Maffulli N. The popliteomeniscal fascicles: from diagnosis to surgical repair: a systematic review of current literature. J Orthop Surg Res 2021; 16:148. [PMID: 33610180 PMCID: PMC7896406 DOI: 10.1186/s13018-021-02290-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/10/2021] [Indexed: 02/07/2023] Open
Abstract
Background Popliteomeniscal fascicles (PMF) are considered the posterolateral meniscocapsular extensions which connect the lateral meniscus to the edge of the tibia. PMFs disruption leads to hypermobility of the lateral meniscus with pain and locking sensation. Recognition and treatment of PMFs tear remain very challenging. The aim of this systematic review is to collect and analyse the articles concerning popliteomeniscal fascicle disruption from diagnosis to surgical approach. Methods PubMed, Scopus, Web of Science and EMBASE were searched. Various combinations of the keywords “Popliteomeniscal Fascicles”, “Lateral Meniscus”, “Popliteal Hiatus”, “Posterolateral Corner”, “Tear” and “Surgical Repair” were used. The original literature search identified a total of 85 articles comprising of duplicates. The PRISMA guidilines were followed. Studies in English language and published in peer-reviewed journals were included. Articles with level of evidence I to IV were included Results A total of three articles were included in the qualitative analysis. All the articles included are retrospective case series, with a level of evidence IV. Studies concerning patients with pre-operative imaging MRI and clinical assessment, reporting surgical technique and clinical outcomes assessed by physical examination and/or subjective evaluation scales were analysed. Conclusions MRI and the Figure-4 test allow to assess PMF tears pre-operatively. Arthroscopic evaluation constitutes the gold standard to confirm the diagnosis. Although surgery is considered resolutive for symptoms, there is still controversy about the most appropriate technique. Further higher quality studies are required.
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Affiliation(s)
- Alessio D'Addona
- A.O.U. Federico II, Department of Public Health, Section of Orthopaedics and Trauma Surgery, Via S. Pansini 5, 80131, Naples, Italy. .,Humanitas Clinical and Research Center-IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy.
| | - Andrea Izzo
- A.O.U. Federico II, Department of Public Health, Section of Orthopaedics and Trauma Surgery, Via S. Pansini 5, 80131, Naples, Italy
| | - Giovanni Di Vico
- Department of Orthopaedics and Trauma Surgery, Clinica San Michele, Maddaloni, CE, Italy
| | - Donato Rosa
- A.O.U. Federico II, Department of Public Health, Section of Orthopaedics and Trauma Surgery, Via S. Pansini 5, 80131, Naples, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno, Salerno, Italy.,Centre for Sports and Exercise Medicine, Mile End Hospital, Barts and The London School of Medicine and Dentistry, 275 Bancroft Road, London, E1 4DG, UK
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Bi C, Thoreson AR, Zhao C. The effects of lyophilization on flexural stiffness of extrasynovial and intrasynovial tendon. J Biomech 2018; 76:229-234. [PMID: 29935733 DOI: 10.1016/j.jbiomech.2018.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/30/2018] [Accepted: 06/09/2018] [Indexed: 11/28/2022]
Abstract
Tendon or ligament reconstructions often use autologous or allogenic tendons from either extrasynovial or intrasynovial sources. Allograft tendons must be lyophilized for preservation before transplantation, a process which can impact mechanical properties of the graft. Reconstituted graft properties that are similar to native tendon are desirable. Although tensile and compressive properties of tendons have been investigated, there is a paucity of information describing flexural properties of tendon, which can impact the gliding resistance. This study aims to design a testing method to quantify tendon flexural modulus, and investigate the effects of lyophilization/rehydration procedures on tendon flexibility. A total of 20 peroneus longus tendons (extrasynovial) and 20 flexor digitorum profundus tendons (intrasynovial) were collected. Ten of each tendon were processed with 5 freeze-thaw cycles followed by lyophilization and rehydration with saline solution (0.9%). Bend testing was conducted on tendons to quantify the flexural modulus with and without processing. As canine FDP tendons contain fibrous and fibrocartilaginous tissue regions, the flexural moduli were measured in both regions. Flexural modulus of rehydrated, lyophilized extrasynovial PL tendon was significantly lower than that of similarly processed intrasynovial FDP tendon (p < 0.001). Flexural moduli of both the fibrocartilaginous and non-fibrocartilaginous regions of intrasynovial tendon significantly increased after lyophilization (p < 0.001). The flexural modulus of the fibrocartilaginous region was significantly higher than that of the non-fibrocartilaginous region in intrasynovial tendon (p < 0.001). Lyophilization significantly increases the flexural modulus of extrasynovial and intrasynovial tendons, and flexural modulus differs significantly between these two tendon types. Increases in stiffness caused by lyophilization may impact the mechanical performance of the allograft in vivo.
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Affiliation(s)
- Chun Bi
- Soft Tissue Biology and Biomechanics Laboratory, Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Orthopaedic Traumatology, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 650 Xin Songjiang Road, Shanghai 201620, China
| | - Andrew R Thoreson
- Materials and Structural Testing Core Laboratory, Mayo Clinic, 200 First ST SW, Rochester, MN 55905, USA
| | - Chunfeng Zhao
- Soft Tissue Biology and Biomechanics Laboratory, Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Cheng YS, Chieh HF, Lin CJ, Kuo LC, An KN, Su FC. Comprehensive simulation on morphological and mechanical properties of trigger finger - A cadaveric model. J Biomech 2018; 74:187-191. [PMID: 29655486 DOI: 10.1016/j.jbiomech.2018.03.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/22/2018] [Accepted: 03/23/2018] [Indexed: 12/17/2022]
Abstract
Trigger finger has long been a common disorder in hand orthopedics. To clarify the unknown causative factors regarding the disease, numerous experiments were done on human cadavers, including tendon forces, tendon moment arm, mechanical properties of the pulley, gliding resistance, etc. However, most of these studies were conducted on normal fingers. As the etiology of trigger finger is still controversial on whether it is an outcome of tendon nodule or pulley scarring, in this study, a trigger finger model was built combining both the nodule created by silicone gel injection and pulley constriction by external compression. Indentation and gliding resistance tests were performed on cadaveric specimens to verify the model. Results showed that after silicone gel injection into the tendon, a significant increase in thickness was found. In addition, no significant difference was found in the toe region compressive modulus of the tendon after injection. Moreover, maximum, drop of gliding resistance and work of extension were all found to be significantly larger as the severity of triggering increased. Our results indicated we have developed a feasible cadaver model simulating trigger finger nodule which could be utilized for further experiments to elucidate other causative factors and biomechanical features of trigger finger in the future.
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Affiliation(s)
- Yu-Shiuan Cheng
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Hsiao-Feng Chieh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Musculoskeletal Research Center, National Cheng Kung University, Tainan, Taiwan.
| | - Chien-Ju Lin
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Li-Chieh Kuo
- Department of Occupational Therapy, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Nan An
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Fong-Chin Su
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Musculoskeletal Research Center, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.
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9
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Wong R, Alam N, McGrouther AD, Wong JKF. Tendon grafts: their natural history, biology and future development. J Hand Surg Eur Vol 2015; 40:669-81. [PMID: 26264585 DOI: 10.1177/1753193415595176] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The use of tendon grafts has diminished as regimes of primary repairs and rehabilitation have improved, but they remain important in secondary reconstruction. Relatively little is known about the cellular biology of grafts, and the general perception is that they have little biological activity. The reality is that there is a wealth of cellular and molecular changes occurring with the process of engraftment that affect the quality of the repair. This review highlights the historical perspectives and modern concepts of graft take, reviews the different attachment techniques and revisits the biology of pseudosheath formation. In addition, we discuss some of the future directions in tendon reconstruction by grafting, which include surface modification, vascularized tendon transfer, allografts, biomaterials and cell-based therapies.
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Affiliation(s)
- R Wong
- Plastic Surgery Research, Faculty of Medicine and Human Sciences, University of Manchester, Manchester, UK
| | - N Alam
- Plastic Surgery Research, Faculty of Medicine and Human Sciences, University of Manchester, Manchester, UK
| | - A D McGrouther
- Plastic Surgery Research, Faculty of Medicine and Human Sciences, University of Manchester, Manchester, UK
| | - J K F Wong
- Plastic Surgery Research, Faculty of Medicine and Human Sciences, University of Manchester, Manchester, UK
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10
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The effect of surface modification on gliding ability of decellularized flexor tendon in a canine model in vitro. J Hand Surg Am 2013; 38:1698-704. [PMID: 23849733 PMCID: PMC3782077 DOI: 10.1016/j.jhsa.2013.05.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 05/16/2013] [Accepted: 05/18/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the gliding ability and mechanical properties of decellularized intrasynovial tendons with and without surface modification designed to reduce gliding resistance. METHODS We randomly assigned 33 canine flexor digitorum profundus tendons to 1 of 3 groups: untreated fresh tendons, to serve as a control; tendons decellularized with trypsin and Triton X-100; and tendons decellularized as in group 2 with surface modification using carbodiimide-derivatized hyaluronic acid and gelatin (cd-HA-gelatin). Tendons were subjected to cyclic friction testing for 1,000 cycles with subsequent tensile stiffness testing. We qualitatively evaluated the surface roughness after 1,000 cycles using scanning electron microscopy. RESULTS The gliding resistance of the decellularized group was significantly higher than that of both the control and cd-HA-gelatin tendons (0.20, 0.09, and 0.11 N after the first cycle; and 0.41, 0.09, and 0.14 N after 1,000 cycles, respectively). Gliding resistance between the control and cd-HA-gelatin groups was not significantly different. The Young modulus was not significantly different between groups. The surfaces of the control and cd-HA-gelatin-treated tendons appeared smooth after 1,000 cycles, whereas those of the decellularized tendons appeared roughened under scanning electron microscopy observation. CONCLUSIONS Decellularization with trypsin and Triton X-100 did not change tendon stiffness. However, although this treatment was effective in removing cells, it adversely altered the tendon surface in both appearance and gliding resistance. Surface modification with cd-HA-gelatin improved the tendon surface smoothness and significantly decreased the gliding resistance. CLINICAL RELEVANCE The combination of decellularization and surface modification may improve the function of tendon allografts when used clinically.
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11
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Comparison of elastic versus rigid suture material for peripheral sutures in tendon repair. Clin Biomech (Bristol, Avon) 2012; 27:506-10. [PMID: 22172800 DOI: 10.1016/j.clinbiomech.2011.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 11/09/2011] [Accepted: 11/15/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND For secure tendon repair, while core suture materials have been previously investigated, the optimum material for peripheral sutures remains unclear. METHODS Transected bovine gastrocnemius tendons were repaired by 2-strand side-locking loop technique using no.2 braided polyblend polyethylene thread for the core suture. Then, 8-strand peripheral cross-stitches were added using either 2-0 rigid sutures (braided polyblend polyethylene) or USP 2-0-sized elastic sutures (nylon). The holding area of each peripheral suture was set at either 3 × 1 mm (shallow holding) or 6 × 2 mm (deep holding). Therefore, 4 groups were compared (the shallow-rigid, deep-rigid, shallow-elastic, and deep-elastic groups). The gap formation, ultimate tensile strength, and suture migration state were measured after 500 cyclic loadings (from 10 to 200 N). METHODS The shallow-rigid group had inferior outcomes compared to the other groups. Although the deep-rigid group had the smallest gap and highest ultimate strength, all peripheral sutures had failure prior to core suture rupture. The two elastic groups showed no significant differences, irrespective of the size of the holding area. Suture migration did not occur in the two elastic groups until the ultimate strength was reached and the core suture ruptured. INTERPRETATION Depending on the suturing method, rigid suture material may not be appropriate for peripheral sutures, when accompanying rigid core suture material. If peripheral sutures can be made with accurate deep holding, rigid suture material will provide favorable outcome. However, in other cases, elastic suture material is considered best for supporting a rigid core suture, as elasticity is another important factor for peripheral sutures.
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Ikeda J, Zhao C, Chen Q, Thoreson AR, An KN, Amadio PC. Compressive properties of cd-HA-gelatin modified intrasynovial tendon allograft in canine model in vivo. J Biomech 2011; 44:1793-6. [PMID: 21549380 DOI: 10.1016/j.jbiomech.2010.12.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 12/06/2010] [Accepted: 12/27/2010] [Indexed: 11/18/2022]
Abstract
Although we sometimes use the intrasynovial tendon allograft as a donor, the gliding ability of allograft prepared by lyophilization is significantly decreased. The gliding ability of the grafted tendon after tendon reconstruction is very important because the high gliding resistance causes more adhesion and leads to poor clinical results. We recently revealed that tendon surface treatment with a carbodiimide derivatized HA (cd-HA)-gelatin mixture for intrasynovial tendon allograft significantly improved its gliding ability. The purpose of this study was to investigate whether this cd-HA-gelatin treatment affects the tendon mechanical property or not. A total of 40 flexor digitorum profundus (FDP) tendons from canines were evaluated for compressive property by using indentation test. Indentation stiffness was measured for normal tendon, rehydrated tendon after lyophilization, rehydrated tendon after lyophilization that was implanted 6 weeks in vivo, and cd-HA treated rehydrated tendon after lyophilization that was implanted 6 weeks in vivo. The results for all groups showed no significant difference in the tendon compressive properties. The findings of these results demonstrate that cd-HA treatment for intrasynovial tendon allograft is an excellent method to improve the tendon gliding ability after lyophilization without changing the compressive property of donor tendon.
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Affiliation(s)
- Jun Ikeda
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Main EK, Goetz JE, Rudert MJ, Goreham-Voss CM, Brown TD. Apparent transverse compressive material properties of the digital flexor tendons and the median nerve in the carpal tunnel. J Biomech 2010; 44:863-8. [PMID: 21194695 DOI: 10.1016/j.jbiomech.2010.12.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 11/12/2010] [Accepted: 12/06/2010] [Indexed: 01/24/2023]
Abstract
Carpal tunnel syndrome is a frequently encountered peripheral nerve disorder caused by mechanical insult to the median nerve, which may in part be a result of impingement by the adjacent digital flexor tendons. Realistic finite element (FE) analysis to determine contact stresses between the flexor tendons and median nerve depends upon the use of physiologically accurate material properties. To assess the transverse compressive properties of the digital flexor tendons and median nerve, these tissues from ten cadaveric forearm specimens were compressed transversely while under axial load. The experimental compression data were used in conjunction with an FE-based optimization routine to determine apparent hyperelastic coefficients (μ and α) for a first-order Ogden material property definition. The mean coefficient pairs were μ=35.3 kPa, α=8.5 for the superficial tendons, μ=39.4 kPa, α=9.2 for the deep tendons, μ=24.9 kPa, α=10.9 for the flexor pollicis longus (FPL) tendon, and μ=12.9 kPa, α=6.5 for the median nerve. These mean Ogden coefficients indicate that the FPL tendon was more compliant at low strains than either the deep or superficial flexor tendons, and that there was no significant difference between superficial and deep flexor tendon compressive behavior. The median nerve was significantly more compliant than any of the flexor tendons. The material properties determined in this study can be used to better understand the functional mechanics of the carpal tunnel soft tissues and possible mechanisms of median nerve compressive insult, which may lead to the onset of carpal tunnel syndrome.
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Affiliation(s)
- Erin K Main
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
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Abstract
Management of flexor tendon injuries is one of the most demanding tasks in hand surgery. Despite substantial improvements in surgical technique and postoperative rehabilitation protocols, functional outcomes may still be somewhat unreliable. In the present article, the authors present complications encountered after flexor tendon repair and provide their preferred methods of prevention and treatment.
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Affiliation(s)
- Arash Momeni
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, 770 Welch Road, Suite 400, Palo Alto, CA 94304, USA
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