1
|
Shipley T, Vanhoof-Villalba SL, Lee S, Saxena T, Adcock W, Bilderback K, Barton RS, Solitro GF. Effects of A2 Pulley Venting on Bowstringing and Tendon Slack: A Biomechanical Investigation. Hand (N Y) 2024:15589447241259804. [PMID: 38902997 DOI: 10.1177/15589447241259804] [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] [Indexed: 06/22/2024]
Abstract
BACKGROUND A2 pulley release is often needed for exposure of the lacerated tendon, retrieval of retracted tendons, placement of core sutures, or to permit full motion and gliding of the repaired and edematous tendon. However, there is no agreement in the literature on the specific quantity of pulley venting that can be performed and recommendations are limited to an undefined "judicious release" of the pulleys when necessary. METHODS Following a previously developed testing protocols, finger kinematics, tendon excursion, and bowstringing were evaluated on cadaveric hands for venting in increments of 20% of the pulley length. RESULTS In our study, we found a statistically significant influence of venting on bowstringing, although no difference was found between fingers, and a significant difference in tendon slack, which was variable depending on the finger. Bowstringing started increasing at 20% of A2 venting and peaked at full release. Tendon slack did not start until 40% of A2 venting on the index finger, but started at 20% on the middle, ring, and small fingers. CONCLUSIONS Venting of the A2 pulley leads to an incremental increase in tendon bowstringing and tendon slack. However, differences in metacarpophalangeal flexion angle were not observed until full A2 pulley release, and only observed in the index finger, and no differences were observed in proximal interphalangeal flexion angles. Therefore, the benefit of releasing the A2 pulley when clinically necessary will likely outweigh the risks of loss of motion or strength.
Collapse
Affiliation(s)
| | | | | | - Tara Saxena
- Louisiana State University Health Shreveport, USA
| | | | | | | | | |
Collapse
|
2
|
Miescher I, Schaffner N, Rieber J, Bürgisser GM, Ongini E, Yang Y, Milionis A, Vogel V, Snedeker JG, Calcagni M, Buschmann J. Hyaluronic acid/PEO electrospun tube reduces tendon adhesion to levels comparable to native tendons - An in vitro and in vivo study. Int J Biol Macromol 2024; 273:133193. [PMID: 38885859 DOI: 10.1016/j.ijbiomac.2024.133193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 06/20/2024]
Abstract
A major problem after tendon injury is adhesion formation to the surrounding tissue leading to a limited range of motion. A viable strategy to reduce adhesion extent is the use of physical barriers that limit the contact between the tendon and the adjacent tissue. The purpose of this study was to fabricate an electrospun bilayered tube of hyaluronic acid/polyethylene oxide (HA/PEO) and biodegradable DegraPol® (DP) to improve the anti-adhesive effect of the implant in a rabbit Achilles tendon full laceration model compared to a pure DP tube. Additionally, the attachment of rabbit tenocytes on pure DP and HA/PEO containing scaffolds was tested and Scanning Electron Microscopy, Fourier-transform Infrared Spectroscopy, Differential Scanning Calorimetry, Water Contact Angle measurements, and testing of mechanical properties were used to characterize the scaffolds. In vivo assessment after three weeks showed that the implant containing a second HA/PEO layer significantly reduced adhesion extent reaching levels comparable to native tendons, compared with a pure DP implant that reduced adhesion formation only by 20 %. Tenocytes were able to attach to and migrate into every scaffold, but cell number was reduced over two weeks. Implants containing HA/PEO showed better mechanical properties than pure DP tubes and with the ability to entirely reduce adhesion extent makes this implant a promising candidate for clinical application in tendon repair.
Collapse
Affiliation(s)
- Iris Miescher
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, 8091 Zurich, Switzerland.
| | - Nicola Schaffner
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, 8091 Zurich, Switzerland.
| | - Julia Rieber
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, 8091 Zurich, Switzerland.
| | - Gabriella Meier Bürgisser
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, 8091 Zurich, Switzerland.
| | - Esteban Ongini
- University Clinic Balgrist, Orthopaedic Biomechanics, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Yao Yang
- Department of Health Sciences & Technology & Department of Materials, Schmelzbergstrasse 9, LFO, 8092 Zürich, Switzerland.
| | - Athanasios Milionis
- Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process Engineering, ETH Zürich, 8092 Zürich, Switzerland.
| | - Viola Vogel
- Laboratory of Applied Mechanobiology, Institute of Translational Medicine, and Department of Health Sciences and Technology, ETH Zurich, 8093 Zurich, Switzerland.
| | - Jess G Snedeker
- University Clinic Balgrist, Orthopaedic Biomechanics, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Maurizio Calcagni
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, 8091 Zurich, Switzerland.
| | - Johanna Buschmann
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, 8091 Zurich, Switzerland.
| |
Collapse
|
3
|
Svingen J, Wiig M, Turesson C, Farnebo S, Arner M. Risk factors for reoperation after flexor tendon repair: a registry study. J Hand Surg Eur Vol 2022; 47:1071-1076. [PMID: 35579214 PMCID: PMC9634328 DOI: 10.1177/17531934221101563] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to identify risk factors for reoperations after Zones 1 and 2 flexor tendon repairs. A multiple logistic regression model was used to identify risk factors from data collected via the Swedish national health care registry for hand surgery (HAKIR). The studied potential risk factors were age and gender, socio-economics and surgical techniques. Included were 1372 patients with injuries to 1585 fingers and follow-up of at least 12 months (median 37 IQR 27-56). Tendon ruptures occurred in 80 fingers and tenolysis was required in 76 fingers. Variables that affected the risk of rupture were age >25 years (p < 0.001), flexor pollicis longus tendon injuries (p < 0.001) and being male (p = 0.004). Injury to both finger flexors had an effect on both rupture (p = 0.005) and tenolysis (p < 0.001). Understanding the risk factors may provide important guidance both to surgeons and therapists when treating patients with flexor tendon injuries.Level of evidence: III.
Collapse
Affiliation(s)
- Jonas Svingen
- Karolinska Institutet, Department of Clinical
Science and Education, Södersjukhuset, Stockholm, Sweden,Department of Hand Surgery, Södersjukhuset,
Stockholm, Sweden,Jonas Svingen, Department of Hand Surgery,
Södersjukhuset, Sjukhusbacken 10, SE 188 83 Stockholm, Sweden.
| | - Monica Wiig
- Department of Surgical Science, Hand surgery,
Uppsala University, and Uppsala University Hospital, Sweden
| | - Christina Turesson
- Department of Hand Surgery, Plastic Surgery and
Burns, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping,
Sweden,Department of Health, Medicine and Caring
Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University,
Linköping, Sweden
| | - Simon Farnebo
- Department of Hand Surgery, Plastic Surgery and
Burns, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping,
Sweden
| | - Marianne Arner
- Karolinska Institutet, Department of Clinical
Science and Education, Södersjukhuset, Stockholm, Sweden,Department of Hand Surgery, Södersjukhuset,
Stockholm, Sweden
| |
Collapse
|
4
|
Zhang G, Zhou X, Hu S, Jin Y, Qiu Z. Large animal models for the study of tendinopathy. Front Cell Dev Biol 2022; 10:1031638. [PMID: 36393858 PMCID: PMC9640604 DOI: 10.3389/fcell.2022.1031638] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/12/2022] [Indexed: 11/23/2022] Open
Abstract
Tendinopathy has a high incidence in athletes and the aging population. It can cause pain and movement disorders, and is one of the most difficult problems in orthopedics. Animal models of tendinopathy provide potentially efficient and effective means to develop understanding of human tendinopathy and its underlying pathological mechanisms and treatments. The selection of preclinical models is essential to ensure the successful translation of effective and innovative treatments into clinical practice. Large animals can be used in both micro- and macro-level research owing to their similarity to humans in size, structure, and function. This article reviews the application of large animal models in tendinopathy regarding injuries to four tendons: rotator cuff, patellar ligament, Achilles tendon, and flexor tendon. The advantages and disadvantages of studying tendinopathy with large animal models are summarized. It is hoped that, with further development of animal models of tendinopathy, new strategies for the prevention and treatment of tendinopathy in humans will be developed.
Collapse
Affiliation(s)
- Guorong Zhang
- School of Clinical Medicine, Changchun University of Chinese Medicine, Changchun, China
- School of Pharmacy, Changchun University of Chinese Medicine, Changchun, China
| | - Xuyan Zhou
- School of Pharmacy, Changchun University of Chinese Medicine, Changchun, China
| | - Shuang Hu
- School of Pharmacy, Changchun University of Chinese Medicine, Changchun, China
| | - Ye Jin
- School of Pharmacy, Changchun University of Chinese Medicine, Changchun, China
- *Correspondence: Ye Jin, ; Zhidong Qiu,
| | - Zhidong Qiu
- School of Pharmacy, Changchun University of Chinese Medicine, Changchun, China
- *Correspondence: Ye Jin, ; Zhidong Qiu,
| |
Collapse
|
5
|
Biomimicry of the flexor digitorum superficialis: Systematic literature review. HAND SURGERY & REHABILITATION 2021; 40:547-553. [PMID: 34146743 DOI: 10.1016/j.hansur.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/10/2021] [Accepted: 06/01/2021] [Indexed: 11/20/2022]
Abstract
Biomimicry consists in imitating nature to solve complex human problems. The hand surgeon usually tries to copy and recreate the structure-to-function and function-to-control relationships of the native tissues after damage. With its exceptional structure and biomechanics, the flexor digitorum superficialis (FDS) has been an important source of inspiration for artificial hand system reconstruction. The present systematic literature review highlights the twenty-two artificial hand system reconstructions derived from the FDS, and presents biomimicry as an alternative approach in clinical research in hand surgery.
Collapse
|
6
|
Closed Traumatic A2 Through A4 Pulley Rupture and Flexor Digitorum Superficialis Avulsion Treated With Reconstruction. Ochsner J 2020; 21:99-103. [PMID: 33828433 PMCID: PMC7993427 DOI: 10.31486/toj.19.0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Multiple closed spontaneous pulley ruptures are rare injuries and require surgical reconstruction to prevent functional deficits. Pulley rupture combined with avulsion of the flexor digitorum superficialis (FDS) tendon is an even more uncommon occurrence. Case Report: We describe a closed traumatic annular 2 (A2) through annular 4 (A4) pulley rupture with avulsion of the FDS tendon. This uniquely associated pathology was treated with a complex surgical reconstruction that corrected flexion contracture and tendon bowstringing in the left long finger. The desired outcome was achieved through A2 and A4 pulley reconstruction using an autologous palmaris longus tendon graft with FDS tendon excision and proximal interphalangeal joint capsulotomy. Conclusion: Multiple pulley rupture is not commonly combined with FDS avulsion, and treatment of this injury requires careful surgical planning based on pulley biomechanics to maximize postoperative function.
Collapse
|
7
|
Fêo HB, Biancalana A, Romero Nakagaki W, Aparecida de Aro A, Gomes L. Morphological Alterations and Increased Gelatinase Activity in the Superficial Digital Flexor Tendon of Chickens During Growth and Maturation. Anat Rec (Hoboken) 2018; 302:964-972. [DOI: 10.1002/ar.24027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 07/30/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Haline Ballestero Fêo
- Department of Structural and Functional BiologyInstitute of Biology, State University of Campinas – UNICAMP Campinas Brazil
| | - Adriano Biancalana
- Department of Structural and Functional BiologyInstitute of Biology, State University of Campinas – UNICAMP Campinas Brazil
- Laboratory of Cellular and Molecular BiologyFederal University of Pará – UFPA Soure Brazil
| | - Wilson Romero Nakagaki
- Department of Structural and Functional BiologyInstitute of Biology, State University of Campinas – UNICAMP Campinas Brazil
- Master's Program in Health SciencesUniversity of Western São Paulo – UNOESTE Presidente Prudente Brazil
| | - Andrea Aparecida de Aro
- Department of Structural and Functional BiologyInstitute of Biology, State University of Campinas – UNICAMP Campinas Brazil
- Biomedical Sciences Graduate ProgramHerminio Ometto University Center –UNIARARAS Araras Brazil
| | - Laurecir Gomes
- Department of Structural and Functional BiologyInstitute of Biology, State University of Campinas – UNICAMP Campinas Brazil
| |
Collapse
|
8
|
Abstract
Flexor pulley ruptures with severe proximal interphalangeal (PIP) joint contracture present a complex challenge for the hand surgeon. Four patients were treated with a delayed presentation of pulley rupture and fixed PIP flexion contracture with a technique of external extension torque application followed by splinting without pulley reconstruction. Using this technique, the PIP joint contractures improved from an average of 66° to an average of 19°, patient satisfaction was high, and the pulley injuries were managed with splinting alone without open pulley reconstruction.
Collapse
|
9
|
Bottagisio M, Lovati AB. A review on animal models and treatments for the reconstruction of Achilles and flexor tendons. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:45. [PMID: 28155051 DOI: 10.1007/s10856-017-5858-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/19/2017] [Indexed: 06/06/2023]
Abstract
Tendon is a connective tissue mainly composed of collagen fibers with peculiar mechanical properties essential to functional movements. The increasing incidence of tendon traumatic injuries and ruptures-associated or not with the loss of tissue-falls on the growing interest in the field of tissue engineering and regenerative medicine. The use of animal models is mandatory to deepen the knowledge of the tendon healing response to severe damages or acute transections. Thus, the selection of preclinical models is crucial to ensure a successful translation of effective and safe innovative treatments to the clinical practice. The current review is focused on animal models of tendon ruptures and lacerations or defective injuries with large tissue loss that require surgical approaches or grafting procedures. Data published between 2000 and 2016 were examined. The analyzed articles were compiled from Pub Med-NCBI using search terms, including animal model(s) AND tendon augmentation OR tendon substitute(s) OR tendon substitution OR tendon replacement OR tendon graft(s) OR tendon defect(s) OR tendon rupture(s). This article presents the existing preclinical models - considering their advantages and disadvantages-in which translational progresses have been made by using bioactive sutures or tissue engineering that combines biomaterials with cells and growth factors to efficiently treat transections or large defects of Achilles and flexor tendons.
Collapse
Affiliation(s)
- Marta Bottagisio
- Cell and Tissue Engineering Laboratory, IRCCS Galeazzi Orthopaedic Institute, via R. Galeazzi 4, 20161, Milan, Italy
| | - Arianna B Lovati
- Cell and Tissue Engineering Laboratory, IRCCS Galeazzi Orthopaedic Institute, via R. Galeazzi 4, 20161, Milan, Italy.
| |
Collapse
|
10
|
Meier Bürgisser G, Calcagni M, Bachmann E, Fessel G, Snedeker JG, Giovanoli P, Buschmann J. Rabbit Achilles tendon full transection model - wound healing, adhesion formation and biomechanics at 3, 6 and 12 weeks post-surgery. Biol Open 2016; 5:1324-33. [PMID: 27635037 PMCID: PMC5051656 DOI: 10.1242/bio.020644] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
After tendon rupture repair, two main problems may occur: re-rupture and adhesion formation. Suitable non-murine animal models are needed to study the healing tendon in terms of biomechanical properties and extent of adhesion formation. In this study 24 New Zealand White rabbits received a full transection of the Achilles tendon 2 cm above the calcaneus, sutured with a 4-strand Becker suture. Post-surgical analysis was performed at 3, 6 and 12 weeks. In the 6-week group, animals received a cast either in a 180 deg stretched position during 6 weeks (adhesion provoking immobilization), or were re-casted with a 150 deg position after 3 weeks (adhesion inhibiting immobilization), while in the other groups (3 and 12 weeks) a 180 deg position cast was applied for 3 weeks. Adhesion extent was analyzed by histology and ultrasound. Histopathological scoring was performed according to a method by Stoll et al. (2011), and the main biomechanical properties were assessed. Histopathological scores increased as a function of time, but did not reach values of healthy tendons after 12 weeks (only around 15 out of 20 points). Adhesion provoking immobilization led to an adhesion extent of 82.7±9.7%, while adhesion inhibiting immobilization led to 31.9±9.8% after 6 weeks. Biomechanical properties increased over time, however, they did not reach full strength nor elastic modulus at 12 weeks post-operation. Furthermore, the rabbit Achilles tendon model can be modulated in terms of adhesion formation to the surrounding tissue. It clearly shows the different healing stages in terms of histopathology and offers a suitable model regarding biomechanics because it exhibits similar biomechanics as the human flexor tendons of the hand. Summary: The rabbit Achilles tendon full transection model can be used to study adhesion extent in a controlled way. It also mimics the biomechanics of human hand flexor tendons.
Collapse
Affiliation(s)
- Gabriella Meier Bürgisser
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Maurizio Calcagni
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Elias Bachmann
- Uniklinik Balgrist, Department of Orthopedics, Forchstrasse 340, Zurich 8008, Switzerland
| | - Gion Fessel
- Uniklinik Balgrist, Department of Orthopedics, Forchstrasse 340, Zurich 8008, Switzerland
| | - Jess G Snedeker
- Uniklinik Balgrist, Department of Orthopedics, Forchstrasse 340, Zurich 8008, Switzerland Laboratory for Orthopaedic Biomechanics, Swiss Federal Institute of Technology in Zurich (ETHZ), Rämistrasse 101, Zurich CH-8092, Switzerland
| | - Pietro Giovanoli
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Johanna Buschmann
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| |
Collapse
|
11
|
Evrova O, Houska J, Welti M, Bonavoglia E, Calcagni M, Giovanoli P, Vogel V, Buschmann J. Bioactive, Elastic, and Biodegradable Emulsion Electrospun DegraPol Tube Delivering PDGF-BB for Tendon Rupture Repair. Macromol Biosci 2016; 16:1048-63. [DOI: 10.1002/mabi.201500455] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/04/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Olivera Evrova
- Division of Plastic Surgery and Hand Surgery; University Hospital Zürich; Sternwartstrasse 14 8091 Zürich Switzerland
- Laboratory of Applied Mechanobiology; ETH Zürich; Vladimir-Prelog-Weg 1-5/10 8093 Zürich Switzerland
| | - Joanna Houska
- Division of Plastic Surgery and Hand Surgery; University Hospital Zürich; Sternwartstrasse 14 8091 Zürich Switzerland
| | - Manfred Welti
- Division of Plastic Surgery and Hand Surgery; University Hospital Zürich; Sternwartstrasse 14 8091 Zürich Switzerland
| | - Eliana Bonavoglia
- ab medica; Via J. F. Kennedy 10/12 20023 Cerro Maggiore (Milan) Italy
| | - Maurizio Calcagni
- Division of Plastic Surgery and Hand Surgery; University Hospital Zürich; Sternwartstrasse 14 8091 Zürich Switzerland
| | - Pietro Giovanoli
- Division of Plastic Surgery and Hand Surgery; University Hospital Zürich; Sternwartstrasse 14 8091 Zürich Switzerland
| | - Viola Vogel
- Laboratory of Applied Mechanobiology; ETH Zürich; Vladimir-Prelog-Weg 1-5/10 8093 Zürich Switzerland
| | - Johanna Buschmann
- Division of Plastic Surgery and Hand Surgery; University Hospital Zürich; Sternwartstrasse 14 8091 Zürich Switzerland
| |
Collapse
|
12
|
Singh R, Rymer B, Theobald P, Thomas PBM. A Review of Current Concepts in Flexor Tendon Repair: Physiology, Biomechanics, Surgical Technique and Rehabilitation. Orthop Rev (Pavia) 2015; 7:6125. [PMID: 26793293 PMCID: PMC4703911 DOI: 10.4081/or.2015.6125] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 09/13/2015] [Indexed: 11/22/2022] Open
Abstract
Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man’s land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into worldwide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biome-chanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs.
Collapse
Affiliation(s)
- Rohit Singh
- University Hospital North Midlands, Stoke-on-Trent, UK; Cardiff School of Engineering, Cardiff University, UK
| | - Ben Rymer
- University Hospital North Midlands , Stoke-on-Trent, UK
| | | | - Peter B M Thomas
- University Hospital North Midlands, Stoke-on-Trent, UK; University Hospital North Midlands, Stoke-on-Trent, UK
| |
Collapse
|
13
|
Bayer T, Adler W, Schweizer A, Schöffl I, Uder M, Janka R. Evaluation of finger A3 pulley rupture in the crimp grip position-a magnetic resonance imaging cadaver study. Skeletal Radiol 2015; 44:1279-85. [PMID: 25930946 DOI: 10.1007/s00256-015-2160-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 04/10/2015] [Accepted: 04/21/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The correct diagnosis of an A3 pulley rupture is challenging for musculoskeletal radiologists. An A3 pulley rupture should in theory influence the shape of the proximal interphalangeal joint volar plate (VP) and the amount of bowstringing at level of the VP during finger flexion. The purpose of this study was to perform MRI with metric analysis of the VP configuration and VP bowstringing in cadaver fingers in the crimp grip position and to determine cut points for A3 pulley rupture. MATERIALS AND METHODS MRI in the crimp grip position was performed in 21 cadaver fingers with artificially created flexor tendon pulley tears (fingers with A3 pulley rupture n = 16, fingers without A3 pulley rupture n = 5). The distances of the translation of the VP relative to the middle phalanx base, the distances between the flexor tendons and the VP body, and the distances between the flexor tendon and bone (TB) were measured. RESULTS Statistical analysis showed significantly lower VP translation distances and significantly higher VP tendon distances if the A3 pulley was ruptured. A2 TB and A4 TB distances did not differ significantly in specimens with and without A3 pulley rupture. The optimal cut points for A3 pulley rupture were a VP translation distance <2.8 mm and a VP tendon distance >1.4 mm. CONCLUSION Reduction of the VP translation distance and augmentation of the VP tendon distance are suitable indirect signs of A3 pulley rupture.
Collapse
Affiliation(s)
- Thomas Bayer
- Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, 91054, Erlangen, Germany,
| | | | | | | | | | | |
Collapse
|
14
|
Bayer T, Fries S, Schweizer A, Schöffl I, Janka R, Bongartz G. Stress examination of flexor tendon pulley rupture in the crimp grip position: a 1.5-Tesla MRI cadaver study. Skeletal Radiol 2015; 44:77-84. [PMID: 25253170 DOI: 10.1007/s00256-014-2002-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/07/2014] [Accepted: 08/31/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objectives of this study were the evaluation of flexor tendon pulley rupture of the fingers in the crimp grip position using magnetic resonance imaging (MRI) and the comparison of the results with MRI in the neutral position in a cadaver study. MATERIALS AND METHODS MRI in the crimp grip position and in the neutral position was performed in 21 cadaver fingers with artificially created flexor tendon pulley tears (combined pulley rupture, n = 14; single pulley rupture, n = 7). Measurement of the distance between the tendon and bone was performed. Images were evaluated by two readers, first independently and in cases of discrepancy in consensus. Sensitivity and specificity for detecting combined pulley ruptures were calculated. RESULTS Tendon bone distances were significantly higher in the crimp grip position than in the neutral position. Sensitivity and specificity for detecting combined pulley rupture were 92.86 % and 100 % respectively in the crimp grip position and 78.57 % and 85.71 % respectively in the neutral position. Kappa values for interobserver reliability were 0.87 in the crimp grip position and 0.59 in the neutral position. CONCLUSION MRI examination in the crimp grip position results in higher tendon bone distances by subjecting the pulleys to a higher strain, which facilitates image evaluation with higher interobserver reliability, higher sensitivity, and higher specificity for combined pulley rupture compared with examination in the neutral position.
Collapse
Affiliation(s)
- Thomas Bayer
- Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, 91054, Erlangen, Germany,
| | | | | | | | | | | |
Collapse
|
15
|
Prevention of peritendinous adhesions using an electrospun DegraPol polymer tube: a histological, ultrasonographic, and biomechanical study in rabbits. BIOMED RESEARCH INTERNATIONAL 2014; 2014:656240. [PMID: 25101292 PMCID: PMC4101979 DOI: 10.1155/2014/656240] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/23/2014] [Accepted: 06/02/2014] [Indexed: 11/17/2022]
Abstract
Purpose. One of the great challenges in surgical tendon rupture repair is to minimize peritendinous adhesions. In order to reduce adhesion formation, a physical barrier was applied to a sutured rabbit Achilles tendon, with two different immobilization protocols used postoperatively. Methods. Thirty New Zealand white rabbits received a laceration on the Achilles tendon, sutured with a 4-strand Becker suture, and half of the rabbits got a DegraPol tube at the repair site. While fifteen rabbits had their treated hind leg in a 180° stretched position during 6 weeks (adhesion provoking immobilization), the other fifteen rabbits were recasted with a 150° position after 3 weeks (adhesion inhibiting immobilization). Adhesion extent was analysed macroscopically, via ultrasound and histology. Inflammation was determined histologically. Biomechanical properties were analysed. Results. Application of a DegraPol tube reduced adhesion formation by approximately 20%—independently of the immobilization protocol. Biomechanical properties of extracted specimen were not affected by the tube application. There was no serious inflammatory reaction towards the implant material. Conclusions. Implantation of a DegraPol tube tightly set around a sutured tendon acts as a beneficial physical barrier and prevents adhesion formation significantly—without affecting the tendon healing process.
Collapse
|
16
|
Buschmann J, Puippe G, Bürgisser GM, Bonavoglia E, Giovanoli P, Calcagni M. Correspondence of high-frequency ultrasound and histomorphometry of healing rabbit Achilles tendon tissue. Connect Tissue Res 2014; 55:123-31. [PMID: 24283274 DOI: 10.3109/03008207.2013.870162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Static and dynamic high-frequency ultrasound of healing rabbit Achilles tendons were set in relationship to histomorphometric analyses at three and six weeks post-surgery. MATERIALS AND METHODS Twelve New Zealand White rabbits received a clean-cut Achilles tendon laceration (the medial and lateral Musculus gastrocnemius) and were repaired with a four-strand Becker suture. Six rabbits got additionally a tight polyester urethane tube at the repair site in order to vary the adhesion extent. Tendons were analysed by static and dynamic ultrasound (control: healthy contralateral legs). The ultrasound outcome was corresponded to the tendon shape, tenocyte and tenoblast density, tenocyte and tenoblast nuclei width, collagen fibre orientation and adhesion extent. RESULTS The spindle-like morphology of healing tendons (ultrasound) was confirmed by the swollen epitenon (histology). Prediction of adhesion formation by dynamic ultrasound assessment was confirmed by histology (contact region to surrounding tissue). Hyperechogenic areas corresponded to acellular zones with aligned fibres and hypoechogenic zones to not yet oriented fibres and to cell-rich areas. CONCLUSIONS These findings add new in-depth structural knowledge to the established non-invasive analytical tool, ultrasound.
Collapse
Affiliation(s)
- Johanna Buschmann
- Department for Plastic Surgery and Hand Surgery, University Hospital Zurich , Zurich , Switzerland
| | | | | | | | | | | |
Collapse
|
17
|
Johnsen P, O'Shea K, Wolfe SW. Traumatic flexor digitorum superficialis and A2-A3 pulley rupture: case report. J Hand Surg Am 2014; 39:524-6. [PMID: 24559629 DOI: 10.1016/j.jhsa.2013.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 12/16/2013] [Accepted: 12/18/2013] [Indexed: 02/02/2023]
Abstract
We present a case of simultaneous traumatic rupture of the flexor digitorum superficialis tendon and the A2 and A3 flexor tendon pulleys. Excision of the flexor digitorum superficialis tendon and reconstruction of the pulleys led to restoration of function.
Collapse
Affiliation(s)
- Parker Johnsen
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY
| | - Kieran O'Shea
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY
| | - Scott W Wolfe
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY.
| |
Collapse
|
18
|
Havulinna J, Leppänen OV, Göransson H. The suture loop holding capacity of flexor digitorum profundus tendon within and outside the digital tendon sheath. J Hand Surg Eur Vol 2013; 38:801-4. [PMID: 23315625 DOI: 10.1177/1753193412474175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In a previous study we found that the strength of a Kessler core suture in the flexor tendon was greater in flexor zone 2 than in zone 3. To further investigate the material properties of the flexor tendon without the influence of a locking suture configuration, we measured the ultimate strength of a simple loop suture in the flexor digitorum profundus tendon in zones 1, 2, and 3. Eight cadaver flexor digitorum profundus tendons were tested in 10 mm increments with a 3-0 polyester suture loop pull-out test in the mid-substance of the tendon. The mean strength in zones 1 and 2 (26.7 N, SD 5.6) was significantly higher than the mean strength in zone 3 (17.7 N, SD 5.4). We conclude that the difference is owing to variations of the structure of the flexor tendon in different sections of the tendon, as the suture configuration was a simple loop without a locking or grasping component.
Collapse
Affiliation(s)
- J Havulinna
- Division of Hand and Microsurgery, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, FI-33521 TAYS, Tampere, Finland.
| | | | | |
Collapse
|
19
|
Abstract
Whether it is a primary or a delayed flexor digitorum profundus (FDP) repair, no general consent has been found, and no perfect treatment has been imposed. The authors utilize 2 new techniques for FDP reconstruction that allow immediate postoperative mobilization and excellent functional outcome. Harvesting of the donor hemi tendon, both FDP and flexor digitorum superficialis, is the closest match in terms of muscle agonism and excursion, and does not result in an imbalance of forces across the donor joint with the potential complications that this may create.
Collapse
Affiliation(s)
- Laura-Carmen Sita-Alb
- Plastic Surgery and Reconstructive Microsurgery, Groupe Main Provence, 42 Maréchal de Lattre de Tassigny Street, 13090 Aix-en-Provence, France
| | | |
Collapse
|
20
|
Martin JR, Paclet F, Latash ML, Zatsiorsky VM. Changes in the flexor digitorum profundus tendon geometry in the carpal tunnel due to force production and posture of metacarpophalangeal joint of the index finger: an MRI study. Clin Biomech (Bristol, Avon) 2013; 28:157-63. [PMID: 23219762 PMCID: PMC3609902 DOI: 10.1016/j.clinbiomech.2012.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 11/04/2012] [Accepted: 11/05/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Carpal tunnel syndrome is a disorder caused by increased pressure in the carpal tunnel associated with repetitive, stereotypical finger actions. Little is known about in vivo geometrical changes in the carpal tunnel caused by motion at the finger joints and exerting a fingertip force. METHODS The hands and forearms of five subjects were scanned using a 3.0 T magnetic resonance imaging scanner. The metacarpophalangeal joint of the index finger was placed in: flexion, neutral and extension. For each joint posture subjects either produced no active force (passive condition) or exerted a flexion force to resist a load (~4.0 N) at the fingertip (active condition). Changes in the radii of curvature, position and transverse plane area of the flexor digitorum profundus tendons at the carpal tunnel level were measured. RESULTS The radius of curvature of the flexor digitorum profundus tendons, at the carpal tunnel level, was significantly affected by posture of the index finger metacarpophalangeal joint (P<0.05) and the radii was significantly different between fingers (P<0.05). Actively producing force caused a significant shift (P<0.05) in the flexor digitorum profundus tendons in the ventral (palmar) direction. No significant change in the area of an ellipse containing the flexor digitorum profundus tendons was observed between conditions. INTERPRETATION The results show that relatively small changes in the posture and force production of a single finger can lead to significant changes in the geometry of all the flexor digitorum profundus tendons in the carpal tunnel. Additionally, voluntary force production at the fingertip increases the moment arm of the FDP tendons about the wrist joint.
Collapse
|
21
|
Buschmann J, Calcagni M, Bürgisser GM, Bonavoglia E, Neuenschwander P, Milleret V, Giovanoli P. Synthesis, characterization and histomorphometric analysis of cellular response to a new elastic DegraPol® polymer for rabbit Achilles tendon rupture repair. J Tissue Eng Regen Med 2012; 9:584-94. [DOI: 10.1002/term.1624] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 07/04/2012] [Accepted: 08/25/2012] [Indexed: 02/05/2023]
Affiliation(s)
- Johanna Buschmann
- Division of Plastic and Reconstructive Surgery; University Hospital Zurich; Sternwartstrasse 14 8091 Zurich Switzerland
| | - Maurizio Calcagni
- Division of Plastic and Reconstructive Surgery; University Hospital Zurich; Sternwartstrasse 14 8091 Zurich Switzerland
| | - Gabriella Meier Bürgisser
- Division of Plastic and Reconstructive Surgery; University Hospital Zurich; Sternwartstrasse 14 8091 Zurich Switzerland
| | | | | | - Vincent Milleret
- Department of Materials; Cells and Biomaterials; ETH Zurich Zurich Switzerland
| | - Pietro Giovanoli
- Division of Plastic and Reconstructive Surgery; University Hospital Zurich; Sternwartstrasse 14 8091 Zurich Switzerland
| |
Collapse
|
22
|
Evans RB. Managing the injured tendon: current concepts. J Hand Ther 2012; 25:173-89; quiz 190. [PMID: 22326362 DOI: 10.1016/j.jht.2011.10.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 10/31/2011] [Indexed: 02/03/2023]
Abstract
Despite advances in understanding of the mechanical aspects of tendon management with improved suture technique and early stress application with postoperative therapy, clinical results remain inconsistent after repair, especially within the synovial regions. Complementary research to enhance the intrinsic pathway of healing, suppress the extrinsic pathway of healing, and manipulate frictional resistance to tendon gliding is now the focus of current basic science research on tendons. In the future, application of these new biologic therapies may increase the "safety zone" (or tolerance for load and excursion without dysfunctional gapping) as therapists apply stress to healing tendons and may alter future rehabilitation protocols by allowing greater angles of motion (and thus tendon excursion), increased external load, and decreased time in protective orthoses (splints). However, at this time, the stronger repair techniques and the application of controlled stress remain the best and most well-supported intervention after tendon injury and repair in the recovery of functional tendon excursion and joint range of motion. The hand therapist's role in this process remains a critical component contributing to satisfactory outcomes.
Collapse
Affiliation(s)
- Roslyn B Evans
- Indian River Hand and Upper Extremity Rehabilitation, Vero Beach, Florida 32960, USA.
| |
Collapse
|
23
|
Murphy RKJ, Ray WZ, Mackinnon SE. Repair of a median nerve transection injury using multiple nerve transfers, with long-term functional recovery. J Neurosurg 2012; 117:886-9. [PMID: 22978538 DOI: 10.3171/2012.8.jns111356] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Complete loss of median nerve motor function is a rare but devastating injury. Loss of median motor hand function and upper-extremity pronation can significantly impact a patient's ability to perform many activities of daily living independently. The authors report the long-term follow-up in a case of median nerve motor fiber transection that occurred during an arthroscopic elbow procedure, which was then treated with multiple nerve transfers. Motor reconstruction used the nerves to the supinator and extensor carpi radialis brevis to transfer to the anterior interosseous nerve and pronator. Sensory sensation was restored using the lateral antebrachial cutaneous (LABC) nerve to transfer to a portion of the sensory component of the median nerve, and a second cable of LABC nerve as a direct median nerve sensory graft. The patient ultimately recovered near normal motor function of the median nerve, but had persistent pain symptoms 4 years postinjury.
Collapse
Affiliation(s)
- Rory K J Murphy
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA
| | | | | |
Collapse
|
24
|
BIOMECHANICS AND HISTOLOGICAL ANALYSIS IN RABBIT FLEXOR TENDONS REPAIRED USING THREE SUTURE TECHNIQUES (FOUR AND SIX STRANDS) WITH EARLY ACTIVE MOBILIZATION. Rev Bras Ortop 2012; 47:92-101. [PMID: 27027087 PMCID: PMC4799348 DOI: 10.1016/s2255-4971(15)30351-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Accepted: 07/12/2011] [Indexed: 11/21/2022] Open
Abstract
Objective: Analyzing suture time, biomechanics (deformity between the stumps) and the histology of three groups of tendinous surgical repair: Brazil-2 (4-strands) which the end knot (core) is located outside the tendon, Indiana (4-strands) and Tsai (6-strands) with sutures technique which the end knot (core) is inner of the tendon, associated with early active mobilization. Methods: The right calcaneal tendons (plantar flexor of the hind paw) of 36 rabbits of the New Zealand breed (Oryctolagus cuniculus) were used in the analysis. This sample presents similar size to human flexor tendon that has approximately 4.5 mm (varying from 2mm). The selected sample showed the same mass (2.5 to 3kg) and were male or female adults (from 8 ½ months). For the flexor tendons of the hind paws, sterile and driven techniques were used in accordance to the Committee on Animal Research and Ethics (CETEA) of the University of the State of Santa Catarina (UDESC), municipality of Lages, in Brazil (protocol # 1.33.09). Results: In the biomechanical analysis (deformity) carried out between tendinous stumps, there was no statistically significant difference (p>0.01). There was no statistical difference in relation to surgical time in all three suture techniques with a mean of 6.0 minutes for Tsai (6- strands), 5.7 minutes for Indiana (4-strands) and 5.6 minutes for Brazil (4-strands) (p>0.01). With the early active mobility, there was qualitative and quantitative evidence of thickening of collagen in 38.9% on the 15th day and in 66.7% on the 30th day, making the biological tissue stronger and more resistant (p=0.095). Conclusion: This study demonstrated that there was no histological difference between the results achieved with an inside or outside end knot with respect to the repaired tendon and the number of strands did not affect healing, vascularization or sliding of the tendon in the osteofibrous tunnel, which are associated with early active mobility, with the repair techniques applied.
Collapse
|
25
|
Viens M, Chauvette G, Langelier È. A Roadmap for the Design of Bioreactors in Mechanobiological Research and Engineering of Load-Bearing Tissues. J Med Device 2011. [DOI: 10.1115/1.4005319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In the field of tissue engineering, a bioreactor is a valuable instrument that mimics a physiological environment to maintain live tissues in vitro. Although bioreactors are conceptually relatively simple, the vast majority of current bioreactors (commercial and custom-built) are not fully adapted to current research needs. Designing the optimal bioreactor requires a very thorough approach to a series of steps in the product development process. These four basic steps are: (1) identifying the needs and technical requirements, (2) defining and evaluating the related concepts, (3) designing the apparatus and drawing up the blueprints, and (4) building and validating the apparatus. Furthermore, the design has to be adapted to the specific purpose of the research and how the tissues will be used. In the emerging field of bioreactor research, roadmaps are needed to assist tissue engineering researchers as they embark on this process. The necessary multidisciplinary expertise covering micromechanical design, mechatronics, viscoelasticity, tissue culture, and human ergonomics is not necessarily available to all research teams. Therefore, the challenge of adapting and conducting each step in the product development process is significant. This paper details our proposal for a roadmap to accompany researchers in identifying their needs and technical requirements: step one in the product development process. Our roadmap proposal is set up in two phases. Phase 1 is based on the analysis of the bioreactor use cycle and phase 2 is based on the analysis of one specific and critical step in the use cycle: conducting stimulation and characterization protocols with the bioreactor. A meticulous approach to these two phases minimizes the risk of forgetting important requirements and strengthens the probability of acquiring or designing a high performance bioreactor.
Collapse
Affiliation(s)
- Mathieu Viens
- PERSEUS Research Group Department of Mechanical Engineering Université de Sherbrooke 2500 boul Université, Sherbrooke Québec J1K 2R1, Canada
| | - Guillaume Chauvette
- PERSEUS Research Group Department of Mechanical Engineering Université de Sherbrooke 2500 boul Université, Sherbrooke Québec J1K 2R1, Canada
| | - Ève Langelier
- PERSEUS Research Group Department of Mechanical Engineering Université de Sherbrooke 2500 boul Université, Sherbrooke Québec J1K 2R1, Canada
| |
Collapse
|
26
|
Buschmann J, Müller A, Feldman K, Tervoort TA, Fessel G, Snedeker JG, Giovanoli P, Calcagni M. Small hook thread (Quill) and soft felt internal splint to increase the primary repair strength of lacerated rabbit Achilles tendons: biomechanical analysis and considerations for hand surgery. Clin Biomech (Bristol, Avon) 2011; 26:626-31. [PMID: 21376437 DOI: 10.1016/j.clinbiomech.2011.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 02/02/2011] [Accepted: 02/03/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND For the prevention of re-rupture during early healing phase, the primary repair strength of repaired lacerated tendons in hand surgery should be maximal and the reconstructed diameter minimal. Two new repair methods (small hook thread and internal splint) were assessed for strength and reconstructed diameter characteristics. METHODS Achilles tendons of 43 female New Zealand White rabbits were sectioned 2 cm above the calcaneus. Specimens were divided into 7 groups and repaired as follows: Kirchmayr method 2-strand with 4.0 polypropylene thread; Becker method 4-strand; 6-strand; internal splint; Kirchmayr method small hook 2-strand; Becker method small hook 4-strand, non-modified tendon. Load until failure, load until gap formation, gap length, cross-sectional area and failure stress were determined. FINDINGS The small hook 2-strand suture had 1.3 fold higher loads until failure compared to a conventional 2-strand suture, P<0.05. The internal splint had a similar load until failure (22 N (SD 6)) as the conventional 2-strand suture (23 N (SD 4)); around half the load until failure of the conventional 4-strand suture (38 N (SD 9)). Load until gap formation correlated positively with load until failure (y=0.65+3.6; r(2)=0.72). The running suture increased the cross-sectional area at the repair site by a factor of 1.3. INTERPRETATION Using a small hook thread instead of a 4.0 polypropylene thread significantly increases the primary repair strength with the same number of strands. Internal splints may be an alternative to conventional 2-strand sutures for bridging large gaps.
Collapse
Affiliation(s)
- Johanna Buschmann
- Division of Plastic and Reconstructive Surgery, University Hospital Zurich, Sternwartstrasse 14, Zurich, Switzerland.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Connor J, Amirouche F, Gonzalez M. Understanding the kinematics and dynamics of the digit. J Bone Joint Surg Am 2009; 91 Suppl 6:74-8. [PMID: 19884414 DOI: 10.2106/jbjs.i.00560] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jennifer Connor
- Department of Orthopaedic Surgery, University of Illinois at Chicago, IL 60612, USA.
| | | | | |
Collapse
|
28
|
Bois AJ, Johnston G, Classen D. Spontaneous flexor tendon ruptures of the hand: case series and review of the literature. J Hand Surg Am 2007; 32:1061-71. [PMID: 17826564 DOI: 10.1016/j.jhsa.2007.06.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Accepted: 06/13/2007] [Indexed: 02/02/2023]
Abstract
Spontaneous flexor tendon ruptures within the hand are incompletely understood. We report 5 cases of spontaneous tendon rupture involving the flexor digitorum profundus tendon. One case involves an abnormal intertendinous connection between the ring and small finger profundus tendons and another involves a lumbrical muscle variant. To our knowledge, the latter has not been reported in association with spontaneous tendon rupture. In reviewing the literature for spontaneous flexor tendon ruptures, a total of 50 spontaneous ruptures in 43 cases was found. The majority involve the profundus tendon of the small finger in the palm. The ruptures most often occur during periods of peak strain but can also occur without identifiable trauma. The pathogenesis of spontaneous tendon ruptures is still unclear and is likely multifactorial. Spontaneous flexor tendon ruptures of the hand occur more often than one might recognize.
Collapse
Affiliation(s)
- Aaron J Bois
- Divisions of Orthopaedic Surgery and Plastic Surgery, Department of Surgery, The University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | | | | |
Collapse
|
29
|
Jeremić J, Vucetić C, Golubović Z, Petronić I. [The influence of duration of Kleinert immobilization on the functional recovery of primarly reconstructed flexor tendons in children and adult patients]. ACTA CHIRURGICA IUGOSLAVICA 2007; 53:73-8. [PMID: 17338204 DOI: 10.2298/aci0603073j] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Flexor tendon repair in the hand is very often complicated by the formation of peritendinous adhesions that result in loss of normal tendon gliding, digital stiffnes and functional disability. While stability is critical for a successful tendon repair, mobility is also important, as motion of the repaired tendon decreases the formation of postoperative adhesions and increases the strength of the repair. Immobilization and its duration, can ensure the integrity of the repair but can also lead to scaring, stiffness, and joint contractures. This study included 20 children and 39 adult patients, in the period from January 2000 to April 2003., with flexor tendon ruptures of the hand. Tendons were primary repaired using direct tennoraphy, and postoperately patients were treated with Kleinert dynamic imobilization. The aim of this study was to investigate the influence of the duration of the dynamic immobilization on successful postoperative functional recovery, separately in children and adult patients. Research in this area has been directed at achieving the optimal balance between stability and mobility, without compromising one for the other.
Collapse
Affiliation(s)
- J Jeremić
- Centar za opekotine, plasticnu i rekonstruktivnu hirurgiju, KCS, Beograd
| | | | | | | |
Collapse
|