1
|
Hendrycks RJ, Reed ER, Graham EM, Patel NK, Rosales M, Mendenhall SD. Learning Curve of Wrist-level Tendon Repairs Using a Novel Tendon Stapler versus Traditional Suture Methods. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5167. [PMID: 37577245 PMCID: PMC10419657 DOI: 10.1097/gox.0000000000005167] [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: 05/14/2023] [Accepted: 06/23/2023] [Indexed: 08/15/2023]
Abstract
Numerous effective techniques for primary tendon coaptations exist. However, these techniques are complex and require a substantial amount of training to become proficient. Recently, a novel tendon stapler device (TSD) was developed that could potentially diminish the discrepancies among surgeons of varying levels of training. We hypothesized that the TSD would be easier to learn and would demonstrate improved learning curve efficiencies across participants of differing tendon repair experience compared with traditional suture methods. Participants included a novice, intermediate, and expert in tendon repairs. Comparisons were performed on wrist-level flexors and extensors from human donor arms. The suture repairs were performed with a modified Kessler with a horizontal mattress and were performed in one session on two donor arms by each participant. In a second session, each participant performed the TSD repairs on the matched, contralateral donor arms. Scatterplots fitted with Loess curves, one-way analysis of variance, Tukey pairwise comparisons, two-sided independent samples t test, and Fisher exact test were used to analyze findings. Results of our study showed that TSD repair times did not vary significantly by experience level. Suture repairs reached a stable "learned" level around repair #30, whereas the TSD repairs showed a more efficient curve that stabilized around repair #23. The TSD required less educational time, demonstrated a more efficient learning curve, and showed less variability across participants and repair order. Overall, the TSD is easy to adopt and may carry positive implications for surgeons and patients.
Collapse
Affiliation(s)
- Russell J. Hendrycks
- From the Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Evelyn R. Reed
- From the Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Emily M. Graham
- From the Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Niki K. Patel
- Division of Plastic, Reconstructive, and Oral Surgery, Division of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Megan Rosales
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Shaun D. Mendenhall
- Division of Plastic, Reconstructive, and Oral Surgery, Division of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| |
Collapse
|
2
|
Graham EM, Oliver JD, Hendrycks R, Maglic D, Mendenhall SD. Alternative Tendon Coaptations to the Pulvertaft Weave Technique: A Systematic Review and Meta-Analysis of Biomechanical Studies. Hand (N Y) 2023; 18:446-455. [PMID: 34528473 PMCID: PMC10152540 DOI: 10.1177/15589447211043213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Pulvertaft weave technique (PT) is frequently used during tendon repairs and transfers. However, this technique is associated with limitations. In this systematic review and meta-analysis, quantitative and qualitative analyses were performed on in vitro, biomechanical studies that compared the PT with alternative techniques. METHODS Articles included for qualitative and/or qualitative analysis were identified following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies included in the meta-analysis were analyzed either as continuous data with inverse variance and random effects or as dichotomous data using a Mantel-Haenszel analysis assuming random effects to calculate an odds ratio. RESULTS A comprehensive electronic search yielded 8 studies meeting inclusion criteria for meta-analysis. Two studies with a total of 65 tendon coaptations demonstrated no significant difference in strength between the PT and traditional side-to-side (STS) techniques (P = .92). Two studies with a total of 43 tendon coaptations showed that the STS with 1 weave has a higher yield strength than the PT (P = .03). Two studies with a total of 62 tendon repairs demonstrated no significant difference in strength between the PT and the step-cut (SC) techniques (P = .70). The final 2 studies included 46 tendon repairs and demonstrated that the wrap around (WA) technique has a higher yield strength than the PT (P < .001). CONCLUSIONS The STS, SC, and WA techniques are preferred for improving tendon form. The STS and WA techniques have superior yield strengths than the PT, and the SC technique withstands similar stress to failure as the PT.
Collapse
Affiliation(s)
- Emily M. Graham
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jeremie D. Oliver
- Department of Biomedical Engineering, University of Utah, Salt Lake
City, UT, USA
| | | | - Dino Maglic
- Division of Plastic Surgery, Department of Surgery, University of Utah
School of Medicine, Salt Lake City, UT, USA
| | - Shaun D. Mendenhall
- Division of Plastic Surgery, Department of Surgery, University of Utah
School of Medicine, Salt Lake City, UT, USA
- Division of Plastic and Reconstructive Surgery, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
3
|
Stirling PHC, McEachan JE. In vitro testing of flexor tendon repair models: variability in the current literature. J Hand Surg Eur Vol 2023; 48:162-168. [PMID: 36428224 DOI: 10.1177/17531934221139068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
4
|
Civera M, Devietti Goggia E, De Ros M, Burgio V, Bergamin F, Rodriguez Reinoso M, Surace C. Implantable medical devices for tendon and ligament repair: a review of patents and commercial products. Expert Rev Med Devices 2022; 19:825-845. [DOI: 10.1080/17434440.2022.2142557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Marco Civera
- Laboratory of Bio-Inspired Nanomechanics, Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, Turin, Italy
| | - Ester Devietti Goggia
- Laboratory of Bio-Inspired Nanomechanics, Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, Turin, Italy
| | - Matteo De Ros
- Laboratory of Bio-Inspired Nanomechanics, Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, Turin, Italy
| | - Vito Burgio
- Laboratory of Bio-Inspired Nanomechanics, Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, Turin, Italy
| | - Federica Bergamin
- Department of Hand, Plastic and Reconstructive Surgery, Ivrea Hospital, Ivrea, Italy
| | - Mariana Rodriguez Reinoso
- Laboratory of Bio-Inspired Nanomechanics, Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, Turin, Italy
| | - Cecilia Surace
- Laboratory of Bio-Inspired Nanomechanics, Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, Turin, Italy
| |
Collapse
|
5
|
Kadar A, Fainzack A, Vigler M. Dynamic Tendon Grip (DTG™) novel knot array compared to traditional sutures for zone two flexor tendon injury - a biomechanical feasibility study. BMC Musculoskelet Disord 2022; 23:320. [PMID: 35379221 PMCID: PMC8978384 DOI: 10.1186/s12891-022-05279-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Flexor tendon injuries pose many challenges for the treating surgeon, the principal of which is creating a strong enough repair to allow early active motion, preserving a low-profile of the repair to prevent buckling and subsequent pulley venting. A main concern is that a low-profile repair is prone to gap formation and repair failure. The Dynamic Tendon Grip (DTG™) all suture staple device claims to allow a strong and low-profile repair of the flexor tendon. The purpose of this study is to test the effects of the DTG™ device in early active motion simulation on range of motion, load to failure and gap formation and to compare it to traditional suturing technique. METHODS Twelve fresh-frozen cadaveric fingers were assigned to two groups: DTG™ device (n = 9) and traditional suturing (double Kessler 4-core suture and a peripheral suture, n = 3). The deep flexor was incised and repaired in zone 2, and active motion simulation was carried out with a cyclic flexion-extension machine. Finger range of motion and gap formation were measured, as well as load to failure and method of repair failure. RESULTS Following motion simulation, ROM decreased from 244.0 ± 9.9° to 234.5 ± 5.8° for the DTG™ device compared to 234.67 ± 6.51° to 211.67 ± 10.50° for traditional suturing. The DTG™ repair demonstrated gap formation of 0.93 ± 0.18 mm in 3 of 8 specimens after applying 1 kg load, which negated after load removal. Load to failure averaged 76.51 ± 23.15 N for DTG™ and 66.31 ± 40.22 N for the traditional repair. Repair failure occurred as the suture material broke for the DTG™ array and at the knot level for the traditional repair. CONCLUSIONS The DTG™ all-suture stapling concept achieved a strong low-profile repair in zone 2 flexor tendon injury after active motion simulation. Further clinical studies will be needed to determine the effectiveness of this device compared to traditional techniques.
Collapse
Affiliation(s)
- Assaf Kadar
- Rabin Medical Center, 39 Jabotinski, Petach Tikva, Israel. .,Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 49100, Tel Aviv, Israel.
| | - Alon Fainzack
- Rabin Medical Center, 39 Jabotinski, Petach Tikva, Israel.,Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 49100, Tel Aviv, Israel
| | - Mordechai Vigler
- Rabin Medical Center, 39 Jabotinski, Petach Tikva, Israel.,Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 49100, Tel Aviv, Israel
| |
Collapse
|
6
|
Dy CJ. What's New in Hand and Wrist Surgery. J Bone Joint Surg Am 2021; 103:463-468. [PMID: 33464783 DOI: 10.2106/jbjs.20.01984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Christopher J Dy
- Department of Orthopaedic Surgery and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|