Spiral-shaped metallic implant in the treatment of Achilles tendon ruptures: an experimental study on the Achilles tendon of sheep

Analytical relationships for 2D Re-entrant auxetic metamaterials: An application to 3D printing flexible implants

Both 2D and 3D re-entrant designs are among the well-known prevalent auxetic structures exhibiting negative Poisson's ratio. The present study introduces novel analytical relationships for 2D re-entrant hexagonal honeycombs for both negative and positive ranges of the cell interior angle θ (θ<0 showing a negative Poisson's ratio). The derived analytical solutions are validated against finite element method (FEM) and experimental results. The results show that, compared to the analytical solutions available in the literature, the analytical relationships presented in this study provide the most accurate results for elastic modulus, Poisson's ratio, and yield stress. The analytical/computational tools are then implemented for designing Kinesio taping (KT) structures applicable to treatment of Achilles tendon injuries. One of the main features of the Achilles tendon is a natural auxetic behavior. Poisson's ratio distribution of an Achilles tendon is obtained using longitudinal and transverse strains and are then used to design and 3D print thermoplastic polyurethane (TPU) KT structures with non-uniform distribution of auxetic unit cells. The presented novel KT shows that it is capable of replicating the deformation and global and local Poisson's ratio distributions, similar to those of the Achilles tendon. Due to the absence of similar formulations and procedures in the literature, the results are expected to be instrumental for designing and 3D printing of flexible implants with unusual auxeticity.

Tendon-holding capacities of two newly designed implants for tendon repair: an experimental study on the flexor digitorum profundus tendon of sheep

Background:

Two main factors determine the strength of tendon repair; the tensile strength of material and the gripping capacity of a suture configuration. Different repair techniques and suture materials were developed to increase the strength of repairs but none of techniques and suture materials seem to provide enough tensile strength with safety margins for early active mobilization. In order to overcome this problem tendon suturing implants are being developed. We designed two different suturing implants. The aim of this study was to measure tendon-holding capacities of these implants biomechanically and to compare them with frequently used suture techniques

Materials and Methods:

In this study we used 64 sheep flexor digitorum profundus tendons. Four study groups were formed and each group had 16 tendons. We applied model 1 and model 2 implant to the first 2 groups and Bunnell and locking-loop techniques to the 3rd and 4th groups respectively by using 5 Ticron sutures.

Results:

In 13 tendons in group 1 and 15 tendons in group 2 and in all tendons in group 3 and 4, implants and sutures pulled out of the tendon in longitudinal axis at the point of maximum load. The mean tensile strengths were the largest in group 1 and smallest in group 3.

Conclusion:

In conclusion, the new stainless steel tendon suturing implants applied from outside the tendons using steel wires enable a biomechanically stronger repair with less tendon trauma when compared to previously developed tendon repair implants and the traditional suturing techniques.

Biomechanical evaluation of acellular collagen matrix augmented Achilles tendon repair in sheep

The rate of rerupture of repaired Achilles tendon in young and athletic populations remains high despite improvement in surgical techniques, suture design, and postsurgical management. Acellular biological matrices can be used to enhance the immediate strength of repaired tendons and to serve as scaffolds for cell in-growth and constructive tissue remodeling. A number of commercially available matrices have been used clinically, albeit with varying degrees of success and failure. The disparity is likely attributable to the different physical and biochemical properties of individual matrices. In this study, we investigated the biomechanical characteristics of 2 different acellular collagen matrices, namely TissueMend and GraftJacket, using a sheep Achilles tendon repair model. Static and cyclic creep, cyclic and linear construct stiffness, maximum load to failure, and displacement at maximum load were determined at time zero. We found that the maximum load to failure, displacement, and ultimate failure mode were similar between tendons augmented with either acellular collagen matrix; however, TissueMend augmentation yielded lower creep and smaller construct elongation than did GraftJacket. The results indicated that the strength of TissueMend-augmented tendons and GraftJacket-augmented tendons was not statistically significantly different, although tendons augmented with TissueMend displayed greater stiffness, which may be clinically advantageous in the restoration of ruptured tendons.