Biomechanical testing of a novel suture pattern for repair of equine tendon lacerations

Cyclic tensile tests of Shetland pony superficial digital flexor tendons (SDFTs) with an optimized cryo-clamp combined with biplanar high-speed fluoroscopy

Background

Long-term cyclic tensile testing with equine palmar/plantar tendons have not yet been performed due to problems in fixing equine tendons securely and loading them cyclically. It is well established that the biomechanical response of tendons varies during cyclic loading over time. The aim of this study was to develop a clamping device that enables repetitive cyclic tensile testing of equine superficial digital flexor tendon for at least 60 loading cycles and for 5 min.

Results

A novel cryo-clamp was developed and built. Healthy and collagenase-treated pony SDFTs were mounted in the custom-made cryo-clamp for the proximal tendon end and a special clamping device for the short pastern bone (os coronale). Simultaneously with tensile testing, we used a biplanar high-speed fluoroscopy system (FluoKin) to track tendon movement. The FluoKin system was additionally validated in precision measurements. During the cyclic tensile tests of the SDFTs, the average maximal force measured was 325 N and 953 N for a length variation of 2 and 4 % respectively. The resulting stress averaged 16 MPa and 48 MPa respectively, while the modulus of elasticity was 828 MPa and 1212 MPa respectively. Length variation of the metacarpal region was, on average, 4.87 % higher after incubation with collagenase. The precision of the FluoKin tracking was 0.0377 mm, defined as the standard deviation of pairwise intermarker distances embedded in rigid bodies. The systems accuracy was 0.0287 mm, which is the difference between the machined and mean measured distance.

Conclusion

In this study, a good performing clamping technique for equine tendons under repetitive cyclic loading conditions is described. The presented cryo-clamps were tested up to 50 min duration and up to the machine maximal capacity of 10 kN. With the possibility of repetitive loading a stabilization of the time-force-curve and changes of hysteresis and creep became obvious after a dozen cycles, which underlines the necessity of repetitive cyclical testing. Furthermore, biplanar high-speed fluoroscopy seems an appropriate and highly precise measurement tool for analysis of tendon behaviour under repetitive load in equine SDFTs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12917-021-02914-w.

An ex vivo biomechanical comparison of two suture materials and two pattern combinations for equine superficial digital flexor tendon tenorrhaphy

OBJECTIVE

To compare biomechanical characteristics of three-loop pulley (3LP) pattern versus Bunnell technique (BT) using polydioxanone (PDS) suture; to determine the influence of polyester tape (PT) versus PDS on the BT for equine superficial digital flexor tendon (SDFT) tenorrhaphy; to compare BT with PT versus 3LP with PDS.

STUDY DESIGN

Ex vivo biomechanical study.

SAMPLE POPULATION

Forty equine forelimb SDFT.

METHODS

Two experiments were performed: (1) 10 SDFT pairs were repaired with 3LP or BT using PDS; (2) 10 SDFT pairs were repaired with PDS or PT using BT. Load at failure, mode of failure, load at 2 mm gap, and gap at failure were obtained using a material testing machine.

RESULTS

In experiment 1, 3LP + PDS₁ had higher loads at failure (p < .001) and at 2 mm gap (p < .001), and smaller gap at failure than BT + PDS₁ (p = .024). In experiment 2, BT + PT₂ had higher loads at failure (p < .001) and at 2 mm gap (p = .001), and larger gap at failure (p = .004) than the BT + PDS₂ . 3LP + PDS₁ and BT + PT₂ mostly failed by suture/implant pull-through while BT + PDS failed by suture breakage. BT + PT₂ had greater load (p = .035) and gap at failure (p < .001) than 3LP + PDS_1, with no difference in load at 2 mm gap (p = .14).

CONCLUSION

The use of BT may be justified over 3LP if combined with PT. However, the larger size of the PT required stab incisions in the tendon for placement and was subjectively more difficult to place than PDS.

CLINICAL SIGNIFICANCE

The BT + PT, although the strongest among the tested repairs, would only be able to withstand 12%-24% of the load encountered by the SDFT at walk.

Comparison of Clinical, Biomechanical, and Histopathological Effects of Various Suture Techniques on Repair of Tendon Rupture by using Autograft

Introduction

The purpose of this study was to compare the effectiveness of four different suture techniques in the treatment of experimentally modelled tendon injuries with tissue loss with autograft and grafting applications in rabbits.

Material and Methods

The study was performed on 30 male mature (2-year-old) New Zealand rabbits with mean body weight of 3.1 kg, divided into three equal groups. A graft measuring 1 cm in length was collected from the m. tibialis cranialis of each rabbit under general anaesthesia. The graft collected from the right tendon was transplanted into the left tendon, and the graft from the left tendon was transplanted into the right tendon. In all groups, a simple interrupted suture was placed on the left tendon as control, a Bunnell-Mayer suture was placed on the right tendon in group I, a Locking-Loop suture in group II, and a Horizontal U suture in group III. Both hindlimbs were bandaged for four weeks. The tendons were assessed biomechanically and histopathologically.

Results

According to the results of the tensile testing, the maximum durability of the techniques ranked as follows: Bunnell-Mayer, Horizontal U, Locking-Loop, and control groups.

Conclusion

The use of autografts was a good alternative for the treatment of tendon ruptures with tissue loss. Furthermore, even though there were no clinical or histopathological differences, the suture technique can be chosen based on the results of the tensile test.

Decellularized and Engineered Tendons as Biological Substitutes: A Critical Review

Tendon ruptures are a great burden in clinics. Finding a proper graft material as a substitute for tendon repair is one of the main challenges in orthopaedics, for which the requirement of a biological scaffold would be different for each clinical application. Among biological scaffolds, the use of decellularized tendon-derived matrix increasingly represents an interesting approach to treat tendon ruptures. We analyzed in vitro and in vivo studies focused on the development of efficient protocols for the decellularization and for the cell reseeding of the tendon matrix to obtain medical devices for tendon substitution. Our review considered also the proper tendon source and preclinical animal models with the aim of entering into clinical trials. The results highlight a wide panorama in terms of allogenic or xenogeneic tendon sources, specimen dimensions, physical or chemical decellularization techniques, and the cell type variety for reseeding from terminally differentiated to undifferentiated mesenchymal stem cells and their static or dynamic culture employed to generate implantable constructs tested in different animal models. We try to identify the most efficient approach to achieve an optimal biological scaffold for biomechanics and intrinsic properties, resembling the native tendon and being applicable in clinics in the near future, with particular attention to the Achilles tendon substitution.