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Biomechanical Comparison of a 3-Loop Pulley and a 4-Loop Pulley Suture for Tenorrhaphy in the Canine Gastrocnemius Tendon. Vet Comp Orthop Traumatol 2022; 35:321-330. [PMID: 35760366 DOI: 10.1055/s-0042-1749398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The aim of this study was to compare a 3-loop pulley (3LP) suture pattern with a 4-loop pulley (4LP) suture pattern for the tenorrhaphy of the canine gastrocnemius tendon STUDY DESIGN: Randomized, cadaveric, biomechanical study of 30 canine gastrocnemius tendons. Tendons were transected and repaired with either 3LP or 4LP suture pattern with 2-0 polypropylene. A tensile load was applied at 25 mm/min until construct failure. The load required to form a 1 mm gap, 3 mm gap and maximum load at failure was recorded and compared between groups. RESULTS The estimated mean load to form a 1 mm gap for the 3LP and 4LP was 28.4 N (95% confidence interval [CI]: 24.0-32.6N) and 45.5 N (95% CI: 40.7-50.1N) respectively. The 4LP mean load to form a 1 mm gap was 17.1 N (95% CI: 11.7-22.5N) greater than the 3LP. The estimated mean load to form a 3mm gap for the 3LP and 4LP was 39.7 N (95% CI: 34.1-45.4N) and 55.0 N (95% CI: 49.3-60.9N) respectively. The mean load to form a 3mm gap was 15.3 N (95% CI: 8.5-21.9N) greater in the 4LP than the 3LP. The estimated mean load for failure in the 3LP and 4LP was 41.2 N (95% CI: 35.6-46.9 N) and 54.3 N (95% CI: 48.7-60.3 N) respectively. CONCLUSION A 4LP pattern was biomechanically superior to a 3LP pattern, as demonstrated by a greater load required to form both a 1 and 3 mm gap and a greater load for failure CLINICAL SIGNIFICANCE: A 4LP suture pattern better resists gap formation and requires greater load prior to construct failure compared with a 3LP, in this canine gastrocnemius model.
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Chang YJ, Duffy DJ, Beamon W, Moore GE. Ex vivo biomechanical characteristics and effects on gap formation of using an internal fixation plate to augment primary three-loop pulley repair of canine gastrocnemius tendons. Am J Vet Res 2022; 83:305-311. [PMID: 35092666 DOI: 10.2460/ajvr.21.07.0088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
OBJECTIVE To evaluate the effects of using an internal fixation plate to augment primary 3-loop pulley (3LP) repair of canine gastrocnemius tendons (GTs). SAMPLE 48 cadaveric GTs from 24 adult dogs. PROCEDURES GTs were dissected free from other tissues, transected, and randomly assigned to 4 groups (n = 12/group). GTs were repaired with 2-0 polypropylene with a 3LP repair alone or a 3LP repair augmented with a 3-hole veterinary cuttable plate (3VCP), a 5-hole veterinary cuttable plate (5VCP), or a 7-hole veterinary cuttable plate (7VC P). Biomechanical loads, construct stiffness, gap formation, and failure modes were compared between groups. RESULTS Yield, peak, and failure loads were all significantly increased for the 5VCP and 7VCP groups, compared with the 3LP alone group. Increasing plate length from 3VCP to 5VCP and from 3VCP to 7VCP increased yield, peak, and failure loads. No differences were found between the 3LP and 3VCP groups with regard to yield and peak loads, but failure load was increased in the 3VCP group. Loads to create 1-mm and 3-mm gaps were significantly greater for the 5VCP and 7VCP groups, compared with the 3LP alone and 3VCP groups. Mode of plate attachment failure differed among groups. CLINICAL RELEVANCE Tendon plate augmentation may be a viable surgical option to increase the strength of the tenorrhaphy in dogs. However, in vivo studies evaluating the effects of plate augmentation on the tendon blood supply and progression of healing are needed prior to clinical application.
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Affiliation(s)
- Yi-Jen Chang
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Daniel J Duffy
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Wes Beamon
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - George E Moore
- Department of Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, IN
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Chang YJ, Duffy DJ, Moore GE. Investigation of the effects of two-, four-, six- and eight-strand suture repairs on the biomechanical properties of canine gastrocnemius tenorrhaphy constructs. Am J Vet Res 2021; 82:948-954. [PMID: 34714764 DOI: 10.2460/ajvr.20.11.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the effects of 2-, 4-, 6- and 8-strand suture repairs on the biomechanical properties of canine gastrocnemius tenorrhaphy constructs in an ex vivo model. SAMPLE 56 cadaveric gastrocnemius musculotendinous units from 28 adult large-breed dogs. PROCEDURES Tendons were randomly assigned to 4 repair groups (2-, 4-, 6- or 8-strand suture technique; n = 14/group). Following tenotomy, repairs were performed with the assigned number of strands of 2-0 polypropylene suture in a simple interrupted pattern. Biomechanical testing was performed. Yield, peak, and failure loads, the incidence of 1- and 3-mm gap formation, forces associated with gap formation, and failure modes were compared among groups. RESULTS Yield, peak, and failure forces differed significantly among groups, with significantly greater force required as the number of suture strands used for tendon repair increased. The force required to create a 1- or 3-mm gap between tendon ends also differed among groups and increased significantly with number of strands used. All constructs failed by mode of suture pull-through. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that increasing the number of suture strands crossing the repair site significantly increases the tensile strength of canine gastrocnemius tendon repair constructs and their resistance to gap formation. Future studies are needed to assess the effects of multistrand suture patterns on tendon glide function, blood supply, healing, and long-term clinical function in dogs to inform clinical decision-making.
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Affiliation(s)
- Yi-Jen Chang
- From the Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607
| | - Daniel J Duffy
- From the Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607
| | - George E Moore
- Department of Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47906 (Moore)
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Hong CK, Chuang HC, Hsu KL, Kuan FC, Chen Y, Yeh ML, Su WR. Knots Tied With High-Tensile Strength Tape Biomechanically Outperform Knots Tied With Round Suture. Orthop J Sports Med 2021; 9:23259671211039554. [PMID: 34671688 PMCID: PMC8521428 DOI: 10.1177/23259671211039554] [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: 05/16/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background Tape-type suture material is well-accepted in arthroscopy surgery. Purpose To compare the knot security of a high-tensile strength round suture and high-tensile strength tape with commonly used arthroscopic knots. Study Design Controlled laboratory study. Methods We compared the performance of No. 2 braided nonabsorbable high-strength suture with that of 1.3-mm braided nonabsorbable high-strength tape. Five commonly used arthroscopic knots were investigated: the Roeder knot; the Western knot; the Samsung Medical Center (SMC) knot; the Tennessee knot; and a static surgeon's knot. Seven knots were tied for each combination of knots and suture types. Knots were tied on a 30-mm circumferential metal post, and the suture loops were transferred to a materials testing machine. After preloading to 5 N, all specimens were loaded to failure. The clinical failure load, defined as the maximal force to failure at 3 mm of crosshead displacement, yield load, and stiffness, were recorded. A 2-way analysis of variance was used to determine differences between the groups. Results Both suture type and knot type significantly affected the clinical failure load, yield load, and stiffness (P = .002). The high-strength tape resulted in a significantly greater clinical failure load than the high-strength suture in the case of the Roeder knot, Western knot, and SMC knot (P = .027, .005, and .016, respectively). When the high-strength round suture was used, the Roeder knot, Western knot, and SMC knot resulted in significantly smaller clinical failure loads compared with the Tennessee knot (P = .011, .003, and .035, respectively) and the static surgeon's knot (P < .001 for all). When the high-strength tape was used, the Roeder knot, Western knot, and SMC knot resulted in significantly smaller clinical failure loads compared with the static surgeon's knot (P = .001, .001, and .003, respectively). Conclusion The results of this study indicated that arthroscopic knots tied using 1.3-mm high-strength tape biomechanically outperformed knots tied using a No. 2 high-strength suture. While the static surgeon's knot exhibited the best biomechanical properties, the Tennessee knot resulted in generally better biomechanical properties among the arthroscopic sliding knots. Clinical Relevance Elongation and loosening of tied knots possibly affects the clinical results of repaired constructs.
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Affiliation(s)
- Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Hao-Chun Chuang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan
| | - Yueh Chen
- Department of Orthopaedic Surgery, Sin Lau Hospital, Tainan City, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan.,Medical Device Innovation Center, National Cheng Kung University, Tainan City, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.,Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan City, Taiwan
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Hale MJ, Zellner EM, Naiman JH, Kraus KH. Ex vivo mechanical testing of various suture patterns for use in tendon plating. Vet Surg 2021; 50:1296-1303. [PMID: 34076285 DOI: 10.1111/vsu.13659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/09/2021] [Accepted: 05/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the influence of suture patterns on resistance to gap formation after tendon plating STUDY DESIGN: Ex vivo study SAMPLE POPULATION: Suspensory ligament and superficial and deep digital flexor tendons harvested from 16 neonatal cadaver foal limbs. METHODS Each tendon/ligament from a given limb was randomly assigned to one of three treatment groups consisting of a 7-hole veterinary cuttable plate fixed with alternating simple interrupted, figure-8, or hybrid suture patterns. The constructs were distracted at a rate of 1.0 mm/s to failure, as determined by the formation of a 1 mm gap for initial failure and a 3 mm gap for ultimate failure. The mode of failure was also recorded. RESULTS Constructs prepared with hybrid and figure-8 patterns sustained over 2× higher (p < .01) forces before gap formation compared to those prepared with a simple interrupted pattern. No difference was identified between tendons whose plate was secured with hybrid or figure-8 suture patterns. Mode of failure between groups did not differ. CONCLUSION The figure-8 and hybrid patterns described herein improved the resistance to gap formation of plated tendons compared to an alternating simple interrupted pattern described previously. CLINICAL SIGNIFICANCE Figure-8 and hybrid patterns should be considered over simple interrupted patterns to improve resistance to gap formation in horses undergoing tendon plating.
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Affiliation(s)
| | - Eric M Zellner
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa, USA
| | - Jaron H Naiman
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa, USA
| | - Karl H Kraus
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa, USA
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Giacchi A, McMaster MA. An ex vivo biomechanical comparison of two suture materials and two pattern combinations for equine superficial digital flexor tendon tenorrhaphy. Vet Surg 2021; 50:1137-1146. [PMID: 33982804 DOI: 10.1111/vsu.13658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 04/25/2021] [Accepted: 04/29/2021] [Indexed: 11/28/2022]
Abstract
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 + PDS1, 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.
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Affiliation(s)
- Andrea Giacchi
- Weipers Centre Equine Hospital, School of Veterinary Medicine, University of Glasgow, Glasgow, UK
| | - Mattie A McMaster
- Weipers Centre Equine Hospital, School of Veterinary Medicine, University of Glasgow, Glasgow, UK
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