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Zuo Y, Luo J, Zhang X. A review on the use of porcine in tendon research. Ann Anat 2023; 250:152166. [PMID: 37806500 DOI: 10.1016/j.aanat.2023.152166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 09/02/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE OF REVIEW Large animals have been increasingly employed in tendon research; the objective of this review was to summarize the employment of porcine in tendon research. RECENT FINDINGS Literature before 2022-03-31 was searched using the following strategy: (pig[MeSH Terms]) AND (tendon[MeSH Terms]); (pig[MeSH Terms]) AND (tendon[title]); (tendon[MeSH Terms]) AND (porcine[title]); (tendon[title]) AND (porcine[title]); (tendon[MeSH Terms]) AND (pig[title]); (tendon[title]) AND (pig[title]); (tendon[MeSH Terms]) AND (swine[title]); (tendon[title]) AND (swine[title]). 296 studies were included in this review. There were wide application areas of porcine tendon, including tissue engineering tendons, training of surgical skills. Porcine tendon was used both in in vitro studies, such as anatomy, biomechanics, cytology, and material science as well as in in vivo studies. The research techniques of porcine tendon are relatively common. SUMMARY In conclusion, pigs have been widely used as a good animal model of tendon research. However, the limitations of porcine tendon research (the lack of anatomical research and in vivo studies) should be given more attention in future studies.
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Affiliation(s)
- Yanhai Zuo
- Department of Orthopedics, SiJing hospital of SongJiang District, Shanghai, China.
| | - Jingtao Luo
- Department of Orthopedics, SiJing hospital of SongJiang District, Shanghai, China
| | - Xinjun Zhang
- Department of Orthopedics, SiJing hospital of SongJiang District, Shanghai, China.
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Nassar M, Sallam A, Sokkar S, Abdelsadek H, Zada M. Comparison of 4 Different 4-Strand Core Suturing Techniques for Flexor Tendon Laceration: An Ex Vivo Biomechanical Study. Hand (N Y) 2023; 18:820-828. [PMID: 35132896 PMCID: PMC10336818 DOI: 10.1177/15589447211073831] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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 Forces applied to the repaired flexor tendon should not exceed its yield force during early postoperative rehabilitation to prevent gapping and rupture. We aimed to biomechanically compare the tensile strengths and the 2-mm gapping of 4 different 4-strand core suturing techniques for flexor tendon repair. METHODS Fifty-six goat deep digital flexor tendons were repaired with the 4-strand double-modified Kessler, the 4-strand augmented Becker, the 4-strand Savage, and the 4-strand modified Tang techniques. All tendons were repaired with 4-0 polyester for core suture and 5-0 polyester for continuous epitendinous running suture. The specimens were subjected to static linear tensile testing by applying a single linear load-to-failure pull. After the linear load testing, the yield load, the ultimate strength of the repaired tendons, and the force exerted to yield a 2-mm gap were measured. RESULTS All peripheral sutures ruptured near the yield point. All core suture techniques were similar regarding the yield force. The augmented Becker 4-strand technique had the greatest ultimate strength (98.7 [82-125.3] N). The modified double Kessler technique was the weakest in resisting a 2-mm gap formation. The 4-strand modified Tang repair had the shortest (11.3 [7-15] minutes), while the 4-strand augmented Becker had the longest operative time (29 [23-33] minutes). CONCLUSIONS All 4 techniques demonstrated similar yield force, with differences in operative time, ultimate strength, and resistance to gapping. Future clinical studies can further elucidate their appropriateness for early active motion protocols.
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Affiliation(s)
| | - Asser Sallam
- Suez Canal University Hospitals, Ismailia, Egypt
| | | | | | - Mohamed Zada
- Suez Canal University Hospitals, Ismailia, Egypt
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Kiszely A, Giddins G. Risk of tendon failure with repeated passage of Kirschner wires or hypodermic needles: an experimental study. J Hand Surg Eur Vol 2022; 47:507-512. [PMID: 35001718 DOI: 10.1177/17531934211067667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
During hand surgery, tendons may be at risk of damage. This biomechanical study aims to assess the risk of tendon rupture due to passage of Kirschner wires or hypodermic needles. Porcine extensor tendons were divided into four groups. Group 1: a control group was tested to ensure that repeated stress alone did not cause failure. Group 2a: 1.1-mm Kirschner wires were hand pushed through tendons 50 times and then stressed to 40 N, repeated until tendon failure. In Group 2b, K-wires were passed while rotating using a drill. Group 3: the experiment was repeated using a 20 G hypodermic needle. Group 2a tendons required a median of 2450 passes (1150-3500) to propagate failure, Group 2b a median of 2250 (1200-3850) and Group 3a median of 200 passes (150-450). The risk of tendon rupture from wires or hypodermic needles in procedures appears very low.
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Ajam Y, Midha S, Tan ACW, Blunn G, Kalaskar DM. Design and In Vivo Testing of Novel Single-Stage Tendon Graft Using Polyurethane Nanocomposite Polymer for Tendon Reconstruction. J Plast Reconstr Aesthet Surg 2021; 75:1467-1475. [PMID: 34953746 DOI: 10.1016/j.bjps.2021.11.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 11/14/2021] [Indexed: 11/18/2022]
Abstract
Severe trauma, failure of prior surgical repair, delayed presentation and excessive scarring around the flexor tendon bed often necessitate a two-stage surgical reconstruction, where a silicone spacer is used in the first stage to recreate the fibro-osseous tunnel through which the tendon graft can glide in the second stage. This staged procedure involves great commitment on the part of both patient and surgeon, over the course of several months, involving a prolonged period of rehabilitation that can be quite disruptive to the patient's life and work. Reducing this from a two-stage into a single-stage procedure, therefore, has the potential to reduce rehabilitation time and cost, expedite return to work, and improve outcomes. To address this, we developed polyurethane (PU) nanocomposite, as an engineered tendon sheath, for treatment of delayed flexor tendon division as a single-stage procedure. The clinically conformant tubular grafts were tested for their efficacy in the peroneus tertius tendon of 6 Mule sheep for 3 months. Semi-quantitative histological assessment was carried out by analysing four descriptive layers: tendon, tendon/polymer sheath interface, polymer sheath, and polymer sheath/surrounding tissue. Four (out of 6) of the implanted PU nanocomposites showed moderate to substantial healing of the injured tendons, with minimal adhesion after repair, ensuring good gliding movement. No statistical differences were observed in tendon repair based on intra-regional variation in the explanted grafts, indicating homogeneity in tendon repair. Overall, the PU nanocomposite bears morphological stability and functionality for tendon repair, in single-stage surgical reconstruction, demonstrating promising evidence for clinical translation.
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Affiliation(s)
- Yazan Ajam
- Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust Hospital, London, United Kingdom
| | - Swati Midha
- UCL Division of Surgery & Interventional Science, University College London, London, United Kingdom; Special Centre for Nanoscience, Jawaharlal Nehru University, New Delhi, 110067, India
| | - Arthur C W Tan
- Ninewells Hospital and Medical School, NHS Tayside, Dundee, United Kingdom
| | - Gordon Blunn
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
| | - Deepak M Kalaskar
- UCL Division of Surgery & Interventional Science, University College London, London, United Kingdom; Royal National Orthopaedic Hospital-NHS Trust, Brockley Hill, Stanmore HA7 4LP, London, United Kingdom.
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Becerikli M, Kopp A, Kröger N, Bodrova M, Wallner C, Wagner JM, Dadras M, Jettkant B, Pöhl F, Lehnhardt M, Jung O, Behr B. A novel titanium implant surface modification by plasma electrolytic oxidation (PEO) preventing tendon adhesion. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 123:112030. [PMID: 33812645 DOI: 10.1016/j.msec.2021.112030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/11/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
Titanium is one of the most commonly used materials for implants in trauma applications due to its low density, high corrosion resistance and biocompatibility. Nevertheless, there is still a need for improved surface modifications of Titanium, in order to change surface properties such as wettability, antibacterial properties or tissue attachment. In this study, different novel plasma electrolytic oxidation (PEO) modifications have been investigated for tendon adhesion to implants commonly used in hand surgery. Titanium samples with four different PEO modifications were prepared by varying the electrolyte composition and analyzed with regards to their surface properties. Unmodified titanium blanks and Dotize® coating served as controls. Samples were examined using scanning electron microscopy (SEM), energy dispersive spectrometer (EDS), contact angle measuring system and analyzed for their biocompatibility and hemocompatibility (according to DIN ISO 10993-5 and 10,993-4). Finally, tendon adhesion of these specific surfaces were investigated by pull-off tests. Our findings show that surface thickness of PEO modifications was about 12-20 μm and had porous morphology. One modification demonstrated hydrophilic behavior accompanied by good biocompatibility without showing cytotoxic properties. Furthermore, no hemolytic effect and no significant influence on hemocompatibility were observed. Pull-off tests revealed a significant reduction of tendon adhesion by 64.3% (35.7% residual adhesion), compared to unmodified titanium (100%). In summary, the novel PEO-based ceramic-like porous modification for titanium surfaces might be considered a good candidate for orthopedic applications supporting a more efficient recovery.
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Affiliation(s)
- Mustafa Becerikli
- Department of Plastic and Reconstructive Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | | | | | | | - Christoph Wallner
- Department of Plastic and Reconstructive Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Johannes Maximilian Wagner
- Department of Plastic and Reconstructive Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Mehran Dadras
- Department of Plastic and Reconstructive Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Birger Jettkant
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Fabian Pöhl
- Chair of Materials Technology, Ruhr-University Bochum, Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic and Reconstructive Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Ole Jung
- Department of Oral and Maxillofacial Surgery, Head- and Neurocenter, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Björn Behr
- Department of Plastic and Reconstructive Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
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Beyond the Core Suture: A New Approach to Tendon Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3280. [PMID: 33425594 PMCID: PMC7787298 DOI: 10.1097/gox.0000000000003280] [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: 09/22/2020] [Accepted: 10/08/2020] [Indexed: 11/26/2022]
Abstract
Despite significant improvements in zone II flexor tendon repair over the last 2 decades, function-limiting complications persist. This article describes 2 novel repair techniques utilizing flexor digitorum superficialis (FDS) autografts to buttress the flexor digitorum profundus (FDP) repair site without the use of core sutures. The hypothesis being that the reclaimed FDS tendon autograft will redistribute tensile forces away from the FDP repair site, increasing overall strength and resistance to gapping in Zone II flexor tendon injuries compared with the current clinical techniques. Methods Two novel FDP repair methods utilizing portions of FDS have been described: (1) asymmetric repair (AR), and (2) circumferential repair. Ultimate tensile strength and cyclical testing were used to compare novel techniques to current clinical standard repairs: 2-strand (2-St), 4-strand (4-St), and 6-strand (6-St) methods. All repairs were performed in cadaveric sheep tendons (n = 10/group), by a single surgeon. Results AR and circumferential repair techniques demonstrated comparable ultimate tensile strength to 6-St repairs, with all 3 of these techniques able to tolerate significantly stronger loads than the 2-St and 4-St repairs (P < 0.0001). Cyclical testing demonstrated that AR and circumferential repair were able to withstand a significantly higher total cumulative force (P < 0.001 and P = 0.0064, respectively) than the 6-St, while only AR tolerated a significantly greater force to 2-mm gap formation (P = 0.042) than the 6-St repair. Conclusion Incorporating FDS as an autologous graft for FDP repair provides at least a comparable ultimate tensile strength and a significantly greater cumulative force to failure and 2-mm gap formation than a traditional 6-St repair.
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Choi RK, Smith MM, Smith S, Little CB, Clarke EC. Functionally distinct tendons have different biomechanical, biochemical and histological responses to in vitro unloading. J Biomech 2019; 95:109321. [DOI: 10.1016/j.jbiomech.2019.109321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 08/02/2019] [Accepted: 08/15/2019] [Indexed: 01/29/2023]
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