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Fine tuning of the side-to-side tenorrhaphy: A biomechanical study assessing different side-to-side suture techniques in a porcine tendon model.

ABSTRACT: Recent studies conclude that a new technique for tendon transfers, the side-to-side tenorrhaphy by Fridén (FR) provides higher biomechanical stability than the established standard first described by Pulvertaft (PT). The aim of this study was to optimize side-to-side tenorrhaphies. We compared PT and FR tenorrhaphies as well as a potential improvement, termed Woven-Fridén tenorrhaphy (WF), with regard to biomechanical stability. Our results demonstrate superior biomechanical stability and lower bulk of FR and, in particular, WF over PT tenorrhaphies. The WF and FR technnique therefore seem to be a notable alternative to the established standard tenorrhaphy as they display lower bulk and higher stability, permitting successful immediate active mobilization after surgery.

SUBMITTER: Wilhelm CJ

PROVIDER: S-EPMC8491917 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Fine tuning of the side-to-side tenorrhaphy: A biomechanical study assessing different side-to-side suture techniques in a porcine tendon model.

Wilhelm Christina J CJ Englbrecht Marc A MA Burgkart Rainer R Micheler Carina C Lang Jan J Hagen Christine S CS Giunta Riccardo E RE Wachtel Nikolaus N

PloS one 20211005 10

Recent studies conclude that a new technique for tendon transfers, the side-to-side tenorrhaphy by Fridén (FR) provides higher biomechanical stability than the established standard first described by Pulvertaft (PT). The aim of this study was to optimize side-to-side tenorrhaphies. We compared PT and FR tenorrhaphies as well as a potential improvement, termed Woven-Fridén tenorrhaphy (WF), with regard to biomechanical stability. Our results demonstrate superior biomechanical stability and lower ...[more]

PMID: 34610029

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Project description:BackgroundPercutaneous repair of acute Achilles tendon rupture (ATR) continues to gain in popularity. The primary aim of the study was to review the outcomes of a patient cohort undergoing a novel technique of endoscopic percutaneous Achilles tendon repair with absorbable suture. A secondary purpose of this study was to evaluate the basic biomechanical properties of the technique.MethodsA cohort of 30 patients who underwent percutaneous ATR repair was retrospectively analyzed with Achilles Tendon Rupture Scores (ATRS), complications, and additional outcome measures. For a biomechanical analysis portion of the study, 12 cadaveric specimens were paired and randomized to either novel percutaneous repair or open Kessler repair with absorbable suture. These specimens were subjected to 2 phases of cyclical testing (100 cycles 10-43 N followed by 200 cycles 10-86 N) and ultimate strength testing.ResultsIn the clinical portion of the study we report excellent patient reported outcomes (mean ATRS 94.1), high level of return to sport, and high patient satisfaction. One partial re-rupture was reported but with no major wound or neurologic complications. In the biomechanical portion of the study we found no significant difference in tendon gapping between percutaneous and open repairs in phase 1 of testing. In phase 2, increased gapping occurred between percutaneous (17.8 mm [range 10.7-24.1, SD 6.4]) and open repairs (10.8 mm [range 7.6-14.9, SD 2.7, P = .037]). The ultimate load at failure was not statistically different between the 2 repairs.ConclusionsA percutaneous ATR repair technique using endoscopic assistance and absorbable suture demonstrated low complications and good outcomes in a cohort of patients, with high satisfaction, and excellent functional outcomes including high rates of return to sport. Cadaveric biomechanical testing demonstrated excellent survival during testing and minimal increase in gapping compared with open repair technique, representing sufficient strength to withstand forces seen in early rehabilitation. A percutaneous Achilles tendon repair technique with absorbable suture may minimize risks associated with operative repair while still maintaining the benefit of operative repair.Level of evidenceLevel IV, retrospective case series.

Project description:PurposeThe purpose of this study was to evaluate three different methods of attachment of continuous loop suspensory cortical preparation of all soft tissue central quad tendon grafts compared to a bone block control for anterior cruciate ligament reconstruction on construct displacement and load to failure.MethodsThirty-two cadaveric central quadriceps tendon (CQT) specimens were harvested, using three clinical techniques for graft fixation: cortical button alone (BTB EB), BTB cortical button with rip-stop suture (BTB RS), and continuous loop cortical button (BTB CL). A control group was also included that consisted of a bone block secured within testing clamps (BTB CON). Specimens were preloaded to 150 N. Tendons were then cyclically loaded between 50 N and 250 N for 1,000 cycles at .5 Hz. Displacement was measured at the point of fixation of the CQT after the 150 N preload, 250 N initial load and every 100th cycle. The specimens were loaded to failure after 1,000 cycles.ResultsThere was a significant increase in displacement from .32 ± .56 mm for the BTB CON to 1.91 ± 1.13 mm for the BTB RS (P = .014) and 3.85 ± 2.32 mm for the BTB CL condition (P = .023). There was no significant increase in displacement for BTB EB (P = .182). Failure occurred for all of the BTB CL and 62.5% of the BTB EB specimens within the first 50 cycles. Twenty-five percent of the BTB CON specimens and 12.5% BTB RS failed at ∼400 and 500 cycles, respectively. Similar failure loads were observed for the BTB CON and the BTB RS (446.4 ± 151.46 N vs 505.74 ± 131.41 N; P = .99) Failure testing was not feasible for the BTB CL and BTB EB preparation methods.ConclusionIn response to cyclic loading, the three all-soft tissue suspensory conditions experienced significantly greater displacement compared to the bone block controls. None of the soft-tissue conditions appeared superior when compared to each other.Clinical relevanceIt remains unknown which method of soft-tissue suspensory provides optimal fixation. As these autografts become more common, it is essential to evaluate which fixation methods provide superior outcomes.

Dataset Information

Fine tuning of the side-to-side tenorrhaphy: A biomechanical study assessing different side-to-side suture techniques in a porcine tendon model.

Publications

Fine tuning of the side-to-side tenorrhaphy: A biomechanical study assessing different side-to-side suture techniques in a porcine tendon model.

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