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Erschienen in: HAND 3/2008

01.09.2008

Does Strand Configuration and Number of Purchase Points Affect the Biomechanical Behavior of a Tendon Repair? A Biomechanical Evaluation Using Different Kessler Methods of Flexor Tendon Repair

Erschienen in: HAND | Ausgabe 3/2008

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Abstract

This study compares the mechanical properties of modified Kessler and double-modified Kessler flexor tendon repair techniques and evaluates simple modifications on both methods. Forty fresh sheep flexor tendons were divided equally into four groups. A transverse sharp cut was done in the middle of each tendon and then repaired with modified Kessler technique, modified Kessler with additional purchase point in the midpoint of each longitudinal strand, double-modified Kessler technique, or a combination of outer Kessler and inner cruciate configuration based on double-modified Kessler technique. The tendons were tested in a tensile testing machine to assess the mechanical performance of the repairs. Outcome measures included gap formation and ultimate forces. The gap strengths of the double-modified Kessler technique (30.85 N, SD 1.90) and double-modified Kessler technique with inner cruciate configuration (33.60 N, SD 4.64) were statistically significantly greater than that of the two-strand modified Kessler (22.56 N, SD 3.44) and modified Kessler with additional purchase configuration (21.75 N, SD 4.03; Tukey honestly significant difference test, P < 0.000). There were statistically significant differences in failure strengths of the all groups (analysis of variance, P < 0.000). With an identical number of strands, the gap formation and ultimate forces of the repairs were not changed by additional locking purchase point in modified Kessler repair or changing the inner strand configuration in double-modified Kessler repair. The results of this study show that the number of strands across the repair site together with the number of locking loops clearly affects the strength of the repair; meanwhile, the longitudinal strand orientation and number of purchase points in a single loop did not affect its strength.
Literatur
1.
Zurück zum Zitat Angeles JG, Heminger H, Mass DP. Comparative biomechanical performances of 4-strand core suture repairs for zone II flexor tendon lacerations. J Hand Surg [Am] 2002;27:508–17.CrossRef Angeles JG, Heminger H, Mass DP. Comparative biomechanical performances of 4-strand core suture repairs for zone II flexor tendon lacerations. J Hand Surg [Am] 2002;27:508–17.CrossRef
2.
Zurück zum Zitat Aoki M, Kubota H, Pruitt DL, et al. Biomechanical and histologic characteristics of canine flexor tendon repair using early postoperative mobilization. J Hand Surg [Am] 1997;22:107–14.CrossRef Aoki M, Kubota H, Pruitt DL, et al. Biomechanical and histologic characteristics of canine flexor tendon repair using early postoperative mobilization. J Hand Surg [Am] 1997;22:107–14.CrossRef
3.
Zurück zum Zitat Cao Y, Tang JB. Biomechanical evaluation of a four-strand modification of the Tang method of tendon repair. J Hand Surg [Br] 2005;30(4):374–8. Cao Y, Tang JB. Biomechanical evaluation of a four-strand modification of the Tang method of tendon repair. J Hand Surg [Br] 2005;30(4):374–8.
4.
Zurück zum Zitat Diao E, Hariharan JS, Soejima O. Effect of peripheral suture depth on strength of tendon repairs. J Hand Surg [Am] 1996;21:234–9.CrossRef Diao E, Hariharan JS, Soejima O. Effect of peripheral suture depth on strength of tendon repairs. J Hand Surg [Am] 1996;21:234–9.CrossRef
5.
Zurück zum Zitat Elliot D, Moiemen NS, Flemming AFS, et al. The rupture rate of acute flexor tendon repairs mobilized by the controlled active motion regimen. J Hand Surg [Br] 1994;19:607–12. Elliot D, Moiemen NS, Flemming AFS, et al. The rupture rate of acute flexor tendon repairs mobilized by the controlled active motion regimen. J Hand Surg [Br] 1994;19:607–12.
6.
Zurück zum Zitat Gelberman RH, Woo SL, Amiel D, et al. Influences of flexor sheath continuity and early motion on tendon healing in dogs. J Hand Surg [Am] 1990;15:69–77.CrossRef Gelberman RH, Woo SL, Amiel D, et al. Influences of flexor sheath continuity and early motion on tendon healing in dogs. J Hand Surg [Am] 1990;15:69–77.CrossRef
7.
Zurück zum Zitat Golash A, Kay A, Warner JG, et al. Efficacy of ADCON-T/N after primary flexor tendon repair in Zone II: a controlled clinical trial. J Hand Surg [Br] 2003;28:113–5. Golash A, Kay A, Warner JG, et al. Efficacy of ADCON-T/N after primary flexor tendon repair in Zone II: a controlled clinical trial. J Hand Surg [Br] 2003;28:113–5.
8.
Zurück zum Zitat Hotokezaka S, Manske PR. Differences between locking loops and grasping loops: effects on 2-strand core suture. J Hand Surg [Am] 1997;22:995–1003.CrossRef Hotokezaka S, Manske PR. Differences between locking loops and grasping loops: effects on 2-strand core suture. J Hand Surg [Am] 1997;22:995–1003.CrossRef
9.
Zurück zum Zitat Kubota H, Manske PR, Aoki M, et al. Effect of motion and tension on injured flexor tendons in chickens. J Hand Surg [Am] 1996;21:456–63.CrossRef Kubota H, Manske PR, Aoki M, et al. Effect of motion and tension on injured flexor tendons in chickens. J Hand Surg [Am] 1996;21:456–63.CrossRef
10.
Zurück zum Zitat Kubota H, Miyanishi K, Hoshino S, et al. Effect of a new repair technique on biomechanical properties of canine flexor tendons in vitro study. Hand Surg 1998;3:247–55.CrossRef Kubota H, Miyanishi K, Hoshino S, et al. Effect of a new repair technique on biomechanical properties of canine flexor tendons in vitro study. Hand Surg 1998;3:247–55.CrossRef
11.
Zurück zum Zitat Lawrence TM, Woodruff MJ, Aladin A, et al. Assessment of the tensile properties and technical difficulties of two and four-strand flexor tendon repairs. J Hand Surg [Br] 2005;30(3):294–7. Lawrence TM, Woodruff MJ, Aladin A, et al. Assessment of the tensile properties and technical difficulties of two and four-strand flexor tendon repairs. J Hand Surg [Br] 2005;30(3):294–7.
12.
Zurück zum Zitat Lee H. Double looped locking suture: a technique of tendon repair for early active mobilization. Part I. Evaluation of technique and experimental study. J Hand Surg [Am] 1990;15:945–52.CrossRef Lee H. Double looped locking suture: a technique of tendon repair for early active mobilization. Part I. Evaluation of technique and experimental study. J Hand Surg [Am] 1990;15:945–52.CrossRef
13.
Zurück zum Zitat Mashadi ZB, Amis AA. The effect of locking loops on the repair strength of tendon repair. J Hand Surg [Br] 1990;16(1):135–9. Mashadi ZB, Amis AA. The effect of locking loops on the repair strength of tendon repair. J Hand Surg [Br] 1990;16(1):135–9.
14.
Zurück zum Zitat McCarthy DM, Boardman ND, Tramaglini DM, et al. Clinical management of partially lacerated digital flexor tendons: a survey of hand surgeons. J Hand Surg [Am] 1995;20:273–5.CrossRef McCarthy DM, Boardman ND, Tramaglini DM, et al. Clinical management of partially lacerated digital flexor tendons: a survey of hand surgeons. J Hand Surg [Am] 1995;20:273–5.CrossRef
15.
Zurück zum Zitat McLarney E, Hoffman H, Wolfe SW. Biomechanical analysis of the cuciate four-strand flexor tendon repair. J Hand Surg [Am] 1999;24:295–301.CrossRef McLarney E, Hoffman H, Wolfe SW. Biomechanical analysis of the cuciate four-strand flexor tendon repair. J Hand Surg [Am] 1999;24:295–301.CrossRef
16.
Zurück zum Zitat Papandrea R, Seitz WH, Shapiro P, et al. Biomechanical and clinical evaluation of the epitenon first technique of flexor tendon repair. J Hand Surg [Am] 1995;20:261–6.CrossRef Papandrea R, Seitz WH, Shapiro P, et al. Biomechanical and clinical evaluation of the epitenon first technique of flexor tendon repair. J Hand Surg [Am] 1995;20:261–6.CrossRef
17.
Zurück zum Zitat Peck FH, Bucher CA, Watson JS, et al. A comparative study of two methods of controlled mobilization of flexor tendon repairs in zone 2. J Hand Surg [Br] 1998;23:41–5. Peck FH, Bucher CA, Watson JS, et al. A comparative study of two methods of controlled mobilization of flexor tendon repairs in zone 2. J Hand Surg [Br] 1998;23:41–5.
18.
Zurück zum Zitat Peck FH, Kennedy SM, Watson JS, et al. An evaluation of the influence of practitioner-led hand clinicson rupture rates following primary tendon repair in the hand. Br J Plast Surg 2004;57:45–9.PubMedCrossRef Peck FH, Kennedy SM, Watson JS, et al. An evaluation of the influence of practitioner-led hand clinicson rupture rates following primary tendon repair in the hand. Br J Plast Surg 2004;57:45–9.PubMedCrossRef
19.
20.
Zurück zum Zitat Piskin A, Yuceturk A, Tomak Y, et al. Tendon repair with the strengthened modified Kessler, modified Kessler, and Savage suture techniques: a biomechanical comparison. Acta Orthop Traumatol Turc 2007;41(3):238–43.PubMed Piskin A, Yuceturk A, Tomak Y, et al. Tendon repair with the strengthened modified Kessler, modified Kessler, and Savage suture techniques: a biomechanical comparison. Acta Orthop Traumatol Turc 2007;41(3):238–43.PubMed
21.
Zurück zum Zitat Rosberg HE, Carlsson KS, Hojgard S, et al. What determines the costs of repair and rehabilitation of flexor tendon injuries in zone II? A multiple regression analysis of data from southern Sweden. J Hand Surg [Br] 2003;28:106–12. Rosberg HE, Carlsson KS, Hojgard S, et al. What determines the costs of repair and rehabilitation of flexor tendon injuries in zone II? A multiple regression analysis of data from southern Sweden. J Hand Surg [Br] 2003;28:106–12.
22.
Zurück zum Zitat Savage R. In vitro studies of a new method of flexor tendon repair. J Hand Surg [Br] 1985;10:135–41. Savage R. In vitro studies of a new method of flexor tendon repair. J Hand Surg [Br] 1985;10:135–41.
23.
Zurück zum Zitat Schuind F, Garcia-Elias M, Cooney WP, et al. Flexor tendon forces: in vivo measurements. J Hand Surg [Am] 1992;17:291–8.CrossRef Schuind F, Garcia-Elias M, Cooney WP, et al. Flexor tendon forces: in vivo measurements. J Hand Surg [Am] 1992;17:291–8.CrossRef
24.
Zurück zum Zitat Shaieb MD, Singer DI. Tensile strength of various suture techniques. J Hand Surg [Br] 1997;22:764–7. Shaieb MD, Singer DI. Tensile strength of various suture techniques. J Hand Surg [Br] 1997;22:764–7.
25.
Zurück zum Zitat Silfverskiold KL, May EJ, Tornvall AH. Gap formation during controlled motion after flexor tendon repair in zone II: a prospective clinical study. J Hand Surg [Am] 1992;17:539–46.CrossRef Silfverskiold KL, May EJ, Tornvall AH. Gap formation during controlled motion after flexor tendon repair in zone II: a prospective clinical study. J Hand Surg [Am] 1992;17:539–46.CrossRef
26.
Zurück zum Zitat Small JO, Brennen MD, Colville J. Early active mobilisation following flexor tendon repair in zone 2. J Hand Surg [Br] 1989;14:383–91. Small JO, Brennen MD, Colville J. Early active mobilisation following flexor tendon repair in zone 2. J Hand Surg [Br] 1989;14:383–91.
27.
Zurück zum Zitat Tang JB, Gu YT, Rice K, et al. Evaluation of four Methods of flexor tendon repair for postoperative active mobilization. Plast Reconstr Surg 2001;107:742–9.PubMedCrossRef Tang JB, Gu YT, Rice K, et al. Evaluation of four Methods of flexor tendon repair for postoperative active mobilization. Plast Reconstr Surg 2001;107:742–9.PubMedCrossRef
28.
Zurück zum Zitat Thurman RT, Trumble TE, Hanel DP, et al. Two-, four-, and six-strand zone II flexor tendon repairs: an in situ biomechanical comparison using a cadaver model. J Hand Surg [Am] 1998;23:261–5.CrossRef Thurman RT, Trumble TE, Hanel DP, et al. Two-, four-, and six-strand zone II flexor tendon repairs: an in situ biomechanical comparison using a cadaver model. J Hand Surg [Am] 1998;23:261–5.CrossRef
29.
Zurück zum Zitat Wada A, Kubota H, Hatanaka H, et al. The Mechanical properties of locking and grasping suture loop configurations in four-strand core suture techniques. J Hand Surg [Br] 2000;25(6):548–51. Wada A, Kubota H, Hatanaka H, et al. The Mechanical properties of locking and grasping suture loop configurations in four-strand core suture techniques. J Hand Surg [Br] 2000;25(6):548–51.
30.
Zurück zum Zitat Zatiti SC, Mazzer N, Barbieri CH. Mechanical strengths of tendon sutures. An in vitro comparative study of six techniques. J Hand Surg [Br] 1998;23:228–33. Zatiti SC, Mazzer N, Barbieri CH. Mechanical strengths of tendon sutures. An in vitro comparative study of six techniques. J Hand Surg [Br] 1998;23:228–33.
31.
Zurück zum Zitat Zhao C, Amadio P, Zobitz M, et al. Gliding resistance after repair of partially lacerated human flexor digitorum profundus tendon in vitro. Clin Biomech 2001;16:696–701.CrossRef Zhao C, Amadio P, Zobitz M, et al. Gliding resistance after repair of partially lacerated human flexor digitorum profundus tendon in vitro. Clin Biomech 2001;16:696–701.CrossRef
Metadaten
Titel
Does Strand Configuration and Number of Purchase Points Affect the Biomechanical Behavior of a Tendon Repair? A Biomechanical Evaluation Using Different Kessler Methods of Flexor Tendon Repair
Publikationsdatum
01.09.2008
Erschienen in
HAND / Ausgabe 3/2008
Print ISSN: 1558-9447
Elektronische ISSN: 1558-9455
DOI
https://doi.org/10.1007/s11552-008-9095-1

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