Skip to main content
Top
Published in: Archives of Orthopaedic and Trauma Surgery 4/2020

01-04-2020 | Extensor Tendon | Handsurgery

Comparison of various tendon repair techniques in extansor zone 3 injuries: an experimental biomechanical cadaver study

Authors: Abuzer Uludağ, Hacı Bayram Tosun, Suat Çelik, Sancar Serbest, Murat Kayalar, Güneş Aytaç, Muzaffer Sindel, Fatma Kübra Erbay Elibol, Teyfik Demir

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 4/2020

Login to get access

Abstract

Purpose

To compare five different repair techniques for extensor tendon zone III modified Kessler (MK), double-modified Kessler (DMK), modified Kessler epitendinous (MKE), double-modified Kessler epitendinous (DMKE), and running-interlocking horizontal mattress (RIHM) in terms of shortening, stiffness, gap formation, and ultimate load to failure.

Methods

A total of 35 human cadaver fingers were randomly assigned to five suture techniques with 7 fingers each and were tested under dynamic and static loading conditions.

Results

DMK was found to be superior over MK in terms of ultimate load to failure (36 N vs. 24 N, respectively), shortening (1.75 vs. 2.20 mm, respectively) and gap formation. However, these two methods had similar characteristics in terms of stiffness. The addition of epitendinous sutures to the repair methods resulted in approximately 40% increase in ultimate load to failure, whereas epitendinous sutures had no effect on shortening. DMKE was found to be superior over MKE in terms of shortening (1.77 vs. 2.22 mm, respectively). However, these two methods had similar characteristics in terms of mean ultimate load to failure and stiffness. RIHM was found to be superior over the other four methods in terms of ultimate load to failure (89 N), stiffness, and shortening (0.75 mm).

Conclusion

RIHM was found to be stronger and more durable for extensor tendon zone III than the other techniques in terms of ultimate load to failure and stiffness.
Literature
1.
go back to reference Matzon JL, Bozentka DJ (2010) Extensor tendon injuries. J Hand Surg Am 35(5):854–861CrossRef Matzon JL, Bozentka DJ (2010) Extensor tendon injuries. J Hand Surg Am 35(5):854–861CrossRef
2.
go back to reference Colzani G, Tos P, Battiston B, Merolla G, Porcellini G, Artiaco S (2016) Traumatic extensor tendon injuries to the hand: clinical anatomy, biomechanics, and surgical procedure review. J Hand Microsurg 8(01):2–12CrossRef Colzani G, Tos P, Battiston B, Merolla G, Porcellini G, Artiaco S (2016) Traumatic extensor tendon injuries to the hand: clinical anatomy, biomechanics, and surgical procedure review. J Hand Microsurg 8(01):2–12CrossRef
3.
go back to reference Hu D, Howard D, Ren L (2014) Biomechanical analysis of the human finger extensor mechanism during isometric pressing. PLoS One 9(4):e94533CrossRef Hu D, Howard D, Ren L (2014) Biomechanical analysis of the human finger extensor mechanism during isometric pressing. PLoS One 9(4):e94533CrossRef
4.
go back to reference Lee SK, Dubey A, Kim BH, Zingman A, Landa J, Paksima N (2010) A biomechanical study of extensor tendon repair methods: introduction to the running-interlocking horizontal mattress extensor tendon repair technique. J Hand Surg Am 35(1):19–23CrossRef Lee SK, Dubey A, Kim BH, Zingman A, Landa J, Paksima N (2010) A biomechanical study of extensor tendon repair methods: introduction to the running-interlocking horizontal mattress extensor tendon repair technique. J Hand Surg Am 35(1):19–23CrossRef
5.
go back to reference Newport ML, Tucker RL (2005) New perspectives on extensor tendon repair and implications for rehabilitation. J Hand Ther 18(2):175–181CrossRef Newport ML, Tucker RL (2005) New perspectives on extensor tendon repair and implications for rehabilitation. J Hand Ther 18(2):175–181CrossRef
6.
go back to reference Newport ML, Williams CD (1992) Biomechanical characteristics of extensor tendon suture techniques. J Hand Surg Am 17(6):1117–1123CrossRef Newport ML, Williams CD (1992) Biomechanical characteristics of extensor tendon suture techniques. J Hand Surg Am 17(6):1117–1123CrossRef
7.
go back to reference Herod TW, Chambers NC, Veres SP (2016) Collagen fibrils in functionally distinct tendons have differing structural responses to tendon rupture and fatigue loading. Acta Biomater 42:296–307CrossRef Herod TW, Chambers NC, Veres SP (2016) Collagen fibrils in functionally distinct tendons have differing structural responses to tendon rupture and fatigue loading. Acta Biomater 42:296–307CrossRef
8.
go back to reference Pennington DG (1979) The locking loop tendon suture. Plast Reconstr Surg 63(5):648–652CrossRef Pennington DG (1979) The locking loop tendon suture. Plast Reconstr Surg 63(5):648–652CrossRef
9.
go back to reference Leddy JP (1993) Flexor Tendon-Acute Injuries. In: Green DP (ed) Operative Hand Surgery, 3rd edn. Churchill Livingstone, New York, pp 1823–1851 Leddy JP (1993) Flexor Tendon-Acute Injuries. In: Green DP (ed) Operative Hand Surgery, 3rd edn. Churchill Livingstone, New York, pp 1823–1851
10.
go back to reference Howard RF, Ondrovic L, Greenwald DP (1997) Biomechanical analysis of four-strand extensor tendon repair techniques. J Hand Surg Am 22(5):838–842CrossRef Howard RF, Ondrovic L, Greenwald DP (1997) Biomechanical analysis of four-strand extensor tendon repair techniques. J Hand Surg Am 22(5):838–842CrossRef
11.
go back to reference Kayalar M, Bal E, Toros T, Sugun T, Kelesoglu B, Kaplan I (2009) The results of treatment for isolated zone 3 extensor tendon injuries. Acta Orthop Traumatol Turc 43(4):309–316CrossRef Kayalar M, Bal E, Toros T, Sugun T, Kelesoglu B, Kaplan I (2009) The results of treatment for isolated zone 3 extensor tendon injuries. Acta Orthop Traumatol Turc 43(4):309–316CrossRef
12.
go back to reference Newport ML, Pollack GR, Williams CD (1995) Biomechanical characteristics of suture techniques in extensor zone IV. J Hand Surg Am 20(4):650–656CrossRef Newport ML, Pollack GR, Williams CD (1995) Biomechanical characteristics of suture techniques in extensor zone IV. J Hand Surg Am 20(4):650–656CrossRef
13.
go back to reference Rawson S, Cartmell S, Wong J (2013) Suture techniques for tendon repair; a comparative review. Muscles Ligaments Tendons J 3(3):220–228CrossRef Rawson S, Cartmell S, Wong J (2013) Suture techniques for tendon repair; a comparative review. Muscles Ligaments Tendons J 3(3):220–228CrossRef
14.
go back to reference Woo SH, Tsai TM, Kleinert HE, Chew WY, Voor MJ (2005) A biomechanical comparison of four extensor tendon repair techniques in zone IV. Plast Reconstr Surg 115(6):1674–1681CrossRef Woo SH, Tsai TM, Kleinert HE, Chew WY, Voor MJ (2005) A biomechanical comparison of four extensor tendon repair techniques in zone IV. Plast Reconstr Surg 115(6):1674–1681CrossRef
15.
go back to reference Chung KC, Jun BJ, McGarry MH, Lee TQ (2012) The effect of the number of cross-stitches on the biomechanical properties of the modified Becker extensor tendon repair. J Hand Surg Am 37(2):231–236CrossRef Chung KC, Jun BJ, McGarry MH, Lee TQ (2012) The effect of the number of cross-stitches on the biomechanical properties of the modified Becker extensor tendon repair. J Hand Surg Am 37(2):231–236CrossRef
16.
go back to reference Dona E, Gianoutsos MP, Walsh WR (2004) Optimizing biomechanical performance of the 4-strand cruciate flexor tendon repair. J Hand Surg Am 29(4):571–580CrossRef Dona E, Gianoutsos MP, Walsh WR (2004) Optimizing biomechanical performance of the 4-strand cruciate flexor tendon repair. J Hand Surg Am 29(4):571–580CrossRef
17.
go back to reference Greenwald DP, Hong HZ, May JW Jr (1994) Mechanical analysis of tendon suture techniques. J Hand Surg Am 19(4):641–647CrossRef Greenwald DP, Hong HZ, May JW Jr (1994) Mechanical analysis of tendon suture techniques. J Hand Surg Am 19(4):641–647CrossRef
18.
go back to reference Wieskötter B, Herbort M, Langer M, Raschke MJ, Wähnert D (2018) The impact of different peripheral suture techniques on the biomechanical stability in flexor tendon repair. Arch Orthop Trauma Surg 138(1):139–145CrossRef Wieskötter B, Herbort M, Langer M, Raschke MJ, Wähnert D (2018) The impact of different peripheral suture techniques on the biomechanical stability in flexor tendon repair. Arch Orthop Trauma Surg 138(1):139–145CrossRef
19.
go back to reference Polykandriotis E, Besrour F, Arkudas A, Ruppe F, Zetzmann K, Braeuer L, Horch RE (2019) Flexor tendon repair with a polytetrafluoroethylene (PTFE) suture material. Arch Orthop Trauma Surg 139(3):429–434CrossRef Polykandriotis E, Besrour F, Arkudas A, Ruppe F, Zetzmann K, Braeuer L, Horch RE (2019) Flexor tendon repair with a polytetrafluoroethylene (PTFE) suture material. Arch Orthop Trauma Surg 139(3):429–434CrossRef
20.
go back to reference Feehan LM, Beauchene JG (1990) Early tensile properties of healing chicken flexor tendons: early controlled passive motion versus postoperative immobilization. J Hand Surg 15(1):63–68CrossRef Feehan LM, Beauchene JG (1990) Early tensile properties of healing chicken flexor tendons: early controlled passive motion versus postoperative immobilization. J Hand Surg 15(1):63–68CrossRef
21.
go back to reference Evans RB, Thompson DE (1992) An analysis of factors that support early active short arc motion of the repaired central slip. J Hand Ther 5(4):187–201CrossRef Evans RB, Thompson DE (1992) An analysis of factors that support early active short arc motion of the repaired central slip. J Hand Ther 5(4):187–201CrossRef
22.
go back to reference Dy CJ, Rosenblatt L, Lee SK (2013) Current methods and biomechanics of extensor tendon repairs. Hand Clin 29(2):261–268CrossRef Dy CJ, Rosenblatt L, Lee SK (2013) Current methods and biomechanics of extensor tendon repairs. Hand Clin 29(2):261–268CrossRef
23.
go back to reference Ketchum LD, Thompson D, Pocock G, Wallingford D (1978) A clinical study of forces generated by the intrinsic muscles of the index finger and the extrinsic flexor and extensor muscles of the hand. J Hand Surg Am 3(6):571–578CrossRef Ketchum LD, Thompson D, Pocock G, Wallingford D (1978) A clinical study of forces generated by the intrinsic muscles of the index finger and the extrinsic flexor and extensor muscles of the hand. J Hand Surg Am 3(6):571–578CrossRef
24.
go back to reference Altobelli GG, Conneely S, Haufler C, Walsh M, Ruchelsman DE (2013) Outcomes of digital zone iv and v and thumb zone ti to tiv extensor tendon repairs using a running interlocking horizontal mattress technique. J Hand Surg Am 38(6):1079–1083CrossRef Altobelli GG, Conneely S, Haufler C, Walsh M, Ruchelsman DE (2013) Outcomes of digital zone iv and v and thumb zone ti to tiv extensor tendon repairs using a running interlocking horizontal mattress technique. J Hand Surg Am 38(6):1079–1083CrossRef
Metadata
Title
Comparison of various tendon repair techniques in extansor zone 3 injuries: an experimental biomechanical cadaver study
Authors
Abuzer Uludağ
Hacı Bayram Tosun
Suat Çelik
Sancar Serbest
Murat Kayalar
Güneş Aytaç
Muzaffer Sindel
Fatma Kübra Erbay Elibol
Teyfik Demir
Publication date
01-04-2020
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 4/2020
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-020-03384-9

Other articles of this Issue 4/2020

Archives of Orthopaedic and Trauma Surgery 4/2020 Go to the issue