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Biomechanical Analysis of Zone 2 Flexor Tendon Repair With a Coupler Device Versus Locking Cruciate Core Suture.
J Hand Surg Am. 2020 Apr 07 [Online ahead of print]JH

Abstract

PURPOSE

To compare flexor tendon repair strength and speed between a tendon coupler and a standard-core suture in a cadaver model.

METHODS

In 5 matched-pair fresh cadaver hands, we cut the flexor digitorum profundus tendon of each finger in zone 2 and assigned 20 tendons to both the coupler and the suture groups. Coupler repair was with low-profile stainless steel staple plates in each tendon stump, bridged by polyethylene thread. Suture repair was performed using an 8-strand locking-cruciate technique with 4-0 looped, multifilament, polyamide suture. One surgeon with the Subspecialty Certificate in Surgery of the Hand performed all repairs. Via a load generator, each flexor digitorum profundus was loaded at 5 to 10 N and cycled through flexion just short of tip-to-palm and full extension at 0.2 Hz for 2,000 cycles to simulate 6 weeks of rehabilitation. We recorded repair gapping at predetermined cycle intervals. Our primary outcome was repair gapping at 2,000 cycles. Tendons that had not catastrophically failed by 2,000 cycles were loaded to failure on a servohydraulic frame at 1 mm/s.

RESULTS

Tendon repair gapping was similar between coupled and sutured tendons at 2,000 cycles. Tendons repaired with the coupler had higher residual load to failure than sutured tendons. Mean coupler repair time was 4 times faster than suture repair.

CONCLUSIONS

Zone 2 flexor repair with a coupler withstood simulated early active motion in fresh cadavers. Residual load to failure and repair speed were better with the coupler.

CLINICAL RELEVANCE

This tendon coupler may eventually be an option for strong, reproducible, rapid flexor tendon repair.

Authors+Show Affiliations

Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD. Electronic address: anne.mattson@medstar.net.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32276814

Citation

Irwin, Chetan S., et al. "Biomechanical Analysis of Zone 2 Flexor Tendon Repair With a Coupler Device Versus Locking Cruciate Core Suture." The Journal of Hand Surgery, 2020.
Irwin CS, Parks BG, Means KR. Biomechanical Analysis of Zone 2 Flexor Tendon Repair With a Coupler Device Versus Locking Cruciate Core Suture. J Hand Surg Am. 2020.
Irwin, C. S., Parks, B. G., & Means, K. R. (2020). Biomechanical Analysis of Zone 2 Flexor Tendon Repair With a Coupler Device Versus Locking Cruciate Core Suture. The Journal of Hand Surgery. https://doi.org/10.1016/j.jhsa.2020.02.015
Irwin CS, Parks BG, Means KR. Biomechanical Analysis of Zone 2 Flexor Tendon Repair With a Coupler Device Versus Locking Cruciate Core Suture. J Hand Surg Am. 2020 Apr 7; PubMed PMID: 32276814.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Biomechanical Analysis of Zone 2 Flexor Tendon Repair With a Coupler Device Versus Locking Cruciate Core Suture. AU - Irwin,Chetan S, AU - Parks,Brent G, AU - Means,Kenneth R,Jr Y1 - 2020/04/07/ PY - 2019/02/27/received PY - 2020/01/14/revised PY - 2020/02/21/accepted PY - 2020/4/12/entrez KW - Tendon repair KW - biomechanical KW - suture devices KW - zone 2 flexor tendon JF - The Journal of hand surgery JO - J Hand Surg Am N2 - PURPOSE: To compare flexor tendon repair strength and speed between a tendon coupler and a standard-core suture in a cadaver model. METHODS: In 5 matched-pair fresh cadaver hands, we cut the flexor digitorum profundus tendon of each finger in zone 2 and assigned 20 tendons to both the coupler and the suture groups. Coupler repair was with low-profile stainless steel staple plates in each tendon stump, bridged by polyethylene thread. Suture repair was performed using an 8-strand locking-cruciate technique with 4-0 looped, multifilament, polyamide suture. One surgeon with the Subspecialty Certificate in Surgery of the Hand performed all repairs. Via a load generator, each flexor digitorum profundus was loaded at 5 to 10 N and cycled through flexion just short of tip-to-palm and full extension at 0.2 Hz for 2,000 cycles to simulate 6 weeks of rehabilitation. We recorded repair gapping at predetermined cycle intervals. Our primary outcome was repair gapping at 2,000 cycles. Tendons that had not catastrophically failed by 2,000 cycles were loaded to failure on a servohydraulic frame at 1 mm/s. RESULTS: Tendon repair gapping was similar between coupled and sutured tendons at 2,000 cycles. Tendons repaired with the coupler had higher residual load to failure than sutured tendons. Mean coupler repair time was 4 times faster than suture repair. CONCLUSIONS: Zone 2 flexor repair with a coupler withstood simulated early active motion in fresh cadavers. Residual load to failure and repair speed were better with the coupler. CLINICAL RELEVANCE: This tendon coupler may eventually be an option for strong, reproducible, rapid flexor tendon repair. SN - 1531-6564 UR - https://www.unboundmedicine.com/medline/citation/32276814/Biomechanical_Analysis_of_Zone_2_Flexor_Tendon_Repair_With_a_Coupler_Device_Versus_Locking_Cruciate_Core_Suture L2 - https://linkinghub.elsevier.com/retrieve/pii/S0363-5023(20)30095-2 DB - PRIME DP - Unbound Medicine ER -
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