Article
Changes in Core Suture Geometry within Repaired Flexor Tendons: Investigations with a novel radiographic method
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Published: | April 26, 2013 |
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Introduction: Early mobilization of a repaired deep flexor tendon promotes better outcomes than immobilization. Tension on the reconstruction, however, produces gap formation at the repair site, which is detrimental. The changes in the 3-dimensional suture geometry when a tendon repair is strained, and the relationship this has to gap formation have not clearly been characterized yet. Therefore, we present a novel X-ray technique to qualitatively and quantitatively examine the three-dimensional changes in the core suture repair configurations under tension.
Material and methods: 40 adult sheep forelimb deep flexor tendons were randomized into 4 repair groups. The repair techniques used reflected prevalent 2-strand and 4-strand methods, using different grasping and locking variants: Kessler Repair, Cruciate Repair, Cross Locked Cruciate Repair (Adelaide Repair) and a novel repair variation, we called the Modified Adelaide repair. 3-0 surgical steel wire was used for all repairs. Sutures were marked at the point of exit from the tendon with a Ligaclip. AP and lateral X-rays were taken. Thereafter the suture strands were loaded to 35N. X-rays were repeated and digitally ananalysed. Gap formation was measured and data pre and post tensioning were compared.
Results: The relative length of suture elongation at the repair site was most in the 2strand Kessler repairs. Significant narrowing of the tendon at the transverse suture component and a complete loss of the 3-dimensional Kessler configuration was noticed. In the 4strand cruciate repair significant cheese-wiring of the loop-locks was noted with a large resultant propensity for gapping. In contrast, the cross-locking variants (Adelaide Repair) locked in itself under tension and showed minimal tendency to cheese-wire. Least propensity for gapping was noticed in the interlocked modification of the Adelaide repair. Figure 1 [Fig. 1].
Conclusion: Several factors influence gap formation in tendon repairs and these are intimately related to 3-dimensional changes in the repair geometry when put under tension. We present a novel method to analyze these changes and investigate 4 prevalent tendon repair constructs.