Artikel
Feasibility of a new pulley repair for multiple pulley ruptures: a cadaver study
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Autoren
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Volker Schöffl
- Zentrum für interdisziplinäre Sportmedizin, Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Bamberg, Germany
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Julia Meisel
- Institute of Anatomy and Department of Trauma Surgery, University Erlangen-Nuremberg, Erlangen, Germany
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Christoph Lutter
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Bamberg, Germany
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Isabelle Schöffl
- Department of Pediatric Cardiology, University Erlangen-Nuremberg, Erlangen, Germany
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: As a consequence of the growing number of climbers and the increase in difficulty in this sport, the number of pulley injuries, and complex pulley ruptures in particular, has grown significantly. In multiple pulley ruptures various repair techniques are described. Mostly used are encircling techniques around the phalanx using a free tendon graft. While these provide a strong repair a bone loss to the proximal phalanx was recently described. In this study, the feasibility of a new pulley reconstruction in which the tendon graft is pulled through a tunnel in the proximal phalanx was evaluated using a cadaver model, with particular attention paid to the weakening of the bone structure by the drill hole.
Methods: 9 fingers from 6 cadaver hands presenting intact pulley systems were compared to 9 fingers from 6 cadaver hands with missing A2 to A4 pulleys, but which featured a repair using the new surgical technique. Each finger was then fixed to an isokinetic loading device which loaded the finger until repair failure or a fracture (first event) occurred. The forces in the flexor tendons were recorded for each finger.
Results and Conclusions: Comparing the forces recorded at the moment of the first event, the forces in the control group were significantly higher (292.4 N) for FDP than in the group with the operated fingers (212.4 N). Although the forces recorded for FDS at the moment of failure were also higher in the control group, the difference did not reach significance (216.3 N vs. 158.2 N). The most common event in the operated fingers was a graft failure. A fracture of the bone due to the drill hole was never observed.
The new pulley reconstruction could represent an alternative to existing reconstructive techniques. The cause for the higher forces recorded in the control group could be attributed to sutures used in the operated fingers. The new pulley reconstruction method may enable reduced extensor tendon irritation as it avoids contact with the extensor hood, and will hopefully prohibit cortical bone loss, a serious side effect in the "one and one half loop" technique.
