Article
One stage flexor tendon reconstruction using a silastic active tendon implant. Ten years of experience
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Authors
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Jhon Fredy Castañeda
- Universidad Nacional de Colombia, Bogota, Colombia
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German Hernandez
- Universidad Nacional de Colombia, Bogota, Colombia
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Ricardo Galan
- Universidad Militar Nueva Granada, Bogota, Colombia
| Published: | February 6, 2020 |
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Outline
Text
Introduction: The idea of reconstruction in only one stage arose when the extraction of the implant was declined by one patient with good results. This study is the first Case-Series with this treatment
Objectives:
- 1.
- Evaluate clinical and functional results after the management with a single-stage procedure in flexor tendon after chronic injuries using a Silastic active tendon implant.
- 2.
- Analyze the biomechanical behavior of the Silastic tendon implant
Methods: Case Series Study. Biomechanical tests of the silastic tendon were performed in the mechatronic engineering laboratory to determine the long-term viability of the implant. Thirty-eight (patients were included, four of them presented situations that led to the removal of the implant and a second time with the conventional technique. 34 patients preserved the active silastic tendon. The longest follow-up is 14 years. 63.2% (24/38 patients) had >10 year follow-up period, with an average of 10.8 years. Two personal assessments (May 2010 - June 2017) of the clinical status were made. The DASH score was used
Results and Conclusions: In the biomechanical tests we found a critical point of failure due to a tear of the tendon fibers in the metallic-elastomeric anchor interface at a breaking load of 400N. This value shows that there will be NO alteration in the functionality of the silastic tendon in the long term because the loads during daily activities (35N) are lower than those of rupture. 100% of the patients improved the previous function and range of motion with an average recovery of 105 degrees for the thumbs and 157 degrees for the long fingers. Complications were few, a non-infectious local reaction and a rupture of the proximal suture. We did not find the presence of complications such as loosening of the implant, infection, rupture or migration, functional loss or joint stiffness. Two patients presented mild mechanical discomfort in the distal phalanx with the pressure at the distal anchor site. Final evaluation with the DASH scale showed a general average of 3.4 (range of 1 to 8).
The functional and biomechanically results are excellent and the tendon does not alter its function in the long term, which allows its use as a definitive management in the treatment of chronic lesions of the flexor tendons. This technique is a valid and safe option with few complications for the management of these injuries since, regardless of the result of the same, conventional management in two stages will always be available.
