Article
Tendon Healing Strengths after Repair with Three Different Configurations in a Chicken Model
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Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: To evaluate tendon healing strengths after different suture constructs in a chicken tendon repair model.
Methods: Sixty chicken flexor tendons were repaired with the following three repair configurations: a two-strand Kessler suture (group 1); a two-strand core suture with an additional circle loop repair (group 2) and a four-strand core suture repair with three separate stitches of peripheral suture (group 3). Biomechanical of flexor tendons was measured by a material testing machine. Twenty-six repaired tendons were tested to record healing strengths at week 4 and twenty-eight tendons were tested to record baseline repair strengths on day 0. The others were used to take photos for observation of suture constructs. We conducted power analysis and obtained a sufficient power of above 70% that proved the sample size to be adequate. Analysis of variance with Tukey post hoc test was used for comparison of the means of the data among the different repair methods groups.
Results and Conclusions: At weeks 4, the ultimate strength of tendon in group 3 was 57.3 ±19.5 N, which was 10 times higher than that of the tendons in group 1 (5.7±1.1 N) (p<0.001). The strength of the tendons in group 2 (34.9±15.8 N) was only 60% that of the tendons in group 3 (p=0.024), which was nearly 6 times higher than that of group 1 (p=0.003). Baseline repair strengths of tendons was significantly different among three groups on day 0. Tendons in group 1 showed the lowest repair strength (5.5±0.9 N) and the tendons in group 2 were 8.4±1.4 N. Tendons in group 3 showed the highest repair strength (14.4±2.6 N) than two other groups (p<0.001). We found that the multi-strand repair techniques significantly increase the healing over the first four weeks after surgery with about 400% increase in the strengths (for both groups 2 and 3), but the strengths of the tendon with a two-strand repair (group 1) does not significantly change over the 4 weeks of tendon healing.
Multi-strand repair techniques enhance tendon healing strengths and significantly increase the healing after surgery, but a two-strand core repair does not significantly change the healing strength of the healing tendon. The increase of the strength by the multi-strand repair is more evident when a more stable repair configuration is used.