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A Biomechanical Assessment of Repair Versus Nonrepair of Sheep Flexor Tendons Lacerated to 75 Percent

Haddad, Roger; Scherman, Peter LU ; Peltz, Tim; Nicklin, Sean and Walsh, William R. (2010) In Journal of Hand Surgery 35A(4). p.546-551
Abstract
Purpose The benefit of repairing a 75% partial flexor tendon laceration remains controversial. The purpose of this study was to assess the degree of gap formation with and without repair when the 75% lacerated tendon is subjected to cyclic loading. Repair with only a peripheral suture was compared to that using a core and peripheral repair technique. Methods Sixteen deep flexor tendons from sheep hind limbs were lacerated to 75% of the tendon diameter. The cut tendons were loaded for 100 cycles from 3 N up to 30 N and then back to 3 N, at a rate of 0.2 Hz. Gap formation was measured at 0 and 100 cycles. Tendons were then randomized into 2 repair groups of 8 each: group 1 was repaired with only a simple, running peripheral suture (6-0... (More)
Purpose The benefit of repairing a 75% partial flexor tendon laceration remains controversial. The purpose of this study was to assess the degree of gap formation with and without repair when the 75% lacerated tendon is subjected to cyclic loading. Repair with only a peripheral suture was compared to that using a core and peripheral repair technique. Methods Sixteen deep flexor tendons from sheep hind limbs were lacerated to 75% of the tendon diameter. The cut tendons were loaded for 100 cycles from 3 N up to 30 N and then back to 3 N, at a rate of 0.2 Hz. Gap formation was measured at 0 and 100 cycles. Tendons were then randomized into 2 repair groups of 8 each: group 1 was repaired with only a simple, running peripheral suture (6-0 polypropylene monofilament), whereas group 2 was repaired with a modified Kessler core suture (4-0 silicone-coated braided polyester) plus a peripheral suture (6-0 polypropylene monofilament). Repaired tendons were tested for 500 cycles, and the gap was measured at 0, 100, and 500 cycles. After cycling, gap was measured at 100 N load, and the peak loads were determined on static failure testing. Results The 75% partially lacerated tendons had >2 mm gap at 100 cycles. This gap was significantly reduced by peripheral or peripheral plus core repairs (p < .001). There was no difference in gap formation between tendons with peripheral repair only and those with both peripheral and core repairs. Gap formation in repaired tendons remained <= 1 mm at 500 cycles. After cycling, neither gap formation at 100 N load or the peak loads on failure testing differed between the 2 repair groups. Conclusions There is a large gap when an unrepaired 75% partial laceration is cyclically loaded. This gap is significantly reduced with a peripheral repair whether or not a core suture is used. (J Hand Surg 2010;35A:546-551. (C) 2010 Published by Elsevier Inc. on behalf of the American Society for Surgery of the Hand.) (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
partial laceration, gap formation, Cyclic testing, flexor tendon
in
Journal of Hand Surgery
volume
35A
issue
4
pages
546 - 551
publisher
Elsevier
external identifiers
  • wos:000276604600004
  • scopus:77950300103
ISSN
1531-6564
DOI
10.1016/j.jhsa.2009.12.039
language
English
LU publication?
yes
id
c921252f-e4e2-4500-aea7-735691fa414e (old id 1602984)
date added to LUP
2010-05-19 10:10:53
date last changed
2018-05-29 11:01:45
@article{c921252f-e4e2-4500-aea7-735691fa414e,
  abstract     = {Purpose The benefit of repairing a 75% partial flexor tendon laceration remains controversial. The purpose of this study was to assess the degree of gap formation with and without repair when the 75% lacerated tendon is subjected to cyclic loading. Repair with only a peripheral suture was compared to that using a core and peripheral repair technique. Methods Sixteen deep flexor tendons from sheep hind limbs were lacerated to 75% of the tendon diameter. The cut tendons were loaded for 100 cycles from 3 N up to 30 N and then back to 3 N, at a rate of 0.2 Hz. Gap formation was measured at 0 and 100 cycles. Tendons were then randomized into 2 repair groups of 8 each: group 1 was repaired with only a simple, running peripheral suture (6-0 polypropylene monofilament), whereas group 2 was repaired with a modified Kessler core suture (4-0 silicone-coated braided polyester) plus a peripheral suture (6-0 polypropylene monofilament). Repaired tendons were tested for 500 cycles, and the gap was measured at 0, 100, and 500 cycles. After cycling, gap was measured at 100 N load, and the peak loads were determined on static failure testing. Results The 75% partially lacerated tendons had &gt;2 mm gap at 100 cycles. This gap was significantly reduced by peripheral or peripheral plus core repairs (p &lt; .001). There was no difference in gap formation between tendons with peripheral repair only and those with both peripheral and core repairs. Gap formation in repaired tendons remained &lt;= 1 mm at 500 cycles. After cycling, neither gap formation at 100 N load or the peak loads on failure testing differed between the 2 repair groups. Conclusions There is a large gap when an unrepaired 75% partial laceration is cyclically loaded. This gap is significantly reduced with a peripheral repair whether or not a core suture is used. (J Hand Surg 2010;35A:546-551. (C) 2010 Published by Elsevier Inc. on behalf of the American Society for Surgery of the Hand.)},
  author       = {Haddad, Roger and Scherman, Peter and Peltz, Tim and Nicklin, Sean and Walsh, William R.},
  issn         = {1531-6564},
  keyword      = {partial laceration,gap formation,Cyclic testing,flexor tendon},
  language     = {eng},
  number       = {4},
  pages        = {546--551},
  publisher    = {Elsevier},
  series       = {Journal of Hand Surgery},
  title        = {A Biomechanical Assessment of Repair Versus Nonrepair of Sheep Flexor Tendons Lacerated to 75 Percent},
  url          = {http://dx.doi.org/10.1016/j.jhsa.2009.12.039},
  volume       = {35A},
  year         = {2010},
}