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Scientific Articles   |    
Biomechanical Evaluation of Various Suture Configurations in Side-to-Side Tenorrhaphy
Emilio Wagner, MD1; Cristian Ortiz, MD1; Pablo Wagner, MD1; Rodrigo Guzman, PT2; Ximena Ahumada, MD1; Nicola Maffulli, MD, MS, PhD, FRCP, FRCS(Orth), FFSEM3
1 Departamento de Traumatologia, Clinica Alemana, Universidad del Desarrollo, Vitacura 5951, Vitacura 7650568, Chile. E-mail address for E. Wagner: ewagner@alemana.cl
2 Laboratorio Integrativo de Biomecanica y Fisiologia del Esfuerzo, Escuela de Kinesiologia, Facultad de Medicina, Universidad de los Andes, Avenida Monseñor Alvaro del Portillo 12455, Las Condes 7620001, Chile
3 Centre for Sports and Exercise Medicine, Mile End Hospital, Barts and The London School of Medicine and Dentistry, 275 Bancroft Road, London E1 4DG, England
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Investigation performed at Universidad de los Andes, Las Condes, Chile



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2014 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2014 Feb 05;96(3):232-236. doi: 10.2106/JBJS.L.01552
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Abstract

Background: 

Side-to-side tenorrhaphy is increasingly used, but its mechanical performance has not been studied.

Methods: 

Two porcine flexor digitorum tendon segments of equal length (8 cm) and thickness (1 cm) were placed side by side. Eight tenorrhaphies (involving sixteen tendons) were performed with each of four suture techniques (running locked, simple eight, vertical mattress, and pulley suture). The resulting constructs underwent cyclic loading on a tensile testing machine, followed by monotonically increasing tensile load if failure during cyclic loading did not occur. Clamps secured the tendons on each side of the repair, and specimens were mounted vertically. Cyclic loading varied between 15 N and 35 N, with a distension rate of 1 mm/sec. Cyclic loading strength was determined by applying a force of 70 N. The cause of failure and tendon distension during loading were recorded.

Results: 

All failures occurred in the monotonic loading phase and resulted from tendon stripping. No suture or knot failure was observed. The mean loads resisted by the configurations ranged from 138 to 398 N. The mean load to failure, maximum load resisted prior to 1 cm of distension, and load resisted at 1 cm of distension were significantly lower for the vertical mattress suture group than for any of the other three groups (p < 0.031).

Conclusions: 

All four groups sustained loads well above the physiologic loads expected to occur in tendons in the foot and ankle (e.g., in tendon transfer for tibialis posterior tendon insufficiency). None of the four side-to-side configurations distended appreciably during the cyclic loading phase. The vertical mattress suture configuration appeared to be weaker than the other configurations.

Clinical Relevance: 

For surgeons who advocate immediate loading or motion of a side-to-side tendon repair, a pulley, running locked, or simple eight suture technique appears to provide a larger safety margin compared with a vertical mattress suture technique.

Peer Review: 

This article was reviewed by the Editor-in-Chief and one Deputy Editor, and it underwent blinded review by two or more outside experts. The Deputy Editor reviewed each revision of the article, and it underwent a final review by the Editor-in-Chief prior to publication. Final corrections and clarifications occurred during one or more exchanges between the author(s) and copyeditors.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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