Biomechanical Comparison of Distal Radioulnar Joint Reconstruction Graft Preparation Techniques

Abstract

Background Graft preparation techniques for the Adams–Berger distal radioulnar joint (DRUJ) reconstruction vary among surgeons with insufficient evidence to support any specific technique.

Questions/Purposes We compared survival with cyclic loading, absolute elongation, elongation rate, and modes of failure of four graft preparation techniques.

Methods Fifteen porcine extensor tendons were divided into three equal groups: tendon only; tendon augmented along its full length with nonlocking 2–0 FiberLoop suture spaced at 6 mm intervals; and tendon with suture at 12 mm intervals. Suture only was also tested. Samples were woven through custom radius- and ulna-simulating jigs mounted on a mechanical testing machine. Samples underwent a staircase cyclic loading protocol and were then inspected visually for the mode of failure. Survival with cyclic loading, absolute elongation, and elongation rate was compared.

Results Average survival with cyclic loading of suture-augmented tendon was significantly higher than tendon only. All tendon groups had significantly higher survival compared with suture only. Absolute elongation was subject to variability due to initial nonlinear elongation behavior of samples. The elongation rate was significantly lower with suture compared with all tendon groups. Modes of failure included rupture of the tendon and/or suture at the simulated graft–bone interface and elongation of the entire construct without rupture.

Conclusions In this biomechanical study, augmentation of porcine tendons with suture spaced at either 6 or 12 mm for DRUJ reconstruction significantly increased survival to a staircase cyclic loading protocol

Clinical Relevance For the Adams–Berger reconstruction, tendon grafts augmented along their entire length by nonabsorbable braided suture are biomechanically superior to tendon alone.

Keywords

biomechanical testing - distal radioulnar joint reconstruction - tendon graft fixation

Ethical Review Committee Statement

Approval for the use of the porcine specimens was obtained under exceptions to the requirement for ACUC review.

Publication History

Received: 10 November 2022

Accepted: 09 May 2023

Article published online:
12 June 2023

• References

• 1 Kakar S, Garcia-Elias M. The “four-leaf clover” treatment algorithm: a practical approach to manage disorders of the distal radioulnar joint. J Hand Surg Am 2016; 41 (04) 551-564
• 2 Adams BD, Berger RA. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 2002; 27 (02) 243-251
• 3 Barber FA, Howard MS, Piccirillo J, Spenciner DB. A biomechanical comparison of six suture configurations for soft tissue-based graft traction and fixation. Arthroscopy 2019; 35 (04) 1163-1169
• 4 Dean R, Sethi P. A novel method for reducing gap formation in tendon repair. J Orthop 2018; 15 (01) 259-263
• 5 Krackow KA, Thomas SC, Jones LC. A new stitch for ligament-tendon fixation. Brief note. J Bone Joint Surg Am 1986; 68 (05) 764-766
• 6 Sakaguchi K, Tachibana Y, Oda H. Biomechanical properties of porcine flexor tendon fixation with varying throws and stitch methods. Am J Sports Med 2012; 40 (07) 1641-1645
• 7 Sasho T, Sasaki T, Hoshi H. et al. Evaluating different closed loop graft preparation technique for tibial suspensory fixation in ACL reconstruction using TightRope™. Asia Pac J Sports Med Arthrosc Rehabil Technol 2018; 12: 5-11
• 8 Hahn JM, Inceoğlu S, Wongworawat MD. Biomechanical comparison of Krackow locking stitch versus nonlocking loop stitch with varying number of throws. Am J Sports Med 2014; 42 (12) 3003-3008
• 9 Deramo DM, White KL, Parks BG, Hinton RY. Krackow locking stitch versus nonlocking premanufactured loop stitch for soft-tissue fixation: a biomechanical study. Arthroscopy 2008; 24 (05) 599-603
• 10 Jassem M, Rose AT, Meister K, Indelicato PA, Wheeler D. Biomechanical analysis of the effect of varying suture pitch in tendon graft fixation. Am J Sports Med 2001; 29 (06) 734-737
• 11 Hong C-K, Lin C-L, Kuan F-C, Wang P-H, Yeh M-L, Su W-R. Longer stitch interval in the Krackow stitch for tendon graft fixation leads to poorer biomechanical property. J Orthop Surg (Hong Kong) 2018; 26 (03) 2309499018799514
• 12 Jang E, Dy CJ, Wolfe SW. Selection of tendon grafts for distal radioulnar ligament reconstruction and report of a modified technique. J Hand Surg Am 2014; 39 (10) 2027-2032
• 13 Ito MM, Aoki M, Kida MY, Ishii S, Kumaki K, Tanaka S. Length and width of the tendinous portion of the palmaris longus: a cadaver study of adult Japanese. J Hand Surg Am 2001; 26 (04) 706-710
• 14 Johnson CC, Vutescu ES, Miller TT, Nwawka OK, Lee SK, Wolfe SW. Ultrasound determination of presence, length and diameter of the palmaris longus tendon. J Hand Surg Eur Vol 2018; 43 (09) 948-953
• 15 Wang RY, Arciero RA, Obopilwe E, Mazzocca AD. A comparison of structural and mechanical properties of tubularized and native semitendinosus graft. Am J Sports Med 2010; 38 (06) 1246-1249
• 16 Sanders DW, Milne AD, Dobravec A, MacDermid J, Johnson JA, King GJW. Cyclic testing of flexor tendon repairs: an in vitro biomechanical study. J Hand Surg Am 1997; 22 (06) 1004-1010
• 17 Pruitt DL, Manske PR, Fink B. Cyclic stress analysis of flexor tendon repair. J Hand Surg Am 1991; 16 (04) 701-707