J Hand Microsurg 2015; 07(01): 6-12
DOI: 10.1007/s12593-014-0144-4
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

The Interlocking Modification of the Cross Locked Cruciate Tendon Repair (Modified Adelaide Repair): A Static and Dynamic Biomechanical Assessment

Ramon Tahmassebi
1   Kings College Hospital London, Denmark Hill, London, UK, SE5 9RS   eMail: rtahmassebi@doctors.org.uk
,
Tim S. Peltz
2   Surgical and Orthopaedic Research Laboratories, University of New South Wales, Prince of Wales Hospital, Sydney, Australia
3   The Department of Hand Surgery, Sydney and St Lukes Hospital, Sydney, Australia
,
Roger Haddad
2   Surgical and Orthopaedic Research Laboratories, University of New South Wales, Prince of Wales Hospital, Sydney, Australia
3   The Department of Hand Surgery, Sydney and St Lukes Hospital, Sydney, Australia
,
Peter Scougall
2   Surgical and Orthopaedic Research Laboratories, University of New South Wales, Prince of Wales Hospital, Sydney, Australia
3   The Department of Hand Surgery, Sydney and St Lukes Hospital, Sydney, Australia
,
Mark Gianoutsos
2   Surgical and Orthopaedic Research Laboratories, University of New South Wales, Prince of Wales Hospital, Sydney, Australia
3   The Department of Hand Surgery, Sydney and St Lukes Hospital, Sydney, Australia
,
William Walsh
2   Surgical and Orthopaedic Research Laboratories, University of New South Wales, Prince of Wales Hospital, Sydney, Australia
3   The Department of Hand Surgery, Sydney and St Lukes Hospital, Sydney, Australia
› Institutsangaben

Verantwortlicher Herausgeber dieser Rubrik:
Weitere Informationen

Publikationsverlauf

03. Dezember 2013

13. Juni 2014

Publikationsdatum:
13. September 2016 (online)

Abstract

The 4-strand cross-locked cruciate flexor tendon repair technique (Adelaide technique) has been shown to have comparably high resistance to gap formation and ultimate tensile strength. This study aimed to determine whether an interlocking modification to the Adelaide repair would impart improved biomechanical characteristics. Twenty four sheep flexor tendons were harvested, transected and repaired using either standard or modified Adelaide techniques. Repaired tendons were cyclically loaded. Gap formation and ultimate tensile strength were measured. Additionally, suture exposure on the tendon surface was determined. There was a statistically significant increase in resistance to gap formation in the early phase of cyclic loading within the modified Adelaide group. In the later stages of testing no significant difference could be noted. The average final load to failure in the modified group was higher than the standard group but this did not achieve statistical significance. Interlocking suture techniques in four strand tendon repair constructs can improve gapping behavior in the early phase of cyclic loading.

 
  • References

  • 1 Small JO, Brennen MD, Colville J. Early active mobilisation following flexor tendon repair in zone 2. J Hand Surg (Br) 1989; 14 (4) 383-391
  • 2 Elliot D, Moiemen NS, Flemming AFS, Harris SB, Foster AJ. The rupture rate of acute flexor tendon repairs mobilized by the controlled active motion regime. J Hand Surg (Br) 1994; 19 (5) 607-612
  • 3 Strickland JW. Development of flexor tendon surgery: twenty-five years of process. 2000; J Hand Surg [Am] 25 (2) 214-235
  • 4 Winters SC, Gelberman RH, Woo SL, Chan SS, Grewal R, Seiler JG. The effects of multiple-strand suture methods on the strength and excursion of repaired intrasynovial flexor tendons: a biomechanical study in dogs. J Hand Surg [Am] 1998; 23 (1) 97-104
  • 5 Viinikainen A, Goeransson H, Huovinen K, Kellomaki M, Rokkanen P. A comparative analysis of the biomechanical behaviour of five flexor tendon core sutures. J Hand Surg (Br) 2004; 29 (6) 536-543
  • 6 Barrie KA, Wolfe SW, Shean C, Shenbagamurthi D, Slade JF, Panjabi MM. A biomechanical comparison of multistrand flexor tendon repairs using an in situ testing model. J Hand Surg 2000; 25 (3) 499-506
  • 7 Sandow MJ, McMahon MM. Single-cross grasp six-strand repair for acute flexor tenorrhaphy: modified Savage technique. Atlas Hand Clin 1996; 1: 41-64
  • 8 Sandow M, Kay S. Flexor tendon injuries. In: Prosser R, Conolly WB. Rehabilitation of the hand and upper limb. Butterworth Heinemann; Edinburgh: 2003: 46-52
  • 9 Sandow M, McMahon M. Active mobilisation following single cross grasp four-strand flexor tenorrhaphy [Adelaide repair]. J Hand Surg [Eur Vol] 2011; 36 (6) 467-475
  • 10 Vigler M, Palti R, Goldstein R, Patel VP, Nasser P, Lee SK. Biomechanical study of cross-locked cruciate versus Strickland flexor tendon repair. J Hand Surg [Am] 2008; 33 (10) 1826-1833
  • 11 Wolfe SW, Barrie KA, Merrell GA. Letter regarding “Influence of locking stitch size in a four-strand cross-locked cruciate flexor tendon repair”. J Hand Surg [Am] 2012; 37 (1) 188 author reply 188-9
  • 12 Savage R, Risitano G. Flexor tendon repair using a “six strand” method of repair and early active mobilisation. J Hand Surg 1989; 14B: 396-399
  • 13 McLarney E, Hoffman H, Wolfe SW. Biomechanical analysis of the cruciate four-strand flexor tendon repair. J Hand Surg [Am] 1999; 24 (2) 295-301
  • 14 Barrie KA, Tomak SL, Cholewicki J, Wolfe SW. The role of multiple strands and locking sutures on gap formation of flexor tendon repairs during cyclical loading. J Hand Surg 2000; 25A: 714-720
  • 15 Barrie KA, Tomak SL, Cholewicki J, Merrell GA, Wolfe SW. Effect of suture locking and suture caliber on fatigue strength of flexor tendon repairs. J Hand Surg 2001; 26A: 340-346
  • 16 Angeles JG, Heminger H, Mass DP. Comparative biomechanical performances of 4-strand core suture repairs for zone II flexor tendon lacerations. J Hand Surg 2002; 27A: 508-517
  • 17 Croog A, Goldstein R, Nasser P, Lee SK. Comparative biomechanic performances of locked cruciate four-strand flexor tendon repairs in an ex vivo porcine model. J Hand Surg 2007; 32A: 225-232
  • 18 Hirpara KM, Sullivan PJ, Raheem O, O’Sullivan ME. A biomechanical analysis of multistrand repairs with the Silfverskiold peripheral cross-stitch. J Bone Joint Surg 2007; 89B: 1396-1401
  • 19 Peltz T, Haddad R, Scougall PJ, Nicklin S, Gianoutsos M, Walsh WR. Influence of Locking Stitch Size in a Four-Strand Cross-Locked Cruciate Flexor Tendon Repair. J Hand Surg 2011; 36A: 450-455
  • 20 Hirpara KM, Sullivan PJ, O’Sullivan ME. The effects of freezing on the tensile properties of repaired porcine flexor tendon. J Hand Surg 2008; 33A: 353-358
  • 21 Schuind F, Garcia-Elias M, Cooney WP, An KN. Flexor tendon forces: in vivo measurements. J Hand Surg [Am] 1992; 17 (2) 291-298
  • 22 Matheson G, Nicklin S, Gianoutsos MP, Walsh WR. Comparison of zone ii flexor tendon repairs using an in vitro linear cyclic testing protocol. Clin Biomech 2005; 20 (7) 718-722
  • 23 Hausmann JT, Vekszler G, Bijak M, Benesch T, Vecsei V, Gabler C. Biomechanical comparison of modified Kessler and running suture repair in 3 different animal tendons and in human flexor tendons. J Hand Surg 2009; 34 (1) 93-101
  • 24 Strickland JW. Flexor tendon injuries: I. Foundations of treatment. J Am Acad Orthop Surg 1995; 3: 44-54
  • 25 Wong JK, Cerovac S, Ferguson MW, McGrouther DA. The cellular effect of a single interrupted suture on tendon. J Hand Surg 2006; 31B: 358-367
  • 26 Thurman RT, Trumble TE, Hanel DP, Tencer AF, Kiser PK. Two-, four-, and six-strand zone II flexor tendon repairs: an in situ biomechanical comparison using a cadaver model. J Hand Surg 1998; 23A: 261-265
  • 27 Dona E, Gianoutsos MP, Walsh WR. Optimizing biomechanical performance of the 4-strand cruciate flexor tendon repair. J Hand Surg 2004; 29A: 571-580
  • 28 Hatanaka H, Manske PR. Effect of the cross-sectional area of locking loops in flexor tendon repair. J Hand Surg 1999; 24A: 751-760
  • 29 Hatanaka H, Manske PR. Effect of suture size on locking and grasping flexor tendon repair techniques. Clin Orthop Relat Res 2000; 375: 267-274
  • 30 Hotokezaka S, Manske PR. Differences between locking loops and grasping loops: effects on 2-strand core suture. J Hand Surg 1997; 22A: 995-1003
  • 31 Wada A, Kubota H, Hatanaka H, Hotokezaka S, Miura H, Iwamoto Y. The mechanical properties of locking and grasping suture loop configurations in four-strand core suture techniques. J Hand Surg 2000; 25B: 548-551
  • 32 Tanaka T, Amadio PC, Zhao C, Zobitz ME, Yang C, An KN. Gliding characteristics and gap formation for locking and grasping tendon repairs: a biomechanical study in a human cadaver model. J Hand Surg 2004; 29A: 6-14
  • 33 Robertson GA. al-Qattan MM. A biomechanical analysis of a new interlock suture technique for flexor tendon repair. J Hand Surg 1992; 17B: 92-93
  • 34 Haddad R, Peltz T, Lau A, Bertollo N, Nicklin S, Walsh WR. The relationship between gap formation and grip-to-grip displacement during cyclic testing of repaired flexor tendons. J Biomech 2010; 43 (14) 2835-2838
  • 35 Gibbons CE, Thompson D, Sandow MJ. Flexor tenorrhaphy tensile strength: reduction by cyclic loading: in vitro and ex vivo porcine study. Hand 2009; 4: 113-118
  • 36 Gelberman RH, Boyer MI, Brodt MD, Winters SC, Silva MJ. The effect of gap formation at the repair site on the strength and excursion of intrasynovial flexor tendons. An experimental study on the early stages of tendon healing in dogs. J Bone Joint Surg 1999; 81A: 975-982