Flexor Tendon Repair Remains a Post Operative Range of Motion - - PowerPoint PPT Presentation

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Feb 02, 2023 20 likes •60 views

5/10/2013 A Knotless Cable-Crimp Flexor Tendon Repair - Disclosure: Biomechanical Comparison to a Four Strand FiberWire Cruciate Repair I have no disclosures PONTiS Orthopaedics provided the materials and devices used for this study UCSF/

SLIDE 1

5/10/2013 1

UCSF/ SFGH Biomechanics Lab Erik McDonald, BS Leonard Gordon, MD Jun Matsui, MD Josh Gordon, MD Ronald Neimkin, MD

A Knotless Cable-Crimp Flexor Tendon Repair - Biomechanical Comparison to a Four Strand FiberWire Cruciate Repair

Disclosure:

I have no disclosures PONTiS Orthopaedics provided the materials and devices used for this study L.Gordon is an investor/owner of PONTiS Orthopaedics

Flexor Tendon Repair Remains a Challenge

JHS 2011

Re-rupture – 3-5%; Reoperation – 4-7%; Adhesions – 2-6%

JHS Br 1998

Mean age of injury – 26.4 years in men, 29.2 years in women

JHS 2012 JHS Br 1998

Post Operative Range of Motion

2013

Recommendations: “Initiate early active motion in compliant patients in the presence of robust repair.”

SLIDE 2

5/10/2013 2

Ideal Core Suture Properties

Strickland 1995 – Flexor Tendon Injuries: I. Foundations of Treatment

Sutures easily placed in tendon
Secure suture knots
Smooth junction of tendon ends
Minimal gapping at repair site
Minimal interference with vascularity
Sufficient strength throughout healing to

permit the application of early motion stress to the tendon

How can we achieve these ideals?

Higher ultimate load and stiffness when compared to Fiberwire, Ethibond, and Supramid

JHS 2011

However the repairs are still complex… OK, but how does it do in a repair?

JHS 2011 JHS 2013

SLIDE 3

5/10/2013 3

Repair Technique

JHS 2011 JHS 2013

8 Fresh Frozen FDP tendons per group

Fiber Wire MFSS Crimp

cross-lock exposure

MFSS Crimp Surgical Technique

A-2 C-1 A-3 A-3 C-1 A-2

Repair time Surgical exposure

MFSS cable-crimp 2-strand -- under 7mins FW cruciate 4-strand -- 12 mins Cable-crimp system 2-strand -- 0.6cm FW cruciate 4-strand -- 2.1cm

20 40 60 80 100 120 140 4 Strand 3-0 FW 2 Strand 3-0 Crimp % Increase in Force of Flexion

Force of Flexion Testing

Intact Tendon Measured, Repair Performed, Repaired Tendon Measured

SLIDE 4

5/10/2013 4

Mechanical Testing Results

JHS 2011 JHS 2013

20 40 60 80 100 120 140 4 Strand 3- 0 FW 2 Strand 3- 0 Crimp Ultimate Load (N) 20 40 60 80 100 120 140 4 Strand 3-0 FW 2 Strand 3-0 Crimp Maximum Load Prior to 2mm Gap (N)

Mode of Failure Results

JHS 2011 JHS 2013

N = 8 / group Pull Thru Tendon Suture Break Ultimate Load Before 2mm Gap Fiber Wire 5 3 MFSS 8 6

3 months FPL repair thro mini-incision

Conclusions

JHS 2011 JHS 2013

The MFSS Crimp system had reduced surgical exposure, repair times and force of flexion while maintaining the strength required for early active range of motion rehabilitation when compared with traditional Fiberwire repairs.