Purpose
To determine strength and failure characteristics of 2 suture anchors used to repair
simulated flexor digitorum profundus avulsions during passive mobilization protocol
simulation.
Methods
We simulated avulsion of the flexor digitorum profundus tendon in 30 distal phalanges
from fresh-frozen human cadavers. Repair was performed with a 1.3 × 3.7 mm Micro-Mitek
suture anchor (3-0 Orthocord suture) and a 2.2 × 4.0-mm Corkscrew suture anchor (2-0
FiberWire suture). All specimens were loaded cyclically from 2 to 15 N at 5 N/s for
a total of 500 cycles. Samples were tested to failure at the completion of 500 cycles.
Load at failure, load at first noteworthy displacement (> 2 mm), elongation of the
system, gap formation at the tendon–bone interface, and the mechanism of failure were
assessed.
Results
Suture failure at maximum load was the prevalent failure mechanism in both groups.
No statistically significant difference in elongation of the tendon–suture complex
was observed. The Corkscrew suture anchor showed a significantly superior performance
in load to failure, load at first significant displacement, and gap formation at the
tendon–bone interface.
Conclusions
The significantly higher load capacity at first displacement (> 2 mm) and the significance
of a lower gap formation at the repair site seem to be the most relevant clinical
parameters. Based on this concept, the Corkscrew anchor may be superior biomechanically
to the Micro-Mitek when considering an early passive mobilization protocol.
Clinical relevance
The choice of an appropriate implant may influence the postoperative mobilization
protocol and thereby improve currently reported success rates. Defining a biomechanically
superior implant will provide an essential basis for further studies in flexor tendon
repair research.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Tendon and muscle ruptures: clinical and experimental studies on the causes and locations of subcutaneous ruptures.J Bone Joint Surg. 1933; 15: 705-722
- Avulsions of the flexor digitorum profundus.Hand Clin. 1985; 1: 77-83
- Avulsion of the profundus tendon insertion in athletes.J Hand Surg Am. 1977; 2: 66-69
- Primary repair of flexor tendons in the hand without immobilization—preliminary report.Hand. 1978; 10: 37-47
- Miniplate fixation for avulsion injuries of the flexor digitorum profundus insertion.J Hand Surg Br. 2003; 28: 363-368
- Bone suture anchors in hand surgery.J Hand Surg Br. 1995; 20: 245-248
- Reconstruction of a functional and esthetic nail.Hand Clin. 1990; 6: 59-68
- Bone suture anchors versus the pullout button for repair of distal profundus tendon injuries: a comparison of strength in human cadaveric hands.J Hand Surg Am. 2001; 26: 489-496
- Comparison of pullout button versus suture anchor for zone I flexor tendon repair.J Hand Surg Am. 2006; 31: 246-251
- Primary flexor tendon repair in zone 1.J Hand Surg Br. 2000; 25: 78-84
- Early active motion following a beveled technique of flexor tendon repair: report on fifty cases.J Hand Surg. 1979; 4: 454-460
- Flexor tendon repair in zone 2 followed by controlled active mobilisation.J Hand Surg Br. 1989; 14: 392-395
- Suture strength and angle of load application in a suture anchor eyelet.J Arthrosc. 2005; 21: 1447-1451
- Results of primary repair of isolated flexor digitorum profundis lesions in the digital canal: 51 cases.Ann Chir Main Memb Super. 1996; 15: 18-24
- Elongation in profundus tendon repair: a clinical and radiological study.Scand J Plast Reconstr Surg. 1981; 15: 61-68
- 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 Am. 1999; 81: 975-982
- Elongation of the repair configuration following flexor tendon repair.J Hand Surg Am. 1983; 8: 182-185
- Gap formation during controlled motion after flexor tendon repair in zone II: a prospective clinical study.J Hand Surg Am. 1992; 17: 539-546
- Early tensile properties of healing chicken flexor tendons: early controlled passive motion versus postoperative immobilization.J Hand Surg Am. 1990; 15: 63-68
- The effects of mobilization on the vascularization of healing flexor tendons in dogs.Clin Orthop Relat Res. 1980; : 283-289
- The early stages of flexor tendon healing: a morphologic study of the first fourteen days.J Hand Surg Am. 1985; 10: 776-784
- The effects of frequency and duration of controlled passive mobilization on tendon healing.J Orthop Res. 1991; 9: 705-713
- The importance of controlled passive mobilization on flexor tendon healing: a biomechanical study.Acta Orthop Scand. 1981; 52: 615-622
- In vitro studies of a new method of flexor tendon repair.J Hand Surg Br. 1985; 10: 135-141
- Double loop locking suture: a technique of tendon repair for early active mobilization. Part II: clinical experience.J Hand Surg Am. 1990; 15: 953-958
- Strength of the suture in the epitenon and within the tendon fibres: development of stronger peripheral suture technique.J Hand Surg Br. 1992; 17: 171-175
- Effects of constant mechanical tension on the healing of rabbit flexor tendons.Clin Orthop Relat Res. 1993; : 301-306
- Cyclic testing of flexor tendon repairs: an in vitro biomechanical study.J Hand Surg Am. 1997; 22: 1004-1010
- Cyclic stress analysis of flexor tendon repair.J Hand Surg Am. 1991; 16: 701-707
- Cyclic stress testing after in vivo healing of canine flexor tendon lacerations.J Hand Surg Am. 1996; 21: 974-977
- A new type of flexor tendon repair: biomechanical evaluation by cyclic loading, ultimate strength and assessment of pulley friction in vitro.J Hand Surg Br. 1995; 20: 578-583
- Cyclic testing of pullout sutures and Micro-Mitek suture anchors in flexor digitorum profundus tendon distal fixation.J Hand Surg Am. 2005; 30: 471-478
- The effect of Mitek anchor insertion angle to attachment of FDP avulsion injuries.J Hand Surg Br. 2006; 31: 292-295
- Security of knots tied with ethibond, fiberwire, orthocord, or ultrabraid.Am J Sports Med. 2008; 36: 2407-2414
- Flexor tendon forces: in vivo measurements.J Hand Surg Am. 1992; 17: 291-298
- Flexor Tendons—Acute Injuries.Churchill Livingstone, Philadelphia, PA1999
- The deadman theory of suture anchors: observations along a south Texas fence line.Arthroscopy. 1995; 11: 119-123
Article info
Publication history
Accepted:
November 13,
2013
Received:
March 20,
2013
Footnotes
The authors acknowledge Mark Daniels, BA, Director Asia Pacific at HVD Life Sciences, Managing Director at Bionoetikos Ltd, for tremendous support in proofreading and improving the quality of the manuscript by contributing his expertise in Biomedicine and Life Sciences; and Zuzana Vančová, MSc, for graphic design.
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
