Purpose
This study evaluated 1.0-mm mini suture anchors for repairing the central slip of
the extensor mechanism at the proximal interphalangeal joint. Studies have reported
a requirement for central slip fixation to withstand 15 N during postoperative rehabilitation
exercises and 59 N during forceful contraction.
Methods
Index and middle fingers from 10 matched pairs of cadaveric hands were prepared with
1.0-mm mini suture anchors with 2-0 sutures or threaded with 2-0 sutures through a
bone tunnel (BTP). In total, 10 index fingers from unmatched hands were prepared with
suture anchors and fixed to the extensor tendons to evaluate the tendon/suture interface
response. Each distal phalanx was secured to a servohydraulic testing machine, and
ramped tensile loads were applied to suture or tendon until failure.
Results
All anchors for the all-suture bone tests failed because of pullout from the bone
(Mean failure force = 52.5+/-17.3 N). Three anchors from the tendon-suture pull out
test failed by pullout from the bone and seven failed at the tendon/suture interface
(Mean failure force = 49.0+/-10.1 N).
Conclusions
The 1.0-mm mini suture anchor provides enough strength for early short-arc motion,
but it may not be adequate for forceful contraction in the early postoperative rehabilitation
stage.
Clinical Relevance
The site of fixation, the type of anchor, and the type of suture used are key factors
to consider for early range of motion, after surgery.
Key Words
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References
- Closed soft tissue extensor mechanism injuries (mallet, boutonniere, and sagittal band).J Hand Surg Am. 2014; 39: 1005-1011
- Management of acute extensor tendon injuries.Clin Plast Surg. 2019; 46: 383-391
- Management of complications of extensor tendon injuries.Hand Clin. 2015; 31: 301-310
- Extensor tendons injuries.Clin Sports Med. 2015; 34: 167-180
- Central slip extensor tendon injuries: a systematic review of treatments.J Hand Surg Eur. 2019; 44: 825-832
- Extensor tendon injuries in athletes.Sports Med Arthrosc Rev. 2014; 22: 45-55
- Extensor tendons: acute injuries.in: Green D.P. Operative Hand Surgery. 3rd ed. Churchill Livingstone, 1993: 1925-1951
- The Effect of distal phalanx bony dimensions in suture anchor fixations of tendon avulsion.J Hand Surg Asian Pac. 2018; 23: 347-350
- Repair of central slip avulsions using Mitek Micro Arc bone anchors. An in vitro biomechanical assessment.J Hand Surg Br. 1999; 24: 679-682
- Bone suture anchors in hand surgery.J Hand Surg Br. 1995; 20: 245-248
- Repair of the central slip of extensor tendon and the open mallet using Mitek mini bone anchors.Eur J Plast. 2011; 34: 13-17
- Peak load resistance of the JuggerKnot soft anchor technique compared with other common fixation techniques for large mallet finger fractures.Hand Surg. 2013; 18: 381-388
- Management of zone 1 flexor digitorum profundus tendon injuries.Chir Main. 2014; 33: S13-S27
- Passive correction of Mallet deformity with a MicrofixQuickanchor Plus: a cadaveric study.J Plast Reconstr Aesthet Surg. 2014; 67: e171-e172
- Clinical orthopaedic rehabilitation. An evidence-based approach. Mosby, 2010: 1-55
- Biomechanical evaluation of classic solid and novel all-soft suture anchors for glenoid labral repair.Arthroscopy. 2012; 28: 642-648
- The histologic and biomechanical response of two commercially available small glenoid anchors for use in labral repairs.J Shoulder Elbow Surg. 2014; 23: 1156-1161
- The use of anchors in shoulder surgery: a shift from metallic to bioabsorbable anchors.Arthroscopy. 2007; 23: 1124-1126
- Arthroscopic bankart reconstruction with a bioabsorbable anchor.J Shoulder Elbow Surg. 2003; 12: 535-538
- A delayed allergic reaction to polypropylene suture used in flexor tendon repair: case report.J Hand Surg Am. 2015; 40: 1377-1381
Basko-Plluska JL, Thyssen JP, Schalock PC. Cutaneous and systemic hypersensitivity reactions to metallic implants. Dermatitis. 201;22(2):65–79.
- Hypersensitivity to suture anchors.Case Rep Orthop. 2013; 2013932167
- Biomechanical evaluation of suture anchor versus transosseous tunnel quadriceps tendon repair techniques.Arthroscopy. 2016; 32: 1117-1124
- Biomechanical analysis of four-strand extensor tendon repair techniques.J Hand Surg Am. 1997; 22: 838-842
- A clinical study of forces generated by the intrinsic muscles of the index finger and the extrinsic flexor and extensor muscles of the hand.J Hand Surg Am. 1978; 3: 571-578
- A biomechanical study of extensor tendon repair methods: introduction to the running-interlocking horizontal mattress extensor tendon repair technique.J Hand Surg Am. 2010; 35: 19-23
- JuggerKnot Soft Anchor-1.0mm Mini Ulnar Collateral (UCL) Repair of Thumb. Biomet Sports Medicine.
- Early active short arc motion for the repaired central slip.J Hand Surg Am. 1994; 19: 991-997
- Early active short arc motion following central slip repair.J Hand Surg Am. 2011; 36: 143-146
- The Mitek Mini G2 suture anchor: biomechanical analysis of use in the hand.J Hand Surg Am. 1995; 20: 877-881
- JuggerKnot and JuggerKnotless soft anchor.
Article info
Publication history
Published online: March 03, 2023
Accepted:
January 18,
2023
Received:
April 11,
2022
Publication stage
In Press Corrected ProofFootnotes
JuggerKnot anchors and suture for both phases of this study were provided by a Biomet representative. Biomet had no role in the study design, collection, analysis and interpretation of data, writing of the manuscript, or the decision to submit the article for publication. This project was supported in part by an award from the National Center for Advancing Translational Sciences, National Institutes of Health under grant number UL1TR001449.
Identification
Copyright
© 2023 by the American Society for Surgery of the Hand. All rights reserved.
