Download PDF
CC BY-NC-ND 4.0 · Revista Iberoamericana de Cirugía de la Mano 2018; 46(02): 143-149
DOI: 10.1055/s-0038-1675390
Update Article | Artículo de Actualización
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Conceptos Biomecánicos de las Suturas Tendinosas

Biomechanical Concepts of Tendon Sutures
Jaime Alonso Pérez-Barquero
1   Unión de Mutuas, Hospital 9 de Octubre, Valencia, España
,
Elena Fernández Sabaté
2   Unión de Mutuas, Valencia, España
,
Eduardo Sánchez-Alepuz
3   Unión de Mutuas, Hospital IMED, Valencia, España
› Author Affiliations
Further Information

Publication History

11 September 2018

27 September 2018

Publication Date:
01 November 2018 (online)

   Permissions and Reprints

Resumen

El objetivo de una sutura tendinosa es que sea lo suficientemente resistente para permitir una movilidad activa precoz. Para ello, los cirujanos deben comprender las características biomecánicas de las suturas tendinosas. El objetivo de este artículo es recoger los aspectos fundamentales de los estudios biomecánicos, así como los principales factores que influyen en la resistencia de una sutura, tanto en tenorrafias primarias como en el caso de injertos y transferencias. Estudios in vitro o in vivo, con tracción lineal o curvilínea, cíclicos o de tracción única, son algunos de los factores que hemos de tener en cuenta a la hora de analizar un estudio sobre suturas tendinosas, así como conocer los principales parámetros físicos que analizan. Así mismo el material, el diámetro, la configuración, el número de hebras, el tipo de agarre al tendón, la tensión de la sutura, el tipo de nudo y la configuración de la sutura epitendinosa son los principales factores que influyen en la resistencia de las suturas primaria. En el caso de los injertos y transferencias, el número de entrelazaos y el tipo de puntos utilizados, son los principales aspectos que influyen en la sutura tipo Pulvertaft y sus alternativas.

Abstract

The goal of a tendon suture is to be strong enough to allow active early mobility. Surgeons must understand the biomechanical characteristics of tendon sutures. The aim of this article is to collect the fundamental aspects of biomechanical studies as well as the main factors that influence the strength of a tendon suture, both in primary tenorrhaphies and in tendon grafts and transfers. Studies in vitro or in vivo, with linear or curvilinear traction, with cyclic or single traction, are some of the factors that we have to take into account when analyzing a study of tendon suture, as well as knowing the main physical parameters. Likewise, the material, the diameter, the configuration, the number of strands, the type of grip to the tendon, the tension of the suture, the knot and the configuration of the epithendinous suture are the main factors that influence the resistance of the sutures. In the case of grafts and transfers, the number of weaves and the type of stitch are the main aspects that influence in the Pulvertaft weave suture and its alternatives.

Palabras clave

Biomecánica - reparación tendón flexor - injerto tendinoso - transferencia tendinosa

Keywords

biomechanical - flexor tendon repair - tendon graft - tendon transfer
 

  • Bibliografía

  • 1 Tang JB, Amadio PC, Boyer MI. , et al. Current practice of primary flexor tendon repair: a global view. Hand Clin 2013; 29 (02) 179-189
    CrossrefPubMedGoogle Scholar
  • 2 Wu YF, Tang JB. Recent developments in flexor tendon repair techniques and factors influencing strength of the tendon repair. J Hand Surg Eur Vol 2014; 39 (01) 6-19
    CrossrefPubMedGoogle Scholar
  • 3 Bo Tang J, Guo Xie R. Biomechanics of Core and Peripheral Tendon Repairs. En: Elsevier Inc (Ed). Tendon Surgery of the Hand. 2012: 35-48
    Google Scholar
  • 4 Kubota H, Aoki M, Pruitt DL, Manske PR. Mechanical properties of various circumferential tendon suture techniques. J Hand Surg [Br] 1996; 21 (04) 474-480
    CrossrefPubMedGoogle Scholar
  • 5 Kang GH-Y, Wong YR, Lim RQ-R, Loke AMK, Tay SC. Cyclic Testing of the 6-Strand Tang and Modified Lim-Tsai Flexor Tendon Repair Techniques. J Hand Surg Am 2018; 43 (03) 285.e1-285.e6
    CrossrefPubMedGoogle Scholar
  • 6 Lim RQR, Wong YR, Loke AMK, Tay SC. A cyclic testing comparison of two flexor tendon repairs: asymmetric and modified Lim-Tsai techniques. J Hand Surg Eur Vol 2018; 43 (05) 494-498
    CrossrefPubMedGoogle Scholar
  • 7 Chang MK, Wong YR, Tay SC. Biomechanical comparison of modified Lim/Tsai tendon repairs with intra- and extra-tendinous knots. J Hand Surg Eur Vol 2018; 24: 1753193418769804
    PubMedGoogle Scholar
  • 8 Kozono N, Okada T, Takeuchi N, Shimoto T, Higaki H, Nakashima Y. A Biomechanical Comparison Between Asymmetric Pennington Technique and Conventional Core Suture Techniques: 6-Strand Flexor Tendon Repair. J Hand Surg Am 2018; 43 (01) 79.e1-79.e8
    CrossrefPubMedGoogle Scholar
  • 9 Hashimoto T, Thoreson AR, An KN, Amadio PC, Zhao C. Comparison of step-cut and Pulvertaft attachment for flexor tendon graft: a biomechanics evaluation in an in vitro canine model. J Hand Surg Eur Vol 2012; 37 (09) 848-854
    CrossrefPubMedGoogle Scholar
  • 10 Vincken NLA, Lauwers TMAS, van der Hulst RRWJ. Biomechanical and Dimensional Measurements of the Pulvertaft Weave Versus the Cow-Hitch Technique. Hand (N Y) 2017; 12 (01) 78-84
    CrossrefPubMedGoogle Scholar
  • 11 Jeon SH, Chung MS, Baek GH, Lee YH, Kim SH, Gong HS. Comparison of loop-tendon versus end-weave methods for tendon transfer or grafting in rabbits. J Hand Surg Am 2009; 34 (06) 1074-1079
    CrossrefPubMedGoogle Scholar
  • 12 Kim SH, Chung MS, Baek GH, Lee YH, Lee S, Gong HS. A loop-tendon suture for tendon transfer or graft surgery. J Hand Surg Am 2007; 32 (03) 367-372
    CrossrefPubMedGoogle Scholar
  • 13 Peltz TS, Hoffman SW, Scougall PJ. , et al. Animal Models for Tendon Repair Experiments: A Comparison of Pig, Sheep and Human Deep Flexor Tendons in Zone II. J Hand Surg Asian Pac Vol 2017; 22 (03) 329-336
    PubMedGoogle Scholar
  • 14 Kadar A, Liu H, Vrieze AM. , et al. Establishment of an in vivo turkey model for the study of flexor tendon repair. J Orthop Res 2018; 36 (09) 2497-2505
    CrossrefPubMedGoogle Scholar
  • 15 An YH, Freidman RJ. Animal Models in Orthopaedic Research. CRC Press; 1998: 1
    Google Scholar
  • 16 Miller L, Mass DP. A comparison of four repair techniques for Camper's chiasma flexor digitorum superficialis lacerations: tested in an in vitro model. J Hand Surg Am 2000; 25 (06) 1122-1126
    CrossrefPubMedGoogle Scholar
  • 17 Brockardt CJ, Sullivan LG, Watkins BE, Wongworawat MD. Evaluation of simple and looped suture and new material for flexor tendon repair. J Hand Surg Eur Vol 2009; 34 (03) 329-332
    CrossrefPubMedGoogle Scholar
  • 18 Mishra V, Kuiper JH, Kelly CP. Influence of core suture material and peripheral repair technique on the strength of Kessler flexor tendon repair. J Hand Surg [Br] 2003; 28 (04) 357-362
    PubMedGoogle Scholar
  • 19 Gan AWT, Neo PY, He M, Yam AKT, Chong AKS, Tay SC. A biomechanical comparison of 3 loop suture materials in a 6-strand flexor tendon repair technique. J Hand Surg Am 2012; 37 (09) 1830-1834
    CrossrefPubMedGoogle Scholar
  • 20 Scherman P, Haddad R, Scougall P, Walsh WR. Cross-sectional area and strength differences of fiberwire, prolene, and ticron sutures. J Hand Surg Am 2010; 35 (05) 780-784
    CrossrefPubMedGoogle Scholar
  • 21 Lee SK, Goldstein RY, Zingman A, Terranova C, Nasser P, Hausman MR. The effects of core suture purchase on the biomechanical characteristics of a multistrand locking flexor tendon repair: a cadaveric study. J Hand Surg Am 2010; 35 (07) 1165-1171
    CrossrefPubMedGoogle Scholar
  • 22 Moriya T, Larson MC, Zhao C, An KN, Amadio PC. The effect of core suture flexor tendon repair techniques on gliding resistance during static cycle motion and load to failure: a human cadaver study. J Hand Surg Eur Vol 2012; 37 (04) 316-322
    CrossrefPubMedGoogle Scholar
  • 23 Waitayawinyu T, Martineau PA, Luria S, Hanel DP, Trumble TE. Comparative biomechanic study of flexor tendon repair using FiberWire. J Hand Surg Am 2008; 33 (05) 701-708
    CrossrefPubMedGoogle Scholar
  • 24 Komatsu F, Mori R, Uchio Y. Optimum surgical suture material and methods to obtain high tensile strength at knots: problems of conventional knots and the reinforcement effect of adhesive agent. J Orthop Sci 2006; 11 (01) 70-74
    CrossrefPubMedGoogle Scholar
  • 25 Taras JS, Raphael JS, Marczyk SC, Bauerle WB. Evaluation of suture caliber in flexor tendon repair. J Hand Surg Am 2001; 26 (06) 1100-1104
    CrossrefPubMedGoogle Scholar
  • 26 Osei DA, Stepan JG, Calfee RP. , et al. The effect of suture caliber and number of core suture strands on zone II flexor tendon repair: a study in human cadavers. J Hand Surg Am 2014; 39 (02) 262-268
    CrossrefPubMedGoogle Scholar
  • 27 Alavanja G, Dailey E, Mass DP. Repair of zone II flexor digitorum profundus lacerations using varying suture sizes: a comparative biomechanical study. J Hand Surg Am 2005; 30 (03) 448-454
    CrossrefPubMedGoogle Scholar
  • 28 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 Am 2001; 26 (02) 340-346
    CrossrefPubMedGoogle Scholar
  • 29 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 Am 1998; 23 (02) 261-265
    CrossrefPubMedGoogle Scholar
  • 30 Winters SC, Gelberman RH, Woo SL, Chan SS, Grewal R, Seiler III 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 (01) 97-104
    CrossrefPubMedGoogle Scholar
  • 31 Wong YR, Lee CS, Loke AMK, Liu X, Suzana MJ I, Tay SC. Comparison of Flexor Tendon Repair Between 6-Strand Lim-Tsai With 4-Strand Cruciate and Becker Technique. J Hand Surg Am 2015; 40 (09) 1806-1811
    CrossrefPubMedGoogle Scholar
  • 32 Wong YR, Loke AMK, Tay SC. The Effect of Suture Materials on the Biomechanical Performance of Different Flexor Tendon Repairs and the Concept of Construct Efficiency. J Hand Surg Asian Pac Vol 2018; 23 (02) 243-247
    PubMedGoogle Scholar
  • 33 Calfee RP, Boone S, Stepan JG, Osei DA, Thomopoulos S, Boyer MI. Looped versus single-stranded flexor tendon repairs: a cadaveric mechanical study. J Hand Surg Am 2015; 40 (05) 958-62.e1
    CrossrefPubMedGoogle Scholar
  • 34 Tang JB. Outcomes and evaluation of flexor tendon repair. Hand Clin 2013; 29 (02) 251-259
    CrossrefPubMedGoogle Scholar
  • 35 Wu YF, Tang JB. Effects of tension across the tendon repair site on tendon gap and ultimate strength. J Hand Surg Am 2012; 37 (05) 906-912
    CrossrefPubMedGoogle Scholar
  • 36 Jiang J, Mat Jais IS, Yam AKT, McGrouther DA, Tay SC. A Biomechanical Comparison of Different Knots Tied on Fibrewire Suture. J Hand Surg Asian Pac Vol 2017; 22 (01) 65-69
    PubMedGoogle Scholar
  • 37 Corella F, Renner C, del Cerro M, Ocampos M. Técnica de sutura tendinosa «un paso, 4-hilos Kessler-Tsuge». Revista Iberoamericana Cirugía Mano 2015; 43 (02) 122-127
    PubMedGoogle Scholar
  • 38 Sull A, Inceoglu S, Wongworawat MD. Does Barbed Suture Repair Negate the Benefit of Peripheral Repair in Porcine Flexor Tendon?. Hand (N Y) 2016; 11 (04) 479-483
    CrossrefPubMedGoogle Scholar
  • 39 de Wit T, Walbeehm ET, Hovius SER, McGrouther DA. The mechanical interaction between three geometric types of nylon core suture and a running epitenon suture in repair of porcine flexor tendons. J Hand Surg Eur Vol 2013; 38 (07) 788-794
    CrossrefPubMedGoogle Scholar
  • 40 Nelson GN, Potter R, Ntouvali E. , et al. Intrasynovial flexor tendon repair: a biomechanical study of variations in suture application in human cadavera. J Orthop Res 2012; 30 (10) 1652-1659
    CrossrefPubMedGoogle Scholar
  • 41 Fufa DT, Osei DA, Calfee RP, Silva MJ, Thomopoulos S, Gelberman RH. The effect of core and epitendinous suture modifications on repair of intrasynovial flexor tendons in an in vivo canine model. J Hand Surg Am 2012; 37 (12) 2526-2531
    CrossrefPubMedGoogle Scholar
  • 42 Kim PT, Aoki M, Tokita F, Ishii S. Tensile strength of cross-stitch epitenon suture. J Hand Surg [Br] 1996; 21 (06) 821-823
    CrossrefPubMedGoogle Scholar
  • 43 Pulvertaft RG. Tendon grafts for flexor tendon injuries in the fingers and thumb; a study of technique and results. J Bone Joint Surg Br 1956; 38-B (01) 175-194
    CrossrefPubMedGoogle Scholar
  • 44 Gabuzda GM, Lovallo JL, Nowak MD. Tensile strength of the end-weave flexor tendon repair. An in vitro biomechanical study. J Hand Surg [Br] 1994; 19 (03) 397-400
    CrossrefPubMedGoogle Scholar
  • 45 Fuchs SP, Walbeehm ET, Hovius SER. Biomechanical evaluation of the Pulvertaft versus the ‘wrap around’ tendon suture technique. J Hand Surg Eur Vol 2011; 36 (06) 461-466
    CrossrefPubMedGoogle Scholar
  • 46 Tanaka T, Zhao C, Ettema AM, Zobitz ME, An K-N, Amadio PC. Tensile strength of a new suture for fixation of tendon grafts when using a weave technique. J Hand Surg Am 2006; 31 (06) 982-986
    CrossrefPubMedGoogle Scholar
  • 47 Mazurek T, Strankowski M, Ceynowa M, Rocławski M. Tensile strength of a weave tendon suture using tendons of different sizes. Clin Biomech (Bristol, Avon) 2011; 26 (04) 415-418
    CrossrefPubMedGoogle Scholar
  • 48 Brown SHM, Hentzen ER, Kwan A, Ward SR, Fridén J, Lieber RL. Mechanical strength of the side-to-side versus Pulvertaft weave tendon repair. J Hand Surg Am 2010; 35 (04) 540-545
    CrossrefPubMedGoogle Scholar
  • 49 Rivlin M, Eberlin KR, Kachooei AR. , et al. Side-to-Side Versus Pulvertaft Extensor Tenorrhaphy-A Biomechanical Study. J Hand Surg Am 2016; 41 (11) e393-e397
    CrossrefPubMedGoogle Scholar
  • 50 Bidic SM, Varshney A, Ruff MD, Orenstein HH. Biomechanical comparison of lasso, Pulvertaft weave, and side-by-side tendon repairs. Plast Reconstr Surg 2009; 124 (02) 567-571
    CrossrefPubMedGoogle Scholar
  • 51 Kulikov YI, Dodd S, Gheduzzi S, Miles AW, Giddins GE. An in vitro biomechanical study comparing the spiral linking technique against the pulvertaft weave for tendon repair. J Hand Surg Eur Vol 2007; 32 (04) 377-381
    CrossrefPubMedGoogle Scholar
  • 52 De Smet L, Schollen W, Degreef I. In vitro biomechanical study to compare the double-loop technique with the Pulvertaft weave for tendon anastomosis. Scand J Plast Reconstr Surg Hand Surg 2008; 42 (06) 305-307
    CrossrefPubMedGoogle Scholar
  • 53 Becker H, Davidoff M. Eliminating the gap in flexor tendon surgery. A new method of suture. Hand 1977; 9 (03) 306-311
    PubMedGoogle Scholar