Download PDF
Vet Comp Orthop Traumatol 2020; 33(03): 205-211
DOI: 10.1055/s-0040-1702141
Original Research
Georg Thieme Verlag KG Stuttgart · New York

Influence of Interlocking Horizontal Mattress Epitendinous Suture Placement on Tendinous Biomechanical Properties in a Canine Common Calcaneal Laceration Model

Christina J. Cocca‡   ∗
1   Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, United States
,
Daniel J. Duffy    ∗
2   Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, United States
,
Mariana E. Kersh
3   Department of Mechanical Science and Engineering, University of Illinois, Urbana, Illinois, United States
,
George E. Moore
4   Department of Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, United States
› Author Affiliations
Further Information

Publication History

03 May 2019

27 December 2019

Publication Date:
31 March 2020 (online)

    Permissions and Reprints

Abstract

Objective This article evaluates the effect of an interlocking horizontal mattress epitendinous suture (IHMES) in addition to a three-loop pulley (3LP) core suture for canine tendon repair.

Study Design Twenty-eight cadaveric common calcaneal tendons were randomized, sharply transected and repaired with either a 3LP or 3LP + IHMES. Tensile loads required to create a 1- and 3-mm gap, yield, peak and failure loads, and mode of failure were analysed. Significance was set at p < 0.05.

Results Mean ± standard deviation yield and failure force for 3LP + IHMES was 178.0 ± 45.3 N and 242.1 ± 47.8 N, respectively, which was significantly greater compared with 3LP alone, 97.9 ± 36.2 N and 119.3 ± 35.6 N (p < 0.0001). Occurrence of 3-mm gap formation was significantly less in the 3LP + IHMES group (p < 0.013). Mode of failure was significantly different between the groups (p < 0.001) with 3LP + IMHES patterns failing by suture breakage (13/14) compared with suture pull-through in the 3LP (11/14).

Conclusion Addition of an epitendinous suture pattern significantly reduced gap formation between tendon ends and significantly increased loads at yield (1.8 × ), peak (2.0 × ) and failure (2.0 × ) force of repairs. Use of an epitendinous suture should be considered to significantly increase biomechanical strength of repairs; however, further in vivo testing is necessary to evaluate its effect on tendinous blood supply.

Keywords

dog - tendon - epitendinous - tenorrhaphy - interlocking horizontal mattress

Authors' Contributions

All authors contributed to conception of study, study design, acquisition of data and data analysis and interpretation. All authors also drafted, revised and approved the submitted manuscript.


∗ Both authors contributed equally to the manuscript.


 

  • References

  • 1 Carmichael S, Marshall WG. Muscle and tendon disorders. In: Veterinary Surgery: Small Animal Expert Consult. 2nd ed. Elsevier; 2018: 1319-1322
    Google Scholar
  • 2 Guzzini M, Lanzetti RM, Proietti L. , et al. Interlocking horizontal mattress suture versus Kakiuchi technique in repair of Achilles tendon rupture: a biomechanical study. J Orthop Traumatol 2017; 18 (03) 251-257
    CrossrefPubMedGoogle Scholar
  • 3 Kjaer M, Langberg H, Miller BF. , et al. Metabolic activity and collagen turnover in human tendon in response to physical activity. J Musculoskelet Neuronal Interact 2005; 5 (01) 41-52
    PubMedGoogle Scholar
  • 4 Schepull T, Aspenberg P. Early controlled tension improves the material properties of healing human Achilles tendons after ruptures: a randomized trial. Am J Sports Med 2013; 41 (11) 2550-2557
    CrossrefPubMedGoogle Scholar
  • 5 Lee SJ, Goldsmith S, Nicholas SJ, McHugh M, Kremenic I, Ben-Avi S. Optimizing Achilles tendon repair: effect of epitendinous suture augmentation on the strength of Achilles tendon repairs. Foot Ankle Int 2008; 29 (04) 427-432
    CrossrefPubMedGoogle Scholar
  • 6 Verdan CE. Primary repair of flexor tendons. J Bone Joint Surg Am 1960; 42-A: 647-657
    PubMedGoogle Scholar
  • 7 Kessler I, Nissim F. Primary repair without immobilization of flexor tendon division within the digital sheath. An experimental and clinical study. Acta Orthop Scand 1969; 40 (05) 587-601
    CrossrefPubMedGoogle Scholar
  • 8 Dona E, Turner AW, Gianoutsos MP, Walsh WR. Biomechanical properties of four circumferential flexor tendon suture techniques. J Hand Surg Am 2003; 28 (05) 824-831
    CrossrefPubMedGoogle Scholar
  • 9 Dona E, Gianoutsos MP, Walsh WR. Optimizing biomechanical performance of the 4-strand cruciate flexor tendon repair. J Hand Surg Am 2004; 29 (04) 571-580
    PubMedGoogle Scholar
  • 10 Silfverskiöld KL, May EJ. Flexor tendon repair in zone II with a new suture technique and an early mobilization program combining passive and active flexion. J Hand Surg Am 1994; 19 (01) 53-60
    CrossrefPubMedGoogle Scholar
  • 11 Silfverskiöld KL, May EJ, Törnvall AH. Gap formation during controlled motion after flexor tendon repair in zone II: a prospective clinical study. J Hand Surg Am 1992; 17 (03) 539-546
    CrossrefPubMedGoogle Scholar
  • 12 Silfverskiöld KL, May EJ. Gap formation after flexor tendon repair in zone II. Results with a new controlled motion programme. Scand J Plast Reconstr Surg Hand Surg 1993; 27 (04) 263-268
    CrossrefPubMedGoogle Scholar
  • 13 Duffy DJ, Chang YJ, Gaffney LS, Fisher MB, Moore GE. Effect of bite depth of an epitendinous suture on the biomechanical strength of repaired canine flexor tendons. Am J Vet Res 2019; 80 (11) 1043-1049
    CrossrefPubMedGoogle Scholar
  • 14 Wade PJ, Muir IF, Hutcheon LL. Primary flexor tendon repair: the mechanical limitations of the modified Kessler technique. J Hand Surg [Br] 1986; 11 (01) 71-76
    CrossrefPubMedGoogle Scholar
  • 15 Wade PJ, Wetherell RG, Amis AA. Flexor tendon repair: significant gain in strength from the Halsted peripheral suture technique. J Hand Surg [Br] 1989; 14 (02) 232-235
    CrossrefPubMedGoogle Scholar
  • 16 Dy CJ, Hernandez-Soria A, Ma Y, Roberts TR, Daluiski A. Complications after flexor tendon repair: a systematic review and meta-analysis. J Hand Surg Am 2012; 37 (03) 543-551.e1
    CrossrefPubMedGoogle Scholar
  • 17 Moores AP, Owen MR, Tarlton JF. The three-loop pulley suture versus two locking-loop sutures for the repair of canine Achilles tendons. Vet Surg 2004; 33 (02) 131-137
    CrossrefPubMedGoogle Scholar
  • 18 Wilson L, Banks T, Luckman P, Smith B. Biomechanical evaluation of double Krackow sutures versus the three-loop pulley suture in a canine gastrocnemius tendon avulsion model. Aust Vet J 2014; 92 (11) 427-432
    CrossrefPubMedGoogle Scholar
  • 19 Corr SA, Draffan D, Kulendra E, Carmichael S, Brodbelt D. Retrospective study of Achilles mechanism disruption in 45 dogs. Vet Rec 2010; 167 (11) 407-411
    CrossrefPubMedGoogle Scholar
  • 20 Worth AJ, Danielsson F, Bray JP, Burbidge HM, Bruce WJ. Ability to work and owner satisfaction following surgical repair of common calcaneal tendon injuries in working dogs in New Zealand. N Z Vet J 2004; 52 (03) 109-116
    CrossrefPubMedGoogle Scholar
  • 21 Meeson RL, Davidson C, Arthurs GI. Soft-tissue injuries associated with cast application for distal limb orthopaedic conditions. A retrospective study of sixty dogs and cats. Vet Comp Orthop Traumatol 2011; 24 (02) 126-131
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Goh KL, Chen Y, Chou SM, Listrat A, Bechet D, Wess TJ. Effects of frozen storage temperature on the elasticity of tendons from a small murine model. Animal 2010; 4 (09) 1613-1617
    CrossrefPubMedGoogle Scholar
  • 23 Dunlap AE, Kim SE, McNicholas Jr WT. Biomechanical evaluation of a non-locking pre-manufactured loop suture technique compared to a three-loop pulley suture in a canine calcaneus tendon avulsion model. Vet Comp Orthop Traumatol 2016; 29 (02) 131-135
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Strickland JW. Flexor tendon injuries: I. Foundations of treatment. J Am Acad Orthop Surg 1995; 3 (01) 44-54
    CrossrefPubMedGoogle Scholar
  • 25 Strickland JW. Development of flexor tendon surgery: twenty-five years of progress. J Hand Surg Am 2000; 25 (02) 214-235
    CrossrefPubMedGoogle Scholar
  • 26 Pruitt DL, Manske PR, Fink B. Cyclic stress analysis of flexor tendon repair. J Hand Surg Am 1991; 16 (04) 701-707
    CrossrefPubMedGoogle Scholar
  • 27 Evans RB, Thompson DE. The application of force to the healing tendon. J Hand Ther 1993; 6 (04) 266-284
    CrossrefPubMedGoogle Scholar
  • 28 Buckwalter JA. Effects of early motion on healing of musculoskeletal tissues. Hand Clin 1996; 12 (01) 13-24
    CrossrefPubMedGoogle Scholar
  • 29 Aoki M, Kubota H, Pruitt DL, Manske PR. Biomechanical and histologic characteristics of canine flexor tendon repair using early postoperative mobilization. J Hand Surg Am 1997; 22 (01) 107-114
    PubMedGoogle Scholar
  • 30 Gelberman RH, Menon J, Gonsalves M, Akeson WH. The effects of mobilization on the vascularization of healing flexor tendons in dogs. Clin Orthop Relat Res 1980; (153) 283-289
    PubMedGoogle Scholar
  • 31 Tanaka H, Manske PR, Pruitt DL, Larson BJ. Effect of cyclic tension on lacerated flexor tendons in vitro. J Hand Surg Am 1995; 20 (03) 467-473
    CrossrefPubMedGoogle Scholar
  • 32 Woo SL, Gelberman RH, Cobb NG, Amiel D, Lothringer K, Akeson WH. The importance of controlled passive mobilization on flexor tendon healing. A biomechanical study. Acta Orthop Scand 1981; 52 (06) 615-622
    CrossrefPubMedGoogle Scholar
  • 33 Wray Jr RC, Ollinger H, Lowrey R, Weeks PM. Effect of continuous load on the mechanical properties of tendon adhesions. Hand 1981; 13 (01) 92-96
    PubMedGoogle Scholar
  • 34 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 Am 1999; 81 (07) 975-982
    PubMedGoogle Scholar
  • 35 Putterman AB, Duffy DJ, Kersh ME, Rahman H, Moore GE. Effect of a continuous epitendinous suture as adjunct to three-loop pulley and locking-loop patterns for flexor tendon repair in a canine model. Vet Surg 2019; 48 (07) 1229-1236
    CrossrefPubMedGoogle Scholar
  • 36 Henderson J, Sutcliffe M, Gillespie P. Epitendinous suture techniques in extensor tendon repairs--an experimental evaluation. J Hand Surg Am 2011; 36 (12) 1968-1973
    CrossrefPubMedGoogle Scholar