Abstract
Background Graft preparation techniques for the Adams–Berger distal radioulnar joint (DRUJ)
reconstruction vary among surgeons with insufficient evidence to support any specific
technique.
Questions/Purposes We compared survival with cyclic loading, absolute elongation, elongation rate, and
modes of failure of four graft preparation techniques.
Methods Fifteen porcine extensor tendons were divided into three equal groups: tendon only;
tendon augmented along its full length with nonlocking 2–0 FiberLoop suture spaced
at 6 mm intervals; and tendon with suture at 12 mm intervals. Suture only was also
tested. Samples were woven through custom radius- and ulna-simulating jigs mounted
on a mechanical testing machine. Samples underwent a staircase cyclic loading protocol
and were then inspected visually for the mode of failure. Survival with cyclic loading,
absolute elongation, and elongation rate was compared.
Results Average survival with cyclic loading of suture-augmented tendon was significantly
higher than tendon only. All tendon groups had significantly higher survival compared
with suture only. Absolute elongation was subject to variability due to initial nonlinear
elongation behavior of samples. The elongation rate was significantly lower with suture
compared with all tendon groups. Modes of failure included rupture of the tendon and/or
suture at the simulated graft–bone interface and elongation of the entire construct
without rupture.
Conclusions In this biomechanical study, augmentation of porcine tendons with suture spaced at
either 6 or 12 mm for DRUJ reconstruction significantly increased survival to a staircase
cyclic loading protocol
Clinical Relevance For the Adams–Berger reconstruction, tendon grafts augmented along their entire length
by nonabsorbable braided suture are biomechanically superior to tendon alone.
Keywords
biomechanical testing - distal radioulnar joint reconstruction - tendon graft fixation
