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Novel Augmentation Technique for Patellar Tendon Repair Improves Strength and Decreases Gap Formation: A Cadaveric Study.
Black, James C; Ricci, William M; Gardner, Michael J; McAndrew, Christopher M; Agarwalla, Avinesh; Wojahn, Robert D; Abar, Orchid; Tang, Simon Y.
Afiliação
  • Black JC; Mercy Orthopedic Trauma, Mercy Springfield, 3050 E. Riverbluff Blvd, Ozark, MO, 65721, USA. blackjamesc@gmail.com.
  • Ricci WM; Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA.
  • Gardner MJ; Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA.
  • McAndrew CM; Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA.
  • Agarwalla A; Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA.
  • Wojahn RD; Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA.
  • Abar O; Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA.
  • Tang SY; Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA.
Clin Orthop Relat Res ; 474(12): 2611-2618, 2016 Dec.
Article em En | MEDLINE | ID: mdl-27492687
ABSTRACT

BACKGROUND:

Patellar tendon ruptures commonly are repaired using transosseous patellar drill tunnels with modified-Krackow sutures in the patellar tendon. This simple suture technique has been associated with failure rates and poor clinical outcomes in a modest proportion of patients. Failure of this repair technique can result from gap formation during loading or a single catastrophic event. Several augmentation techniques have been described to improve the integrity of the repair, but standardized biomechanical evaluation of repair strength among different techniques is lacking. QUESTIONS/

PURPOSES:

The purpose of this study was to describe a novel figure-of-eight suture technique to augment traditional fixation and evaluate its biomechanical performance. We hypothesized that the augmentation technique would (1) reduce gap formation during cyclic loading and (2) increase the maximum load to failure.

METHODS:

Ten pairs (two male, eight female) of fresh-frozen cadaveric knees free of overt disorders or patellar tendon damage were used (average donor age, 76 years; range, 65-87 years). For each pair, one specimen underwent the standard transosseous tunnel suture repair with a modified-Krackow suture technique and the second underwent the standard repair with our experimental augmentation method. Nine pairs were suitable for testing. Each specimen underwent cyclic loading while continuously measuring gap formation across the repair. At the completion of cyclic loading, load to failure testing was performed.

RESULTS:

A difference in gap formation and mean load to failure was seen in favor of the augmentation technique. At 250 cycles, a 68% increase in gap formation was seen for the control group (control 5.96 ± 0.86 mm [95% CI, 5.30-6.62 mm]; augmentation 3.55 ± 0.56 mm [95% CI, 3.12-3.98 mm]; p = 0.02). The mean load to failure was 13% greater in the augmentation group (control 899.57 ± 96.94 N [95% CI, 825.06-974.09 N]; augmentation 1030.70 ± 122.41 N [95% CI, 936.61-1124.79 N]; p = 0.01).

CONCLUSIONS:

This biomechanical study showed improved performance of a novel augmentation technique compared with the standard repair, in terms of reduced gap formation during cyclic loading and increased maximum load to failure. CLINICAL RELEVANCE Decreased gap formation and higher load to failure may improve healing potential and minimize failure risk. This study shows a potential biomechanical advantage of the augmentation technique, providing support for future clinical investigations comparing this technique with other repair methods that are in common use such as transosseous suture repair.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Traumatismos dos Tendões / Técnicas de Sutura / Ligamento Patelar / Procedimentos Ortopédicos / Traumatismos do Joelho Tipo de estudo: Clinical_trials / Evaluation_studies Limite: Aged / Aged80 / Female / Humans / Male Idioma: En Ano de publicação: 2016 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Traumatismos dos Tendões / Técnicas de Sutura / Ligamento Patelar / Procedimentos Ortopédicos / Traumatismos do Joelho Tipo de estudo: Clinical_trials / Evaluation_studies Limite: Aged / Aged80 / Female / Humans / Male Idioma: En Ano de publicação: 2016 Tipo de documento: Article