An, Kai‐Nan

The purpose of this study was to compare two different methods of joining tendons of similar and dissimilar sizes between recipient and donor tendons for flexor tendon grafts. Flexor digitorum profundus (FDP) and peroneus longus (PL) canine tendons were harvested and divided into four groups. The repair technique we compared was a step-cut (SC) suture and a Pulvertaft weave (PW). FDP tendons were significantly larger in diameter than PL tendons ( p < 0.05). The volume of the SC repairs using either FDP or PL tendon as a graft was significantly smaller than PW repairs ( p < 0.05). The ultimate load to failure and repair stiffness in FDP graft tendons significantly increased compared with the PL graft tendons ( p < 0.05). The SC suture can be used as an alternative to the PW, with similar strength and less bulk for repairs using graft tendons of similar diameter. Surgeons should be aware of the effect of graft tendon size and repair method on strength and bulk when performing flexor tendon grafts.

There is very little data addressing cartilage response to tensile forces, and no literature attempts to correlate compressive with tensile modalities. Our hypothesis was that the cyclic compression and tension modulate chondrocyte matrix proteoglycan synthetic response differently. Porcine chondrocytes cultured to confluence on a flexible membrane were subjected to cyclic compression (Group A: 13 KPa at 1 Hz) or tension (Group C: 10% strain at 1 Hz) for 16 or 32 h; while controls not subjected to any force were kept (Group B). The chondrocytes were then stained with alcian blue and stained areas quantified with confocal microscopy and image processing software. Two-factor ANOVA with post-hoc tests (Scheffe and Bonferroni) statistical analysis were used. Proteoglycan staining covered 46% (range 28%–61%) and 39% (range 26%–49%) of the surface area following 32 and 16 h of compression respectively, 23% (range 15%–49%) for control, and 19% (range 10%–29%) and 16% (range 9%–25%) following 16 and 32 h tension respectively. Proteoglycan content following all compressions was significantly greater than with cyclic tension or control (p < 0.0001). Our data demonstrate that chondrocytes cultured in vitro respond to compression distinctly different from tension and that it is highly sensitive to mechanical loading, with rapid adaptation to its mechanical environment. These results imply that cartilage grown in culture, with the intention of transplantation, may structurally benefit from an environment of cyclic loading at higher frequencies.

We undertook this study to determine the minimum amount of coronoid necessary to stabilise an otherwise intact elbow joint. Regan–Morrey types II and III, plus medial and lateral oblique coronoid fractures, collectively termed type IV fractures, were simulated in nine fresh cadavers. An electromagnetic tracking system defined the three-dimensional stability of the ulna relative to the humerus. The coronoid surface area accounts for 59% of the anterior articulation. Alteration in valgus, internal and external rotation occurred only with a type III coronoid fracture, accounting for 68% of the coronoid and 40% of the entire articular surface. A type II fracture removed 42% of the coronoid articulation and 25% of the entire articular surface but was associated with valgus and external rotational changes only when the radial head was removed, thereby removing 67% of the articular surface. We conclude that all type III fractures, as defined here, are unstable, even with intact ligaments and a radial head. However, a type II deficiency is stable unless the radial head is removed. Our study suggests that isolated medial-oblique or lateral-oblique fractures, and even a type II fracture with intact ligaments and a functional radial head, can be clinically stable, which is consistent with clinical observation.

The purpose of this study was to describe a modification of the Massachusetts General Hospital (MMGH) tendon repair and to compare it with three other suture techniques. Twenty human flexor digitorum profundus (FDP) tendons were randomly assigned to the modified Pennington (MP) suture and the MMGH suture. These were compared to the modified Kessler (MK) and Massachusetts General Hospital (MGH) sutures, using data from a previous study. All tendons were repaired with a similar epitendinous stitch and core sutures of 4-0 FiberWire. There was no significant difference in the normalized gliding resistance within the two-strand or four-strand core repair groups. The MP suture had significantly higher 2 mm gap force and ultimate load to failure than the MK suture. The MMGH suture had significantly higher 2 mm gap force and maximum failure ultimate load than the MGH suture. All repairs failed by knot unravelling.

Background The etiology of carpal tunnel syndrome (CTS) remains idiopathic in many cases. Noninflammatory fibrosis of the subsynovial connective tissue (SSCT) within the carpal tunnel is common in CTS, and some clinicians have hypothesized that this fibrosis might be a cause rather than an effect of CTS. An animal model in which to test this hypothesis would be useful. The principal objective of this study was to investigate the effect of a surgical injury on SSCT fibrosis and median nerve function within the carpal tunnel in an in vivo rabbit model. Methods Rabbits were sacrificed 12 weeks after surgery and were evaluated by mechanical testing, histology, transmission and scanning electron microscopy, and electrophysiology. Results SSCT fibroblast density ( p<0.0001) and collagen fiber size ( p=0.0004) were significantly higher, and the median nerve distal motor amplitude was significantly lower ( p=0.0018), in the tendon injury group SSCT than in either the sham or control groups. Conclusions Our findings are similar to those seen in patients with carpal tunnel syndrome and suggest that the tendon injury procedure may be the basis of a new animal model of SSCT injury and, possibly, CTS.

Barbed sutures and connecting devices have been historically described and used in flexor tendon tenorrhaphies. With the improvement in biomaterial, we have witnessed recently the resurgence of this concept. In this article, we review the historical use of barbed devices in repairing flexor tendons and explore the available barbed surgical devices that have been described in recent years.

Clinical results following four-corner arthrodesis vary and suggest that nonunion may be related to certain fixation techniques. The purpose of our study was to examine the displacement between the lunate and capitate following a simulated four-corner arthrodesis with the hypothesis that three types of fixation (Kirschner wires, dorsal circular plate, and a locked dorsal circular plate) would allow different amounts of displacement during simulated wrist flexion and extension. Cadaver wrists with simulated four-corner arthrodeses were loaded cyclically either to implant failure or until the lunocapitate displacement exceeded 1 mm. The locked dorsal circular plate group was significantly more stable than the dorsal circular plate and K-wire groups ( p = 0.018 and p = 0.006). While these locked dorsal circular plates appear to be very stable our results are limited only to the biomechanical behavior of these fixation techniques within a cadaver model.

AbstractPurposeThe purpose of this study is to determine whether the RetroScrew tibial fixation system offers a biomechanical advantage over the Delta screw for anterior cruciate ligament (ACL) reconstruction in cadaveric tibias with low bone mineral density (BMD).MethodsTen matched pairs of osteoporotic cadaveric tibiae underwent simulated ACL reconstruction using quadrupled hamstring grafts with one of the two tibial fixation constructs. Group 1 was fixed with the Delta screw (DS; 35‐mm antegrade biointerference screw), and group 2 was fixed with the RetroScrew system (RSS; 20‐mm retrograde and 17‐mm antegrade biointerference screws). Each construct was cyclically loaded (50–200 N, 1 Hz, 500 cycles) and subsequently loaded to failure (20 mm/s).ResultsAll specimens were osteoporotic without significant segmental (proximal, middle, and distal) BMD differences between groups by quantitative computed tomography (P = n.s.). A trend was noted for more construct failures due to graft slippage in the DS group (n = 3) over the RSS group (n = 1). There were no significant differences in cyclic displacement (P = n.s.), maximum cyclic stiffness (P = n.s.), maximum load at failure (P = n.s.), or pullout stiffness (P = n.s.) between groups.ConclusionsIn an osteoporotic cadaveric model, there was no significant biomechanical advantage of the RetroScrew system versus the Delta screw for tibial fixation in soft tissue graft ACL reconstruction. However, a trend toward lower graft fixation failure to cyclic loading was noted with the RetroScrew system.Level of evidenceBiomechanical comparative study, Level II.

A three-dimensional (3D) geometric model for predicting muscle forces in the shoulder complex is proposed. The model was applied throughout the range of arm elevation in the scapular plan. In vitro testing has been performed on 13 cadaveric shoulders. The objectives were to determine homogeneous values of physiological parameters of shoulder muscles and to locate sites of muscular attachment to any bone of the shoulder complex. Muscular fiber lengths, lengths of contractile element (CE), and muscle volumes were measured, corresponding physiological cross-sectional area (PCSA) were calculated, and force/length muscle relations were found. An in vivo biplanar radiography was performed on five volunteers. The photogrammetric reconstruction of bone axes and landmarks were coupled with a geometric modeling of bones and muscle sites of attachment. Muscular paths were drawn and changes in lengths during movement have been estimated. Directions of muscle forces are the same as that of muscular path at the point of attachment to bone. Magnitudes of muscular forces were found from muscle lengths coupled with force/length relations. Passive forces were directly determined contrary to active muscle forces. A resulting active muscle force is calculated from balancing weight and passive forces at each articular center. Active muscle forces were calculated by distributing the resulting force among active muscles based on the muscular PCSA values.

Background: We performed a laboratory-based study of the ankle-hindfoot complex in normal cadaveric ankles with simulated lateral ankle ligament injuries, utilizing an ankle stability testing device. The ankle stability testing device distinguished between intact, injury to anterior talofibular ligament (ATFL) and combined injury to ATFL and calcaneofibular ligament (CFL). Materials and Methods: Ankles were tested in an ankle stability testing device, with a specified inversion torque applied through the range of sagittal plane motion, then internal rotation torque applied through the entire range of sagittal plane motion. Three-dimensional motion of the calcaneus and talus in relation to the tibia were determined with a magnetic tracking system. The specimens were tested in the intact condition, then after sectioning the ATFL, then the CFL. Results: Upon sectioning the ATFL, there was a significant increase in the internal rotation motion at the tibiotalar joint. Subsequent sectioning of the CFL did not significantly increase ankle-hindfoot internal rotation, but it did significantly increase the motion in inversion testing. This increase occurred primarily at the tibiotalar level. Conclusion: The isolated ATFL injury was clearly distinguished from the intact condition by increased talar-tibial internal rotation, but not inversion. The more severe combined ATFL/CFL injury was distinguished from the ATFL injury condition with inversion torque. Clinical Relevance: Inversion torque may disclose combined ATFL/CFL injury, and internal rotation torque may be the key to distinguish isolated ATFL and combined ATFL/CFL injuries.