An Analysis of the Pull-Out Strength of 6 Suture Loop Configurations in Flexor Tendons

Purpose New, stronger suture materials have been introduced for flexor tendon surgery. The advantage of these materials can be lost if the suture loop pulls out from the tendon. The aim of this study was to compare the ability of various locking loops to grip the tendon. Methods We inserted 4 differ...

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Veröffentlicht in:The Journal of hand surgery (American ed.) 2012-02, Vol.37 (2), p.217-223
Hauptverfasser: Karjalainen, T., MD, He, M., PhD, Chong, A.K.S., MD, Lim, A.Y.T., MD, Ryhanen, J., MD
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container_end_page 223
container_issue 2
container_start_page 217
container_title The Journal of hand surgery (American ed.)
container_volume 37
creator Karjalainen, T., MD
He, M., PhD
Chong, A.K.S., MD
Lim, A.Y.T., MD
Ryhanen, J., MD
description Purpose New, stronger suture materials have been introduced for flexor tendon surgery. The advantage of these materials can be lost if the suture loop pulls out from the tendon. The aim of this study was to compare the ability of various locking loops to grip the tendon. Methods We inserted 4 different standard and 2 experimental locking loops with 200-μm nitinol wire into human cadaveric flexor digitorum profundus tendons. The standard loops were: group 1, cruciate; group 2, Pennington modified Kessler; group 3, cross-stitch; and group 4, Lim-Tsai. The experimental loops were: group 5, a composition of Pennington modified Kessler with a cross-stitch loop; and group 6, a locking Kessler type of loop with a superficial transverse component. We loaded the loops until failure. We recorded the pull-out strength and stiffness and documented failure mechanisms during the pull-out test. Results The cruciate loop had the weakest holding capacity, 20 N, which was significantly less than in groups 2 to 6. The cross-stitch loop, Lim-Tsai loop, and modified Kessler loop performed similarly (36 N, 37 N, and 39 N, respectively). The experimental loops had the highest pull-out strength (group 5, 59 N; and group 6, 60 N, both significantly greater than groups 1 to 4). The mode of failure was pull-out for all of the standard loops and 7 of the experimental loops. Of 20 experimental loops, 13 failed by suture rupture. Conclusions The 2 experimental loop configurations demonstrated higher pull-out strength and may have advantages when used with newer and stronger suture materials. The number of the locking components in the loops and the way the tension is transmitted to the tendon fibrils explain the results. Clinical relevance The loops presented in this study and that grip the tendon better may be useful with new materials that have high tensile strength.
doi_str_mv 10.1016/j.jhsa.2011.10.039
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The advantage of these materials can be lost if the suture loop pulls out from the tendon. The aim of this study was to compare the ability of various locking loops to grip the tendon. Methods We inserted 4 different standard and 2 experimental locking loops with 200-μm nitinol wire into human cadaveric flexor digitorum profundus tendons. The standard loops were: group 1, cruciate; group 2, Pennington modified Kessler; group 3, cross-stitch; and group 4, Lim-Tsai. The experimental loops were: group 5, a composition of Pennington modified Kessler with a cross-stitch loop; and group 6, a locking Kessler type of loop with a superficial transverse component. We loaded the loops until failure. We recorded the pull-out strength and stiffness and documented failure mechanisms during the pull-out test. Results The cruciate loop had the weakest holding capacity, 20 N, which was significantly less than in groups 2 to 6. The cross-stitch loop, Lim-Tsai loop, and modified Kessler loop performed similarly (36 N, 37 N, and 39 N, respectively). The experimental loops had the highest pull-out strength (group 5, 59 N; and group 6, 60 N, both significantly greater than groups 1 to 4). The mode of failure was pull-out for all of the standard loops and 7 of the experimental loops. Of 20 experimental loops, 13 failed by suture rupture. Conclusions The 2 experimental loop configurations demonstrated higher pull-out strength and may have advantages when used with newer and stronger suture materials. The number of the locking components in the loops and the way the tension is transmitted to the tendon fibrils explain the results. Clinical relevance The loops presented in this study and that grip the tendon better may be useful with new materials that have high tensile strength.</description><identifier>ISSN: 0363-5023</identifier><identifier>EISSN: 1531-6564</identifier><identifier>DOI: 10.1016/j.jhsa.2011.10.039</identifier><identifier>PMID: 22281167</identifier><identifier>CODEN: JHSUDV</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Alloys ; Biological and medical sciences ; Biomechanical testing ; Biomechanics. Biorheology ; Cadaver ; Diseases of the osteoarticular system ; Fingers ; flexor tendon repair ; Fundamental and applied biological sciences. Psychology ; Humans ; loop configuration ; Materials Testing ; Medical sciences ; Orthopedics ; pull-out ; suture ; Suture Techniques ; Sutures ; Tendons - surgery ; Tensile Strength ; Tissues, organs and organisms biophysics</subject><ispartof>The Journal of hand surgery (American ed.), 2012-02, Vol.37 (2), p.217-223</ispartof><rights>American Society for Surgery of the Hand</rights><rights>2012 American Society for Surgery of the Hand</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c440t-fc10a883005e3aab247f641a37c0c874115fa929b0846e7c194c0ef99626b2513</citedby><cites>FETCH-LOGICAL-c440t-fc10a883005e3aab247f641a37c0c874115fa929b0846e7c194c0ef99626b2513</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jhsa.2011.10.039$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=25527451$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22281167$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Karjalainen, T., MD</creatorcontrib><creatorcontrib>He, M., PhD</creatorcontrib><creatorcontrib>Chong, A.K.S., MD</creatorcontrib><creatorcontrib>Lim, A.Y.T., MD</creatorcontrib><creatorcontrib>Ryhanen, J., MD</creatorcontrib><title>An Analysis of the Pull-Out Strength of 6 Suture Loop Configurations in Flexor Tendons</title><title>The Journal of hand surgery (American ed.)</title><addtitle>J Hand Surg Am</addtitle><description>Purpose New, stronger suture materials have been introduced for flexor tendon surgery. The advantage of these materials can be lost if the suture loop pulls out from the tendon. The aim of this study was to compare the ability of various locking loops to grip the tendon. Methods We inserted 4 different standard and 2 experimental locking loops with 200-μm nitinol wire into human cadaveric flexor digitorum profundus tendons. The standard loops were: group 1, cruciate; group 2, Pennington modified Kessler; group 3, cross-stitch; and group 4, Lim-Tsai. The experimental loops were: group 5, a composition of Pennington modified Kessler with a cross-stitch loop; and group 6, a locking Kessler type of loop with a superficial transverse component. We loaded the loops until failure. We recorded the pull-out strength and stiffness and documented failure mechanisms during the pull-out test. Results The cruciate loop had the weakest holding capacity, 20 N, which was significantly less than in groups 2 to 6. The cross-stitch loop, Lim-Tsai loop, and modified Kessler loop performed similarly (36 N, 37 N, and 39 N, respectively). The experimental loops had the highest pull-out strength (group 5, 59 N; and group 6, 60 N, both significantly greater than groups 1 to 4). The mode of failure was pull-out for all of the standard loops and 7 of the experimental loops. Of 20 experimental loops, 13 failed by suture rupture. Conclusions The 2 experimental loop configurations demonstrated higher pull-out strength and may have advantages when used with newer and stronger suture materials. The number of the locking components in the loops and the way the tension is transmitted to the tendon fibrils explain the results. Clinical relevance The loops presented in this study and that grip the tendon better may be useful with new materials that have high tensile strength.</description><subject>Alloys</subject><subject>Biological and medical sciences</subject><subject>Biomechanical testing</subject><subject>Biomechanics. Biorheology</subject><subject>Cadaver</subject><subject>Diseases of the osteoarticular system</subject><subject>Fingers</subject><subject>flexor tendon repair</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Humans</subject><subject>loop configuration</subject><subject>Materials Testing</subject><subject>Medical sciences</subject><subject>Orthopedics</subject><subject>pull-out</subject><subject>suture</subject><subject>Suture Techniques</subject><subject>Sutures</subject><subject>Tendons - surgery</subject><subject>Tensile Strength</subject><subject>Tissues, organs and organisms biophysics</subject><issn>0363-5023</issn><issn>1531-6564</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kVGLEzEUhYO4uHX1D_ggeRGfppubTDIzIEIprgqFFbr6GtL0zjbjNKnJjNh_b8bWXfDBp8DJOfdevkPIK2BzYKCuu3m3S2bOGUAW5kw0T8gMpIBCSVU-JTMmlCgk4-KSPE-pYyynhHxGLjnnNYCqZuTbwtOFN_0xuURDS4cd0i9j3xe340DXQ0R_P-ymD0XX4zBGpKsQDnQZfOvux2gGF3yiztObHn-FSO_Qb7Pygly0pk_48vxeka83H-6Wn4rV7cfPy8WqsGXJhqK1wExdC8YkCmM2vKxaVYIRlWW2rkoA2ZqGNxtWlworC01pGbZNo7jacAniirw9zT3E8GPENOi9Sxb73ngMY9IN1LKSvFHZyU9OG0NKEVt9iG5v4lED0xNO3ekJp55wTlrGmUOvz-PHzR63D5G__LLhzdlgkjV9G423Lj36pORV-efOdycfZhg_HUadrENvcesi2kFvg_v_He__idveeZc3fscjpi6MMXeYNOjENdPrqfipd8gDhZKV-A3IjqYF</recordid><startdate>20120201</startdate><enddate>20120201</enddate><creator>Karjalainen, T., MD</creator><creator>He, M., PhD</creator><creator>Chong, A.K.S., MD</creator><creator>Lim, A.Y.T., MD</creator><creator>Ryhanen, J., MD</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120201</creationdate><title>An Analysis of the Pull-Out Strength of 6 Suture Loop Configurations in Flexor Tendons</title><author>Karjalainen, T., MD ; He, M., PhD ; Chong, A.K.S., MD ; Lim, A.Y.T., MD ; Ryhanen, J., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c440t-fc10a883005e3aab247f641a37c0c874115fa929b0846e7c194c0ef99626b2513</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Alloys</topic><topic>Biological and medical sciences</topic><topic>Biomechanical testing</topic><topic>Biomechanics. Biorheology</topic><topic>Cadaver</topic><topic>Diseases of the osteoarticular system</topic><topic>Fingers</topic><topic>flexor tendon repair</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Humans</topic><topic>loop configuration</topic><topic>Materials Testing</topic><topic>Medical sciences</topic><topic>Orthopedics</topic><topic>pull-out</topic><topic>suture</topic><topic>Suture Techniques</topic><topic>Sutures</topic><topic>Tendons - surgery</topic><topic>Tensile Strength</topic><topic>Tissues, organs and organisms biophysics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Karjalainen, T., MD</creatorcontrib><creatorcontrib>He, M., PhD</creatorcontrib><creatorcontrib>Chong, A.K.S., MD</creatorcontrib><creatorcontrib>Lim, A.Y.T., MD</creatorcontrib><creatorcontrib>Ryhanen, J., MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of hand surgery (American ed.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Karjalainen, T., MD</au><au>He, M., PhD</au><au>Chong, A.K.S., MD</au><au>Lim, A.Y.T., MD</au><au>Ryhanen, J., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An Analysis of the Pull-Out Strength of 6 Suture Loop Configurations in Flexor Tendons</atitle><jtitle>The Journal of hand surgery (American ed.)</jtitle><addtitle>J Hand Surg Am</addtitle><date>2012-02-01</date><risdate>2012</risdate><volume>37</volume><issue>2</issue><spage>217</spage><epage>223</epage><pages>217-223</pages><issn>0363-5023</issn><eissn>1531-6564</eissn><coden>JHSUDV</coden><abstract>Purpose New, stronger suture materials have been introduced for flexor tendon surgery. The advantage of these materials can be lost if the suture loop pulls out from the tendon. The aim of this study was to compare the ability of various locking loops to grip the tendon. Methods We inserted 4 different standard and 2 experimental locking loops with 200-μm nitinol wire into human cadaveric flexor digitorum profundus tendons. The standard loops were: group 1, cruciate; group 2, Pennington modified Kessler; group 3, cross-stitch; and group 4, Lim-Tsai. The experimental loops were: group 5, a composition of Pennington modified Kessler with a cross-stitch loop; and group 6, a locking Kessler type of loop with a superficial transverse component. We loaded the loops until failure. We recorded the pull-out strength and stiffness and documented failure mechanisms during the pull-out test. Results The cruciate loop had the weakest holding capacity, 20 N, which was significantly less than in groups 2 to 6. The cross-stitch loop, Lim-Tsai loop, and modified Kessler loop performed similarly (36 N, 37 N, and 39 N, respectively). The experimental loops had the highest pull-out strength (group 5, 59 N; and group 6, 60 N, both significantly greater than groups 1 to 4). The mode of failure was pull-out for all of the standard loops and 7 of the experimental loops. Of 20 experimental loops, 13 failed by suture rupture. Conclusions The 2 experimental loop configurations demonstrated higher pull-out strength and may have advantages when used with newer and stronger suture materials. The number of the locking components in the loops and the way the tension is transmitted to the tendon fibrils explain the results. Clinical relevance The loops presented in this study and that grip the tendon better may be useful with new materials that have high tensile strength.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>22281167</pmid><doi>10.1016/j.jhsa.2011.10.039</doi><tpages>7</tpages></addata></record>
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subjects Alloys
Biological and medical sciences
Biomechanical testing
Biomechanics. Biorheology
Cadaver
Diseases of the osteoarticular system
Fingers
flexor tendon repair
Fundamental and applied biological sciences. Psychology
Humans
loop configuration
Materials Testing
Medical sciences
Orthopedics
pull-out
suture
Suture Techniques
Sutures
Tendons - surgery
Tensile Strength
Tissues, organs and organisms biophysics
title An Analysis of the Pull-Out Strength of 6 Suture Loop Configurations in Flexor Tendons
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