Our Initial Experience with the PONTiS Tendon Repair System In Traumatic Upper Extremity Injuries
Karan Desai, MD; Daniel Maxwell, DO; Robert Fang, MD; Diane Payne, MD; Angela Cheng, MD
Emory University, Atlanta, GA
Backround: Traumatic tendon injuries remain a common, debilitating challenge requiring prompt surgical intervention to ensure optimal functional outcomes. New developments in sutures and suturing-techniques continue to emerge and so we review our initial experience with a new, multifilament, braided steel, tendon repair system named the PONTiS Flexor Repair System (PFRS) at an urban, level-1, trauma center.
Methods: We reviewed the medical records of patients undergoing traumatic tendon repair with the PFRS in the upper extremity between February 2015 to September 2017. All patients presented with acute traumatic injuries. Surgeries were performed by 3 attending surgeons on 2 teams: Plastic and Reconstructive (n = 2) and Orthopedic (n = 1) surgery. Multivariate regression was utilized for risk factor assessment.
Results: Of 81 patients, there were 169 injured digits and 311 tendons, an average age of 37.4±14.0 years and median follow-up time of 168 days (range 0–688 days). The average patient was a right-handed (67; 82.7%), African American (61; 75.3%), male (59; 72.8%), laborer (31; 38.3%), receiving a laceration injury (63; 77.8%) to their volar left hand (43; 53.1%) at zone 2 (21; 25.9%) of the left index finger (41; 50.6%). Fractures, arterial injuries, and nerve injuries were present in 21.4%, 25.9%, and 65.4% of cases, respectively. The average number of tendons injured was 3.8±3.3 with 3.3±3.1 PFRS devices placed per patient. Five patients (6.2%) were lost to follow-up after repair and 13 (16.0%) patients developed the following complications: adhesions/contracture (4), rupture (2), flap ischemia (2), arterial anastomosis thrombosis (1), wound dehiscence (1), EDI lag (1), and two cases of erosion of the PFRS through autologous soft-tissue coverage (2). All complications occurred within 1 year of surgery. On multivariate regression analysis, injuries requiring soft-tissue coverage (OR 9.990; p=0.043) and involvement of zone 2 (OR 7.936; p=0.016) were risk factors for developing a post-operative complication while epitendinous repairs (OR 0.096; p=0.010) and the absence of active insurance (OR 0.182; p=0.040) were shown to be protective.
Summary: The PFRS is a durable alternative to traditional suture repair methods and suitable for urban populations where follow-up is difficult. Avoidance of placing this device adjacent to injuries requiring soft-tissue coverage or when epitendinous repairs cannot be performed may decrease complication rates.
Figure 1. Onset of complications stratified by reconstructions with and without an epitendinous repair. Significance determined with log rank test: p = 0.001.
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