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Biomechanics and Histological Analysis in Rabbit Flexor Tendons Repaired Using Three Suture Techniques (4 and 6 strands) with Early Active Mobilization
Antônio Lourenço Severo, MD, MSc1; Rodrigo Arenhart, PT, MSc2; Daniela Silveira, MD, MSc3; Aluísio Octávio Vargas Ávila, BE, PhD4; Francisco José Berral, MD, PhD5; Marcelo Barreto Lemos, MD6; Paulo César Faiad Piluski, MD1; Osvandré Luis Canfield Lech, MD7
1Center of the Upper Limb Surgery, IOT/RS (Institute of Orthopedics and Traumatology), Passo Fundo, Brazil; 2Center of Physiotherapy, URI (Regional Integrated University), Erechim, Brazil; 3Center of Pathology, UPF (University of Passo Fundo), Passo Fundo, Brazil; 4Laboratory of Biomechanics, UDESC (State University of Santa Catarina), Florianópolis, Brazil; 5Department of Sports and Computer Science, UPO (University of Pablo de Olavide), Sevilla, Spain; 6Center of the Upper Limb Surgery, IOT (Institute of Orthopedics and Traumatology), Passo Fundo, Brazil; 7Chief Medical Residency, IOT/RS (Institute of Orthopedics and Traumatology), Passo Fundo, Brazil

Purpose: This study has the objective of analyzing suture time, biomechanics (deformity between the stumps) and the histology of three groups of tendinous surgical repair: Brazil (4-strands) which the end knot (core) is located outside the tendon, Indiana (4-strands) and Tsai (6-strands) with sutures technique which the end knot (core) is inner part of the tendon, associated with early active mobilization.

Methods: The right calcaneal tendons (plantar flexor of the hind paw) of 36 rabbits of the New Zealand were used in the analysis; in accordance to the Committee on Animal Research and Ethics (CETEA) of the University of the State of Santa Catarina (UDESC), municipality of Lages, in Brazil (protocol # 1.33.09). This sample presents similar size to human flexor tendon that has approximately 4.5 mm (varying from 2mm). It showed the same mass (2.5 to 3kg) and age where were male or female adults (from 8 ½ months old).

Results: In the biomechanical analysis (deformity) carried out between tendinous stumps, there was no statistically significant difference. There was no statistical difference in relation to surgical time in all three suture techniques with a mean of 6.0 minutes for Tsai (6- strands), 5.7 minutes for Indiana (4-strands) and 5.6 minutes for Brazil (4-strands). With the early active mobility, there was qualitative and quantitative evidence of thickening of collagen in 38.9% on the 15th day and in 66.7% on the 30th day, making the biological tissue stronger and more resistant.

Conclusions: This study helped to demonstrate that there was no histological difference between the inside and the outside end knot (core) of the repaired tendon, as well as the number of strands regarding healing, vascularization or sliding of the tendon in the osteofibrous tunnel with repair techniques applied, associated with early active mobility.

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