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Biomechanical Comparison of Tendon-to-Tendon Attachment Constructs for Tendon Reconstructions and Transfers
Christian Athens, DO1, Joshua A Gillis, MD, BSc2, Aaron Paul, MD1, Peter Rhee, DO, MS3 and Steven L Moran, MD1, (1)Mayo Clinic, Rochester, MN, (2)Division of Plastic Surgery, Dalhousie University, Halifax, NS, Canada, (3)Orthopaedic Surgery, Mayo Clinic, Rochester, MN

Biomechanical Comparison of Tendon-to-Tendon Attachment Constructs for Tendon Reconstructions and Transfers Abstract Purpose: Tendon-to-tendon attachments sites for tendon reconstructions or transfers must be stable enough to withstand early mobilization in the immediate postoperative period in order to enhance function and decrease adhesion formation. The purpose of this study was to compare the strength, bulk, and frictional force of common tendon -to-tendon attachment constructs or weaves. Methods: A biomechanical study was performed utilizing 80 cadaveric lower extremity tendons to compare four common tendon weave constructs, the Pulvertaft (PT); end-weave (EW); single-pass, side-to-side (SP-STS); and simple, side-to-side (STS) attachments. The main outcome measures investigated included tendon morphology, frictional force, measured in a novel tissue simulator, and the strength of the different constructs by linear loading with a tensile testing machine. Results: A total of 40 tendon pairs, 10 per repair group were biomechanically evaluated and outcomes were compared. There were no significant differences in the native tendon (p=0.334) and repair site (p=0.564) cross-sectional area, and no difference in the added bulk of the repair (p=0.663) between the repair groups. Frictional resistance was not significantly different between the groups. The SP-STS repair was significantly stronger, stiffer, and exhibited less displacement compared to the other constructs. Conclusion: The SP-STS is significantly stronger, without a significant difference in bulk and frictional resistance compared to the PT, EW, STS repairs. Clinical Significance: The SP-STS is the optimal repair construct for use in tendon transfers and reconstructions to permit early active mobilization.


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