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Side-to-Side Tendon Coaptation Yields Greater Load to Failure and Stiffness than Pulvertaft Weave: A Meta-Analysis of Biomechanical Studies
Casey Imbergamo, MD
1; Calvin Wang, BS
2; Daniel Devine, BS
2; Kenneth R. Means, Jr., MD
31The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; 2Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; 3The Curtis National Hand Center, Baltimore, MD
Introduction: Tendon transfers benefit from a coaptation method that allows for early rehabilitation. Two of the most prevalent techniques are Pulvertaft weave (PTW) and side-to-side (STS) constructs. Our purpose was to compare reported tendon transfer biomechanical properties of PTW and STS approaches. Our null hypothesis was there are no significant differences in load to failure, stiffness, or cross-sectional area between constructs.
Materials & Methods: Following PRISMA guidelines, we performed a systematic review of PubMed, the Cochrane library, and Embase to identify candidate studies. The search string included ("tendon transfer” OR "tenorraphy” OR "tennorhaphy”) AND ("side to side” OR "side-to-side” OR "pulvertaft”) AND ("biomechanical” OR "cadaver”). References of search-identified reports were reviewed for additional studies. Studies with direct comparisons of PTW and STS constructs were included. We performed a meta-analysis comparing the two techniques for load to failure (LTF)(N), stiffness (N/mm), and cross-sectional area (CSA)(mm2).
Results: Eight studies with a total of 235 tested specimens (107 PTW, 128 STS) met inclusion criteria (Figure 1). Figure 2 outlines tenorraphy construct details in each study. Eight studies reported LTF, with weighted mean values of 103 (+ 36) N and 198 (+ 61) N for the PTW and STS groups, respectively (p < 0.05)(Figure 3). Four studies reported initial construct stiffness, with weighted mean values of 16 (+ 4) N/mm and 34 (+ 16) N/mm for the PTW and STS groups, respectively (p < 0.05)(Figure 4). Five studies evaluated size as measured by CSA, with weighted mean values of 28 (+ 14) mm2 and 29 (+ 13) mm2 for the PTW and STS groups, respectively (p>0.05)(Figure 5).
Conclusion: Our meta-analysis of biomechanical studies demonstrated significant increased load to failure and stiffness with side-to-side tendon coaptation as compared to Pulvertaft weave. We found no difference in the cross-sectional area between the two constructs. Our findings can inform clinical decision making for surgeons implementing tendon transfers as part of their practice and favor side-to-side tendon coaptation as an alternative.
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