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1.
Thirty-six superficial digital flexor tendons from nine fresh equine cadavers were transected and sutured with size 2 monofilament nylon. Nine tendons were repaired with each of four suture patterns: single-locking loop, double-locking loop, triple-locking loop, or three-loop pulley. The times required for application, tensile strengths, resistance to distraction (gap), and modes of failure were analyzed. The mean times required were: single-locking loop, 3 mins, 15 secs; double-locking loop, 4 mins, 15 secs; triple-locking loop, 10 mins, 50 secs; and three-loop pulley, 4 mins. The double-locking loop, triple-locking loop, and three-loop pulley suture patterns were stronger than the single-locking loop. The triple-locking loop and three-loop pulley patterns were close in strength and only the triple-locking loop was stronger than the double-locking loop. The three-loop pulley had the greatest resistance to gap formation and its mode of failure was different from the others. The three-locking loop suture patterns failed by suture breakage but the three-loop pulley failed first by suture pull-out and then by suture breakage.  相似文献   

2.
Objective: To test single cycle to failure tensile strength characteristics of 6 suture material–pattern combinations in equine superficial digital flexor (SDF) tenorrhaphy, specifically to compare a 10‐strand modification of the Savage core suture technique with the 3‐loop pulley technique. Study Design: Ex vivo mechanical experiment comparing 3 different suture patterns with 2 different materials. Sample Population: Forelimb and hindlimb SDF tendons (n=48) harvested from adult Thoroughbred and Standardbred horses of mixed age and gender. Methods: Six suture material–pattern combinations were evaluated: (1) 10‐strand Savage, size 2 polydioxanone (PDS); (2) 10‐strand Savage, size 2 polyglactin 910 (PG910); (3) 10‐strand Savage, size 2 PDS with Lin‐locking epitenon suture, size 2–0 PDS; (4) 10‐strand Savage size 2 PG910 with Lin‐locking epitenon suture, size 2–0 PDS; (5) 3‐loop pulley, size 2 PDS; and (6) 3‐loop pulley, size 2 PG910. Maximum load at failure (N), gap at failure (mm), and mode of failure (suture breakage or pull through) were evaluated for each of the 6 suture material–pattern combinations and underwent statistical analysis to determine significance of differences and interactions of the measured data. Results: The 10‐strand Savage technique failed at a mean load of 872 N (804–939, 95% CI). The 10‐strand Savage with Lin‐locking failed at a significantly greater mean load of 998 N (930–1065, 95% CI). The 3‐loop pulley pattern failed with a mean load of 337 N (270–405, 95% CI). There were significant interactions between the technique and suture material used. Conclusion: The 10‐strand Savage technique for repair of transected cadaver SDF tendons has superior strength characteristics with or without the epitenon suture when compared to the 3‐loop pulley. Suture material and pattern interactions were observed with PG 910 conferring higher strength for the 10‐strand Savage whereas PDS did so for the 3‐loop pulley.  相似文献   

3.
Size 3-0 polydioxanone was used as a single strand, single braid (3 strands), or double braid (6 strands) to create six suture material-pattern combinations for equine tenorrhaphy: single-strand locking loop, single-braid locking loop, double-braid locking loop, single-strand three-loop pulley, single-braid three-loop pulley, and double-braid three-loop pulley. Maximum load to failure for the single-strand locking loop (46.1 +/- 2.9 newtons [N]) was less than for all other sutures (range, 103-155 N). The load required to form a 2 mm gap between tendon ends was greater for the single-braid three-loop pulley (66.7 +/- 6.9 N) and double-braid three-loop pulley (85.4 +/- 17.7 N) than any other sutures. The load required to produce a 10 mm gap was least for the single-strand locking loop (34.3 +/- 3.9 N) and greatest for the double-braid three-loop pulley (131.5 +/- 27.5 N). Gap between tendon ends at maximum load was greater for the single-braid (18.1 +/- 0.9 mm) and double-braid (19.2 +/- 2.2 mm) locking loops than for any other sutures. Suture material broke in 53% of the locking-loop tests but in only 17% of the three-loop pulley tests. Tendon matrix disruption accounted for 43% of the locking-loop failures and 77% of the three-loop pulley failures. The three-loop pulley pattern provided more support, less tendon distraction, and less tendon matrix constriction and distortion than the locking-loop pattern.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

4.
OBJECTIVE: To compare a 3-loop pulley suture pattern with 2 locking-loop sutures for the repair of components of the canine Achilles mechanism. STUDY DESIGN: In vitro biomechanical study. ANIMALS: Forty-eight paired tendons collected from 9 canine cadavers. METHODS: Paired tendons were repaired with either a 3-loop pulley suture or 2 locking-loop sutures and tensile tested to failure. To ensure accurate anastomosis gap measurement a direct, non-contact, method of gap measurement, using digital video, was devised. Load initiating gap formation (defined as load at a 1 mm gap) and load producing a 3 mm gap were evaluated in addition to maximum load, gap at failure, mode of failure, and time spent placing the sutures. RESULTS: Maximum load values were similar for both repairs. The mean 1 mm gap loads were 44.0 and 18.4 N, and the mean 3 mm gap loads were 56.3 and 34.7 N, for the 3-loop pulley pattern and the 2 locking-loops, respectively; these differences were statistically significant. The 3-loop pulley pattern was faster to place and resulted in a smaller gap at failure. All but 2 repairs failed by suture pull out. CONCLUSIONS: The 3-loop pulley pattern is more resistant to gap formation during tensile loading, and is quicker to place, than 2 locking-loop sutures. CLINICAL RELEVANCE: Gap formation can significantly delay tendon healing. Tendon repairs with a gap >3 mm are reported to be at increased risk of rupture during the first 6 weeks postoperatively.  相似文献   

5.
The locking loop tendon suture is demonstrated. Five cases of its use in both acute and chronic lacerations of the calcanean tendon are presented. The results in all five cases were excellent. Advantages of this suture pattern include preservation of the intrinsic blood supply of the tendon, gap formation produced only with extreme load, simple and rapid placement of the suture, and reduction in adhesions. This suture pattern also can be used for other tendons.  相似文献   

6.
OBJECTIVE: To test the failure strength and energy of 2 bioabsorbable implants applied to transected deep digital flexor tendons (DDFT) from adult horses. STUDY DESIGN: Ex vivo biomechanical experiment. SAMPLE POPULATION: Twelve pairs of deep digital flexor tendons harvested from the forelimbs of fresh equine cadavers. METHODS: Poly-L-lactic acid tendon plates were custom manufactured for application to the cylindrical surface of an adult equine deep digital flexor tendon. Twelve pairs of DDFTs were transected 2 cm distal to the insertion of the distal check ligament of the deep digital flexor tendon. One tendon of each pair was randomly selected for repair with a biodegradable plate or a 3-loop pulley method. Size 2 polydioxanone suture was used in both repairs. Repairs were tested in tension to failure, with peak force (PF) and total energy (TE) at repair failure recorded in Newtons (N) and Joules (J), respectively. A paired t-test was used for statistical evaluation with a significant level set at P< or = .05. RESULTS: Mean+/-SD PF for failure of plated tendons (1507.08+/-184.34 N) was significantly greater than for sutured tendons (460.86+/-60.93 N). TE was also significantly greater for failure of plated tendons versus sutured tendons. CONCLUSIONS: Plate fixation of transected cadaver DDFTs appear to have superior immediate failure strength than 3-loop pulley repairs. CLINICAL RELEVANCE: Whereas in vivo testing is required, a bioabsorbable tendon plate may provide initial increased strength to support tendon healing and decrease external coaptation requirements.  相似文献   

7.
OBJECTIVE: To describe a modified 3-loop pulley suture pattern for the reattachment of canine tendons to bone along with a biomechanical comparison with the locking-loop suture. STUDY DESIGN: In vitro biomechanical study and clinical case report. ANIMALS OR SAMPLE POPULATION: Biomechanical study: 10 paired gastrocnemius tendons and calcaneii harvested from 5 canine cadavers. Case report: a Doberman with avulsion of the gastrocnemius tendon of insertion. METHODS: Biomechanical study: paired tendons were reattached to the calcaneus with either a modified 3-loop pulley pattern or a locking-loop pattern. Tensile loading to failure was performed. A direct, non-contact, method of gap measurement, using digital video, was used to measure gap formation. Load required to initiate gap formation (defined as load at a 1 mm gap) and to produce a 3 mm gap was evaluated in addition to maximum load and gap at failure. RESULTS: Mean (+/-SEM) 1 mm gap loads were 31.0+/-4.2 and 17.2+/-2.5 N, mean 3 mm gap loads were 49.1+/-2.4 and 28.9+/-3.2 N, and mean maximum loads were 72.9+/-4.3 and 55.8+/-2.2 N for the modified 3-loop pulley suture and the locking-loop suture, respectively. These differences were statistically significant (P<.05). The gap at failure was similar for both repairs. The clinical case remained sound 7 months postoperatively. CONCLUSIONS: A modified 3-loop pulley pattern is biomechanically superior to a locking-loop pattern for reattachment of the canine gastrocnemius tendon to bone and may be suitable for clinical use. CLINICAL RELEVANCE: Tendon repairs with a gap >3 mm are reported to be at increased risk of rupture during the first 6 weeks postoperatively. A modified 3-loop pulley pattern resists gap formation better than a locking-loop pattern.  相似文献   

8.
A Comparison of Repair Methods for Gap Healing in Equine Flexor Tendon   总被引：1，自引：0，他引：1  
In nine horses (18 forelimbs), a 3 cm section of superficial digital flexor tendon was removed and the tendons were repaired with immobilization for 6 weeks and (1) no suture (n = 6); (2) a double locking loop tenorrhaphy with carbon fiber (n = 6); or (3) a double locking loop tenorrhaphy with size 2 nylon suture (n = 6). Clinical assessment, gross evaluation, morphometry, histology, and mechanical testing were performed on two limbs from each treatment group at weeks 6, 12, and 24. At weeks 6 and 12, the unsutured tissue was less mature than the tissue sutured with nylon. By week 24, the carbon fiber repair had breaking stress (mean, 12.5 M Pa) similar to the unsutured repair (mean, 10.6 M Pa). There was necrosis and a granulomatous foreign body reaction around the carbon fiber. The nylon suture repair had significantly greater strength per unit area (mean breaking stress, 20.4 M Pa) because of a smaller area of repair tissue in the gap (mean, 3.6 cm2). At week 24, the nylon suture repair tissue was the most mature with the least inflammation of the three repair methods. A nylon double locking loop suture was the preferred method for equine flexor tenorrhaphy of a tendon gap because of greater breaking stress, histologic maturity, biocompatibility, and the adequate functional and cosmetic outcome.  相似文献   

9.
Healing of transected superficial digital flexor tendons was evaluated mechanically and histologically in eight horses. Tendons sutured with polyglyconate had higher loads at failure than nonsutured tendons at weeks 5 and 9. The tendon stress at failure (force per unit area) was higher in the sutured tendons at week 5 but not at week 9, reflecting the increased size of the scar at week 9. Histologically, scars after tenorrhaphy were consistently more mature than nonsutured tenotomy scars. The mean maturity score for sutured tendons was higher than for nonsutured tendons at weeks 5 and 9. Overall, these data support tenorrhaphy with absorbable suture.  相似文献   

10.
This report describes the temporary fixation of a traumatic shoulder luxation in a large-breed dog using a 3.5-mm Locking Round-Hole Reconstruction Plate (LRHRP) to provide stable internal splinting, allowing healing of the injured ligaments, joint capsule, glenohumeral ligaments, tendons, and muscles for restoration of joint stability. The use of a temporary plate with a locking system should be considered as an option in the treatment of canine shoulder joint luxations with severe tissue damage.  相似文献   

11.
OBJECTIVE: To evaluate the mechanical properties of canine arytenoid cartilage-suture constructs. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Eighty canine cadaveric larynges. METHODS: Arytenoid cartilage-suture constructs were loaded to failure on a materials testing machine. The effect of hole size, suture configuration, suture size, and rate of distraction on load at failure, displacement at failure, energy to failure, and construct stiffness were evaluated. Polypropylene sutures were used exclusively. Specific variables evaluated were: (1) hole size-SH needle, 22, 20, and 18 ga hypodermic needles; (2) suture configurations-single dorsal and ventral articular sutures, double sutures, horizontal mattress, locking loop, and single non-articular sutures; (3) suture size-1, 0, 2-0, and 3-0; and (4) distraction rate-0.83 and 36.66 mm/s. RESULTS: Hole size had no effect on any biomechanical variable. Double suture and horizontal mattress configurations had the highest median load and energy at failure. Single dorsal suture configurations that did not include the arcuate crest had the lowest median load at failure. Larger suture sizes tended to result in stiffer constructs. Cartilage-suture constructs behaved in a viscoelastic manner where load at failure, energy at failure, and stiffness increased when distraction rate was increased, whereas displacement at failure did not. Most constructs failed by suture pullout regardless of distraction rate, although 50% of horizontal mattress configurations failed by avulsion of the muscular process. CONCLUSION: Suture and hole sizes appear to have few effects on the biomechanical performance of arytenoid-suture constructs. Double-suture and horizontal mattress suture patterns had the best overall mechanical properties for arytenoid lateralization. Single-suture techniques, which do not incorporate the arcuate crest, were biomechanically inferior. CLINICAL RELEVANCE: Cumbersome large-diameter sutures offer no advantage over smaller sutures when performing arytenoid lateralization. The cross-sectional geometry of the muscular process should be taken into account when placing sutures in the arytenoid cartilages. Single-suture techniques that do not incorporate the arcuate crest should be avoided.  相似文献   

12.
The load-to-gap formation, maximum load, gap present at maximum load, and failure mode were compared among four suture patterns: Bunnell-Mayer, modified Kessler, Mason-Allen, and simple interrupted. Sixty-four goat tendons were sutured with 2-0 monofilament polypropylene in one of the patterns and distracted at 92 cm/min with an electrohydraulic materials testing system. All tests were filmed at 40 frames/sec with an intermittent pin registered camera. The load-to-gap formation was not significantly different among the Bunnell (13.3 +/- 1.5 newtons [N]), Kessler (12.8 +/- 1.3 N), and simple interrupted (11.7 +/- 1.7 N) patterns. The Mason-Allen pattern was significantly different )8.2 +/- 0.5 N). The Bunnell-Mayer had the highest mean maximum load to failure (43.0 +/- 1.6 N) followed by the modified Kessler (34.1 +/- 1.9 N). There was no difference between the Mason-Allen (22.9 +/- 1.4 N) and simple interrupted (21.2 +/- 1.4 N). All of the patterns permitted at least a 1 cm gap to form when the maximum load was applied. The Bunnell pattern caused severe constriction of the tendon and failed by suture material disruption. The modified Kessler caused some focal constriction, but the suture material pulled out before breaking and sliced the tendon in the process. The Mason-Allen and the simple interrupted patterns sliced the tendon as the suture pulled out of the tendon.  相似文献   

13.
Objective —To test a crimp clamp system designed to secure monofilament nylon leader (MNL) material commonly used as lateral fabellotibial sutures (LFS) in extra-articular stabilization of the canine stifle joint.
Study Design — In vitro biomechanical tests of MNL loops secured with either the crimp clamp system or knots were performed. Suture loops (n = 94) were created from 27.3 kg tensile strength MNL and fastened with knots or crimp clamps. Tests were conducted on steam-sterilized, ethylene-oxide-sterilized, and nonsterilized MNL sutures. Loops were evaluated in single load tests and cycled tests. Values for load to failure, initial loop tension, loop elongation, mode of failure, and point of failure were determined.
Results —Crimp-clamped loops were superior to knotted loops in all parameters tested in both cycled and noncycled tests. Loop failure generally occurred by breaking within 3 mm of the fixation in both clamped and knotted tests. Loop elongation after cycling was greater in the knotted loops compared with clamped loops ( P < .001). Load to failure was greater in clamped tests than in knotted tests (P < .001), regardless of sterilization technique used. Significantly higher initial loop tension could be achieved with the clamp system compared with knot fixation ( P < .001).
Conclusions —The crimp clamp system provides superior in vitro loop fixation characteristics compared with knot fixation in 27.3 kg test MNL.
Clinical Relevance —Based on the results of biomechanical testing and the known biocompatibility of the system's implant components, clinical trials using the crimp clamp system are warranted.  相似文献   

14.
Normal and diseased superficial digital flexor tendons at different stages of healing from seven Thoroughbred horses, aged 3–6 years, were evaluated by correlation of gray scale histogram analysis of tendon cross-sectional ultrasonograms with histopathologic examination. Normal tendon and tendons at different stages of healing, excluding acute tear stage, were characterized by normally distributed histogram patterns. The histogram mean value of normal tendons was higher than the corresponding values in diseased tendons at different stages of healing (p < 0.01). In addition, the histogram mean of acute lesions was lower than for early fibrosis or healed lesions (p < 0.01). The histogram mean increased as healing progressed. The results show that gray scale histogram analysis of tendon ultrasonogram can be used to distinguish between normal and abnormal superficial digital flexor tendon in racing horses.  相似文献   

15.
Objective— To describe a laparoscopic‐sutured gastropexy technique in dogs and evaluate the tensile strength of the adhesion and effects on gastric function. Study Design— Experimental study. Animals— Female beagle dogs (n=7). Methods— A laparoscopic‐sutured gastropexy technique was evaluated by ex vivo tensile distraction tests 10 weeks after surgery. The effect of the adhesion on gastric emptying, mucosal permeability, and systemic inflammation were evaluated by monitoring the C‐reactive protein (CRP) and sucrose permeability, and by radiographic evaluation of gastric emptying 2 weeks before and 10 weeks after surgery. Results— Mean (±SD) tensile force to disrupt adhesions was 51.1±16.4 N. There was no significant postoperative increase in CRP concentration or change in sucrose permeability. The area under the curve representing the postprandial decrease in gastric radiographic area increased by 11% after gastropexy. Conclusions— This laparoscopic gastropexy technique had appropriate mechanical and functional characteristics with limited morbidity. Clinical Relevance— This laparoscopic‐sutured gastropexy provides adhesion strength comparable with other gastropexy techniques tested at 10 weeks postoperatively. Only minor changes in gastric emptying were observed 10 weeks after surgery.  相似文献   

16.
Objective— To evaluate the effect of 6 different knotting methods on the mechanical properties of 3 large absorbable suture materials used in large animal surgery. Study Design— In vitro mechanical study. Sample Population— Knotted suture loops (n=15 per group). Methods— Suture loops were created between two low‐friction pulleys with either 2 polydioxanone, 2 polyglactin 910 or 3 polyglactin 910. Strands were tied using 1 of 6 knotting technique: square knot, surgeon knot, clamped surgeon's knot, sliding half‐hitch knot (HH), Delimar knot and self‐locking knot (SLK). A single cycle to failure test was performed on each suture loop with a distraction rate of 100 mm/min. Failure modes were evaluated and breaking strength, elongation to failure and stiffness were compared. Results— All loops except two HH failed at the knot by acute breaking. The double‐stranded SLK was both stronger and stiffer than all other knots for each suture material. Clamping the first throw of the surgeon knot decreased load to failure significantly (143.11 ± 8.64 N) compared with not clamping (159.21 ± 6.14 N) for polydioxanone. Stiffness and elongation to failure were respectively lower and increased for 2 polydioxanone compared with both polyglactin 910 materials for all knotting techniques. Conclusions— Knotting techniques do influence structural properties of suture loops. The double strand loop conferred stiffer and stronger properties to the SLK Clinical Relevance— Clamping the first throw of polydioxanone should be avoided when tying a suture under tension even using large diameter suture materials. Using a SLK might be considered as a useful alternative when excessive tension is present.  相似文献   

17.
Eighty 25-week-old male broiler-breeder chickens were placed in pens with elevated slats for 16 weeks. A similar group of birds was housed on floor pens for comparison. The coxofemoral, stifle, and tibiotarsal joints and their supporting tendons and ligaments were examined grossly. Rearing heavy broiler-breeders on elevated slats did not result in grossly apparent arthritis, tendonitis, or tendon failure. Body weights and shank lengths and diameters were not markedly different. Microscopically, the broiler-breeders reared on slats had a lymphocytic synovitis with synovial cell hyperplasia involving the gastrocnemius and digital flexor tendons. The incidence and severity of the lesion increased with time.  相似文献   

18.
A seven-year-old, 41 kg, intact, cross breed dog, was presented with a history of bilateral hind limb lameness after falling from a height of 1 m. Clinical and radiographic findings were consistent with bilateral patellar tendon rupture. Surgical repair was performed bilaterally. The tendons were sutured primarily, and an internal splint of nylon leader was added. Good apposition of the severed tendon ends had been achieved intraoperatively; however, post operative radiographs showed supra-trochlear displacement of both patellae. The casts used to immobilize the stifle joints slipped distally and three days post operatively the tendon repair had broken down, bilaterally. Revision surgery was undertaken and the tendons were re-sutured. Nylon leader was placed through holes that had been drilled in the patellae and tibiae. The stifle joints were immobilized with type I external skeletal fixators (ESFs). Both freeform polymethylmethacrylate (PMMA) connecting bars were found to be broken at the level of the stifle joints two days later, without any disruption of the primary tendon repair. Each connecting bar was replaced with two connecting bars of PMMA reinforced with 3 mm steel wire. The dog was fully weight-bearing with a reduced range of motion in flexion immediately after removal of the ESFs at six weeks and was still sound 18 months post-operatively. Primary tendon repair in combination with adequate immobilization allowed for an excellent outcome in a complicated bilateral pathology.  相似文献   

19.
An in vitro study of rottweiler and racing greyhound cranial cruciate ligaments revealed that the rottweiler ligaments had a significantly greater cross-sectional area at their distal attachments. Mechanical testing showed that the ultimate load related to body mass was significantly higher in the extended racing greyhound stifle during cranial tibial loading to failure, as were linear stiffness, tensile strength and tangent modulus. During ligament axis loading to failure, the only significant difference in structural and mechanical properties recorded between the two breeds was a greater ultimate strain for the greyhound ligament with the stifle joint flexed. Energy absorbed by the ligament complex at failure during cranial tibial loading was twice that for ligament axis loading for both breeds. The clinical significance is that the rottweiler cranial cruciate ligament is more vulnerable to damage as it requires half the load per unit body mass that the greyhound requires to cause a rupture.  相似文献   

20.
Objective— To describe augmentation of primary Achilles tendon repair using suture with a semitendinosus muscle flap and report outcome in 5 dogs.
Study Design— Prospective clinical study.
Animals— Dogs (n=5) with Achilles tendon rupture (n=6).
Methods— After tendon repair with #2 polypropylene in a 3-loop pulley suture pattern, the lateral one-half of the semitendinosus muscle was transected from the ischium, rotated distally then sutured with #2 polypropylene to the calcaneus in a 3-loop pulley pattern. The epitenon was sutured to the muscle flap fascia with interrupted sutures. All dogs had a bivalved cast for 2 weeks then a cranial splint for 2–6 weeks. Lameness scores (0=stands and walks normally to 4=non-weight-bearing lameness, plantigrade stance on affected pelvic limb) were determined every 2–3 weeks postoperatively for 12 weeks. Outcome was determined from telephone questionnaire of owners.
Results— Four had lameness scores of 0, the 5th had a score of 1 at 12 weeks. Three owners were very satisfied with outcome. Minor complications included cast sores (2 dogs), infection (2), and acute swelling (1); 1 major complication occurred (infection resulting in reoperation).
Conclusions— Semitendinosus flap augmentation resulted in early return to function without prolonged postoperative immobilization. Three dogs returned to full work/activity after repair.
Clinical Relevance— Augmentation of primary Achilles tendon repair with a semitendinosus flap can be considered in dogs with chronic rupture but further investigation of the long-term outcome using this technique is needed.  相似文献   

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