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1.
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   

2.
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   

3.
Both triceps tendons and the medial collateral ligaments of both stifles of 10 freshly euthanized dogs were sharply transected. One tendon and one ligament of each dog were sutured with a three loop pulley pattern, and the opposite tendons and ligaments were sutured with a locking loop pattern. The tendons and ligaments were harvested with their muscular and bony attachments. The anastomoses were slowly tested in tension until failure occurred. The amount of tensile load required to produce failure of the anastomosis, the amount of distraction of the sutured ends prior to failure, and the modes of failure were recorded. In both tendons and ligaments, the three loop pulley pattern provided significantly greater tensile strength (p < 0.01) and allowed significantly less distraction between the sutured ends (p < 0.01) than the locking loop pattern. In tendons, disruption of the suture material was the most common mode of failure with both patterns. In ligaments, both patterns failed most commonly by pulling free from the tissue.  相似文献   

4.
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   

5.
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   

6.
Traumatic avulsion of the triceps tendon was diagnosed in a 15-month-old, male, neutered European shorthair cat. Diagnosis was established clinically by palpation of a transverse groove proximal to the olecranon and by radiography. The avulsed end of the tendon was surgically reapposed using a modified three-loop pulley suture and horizontal mattress sutures. Postoperatively, elbow flexion was limited for three weeks with the aid of a spica splint and by exercise restriction for six weeks. The cat showed no lameness after bandage removal up to the time of writing (seven months). Although rare, triceps tendon injuries can occur after a blunt trauma and should be included in the differential diagnosis of foreleg lameness in the cat. The modified three-loop pulley suture in combination with subsequent immobilisation of the limb with a splinted bandage resulted in a successful outcome in this cat with a triceps tendon avulsion.  相似文献   

7.
OBJECTIVES: To compare suture patterns (simple interrupted, modified pulley, horizontal mattress, double butterfly) by use of a novel in vitro model that quantifies force required for closure against tension. STUDY DESIGN: In vitro study. SAMPLE POPULATION: Suture constructs. METHODS: An in vitro suturing frame was constructed with extension springs to provide a standard resistance against movement of 2 panels of loops toward each other. Four different suture patterns were applied to the frame in randomized trials. The frame was affixed to a tensiometer that measured the force required for each suture pattern to close a fixed distance (3.81 cm) at a constant rate (5.08 cm/min) against the tension (0.6 kg/cm) of the extension springs. The closure distance and tension were selected subjectively to mimic tension encountered clinically during wound reconstruction oncologic surgical procedures. RESULTS: The modified pulley suture required the least force to close, followed by the double butterfly, simple interrupted, and horizontal mattress patterns. CONCLUSIONS: The modified pulley suture and double butterfly suture patterns require less force to close a given distance under tension than either simple interrupted or horizontal mattress suture patterns. CLINICAL RELEVANCE: Application of tension relieving suture techniques for fascia, subcutaneous, and buried-knot subdermal suturing should be considered to facilitate direct closure of wounds under tension. Modified pulley and double butterfly suture patterns offer some mechanical advantage by requiring less force to achieve closure compared with other suture patterns that might be used in reconstructive surgery.  相似文献   

8.
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   

9.
Objective— To compare mechanical stability between a novel polypropylene mesh repair (Mesh), a modified 3-loop pulley suture (Suture), and a combination of the techniques (Suture+Mesh) for the repair of distal canine Achilles' tendon ruptures.
Study Design— In vitro mechanical evaluation.
Sample Population— Cadaveric canine Achilles' tendon/calcaneus units (n=34).
Methods— Constructs were loaded under tension to failure in a materials testing machine with synchronized kinematic analysis. Ultimate load to failure, global construct stiffness, and force required to reach 1 and 3 mm gap formation was recorded.
Results— Ultimate load to failure was greatest for the Suture+Mesh group and lowest for the Suture group. The Suture+Mesh technique afforded a significantly greater global stiffness than the Suture or Mesh treatments. Force to generate 1 and 3 mm gap formation was greatest with the Suture group.
Conclusions— The Suture+Mesh group had the highest ultimate load to failure and afforded the greatest global stiffness though it had no added benefit to resist local gap formation at the repair.
Clinical Relevance— Achilles' ruptures repaired with suture can be augmented with mesh to increase the ultimate load to failure, but as currently tested, there was a decrease in resistance to gap formation At this time we cannot recommend Mesh or the Suture+Mesh techniques without further testing.  相似文献   

10.
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   

11.
Objective— To compare Chinese finger trap (CFT) and 4 friction suture (FFS) techniques to secure gastrostomy (GT), jejunostomy (JT), and thoracostomy (TT) tubes of different materials.
Study Design— Prospective experimental study.
Animals— Canine cadavers (n=20).
Methods— Randomly, GT (n=20), JT (20), and TT (20) were inserted using 2 different suture techniques (10 for each tube type) and either silicone or another material (10 for each type). Axial distraction was applied to each tube until failure. Force and displacement to failure and failure mode were recorded and compared between techniques and materials for GT, JT, and TT.
Results— CFT failed most commonly by suture breakage whereas FFS failed mainly by tube slippage ( P =.003). For GT, failure occurred more commonly by tube slippage (n=15; P <.001) whereas tube breakage was more common for JT (n=10; P <.001) and suture breakage for TT (n=14; P =.022). Silicone had higher force to failure than latex with GT, lower force to failure than red rubber with JT, and lower displacement to failure than polyvinylchloride with TT.
Conclusions— Different failure modes occurred for CFT (suture breakage) and FFS (tube slippage) and among different tube types (tube slippage with GT, tube breakage with JT, and suture breakage with TT). Based on study results, CFT is preferred to FFS for anchoring silicone GT and TT. Silicone GT, red rubber JT, and polyvinylchloride TT were more secure than latex GT, silicone JT, and silicone TT, respectively.
Clinical Relevance— CFT should be preferred over FFS based on force and displacement to failure, but tube type and tissue reaction could influence anchoring strength.  相似文献   

12.
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   

13.
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   

14.
The mechanical characteristics of toggle rods and Bone Biter anchors inserted through the medial acetabular wall for toggle pin repair of coxofemoral luxations were compared in 16 canine cadaver pelves. No differences were detected in maximum load to failure, displacement at failure, or energy to failure between the two constructs. Toggle rod constructs failed primarily by breakage of the suture at the rod eyelet. All of the Bone Biter anchor constructs failed when the anchors pulled through the medial acetabular wall.  相似文献   

15.
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   

16.
A prosthesis, composed of a steel cable and stress-reducing washers, was developed to prevent failure of laryngoplasty, a common treatment for horses affected by recurrent laryngeal neuropathy. Laryngoplasties were performed on 15 cadaveric larynges using a polyester suture on one side and the cable prosthesis on the other. Each prosthesis was distracted at a displacement rate of 20 mm/s using a servohydraulic materials testing machine until laryngoplasty failed. Distraction force and actuator displacement were recorded and analysed. All 15 laryngoplasties performed with a suture failed at the muscular process at a mean +/- s.d. force of 55.8 +/- 13.1 N. Six laryngoplasties performed with the cable prosthesis failed at the muscular process at mean force 219.6 +/- 125.0 N. In the other 9, the arytenoid cartilage was avulsed from the larynx at mean force 206.4 +/- 75.3 N, and the cable then tore through the muscular process at mean force 357.0 +/- 32.0 N. The difference in force required to cause failure of laryngoplasty was significant (P<0.0001). Although the prosthesis resisted substantially higher forces than did the suture, the effects of the prosthesis in vivo must be evaluated.  相似文献   

17.
OBJECTIVE: To compare bursting strength and failure modes of ventral median abdominal incisions closed with loop suture in a simple continuous pattern using two different suture-bite intervals. STUDY DESIGN: In vitro experiment. SAMPLE POPULATION: Equine cadavers (n=14; weighing >318 kg; postmortem interval <2 hours). METHODS: A template was used to make a 25 cm incision with suture interval and bite size of either 1.0 cm x 1.5 cm or 1.5 cm x 1.5 cm. A 200 L polyurethane bladder was inserted within the abdomen and insufflated to create abdominal wall tension. Celiotomies were closed with a #2 braided lactomer 9-1 continuous pattern with a loop suture. Deviation from the linea, closure time (minutes), total suture length (cm), suture length to wound ratio (SL:WL), bursting pressure (mm Hg), and failure modes (fascial or suture) were compared between groups using a Mann-Whitney U test. Significance was set at P<.05. RESULTS: No significant differences were identified between closing time, total suture length used, SL:WL, bursting pressure, or failure mode. Fascial failure was the main failure mode for both techniques; suture failure occurred rarely and knot failure did not occur. CONCLUSION: Based on the overall bursting pressure and failure mode, #2 braided lactomer loop suture placed in a continuous pattern should provide sufficient security for closure of the equine linea alba during recovery and the immediate postoperative period. CLINICAL RELEVANCE: Although there were no significant differences in the 2 patterns evaluated, the 1.5 cm x 1.5 cm pattern may have potential advantages for closure time, less total suture remaining in the wound, and strength.  相似文献   

18.
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   

19.
Objective: To compare mechanical performance of 2 orientations of the 5 mm Corkscrew® suture anchor with #5 Fiberwire®. Study Design: In vitro biomechanical study. Sample Population: Suture anchor–suture constructs (n=40). Methods: Acute and cyclic tensile loads were applied to suture threaded through eyelets of 40 anchors perpendicular to the long axis of the anchor. Eyelets were positioned so that the suture pull was in line with (anchor rotation angle of 0° [ARA 0]) or 90° (ARA 90) to the eyelet plane. Load at failure, stiffness, and cycles to failure were determined. Results: All constructs failed by suture breakage at the eyelet. Mean load at failure was significantly higher in the ARA 90 group (634±93 N) compared with the ARA 0 group (495±52 N; P=.0015). No significant difference was found between groups for mean number of cycles to failure (270±177 versus 178±109; P=.2166) and stiffness (50±4 versus 48±5 N/mm; P=.3141). Conclusions: The Corkscrew® 5 mm suture anchor with Fiberwire® suture fails via suture breakage at the eyelet under higher acute loads if the suture is loaded at an angle of 90° compared with 0° with respect to the plane of the eyelet.  相似文献   

20.
OBJECTIVE: To compare the monotonic tensile and fatigue strength of 16-gauge stainless steel wire (SSW) to ultra-high-molecular weight polyethylene (UHMWPE) cable using a transfixed cerclage technique in an in vitro midbody sesamoid osteotomy model. Endoscopic modifications to Martins transfixed cerclage technique were developed. A new suture technique of fixation was compared with the transfixed cerclage technique by measuring gap formation after cyclic testing. STUDY DESIGN: An in vitro biomechanical paired equine cadaver limb study. SAMPLE POPULATION: Twenty-one paired cadaveric adult equine forelimbs. METHODS: Uniaxial medial midbody sesamoid osteotomies were created in paired adult equine forelimbs. Monotonic tensile strength was measured on 10 forelimbs repaired by a transfixed cerclage technique using wire or cable. Fatigue testing to failure was performed on 4 forelimbs repaired using the transfixed cerclage technique by cycling the limbs between 500 N and 2,000 N. The limbs were initially repaired with wire, cycled until the wire broke, then repaired with cable and cycled again to failure. Fatigue testing for gap displacement was performed on 8 limbs repaired with either the transfixed cerclage technique or the suture technique. Limbs were cycled between 500 N and 2,000 N for 10,000 cycles. The limbs were repaired with wire initially, tested, and then repaired with cable and tested again. Twenty-two limbs were used for mechanical testing. The remaining limbs (20) were used to develop and practice the endoscopic transfixed cerclage (10 limbs) and suture (10 limbs) techniques. RESULTS: Ultimate tensile strength (UTS) of UHMWPE cable constructs was 34% greater than the UTS of SSW constructs. Fatigue strength was 2 to 20 times greater for UHMWPE cable constructs than SSW constructs. Separation of fragments was 153% less for limbs repaired by the suture technique compared with those repaired by the transfixed cerclage technique. CONCLUSIONS: UHMWPE cable shows promise for this clinical application because of its greater tensile and fatigue strength. The newly described suture technique significantly reduced gap formation compared with the transfixed cerclage technique. Osteotomy gap formation occurred early in cycling, suggesting that rigid support in the form of a cast may be needed during the early postoperative period for wiring techniques. CLINICAL RELEVANCE: Clinical testing of UHMWPE cable should eliminate problems of wire breakage seen with SSW. The endoscopic transfixed cerclage technique can be used by surgeons familiar with arthroscopic surgery. However, the suture technique needs to be tested in vivo to determine whether there is a clinical advantage compared with the transfixed cerclage technique.  相似文献   

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