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Biomechanical Properties of First Dorsal Extensor Compartment Regarding Adequacy as a Bone-Ligament-Bone Graft.

ABSTRACT: Bone-ligament-bone grafts for reconstruction of the scapholunate ligament are a valuable tool to prevent disease progression to carpal collapse. Locally available grafts do not require an additional donor site. The first extensor compartment was evaluated biomechanically regarding its possible use as an autograft.Twelve native fresh-frozen, human cadaver specimens were tested by applying axial tension in a Zwick Roell machine. Load to failure, transplant elongation, and bony avulsion were recorded. The load to failure was quantitated in newtons (N) and the displacement in length (millimeters). Parameters were set at distinct points as start of tension, 1 mm stretch and 1.5 mm dissociation, failure and complete tear, and were evaluated under magnified visual control. Although actual failure occurred at higher tension, functional failure was defined at a stretch of 1.5 mm.Mean load at 1 mm elongation was 44.1 ± 28 N and at 1.5 mm elongation 57.5 ± 42 N. Failure occurred at 111 ± 83.1 N. No avulsion of the bony insertion was observed. Half the transplants failed in the central part of the ligament, while the rest failed near the insertion but not at the insertion itself. Analysis of tension strength displayed a wide range from 3.8 to 83.7 N/mm at a mean of 33.4 ± 28.4 N/mm.The biomechanical tensile properties of the first dorsal extensor compartment are similar to those of the dorsal part of the scapholunate ligament. A transplant with a larger bone stock and a longer ligament may display an advantage, as insertion is possible in the dorsal, easily accessible part of the carpal bones rather than in the arête-like region adjacent to the insertion of the scapholunate ligament. In this study, 1.5 mm lengthening of the bone-ligament-bone transplant was defined as clinical failure, as such elongation will cause severe gapping and is considered as failure of the transplant.

SUBMITTER: Jakubietz MG

PROVIDER: S-EPMC5548566 | biostudies-other | 2017 Jul

REPOSITORIES: biostudies-other

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Project description:PurposeTo investigate the graft diameters and mechanical properties of hamstring tendons sutured using different materials and techniques.MethodsThis study used 30 fresh, frozen human cadaveric semitendinosus tendons; the free ends of 10 specimens each were sutured by 2 No. 3 braided polyester sutures with the Krackow technique (BP group), SutureTape with the Krackow technique (ST group), or SutureTape Loop with the locking SpeedWhip technique (SL group). First, the changes in graft diameter from before suturing to after suturing were investigated. Each graft was pre-tensioned to 100 N for 3 cycles and then cyclically loaded to 200 N for 200 cycles. Elongation after cyclic loading and displacement in the 200th cycle were calculated. Finally, each specimen was loaded to failure. The ultimate failure load and stiffness were analyzed. These mechanical properties were statistically analyzed using 1-way analysis of variance. The level of statistical significance was set at P < .05.ResultsIn the BP group, the changes in graft diameter were significantly larger than those in the ST and SL groups (P = .001). The elongation values after 200 cycles in the BP and ST groups were 3.1 ± 2.0 mm and 5.9 ± 3.4 mm, respectively. In the SL group, elongation (7.7 ± 3.6 mm) was significantly larger compared with that in the BP group (P = .037). In contrast, displacement in the 200th cycle was significantly smaller in the ST and SL groups compared with the BP group (P = .017). No statistically significant difference was evident for the ultimate failure loads among the 3 groups (P = .543).ConclusionsThe results of this study suggest that SutureTape may be an appropriate option for preparing the hamstring graft in anatomic anterior cruciate ligament (ACL) reconstruction.Clinical relevanceThis biomechanical study shows the effectiveness of SutureTape in ACL graft preparation. Clinically, SutureTape may be of benefit in single- or double-bundle ACL reconstruction.

Project description:PurposeTo evaluate clinical and biomechanical outcomes after knee extensor mechanism reconstruction (KEMR).MethodsPatients who underwent KEMR at our institution from 2011 to 2018 were identified. Patient-reported outcomes (Kujala, Lysholm, Tegner Activity Scale) were compiled at clinical follow-up. Isokinetic testing was conducted using the BioDex system 4 pro dynamometer at slow (60°/s), intermediate (180°/s), and fast (300°/s) speeds in a 9-patient subset.ResultsFrom 2011 to 2018, 12 patients (12 knees, 10 male, 5 right, mean age: 54.3 ± standard deviation: 15.2 years) with KEM injuries requiring tendon reconstruction with a 1-year minimum follow up were identified. Postoperative follow-up was 42.6 months (range: 12.0-93.0 months). Procedures included patellar (7) and quadriceps tendon reconstruction (5). Postoperative versus preoperative Tegner Activity Scale scores demonstrated significant improvement (3.5 ± 2.5 vs 1.5 ± 1.2, n = 8, P = .05). Postoperative versus preoperative Kujala scores significantly improved (70.3 ± 11.7 vs 43.6 ± 15.7, n = 8, P = .010). There was significant improvement in preoperative to postoperative KEMR extension lag (29.4 ± 22.2° vs 0.83 ± 1.9°, P = .002). Clinically, there was no difference in passive range of motion between the operative and contralateral knee. BioDex testing demonstrated decreased maximum work generated from the operative versus contralateral knee at slow (70.4 ± 30.4 Joules vs 101.9 ± 40.6 J; P = .028), intermediate (52.0 ± 45.4 J vs 69.8 ± 63.7 J; P = .038), and fast (43.8 ± 41.7 J vs 57.5 ± 53.8 J; P = .050) speeds. Range of motion was less in the operative versus contralateral knee at all speeds: P = .011, .038, and .024. The average peak torque generated per body weight was smaller in the operative versus contralateral knee at slow speed (P = .038).ConclusionsPatients undergoing KEMR in this study have significantly improved clinical outcomes despite having strength deficits that persist postoperatively.Level of evidenceTherapeutic Case Series, Level IV.

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Biomechanical Properties of First Dorsal Extensor Compartment Regarding Adequacy as a Bone-Ligament-Bone Graft.

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