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. 2015 Mar;40(3):239-45.
doi: 10.1177/1753193413517327. Epub 2014 Jan 10.

The mechanical strength of side-to-side tendon repair with mismatched tendon size and shape

J Fridén  1 , T F Tirrell  2 , S Bhola  3 , R L Lieber  4
Affiliations

The mechanical strength of side-to-side tendon repair with mismatched tendon size and shape

J Fridén et al. J Hand Surg Eur Vol. 2015 Mar.

Abstract

Tendon transfers frequently require coaptation of two mismatched tendons. In this cadaver study, ultimate load, stiffness, and Young's modulus were measured in tendon-to-tendon attachments with mismatched donor and recipient tendons, using pronator teres (PT) to extensor carpi radialis brevis (ECRB) and flexor carpi ulnaris (FCU) to extensor digitorum communis (EDC). FCU-to-EDC attachments failed at higher loads than PT-to-ECRB attachments, but they had similar modulus and stiffness values. Ultimate tensile strength of the tendon attachments exceeded the maximum predicted contraction force of any of the transferred muscles, with safety factors of four-fold for the FCU-to-EDC and two-fold for the PT-to-ECRB transfers. This implies that size and shape mismatches should not be contraindications to tendon attachment in transfers. The strength safety factors suggest that postoperative immobilization of these transfers is unnecessary.

Keywords: Tendon transfer; stiffness; ultimate tensile strength.

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Conflict of interest statement

Conflicts of interest: All named authors hereby declare that they have no conflicts of interest to disclose

Figures

Figure 1
Figure 1
Generalized scheme of the side-to-side tendon attachment method. Stay sutures are placed at the proximal point of overlap (A). Running sutures are placed from proximal to distal and then overlapped from distal to proximal (B). Equivalent overlapping running sutures are placed on the other side of the construct.
Figure 2
Figure 2
Photographs of the attachments of FCU-to-EDC (A and C) and PT-to-ECRB (B and D), in their intact states (A and B) and after mechanical loading (C and D). Note that failures occur by the suture effectively “splitting” one of the tendons, allowing it to migrate away from the other. Note also that the scale bar is approximate.
Figure 3
Figure 3
Sample load-deformation curves (solid) for FCU-to-EDC (blue) and PT-to-ECRB (red) attachments. The dashed black line overlaying each curve represents the period over which data were used to calculate modulus and stiffness values for the attachment constructs. Note that the FCU-to-EDC attachment is both stiffer and bears a higher ultimate load before failure.
Figure 4
Figure 4
Maximum load (A), modulus (B) and stiffness (C) of the FCU-to-EDC (blue) and PT-to-ECRB (red) attachments. The FCU-to-EDC bears significantly higher loads (as indicated by the * symbol), but the two constructs have similar modulus and stiffness values. Error bars represent standard error.
See this image and copyright information in PMC

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