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Meta-Analysis
. 2023 May;18(3):446-455.
doi: 10.1177/15589447211043213. Epub 2021 Sep 16.

Alternative Tendon Coaptations to the Pulvertaft Weave Technique: A Systematic Review and Meta-Analysis of Biomechanical Studies

Emily M Graham  1 , Jeremie D Oliver  2 , Russell Hendrycks  1 , Dino Maglic  3 , Shaun D Mendenhall  3   4
Affiliations
Meta-Analysis

Alternative Tendon Coaptations to the Pulvertaft Weave Technique: A Systematic Review and Meta-Analysis of Biomechanical Studies

Emily M Graham et al. Hand (N Y). 2023 May.

Abstract

Background: The Pulvertaft weave technique (PT) is frequently used during tendon repairs and transfers. However, this technique is associated with limitations. In this systematic review and meta-analysis, quantitative and qualitative analyses were performed on in vitro, biomechanical studies that compared the PT with alternative techniques.

Methods: Articles included for qualitative and/or qualitative analysis were identified following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies included in the meta-analysis were analyzed either as continuous data with inverse variance and random effects or as dichotomous data using a Mantel-Haenszel analysis assuming random effects to calculate an odds ratio.

Results: A comprehensive electronic search yielded 8 studies meeting inclusion criteria for meta-analysis. Two studies with a total of 65 tendon coaptations demonstrated no significant difference in strength between the PT and traditional side-to-side (STS) techniques (P = .92). Two studies with a total of 43 tendon coaptations showed that the STS with 1 weave has a higher yield strength than the PT (P = .03). Two studies with a total of 62 tendon repairs demonstrated no significant difference in strength between the PT and the step-cut (SC) techniques (P = .70). The final 2 studies included 46 tendon repairs and demonstrated that the wrap around (WA) technique has a higher yield strength than the PT (P < .001).

Conclusions: The STS, SC, and WA techniques are preferred for improving tendon form. The STS and WA techniques have superior yield strengths than the PT, and the SC technique withstands similar stress to failure as the PT.

Keywords: Pulvertaft; basic science; hand surgery; side-to-side; step-cut; tendon; wrap around.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: S.D.M. is an educational consultant for PolyNovo and receives research funding from CoNextions Medical. The other authors have no potential conflicts of interests pertaining to this article.

Figures

Figure 1.
Figure 1.
Selection flowchart. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 8 articles were included in the meta-analysis.
Figure 2.
Figure 2.
(a) The side-to-side technique with 1 weave. The side-to-side is traditionally performed by placing donor and recipient tendons in parallel and anchoring the product with suture. Several variations to the side-to-side exist, although adding 1 weave is common. In this modification, a slit is made in the recipient tendon and the donor tendon is weaved through the slit once before securing the tendons together. (b) The wrap around technique. The proximal edge of the donor tendon is placed inside the flared, distal end of the recipient tendon. The edges of the recipient tendon are subsequently wrapped around the donor tendon and are secured with suture. (c) The step-cut technique. This technique is performed by excising one-third of the recipient and donor tendons and joining the residual two-thirds through cross-stitch core sutures and epitendinous sutures. (d) The Pulvertaft weave technique. Placing 3 orthogonal slits into a recipient tendon, a donor tendon is subsequently weaved through the slits. Mattress, figure-of-eight, and simple sutures are commonly used to secure the tendons together.
Figure 3.
Figure 3.
There is no significant difference in strength between the Pulvertaft weave technique and the traditional side-to-side technique. Note. CI = confidence interval.
Figure 4.
Figure 4.
The side-to-side technique with 1 weave withstands higher stress to failure than the Pulvertaft weave technique. Note. CI = confidence interval.
Figure 5.
Figure 5.
There is no significant difference in yield strength between the step-cut technique and the Pulvertaft weave technique. Note. CI = confidence interval.
Figure 6.
Figure 6.
The wrap around or open-book technique withstands higher stress to failure than the Pulvertaft weave technique. Note. CI = confidence interval.
See this image and copyright information in PMC

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