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. 2025 May;49(5):1055-1063.
doi: 10.1007/s00264-025-06481-9. Epub 2025 Mar 20.

Reinforced lengthening Achilles tendon Z-plasty - ex vivo assessment of biomechanical augmentation with surgical-fiberlock technology

Thomas Dreher  1   2 , Andrea Moehl  3 , Elias Bachmann  3 , Arend Nieuwland  4   5 , Jess G Snedeker  3   6   7
Affiliations

Reinforced lengthening Achilles tendon Z-plasty - ex vivo assessment of biomechanical augmentation with surgical-fiberlock technology

Thomas Dreher et al. Int Orthop. 2025 May.

Abstract

Purpose: Tendon lengthening is a common lower limb surgical procedure in paediatric orthopaedics and deformity correction. Healing of a lengthened tendon is typically supported by casting and unloading of the operated limb. Although tendon rupture or overcorrection may adversely affect surgical outcomes, few studies have examined surgical means of improving post-operative stability of the tendon. We aim to evaluate a novel method for augmenting Z-Plasty tendon lengthening as a first step to clinical translation.

Methods: In this experimental ex vivo study, we employed a bovine flexor tendon model (n = 18) to examine a novel mechanical augmentation method after tendon lengthening by Z-plasty. Conventional surgical suturing of the imposed Z-plasty (n = 6) and an experimental group (n = 6), in which additional augmentation was performed by interlocking fibres of a biomaterial scaffold to the underlying tendon using a novel micro-needling technique, were compared to native tendons (n = 6).

Results: The needle interlocked scaffold successfully augmented the suture repair, showing more than doubled ultimate failure force compared to controls (482 ± 107 N vs. 206 ± 37 N, p < 0.01), and more than 1.5-fold repair stiffness (41 ± 7 N/mm vs. 26 ± 9 N/mm, p < 0.01).

Conclusion: We conclude that the use of an interpenetrating biomaterial scaffold represents a promising new approach for improving biomechanical tendon properties, which may have an implication on the stability of tendon suture, lengthening and tendon transfer procedures as well as on post-operative management and earlier mobilization.

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Conflict of interest statement

Declarations: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Consent for publication: The manuscript does not contain any individual person’s data in any form. Informed consent: Not applicable. Ethical Review Committee Statement: The study was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki and in accordance with relevant regulations of the US Health Insurance Portability and Accountability Act (HIPAA). No further approval of the local ethical Review Committee was needed, as no live animal data were used. The bovine flexor tendons were obtained from a local abattoir. Conflict of interest: Andrea Moehl and Elias Bachmann are employees of ZuriMED technologies, the manufacturer of Surgical Fiberlock Technology. Jess Snedeker is founder of and shareholder in ZuriMED Technologies AG, the manufacturer of Surgical Fiberlock Technology.

Figures

Fig. 1
Fig. 1
Study groups and surgical techniques
Fig. 2
Fig. 2
A Procedure for Z-plasty and B Z-plasty with PET patch (FLP)
Fig. 3
Fig. 3
Set up of tensile testing to failure with conventional Z-plasty specimen
Fig. 4
Fig. 4
Boxplots with median and whiskers from minimum to maximum for pull-to-failure testing (A) Cyclic elongation (B) Ultimate failure force (C) Linear stiffness
See this image and copyright information in PMC

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