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Bone-Prosthesis Junction for Active Tendon Implants: A Biomechanical Comparison of 2 Fixation Techniques
Clarence B Toney1, John R Owen1, Imran A Khatri1
1Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, Virginia Commonwealth University, Richmond, VA.
The Journal of Hand Surgery
|February 17, 2016
Summary
Comparing two distal fixation techniques for active tendon implants, knot constructs showed more stretch while screw constructs offered greater stiffness. Both methods exceeded 340 N failure load, aiding surgical choices for flexor tendon reconstruction.
Area of Science:
- Orthopedic surgery
- Biomedical engineering
- Tendon reconstruction
Background:
- Flexor tendon injuries require robust surgical reconstruction.
- Active tendon implants offer dynamic joint motion restoration.
- Distal fixation is critical for implant biomechanical integrity.
Purpose of the Study:
- To compare the biomechanical properties of two distal fixation techniques for active tendon implants.
- Evaluate percent stretch, stiffness, and ultimate load capacity.
- Inform surgical decision-making in flexor tendon reconstruction.
Main Methods:
- Cadaveric canine middle phalanges were used for biomechanical testing.
- Two fixation techniques were evaluated: metal cleat and screw vs. polyester cords secured with a knot.
- Cyclical loading and load-to-failure tests assessed stretch, stiffness, and peak load.
Main Results:
- Knot constructs exhibited greater percent stretch under cyclical and peak loads.
- Screw constructs demonstrated superior stiffness between 50 N and 150 N.
- Both techniques achieved a mean failure load exceeding 340 N.
Conclusions:
- Both fixation methods are suitable for immediate postoperative motion following flexor tendon repair.
- Knot constructs require surgical compensation for significant stretch.
- Screw fixation offers higher stiffness but risks intra-articular fracture.
