An Exploratory Study Using Semi-Tabular Plate in Zone II Flexor Tendon Repair

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Hand Surgery

Background:

• Zone II flexor tendon injuries are challenging to repair effectively.
• Traditional repair methods can have limitations in biomechanical strength and healing outcomes.
• A novel low-profile titanium (Ti) plate implant, the Ti-button, is being evaluated for flexor tendon repair.

Purpose of the Study:

• To evaluate the feasibility and biomechanical performance of the Ti-button implant for Zone II flexor tendon repair.
• To compare the Ti-button repair technique against the 6-strand modified Lim-Tsai technique.
• To assess tensile strength, gap formation, and gliding resistance of the repair methods.

Main Methods:

• Twenty lacerated porcine flexor tendons were repaired using either the Ti-button or modified Lim-Tsai technique.
• Biomechanical testing included ultimate tensile strength and load to 2 mm gap force.
• Gliding resistance and coefficient of friction were measured at the A2 pulley using a custom jig on cadaveric specimens.

Main Results:

• Ti-button repairs demonstrated significantly higher ultimate tensile strength (101.5 N) and stiffness (7.8 N/mm) compared to the modified Lim-Tsai technique.
• Load to 2 mm gap force was 25.7 N for Ti-button repairs.
• While Ti-button increased gliding resistance (2.2 N), there was no significant difference in this parameter or coefficient of friction between the two techniques.

Conclusions:

• The Ti-button implant provides a stronger repair construct for Zone II flexor tendons.
• It exhibits comparable mechanical properties to traditional repairs regarding gap formation and gliding resistance.
• Further investigation into the mechanical and biochemical (tendon healing) properties of the Ti-button is warranted.