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Initial Experience with the PONTiS Tendon Repair System in Traumatic Upper Extremity Injuries
Daniel W Maxwell1, Karan A Desai1, Robert C Fang1
1From the Department of General Surgery, Division of Plastic and Reconstructive Surgery, and Department of Orthopedic Surgery, Emory University Hospital; and Grady Memorial Hospital.
Insights
The PONTiS flexor tendon repair system offers a rapid and simple solution for upper extremity tendon injuries, with complication rates comparable to traditional sutures but better outcomes for rupture and tenolysis. Caution is advised with poor soft-tissue coverage.
Area of Science:
- Orthopedic Surgery
- Hand Surgery
- Trauma Surgery
Background:
- Tendon injuries of the upper extremity are common and necessitate prompt surgical intervention.
- The PONTiS flexor tendon repair system, a knotless, multifilament, stainless steel crimp device, was evaluated for its initial clinical experience.
Purpose of the Study:
- To review the initial experience with the PONTiS flexor tendon repair system in patients undergoing surgical repair.
- To assess risk factors associated with complications following flexor tendon repair using the PONTiS system.
Main Methods:
- A review of consecutive patients undergoing flexor tendon repair with the PONTiS system between 2015 and 2017.
- Multivariate risk and Kaplan-Meier survival analyses were employed to identify risk factors for complications.
- Data collected included patient demographics, injury characteristics, and post-operative outcomes.
Main Results:
- Eighty-one patients were analyzed with a mean follow-up of 75 days.
- Common demographics included right-handed males in labor professions sustaining zone 2 lacerations.
- Thirteen patients (16.0%) experienced complications; poor soft-tissue coverage and zone 2 involvement were identified as risk factors, while epitendinous repairs showed protective effects.
Conclusions:
- The PONTiS flexor tendon repair system is efficient for multiple tendon injuries, demonstrating comparable overall complication rates to traditional sutures but improved rupture and tenolysis rates.
- Recommendations include cautious use in cases with poor soft-tissue coverage to prevent extrusion.
- Concurrent use of epitendinous sutures is strongly advised to mitigate complications.
Background:
Tendon injuries of the upper extremity remain a common surgical condition requiring prompt intervention. The authors review their initial experience with the PONTiS flexor tendon repair system, a knotless, multifilament, stainless steel crimp system.
Methods:
Consecutive patients undergoing repair by plastic and orthopedic surgeons with the PONTiS system were reviewed for the period from 2015 to 2017. Multivariate risk and Kaplan-Meier survival analyses were performed to assess risk factors associated with complications.
Results:
Eighty-one patients, with a mean follow-up of 75 days (range, 0 to 33 months), were identified. The most common demographics showed patients were right-handed (82.9 percent), male (71.4 percent), and laborers (35.7 percent) and sustained laceration injuries (77.1 percent) at zone 2 (27.2 percent). There were, on average, 3.7 tendon injuries per patient. Associated injuries included fractures (21.4 percent), arterial injuries (24.3 percent), and nerve injuries (61.4 percent). Thirteen patients (16.0 percent) developed complications, including adhesions/contracture ( n = 4), rupture ( n = 2), flap ischemia ( n = 2), arterial thrombosis ( n = 1), wound dehiscence ( n = 1), tendon lag ( n = 1), and erosion of the PONTiS system through soft-tissue grafts ( n = 2). Multivariate analysis identified poor soft-tissue coverage (OR, 9.990; p = 0.043) and zone 2 involvement (OR, 7.936; p = 0.016) as risk factors, while epitendinous repairs (OR, 0.096; p = 0.010) were protective against complications.
Conclusions:
The PONTiS flexor tendon repair system is rapid, simple to deploy, and advantageous, especially in multiple traumatic tendon injuries. In comparison to traditional suture repair, it has a comparable overall complication profile but superior rupture and tenolysis rates. The authors advise using it with caution in cases with poor soft-tissue coverage to minimize risks of extrusion, and they strongly recommend the use of epitendinous sutures concurrently to limit complications.
