Wrist-Level Tendon Repairs Utilizing a Novel Tendon Stapler Device: An Efficiency and Biomechanical Study

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Musculoskeletal Research

Background:

• A novel tendon stapler device (TSD) has received FDA approval for enhancing primary tendon repairs.
• This study investigates the TSD's biomechanical properties against standard suture coaptation techniques.
• Hypotheses centered on the TSD's speed, strength, and consistency across different surgeon experiences.

Purpose of the Study:

• To compare the biomechanical properties of a novel tendon stapler device (TSD) against standard suture repair.
• To evaluate the TSD's performance in terms of speed, strength, and consistency.
• To assess the TSD's reliability across varying levels of surgeon expertise in tendon repair.

Main Methods:

• Human cadaver arms (flexor zones IV-VII) were used for repairs by novice, intermediate, and expert participants.
• Repairs were performed using a modified Kessler technique with a horizontal mattress suture versus the TSD.
• Biomechanical testing included 2-mm gap force, ultimate failure load, and mode of failure analysis.

Main Results:

• The TSD repairs were 3 times faster than suture repairs.
• TSD coaptations demonstrated nearly 50% higher 2-mm gap force and 30% higher ultimate failure load.
• Failure modes for sutures included pull-through, breakage, or knot failure, while TSD failures were primarily device pull-through.

Conclusions:

• The TSD significantly enhances the speed and strength of primary tendon coaptations compared to standard 4-strand suture repairs.
• The TSD's biomechanical performance showed minimal variability across participants with different levels of tendon repair experience.
• The TSD shows promise for revolutionizing tendon repair procedures, though further research is warranted.