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Side-to-Side Tendon Coaptation Yields Greater Load to Failure and Stiffness Than Pulvertaft Weave: A Systematic
Casey Imbergamo1, Calvin Wang2, Daniel Devine2
1The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, USA.
Background:
Two of the most prevalent techniques for tendon transfer are Pulvertaft weave (PTW) and side-to-side (STS) constructs. Our purpose was to compare pooled results from reported biomechanical properties of these approaches by a meta-analysis. Our null hypothesis was there are no significant differences in load to failure (LTF), initial construct stiffness, or cross-sectional area (CSA) between these techniques.
Methods:
We performed a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify candidate studies. We included studies with direct LTF comparisons of PTW and STS constructs. We performed a meta-analysis of pooled data comparing the 2 techniques for initial construct LTF (N), stiffness (N/mm), and CSA (mm2).
Results:
Eight studies with a total of 235 tested human or porcine tendon reconstruction constructs (107 PTW, 128 STS) met our inclusion criteria. Eight studies reported initial construct LTF, with weighted mean values of 103 (±36) and 198 (±61) N for the PTW and STS groups, respectively (P < .05). Four studies reported initial construct stiffness, with weighted mean values of 16 (±4) and 34 (±16) N/mm for the PTW and STS groups, respectively (P < .05). Five studies evaluated initial transfer bulk as measured by CSA, with weighted mean values of 28 (±14) and 29 (±13) mm2 for the PTW and STS groups, respectively (P > .05).
Conclusions:
Our meta-analysis demonstrated significant increased initial construct LTF and stiffness with STS tendon coaptation as compared with PTW. We found no difference for initial CSA between the 2 techniques.
