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Presenter: Tim S Peltz, BS, MASc candidate
Co-Authors: Haddad RH; Scougall PS; Bertollo NB; Pelletier MP; Oliver RO; Gianoutsos MG; Walsh WW
Surgical Research Laboratories Prince of Wales Hospital University of New South Wales

INTRODUCTION: Current literature suggests that the cross locked cruciate repair not only provides a good compromise between complexity and final failure force, but also is a favorable repair in terms of gap formation. In this study we modified this repair configuration by interlocking its distal components to further improve gapping propensities. Additionally we introduce a new tendon repair technique: The three-dimensional knotless barbed suture tenorrhaphy. Aim of this study was to compare these two new tendon repair methods with the conventional cross locked cruciate repair in a dynamic testing scenario, focusing on maximum load capacity and gap formation.

METHODS: 45 deep flexor tendons were harvested from adult sheep forelimbs. Three groups were randomly divided and repaired with the four strand cross locked cruciate technique, the four-strand modified cross locked cruciate technique and a new four-strand barbed suture tendon repair technique. All repairs were performed by one surgeon using 3-0 braided polyester sutures for the conventional repair groups and a unidirectional barbed glycolic-carbonate suture for the barbed suture repair group (see figure 1 for repair configurations). No circumferential suture was added to exaggerate differences in these core repair methods. Cyclic loading (3N to 30N) and static pull to failure was performed using a MTS Bionix biomechanical testing machine.

RESULTS: Significant differences between the three tested groups could be shown regarding gapping and maximum load to failure (see figure 2).

CONCLUSION: In this ex vivo experiment our interlocking modification of the cross locked cruciate repair could improve gapping propensities in the early phase of dynamic testing, final failure force could not be improved significantly. Our three-dimensional barbed suture tendon repair method showed significant better gapping resistance and higher resistance to final failure in comparison to the conventional four-strand suture constructs.

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