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The elastic capacity of a tendon-repair construct influences the force necessary to induce gapping

  • Sports Medicine
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Most biomechanical investigations of tendon repairs were based on output measures from hydraulic loading machines, therefore, accounting for construct failure rather than true gapping within the rupture zone. It was hypothesized that the elastic capacity of a tendon-repair construct influences the force necessary to induce gapping.

Methods

A tendon-repair model was created in 48 porcine lower hind limbs, which were allocated to three fixation techniques: (1) Krackow, (2) transosseous and (3) anchor fixation. Loading was performed based on a standardized phased load-to-failure protocol using a servohydraulic mechanical testing system MTS (Zwick Roell, Ulm, Germany). Rupture-zone dehiscence was measured with an external motion capture device. Factors influencing dehiscence formation was determined using a linear regression model and adjustment performed as necessary. A 3-mm gap was considered clinically relevant. Analysis of variance (ANOVA) was used for comparison between groups.

Results

The elastic capacity of a tendon-repair construct influences the force necessary to induce gapping of 3 mm (F3mm) [β = 0.6, confidence interval (CI) 0.4–1.0, p < 0.001]. Furthermore, the three methods of fixation did not differ significantly in terms of maximum force to failure (n.s) or F3mm (n.s).

Conclusion

The main finding of this study demonstrated that the higher the elastic capacity of a tendon-repair construct, the higher the force necessary to induce clinically relevant gapping.

Level of evidence

Controlled biomechanical study.

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Funding

The study was financed by institutional research funds.

Author information

Author notes

  1. Atesch Ateschrang and Christoph Salewski contributed equally to this work.

Authors and Affiliations

  1. Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard-Karls University of Tübingen, Tübingen, Germany

    Atesch Ateschrang, Christoph Salewski, Marc-Daniel Ahrend, Anna Janine Schreiner & Ulrich Stöckle

  2. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland

    Michael T. Hirschmann

  3. Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital of Bern, Bern, Switzerland

    Sufian S. Ahmad

Authors
  1. Atesch Ateschrang
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  2. Christoph Salewski
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  3. Marc-Daniel Ahrend
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  4. Anna Janine Schreiner
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  5. Michael T. Hirschmann
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  6. Ulrich Stöckle
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  7. Sufian S. Ahmad
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Corresponding author

Correspondence to Anna Janine Schreiner.

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The authors declare that they have no conflict of interest.

Ethical approval

The controlled biomechanical study did not require an ethical approval.

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For this type of study formal consent is not required.

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Ateschrang, A., Salewski, C., Ahrend, MD. et al. The elastic capacity of a tendon-repair construct influences the force necessary to induce gapping. Knee Surg Sports Traumatol Arthrosc 27, 971–977 (2019). https://doi.org/10.1007/s00167-018-4972-9

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  • DOI: https://doi.org/10.1007/s00167-018-4972-9

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