title: Enhancing the strength of the tendon-suture interface using 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride and cyanoacrylate.
abstract: OBJECTIVE
  Preventing gap or rupture is important to achieving a successful outcome after tendon repair. Weak sutures break; strong sutures fail by pull-out at the tendon-suture interface. In this study, we investigated the use of 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (EDC) and cyanoacrylate to enhance the strength of the tendon-suture interface.
  
  
  METHODS
  Twenty-four canine flexor digitorum profundus tendons were used to test EDC and cyanoacrylate reinforcement methods, with 12 tendons in each group. A single-loop suture technique was used to test the tendon-suture interface strength.
  
  
  RESULTS
  The mean ultimate strengths of the EDC group and the cyanoacrylate group were significantly higher than those of their respective control groups. The stiffness of the group with cyanoacrylate-augmented loops was significantly higher than that of its respective control group. There was no significant difference in stiffness between the 2 reinforcement methods.
  
  
  CONCLUSIONS
  Our results suggest that tendon-suture interface reinforcement may improve the pull-out failure strength of a suture construct and thereby increase the effectiveness of stronger suture materials. Future studies might address the effects of different kinds and methods of reinforcement with various suture materials and constructs and in different tissues.
authors.affiliation: Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. zhao.chunfeng@mayo.edu
authors.forename: Chunfeng
authors.initials: C
authors.lastname: Zhao
authors.forename: Yu-Long
authors.initials: YL
authors.lastname: Sun
authors.forename: Mark E
authors.initials: ME
authors.lastname: Zobitz
authors.forename: Kai-Nan
authors.initials: KN
authors.lastname: An
authors.forename: Peter C
authors.initials: PC
authors.lastname: Amadio
mesh_terms: D000818:Animals; D003487:Cyanoacrylates; D004285:Dogs; D005022:Ethyldimethylaminopropyl Carbodiimide; D007267:Injections; D008422:Materials Testing; D023421:Models, Animal; D013536:Suture Techniques; D013537:Sutures; D013708:Tendon Injuries / Q000601:surgery*; D013718:Tensile Strength
chemical_list: D003487:Cyanoacrylates; D005022:Ethyldimethylaminopropyl Carbodiimide