title: Side-to-Side Versus Pulvertaft Extensor Tenorrhaphy-A Biomechanical Study.
abstract: OBJECTIVE
  We hypothesized that a side-to-side (STS) tendon repair has biomechanical characteristics that match those of a Pulvertaft (PT) weave.
  
  
  METHODS
  Thirty extensor tendons were harvested (4 extensor digitorum communis and 1 extensor indicis proprius from 6 cadaver arms). Three hand surgery fellows with similar backgrounds of training under the same conditions and precise standardized technique performed the repairs (5 PT and 5 STS per surgeon). After the repairs, the tendons were passed through a graft-sizing guide to determine bulk and results were expressed as a repaired versus native diameter ratio. The specimens were then tested for ultimate strength and fatigue properties. Failure type and mechanical properties were recorded and compared with those of the native tendon.
  
  
  RESULTS
  The average peak force to failure was 93 ± 20 N for the STS and 62 ± 32 N for PT group. Relative strength ratio (repair strength compared with native tendon strength) was 37% ± 21% for the STS and 22% ± 11% for the PT group. In the STS group, all failures occurred as a result of tissue failure; however, in the PT, suture failures occurred in 3 tendons before tissue failure. The mean bulk ratio of the repaired site versus native proximal tendon was 37 ± 14% and 40% ± 22% more for the STS and PT groups, respectively. These values for native distal tendon were 28% ± 9.9% and 26% ±24 %, respectively for STS and PT repair. Furthermore, the bulk of the repaired site for the STS and PT groups was 4.2 ± 0.50 and 4.7 ± 1.2 mm, respectively.
  
  
  CONCLUSIONS
  Side-to-side repair technique showed superior biomechanical properties while demonstrating comparable repair bulk of the tendon coaptation compared with the Pulvertaft weave.
  
  
  CONCLUSIONS
  The results of this study may help guide a surgeon's choice of repair technique when addressing tendon injuries or tendon transfers.
authors.affiliation: Department of Hand and Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Michael
authors.initials: M
authors.lastname: Rivlin
authors.affiliation: Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Kyle R
authors.initials: KR
authors.lastname: Eberlin
authors.affiliation: Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Amir Reza
authors.initials: AR
authors.lastname: Kachooei
authors.affiliation: Bioengineering Laboratory, Harvard Medical School, Boston, MA.
authors.forename: Ali
authors.initials: A
authors.lastname: Hosseini
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Nikola
authors.initials: N
authors.lastname: Zivaljevic
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Guoan
authors.initials: G
authors.lastname: Li
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: cmudgal@partners.org.
authors.forename: Chaitanya
authors.initials: C
authors.lastname: Mudgal
mesh_terms: D001132:Arm; D001696:Biomechanical Phenomena; D002102:Cadaver; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods*; D013536:Suture Techniques; D013708:Tendon Injuries / Q000601:surgery*; D013710:Tendons / Q000601:surgery*; D013718:Tensile Strength
keywords: Biomechanics; Pulvertaft; extensor tendon; side to side