Abstract
BackgroundPurpose and hypothesis: Patellar ligament rupture is a rare disabling pathology requiring a surgical ligament suture protected by a frame. The gold standard is the steel cable, but its rigidity and the necessity of a surgical re-intervention for its removal render it unsatisfactory. The objective of this paper is to quantify the mechanical protection provided by the terylene® in comparison with steel.MethodsTwenty-four knees of 12 fresh frozen cadaveric subjects were divided into 2 homogeneous groups (terylene and steel) of 12 knees (mean age = 69.3 years). Proximal ligament repair was performed according to a three-tunnel transosseous reinsertion technique. Mechanical tests were performed in flexion to simulate movement of the knee. The interligament gap and the amplitude angulation of the knee were measured by a system of extensometer and optical goniometer. Mechanical analysis permitted calculation of flexion amplitude for a ligament gap of 1 and 2 mm taking as initial angle the adjusting angle of pretension of the protection frame. Study of deformations of frames was performed. Statistical analysis was performed with a Wilcoxon Mann Whitney test.ResultsThere is no significant difference in protection of the ligament suture between the “terylene” and “steel” groups. Mean flexion amplitudes (mΔF) show no significant differences between the 2 groups for a distension of the suture of 1 mm (m ΔF terylene1 = 4.74 °; mΔF steel1 = 5.91°; p = 0.198) and 2 mm (mΔF terylene2 = 8.71°; mΔF steel2 = 10.41°; p = 0.114). Elastic deformation of terylene was significantly greater than that of steel (p = 0.0004).ConclusionSuture protection of the patellar ligament by a terylene wire is not significantly different from that provided by steel frame. The elastic properties of terylene and absence of a need for re intervention to secure its removal lead us towards its use in acute ruptures of the patellar ligament. The main limits involve the properties of the chain extenders with no contraction/muscle shortening and partial dehydration of tendons and ligaments and the mean age of 69.3 years.Level 5.
Highlights
Purpose and hypothesis: Patellar ligament rupture is a rare disabling pathology requiring a surgical ligament suture protected by a frame
Groups were comparable by age (mean Group protected by a steel frame (Gsteel) = 69.3 years [53.69; 84.97]; mean Gterylene =69.3 years [53.69; 84.97], sex and by laterality of knees by distribution of a knee of the same subject in each group to obtain two groups of 12 knees: a group protected by a steel frame (Gsteel) and the other by a terylene frame (Gterylene) (Additional file 1)
There was no significant difference between the “terylene frame” and “steel frame” groups in delta flexion angles for a distension of the suture of 1 mm (p = 0.198) and 2 mm (p = 0.114) (Table 1) (Additional file 2)
Summary
Purpose and hypothesis: Patellar ligament rupture is a rare disabling pathology requiring a surgical ligament suture protected by a frame. Patellar ligament rupture is a rare pathology (Badelon et al 1985; Coudane & Huttin 1999; Otsubo et al 2017; Saragaglia et al 2013) that compromises knee function. It is mostly complete and mainly affects the tip of the patella (43%) (Ait Si Selmi et al 1999). Protection by a frame is a necessity (Shelbourne et al 2001), permitting early mobilization to limit knee stiffness and quadricipital adherences and amyotrophy (Lindy et al 1995) and to give rise to better functional recovery.
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