Double-loop Suture Research Articles

Management of ganglion by double loop suture technique

Background: Ganglion is a common cystic swelling around wrist presenting in outdoor department, clinical examination is sufficient for making diagnosis of simple cyst, cosmesis and pain are main presenting complain. Treatment includes aspiration with or without injections but has high recurrence rate, surgical excision has low recurrence rate but being invasive there are numerous complications and should be warrant depending on patient complain. Minimal invasive loop suture technique has low recurrence and minimalcomplication. Aims and Objectives: The aim of the study was to manage the ganglion by double loop suture technique. Materials and Methods: One hundred and four patients with volar and dorsal wrist ganglion fulfilling inclusion and exclusion criteria received treatment by minimal invasive loop suture technique, 6-month follow-up was done for reviewing any recurrence of cyst. Results: From these 104 patients, 76 were females and 28 were males, with a median age of 22 years. Ninety-four (90.4%) patients presented with dorsal wrist ganglion and 10 (9.6%) patients had volar wrist ganglion. The size of simple ganglia varied from 10 mm to 32 mm Cosmesis was the most common presenting complaint in 84 patients (80.7%) followed by pain (19.3%). Recurrence of swelling was observed in four patients (3.8%). Complications were encountered in two cases in the form of superficial infection at the site of entry point of threads. Conclusion: Radical surgical excision is gold standard but warranted by patient complains as there are numerous complications. Double loop suture technique is an ambulatory surgical procedure and has very promising results with low recurrence rate and complications.

Arthroscopically Assisted Double-Loop Suture Repair for Acute Acromioclavicular Joint Disruption

The surgical management of acute high-grade acromioclavicular (AC) joint (ACJ) injuries has evolved during the last decades. Numerous surgical techniques exist and recently arthroscopically assisted or all endoscopic techniques have gained popularity due to certain advantages. The goals of the new anatomic coracoclavicular ligament reconstruction techniques are to achieve anatomic reduction of the ACJ to allow and facilitate primary healing of AC and coracoclavicular (CC) ligaments, and also to minimize the risk of associated complications. We regularly use the open repair with double-loop sutures for the acute ACJ disruption, as described by Dimakopoulos et al. at 2006. In this surgical technique article, we present the arthroscopically assisted technique for the double-loop suture repair.

Type II Monteggia Lesion with Complete Elbow Dislocation in a Cat

AbstractA 2-year-old neutered male cat was presented for right forelimb non-weight-bearing lameness. A fracture of the proximal third of the ulna (associated with a caudal radio-humeral and humero-ulnar dislocations and a radio-ulnar dislocation) was radiographically identified, leading to a diagnosis of type II Monteggia lesion with complete elbow joint dislocation. The ulnar fracture was reduced and stabilized using an intramedullary pin. During surgery, the lateral collateral ligament and the annular ligament appeared disrupted. The radio-ulnar dislocation was reduced and stabilized, using a double-loop suture prosthesis passing through the metaphysis of the ulna and around the radial head. The radio-humeral dislocation was reduced and stabilized using a lateral collateral suture prosthesis. No postoperative complications were observed and the patient regained good elbow joint range of motion, with no significant lameness at 8 postoperative months.

A Case-control Analysis of the Knight's Move Technique in a Chicken Wing Microsurgery Model: Video Article.

A Case-control Analysis of the Knight's Move Technique in a Chicken Wing Microsurgery Model: Video Article.

A new modified Tsuge suture for flexor tendon repairs: the biomechanical analysis and clinical application.

PurposeThis study is to develop a new suturing technique for flexor tendon repair by modifying the extant Tsuge repair techniques and to use biomechanical analysis to compare the new method with four established repair techniques and evaluate its clinical efficacy in the repair of 47 flexor tendons in 22 patients.MethodsThe biomechanical analysis relied on 50 flexor digitorum profundus tendons harvested from fresh cadavers. The tendons were randomly divided into five groups, transected, and repaired by use of a 1. double-loop suture, 2. double modified locking Kessler, 3. four-strand Savage, 4. modified six-strand Savage, and 5. the new technique. The tensile force and breaking force of all repaired tendons were measured by static loading trials. For clinical application, 22 patients with acute flexor tendon injuries were treated with the new modified Tsuge suture and follow-up for more than 12 months.ResultsWhile differences in the tensile force and breaking force in the modified Tsuge sutures and modified six-strand Savage sutures were not statistically significant, static loading trials showed the tensile force, in the form of a 2-mm gap formation, and the breaking force of the new modified Tsuge sutures were, statistically, both higher than the ones characteristic of double-loop sutures, double modified locking Kessler, and four-strand Savage sutures. After 12 months, restored functions were observed in all the patients during the postoperative 12 months. Total active motion (TAM) score demonstrated that more than 90% fingers were estimated as excellent or good.ConclusionThe new modified Tsuge sutures described here have evident higher tensile and breaking forces compared to other four-strand core suture techniques, suggesting, in turn, that this new technique is a good alternative for flexor tendon repairs in clinical applications.

Mechanical Strength of the Side-to-Side Versus Pulvertaft Weave Tendon Repair

The side-to-side (SS) tendon suture technique was designed to function as a repair that permits immediate postoperative activation and mobilization of a transferred muscle. This study was designed to test the strength and stiffness of the SS technique against a variation of the Pulvertaft (PT) repair technique. Flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) tendons were harvested from 4 fresh cadavers and used as a model system. Seven SS and 6 PT repairs were performed, using the FDS as the donor and the FDP as the recipient tendon. For SS repairs, the FDS was woven through one incision in the FDP and was joined with 4 cross-stitch running sutures down both sides and one double-loop suture at each tendon free end. For PT repairs, the FDS was woven through 3 incisions in the FDP and joined with a double-loop suture at both ends of the overlap and 4 evenly spaced mattress sutures between the ends. Tendon repairs were placed in a tensile testing machine, preconditioned, and tested to failure. There were no statistically significant differences in cross-sectional area (p = .99) or initial length (p = .93) between SS and PT repairs. Therefore, all comparisons between methods were made using measures of loads and deformations, rather than stresses and strains. All failures occurred in the repair region, rather than at the clamps. However, failure mechanisms were different between the 2 techniques-PT repairs failed by the suture knots either slipping or pulling through the tendon material, followed by the FDS tendon pulling through the FDP tendon; SS repairs failed by shearing of fibers within the FDS. Load at first failure, ultimate load, and repair stiffness were all significantly different between SS and PT techniques; in all cases, the mean value for SS was higher than for PT. The SS repair using a cross-stitch suture technique was significantly stronger and stiffer than the PT repair using a mattress suture technique. This suggests that using SS repairs could enable patients to load the repair soon after surgery. Ultimately, this should reduce the risk of developing adhesions and result in improved functional outcome and fewer complications in the acute postoperative period. Future work will address the specific mechanisms (eg, suture-throw technique and tendon-weave technique) that underlie the improved strength and stiffness of the SS repair.

Reconstruction of extensor apparatus insertion using crisscross tunneling and double loop suture

Objective To introduce a method of extensor apparatus insertion reconstruction.Methods The distal interphalangeal joint was fixed by a Kirschner wire.Two loop sutures were placed on both sides of the distal end of the extensor tendon and passed through a transverse tunnel at the base of the distal phalanx in a crisscross fashion.One end of the loop suture was reflected proximally to weave through the extenser tendon and tied on the axis of the tendon.Another end of the loop suture was directly tied against the dorsum of the tendon.This technique was applied in 39 cases of mallet fingers due to extensor tendon insertion rupture.Results All the cases were followed for 5 months to 2 years.There was no tendon rupture and tendon adhesion.Range of motion of the distal interphalangeal joint was 0°-70°in 18 cases,0°-60° in 17 cases,and 0°-50° in 4 cases.According to TAM evaluation criteria,the results were rated as excellent in 25 cases and good in 14 cases.The overall satisfactory rate was 100%.Conclsion Crisscross tunneling and double loop suture is an easy and effective way to reconstruct extensor apparatus insertion. Key words: Tendon injuries; Surgical procedures,operative; Mallet fingers

Double-Loop Suture Repair for Acute Acromioclavicular Joint Disruption

Background Although it has been established that surgical treatment for acromioclavicular joint disruption (types IV-VI and type III in overhead throwing athletes and heavy laborers) is preferred, the literature is inconclusive about the best type of surgery. Purpose With the goal of avoiding the potential complications of hardware use, the authors present a coracoclavicular functional stabilization technique with the intention to restore the anteroposterior and superior displacement of the clavicle. Study Design Case series; Level of evidence, 4. Methods From 1999 to 2003, 38 patients with an acute, complete acromioclavicular joint separation (34 men, 4 women; mean age, 33.5 years) underwent surgical reconstruction with the described coracoclavicular loop stabilization technique. With this technique, the superior and anteroposterior displacement of the clavicle can be easily controlled using 2 pairs of Ethibond No. 5 nonabsorbable sutures—one passed in front and the other behind the clavicle, through a central drill hole, 2 cm from its lateral end, directly above the base of the coracoid process (at the corresponded attachment of coracoclavicular ligaments). Passive shoulder motion was encouraged by the second postoperative day. Results Thirty-four patients were available for the last clinical and radiologic evaluation. At a mean follow-up of 33.2 months (range, 18-59 months), the mean Constant-Murley score was 93.5 points (range, 73-100 points), and 2 cases with slight loss of reduction (less than half of the width of the clavicle) were detected. Complications included 1 case with superficial infection and 1 patient (basketball player) with persistent tenderness in the acromioclavicular joint without signs of secondary arthritis. The incidence of periarticular ossification was 17.6% and did not affect the final outcome. Secondary degenerative changes were not detected. Conclusion Considering the nearly anatomical reconstruction, the avoidance of hardware complications, and the low rate of recurrence, this technique may be an attractive alternative to the management of acute acromioclavicular joint separations.

In vitro biomechanical evaluation of the double loop suture for flexor tendon repair.

Fifty-one fresh frozen human anatomic specimen flexor superficialis and profundus tendons that had been transected completely were repaired using the double loop, the single loop, and the modified Kessler techniques, and the resistances to mechanical distraction at 1, 2, and 3 mm and the ultimate load to failure were compared. The mechanical distraction at 1, 2, and 3 mm created nearly identical gaps at the tendon repair sites. There was no significant difference among the three repair techniques to resisting distraction at 1 and 2 mm. However, the double loop technique presented a mean resistance force of 22.0 N to distraction at 3 mm and 45.8 N in load to failure, which was significantly greater than the single loop (18.8 N at 3 mm distraction and 31.5 N failure load) and the modified Kessler (19.0 N at 3 mm distraction and 26.0 N failure load). This suggests the double loop technique may be superior to the single loop and the modified Kessler techniques in resisting gap in the range of forces generated in the early rehabilitation protocol.

A simple suture shuttle in rotator cuff repairs: A technical note

In rotator cuff repairs, it is often necessary to pass 2 tails of 2 sutures through 1 transosseous hole to maximize the number of sutures per hole. We report on a simple technique with a double-loop suture thread that allows the passing of more than 1 suture limb through the same hole. This simple device, the simple suture shuttle, used in cuff repairs in combination with the modified Mason-Allen suture technique, significantly reduces the difficulty of passing more than 1 suture tail through a single bone tunnel. By reducing the number of bone tunnels, the weakening of a bone that might not be very strong is kept to a minimum. The Simple Suture Shuttle can also be used to pass more sutures through a given number of transosseous holes.

Modified double loop suture technique for flexor tendon repair

Modified double loop suture technique for flexor tendon repair