Peter C. Amadio

The effect of core suture flexor tendon repair techniques on gliding resistance during static cycle motion and load to failure: a human cadaver study.

The purpose of this study was to describe a modification of the Massachusetts General Hospital (MMGH) tendon repair and to compare it with three other suture techniques. Twenty human flexor digitorum profundus (FDP) tendons were randomly assigned to the modified Pennington (MP) suture and the MMGH suture. These were compared to the modified Kessler (MK) and Massachusetts General Hospital (MGH) sutures, using data from a previous study. All tendons were repaired with a similar epitendinous stitch and core sutures of 4-0 FiberWire. There was no significant difference in the normalized gliding resistance within the two-strand or four-strand core repair groups. The MP suture had significantly higher 2 mm gap force and ultimate load to failure than the MK suture. The MMGH suture had significantly higher 2 mm gap force and maximum failure ultimate load than the MGH suture. All repairs failed by knot unravelling.

The effects of growth and differentiation factor 5 on bone marrow stromal cell transplants in an in vitro tendon healing model

The effects of growth differentiation factor-5 (GDF-5) and bone marrow stromal cells (BMSCs) on tendon healing were investigated under in vitro tissue culture conditions. BMSCs and GDF-5 placed in a collagen gel were interpositioned between the cut ends of dog flexor digitorum profundus tendons. The tendons were randomly assigned into four groups: 1) repaired tendon without gel; 2) repaired tendon with BMSC-seeded gel; 3) repaired tendon with GDF-5 gel without cells; and 4) repaired tendon with GDF-5 treated BMSC-seeded gel. At 2 and 4 weeks, the maximal strength of repaired tendons with GDF-5 treated BMSCs-seeded gel was significantly higher than in tendons without gel interposition. However, neither BMSCs nor GDF-5 alone significantly increased the maximal strength of healing tendons at 2 or 4 weeks. These results suggest that the combination of BMSCs and GDF-5 accelerates tendon healing, but either BMSCs or GDF-5 alone are not effective in this model.

Flexor tendon-pulley interaction after annular pulley reconstruction: A biomechanical study in a dog model In vivo

The excursion resistance between the canine flexor digitorum profundus tendon and A2 pulley was compared after pulley reconstruction using tendon grafts of either intrasynovial or extrasynovial origin at 10 days, 3 weeks, and 6 weeks after surgery. The changes over time in the underlying flexor digitorum profundus tendon after pulley reconstruction were also evaluated. The excursion resistance for both types of pulley reconstruction was significantly greater than that of the control group at all time periods. The excursion resistance of the extrasynovial tendon graft reconstruction was greater than that of intrasynovial pulley reconstruction at all time periods. In conclusion, pulley reconstruction with intrasynovial tendon grafts may facilitate tendon gliding after surgery.

Analysis of carpal instability: II. Clinical applications.

An analytic scheme for carpal instability patterns has been described to help standardize reporting of these conditions. Six categories to be recognized in each case are chronicity, constancy, etiology, location, direction, and pattern. Examples are presented to illustrate the use of this scheme.

Prospective comparative clinical trials in The Journal of Hand Surgery (American)

All issues of The Journal of Hand Surgery (American) from volume 1, number 1 through volume 19, number 6, were reviewed to identify studies that might qualify as prospective, comparative clinical trials. Prospective studies that compared two or more clinical treatments were labeled as either randomized controlled trials (RCT) if they included some form of random assignment or controlled clinical trials (CCT) if they did not. A total of 25 CCT and 8 RCT were identified among the 3,107 articles, letters, and abstracts that were reviewed. The results will be used to update the Medline Database, to make online identification of RCTs and CCTs easier.