ABSTRACT
PURPOSE: To define the more stable knot tightening of a suture bridge when a single limb is preserved. METHODS: Five different sutures were tested: No. 2 Ethibond (Ethicon), Hi-Fi (ConMed Linvatec), Sutblue (SBM), SingleFlat (SBM), Hi-Fi Ribbon (ConMed Linvatec). A Surgeon's Knot was tied around a 30-mm circumference device, 6 times for each experiment. A single limb was kept to analyze failure modes of the knot. First step was to analyze which of pulling or sliding suture of the construct must be kept preventing failure of the knot. The cutting distance from the knot was evaluated at 1 mm and 4 mm with the suture loops pre-tensioned to 10 N and fixed to a second row after a 50 N tension load. The more stable construct was found: a single-pull load to 100 N and cyclic load (to 50 N for 30 cycles) experiments were conducted to evaluate the impact of cycling on knot loosening. RESULTS: The more stable construct was obtained when the non-post limb was tensioned, and the post limb was cut at 4 mm (p < 0.01). Loop circumference increased after each experiment for all tested sutures, independently of the preserved limb and the cutting distance. Elongation was significant for all tested sutures in all groups. Knot failure mostly occurred by slippage, only with tapes. CONCLUSIONS: A suture-bridge construct with the non-post limb preserved and the post limb cut at a 4 mm distance from the knot provides with the best security. Sutures are safer than tapes in suture bridge.
Subject(s)
Arthroscopy , Suture Techniques , Biomechanical Phenomena , Materials Testing , SuturesABSTRACT
This single-centre retrospective study reports our management of carpal tunnel syndrome in 52 children (103 hands) with mucopolysaccharidoses and mucolipidoses. All except one were bilateral. The median age at surgery was 4 years (range 1.5 to 12). The diagnosis of carpal tunnel syndrome was confirmed by an electromyogram (EMG) in all patients; 38% of these presented without any clinical signs. Surgical neurolysis was performed in all hands, combined with epineurotomy in 52 hands (50%) and flexor tenosynovectomy in 75 hands (73%). Surgery was bilateral in 98% of children (102 hands). The mean follow-up was 12 years (range 1 to 19) and the EMG was normalized in 78% of hands. Ten patients suffered recurrence, eight of whom required further surgery. Screening for carpal tunnel syndrome is essential for the management of children mucopolysaccharidoses and mucolipidoses. Surgical treatment should be carried out early with follow-up by EMG to detect recurrence.Level of evidence: IV.
