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David G. Hunter - One of the best experts on this subject based on the ideXlab platform.
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Long-term results of an intraoperative adjustable superior oblique Tendon Suture spacer using nonabsorbable Suture for Brown Syndrome.
Ophthalmology, 2008Co-Authors: Darren T Oystreck, David G. HunterAbstract:Objective To investigate the long-term surgical outcome of Brown syndrome using an intraoperative adjustable superior oblique (SO) Tendon Suture spacer. Design Retrospective case series. Participants Thirteen patients with congenital unilateral Brown syndrome operated on at the Wolfe Eye Clinic from 2001 through 2007. Methods Retrospective analysis of consecutive patients managed with the SO Suture spacer followed up for at least 10 months. Main Outcome Measures Surgical intervention for patients having severe or moderate forms of Brown syndrome. Postoperative effect on abnormal head posture, vertical strabismus in primary gaze, vertical strabismus into affected side gaze, and elevation in adduction. Results The mean duration of follow-up was 30 months (range, 10–72 months). Abnormal head posture improved from 13° (range, 0°–30°) to 0.4° (range, 0°–5°). Vertical strabismus in primary gaze improved from −10Δ (range, 0Δ to −35Δ) to 2.8Δ (range, −16Δ to 16Δ). Vertical in side gaze improved from −20Δ (range, −35Δ to −8Δ) to −1.5Δ (range, −20Δ to 18Δ). Elevation in adduction improved from −3.5 (range, −4 to −2) to −0.4 (range, −2 to 4). Four patients had an overcorrection and 2 patients experienced an increasing late effect. In no patient did a late under correction develop. Conclusions The SO Suture spacer procedure alleviated abnormal head positions in patients with Brown syndrome by improving vertical strabismus in primary position and in the affected field of gaze while avoiding overcorrection in contralateral gaze. The benefits of the procedure persisted over time. Financial Disclosure(s) The authors have no proprietary or commercial interest in any materials discussed in this article.
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An adjustable superior oblique Tendon spacer with the use of nonabsorbable Suture.
Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 2001Co-Authors: Donny W. Suh, David L. Guyton, David G. HunterAbstract:Abstract Purpose: Philip Knapp described a method, sometimes referred to as the "chicken Suture,"of securing a loose nonabsorbable Suture to the cut ends of the superior oblique Tendon to facilitate future reversal. The purpose of this study is to describe a modification of Knapp's technique to achieve partial, reversible, and intraoperatively adjustable superior oblique weakening. Methods: The superior oblique Tendon was exposed, 2 polyester nonabsorbable Sutures were placed 4 mm apart, and the Tendon was cut. With the use of a slip knot, the cut ends of the Tendon were separated by 2 to 8 mm. Tendon separation was adjusted intraoperatively according to the exaggerated traction test and, in some cases, fundus torsion. Medical records of all patients who underwent surgery with this technique were reviewed and the outcomes tabulated. Results: Twelve patients (16 eyes) were treated for superior oblique overaction and 3 patients (3 eyes) for Brown syndrome. Follow-up was 2 to 46 months (mean, 17 months). Mean superior oblique overaction improved from +1.3 before surgery to +0.3 after surgery, mean A pattern improved from 20 PD to 2 PD, and fundus intorsion improved from +1.2 to +0.3. In Brown syndrome, the mean elevation in adduction improved from −3.8 to −1.0. One patient from each group developed an overcorrection. None of the patients developed recurrence. The patients with Brown syndrome continued to improve over a 1-year period. Conclusions: The superior oblique Tendon Suture spacer is effective, intraoperatively adjustable, and technically easier to perform than a silicone expander procedure. This technique should be considered as an alternative for patients requiring superior oblique weakening. (J AAPOS 2001;5:164-71)
Richard H. Gelberman - One of the best experts on this subject based on the ideXlab platform.
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the effect of modified locking methods and Suture materials on zone ii flexor Tendon repair an ex vivo study
PLOS ONE, 2018Co-Authors: Matthew J Silva, Stavros Thomopoulos, Stephen W Linderman, Susumu Yoneda, Hirotaka Okubo, Nozomu Kusano, Fuminori Kanaya, Richard H. GelbermanAbstract:The failure rate of intrasynovial Tendon repair is high due to substantial elongation at the repair site and to the development of adhesions between the Tendon’s surface and the surrounding digital sheath. To minimize these complications, we sought to reduce the incidence of gapping and to facilitate the initiation of early motion by improving the time zero structural properties of repair. The Winters-Gelberman 8-strand repair technique was modified by adding surface lock loops and by using Fiberwire Suture material. Forty-eight canine flexor digitorum profundus Tendons were transected and repaired with one of three 8-strand techniques (Pennington modified Kessler, half hitch loops, or surface locking Kessler) using either 3–0 Supramid or 4–0 Fiberwire Suture. Biomechanical testing was performed to determine the physiologic and failure mode properties of the repairs. The surface locking Kessler technique improved repair maximum load, load necessary to create a 2 mm repair site gap, and yield force compared to the modified Kessler and half hitch loop techniques. Fiberwire Suture improved maximum load, the load necessary to create a 2 mm repair site gap, stiffness, and yield force compared to Supramid Suture. Failure occurred by both Suture pull out and by Suture breakage in the modified Kessler, Supramid Suture repair group. Failure occurred consistently by Suture breakage in the surface locking Kessler, Supramid Suture repair group. These results reveal that a novel locking Kessler repair is significantly stronger than the current state-of-the art flexor Tendon Suture repair technique. The use of a surface locking Kessler technique with Fiberwire Suture markedly improves the mechanical properties of intrasynovial Tendon repair by reducing the risk of post-operative gapping and rupture.
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INTRASYNOVIAL FLEXOR Tendon REPAIR: A BIOMECHANICAL STUDY OF VARIATIONS IN Suture APPLICATION IN HUMAN CADAVERA
Journal of Orthopaedic Research, 2012Co-Authors: Gregory N. Nelson, Ryan Potter, Eleni Ntouvali, Richard H. Gelberman, Matthew J Silva, Martin I Boyer, Stavros ThomopoulosAbstract:To improve the functional outcomes of intrasynovial Tendon Suture, prior experiments evaluated individual technical modifications used in the repair process. Few studies, however, have assessed the combinatorial effects of those Suture modifications in an integrated biomechanical manner, including a sample size sufficient to make definitive observations on repair technique. 256 flexor Tendon repairs were performed in cadavera, and biomechanical properties were determined. The effects of five factors for flexor Tendon repair were tested: core Suture caliber (4-0 or 3-0), number of Sutures crossing the repair site (4- or 8-strand), core Suture purchase (0.75 cm or 1.2 cm), peripheral Suture caliber (6-0 or 5-0), and peripheral Suture purchase (superficial or 2 mm). Significant factors affecting the properties of the repair were the number of core Suture strands and the peripheral Suture purchase. The least significant factors were core Suture purchase and peripheral Suture caliber. The choice of core Suture caliber affected the properties of repair marginally. Based on these results, we recommend that surgeons continue to focus on multi-strand repair methods, as the properties of 8-strand repairs were far better than those of 4-strand repairs. To resist gap formation and enhance repair strength, a peripheral Suture with 2mm purchase is also recommended. Finally, since core Suture caliber affected some biomechanical properties, including the failure mode, a 3-0 Suture could be considered, provided that future in vivo studies can confirm that gliding properties are not adversely influenced.
Susumu Yoneda - One of the best experts on this subject based on the ideXlab platform.
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the effect of modified locking methods and Suture materials on zone ii flexor Tendon repair an ex vivo study
PLOS ONE, 2018Co-Authors: Matthew J Silva, Stavros Thomopoulos, Stephen W Linderman, Susumu Yoneda, Hirotaka Okubo, Nozomu Kusano, Fuminori Kanaya, Richard H. GelbermanAbstract:The failure rate of intrasynovial Tendon repair is high due to substantial elongation at the repair site and to the development of adhesions between the Tendon’s surface and the surrounding digital sheath. To minimize these complications, we sought to reduce the incidence of gapping and to facilitate the initiation of early motion by improving the time zero structural properties of repair. The Winters-Gelberman 8-strand repair technique was modified by adding surface lock loops and by using Fiberwire Suture material. Forty-eight canine flexor digitorum profundus Tendons were transected and repaired with one of three 8-strand techniques (Pennington modified Kessler, half hitch loops, or surface locking Kessler) using either 3–0 Supramid or 4–0 Fiberwire Suture. Biomechanical testing was performed to determine the physiologic and failure mode properties of the repairs. The surface locking Kessler technique improved repair maximum load, load necessary to create a 2 mm repair site gap, and yield force compared to the modified Kessler and half hitch loop techniques. Fiberwire Suture improved maximum load, the load necessary to create a 2 mm repair site gap, stiffness, and yield force compared to Supramid Suture. Failure occurred by both Suture pull out and by Suture breakage in the modified Kessler, Supramid Suture repair group. Failure occurred consistently by Suture breakage in the surface locking Kessler, Supramid Suture repair group. These results reveal that a novel locking Kessler repair is significantly stronger than the current state-of-the art flexor Tendon Suture repair technique. The use of a surface locking Kessler technique with Fiberwire Suture markedly improves the mechanical properties of intrasynovial Tendon repair by reducing the risk of post-operative gapping and rupture.
Stavros Thomopoulos - One of the best experts on this subject based on the ideXlab platform.
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the effect of modified locking methods and Suture materials on zone ii flexor Tendon repair an ex vivo study
PLOS ONE, 2018Co-Authors: Matthew J Silva, Stavros Thomopoulos, Stephen W Linderman, Susumu Yoneda, Hirotaka Okubo, Nozomu Kusano, Fuminori Kanaya, Richard H. GelbermanAbstract:The failure rate of intrasynovial Tendon repair is high due to substantial elongation at the repair site and to the development of adhesions between the Tendon’s surface and the surrounding digital sheath. To minimize these complications, we sought to reduce the incidence of gapping and to facilitate the initiation of early motion by improving the time zero structural properties of repair. The Winters-Gelberman 8-strand repair technique was modified by adding surface lock loops and by using Fiberwire Suture material. Forty-eight canine flexor digitorum profundus Tendons were transected and repaired with one of three 8-strand techniques (Pennington modified Kessler, half hitch loops, or surface locking Kessler) using either 3–0 Supramid or 4–0 Fiberwire Suture. Biomechanical testing was performed to determine the physiologic and failure mode properties of the repairs. The surface locking Kessler technique improved repair maximum load, load necessary to create a 2 mm repair site gap, and yield force compared to the modified Kessler and half hitch loop techniques. Fiberwire Suture improved maximum load, the load necessary to create a 2 mm repair site gap, stiffness, and yield force compared to Supramid Suture. Failure occurred by both Suture pull out and by Suture breakage in the modified Kessler, Supramid Suture repair group. Failure occurred consistently by Suture breakage in the surface locking Kessler, Supramid Suture repair group. These results reveal that a novel locking Kessler repair is significantly stronger than the current state-of-the art flexor Tendon Suture repair technique. The use of a surface locking Kessler technique with Fiberwire Suture markedly improves the mechanical properties of intrasynovial Tendon repair by reducing the risk of post-operative gapping and rupture.
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INTRASYNOVIAL FLEXOR Tendon REPAIR: A BIOMECHANICAL STUDY OF VARIATIONS IN Suture APPLICATION IN HUMAN CADAVERA
Journal of Orthopaedic Research, 2012Co-Authors: Gregory N. Nelson, Ryan Potter, Eleni Ntouvali, Richard H. Gelberman, Matthew J Silva, Martin I Boyer, Stavros ThomopoulosAbstract:To improve the functional outcomes of intrasynovial Tendon Suture, prior experiments evaluated individual technical modifications used in the repair process. Few studies, however, have assessed the combinatorial effects of those Suture modifications in an integrated biomechanical manner, including a sample size sufficient to make definitive observations on repair technique. 256 flexor Tendon repairs were performed in cadavera, and biomechanical properties were determined. The effects of five factors for flexor Tendon repair were tested: core Suture caliber (4-0 or 3-0), number of Sutures crossing the repair site (4- or 8-strand), core Suture purchase (0.75 cm or 1.2 cm), peripheral Suture caliber (6-0 or 5-0), and peripheral Suture purchase (superficial or 2 mm). Significant factors affecting the properties of the repair were the number of core Suture strands and the peripheral Suture purchase. The least significant factors were core Suture purchase and peripheral Suture caliber. The choice of core Suture caliber affected the properties of repair marginally. Based on these results, we recommend that surgeons continue to focus on multi-strand repair methods, as the properties of 8-strand repairs were far better than those of 4-strand repairs. To resist gap formation and enhance repair strength, a peripheral Suture with 2mm purchase is also recommended. Finally, since core Suture caliber affected some biomechanical properties, including the failure mode, a 3-0 Suture could be considered, provided that future in vivo studies can confirm that gliding properties are not adversely influenced.
Thay Q Lee - One of the best experts on this subject based on the ideXlab platform.
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part i footprint contact characteristics for a transosseous equivalent rotator cuff repair technique compared with a double row repair technique
Journal of Shoulder and Elbow Surgery, 2007Co-Authors: Maxwell C Park, Neal S Elattrache, James E Tibone, Christopher S Ahmad, Bongjae Jun, Thay Q LeeAbstract:Rotator cuff repair via transosseous tunnels can improve footprint contact area and pressure when compared with Suture anchor techniques. A double-row technique has been used clinically to improve footprint coverage by a repaired Tendon. We hypothesized that a transosseous-equivalent rotator cuff repair via Tendon Suture bridges would demonstrate improved pressurized contact between the Tendon and tuberosity when compared with a double-row technique. In 6 fresh-frozen human shoulders, a transosseous-equivalent rotator cuff repair was performed: a Suture limb from each of 2 medial anchors was bridged over the Tendon and fixed laterally with an interference screw (4 Suture bridges). In 6 of the contralateral specimens, two types of repair were performed randomly in each specimen: (1) a double-row repair and (2) a transosseous-equivalent repair with a single screw (2 Suture bridges). For all repairs, pressure-sensitive film was placed at the Tendon-footprint interface, and software was used to obtain measurements. The mean pressurized contact area between the Tendon and insertion was significantly greater for the 4–Suture bridge technique (124.2 ± 16.3 mm 2 , 77.6% footprint) compared with both the double-row (63.3 ± 28.5 mm 2 , 39.6% footprint) and 2–Suture bridge (99.7 ± 22.0 mm 2 , 62.3% footprint) techniques (P
