TY - JOUR
T1 - Histological and radiographic evaluation of three common tendon transfer techniques in an un-ossified bone porcine model
T2 - Implications for early anterior tibialis tendon transfers in children with clubfeet
AU - Korth, Kyle
AU - Bolam, Scott
AU - Leiferman, Ellen
AU - Crenshaw, Thomas
AU - Dray, Michael
AU - Crawford, Haemish A.
AU - Wallace, Maegen
AU - Halanski, Matthew A.
N1 - Publisher Copyright:
© 2021, British Editorial Society of Bone and Joint Surgery. All rights reserved.
PY - 2021/10
Y1 - 2021/10
N2 - Purpose To compare the histological healing and radiographic effects of tendons transferred to ossified or unossified bone using different tendon fixation techniques Methods Nine new-born piglets underwent bilateral tendon transfers to either the ossified boney calcaneal body or unossified apophysis. The tendons were fixed using metallic suture anchors, sutures alone or a bone tunnel. At six weeks of age, calcanei were harvested, radiologically imaged and then prepared for histology. A semi-quantitative aggregated scoring system with values ranging from 0 (poor) to 15 (excellent), was used to grade healing at the surgical enthesis and the apophyseal ossification was graded by five independent reviewers in triplicate using a modified (1 to 4) validated scoring system. Results Histologically, the cartilaginous transfers utilizing the tunnel and suture techniques also demonstrated the best average aggregated scores of entheses healing rivalling that measured in transfers using the classic bone tunnel technique (clinical benchmark), whereas suture anchor fixation demonstrated the worst healing in both the ossified and unossified samples. All three transfer techniques caused at least minor alterations in apophyseal ossification, with the most significant changes observed in the metallic suture anchor cohort. The tunnel and suture techniques demonstrated similar and more mild abnormalities in ossification. Conclusion Tendon transfers to unossified bone heal histo-logically as well as transfers classically performed through tunnels in bone. Suture fixation or tunnel techniques appear radiographically and histologically superior to suture anchors in our newborn porcine model.
AB - Purpose To compare the histological healing and radiographic effects of tendons transferred to ossified or unossified bone using different tendon fixation techniques Methods Nine new-born piglets underwent bilateral tendon transfers to either the ossified boney calcaneal body or unossified apophysis. The tendons were fixed using metallic suture anchors, sutures alone or a bone tunnel. At six weeks of age, calcanei were harvested, radiologically imaged and then prepared for histology. A semi-quantitative aggregated scoring system with values ranging from 0 (poor) to 15 (excellent), was used to grade healing at the surgical enthesis and the apophyseal ossification was graded by five independent reviewers in triplicate using a modified (1 to 4) validated scoring system. Results Histologically, the cartilaginous transfers utilizing the tunnel and suture techniques also demonstrated the best average aggregated scores of entheses healing rivalling that measured in transfers using the classic bone tunnel technique (clinical benchmark), whereas suture anchor fixation demonstrated the worst healing in both the ossified and unossified samples. All three transfer techniques caused at least minor alterations in apophyseal ossification, with the most significant changes observed in the metallic suture anchor cohort. The tunnel and suture techniques demonstrated similar and more mild abnormalities in ossification. Conclusion Tendon transfers to unossified bone heal histo-logically as well as transfers classically performed through tunnels in bone. Suture fixation or tunnel techniques appear radiographically and histologically superior to suture anchors in our newborn porcine model.
KW - Animal model
KW - Cartilage
KW - Clubfoot
KW - Tendon transfer
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U2 - 10.1302/1863-2548.15.210076
DO - 10.1302/1863-2548.15.210076
M3 - Article
C2 - 34858530
AN - SCOPUS:85119119373
SN - 1863-2521
VL - 15
SP - 443
EP - 450
JO - Journal of Children's Orthopaedics
JF - Journal of Children's Orthopaedics
IS - 5
ER -