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Biomechanical Analysis of Single Interference Screw vs Interference Screw With Cortical Button for Flexor Hallucis Longus Transfer

BACKGROUND: Flexor hallucis longus tendon transfer (FHL) with a cortical button tension slide is an innovative addition that has not been measured against traditional methods. METHODS: 12 pairs (n=24) of fresh-frozen cadaveric tibia-to-toe samples were used and randomized to receive one of the opera...

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Autores principales: Neary, Kaitlin C., McClish, Sarah J., Khoury, Anthony N., Denove, Nicholas, Konicek, John, Wijdicks, Coen A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8529321/
https://www.ncbi.nlm.nih.gov/pubmed/35097471
http://dx.doi.org/10.1177/24730114211040445
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author Neary, Kaitlin C.
McClish, Sarah J.
Khoury, Anthony N.
Denove, Nicholas
Konicek, John
Wijdicks, Coen A.
author_facet Neary, Kaitlin C.
McClish, Sarah J.
Khoury, Anthony N.
Denove, Nicholas
Konicek, John
Wijdicks, Coen A.
author_sort Neary, Kaitlin C.
collection PubMed
description BACKGROUND: Flexor hallucis longus tendon transfer (FHL) with a cortical button tension slide is an innovative addition that has not been measured against traditional methods. METHODS: 12 pairs (n=24) of fresh-frozen cadaveric tibia-to-toe samples were used and randomized to receive one of the operative FHL techniques. Specimens underwent bone density analysis. Biomechanical loading was applied between 20 and 60 N at 1 Hz for 100 cycles. Post–cyclic load to failure occurred at 1.25 mm/s. Cyclic displacement, structural stiffness, and ultimate load were derived from load-displacement curves. Student t tests evaluated significant effects between both FHL techniques. Linear regression analysis assessed interactions between bone density and strength of FHL technique. RESULTS: Average tendon diameter was 5.44±0.46 mm. Average bone density was 1.06±0.08 g/cm(2). Addition of a cortical button to FHL transfer did not significantly affect cyclic displacement (0.78±0.52 mm vs 0.87±0.80 mm) or structural stiffness (162.11±43.34 N/mm vs 167.57±49.19 N/mm). Cortical button addition to FHL transfer resulted in significantly increased ultimate load (343.72±68.93 N) compared with interference screw alone (255.62±77.17 N) (P = .0002). Linear regression analyses did not reveal any significant interactions between bone density and FHL tendon transfer technique. CONCLUSION: Enhanced strength can be achieved with FHL tendon transfer to calcaneus using an interference screw and cortical button tension slide technique as compared to an interference screw alone. Cortical buttons in the setting of FHL tendon transfer to the calcaneus offers an additional level of support. CLINICAL RELEVANCE: Operative cases presenting with poor bone quality due to osteoporosis or osteopenia could benefit from cortical button fixation during FHL transfer. Clinical studies are needed to determine if the increased construct stability conferred from the additional use of a flip button results in fewer FHL transfer failures or better clinical outcomes. LEVEL OF EVIDENCE: Level V, Controlled Laboratory Study.
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spelling pubmed-85293212022-01-28 Biomechanical Analysis of Single Interference Screw vs Interference Screw With Cortical Button for Flexor Hallucis Longus Transfer Neary, Kaitlin C. McClish, Sarah J. Khoury, Anthony N. Denove, Nicholas Konicek, John Wijdicks, Coen A. Foot Ankle Orthop Article BACKGROUND: Flexor hallucis longus tendon transfer (FHL) with a cortical button tension slide is an innovative addition that has not been measured against traditional methods. METHODS: 12 pairs (n=24) of fresh-frozen cadaveric tibia-to-toe samples were used and randomized to receive one of the operative FHL techniques. Specimens underwent bone density analysis. Biomechanical loading was applied between 20 and 60 N at 1 Hz for 100 cycles. Post–cyclic load to failure occurred at 1.25 mm/s. Cyclic displacement, structural stiffness, and ultimate load were derived from load-displacement curves. Student t tests evaluated significant effects between both FHL techniques. Linear regression analysis assessed interactions between bone density and strength of FHL technique. RESULTS: Average tendon diameter was 5.44±0.46 mm. Average bone density was 1.06±0.08 g/cm(2). Addition of a cortical button to FHL transfer did not significantly affect cyclic displacement (0.78±0.52 mm vs 0.87±0.80 mm) or structural stiffness (162.11±43.34 N/mm vs 167.57±49.19 N/mm). Cortical button addition to FHL transfer resulted in significantly increased ultimate load (343.72±68.93 N) compared with interference screw alone (255.62±77.17 N) (P = .0002). Linear regression analyses did not reveal any significant interactions between bone density and FHL tendon transfer technique. CONCLUSION: Enhanced strength can be achieved with FHL tendon transfer to calcaneus using an interference screw and cortical button tension slide technique as compared to an interference screw alone. Cortical buttons in the setting of FHL tendon transfer to the calcaneus offers an additional level of support. CLINICAL RELEVANCE: Operative cases presenting with poor bone quality due to osteoporosis or osteopenia could benefit from cortical button fixation during FHL transfer. Clinical studies are needed to determine if the increased construct stability conferred from the additional use of a flip button results in fewer FHL transfer failures or better clinical outcomes. LEVEL OF EVIDENCE: Level V, Controlled Laboratory Study. SAGE Publications 2021-10-18 /pmc/articles/PMC8529321/ /pubmed/35097471 http://dx.doi.org/10.1177/24730114211040445 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Neary, Kaitlin C.
McClish, Sarah J.
Khoury, Anthony N.
Denove, Nicholas
Konicek, John
Wijdicks, Coen A.
Biomechanical Analysis of Single Interference Screw vs Interference Screw With Cortical Button for Flexor Hallucis Longus Transfer
title Biomechanical Analysis of Single Interference Screw vs Interference Screw With Cortical Button for Flexor Hallucis Longus Transfer
title_full Biomechanical Analysis of Single Interference Screw vs Interference Screw With Cortical Button for Flexor Hallucis Longus Transfer
title_fullStr Biomechanical Analysis of Single Interference Screw vs Interference Screw With Cortical Button for Flexor Hallucis Longus Transfer
title_full_unstemmed Biomechanical Analysis of Single Interference Screw vs Interference Screw With Cortical Button for Flexor Hallucis Longus Transfer
title_short Biomechanical Analysis of Single Interference Screw vs Interference Screw With Cortical Button for Flexor Hallucis Longus Transfer
title_sort biomechanical analysis of single interference screw vs interference screw with cortical button for flexor hallucis longus transfer
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8529321/
https://www.ncbi.nlm.nih.gov/pubmed/35097471
http://dx.doi.org/10.1177/24730114211040445
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