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History

A 7-year-old 30-kg (66-lb) castrated male Belgian Malinois was examined by a veterinarian because of sudden-onset left pelvic limb lameness. The veterinarian suspected a cranial cruciate ligament rupture, and the dog was referred to a veterinary teaching hospital for further evaluation. Two years earlier, the dog underwent castration to remove a left testicular Sertoli cell tumor as well as drainage and omentalization of several prostatic abscesses.

Clinical and Clinicopathologic Findings

On physical examination, the dog was bright, alert, and responsive. No neurologic deficits were evident. A firm mass in the caudal portion of the abdomen was detected, palpation of

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in Journal of the American Veterinary Medical Association
History

A 3.5-year-old castrated male Bernese Mountain Dog was referred to the Colorado State University Veterinary Teaching Hospital for evaluation of inappetence, weight loss, and periodic shifting forelimb lameness of 1 to 2 months’ duration. The dog had a history of 2 occurrences of hematuria, which resolved with empirical antimicrobial treatment. The owner reported weight loss of 9.1 kg (20 lb) in the 2 months prior to evaluation.

Physical examination revealed mild bilateral forelimb lameness (grade 1/5), bilateral soft tissue swelling that was firm on palpation of the distal aspect of the forelimbs, and a body condition score of 4

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in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To evaluate the effect of presurgical storage conditions on leakage pressures of enterotomy sites closed with unidirectional barbed suture material in fresh, chilled, and frozen-thawed cadaveric canine jejunal specimens.

SAMPLE

36 grossly normal jejunal segments obtained from 4 dog cadavers.

PROCEDURES

9 jejunal segments were harvested immediately from each euthanized dog and randomly assigned to be tested within 4 hours after collection (fresh segments), stored at 4°C for 24 hours before testing (chilled segments), or stored at −20°C for 7 days and thawed at 21°C for 6 hours before testing (frozen-thawed segments). For leakage pressure testing, a 3-cm-long antimesenteric enterotomy was performed and repaired with 3-0 unidirectional barbed suture material in a simple continuous pattern in each segment. Time to complete the enterotomy, initial leakage pressure, maximum intraluminal pressure, and leakage location were recorded for each segment.

RESULTS

Mean ± SD initial leakage pressure for fresh, chilled, and frozen-thawed segments was 52.8 ± 14.9 mm Hg, 51.8 ± 11.9 mm Hg, and 33.3 ± 7.7 mm Hg, respectively. Frozen-thawed segments had significantly lower mean initial leakage pressure, compared with findings for fresh or chilled segments. Time to complete the enterotomy, maximum intraluminal pressure, and leakage location did not differ among groups.

CONCLUSIONS AND CLINICAL RELEVANCE

Leak pressure testing of cadaveric jejunal segments that are fresh or chilled at 4°C for 24 hours is recommended for enterotomy studies involving barbed suture material in dogs. Freezing and thawing of cadaveric jejunal tissues prior to investigative use is not recommended because leak pressure data may be falsely low.

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in American Journal of Veterinary Research

Abstract

OBJECTIVE

To determine the effects of 2-, 4-, 6- and 8-strand suture repairs on the biomechanical properties of canine gastrocnemius tenorrhaphy constructs in an ex vivo model.

SAMPLE

56 cadaveric gastrocnemius musculotendinous units from 28 adult large-breed dogs.

PROCEDURES

Tendons were randomly assigned to 4 repair groups (2-, 4-, 6- or 8-strand suture technique; n = 14/group). Following tenotomy, repairs were performed with the assigned number of strands of 2-0 polypropylene suture in a simple interrupted pattern. Biomechanical testing was performed. Yield, peak, and failure loads, the incidence of 1- and 3-mm gap formation, forces associated with gap formation, and failure modes were compared among groups.

RESULTS

Yield, peak, and failure forces differed significantly among groups, with significantly greater force required as the number of suture strands used for tendon repair increased. The force required to create a 1- or 3-mm gap between tendon ends also differed among groups and increased significantly with number of strands used. All constructs failed by mode of suture pull-through.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that increasing the number of suture strands crossing the repair site significantly increases the tensile strength of canine gastrocnemius tendon repair constructs and their resistance to gap formation. Future studies are needed to assess the effects of multistrand suture patterns on tendon glide function, blood supply, healing, and long-term clinical function in dogs to inform clinical decision-making.

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in American Journal of Veterinary Research

Abstract

OBJECTIVE

To evaluate effects of bite distance of an interlocking horizontal mattress epitendinous suture (IHMES) from the repair site on tensile strength of canine tendon repairs.

SAMPLE

72 canine cadaveric superficial digital flexor tendons (SDFTs).

PROCEDURES

Transverse tenotomy was performed, and SDFTs were repaired with a locking-loop construct (LL construct) or 3 LL constructs with IHMES suture bites placed 5 (LL + 5ES construct), 10 (LL + 10ES construct), or 15 (LL + 15ES construct) mm from the transection site (18 SDFTs/group). Constructs were loaded to failure. Load at 1− and 3-mm gapping, yield force, failure load, and failure mode were evaluated.

RESULTS

Mean ± SD yield force and failure load for LL constructs were significantly lower than for IHMES constructs. Load at 1− and 3-mm gapping was significantly higher for IHMES constructs. Increasing the bite distance significantly increased construct strength (134.4 ± 26.1 N, 151.0 ± 16.8 N, and 182.1 ± 23.6 N for LL + 5ES, LL + 10ES, and LL + 15ES constructs, respectively), compared with strength for the LL construct. Failure mode differed significantly among constructs when an IHMES was used.

CONCLUSIONS AND CLINICAL RELEVANCE

Addition of an IHMES to an LL construct led to increased ultimate tensile strength by 2.5 times and significantly reduced gap formation. Increasing the IHMES bite distance increased yield force by 2.1, 2.3, and 2.7 times for bites placed 5, 10, and 15 mm from the tenotomy, respectively. Positioning an IHMES at a greater distance from the repair site provided superior biomechanical strength for tendon repairs in dogs.

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in American Journal of Veterinary Research

Abstract

OBJECTIVE

To evaluate the effect of suture caliber on the tensile strength of tenorrhaphies performed with a locking-loop technique in cadaveric canine tendons

SAMPLE

60 superficial digital flexor tendons (SDFTs) from 30 cadaveric adult dogs.

PROCEDURES

Transverse tenotomy was performed, and SDFTs were repaired with a locking-loop technique and polypropylene suture of 5 randomly assigned calibers: size-0, 2-0, 3-0, 4-0, or 5-0 (n = 12 SDFTs/suture caliber). Tendon constructs were tested to failure. Yield, peak, and failure forces and causes of failure were compared between groups.

RESULTS

Mean ± SD failure force for the constructs was significantly greater with large-caliber suture (size-0: 73.5 ± 3.1 N; size 2-0: 54.4 ± 7.1 N; size 3-0: 28.7 ± 4.9 N; size 4-0: 18.7 ± 3.4 N; and size 5-0: 8.8 ± 2.8 N). The likelihood of construct failure by suture pullout through the tendon substance increased with large-caliber suture (size-0: 12/12), whereas the likelihood of construct failure by suture breakage increased with small-caliber suture (2-0: 10/12; 3-0, 4-0, and 5-0: 12/12 each).

CONCLUSIONS AND CLINICAL RELEVANCE

Large-caliber suture had greater tensile strength for tenorrhaphies performed with a locking-loop technique in cadaveric canine tendons. Prior to the use of large-caliber suture in patients requiring tenorrhaphy, however, in vivo studies are required to confirm the results obtained here.

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in American Journal of Veterinary Research
History

A 4-year-old 43.5 kg (96-lb) castrated male Great Pyrenees was referred for evaluation of right pelvic limb lameness of approximately 3 months' duration. No history of trauma was documented. Orthopedic examination revealed a grade 2/5 lameness of the right pelvic limb at a walk. An audible click was appreciable on maximal flexion and extension of the right stifle joint, with palpable joint effusion both medial and lateral to the patellar ligament, decreased range of motion, and signs of pain when placing the right stifle joint through a range of motion. A cranial drawer sign was present on examination of

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in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To determine the effect of epitendinous suture (ES) caliber on the tensile strength of flexor tendon repairs in cadaveric specimens from dogs.

SAMPLE

60 cadaveric superficial digital flexor tendons (SDFTs) from 30 skeletally mature dogs.

PROCEDURES

Specimens were randomly assigned to 5 suture caliber groups (n = 12 SDFTs/group). After sharp transection, SDFTs were repaired by placement of a simple continuous circumferential ES created with size-0, 2-0, 3-0, 4-0, or 5-0 polypropylene suture. Constructs were preloaded to 2 N and load tested to failure. Loads at yield, peak, and failure and mode of failure were compared among groups by statistical methods.

RESULTS

Yield, peak, and failure loads for SDFT repair constructs were positively correlated with ES caliber and did not differ between the size-0 and 2-0 groups on pairwise comparisons. Yield load was significantly greater for size-0, 2-0, and 3-0 groups than for the 4-0 and 5-0 groups. Peak and failure loads were significantly greater for the size-0 and 2-0 groups than for the remaining groups. Most size-0 (12/12), 2-0 (12/12), and 3-0 (10/12) group constructs failed because of ES pull-through; several constructs in the 4-0 group (5/12) and most in the 5-0 group (11/12) failed because of ES breakage.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested size-0 and 2-0 sutures should be considered when placing an ES for flexor tendon repairs in dogs. However, in vivo studies are needed determine the effects of increasing ES caliber on clinical outcomes for dogs undergoing these procedures.

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in American Journal of Veterinary Research

Abstract

OBJECTIVE

To evaluate the effects of using an internal fixation plate to augment primary 3-loop pulley (3LP) repair of canine gastrocnemius tendons (GTs).

SAMPLE

48 cadaveric GTs from 24 adult dogs.

PROCEDURES

GTs were dissected free from other tissues, transected, and randomly assigned to 4 groups (n = 12/group). GTs were repaired with 2-0 polypropylene with a 3LP repair alone or a 3LP repair augmented with a 3-hole veterinary cuttable plate (3VCP), a 5-hole veterinary cuttable plate (5VCP), or a 7-hole veterinary cuttable plate (7VC P). Biomechanical loads, construct stiffness, gap formation, and failure modes were compared between groups.

RESULTS

Yield, peak, and failure loads were all significantly increased for the 5VCP and 7VCP groups, compared with the 3LP alone group. Increasing plate length from 3VCP to 5VCP and from 3VCP to 7VCP increased yield, peak, and failure loads. No differences were found between the 3LP and 3VCP groups with regard to yield and peak loads, but failure load was increased in the 3VCP group. Loads to create 1-mm and 3-mm gaps were significantly greater for the 5VCP and 7VCP groups, compared with the 3LP alone and 3VCP groups. Mode of plate attachment failure differed among groups.

CLINICAL RELEVANCE

Tendon plate augmentation may be a viable surgical option to increase the strength of the tenorrhaphy in dogs. However, in vivo studies evaluating the effects of plate augmentation on the tendon blood supply and progression of healing are needed prior to clinical application.

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in American Journal of Veterinary Research

Abstract

OBJECTIVE

To evaluate the effect of knot location on the biomechanical strength and gapping characteristics of ex vivo canine gastrocnemius tenorrhaphy constructs.

SAMPLE

36 cadaveric gastrocnemius tendons from 18 adult dogs.

PROCEDURES

Tendons were randomly assigned to 3 groups (12 tendons/group) and sharply transected and repaired by means of a core locking-loop suture with the knot at 1 of 3 locations (exposed on the external surface of the tendon, buried just underneath the external surface of the tendon, or buried internally between the apposed tendon ends). All repairs were performed with size-0 polypropylene suture. All constructs underwent a single load-to-failure test. Yield, failure, and peak forces, mode of failure, and forces required for 1- and 3-mm gap formation were compared among the 3 knot-location groups.

RESULTS

Mean yield, failure, and peak forces and mean forces required for 1- and 3-mm gap formation did not differ significantly among the 3 groups. The mode of failure also did not differ significantly among the 3 groups, and the majority (33/36 [92%]) of constructs failed owing to the suture pulling through the tendinous substance.

CONCLUSIONS AND CLINICAL RELEVANCE

Final knot location did not significantly affect the biomechanical strength and gapping characteristics of canine gastrocnemius tenorrhaphy constructs. Therefore, all 3 evaluated knot locations may be acceptable for tendon repair in dogs. In vivo studies are necessary to further elucidate the effect of knot location in suture patterns commonly used for tenorrhaphy on tendinous healing and collagenous remodeling at the repair site.

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in American Journal of Veterinary Research