Abstract 10

TENDON TRANSFER FIXATION IN THE FOOT

Butler. AM, Salleh. R, Datta. B and, Walsh. WR

Orthopaedic Research Laboratory, Prince of Wales Hospital, University of New South Wales, Sydney, Australia

Purpose: This study compares a tendon to tendon technique vs. a bioabsorbable interference-fit screw (BIORCI 7X20mm, Smith & Nephew, Memphis, USA) with and without Krakow suture for the fixation of tendon to bone in tibialis posterior reconstructions. The goal is to provide reproducible stable fixation that maintains the tendon in the operatively placed position. We compared the failure load of the various techniques employed for fixation. Investigating current techniques is important to qualify their application. Methods: Eighteen human naviculi were dissected from fresh frozen cadaver feet. Eighteen ovine tendons from same aged sheep were obtained. These were divided into three groups (n=6) representing 1. tendon to tendon group 2. bioabsorbable interference-fit screw 3. bioabsorbable interference-fit screw with Krakow suture. The tendons were reconstructed with the navicular using the various techniques and tested in tension (displacement of 1mm/sec) until failure. Results: The tendon to tendon group had the highest average load to failure (96.9±24.3 N) followed by the interference-fit screw with Krakow suture (63.2±31.5 N). The interference-fit screw-only group had the lowest load to failure (33.4±15.7 N). All bioabsorbable interference-fit screw fixations failed by tendon pull-out regardless of Krakow suture being present. Tendon to tendon fixation, although strongest, is not always desirable due to operative limitations. Using bioabsorbable screws result in decreased operative dissection. Conclusions: Using interference screws showed decreased fixation strength but incorporating the Krakow suture effectively doubled the strength of fixation. This is a simple yet effective method to increase the fixation if this is an issue.

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