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HAND

, Volume 10, Issue 1, pp 116–122 | Cite as

Implanted passive engineering mechanism improves hand function after tendon transfer surgery: a cadaver-based study

  • Katherine L. Mardula
  • Ravi BalasubramanianEmail author
  • Christopher H. Allan
Article

Abstract

Purpose

The purpose of this study was to investigate if a new tendon transfer surgical procedure that uses an implanted passive engineering mechanism for attaching multiple tendons to a single donor muscle in place of directly suturing the tendons to the muscle improves hand function in physical interaction tasks such as grasping.

Methods

The tendon transfer surgery for high median ulnar palsy was used as an exemplar, where all four flexor digitorum profundus (FDP) tendons are directly sutured to the extensor carpi radialis longus (ECRL) muscle to restore flexion. The new procedure used a passive hierarchical artificial pulley system to connect the muscle to the tendons. Both the suture-based and pulley-based procedures were conducted on N = 6 cadaver hands. The fingers’ ability to close around four objects when the ECRL tendon was pulled was tested. Post-surgery hand function was evaluated based on the actuation force required to create a grasp and the slip between the fingers and the object after the grasp was created.

Results

When compared with the suture-based procedure, the pulley-based procedure (i) reduced the actuation force required to close all four fingers around the object by 45 % and (ii) improved the fingers’ individual adaptation to the object’s shape during the grasping process and reduced slip by 52 % after object contact (2.99° ± 0.28° versus 6.22° ± 0.66°).

Conclusions

The cadaver study showed that the implanted engineering mechanism for attaching multiple tendons to one muscle significantly improved hand function in grasping tasks when compared with the current procedure.

Keywords

Tendon transfer surgery High median ulnar palsy Implant Engineering mechanism 

Notes

Acknowledgments

A special thanks to the Institute for Simulation and Interprofessional Studies at UW Medicine for their support during the cadaver experiments, Sarani Chatterjee for aiding in the data processing, and Dr. Cliff Pereira for the statistical guidance. Drs. Joseph McGuire, Brian Bay, and Buddy Ratner also provided advice for the project.

Conflict of Interest

Katherine L. Mardula states that she has no conflict of interest in conducting this research.

Christopher H. Allan states that he received a grant from the army and money from Oregon State University for conducting this research (please see complete COI statement).

Ravi Balasubramanian states that he has no conflict of interest in conducting this research.

Statement of Human and Animal Rights

This article does not contain any studies with human or animal subjects.

Statement of Informed Consent

This is to state that no human subjects were used in the conduct of the experiment described in the paper titled “Implanted Passive Engineering Mechanism Improves Hand Function After Tendon-Transfer Surgery: A Cadaver-Based Study.”

References

  1. 1.
    Balasubramanian R, Montgomery J, Mardula KL, et al. Implanted miniature engineering mechanisms in tendon-transfer surgery improve robustness of post-surgery hand function. Hamlyn Symp Med Robot. 2013.Google Scholar
  2. 2.
    Beaton DE, Davis AM, Hudak P, et al. The DASH (disabilities of the arm, shoulder, and hand) outcome measure: what do we know about it now? Br J Hand Ther. 2001;6(4):109–18.Google Scholar
  3. 3.
    Bennett DJ, Hollerbach JM, Xu Y, et al. Time-varying stiffness of human elbow joint during cyclic voluntary movement. 1992; 88:433–442.Google Scholar
  4. 4.
    Birglen L, Lalibert’e T, Gosselin C. Underactuated robotic hands. Springer, 2008.Google Scholar
  5. 5.
    Bookman A, Harrington M, Pass L, et al. Family caregiver handbook. Cambridge: MIT Press; 2007.Google Scholar
  6. 6.
    Bosse M, Ficke JR. Extremity war injuries V: barriers to return of function and duty. J Am Acad Orthop Surg. 2011.Google Scholar
  7. 7.
    Brand PW, Hollister A. Clinical mechanics of the hand. 2nd ed. Mosby Year Book Inc.; 1993.Google Scholar
  8. 8.
    Bullock IM, Dollar AM. Classifying human manipulation behavior. In: 2011 I.E. international conference on rehabilitation robotics (ICORR). Switzerland, EHT Surich Science City; 2011.Google Scholar
  9. 9.
    Cater DR, Belenman PR, Beaupr GS. Correlations between mechanical stress history and tissue differentiation in initial fracture healing. J Orthop Res. 1988;6(5):736–48.CrossRefGoogle Scholar
  10. 10.
    Chen S, Kao I. Conservative congruence transformation for joint and Cartesian stiffness matrices of robotic hands and fingers. Int J Robot Res. 2000;19(9):835–47.CrossRefGoogle Scholar
  11. 11.
    Cooney WP, Linscheid RL, An KN. Opposition of the thumb: an anatomic and biomechanical study of tendon transfers. J Hand Surg. 1984;9A(6):777–86.CrossRefGoogle Scholar
  12. 12.
    Cross J, Ficke J, Hsu J, et al. Battlefield orthopedic injuries cause the majority of long-term disabilities. J Am Acad Orthop Surg. 2011;19 suppl 1:S1–7.PubMedGoogle Scholar
  13. 13.
    Dollar AM, Howe RD. The highly adaptive SDM hand: design and performance evaluation. Int J Robot Res. 2010;29(5):585–97.CrossRefGoogle Scholar
  14. 14.
    Friden J, Lieber R. Tendon transfer surgery: clinical implications of experimental studies. Clin Orthop Relat Res. 2002; 403S(S163-S170).Google Scholar
  15. 15.
    Green DP, Hotchkiss RN, Pederson WC, et al. Green’s operative hand surgery, volume 1. 2. fifth ed. Elsevier Churchill Livingstone; 2005.Google Scholar
  16. 16.
    Holzbaur KRS, Murray WM, Delp SL. A model of the upper extremity for simulating musculoskeletal surgery and analyzing neuromuscular control. Ann Biomed Eng. 2005;33(6):829–40.CrossRefPubMedGoogle Scholar
  17. 17.
    Hunter Implants. Ortotech. http://www.ortotech.c.
  18. 18.
    Labview. National Instruments. http://www.ni.com/labvie.
  19. 19.
    Lieber RL. Biology and mechanics of skeletal muscle: what hand surgeons need to know when tensioning a tendon transfer. J Hand Surg. 2008. doi: 10.1016/j.jhsa.2008.08.010.Google Scholar
  20. 20.
    Lilla JA, Vistnes LM. Long-term study of reactions to various silicone breast implants in rabbits. Plast Reconstr Surg. 1976;57(5):637–49.CrossRefPubMedGoogle Scholar
  21. 21.
    Melvin AJ, Litsky AS, Mayerson JL, et al. Extended healing validation of an artificial tendon to connect the quadriceps muscle to the tibia: 180-day study. J Orthop Res. 2012;30(7):1112–7.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Murray WM, Buchanan TS, Delp SL. The isometric functional capacity of muscles that cross the elbow. J Biomech. 2000;30:943–52.CrossRefGoogle Scholar
  23. 23.
    OptiTrack. Natural point. http://www.naturalpoint.com/optitrac.
  24. 24.
    Riordan DC. Tendon transfers for median, ulnar or radial nerve palsy. Hand. 1969;1:42–6.CrossRefGoogle Scholar
  25. 25.
    Sammer DM, Chung KC. Tendon transfers: part I. Principles of transfer and transfers for radial nerve palsy. Plast Reconstr Surg. 2009;123(5):169e–77.CrossRefPubMedGoogle Scholar
  26. 26.
    Sepienza A, Green S. Correction of the claw hand. Hand Clin. 2012; 28(1).Google Scholar
  27. 27.
    Strickland JW, Graham TJ. The hand: master techniques in orthopedic surgery. Lippincott Williams & Wilkins; 2005.Google Scholar
  28. 28.
    Su BW, Solomans M, Barrow A, et al. A device for zone II flexor tendon repair. J BoneJoint Surg [AM]. 2006;88-A(Supplement 1):37–49.Google Scholar
  29. 29.
    Wikipedia. Differential mechanisms. http://en.wikipedia.org/wiki/Differential.
  30. 30.
    Zhang L, Cao Z, Bai T, et al. Zwitterionic hydrogels implanted in mice resist the foreign-body reaction. Nat Biotechnol. 2013;31:553–6.CrossRefPubMedGoogle Scholar

Copyright information

© American Association for Hand Surgery 2014

Authors and Affiliations

  • Katherine L. Mardula
    • 1
  • Ravi Balasubramanian
    • 1
    Email author
  • Christopher H. Allan
    • 2
  1. 1.School of Mechanical, Industrial and Manufacturing EngineeringOregon State UniversityCorvallisUSA
  2. 2.School of MedicineUniversity of WashingtonSeattleUSA

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