Mediclinic specialist among first to use revolutionary CoNextions TR Tendon Repair System

At the end of last year, an orthopaedic surgeon at Mediclinic Worcester achieved a first for the hospital when he operated using the revolutionary CoNextions TR Tendon Repair System.

The challenges of tendon repairs

“Conventional suture repair of ruptured tendons is a delicate and tricky procedure,” says Dr Peter O’Farrell, a hand and upper-limb specialist at Mediclinic Worcester. This especially applies to tendon repairs in Zone 2 – the middle phalanx, the middle or second of the three bones in each finger.

“With tendon repair in the hands, you have a tendon with multiple pulleys around it, and when the tendons are cut, you must suture each tendon to get it back together. It’s a balancing act between suturing the tendon and allowing it to heal without letting the whole finger get stiff. You need a strong repair so the patient can start moving their finger soon after the surgery.”

When surgeons manually put in sutures, they need to cross over a tendon around six to eight times to adequately repair it, which results in a relatively big, bulky knot. “To ensure there's no gap between the tendon you must try and bunch it up,” Dr O’Farrell says. “It's always difficult to get that balance right.”

Because the procedure is intricate, correct postoperative rehabilitation consisting of physiotherapy and occupational therapy is critical, regardless of the surgical approach to the repair.

The CoNextions TR Tendon Repair System

The CoNextions TR Tendon Repair System holds many advantages over conventional suture repair of ruptured tendons, all contributing to superior patient outcomes. Having formerly been the subject of a clinical studies at state hospitals in South Africa, the system offers an innovative and effective alternative to sutures.

It provides precise tendon-to-tendon approximation and repair, according to CoNextions Inc, the company behind the device. “The system allows surgeons to produce a rapid, strong, and reproducible repair in any lacerated or ruptured tendon appropriately sized for the system.”

The device eliminates the challenges posed by suturing tendons, Dr O’Farrell says. “Above all, it gets the required tension just right.” 

It consists of a single-use, sterile implant with two identical stainless-steel anchors implanted in either end of the injured tendon that are connected by two loops of ultra-high tenacity polyethene yarn spanning the injury site. “There’s no suturing back and forth and ending up with a thick knot, just to make sure it's a tight repair. It’s one procedure, literally the firing of a gun, releasing a pre-loaded spring.” This deployment mechanism “staples” the ruptured tendon ends together in one swift motion. 

The benefits for tendon repair

The medical-grade stainless steel and high molecular weight polyethylene implants are stronger than suture, reducing the chance of tendons rupturing postoperatively. The device’s makeup also means the surrounding tissue isn’t irritated, which limits infection and leads to better long-term outcomes. The implant's design also minimises friction and facilitates smooth tendon gliding. This promotes superior range of motion and hand function.

The system also reduces theatre time significantly. “The longer any wound is open, the higher the chance of having bruised tissues, infection and stiffness,” Dr O’Farrell explains. “The quicker you get in, operate and get out, the better. For example, doctors work under a tourniquet for these procedures and any time over an hour with a tourniquet can lead to more swelling and stiffness. Why have this knock-on effect when you can cut down your surgery time?”

The CoNextions TR System also allows patients to start moving their hand the day of the surgery, speeding up recovery. With sutures, rehabilitation may only begin slowly around two weeks after surgery. It only becomes and more intensive weeks later, as there is a risk of pulling out or damaging the repairs.

“Now, patients don't develop a stiff hand or finger because it’s never allowed to develop,” Dr O’Farrell says. “You're eliminating that expected complication. The patient’s normal function returns sooner in a more reliable way and allows them to return to normal activity sooner.” To date, Dr O’Farrell has used the system four times with successful results. “It has benefits in every direction,” he emphasises.

It’s worth noting that as with all new technologies and devices, there are specific cases when they cannot be used. Your healthcare professional will decide on the most appropriate treatment based on your clinical condition and individual medical history.