Side-to-Side Tendon Coaptation Yields Greater Load to Failure and Stiffness Than Pulvertaft Weave: A Systematic Review and Meta-Analysis of Biomechanical Studies

Background: Two of the most prevalent techniques for tendon transfer are Pulvertaft weave (PTW) and side-to-side (STS) constructs. Our purpose was to compare pooled results from reported biomechanical properties of these approaches by a meta-analysis. Our null hypothesis was there are no significant differences in load to failure (LTF), initial construct stiffness, or cross-sectional area (CSA) between these techniques. Methods: We performed a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify candidate studies. We included studies with direct LTF comparisons of PTW and STS constructs. We performed a meta-analysis of pooled data comparing the 2 techniques for initial construct LTF (N), stiffness (N/mm), and CSA (mm 2 ). Results: Eight studies with a total of 235 tested human or porcine tendon reconstruction constructs (107 PTW, 128 STS) met our inclusion criteria. Eight studies reported initial construct LTF, with weighted mean values of 103 (±36) and 198 (±61) N for the PTW and STS groups, respectively ( P < .05). Four studies reported initial construct stiffness, with weighted mean values of 16 (±4) and 34 (±16) N/mm for the PTW and STS groups, respectively ( P < .05). Five studies evaluated initial transfer bulk as measured by CSA, with weighted mean values of 28 (±14) and 29 (±13) mm 2 for the PTW and STS groups, respectively ( P > .05). Conclusions: Our meta-analysis demonstrated significant increased initial construct LTF and stiffness with STS tendon coaptation as compared with PTW. We found no difference for initial CSA between the 2 techniques.