Biomechanical Strength Comparison Between Pulvertaft Weave and Side-to-Side Tendon Repair: A Meta-Analysis and Systematic Review

Background: To compare biomechanical strength of the Pulvertaft (PT) weave and the side-to-side (STS) tendon repair techniques. Methods: We conducted a comprehensive literature search using PubMed, MEDLINE and Cochrane library from inception to November 2020. All studies comparing the PT weave and STS were included. Methodological quality and assessment of risk of bias were assessed by two independent researchers. Publication bias was assessed using a funnel plot and confirmed by the Begg’s and Egger’s test. The random effects mode was used due to both statistical and clinical heterogeneity among studies. Results: The initial search resulted in 624 articles; however, after a thorough review, only six studies were selected for inclusion in the meta-analysis and systematic review. We were able to pool findings for maximum load and load to failure. By definition, maximum load is the peak force achieved in tensile testing while load to failure is the first negative inflection of force during the failure test. For maximum load, results showed that there was no evidence that the two tendon repair techniques were significantly different (SMD = –0.84, z = 0.88, p = 0.379, 95% CI = –2.72 – 1.04). However, there was significantly high heterogeneity detected among the included studies (Q=21.10, p = 0.001, I2 = 90.50%, τ2 = 2.47). For load to failure, results indicated that the load to failure was statistically higher in the side-to-side approach (SMD = 1.36, z = 5.26, p = 0.001, 95% CI = 0.85 – 1.86) than the PT approach. It is also notable that a small, non-significant heterogeneity was detected among the included studies (Q=3.66, p = 0.300, I2 = 18.10%, τ2 = 0.05). Conclusion: STS is stronger than PT weave in terms of load to failure but comparable in terms of maximum load. STS is a possible alternative to PT weave for tendons in need of grafting.