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Turkey Model for Flexor Tendon Related Research: An Anatomic and Biomechanical Comparison of Human, Canine, Turkey, and Chicken Flexor Tendons
Assaf Kadar, MD1; Chunfeng Zhao, MD2; Steven L. Moran, MD2; Peter C. Amadio, MD2; Andrew Thoreson, MS2 and Ramona Reisdorf, BS2
1Tel Aviv Sourasky Medical Center Orthopaedic Division, Tel Aviv, Israel, 2Mayo Clinic, Rochester, MN
Background: Flexor tendon injuries are one of the most common and serious types of hand injuries. Animal models are commonly used for flexor tendon research including canine and chicken models. Canines have anatomical and biomechanical similarities to human; however, the major disadvantages of the canine model include higher costs and ethical considerations as this animal model is considered a human companion. The chicken model has some similarities to humans however the small tendons of this species cannot be used for advanced tendon research. Therefore, developing a low cost, non-companion large animal model that has similarities to human flexor tendon in size, anatomy, structure, and biomechanical is critical for advancing flexor tendon related research.
Methods: The 3rd digit from human cadaveric hands, canine forepaws, and turkey and chicken feet were used for this study. Six digits in each of four species were studied in detail, comparing anatomy of the flexor apparatus, joint range of motion¸ tendon excursion, tendon cross-sectional area, work of flexion (WOF), gliding resistance at the level of the A2 pulley, modulus of elasticity, suture retention strength, and histology across species.
Results: Anatomically, the third digit in the four species displayed structural similarities including a closed flexor synovial sheath in which two flexor tendons are located in the zone II area. However, the tendon cross-sectional area of the turkey and human were similar and larger than canine and chicken. Furthermore, the turkey digit resembles the human's finger with lack of webbing between digits, unlike the canine. Although turkey digits had less joint range of motion compared to humans, tendon excursion was similar to humans. Digit nWOF was not significantly different among human, canine, and turkey, all of which were significantly higher than chicken. Gliding resistance of human tendon was higher than all three animal models, but the turkey was the closest to human. Tendon modulus of elasticity and suture pullout strength were also similar between human and turkey tendons. Histologically, human and turkey tendons were very similar.
Conclusion: We have explored the turkey digit and flexor tendon in anatomy, structure, and function compared to human and other commonly-used models (canine and chicken); this animal model has not been reported previously. We found that the Turkey tendons have properties that are comparable to human tendons and that this model would be a relevant, economical, non-human-companion addition to the array of animals models previously established for flexor tendon research.
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