The impact of different peripheral suture techniques on the biomechanical stability in flexor tendon repair

Abstract

Beside the distance from tendon gap, the type of linkage of the suture material across and beneath the epitendineum is important for biomechanical stability. Simple-running suture is easy to use, even with a slight increase of the distance from tendon gap significantly increases biomechanical strength. For future repairs of flexor tendon injuries, 3 mm stitch length is highly recommended for simple peripheral suture, while the Halsted-mattress suture unites the most important qualities: biomechanically strong, most part of suture material placed epitendinous, and not too complicated to perform.

Biomechanical comparison of three epitendinous suture patterns as adjuncts to a core locking loop suture for repair of canine flexor tendon injuries

“…In that study, constructs incorporating IHM sustained greater loads to failure, 2‐mm gap formation, and stiffness . Similarly to our findings, Wieskötter et al found no difference in yield force and gap formation among six ES techniques in a translational porcine flexor tendon repair model. Biomechanical properties may slightly differ between ES patterns, and their influence may vary with the types of tendon (flat, round, sheathed) repaired.…”

“…Putterman and Duffy et al 30 published similar results in a canine model, in which gapping between tendon ends was eliminated by addition of a continuous epitendinous suture. In our study, the forces required to produce 1-and 3-mm gaps did not differ between ES groups, similarly to the findings of Wieskötter et al 38 Additional suture strands crossing the repair must be delicately balanced with the difficulty in performing increasingly intricate patterns, surgical time associated with application, the propensity to cause vascular damage, and increased bulk at the repair site. 8,39 Traditional immobilization has been abandoned for the beneficial effects of applying early passive and active rehabilitation protocols in human patients after tendon repair.…”

The single-suture technique for anterior cruciate ligament graft preparation provides similar stability as a three-suture technique: a biomechanical in vitro study in a porcine model

“…However, Domnick et al could demonstrate that for biomechanical investigations, fresh-frozen porcine flexor tendons represent an appropriate substitute for human semitendinosus tendons [20]. Both porcine flexor tendons and the mechanical setup in this study have been used in other investigations on the strength of suture-tendon constructs [12,[20][21][22][23]. Freezing the samples for storage might have influenced the material properties, but the tensile force gets lower because of freezing [20].…”

“…The samples were thawed to room temperature for 12 h before the testing and cut to a length of 24 cm. Fresh-frozen porcine flexor tendons were used based on availability and comparable biomechanical properties compared to human tendons [20] and they had been established for similar testing setups in previous studies [21][22][23].…”

Versorgung von frischen Beugesehnenverletzungen

“…Auch hier stehen diverse Nahttechniken zur Verfügung, wie z. B. die einfach fortlaufende Naht nach Kleinert oder Kreuzstichnähte nach Lembert und Halsted [10,27]. Trotz der biomechanischen Überlegenheit anderer Nähte wird die fortlaufende Ringnaht aufgrund ihrer Einfachheit sehr häufig verwendet [27,29].…”