Suture constructs for rehabilitation using early active motion after tendon transfer surgery

Abstract

The purpose of this study was to better define an ideal tendon transfer suture construct to allow for early active range of motion. A side-to-side tendon construct was used to test suture technique (cross stich vs. Krackow stitch), number of suture throws, and calibre of suture. A minimum load to failure of 100 N was used to comfortably allow early motion while minimizing rupture risk. All constructs tested, except the 4-0 Krackow construct, were strong enough to withstand 100 N of load. The choice of suture should be based on surgeon preference, patient compliance, and specific surgery, and 3-0 non-absorbable suture may be more suitable for tendon transfers from a yield force standpoint.

Gene-Loaded Nanoparticle-Coated Sutures Provide Effective Gene Delivery to Enhance Tendon Healing

“…The tensile strength of sutures is also an important aspect of tendon repair because it is the basis of a strong repair of the tendons that resists gapping or breakage at the repair site. [37][38][39][40][41][42][43][44] Lowstrength sutures easily lead to postoperative rupture and should always be avoided. [37][38][39][40][41][42][43][44] The tensile strengths of two modified sutures (Ethicon and PDS II) were tested with a mechanical testing instrument, and no significant change was found in tensile strengths.…”

“…[37][38][39][40][41][42][43][44] Lowstrength sutures easily lead to postoperative rupture and should always be avoided. [37][38][39][40][41][42][43][44] The tensile strengths of two modified sutures (Ethicon and PDS II) were tested with a mechanical testing instrument, and no significant change was found in tensile strengths. The results show that this modification method does not affect the mechanical properties of the sutures.…”

New dynamic suture material for tendon transfer surgeries in the upper extremity – a biomechanical comparative analysis

“…Nevertheless, the results of the current study suggest that 11 mm overlap might be sufficient when high-strength suture material is used in tendon transfer surgery as only one failure occurred in the intermediate zone in the FW group and none in the DC group during load to failure testing. Furthermore, tendons in both groups ruptured at a mean load of 387 N for FW and 256 N for DC, which is far stronger than the previously reported 92 N in PT and 182 N in side-to-side repair [ 13 ], and the 100 N reported by Fitzgerald et al [ 20 ]. It is therefore hypothesized that the postoperative motion protocol after tendon transfer or reconstruction surgery might allow finger movements against resistance when high strength sutures ae used.…”

“…They reported no significant differences in the yield force for each suture and observed that 6 out of 8 specimens with the 4-0 and 2 out of 8 with the 3-0 failed due to the suture material, in contrast to the thicker 2-0 suture which could withstand the loads. Considering the yield force over 100 N for all tested sutures, the authors prefer using a 3-0 suture over a 2-0 suture due to the thinner knot bulk [ 20 ]. Gillis et al biomechanically tested a new 2-0 nonabsorbable meshed suture construct (Ethibond Excel 2-0).…”

Re: Fumiki Kamoi, Makoto Kondo, Masanori Hayashi, Shigeharu Uchiyama and Hiroyuki Kato. A new technique to determine the tension in extensor pollicis longus reconstruction. J Hand Surg Eur. 2019, 44: 790–4.

“…This strength was lower than 100 N, which Fitzgerald et al. also mentioned would suffice for the majority of tendon transfers (Fitzgerald et al., 2018). This could be a concern for a small and thin extensor indicis tendon transfer, especially for Japanese patients who have relatively small hands (Uchiyama et al., 2002).…”