A biomechanical analysis of multistrand repairs with the Silfverskiöld peripheral cross-stitch

Abstract

We compared the bulking and tensile strength of the Pennington modified Kessler, Cruciate and the Savage repairs in an ex vivo model. A total of 60 porcine tendons were randomised to three groups, half repaired using a core suture alone and the remainder employing a core and peripheral technique. The tendons were distracted to failure. The force required to produce a 3 mm gap, the ultimate strength, the mode of failure and bulking for each repair were assessed. We found that there was a significant increase in strength without an increase in bulk as the number of strands increased. The Cruciate repair was significantly more likely to fail by suture pullout than the Pennington modified Kessler or Savage repairs. We advise the use of the Savage repair, especially in the thumb, and a Cruciate when a Savage is not possible. The Pennington modified Kessler repair should be reserved for multiple tendon injuries.

The search for the ideal tendon repair in zone 2: strand number, anchor points and suture thickness

“…An improvement of the cross stitch with interlocking anchor points (Figure 4(C)), thus preventing narrowing of the transverse strands and lengthening of the longitudinal strands, gave an additional 26% strength (Dona et al, 2003). Hirpara et al (2007) studied core sutures without a peripheral suture in pig flexors: the two-strand Pennington modified Kessler, four-strand non-locked cruciate and six-strand Savage core sutures, using 4-0 polyester (Ethibond; Ethicon, Somerville, NJ, USA). In a second series of tests they added the Silfverskiöld peripheral suture (using 6-0 nylon) to each core suture.…”

Influence of Locking Stitch Size in a Four-Strand Cross-Locked Cruciate Flexor Tendon Repair

“…Current literature suggests that this cross-locked cruciate repair is not only stronger than other 4-strand techniques but also is a favorable repair in terms of gap formation and simplicity. [13][14][15][16][17] However, the optimum size of the cross-locks in this specific repair technique has not been investigated, or indeed whether the size of the locking stitch effects the repair strength or gapping behavior. The purpose of this article was to address this question in an ex vivo porcine model.…”

The effect of a collagen-elastin matrix on adhesion formation after flexor tendon repair in a rabbit model

“…To allow for early active motion, the tendon-suture construct needs to be designed to prevent re-rupture or knot unravelling. The initial strength of a tendon repair is roughly proportional to the number of suture strands that cross the repair site [19][20][21][22][23][24]. The most commonly used techniques have involved a two-strand repair.…”