Elongation in Profundus Tendon Repair: A Clinical and Radiological Study

Abstract

A radiographical study of 63 digits with tendon lacerations within the digital sheath is presented. 60 of these digits were evaluated clinically 6-36 months (mean 15 months) after surgery. At primary tendon repair one wire marker was placed on each side of the repair site in the profundus tendon. The distance between the markers was measured at operation and postoperatively on 3 different occasions on radiograms. The results showed that increase of the distance between the markers by more than 5 mm, considered to indicate elongation in the suture, occurred in 25 out of 59 repaired profundus tendons (42%) and in most instances this happened during the period of immobilization. The cause of elongation could be identified in 9 digits. In 5 it was due to rupture of the suture material, the tendons being repaired with 5-0 Flexon steel wire. In the other 4 digits, sutured with 4-0 Silky Polydec, slipping of the knot was revealed at reoperation. There was a strong correlation between increased distance between the markers and a poor outcome, elongation being the most frequent cause.

Gliding characteristics and gap formation for locking and grasping tendon repairs: a biomechanical study in a human cadaver model

“…It is not certain how much gapping is tolerable in the clinical situation, but it is unlikely that a gap of 10 mm would be well tolerated clinically. Silfverskiold et al 54 and Ejeskar and Irstam 7 have reported that gaps of up to 10 mm were quite compatible with good results clinically. Gelberman et al 55 showed that gaps less than 3 mm had no biomechanical effect and that they detected no association between the size of the gap and the presence of adhesion.…”

Comparison of 1- and 2-Knot, 4-Strand, Double-Modified Kessler Tendon Repairs in a Porcine Model

“…32 However, others report that gapping of up to 10 mm is well tolerated with no functional deficit. 33 The amount of gap formation has been measured previously, either as a clamp-to-clamp displacement 30,34 or by attaching a transducer at the repair site. 35 The former has the disadvantage of including in the measurement the relaxation of the tissue due to its viscoelasticity; the latter avoids this problem and approximates better the amount of gap, but it might alter the response under load or induce a mode of failure at the repair site because it has to be fixed with sharp pins to the tissue.…”

The biomechanical analysis of a tendon fixation device for flexor tendon repair

“…The higher 2-mm gapping force of the Teno Fix compared with the 4-0 suture repair may be clinically helpful because most surgeons feel that a gap greater than 1 to 3 mm is incompatible with a good result because it causes gap-associated adhesions to form. [51][52][53][54][55][56] The energy absorbed by the repair to 2-mm gap was significantly greater for the Teno Fix repair than for both the 3-0 and 4-0 suture repairs. We attribute this to the increased surface area of the coil in contact with tendinous fibrils; this may explain why at ultimate failure the anchor eviscerates a central portion of tendon.…”