Flexor Tendon Repair With Looped Suture: 1 Versus 2 Knots

Gil, Joseph A.; Skjong, Christian; Katarincic, Julia A.; Got, Christopher

doi:10.1016/j.jhsa.2015.12.011

Cited by 7 publications

(2 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 20 2-strand Kessler's yield point load in peripheral suture before rupture occurred was found as 16–20 N. 21 Lawrence and Davis 22 showed that 50% of the locking Kessler sutures had ruptures due to forces less than 29 N, whereas all 4-strand repairs were resisted this degree of force without gap formation. Gil et al, 23 stated that passive motion generates up to 17 N and passive place hold manoeuvers generate up to 9 N. It would not be wrong to deduce that 4-strand M. Kessler suture could meet the load of 17 N which is generated by controlled passive motion. That is why we prefer 4 strand m. Kessler over the 2-strand m. Kessler.…”

Section: Discussionmentioning

confidence: 99%

Results of 4-strand modified Kessler core suture and epitendinous interlocking suture followed by modified Kleinert protocol for flexor tendon repairs in Zone 2

Kayalar¹,

Kaplan²,

Uludağ

et al. 2018

Acta Orthopaedica et Traumatologica Turcica

View full text Add to dashboard Cite

ObjectiveThere has been no consensus in literature for the ideal flexor tendon repair technique. The results of zone 2 flexor tendon lacerations repaired primarily by 4 strand Modified Kessler core suture and epitendinous interlocking suture technique followed by Modified Kleinert protocol were investigated.Methods128 fingers of 89 patients who had flexor tendon laceration in zone 2 built the working group. Functional outcomes were evaluated using the Strickland formula. A statistical analysis was made between Strickland scores and some parameters such as age, gender, follow-up time, co-existing injury existence, repair time, single or multiple finger injury, tendon rupture and the effect of FDS injury and repair.ResultsExcellent, good, fair, poor results were obtained from 71 (55.5%), 46 (35.9%), 8 (6.3%), 3 (2.3%) fingers, respectively. Time of the repair has a significant effect on the strickland scores. Surgery performed within the first 24 hours following the injury gave better results. 3 fingers (2.3%) had tendon ruptures. Existence of ruptures affected the results significantly. Co-existing injuries were found that they did not have any effect on the results. In the fingers in which both FDP and FDS tendons were lacerated, no significant relationship was found between only FDP repair, both FDP and FDS repair and single FDS slip repair. Additionally no significant relationships between follow-up time, gender, single or multiple finger injury and Strickland scores were observed. 13 fingers (10.1%) had PIP joint contracture above 20°.ConclusionThe low rupture rate (2.3%) and 91.4% ‘good’ and ‘excellent’ scoring rates in our series support the idea that modified Kessler 4-strand core suture and epitendinous interlocking suture repair combined with modified Kleinert protocol gives satisfactory results. Repair time is one of the most important factors affecting the functional results and surgery should not be delayed if there is an experienced surgeon available.Level of evidenceLevel IV, therapeutic study.

show abstract

Section: Discussionmentioning

confidence: 99%

Results of 4-strand modified Kessler core suture and epitendinous interlocking suture followed by modified Kleinert protocol for flexor tendon repairs in Zone 2

Kayalar¹,

Kaplan²,

Uludağ

et al. 2018

Acta Orthopaedica et Traumatologica Turcica

View full text Add to dashboard Cite

show abstract

“…These factors have led to earlier loading and institution of controlled rehabilitation protocols in affected patients [8]. Use of a single, swaged, looped suture has gained popularity for human tendon repair within recent years [9]. Looped suture use for flexor tendon repair effectively doubles number of suture strands achieved with each suture pass, thereby reducing the number of needle passes necessary to reach the equivalent number of core suture strands crossing the repair site.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Evaluation of a Novel Double-Strand (Looped) Polyamide Monofilament Suture for Canine Flexor Tendon Repair

Duffy¹

2022

Corpus J Vet Dairy Sci

View full text Add to dashboard Cite

Objective: Determine the influence of a novel looped polyamide suture on the biomechanical properties and gap formation of repaired canine flexor tendons. Study Design: Tendons were assigned to 3 groups (n=12/group). Following transection, tendons were repaired with a Kessler pattern using monofilament polypropylene, Kessler pattern using looped polyamide suture and a Kessler pattern using looped polyamide augmented with a continuous Epitendinous Suture (ES) representing groups 1, 2, and 3 respectively. Constructs were tested to simulate clinical failure. Yield, peak and failure loads, loads at -1 and 3mm gap formation and failure modes were analyzed. Results: Looped polyamide suture is equivalent to monofilament polypropylene using a Kessler core pattern. Looped polyamide suture augmented with a running ES significantly increased yield, peak and failure loads by 3.2x, 3.0x and 2.6x respectively, compared to core suture use alone. Use of an ES required significantly greater force to cause 3mm gap formation while reducing occurrence of gapping in tested constructs. Mode of failure differed among experimental constructs. Conclusion: Looped polyamide suture is equivalent to monofilament polypropylene in the same pattern. Our results support the addition of ES augmentation, a simple technique modification that demonstrates substantially improved repair strength while reducing the occurrence of gapping between tendon ends. Future in-vivo studies investigating effect of suture placement on tendinous healing, blood supply, and glide function are warranted.

show abstract