The effect of core suture flexor tendon repair techniques on gliding resistance during static cycle motion and load to failure: a human cadaver study

Abstract

The purpose of this study was to describe a modification of the Massachusetts General Hospital (MMGH) tendon repair and to compare it with three other suture techniques. Twenty human flexor digitorum profundus (FDP) tendons were randomly assigned to the modified Pennington (MP) suture and the MMGH suture. These were compared to the modified Kessler (MK) and Massachusetts General Hospital (MGH) sutures, using data from a previous study. All tendons were repaired with a similar epitendinous stitch and core sutures of 4-0 FiberWire. There was no significant difference in the normalized gliding resistance within the two-strand or four-strand core repair groups. The MP suture had significantly higher 2 mm gap force and ultimate load to failure than the MK suture. The MMGH suture had significantly higher 2 mm gap force and maximum failure ultimate load than the MGH suture. All repairs failed by knot unravelling.

Intrasynovial flexor tendon repair: A biomechanical study of variations in suture application in human cadavera

“…24, 30, 31 Moriya, et al showed no difference between work of flexion for 2- vs. 4-strand techniques. 31 Our repairs were performed with a looped suture employed in a locking Kessler configuration similar to Moriya’s modified Kessler. Using a looped suture in this fashion produces a repair with twice as many strands crossing the repair site, but achieved with the same number of needle passes (i.e., 4- and 8-strand techniques in our study had equivalent needle passes to 2- and 4-strand techniques in the published study).…”

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

“…Increased tendon damage may increase adhesion formation. Multiple strands increase the bulk of the repair [1,7]. At the same time, more foreign material is presented on the tendon surface which can lead to increased external foreign body reaction.…”

“…Different suture techniques involving multiple suture strands and modern suture materials are used to improve the strength of the tendon repair to allow for active early motion of the injured digit [1][2][3][4][5][6]. Some studies have shown that an increased gliding resistance due to the suture material and suture technique cannot be overcome by passive mobilization alone, probably due to buckling up of the tendons inside the flexor sheath, or possibly as a result of post-injury oedema and exudative fluid reactions [7]. Active rehabilitation programs have been proven to minimize the formation of fibrous adhesions between the healing tendon and the tendon sheath [8].…”

“…A large series of studies deal with biomechanical testing of different suture materials and techniques, yet there are few statements on their in vivo performance [1,4,7]. A multistrand interlocking suture technique leads to greater solidity of the tendon-suture construct [1,5,8].…”

Re: Le et al. Number of suture throws and its impact on the biomechanical properties of the four-strand cruciate locked flexor tendon repair with FiberWire. J Hand Surg Eur. 2012, 37: 826–31

“…A recent study showed that all repairs failed by knot unraveling (Moriya et al, 2012). Therefore, the point of our study was to demonstrate that more throws are needed to prevent this problem.…”