Flexor Tendon Repair With a Knotless, Bidirectional Barbed Suture: An In Vivo Biomechanical Analysis

We compared the tensile strength of a novel knotless barbed suture method with a traditional four-strand Adelaide technique for flexor tendon repairs. Forty fresh porcine flexor tendons were transected and randomly assigned to one of the repair groups before repair. Biomechanical testing demonstrated that the tensile strengths between both tendon groups were very similar. However, less force was required to create a 2 mm gap in the four-strand repair method compared with the knotless barbed technique. There was a significant reduction in the cross-sectional area in the barbed suture group after repair compared with the Adelaide group. This would create better gliding within the pulley system in vivo and could decrease gapping and tendon rupture.

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Biomechanical Analysis of Barbed Suture in Flexor Tendon Repair versus Conventional Method

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000002573 ◽

2016 ◽

Vol 138 (4) ◽

pp. 666e-674e ◽

Cited By ~ 5

Author(s):

Jin Yong Shin ◽

Jin Soo Kim ◽

Si-Gyun Roh ◽

Nae-Ho Lee ◽

Kyung-Moo Yang

Keyword(s):

Conventional Method ◽

Flexor Tendon ◽

Tendon Repair ◽

Biomechanical Analysis ◽

Barbed Suture ◽

Flexor Tendon Repair

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Asymmetric 6-Strand Flexor Tendon Repair – Biomechanical Analysis Using Barbed Suture

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835519500371 ◽

2019 ◽

Vol 24 (03) ◽

pp. 297-302

Author(s):

Jasmin Shimin Lee ◽

Yoke-Rung Wong ◽

Shian-Chao Tay

Keyword(s):

Tensile Strength ◽

Ultimate Tensile Strength ◽

Flexor Tendon ◽

Tendon Repair ◽

Biomechanical Analysis ◽

Barbed Suture ◽

Flexor Tendon Repair ◽

Barbed Sutures ◽

Repair Technique ◽

Nylon Suture

Background: This study investigates the biomechanical performance of the Asymmetric flexor tendon repair technique using barbed suture. The Asymmetric repair technique using monofilament nylon suture was previously reported to have a higher tensile strength than the modified Lim-Tsai repair technique, but its repair stiffness and load to gap force were significantly lower. There is hence an unmet need to improve this technique and the substitution of nylon suture with barbed sutures may be the solution. Methods: Two groups consisting of 10 porcine tendons each were repaired with the six-strand Asymmetric repair technique using V-Loc® 3-0 and Supramid® 4-0 respectively. The repairs were subjected to a mechanical tester for static testing. The ultimate tensile strength, load to 2 mm gap force, repair stiffness, time taken to complete a repair and failure mechanism of the repairs were recorded and analyzed. Results: All the repairs using V-Loc® 3-0 sutures had significantly higher median values of ultimate tensile strength (64.1 N; 56.9 N), load to 2 mm gap force (39.2 N; 19.7 N), repair stiffness (6.4 N/mm; 4.7 N/mm) and time taken to complete a repair (9.4 mins; 7.7 mins). All the repairs using V-Loc® sutures failed by suture breakage while 80% of repairs using Supramid® sutures failed by suture pullout. Conclusions: The use of the barbed sutures in the Asymmetric repair technique, whilst more time consuming, has shown promising improvement to its biomechanical performance (i.e. better ultimate tensile strength, stiffness and resistance to gap formation).

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Biomechanical analysis of the cruciate four-strand flexor tendon repair

The Journal Of Hand Surgery ◽

10.1053/jhsu.1999.0295 ◽

1999 ◽

Vol 24 (2) ◽

pp. 295-301 ◽

Cited By ~ 105

Author(s):

Elizabeth McLarney ◽

Hans Hoffman ◽

Scott W. Wolfe

Keyword(s):

Flexor Tendon ◽

Tendon Repair ◽

Biomechanical Analysis ◽

Flexor Tendon Repair

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Gross and Histological Analysis of Healing After Dog Flexor Tendon Repair with the Teno Fix™ Device

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2006.01.006 ◽

2006 ◽

Vol 31 (5) ◽

pp. 524-529 ◽

Cited By ~ 13

Author(s):

B. W. SU ◽

F. J. RAIA ◽

H. M. QUITKIN ◽

M. PARISIEN ◽

R. J. STRAUCH ◽

...

Keyword(s):

Flexor Tendon ◽

Weight Bearing ◽

Tendon Repair ◽

Tendon Healing ◽

Full Weight Bearing ◽

Cast Immobilization ◽

Flexor Tendon Repair ◽

The Common ◽

Flexor Digitorum

The purpose of this study was to examine the in vivo characteristics of the stainless-steel Teno Fix™ device used for flexor tendon repair. The common flexor digitorum superficialis tendon was transected in 16 dogs and repaired with the device. The animals were euthanized at 3, 6, or 12 weeks postoperatively. Difficulties with cast immobilization led nine of 16 animals to be full weight bearing too early, leading to rupture of their repairs. The seven tendons with successful primary repairs (gap <2 mm) underwent histological examination. This in vivo study demonstrates that use of the Teno Fix™ in “suture” of dog flexor tendons did not lead to scarring at the tendon surface, does not cause an inflammatory reaction within the tendon and does not interfere with tendon healing.

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