A study to compare strengths of cadaveric tendon repairs with round-bodied and cutting needles

This human cadaver study investigated whether flexor tendon repairs performed with round-bodied needles had a higher risk of pull-out compared with those performed with cutting needles. Forty human cadaver tendons were repaired (20 with each type of needle), subjected to tensile traction testing and evaluated by failure load and mode of failure. The average failure load was 50 N (SD 13 N) for tendons repaired with round-bodied needles, compared with 49 N (SD 16 N) for tendons repaired with cutting needles. Round-bodied needles resulted in more suture pull-out (18 out of 20 tendons) than cutting needles (6 out of 20 tendons). We found no differences in failure load, but significant differences in the mode of failure between round-bodied and cutting needles when used for cadaveric flexor tendon repair.

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The mechanical interaction between three geometric types of nylon core suture and a running epitenon suture in repair of porcine flexor tendons

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413484876 ◽

2013 ◽

Vol 38 (7) ◽

pp. 788-794 ◽

Cited By ~ 6

Author(s):

T. de Wit ◽

E. T. Walbeehm ◽

S. E. R. Hovius ◽

D. A. McGrouther

Keyword(s):

Failure Load ◽

Flexor Tendon ◽

Tendon Repair ◽

Mechanical Effect ◽

Mechanical Interaction ◽

Flexor Tendon Repair ◽

Flexor Tendons ◽

The Core ◽

Pull Out ◽

Mode Of Failure

The effect of core suture geometry on the mechanical interaction with the epitenon suture in terms of gap prevention, failure strength and mode of failure was investigated in a flexor tendon repair model. A total of 48 porcine flexor tendons were repaired using three techniques with distinct core suture geometry: single Kessler; double Kessler; and cruciate repair. Cyclic linear testing was carried out with and without a simple running epitenon suture. At failure load the epitenon suture reduced gapping by 87% in the double Kessler, 42% in the single Kessler and 15% in cruciate repairs. It increased the strengths of the repairs by 58%, 33% and 24%, respectively. Kessler repairs failed mainly by suture rupture, with and without epitenon suture, but cruciate repairs failed mainly by suture pull-out. The epitenon suture did not have a significant mechanical effect on the three repairs. Rather, its effect varied with the core suture geometry. The greatest effect occurred with double Kessler repairs.

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Causes of Flexor Tendon Repair Failures in Two Common Repair Techniques: A Cadaver Study

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

10.1142/s2424835516500302 ◽

2016 ◽

Vol 21 (03) ◽

pp. 333-338 ◽

Cited By ~ 1

Author(s):

Raakhi Mistry ◽

Michael John McCleave ◽

John Codrington

Keyword(s):

Tensile Strength ◽

Flexor Tendon ◽

Tendon Repair ◽

Cadaver Study ◽

Flexor Tendon Repair ◽

Maximum Tensile Strength ◽

Pull Out ◽

Mechanism Of Failure ◽

Suture Failure ◽

Repair Techniques

Background: Flexor tendon repair failures have primarily been attributed to either core suture rupture or core suture pull out. Recent studies have suggested that knot unravelling may also cause failure of a tendon repair. The aim of this study was to investigate the causes of core suture failure in two types of common flexor tendon repairs. Methods: Twenty four cadaver tendons were divided into three groups of eight. Each group tested a specific flexor tendon repair. The repairs tested included an Adelaide repair using 4/0 Ethibond (Ethicon), an Adelaide repair using 4/0 Fiberwire (Arthrex) and the Tsai repair with 4/0 Fiberloop (Arthrex). The repaired tendons were pull-tested to failure. The mechanism of failure, maximum tensile strength and 2 mm gap force were recorded. Results: The predominant mode of failure was by the knot unravelling. This occurred in 50-88% of the tendon repairs. The sequence of failure was initiated with gapping at the repair site followed by failure of the epitendinous suture. Next the core suture knot unravels. Once the knot unravels, the suture thread slips out of the tendon resulting in the repair failure. Failures due to knot slippage occurred at a lower maximum tensile strength in Ethibond and Fiberloop sutures than failure due to core rupture or pull out. However, given the small number of tendons tested, this result was not significant. Conclusions: This study has clearly demonstrated one of the main causes of flexor tendon repair failure in two common repair techniques is knot unravelling.

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Modified Brunelli Pull-Out Technique in Flexor Tendon Repair for Zone II: A Study on 58 Cases

Hand ◽

10.1007/s11552-011-9345-5 ◽

2011 ◽

Vol 6 (3) ◽

pp. 276-281 ◽

Cited By ~ 8

Author(s):

Alexandru Valentin Georgescu ◽

Ileana R. Matei ◽

Irina M. Capota ◽

Filip Ardelean ◽

Octavian D. Olariu

Keyword(s):

Flexor Tendon ◽

Tendon Repair ◽

Flexor Tendon Repair ◽

Pull Out ◽

Zone Ii

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Number of suture throws and its impact on the biomechanical properties of the four-strand cruciate locked flexor tendon repair with FiberWire

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193412447503 ◽

2012 ◽

Vol 37 (9) ◽

pp. 826-831 ◽

Cited By ~ 22

Author(s):

S. V. Le ◽

S. Chiu ◽

R. C. Meineke ◽

P. Williams ◽

M. D. Wongworawat

Keyword(s):

Tensile Strength ◽

Ultimate Tensile Strength ◽

Flexor Tendon ◽

Tendon Repair ◽

Tendon Healing ◽

Early Mobilization ◽

Biomechanical Properties ◽

Optimal Number ◽

Flexor Tendon Repair ◽

Mode Of Failure

FiberWire is a popular suture in flexor tendon repair that allows for early mobilization, but its poor knot-holding properties have raised concerns over the potential effects on tendon healing and strength. We examined how the number of knot throws affects the 2 mm gap force, ultimate tensile strength, and mode of failure in a four-strand cruciate locked tendon repair in porcine flexor tendons in order to elucidate the optimal number of suture throws. There was no effect on the 2 mm gap force with increasing knot throws, but there was a significant increase in ultimate tensile strength. A minimum of six-knot throws prevents unravelling, whereas five out of 10 of repairs unravelled with less than six throws.

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Biomechanical study of a newly developed continuous double knots technique compared with the 4-strand double-modified Kessler technique for flexor tendon repair

Journal of Experimental Orthopaedics ◽

10.1186/s40634-021-00404-4 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Sunton Wongsiri ◽

Wongthawat Liawrungrueang

Keyword(s):

Tensile Strength ◽

Failure Load ◽

Flexor Tendon ◽

Tendon Repair ◽

Biomechanical Properties ◽

Suture Technique ◽

Cyclic Testing ◽

Flexor Tendon Repair ◽

Ultimate Failure Load ◽

Ultimate Failure

Abstract Purpose In this study we compare the biomechanical properties of a novel suture technique that we developed called the continuous double knots technique for repairing flexor tendon injuries with the standard 4-strand double-modified Kessler technique. Methods This was an experimental study. Eighty porcine flexor digitorum profundus tendons were harvested and divided randomly into two groups of 40. The first group (N = 40) was repaired using the 4-strand double modified Kessler technique and the second group (N = 40) was repaired using our new continuous double knots technique. The two groups were randomly divided and the ultimate failure load (n = 20) and cyclic testing to failure (n = 20) were compared. Results The mean ultimate failure load was 25.90 ± 7.11 (N) and cyclic testing to failure 88 ± 47.87 (cycles) for the 4-strand double modified Kessler technique and 34.56 ± 6.60 (N) and 189 ± 66.36 (cycles) for our new continuous double knots technique. The T-test revealed a significant difference between the 2 techniques (p < 0.05). In terms of biomechanical properties in tendon repair, the continuous double knots technique group had a higher tensile strength than the 4-strand double-modified Kessler technique group. There were also significant differences between the ultimate failure load and cyclic testing to failure for the flexor tendon sutures. Conclusions The continuous double knots technique suture technique had significantly higher maximum tensile strength and cyclic testing than the 4-strand double modified Kessler technique in an in vitro study, and in thus an optional technique for flexor tendon repair.

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A2 PULLEY INTEGRITY AND THE STRENGTH OF FLEXOR TENDON REPAIR: A BIOMECHANICAL STUDY IN A CHICKEN MODEL

Hand Surgery ◽

10.1142/s021881041550001x ◽

2015 ◽

Vol 20 (01) ◽

pp. 11-17 ◽

Cited By ~ 3

Author(s):

Marc J. Langbart ◽

Constantine M. Glezos ◽

Belinda J. Smith ◽

Elizabeth C. Clarke ◽

Richard D. Lawson ◽

...

Keyword(s):

Flexor Tendon ◽

Tendon Repair ◽

Interphalangeal Joint ◽

Flexor Digitorum Profundus ◽

Distal Interphalangeal Joint ◽

Flexor Tendon Repair ◽

Pull Out ◽

A2 Pulley ◽

Distal Interphalangeal ◽

Joint Flexion

Purpose: This study assesses the influence of A2 pulley integrity on the strength of the repair. Method: Part 1- The flexor digitorum profundus (FDP) tendons of 72 Cobb chicken feet were severed and repaired in the region of the A2 pulley using a modified Kessler core suture and an epitendinous suture. The A2 pulley was either left intact, divided for 50% of its length, or divided in its entirety. The distal interphalangeal joint was fixed at a position of 20°, 40° or 60° of joint flexion. The load to failure, integrity of the A2 pulley and the site of tendon failure were analysed. Part 2- A further 32 chicken feet were used to exclude the effects of freezing and thawing on results and to analyse differences when using a core suture only. Results: No difference in failure load between any of the test groups or subgroups was identified. The integrity of the A2 pulley was preserved in all specimens. The most common cause of failure was distal suture pull-out. Discussion: This study does not demonstrate that release of the A2 pulley provides an advantage in increasing tendon repair strength. Division of 50% of the A2 pulley does not predispose to pulley rupture. Flexor tendon repair strength did not alter with distal interphalangeal joint flexion between 20° and 60°. Clinical Relevance: The findings of this study do not support division of the A2 pulley to prevent flexor tendon repair failure if repair methods of appropriate strength are utilised.

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A prospective comparative study of pull-out suture technique versus modified Kessler technique in flexor tendon repair for Zone I and distal Zone II injuries

Journal of Medical Society ◽

10.4103/jms.jms_109_21 ◽

2021 ◽

Vol 35 (2) ◽

pp. 72

Author(s):

AkoijamIbohal Singh ◽

ManisanaSingh Pebam ◽

Saugat Das ◽

LaishramOken Singh ◽

Nehar Sinam ◽

...

Keyword(s):

Comparative Study ◽

Flexor Tendon ◽

Tendon Repair ◽

Suture Technique ◽

Flexor Tendon Repair ◽

Pull Out ◽

Prospective Comparative Study ◽

Zone Ii ◽

Pull Out Suture

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The Mantero Flexor Tendon Repair in Zone 1

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.1998.0173 ◽

1999 ◽

Vol 24 (2) ◽

pp. 148-151 ◽

Cited By ~ 22

Author(s):

D. GUINARD ◽

F. MONTANIER ◽

D. THOMAS ◽

D. CORCELLA ◽

F. MOUTET

Keyword(s):

Functional Assessment ◽

Functional Outcomes ◽

Flexor Tendon ◽

Tendon Repair ◽

Flexor Digitorum Profundus ◽

Flexor Tendon Repair ◽

Pull Out ◽

Active Mobilization ◽

The Mean ◽

Flexor Digitorum

Mantero and colleagues have reported a modification of the Bunnell pull-out method for the repair of zone 1 flexor digitorum profundus (FDP) lacerations that allows active postoperative mobilization. We report a series of 24 FDP lesions in 20 adult patients treated with this technique. The mean duration of the rehabilitation regimen, which was followed by all patients, was 4.2 months. Functional assessment using Strickland’s criteria demonstrated 23 excellent to good results and one poor due to a septic rupture. Nineteen of the 20 patients were satisfied with treatment and all but one of the patients returned to work within an average of 2.6 months after operation. In comparison to other zone 1 repair methods with active mobilization regimens, the Mantero technique gives better functional outcomes and appears to be more reliable.

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