Abstract
OBJECTIVES:In the present study, a novel single knot tenorrhaphy was developed by combining the modified Kessler flexor tendon suture (MK) with the loop lock technique.METHODS:A total of 48 porcine flexor digitorum profundus tendons were collected and randomly divided into six groups. The tendons were transversely cut and then repaired using six different techniques, the MK method, double knot Kessler-loop lock flexor tendon suture (DK), and single knot Kessler-loop lock flexor tendon suture (SK), each in combination with the epitendinous suture (P), and the same three techniques without P. Furthermore, by performing the load-to-failure tests, the biomechanical properties and the time taken to complete a repair, for each tenorrhaphy, were assessed.RESULTS:Compared to the MK+P method, DK+P was more improved, thereby enhancing the ultimate tensile strength. The SK+P method, which required fewer knots than DK+P, was easier to perform. Moreover, the SK+P repair increased the force at a 2-mm gap formation, while requiring lesser knots than DK+P.CONCLUSION:As opposed to the traditional MK+P method, the SK+P method was improved and exhibited better biomechanical properties, which may facilitate early mobilization after the repair.
Highlights
A range of factors, including surface suture, suture materials, and different suture methods, impact the strength of flexor tendon repair
Tendon harvest and repair Since their structure and diameter are similar to those of human flexor tendons, porcine flexor tendons were used in this study for tendon suture research and biomechanical studies
The tendons were transversely cut in the middle with a scalpel and repaired with six different techniques: (A) Modified Kessler suture without epitendinous suture (MK), (B) double knot Kessler-loop lock flexor tendon suture without epitendinous suture (DK), (C) single knot Kesslerloop lock flexor tendon suture without epitendinous suture (SK), (D) Modified Kessler suture with epitendinous suture (MK+P), (E) DK+P, and (F) single knot Kessler-loop lock flexor tendon suture with epitendinous suture (SK+P)
Summary
A range of factors, including surface suture, suture materials, and different suture methods, impact the strength of flexor tendon repair. The optimal surgical approach for achieving successful results remains controversial. Flexor tendon injury continues to pose a number of challenges for hand surgeons. The injury cannot heal unless the two ends of the tendon are meticulously connected. Postoperative mobilization is critical to reduce local edema, prevent epitendinous adhesions, restore tendon strength, and improve gliding; this increases the risk of suture rupture and repair site gapping [1,2]. The ideal repair method should be easy to perform, exhibit sufficient strength for healing, show minimal interference with tendon vascularity, and involve less suture knots with a smooth junction of the tendon ends [3]
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