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

Sunton Wongsiri,Wongthawat Liawrungrueang

doi:10.1186/s40634-021-00404-4

Sunton Wongsiri, Wongthawat Liawrungrueang

Open Access

https://doi.org/10.1186/s40634-021-00404-4

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Abstract

PurposeIn 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.MethodsThis 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.ResultsThe 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.ConclusionsThe 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.

Highlights

The most common injury around the hand and finger is tendon injury [1], with the highest incidence in males aged between 20 and 29 years old [2]
In this study we developed a novel suture technique we call the continuous double knots technique to repair flexor tendon injuries, and in this study compared the biomechanical properties, including maximum tensile strength and cyclic load to failure, with the 4-strand double-modified Kessler technique
We carried out an interesting experimental study comparing two 4-core suture techniques

Summary

Introduction

The most common injury around the hand and finger is tendon injury [1], with the highest incidence in males aged between 20 and 29 years old [2]. Acute injury of the flexor tendon is more common than the extensor tendon and the standard treatment is primary end-to-end repair. Wongsiri and Liawrungrueang J EXP ORTOP (2021) 8:79 suggested to overcome this weakness and improved the tensile strength of tendon repair [4,5,6,7]. A primary end to end flexor tendon repair technique must be strong enough for early passive mobilization rehabilitation. The field of flexor tendon repair still remains a challenge for hand surgeons who are always looking for the best compromise between suture strength and early mobilization. In this study we developed a novel suture technique we call the continuous double knots technique to repair flexor tendon injuries, and in this study compared the biomechanical properties, including maximum tensile strength and cyclic load to failure, with the 4-strand double-modified Kessler technique. The protocol is well explained and all the experimental steps conducted in the right path

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