Effects of Tension Across the Tendon Repair Site on Tendon Gap and Ultimate Strength

Abstract

Tendons repaired with varying amounts of tension result in different degrees of shortening of the tendon segment within core sutures, which may affect tensile strengths. We aimed to investigate the effects of tension across the repair site on gap formation forces and ultimate strength. Fifty-seven porcine flexor tendons were repaired with a 2-strand modified Kessler repair or a 4-strand cross-lock repair. For each type of repair, the tendons were divided into 3 groups: by 0%, 10%, or 20% shortening of tendon segment encompassed within core sutures. The repaired tendons had a single load-to-failure test in a materials testing machine. The forces required for initial and 2-mm gap formation and ultimate failure were recorded and statistically compared for each group. With either 2-strand or 4-strand repair, the tendons in the 10% tendon-segment shortening group withstood significantly higher initial and 2-mm gap formation forces than those in the group with no shortening, with average increases of 5 to 10 N after 10% shortening. Increasing the tendon-segment shortening to 20% produced a slight increase in the initial and 2-mm gap forces compared with those with 10% shortening, which was statistically significant only in the tendons with the 4-strand repair. The ultimate strengths were not significantly different among the tendons with either 2-strand or 4-strand repair of any degrees of shortening. Tensioning the core suture to shorten its encompassed tendon segment by 10% substantially increases resistance to postoperative gapping. Further tensioning to produce 20% shortening of the tendon segment increased the gapping forces by a much smaller amount. This study suggests that a slightly tensioned surgical repair, shortening the encompassed tendon segment by approximately 10%, is appropriate. Slightly tensioning core sutures across the tendon repair site, such as adding tension to cause 10% tendon-segment shortening, would greatly increase the gap resistance of the surgical repair.