Abstract
This study evaluated the impact of a new half hitch loop suture configuration on flexor tendon repair mechanics. Cadaver canine flexor digitorum profundus tendons were repaired with 4- or 8-strands, 4–0 or 3–0 suture, with and without half hitch loops. An additional group underwent repair with half hitch loops but without the terminal knot. Half hitch loops improved the strength of 8-strand repairs by 21% when 4–0, and 33% when 3–0 suture was used, and caused a shift in failure mode from suture pullout to suture breakage. 8-strand repairs with half hitch loops but without a terminal knot produced equivalent mechanical properties to those without half hitch loops but with a terminal knot. 4-strand repairs were limited by the strength of the suture in all groups and, as a result, the presence of half hitch loops did not alter the mechanical properties. Overall, half hitch loops improved repair mechanics, allowing failure strength to reach the full capability of suture strength. Improving the mechanical properties of flexor tendon repair with half hitch loops has the potential to reduce the postoperative risk of gap formation and catastrophic rupture in the early postoperative period.
Highlights
Despite improved operative technique and postoperative rehabilitation, the outcomes of intrasynovial flexor tendon repair are highly variable [1,2,3,4,5]
When suture caliber was increased from 4–0 to 3–0, the failure mode of the standard 8-strand repairs without half hitch loops shifted from suture breakage to suture pullout
When half hitch loops were added to the 8-strand repairs performed with 3–0 caliber sutures, the failure
Summary
Despite improved operative technique and postoperative rehabilitation, the outcomes of intrasynovial flexor tendon repair are highly variable [1,2,3,4,5]. The most commonly manifested complications of tendon repair are gap formation, repair-site failure, and adhesion formation between the repaired tendon and synovial sheath [6]. Complications are noted within the initial few weeks following suture repair and depend, to a considerable extent, on the initial biomechanical properties of the repair [7]. PLOS ONE | DOI:10.1371/journal.pone.0153822 April 21, 2016
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